Bell''''s面瘫急性期的电针综合治疗

Bell’s面瘫．又称特发性周围性面神经炎，是指因颈乳突孔内急性非化脓性面神经炎所引起周围性面神经麻痹的一种疾病。相当于中医学的“面瘫”范畴，是临床常见病、多发病，也是世界卫生组织较早认定的针灸适应治疗的43种疾病之一。但是，临床是否能在急性期进行针灸，特别是能否进行电针等强刺激的治疗存有很大的争论。本研究对在我院采用电针刺患侧面部治疗的急性期Bell’s面瘫患者与未采用针刺治疗患者的治疗后果及其后遗症情况进行了比较研究。     

颅脑损伤脱水治疗近红外实时监测与评估研究

利用近红外光谱技术实时监测与评估大鼠颅脑损伤脱水治疗效果。采用Feeney’s自由落体法建立大鼠颅脑损伤模型,然后使用不同剂量甘露醇进行脱水治疗,并采集伤后及治疗过程中优化散射系数(μ′s)和颅内压(ICP)的值。结果显示,伤后1h大鼠脑组织发生水肿,伤后72h左右达到峰值,之后开始逐渐减小。注射甘露醇的治疗组μ′s与ICP值在给药后均下降,大剂量甘露醇(2g/kg)平均下降幅度大,平台期持续时间长,总体下降情况更为明显。由此我们得到结论:μ′s和ICP的变化趋势一致,可以代替ICP作为监测脑水肿的参数。     

颅底多孔道蔓延的海绵窦原发性硬脑膜淋巴瘤1例

患者男性,68岁,2020年1月4日因“左眼胀痛伴面部麻木疼痛1个月”于南通大学附属东台医院就诊。患者自觉左眼有轻度视力下降。既往史无特殊。体格检查：神志清楚,浅表淋巴结未触及肿大,格拉斯哥昏迷评分（Glasgow coma scale,GCS）15 分。左眼睑下垂,双瞳孔等大等圆,对光反射灵敏,双侧视乳头边界清、无出...     

不同剂量肝素在血液灌流治疗农药中毒中的应用

目的 分析血液灌流治疗农药中毒中肝素的用量。方法 选取2017年1月~2018年12月我院重症医学科收治的农药中毒患者116例,按照肝素使用剂量的不同分成两组,其中采用首剂量0.5 mg/kg者63例设为A组,采用首剂量8 mg/kg者53例设为B组,比较两组不同时间段血小板计数、APTT指标以及出血发生率。结果 两组治疗前及治疗后24、48、72 h血小板计数指标比较,差异均无统计学意义（P＞0.05）;治疗后4 h,B组血小板计数为（150.92±23.83）×109/L,低于A组的（178.73±39.18）×109/L,差异有统计学意义（P＜0.05）;两组治疗前后48、72 h APTT比较,差异均无统计学意义（P＞0.05）;治疗后A组4、24 h APTT较B组延长,差异有统计学意义（P＜0.05）;B组出血发生率为5.67%,低于A组的22.22%,差异有统计学意义（P＜0.05）。结论 农药中毒患者血液灌流治疗中肝素首剂量采用8 mg/kg,效果较好,对血液抗凝效果较好,出血率低。     

85例昏迷患者病因诊断及救治

自1998年1月～2000年12月,急诊收治昏迷病人共85例。本文就其昏迷原因及救治进行探讨,以期进一步提高对昏迷病人病因的诊断,及时提出救治办法,缩短昏迷时间,减少并发症,挽救病人生命。 一、临床资料 1.一般资料:男性45例,女性40例,年龄17～73岁,昏迷时间2～72h不等,既往有慢性器质性疾病者60例,既往身体健康者25例。80名患者(94.11％)病因明确,5名患者(5.89％)病因不明确。     

