Cerebral infarctions in elderly patients with anemia]

The authors investigated the cause of cerebral infarctions in elderly patients with anemia. Among 411 patients with acute cerebral infarctions, eight patients showed anemia (Hb < 10 g/dl) at the time of stroke. Only 2 patients had strokes during hospitalization were aware of their anemias before stroke. They were classified into two groups. One was the sudden onset group (4 patients) of whom 3 had malignant tumors, and 2 showed disseminated intravascular coagulations (DIC). There were no patients with atrial fibrillation or cardiac disease. All patients showed cortical infarction, and two died soon after stroke. Autopsy revealed verruca formation of the mitral valve in one patient and thrombus in the right ventricle in another. We thought that non-bacterial thrombotic endocarditis (NBTE) was the major cause of cerebral infarctions in this group. The other group consisted of 4 cases of thrombotic stroke. Their neurological symptoms appeared to be progressive. They also showed cortical infarctions except for one case of pontine infarction. Severe stenosis of the cerebral arteries was revealed by angiography in two patients and by autopsy in one. We concluded that cerebral infarctions in elderly patients with anemia can be important signs of underlying malignant tumors in sudden onset strokes or cases of severe cerebral artery stenosis with thrombotic strokes.     

大鼠颈总动脉重度狭窄模型建立与超声对其的评价

目的建立大鼠颈总动脉（CCA）重度狭窄模型，并探讨采用高频彩色多普勒血流显像（CDFI）评价其狭窄程度。方法将19只SD大鼠随机分为两组，假手术组11只，CCA狭窄组8只。采用针控线栓法制作大鼠CCA狭窄模型。术后3h以高频CDFI检测CCA内径、收缩期峰值流速（PSV）、舒张期峰值流速（EDV）、PSVCCA／颈内动脉PSV（PSVICA）及阻力指数（RI），评价CCA狭窄程度。术后6h，在显微镜直视下观察CCA血管内壁情况。结果假手术组原始管径为（0．65±0．07）mm，PSVCCA中位数为101．1cm／s，EDVCCA中位数为13．4cm／s；PSVCCA／PSVICA为1．36；狭窄组大鼠残余管径为（0．18±0．06）mm，PSVCCA中位数为334．2cm／s，EDVCCA中位数为98．4cm／s，PSVCCA／PSVICA为6．43。两组相应指标比较，差异有统计学意义（P〈0．05）。两组大鼠超声检查结果与显微镜直视下的观察结果完全符合。结论采用高频CDFI可准确评价线栓法制作的大鼠CCA重度狭窄模型的狭窄程度。     

The association between the lupus anticoagulant and cerebral infarction in systemic lupus erythematosus

The lupus anticoagulant (LAC) is associated with the occurrence of thromboembolic complications. Assuming that thrombosis may underlie manifestations of the central nervous system (CNS) in patients with systemic lupus erythematosus (SLE), we studied 20 patients with SLE and CNS manifestations for the presence of LAC. In 8 patients (40%) including 4 with overt cerebral infarction, LAC was demonstrated. The 4 patients with LAC and cerebral infarction all had thrombocytopenia, 2 had a history of peripheral thrombosis, and one recurrent abortion. In the 4 LAC-positive patients without overt cerebral infarction, thrombocytopenia was present in 3, a history of thrombosis in 2, and fetal wastage in one. We conclude that LAC identifies within the CNS-SLE group a subpopulation of patients in whom CNS manifestations are caused by cerebral infarction. This subpopulation is further characterized by increased prevalence of thrombocytopenia, peripheral thrombosis and fetal wastage. A possible pathogenetic role of LAC may be related to a hypercoagulable state occurring in this subgroup of SLE patients.     

