高胆固醇饮食对阿尔茨海默病大鼠脑内白介素-6和肿瘤坏死因子-α表达的影响

目的 探索高胆固醇饮食对阿尔茨海默病(AD)大鼠脑内白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的影响.方法 海马齿状回注射β淀粉样蛋白(Ap)建立AD大鼠模型,根据饮食及注射试剂不同,分为高胆固醇+Aβ组、高胆固醇+磷酸盐缓冲液(PBS)组、标准饮食+Aβ组和标准饮食+PBS组;采用免疫组化和原位杂交检测海马齿状回、CA1区及皮质IL-6和TNF-α的水平.结果 海马齿状回和CA1区的IL-6和TNF-α阳性细胞数,高胆固醇+Aβ组分别为(44±5)个、(35±3)个和(35±6)个、(33±4)个,标准饮食+Aβ组分别为(29±3)个、(22±4)个和(28±4)个、(21±3)个,高胆固醇+PBS组分别为(18±3)个、(11±2)和(17±3)个、(14±4)个,标准饮食+PBS组分别为(11±3)个、(8±2)个和(13±2)个、(8±2)个,高胆固醇+Aβ组多于其他3组(P≤0.05).高胆固醇+Aβ组、高胆固醇+PBS组、标准饮食+Aβ组和标准饮食+PBS组皮质区IL-6阳性细胞数分别为(23±5)个、(20±3)个、(9±3)个和(11±3)个,TNF-α分别为(23±7)个、(21±6)个、(11±4)个和(10±4)个,高胆固醇组高于标准饮食组,IL-6、TNF-α水平仅与饮食有关,而与注射试剂无关.结论 高胆固醇饮食增加AD大鼠脑内重要炎症因子IL-6和TNF-α的表达,后者参与了神经变性.     

中国居民颅内动脉粥样硬化性狭窄危险因素的meta分析

目的 探讨中国大陆地区居民性别、吸烟、饮酒、高血压、糖尿病、血脂代谢异常等危险因素与颅内动脉粥样硬化性狭窄(intracranial atherosclerotic stenosis,ICAS)的关系.方法 系统检索中国生物医学文献数据库、中国期刊全文数据库、MEDLINE和EMBASE数据库.综合效应分析采用RevMan 5.0.23版本软件进行meta分析.经异质性检验后对性别、吸烟、饮酒、高血压、糖尿病进行OR值的合并;血脂代谢异常(TG、TC、HDL-C、LDL-C)进行MD值的合并;绘制漏斗图和计算失安全系数判断发表偏倚;敏感性分析检验meta分析结果稳定性.结果 最后9篇文献纳入meta分析,均为病例-对照研究,研究论证强度中等.性别(男性)、吸烟、饮酒、高血压、糖尿病对ICAS影响的合并OR(95%CI)值分别为1.00(0.82～1.23,P=0.99)、1.04(0.82～1.33,P=0.74)、0.91(0.69～1.20,P=0.51)、1.35(0.73～2.50,P=0.33)和1.71(1.04～2.81,P=0.03);TG、TC、HDL-C、LDL-C对ICAS影响的合并MD(95%CI)值分别为0.12(0.00～0.25,P=0.05)、0.06(-0.09～0.20,P=0.43)、-0.12(-0.23～-0.01,P=0.03)和0.24(0.14～0.33,P<0.001).结论 基于目前的研究,中国大陆地区居民糖尿病、LDL-C是ICAS的危险因素;HDL-C是ICAS的保护因素;尚无证据显示男性、吸烟、饮酒、高血压、TG、TC是ICAS的危险因素.     

药物及介入治疗对症状性大脑中动脉狭窄患者预后的影响

目的 探讨症状性大脑中动脉狭窄患者药物及介入治疗对疾病转归和预后的影响.方法 将符合入选标准的56例症状性大脑中动脉狭窄患者按治疗方法 不同分为两组,支架介入治疗组(n=21)和药物治疗组(n=35),支架介入治疗组进行大脑中动脉狭窄支架置入治疗,药物治疗组单纯应用药物治疗;两组病例观察疗效并随访1年,观察脑血管事件发...     

电磁辐射孕鼠对仔鼠神经发生和学习记忆影响研究

目的 研究电磁辐射孕鼠对仔鼠学习记忆和海马神经发生的影响.方法 将8只孕鼠随机分为对照组和辐射组,每组4只.辐射组以平均功率密度( 10::4) W/m2的900 MHz电磁波辐射孕鼠,从妊娠第1天到妊娠最后一天,每天辐射60 min;对照组不施加电磁波辐射.仔鼠出生后3周,利用Morris水迷宫检测仔鼠学习记忆功能,以5-溴脱氧尿嘧啶核苷检测海马齿状回神经发生.结果 900 MHz电磁辐射孕鼠会导致仔鼠学习记忆能力减退,辐射组逃避潜伏期(20.2±1.4)s高于对照组(11.0±2.4)8,而目标象限游泳距离百分比(35.3±3.2)%和穿环数(6.3±1.7)次/min均少于对照组(58.6±5.4)%和(14.5±2.2)次/min;辐射组仔鼠海马齿状回颗粒下层新生神经细胞数(96.7±23.4)个/视野少于时照组(156.5土28.1)个/视野;上述各指标2组比较,差异均有统计学意义(P＜0.05或P＜0.01).结论 孕期电磁辐射会抑制仔鼠海马神经发生,进而损害子代认知功能.     

