Cerebrovascular ischaemia after carbon monoxide intoxication

Carbon monoxide intoxication is the most prevalent cause of death from carbon monoxide poisoning. We herein report the case of a 56-year-old man who was found unconscious and smelled of smoke after exposure to carbon monoxide from a heater. He scored 5 on the Glasgow Coma Scale, and had respiratory insufficiency and elevated troponin I, creatine kinase-MB fraction and carboxyhaemoglobin levels. He was treated by mechanical ventilation. After regaining consciousness, brain magnetic resonance imaging showed diffusion restriction in the left occipital lobe; there was a loss of vision (right temporal hemianopsia), which improved by the follow-up session. Carbon monoxide intoxication may cause neurologic and cardiac sequelae, and the initial treatment includes oxygen therapy. Acute carbon monoxide poisoning can cause serious injury to the brain, heart and other organs; the most severe damages that could be inflicted to the brain include cerebral ischaemia and hypoxia, oedema, and neural cell degeneration and necrosis.     

46例CO中毒脑病病例脑部MRI影像特征及ADC值分析

目的探讨急性一氧化碳中毒(ACOP)脑病患者脑部MRI影像特征及弥散加权成像表观弥散系数(ADC)值分析的临床价值。方法回顾性分析46例急性CO中毒迟发性脑病(DEACMP)患者(观察组)及30例健康志愿者(对照组)脑部MRI影像及临床资料,分析其影像特征。对比两组受试者皮质区、半卵圆中心区、侧脑室周围白质区、苍白球区等相同部位的ADC平均值差异。结果 46例观察组受试者中15例(32.6%)MRI影像表现正常(无重度ACOP者,轻度14例、中度1例);剩余31例受试者头颅MRI影像可见异常信号,其中大脑皮质区受累2例,双侧顶叶皮质区可见T1WI对称性低信号、T2WI及DWI呈对称性高信号;双侧苍白球区异常信号者19例,表现为对称性长T1、长T2信号,呈现典型的"熊猫眼"特征;双侧脑白质区异常信号者10例,MRI图像可见对称分布的斑片状异常信号影,T1WI呈稍低信号,T2WI呈稍高信号,脑沟及脑裂均未见异常。观察组皮质区、半卵圆中心区、侧脑室周围白质区、苍白球区等部位ADC平均值均显著低于对照组,差异具有统计学意义(P0.05)。结论 MRI在DEACMP的临床诊断中具有明显的影像特征,联合ADC值评估可有效提高诊断准确性,为后续诊疗工作的顺利开展提供条件。     

SP600125对急性一氧化碳中毒大鼠的脑保护作用

目的探讨JNK特异性抑制剂-SP600125对急性一氧化碳中毒大鼠的脑保护作用。方法 48只雄性SD大鼠随机分成空白对照组（BC组）、急性一氧化碳中毒组（CO组）和SP600125处理组（SP组）,每组16只。采用静态吸入法复制急性一氧化碳中毒大鼠模型,选取染毒后14天和28天为时相点,应用Morris水迷宫试验检测大鼠平均逃避潜伏期等学习记忆能力的变化情况。结果定位航行试验：实验大鼠14天时的平均逃避潜伏期BC组〈SP组〈CO组（F=196.37,P〈0.01）,28天时BC组〈SP组〈CO组（F=165.24,P〈0.01）。空间探索试验：14天时,首次穿越平台时间BC组（3511.97±336.88）ms〈SP组（5223.84±475.06）ms〈CO组（7929.25±1060.62）ms（F=81.31,P〈0.01）,穿越平台次数BC组〉SP组〉CO组（F=14.50,P〈0.01）;28天时,首次穿越平台时间BC组（3704.94±427.18）ms〈SP组（5782.44±311.48）ms〈CO组（8851.97±542.65）ms（F=280.36,P〈0.01）,穿越平台次数BC组〉SP组〉CO组（F=11.71,P〈0.01）。结论急性一氧化碳中毒对大鼠的学习记忆能力有明显损害,SP 600125能部分减轻这种损害作用,提示SP600125对急性一氧化碳中毒大鼠有一定的脑保护作用。     

