高压氧辅助治疗对卒中后抑郁患者血清5-HT、NE及神经功能的影响

目的：观察高压氧（HBO）辅助治疗对卒中后抑郁（PSD）患者血清5-羟色胺（5-HT）、去甲肾上腺素（NE）及神经功能的影响。方法70例PSD患者根据数字表法随机分为2组,对照组（n=35例）采用常规措施治疗,观察组（n=35例）待确定活动性出血已稳定或已趋于稳定后,在对照组治疗基础上加用HBO治疗。两组疗程均为30d,比较两组患者治疗前后血清5-HT、NE表达水平及汉密尔顿抑郁量表（HAMD）、中国脑卒中量表（CSS）,改良Barthel指数（MBI）评分变化。结果两组患者治疗后血清5-HT、NE表达水平均明显升高（P<0.05）,且观察组升高较对照组更为显著（P<0.05）;两组患者治疗后HAMD、CSS评分明显降低（P<0.05）,而MBI评分明显升高（P<0.05）,且观察组降低或升高较对照组更为显著（P<0.05）。结论 HBO辅助治疗可明显升高PSD患者血清5-HT、NE表达水平,改善抑郁状态和神经功能。     

针刺配合舍曲林对卒中后抑郁患者抑郁及神经功能恢复的疗效观察

目的观察针刺配合舍曲林对卒中后抑郁（post stroke depression,PSD）患者抑郁状态、日常生活能力和神经功能缺损程度的影响。方法对治疗组86例PSD患者进行针刺治疗,配合服用盐酸舍曲林片;对照组51例仅服用盐酸舍曲林片。采用汉密尔顿抑郁量表（Hamilton depression scale,HAMD）、日常生活活动量表Barthel指数（Barthel index,BI）、神经功能缺损程度评分表（CSS）评价两组治疗前后抑郁状态及神经功能恢复情况。结果治疗组总有效率88.37%,对照组总有效率72.54%,两组比较差异有统计学意义。与治疗前相比,治疗后两组HAMD、CSS评分明显下降,BI评分明显提高（P〈0.01）,且治疗组优于对照组。结论针刺配合舍曲林明显改善PSD患者抑郁状态及日常生活能力,促进神经功能的恢复。     

纤维蛋白原、C反应蛋白及同型半胱氨酸与大动脉粥样硬化型卒中患者颈动脉易损性斑块的相关性分析

目的 探讨血清纤维蛋白原(FIB)、C反应蛋白(CRP)及同型半胱氨酸(Hcy)水平与大动脉粥样硬化(LAA)型卒中患者颈动脉易损性斑块的关系.方法 收集2014年3月-2015年2月兰州大学第二医院神经内科连续收治的急性缺血性卒中(AIS)住院患者,依据TOAST分型选择其中的LAA型前循环区域卒中患者273例,根据颈部血管超声结果分为无斑块组(n=84)、稳定斑块组(n=42)、易损斑块组(n=147),另收集同期住院的非脑卒中患者中无颈动脉病变的182例作为对照组,比较4组患者19项人口学和血液检测指标的差异.采用Logistic回归对LAA型卒中患者颈动脉易损性斑块的危险因素进行筛选,采用Spearman秩相关对患者颈动脉斑块易损性与各指标的相关性进行分析.结果FIB、CRP及Hcy水平在四组间的比较差异有统计学意义(P<0.05);多因素Logistic回归分析显示,FIB(OR=1.408,95%CI 1.028-1.927,P=0.033)是LAA型卒中患者颈动脉易损性斑块的独立危险因素;Spearman相关分析显示,FIB(r=0.292,P=0.000)、Hcy(r=0.172,P=0.000)与LAA型卒中患者颈动脉斑块易损性呈正相关.结论 血清FIB、Hcy水平可能是预测LAA型卒中患者颈动脉斑块易损性的生物学指标;血清CRP水平与LAA型卒中患者颈动脉斑块易损性无明显关联.     

