脑苷肌肽对脑卒中患者50例神经功能恢复的影响

目前脑卒中治疗的关键是超早期溶栓复流及确实的脑保护阻断缺血瀑布,但溶栓时间窗过于狭小,所以神经保护剂的使用更重要,脑卒中的治疗中神经保护仍然是主要措施之一.本文回顾性分析脑苷肌肽治疗50例脑卒中患者的临床资料.     

远隔缺血后适应对脑缺血的保护及相关机制

对于急性中风患者施行早期有效的溶栓治疗,恢复缺血脑组织的血流和功能已成为临床公认有效的治疗手段。但溶栓治疗有严格的时间窗限制,且并发症很多,为了解决这一难题,"缺血预适应"对脑组织缺血/再灌注损伤保护作用的研究进入了人们的视线。目前已有研究证明远隔缺血后适应的脑保护作用。但作用机制尚不明确。因此本课题的目的是应用远隔缺血后适应模型即脑缺血后给予远隔器官(双下肢缺血处理)研究远隔缺血后适应对脑缺血的保护作用及机制。基于既往的研究结果,我们提出了这样假说:脑缺血再灌注时给予双侧或单侧下肢的缺血可以对脑缺血造成的损伤具有保护作用,其保护机制可能是多方面,一方面,可能通过减轻缺血再灌注的损伤,从而减轻了缺血引起的血脑屏障的损伤;另一方面,可能远隔器官的缺血产生了神经保护物质。本课题研究,为将来急性脑梗塞的临床治疗,特别是通过神经保护治疗措施,延长治疗时间窗提供新的理论依据。     

缺血性脑血管病神经保护药转化医学的现状

重组组织型纤溶酶原激活剂是目前唯一被国际认可的治疗急性期脑缺血有效的药物。然而,因溶栓时间窗及溶栓禁忌证的限制,能成功进行溶栓的患者极少。即使成功溶栓后恢复脑血流,因重组组织型纤溶酶原激活剂并无神经保护作用,且本身存在神经毒性,还需要其他神经保护药物进行治疗。抗栓治疗虽可降低卒中的复发率及栓塞并发症的发生率,但并不能降低患者的病死率,且可增加出血性转化的风险。     

新型强效自由基清除剂依达拉奉治疗急性缺血性卒中——从实验室到临床

自由基在缺血性脑损伤过程中起着关键作用,通过不饱和脂肪酸过氧化反应加重细胞膜损伤,进而导致神经无死亡和脑水肿.依达拉奉是一种新型强效自由基清除剂,可通过抑制脑缺血区内皮损伤和缓解神经细胞损害发挥神经保护作用,还能减轻溶栓治疗诱导的再灌注后脑水肿和出血事件.l临床经验提示,依达拉奉的治疗时间窗很宽,与溶栓疗法联合应用能降低卒中病死率和促进神经功能缺损的恢复.文章对依达拉奉从实验事到临床阶段的发展历程做了综述.     

亚低温对局灶性脑缺血治疗时间窗的实验研究进展

脑血管病是严重威胁人类生命健康的临床常见病，而缺血性脑血管病占其中的70％，大脑中动脉阻塞（MCAO）是临床上常见的局灶性脑缺血性疾病。目前，对于急性MCAO的治疗已经由单纯的药物治疗发展成为神经介入和（或）药物联合治疗。由于急性脑缺血再通后可以级联一系列再灌注损伤，因此，进行MCAO的动物实验研究具有现实的临床意义。什么时间内实施亚低温治疗才能起到最大限度的神经保护作用，这涉及到亚低温治疗的时间窗问题。作者对亚低温局灶性脑缺血治疗时间窗的实验研究及临床应用前景综述如下。     

间充质干细胞治疗缺血性脑卒中的新策略

<正>脑卒中是目前世界范围内第一位的成年人致残、致死原因,而其中占大多数的是缺血性脑卒中,缺血性损伤导致了包括神经元、胶质细胞、血管内皮细胞等多种神经血管单元组分的损伤和死亡,引起相应的神经功能缺损[1]。目前,治疗缺血性脑卒中的策略包括急性期溶栓、血管再通和神经保护等,其中只有4.5h时间窗内的溶栓治疗具有循证医学证据支持。但是符合溶栓治疗标准并且能够最终获益的患者有限。而近年来,干细胞治疗等的生物疗法为脑卒中后神经     

缺血后处理脑保护作用的研究进展

缺血性脑卒中是临床常见病和多发病,也是造成病人死亡和残疾的主要原因之一.针对缺血性脑卒中目前临床已开展溶栓和动脉介入治疗,在溶栓时间窗内使闭塞的脑动脉再通,恢复梗死区的血液供应,减少神经功能的损伤.但是,血管再通后再灌注会加重组织细胞功能代谢障碍及结构破坏,即再灌注损伤[1].如何寻找有效的方法减轻再灌注损伤是临床上的难题.脑缺血后处理是指在脑缺血后再灌注早期对缺血脑组织进行反复、短暂性缺血再灌注,使脑组织对前面较长时间的缺血产生耐受性,减轻再灌注损伤,是最近研究发现一种有效的内源性保护机制,能减轻缺血再灌注损伤,成为脑保护研究的热点.     

早期动脉溶栓联合法舒地尔注射液治疗急性脑梗死患者22例

早期介入性动脉溶栓在治疗急性脑梗死方面已经取得了较好的效果,不仅显著减少了患者死亡及严重残疾的危险性,而且还大大地改善了患者的生活质量[1].目前的研究显示,在溶栓治疗前后积极给予神经保护剂减少脑组织缺血性损伤是延长治疗时间窗最有前途的方法[2].血管收缩功能蛋白质激酶(Rho)在缺血性神经系统疾病的病理过程中起关键作用[3].应用Rho激酶抑制剂对急性缺血性脑损害具有显著的神经保护和治疗作用.本文采用超早期选择动脉内溶栓并联合Rho激酶抑制剂--法舒地尔注射液(天津红日药业股份有限公司研制)治疗急性脑梗死患者,取得较好疗效.     

如何延长急性缺血性卒中溶栓治疗时间窗?

溶栓治疗目前是急性缺血性卒中最有效的治疗方法,发病3h内静脉给予重组组织型纤溶酶原激活剂是唯一被美国食品和药品监督管理局批准用于急性缺血性卒中治疗的药物.不过,由于静脉溶栓治疗的时间窗很短,只有极少数患者能在发病3h内到达医院并接受静脉溶栓治疗.因此,如何延长溶栓治疗时间窗,使更多的患者有机会接受溶栓治疗并从中获益,是学者们一直关注的问题.文章对近年来有关延长溶栓治疗时间窗的研究进展进行了综述.     

脑缺血半暗带的病理损伤机制与干预对策

文章综述了脑缺血半暗带病理损伤机制与缺血性卒中治疗干预对策的主要进展,并对溶栓药与神经保护药联合应用在缺血性卒中的潜在临床价值进行了评述。     

《佛山市结核病监测管理平台》在结核病防治工作中的应用评价

目的 评价《佛山市结核病监测管理平台》在结核病防治工作中的应用效果,为结核病防治的信息化管理提供新的思路和参考。 方法 通过描述性研究,比较应用《佛山市结核病监测管理平台》前2年(2015、2016年)和后2年(2017、2018年)佛山市5个县区转诊追踪、患者发现和治疗管理等指标情况并进行数据对比。运用SPSS 20.0进行统计学分析,计数资料的比较采用χ²检验,以P<0.05为差异有统计学意义。 结果 应用《佛山市结核病监测管理平台》前后2年,佛山市非结核病防治机构(简称“结防机构”)实际报告的肺结核或疑似肺结核患者数分别为16914例和15124例,转诊患者例数分别为16588例和15121例,转诊率由应用前2年的98.07%上升至应用后2年的99.98%,差异有统计学意义(χ²=285.86,P<0.001);结防机构追踪率由应用前2年的99.11%(7421/7488)上升至应用后2年的99.63%(7459/7487),差异有统计学意义(χ²=16.11,P<0.001);追踪到位率从应用前2年的83.87%(6280/7488)上升至应用后2年的86.82%(6500/7487),差异有统计学意义(χ²=26.04,P<0.001);总体到位率从应用前2年的91.02%(15395/16914)上升至应用后2年的93.98%(14214/15124),差异有统计学意义(χ²=100.10,P<0.001);患者丢失率由应用前2年的3.92%(300/7654)下降至应用后2年的3.10%(210/6785),差异有统计学意义(χ²=7.18, P=0.007);规则服药率由应用前2年的93.01%(7119/7654)上升至应用后2年的94.22%(6393/6785),差异有统计学意义(χ ²=8.80, P=0.003);总体漏服率从应用前2年的4.08%(56210/1377720)下降至应用后2年的3.10%(37860/1221300),差异有统计学意义(χ ²=1782.19,P<0.001)。结论 《佛山市结核病监测管理平台》的应用提高了佛山市结核病患者管理的效率及质量,为结核病防治信息化管理提供了依据和参考。     

中药注射剂应用现状及分析

目的分析我院中药注射剂的应用状况,为临床合理应用中药注射剂提供参考。方法对我院2006—2008年应用的中药注射剂的用量、销售金额进行统计分析。结果我院治疗心脑血管类疾病的中药注射剂的用药品种数、用药金额和应用频率均逐年增长。结论中药注射剂在我院临床应用逐年增加,我院中药注射剂的应用基本合理,在治疗疾病的同时不可忽视用药安全性。     

Ablation of idiopathic ventricular tachycardia by bipolar radiofrequency current application between the left aortic sinus and the left ventricle.

