三种药物联合治疗不同亚型急性脑梗死的效果及对纤维蛋白原水平的影响

目的探讨三种药物联合治疗不同病因亚型急性脑梗死的效果及对纤维蛋白原水平的影响。方法选取入院治疗的急性脑梗死患者96例为研究对象,按照急性卒中治疗低分子肝素实验进行疾病(TOAST)分型,予以拜阿司匹林、疏血通注射液、三七通舒胶囊治疗,采用美国国立卫生研究元卒中量表评分(NIHSS),观察纤维蛋白(Fbg)及血流动力学变化情况。结果治疗后5种亚型Fbg水平均呈下降趋势,LAA、SAO、CE治疗后Fbg水平为(3.81±0.52)g/L、(3.23±0.39)g/L、(3.52±0.51)g/L,均显著低于治疗前,差异具有统计学意义(P0.05);OC、UE治疗后与治疗前相比无明显差异(P0.05);治疗后NIHSS评分均呈明显下降趋势,其中LAA、CE、OC、UE治疗后NIHSS评分分别为(4.99±1.87)分、(7.16±1.53)分、(3.14±1.85)分、(2.44±0.73)分,与治疗前相比差异有统计学意义(P0.05);干预治疗后5种亚型全血切黏度、全血中切黏、全血高切黏度全血黏度水平均呈明显下降趋势,其中LAA、SAO治疗后明显改善,与治疗相比,差异有统计学意义(P0.05)。结论 Fbg与急性脑梗死亚型有关;予以拜阿司匹林、疏血通注射液、三七通舒胶囊联合治疗,可降低患者Fbg水平,改善预后。     

不同类型急性脑梗死患者血液流变学变化及三七通舒胶囊的干预效果

目的 观察不同亚型急性脑梗死(ACI)患者血液流变学各项指标的变化及三七通舒胶囊的干预作用.方法 对352例ACI患者进行血液流变学指标测定,并按照急性脑卒中低分子肝素试验(TOAST)病因分型标准分为5大亚型,分析TOAST各亚型血液流变学指标变化;患者口服三七通舒胶囊治疗28 d后,观察治疗前后血液流变学指标、美国卒中量表(N1HSS)评分变化.结果 本组TOAST各亚型构成比为:小动脉闭塞型42.89％,大动脉粥样硬化型17.05％,心源性栓塞型10.80％,其他明确病因型3.69％,不明原因型25.57％.大动脉粥样硬化型血液流变学指标水平最高,其次为小动脉闭塞型,而其他明确病因型最低.经三七通舒胶囊干预后,患者的血液流变学指标有不同程度降低、NIHSS均数高于干预前,差异有显著统计学意义(P＜0.05).结论 ACI患者血液流变学指标水平随TOAST亚型的不同而变化,三七通舒胶囊能降低ACI患者血液流变学、改善ACI患者的预后.     

脑梗死患者血清AST CK CK-MB LDH及Fbg水平与TOAST分型的关系

目的探讨脑梗死患者血清AST、CK、CK-MB、LDH及Fbg水平与TOAST分型的关系。方法分析2012-01—2014-01我院神经内科收治的125例脑梗死患者的临床资料。结果 LAA组、CE组、SAO组患者AST、CK、CK-MB、LDH水平均明显比OC组、UE组高(P0.05);5组患者补体C3水平差异均无统计学意义(P0.05),但LAA组、CE组、SAO组Fbg水平均明显比OC组、UE组高(P0.05)。结论脑梗死患者血清AST、CK、CK-MB、LDH及Fbg水平与TOAST分型关系密切。     