ADC值的变化对急性CO中毒迟发性脑病的预测价值

目的利用MR扩散加权成像监测CO中毒家兔模型急性期脑组织ADC值的变化并与病理对照，探讨MR扩散加权成像对CO中毒急性期诊断的价值并尝试寻找一种能预测CO中毒迟发性脑病的指标。方法通过静吸法建立家兔CO中毒模型15只，成功13只。行磁共振功能成像（本文主要探讨MR扩散加权成像）动态观察家兔中毒后1h、第3天、第5天、第7天的脑部损伤情况，动态测量兔脑皮层的ADC值，并结合病理结果分别与中毒前ADC值相对照。与此同时，连续观察染毒家兔临床表现60d，并根据临床表现不同分为两组，即出现迟发性脑病组和未出现迟发性脑病组。结果所有染毒成功家兔在染毒后1h兔脑皮层均出现ADC值不同程度下降，平均ADC值与染毒前对照差别有显著性（P〈0．05），部分出现了异常信号；未出现迟发性脑病的家兔组各时间点脑皮层ADC值与染毒前对照差异均无显著性意义（P〉0．05）；出现迟发性脑病的家兔组染毒后1h脑皮层ADC值与染毒前对照差异有显著性（P〈O．05）。病理表现与影像学表现一致。结论ADC值对评价急性CO中毒的程度具有重要价值，并且可以初步预测CO中毒迟发性脑病发生的可能性。     

Surveillance of childhood blood lead levels in Chengdu,China in 2010–2011

INTRODUCTION

Lead poisoning has been receiving great attention around the world. The Child Hygiene Cooperation Center of the World Health Organization in China has been conducting investigations to monitor blood lead levels (BLLs) from as early as 2004. However, only several lead poisoning studies have been conducted in China since August 2009. The aim of the present study was to investigate the BLLs in children aged < 7 years and to analyse the risk factors of high BLLs in Chengdu, China.

METHODS

Questionnaires were distributed to children in Chengdu from 2010 to 2011. A total of 2,271 children were included in this study – 1,157 received BLL tests in 2010 and the remaining received the tests in 2011. BLL was measured using a tungsten atomiser absorption spectrophotometer.

RESULTS

The mean BLL of the 2,271 children was 6.2 µg/dL and 2.03% of the children had BLLs ≥ 10 µg/dL. Mean BLL seemed to increase with age. Unhygienic habits (e.g. not washing hands frequently, biting of toys and pencils), history of pica, use of coal and residence in an industrial zone were found to be the main risk factors contributing to high BLL (p < 0.05). Children with high BLLs have a higher risk of manifesting anorexia and/or abdominal pain as compared to those with low BLLs (p < 0.05).

CONCLUSION

The mean BLL of children in Chengdu (i.e. 6.2 µg/dL) was found to be higher than that of children in developed countries. Childhood lead poisoning remains a public health problem.     

一氧化碳中毒神经系统后发症(附12例临床分析)

目的：探讨一氧化碳中毒后发症的神经系统症状、体征和神经影像学表现。方法：分析12例一氧化碳中毒后发症患者的症状、体征、影像学表现，并按诊断标准诊断及高压氧治疗。结果：12例一氧化碳中毒神经系统后发症患者3例死亡，1例遗留精神分裂样症状，8例痊愈。结论：一氧化碳中毒后发症患者的发生与中毒后发现的早晚和开始高压氧治疗的时间密切相关，积极治疗亦能得到较好的康复。     

15例一氧化碳中毒性脑病的临床特点与CT分析

目的探讨一氧化碳中毒性脑病的CT特征。方法回顾性分析了15例一氧化碳中毒病人的脑部CT表现。结果双侧苍白球对称性低密度与脑白质低密度为最常见征象,前者占本组病例的65%,具有特征性。结论CT能直接地反映一氧化碳中毒性脑病的改变,有助于明确一氧化碳中毒性脑病的诊断,对于预后的评估有重要价值。     

15例一氧化碳中毒性脑病的临床特点与CT分析

目的探讨一氧化碳中毒性脑病的CT特征。方法回顾性分析了15例一氧化碳中毒病人的脑部CT表现。结果双侧苍白球对称性低密度与脑白质低密度为最常见征象,前者占本组病例的65%,具有特征性。结论CT能直接地反映一氧化碳中毒性脑病的改变,有助于明确一氧化碳中毒性脑病的诊断,对于预后的评估有重要价值。     

急性一氧化碳中毒后迟发性脑病的磁共振波谱及弥散张量成像表现

急性一氧化碳中毒(ACMP)在我国是中毒的重要病因之一,急性一氧化碳中毒后迟发性脑病(DEACMP)是急性一氧化碳中毒后最严重的并发症之一,目前发病机制尚未明确。通过对DEACMP患者行磁共振波谱研究显示患者病变大脑各代谢物比值相对浓度及比值发生有统计学意义的改变;通过对DEACMP患者行磁共振弥散张量成像研究显示患者白质纤维破坏。现主要对磁共振波谱及磁共振弥散张量成像在DEACMP的研究应用现状予以综述。     

Multimodality evoked potentials in patients with delayed encephalopathy after acute carbon monoxide poisoning

Objective： To evaluate the diagnostic and prognostic values in patients with delayed encephalopathy after acute carbon monoxide poisoning. Methods： The tibial nerve somatosensory evoked potentials （SEPs）, vision evoked potentials （VEPs）, and brain stem audition evoked potentials（BAEPs） were performed in 32 healthy adults and 43 patients with delayed encephalopathy after acute carbon monoxide poisoning. Results： This paper indicated abnormalities of tibial nerve SEPs in 31 patients （31/43, 72.1%）, VEPs in 17 patients （17/28, 60.7%）, and BAEPs in 14, patients （14/43, 32.6%）. These results showed that the greatest diagnostic value was SEPs, followed by VEPs and, BAEPs with the lowest sensitivity. Conclusion： Multimodality evoked potentials （EPs） can be used for evaluating the diagnostic and prognostic values in cases of delayed encephalopathy after acute carbon monoxide poisoning.     

