短暂性脑缺血发作后短期内发生脑梗死的风险分析

目的分析ABCD2评分结合MRA对短暂性脑缺血发作(TIA)后7~30d脑梗死发生的评估价值。方法以2008年12月~2009年10月住院的TIA患者为研究对象,收集其临床资料和磁共振血管成像(MRA)检查结果,按Johnston提出的7分"ABCD2"评分法给予评分,随访TIA后7d和30d内脑梗死的发生率,并分析"AB-CD2"评分、MRA与TIA后短期内发生脑梗死的关系。结果 50例(42.0%)TIA患者于30d内发生脑梗死,其中29例(24.4%)发生于7d内;"ABCD2"评分与TIA后7d和30d脑梗死发生率之间呈直线相关,"ABCD2"评分越高,脑梗死的发生率越高(P0.001);TIA后7d和30d颅内动脉狭窄≥50%的患者中脑梗死发生率比50%的患者明显增高(P0.05)。结论 "ABCD2"评分法对TIA后脑梗死发生有预测价值,"ABCD2"评分结合MRA检查能进一步提高预测的准确性。     

ABCD2评分结合管腔狭窄程度对TIA发展为脑梗死的预测价值

目的 探讨ABCD2评分结合颈内动脉粥样硬化(ICAS)所致管腔狭窄程度对短暂性脑缺血发作(TIA)后7d内发展为脑梗死的预测价值. 方法 选取北京水利医院神经内科自2008年9月至2011年3月收治的171例TIA患者作为研究对象,应用ABCD2评分法进行评分,彩色多普勒超声检查ICAS所致管腔狭窄程度,筛选出TIA发生后7d内发生脑梗死的患者并分析ABCD2评分、管腔狭窄程度对脑梗死发生率的影响. 结果 TIA后7d内发生脑梗死者39例(22.8％);ABCD2评分、颈内动脉狭窄程度不同患者脑梗死发生率不同,差异有统计学意义(P＜0.05).中危组、高危组患者TIA后7d脑梗死发生率高于低危组,中度狭窄组和重度狭窄或闭塞组脑梗死发生率高于与正常或轻度狭窄组,差异均有统计学意义(P＜0.05). 结论 ABCD2评分、ICAS所致管腔狭窄程度可以影响TIA后7d内脑梗死的发生,两者结合对于TIA后7d内发展为脑梗死更有预测价值.     

短暂性脑缺血发作患者短期发生脑梗死的危险因素分析

目的分析短暂性脑缺血发作(TIA)患者7d和30d内进展为脑梗死的危险因素。方法以119例住院TIA患者为研究对象,收集其临床资料和磁共振血管成像(MRA)结果,并按Johnston提出的7分"ABCD2"评分法给予评分,随访发生TIA后7d和30d内脑梗死的发生率。结果 TIA发生后50例(42.0%)患者于30d内发生脑梗死,其中29例(24.4%)发生于7d内。Logistic回归分析发现,症状持续时间≥10min、ABCD2评分≥4分是TIA后7d发生脑梗死的独立危险因素;发作次数≥3次、颅内动脉狭窄≥50%是TIA后30d发生脑梗死的独立危险因素。抗凝治疗是TIA进展为脑梗死的保护因素。结论发作持续时间长、次数多、颅内动脉狭窄重和"ABCD2"评分高的TIA患者短期内脑梗死发生危险性较高,抗凝治疗可使TIA患者有降低脑梗死发生的风险性。     