大脑中动脉狭窄和闭塞致不同供血区脑梗死的对比研究

目的通过对大脑中动脉（MCA）主干动脉粥样硬化性狭窄和闭塞所致MCA不同供血区脑梗死的对比研究，为相关治疗策略提供依据。方法回顾性分析61例由MCA动脉粥样硬化性狭窄（狭窄率〉50％）和闭塞所致的新发脑梗死患者的临床和影像学资料。将患者分为狭窄组（27例）和闭塞组（34例）。根据发病1周内磁共振弥散加权像（DWI）的结果，确定脑梗死的部位并进行对比。结果狭窄组和闭塞组单发性梗死分别为15例（55．6％）和8例（23．5％），多发性梗死分别为12例（44．4％）和26例（76．5％），P〈0．05。狭窄组和闭塞组单发性梗死中，小穿支动脉脑梗死为11例（11／15）和2例（2／8），P=0．039；多发性梗死中，穿支动脉脑梗死（PAI）合并皮质梗死（PI）为7／12和3／26（11．5％），P=0．005；多发性梗死中，PAI＋PI＋分水岭梗死为1例（1／12）和16例（61．5％），P=0．004；分水岭梗死分别为5例和23例，P〈0．001。结论MCA主干动脉粥样硬化性狭窄和闭塞所致的脑梗死部位有显著差异，前者多引起单发性脑梗死，后者多引起多发性脑梗死。提示两者的发病机制存在不同之处。     

进展性神经功能恶化与脑分水岭梗死早期预后的相关性分析

目的探讨脑分水岭梗死进展性神经功能恶化(PND)对早期预后的影响。方法回顾性连续纳入2009年3月—2014年3月于南京军区南京总医院神经内科住院,且经影像学检查证实为脑分水岭梗死患者。确定并分析内分水岭梗死、外分水岭梗死及混合分水岭梗死的临床特点、实验室指标及影像学特征。采用美国国立卫生研究院卒中量表(NIHSS)对神经功能缺损进行评分,采用改良Rankin量表(mRS)对患者预后进行评分。应用单因素分析比较组间差异,同时进行多因素Logistic回归分析PND与脑分水岭梗死90d预后不良的相关性。结果共纳入89例脑分水岭梗死患者,其中外分水岭梗死患者43例,内分水岭梗死36例,混合分水岭梗死10例。单因素分析显示,内分水岭梗死及混合分水岭梗死PND发生率明显高于外分水岭梗死[分别为36.1%(13例)、50.0%(5例)、16.3%(7例)],组间差异有统计学意义(P=0.018)。28例(31.5%)患者90 d预后不良,90d mRS为(3.4±1.0)分。预后不良患者梗死类型与预后良好患者间差异有统计学意义(P0.05),预后不良患者中,以内分水岭梗死患者较多,占50.0%(14例),而预后良好患者中,以外分水岭患者较多,占57.4%(35/61)。预后不良患者PND发生率明显高于预后良好患者[57.1%(16/28)比14.8%(9/61)],组间差异有统计学意义(P0.05)。多因素Logistic回归分析结果显示,经过校正混杂因素后,PND与脑分水岭梗死90d预后不良独立相关(OR=6.969,95%CI:2.451~19.869;P0.01)。结论相比于脑外分水岭梗死,梗死部位累及内分水岭的患者较易发生PND,且PND与90d预后不良独立相关。     

缺血性脑卒中患者夜间睡眠呼吸紊乱的初筛调查

目的 初步研究脑梗死患者睡眠呼吸紊乱的患病情况。方法 对41例脑梗死患者进行睡眠呼吸初筛监测，比较脑梗死部位、范围大小、病史和症状对呼吸紊乱的影响。结果 呼吸暂停低通气指数（AHI）〉20次／h的脑梗死患者呼吸频率明显降低，与AHI≤20次／h组比较，差异有统计学意义（P〈0．01），病史在1个月以内例数增多（P=0．043）。发病部位累及脑干的患者低通气指数（HI）明显增高（P=0．045）；病变范围较大以及出现吞咽、咽反射、言语、伸舌、意识、共济运动异常的患者呼吸紊乱明显较重。结论 新发脑梗死病变常伴有较严重的呼吸紊乱，累及脑干时低通气的发生明显增加，梗死范围越大呼吸紊乱程度越高，上气道周围组织功能异常是引起呼吸紊乱加重的重要因素。     

