高血压对缺血性卒中 TOAST 各亚型复发风险的影响

目的：高血压与缺血性卒中复发之间的关系尚未有定论,但其对缺血性卒中各亚型复发的影响可能存在差异。本文旨在探讨高血压与缺血性卒中各亚型复发风险的关系。方法采用前瞻性队列研究的方法,选取2008年7月至2012年12月在南京卒中注册系统注册的患者,最终纳入缺血性卒中患者1114例。按照急性卒中Orgl 10172治疗试验（ Trial of Org 10172 in Acute Stroke Treatment, TOAST）分型对其进行分型,其中大动脉粥样硬化型（large-artery atheroselerosis, LAA）315例（28．3％）、心源性栓塞型（cardioembolism, CE）212例（19．0％）、小动脉闭塞型（small-artery occlusion, SAO）266例（23．9％）、不明原因及其他病因型（other determined and undetermined etiologies , Other）321例（28．8％）。利用多因素Cox回归分析高血压对缺血性卒中各亚型复发风险的影响。结果入组患者平均随访（19．4±10．3）个月,158例（14．2％）患者在随访期内出现卒中复发。高血压患者卒中复发率高于非高血压患者（16．5％vs 10．5％,P＜0．05）。多因素Cox回归分析结果显示,高血压是缺血性卒中复发的独立危险因素（HR＝1．722,95％CI：1．181～2．512,P＝0．005）。 TOAST分型中,高血压可增加LAA亚型（HR＝3．767,95％CI：1．866～7．585,P＝0．001）和SAO亚型（HR＝3．838,95％CI：1．156～12．740,P＝0．028）卒中的复发风险,对CE亚型和Other亚型复发影响不显著（CE亚型：HR＝0．773,95％CI：0．370～1．615,P＝0．493;Other亚型：HR＝1．498,95％CI：0．590～3．807,P＝0．395）。结论高血压是缺血性卒中复发的独立危险因素,有增加LAA亚型和SAO亚型卒中复发的风险。     

青年缺血性脑卒中类肝素药物治疗急性缺血性脑卒中试验分型与中国缺血性卒中亚型分型比较

目的比较类肝素药物治疗急性缺血性脑卒中试验(TOAST)分型和中国缺血性卒中亚型(CISS)分型在青年缺血性脑卒中患者中的应用价值。方法选取2014年3月至2016年6月新乡医学院第三附属医院收治的首发青年缺血性脑卒中患者148例,根据患者的临床症状、影像学特点及相关辅助检查结果,分别由2位神经内科医师进行TOAST分型和CISS分型,并对2种分型方法的结果进行比较。结果 148例患者的TOAST分型病因学亚型依次为:大动脉粥样硬化型(LAA)58例(39.19%)、小动脉闭塞型(SAA)53例(35.81%)、其他明确病因型(SOE)18例(12.16%)、原因不明的卒中(SUE)11例(7.43%)、心源性栓塞型(CE)8例(5.41%);CISS分型病因学亚型依次为:LAA75例(50.68%)、穿支动脉疾病型(PAD)35例(23.65%)、其他明确病因型(OE)29例(19.60%)、心源性卒中型(CS)6例(4.05%)、原因不明的卒中(UE)3例(2.03%)。CISS分型中LAA比例显著高于TOAST分型中LAA的比例,TOAST分型中SAA和SUE比例显著高于CISS分型中PAD和UE比例,差异均有统计学意义(P<0.05)。CISS分型中CS和OE比例与TOAST分型中CE和SOE比例比较差异无统计学意义(P>0.05)。结论大动脉粥样硬化是青年缺血性卒中的重要原因;相对于TOAST分型,CISS分型在指导对青年缺血性脑卒中的临床诊断与治疗更具有优势。     