盐酸氟西汀治疗脑卒中后抑郁症112例观察

目的：观察脑卒中后抑郁（PSD）的临床特点与盐酸氟西汀治疗效果与不良反应。方法：213例PSD患者中112例应用盐酸氟西汀治疗为治疗组,101例采用阿米替林治疗为对照组,疗程均为4周。结果：治疗组对PSD按密尔顿抑郁量表（HAMD）评价的总分及其中4个因子等抑郁状态改善较对照明显,不良反应减少。结论：PSD发生的解剖学基础是脑卒中灶,盐酸氟西汀较传统抑郁药对PSD疗效佳,且无明显副作用。     

缺血性卒中部位与抑郁症的相关性分析

目的：探讨不同缺血性卒中部位与卒中后抑郁的关系。方法：入选103例缺血性卒中患者，采用汉密尔顿抑郁量表（HAMD）评定患者抑郁状态，按卒中部位进行分组比较分析。结果：缺血性卒中部位与抑郁症患病无确切相关性，多病灶组与单病灶组间发生率有显著性差异。结论：抑郁症发病与缺血性卒中部位无确切相关性，而与病灶数量相关性显著。     

梗死核心容积预测急性前循环大血管闭塞患者机械取栓术后出血转化的价值

【摘要】 目的 探讨急性前循环大血管闭塞患者机械取栓术后梗死核心容积与出血转化（HT）的关系。 方法 回顾性分析2019年10月至2020年2月在南京医科大学第一附属医院接受机械取栓术治疗前循环大血管闭塞的急性缺血性脑卒中（AIS）患者临床和影像学资料。根据欧洲急性脑卒中协作研究（ECASS）Ⅱ标准,将患者分为HT组和Non-HT组,同时根据术后是否发生实质性血肿（PH）分为PH组和Non-PH组,分别比较两组患者临床资料。采用多因素logistic回归分析评估HT和PH独立危险因素,受试者工作特征曲线（ROC）分析梗死核心容积预测HT和PH的效能。 结果 共76例患者纳入分析。HT组26例, Non-HT组50例;PH组10例,Non-PH组66例。HT组梗死核心容积、美国国立卫生研究院卒中量表（NIHSS）评分及血糖水平均高于Non-HT组（P＜0.05）。PH组梗死核心容积、NIHSS评分均高于Non-PH组（P＜0.05）。多因素logistic回归分析显示,梗死核心容积较大是机械取栓术后发生HT的独立危险因素（OR=1.032,95%CI=1.003～1.061, P=0.028）,也是发生PH的独立危险因素（OR=1.045,95%CI=1.007～1.085,P=0.021）。梗死核心容积预测HT的灵敏度为57.7%,特异度为72.0%,ROC曲线下面积（AUC）为0.658,预测值为13.5 mL;预测PH的灵敏度为54.5%,特异度为93.8%,AUC为0.755,预测值为36 mL。 结论 梗死核心容积较大是AIS患者机械取栓术后发生HT、PH的独立危险因素。梗死核心容积对AIS患者取栓术后HT具有预测价值。     

卒中后抑郁的特点及其相关因素的Logistic回归分析

目的研究卒中后抑郁（PSD）的特点和相关因素,为卒中后抑郁的干预提供依据。方法采用临床流行病学调查方法对门诊和住院的198例脑卒中患者进行卒中后抑郁及其相关因素的现状调查,运用抑郁自评量表（SDS）、汉密尔顿抑郁量表（HAMD）、简易智力状态检查（MMSE）、日常生活能力量表（ADL）、神经功能缺损量表（NFDS）和自制一般情况调查表对卒中患者进行评定,并用Logistic回归分析法对相关因素进行分析。结果卒中后抑郁的发生率为36．86％,其中轻度63．01％、中度26．03％、重度10．96％;卒中后抑郁的特点为睡眠障碍、绝望、运动阻滞和焦虑等为主要表现;经Logistic回归分析,卒中后抑郁发生的相关因素有负性生活事件、病灶数目、心血管病史、抑郁症史、病灶部位以及脑卒中史。结论卒中后抑郁发生率较高,以睡眠障碍、绝望、运动阻滞和焦虑等主要表现,其相关因素有负性生活事件、病灶数目、心血管病史、抑郁症史,它的发生可能是社会心理学因素和神经生物学因素共同作用的结果。     

