颅脑损伤与血清α-黑色素细胞刺激素含量的相关研究

目的 本研究探讨颅脑损伤后血清黑色素细胞刺激素α-MSH含量变化,以及与颅脑损伤严重程度、血清肿瘤坏死因子-α (TNF-α)的关系.方法 选取急性颅脑损伤患者48例,按GCS评分归为3组,重度组(3～8分)18例,中度组(9～12分)16例,及轻度组(13～ 15分)14例;并选取健康自愿者10例为对照组.于伤后24 h内、3d、5d、7d分别抽取血标本,采用酶联免疫吸附双抗体夹心(ELISA)方法测定血清α-MSH和TNF-α的含量.数据用均数±标准差((x)±s)表示;统计分析采用重复测量的方差分析及进一步多重比较;如需两数据之间单独比较采用LSD-t检验法;相关性分析采用Pearson相关性分析.结果 各颅脑损伤组血清α-MSH含量均低于对照组(P＜0.05),且病情越重α-MSH含量越低,其最低值在第3天或第5天[重度组(9.65±4.21)pg/mL,中度组(10.69±4.30) pg/mL,轻度组(18.89 ±7.19) pg/mL vs.对照组(45.67±10.95) pg/mL].各损伤组血清TNF-α含量与对照组比较均增高(P＜0.05),病情越重TNF-α含量越高,且三组均于第3天达最高[重度组(37.24±18.28) pg/mL,中度组(26.19±6.78) pg/mL,轻度组(18.60±7.83) pg/mL vs.对照组(10.74 ±1.71) pg/mL].患者血清α-MSH含量和TNF-α含量在四个时间点均呈负相关.结论 颅脑损伤后血清α-MSH含量降低,低点在3d或5d;血清TNF-α含量增高,峰值在3d;损伤程度越重,这些含量改变越明显;血清α-MSH和TNF-α含量基本呈负相关.     

急性颅脑损伤后血高迁移率蛋白-1及中性粒细胞激活肽-78的变化

目的 研究急性颅脑损伤后血中高迁移率蛋白-1(HMGB1)和中性粒细胞激活肽-78(ENA-78)的动态变化及其与继发性脑水肿的关系.方法 采用酶联免疫吸附法(ELISA)检测HMGB1和ENA-78血中含量,回顾性分析110例急性颅脑损伤住院患者伤后12 h内、伤后第3,5d血中HMGB1和ENA-78含量,采用t检验并结合临床表现、影像学检查及格拉斯哥预后评分(GOS)进行比较分析.结果 急性颅脑损伤患者伤后早期12h内血中HMGB1和ENA-78含量随着格拉斯哥昏迷评分(GCS)下降均有不同程度的升高.颅脑损伤越严重,HMGB1和ENA-78升高越明显,脑水肿程度越重,并且脑水肿高峰持续时间越长(P＜0.01).颅脑损伤早期血中HMGB1和ENA-78含量与脑水肿严重程度(r=0.69,0.62,P＜0.01)和脑水肿高峰持续时间呈正相关(r =0.70,0.65,P＜0.01).此外,不同GOS组之间HMGB1和ENA-78差异亦有统计学意义,其中预后不良组血中HMGB1和ENA-78含量在伤后5d内持续升高,而且显著高于预后良好组和健康对照组(P＜0.01或P＜0.05).同时急性颅脑损伤后血中HMGB1与ENA-78的含量呈正相关(r=0.68,P＜0.01).结论 急性颅脑损伤后血中HMGB1和ENA-78的变化与继发性脑水肿存在一定的相关性.     