缺血性脑卒中TOAST分型及其复发率和危险因素分析

目的探讨缺血性脑卒中患者类肝素药物治疗急性缺血性脑卒中试验（TOAST）病因分型各亚型的构成、危险因素及与复发的关系。方法采用前瞻性队列研究方法,对2006年10月1日至2007年9月30日本院首发急性缺血性脑卒中患者441例的临床资料,按照TOAST标准进行病因分型,随访1年,记录终点事件。结果TOAST分型各亚型构成为不明病因型（SUE）42．3％、小动脉闭塞型（SAO）30．9％、大动脉粥样硬化型（LAA）17．3％、心源性栓塞型（CE）9．3％、其他明确病因型（SOE）0．2％;各亚型分布在性别、年龄上差异有统计学意义;缺血性脑卒中各亚型1年复发率分别为CE33．3％、SUE14．6％、LAA 13．7％、SAO6．9％;各亚型在吸烟史、高血压、糖尿病、心脏病、总胆固醇、低密度脂蛋白、纤维蛋白原、血糖等方面差异有统计学意义。结论TOAST分型各亚型间的复发率及危险因素不尽相同,可以为缺血性脑卒中二级预防提供参考依据。     

青年缺血性脑卒中患者病因TOAST分型与住院费用分析

目的:了解青年缺血性脑卒中患者67例TOAST分型的住院成本及各型住院成本差别.方法:回顾性分析青年(15～45岁)缺血性脑卒中患者的临床资料,排除手术治疗及并发晚期肿瘤等重大疾病,按照TOAST标准进行病因分型,统计各型住院费用,分析其构成比.结果:①心源性栓塞型(CE)占20.9％;②大动脉粥样硬化型(LAA)14.9％;③小动脉闭塞型(SAO)23.9％;④其他明确病因型11.9％;⑤不明原因型(UND)28.4％,各型比例中CE较SAO及UND住院总费用高,表现在治疗费用、药费及检查化验费等,其住院天数也较LAA长,且CE在功能康复上费用也较其他4型高.结论:通过病因TOAST分型可为不同型青年急性缺血性脑卒中患者住院成本评估提供参考,并在各亚型诊治上有所侧重.     

急性脑梗死TOAST病因分型及血清炎性标志物测定的临床意义

目的探讨急性脑梗死患者血清炎性标志物水平与颈动脉硬化及脑梗死各亚型的关系。方法检测168例急性脑梗死患者血清高敏c反应蛋白（hsCRP）、金属基质蛋白酶9（MMP9）、白介素6（IL-6）浓度，检查颈动脉彩超，并和对照组进行比较分析；对脑梗死组按TOAST病因分型方法分类后。各亚型与对照组进行比较。结果脑梗死组患者血清hsCRP、MMP9、IL-6水平均明显高于对照组，颈动脉彩超提示的软斑数也明显多于对照组。亚组比较中，除其他原因引起的缺血性卒中（SOE）因例数少未作分析，其他各型均存在多项血清炎性标志物水平异常，其中大动脉粥样硬化性卒中（LAA）及小动脉卒中／腔隙性脑梗死（SAA）三项指标均明显高于对照组，以LAA组增高最显著。结论炎症及炎性血清标志物在脑梗死发生、发展过程中起重要作用，它与LAA、SAA型的发生关系更为密切。     

尤瑞克林治疗急性脑梗死三种TOAST分型效果观察

目的:观察尤瑞克林治疗急性脑梗死三种TOAST分型的效果。方法:选取150例急性脑梗死患者,在对症治疗的基础上给予尤瑞克林治疗,比较治疗前后急性脑梗死三种TOAST分型患者神经功能、临床疗效及并发症发生情况。结果:治疗后三组亚型的NIHSS评分均较治疗前明显改善,且CE型改善幅度最大,LAA型次之,差异均有统计学意义(P<0.05);LAA型的治疗有效率为90.57%(48/53),明显高于SAA型的65.31%(32/49)和CE型的83.33%(40/48),且CE型明显高于SAA型,差异均有统计学意义(P<0.05);三组亚型患者的不良反应发生率比较,差异无统计学意义(P>0.05)。结论:尤瑞克林治疗急性脑梗死三种TOAST分型患者的有效率从高到低依次为LAA型、CE型和SAA型。     

