甘露醇对高血压性脑出血早期血肿扩大的影响

目的探讨自发性脑出血早期应用甘露醇与血肿扩大的关系,探讨应用甘露醇的时机。方法选择85例幕上性非丘脑性高血压性脑出血患者,40例在发病24h内应用甘露醇125mL静滴,q6h~q12h,45例在发病24h内不应用甘露醇等脱水药物。结果发病24h内应用甘露醇组发生早期血肿扩大16例,未用甘露醇组3例,2组比较有显著差异(P0.05)。结论小到中等量脑出血患者,发病24h内开始应用甘露醇可增加早期血肿扩大的发生率,加重病情,而24h后开始使用甘露醇则血肿扩大较少,故脑出血早期不可盲目、仓促地使用甘露醇。     

水蛭素和重组链激酶联合应用于脑出血血肿腔中的实验研究

目的研究水蛭素和重组链激酶联合应用于脑内出血(ICH)血肿腔中对血肿周围脑组织的影响.方法 72只SD雄性大鼠制成ICH模型,随机分为对照组、重组链激酶组、水蛭素 重组链激酶组(联合组),各组分别在ICH后8 h、16 h、24 h、48 h向血肿腔中注入生理盐水、重组链激酶、或重组链激酶加水蛭素.ICH后72 h处死大鼠,观察脑组织中的含水量、Na 、K 以及血脑屏障通透性的变化.结果在ICH后8 h、16 h、24 h、48 h应用重组链激酶,可引起脑组织含水量增加以及Na 、K 的变化(P<0.05),在ICH后8 h重组链激酶组,脑组织中伊文思蓝(Evans blue,EB)含量明显升高(P<0.05).联合组与重组链激酶组比较脑组织的含水量在8 h、16 h、24 h、48 h明显降低(P<0.05),脑组织中EB含量在8 h、16 h、24 h、48 h也明显降低(P<0.05).结论 ICH血肿腔内单独应用重组链激酶可加重ICH血肿周围脑组织的损伤,联合应用水蛭素不但可防治重组链激酶溶化血块时对脑组织的损伤,而且还可降低血肿本身所释放的毒性物质所引起的脑水肿及血脑屏障的破坏.     

大鼠脑出血后基质金属蛋白酶的动态表达及七叶皂苷钠对其表达的影响

目的 观察大鼠脑出血(ICH)后基质金属蛋白酶-2( MMP-2)、MMP-9蛋白动态表达及其与血肿周围脑组织含水量的关系,以及观察七叶皂苷钠对MMP-2、MMP-9表达的影响.方法 Wistar大鼠250只随机分为4组:正常对照组10只、假手术组、ICH组和七叶皂苷钠治疗组各80只,于制模后6 h、12 h、24 h、48 h、72 h、120 h、7 d、15 d 8个时间点,测定各组血肿周围脑组织含水量、MMP-2和MMP-9的蛋白表达.结果 治疗组神经功能缺损较ICH组明显改善,尤以6 h～7 d时明显(P<0.01～0.05);6～120 h各治疗组血肿周围脑组织含水量较ICH组明显减少(P<0.01～0.05);ICH后MMP-2蛋白表达在6 h达到高峰,12 h时下降,与正常对照组相比具有统计学意义 (均P<0.01),治疗组MMP-2蛋白表达在各时间点较ICH组明显减少(均P<0.01);ICH后MMP-9蛋白表达在6 h开始上升,24～48 h达高峰,72 h时下降,与正常对照组相比,具有统计学意义(均P<0.01),其表达水平与血肿周围脑组织含水量呈正相关 (r=0.949, P<0.05);治疗组MMP-9蛋白表达在各时间点较ICH组明显减少(均P<0.01).结论 大鼠ICH后MMP-2、MMP-9蛋白的表达是ICH后早、中期脑水肿形成主要因素,七叶皂苷钠能降低MMP-2、MMP-9蛋白表达和脑组织含水量,对ICH具有保护作用.     