电针对酒精性周围神经病大鼠NGFmRNA受体的表达

目的：通过酒精自由饮建立慢性酒精中毒性大鼠周围神经病变模型,从细胞分子生物学等不同层面探讨电针对慢性酒精中毒型周围神经病的作用机制,为针灸治疗慢性酒精中毒性周围神经病的临床应用提供新的理论依据。方法成年雄性WISTAR大鼠50只,体重200~250 g,随机分成5组,慢性酒精中毒模型组10只,弥可保对照组10只,电针组10只,针刺组10只,空白对照组10只。结果正常坐骨神经的NGFmRNA表达量极低,酒精中毒损伤后坐骨神经NGFmRNA表达明显增高；2~4 w NGFmRNA的表达出现一轻度回落趋势,但4 w后又继续升高。针刺治疗后,治疗组的NGFmRNA表达较模型组均有不同程度升高,其中电针组升高幅度最为明显,始终处于高水平。结论电针可升高酒精中毒性大鼠坐骨神经中NGFmRNA的含量     

苯二氮革类药物治疗慢性酒精中毒伴精神障碍32例临床分析

目的 探讨慢性酒精中毒伴精神障碍患者应用苯二氮(草)类药物治疗的效果.方法 根据患者及其家属自愿情况,将患者随机分为对照组与观察组;对照组选用氯丙嗪控制精神症状,观察组用苯二氮(草)类药物(选用地西泮)对症治疗;两组都给予维生素及心理治疗.结果 对照组与观察组临床症状、认知功能、生活质量、住院天数比较,治疗前PANSS...     

大剂量维生素B6加升自安治疗化疗后自细胞减少46例临床观察

化学治疗(化疗)是目前治疗急性白血病(急白)的主要方法。而化疗可导致严重的白细胞减少．从而诱发严重的感染，影响化疗的效果，增加急白患早期的死亡率。我院自1993年1月-1996年12月，采用大剂量维生素B6加升白安治疗因化疗引起的白细胞减少的急白患，取得了较蒲意的效果。     

慢性酒精中毒性周围神经病患者的临床与神经电生理研究

目的:探讨神经电生理检测对慢性酒精中毒性周围神经病的诊断价值.方法:对49例慢性酒精中毒患者进行电生理检查,观察肌电图(EMG)、运动神经传导速度(MCV)和感觉神经传导速度(SCV)的变化情况.结果:49例患者EMG检测综合判断提示神经原性损害.MCV及SCV较对照组有不同程度的减慢(P＜0.01);下肢神经病变重于上肢,感觉神经病变重于运动神经.15例双上肢无临床症状的患者中8例尺神经SCV有改变.结论:神经电生理检测为慢性酒精中毒性周围神经病的临床诊断,特别是早期诊断提供了客观依据.     

维生素K1缺乏出血15例临床分析

目的探讨近3a来婴幼儿维生素K1缺乏痘的发病情况,提高农村地区及基成医院医生对本病的认识,加强预防。方法分析近3a来15例本地区婴幼儿晚发性维生素K1缺乏症的临床资料。结果15例婴儿日龄为15-55d,全部为农村地区,母乳喂养,10例当地卫生院接生。均未进行维生素K1预防,5例城镇医院出生,进行维生素KI预防注射。结论农村婴儿单纯母乳喂养本病发生率较高,与早期未预防性应用维生素K1有很大关系,早期预防性应用维生素K1,及时诊断,减少发病率,早期发现,合理的治疗对提高治愈率、减少病死率和后遗症发生率有重要临床意义。     

Hepatic encephalopathy and cerebral blood flow improved by liver dialysis treatment