2型糖尿病血小板活化物质表达与脑梗死的关系

目的　探讨 2型糖尿病患者血小板活化物质表达与脑梗死的关系。　 方法 　采用流式细胞仪对 76例 2型糖尿病和 3 2例糖耐量减退患者测定血小板活化、血小板与白细胞粘附的表达。　 结果　无论 2型糖尿病组还是糖耐量减退组发生急性脑梗死患者血小板活化、血小板与白细胞粘附水平高于腔隙性脑梗死患者 (P <0 0 5 ) ,后者又高于未发生脑梗死患者 (P <0 0 5 ) ;2组中发生急性脑梗死和腔隙性脑梗死患者血小板活化、血小板与白细胞粘附水平与对照组比较差异有显著性 (P <0 0 5 )。　 结论 　 2型糖尿病和糖耐量减退患者测定血小板活化、血小板与白细胞粘附表达对缺血性脑卒中的早期诊断和病情监测有一定的临床价值     

Use of Statewide Hospital Discharge Data to Evaluate the Economic Burden of Neurocysticercosis in Los Angeles County (1991–2008)

Statewide hospital discharge data were used to assess the economic burden of neurocysticercosis in Los Angeles County (LAC) from 1991 through 2008. A neurocysticercosis hospitalization was defined as having a discharge diagnosis of cysticercosis in addition to convulsions, seizures, hydrocephalus, cerebral edema or cerebral cysts. This study identified 3,937 neurocysticercosis hospitalizations, with the number of annual hospitalizations remaining relatively unchanged over the study period (R² = 0.01), averaging 219 per year (range 180–264). The total of all neurocysticercosis hospitalization charges over the study period was $136.2 million, averaging $7.9 million per year. The average charge per patient was $37.6 thousand and the most common payment method was Medicaid (43.9%), followed by private insurance (24.5%). The average length of stay was 7.2 days. The substantial number of hospitalizations and significant economic cost underscore the importance of neurocysticercosis in LAC.     

Fatal diffuse thrombotic microangiopathy after a bite by the "Fer-de-Lance" pit viper (Bothrops lanceolatus) of Martinique

In Martinique, a man bitten two days earlier by a pit viper (Bothrops lanceolatus) was hospitalized with impaired consciousness and tetraplegia. Investigations confirmed cerebral and myocardial infarctions. Resolving thrombocytopenia was associated with virtually normal blood prothrombin time/activated partial thromboplastin time but increasing hyperfibrinogenemia. Despite specific antivenom treatment, he developed fatal left ventricular failure six days after the bite. At autopsy, multiple cerebral, myocardial and mesenteric infarctions were found. Rupture of mitral chordae tendinae was the likely cause of death. Histopathologic examination showed multi-focal thrombotic microangiopathy with intimal-medial dissection by thrombi extending from foci of endothelial damage in small cerebral, myocardial, pulmonary, mesenteric, and interlobular renal arteries and arterioles. These findings were the causes of infarctions. There was intense angiogenesis in organizing cerebral infarcts. Immunohistochemical analysis showed platelet aggregates and endothelial cells within microthrombi. Viperidae venoms contain vascular endothelial toxins, notably metalloproteinase hemorrhagins, but von Willebrand factor activators or vascular endothelial growth factor-type factors are more likely to have been implicated in this case.     

Borderline infarcts with symptomatic epilepsy--clinical and electroencephalographic findings

In 6 patients with repeating seizures early after stroke periodic lateralizing epileptiform discharges were detected in EEG. Computed tomography scans showed border-zone infarctions including the territories of the middle and the posterior cerebral artery in four patients; sonographic and angiographic findings were suspicious of embolic stroke in five cases. Seizures and EEG-discharges resolved during a short term treatment with anticonvulsants. In contrast to cerebral infarctions of other regions with comparable EEG-changes long term treatment was necessary in none of the patients.     

Effects of l-Acetylcarnitine on Cirrhotic Patients with Hepatic Coma: Randomized Double-Blind, Placebo-Controlled Trial

