血浆和肽素水平对急性脑梗死患者预后的评估价值

目的 探讨血浆和肽素水平对急性脑梗死患者预后的评估价值.方法 对60例急性脑梗死患者(急性脑梗死组)和60例健康体检者(正常对照组)进行血浆和肽素水平检测;并对急性脑梗死患者进行血压、血糖、血清超敏C反应蛋白(hs-CRP)水平检测,应用美国国立卫生研究院卒中量表(NIHSS)进行评分,应用MRI测量脑梗死体积,3个月后采用改良的Rankin量表(mRS)评分评价预后;分析血浆和肽素水平对急性脑梗死患者预后的影响.结果 急性脑梗死组血浆和肽素水平[( 3.73±0.49) ng/ml]明显高于正常对照组[ (2.85±0.24) ng/ml](P＜0.01);脑梗死预后不良亚组(42例)[(3.84±0.44) ng/ml]明显高于预后良好亚组(18例)[ (3.47±0.53) ng/ml] (P＜0.05);两亚组间年龄、血糖、血清hs-CPR水平、NIHSS评分、脑梗死体积的差异有统计学意义(P ＜0.05 ～0.01);单因素Logistic回归分析显示,血浆和肽素水平、年龄、NIHSS评分是影响急性脑梗死患者预后的因素(P ＜0.05 ～0.01).ROC分析显示,影响急性脑梗死患者预后的因素中,血浆和肽素水平与年龄、hs-CRP水平、脑梗死体积、NIHSS评分间差异无统计学意义.结论血浆和肽素水平升高是预测急性脑梗死患者预后不良的因素之一.     

血浆D-二聚体水平与急性脑梗死患者预后的关系

目的探讨血浆D-二聚体水平与急性脑梗死患者预后的关系。方法采用乳胶免疫比浊法检测673例急性脑梗死患者血浆D-二聚体的含量。并于发病30 d时对患者进行改良Rankin量表评分,评定预后。对不同预后患者的结果进行比较分析。结果发病30 d时,mRS评分0~2分(预后良好组)342例;mRS评分3~6分(预后不良组)331例。预后不良组患者血浆D-二聚体水平[(386.56±31.22)μg/L]明显高于预后良好组[(379.84±33.71)μg/L](P0.01)。Logistic回归分析显示,血浆D-二聚体水平升高是急性脑梗死患者预后不良的独立危险因素(OR=2.423,95%CI:1.537~3.862,P0.05)。结论血浆D-二聚体水平升高是急性脑梗死患者预后不良的独立危险因素。     

急性高血压脑出血患者血浆CXCL12水平与脑水肿的相关性研究

目的探讨急性高血压脑出血患者血浆CXCL12水平的动态变化及其对预后的影响,以及血浆CXCL12水平与相对水肿体积的关系。方法选择急性高血压脑出血患者34例,于发病24小时内、第3天、第7天和第14天采用ELISA法检测血浆CXCL12水平,选择同期25例健康体检者作为对照组。根据mRS评分将脑出血患者分为预后良好组(mRS≤2分)和预后不良组(mRS2分)。于发病24小时内、第3天和第7天根据颅脑CT计算相对水肿体积。结果脑出血组24小时内血浆CXCL12水平(19.85±1.84)μg/L明显高于对照组(11.34±2.23)μg/L,P0.01。脑出血组血浆CXCL12水平在第3天时快速上升(22.56±1.56)μg/L,在第7天达高峰(23.38±1.53)μg/L,在第14天时下降(22.64±1.78)μg/L。预后良好组与整体的变化趋势一致,预后不良组血浆CXCL12水平在第14天时未见下降;两组血浆CXCL12水平在第7天时和第14天时比较差异均有统计学意义,P值分别为0.05和0.01。Pearson相关性分析显示第3天和第7天血浆CXCL12水平与相对水肿体积呈正相关,相关系数分别为(r=0.631,P0.01)和(r=0.435,P0.05)。结论血浆CXCL12水平在脑出血后明显升高,持续性CXCL12水平升高的患者预后较差。动态检测血浆CXCL12水平能够为脑水肿的评估和治疗提供依据。     

