流式细胞术分析急性脑缺血患者血小板膜糖蛋白改变

应用流式细胞术（FCM）检测急性脑缺血患者血小板膜糖蛋白Ⅱb／Ⅲa复合物（GPⅡb／Ⅲa）、GPⅠb、α-颗粒膜蛋白（GMP－140）、假血管性血友病因子（vWF）等的改变，结果显示病例组GP阳性细胞百分率及平均荧光强度均较对照组明显升高（P＜0．001～0．05），表明急性脑缺血患者血小板处于激活状态，并探讨了GP在脑缺血发病中的作用，FCM为研究脑缺血患者血小板活化程度和抗血小板药物疗效提供了一种新方法。     

NON-NEUROLOGICAL VARIABLES AND MORTALITY OF ACUTE STROKE

Acute stroke is associated with high mortality. While this is the direct consequence of the neurological injury, stroke patients develop a number of physiological abnormalities and complications in the acute phase. Extensive research has produced a plethora of information about these non-neurological variables. Different patients have different abnormalities. Some of these variables have severe adverse effects on mortality, both acute and long term. Some of the variables are pre-existing, while others are non-modifiable. The body responds to cerebral tissue injury in a way that seems to lead to further damage to the brain and other vital systems, and patients usually have more than one variable needing attention. Acute stroke presents as a multisystem disease on the verge of multisystem failure. Although there is lack of evidence of the benefits of correcting the deranged variables, it makes clinical sense that non-neurological variables should be identified, monitored and managed, with the aim of improving the outcome of acute stroke patients.     

EXPERIMENTAL NEPHRITIS IN RATS INDUCED BY INJECTION OF ANTIKIDNEY SERUM : V. CHRONIC NEPHRITIS OF INSIDIOUS DEVELOPMENT FOLLOWING APPARENT RECOVERY FROM ACUTE NEPHROTOXIC NEPHRITIS

1. Three different inbred lines of rats were found to vary in their response to antikidney serum: rats of the Whelan strain were most susceptible to nephrotoxin and most prone to develop chronic glomerulonephritis immediately following the acute injury induced by this agent; animals of the Evans strain were almost as vulnerable to the acute effects of nephrotoxin; Wistar rats were the least affected. 2. Both Evans and Wistar rats usually recovered quickly from the acute injury, and between the 2nd and 5th months after injection they excreted normal or only slightly abnormal urines. During this period of absence of clinical signs of disease, histopathological examination of their kidneys revealed only minor scarring in the glomerular tufts. 3. Most of these apparently recovered rats subsequently developed a slowly progressing chronic glomerulonephritis irrespective of whether they were fed a basal or high protein diet. 4. Histopathologically similar renal lesions were present in all three strains of rats with active chronic nephritis regardless of whether the chronic disease followed immediately the acute nephrotoxic injury or was separated from it by an interval of months. These lesions were somewhat more severe, however, in Whelan rats. 5. Some intraglomerular scarring was present in the kidneys of all rats which survived acute nephrotoxic nephritis. It was especially prominent in those animals that remained clinically cured for as long as a year. 6. The permanent clinical recovery of certain animals, which were found to have moderate glomerular fibrosis on postmortem examination, suggests that factors other than this residual scarring contributed to the development of the recurrent nephritis observed in most of the Evans and Wistar rats. These unknown factors may produce varying degrees of renal functional trauma affecting both glomeruli and tubules.     

中风后肩手综合征各期交感皮肤反应变化

目的:观察中风后肩手综合征(SHSAS)各期的交感皮肤反应(SSR)的变化.方法:中风后肩手综合征属于反射性交感神经萎缩症(RSD)的范畴,对此类RSD患者28例,按Bonica的RSD诊断标准分为三期(S1,S2和S3),分别测定各期患者的患侧与健侧上肢正中神经的SSR的波幅及潜伏期,进行对比,并将其健侧SSR与20例正常人比较.结果:S1患者患侧与健侧对比,其SSR的波幅明显下降,潜伏期明显延长(P＜0.001);S2患者其患侧SSR的波幅增高(P＜0.05),潜伏期无显著改变(P＞0.05);S3患者患侧SSR与健侧对比无明显变化(P＞0.05).结论:在SHSAS中,其各期的交感活动并非都是亢进的,S1交感神经活动减弱,S2交感活动增强,S3交感活动两侧无显著差异.     