颅脑损伤后24h内血糖值与伤情程度和预后的关系

目的探讨重度颅脑损伤后24h血糖与格拉斯哥昏迷评分(GCS)的关系及其对预后的影响。方法将81例重度颅脑损伤患者(GCS≤8分)分为两组:A组31例(GCS 3～5分),B组50例(GCS 6～8分);测定入院12h和24h内血糖,出院时根据GCS预后评分表(GOS)标准分为:预后良好组49例(C组,GOS 4～5级),预后较差组32例(D组,GOS 1～3级)。结果 A组伤后12h血糖均值为(10.87±3.94)mmol/L,B组为(6.43±2.30)mmol/L,A组伤后24h血糖均值为(14.46±2.83)mmol/L,B组为(8.53±3.01)mmol/L,差异有统计学意义(P<0.01),GCS评分愈低者血糖值愈高,持续时间愈长,两者呈负相关;C组伤后12h血糖均值为(6.37±2.51)mmol/L,D组为(10.73±3.76)mmol/L;C组伤后24h血糖均值为(8.76±2.12)mmol/L,D组为(14.32±2.54)mmol/L,差异有统计学意义(P<0.01),血糖值高者预后较差。结论颅脑损伤后血糖值越高,持续时间越长,则伤情越严重,预后越差,及时有效地控制血糖能提高救治成功率。     

颅脑损伤患者脑脊液和血清神经元特异性烯醇化酶及髓鞘碱性蛋白水平变化及临床意义

目的探讨颅脑损伤患者脑脊液及血清神经元特异性烯醇化酶(NSE)和髓鞘碱性蛋白(MBP)的浓度与病情发展与预后的关系。方法选取45例颅脑损伤患者,根据病情严重程度分为轻度组、中度组、重度组;根据损伤类型分为硬膜下血肿组、硬膜外血肿组、脑挫裂伤组、合并伤组;根据预后情况分为死亡及植物生存组、残疾组、良好恢复组。另选取15例体检健康者作为对照组。检测颅脑损伤患者及对照组入院时,以及重症颅脑损伤患者伤后第1、7、14天的脑脊液及血清NSE、MBP浓度。结果轻度、中度、重度颅脑损伤患者血清和脑脊液NSE及MBP浓度均明显高于对照组,重度组明显高于中度组(P0.05)。硬膜外血肿组血清和脑脊液NSE、MBP浓度最低,而合并伤组NSE、MBP浓度显著高于硬膜下血肿组、硬膜外血肿组、脑挫裂伤组(P0.05)。死亡及植物生存组血清和脑脊液NSE、MBP浓度均显著高于残疾组和良好恢复组(P0.05)。重症颅脑损伤患者伤后1~14d,其血清和脑脊液NSE、MBP浓度均呈下降趋势,但第14天的浓度仍显著高于对照组(P0.05)。结论脑脊液及血清NSE、MBP浓度与损伤严重程度呈正相关,可以作为病情诊断及预后判断的依据。     

有创颅内压监测在颅脑损伤开颅术后患者中的应用

目的探讨颅内压(ICP)监测在中重型颅脑损伤行开颅去骨瓣减压术后患者中的应用效果。方法回顾性收集惠州市中大惠亚医院2013年7月~2017年7月68例中重型颅脑损伤行去骨瓣减压术患者,根据术中有无留置有创颅内压监测传感器分为观察组(24例)和对照组(44例)。分析ICP与格拉斯哥昏迷评分(GCS)和格拉斯哥预后评分(GOS)之间的关系,了解ICP对此类患者预后的影响;对比两组患者28d后GCS和GOS预后评分,以及两组患者脱水剂应用天数、剂量,常见并发症的发生率(如轻、中、重度高钠血症、急性肾功能损伤)等,分析持续颅内压监测对患者预后及并发症的影响。结果 ICP与GCS评分呈负相关(P0.05),与GOS预后评分也呈负相关(P0.05)。观察组甘露醇应用天数(9±3)d及总剂量(630.25±45.03)g均明显低于对照组(14±3)d、(1732.50±98.50)g,两组差异均有统计学意义(P0.05);观察组患者出现重度高钠血症的1例(4.17%),中度高钠血症2例(8.3%),轻度高钠血症4例(16.7%),急性肾功能损害1例(4.17%),而对照组严重高钠血症的6例(9.09%),中度高钠血症6例(13.6%),轻度高钠血症9例(20.45%),急性肾功能损害3例(6.81%),差异均有统计学意义(P0.05)。观察组患者死亡率和植物生存状态的比例明显少于对照组(P0.05),但在轻度到重度残疾方面,两组差异无统计学意义(P0.05)。结论颅高压严重影响中重型颅脑损伤患者的预后,持续颅内压监测对中重型颅脑损伤患者的预后会产生积极的影响,并明显减少相关的并发症,值得临床应用。     