大剂量阿托伐他汀预防缺血性脑卒中后抑郁的初步研究

目的：初步探究大剂量阿托伐他汀预防缺血性脑卒中后抑郁的临床疗效。方法选取2013年1月～2014年12月神经内科收治的78例缺血性脑卒中后抑郁患者为研究对象,按照入院顺序均分为观察组和对照组各39例,对照组给予基础治疗药物及常规量阿托伐他汀钙分散片治疗;观察组在对照组基础上给予大剂量阿托伐他汀钙分散片治疗,两组疗程均为一个月,比较治疗前后两组临床疗效,观察治疗前后两组患者汉密尔顿抑郁量表评分（HAMD）、神经功能缺损评分（SSS）、和日常生活能力评分（ADL）变化情况。结果治疗后观察组总有效率94.87％比对照组66.67％高,差异具有统计学意义（ P＜0.05）。两组患者HAMD、SSS均较治疗前减小,BI较治疗前增大,观察组差异具有统计学意义（ P＜0.05）,对照组无统计学意义（ P＞0.05）;治疗后观察组HAMD （6.59±1.25）分、SSS（10.59±1.31）分均较对照组减小地更显著,BI（75.78±10.18）分较对照组增大地显著,差异具有统计学意义（ P＜0.05）。结论大剂量阿托伐他汀对出血性脑卒中后抑郁患者预防作用疗效显著,改善患者神经功能缺损程度,同时改善脑卒中后抑郁患者抑郁程度,并且能够让患者恢复自主生活能力。大剂量阿托伐他汀对出血性脑卒中后抑郁患者预防作用具有临床应用价值。     

卒中后抑郁特点及舍曲林治疗效果临床分析

目的研究卒中后抑郁（PSD）的特点，观察抗抑郁剂舍曲林对卒中后抑郁患者神经功能康复的影响，为卒中后抑郁的干预提供依据。方法采用临床流行病学调查方法对198例脑卒中患者进行卒中后抑郁及其相关因素的现状调查，将PSD患者随机分为舍曲林治疗组和对照组，观察舍曲林对患者神经功能康复的疗效。结果卒中后抑郁的发生率为36．86％，卒中后抑郁的特点为睡眠障碍、绝望、运动阻滞和焦虑等主要表现；卒中后抑郁患者HAMD和ADI评分高；口服舍曲后治疗组与对照组相比HAMD、HDL、NFDS减分明显，抗抑郁治疗在缓解抑郁症状的同时，可以改善患者日常生活能力和神经功能缺损。结论卒中后抑郁发生率较高，以睡眠障碍、绝望、运动阻滞和焦虑等为主要表现，抗抑郁剂舍曲林不仅可以明显改善卒中后抑郁的抑郁症状，还能提高患者的日常生活能力，促进患者神经功能的康复。     

依托互联网平台实现全程系统化康复训练在脑卒中构音障碍患者中的临床疗效研究

目的 探究在脑卒中后发生构音障碍的患者中实行依托互联网平台的全程系统化康复训练策略的临床疗效。方法 选入2019年6月—2021年6月于开滦总医院诊治的脑卒中后构音障碍患者55例,采用随机数表法将患者分为对照组和研究组。对照组27例,进行临床脑卒中患者的常规护理,出院后进行电话随访;研究组28例,院内护理中采用系统化康复训练,出院后依托微信平台对患者进行康复指导和随访。随后比较2组临床一般资料信息、Frenchay活动量表、脑卒中专用生活质量评定量表（Stroke Specific Quality Of Life,SS-QOL）、焦虑自评量表（Self-Rating Anxiety Scale,SAS）和抑郁自评量表（Self-Rating Depression Scale,SDS）得分情况。结果 在经全程系统化康复训练后,研究组Frenchay活动量表得分低于对照组（t=3.10,P=0.003）,而SS-QOL量表得分则高于对照组（t=4.38,P=0.001）。研究组SAS及SDS量表得分均低于对照组（t=2.94、3.33,P=0.005、0.002）。结论 依托互联网平台的全...     