ABCD2评分法结合CTA预测TIA患者近期卒中风险的临床研究

目的 探讨采用ABCD2评分法对短暂脑缺血发作(TIA)患者短期内进展为脑梗死的预测价值;评价脑血管狭窄与TIA患者脑梗死发生率及ABCD2评分之间的关系.方法 按照Johnston等对TIA的ABCD2评分标准,测定98例TIA患者的评分并危险分组,观察其2、7d内脑梗死的发生率,比较各危险组之间卒中率的差异;通过CTA评估脑血管狭窄,并分为血管狭窄≥50％组与血管狭窄＜50％组,分析脑血管狭窄与2、7d内脑梗死的发生率的关系,评价ABCD2评分与脑血管狭窄之间的相关性.结果 (1)评分≤3分的TIA患者有40例.2、7d发生脑梗死的例数分别为0例(0％)、2例(5％);评分为4～5分的患者46例,2、7d进展为脑梗死的例数分别为4例(8.7％)、11例(23％);评分≥6分的患者12例,2、7d进展为脑梗死的例数分别为3例(25％)、4例(33.3％).不同ABCD2评分值的TIA患者,其脑梗死发生率差异均有统计学意义(P均＜0.05).(2)脑血管狭窄≥50％组与狭窄＜50％组比较,TIA后7d内卒中发生率明显增高,且其脑梗死发生率差异有统计学意义(21.4％ vs 5.6％,P=0.04).(3)血管狭窄≥50％组与狭窄＜50％组比较,中、高危的比率增高(46.4％ vs 19.4％),且其比率增高有统计学意义(P=0.02).结论 (1) ABCD2评分能够预测TIA患者2、7d内卒中发生率,是临床预测TIA短期进展为脑梗死的一种简便、有效的方法.ABCD2评分值不同的TIA患者,脑梗死的发生率不同,分值越高,发生率越高.(2)合并中重度血管狭窄的TIA患者较脑血管无明显狭窄的TIA患者更易发生脑梗死.(3)ABCD2评分与脑血管狭窄具有相关性.     

ABCD2评分及责任血管狭窄对短暂性脑缺血发作进展为脑梗死的预测价值

目的 探讨ABCD2评分与责任血管狭窄对短暂性脑缺血发作(TIA)后脑梗死发生的预测价值. 方法 将焦作市人民医院神经内科自2008年至2011年收治的93例TIA患者根据ABCD2评分分为低危组(20例)、中危组(48例)、高危组(25例),并行DSA检查,根据责任血管狭窄程度分为正常或轻度狭窄(狭窄率＜50％)、中度狭窄(狭窄率50％～69％)、重度狭窄(狭窄率70％～100％).根据Logistic β回归系数分别对ABCD2评分及责任血管狭窄程度进行危险因素赋分,通过线性函数转换建立危险评分系统. 结果 发病7d内低危组脑梗死发生率为5.0％,中危组为10.4％,高危组为36.0％;中、低危组的脑梗死率发生率均明显低于高危组,差异有统计学意义(P＜0.05).65例(69.9％)患者有不同程度的责任血管狭窄或闭塞,其中正常或轻度狭窄54例、中度狭窄22例及重度狭窄17例;中度狭窄组及重度狭窄组脑梗死发生率(27.3％、47.1％)均明显高于正常或轻度狭窄组(1.9％),差异有统计学意义(P＜0.05).基于入院危险因素建立的预测模型性能良好(拟合优度检验P＞0.05,C统计值为0.887).利用危险评分系统成功地将TIA患者分为低危、中危和高危脑梗死组,模型建立数据中患者进展性脑梗死发生率分别为1.9％、25.0％和47.1％. 结论 ABCD2评分及责任血管狭窄程度对TIA患者进展为脑梗死的预测有重要意义.根据ABCD2评分及责任血管狭窄程度建立的预测模型可以早期、方便、准确地预测TIA后脑梗死的发生,开发的预测工具可辅助临床决策的制定.     

颈内动脉系统短暂性脑缺血发作患者颅内血管狭窄程度和ABCD2评分与近期预后的关系

目的探讨颈内动脉系统短暂性脑缺血发作(TIA)患者颅内血管狭窄和ABCD2评分与近期预后的关系。方法对64例颈内动脉系统TIA患者行MRI、MR血管成像(MRA)检查及ABCD2评分,并分析其与近期预后的关系。结果 MRA结果显示,47例(73.4%)患者有不同程度的颅内血管狭窄或闭塞,其中正常或轻度狭窄组37例,中度狭窄组16例及重度狭窄组11例;根据ABCD2评分结果,低危组22例,中-高危组42例。发病7 d内14例(21.9%)发生脑梗死,中度狭窄组(12.5%)及重度狭窄组(7.81%)脑梗死发生率显著高于正常及轻度血管狭窄组(1.6%)(均P<0.05)。中-高危组中重度血管狭窄率及脑梗死发生率显著高于低危组(均P<0.05)。结论颈内动脉系统TIA患者颅内血管狭窄程度及ABCD2评分对TIA的近期预后评估有重要的意义。     

