成都地区脑卒中住院患者对卒中症状及急救知识的认知

目的调查分析成都地区脑卒中住院患者对于卒中症状及急救知识的认知情况,并对相关数据进行分析研究。方法由经过培训的调查员对180例2012-12—2013-09在成都地区脑卒中住院患者采用面对面的方式进行询问调查,调查前会向患者及其家属说明此调查的目的,并由其签署知情同意书。结果统计结果显示男性对于卒中症状的认识和急救意识均较女性强,年龄大的人群对于卒中的症状认识不够充分,且不能在出现卒中症状时及时拨打救助电话,家庭收入和文化程度对于患者对卒中症状的认知和急救意识均有显著影响(P0.05)。家庭收入高及受教育程度高的患者认知全面,且急救意识强。结论根据在此地区的调查发现该地区卒中患者对于卒中症状了解不够全面和急救意识不强,还需要政府及社会加强普及,减少卒中发病率,出现卒中症状时可以及时救助,减少后遗症的发生。     

缺血性卒中恢复期伴失眠的危险因素研究

目的探讨缺血性脑卒中患者恢复期伴失眠的临床及神经心理学危险因素。方法纳入225例急性缺血性脑卒中患者,在卒中后3个月进行失眠及神经心理学评估。失眠的评估采用标准的失眠问卷,抑郁症状评估采用汉密尔顿抑郁量表(HDS),焦虑症状评估采用汉密尔顿焦虑量表(HAS)。比较失眠及非失眠2组间的临床及神经心理学指标,应用Logistic回归分析失眠的影响因素。结果 67例(29.8%)存在失眠。失眠患者入院NIHSS评分及HDS评分较非失眠者更高(P0.05),卒中前失眠更常见(52.2%vs.12.7%,P0.001)。Logistic回归分析显示,卒中前失眠症状(OR=2.729,95%CI=1.550~4.804,P=0.001)及HDS(OR=1.240,95%CI=1.158~1.327,P0.001)均为缺血性卒中患者伴失眠的独立危险因素。结论缺血性卒中恢复期伴失眠十分常见。卒中前存在失眠症状以及卒中后抑郁症状的严重程度是伴失眠的主要影响因素。     

卒中后癫痫危险因素的病例对照研究

目的通过了解卒中后癫痫的临床特征,探讨影响卒中后癫痫发生的危险因素。方法本研究采用病例对照研究设计,选择确诊的脑卒中后发生癫痫的患者80例为病例组;脑卒中未发生癫痫患者80例为对照组。收集两组年龄、性别、高血压史、糖尿病史、脑卒中类型、脑卒中部位、心电图检查结果和血清学检查结果等资料,分析卒中后癫痫的危险因素。资料录入采用Epidata3.2,统计分析采用SPSS 13.0。计量资料采用t检验,计数资料采用χ2检验,检验标准α=0.05。采用Logistic回归模型对卒中后癫痫的危险因素进行单因素和多因素回归分析。结果单因素Logistic回归分析结果显示:房颤、卒中部位累及皮质、颞叶、血清钠值、氯值与卒中后癫痫的发生有关(P<0.05);多因素Logistic回归分析结果表明,卒中部位累及皮质(OR=3.53,P=0.002,95%CI=1.62~7.69)、卒中位于颞叶(OR=3.06,P=0.015,95%CI=1.28~7.35)和血清氯值(OR=1.21,P=0.012,95%CI=1.04~1.40)是卒中后癫痫的危险因素。结论卒中部位累及皮质、位于颞叶和血清氯是卒中后癫痫的危险因素,应采取针对性的措施进行干预。     

急性缺血性与出血性脑卒中危险因素的对比研究

目的 探讨各种危险因素在脑卒中患者中的构成比,并对脑梗死与脑出血的危险因素进行比较,为脑卒中防治提供依据.方法 收集1995-2002年福建医科大学附属第一医院急性脑卒中住院病例1875例,其中缺血性脑卒中1504例,出血性脑卒中371例;男1216例,女659例;平均年龄(73.42±10.35)岁,对两种脑卒中类型的多种危险因素进行描述性对比分析研究.结果 高血压、脉压增大是本组脑卒中患者突出的危险因素.相对于脑出血,与脑梗死相关更密切的危险因素依次是房颤(OR=3.942)、糖尿病(OR=3.674)、肥胖(OR=3.647)、高纤维蛋白原(OR=2.781)、高血压家族史(OR=2.573)、高LDL-C(OR=2.167)、高甘油三酯(OR=1.976)、吸烟(OR=1.849)、年龄增大(OR=1.588)、低Apo A(OR=1.460)(P＜0.05).相对脑梗死,仅高血压(OR=0.545)和饮酒(OR=0.662)与脑出血有更显著的相关性(P＜0.05).除共同危险因素外,高尿酸血症和低HDL-C血症与男性脑梗死关系更密切,而肥胖、高LDL-C及高纤维蛋白原血症与女性脑梗死相关性更强.结论 高血压、饮酒是脑出血患者主要的危险因素.相对于脑出血,与脑梗死相关密切的危险因素除了高血压外,依次为房颤、糖尿病、肥胖、高纤维蛋白原、高血压家族史、高LDL-C等.不同危险因素对男女脑梗死的影响不同.     