急性脑梗死患者血清骨桥蛋白水平的改变及其对预后的影响

目的探究急性脑梗死患者血清骨桥蛋白水平的变化及其对预后的影响。方法详细收集112例急性脑梗死患者及53例健康对照组的临床资料并通过ELISA法测定患者1 d、7 d、12 d血清骨桥蛋白水平,计算脑梗死患者梗死面积,并进行NIHSS评分、TOAST及OCSP分型,采用Pearson相关分析法分析7 d血清骨桥蛋白水平与各危险因素的相关性,根据mRS评分将脑梗死患者分为预后良好组(2分)及预后不良组(2分),比较两亚组血清骨桥蛋白水平,进行Logistic回归分析,探讨其在急性脑梗死预后中的作用。结果急性脑梗死患者7 d血清骨桥蛋白水平较对照组显著升高[(8.05±5.47)ng/ml vs(5.05±2.37)ng/ml,P0.01]。其水平与入院时梗死面积(r=0.254,P=0.007),NIHSS评分(r=0.233,P=0.013)均呈正相关。在Logistic回归分析中,我们发现骨桥蛋白水平6.565 ng/ml是不良预后的独立危险因素(OR=3.207,95%CI 1.212~8.485,P=0.019)。结论骨桥蛋白参与缺血性脑卒中的病理生理过程,可以作为评价急性脑梗死预后的一个重要的生物学指标。     

血清血管生成素1水平与急性脑梗死发病、病情严重程度及90 d预后的关系

目的探讨血清血管生成素1(Ang-1)水平与急性脑梗死发病、病情严重程度及90 d预后的关系。方法对132例急性脑梗死患者(病例组)及108名健康体检者(对照组)进行血清Ang-1水平检测,同时采集相关的临床资料。病例组入院时进行NIHSS评分,将NIHSS评分5分者定义为病情轻度组,5~15分为病情中度组,≥16分为病情重度组。病例组90 d后随访行mRS评分,将mRS评分≤2分者定义为预后良好组,2分者定义为预后不良组。结果病例组吸烟史、高血压病、糖尿病、心房纤颤的比例明显高于对照组,血清Ang-1水平明显低于对照组(均P0.05)。Logistic回归分析显示,糖尿病及血清Ang-1水平均与急性脑梗死的发病密切相关(均P0.01)。病情轻度组患者血清Ang-1水平[(1.12±0.35)ng/ml]与病情中度组[(0.96±0.39)ng/ml]、病情重度组[(0.76±0.49)ng/ml]比较,差异有统计学意义(P=0.003)。进一步分析显示,急性脑梗死患者病情严重程度与血清Ang-1水平呈负相关(r=-0.267,P=0.002)。预后不良组患者的入院时NIHSS评分、高血压病、糖尿病、心房纤颤的比例均明显高于预后良好组,而血清Ang-1水平明显低于预后良好组显著降低(均P0.05)。Logistic回归分析显示,入院时NIHSS评分及血清Ang-1水平均与急性脑梗死患者90 d预后密切相关(均P0.01)。结论急性脑梗死患者的血清Ang-1水平较低,且血清Ang-1水平与急性脑梗死的发病、病情严重程度及90 d预后均密切相关。     

