早期康复治疗对急性脑卒中运动功能的影响

目的对急性脑卒中患者实施早期康复治疗,分析其对患者运动功能的影响。方法对本院2015年1月—2018年6月期间收治的急性脑卒中患者,从中选择50例进行研究。根据病历单双号进行分组,每组各25例。对照组患者接受常规治疗,观察组患者在此基础上应用早期康复治疗。对两组患者的运动功能进行分析和评价。结果对照组治疗前的Fugl-Meyer评分为(17.4±7.4)分,治疗后的评分为(57.9±15.4)分,观察组治疗前的Fugl-Meyer评分为(18.1±7.3)分,治疗后的评分为(71.3±15.2)分。观察组患者与对照组治疗前的Fugl-Meyer评分差异无统计学意义(P>0.05),观察组治疗后的Fugl-Meyer评分明显高于对照组,两组相比差异有统计学意义(P<0.05)。结论采用早期康复治疗对急性脑卒中患者进行治疗,可以明显改善患者的运动功能,具有较高的应用价值。     

Interactions between rat cortico-striatal slice cultures and neutrophil-like HL60 cells under thrombin challenge: Toward elucidation of pathological events in intracerebral hemorrhage

Neutrophils constitute the major population of infiltrating leukocytes after stroke including intracerebral hemorrhage (ICH), and these cells may exhibit pro-inflammatory and anti-inflammatory phenotypes depending on the external stimuli. Here we constructed an experimental system to evaluate how the properties of neutrophils were influenced by the injured brain tissues. HL60 cells differentiated into neutrophils were added to the culture medium of neonatal rat cortico-striatal slices maintained at liquid–air interface. Thrombin was applied to the cultures to mimic the pathogenic events associated with ICH. HL60 cells responded to thrombin by increasing mRNA expression of pro-inflammatory IL-1β and anti-inflammatory IL-10 with a different time course. Co-presence of cortico-striatal slice cultures significantly enhanced IL-1β mRNA expression, whereas attenuated IL-10 mRNA expression, in HL60 cells. Toll-like receptor 4 (TLR4) agonist lipopolysaccharide synergistically enhanced IL-1β mRNA expression with thrombin, and TLR4 inhibitor TAK-242 abolished thrombin-induced IL-1β mRNA expression in the presence of slice cultures. On the other hand, thrombin-induced cell death in cortico-striatal cultures was attenuated by the presence of HL60 cells. This experimental system may provide a unique platform to elucidate complex cell-to-tissue interactions during ICH pathogenesis.     

羟基红花黄色素A通过抑制程序性坏死减轻小鼠重症中暑引起的急性肺损伤

目的 研究羟基红花黄色素A（HSYA）是否在重症中暑肺损伤中起保护作用及其可能的作用机制。方法 使用不同浓度（1.125、2.25、4.5 mg/kg）HSYA腹腔注射预处理小鼠，建立重症中暑（sHS）小鼠模型，分为低、中、高剂量HSYA中暑组、单纯中暑组及正常对照组，12只/组。初步观察及比较各组热耐受的情况，以确定HSYA最佳治疗剂量；后使用中剂量HSYA及RIP1活化抑制剂Nec-1预处理小鼠，分组为HSYA+HS组、Nec-1+HS组、HS组及正常对照组，8只/组，观察72 h恢复期核心体温变化特征，比较热耐受情况及生存情况。给予相同处理因素处理小鼠分组为正常对照组，HS组，HSYA+HS组及Nec-1+HS组，正常对照组6只，其余18只/组，分别于重症中暑恢复期不同阶段（0、2、6、12、24 h）处死小鼠，每个时间点处死3只小鼠，收集小鼠的肺组织、肺泡灌洗液及血液样本，取肺组织行HE染色，并进行病理评分，检测肺湿干重比，肺含水量，肺泡灌洗液中白细胞、中性粒细胞、蛋白含量；ELISA法检测肺泡灌洗液中HMGB1水平及血清中TNF-α、IL-6及HMGB1水平；Western blotting检测恢复期（2、6、12 h）肺组织中RIP1、RIP3、MLKL-s358、MLKL表达水平，及经HSYA预处理后MLKL-s358蛋白水平。结果 中剂量及高剂量HSYA预处理可明显改善小鼠热耐受能力，中剂量与高剂量无显著差异，后续药物预处理以中剂量（2.25 mg/kg）作为标准剂量；与HS组相比，HSYA+HS组和Nec-1+HS组小鼠热耐受程度均增加（P<0.05），HSYA+HS组和Nec-1+HS组无明显差异。HSYA及Nec-1预处理组小鼠生存率增加（P<0.05），肺组织病理评分、TNF-α、IL-6及HMGB1水平降低（P<0.05），肺湿干重比，肺含水量，肺泡灌洗液中白细胞、中性粒细胞、蛋白含量及HMGB1水平降低（P<0.05），HS小鼠恢复期肺组织RIP1水平及MLKL-s358磷酸化水平升高（P<0.05），与HS组相比，HSYA+HS组MLKL-s358磷酸化水平降低。结论 重症中暑小鼠肺组织可发生程序性坏死，HSYA可通过抑制程序性坏死发挥肺保护作用。     