脑电图结合CT预测一氧化碳中毒迟发性脑病

探讨预测一氧化碳中毒迟发性脑病的检查方法,以及高压氧治疗时间与脑病的关系。方法用脑电地形图和头颅ＣＴ分析２９３例一氧化碳中毒不同程度、不同高压氧治疗时间与一氧化碳中毒迟发性脑病发生的关系。结果中重度中毒脑电地形图与轻度中毒异常率比较差异显。     

Prevalence of oral lesions and measurement of salivary pH in the different trimesters of pregnancy

INTRODUCTION

Oral changes observed during pregnancy have been studied for many years, but their magnitude and frequency have not been stressed upon. This study was undertaken to assess the prevalence of oral lesions during different trimesters of pregnancy and their correlation with salivary pH change.

METHODS

The gingival, simplified oral hygiene, community periodontal and decayed-missing-filled teeth indices were used to assess a total of 120 pregnant women (40 in each trimester group) and 40 nonpregnant women (control group). Salivary pH was measured using a digital pH meter. Presence of any oral lesions was determined via oral examination.

RESULTS

Scores for all indices increased while salivary pH decreased from the control group to the first trimester group, through to the third. Oral lesions were seen in 44.2% of pregnant women. Lesions were seen in 27.5%, 52.5% and 52.5% of women in the first, second and third trimesters, respectively. The percentage of pregnant women with one oral lesion was highest in the second trimester (47.5%), whereas the third trimester had the highest prevalence (17.5%) of two concurrent oral lesions. The incidence of fissured tongue was highest in the first trimester group, and that of gingival enlargement was highest in the third trimester group. In the second trimester group, there was an almost equal incidence of fissured tongue and gingival/mucosal enlargement.

CONCLUSION

Most changes in oral tissues during pregnancy can be avoided with good oral hygiene. Salivary pH could be used to assess the prevalence of oral lesions in the different trimesters of pregnancy.     

一氧化碳中毒患者电解质改变的分析

目的通过检测CO中毒患者血浆中电解质浓度情况,了解当CO中毒时患者电解质的浓度改变的规律及临床意义。方法统计2003年11月至2004年2月期间在我院61例CO中毒患者抢救时检测血钾、钠、氯、钙离子及二氧化碳姑合力(CO2CP)五项浓度,将其与健康体检者进行对比,用SFSS统计学软件进行分析。结果CO中毒患者电解质中钾、钠、钙离子浓度及二氧化碳结合力值普遍出现不同程度降低(P<0.01),而氯离子及阴离子隙(AG)值没有明显改变(P>0.05)。结论CO中毒患者电解质浓度改变与机体一系列病理生理过程有关,治疗CO中毒患者时,在防治代谢性酸中毒的同时应及时控制其电解质紊乱情况。     

急性一氧化碳中毒继发脑梗死20例临床分析

目的探讨急性一氧化碳中毒继发脑梗死诊治的最佳方法。方法回顾总结我院2007年12月—2009年12月收治的20例急性一氧化碳中毒继发脑梗死的患者,入院后给予吸氧、高压氧治疗,同时按缺血性脑血管病给予减轻脑水肿、保护脑细胞、抗凝、抗自由基以及营养神经等综合治疗,防治脑水肿,防止并发症和后遗症的发生。结果治愈12例,6例留有不同程度的后遗症,死亡2例。结论入院后及时进行针对脑水肿的脱水治疗以及高压氧疗至关重要,脑CT、MRI动态观察,是早期发现急性一氧化碳中毒患者并发脑梗死的关键。     

急性液化石油气中毒的临床特征研究

目的 加深对急性液化石油气中毒（ALPGT）的认识，为ALPGT的实验研究提供临床资料。方法 对29例急性液化石油气中毒的临床及影像学资料进行分析，探讨其表现、预后、影像学改变与急性一氧化炭中毒的差异。结果本组病例均在意识障碍恢复后立即出现持续的神经精神症状，表现为明显的认知功能障碍及精神行为异常。头颅MRI改变以双侧大脑皮质对称性异常信号为主，不同于急性一氧化碳中毒以双侧基底节及皮层下白质损害为主。大脑皮质的损害范围与认知障碍的程度相关。结论 急性液化石油气中毒对高级神经功能损害更严重，近期预后差。     

