中西医结合治疗缺血性脑血管病临床疗效观察

目的 回顾性分析中西医结合治疗缺血性脑血管病的疗效。方法 对126例缺血性脑血管病患者，在早期西医溶栓、抗凝、降低血液粘度、扩张血管和促进脑细胞代谢等治疗基础上，结合中医辩证施治治疗。结果 42例瘫肢肌力恢复达V级；48例肌力≥Ⅳ级，言语流畅；27例生活能基本自理，可依杖散步，肌力≥Ⅲ级：9例与治疗前对比肌力提高Ⅰ～Ⅱ级，但生活仍不能自理。结论 在西药治疗基础上，结合益气活血中药调理可显著提高患者的疗效。     

Involvement of Apoptosis in 3-nitropropionic Acid-induced Ischemicl Tolerance to Transient Focal Cerebral Ischemia in Rats

Preconditioningofbraintissueswithsub lethalstressesorstimulicanresultinresistancetosubse quentlethalischemiceventsinaresponsecalledis chemictolerance .Recently ,severalstudieshaveshownthatasinglesystemicdoseof 2 0mg/kg 3 NPAcausednohistopathologicalabnorm…     

参附注射液对大鼠缺血再灌注小肠细胞Bax、Bcl-2及c-myc蛋白表达的影响

目的　探讨参附注射液对大鼠缺血再灌注小肠细胞Bax、Bcl 2及c myc蛋白表达的影响及它们与肠细胞凋亡的内在联系。方法　健康SD大鼠 36只随机分为 3组 ,空白对照组 (S组 )、缺血再灌注 +生理盐水组 (IR +NS组 )、缺血再灌注 +参附注射液组 (IR +SF组 ) ,每组 12只。采用钳闭肠系膜前动脉制备小肠缺血再灌注模型。免疫组化检测Bax、Bcl 2及c myc蛋白的表达 ,每组选 2 4个视野分别测量光密度值 (OD值 )。TUNEL法检测凋亡的小肠细胞并计算凋亡指数。结果　IR +NS组BaxOD值明显高于S组 (P <0 .0 1) ,IR +SF组BaxOD值明显低于IR +NS组 (P <0 .0 1) ,且低于S组 (P <0 .0 5 )。IR +NS组Bcl 2OD值高于S组 (P <0 .0 5 ) ,且IR +SF组Bcl 2OD值高于S组 (P <0 .0 1) ,但IR +NS组与IR +SF组比较无显著差异。IR +NS组c mycOD值明显高于S组 (P<0 .0 1) ,且明显高于IR +SF组 (P <0 .0 1)。IR +NS组细胞凋亡指数明显高于S组和IR +SF组 (P <0 .0 1) ,而IR +SF组高于S组 (P <0 .0 5 )。结论　参附注射液增加小肠组织Bcl 2蛋白的表达 ,降低Bax及c myc蛋白的表达 ,抑制小肠细胞凋亡 ,保护缺血再灌注小肠。     

A multiparametric index of platelet in vitro aggregation in cerebrovascular disease

148 patients with various forms of cerebrovascular disease (CVD) were studied by means of a multiparametric analysis ofin vitro platelet aggregation, based on the following six parameters: ADP and epinephrine primary and secondary aggregation thresholds and percent maximum aggregation induced by optimal concentrations of ADP and epinephrine. These patients were assigned to four study groups, according to clinical diagnosis supported by CT scan, of transient ischemic attack and reversible neurological deficit (TIA-RIND), or completed stroke, in the presence or absence respectively of antiplatelet medical treatment at the time of the study. A statistically significant increase of thein vitro platelet aggregation was found in 44.4% of the untreated TIA-RIND patients and in 33.9% of the untreated stroke patients. However this last group showed a higher percentage of very marked hyperaggregation. Differences between the two treated study groups and controls were not signicant. No difference was found in collagen-and ristocetin-induced aggregation between the patient groups and the controls.

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Sommario 148 pazienti con varie forme di malattia cerebrovascolare, sono stati studiati con analisi multiparametriche dell'aggregazione piastrinica in vitro sulla base dei seguenti sei parametri: le soglie di aggregazione primaria e secondaria e l'aggregazione massima percentuale indotta da ADP ed Epinefrina. Questi pazienti sono stati suddivisi in 4 gruppi di studio in accordo con la diagnosi clinica confortata dai dati della TAC e cioè: TIA, RIND, o rammollimento in presenza o in assenza rispettivamente di un trattamento antiaggregante nel momento dello studio. è stato trovato un aumento statisticamente significativo dell'aggregazione in vitro delle piastrine nel 44.4% dei casi TIA, RIND non trattati e nel 33,9% dei casi di rammollimento non trattati. Quest'ultimo gruppo, però, ha dimostrato una più alta percentuale di iperaggregazione molto marcata. Le differenze tra i 2 gruppi di studio trattati con antiaggreganti e i controlli non erano significative. Inoltre nessuna differenza è stata riscontrata tra i gruppi e i controlli nell'aggregazione indotta da collageno e ristocetina.

