脑梗死患者颈动脉粥样硬化斑块与血浆胆红素、尿酸的关系

目的 探讨脑梗死患者颈动脉粥样硬化斑块与血浆胆红素、尿酸的关系. 方法 对351例脑梗死患者行颈动脉彩色超声检查确定有无颈动脉斑块,根据斑块的有无分为颈动脉斑块组(n=218)和对照组(n=133).检测两组患者血浆胆红素、尿酸,同时调查血糖、血脂、吸烟、酗酒、高血压等其他危险因素并比较分析. 结果 颈动脉斑块组血浆胆红素水平低于对照组,尿酸水平高于对照组,差异有统计学意义(P＜0.05).Logistic多元回归分析发现,血浆胆红素、尿酸均为脑梗死患者颈动脉粥样硬化斑块的独立危险因素. 结论 在脑梗死患者颈动脉斑块的发生发展中,血浆胆红素、尿酸起了非常重要的作用.     

急性脑梗死患者糖耐量减低与颈动脉硬化的相关研究

目的 探讨急性脑梗死患者糖耐量减低与颈动脉粥样硬化的关系及其相关影响因素. 方法 将326例急性脑梗死患者根据病情分为糖尿病组(DM组)、糖耐量减低组(IGT组)、糖耐量正常组(NGT组),比较3组患者的临床资料、生化指标及颈动脉B超检查结果. 结果 IGT组和DM组体重指数、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)比NGT组明显增高,IGT组和DM组颈总动脉内膜一中层厚度(IMT)、斑块检出率、内膜光滑性和连续性评分、中重度血管狭窄及颈动脉粥样硬化的发生率均明显高于NGT组,差异均有统计学意义(P＜0.05).Logistic多元回归分析结果显示年龄、TC、LDL-C、餐后2h血糖是颈动脉粥样硬化发生的独立危险因素. 结论 急性脑梗死患者中,合并IGT人群已经存在明显的颈动脉粥样硬化病变,其程度与DM类似.     

血浆同型半胱氨酸水平与动脉粥样硬化性脑梗死的关系

目的探讨血浆同型半胱氨酸水平与动脉粥样硬化性脑梗死的关系,为动脉粥样硬化性脑梗死的预防提供指导依据。方法选择107例动脉粥样硬化性脑梗死患者为脑梗死组,同时选择同期本院健康体检者76例为对照组。所有研究对象均记录年龄、性别,吸烟、饮酒、高血压、糖尿病等既往史,测定血浆同型半胱氨酸(homocysteine,HCY)水平及空腹血糖(FBG)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C),应用彩色超声多普勒检查患者颈动脉内膜中层厚度(intimal-medial wall thickness,IMT)。根据颈动脉彩色超声多普勒检查结果将脑梗死组分为脑梗死伴颈动脉粥样硬化斑块组和脑梗死无斑块组,将对照组分为对照有颈动脉粥样硬化斑块组和对照无斑块组;脑梗死有斑块组和对照有斑块合并为斑块组,脑梗死无斑块组和对照无斑块组合并无斑块组。结果脑梗死组男性、高龄、吸烟、高血压患者较对照组增多,FBG、血浆TC、LDL-C、HCY水平均高于对照组,差异有统计学意义(P0.05)。多元Logistic回归分析显示吸烟、高血压、糖尿病、高血浆TC、LDL-C、HCY水平均是动脉粥样硬化性脑梗死的危险因素。Sperman秩相关显示HCY与吸烟、饮酒、高血压、糖尿病、TC、TG、LDL-C均无相关性。脑梗死组血浆HCY水平、IMT均高于对照组,斑块组血浆HCY、IMT水平均高于无斑块组,脑梗死有斑块组血浆HCY、IMT水平均高于脑梗死无斑块组,对照有斑块组血浆HCY、IMT水平均高于对照无斑块组,且差异均有统计学意义(P0.05);直线相关分析显示血浆HCY水平与IMT水平呈正相关(r=0.86,P0.05)。结论血浆HCY水平与脑梗死关系密切,高血浆HCY水平是动脉粥样硬化性脑梗死的独立危险因素,高血浆HCY水平主要通过加速动脉粥样硬化影响脑梗死的发病。     