Tau蛋白在颅脑损伤患者脑脊液中的改变及临床意义

[目的]探讨Tau蛋白在颅脑损伤患者脑脊液(CSF)中的改变以及临床意义.[方法]检测70例颅脑损伤患者伤后12 h、1d、3d、7d、12 d时CSF中Tau蛋白水平,并以30例行腰麻的非神经系统疾病患者为对照组.[结果]颅脑损伤重型组、轻中型组在伤后12h、1d、3d、7d、12d时CSF中Tau蛋白水平高于对照组,且差异有显著性(均P ＜0.05).且重型组CSF中Tau蛋白水平均高于轻中型组(P＜0.05).在伤后12h、1d、3d、7d、12 d时CSF中Tau蛋白水平死亡组＞不良组＞良好组,且组间比较差异均有显著性(P＜0.05).GCS评分与CSF中Tau蛋白水平呈显著负相关性(r=-0.610,P＜0.05).[结论]Tau蛋白在颅脑损伤患者CSF中呈高表达,CSF中Tau蛋白水平与颅脑损伤严重程度和预后密切相关.     

七叶皂苷钠对重型颅脑创伤患者脑脊液肿瘤坏死因子-α及白细胞介素-6表达的影响

目的 观察七叶皂苷钠对重型颅脑创伤患者脑脊液肿瘤坏死因子-α (TNF-α)及白细胞介素-6(IL-6)表达的影响,探讨其临床意义.方法 将73例重型颅脑创伤患者按入院先后顺序分为对照组(36例)及治疗组(37例).对照组采用西医常规治疗,治疗组在西医治疗的基础上加用七叶皂苷钠每日20 mg静脉滴注,连续治疗10d.采用放射免疫法测定两组患者不同时间点脑脊液中TNF-α及IL-6的含量,同时监测患者颅内压(ICP)变化,并在伤后6个月根据格拉斯哥预后评分(G0S)判断预后.结果 治疗组治疗前及伤后1d脑脊液TNF-α及IL-6水平与对照组无明显差异(均P＞ 0.05),伤后3、7及14d均较对照组明显降低(P＜0.05或P＜0.01).在治疗前及伤后1d,治疗组ICP与对照组比较无明显差异(均P＞ 0.05),在伤后3、7、14 d均较对照组明显降低(均P＜ 0.01);治疗组病死率低于对照组(27.03％比38.89％,P＜0.05),预后改善明显.结论 七叶皂苷钠可明显降低重型颅脑创伤患者脑脊液TNF-α及IL-6表达水平,降低ICP,促进神经功能恢复,改善预后.     

急性颅脑损伤后部分凝血指标变化的研究

目的评估急性颅脑损伤患者血浆部分凝血指标变化对判断损伤程度及预后的价值。方法检测40例急性颅脑损伤患者伤后24 h、3 d、7 d的D-二聚体(DD)、抗凝血酶(AT)、纤维蛋白原(Fg)血浆含量,结合临床格拉斯哥评分(GCS)分型及格拉斯哥预后评分(GOS)预后分级进行统计学分析。结果患者伤后24 h内、3 d、7 d分别与对照组比较,DD、Fg均有统计学意义,DD含量与GCS、GOS呈负相关;Fg与GCS、GOS呈正相关;AT有变化,但无统计学意义。结论DD、Fg对判断颅脑损伤程度及预后有明显参考价值,可作为临床应用的监测指标。     