脑梗死TOAST分型与同型半胱氨酸和血尿酸水平关系的研究

目的:探讨不同TOAST分型的脑梗死与同型半胱氨酸(Hcy)、血尿酸(UA)水平之间的关系。方法:选取本院急性脑梗死患者121例,按TOAST分型方法进行分型,另选取50例同期门诊健康体检者为对照组,测定每组患者Hcy、UA水平并进行对比。结果:(1)脑梗死组Hcy、UA水平均高于对照组(P0.01);(2)Hcy水平对比为:LAA型高于其他4个亚型及对照组(P0.01),SAA型高于SOE型(P0.05),其余亚型两两对比无差异(P0.05);CE型、SAA型、SUE型高于对照组(P0.05),SOE型与对照组比较无差异(P0.05);(3)UA水平对比为:LAA型高于CE型、SAA型、SUE型及对照组(P0.05),SAA型高于对照组(P0.01),CE型、SOE型、SUE型与对照组比较无差异(P0.05)。结论:Hcy、UA水平与脑梗死发病密切相关,其中对于LAA亚型脑梗死患者发病有更为重要的临床意义。     

尤瑞克林在不同TOAST分型急性脑梗死临床治疗中应用观察

目的:观察尤瑞克林在不同TOAST分型急性脑梗死的临床疗效。方法:按TOAST病因分型,将70例急性脑梗死患者随机分为大动脉粥样硬化性卒中(LAA)组、心源性脑栓塞(CE)组、小动脉闭塞性卒中或腔隙性卒中(SAA)组,三组均给予抗血小板聚集、一般营养脑神经细胞药物、降压和控制血糖等常规治疗,同时应用尤瑞克林治疗。观察三组治疗前,治疗后第7天和第14天的神经功能缺损程度,并进行神经功能缺损评分(NIHSS)。结果:组内比较,治疗7d和14d后,三组的NIHSS评分均较治疗前明显降低,差异有统计学意义;组间比较,治疗后,SAA组NIHSS评分明显低于LAA组和CE组,差异有统计学意义。结论:尤瑞克林可以显著改善缺血性脑卒中患者的神经功能缺损症状,对小动脉闭塞性卒中或腔隙性卒中(SAA)疗效更显著。     

脑梗死血清髓鞘碱性蛋白水平与TOAST分型相关性

目的观察不同类型急性脑梗死(ACI)患者血清髓鞘碱性蛋白(MBP)水平变化及其与预后的关系。方法采用ELISA法检测384例连续收住入院、发病在3 d内的ACI患者血清MBP水平,并按照急性卒中治疗低分子肝素试验(TOAST)分型标准分为5大亚型,分析TOAST各亚型MBP水平变化及其与改良Rankin评分(mRS)的相关性。结果TOAST各亚型构成比依次为大动脉粥样硬化型(LAA)35.16%、小动脉闭塞型(SAO)21.09%、心源性栓塞型(CE)17.19%、其他明确病因型(SDE)16.41%、不明原因型(SUE)10.15%。CE、LAA、SUE亚型MBP水平较对照组升高、SAO亚型变化不明显。与对照组比较,LAA、CE亚型MBP水平差异具有统计学意义(P<0.01)。LAA、CE预后不良率高,SAO、SUE预后良好率高。结论 MBP随TOAST亚型不同而异,发病后血清MBP可以作为急性脑梗死患者预后判断的指标之一。     

急性期脑梗死患者血浆同型半胱氨酸水平与TOAST分型关系的研究

目的观察不同病因类型脑梗死患者急性期血浆同型半胱氨酸水平,探讨其与TOAST分型的关系。方法测定在我院神经内科住院的发病48h内的117例脑梗死患者及40例健康对照者血浆同型半胱氨酸水平,按TOAST分型将脑梗死患者分为心源性脑梗死（CE）组、大动脉粥样硬化性脑梗死（LAA）组、小动脉闭塞性脑梗死（SAO）组、其他病因明确性脑梗死（OC）组、不明病因性脑梗死（UND）组,并进行统计学分析。结果LAA及SAO组同型半胱氨酸水平明显高于对照组,其余各组同型半胱氨酸水平与对照组差异无统计学意义。结论同型半胱氨酸水平增高可能是LAA、SAO亚型脑梗死的危险因素,且同型半胱氨酸水平对TOAST分型的提示具有一定的临床意义。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.