Multiple therapeutic modalities have been used to treat hepatic encephalopathy. l-Acetylcarnitine (LAC) is a physiologically active substance that improves both the energetic and the neurotransmission profiles. LAC is able to cross the hematoencephalic barrier and reach the cerebral regions, where the acetylic group may be utilized. The aim of this work was to evaluate the efficacy of LAC in the treatment of hepatic coma in cirrhotic patients. Twenty-four suitably selected patients were enrolled in the study and, following randomization, received either LAC (n=13) or placebo (n=11). Statistically significant differences in neurological findings, as evaluated by the Glasgow Scale, as well as in ammonia serum levels and BUN were found following LAC treatment. In the placebo group we observed two cases of improved neurological findings as well as one case of improved EEG grading. In the other group we observed an improvement of neurological findings and of EEG grade in 10 and 8 subjects, respectively. Noteworthily, seven (54%) patients went from grade 4 down to grade 3, and one from grade 4 down to grade 1. The improvement in the neurological picture was evident at between 1 and 4 hr after the end of treatment, remaining until 24 hr after. No side effects were observed in our study series. Our study demonstrates that LAC administration improved neurological and biohumoral symptoms in selective cirrhotic patients with hepatic coma.     

大脑中动脉中度与重度狭窄所致脑梗死病灶的分布特征分析

目的探讨大脑中动脉（MCA）中度和重度狭窄所致脑梗死的病灶分布特征。方法回顾性分析51例MCA主干动脉粥样硬化性狭窄（狭窄率〉50％）所致急性脑梗死患者的影像学资料,根据NCA主于的狭窄程度,分为中度狭窄组（狭窄率51％～69％,19例）和重度狭窄组（狭窄率70％～99％,32例）,比较两组患者脑梗死病灶的分布情况。结果①MCA中度狭窄组和重度狭窄组发生单发性梗死分别为17例（89．5％）和10例（31．3％）,多发性梗死分别为2例（10．5％）和22例（68．8％）,P〈0．001。②MCA中、重度狭窄组的单发性梗死中,小的穿支动脉梗死（SPAI）分别为10例（10／17）和1例（1／10）,P=0．018;皮质梗死（CI）分别为1例（1／17）和4例（4／10）,P=0．047;分水岭梗死（BZI）分别为0例和3例（3／10）,P=0．041。③重度狭窄组多发性梗死中以穿支动脉梗死（PAI）＋CI、CI＋BZI和PAI＋BZI多见,分别为9例、7例和5例。④中、重度狭窄组脑梗死累及穿支动脉供血区分别为18例（18／19）和18例（18／32）,P=0．041;其中表现为SPAI的分别为为11／18和4／18,P=0．041。⑤MCA中、重度狭窄组脑梗死累及皮质供血区分别有3例（3／19）和21例（21／32）,P：0．001;梗死累及分水岭区分别为0例和16例（16／32）,P〈0．001。结论MCA主干中度狭窄和重度狭窄所致脑梗死的梗死病灶分布特征有所不同,前者主要为穿支动脉供血区单发性梗死,后者以多发性梗死为主,提示两者致脑梗死机制存在差异。     

急性脑梗死与颈动脉及其下肢动脉粥样硬化斑块的关系

目的 探讨急性脑梗死患者颈动脉和下肢动脉粥样硬化斑块的发病情况及其相关性.方法 186例急性脑梗死患者均做颈部和下肢彩色多普勒超声及其相关检查,另设70名门诊健康体检者为对照组.结果 186例患者中总共有161例检出斑块(占86.55%),对照组70名检出斑块12名(占17.14%).急性脑梗死患者动脉粥样硬化斑块[颈动脉和(或)下肢动脉]检出率明显高于对照组(P《0.01).高龄、糖尿病史、高血脂史和吸烟史患者的斑块检出率明显增高(P《0.01).结论 不论是颈动脉还是下肢动脉,其粥样硬化斑块在急性脑梗死发病中占有重要地位,具有高度危险性,应高度重视.高龄、糖尿病、高血脂及吸烟是形成动脉粥样硬化斑块的重要危险因素.     