格拉斯哥昏迷-瞳孔反应评分在ICU重型颅脑损伤患者中的临床应用价值

目的:探究格拉斯哥-瞳孔反应(Glasgow Coma Scale-Pupil Response,GCS-P)评分在重症医学科(ICU)重型颅脑损伤(severetraumaticbraininjur y,sTBI)患者中的临床实用价值。方法:通过回顾安徽医科大学第三附属医院ICU收治的160名sTBI患者的一般资料,分析GCS评分、P评分、G CS-P评分分别与28d病死率、根据伤后第3个月G OS预后评分评估的不良预后比例的相关性。结果:GCS评分、P评分、GCS-P评分均与患者的28 d病死率及伤后第3个月不良预后比例呈负相关。GCS-P评分与病死率、不良预后比例的相关系数均大于GCS评分。GCS评分与GCS-P评分分值相同时,除4分外,GCS-P评分评估出的病死率及不良预后比例更高。GCS评分3分患者病死率及不良预后比例低于GCS评分4分患者,这一结果在GCS-P评分中未观察到。结论:GCS-P评分与病死率及不良预后比例的相关性优于GCS评分,比GCS评分能提供更多信息,评价范围更大,且简单实用,对临床快速评估颅脑损伤患者病情及预后具有重要价值。     

重型颅脑损伤后内皮素、降钙素基因相关肽的动态变化及其意义

目的 :探讨重型颅脑损伤后内皮素 (ET)、降钙素基因相关肽 (CGRP)的动态变化及其意义。方法 :对 2 9例重型颅脑损伤病人 (GCS≤ 8分 )在伤后 6h内 ,3d ,7d测定血浆ET、CGRP含量 ,并与 36例正常人对照 ,分析其变化规律及与预后的关系。结果 :重型颅脑损伤后 6h内ET及CGRP含量即急剧升高 ,并在一周内始终维持在较高的水平。预后良好者 (GOS3～ 5组 ) ,早期ET含量及E/C比值均明显低于预后不良者 (GOS≤ 2组 )。而不同预后组间CGRP含量则无明显差异。结论 :对重型颅脑损伤患者进行ET、CGRP含量测定有助于早期判断预后     

Measurement of L-carnitine and acylcarnitines in body fluids and tissues in children and in adults

We have developed a reliable and validated radio-enzymatic method for the assay of L-carnitine and acylcarnitines, using a modification of existing methods. The sensitivity of the assay is 10 mumol/l using 10 microliters of plasma or urine. It is also suitable for measurements of carnitine in a 10 mg sample of liver or muscle obtained by percutaneous biopsy. The use of N-ethylmaleimide in the reaction mixture together with an excess of [1-14C]acetyl CoA ensures that the reaction proceeds to completion and a linear response is obtained. Using this method control ranges have been established for plasma and urine carnitine concentrations in healthy children and adults, and for the carnitine content of liver and muscle in adults. No significant difference was found between fasting and post-prandial plasma carnitine levels. An age-related increase was found in urinary total carnitine and acylcarnitine concentration throughout childhood. These data provide a reliable basis for studies of patients with abnormal carnitine and acylcarnitine metabolism, distribution and excretion.     

Rosamicin in Urethral and Vaginal Secretions and Tissues in Dogs and Rats

In animal studies we investigated the distribution of rosamicin in plasma and urethral and vaginal tissues in rats as well as in urethral and vaginal secretions in dogs. We found concentration ratios between urethral secretion and plasma of 1.9 and between vaginal secretion and plasma of 2.4. The rosamicin concentrations in urethral and vaginal tissue significantly exceeded the levels of all other tissues investigated. Because rosamicin could be valuable for the treatment of bacterial urethritis and the colonization of the vaginal introitus with fecal bacteria in women, it should be investigated clinically in this respect.     

