急性脑卒中与血清N末端B型利钠肽相关性的研究

目的 探讨急性脑卒中患者的血清N末端B型利钠肽 (NT-pro BNP)的变化,评价血清NT-pro BNP测定的临床意义.方法 74例患者分别为急性脑梗死 (CI) (42例)和急性脑出血 (ICH)组 (32例),根据入院时NIHSS评分分为轻度、中度和重度3个亚组,采用ECLIA法检测发病48 h内 (急性期)及发病第21天 (亚急性期)的血清NT-pro BNP水平,与健康对照组进行比较,比较急性期与亚急性期间、各亚组间的血清NT-pro BNP水平差异.结果 CI组和ICH组急性期血清NT-pro BNP显著高于对照组 (P<0.01),并在亚急性期显著下降(P<0.01);各亚组间急性期血清NT-pro BNP水平均有显著统计学差异 (P<0.01).结论 急性期脑卒中患者急性期血清NT-pro BNP水平与病情程度相关.     

体感诱发电位在急性脑卒中后的变化观察和意义探讨

目的观察急性脑卒中患者体感诱发电位（SEP）改变特点，评价其对于脑功能监测的价值。方法对58例脑梗死、27例脑出血和11例蛛网膜下腔出血患者，检测发病后不同时期（1～12d）SEP和血清神经元特异性烯醇化酶（NSE）改变，结合中国卒中量表评分（CSS）、Barthel指数、Glasgow-Pittsburgh昏迷量表评分以及颅脑影像学检查结果，分析与临床神经功能缺失的关系。25例年龄和性别匹配的正常人作为对照。结果发病后4d内各型脑卒中患者的SEP—P15、N20、P25和P40峰潜伏期较正常对照显著延长（P〈0．01）。脑出血和脑梗死患者发病后4d内SEP异常率高于发病后5～12d测定结果。发病后4d内，幕下脑出血和后循环脑梗死患者SEP—N20峰潜伏期与其病灶大小呈正相关（P〈0．01）。脑出血和脑梗死患者SEP—N20峰潜伏期与其血清NSE水平和CSS评分呈正相关（P〈0．01）。各型脑卒中患者SEP—N20峰潜伏期与其Glasgow-Pittsburgh昏迷量表评分呈负相关（P〈0．01）。结论SEP—N20峰潜伏期异常反映脑出血和脑梗死患者脑损伤和神经功能缺失严重程度，并可作为评估蛛网膜下腔出血患者昏迷程度的指标。     

脑梗死患者血清可溶性血管黏附蛋白-1及C-反应蛋白水平的变化

目的 探讨脑梗死(CI)患者血清可溶性血管黏附蛋白(sVAP)-1及C-反应蛋白(CRP)水平的变化.方法 分别检测CI急性期患者(CI急性期组,20例)及恢复期患者(CI恢复期组,21例)血清sVAP-1、CRP水平,并与健康对照组(21人)比较.结果 CI急性期组血清sVAP-1、CRP水平显著高于CI恢复期组及健康对照组(P<0.05～0.01);CI恢复期组血清CRP水平显著高于健康对照组(P<0.01);血清sVAP-1水平在两CI组间差异无统计学意义.CI急性期组血清sVAP-1与CRP水平呈正相关(r=0.841,P<0.001).结论 血清sVAP-1及CRP水平的变化可能与CI发生和发展有关.     

急性脑卒中患者血清白蛋白水平与近期预后的关系

目的 探讨急性脑卒中患者血清白蛋白(Alb)水平与近期预后的关系.方法 对242例急性脑卒中患者入院时和住院期间每2周检测血清Alb 1次,比较低Alb组(Alb<35 g/L)和正常Alb组(Alb≥35 g/L)脑卒中并发症的发生率、死亡率以及好转率.结果 242例患者中入院时低Alb 38例(15.7%),住院期间出现低Alb 105例(46.5%).与入院时正常Alb组比较,入院时低Alb组的死亡率、卒中后并发症的发生率明显增高,出院时病情好转率明显下降(P<0.05～0.01);与病程中正常Alb组比较,住院期间低Alb组的死亡率、并发症的发生率明显升高,出院时病情好转率明显降低(P<0.05～0.01).入院时Alb水平与死亡率呈负相关,与美国国立卫生研究院卒中量表(NIHSS)评分差值正相关(r=-0.297,r=0.282;均P<0.01).住院期间Alb水平与肺部感染发生率、死亡率呈负相关(r=-0.545,r=-0.336),与NIHSS评分差值呈正相关(r=0.274;均P<0.01).Logistic回归分析显示,排除年龄、病情因素后,急性脑卒中患者入院时及住院期间血清Alb水平对近期预后影响显著. 结论血清Alb水平是影响急性脑卒中患者近期预后的因素.     

S-100b蛋白、神经元特异性烯醇化酶与进展性卒中的关系

目的探讨血清S-100b蛋白、神经元特异性烯醇化酶与进展性缺血性脑卒中的关系。方法应用ELISA法检测150例急性脑梗死患者入院72h内S-100b蛋白及NSE的水平变化,并根据美国国立卫生院卒中量表判断是否为进展性卒中。同时进行神经功能缺损评分(NIHSS评分)、改良神经功能评分(mRS评分)及颅脑MRI/MRA扫描。结果 150例急性脑梗死患者中有30例(20%)于入院后3d内发展为进展性脑卒中,进展组患者入院后24h、36h、48h、72h血清S-100b蛋白、NSE明显高于无进展组(P0.01)。急性脑梗死患者S-100b蛋白、NSE与NIHSS评分、mRS评分及脑梗死体积呈正相关(r=0.65～0.75,P0.01;r=0.59～0.69,P0.01),颈内动脉颅内段、大脑中动脉M1段闭塞/狭窄的患者血清S-100b蛋白、NSE的水平较无血管闭塞组明显增高(P0.05)。结论急性脑梗死患者血清S-100b蛋白及NSE水平可能是进展性脑卒中的有效预测指标,且S-100b蛋白及NSE水平与颅内动脉狭窄、神经功能评分以及脑梗死体积密切相关。     

