小剂量rt-PA静脉溶栓治疗超早期心源性脑栓塞临床分析

目的探讨小剂量rt-PA静脉溶栓治疗超早期心源性脑栓塞的安全性及近期疗效。方法回顾性分析我院2008-01—2013-12超早期心源性脑栓塞患者47例,其中接受小剂量rt-PA静滴溶栓治疗24例为溶栓组,接受常规二级预防23例为对照组。比较2组治疗前后美国国立卫生研究院卒中量表(NIHSS)、Barthel指数(BI)及改良Rankin评分(mRS)。结果2组治疗前基本临床资料比较差异无统计学意义(P0.05);溶栓组NIHSS评分明显下降,BI、mRS上升,2组治疗后NIHSS评分、BI、mRS比较差异有统计学意义(P0.05),其中1例出现无症状性脑出血。对照组治疗后NIHSS评分、BI、mRS与治疗前相比差异无统计学意义(P0.05)。结论小剂量rt-PA静脉溶栓治疗超早期心源性脑栓塞是安全的,近期疗效显著。     

轻型急性缺血性脑卒中患者静脉溶栓治疗的疗效分析

目的 探讨重组组织型纤溶酶原激活剂(rt-PA)治疗轻型急性缺血性脑卒中患者的疗效。方法 收集100例发病<4.5 h的轻型急性缺血性脑卒患者,随机分为溶栓组50例,未溶栓组50例; 溶栓组于入院后给予重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗,24 h后非心源性脑栓塞患者给予阿司匹林+氯吡格雷双联抗血小板聚集治疗,21d后改阿司匹林或氯吡格雷治疗,心源性脑栓塞患者给予抗凝治疗; 未溶栓组非心源性脑栓塞患者给予阿司匹林+氯吡格雷双联抗血小板聚集治疗,21d后改阿司匹林或氯吡格雷治疗,心源性脑栓塞患者给予抗凝治疗; 对所有患者入院时及治疗后第14 d、90 d分别进行NIHSS神经功能缺损评分及第90 d mRS评分,比较2组患者的疗效和预后。结果 入院时溶栓组及未溶栓组患者一般临床资料、NIHSS评分及mRS评分等比较无明显差异(P>0.05); 治疗后第14、90 d与未溶栓组患者比较,溶栓组患者的NIHSS评分及mRS评分显著降低,溶栓组患者的预后明显好于未溶栓组(P<0.05); 2组患者的颅内出血发生率、缺血性脑卒中复发率比较无明显差异(P均>0.05),且2组患者均无死亡。结论 rt-PA静脉溶栓治疗轻型急性缺血性脑卒中患者安全有效。     

重组组织型纤溶酶原激活剂治疗心源性脑栓塞的疗效观察

目的观察重组组织型纤溶酶原激活剂(rt-PA)治疗心源性脑栓塞的临床疗效。方法将我院收治的62例心源性脑栓塞患者分为溶栓组32例和对照组30例。对照组行常规治疗,溶栓组在常规治疗的基础上行rt-PA溶栓治疗。于2组入院时及发病24h时,采用NIHSS量表分别对患者进行神经功能缺损评分;同时,予以患者复查头颅CT,统计2组患者出血性转化(HT)及症状性出血转化(SICH)的发生率;并检测2组治疗前后血清MMP-9的表达水平。另外,于2组治疗后第30天,再次根据NIHSS评分评价患者的远期治疗效果。结果发病24h后,溶栓组NIHSS评分低于对照组(P0.05);且溶栓组NIHSS早期改善率(56.25%)高于对照组(40%),(P0.05)。溶栓组HT、SICH的发生率依次为15.63%、12.5%,对照组依次为13.33%、10%,2组比较差异无统计学意义(P0.05);治疗前后2组患者平均血清MMP-9表达水平比较,差异均无统计学意义(P0.05)。治疗30d后,溶栓组总有效率为75%,对照组为56.67%,2组比较差异具有统计学意义(P0.05)。结论心源性脑栓塞患者溶栓时间窗内予以rt-PA溶栓治疗可有效提高近远期疗效,改善患者预后,且不会增加症状性出血转化的发生率,安全有效,值得临床推广应用。     