脑卒中急性期患者卒中后抑郁的发生率及其危险因素

目的 探讨脑卒中急性期患者卒中后抑郁(PSD)的发生率及其危险因素.方法 连续入组的发病24 h内入院的急性脑卒中患者127例,根据入院14 d内汉密尔顿抑郁量表(17项)和蒙哥马利抑郁量表评分分为PSD组和非PSD组,分析PSD与性别、婚姻状况、年龄、文化程度、卒中类型、病灶部位、脑梗死容积、高血压、糖尿病、冠心病、吸烟、饮酒、体质量指数(BMI)、卒中家族史、卒中病史、颈动脉斑块、美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)和简易精神状态检查(MMSE)量表评分等临床因素的关系.结果 本组PSD发生率为37.0%(47例).PSD组脑梗死比率、伴高血压病比率、脑梗死容积、入院时NIHSS评分均明显高于非PSD组,BI和MMSE评分均明显低于非PSD组(P＜0.05～0.01).多因素Logistic回归分析显示脑梗死、高血压和入院时BI与PSD独立相关(OR=5.084,95%CI:1.255～20.592,P=0.023;OR=4.846,95%CI:1.447～16.225,P=0.010;OR=0.966,95%CI:0.951～0.981,P＜0.001).结论 脑卒中急性期患者PSD的发生率较高,脑梗死、高血压和入院时BI是PSD的独立危险因素.     

卒中后深静脉血栓形成调查及危险因素探讨

目的 调查卒中后急性期和随访期深静脉血栓形成(DVT)发生率,并探讨DVT发生的危险因素.方法 采用多中心、前瞻性研究设计.所有患者于发病后10～14 d进行双下肢静脉超声检查,出院后继续随访6个月.计算出卒中后急性期和随访期DVT发生率.通过比较卒中后并发DVT与卒中后无DVT的患者多种相关因素,筛选出卒中后DVT发生的危险因素.结果 卒中急性期DVT发生率为4.49%,其中有DVT症状者为51.6%,无症状者为48.4%;多因素Logistic分析显示:年龄(≥70岁,OR=1.63,95%CI 1.08～2.84)、卧床(OR=4.85,95%CI 2.65～9.68)、Wells评分≥2(OR=3.96,95%CI 1.86～7.86)、下肢NIHSS评分≥3分(OR=4.56,95%CI 2.07～8.85)、D-二聚体水平高(OR=3.45,95%CI 2.01～8.52)、Barthel指数(BI)评分低(OR=2.98,95%CI 1.52～6.47)、是否康复治疗(OR=1.82,95%CI 1.22～3.43)、是否抗凝治疗(OR=1.91,95%CI 1.34～4.92)是急性期卒中患者DVT发生的独立危险因素,其中康复治疗和抗凝治疗是保护因素;卒中随访期DVT发生率为1.51%,年龄(≥70岁,OR=1.82,95%CI 1.21～3.98)、出院后仍卧床(OR=5.12,95% CI 2.82～11.32)、出院时下肢NIHSS评分≥3分(OR=4.25,95%CI 2.11～7.87)、出院时BI评分低(OR=2.18,95%CI 1.18～6.23)、急性期有DVT(OR=3.81,95% CI 1.87～7.48)是随访期卒中患者DVT发生的独立危险因素.结论 卒中后DVT多发生于老年患者,48.4%DVT无症状,卒中患者发生DVT的独立危险因素多,对有上述危险因素卒中患者进行DVT监测和预防干预十分必要,康复治疗和抗凝治疗可能能降低DVT的发生.     

缺血性脑卒中患者二级预防现状及再发脑卒中的危险因素分析

目的探讨缺血性脑卒中患者二级预防现状,并对其再发脑卒中危险因素及干预对策进行分析,以降低再发脑卒中的发生率。方法对2012-06—2013-06收治的278例脑卒中患者的临床资料进行回顾性分析,其中再发性脑卒中61例为观察组,未再发性脑卒中217例为对照组,采用Logistic逐步回归分析,分析其再发脑卒中的危险因素及干预对策。结果脑卒中患者再次发生脑卒中的发病率为24.10%(67/278),相关危险因素方面,2型糖尿病病史和高血压患病率较高,均为85.61%,控制率较低,分别为49.58%、49.16%,超重肥胖和总胆固醇水平异常的阳性率也较高,控制率也较低;单因素分析结果显示,缺血性脑卒中患者发生脑卒中有统计学意义的相关危险因素包括高血压、2型糖尿病、房颤病史、总胆固醇水平异常等相关因素;本研究中多因素分析进一步表明,再发缺血性脑卒中的独立相关危险因素是总胆固醇异常(OR=3.472)、2型糖尿病血糖未控制(OR=2.237),高血压未控制(OR=2.851)和房颤病史(OR=1.945)等。结论缺血性脑卒中患者在2型糖尿病和高血压控制率低,总胆固醇升高和超重肥胖发生率较高,总胆固醇水平升高、房颤病史及血糖、血压控制欠佳与脑卒中再发显著相关。     