普罗布考联合阿司匹林溶解治疗颈动脉斑块的疗效观察

目的研究普罗布考联合阿司匹林在颈动脉粥样硬化中的应用价值。方法选取2011-12—2013-12我院收治的颈动脉粥样硬化患者62例为研究对象,采用单双号法分为2组,对照组采用阿司匹林治疗,观察组在对照组基础上采用普罗布考治疗,观察2组治疗前后血脂水平变化情况以及脑梗死的发生率。结果 2组治疗前TC、TG、HDL-C、LDL-C水平无显著差异(P0.05),治疗后观察组TC、TG、HDL-C均低于对照组,差异有统计学意义(P0.05)。观察组脑梗死发生率为3.23%,显著低于对照组的19.35%,差异有统计学意义(P0.05)。结论普罗布考联合阿司匹林治疗颈动脉粥样硬化,能够显著改善血脂异常状态,降低脑梗死的发生率。     

脑梗死合并2型糖尿病的发生与颈动脉粥样硬化的相关性

目的 探讨脑梗死合并2型糖尿病与颈动脉粥样硬化之间的关系. 方法 选择自2010年1月至2011年12月合肥市第二人民医院收治的脑梗死合并2型糖尿病患者132例(观察组),与同期单纯2型糖尿病患者150例(对照组)进行生化指标的对比分析,其中全自动生化分析仪检测2组患者C反应蛋白、高同型半胱氨酸、三酰甘油等,胆固醇氧化酶法测总胆固醇、高密度脂蛋白、低密度脂蛋白,免疫比浊法测纤维蛋白原,彩色多普勒超声检查颈动脉粥样硬化斑块的形成情况. 结果 观察组C反应蛋白、高同型半胱氨酸和低密度脂蛋白水平明显高于对照组,差异有统计学意义(P＜0.05).观察组高密度脂蛋白水平明显低于对照组,差异有统计学意义(P＜0.05).观察组颈动脉粥样硬化不稳定型斑块检出率(54.5％)明显高于对照组(21.3％),差异有统计学意义(P＜0.05). 结论 颈动脉粥样硬化与脑梗死合并2型糖尿病的发生有密切关系.     

脑梗死与血脂水平和颈动脉粥样硬化斑块的相关性及彩色多普勒超声的价值分析

目的分析脑梗死的发生与血脂、颈动脉粥样硬化斑块间的相关性。方法选取我院2014-06—12门诊收治的100例脑梗死患者为研究组,其中动脉粥样硬化斑块者76例,动脉粥样硬化未出现斑块者24例;另选取门诊同期健康体检者100例作为对照组。对2组动脉粥样硬化斑块和血脂水平进行检测。结果 2组TC、TG、LDL-C、HDL-C及Lp(a)水平比较,差异均有统计学意义(t=8.2211、21.5728、10.3020、8.4853、17.8318,P0.05);研究组中颈动脉硬化斑块与无斑块者在TC、TG、LDL-C、HDL-C及Lp(a)水平方面比较,差异均有统计学意义(t=2.4074、6.1549、4.7956、2.6626、37.8886,P0.05)。结论脑梗死与颈动脉硬化斑块关系密切,而血脂相关指标的升高是导致脑梗死和动脉硬化斑块的重要因素。临床应选择有效检测手段,及时采取治疗措施。     

急性脑卒中患者颈动脉粥样硬化与血压水平的相关性探讨

目的 观察急性脑卒中患者颈动脉粥样硬化与血压水平的相关性.方法 测定急性脑卒中患者和健康者的血压、血脂.结果 颈动脉硬化的急性脑卒中患者的收缩压、脉压、TC、LDL-C显著高于非颈动脉硬化的患者和健康者(P＜0.05).结论 颈动脉粥样硬化与血压和脂代谢相互影响,共同参与急性脑卒中的发生和发展.     