依达拉奉治疗急性脑梗死的临床疗效及其安全性观察

目的评价依达拉奉治疗急性脑梗死的临床疗效及其安全性。方法80例急性脑梗死病人随机分为治疗组和对照组。两组基础治疗相同。治疗组接受依达拉奉注射液30mg加入生理盐水250mL静脉输注，每日2次，14d为1个疗程。对照组接受胞二磷胆碱治疗500mg加入生理盐水250mL中静脉输注，每日1次，14d为1个疗程。第14天时评定两组总疗效，并采用中国卒中量表（CSS）、Parthel指数（BI）评价神经功能恢复状况。结果14d后治疗组总有效率达82.5％，对照组总有效率达67．5％，两组疗效比较有统计学意义（P〈0．05）；治疗组CSS评分降低优于对照组，BI明显高于对照组（P〈0.05）。两组均未发现明显副反应。结论依达拉奉可用于治疗急性脑梗死，能有效改善神经功能缺损及日常生活能力，是一种安全有效的药物。     

乳酸清除率在甲型H1N1流感危重症患者预后评估中的应用

目的探讨甲型H1N1流感危重症患者动脉乳酸及乳酸清除率的变化与预后的关系。方法对我院收治的43例甲型H1N1流感危重症患者测定入院和入院12 h动脉乳酸,计算12 h乳酸清除率。根据24 h内最差生命体征、生化指标、年龄及是否手术计算APACHEⅡ。据患者预后分为存活组和死亡组,比较两组动脉乳酸及12h乳酸清除率;据APACHEⅡ分为≤20分组及〉20分组,比较两组动脉乳酸及乳酸清除率;用Pearson相关分析APACHEⅡ与动脉乳酸相关性。结果 APACHEⅡ〉20分组较≤20分组初始动脉乳酸升高,有统计学差异（P〈0.05）;线性相关分析示初始动脉乳酸与APACHEⅡ呈正相关（r=0.487,P〈0.05）。死亡组APACHEⅡ评分明显高于存活组,死亡组患者乳酸清除率明显低于存活组,有统计学差异（P〈0.05）。结论随着APACHEⅡ评分的增高,动脉乳酸也相应增高,且12 h动脉乳酸清除率低者,病情严重预后愈差。早期动态监测甲型H1N1流感患者动脉乳酸及其清除率是判断病情严重程度和预后的有效方法     

Molecularly engineered resistance to California serogroup virus replication in mosquito cells and mosquitoes.

Introduction of genetic elements derived from a viral pathogen's genome may be used to reduce the vectorial capacity of mosquitoes for that virus. A double subgenomic Sindbis virus expression system was utilized to transcribe sequences of LaCrosse (LAC) virus small (S) or medium (M) segment RNA in sense or antisense orientation; wild-type Sindbis and LaCrosse viruses have single-stranded RNA genomes, the former being positive sense and the latter being negative sense. Recombinant viruses were generated and used to infect Aedes albopictus (C6/36) mosquito cells, which were challenged with wild-type LAC virus and then assayed for LAC virus replication. Several recombinant viruses containing portions of the LAC S segment were capable of inducing varying degrees of interference to the challenge virus. Cells infected with TE/3'2J/ANTI-S virus, expressing full-length negative-sense S RNA of LAC virus, yielded 3-6 log10TCID50 (tissue culture 50% infective dose) less LAC virus per ml than did cells infected with a double subgenomic sindbis virus containing no LAC insert. When C6/36 cells infected with TE/3'2J/ANTI-S were challenged with closely related heterologous bunyaviruses, a similar inhibitory effect was seen. Adult Ae. triseriatus mosquitoes infected with TE/3'2J/ANTI-S were also resistant to challenge by LAC virus. Organs that were productively infected by the double subgenomic Sindbis virus expressing the LAC anti-S sequences demonstrated little LAC virus or antigen. These studies indicate that expression of carefully selected antiviral sequences derived from the pathogen's genome may result in efficacious molecular viral interference in mosquito cells and, more importantly, in mosquitoes.     

Efficacy of short‐course lansoprazole with clarithromycin and amoxicillin in the eradication of Helicobacter pylori in South‐East Asian patients: 5‐day t.d.s. versus 7‐day b.d. treatment regimens