高血压脑出血早期降压对血肿扩大的影响

目的探讨高血压脑出血患者早期降压对血肿扩大的影响。方法 2008-03-2010-05我院急诊入院高血压ICH患者120例,随机分为早期强化降压组和指南标准降压组,早期强化降压组给予呋塞米、硝普钠强化降压,指南标准降压组按照指南降压治疗。观察治疗24h后2组血肿体积的变化情况。结果早期强化降压组发病1～24h平均收缩压控制为148mm Hg,24h内血肿体积扩大5例（8.3%）;标准血压组平均收缩压控制为172mmHg,24h内血肿体积扩大11例（18.3%）,早期强化降压组血仲体积扩大发生率明显小于标准血压组,差异有统计学意义（P〈0.05）。结论对高血压ICH患者早期强化降压可减少血肿扩大的发生率,改善预后。     

高血压脑出血血肿扩大相关因素分析

目的通过对比分析明确幕上高血压脑出血血肿扩大的危险因素。方法将幕上高血压脑出血患者313例,根据是否存在血肿扩大,分为血肿扩大组和非血肿扩大组,明确血压、早期使用甘露醇、血肿特点、发病时搬动与血肿扩大的关系。结果 (1)血肿扩大组入院时收缩压200mmHg者占40.34%,非血肿扩大组占12.37%;血肿扩大组入院时舒张压110mmHg者占57.14%,非血肿扩大组占26.80%,两组比较,血肿扩大组血压明显高于非血肿扩大组,差异显著(P0.01)。(2)血肿扩大组早期(发病6h内)使用甘露醇者占85.71%,非血肿扩大组占54.12%,差异显著(P0.01)。(3)血肿扩大组丘脑出血占38.66%,显著多于非血肿扩大组的26.28%(P0.05);血肿扩大组出血量20ml者58.82%,显著高于非血肿扩大组的16.50%(P0.01);血肿扩大组血肿形态不规则者93.28%,显著高于非血肿扩大组的61.34%(P0.01)。(4)血肿扩大组存在搬动史者57.98%,非血肿扩大组41.75%,差异显著(P0.01)。结论血压升高(收缩压200mmHg和/或舒张压110mmHg)、发病早期(6h内)使用甘露醇、丘脑出血、出血量大于20ml、血肿形态不规则、发病早期存在搬动是脑出血血肿扩大的危险因素。     

高血压脑出血患者血肿周围血-脑屏障葡萄糖转运蛋白1表达的研究

目的观察高血压脑出血(ICH)患者血肿周围血-脑屏障葡萄糖转运蛋白1(GLUT1)表达的变化。方法采用免疫组化方法检测28例高血压ICH患者不同病程血肿周围脑组织GLUT1的表达情况。结果与对照组相比,ICH组发病12 h GLUT1表达开始增强,24 h、48 h表达最强(均P<0.01);72 h表达明显下降(P<0.01)。结论ICH早期血肿周围GLUT1表达增多,有助于恢复脑的能量代谢。     

血浆c-Fn与原发性脑出血早期血肿扩大关系的初步研究

目的探讨原发性脑出血(ICH)患者血浆中细胞纤维连接蛋白(c-Fn)浓度与早期血肿扩大(EHG)的关系。方法入选发病6h内ICH患者59例,健康对照30例。用酶联免疫吸附法(ELISA)测定血浆c-Fn浓度,根据发病后颅脑CT扫描及(24±3)h的第2次CT测定的血肿容量和血肿扩大情况分组。结果 19例患者发生血肿扩大,血肿扩大组血浆c-Fn浓度高于相同血肿容量非血肿扩大组。结论 ICH早期(6h)血肿扩大患者外周血血浆c-Fn浓度高于非血肿扩大患者。     