血清miR-17-5p与Hcy水平联合预测急性缺血性脑卒中患者预后的价值

目的探讨血清miR-17-5p及同型半胱氨酸(Hcy)水平联合预测急性缺血性脑卒中(AIS)患者预后的价值。方法选取2016年1月至2019年3月儋州市人民医院收治的158例AIS,根据改良Rankin量表(mRS)评分将患者分为预后良好组(n=98,mRS评分≤2分)和预后不良组(n=60,mRS评分2分),采用美国国立卫生研究院卒中量表(NIHSS)评分将患者分为轻度组(n=47,NIHSS评分5分)、中度组(n=73,5分≤NIHSS评分≤20分)、重度组(n=38,NIHSS评分20分)。检测各组血清miR-17-5p及Hcy水平,应用ROC曲线分析miR-17-5p联合Hcy预测AIS患者预后不良的价值。采用Pearson相关分析方法分析AIS患者血清miR-17-5p及Hcy水平与NIHSS及mRS评分的相关性。结果 AIS组血清miR-17-5p[(2.38±0.74)比(0.24±0.08)]及Hcy[(18.60±5.30)μmol/L比(5.70±1.15)μmol/L]水平明显高于对照组(均P0.01)。预后不良组血清miR-17-5p[(3.24±1.08)比(1.56±0.63)]及Hcy[(23.40±6.10)μmol/L比(14.25±3.58)μmol/L]水平明显高于预后良好组(均P0.01)。重度组血清miR-17-5p[分别为:(3.60±1.15)比(2.52±0.90),(3.60±1.15)比(1.20±0.47)]及Hcy[(28.20±6.74)μmol/L比(18.36±4.82)μmol/L,(28.20±6.74)μmol/L比(11.35±3.20)μmol/L]水平均明显高于中度组和轻度组(P0.01),且中度组血清miR-17-5p[(2.52±0.90)比(1.20±0.47)]及Hcy[(18.36±4.82)μmol/L比(11.35±3.20)μmol/L]水平均明显高于轻度组(P0.01)。ROC曲线分析显示,血清miR-17-5p及Hcy水平预测AIS患者预后不良的最佳截值分别为2.06、17.62μmol/L,两项联合预测AIS患者预后不良的曲线下面积[0.918(95%CI:0.860～0.975)]较高,其敏感度和特异度分别为92.0%和85.3%。相关分析结果显示,预后不良组血清miR-17-5p及Hcy水平与NIHSS(分别r=0.772、0.853,P0.01)及mRS评分(分别r=0.740、0.807,P0.01)均呈正相关。结论血清miR-17-5p及Hcy水平升高与AIS患者神经功能缺损的严重程度及预后不良相关,且miR-17-5p联合Hcy对AIS患者预后预测具有较高的价值。     

血清IL-11水平在急性脑梗死患者诊断和预后中的评估价值及其与血清脑源性神经营养因子的相关性

目的 探讨血清IL-11在急性脑梗死诊断和预后评估中的价值及其与血清脑源性神经营养因子(BDNF)的相关性。方法 收集102例急性脑梗死患者(脑梗死组)和64名正常对照者(正常对照组)的一般临床资料。根据90 d mRS评分将脑梗死组分为预后良好亚组和预后不良亚组。采用Pearson相关性分析血清IL-11和NIHSS评分、脑梗死体积、血清BDNF的相关性,Logistics回归分析脑梗死预后的影响因素,并绘制IL-11在脑梗死诊断和预后预测中的ROC曲线。结果 脑梗死组高血压比率及糖化血红蛋白、低密度脂蛋白水平显著高于正常对照组(均P<0.05)。预后不良亚组的年龄、糖尿病比率、糖化血红蛋白水平、入院时NIHSS评分、脑梗死体积显著高于预后良好亚组(均P<0.05)。脑梗死组血清IL-11水平显著低于正常对照组(t=10.123,P<0.001)。脑梗死预后不良亚组血清IL-11水平显著低于预后良好亚组(t=7.438,P<0.001)。脑梗死患者血清IL-11表达与NIHSS评分(r=-0.603,P<0.001)及脑梗死体积(r=-0.681,P&l...     

