缺血性卒中TOAST分型与预后关系的一年随访研究

目的研究缺血性脑卒中TOAST分型与预后的关系。方法收集自2007年1月—2008年5月在天津市环湖医院卒中单元病房住院治疗的1 019例急性缺血性脑卒中患者,男性630例,女性389例,平均年龄(64.54±11.60)岁。脑卒中依据TOAST标准分型,即大动脉粥样硬化型(LAA)、心源性栓塞型(CE)、小动脉闭塞型(SAO),其他明确病因型(SOE)和不明原因型(SUE)5型。应用NIHSS评分和改良Rankin评分(mRS)了解不同亚型患者入院时和随访1年时的功能状态,并评价不同亚型患者预后,复发率和病死率的差异。结果缺血性脑卒中男性患者发病年龄较女性患者早(P0.001)。脑卒中亚型:LAA 689例(67.6%),SAO例(20.4%),CE例(7.0%),SUE例(3.8%),SOE例(1.2%),其中LAA亚型所占比例最高。各亚型与预后的关系:CE型患者入院时病情危重,神经功能缺损最严重,NIHSS评分最高(15.82±9.56),SAO亚型入院时病情最轻(4.19±4.30)。1年时CE亚型预后不良发生率(50.70%)、复发率(33.3%)和病死率(36.62%)均高于其他亚型。SAO亚型预后不良发生率(7.96%)、复发率(15.8%)和病死率(2.88%)均为最低。结论 SAO亚型预后佳,可作为独立的因素预测预后。CE亚型复发率和病死率最高,预后最差。     

缺血性脑卒中TOAST分型各亚型评定量表选择及分型相关研究

目的 探讨缺血性脑卒中TOAST分型各亚型神经功能缺损的合适临床评定量表.方法 选择289例缺血性脑卒中患者进行前瞻性分析.结果 （1）缺血性脑卒中TOAST病因分型各亚型构成比：UND（36.6%）最大,SAO（29.8%）次之,OC（1.7%）最小;三个月死亡率：CE（15.5%）最高,LAA（11.8%）次之,SAO（1.2%）最低;三个月的复发率：LAA（17.6%）最高,CE（8.6%）次之,SAO（2.4%）最低.（2）LAA、CE、UND、SAO亚型量表评定效度最好的分别为MESSS（-0.812）、ESS（0.816）、NIHSS（-0.807）、NIHSS（-0.795）,信度和可操作性均为中等.结论 缺血性脑卒中TOAST分型各亚型中UND发病率最高,CE死亡率最高,LAA复发率最高,SAO死亡率和复发率最低;缺血性脑卒中TOAST分型各亚型中LAA最适合的量表是MESSS,CE最适合的量表是ESS,UND和SAO最适合的量表是NIHSS.     

大动脉粥样硬化型与心源型急性缺血性脑卒中患者脑缺血状态及血管内治疗效果的差异性分析

目的探讨大动脉粥样硬化型(LAA)与心源型(CE)急性缺血性脑卒中(AIS)患者磁共振加权成像(DWI)特征、侧支循环建立情况及采用血管内治疗的效果差异。方法采用回顾性研究方案, 选取2020年1月至2021年12月佛山市三水区人民医院神经内科收治的120例AIS患者进行临床研究, 根据急性卒中治疗Org 10172试验(TOAST)分型, 将患者分为LAA组73例、CE组47例。查阅两组患者入院时的MRI资料, 对比两组DWI分型、侧支循环分级及入院时的基本情况, 并观察两组患者治疗后的预后结局差异, 采用Cox比例风险回归模型分析AIS患者预后的影响因素。结果 CE组的年龄、入院时NIHSS评分、合并房颤患者占比、侧支循环分级0～1级的患者占比均大于LAA组, 差异有统计学意义(均P<0.05)。CE组患者主要为皮质-皮质下型梗死、前-后循环型脑梗死, 且患者占比高于LAA组, 差异有统计学意义(均P<0.05);LAA组患者大的穿通支梗死、单侧前循环梗死患者占比高于CE组, 差异均有统计学意义(均P<0.05)。CE组患者入院时、治疗后28 d的NIHSS评分均...     