急性脑梗死合并2型糖尿病患者TOAST分型与尿酸、LDL-C的关系

目的探讨急性脑梗死合并2型糖尿病患者的TOAST分型与血尿酸(SUA)、低密度脂蛋白胆固醇(LDL-C)的相关性。方法选择收入我院神经内科发病72 h且合并2型糖尿病的急性脑梗死患者426例,并进行TOAST分型,抽取空腹静脉血检测血SUA、LDL-C值,并分析其与TOAST分型的相关性。结果 TOAST分型中,大动脉粥样硬化性卒中(LAA)所占比例最高(48.6%),小动脉卒中或腔隙性卒中(SAO)居第2位(31%),其次分别为心源性卒中(CE)(9.9%)、其他原因所致缺血性卒中(SOE)(5.6%)、不明原因的缺血性卒中(SUE)(4.9%);比较5种亚型SUA水平:LAA高于其他4类亚型(P0.01),其余亚型两两比较无差异(P0.05);LDL-C水平比较:LAA高于其他4种亚型(P0.05),SAO高于CE(P0.05),其余两两比较无差异;SUA(OR=1.26,95%CI 1.31~2.17)、LDL-C(OR=1.42,95%CI 1.32~1.96)是LAA的独立危险因素(P0.01)。结论急性脑梗死合并2型糖尿病患者中以LAA型最为多见,检测SUA、LDL-C值对进行病因分型具有重要临床意义。     

不同TOAST亚型的青年脑梗死患者预后的差别及影响因素

目的探讨不同TOAST亚型青年脑梗死患者预后差别和影响因素。方法对2012-01—2013-12我院收治的261例青年脑梗死患者(年龄≤45岁)的临床资料进行回顾性分析,按照TOAST标准进行病因分型,并根据随访记录,比较不同亚型患者复发率和病死率,找出不同TOAST亚型的预后影响因素。结果本组TOAST各亚型构成,心源性栓塞型(CE)40例(15.33%),大动脉粥样硬化型(LAA)90例(34.48%),小动脉闭塞型(SAO)47例(18.01%),其他明确病因型(ODC)32例(12.26%),不明原因型(UND)52例(19.92%);各亚型和病死率比较,差异有统计学意义(P0.05),CE病死率最高;各亚型复发率比较,差异无统计学意义(P0.05);血糖异常、吸烟、抗血小板凝聚治疗、NIHSS评分、饮酒、血脂异常是影响各亚型预后危险因素。结论不同TOAST亚型的青年脑梗死患者病死率有显著性差异,复发率差异不明显,预后影响因素各有特点,在临床诊断中应针对不同亚型有所侧重。     

青年与中老年脑梗死TOAST分型及危险因素的对照研究

目的 比较青年与中老年脑梗死TOAST分型及各亚型危险因素的异同点,为不同年龄脑梗死的防治提供依据.方法 对64例青年脑梗死及75例中老年脑梗死的TOAST分型及各亚型的危险因素进行回顾性分析.结果 青年组TOAST分型构成比从高到低依次为:LAA型43.8％(28/64)、OD型25.0％(16/64)、SAO型15.6％(10/64)、UD型12.5％(8/64)、CE型3.1％(2/64);而中老年组TOAST分型构成比以高到低依次为:LAA型44.0％(33/75)、SAO型30.7％(23/75)、UD型13.3％(10/75)、CE型8.0％(6/75)、OD型4.0％(3/75).青年组与中老年组小动脉闭塞型患者危险因素暴露率差异无统计学意义(P＞0.05);青年组与中老年组大动脉粥样硬化型患者糖尿病的暴露率差异有统计学意义(P＜0.05).青年组与中老年组UD型和OD型的危险因素差异明显.结论 青年与中老年脑梗死TOAST分型构成比不同,但本研究中均以LAA型为最常见类型.不同亚型暴露的危险因素有所不同,应针对不同亚型的特点采取相应的防治措施.     