     

强化康复指导对脑卒中患者日常生活活动能力恢复的影响

目的探讨康复教育干预方式对脑卒中患者日常生活活动能力的影响。方法64例急性脑卒中患者随机分成个体化教育组31例和对照组33例。个体化教育组护士每日至少2次康复指导,对患者本人及家属进行康复教育及康复活动指导并随时检查其依从性;对照组进行集体康复指导授课,两组病人康复指导的总时间一致,内容一致。随访3个月。用Barthel指数评价日常生活活动能力。结果个体化教育组Barthel指数变化与对照组比较,差异有统计学意义(P<0.05)。结论康复教育干预个体化,可明显改善患者的日常生活活动能力。     

Variations in the use of diagnostic procedures after acute stroke in Europe: results from the BIOMED II study of stroke care

Valid classification of stroke is essential to initiate effective acute management and early secondary prevention strategies. To accurately evaluate stroke subtype a number of diagnostic procedures have to be performed. This study sought to investigate variations in use of diagnostic procedures across selected European hospitals. First-ever stroke patients were sampled over a 1-year period through 11 hospital-based registers across 10 European countries. We defined a diagnostic standard for valid aetiological classification of ischemic stroke including brain imaging, vascular imaging and echocardiography. The impact of socio-demographic, clinical and structural characteristics on performance of the diagnostic standard was assessed using multivariate logistic regression analyses. A total of 1721 patients were included in the study. 83.1% received brain imaging, ranging from 32.8% to 100%. The diagnostic standard was performed in 40.4% of stroke patients, ranging from 0% to 77.2%. Patients with increasing age ( P  < 0.001) and with more severe strokes ( P  = 0.001) were less probably to receive the diagnostic standard. Patients treated in stroke units and neurological departments were more frequently investigated with the diagnostic standard ( P  < 0.001). Less than half of hospitalized stroke patients across Europe underwent diagnostic procedures to allow for aetiological classification of stroke, which may hamper the initiation of effective early management and secondary prevention.     

认知疗法合并黛力新治疗脑卒中后焦虑的疗效

目的评价认知疗法合并黛力新(氟哌噻吨/美利曲辛)治疗脑卒中后焦虑的疗效。方法将80例脑卒中后焦虑患者随机分为治疗组(n=40)和对照组(n=40),分别给予认知疗法合并黛力新、单用黛力新治疗8周。用汉密顿焦虑量表、副反应量表分别评定疗效和副反应。结果治疗4、8周时,治疗组汉密顿焦虑量表评分(16.08±7.45,8.80±4.73)明显低于对照组(19.80±8.26,11.35±5.03),P<0.05;临床总疗效无论治疗4、8周,治疗组均优于对照组,P<0.01。结论认知疗法合并黛力新治疗脑卒中后焦虑的疗效较好。     

Intracranial Angioplasty and Stenting in the Awake Patient

BACKGROUND AND PURPOSE: Endovascular treatment for intracranial atherosclerosis is evolving, but complications remain an issue. Most interventions are performed under general anesthesia, preventing intraprocedural clinical evaluations. We describe our approach to intracranial angioplasty and stenting, using local rather than general anesthesia, and intraprocedural neurological assessment. METHODS: We prospectively collected procedural and outcome information on all patients undergoing intracranial angioplasty and stenting. Patients underwent interventions under local anesthesia with mild intravenous sedation or analgesia only if needed. Intraoperative neurological evaluations were performed, and symptomatology was used to guide the interventional technique. RESULTS: Forty-eight arteries in 40 patients with a mean age of 65.2 years were treated. Thirty-two anterior and 16 posterior circulation segments were treated. Technical success was achieved in 100% of patients with reduction of the mean pretreatment stenosis from 85 +/- 8.6% to 7 +/- 10.1%. Stents were deployed in 40 segments; five patients were treated with drug-eluting stents. The cobalt-chromium coronary stents were the easiest to deliver. Thirty-seven patients were treated under local anesthesia and, of those, 61.4% experienced intraprocedural symptoms that led to some alteration of the interventional technique. Headache was the most common symptom, and, when persistent, it heralded the occurrence of subarachnoid hemorrhage. There were seven total neurological complications, but only five (10.5%) led to permanent morbidity (4 strokes) or mortality (1 death). CONCLUSIONS: Intracranial angioplasty and stenting can be successfully performed using coronary techniques and equipment including drug-eluting stents. Local anesthesia permits neurological evaluations and often leads to the adjustment of the interventional technique, potentially making the procedure safer.     

Concomitant mitral valve repair and left ventricular reconstruction in a patient with chronic ischemic mitral regurgitation and inferior left ventricular aneurysm

The surgical approach to ischemic mitral regurgitation with concomitant inferior left ventricular aneurysm remains uncertain in terms of the indication for operation and the short-and long-term outcomes. We performed concomitant mitral valve repair, left ventricular reconstruction, and aortic valve replacement on a 71-year-old male with severe ischemic mitral regurgitation, inferior left ventricular aneurysm, and degenerative aortic regurgitation. Postoperative status was in New York Heart Association functional class I without mitral regurgitation 8 months after operation. We discuss, and review the procedures reported in the literature.     

Hemiballismus from a parietal stroke in a Parkinson patient.

Stroke-induced hemiballismus (HB) has been reported to improve motor function in people with Parkinson's disease (PD). We report on a patient who developed HB from a parietal infarct. The HB was improved by very low-dose clozapine but the HB did not improve the parkinsonism. This suggests that HB itself, whether from a lesion in the subthalamic nucleus or elsewhere, is not what improves motor function in PD; instead, the physiological function of the damaged structure is the determining factor.