吸烟与脑动脉瘤出血的关系

吸烟可增加动脉瘤破裂和蛛网膜下腔出血（ＳＡＨ）的危险性。大量资料表明,ＳＡＨ在吸烟者中的相对危险度为１．９（１．５～２．３）,ＳＡＨ的发生机率为３．３（２．９～４．３）。吸烟还可合动脉瘤破裂出血的时间提前,女性提前７～１０年,男性提前２～６年。吸烟也可合在后血管痉挛发生率升高（发生机率为４．７）,相对危险度为１．２。     

未破裂颅内动脉瘤的诊治进展

颅内动脉瘤是脑血管病中死亡率最高的疾病 ,未破裂颅内动脉瘤是其中的重要组成部分 ,有极大的危害性。文章介绍了该病的自然史、诊断、治疗及预后     

破裂颅内动脉瘤的外科处理进展

近年来显微外科技术和麻醉技术的发展，使得神经外科医师能够得心应手地处理颅内破裂动脉瘤；如何选择动脉瘤的手术时机问题，经过国际合作研究已逐渐明朗化，目前更加重视采用早期手术。文章分别介绍了上述两个方面的进展。     

吸烟与脑动脉瘤出血的关系

吸烟可增加动脉瘤破裂和蛛网膜下腔出血(SAH)的危险性。大量资料表明,SAH在吸烟者中的相对危险度为19(15～23),SAH的发生机率为33(29～43)。吸烟还可使动脉瘤破裂出血的时间提前,女性提前7～10年,男性提前2～6年。吸烟也可使出血后血管痉挛发生率升高(发生机率为47),相对危险度为12。     

未破裂颅内动脉瘤的治疗

未破裂颅内动脉瘤包括偶然发现的动脉瘤、多发性颅内动脉瘤中的未破裂动脉瘤以及有临床症状但未出血的动脉瘤。该类动脉瘤虽未破裂，但都存在破裂出血的风险。破裂风险因动脉瘤的大小、位置和患者自身情况的不同而存在差异，应通过综合评价各种危险因素来确定个性化治疗方案。     

动脉瘤破裂与脑脊液引流的关系

颅内动脉瘤破裂所致的蛛网膜下腔出血（ＳＡＨ）是导致死亡和残废的重要原因，对ＳＡＨ的患者进行单纯脑室脑脊液（ＣＳＦ）持续引流或分流，可能因降低了颅内压（ＩＣＰ）升高了动脉瘤的穿膜压力，而使动脉瘤再破裂的危险性明显增加，尤其是在脑积水的病人中。对ＳＡＨ的患者进行早期手术畏以脑池或脑室ＣＳＦ持续引流，其脑积水的发生率比非引流者高，有显著的统计学意义。     

改良Fisher分级与破裂动脉瘤患者症状性脑血管痉挛的关系

目的分析破裂出血动脉瘤患者改良Fisher分级与术后症状性脑血管痉挛发生的关系。方法按改良Fisher分级评价动脉瘤破裂出血患者216例。症状性血管痉挛的诊断根据迟发性神经功能损害并经颅多普勒检查证实。结果 216例患者中共发生症状性血管痉挛79例(36.6%),按照改良Fisher分级评价,术前不同级别的患者术后症状性脑血管痉挛发生率比较,差异有统计学意义。结论症状性脑血管痉挛的发生率与蛛网膜下腔出血量有显著的相关关系。     

高血压、年龄和部位可预测颅内小动脉瘤破裂

尽管目前关于未破裂颅内动脉瘤的治疗指南认为〉7mm的动脉瘤才应考虑治疗，但仍然有相当一部分蛛网膜下腔出血（subarachnoid hemorrhage，SAH）是≤7mm的动脉瘤破裂所致。因此，耶鲁大学医学院神经外科的Nahed等进行了一项回顾性病例对照研究，以确定与≤7mm颅内动脉瘤破裂有关的危险因素。其结果刊登在最近出版的Neurosurgery。     

脑动脉瘤破裂后蛛网膜下腔出血引起脑血管痉挛的处理

脑动脉破裂后蛛网膜下因引起脑血管痉挛的致死放致残率均较高。治疗脑血管痉挛的几种方法：血管内球囊扩张术、动脉内灌注罂栗碱、脑池内血块清除及池内注入ｔ－ＰＡ等是近１０年来的新发展。     