Eight acute liver failure patients, all in grade IV hepatic encephalopathy, were administered liver dialysis treatment with the Hemo Therapies Unit (Hemo Therapies Inc, San Diego, CA, USA). The patients were evaluated to determine whether the Glasgow Coma Scale score and cerebral blood flow improved with treatment. After the initial treatment, consciousness levels as measured by the Glasgow Coma Scale improved from a pre-treatment median of 5 (range 3 to 6) to a post-treatment median of 7 (range 5 to 9) (p=0.0005 by paired Wilcoxon test); mean blood flow velocity in the middle cerebral arteries as shown by transcranial Doppler sonography increased from a median of 37.85 cm/sec (range 20.3 to 114.0) to 57.90 (32.5 to 135.0) post-treatment (p=0.022); however, there was no significant change in the pulsatility index from a median of 1.18 (range 0.61 to 1.71) to 0.85 (range 0.70 to approximately 1.79) post-treatment (p=0.13). The 8 patients received 2 to 7 (median 5.5) times of daily 6-h liver dialysis treatments. Following the completion of all liver dialysis treatments, hepatic coma was fully resolved in 4 of 8 patients (50%) Three of 8 patients (37.5%) survived to hospital discharge, whereas 5 patients did not survive due to irreversible liver function and associated complications. In conclusion, liver dialysis treatment could improve hepatic encephalopathy, but the prognosis still depended on the underlying diseases.     

Comparison of outcome predictions by the Glasgow coma scale and the Full Outline of UnResponsiveness score in the neurological and neurosurgical patients in the Intensive Care Unit

Assessment of level of consciousness is very important in predicting patient''s outcome from neurological illness. Glasgow coma scale (GCS) is the most commonly used scale, and Full Outline of UnResponsiveness (FOUR) score is also recently validated as an alternative to GCS in the evaluation of the level of consciousness. We carried out a prospective study in 97 patients aged above 16 years. We measured GCS and FOUR score within 24 h of Intensive Care Unit admission. The mean GCS and the FOUR scores were lower among nonsurvivors than among the survivors and were statistically significant (P < 0.001). Discrimination for GCS and FOUR score was fair with the area under the receiver operating characteristic curve of 0.79 and 0.82, respectively. The cutoff point with best Youden index for GCS and FOUR score was 6.5 each. Below the cutoff point, mortality was higher in both models (P < 0.001). The Hosmer-Lemeshow Chi-square coefficient test showed better calibration with FOUR score than GCS. A positive correlation was seen between the models with Spearman''s correlation coefficient of 0.91 (P < 0.001).Key words: Coma, consciousness, Full Outline of UnResponsiveness score, Glasgow coma scale     

Acute Marchiafava-Bignami disease: diffusion-weighted MRI in cortical and callosal involvement

Marchiafava-Bignami disease (MBD) is a fatal disorder characterized by demyelination of the corpus callosum. MRI, suggestive of corpus callosum demyelination with associated white matter involvement in both cerebral hemispheres, indicates a diagnosis of MBD. In this case, MR diffusion-weighted findings taken at an acute stage of MBD revealed lesions not only in the corpus callosum but also in the cerebral cortex. Lower apparent diffusion coefficient values of the corpus callosum and cortical lesions were associated with poor clinical outcome.     

Corpus callosum and cerebral laterality in a modular brain model

This paper elaborates the function of corpus callosum in the brain model that contains encoding and modulating axons: the former encode data as presynaptic axonal 'on-off' patterns, and the latter help the former convert data into long-term memory through the development of long-term potentiation and depression. It is hypothesized that callosal axons transfer data codes as interhemispheric memory. Bisection of corpus callosum cuts off interhemispheric data transfer and results in strange-hand syndrome, decreased attention and difficulties in acquiring new interdependent bimanual skills. While uniting two hemispheres for a unitary consciousness, corpus callosum contributes to two similar sets of integrated abstract memory, one in each hemisphere. Therefore, it takes bilateral cerebral lesions to manifest a failure of converting short-term memory into long-term memory. The asymmetric callosal data transfer may correlate with cerebral laterality where a cerebral function, such as language, is conducted mainly in one hemisphere for the benefit of less interhemispheric data-traffic. Complete lateralization of a cerebral function is the rare occasion when the specialized neuron groups (modules) for that function all reside in one hemisphere. It is possible that many cerebral functions including language are incompletely lateralized, and corpus callosum links the non-lateralized modules with the lateralized ones. The more the cerebral lateralization, the fewer the non-lateralized modules to be linked, and the smaller the corpus callosum.     

