颈动脉易损斑块对缺血性脑卒中预后的影响

目的探讨颈动脉易损斑块与缺血性脑卒中预后的关系。方法经头颅MRI证实的首发或再发缺血性脑卒中患者152例,根据诊断分为易损斑块组56例,非易损斑块组96例,并进行CT血管成像联合颈动脉超声检查,分析斑块性质、形态,发病后根据美国国立卫生研究院卒中量表(NIHSS)评分对患者的神经功能缺损情况进行评估,采用改良的Rankin残障量表(mRS)评估预后,评估各项危险因素,动态观察其入院后7、14、30d时NIHSS评分、mRS评分、梗死灶体积,观察分析患者的脑血管事件。结果与非易损斑块组比较,易损斑块组7、14、30d NIHSS评分及mRS评分所占比例明显增高,大面积脑梗死体积明显增多,差异有统计学意义(P<0.05,P<0.01)。logistic回归分析显示,颈动脉易损斑块与缺血性脑卒中预后密切相关;NIHSS评分、高敏C反应蛋白、年龄与缺血性脑卒中预后相关。结论缺血性脑卒中易损斑块患者病情重、预后不良,动态观察易损斑块与缺血性脑卒中预后的病情变化程度能够更充分的预测脑卒中的预后。     

中老年脑卒中瘫痪患者外科手术预后的影响因素

目的分析中老年脑卒中瘫痪患者外科手术预后状况的影响因素。方法回顾中老年脑卒中瘫痪患者438例外科手术资料,搜集并分析一般情况、可能影响预后不良的相关因素、神经功能缺损评分(NIHSS)、Barthel指数(BI)、改良Rankin量表(mRS)评分、感染和并发症发生情况,评价患者外科手术预后不良的危险因素。以格拉斯哥(GOS)评分3分为预后良好组,≤3分为预后不良组。结果脑卒中瘫痪患者外科手术后预后不良检出率为52.7%,GOS评分与外科手术后死亡情况明显相关(P0.05),多因素Logistic回归分析显示,外科手术次数多(OR=11.00)、NIHSS(OR=7.09)、BI(OR=15.77)、mRS分数高(OR=20.02)是脑卒中瘫痪患者外科手术预后不良的危险因素;预后不良组中重度神经功能缺损、日常生活重度依赖程度、感染并发症发生情况明显差于预后良好组(P0.05)。结论应关注脑卒中瘫痪患者外科手术的预后不良情况及干预其危险因素,以改善其预后。     

椎基底动脉延长扩张症与急性缺血性脑卒中患者预后的相关性

目的探讨椎基底动脉延长扩张症(vertebrobasilar dolichoectasia,VBD)与急性缺血性脑卒中患者预后的关系。方法选择2015年12月～2019年6月开封市中心医院神经内科住院的急性缺血性脑卒中患者467例,依据影像标准分为VBD组37例,非VBD组430例。采用美国国立卫生研究院卒中量表(national institutes of health stroke,NIHSS)评分,综合评估患者患病的严重程度,其次行头颅CT、MRI、CT血管造影和数字减影血管造影等影像学检查,进一步评估颅内血管形态、结构等情况。根据发病后90 d改良的Rankin量表(modified Rankin scale,mRS)评分分为预后良好组386例(mRS评分≤3分预后良好)及预后不良组81例(mRS评分3分预后不良)。采用SPSS 16.0统计软件分析患者流行病学特征、TOAST分型、血管危险因素、血管变异的情况和实验室检查结果,评估可能影响患者临床预后的相关因素。结果 VBD组发病90 d转归良好28例,转归不良9例;非VBD组发病90 d转归良好358例,转归不良72例。随访期间VBD组死亡2例,再次非致死性脑梗死7例;非VBD组死亡11例,再次非致死性脑梗死61例。VBD组基线NIHSS评分和Hcy水平明显高于非VBD组,差异有统计学意义(P0.01)。预后不良组基线NIHSS评分、高血压、高脂血症、脑梗死、Hcy和心房颤动比例明显高于预后良好组,差异有统计学意义(P0.05,P0.01)。多元logistic回归分析显示,Hcy是发生VBD的独立危险因素(OR=1.04,95%CI:1.01～1.08,P=0.005);VBD和基线NIHSS评分是急性缺血性脑卒中预后不良的独立危险因素(OR=2.75,95%CI:1.04～7.29,P=0.042;OR=1.54,95%CI:1.40～1.69,P=0.005)。结论 VBD合并急性缺血性脑卒中患者早期预后差,VBD和基线NIHSS评分是急性缺血性脑卒中患者早期预后的独立预测因素;Hcy是VBD的独立预测因素。     