56例心源性脑栓塞患者静脉溶栓治疗的疗效观察

目的观察大剂量尿激酶静脉溶栓治疗心源性脑栓塞的疗效及安全性。方法将109例心源性脑栓塞患者分为2组,溶栓组56例,对照组53例,溶栓组使用尿激酶100-150万单位加入100ml生理盐水中静脉溶栓治疗,非溶栓组（对照组）使用抗血小板聚集或抗凝治疗,并观察疗效。结果2组患者治疗后均减少了缺血性脑卒中的神经功能缺损评分,治疗前后比较有显著性差异（P〈0.05）,且溶栓组较非溶栓组疗效为佳（P〈0.05）,但2组出血转化发生率无显著性差异（P〉0.05）。进一步分析2组的医疗费用,溶栓组平均费用（6235.3±568.2）元,非溶栓组平均费用（8215.0±318.5）元,两组产生的医疗费用比较有显著性差异（P〈0.05）。结论大剂量尿激酶静脉溶栓治疗能有效改善心源性脑栓塞患者的神经功能,相对于抗凝或抗血小板聚集等抗栓方案,能减少患者医疗费用支出,而溶栓组和非溶栓组的出血转化发生率无明显差异。     

急性脑梗死行rt-PA静脉溶栓治疗的安全性和有效性研究

目的探讨重组组织纤溶酶原激活物(rt-PA)静脉溶栓治疗急性脑梗死的安全性和有效性。方法选取我院收治的急性脑梗死患者121例,随机分为溶栓治疗组和对照组,溶栓治疗组在抗凝治疗的基础上给予rt-PA静脉溶栓治疗,对照组给予单纯抗凝治疗。治疗14d后,比较2组NIHSS评分,随访3个月,采用中国卒中量表(CSS)评分和ADL指数评价临床疗效并记录不良反应发生率。结果 2组治疗前NIHSS评分差异无统计学意义(P0.05),治疗后溶栓治疗组总有效率96.7%,显著高于对照组的83.3%,NIHSS评分、CSS评分与ADL均显著优于对照组(P0.05),2组不良反应发生率无显著性差异(P0.05)。结论 rt-PA静脉溶栓治疗急性脑梗死具有较好的临床疗效,安全、有效,值得临床推广使用。     

经颅超声溶栓对急性脑梗死患者神经功能缺损及日常生活活动能力的改善情况

目的分析经颅超声溶栓对急性脑梗死患者神经功能缺损和日常生活活动能力的积极影响。方法选择我院收治的110例急性脑梗死患者为研究对象,随机分为A组30例、B组45例、C组35例,A组给予尿激酶溶栓治疗,100万U尿激酶+100mL生理盐水静滴;B组给予经颅超声溶栓治疗仪治疗(频率为800kHz、1.25 W/cm2、脉冲超声,20min/次,1次/d,连续治疗10d);C组给予联合溶栓治疗。通过NIHSS(神经功能缺损评分)及BI(Barthel指数,日常生活活动能力评分)观察比较3组治疗前后神经功能缺损改善指标、日常生活能力指标等。结果治疗后C组NIHSS评分明显低于A组、B组,B组NIHSS评分明显低于A组,差异具有统计学意义(P0.05);治疗后C组BI评分明显高于A组、B组,B组BI评分均明显高于A组,差异具有统计学意义(P0.05)。结论经颅超声溶栓对急性脑梗死患者具有极高的应用价值,溶栓效果较高,能加速神经功能恢复,改善患者日常生活活动能力,是一种操作简单、安全有效的溶栓治疗方法。     

尿激酶溶栓联合阿司匹林治疗风湿性心脏病左心房内血栓脱落致脑栓塞的疗效

目的 分析尿激酶溶栓联合阿司匹林在风湿性心脏病左心房内血栓脱落所致脑栓塞治疗中的应用价值.方法 应用随机数字表法,将60例风湿性心脏病左心房内血栓脱落所致脑栓塞患者分为2组,每组30例.对照组接受包括阿司匹林在内的常规治疗,观察组接受联合尿激酶溶栓及阿司匹林治疗,对比2组治疗效果.结果 对照组治疗前后NIHSS评分及ADL评分无明显变化(P＞0.05),观察组治疗前后NIHSS评分呈下降趋势,ADL评分呈升高趋势(P＜0.05);2组治疗前NIHSS评分及ADL评分比较,差异无统计学意义(P＞0.05),而观察组治疗1d、2d及3d时NIHSS评分低于对照组,ADL评分高于对照组(P＜0.05).2组不良反应发生率比较,差异无统计学意义(P＞0.05).结论 联合尿激酶溶栓及阿司匹林可有效改善风湿性心脏病左心房内血栓脱落致脑栓塞的疗效.     