实验性脑出血血肿周围脑组织基质金属蛋白酶组织抑制剂-1的表达及其与脑水肿的关系

目的探讨实验性脑出血(ICH)血肿周围脑组织基质金属蛋白酶组织抑制剂-1(TIMP-1)的表达及其与脑水肿的关系。方法采用自体血注入法建立大鼠ICH模型,制模后1h、3h、6h、12h、24h、36h、48h、72h、7d共9个时间点分别用干湿重法测血肿周围脑组织含水量,伊文思蓝(EB)检测血-脑屏障(BBB)通透性,Western Blot方法检测血肿周围组织的TIMP-1的表达;分析三者间的关系,并与假手术组相比较。结果与假手术组比较,ICH后各时间点血肿周围脑组织含水量和EB含量均明显增加(P<0.05～0.01),均于ICH48h达到高峰,且二者呈正相关(r=0.940,P<0.01);TIMP-1在ICH12～36h表达明显减低,ICH1～24h TIMP-1表达量与脑组织含水量以及EB含量呈负相关(r=-0.922,-0.950,均P<0.05)。结论大鼠ICH后血肿周围脑组织TIMP-1表达下调,可能促进了ICH早期的脑水肿形成。     

脑出血早期血肿扩大危险因素的研究进展

脑出血具有较高发病率、病死率、致残率的特点.早期血肿扩大是其不良预后的重要危险因素,预防早期血肿扩大成为近年来研究的热点.目前已经确认一系列脑出血血肿扩大的危险因素,本研究总结了最新进展,并将其分为4类:临床特征(意识障碍的严重程度、血压、血糖)、实验室参数(凝血及其他炎症相关因子)、影像学(CTA征象)和预测评分量表(9 点或24 点临床预测算法、PREADICT A/B、HEAVEN评分、NAG评分及BAT评分).脑出血(Intracerebral Hemorrhage,ICH)约占所有脑卒中的10%~30%,其发病率和病死率均高于缺血性脑卒中.血肿扩大(Hematoma expansion,HE)是近1/3的ICH 患者在入院后24~48 h内发生早期神经功能恶化和长期临床结局不良的重要危险因素之一[1-2].HE一般发生在发病初始6 h以内,尤其是发病2~3 h以内.血肿体积每增加10%,死亡风险比就会增加5%.绝对体积每增加1 mL,临床结局产生生活依赖的几率就会增加7%[3].因此,探讨ICH早期血肿扩大的危险因素及治疗对临床实践有着重要的意义.     

早期应用甘露醇对高血压脑出血血肿的治疗作用

目的探讨高血压脑出血血肿扩大与甘露醇注射液治疗的关系。方法选择120例高血压脑出血患者,随机分为3组,A组于入院即开始给予250mL甘露醇注射液静滴,q12h;B组入院12h后开始给予250mL甘露醇注射液静滴,q12h;C组入院12h后开始给予125mL甘露醇注射液静滴,q12h。对比治疗前和治疗48h后CT检查结果,比较血肿扩大情况。结果 3组血肿扩大发生率分别为37.5%(15例)、22.5%(9例)和7.5%(3例)。相比入院立即给予甘露醇注射液(A组),入院12h后开始给予(B组)能够明显减少血肿扩大的发生(P<0.05),但降低甘露醇的给药剂量(C组)并不能明显减少血肿扩大的发生(P>0.05)。结论甘露醇注射液对高血压脑出血患者血肿扩大有影响,入院12h后可减少血肿扩大的发生。     

Nervenkitt: notes on the history of the concept of neuroglia

The evolution of concepts concerning the identity and the functions of neuroglia is traced. Some of the main ideas in the works of Virchow, Deiters, Golgi, Lenhossék, Lugaro, Ramón y Cajal, del Río-Hortega, Achúcarro, Penfield, and others are highlighted.     

Effects of Family Interventions on Burden of Relatives of Psychiatric Patients in The Netherlands: A Pilot Study

In this study, the effects of psychoeducational family support groups in the Netherlands on relatives' burden were investigated, using a quasi-experimental design. The experimental group consisted of 119 participants of 19 family support groups, the control group of 45 relatives of once-only informational meetings. Subjects from both groups filled in a questionnaire before the group started and one year later. While controlling for confounding variables in multiple regression analyses, significant effects of family support groups were found on elements of burnout and burden.     