人参皂苷Rbl对大鼠局灶性脑缺血白质重塑的影响

目的　探讨人参皂苷Rbl(Ginsenoside Rb1,GSRb1)对大鼠局灶性脑缺血白质重塑的影响。 方法　大鼠随机分为假手术组、溶媒处理组和人参皂苷Rbl处理组,采用线栓法建立大鼠大脑中动脉缺血再灌注（middle cerebral artery occlusion/reperfusion, MCAO/R）损伤模型,用LFB染色观察大鼠胼胝体和内囊的髓鞘变化,用免疫组化染色法检测缺血侧胼胝体GFAP和APP的表达以评估星形胶质细胞和轴突的改变。 结果　缺血2 h再灌72 h后,溶媒处理组胼胝体和内囊有明显的髓鞘紊乱、脱失,胼胝体GFAP和APP表达显著增加。与溶媒处理组相比,GSRb1处理组髓鞘脱失有明显改善 (P<0. 01, P<0. 05)且胼胝体GFAP和APP表达显著减少(P<0. 05)。 结论　GSRb1可能促进大鼠局灶性脑缺血后脑白质重塑。     

醒脑静联合盐酸纳洛酮治疗脑出血后昏迷患者的疗效分析

目的 分析醒脑静联合盐酸纳洛酮治疗脑出血后昏迷患者治疗效果。方法 选取我院2015年1月~2017年10月中收治脑出血后昏迷患者68例作为研究对象,随机分为参照组和联合组,每组34例。参照组在常规治疗上加盐酸纳洛酮,联合组在参照组的基础上加用醒脑静配合治疗,将两组GCS分值与脑血肿量变化及NIHSS评分情况进行比较。结果 治疗后联合组的GCS分值（14.24±2.05）分与脑血肿量（17.41±2.44）ml明显优于参照组的（9.87±1.62）分和（25.50±2.42）ml,差异有统计学意义（P＜0.05）;联合组在出院后3个月的NIHSS评分情况（10.01±1.95）分优于参照组（12.50±2.31）分,差异有统计学意义（P＜0.05）。结论 采用醒脑静联合盐酸纳洛酮治疗脑出血后昏迷患者可显著改善脑出血患者的意识障碍,促进神经功能恢复,减轻脑部水肿情况,改善患者临床疗效。     

Intracarotid transplantation of bone marrow stromal cells increases axon-myelin remodeling after stroke

The present study investigates the induction of axon and myelin remodeling as a possible mechanism by which treatment of stroke with bone marrow stromal cells improves neurological functional recovery. Adult male Wistar rats were subjected to 2 h of middle cerebral artery occlusion, followed by an injection of 2 x 10(6) rat bone marrow stromal cells or phosphate-buffered saline into the internal carotid artery 24 h later. Animals were killed at 28 days after stroke. Functional tests, histo- and immunohistochemical staining were performed. Significant functional recovery was found after bone marrow stromal cell administration in all the three tests performed (modified neurological severity score, adhesive-removal and corner tests). Bone marrow stromal cell treatment markedly increased vessel sprouting, synaptophysin expression and NG2 positive cell numbers and density in the cortical peri-infarct area. In bone marrow stromal cell-treated rats, the number of Ki-67 positive proliferating cells and oligodendrocyte precursor cells in the corpus callosum increased significantly in concert with the enhancement of the areas of the corpus callosum in both hemispheres. These results suggest that bone marrow stromal cells facilitate axonal sprouting and remyelination in the cortical ischemic boundary zone and corpus callosum, which may underlie neurological functional improvement caused by bone marrow stromal cell treatment.     