THE TREATMENT OF ACUTE AND CHRONIC VAGINAL CANDIDOSIS

Vaginal candidosis is one of the most common infections of the vagina and the first accredited record of the disease appeared in 1849. Over the years the terms ‘candidiasis’ and ‘candidosis’ have been used, but it is generally accepted now that the terms are synonymous, and the term most commonly in use today is ‘candidosis’. Mainly caused by the yeast Candida albicans, the condition is characterised by intense inflammation of the vaginal mucosa and a curdy, off-white discharge; it is often associated with severe vulval itching and possibly burning pain. The severity of symptoms seems to vary greatly from patient to patient and the reason for this is unclear. It is suggested that in some patients there may be an element of hypersensitivity. Vaginal candidosis may occur in children but is most common in adults and only sometimes affects the elderly. The majority of women will suffer at least one attack of vaginal candidosis during their lifetime, and there are several predisposing factors such as diabetes, pregnancy and antibiotics. Some authorities consider the condition more frequent in those taking oral contraceptives or other hormones.     

妊娠期慢性疼痛对母鼠认知功能影响机制研究

目的:研究妊娠期慢性疼痛对孕鼠认知功能的影响及其分子机制。方法:选取40只同批成功受孕小鼠,采用随机数字表法分为四组(n=10):正常对照组、假手术对照组、慢性疼痛组、慢性疼痛+优裕胎教组。采用酶联免疫吸附法分别在不同时间点检测各组孕鼠血清中5-羟色胺(5-HT)和多巴胺(DA)水平并进行比较分析。结果:与假手术对照组相比,慢性疼痛组孕鼠学习能力和记忆能力显著降低,且在各时间点5-HT、DA水平显著降低(P<0.05)。与慢性疼痛组孕鼠相比,慢性疼痛+优裕胎教组孕鼠学习能力和记忆能力显著增强,且在各时间点5-HT、DA水平显著升高(P<0.05)。结论:5-HT和DA分泌异常可能是慢性疼痛导致孕鼠认知障碍的分子机制,优裕胎教可通过改变上述递质的分泌从而有效改善孕鼠认知功能。     

ARM IMPAIRMENT AND WALKING SPEED EXPLAIN REAL-LIFE ACTIVITY OF THE AFFECTED ARM AND LEG AFTER STROKE

ObjectiveTo determine to what extent accelerometer-based arm, leg and trunk activity is associated with sensorimotor impairments, walking capacity and other factors in subacute stroke.DesignCross-sectional study.PatientsTwenty-six individuals with stroke (mean age 55.4 years, severe to mild motor impairment).MethodsData on daytime activity were collected over a period of 4 days from accelerometers placed on the wrists, ankles and trunk. A forward stepwise linear regression was used to determine associations between free-living activity, clinical and demographic variables.ResultsArm motor impairment (Fugl-Meyer Assessment) and walking speed explained more than 60% of the variance in daytime activity of the more-affected arm, while walking speed alone explained 60% of the more-affected leg activity. Activity of the less-affected arm and leg was associated with arm motor impairment (R² = 0.40) and independence in walking (R² = 0.59). Arm activity ratio was associated with arm impairment (R² = 0.63) and leg activity ratio with leg impairment (R² = 0.38) and walking speed (R² = 0.27). Walking-related variables explained approximately 30% of the variance in trunk activity.ConclusionAccelerometer-based free-living activity is dependent on motor impairment and walking capacity. The most relevant activity data were obtained from more-affected limbs. Motor impairment and walking speed can provide some information about real-life daytime activity levels.LAY ABSTRACTActivity data from accelerometers can help clinicians to better understand factors limiting physical activity levels. This study aimed to determine to what degree arm, leg and trunk activity, measured with accelerometers, is associated with sensorimotor impairments, walking and other factors in people with stroke in the subacute stage of recovery. Real-life activity, measured by accelerometers, was primarily associated with motor impairment and walking speed. Spasticity, dependency in walking, and disability level also showed association with real-life activity, although to a lesser degree. Accelerometers, placed on the more-affected wrist and ankle, provided most relevant clinical information and are therefore recommended for research and clinical practice. The strong associations observed in this study suggest that when accelerometers are not available, clinical assessments of arm motor function and walking speed can provide some information on real-life activity levels in people with stroke.Key words: stroke, accelerometry, clinical research, rehabilitation, ambulatory monitoring, wearable technology, outcome assessment (healthcare), outcome measures