老年缺血性脑卒中后轻度血管性认知障碍的影响因素

目的分析老年缺血性脑卒中后轻度血管性认知障碍(VCI)的影响因素。方法对患者一般资料、体格检查、认知评估及影像学资料进行收集与调查,并行单因素分析与Logistic回归分析。结果老年缺血性卒中后轻度VCI的发生与患者年龄、文化程度、冠心病、糖尿病、高血压、卒中次数、发病部位及卒中面积有关;与性别、BMI、吸烟、饮酒等无明显相关。Logistic回归分析显示,文化程度为老年缺血性脑卒中后轻度VCI发生的保护因素,而年龄、冠心病、糖尿病、高血压、卒中次数、发病部位及卒中面积是危险因素。结论老年缺血性脑卒中后轻度VCI发生的危险因素众多,临床上可进行针对性的早期干预。     

急性缺血性脑卒中后认知障碍的危险因素分析

目的明确急性缺血性脑卒中患者发生认知障碍的情况并分析其危险因素。方法根据纳入与排除标准连续收集2017年7月~2018年8月于武汉大学人民医院住院的急性缺血性脑卒中患者104例,所有患者经过MMSE量表评分后分为卒中后认知障碍组(PSCI)及卒中后认知正常组(PSCN),比较两组患者的一般人口学资料、血生化检查结果及卒中病灶部位等指标。结果104例急性缺血性脑卒中患者发生认知障碍的有41例,发生率为39.4%。单因素分析显示两组患者的年龄、血清hs-CRP水平及病灶所在的部位等因素的差异有统计学意义(P<0.05),病灶位于基底节与认知障碍可能相关(P=0.057),多因素Logistic回归分析显示,与PSCN组相比,PSCI组患者的年龄更高(OR=1.087),基底节病灶的发生率也更高(OR=3.935),且两组差异具有统计学意义(P<0.05)。结论急性缺血性脑卒中患者认知障碍发生率较高,高龄和基底节病灶是卒中后认知障碍的独立危险因素。     

围手术期缺血性脑卒中危险因素分析

目的探讨可能引起围手术期缺血性卒中的危险因素。方法收集非心脏、非血管手术围手术期缺血性脑卒中患者的临床资料,用条件Logistic回归做单因素、多因素分析。结果对41例围手术期缺血性脑卒中患者进行回归分析,显示术中血压下降(OR=6.458,95%CI=2.842～13.267)、脑血管病(OR=2.216,95%CI=1.427～5.367)、心房颤动(OR=5.623,95%CI=3.367～8.476)是围手术期缺血性卒中的危险因素。结论对既往有脑血管疾病患者,术中严格维持血压稳定,减少心房颤动发作,对预防围手术期缺血性脑卒中的发生具有重要临床意义。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

Release of endogenous catecholamines from slices of hypothalamus of rats

The release of endogenous catecholamines from superfused slices of rat hypothalamus was studied under basal conditions and during release evoked by 40 mM K⁺. Catecholamines in superfusates, and in extracts of the tissue after stimulation, were isolated by column chromatography and quantitated by liquid chromatography with electrochemical detection. Norepinephrine (NE) was not consistently demonstrable in superfusate collected under basal conditions, but 40 mM K⁺ caused the release of from 2 to 4 ng/g of tissue per min. The addition of cocaine to the superfusate caused increases in basal and evoked release of NE. Epinephrine (E) could be measured in superfusates of slices from male but not female rats and then only when cocaine was added to the superfusate. Accordingly, the concentration of E in hypothalamus was greater in male rats than in female rats. Dopamine (DA) was not consistently measurable in the spontaneous overflow from slices either in the presence or absence of cocaine. K⁺-evoked release of DA could be demonstrated in slices from female rats. The addition of cocaine increased the evoked release of DA from slices from both sexes. Corticosterone, added to cocaine, had no effects on the efflux of any of the catecholamines. The experiments suggest that neuronal reuptake of all catecholamines is very efficient in the hypothalamus both under basal conditions and during evoked release.     

《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

阿立哌唑对精神分裂症患者生活质量的影响

目的:比较阿立哌唑与利培酮对精神分裂症患者生活质量的影响。方法:60例精神分裂患者随机平分为两组各30例,分别给予阿立哌唑和利培酮治疗。疗程8周。用生活质量综合评定问卷-74(GQOLI-74)、阳性与阴性症状量表(PANSS)及副反应量表(TESS)评定疗效及不良反应。结果:阿立哌唑与利培酮均能显著提高精神分裂症患者生活质量,但阿立哌唑在改善GQOLI-74总分、躯体健康及社会功能维度优于利培酮。结论:阿立哌唑治疗有利于提高精神分裂症患者生活质量。