Similarities and differences in clients treated and in medications prescribed by APRNs and psychiatrists in a CMHC

This study is part of a larger study comparing prescribing practices of psychiatrists and advanced practice psychiatric nurses (APRNs) using the following three groups of patients: patients treated by psychiatrists, those treated by APRNs, and those treated by both APRNs and psychiatrists at different times in 1 year. Demographics for 5507 patients were examined. A subsample of APRNs and psychiatrists prescribed similar total numbers of medications. Psychiatrists prescribed more types of antidepressant medications other than the SSRI antidepressants, and they prescribed more than twice the number of benzodiazepines. APRNs prescribed more SSRIs and spent more time with clients during medication visits.     

Postural strategies and falls in elderly and in parkinsonism]

OBJECTIVE: To use a posture analysis to show the evolution of postural pattern connected with falls.MATERIAL AND METHOD: It is a prospective study on two groups of 16 persons of more than 60 years. A group concerns 16 small disability off drug parkinsonian patients, a group concerns 16 healthy witnesses. All the persons benefited from a posture recording by means of a force platform and were followed during 1 year. RESULTS: Data analysis underlines three groups of persons corresponding to three postural patterns, independently of the presence of Parkinson disease. A group (n = 18) did not contain fallers, the second (n = 10 ) contained 20% of fallers, the third (n = 4) contained 100% of fallers. Differences between the groups were identified on 16 posturographic parameters. DISCUSSION: A group has a good functional value and one does not record any fall. Its characteristics, which correspond to a category of persons who compensate well for the phenomena of ageing, are found in the literature. A group has an intermediate functional value and regrets 20% of fallers. Kinetic profile reveals a tendency to the stiffness of the posture. This group is going to operate rather ankle strategies. A group has an inferior functional value and regrets 100% of fallers. Kinetic profile seems disrupted and not to be able to adapt itself in a satisfactory way to the situation otherwise than by stereotypical reactions. This group is going to operate systematically much less stabilizing hip strategies. CONCLUSION: A close determinism between physiological neuromotor ageing and Parkinson disease does exist. We showed with a prospective follow-up, the arisen of fall and showed the evolution of postural patterns related to fall. It appears as well that evolution mainly follows three stages leading from a small risk of fall gait pattern to a major risk of fall gait pattern.     

Racial differences in oxidative stress and inflammation: in vitro and in vivo

African American race is an independent risk factor for enhanced oxidative stress and inflammation. We sought to examine whether oxidative-stress and inflammatory markers that are typically measured in humans also differ by race in cell culture. We compared levels between African American and Caucasian young adults and then separately in human umbilical vein endothelial cells (HUVECs) from both races. We found heightened oxidative stress and inflammation in the African Americans both in vitro and in vivo. African American HUVECs showed higher nitric oxide (NO) levels (10.8 ± 0.4 vs. 8.8 ± 0.7 μmol/L/mg, p = 0.03), Interleukin-6 (IL-6) levels (61.7 ± 4.2 vs. 23.9 ± 9.0 pg/mg, p = 0.02), and lower superoxide dismutase activity (15.6 ± 3.3 vs. 25.4 ± 2.8 U/mg, p = 0.04), and also higher protein expression (p < 0.05) of NADPH oxidase subunit p47phox, isoforms NOX2 and NOX4, endothelial nitric oxide synthase (NOS), inducible NOS, as well as IL-6. African American adults had higher plasma protein carbonyls (1.1 ± 0.1 vs. 0.8 ± 0.1 nmol/mg, p = 0.01) and antioxidant capacity (2.3 ± 0.2 vs. 1.1 ± 0.3 mM, p = 0.01). These preliminary translational data demonstrate a racial difference in HUVECs much like that in humans, but should be interpreted with caution given its preliminary nature. It is known that racial differences exist in how humans respond to development and progression of disease, therefore these data suggest that ethnicity of cell model may be important to consider with in vitro clinical research.