The relationship between age and fever magnitude

BACKGROUND: Infections are an important cause of morbidity and mortality in older people; however, they are often difficult to diagnose because the signs and symptoms of infection in older people are frequently atypical. Fever, one of the most important signs of infection, is a case in point. Preliminary evidence suggests that the febrile response in older persons is blunted, leading to the clinical maxim, "the older, the colder." The objective of this study was to assess the effect of age on the febrile response to moderate-to-severe pneumonia in hospitalized patients adjusted for the effect of anatomic site at which the temperature was measured. METHODS: This is a retrospective cohort study of 320 hospitalized patients with moderate-to-severe pneumonia. The study was designed to assess the effect of age on the febrile response to moderate-to-severe pneumonia in hospitalized patients, adjusting for the effect of the anatomic location of the temperature measurement. The highest temperature of each day and the anatomic sites at which temperatures were taken (axillary, oral, rectal, or other) on days 1 and 2 of infection and at hospital discharge. Baseline demographic information, including age, were obtained for each patient. RESULTS: There were 320 patients (median age, 64 years; range, 18-97 years). Using a linear regression model, significant inverse correlations were found between age and the temperature for patients on the first and second days of hospitalization (P < 0.001). For each decade increase in age, the average temperature on the first 3 days of infection was lower by 0.15 degrees C. Temperature at discharge, a surrogate for baseline temperature, also decreased at an equal rate with age. CONCLUSION: In this study, the febrile response to infections was reduced with increasing age and baseline temperatures were generally lower in older patients.     

The relationship between atrial septal aneurysm and autonomic dysfunction

BACKGROUND:

Systemic thromboembolism is a serious, major complication in patients with an atrial septal aneurysm (ASA). Atrial dysfunction resulting from paroxysmal atrial fibrillation is more common in patients with ASA than in the general population. The autonomic nervous system plays an important role in the initiation of atrial fibrillation.

OBJECTIVE:

To investigate autonomic function and its impact on ventricular and atrial arrhythmia in a group of ASA patients compared with a control group of healthy volunteers.

METHODS:

The study group consisted of 40 patients with ASA; the control group consisted of 30 age-, sex- and body mass index-matched healthy volunteers. All patients and control subjects underwent echocardiographic examination. Autonomic function was assessed by determining heart rate variability (HRV) indexes.

RESULTS:

HRV time and frequency domain indexes were lower in patients with ASA compared with healthy controls (188±32 ms² and 323±42 ms² for low-frequency HRV; 195±39 ms² and 377±43 ms² for high-frequency HRV; P<0.001 for all). Statistically significant differences with respect to other HRV indexes were also found between the two groups.

CONCLUSION:

ASA appears to be associated with cardiac autonomic dysfunction; however, the mechanisms of this association are not known in detail.     

The situational relationship between age and the fear of crime

It is commonly accepted that there is a positive relationship between age and the fear of crime, although there is some indication that this may not hold under all conditions. Most studies concerning fear of crime have been based upon questions involving fear of walking alone within one's neighborhood. This study examined fear of crime both in the relative danger of walking in the neighborhood and in the safety of one's home. Age was found to be positively associated with fear of crime in the former situation, but slightly negatively associated in the latter. It was suggested that the aged may only be more fearful of crime in particularly dangerous situations, and that there is a need for fear of crime measures with greater content validity.     

颈动脉粥样硬化与脑梗死复发的关系研究

目的探讨颈动脉粥样硬化与脑梗死复发的关系。方法采用彩色多普勒超声对278例脑梗死患者的颈动脉进行检测,并随访18个月,脑梗死复发64例(复发组),脑梗死无复发214例(无复发组),比较2组患者颈动脉粥样硬化的特征。结果复发组患者高血压、高胆固醇血症、糖尿病明显高于无复发组(P0.05,P0.01)。颈动脉中、重度狭窄及闭塞患者脑梗死复发率明显高于无颈动脉粥样硬化改变及颈动脉轻度狭窄患者(P0.05)。软斑患者脑梗死复发率明显高于无斑块及硬斑患者(P0.05)。结论颈动脉粥样硬化与脑梗死的复发密切相关,颈动脉粥样硬化的严重程度是脑梗死复发的危险因素,可作为脑梗死复发的预测指标。     

The relationship between age and adjustment of patients new to dialysis

Dialysis patients and their families experience many stresses. This study examines the effect of older age on psychosocial adaptation to dialysis. It was hypothesized that patients 60 years and older would have more difficulty adjusting to dialysis. Subjects on dialysis ≦ 6 months were administered the Psychosocial Adjustment to Illness Scale (PAIS) and the family Environment Scale (FES) which measure aspects of psychosocial adjustment. Twenty-two patients (41.5%) were ≧ 60 years of age and 31 (58.5%) were <60 years. The only difference between the older and younger patients on the PAIS was that the older subjects demonstrated less psychological distress (a positive adjustment). On the FES, older patients reported less conflict and less control (positive adjustments) but less achievement orientation and less active recreational orientation (negative adjustments). Unmarried younger subjects were the most independent (a positive adjustment). The results of this study indicate that the psychosocial adjustment of older patients new to dialysis is no worse than the adjustment of younger patients and in fact may be better.     