Individuals with stroke spend approximately 70–80% of their daytime in sedentary activities, and, when active, their activity level seldom reaches moderate-to-vigorous levels of intensity (1–3). To better understand which factors limit activity levels, wearable devices for movement monitoring, such as accelerometers, can be used effectively (4–6). Interest in using wearable technology for quantification of activity and motor function in real-life activities after stroke is increasing within the field of neurorehabilitation (7–9), although application in clinical practice is sparse (7, 10, 11).The Fugl-Meyer Assessment (FMA) is one of the most widely used clinical scales to assess sensorimotor function after stroke. The FMA has excellent psychometric properties (12, 13) and is commonly used as reference when validating new instruments. In addition to motor impairment, sensory function, spasticity, walking ability and speed are commonly assessed in clinical practice after stroke. In general, clinical assessments rely on therapists’ observational skills, and the scoring is limited to predefined categories of the scale. Traditional clinical assessments provide a snapshot of how the patient is functioning at the time of testing, which does not always overlap with the real-life functioning in daily activities (7, 8). Here accelerometers can offer several advantages, by measuring movements and activity continuously over a defined period of time in free-living conditions, and providing an objective measure of motor functioning (9, 14). Such measurements are complicated by the fact that there are numerous different accelerometer devices available, the placement of devices differs, and the metrics obtained are diverse. To overcome this limitation, the use and reporting of accelerometer data in acceleration metrics (m/s²) is advocated to allow comparison between systems, studies and conditions (10). Even though the number of studies using accelerometers is increasing, the validation of the obtained measures is critical for meaningful use in clinical research and practice (14, 15).Moderate-to-strong correlations have been reported between accelerometer-based activity measures and FMA scores (16, 17) as well as Action Research Arm Test (18) among stroke-survivors at different phases of recovery after stroke. Accelerometer-based arm ratio (i.e. the ratio between more-affected and less-affected arm) showed strong correlation with FMA, after controlling for cofactors, such as age, sex, time since stroke, sensory deficit, neglect, apraxia or lower extremity function (17). Knowledge is, however, limited regarding how different relevant cofactors might be associated with real-life activity in people with stroke in a multifactor model. Such knowledge is necessary to advance the routine use of technology-based assessment in clinical practice (19–21).The aim of this study was to determine to what degree arm, leg and trunk activity, measured with accelerometers, is associated with sensorimotor impairments and activity limitations as well as clinical and demographic characteristics in individuals with subacute stroke.     

脑卒中病人早期康复的效果观察

目的探讨脑卒中病人早期康复指导及康复训练的效果。方法随机将95例脑卒中病人分为两组，早期康复组病人（50例）病情稳定后2～10d内开始康复训练指导及相应的康复训练；对照组（45例）按神经内科常规治疗方法应用降纤、抗凝、抗血小板及营养脑神经等药物进行治疗，于病情稳定后3周进行康复指导及康复训练。两组病人分别于入院时、入院后2、4和8周，采用BARTHEL指数评定法进行日常生活活动能力评分，并比较两组评分结果。结果早期康复组BARTHEL指数评分高于对照组，差异有显著意义（t=2．738～4．568，P〈0．05）。结论早期康复指导及康复训练能使病人日常生活能力有明显的改善，康复实施的时间越早效果越好。     

SOCIETAL BURDEN OF STROKE REHABILITATION: COSTS AND HEALTH OUTCOMES AFTER ADMISSION TO STROKE REHABILITATION

ObjectiveTo estimate societal costs and changes in health-related quality of life in stroke patients, up to one year after start of medical specialist rehabilitation.DesignObservational.PatientsConsecutive patients who received medical specialist rehabilitation in the Stroke Cohort Out-comes of REhabilitation (SCORE) study.MethodsParticipants completed questionnaires on health-related quality of life (EuroQol EQ-5D-3L), absenteeism, out-of-pocket costs and healthcare use at start and end of rehabilitation and 6 and 12 months after start. Clinical characteristics and rehabilitation costs were extracted from the medical and financial records, respectively.ResultsFrom 2014 to 2016 a total of 313 stroke patients completed the study. Mean age was 59 (standard deviation (SD) 12) years, 185 (59%) were male, and 244 (78%) inpatients. Mean costs for inpatient and outpatient rehabilitation were US$70,601 and US$27,473, respectively. For inpatients, utility (an expression of quality of life) increased significantly between baseline and 6 months (EQ-5D-3L 0.66–0.73, p = 0.01; visual analogue scale 0.77–0.82, p < 0.001) and between baseline and 12 months (visual analogue scale 0.77–0.81, p < 0.001).ConclusionOne-year societal costs from after the start of rehabilitation in stroke patients were considerable. Future research should also include costs prior to rehabilitation. For inpatients, health-related quality of life, expressed in terms of utility, improved significantly over time.LAY ABSTRACTThe objective of this study was to estimate societal costs and changes in health-related quality of life in stroke patients, up to one year after the start of rehabilitation. Participants were stroke patients who received inpatient or outpatient rehabilitation. They completed questionnaires on quality of life, absenteeism, out-of-pocket costs and healthcare use at start and end of rehabilitation and 6 and 12 months after the start of rehabilitation. Rehabilitation costs were obtained from the financial records. From 2014 to 2016 a total of 313 patients completed the study. Mean age was 59 years, 185 (59%) were male and 244 (78%) inpatients. Mean costs for inpatient and outpatient rehabilitation were $70,601 and $27,473, respectively. For inpatients, health-related quality of life increased significantly between baseline and 6 months, and between baseline and 12 months. In conclusion, societal costs one year after the start of rehabilitation were considerable and health-related quality of life improved for inpatients.Key words: stroke, rehabilitation, cost analysis, utility, health-related quality of life

