心源性栓塞的药物治疗

根据流行病学资料,缺血性卒中约20%为心源性,其中近50%为非瓣膜病性房颤,1/4为瓣膜性心脏病,左室附壁血栓约占1/3.本文就美国心脏协会(American Heart Association,AHA)/美国卒中协会(American Stroke Association,ASA)2011版缺血性卒中/短暂性脑缺血发作(Transient Ischemic Attack,TIA)二级预防指南(ASA2011二级预防指南)中关于心源性脑栓塞预防相关问题进行解读[1].     

偏头痛遗传学研究进展

根据2004年国际头痛协会(International Headache Society,HIS)分类标准,偏头痛分为有先兆偏头痛(migraine with aura,MA)和无先兆偏头痛(migraine without aura,MO).MO临床表现为中重度、单侧、搏动性头痛,并伴有恶心、呕吐、畏声、畏光等症状,持续几小时至几天;MA在临床上的表现除具有以上症状外,还会在偏头痛发生之前出现神经系统的症状,如,视野缺损,构音障碍,一侧的轻偏瘫,面部或四肢末梢的感觉麻木等先兆症状[1].另外,偏头痛患者不存在神经系统的阳性体征,并且辅助检查无阳性结果.通过流行病学研究得出,在普通人群中偏头痛的发病率约为15%,其中,女性患病率约为男性的3倍[2],40岁之后患病率逐渐降低.     

偏头痛遗传机制的研究进展

偏头痛(migraine)是一种反复发作的具有明显家族聚集性的神经血管性疾病.根据世界头痛协会(HIS)的分类[1],偏头痛分为有先兆的偏头痛(migraine with aura,MA)和无先兆的偏头痛(migraine without aura,MOA),其中MOA约占2/3.在欧洲国家,偏头痛的患病率约14%,男女比例约为1:3.家族聚集现象和双胞胎研究表明,偏头痛存在着明显的遗传机制.     

经颅多普勒对偏头痛性脑梗死的应用价值及临床意义

偏头痛是神经内科的一种常见病与多发病,有报道其发病率约为15%～25%[1].又有报道偏头痛与脑梗死的发病存在着密切关系,在脑梗死患者中有5.46%存在先兆型偏头痛,有2.45%存在无先兆型偏头痛[2].本研究运用经颅多普勒(TCD)检测偏头痛性脑梗死患者脑血流动力学,观察其各项参数的变化,以探讨此类患者发病的血管源性机制.     

多巴胺D2受体NcoI基因多态性与偏头痛关系的meta分析

<正>偏头痛(migraine)是一种常见病,发病率约10%¹8%,男女比例1:218%,男女比例1:2³。虽然偏头痛患者常有家族史(50%3。虽然偏头痛患者常有家族史(50%⁷0%)及一级亲属同病患者,但其遗传学并不是十分清楚[1]。通常所讲的偏头痛发作包括先兆性偏头痛(migraine with aura,MWA)和无先兆性偏头痛(migraine without aura,MO),多项研究试图从基因层     

偏头痛与中风

偏头痛的发病率较高 ,尤其是女性。在美国男性占 1%～10 % ,女性占 3 %～ 2 0 %。临床研究表明 ,偏头痛与中风之间存在着密切的关系 ,为了更好地预防中风 ,现就偏头痛相关性中风的流行病学、分型和发病机制作一论述 ,希冀有益于临床。1　流行病学特点一项资料表明 ,偏头痛可增加青年女性缺血性和出血性中风的发病率。而另一项调查则认为典型偏头痛可使男性缺血性中风发病增加 ,并且仅影响无其他中风危险因素的男性。最近一项研究表明 ,偏头痛可使中风的总发病率及缺血性中风的发病率增加 ,它可使中风的总发病率增加 80 % ,使缺血性中风的发…     

抑郁症是常见病

抑郁症的患病率相当高.Phillips等[1]的调查结果显示,我国成年社区居民抑郁症月患病率为6.1%;据此推算,我国现有抑郁症患者约6100万人.如果单以重性抑郁障碍(major depressive disorder,MDD)统计,患病率为2.1%,推算患病人数＞2000万人.这是1项按照国际通用的方法、工具和诊断标准设计的,关于中国4个省市精神障碍流行病学的调查研究,发表在Lancet上,其结果可信,具有可比性.     

抑郁症是常见病

抑郁症的患病率相当高.Phillips等[1]的调查结果显示,我国成年社区居民抑郁症月患病率为6.1%;据此推算,我国现有抑郁症患者约6100万人.如果单以重性抑郁障碍(major depressive disorder,MDD)统计,患病率为2.1%,推算患病人数＞2000万人.这是1项按照国际通用的方法、工具和诊断标准设计的,关于中国4个省市精神障碍流行病学的调查研究,发表在Lancet上,其结果可信,具有可比性.     

偏头痛与一氧化氮关系的研究

偏头痛 (migraine)是临床上一种常见病、多发病 ,16岁以上成年人中患病率为 7.7%～ 18.7% ,其中成年男性为 1%～19% ,女性为 3%～ 2 9%。而迄今偏头痛的发病机制尚未阐明 ,近年发现一氧化氮 (NO)具有多种生物学活性 ,在神经系统疾病中具有十分重要的作用 ,在偏头痛发病机制中也是十分关键的因子[1、2 ] 。对偏头痛患者血浆、脑脊液中 NO含量进行测定 ,以探讨偏头痛的发病机制。资料与方法　 1、临床资料 :按照国际头痛分类及诊断标准[3] ,选取偏头痛发作期患者 4 6例 ,其中男 11例 ,女 35例 ;年龄 (2 8.6 0± 11.4 0 )岁。偏头痛间歇期 4 …     

偏头痛、抗磷脂抗体与脑梗塞三者关系的临床研究

目的 :研究和探讨偏头痛与缺血性卒中的相关性以及抗磷脂抗体在偏头痛相关性卒中中的作用。方法 :运用问卷调查方式统计普通人群及脑梗塞患者偏头痛的患病率 ,将脑梗塞患者按有否偏头痛病史分为两组 ,用 EL ISA方法分别测定其血清抗心磷脂抗体 (ACA)水平。结果 :(1)脑梗塞患者偏头痛的患病率与普通人群偏头痛的患病率分别为 2 0 %和 5 .95 % ,二者之间有显著性差异 (P<0 .0 5 )。 (2 )脑梗塞伴有偏头痛史者和无偏头痛史者 ,其 ACA阳性率分别为 4 1.6 7%和 14 .5 8% ,二者具有显著性差异 (P<0 .0 5 )。结论 :偏头痛病史与脑梗塞具有明显相关性。抗磷脂抗体可能参与偏头痛所相关的脑梗塞的发病机制     

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.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -