上臂间血压差异增大与缺血性脑卒中的相关性研究

目的 研究缺血性脑卒中与上臂间血压差异增大的相关性,探讨上臂间血压差异增大是否为缺血性脑卒中的危险因素及早期预测指标.方法 以确诊为TOAST分型大动脉粥样硬化型缺血性脑卒中的84例患者作为卒中组,以无缺血性脑卒中病史的80例门诊就诊患者作为对照组.测量上臂间血压差异,以≥10 mm Hg(1 mm Hg≈0.133 kPa)为异常标准,比较两组间上臂间血压差均值大小的差异及异常比例的差异.结果 卒中组平均压差均值为(8.34±1.38)mm Hg;对照组为(5.23±1.22)mm Hg;上臂间血压差异≥10 mm Hg者卒中组为35例(41.67％),对照组为14例(17.5％).两组间比较差异均有统计学意义(P＜0.01).结论 在缺血性脑卒中人群中,上臂间血压差异增大患病比例明显高于正常组,上臂间血压差异的增大可能为患缺血性脑卒中的危险因素,同时对于上臂间血压差异增大的监测有利于缺血性脑卒中的早期预测及一级预防.     

Intensive care management [corrected] of patients with intracerebral hemorrhage

Approximately 10-15% of acute strokes are caused by non-aneurysmatic intracerebral hemorrhage (ICH) and incidences are expected to increase due to an aging population. Studies from the 1990s estimated mortality of ICH to be as high as 50%. However, these figures may partly be attributed to the fact that patients suffering from ICH frequently received only supportive therapy and the poor prognosis may therefore be more a self-fulfilling prophecy. Recently it has been shown that treatment in a specialized neurological intensive care unit alone was associated with better outcomes after ICH. In recent years considerable efforts have been undertaken in order to develop new therapies for ICH and to assess them in randomized controlled trials. Apart from admission status, hemorrhage volume is considered to be the main prognostic factor and impeding the spread of the hematoma is thus a basic therapeutic principle. The use of activated factor VIIa (aFVIIa) to stop hematoma enlargement has been assessed in two large randomized controlled trials, however the promising results of the dose-finding study could not be confirmed in a phase III trial. Although hemostatic therapy with aFVIIa reduced growth of the hematoma it failed to improve clinical outcome. Similar results were found in a randomized controlled trial on blood pressure management in acute ICH. The link between reduction of hematoma growth and improved outcome is therefore still lacking. Likewise the value of surgical hematoma evacuation remains uncertain. In the largest randomized controlled trial on surgical treatment in ICH so far, only a small subgroup of patients with superficial hemorrhages seemed to benefit from hematoma evacuation. Whether improved intensive care can contribute to improved outcome after ICH will be shown by data obtained in the coming years.     

Xenon-enhanced CT assessment of cerebral blood flow in stroke-in-progress patients with unilateral internal carotid artery or middle cerebral artery stenosis

Carotid or cerebral artery stenosis resulting in low perfusion is a major cause of ischemic stroke.Understanding the unique hemodynamic features in each patient undergoing a stroke-in-progress（SIP） and the correlation between progression and cerebral blood flow（CBF） status would help in the diagnosis and treatment of individual patients.We used xenonenhanced CT（Xe-CT） to examine cerebral perfusion in patients with or without SIP（30 patients/group）,recruited from October 2009 to October 2010.Only SIP patients with unilateral stenosis in the internal or middle cerebral artery were recruited.The occurrence of watershed infarction was higher in the SIP group than in the non-SIP group（P ＆lt;0.05）.In the SIP group,larger hypoperfused areas were found around the lesions than in the non-SIP group.In the SIP group,the CBF values in the ipsilateral areas were significantly lower than those in corresponding regions on the contralateral side.CBF values in the contralateral hemisphere were significantly lower in the SIP group than in the non-SIP group.In SIP patients,infarctions were surrounded by larger hypoperfused areas than in non-SIP patients.These larger hypoperfused areas may result in pathological damage to the brain that is responsible for the progression of stroke.     

正常成人吞咽时的脑激活区域：功能磁共振初步研究

BACKGROUND： While brain-imaging studies in healthy adults have indicated that multiple cortical regions are involved in swallowing, these functional imaging techniques have not been extensively applied to the complete understand neurophysiology of swallowing in China. A full understanding of normal swallowing neurophysiology is important for improving functional outcomes for dysphagia due to neurologic disorders or damage with increasing age. Thus the interpretations of the functional contributions of various brain areas in swallowing should be scientifically researched. OBJECTIVE： To identify the activation and characteristic of swallowing center in healthy adults using functional magnetic resonance imaging. DESIGN, TIME AND SETTING： An uncontrolled neuroimaging study was performed at the Outpatient Clinic, Department of Radiology, West China Hospital of Sichuan University between March and November 2008. PARTICIPANTS： Ten healthy right-handed volunteers, aged over 20 years with a mean age of （34.2 ＋ 8.1） years, a range of 25-45 years and including five males and five females participated. A medical history was obtained from all potential subjects and all subjects were free of systemic diseases and neurological disorders. METHODS： The healthy volunteers were examined with event-related functional magnetic resonance imaging of blood oxygenation level-dependent while laryngeal swallow-related movements were recorded. Subjects were scanned during voluntary saliva swallowing and water bolus swallowing activation tasks. Data was processed using the General Linear Model. A voxel by voxel group comparison was performed using random effect analysis. Any cluster with a corrected P 〈 0.05 for spatial extent was considered significant. MAIN OUTCOME MEASURES： The cerebral cortical activation maps of voluntary swallowing of saliva and swallowing of water bolus in healthy adults were observed. RESULTS： A multifocal cortical representation of swallowing was in the precentral gyrus, postcentral gyrus, insula, anterior cingulate gyrus, thalamus, basal ganglia and cerebellum, in a bilateral and asymmetrical manner, predominantly on the left hemisphere in the volunteers （P 〈 0.05）. CONCLUSION： Activation of the cortex during normal swallowing tasks may be functionally linked to basal nuclei, thalamus, and cerebellum, greatly appearing in the left hemisphere.     

颅内未破裂动脉瘤及其治疗策略

颅内未破裂动脉瘤在临床上比较常见,动脉瘤破裂的后果严重,因此未破裂动脉瘤的研究一直是神经外科的研究热点.颅内未破裂动脉瘤的破裂率与既往蛛网膜下腔出血史、性别与年龄、动脉瘤大小、所处位置、多发动脉瘤、家族动脉瘤史等相关,治疗颅内未破裂动脉的手段主要有开颅夹闭术、血管内介入动脉瘤栓塞术、保守治疗以及动脉瘤孤立术或载瘤动脉闭塞术＋血管吻合术,医师应该根据患者的情况（年龄、并发症等）,动脉瘤情况（大小、形态、位置）以选择合适的方法.现对颅内未破裂动脉瘤的危险因素和治疗方法进行综述.     

苍附导痰丸治疗利培酮引起的女性精神分裂症患者高催乳素血症

目的观察苍附导痰丸对因服用利培酮治疗女性精神分裂症患者高催乳素血症的影响和安全性。方法将120例服用利培酮的女性精神分裂症患者随机分为研究组60例和对照组57例（脱落3例）,治疗组用苍附导痰丸施治及对照组用安慰剂治疗,总疗程12周,研究周期8周。于第0,4,8,12周末检测血清催乳素含量,并用阳性和阴性症状量表（PANSS）,治疗中需要处理的不良反应量表（TESS）进行评定。结果研究组第8,12周末催乳素水平明显低于第4周末,差异有统计学意义（P〈0．01）;组间比较,差异亦有统计学意义（P〈0．01）。研究组治疗第12周末,催乳素下降率为（64土10）％,对照组下降率为（2．01±1．6）％,差异有统计学意义（t=16．85;P〈0．01）;治疗第12周末,研究组催乳素正常率为70．12％,明显高于对照组的8．6％,差异有统计学意义（x^2=21．35,P〈0．01）。两组患者治疗前后比较,PANSS评分总分及分量表分均明显下降,差异具有统计学意义（P〈0．05）。治疗第12周末,研究组TESS（5．1土4．2）分,对照组（4．8±3．9）分,差异无统计学意义（t=0．28,P〉0．05）。结论用苍附导痰丸治疗利培酮所致的女性精神分裂症患者高催乳素血症有效且安全。     

颅内压监测在急性颅脑损伤救治中的应用进展

急性颅脑损伤的发生率日益提高,严重的颅脑损伤极大威胁国民健康水平.急性颅脑损伤后7d内最主要的致死原因为颅内压(ICP)增高,控制ICP是急性颅脑损伤处理的重要前提.ICP监测可迅速及准确地反应急性颅脑损伤患者的颅内压力情况,有效反应急性颅脑外伤患者的病情变化,现已广泛用于急性颅脑损伤的救治.ICP监测技术主要分为有创性和无创性两大类,无创性ICP监测具有低感染率等一系列优势,有创性ICP监测虽有感染、出血等风险,但由于其能直观反映ICP变化,故目前仍具有不可替代的优势.ICP监测在急性颅脑损伤的救治中具有协助诊断、为治疗提供量化依据以及判断预后等重要作用.对降低急性颅脑损伤患者的病死率和致残率,改善患者的预后,有效地提高急性颅脑损伤患者的抢救成功率、治愈率具有重要意义.     

提高对胰岛β细胞瘤所致精神障碍的识别及诊断水平

胰岛β细胞瘤所致的精神障碍是一种由于血糖过低导致脑内从皮层到自主神经逐步受损而出现精神症状的疾病。胰岛细胞瘤发病率低,年发病率为0.4/ 10万,占胰岛细胞瘤的1%-2%。典型表现为Whipple三联征：（1）反复发作性低血糖性昏迷或痉挛,尤其是空腹或劳累时发作;（2）空腹或发作时血糖（BS）≤2.8mmol/L;（3）口服或静脉注射葡萄糖后症状消失。     

Environmental factors in the development and progression of late-onset Alzheimer＇s disease

Late-onset Alzheimer＇s disease （LOAD） is an age-related neurodegenerative disorder characterized by gradual loss of synapses and neurons, but its pathogenesis remains to be clarified. Neurons live in an environment constituted by neurons themselves and glial cells. In this review, we propose that the neuronal degeneration in the AD brain is partially caused by diverse environmental factors. We first discuss various environmental stresses and the corresponding responses at different levels. Then we propose some mechanisms underlying the specific pathological changes, in particular, hypothalamic-pituitary adrenal axis dysfunction at the systemic level; cerebrovascular dysfunction, metal toxicity, glial activation, and Aβ toxicity at the intercellular level; and kinase-phosphatase imbalance and epigenetic modification at the intracellular level. Finally, we discuss the possibility of developing new strategies for the prevention and treatment of LOAD from the perspective of environmental stress. We conclude that environmental factors play a significant role in the development of LOAD through multiple pathological mechanisms.     

Emergency Neurological Life Support: Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) is a subset of stroke due to spontaneous bleeding within the parenchyma of the brain. It is potentially lethal, and survival depends on ensuring an adequate airway, proper diagnosis, and early management of several specific issues such as blood pressure, coagulopathy reversal, and surgical hematoma evacuation for appropriate patients. ICH was chosen as an Emergency Neurological Life Support (ENLS) protocol because intervention within the first hours may improve outcome, and it is critical to have site-specific protocols to drive care quickly and efficiently.     

Disrupted structural and functional brain connectomes in mild cognitive impairment and Alzheimer＇s disease

Alzheimer＇s disease （AD） is the most common type of dementia, comprising an estimated 60-80% of all dementia cases. It is clinically characterized by impairments of memory and other cognitive functions. Previous studies have demonstrated that these impairments are associated with abnormal structural and functional connections among brain regions, leading to a disconnection concept of AD. With the advent of a combination of non-invasive neuroimaging （structural magnetic resonance imaging （MRI）, diffusion MRI, and functional MRI） and neurophysiological techniques （electroencephalography and magnetoencephaJography） with graph theoretical analysis, recent studies have shown that patients with AD and mild cognitive impairment （MCI）, the prodromal stage of AD, exhibit disrupted topological organization in large-scale brain networks （i.e., connectomics） and that this disruption is significantly correlated with the decline of cognitive functions. In this review, we summarize the recent progress of brain connectomics in AD and MCI, focusing on the changes in the topological organization of large-scale structural and functional brain networks using graph theoretical approaches. Based on the two different perspectives of information segregation and integration, the literature reviewed here suggests that AD and MCI are associated with disrupted segregation and integration in brain networks. Thus, these connectomics studies open up a new window for understanding the pathophysiological mechanisms of AD and demonstrate the potential to uncover imaging biomarkers for clinical diagnosis and treatment evaluation for this disease.     

Oxidative stress in Alzheimer＇s disease

Oxidative stress plays a significant role in the pathogenesis of Alzheimer＇s disease （AD）, a devastating disease of the elderly. The brain is more vulnerable than other organs to oxidative stress, and most of the components of neurons （lipids, proteins, and nucleic acids） can be oxidized in AD due to mitochondrial dysfunction, increased metal levels, inflammation, and β-amyloid （Aβ） peptides. Oxidative stress participates in the development of AD by promoting Aβ deposition, tau hyperphosphorylation, and the subsequent loss of synapses and neurons. The relationship between oxidative stress and AD suggests that oxidative stress is an essential part of the pathological process, and antioxidants may be useful for AD treatment.     

Dysfunctional autophagy in Alzheimer＇s disease： pathogenic roles and therapeutic implications

Neuronal autophagy is essential for neuronal survival and the maintenance of neuronal homeostasis. Increasing evidence has implicated autophagic dysfunction in the pathogenesis of Alzheimer＇s disease （AD）. The mechanisms underlying autophagic failure in AD involve several steps, from autophagosome formation to degradation. The effect of modulating autophagy is context-dependent. Stimulation of autophagy is not always beneficial. During the implementation of therapies that modulate autophagy, the nature of the autophagic defect, the timing of intervention, and the optimal level and duration of modulation should be fully considered.     

高血压脑出血的显微外科治疗进展

高血压脑出血（Hypertensive intrac-rebral hemorrhage,HICH）是具有高发病率、高病死率、高致残率的急性脑血管疾病,占所有脑卒中患者的10%-20%,早期病死率可高达49.4%。随着人口老龄化,其发病率逐年提高;而外科手术的干预,使其病死率有所下降,但致残率居高不下。如何提高手术疗效和患者生存质量,一直是神经外科医师努力的方向。微侵袭血肿清除术因其手术创伤小,恢复快,是目前国内治疗高血压脑出血的重要手段。     

雷公藤内酯对癫痫大鼠神经元P13K／Akt／mTOR蛋白的影响

目的通过检测癫痫大鼠海马神经元P13K、Akt和mTOR蛋白表达,探讨雷公藤内酯抑制癫痫大鼠神经元凋亡的分子机制。方法30只大鼠随机分为对照组、海人酸组、雷公藤内酯干预组,免疫组化法检测各组大鼠海马神经元P13K、Akt和mTOR蛋白的表达情况。结果海人酸组神经元胞体皱缩,形态不规则,数量减少,而雷公藤内酯干预组神经元的数量和形态与对照组相似,海人酸组海马神经元P13K、Akt、ITITOR蛋白表达与对照组比较均减少,而雷公藤内酯干预组海马神经元的P13K、Akt、mTOR蛋白表达均较海人酸组增加,差异均有统计学意义（P〈0．05）。结论雷公藤内酯可能通过上调P13K／Akt／mTOR信号通路蛋白表达对癫痫大鼠海马神经元发挥保护作用。     

神经内镜联合亚低温治疗高血压基底节区脑出血

目的 探讨神经内镜联合亚低温在治疗高血压基底节区脑出血中的临床应用价值.方法 回顾性分析我院神经内镜治疗高血压基底节区脑出血患者40例的临床资料,并对治疗结果进行分析.结果 神经内镜治疗组22例(甲组),神经内镜联合亚低温治疗组18例(乙组),术后3个月根据GCS评分,甲组恢复良好1例,中残4例,重残6例,植物生存6例,死亡5例;乙组恢复良好4例,中残8例,重残3例,植物生存1例,死亡2例,两组比较差异有统计学意义(P＜0.05).两组颅内压比较第1天两者差异不明显,但第2、3天亚低温组颅内压明显降低.结论 神经内镜是治疗高血压基底节区脑出血较为有效的手术方式,联合亚低温治疗能有效降低颅内压,改善术后神经功能恢复,具有较好的临床应用价值.     

阿尔茨海默病治疗的研究进展

阿尔茨海默病（AD）是一种隐匿性起病,进行性恶化的神经退行性疾病,临床最初表现为认知功能障碍,并有可能在5～10年内完全衰退。患者往往伴随严重的记忆力丧失、精神行为异常、人格改变、言语功能障碍,无法独立生活,最终近乎于植物状态。Ferri等采用DISMOD软件在全球60岁以上人群中估计,全球的痴呆患者人数到2040年将达到8llO万左右。