The number of people living with stroke in Europe is expected to increase from 1.1 million per year in 2000 to 1.5 million per year in 2025 (1). Stroke survivors may experience severe functional impairments, including impairments in physical functioning (2), cognition (3), and speech/language (4), which, in turn, lead to limitations in activities and participation and to worse quality of life (QoL) (5). Specialist rehabilitation was proven to be effective in improving functional outcomes after stroke (6), such as motor function, balance, walking speed and activities of daily living (7–9). Furthermore, in stroke patients admitted for inpatient rehabilitation, QoL increased significantly between admission and discharge (10).Besides the fact that rehabilitation after stroke is effective, rehabilitation was also found to be the main contributor to the costs of post-stroke care, according to a systematic review published in 2018 including 42 publications (11). Costs of post-stroke care, but not those of acute care, were included. Rehabilitation in different care settings was evaluated, which included primary, secondary and tertiary care, and the costs often applied to part of the patients and were not described in detail. For the delivery of value-based healthcare (VBHC), it is important to consider not only the health effects and patient-reported outcome measures, but to also evaluate the costs of care, since it is important to achieve good patient outcomes per dollar spent (12, 13).The aim of the current study was therefore: (i) to estimate the 1-year societal costs from the start of the rehabilitation in stroke patients treated in a medical specialist rehabilitation facility in The Netherlands; and (ii) to evaluate health changes in terms of utility (an expression of quality of life) over that year.     

丙烯酰胺急性中毒的临床分型探讨

目的:探讨丙烯酸胺急性中毒临床分型的新方法.方法:本文根据3例急性中毒致死(其中1例尸检进行了病理组织学及电镜观测),1例中毒后致残的情况进行了讨论,也对急性中毒的临床与死亡特征作了介绍.结果:在上述基础上,提出临床分型的意见及其与预后之间的关系.结论:丙烯酰胺急性中毒的临床分型新方法可供拟订丙烯酰胺急性中毒临床诊断标准、分型时参考.     

普恩复对缺血性脑卒中病人LPA及神经功能转归影响

目的观察普恩复对缺血性脑卒中病人血清溶血磷脂酸（LPA）含量及神经功能转归的影响。方法选择缺血性脑卒中病人78例,随机分为治疗组（38例）和对照组（40例）。治疗组在对照组治疗的基础上,加用普恩复口服治疗,每次60万单位,每天3次,连用20 d。分别于治疗前和治疗后取静脉血测定LPA水平,并于治疗后应用欧洲卒中量表（ESS）进行神经功能转归评价。结果对照组与治疗组治疗20 d后LPA水平均较治疗前显著降低（t=17.00、34.62,P〈0.01）,ESS评分亦显著改善（t=-5.57、-8.85,P〈0.05）;与对照组相比,治疗组上述指标改善更明显（t=-13.71、3.21,P〈0.01）。结论普恩复能降低血清LPA的含量,改善缺血性脑卒中病人的预后。     

THE EFFECT OF DIET ON THE SUSCEPTIBILITY OF THE CANINE HEMATOPOIETIC FUNCTION TO DAMAGE BY AMIDOPYRINE

1. By feeding dogs a black tongue diet and at the same time administering amidopyrine, acute stomatitis and anemia may be produced. 2. Both stomatitis and anemia occur some time before they could be expected to appear as result of the diet feeding alone. 3. The anemia is associated with suppression of maturation of the hematopoietic bone marrow elements.     

EXPERIMENTAL NEPHRITIS IN RATS INDUCED BY INJECTION OF ANTI-KIDNEY SERUM : III. PATHOLOGICAL STUDIES OF THE ACUTE AND CHRONIC DISEASE

Administration of the relatively organ specific antibody, so called nephrotoxin, present in anti-kidney serum, is followed by a diffuse glomerulonephritis. This is characterized early by swelling of the intercapillary substance of the glomerular tuft and by tubular degeneration. Fibrin thrombi are only present in the glomerular capillaries when the injection of anti-kidney serum results in a severe anaphylactoid reaction, and are due to factors other than nephrotoxin. The urinary abnormalities which develop in all rats after a suitable injection of nephrotoxin usually continue until the animal dies or is sacrificed. Microscopic renal lesions of the early phase merge into scarring of the glomeruli and tubules. Histological study of those animals which die from 3 to 11 months after treatment reveals a chronic progressive glomerulonephritis with generalized vascular lesions.