促血小板生成素对预测脑瘫高危儿的意义

目的探讨缺氧缺血性脑病(hypoxia-ischem ia encephalopathy,H IE)胎儿和H IE新生儿血清中促血小板生成素(Thrombopoietin,TPO)水平与脑损伤的关系,为脑瘫(cerebral palsy,CP)高危儿人群进行早期干预提供监测手段。方法收集23例H IE胎儿和34例H IE新生儿血清以及25例正常胎儿和30例正常新生儿血清,34例H IE新生儿包括11例轻度H IE,8例中度H IE和15例重度H IE。采用双抗体夹心ABC-ELISA法检测H IE胎儿组和轻、中、重H IE新生儿组血清中TPO的水平,并与正常胎儿组和正常新生儿组比较。结果H IE胎儿组和H IE新生儿组TPO分别高于正常胎儿组和正常新生儿组(分别P<0.01,P<0.01),重度H IE组TPO低于轻度H IE组(P<0.05)。结论血清TPO水平与H IE所致脑损伤严重程度有关。脐血TPO检测可为脑瘫高危儿人群进行早期干预提供监测手段。     

28例颈内动脉系统急性脑梗塞动脉溶栓治疗

目的分析颈内动脉系统急性脑梗塞动脉溶栓治疗的有效性和安全性。方法对28例颈内动脉急性脑梗塞的患者进行了动脉溶栓治疗．通过造影显示血管再通情况。术后即刻和24h后分别行头颅CT扫描以了解有无颅内出血（ICH）。术后第90天采用Barthel指数（BI）对患者生活状态进行评估。结果28例患者经动脉溶栓治疗，堵塞血管再通18例，部分再通6例，未通4例；症状性颅内出血8例，死亡5例。术后第90天，生活状态优者14例，良者8例，差或者死亡6例。再通患者生活状态明显优于部分再通及未通患者。结论动脉溶栓具有较高的症状性颅内出血率及死亡率。再通患者生活状态较好。     

Sources of Variability in the Detection of Cerebral Emboli with Transcranial Doppler During Cardiac Surgery

OBJECTIVE: The application of intensity thresholds for embolus detection with transcranial Doppler (TCD) can exclude from analysis an unrecognized proportion of high-intensity transient signals (HITS))whose intensities are below the threshold. The lack of consistent threshold criteria between clinical trials may explain part of the discrepancy in the reported HITS counts. We investigated the effect of choosing different thresholds on the sensitivity and specificity of detecting HITS during cardiopulmonary bypass (CPB). METHODS: Two observers independently analyzed TCD recordings from 8 patients under CPB. Doppler signals were classified as true HITS, equivocal HITS, artifacts, and Doppler speckles according to preestablished criteria. The relative intensity of Doppler signals was measured by two different methods (TCD software vs manual). Receiver Operating Characteristic curves determined the optimal threshold for each of the two intensity methods. RESULTS: Reviewers achieved agreement in 96% of 2190 Doppler signals (kappa = 0.90). Relative intensities calculated with the TCD-software method were 3 dB (95% CI: 3.0-3.4) higher than the manual method. The optimal threshold was found at 10 dB (sensitivity: 99%; specificity: 90.8%) with the software method and at 7 dB with the manual method (sensitivity: 96%; specificity: 83%). The use of an intensity threshold 2 dB higher than the optimal increased the rejection of true HITS by 8% and 14%, respectively. CONCLUSIONS: Using intensity thresholds higher than the optimal for embolus detection decreases HITS counts. Choosing a threshold depends on the type of method used for measuring the signal intensity. Uniform threshold criteria and comparative studies between different Doppler devices are necessary for making clinical trials more comparable.     

一种新型的适用于延迟溶栓治疗的大鼠脑血栓模型的制作

目的 通过对血栓大小的改良,建立适用于延迟溶栓治疗的大鼠脑血栓模型.方法 将10个长度0.8～1.0 mm、宽度0.35 mm的白色血栓经颈内动脉分别注入栓塞脑动脉,形成局灶性脑血栓模型.接受脑血管栓塞的138只SD雄性大鼠被随机分为两大组,分别为单纯缺血组(n=68)和延迟溶栓治疗组(n=70).单纯缺血组不接受任何治疗;延迟溶栓治疗组分别在血栓注入3、6和9 h后,将10 mg/kg的rt-PA自股静脉缓慢注入.使用MRI评价梗死灶的位置、大小、栓塞后不同时间的相对脑血流量.末次MRI检查结束后,大鼠脑组织用4%甲醛固定,作病理检查.结果 共有131只大鼠在血栓注入后脑内形成明确梗死灶,模型成功率为95%,脑梗死仅位于同侧大脑半球占84.7%(111/131),局限于左侧顶叶皮质或(和)左侧基底节的占79.4%(104/131),局灶性脑梗死体积占同侧大脑半球(23.12±6.04)%;对侧大脑半球也同时出现梗死灶占14.5%(19/131).发生局灶性出血11只,大面积出血1只,出血率为9.2%(12/131),均发生在延迟溶栓组.单纯缺血组大鼠,在血栓注入后3、6和9 h的rCBV分别为(34.13±17.55)%、(40.67±25.91)%和(40.72±26.51)%,各组之间rCBV均无显著差异(分别为3 h和6 h,Z=-0.958,P=0.338,3 h比9 h,Z=-1.147,P=0.251).延迟溶栓后成活率高(24 h死亡13只;48 h死亡1只,溶栓后8 d和12 d各死亡1只).结论 改良后的大鼠脑血栓模型是可靠的可重复性的类似于人类大脑中动脉分支栓塞的脑血栓模型,适用于研究延迟溶栓治疗的大鼠脑血栓模型.     