脑卒中患者急性期血糖水平与病情严重程度的关系

目的探讨脑卒中患者急性期血糖水平与病情严重程度的关系。方法采用前瞻性队列研究的方法检测2005-02～2008-02所有入院病程<24h的340例脑卒中患者(其中出血性卒中153例,缺血性卒中187例)的空腹血糖水平。采用斯勘的纳维亚卒中评分(SSS)量表评价患者入院时神经功能缺损程度。按卒中类型和空腹血糖水平分组,比较各组间指标差异。结果出血性卒中组空腹血糖水平及SSS评分高于缺血性卒中组(P<0.05);血糖升高组SSS评分高于正常血糖组(P<0.01)。结论急性脑卒中患者血糖越高,病情越重,其中出血性卒中更显著。对急性脑卒中患者检测血糖有利于病情的判断。     

脑梗死后认知障碍与血清视锥蛋白样蛋白-1水平及神经功能缺损关系的研究

目的探讨脑梗死后认知障碍与血清视锥蛋白样蛋白-1(VILIP-1)水平及神经功能缺损的相关性。方法收集120例急性脑梗死患者,根据蒙特利尔认知评估量表(Mo CA)测评结果分为认知障碍组和认知正常组,比较两组患者入院时和发病1年时血清VILIP-1水平、美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)评分,分析Mo CA分值与血清VILIP-1水平、NIHSS评分和BI评分的相关性。结果两组患者发病1年时NIHSS评分均低于入院时(P0.01);BI评分均高于入院时(P0.01)。认知障碍组入院时及发病1年时血清VILIP-1水平高于认知正常组(P0.01);NIHSS评分高于认知正常组(P0.01);BI评分低于认知正常组(P0.01)。入院时及发病1年时所有患者Mo CA分值与血清VILIP-1水平呈负相关(r=-0.736,P=0.000;r=-0.450,P=0.000);与NIHSS评分呈负相关(r=-0.575,P=0.000;r=-0.377,P=0.001);与BI评分呈正相关(r=0.431,P=0.000;r=0.483,P=0.000)。结论脑梗死后认知障碍与血清VILIP-1水平及神经功能的康复有重要相关性。     

血清S-100β神经元特异性烯醇化酶水平与脑卒中患者神经功能损害程度的相关性研究

目的探讨血清S-100β、神经元特异性烯醇化酶(NSE)与脑卒中患者神经功能损害程度的相关性。方法选取2017-02—2020-02开封市人民医院治疗的115例急性缺血性脑卒中患者为观察组,同时选取健康志愿者50例为对照组,检测2组血清S-100β、NSE水平。结果观察组血清S-100β、NSE水平明显高于对照组(P<0.05);观察组中大面积梗死患者S-100β、NSE水平高于腔隙性梗死和小面积梗死患者(P<0.05);观察组美国国立卫生研究院卒中量表(NIHSS)评分≥31分患者血清S-100β、NSE水平高于NIHSS评分16~30分和≤15分患者(P<0.05);血清S-100β、NSE水平与梗死面积呈正相关(P<0.05),与NIHSS评分亦呈正相关(P<0.05)。结论急性缺血性脑卒中患者血清S-100β、NSE水平升高,与梗死面积、神经功能损害程度存在正相关关系。     

微创血肿清除术对脑出血患者血清NSE水平的影响

目的 探讨微创血肿清除术对脑出血患者血清神经元特异性烯醇化酶(NSE)水平的影响.方法 住院脑出血患者80例,随机分为微创手术组38例和保守治疗组42例.在入院当时及2,4,7,14d各留取血液标本1次,测定血清中神经元特异性烯醇化酶(NSE)的水平.在入院时和7、14、21d进行欧洲卒中量表(ESS)和日常生活能力(ADL)评分.结果 脑出血患者入院时血清NSE含量即有升高,微创组与保守组NSE水平均在2d达到高峰,4、7、14d时微创组NSE水平低于保守组(P<0.05),微创组神经功能缺损和生活能力神经功能缺损和生活能力评分明显高于保守组(P<0.05).结论 微创穿刺血肿清除术能降低ICH患者血清NSE水平,减轻神经损伤,促进神经功能恢复.     

男性卒中后焦虑/抑郁症患者血清性激素水平变化研究

目的 探讨男性性激素水平(雌二醇、睾酮、孕酮)与卒中后焦虑、抑郁症的关系.方法 检测和比较30例男性卒中后焦虑、抑郁症患者和30例非卒中后焦虑、抑郁症患者的血清雌二醇、睾酮、孕酮的水平,并应用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)对卒中后焦虑、抑郁症患者进行临床评分,同时作相关分析.结果 男性卒中后焦虑、抑郁症患者血清雌二醇水平均显著低于对照组(P<0.05),雌二醇水平与HAMA分和HAMD分呈负相关(r=-0.540,P<0.05;r=-0.503,P<0.05).睾酮水平显著低于对照组(P<0.05),睾酮水平与HAMA分和HAMD分呈负相关(r=-0.535,P<0.05;r=-0.602,P<0.05).两组的孕酮水平无显著变化(P>0.05).结论 卒中后焦虑、抑郁症存在明显的性激素水平的紊乱,与脑卒中的发病发展有着密切的关系.血清雌二醇、睾酮可能成为卒中后焦虑、抑郁症的生物学标记.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

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     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.