脑静脉窦血栓形成的全身抗凝治疗与局部溶栓治疗疗效比较

目的 探讨全身抗凝治疗与局部溶栓治疗对脑静脉窦血栓形成的疗效差异. 方法 选择井冈山大学附属医院神经内科自2008年1月至2011年10月收治的脑静脉窦血栓形成患者共42例,根据治疗方式不同分为2组:全身抗凝治疗组及局部溶栓治疗组,每组各21例.对比2组患者NIHSS评分、mRS评分、溶栓后造影及不良反应情况. 结果 全身抗凝治疗组患者神经功能缺损改善率为33.4％,明显低于局部溶栓治疗组的61.9％,差异有统计学意义(P＜0.05).局部溶栓治疗组患者mRS评分明显低于全身抗凝治疗组,差异有统计学意义(P＜0.05).2组患者均行溶栓后造影复查,局部溶栓治疗组患者完全再通率明显高于全身抗凝治疗组,差异有统计学意义(P＜0.05). 结论 局部溶栓治疗较全身抗凝治疗更有利于脑静脉窦血栓形成患者神经系统功能缺损的改善,有助于神经功能的恢复.     

辅助抗凝治疗在心源性脑梗死中的临床疗效

目的对联合抗凝治疗心源性脑梗死的效果分析。方法随机抽取2013-05—2014-05我院收治的106例心源性脑梗死患者为观察对象。按就诊先后顺序,单号为观察组,双号为对照组,各53例。对照组实施常规抗血小板治疗,观察组在常规治疗基础上,联合抗凝疗法。疗程结束观察2组神经功能缺损评分(NIHSS)和BI指数(日常生活自理能力)的改变。结果观察组总疗效显著优于对照组(P0.05);2组NIHSS评分明显降低,BI指数明显提高,但观察组治疗30d、90d的NIHSS评分与BI指数改变幅度较对照组更大,组间差异有统计学意义(P0.05)。2组不良反应发生情况差异无统计学意义(P0.05)。结论采取联合抗凝疗法治疗心源性脑梗死,能显著改善患者神经功能和自理功能,不良反应少,安全可靠。     

脑梗死静脉溶栓护理对患者神经功能缺损评分的影响

目的探讨溶栓护理干预对脑梗死静脉溶栓患者神经功能缺损评分的影响。方法 71例急性脑梗死患者随机分为2组,观察组在常规护理的基础上增加溶栓护理干预,观察护理效果。结果入院时观察组和对照组NIHSS评分分别为8.3±5.0和8.1±4.9,差异无统计学意义(P0.05);第15天时NIHSS评分分别为3.5±3.3和6.9±4.5,疗效分别为82.9%和61.1%,差异均具有统计学意义(P0.05)。结论静脉溶栓治疗脑梗死时,加强护理干预,能提高神经功能缺损评分。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Release of endogenous catecholamines from slices of hypothalamus of rats

The release of endogenous catecholamines from superfused slices of rat hypothalamus was studied under basal conditions and during release evoked by 40 mM K⁺. Catecholamines in superfusates, and in extracts of the tissue after stimulation, were isolated by column chromatography and quantitated by liquid chromatography with electrochemical detection. Norepinephrine (NE) was not consistently demonstrable in superfusate collected under basal conditions, but 40 mM K⁺ caused the release of from 2 to 4 ng/g of tissue per min. The addition of cocaine to the superfusate caused increases in basal and evoked release of NE. Epinephrine (E) could be measured in superfusates of slices from male but not female rats and then only when cocaine was added to the superfusate. Accordingly, the concentration of E in hypothalamus was greater in male rats than in female rats. Dopamine (DA) was not consistently measurable in the spontaneous overflow from slices either in the presence or absence of cocaine. K⁺-evoked release of DA could be demonstrated in slices from female rats. The addition of cocaine increased the evoked release of DA from slices from both sexes. Corticosterone, added to cocaine, had no effects on the efflux of any of the catecholamines. The experiments suggest that neuronal reuptake of all catecholamines is very efficient in the hypothalamus both under basal conditions and during evoked release.     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

阿立哌唑对精神分裂症患者生活质量的影响

目的:比较阿立哌唑与利培酮对精神分裂症患者生活质量的影响。方法:60例精神分裂患者随机平分为两组各30例,分别给予阿立哌唑和利培酮治疗。疗程8周。用生活质量综合评定问卷-74(GQOLI-74)、阳性与阴性症状量表(PANSS)及副反应量表(TESS)评定疗效及不良反应。结果:阿立哌唑与利培酮均能显著提高精神分裂症患者生活质量,但阿立哌唑在改善GQOLI-74总分、躯体健康及社会功能维度优于利培酮。结论:阿立哌唑治疗有利于提高精神分裂症患者生活质量。