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。     

Cerebrovascular inflammation promotes the formation of brain metastases

Brain metastases are the most prevalent intracranial malignancy. Patient outcome is poor and treatment options are limited. Hence, new avenues must be explored to identify potential therapeutic targets. Inflammation is a known critical component of cancer progression. Intratumoral inflammation drives progression and leads to the release of circulating tumor cells (CTCs). Inflammation at distant sites promotes adhesion of CTCs to the activated endothelium and then initiates the formation of metastases. These interactions mostly involve cell adhesion molecules expressed by activated endothelial cells. For example, the vascular cell adhesion molecule-1 (VCAM-1) is known to promote transendothelial migration of cancer cells in different organs. However, it is unclear whether a similar mechanism occurs within the specialized environment of the brain. Our objective was therefore to use molecular imaging to assess the potential role of VCAM-1 in promoting the entry of CTCs into the brain. First, magnetic resonance imaging (MRI) and histological analyses revealed that cerebrovascular inflammation induced by intracranial injection of lipopolysaccharide significantly increased the expression of VCAM-1 in the Balb/c mouse brain. Next, intracardiac injection of 4T1 mammary carcinoma cancer cells in animals with cerebrovascular inflammation yielded a higher brain metastasis burden than in the control animals. Finally, blocking VCAM-1 prior to 4T1 cells injection prevented this increased metastatic burden. Here, we demonstrated that by contributing to CTCs adhesion to the activated cerebrovascular endothelium, VCAM-1 improves the capacity of CTCs to form metastatic foci in the brain.     

Valor de la escala ASPECTS de circulación posterior y del índice puente-mesencéfalo en imágenes de TC sin contraste y angiografía por TC en pacientes con oclusiones de la arteria basilar recanalizados tras trombectomía mecánica

Purpose

Endovascular treatment with mechanical thrombectomy devices demonstrated high recanalization rates but functional outcome did not correlate with high rates of recanalization obtained. Patient selection prior to the endovascular treatment is very important in the final outcome of the patient. The primary aim of our study was to evaluate the prognostic value of posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and Pons-Midbrain Index (PMI) scores in patients with Basilar Artery Occlusion (BAO) treated with successful angiographic recanalization after mechanical thrombectomy.

新疆心脑血管疾病治疗费用核算与住院费用影响因素分析

目的 综合分析新疆心脑血管疾病总治疗费用现状，为医疗资源的合理配置提供理论依据。方法 通过多阶段分层随机抽样，收集2017年新疆心脑血管疾病患者样本信息。在SHA 2011框架下，采用自上而下的分摊方法，核算心脑血管疾病的治疗费用。建立线性回归模型，用以分析住院费用的影响因素。结果 心脑血管疾病总治疗费用达105.74亿元；占比67.22%的治疗费用发生在综合医院；排名前三位的疾病分别为冠心病、高血压和脑梗塞，占比达74.20%；65岁及以上老年人群花费占比为43.51%；县（区）级机构（t = - 218.362，P＜0.001）、市级机构（t = - 103.65，P＜0.001）、住院天数（t = 233.297,P＜0.001）、65岁以上人群（t = 58.422，P＜0.001）、手术情况（t = 101.514，P＜0.001）均是影响住院费用的主要因素。结论 新疆心脑血管疾病消耗大量医疗资源；防控工作重点关注老年人群；治疗费用机构流向有待优化，应强化基层医疗机构在防治慢病工作中的主导作用；缩短住院时间是有效控制治疗费用的直接途径。     

缺血性脑血管病梗死模式的分类及病因、发病机制研究进展

缺血性脑血管病的梗死模式具有多样性，根据梗死数目可分为无梗死、单发梗死和多发 梗死。单发梗死主要根据病灶的位置和大小进行分类，多发梗死则根据血管的供血范围进行分类。 单发梗死和多发梗死的不同梗死模式分别与不同的病因和发病机制相关。     

七氟醚对室间隔缺损患儿脑血管CO2反应性的影响

目的使用经颅多普勒超声监测脑血流,比较静脉麻醉药与七氟醚对室间隔缺损患儿脑血管二氧化碳反应性(cerebrovascular carbon dioxide reactivity,CO_2R)的影响。方法纳入3～12月龄患儿32例,随机分为两组。静脉组静注哌库溴铵0.2 mg/kg、咪达唑仑0.2 mg/kg及舒芬太尼1μg/kg,肌松满意后行气管插管,全凭静脉维持麻醉。吸入组持续吸入七氟醚1.5 MAC,静注哌库溴铵0.2 mg/kg,自主呼吸消失后行气管插管,七氟醚1.0 MAC维持麻醉。调整机械通气条件,使P_(ET)CO_2依次维持在30 mmHg(T_1)、35 mmHg(T_2)、40 mmHg(T_3)、45 mmHg(T_4),使用经颅多普勒超声测量右侧大脑中动脉血流平均速度(V_(MCA)),同时记录HR、心脏指数(CI)及BIS,计算CO_2R。结果T_1—T_4时两组V_(MCA)明显增加,HR明显减慢(P0.01);吸入组BIS值和CO_2R明显下降(P0.01或P0.05)。与静脉组比较,吸入组T_3和T_4时V_(MCA),T_1—T_4时HR、T_1—T_2时段CO_2R明显增高(P0.01或P0.05)。结论 1.0 MAC七氟醚麻醉下,在低P_(ET)CO_2范围内CO_2R更高,且高于使用静脉麻醉药物。