Psychology in Cognitive Science: 1978–2038

This paper considers the past and future of Psychology within Cognitive Science. In the history section, I focus on three questions: (a) how has the position of Psychology evolved within Cognitive Science, relative to the other disciplines that make up Cognitive Science; (b) how have particular Cognitive Science areas within Psychology waxed or waned; and (c) what have we gained and lost. After discussing what’s happened since the late 1970s, when the Society and the journal began, I speculate about where the field is going.     

Outcome and neurological sequelae of patients after tetanus

From 1969-1985, 106 people contracted tetanus in Finland. The outcome of the disease was good in 78 cases (returned to work), poor in 27 (12 died, 5 institutionalized and 10 retired) and unknown in 1. Poor outcome was the result of a disease requiring respirator treatment. Other clinical factors significantly correlated with poor outcome were blood pressure lability, hyperglycemia, hyperthermia, tachycardia and anticoagulation therapy. Forty people who were representative of the whole series with regard to sex, age and severity of disease attended a follow-up study on average 7 years and 4 months later. Forty age- and sex-matched controls had the same examinations, and compared with them, the 40 patients still had significantly more muscle fatigue and cramps, nervousness, decreased mental capacity and difficulties in balance, speech and memory. They also had more clinical findings, such as peripheral paresis, muscular atrophy, decreased or absent tendon reflexes and decreased mental capacity than the controls.     

头痛严重程度对偏头痛患者生活质量的影响

目的 探讨头痛严重程度对偏头痛患者生活质量的影响.方法 根据头痛严重程度将84例偏头痛患者分为轻、中、重度3组,采用生活质量综合评定问卷-74(GQOLI-74)对患者进行测试.结果 轻、中、重度3组偏头痛患者在躯体不适感、进食功能、工作与学习、婚姻与家庭方面评分的平均值差异均有统计学意义(均P＜0.05),其余牛活质...     

Italian neurology: past, present and future

This short history of the Italian Society of Neurology focuses on its founders and leading personalities. The article also considers the present and the future of Italian neurology, emphasising in particular the scientific impact of Italian neurological research on the main international journals and the activities undertaken to increase the role of neurologists.     

Perceptual Pragmatism and the Naturalized Ontology of Color

This paper considers whether there can be any such thing as a naturalized metaphysics of color—any distillation of the commitments of perceptual science with regard to color ontology. I first make some observations about the kinds of philosophical commitments that sometimes bubble to the surface in the psychology and neuroscience of color. Unsurprisingly, because of the range of opinions expressed, an ontology of color cannot simply be read off from scientists’ definitions and theoretical statements. I next consider two alternative routes. First, conceptual pluralism inspired by Mark Wilson's analysis of scientific representation. I argue that these findings leave the prospects for a naturalized color ontology rather dim. Second, I outline a naturalized epistemology of perception. I ask how the correctness and informativeness of perceptual states is understood by contemporary perceptual science. I argue that the detectionist ideal of correspondence should be replaced by the pragmatic ideal of usefulness. I argue that this result has significant implications for the metaphysics of color.     

The use of quality of life data at the organization and systems level

Background To date researchers have given little attention to the use of quality of life (QOL) data for organization and systems-level change. This article presents two state-level examples of how QOL data are currently used in the USA. Method Individuals with intellectual disability (ID) were assessed on an ongoing basis using two multidimensional QOL instruments. Data were analysed at the individual and organizational level. Results Examples of statewide data utilization include: (1) determining significant predictors of quality outcomes; (2) developing provider profiles; (3) comparing individuals with ID with those without ID; (4) developing state-level performance standards; and (5) implementing continuous programme improvement. Conclusions The availability of this type of data allows service delivery systems to: (1) significantly alter the relationship between individual consumers and service providers; (2) open the system to scrutiny by citizens with and without ID; (3) improve responsiveness and quality outcomes; and (4) shape future directions of the service delivery system for people with ID.