Observations on the efficacy of combined acupuncture and medicine in Treating 50 cases of pseudobulbar paralysis

目的：观察针药结合治疗假性延髓麻痹的疗效。方法：采用完全随机抽样法分为针刺组50例，对照组48例。针刺组在西医治疗的同时，应用针刺进行综合治疗；对照组单纯接受西医药物治疗。结果：针刺组有效率为92．0％，对照组为62．5％。两组疗效差异具有非常显著性意义（P〈0．01）。结论：针药结合治疗假性延髓麻痹效果明显优于单纯西药治疗。     

应用SPECT研究地氟醚麻醉对人脑血流分布的影响

目的研究吸入不同浓度地氟醚麻醉下健康志愿者脑血流(CBF)分布的动态变化。方法选择9名志愿者,每位志愿者分别在清醒、吸入0.5和1.0MAC地氟醚后采用单光子发射计算机断层成像(SPECT)仪进行扫描,观察地氟醚麻醉下人局部脑血流(rCBF)的动态变化。结果全脑CBF计数在清醒时为127.5±23.1,吸入0.5MAC地氟醚麻醉后全脑CBF计数为130.8±25.4,吸入1.0MAC地氟醚后为128.8±22.9,三组间比较差异无显著意义;额叶、顶叶、颞叶、枕叶、中脑、小脑、丘脑、海马、基底核、扣带回和舌回等脑区rCBF计数差异也均无显著意义。结论在保持PETCO2和MAP稳定且在正常范围时,吸入地氟醚麻醉不影响人脑内血流量的分布。     

大鼠脑缺血损伤后锂盐治疗对海马CA1区的影响

目的探讨大鼠局灶脑缺血损伤后锂盐治疗对海马CA1神经元形态学变化的影响。方法将SD大鼠随机分为假手术组(SH组)、缺血-再灌注组(IR组)和缺血损伤后氯化锂治疗组(LI组),按处死时间不同,将各组再分为三个亚组:SH1d、SH2d、SH3d组;IR1dI、R2dI、R3d组;LI1d、LI2d、LI3d组。线栓法制作大鼠大脑中动脉闭塞(MCAO)局灶脑缺血模型,1.5 h后再灌注。LI组于脑缺血后1 h,氯化锂(3 mmol/kg)腹腔注射,每天一次至处死。SH组和IR组以生理盐水替代。HE染色比较各组缺血损伤后1、2、3 d海马CA1区神经元损伤程度。结果虽然LI组与IR组的CA1区存活锥体细胞数存在类似下降趋势,但LI2d组、LI3d组分别较IR2d组I、R3d组存活锥体细胞数明显增多(P<0.01)。结论大鼠局灶脑缺血后氯化锂的治疗能减轻海马神经元的损伤程度。     

进展性卒中与脑动脉狭窄的脑血管造影研究

目的探讨进展性脑梗死的影像学特点及与脑动脉狭窄之间的相关性。方法选择我院29例进展性脑梗死患者并与同期收治的31例完全性脑梗死患者比较,所有患者均行头颅MRI (或头颅CT)及脑血管造影检查(DSA检查),分析进展性脑梗死的影像特点及其与脑动脉狭窄的相关性。结果进展性脑梗死组分水岭脑硬死或侧脑室体旁梗死发生率72．4％(21／29)及脑动脉狭窄发生率75．86%(22／29)均明显高于完全性脑梗死组22．6％(7／31),35．48％(11／31)。进展性脑梗死组中重度狭窄发生率为55．17％(16／29),高于完全性脑硬死组的12．90%(4／31)。溃疡性斑块发生率在进展性脑梗死组48．28%(14／29)高于完全性脑梗死组16．13％(5／31)。结论中重度脑动脉狭窄及溃疡是进展性卒中的重要危险因素,应早期检查及处理脑动态狭窄以防止病情进展。     

中青年脑梗死68例临床分析

脑梗死多见于老年人，但近年来中青年（16-45岁）患者逐渐增多且有年轻化趋势，深人探讨中青年脑梗死的致病因素及临床表现对其防治有重要意义。本文回顾性分析了我院自1998年1月到2004年12月问收治的中青年脑梗死患者68例，现报告如下。     

Co-localization of vasoactive intestinal polypeptide, γ-aminobutyric acid and choline acetyltransferase in neocortical interneurons of the adult rat

Interneurons immunoreactive for vasoactive intestinal polypeptide (VIP) are integral elements of columnar organization patterns in the rat cerebral cortex. By application of the sensitive mirror technique, the co-localization of VIP with the classical inhibitory neurotransmitter γ-aminobutyric acid (GABA) and the acetylcholine-synthesizing enzyme, choline acetyltransferase (ChAT), was investigated in neocortical neurons. Furthermore, the frequency of co-localization of ChAT with GABA was determined. In a sample of 118 VIP-immunoreactive neurons, mostly from the primary somatosensory cortex, it was demonstrated that virtually all of them reveal immunoreactivity for GABA and, therefore, are to be GABAergic. Moreover, 34% of mostly bipolar, VIP-positive neurons contained ChAT and are, thus, supposedly cholinergic as well. Co-localization of VIP and ChAT varied according to cortical laminae. Finally, 88% of a total of 60 ChAT-immunoreactive neurons were also immunostained for GABA. It is concluded that almost all VIP-immunoreactive neurons and most of the cholinergic neurons in rat neocortex represent partly overlapping subpopulations of inhibitory interneurons utilizing GABA.