缺血性卒中患者血清中热休克蛋白-70、半胱氨酸蛋白酶3水平与TOAST和OCSP分型的关系

目的探讨缺血性脑卒中患者血清中HSP-70、Caspase-3水平与患者TOAST和OCSP分型及预后的关系。方法将本院2017年11月-2018年11月收治的198例缺血性卒中患者作为研究对象,抽血检测患者血清中HSP70、Caspase-3水平,所有脑卒中患者按照OCSP和TOAST标准进行分型,采用NIHSS评分评价患者神经功能、采用日常生活活动能力表SF-36评价患者生活质量,评价患者预后,分析不同预后患者血清中HSP-70、Caspase-3和TOAST、OCSP分型的关系。结果 TOAST分型中CE型HSP-70、Caspase-3水平,明显高于LAA、SUE、SOD、SAO型; OCSP分型中TACI型HSP-70、Caspase-3水平,明显高于POCI、PACI、LACI型; HSP-70低水平组患者入院和出院NIHSS评分均明显低于对应高水平组;上述差异均有统计学意义(P 0.05); HSP-70、Caspase-3、入院时NIHSS评分、TOAST分型-SE、OCSP分型-TACI是患者预后不良的重要危险因素(P 0.05)。结论缺血性脑卒中患者血清中HSP-70、Caspase-3水平是患者预后不良的重要危险因素。     

脑卒中急性期的血压管理和影响因素

目的 监测脑卒中急性期患者血压变化规律,并探讨帕罗西汀对脑卒中伴抑郁状态患者血压的影响.方法 选择脑卒中急性期患者148例,其中脑梗死102例(脑梗死组),脑出血46例(脑出血组).应用动态血压监测仪观察脑卒中急性期两组患者的血压变化及帕罗西汀对脑卒中伴抑郁状态患者血压的影响.结果 148例患者,首次测量血压高于140/90 mm Hg(1 mm Hg=0.133kPa)者97例,占65.5%c.以后血压随时问逐渐下降,入院第3天与第1天的收缩压及舒张压比较,差异均有统计学意义(P＜0.01);脑梗死组与脑出血组血压变化比较差异无统计学意义.127例脑卒中急性期患者血压昼夜节律消失,血压昼夜节律消失率为85.8%047例经Zung-抑郁自评量表(SDS)筛选确定为抑郁状态的患者给予帕罗西汀20mg/d,10 d内有9例患者血压增高,停药2～3 d好转.结论 脑卒中急性期患者血压增高,但增高的血压有自行下降的趋势;大多数脑卒中急性期患者血压昼夜节律消失;伴抑郁状态的患者用帕罗西汀治疗可导致血压升高或不稳定.     

肱踝脉搏波传导速度与小血管阻塞型脑卒中的相关性研究

目的探讨肱踝脉搏波传导速度(ba PWV)与缺血性脑卒中不同亚型之间的相关性及特点,为缺血性脑卒中患者的预防与治疗提供理论依据。方法本研究依托"北方农村地区居民常见慢性非传染病疾病家系队列研究",选取2013-2015年房山区脑卒中队列患者中缺血性脑卒中患者279名,进行问卷调查、体格检查、生化指标检测、ba PWV和颈动脉内膜中层厚度测量,根据不同缺血性脑卒中TOAST(急性卒中Org10172治疗试验)分型的亚型将患者分为大动脉粥样硬化(LAA)型脑卒中组和小血管阻塞(SAO)型脑卒中组。用R语言1.0.142软件进行t检验、χ~2检验和Z检验,用logistic回归模型分析TOAST分型各亚型与ba PWV之间的关系。结果 LAA型脑卒中患者的收缩压、舒张压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、颈动脉内膜中层厚度和中心性肥胖率均显著高于SAO型脑卒中患者,HDL-C、ba PWV、ba PWV异常率均显著低于SAO型脑卒中患者,差异均有统计学意义(P0.01)。多元logistic回归分析结果显示,在调整了年龄、性别、血压是否正常等因素之后,SAO型脑卒中患者ba PWV异常的风险是LAA型脑卒中患者的2.747倍(OR=2.747,95%CI:1.500~6.118,P0.05);在调整了年龄、颈动脉内膜中层厚度、心脑血管疾病病史及低密度脂蛋白胆固醇后,SAO型脑卒中患者ba PWV异常的风险是LAA型脑卒中患者的1.542倍(OR=1.542,95%CI:1.051~2.242,P0.05)。结论缺血性脑卒中TOAST分型不同亚型间ba PWV存在差异,相比于LAA型脑卒中患者,SAO型脑卒中患者肱踝脉搏波传导速度异常的风险更高。     

不同性别缺血性脑卒中TOAST分型分析

目的 了解不同性别缺血性脑卒中的TOAST分型构成情况,为不同性别缺血性脑卒中的防治提供科学依据。方法 选择2007年10月至2009年10月诊治的缺血性脑卒中患者463例为研究对象,其中男279例（男性组）,女184例（女性组）,分析不同性别缺血性脑卒中患者TOAST 分型的构成情况。结果 根据TOAST病因分型,男性组大动脉粥样硬化(LAA)型54例(19.4％,54/279),小动脉闭塞(SAO)型95例(34.1％,95/279),心源性栓塞(CE)型33例(11.8％,33/279),其他明确病因(SOE)型9例（3.2％,9/279）,不明原因(SUE)型88例(31.5％,88/279);女性组LAA型22例(12.0％,22/184),SAO型66例(35.9％,66/184),CE型35例(19.0％,35/184),SOE型6例(3.3％,6/184),SUE型55例(29.9％,55/184)。男性组LAA型所占比例显著高于女性组,而CE型所占比例显著低于女性组,差异均有统计学意义(P＜0.05)。结论 根据TOAST分型,缺血性脑卒中患者各型所占比例在不同性别患者中有所不同。     