Unknown Tetrahydrocannabinol Edible Ingestion Resulting in Acute Stroke Presentation

BackgroundMarijuana is a commonly used substance in the United States for both recreational and medicinal purposes. Detrimental health-related effects of marijuana continue to be a source of controversy.Case ReportWe describe a case of a woman who presented to the emergency department with acute right upper and lower extremity weakness and altered speech after accidental unknown ingestion of food containing tetrahydrocannabinol (THC). This is a unique case in that we could find no other published report of focal weakness or motor stroke symptoms occurring in the setting of THC ingestion. We will discuss in detail the patient's medical history and timeline of events leading to her presentation to the emergency department. Marijuana contains the psychoactive substance THC and is becoming more commonly used for medicinal and recreational purposes in the United States and abroad. The use of THC is associated with changes in levels of consciousness, perception, and several other physiologic processes. We hope to increase awareness through this case report of accidental THC use by a female patient that resulted in a stroke code and potentially could have led to the use of tissue plasminogen activator.Why Should an Emergency Physician Be Aware of This?To the best of our knowledge, focal neurologic deficits associated with THC use have not been reported in the published literature. We hope that this knowledge will encourage physicians to consider THC intoxication as a cause of new onset extremity weakness.     

Effects of dynamic lycra orthosis as an adjunct to rehabilitation after botulinum toxin-A injection of the upper-limb in adults following stroke: A single-blinded randomized controlled pilot study

ABSTRACT

Background

Dynamic lycra splints are proposed to modify hypertonicity due to their characteristics – neutral warmth, circumferential pressure, and creating a low-intensity prolonged stretch on hypertonic muscles – to contribute to increased sensory awareness of the involved limb.     

炎症反应与缺血性卒中

炎症反应是缺血性卒中后病理生理的核心内容，其过程涉及免疫和炎症细胞，不同途径 和来源的被激活的炎症因子共同参与。早期小胶质细胞、中性粒细胞被激活，随之淋巴细胞的聚集 和浸润也增加了对脑细胞的损伤；但也有研究发现，在特定刺激下，中性粒细胞可以从促炎表型向 抗炎表型转变，进而保护脑细胞；淋巴细胞中部分T细胞亚型可以抑制促炎因子的表达、调节淋巴细 胞的活性，从而起到脑保护作用。另外，在缺血性卒中后，除脑内局部的炎症反应外，外周循环的炎 性反应和免疫抑制也参与其病理机制。免疫调节有望成为未来缺血性卒中治疗的靶点。     

活血通络汤治疗痰瘀阻络型缺血性脑卒中临床研究

目的:探讨活血通络汤治疗痰瘀阻络型缺血性脑卒中的临床疗效和安全性。方法:选取82例痰瘀阻络型缺血性卒中患者作为研究对象,按照其治疗方法分为对照组40例和观察组42例,对照组予以常规西药治疗,观察组患者在对照组治疗基础上予以活血通络汤治疗,两组患者均治疗2周,治疗结束后比较两组患者临床疗效、中医症候积分、神经功能、日常生活能力、血液流变学指标水平及不良反应。结果:经治疗2周后,观察组患者临床治疗总有效率为97.62%,显著高于对照组临床总有效率82.50%(P<0.05); 两组患者治疗前中医症候积分、NIHSS及BI评分比较,差异无统计学意义,治疗后两组患者中医症候积分和NIHSS评分均较治疗前下降,而BI评分显著上升,但治疗后观察组患者中医症候积分和NIHSS评分下降和BI评分上升程度均显著高于对照组患者(P<0.05); 两组患者治疗前全血高切黏度、全血低切黏度、纤维蛋白原及血浆黏度水平比较,差异无统计学意义,治疗后两组患者全血高切黏度、全血低切黏度、纤维蛋白原及血浆黏度水平均较治疗前明显下降,但治疗后观察组患者血液流变学指标水平均低于对照组患者,差异有统计学意义(P<0.05); 两组患者均未出现不良事件。结论:活血通络汤可提高痰瘀阻络型缺血性脑卒中患者临床疗效,改善其症状体征、神经功能及血液状态,提高日常活动能力。