BACKGROUND: Failure to ablate idiopathic ventricular outflow tract tachycardia by radiofrequency current is not uncommon and suggests that non-standard approaches may be required to map and suppress idiopathic ventricular tachyarrhythmias in some patients. METHODS AND RESULTS: Left and right ventricular activation and pace mapping proved inadequate for radiofrequency application in a patient with idiopathic ventricular outflow tract tachycardia. Presystolic activity was recorded at the left aortic sinus of Valsalva, and the QRS complex recorded at this location during pacing showed few differences compared with that recorded during tachycardia. Radiofrequency current application at this site transiently suppressed the tachycardia. Following new mapping of the left ventricle outflow tract, radiofrequency application just below the aortic valve in close proximity to the previous aortic application site transiently abolished the arrhythmia. Finally, bipolar radiofrequency application between the distal electrode of the aortic catheter and the distal electrode of a second catheter placed in the left ventricular subaortic area permanently suppressed the tachycardia. CONCLUSION: Bipolar radiofrequency application between the aortic sinus of Valsalva and the left ventricle could be an alternative approach in occasional patients with idiopathic ventricular outflow tract tachycardia resistant to conventional left ventricular and aortic root unipolar radiofrequency application.     

Effects of altering infusion parameters on intimal hyperplasia following local catheter-based delivery into the rabbit iliac artery

BACKGROUND: Efficient local gene or drug therapy requires optimized application modalities to avoid vessel damage, which might lead to increased neointimal hyperplasia. Aim of the study was to evaluate different application parameters for local delivery using the channeled balloon catheter in order to minimize vessel trauma induced by local application. METHODS AND RESULTS: Sixty cholesterol fed rabbits were randomly enrolled into twelve groups of different local application parameters: group I, application pressure 2atm/application volume 1ml physiologic saline; group II, 2atm/2ml; group III, 2atm/5ml; group IV, 4atm/1ml; group V, 4atm/2ml; group VI, 4atm/5ml. The other six groups received Ringer's solution instead of saline. Administration of the solution was randomly performed in one iliac artery using the channeled balloon catheter with simultaneous balloon angioplasty (8atm). The contralateral iliac artery served as a control and was treated with balloon angioplasty only. Four weeks after local therapy, calibrated angiography was performed; the animals were sacrificed, vessel segments were excised and quantitative morphometric measurements were obtained. In none of the animals acute complications, e.g. dissection, thrombosis or perforation of the vessel, was noted. Up to an application pressure of 4atm and an application volume of 5ml, no significant neointima formation was seen compared to arteries which underwent angioplasty only. Additionally, no significant differences between saline and Ringer's solution were detected. In a multivariate analysis, neither application pressure nor volume were found to have a statistically significant influence on the amount of neointimal hyperplasia. CONCLUSIONS: Local application of "drugs" using the channeled balloon catheter is safe and feasible without significant induction of neointimal hyperplasia compared to angioplasty, if an application volume of 5ml and a pressure of 4atm is not exceeded.     

静脉用小剂量红霉素对极低体重早产儿的影响

目的探讨静脉缓慢滴人小剂量红霉素防治早产儿喂养不耐受与口服方式的疗效及不良反应差异。方法我科收治的VLBW患儿随机分为三组,分别给予小剂量静脉滴注红霉素、口服红霉素及对照组,观察三组患儿疗效及不良反应等方面差异。结果口服与静脉使用红霉素两组的喂养不耐受发生率、住院时间、体重增长情况等均无差异（P〉0．05）,静脉组早产儿达到足量喂养的平均时间要略短于口服治疗组（P〉0．05）。静脉滴注红霉素与口服红霉素后不良反应发生情况无差异（P〉0．05）。结论口服红霉素治疗早产儿喂养不耐受是有效的,静脉小剂量红霉素防治早产儿喂养不耐受效果与口服类似,并且更易操作,不良反应发生率无明显升高。     

Nonvasomotor influence of sodium nitroprusside on arteriolar remote response to methacholine