Clinics in diagnostic imaging (166)

A 68-year-old woman with poorly controlled diabetes mellitus presented to the emergency department with choreoathetoid movements affecting the upper and lower left limbs. Computed tomography of the brain did not show any intracranial abnormalities. However, subsequent magnetic resonance (MR) imaging of the brain revealed an increased T1 signal in the right basal ganglia, raising the suspicion of nonketotic hyperglycaemic chorea-hemiballismus. Management consisted of adjusting her insulin dose to achieve good glycaemic control. The patient subsequently recovered and was discharged after eight days. There are many causes of basal ganglia T1 hyperintensity, including hyperglycaemia in patients with poorly controlled diabetes mellitus. This case emphasises the importance of MR imaging in the early diagnosis of hyperglycaemia as a cause of chorea-hemiballismus, to enable early treatment and a better clinical outcome.     

骨髓间充质干细胞对大鼠急性一氧化碳中毒脑损伤的作用及机制研究

 目的  观察骨髓间充质干细胞(MSCs)对大鼠急性一氧化碳（CO）中毒脑损伤的作用并探讨其机制。  方法 体外培养MSCs并标记,制备MSCs悬液;100～150mL/kg腹腔注射CO建立动物模型,随后将标记5-溴脱氧尿嘧啶(Brdu)的MSCs经颈内动脉移植入脑损伤的大鼠体内;采用Morris水迷宫实验检测大鼠神经系统功能;采用免疫组化、尼氏染色方法检测海马损伤区细胞变化。  结果 MSCs在脑内存活并减少神经细胞凋亡,促进神经细胞结构和功能恢复。MSCs移植1、4周后,MSCs组大鼠水迷宫实验显示空间学习能力有所提高,脑组织损伤明显改善(P＜0.05)。 结论 MSCs移植治疗大鼠CO中毒后的脑损伤具有较好的疗效。     

依达拉奉对一氧化碳中毒迟发性脑病小鼠脑细胞凋亡及相关基因表达的影响

目的：观察自由基清除剂依达拉奉对CO中毒迟发性脑病（ DNS）小鼠细胞凋亡及相关基因表达的影响。方法雄性昆明小鼠72只,18～22 g,随机分为对照组、中毒组、生理盐水组和依达拉奉组,一氧化碳腹腔注射建立一氧化碳中毒迟发性脑病的模型。染毒后5～21 d生理盐水组腹腔注射生理盐水,依达拉奉组腹腔注射依达拉奉,治疗结束后处死动物每组用免疫组化检测脑组织神经细胞的Bcl-2、Bax蛋白表达。应用流式细胞仪法检测脑凋亡细胞。结果与中毒组（38.5±0.58）及生理盐水组（36.5±0.46）比较,依达拉奉组（24.5±0.48）神经细胞凋亡显著减少（P＜0.05）;凋亡调控基因Bax/Bcl-2值明显降低（P＜0.05）。结论依达拉奉注射液对CO中毒迟发性脑病的脑保护作用机制可能与干预脑细胞凋亡相关基因表达并减少神经细胞凋亡有关。     

一氧化碳中毒及迟发脑病合并临床脑卒中1例分析

脑卒中患者合并一氧化碳（CO）中毒时,易造成后者的漏诊与误诊。本资料报道1例存在无症状脑梗死病理基础的患者发生CO中毒后,仅简单依据不对称神经体征及颅脑CT局限病灶诊断为“脑梗死”,而未按CO中毒作及时处理。此患者随后出现了CO中毒迟发性脑病的临床表现,印证了CO中毒之诊断。现从脑功能储备的角度,探讨无症状脑梗死伴发合并症（CO中毒）的病理及临床转归特点,以期提高对此类病例的诊治水平。     

急性一氧化碳中毒对大鼠脑红蛋白的影响

目的探讨急性一氧化碳中毒对大鼠脑红蛋白的影响,为一氧化碳中毒的防治提供理论依据。方法健康雄性SD大鼠20只随机分为对照组和一氧化碳染毒组,每组10只。染毒组按60ml/kg体重腹腔注射一氧化碳,每周一次,注射4周。对照组注射等量的空气。染毒结束后进行神经行为学测试包括旷场试验、甩尾试验和后肢撑力试验,同时检测大鼠海马、皮质、小脑中脑红蛋白的变化。结果一氧化碳中毒后大鼠在中央格停留时间明显增加,修饰次数、直立次数和大小便次数也较对照组明显增加,穿格次数明显减少;甩尾时间比对照组明显延长、后肢展开距离增加明显,差异有统计学意义。此外CO染毒大鼠皮质和小脑中的NGB含量增加,而海马中的NGB呈下降的趋势。结论一氧化碳中毒致脑组织脑红蛋白含量变化,这可能参与了CO中毒致神经损伤的机制。