影像学检查对判断短暂性脑缺血发作患者短期预后的价值

目的 探讨影像学检查对判断短暂性脑缺血发作(TIA)患者短期预后的价值.方法 以TIA后90 d内是否发生脑梗死作为短期预后指标,分析76例TIA患者的临床资料、磁共振弥散加权成像(DWI)和磁共振血管成像(MRA)的检查结果与脑梗死发生的关系.结果 本组DWI异常33例(43.4%),MRA显示颅内动脉病变31例(40.8%),DWI及MRA 均异常19例(25%);90 d内12例(15.8%)发生脑梗死,脑梗死发生率在DWI异常者中(10例,30.3%)显著高于DWI正常者(2例,4.7%)(P<0.05);MRA异常者(9例,29%)显著高于MRA正常者(3例,6.7%)(P<0.05).DWI及MRA 均异常者(8例,42.1%)极显著高于影像学检查正常者(1例,3.2%)(P<0.01).结论 DWI和MRA检查有助于判断TIA患者短期预后,发现高危患者并指导临床治疗.     

ABCD2评分结合头颈CTA对短暂性脑缺血发作后近期发生脑梗死的评估价值

目的：分析ABCD2评分结合头颈CT血管成像（CTA）表现对短暂性脑缺血发作（TIA）后7 d患者发生脑梗死的评估价值。方法：以2008年12月至2011年3月住院的120例TIA患者为研究对象,收集相关资料并进行率的χ2检验。结果：31/120例（25.83%）患者在TIA后7 d内发生脑梗死。ABCD2评分≥6分为高危组,ABCD2评分4~5分为中危组,ABCD2评分≤3分为低危组。TIA后7 d脑梗死发生率,CTA颅内外动脉狭窄≥50%的患者中与〈50%的患者相比明显增高（P〈0.01）。结论：ABCD2评分法预测7 d发生脑梗死风险的准确性较高,进一步结合CTA检查能提高预测的准确性。     

ABCD~2评分结合DWI和PWI对TIA后发生脑梗死的预测价值

目的观察ABCD~2评分联合核磁共振弥散加权成像(DWI)和灌注加权成像(PWI)对短暂性脑缺血发作(TIA)后7 d和30 d内发生脑梗死风险的预测价值。方法 247例TIA患者发病后72 h内分别行ABCD~2评分联合头部DWI和PWI检查,随访发病后7 d和30 d脑梗死发生率。结果 247例TIA患者中,7 d和30 d内脑梗死发生率分别为21例(8.5%)和27例(14.8%);ABCD~2危险度分层7 d和30 d内脑梗死发生率低危组中危组高危组(均P0.05);DWI和PWI阳性且ABCD~2≥4分组显著高于DWI、PWI阴性组且ABCD~24分(均P0.05);DWI和PWI阳性组与DWI和PWI阴性组在各ABCD~2评分因素方面差异均有统计学意义(P0.05);Logistic回归分析表明ABCD~2评分中高危、DWI阳性和PWI阳性为TIA后发生脑梗死的独立危险因素。结论 ABCD~2联合DWI和PWI评分对预测TIA后7 d和30 d内脑梗死的发生风险具有重要的价值。     

短暂性脑缺血发作患者ABCD2评分与脑血管狭窄相关性初步研究

目的 评价短暂性脑缺血发作（transient ischemic attack,TIA）患者ABCD2评分和脑血管狭窄之间的关系。方法 回顾性研究了88例TIA患者ABCD2评分和颅脑磁共振血管成像（magnetic resonance angiography,MRA）影像资料,根据ABCD2评分分为评分≥4分组和评分＜4分组,根据MRA评估分为血管狭窄≥50%组和狭窄＜50%组,评价ABCD2评分与脑血管狭窄之间的相关性。结果 血管狭窄≥50%组与狭窄＜50%组比较,ABCD2评分≥4分的比率增高[74.4% vs 44.9%,比值比（odds ratio,OR）3.559,95%可信区间（credibility interval,CI）1.428～8.868,P =0.005];既往有卒中病史的患者比率增高（33.3% vs 10.2%,OR =4.400,95%CI 1.408～4.869,P =0.01）;脑血管狭窄≥50%组与狭窄＜50%组比较,前者TIA后2d内卒中发生率明显增高（10.3% vs 0%,OR =0.417,95%CI 0.324～0.537,P =0.04）。结论 ABCD2评分≥4分MRA示颅内血管狭窄率高,既往有卒中病史的TIA患者颅内血管狭窄率增高,颅内血管狭窄≥50%TIA后2d内发生卒中的风险增高。     

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.