Vascular communication functions to facilitate blood distribution within tissues and can be demonstrated as conducted vasomotor responses. This study was designed to determine if local application of sodium nitroprusside (SNP) would affect arteriolar function at remote sites. In the cheek pouch of anesthetized hamsters, local application of SNP and nifedipine caused arteriolar dilation only at the site of application (7.1 +/- 0.5 and 7.4 +/- 0.6 microm), but not at remote sites. The application of SNP enhanced subsequent remote, nitric oxide (NO)-independent dilation in response to methacholine, which was applied at a site upstream from the SNP application site (6.7 +/- 0.7 versus 4.5 +/- 0.7 microm for methacholine alone). This potentiating effect was also observed following application of 3-morpholinosydnonimine, but not following nifedipine. This nonvasomotor influence of SNP was not affected by N(omega)-nitro-L-arginine (L-NA), tetrodotoxin (TTX), Gap 27 peptide or halothane. Attenuated local dilation in response to methacholine by L-NA could be partially recovered following downstream application of SNP, suggesting that SNP-induced potentiation was associated with enhanced vasodilatory signals at the methacholine application site. Thus, our results suggest that SNP induces nonvasomotor signals in arterioles to affect the network distribution of blood flow. Intrinsic NO, TTX-sensitive Na(+) channels and gap junctional communication do not seem to play a major role in the conduction of the nonvasomotor signals.     

Temporal and spatial organization of doctors' computer usage in a UK hospital department

This paper describes the use of an application accessible via distributed desktop computing and wireless mobile devices in a specialist department of a UK acute hospital. Data (application logs, in-depth interviews, and ethnographic observation) were simultaneously collected to study doctors' work via this application, when and where they accessed different areas of it, and from what computing devices. These show that the application is widely used, but in significantly different ways over time and space. For example, physicians and surgeons differ in how they use the application and in their choice of mobile or desktop computing. Consultants and junior doctors in the same teams also seem to access different sources of patient information, at different times, and from different locations. Mobile technology was used almost exclusively during the morning by groups of clinicians, predominantly for ward rounds.     

内皮前体细胞移植:冠心病治疗的新策略

干细胞研究的进展和基因治疗技术在心血管的应用为缺血性心脏病的治疗提供了新策略。基因修饰后内皮前体细胞移植既补充了功能不良且数量不足的内皮前体细胞又诱导并促进了局部新血管的生成 ,展示了美好的临床应用前景。本文回顾了近几年来缺血性心脏病治疗的新概念 ,重点介绍了国外内皮前体细胞及其基因修饰应用的新进展 ,并对存在的问题和应用前景分别进行了讨论和展望     

PCR及相关技术在恙虫东方体检测和研究中的应用

随着PCR技术在医学领域的广泛应用和深入研究,PCR及其相关技术在检测恙虫东方体领域亦取得了一系列进展,对恙虫病的早期诊断和恙虫东方体的基础研究产生了深远影响。本文对PCR及其相关技术在恙虫东方体检测和研究中的应用状况进行综述。     

Effect of topical application of capsaicin and its related compounds on dermal insulin-like growth factor-I levels in mice and on facial skin elasticity in humans.

Capsaicin increases calcitonin gene-related peptide (CGRP) release from sensory neurons by stimulating vanilloid receptor-1 (VR-1). Since CGRP increases production of insulin-like growth factor-I (IGF-I) in fetal osteoblasts in vitro, it is possible that sensory neuron activation by capsaicin increases production of IGF-I. In the present study, we attempted to determine whether topical application of capsaicin and related compounds increases dermal IGF-I level in mice and whether it increases facial skin elasticity in humans. Topical application of 0.01% capsaicin significantly increased dermal IGF-I levels from 30 to 180min (p<0.01), but not at 360min, after application in mice. Topical application of 0.01% capsaicinoids (dihydrocapsaicin and nordihydrocapsaicin), 0.01% capsinoids (capsiate, dihydrocapsiate and nordihydrocapsiate), 0.01% anandamide (an endogenous agonist of VR-1), and 0.01% nonylic acid vanillylamide (a synthetic capsaicin) significantly increased dermal IGF-I levels at 30min after topical application in mice (p<0.01). Topical application of 0.01% capsaicin to faces of 17 healthy female volunteers for seven days significantly increased cheek skin elasticity (p<0.01). These observations suggest that topical application of capsaicin and related compounds might be useful in the treatment of detrimental morphological changes of the skin in patients with growth hormone deficiency and those in the elderly by increasing dermal IGF-I levels.