尿酸与急性缺血性脑卒中早期预后关系的研究

目的探讨血清尿酸与急性缺血性脑卒中早期预后的关系。方法选择2015年3月～2016年3月西安交通大学第一附属医院神经内科连续住院治疗的急性缺血性脑卒中患者421例,根据出院时预后情况分为预后良好组232例[改良的Rankin评分(modified Rankin scale,mRS)0～2分],预后不良组189例(mRS 3～6分)。采集整理患者入院时人口学信息、血管相关危险因素、尿酸等实验室指标、影像学资料及疾病相关临床指标,包括美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)评分。对2组患者上述临床特点进行比较,并通过非条件logistic回归分析尿酸与急性缺血性脑卒中早期预后的关系。结果预后不良组心房颤动、收缩压、TC、LDL、尿素、NIHSS评分、脑梗死位于大脑前动脉及大脑中动脉、住院时间、死亡和出院mRS评分明显高于预后良好组,尿酸和格拉斯哥昏迷评分明显低于预后良好组,差异有统计学意义(P0.05,P0.01)。非条件logistic回归分析显示,收缩压、NIHSS评分和尿酸为急性缺血性脑卒中患者预后不良的主要因素(OR=1.017,95%CI:1.003～1.031,P=0.018;OR=1.274,95%CI:1.178～1.378,P=0.000;OR=0.993,95%CI:0.989～0.996,P=0.000)。结论血清低尿酸可能与急性缺血性脑卒中早期预后不良相关。     

血糖对部分前循环梗死预后的影响

目的探讨急性期血糖水平对部分前循环梗死近期及远期预后的影响。方法选择部分前循环梗死患者94例,按入院24h内患者血糖水平分组,血糖正常组28例,单纯应激性高血糖组36例,糖尿病组30例。分别于入院、住院14d及6个月时进行神经系统功能缺损评分,包括美国国立卫生研究院卒中量表(the National Institutes of Health Stroke Scale,NIHSS)、Bathe1指数(Bathel index,BI)以及改良Rankin量表(modified Rankin scale,mRS)评分。比较各组血糖水平与预后的关系。结果与血糖正常组比较,单纯应激性高血糖组和糖尿病组入院、住院14d及6个月NIHSS评分、mRS评分明显升高,BI明显降低,差异有统计学意义(P<0.05);与单纯性应激性高血糖组比较,糖尿病组住院14d及6个月BI明显降低,入院、住院14d及6个月NIHSS评分、mRS评分明显升高,差异有统计学意义(P<0.05)。结论部分前循环梗死患者急性期血糖水平与预后明显相关,合并糖尿病患者的近期及远期预后均差。     

急性缺血性脑卒中合并糖尿病患者磁共振指导下溶栓治疗及预后的影响因素

目的分析急性缺血性脑卒中合并糖尿病患者磁共振指导下溶栓治疗及预后的影响因素。方法选取2012年4月~2014年12月我院收治的急性缺血性脑卒中患者95例作为研究对象,将合并糖尿病患者分为研究组(48例),非糖尿病患者分为对照组(47例)。对患者进行头颅CT扫面、给予重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗、头颅磁共振(MRI)评价、美国国立卫生院卒中量表(NIHSS)评分,3个月后针对存活患者进行改良Ranlin量表(m RS)评分。观察两组患者的溶栓情况及预后,并分析3个月m RS评分与有关指标的相关性。结果发病时24 h、1周NIHSS评分比较,差异无统计学意义(P0.05);但研究组的3个月m RS评分(1分)比例显著低于对照组,差异有统计学意义(P0.05);单因素相关分析,预后与糖尿病、基线NIHSS评分、血管狭窄、继发性出血有关。结论急性缺血性脑卒中合并糖尿病患者磁共振指导下溶栓治疗较非溶栓治疗安全有效,预后较佳,但较非糖尿病患者预后较差,临床上需进一步扩大样本量研究。     