神经肽Y启动子基因多态性与脑梗死TOAST亚型相关性研究

目的 针对脑梗死多因素致病特点,探讨神经肽Y(NPY)启动子基因多态性与脑梗死TOAST分型各亚型的关系. 方法 采用聚合酶链反应(PCR)和基因测序技术,检测549例脑梗死患者NPY启动子基因-399T/C、-883Tgins/del和-602G/T基因型及等位基因,其中大动脉粥样硬化型(LAA)190例,小动脉闭塞型(SAO)260例,心源性栓塞型(CE)60例,其他明确原因型(ODE)29例,原因不明型(UE)10例,并与423例汉族健康体检者对照.Logistic回归分析去除混杂因素影响,分析NPY启动子基因多态性与脑梗死TOAST分型各亚型的相关性. 结果 SAO亚型-399T/C突变基因型CC和等位基因C频率与对照组比较差异均有统计学意义(P=0.046,P=0.010);LAA亚型和SAO亚型高尿酸、高血压、心脏病和DM病史较对照组明显增高,比较差异有统计学意义(P＜0.05);SAO亚型-883Tgins/del缺失突变基因型DD、等位基因D频率与对照组比较差异无统计学意义(P=0.061,P=0.155);-399T/C、-883Tgins/del、-602G/T多态性与LAA亚型、CE亚型、ODE亚型和UE亚型患者均无相关性. 结论 NPY启动子基因-399T/C多态性可能与脑梗死SAO亚型发病存在相关性,高频率等位基因-399C个体可能是SAO亚型重要危险因素.没发现-399T/C、-883Tgins/del、-602G/T基因多态性与LAA亚型、CE亚型、ODE亚型和UE亚型患者有相关性.高尿酸、高血压、心脏病和糖尿病史是LAA亚型和SAO亚型危险因素.     

同型半胱氨酸、血尿酸水平与不同分型急性脑梗死的相关性研究

目的 探讨同型半胱氨酸、血尿酸水平与不同分型急性脑梗死的相关性.方法 对本院神经内科卒中注册登记的505例急性脑梗死患者,按照OCSP分型标准和TOAST分型标准进行分型,入院后检测血清同型半胱氨酸、血尿酸水平,分析不同分型脑梗死与两指标之间的的关系.结果 OCSP分型各亚型间同型半胱氨酸水平、血尿酸水平差异均不明显,TOAST分型中LAA亚型Hcy水平高于SAO、CE亚型,SAO、CE、SUE亚型Hcy水平高于SOD亚型,LAA亚型、SAO亚型UA水平高于CE亚型、SOD亚型,差异均明显.结论 急性脑梗死患者同型半胱氨酸水平、血尿酸水平对OCSP分型的提示作用有限,对TOAST分型有提示作用,两种分型相结合可以更好地指导急性脑梗死患者的治疗.     

急性脑梗死TOAST病因分型与血浆纤维蛋白原的相关研究

目的探讨急性脑梗死患者血浆纤维蛋白原(FIB)水平与脑梗死TOAST各亚型的关系。方法79例急性脑梗死患者按TOAST病因分型方法分类后,检测患者血浆纤维蛋白原浓度,比较病例组与对照组以及各亚型之间的血浆FIB水平。结果除其他原因引起的缺血性卒中(SOE)因例数少未作分析外,与对照组相比,脑梗死组各亚型中的FIB浓度增高均有显著意义;其中,FIB浓度在大动脉粥样硬化亚型(LAA)中的浓度最高,但与心源性亚型(CE)无明显差异,与腔隙性亚型(SAA)相比,两组均有显著意义。结论血浆FIB水平在脑梗死发生、发展过程中起重要作用,其中与LAA、CE型的发生关系更为密切。     

脑脉利颗粒治疗不同亚型急性脑梗死的临床疗效观察

目的研究脑脉利颗粒治疗不同类型急性脑梗死患者的临床效果及安全性。方法收集2019年6月-12月122例急性脑梗死住院患者,随机分为对照组56例,观察组66例。对照组按急性缺血性脑卒中诊治指南治疗,观察组在此基础上给予脑脉利颗粒治疗,两组均按TOAST分型标准进行分型。比较对照组及观察组不同亚型脑脉利颗粒治疗前后的NIHSS评分、Barthel指数评分以及不良反应。结果与对照组比较,观察组治疗后3 w的NIHSS评分降低,Barthel指数评分升高(P 0.05)。大动脉粥样硬化型(LAA)、小血管闭塞型(SAO)、其他明确原因型(OD)、不明原因型(UND)的NIHSS评分明显下降(P 0.05),Barthel指数评分明显升高(P 0.05),其中LAA改善最明显(P 0.05);而心源性栓塞型(CE)的评分改善在对照组和观察组的差异无统计学意义(P0.05)。结论脑脉利颗粒对急性脑梗死临床效果良好,能有效改善TOAST病因分型中LAA、SAO、OD、UND亚型的神经功能以及日常生活能力。     

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.