《中国脑卒中防治报告2019》概要

  目的  了解血压水平及其不同组合对金昌队列人群脑卒中发病的影响,为人群血压管理和脑卒中的防控提供参考依据。  方法  收集金昌队列2011年6月 — 2015年12月完成基线调查和随访调查的32 736名金昌队列人群的相关数据,应用单因素和多因素Cox比例风险回归模型分析不同血压水平及其组合对脑卒中发病风险的影响。  结果  金昌队列人群随访期间脑卒中发病率为0.88 %,男性和女性人群发病率分别为1.03 %和0.65 %。调整性别、年龄、文化程度、吸烟情况、饮酒情况、有无糖尿病和脑卒中家族史等混杂因素后,多因素Cox比例风险回归分析结果显示,金昌队列人群收缩压为120～139、140～159和 ≥ 160 mm Hg时发生脑卒中的风险分别为 < 120 mm Hg时的1.53、2.65和3.09倍,舒张压为80～89、90～99和 ≥ 100 mm Hg时发生脑卒中的风险分别为 < 80 mm Hg时的1.42、2.17和2.79倍;收缩压/舒张压为120～139/80～89、140～159/ < 80、140～159/80～89、140～159/90～99、140～159/ ≥ 100、 ≥ 160/ < 100和 ≥ 160/ ≥ 100 mm Hg时发生脑卒中的风险分别为 < 120/ < 80 mm Hg时的1.83、2.55、1.81、3.21、3.34、2.28和3.97倍。在调整了年龄、文化程度、吸烟情况、饮酒情况、有无糖尿病和有无脑卒中家族史等混杂因素后,多因素Cox回归分析结果显示,金昌队列男性人群收缩压为140～159和 ≥ 160 mm Hg时发生脑卒中的风险分别为 < 120 mm Hg时的2.44和2.86倍,舒张压为90～99和 ≥ 100 mm Hg时发生脑卒中的风险分别为 < 80 mm Hg时的2.02和2.95倍;金昌队列女性人群收缩压为120～139、140～159和 ≥ 160 mm Hg时发生脑卒中的风险分别为 < 120 mm Hg时的2.03、2.55和2.83倍,舒张压为90～99 mm Hg时发生脑卒中的风险为 < 80 mm Hg时的2.34倍。  结论  不同血压水平及其组合金昌队列人群脑卒中发病风险不同,在血压管理和脑卒中的防控工作中应予以综合考量。     

脑梗死急性期血压变化规律及处理原则研究

目的:观察起病24小时内入院,经CT确诊的脑梗死急性期血压变化特点。方法:对48例脑梗死病人分别测量其入院时,24小时,5天,7天,30天的平均血压。结果:入院时血压普遍较高,24小时内血压下降幅度最大,收缩压平均下降17mmHg,舒张压平均下降5mmHg。1周内血压持续下降,1周后血压平稳。结论:急性脑梗死发病后血压升高经自身调节及应用脱水利尿剂后血压会逐渐下降,不宜积极、过早、过快降血压,以免影响预后,应根据血压变化采取相应治疗措施。     

MMP-9、TIMP-1水平与急性脑梗死关系的研究

目的 探讨MMP-9、TIMP-1水平与脑梗死TOAST分型及预后的关系. 方法 收集急性脑梗死患者90例,按照TOAST分型分为CE、LAA、SA三组;对照组30例;采用ELISA法,测定发病24 h内、第5 d和第10 d的血清MMP-9、TIMP-1:对照组采清晨空腹血1次,测定血清MMP-9、TIMP-1含量.随访1个月,记录发病1个月时的BI(Barthal Index)来评价预后含量. 结果发病后24 h内,TOAST各亚型血清MMP-9含量均升高,与对照组比较差异有统计学意义(P＜0.05),其中,CE组和LAA组高于SA组(P＜0.05);第14 d各组MMP-9含量均降至正常水平.发病后24 h内,TOAST各亚型血清TIMP-1含量亦均升高,与对照组比较差异有统计学意义(P＜0.05),其中,CE组和LAA组高于SA组(P＜0.05);第14 d各组TIMP-1含量均降至正常水平.预后较好者其发病24 h内血清MMP-9含量为(567.1±263.0)ng/ml,明显低于预后较差者,其MMP-9含量为(893.7±451.1)ng/ml,两者比较差异有统计学意义(P＜0.05). 结论 MMP-9作为生物活性指标,有助于急性脑梗死的分型,并为我们提供病变程度和预后的信息,同时也可以作为我们评定预后的指标之一.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.