旁正中动脉入口部梗死82例临床分析

目的 探讨急性桥脑旁正中动脉入口部梗死(branch atheromatous disease，BAD)的临床特点。方法 回顾性分析1997～2003年本院神经内科收治的82例桥脑BAD的临床表现、MR／影像特点、脑干听觉诱发电位(BAEP)表现、危险因素。结果 本组病例的临床特点是：平均发病年龄69．2岁，男性／女性=46／36，56／82病情呈进行性发展，75／82有构音障碍，72／82有肢体偏瘫，29／82为高度肢体瘫痪，27／82有轻度意识障碍，6／82伴有不全Homer征，49／82出现面部或(和)偏侧肢体感觉减退，25／82出现周围性面瘫，42／82有非旋转性头晕；13／82有眼球运动障碍。MRI表现有：梗死灶位于桥脑中上部、达桥脑表面，楔形，内侧位于桥脑旁正中、呈类似直线，可显示出基底动脉壁不整；危险因素方面除高血压外还与糖尿病、脂质代谢异常有关。结论 根据临床特点及MRI表现正确诊断出桥脑BAD，以指导进一步的病因治疗及预防。     

偏侧体征的急性桥脑旁正中梗死10例临床分析

目的:探讨偏侧体征的急性桥脑旁正中梗死的临床特点。方法:收治偏侧体征的急性桥脑旁正中梗死患者10例,回顾分析临床表现、MRI影像特点、危险因素、恢复情况。结果:本组病例临床特点:平均发病年龄65.3岁,男性/女性=6/4,8/10病情呈进行性进展加重,均表现为偏侧体征(同侧面中枢性瘫、肢体瘫),8/10伴有构音障碍,6/10伴有面部和(或)偏侧肢体感觉障碍,9/10伴有头晕或眩晕。MRI表现:梗死灶位于桥脑旁正中,楔形,呈类似直线,MRA均未见基底动脉严重狭窄及闭塞。危险因素与高血压、糖尿病、脂质代谢异常有关。结论:通过临床特点、MRI表现早期诊断偏侧体征的急性桥脑旁正中梗死,以指导到进一步的病因治疗及预防。     

桥脑旁正中梗死的临床特点及预后分析

目的 研究桥脑旁正中梗死的临床特点及预后.方法 收集136例桥脑旁正中梗死患者的资料,包括患者的病史、临床症状及体征及相关危险因素;随访半年,应用改良的Rankin评分(mRS)评估患者预后.结果 高血压106例(78％),2型糖尿病74例(54％),高脂血症(包括高甘油三酯和高胆同醇血症)101例(74％);心脏疾病病史55例(40％);既往卒中病史48例(35％);吸烟史62例(46％),饮酒史53例(39％).全部入组患者均有不同程度的运动障碍,其中49例(36％)表现重度运动障碍,97例(71％)患者表现轻中度运动障碍;31例(23％)出现头晕,没有典型的眩晕发作;9例(0.07％)出现和肌力不相称的共济失调;5例(4％)患者出现构音障碍手笨拙综合征;11(0.8％)例出现感觉障碍.MRI显示左侧桥脑受累79例(58％),右侧桥脑受累57例(42％).TCD显示基底动脉病变45例(33％).6个月随访:0分30例(22％),1分46例(34％),2分47例(34％),3分8例(6％),4分5例(4％),5分及以上0例.结论 桥脑旁正中梗死是桥脑梗死的常见类型,临床表现以单侧运动障碍为主;动脉粥样硬化是最常见病因,高血压病、2型糖尿病、高脂血症是该病常见的危险因素;发病6个月90％的患者预后良好.     