急性脑梗死患者血清纤维蛋白原、D-二聚体与颈动脉粥样硬化斑块的相关性研究

目的 探讨急性脑梗死患者血清纤维蛋白原、D-二聚体与颈动脉粥样硬化斑块的关系. 方法 选择解放军第三医院神经内科自2009年4月至2011年4月收治的120例急性脑梗死患者(脑梗死组)、同期单纯颈动脉粥样硬化而无脑梗死患者60例(颈动脉粥样硬化组)和健康体检者80例(正常对照组)作为研究对象,采用双抗体夹心法测定血清D-二聚体含量,全自动血凝仪测定纤维蛋白原含量,颈动脉彩色多普勒超声检测患者颈动脉粥样硬化斑块和颈动脉内一中膜厚度(IMT)值. 结果 脑梗死组、颈动脉粥样硬化组及正常对照组血清纤维蛋白原、D-二聚体水平及颈动脉IMT值依次降低,差异有统计学意义(P＜0.05);进展性卒中患者血清纤维蛋白原、D-二聚体水平高于非进展性卒中患者,差异有统计学意义(P＜0.05);随着动脉粥样硬化严重程度的升高,脑梗死患者血清纤维蛋白原及D-二聚体水平逐渐升高,差异有统计学意义(P＜0.05);脑梗死患者血清纤维蛋白原、D-二聚体水平均与颈动脉粥样硬化严重程度呈正相关关系(r=0.426,P=0.006; r=0.535,P=0.001). 结论 纤维蛋白原及D-二聚体参与了急性脑梗死的发生发展,与病情进展密切相关.二者做为急时相反应物参与动脉粥样硬化的发生机制提示,相对于高凝状态,动脉粥样硬化的形成与慢性炎症反应关系更为密切.     

短暂性脑缺血发作患者颈动脉粥样硬化斑块与血浆胆红素、尿酸的关系

目的 探讨短暂性脑缺血发作(TIA)患者颈动脉粥样硬化与血清胆红素和尿酸的关系.方法 对156例TIA患者行彩色多普勒超声检测观察颈动脉有无粥样硬化斑块,根据结果分成斑块组和无斑块组,比较两组间血清胆红素和尿酸水平的差异.结果 有斑块组血清总胆红素水平、间接胆红素水平均明显低于无斑块组(P＜0.001),有斑块组血尿酸水平显著高于无斑块组,差异有显著性(P＜0.05).Logistic多元回归分析发现,血清胆红素、尿酸均为TlA患者颈动脉粥样硬化的独立危险因素.结论 在TIA患者颈动脉粥样硬化的发生发展中,血清胆红素、尿酸起了非常重要的作用.     

代谢综合征对脑梗死患者颈动脉粥样硬化的影响

目的 研究代谢综合征(MS)对脑梗死患者颈动脉粥样硬化的影响.方法 对30例脑梗死合并MS、37例脑梗死合并高血压和21例单纯脑梗死患者进行颈动脉彩色多普勒超声检查.比较3组患者颈动脉斑块形成状况及其性质.结果 脑梗死合并MS组颈动脉粥样硬化斑块的检出率、斑块总数和不稳定斑块数均明显高于脑梗死合并高血压组和单纯脑梗死组(P＜0.05～0.01),稳定性斑块数明显高于单纯脑梗死组(P＜0.05);颈动脉内-中膜厚度(IMT)、斑块面积亦明显大于脑梗死合并高血压组和单纯脑梗死组(P＜0.05 ～0.01).脑梗死合并高血压组与单纯脑梗死组以上颈动脉粥样硬化斑块各项指标比较,差异均无统计学意义.结论 MS对脑梗死患者颈动脉粥样硬化的发生和病变程度有显著的影响,并且其影响甚至大于高血压.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.