动脉溶栓辅助支架置入术治疗急性脑梗死

目的 观察动脉溶栓辅助血管内支架成形术治疗急性脑梗死的效果.方法 采用前瞻性病例对照设计,将24例动脉溶栓后遗留血管狭窄(＞50%)的急性脑梗死患者分为支架治疗组和药物治疗组,分别给予支架成形术+药物治疗和常规药物治疗,评价两组血管完全再通率、残余狭窄率以及3个月时改良Rankin量表评分.结果 支架治疗组血管完全再通率高于药物治疗组(54.5%对0%,χ2=6.382,P＜0.001),残余狭窄率显著低于药物治疗组(4.5%±5.2%对82.5%±10.5%,t=7.464,P＜0.001),临床转归良好率显著高于药物治疗组(100%对76.9%,χ2=14.263,P=0.038).结论 动脉溶栓辅助血管内支架治疗急性脑梗死疗效优于药物治疗组,且较为安全.

Abstract：

Objective To investigate the efficacy of intra-arterial thrombolysis with stenting for acute cerebral infarction. Methods Using a prospective case-control design, 24 patients with acute cerebral infarction who remained angiostegnosis ( ＞ 50%) after intra-arterial thrombolysis were randomly divided into stent treatment group and drug treatment group. They were treated with stenting + drug treatment and conventional drug treatment. The rates of vascular complete revascularization and residual stenosis, and the modified Rankin scale scores at 3 months in both groups were evaluated. Results The rate of complete revascularization in the stent treatment group was significantly higher than that in the drug treatment group (54. 5% vs.0%,χ2 =6.382, P ＜0. 001), and the rate of residual stenosis was significantly lower than that in the drug treatment group ([4.5 ±5.2]% vs. [82. 5 ±10. 5]%, t =7.464, P＜0.001). The rate of favorable clinical outcome in the stent treatment group was significantly higher than that in the drug treatment group (100% vs. 76. 9%,χ2 = 14. 263, P = 0.038). Conclusion The efficacy of intra-arterial thrombolysis with stenting in the treatment of acute cerebral infarction is superior to that in the drug treatment group, and it is safer.     

尿激酶动脉溶栓联合支架置入术与单纯尿激酶动脉溶栓治疗缺血性卒中的比较

Objective To compare the safety and efficacy of intra-arterial urokinase thrombolysis alone and intra-arterial urokinase thrombolysis + stenting for ischemic stroke. Methods Sixty-four patients with acute cerebral infarction in the internal carotid artery system were analyzed retrospectively. The patients were divided into intra-arterial thrombolysis group (n = 38; using urokinase only) and stenting group (n = 26; using urokinase + stenting). The medical and imaging data of the patients in both groups were collected. The revascularization rate, and symptomatic intracranial hemorrhage and/or mortality rates were compared. The modified Rankin Scale (mRS) scores at 3 months were used to evaluate the clinical outcome in both groups. Results Of the 64 patients with ischemic stroke, 55 (85. 9%) had vascular occlusion, 9 (14. 0% ) had severe arterial stenosis. The revascularization rate in the thromborysis group was 47.4% (18/38), and that in the stenting group was 88.5% (23/26). Compared to the drug thrombolysis group, the proportion of patients whose mRS scores ＜2 at 3 months after procedure (47. 4% vs. 73. 1%,χ2 = 4. 18,P = 0. 00). There was no significant difference between the symptomatic intracranial hemorrhage rate and death rate (7. 8% vs. 7.7% , χ2 = 0.00, P =0. 62). Conclusions When patients with acute ischemic stroke are treated with ultra-early endovascular treatment, the revascularization rate of the occlusion and severe artery stenosis treated with mechanical recanalization + stenting was significantly higher than that of the simple intra-arterial thrombolytic drug, and the long-term clinical outcome is better.     

颅内支架置入术后蛛网膜下腔出血并发症的诊治

目的 探讨颅内支架置入术后蛛网膜下腔出血(SAH)的发生及处理方法.方法 回顾性分析2007年1月至2008年5月本院开展颅内支架置入术后发生3例SAH的临床资料、发生特点、处理方法及临床转归.结果 颅内支架置入术后SAH的发生率为4.5%(3/66),3倒患者早期复查头颅CT未见出血增加,于24h后恢复抗凝、抗血小板治疗,3例患者出血分别于24h、3d和5d吸收,随访至今无明显异常.初步分析显示,SAH发生与血管狭窄率、支架释放前是否球囊扩张等明显相关.结论 颅内支架置入术后发生SAH机制复杂,及时有效的处理可获得满意的临床疗效.停用和恢复抗凝、抗血小板的最佳时间需要大样本、随机多中心的临床研究.     

PBL教学法在神经病学教学中的应用

PBL(problem-based learning)即"以问题为基础"的教学法,是由美国神经病学教授Barrows于1969年在加拿大的 Macmaster大学创立的[1].     

进修医生医疗安全意识的培养

进修医生往往是一些医院的临床一线主力,业务水平参差不齐、部分存在医德问题易导致医疗纠纷;对其加强医德教育,注重医疗法规学习,重视病案尽收眼底写,关心其生活,增强其医患沟通能力,提高业务能力等可以有效减少医疗纠纷,达到进修目的。