191例脑干梗死的临床特点及预后分析

目的对191例脑干梗死患者临床资料及预后进行分析,探讨其临床特点,并分析影响预后的相关危险因素。方法回顾性分析191例脑干梗死患者,按梗死部位分为中脑、桥脑和延髓梗死三组,分析比较脑干梗死的临床特点、预后及其相关影响因素。结果脑干梗死主要发生在桥脑,占82.20%;其次是延髓和中脑,分别占12.04%和5.76%。对桥脑组、中脑组、延髓组三组进行分析,高血压、糖尿病、冠心病、房颤、吸烟具有统计学意义(P0.05)。常见的首发症状是单侧肢体无力68.06%,其次为言语不利40.83%。平均随访25个月,77.25%的患者预后良好(MRS≤2分)。多因素Logistic回归分析显示预后与患者的危险因素、入院NIHSS无关。结论脑干梗死以桥脑部位为主。单侧肢体无力和言语不利为临床常见症状。脑干梗死患者多预后良好,预后与危险因素及入院NIHSS值无关。     

一侧脑桥旁正中梗死临床及影像学分析

目的 探讨一侧脑桥旁正中梗死的临床及影像学特点.方法 回顾2009年7月~2011年12月在我院神经内科住院的15例脑桥旁正中梗死患者的病例资料,分析脑桥旁正中梗死患者的症状、体征、影像学表现、发病机制及预后.结果 15例患者均有一侧肢体无力,肌力从0级至轻瘫,与肢体瘫痪同侧的中枢性面瘫9例,与肢体瘫痪同侧的舌瘫7例;一侧肢体感觉障碍11例;10例起病时伴有头晕或眩晕;13例伴有构音障碍;6例有饮水呛咳;1例患者出现一侧肢体共济失调;1例患者出现复视,在体征上表现为病灶侧眼球外展障碍对侧肢体瘫痪的交叉瘫.头颅MRI示梗死灶位于一侧脑桥内侧,多为楔形,底部紧靠脑桥腹侧表面,尖部朝向脑桥被盖;病灶大部分位于基底动脉旁中央支的供血区域内,常位于脑桥中上部,很少累及第四脑室底.结论 一侧脑桥旁正中梗死位于脑桥内侧2/3区域,主要由基底动脉穿支病变引起;凡在临床诊疗中发现一侧偏瘫或偏身感觉障碍伴有头晕或眩晕、构音障碍、饮水呛咳的患者均要考虑到脑桥旁正中梗死,及时行MRI检查;一侧脑桥旁正中梗死预后较好.     

139例脑桥梗死患者的临床分析

目的 根据脑桥梗死患者的症状、体征,结合脑桥的解剖学特点和头颅MRI检查对患者病灶定位,随之探讨脑桥梗死与椎基底动脉病变的相关关系.方法 连续入选2003年6月～2007年12月收住益阳医专附属医院神经内科的急性脑桥梗死患者139例,所有患者均行头颅MRI检查,将病例分为A(腹内侧梗死组--脑桥旁中央动脉分布区)、B(腹外侧梗死组-脑桥短旋动脉分布区)、C(被盖部梗死组-脑桥长旋动脉分布区)、D(混合组-可能累及A、B、C多条动脉分布区),并对其病灶位置分布、神经系统体征、神经功能缺损程度 (改良Rankin评分)等指标进行分析.结果 139例患者中A、B、C、D组各占66(47.5%)、44(31.6%)、17(12.2%)、12(8.7%).在临床表现特点上,腹内、外侧梗死多,表现为病灶对侧肢体偏瘫、中枢性面瘫以及构音障碍,同时伴或不伴肢体共济失调;脑桥被盖部梗死主要表现为脑神经瘫痪及感觉障碍;双侧脑桥梗死则往往表现为假性延髓性麻痹、双侧肢体运动障碍.结论 脑桥梗死病灶多位于腹内、外侧,且多表现为病灶对侧肢体瘫痪、中枢性面瘫以及构音障碍;不同梗死部位影响神经功能缺失程度不同,不同部位的梗死与椎基底动脉的狭窄或闭塞关系密切.     

基底动脉尖综合征12例分析

目的: 探讨基底动脉尖综合征的病因、临床表现、发病机制及影像学特征。方法: 回顾分析12例基底动脉尖综合征病例的临床及影像学资料。结果: 该病居前几位的症状和体征依次为意识障碍(75.0%)、眼球运动障碍(66.7%)、肢体活动障碍(58.3%)、眩晕(58.3%)和瞳孔改变(50.0%);栓塞和脑血栓形成是常见病因,危险因素为高血压(75.0%)、糖尿病(33.3%)、高血脂(25.0%)等;影像学表现以中脑、丘脑梗死(75.0%)多见,可合并颞叶(33.3%)、枕叶(41.7%)、小脑(41.7%)梗死。结论: 基底动脉尖综合征临床及影像学表现复杂,常见病因和危险因素同一般脑卒中。头颅MRI检查有助于明确诊断。     