血浆CX3CL1水平与急性脑梗死病情严重程度及预后的相关性

目的 探讨血浆CX3CL1水平与急性脑梗死患者病情严重程度及预后的关系.方法 收集139例急性脑梗死患者(病例组)及82名健康对照者(对照组)的临床资料及血浆,采用ELISA法测定其血浆CX3CL1水平.病例组患者于入院后24 h内行NIHSS评分,并于发病3个月后随访行mRS评分.将病例组患者根据NIHSS评分及mRS评分分别进行分组,比较各亚组间血浆CX3CL1水平有无差异.结果 病例组血浆CX3CL1水平明显低于对照组(P=0.009),经Logistic回归分析显示血浆CX3CL1水平与急性脑梗死发病密切相关(OR=0.387,P=0.020),且血浆CX3CL1水平与CRP呈负相关(r=-0.232,P=0.003).急性脑梗死患者血浆CX3CL1水平与其入院后24 h内NIHSS评分呈负相关(r=-0.179,P=0.034).预后不良组(mRS>2分)血浆CX3CL1水平显著低于预后良好组(mRS≤2分),白细胞计数及CRP显著高于预后良好组(均P<0.05),血浆CX3CL1水平与急性脑梗死后3个月mRS评分呈负相关(r=-0.263,P=0.002).Logistic回归分析提示血浆CX3CL1水平与急性脑梗死预后密切相关(OR=0.087,P=0.004).结论 急性脑梗死患者的血浆CX3CL1水平较低,且血浆CX3CL1水平与急性脑梗死患者的病情严重程度及预后密切相关.     

血清CXCL12与老年急性缺血性轻型脑卒中早期进展及预后的关系

目的 探讨血清CXCL12与老年急性缺血性轻型脑卒中早期进展及预后的关系。方法 选取180例2020-04—2021-09在山东第一医科大学附属人民医院神经内科住院的老年急性缺血性轻型脑卒中患者,将患者分成进展组和非进展组,发病第5天NIHSS评分较入院首次NIHSS评分≥2分为进展组,否则为非进展组。入院当日采用自制基线资料调查表收集所有患者的基线资料,入院次日检测血清CXCL12水平。所有患者随访3个月,随访结束时对患者进行mRS量表评价,m RS评分0～2分为预后良好组,mRS评分3～4分为预后不良组。对比进展组、非进展组血清CXCL12水平的差异,比较预后良好组、预后不良组血清CXCL12水平的差异,分析各组NIHSS评分、mRS评分与血清CXCL12的相关性。结果 与非进展组比较,进展组患者血清CXCL12水平明显升高,差异有统计学意义（t=15.194,P<0.05）。与预后良好组比较,预后不良组患者血清CXCL12水平明显升高,差异有统计学意义（t=16.098,P<0.05）。NIHSS评分>4分及同型半胱氨酸>10μmol/L的患者血清CXCL...     

脑出血患者血清骨桥蛋白水平的变化及其对预后的影响

目的探究脑出血患者血清骨桥蛋白水平的变化及其对预后的影响。方法收集61例脑出血患者(脑出血组)及54名健康对照者(对照组)的临床资料,采用ELISA法测定血清骨桥蛋白水平。脑出血组患者于入院后24 h内进行脑出血评分,根据CT计算脑出血体积,于发病3个月后行mRS评分。对结果进行分析比较。结果脑出血组患者血清骨桥蛋白水平[(7.69±5.10)ng/ml]明显高于对照组[(5.58±3.12)ng/ml](P=0.008)。脑出血组中预后良好亚组(mRS评分4分)36例(59.02%),预后不良亚组(mRS评分≥4分)25例(40.98%)。预后不良亚组WBC、脑出血体积、脑出血破入脑室比例、脑出血评分及血清骨桥蛋白浓度均明显高于预后良好亚组(均P0.05)。ROC曲线分析示,血清骨桥蛋白水平的截断点为7.57 ng/ml时,曲线下面积为0.634,灵敏度为0.720,特异度为0.611。多因素Logistic回归分析显示,血清骨桥蛋白水平7.57 ng/ml(OR=4.045,95%CI:1.143~14.320,P=0.030)、脑出血破入脑室(OR=5.236,95%CI:1.009~27.172,P=0.049)是脑出血预后不良的独立危险因素。结论急性脑出血患者血清骨桥蛋白水平升高,是其预后不良的独立危险因素,可以作为评价脑出血预后的一个重要的生物学指标。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.