不同昏迷量表和95%频谱边缘频率对急性昏迷患者近期死亡的预测价值

目的 评估不同昏迷量表和中央区95%频谱边缘频率（SEF）预测急性昏迷患者近期死亡的价值。方法 研究对象为2014年8月至2016年10月南通大学附属医院神经内科重症监护病房收治的52例急性昏迷患者。在患者发病72 h内进行格拉斯哥昏迷量表（GCS）、格拉斯哥匹兹堡昏迷量表（GCS-P）、全面无反应性量表（FOUR）评分,同时行脑电图（EEG）监测,记录中央区95% SEF数据。随访1个月,患者分为生存组和死亡组,比较两组年龄、性别、既往史、GCS评分、GCS-P评分、FOUR评分和中央区95%SEF,采用单因素和多因素Logistic回归分析影响近期死亡的相关因素。采用受试者工作特征（ROC）曲线比较GCS评分、GCS-P评分、FOUR评分和中央区95%SEF对近期死亡的预测价值。采用McNemar χ²检验对GCS评分、GCS P评分、FOUR评分联合中央区95%SEF与单独使用上述评分在预测近期死亡的敏感性和特异性方面进行比较。结果 52例患者中,生存组39例,死亡组13例。与生存组相比,死亡组的GCS评分、GCS-P评分、FOUR评分以及中央区95%SEF均明显降低（P<0.05, P<0.01,P<0.01和P<0.01）。多因素Logistic回归分析显示,GCS评分、GCS-P评分、FOUR评分以及中央区95%SEF均为近期死亡的独立预测因素。ROC曲线分析显示,GCS评分、GCS-P评分、FOUR评分以及中央区95%SEF对近期死亡均具有中等预测价值。与单独用昏迷量表预测相比,联合GCS评分、GCS-P评分、FOUR评分和中央区95%SEF预测在敏感性上差异无显著性（均P>0.05）,而特异性明显提高（均P<0.05）。结论G CS评分、GCS-P评分、FOUR评分以及中央区95%SEF均可用于急性昏迷患者近期死亡的预测,联合昏迷量表和中央区95%SEF能更有效地预测急性昏迷患者的近期死亡。     

Prognostic factors in adult community-acquired bacterial meningitis: a 4-year retrospective study

The aim of this 4-year, observational, single-center study was to identify prognostic factors and evaluate the need for intensive care in cases of bacterial meningitis. During the study period, 60 cases of adult bacterial meningitis were identified. Fifty-one patients were transferred to the intensive care unit at various times during their hospital stay. In the multivariate analysis, factors significantly associated with the need for mechanical ventilation and/or vasopressive drugs included comorbidity and a Glasgow coma score of less than 12 at hour 6 following presentation. The results indicate patients with a decreased level of consciousness, neurological deficit or comorbidity should be admitted to the intensive care unit at an early stage of illness. When patients lack these criteria 6 h following presentation, admission to the medical ward is reasonable.     

Clinical features of acute corpus callosum infarction patients

The clinical manifestation of acute corpus callosum (CC) infarction is lack of specificity and complex, so it is easily missed diagnosis and misdiagnosis in the early stage. The present study aims to describe the clinical features of the acute CC infarction. In this study, 25 patients with corpus callosum infarction confirmed by the brain MRI/DWI and the risk factors were summarized. Patients were classified into genu infarction (3 cases), body infarction (4cases), body and genu infarction (4 cases), body and splenium infarction (1 case), splenium infarction (13 cases) according to lesion location. Clinical manifestation and prognosis were analyzed among groups. The results indicated that CC infarction in patients with high-risk group accounted for 72%, moderate-risk group accounted for 20%, low-risk group (8%). The main risk factors are carotid intimal thickening or plaque formation, hypertension, hyperlipidemia, cerebral artery stenosis, and so on. The CC infarction often merged with other parts infarction, and splenium infarction had the highest incidence, the clinical symptoms in the body infarction which can appear typical signs and symptoms, but in other parts infarction which always merged many nerve defect symptoms. The body infarction prognosis is poor; the rest parts of infarction are more favorable prognosis. In conclusion, CC infarction has the highest incidence in the stroke of high-risk group; neck color Doppler and TCD examination can be found as early as possible to explore the pathogenic factors. Prognosis is usually much better by treatment according to the location and risk factors.