脑干腔隙性梗死的MRI、TCD、BAEP检查与临床

目的探讨MRI、TCD、BAEP联合检查脑干腔隙性梗死的价值。方法对28例脑干腔隙性梗死患者的头颅MRI、TCD、BAEP及临床特征作回顾性分析。结果本组患者中老年男性较多,71%有高血压史,临床表现多样,MRI扫描显示腔隙灶直径在0.2～1.5cm,桥脑腹侧居多;24例TCD异常：20例提示椎-基底动脉血流速度下降或增高,4例频谱显示典型的脑动脉硬化改变;22例BAEP异常,主要表现为Ⅲ、Ⅴ波PL及Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ的IPL延长,脑干下段（桥脑、延脑）多表现为Ⅲ波、Ⅰ～Ⅲ异常,脑干上段（桥脑、中脑）多表现为V波、Ⅲ～V、I～V异常。结论MRI是诊断脑干腔隙性梗死的最佳手段,TCD反映椎-基底动脉系统血管弹性及血流速度,对诊断有一定帮助,BAEP对病变的定位有较高的应用价值。     

梗死位置预测大脑中动脉区脑梗死进展性运动神经功能损伤

目的 探讨脑梗死位置与进展性运动神经功能损伤(PMD)发生的相关性.方法 纳入发病24 h内、未行溶栓治疗的大脑中动脉区梗死患者,以发病7d内美国国立卫生研究院卒中量表(NIHSS)评分运动项目较基线升高大于或等于2分作为PMD的诊断标准,比较PMD组与非PMD组的临床、实验室资料及梗死位置的差异.多因素Logistic回归分析预测PMD发生的危险因素.结果 共纳入大脑中动脉区急性脑梗死患者121例,分为PMD组(45例)与非PMD组(76例).PMD组内分水岭梗死的发生率高于非PMD组(26.7％ vs.5.3％,P=0.001).穿支动脉区梗死的发生率在PMD组与非PMD组之间差异无统计学意义(42.2％ vs.35.5％,P=0.463),进一步将穿支动脉区梗死分为穿支动脉粥样硬化性疾病(BAD)及脂质玻璃样变(LD)后.PMD组中BAD的发生率高于非PMD组,差异有统计学意义(28.9％ vs.9.2％,P=0.005).逐步Logistic回归显示内分水岭梗死(OR=9.750,95％ CI:2.828～33.612,P=0.000)与BAD病变(OR=6.036,95％ CI:2.119～17.190,P=0.001)是PMD的独立危险因素.结论 内分水岭梗死、BAD病变可以预测PMD的发生.梗死位置有助于发现脑梗死进展的高危人群.     

脑性瘫痪患儿脑电图与头颅磁共振对比研究

目的:通过对比脑电图(EEG)和头颅核磁共振(MRI)的变化,分析2种检查方法在脑性瘫痪中的应用,探讨EEG和MRI检查与脑性瘫痪患儿中枢神经系统发育特点之间的关系。方法:103例脑性瘫痪患儿在康复治疗前后各做1次EEG与头颅MRI,分析其改变及相关性。结果:103例脑性瘫痪患儿EEG异常率为74.8%,异常表现以广泛性慢波异常为主。MRI异常率为86.41%,异常MRI表现有皮质-皮质下梗死32例(31.1%)。脑白质髓鞘形成延迟22例(21.4%),脑室旁白质软化(PVL)24例(23.3%),白质多发性脑病4例(3.9%),先天发育畸形7例(6.8%)。康复治疗前后脑电图变化有显著性差异(P=0.012),MRI无明显变化。MRI表现为皮质-皮质下梗死的脑性瘫痪患者脑电图异常表现以广泛性慢波异常为主,占62.5%,康复治疗前后脑电图变化有显著性差异。结论:EEG和MRI作为脑性瘫痪的辅助检查,各具意义:EEG可以更明显地表现出脑瘫患儿的中枢神经系统发育变化,MRI对于脑性瘫痪脑损伤定位意义更大。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.