OBJECTIVE : To determine and compare the efficacy of 5‐day t.d.s and 7‐day b.d. treatment regimens comprising lansoprazole, clarithromycin and amoxicillin in the eradication of Helicobacter pylori. METHODS : Patients with unequivocal evidence of H. pylori infection based on histology and rapid urease tests of both antrum and corpus biopsies were recruited for the study. The study was a randomized, investigator‐blind, comparative study. Patients received either 500 mg clarithromycin t.d.s. and 500 mg amoxicillin t.d.s. for 5 days (LAC5) or 500 mg clarithromycin b.d. and 500 mg amoxicillin b.d. for 7 days (LAC7) together with 30 mg lansoprazole (both groups) daily for either 5 or 7 days, depending on the treatment group. Patients were assessed for the successful eradication of H. pylori, defined as the absence of bacteria based on histology and urease tests on both antral and corporeal biopsies, carried out at least 4 weeks after completion of the therapy. RESULTS : One hundred and eight patients were recruited for the study. In the LAC5 treatment group, four patients failed to return for follow up and in the LAC7 group, two failed to return for follow up and two were not compliant with medications. Eradication rates based on an intention‐to‐treat analysis were: 46/54 for LAC5 (85.2%; 95% CI = 72.9–93.4) and 47/54 for LAC7 (87.0%; 95% CI = 75.1–94.6). Based on a per protocol analysis, the rates were: 46/50 for LAC5 (92.0%; 95% CI = 80.8–97.8) and 47/50 for LAC7 (94.0%; 95% CI = 83.5–98.7). Both treatment regimens were convenient for patients and except for two patients in the LAC7 group, all patients reported taking 100% of all prescribed medications. The side‐effects encountered were uniformly mild and no patient discontinued treatment because of intolerance to medications. The most common side‐effects were altered taste (LAC5 64.7%; LAC7 78.8%). Diarrhea, nausea and anorexia were reported in a minority of patients. CONCLUSIONS : Both the LAC5 t.d.s. and the LAC7 b.d. treatment regimens were well tolerated by patients and were highly effective in the eradication of H. pylori.     

Morphological analysis of the pathogenesis of hypertensive cerebrovascular lesions: role of monocytes and platelets in intracerebral vessel occlusions

We performed ultrastructural studies of intracerebral vessels in stroke-prone spontaneously hypertensive rats (SHRSP). The initial vascular lesions observed in the asymptomatic SHRSP were focal cytoplasmic necrosis in the outer layers of the media. Focal cytoplasmic necrosis progressed into wide-spread medial necrosis with time. In the SHRSP with cerebral infarctions we discovered that numerous monocytes adhered to the endothelium of the arteries having advanced medial damage. Following the adherence of the monocytes to the endothelium enormous amounts of plasma components entered and accumulated in the arterial wall. The accumulation of the plasma components, especially fibrin, thickened the wall, narrowed the lumen and resulted in occlusion with resultant cerebral infarctions. A lot of activated platelets are seen adhering to the endothelium of the capillaries and the venules around the cerebral infarctions. These results suggest that the monocytes and the platelets may be closely related to the occurrence of cerebrovascular occlusions. The occlusions may result in further cerebral blood flow reduction and continuous deterioration.     

体外循环心内直视手术对病人颅内血浆S-100蛋白水平影响因素分析

目的分析体外循环心内直视手术后病人颅内血浆S-100蛋白水平的影响因素,以提高心内直视手术后病人神经系统并发症的诊治水平。方法择期心内直视手术病人18例,在CPB结束后30 min采集颈内静脉球部血液检测S100蛋白水平。并用多因素线性回归分析模型评价各影响因素的作用大小。结果体外循环后神经系统并发症的相关危险因素包括病人年龄、体外循环时间和停机后颅内血浆乳酸浓度。结论本研究提示在体外循环心内直视手术的临床监测指标中患者的年龄、体外循环时间和颅内血浆乳酸水平与术后神经系统并发症的发生高度相关。     

缺铁性贫血并发脑血栓形成4例临床分析

目的 探讨脑血栓形成与缺铁性贫血之间的关系,临床表现及治疗.方法:回顾性分析4例缺铁性贫血并发脑梗死患者的临床资料.结果:4例患者均为中重度贫血,血小板增多,血压偏低,2例存在慢性感染病灶.所有患者均为颈内动脉系统脑梗死,其中2例为分水岭梗死,2例为基底节梗死.吸氧、纠正贫血、调整血压在适当水平以及其他常规治疗有效.结论:对于中重度缺铁性贫血患者,如伴有血小板增多和血压偏低等情况,易导致脑血栓形成.在常规治疗脑血栓形成的同时应注意寻找贫血原因并且纠正贫血.