载脂蛋白E基因多态性与脑梗死的关系

目的探讨载脂蛋白E（apoE）基因多态性与中国东北汉族人脑梗死的关系.方法选择中国东北汉族人140例,其中72例为脑梗死患者（脑梗死组）,68例为健康体格检查者和因肛肠疾病住院的患者（对照组）.采用聚合酶链反应-限制性片段长度多态性（PCR-RFLP）技术,检测所有患者apoE基因多态性;一步法测定70例脑梗死患者的血脂含量.结果对照组和脑梗死组apoE基因型均以ε3ε3多见,分别为67.6%、72.2%（P＞0.05）.未见ε4ε4.两组ε2ε2、ε2ε3、ε2ε4、ε3ε4基因型频率（对照组为2.9%、13.2%、0%和16.2%,脑梗死组为2.8%、15.3%、2.8%和6.9%）和等位基因ε2、ε3、ε4频率（对照组为9.6%、82.4%和8.1%,脑梗死组为11.8%、83.3%和4.9%）,差异无显著性,P＞0.05.各基因型脑梗死患者血浆总胆固醇、三酰甘油、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）含量无显著差异（P＞0.05）.结论在中国东北汉族人中,未发现apoE基因多态性与脑梗死相关,亦未发现apoE基因多态性与脑梗死患者血浆总胆固醇、三酰甘油、HDL-C和LDL-C之间相关.     

白细胞介素10基因多态性与脑梗死的关系

目的探讨白细胞介素10（IL-10）基因多态性与脑梗死的关系。方法用聚合酶链反应一限制性片段长度多态性技术，对204例脑梗死患者（脑梗死组）和131名健康者（对照组）的IL-10-592C／A、IL-10-819C／T及IL-10．1082G／A，共3个位点的基因多态性进行分析。结果脑梗死组IL-10—1082G／A基因型的分布频率与对照组比较，差异有统计学意义（X^2=11．764，P=0．001）；IL-10-1082A等位基因频率为99．5％，对照组为95．8％，两组比较差异有统计学意义（P=0．001）；IL-10-592C／A和IL-10-819C／T的基因型分布频率及等位基因频率与对照组比较差异无统计学意义（P〉0．05）。结论IL-10—1082G／A基因多态性与脑梗死的发病有一定关系，其中A等位基因频率增高与脑梗死发病有关。     

冠状动脉粥样硬化狭窄与脑动脉粥样硬化狭窄的关系

目的探讨颈动脉和（或）脑动脉粥样硬化狭窄与冠状动脉狭窄的关系。方法选择34例心内科住院伴有脑缺血症状、接受冠状动脉造影并颈动脉造影或全脑血管造影的患者。根据造影动脉管腔狭窄的程度分别分成三个亚组,冠状动脉狭窄分为轻度狭窄组（5例）、中度狭窄组（4例）、重度狭窄组（25例）;脑血管狭窄分为轻度狭窄组（6例）、中度狭窄组（4例）、重度狭窄组（24例）。结果冠状动脉狭窄与颈动脉或椎动脉狭窄程度分布一致,冠状动脉血管重度狭窄者25例,脑血管重度狭窄者24例,二者间差异无统计学意义;冠状动脉Califf危险记分≥2分者,脑血管中、重度狭窄的比例高达92％,且随着冠状动脉狭窄程度的加重,颈动脉及脑血管狭窄的程度亦加重。随访发现中重度双重狭窄（冠状动脉狭窄同时伴有脑动脉狭窄）病变的心脑事件发生明显增多,其中双重度狭窄死亡3例。结论颈动脉或椎动脉粥样硬化性狭窄的发生率及程度与冠状动脉狭窄是平行的。故对冠状动脉狭窄合并颈动脉和（或）椎动脉粥样硬化狭窄者,尤其伴有高血压、糖尿病、吸烟等多重危险因素时,应给予积极强化的联合治疗以减少心脑血管事件的发生。