磁共振成像引导下静脉溶栓治疗急性缺血性脑卒中合并糖尿病的临床效果研究

目的探讨磁共振成像引导下静脉溶栓治疗急性缺血性脑卒中合并糖尿病的临床效果。方法选取2014年4月—2015年4月在聊城市第三人民医院住院的急性缺血性脑卒中患者120例,根据是否合并糖尿病分为糖尿病组(n=23)和非糖尿病组(n=97),两组患者均采用磁共振成像引导下静脉溶栓治疗。比较两组患者基线资料,治疗后1 d、1周美国国立卫生研究院卒中量表(NIHSS)评分,治疗3个月后预后情况,调查糖尿病组患者治疗前后家属满意度。结果两组患者高血压发生率、年龄、舒张压比较,差异无统计学意义(P0.05);糖尿病组患者收缩压、空腹血糖、糖化血红蛋白及纤维蛋白原高于非糖尿病组(P0.05)。治疗后1 d、1周两组患者NIHSS评分比较,差异无统计学意义(P0.05)。非糖尿病患者治疗3个月后预后良好率高于糖尿病组(P0.05)。治疗后糖尿病组患者家属满意度高于治疗前(P0.05)。结论磁共振成像引导下静脉溶栓治疗急性缺血性脑卒中合并糖尿病安全有效。     

老年人首次急性缺血性脑卒中的预后

目的 探讨老年人首次急性缺血性脑卒中的预后.方法 选择老年人首次发作急性缺血性脑卒中患者652例,男345例,女307例,根据高血压、冠心病、糖尿病、高血脂等分为不同组,在老年人发生首次急性缺血性脑卒中出院后随访6个月,统计各组患者的病死率及NIHSS、BI量表评分.结果 老年人首次急性缺血性脑卒中伴有高血压、冠心病、糖尿病、高血脂的患者3个月的病死率较高,而NIHSS、BI评分较低.结论 老年人首次急性缺血性脑卒中患者预后与血压、血糖、血脂、血胆固醇、血管粥样硬化等密切相关.     

缺血性脑卒中急性期血糖与预后关系的探讨

影响缺血性脑卒中患者预后的因素很多。急性脑卒中早期,经常可以见到神经功能缺损进行性恶化的病例。资料显示脑卒中加重发生率约为20％-40％,临床观察发现血糖水平与脑梗死预后密切相关。糖尿病合并脑卒中,不仅临床表现重,而且预后也差,其死亡率明显高于非糖尿病合并脑卒中者。现将我院收治的158例脑梗死患者的临床资料报道如下。     

CHADS2评分在非瓣膜病心房颤动患者发生缺血性脑卒中短期预后的预测价值

目的探讨CHADS2评分对非瓣膜病心房颤动发生缺血性脑卒中早期的严重程度和短期预后是否有预测价值。方法回顾性分析非瓣膜病心房颤动缺血性脑卒中患者192例,根据CHADS2评分分为低危组(0~1分)79例、中危组(2~3分)88例、高危组(4~6分)25例,分别统计3组患者发病1、7和30d美国国立卫生研究院卒中量表(NIHSS)评分,以及发病30d改良的Rankin量表(mRS)评分。结果低危组、中危组、高危组NIHSS评分、发病1、7和30d比较,差异有统计学意义(P<0.01)。中危组、高危组不同时间NIHSS评分及发病30dmRS评分明显高于低危组(P<0.01)。中危组、高危组患者神经功能恶化(23.9%,28.0%vs 10.1%)、不良转归(43.2%,64.0%vs 22.8%)比例明显高于低危组,差异有统计学意义(P<0.05,P<0.01)。结论 CHADS2评分越高的非瓣膜病心房颤动患者发生缺血性脑卒中的严重程度越高,短期内预后越差、残障程度越高。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.