D-二聚体、纤溶酶原激活物抑制物在急性肾衰竭患者血液净化中的临床意义

目的探讨急性肾衰竭(ARF)时D-二聚体(D-D)、纤溶酶原激活物抑制物(PAI)在不同的血液净化方法中的动态变化及临床意义。方法对我院2007年1月—2010年3月急诊住院58例ARF患者血液净化前、净化后4 h及38例健康人进行血浆中D-D含量及PAI水平测定。ARF患者血液净化方法随机采用血液透析(HD)(31例)、血液透析滤过(HDF)(27例)。结果 ARF患者D-D含量及PAI水平较对照组明显升高[D-D(0.83±0.04)与(0.48±0.03)mg/L,P=0.000 2;PAI(14.95±0.73)与(8.03±0.30)103kat/L,P<0.0001;]HD治疗4 h后D-D含量和PAI活性较治疗前升高[D-D(0.89±0.05)与(1.48±0.37)mg/L,P=0.018;PAI(14.89±1.78)与(22.10±3.56)103kat/L,P=0.025],而HDF治疗后D-D含量和PAI无明显变化[D-D(0.91±0.06)与(1.12±0.09)mg/L,P=0.65;PAI(15.81±1.98)与(16.10±2.56)103kat/L,P=0.86]。结论 ARF患者D-D、PAI水平升高,存在凝血-纤溶系统的紊乱,HD可以加重这种改变,而采用HDF治疗可避免对患者凝血机能的影响,在急性肾衰竭治疗中有一定临床价值。     

Image quality dependence on in-plane positions and directions for MDCT images

Objective

The present study was performed to examine the dependence of image quality on in-plane position and direction in computed tomography (CT) imaging using the modulation transfer function (MTF), noise power spectrum (NPS) and analysis of signal-to-noise ratio (SNR). For detailed analysis of SNR, the low-contrast detectability was compared using simulated small low-contrast objects.

Materials and methods

Three models of multidetector-row CT (MDCT) were employed. The measurement positions for MTF were set to the isocentre and several peripheral areas, and NPS and SNR were calculated for the isocentre and 128 mm off-centre. To evaluate directional dependence, the one-dimensional physical properties were measured separately in the radial and azimuthal directions. Seven radiological technologists also performed a perceptual detection study at the different in-plane positions using computer-simulated low-contrast images.

Results

The results of MTF and SNR differed between the isocentre and the peripheral area. The MTF values also tended to decrease with distance from the isocentre, and the SNR values in the low frequency range for the peripheral area were superior to those for the isocentre. In the detection study, the low-contrast detectability in the peripheral area was 13-40% higher than the value in the isocentre.

Conclusion

The results of the present study indicated that clinical CT images have remarkable non-uniformity of image quality. Therefore, the detailed analysis performed in this study will provide useful information for the development of advanced image processing applications, such as computer-aided diagnosis (CAD) and de-noising of CT images.     

Anterior interosseous nerve lession and distal myoclonus revealing a parsonage turner syndrome associated with hashimoto thyroiditys

Parsonage-Turner Syndrome (PTS), also known as brachial neuritis or neuralgic amyotrophy, is a rare disorder affecting 2 to 3 individuals per 100,000 each year. Abrupt onset shoulder pain, followed by motor weakness, paresthesia and hypoesthesia, is usually reported, lasting several months with variable recovery. The etiology of the disease may be idiopathic or triggered by an underlying autoimmune disease in genetically susceptible individuals. Our report addresses a unique case of Parsonage-Turner Syndrome in a patient suffering from concurrent Hashimoto Thyroiditis. A previously healthy A 22 year-old female was referred to the Department of Neurology after complaints of sudden-onset motor weakness in her left upper limb. On physical examination, the patient could not make an “Ok sign” with her thumb and distal phalanx or form a complete fist, revealing weakness within the anterior interosseous branch of the median nerve. Further testing with electromyography demonstrated muscular atrophy within the arm''s anterior compartment, forearm, and triceps brachii of the posterior compartment. Additional imaging and physical examination were unremarkable, confirming our diagnosis of PTS. Furthermore, lab reports revealed elevated levels of anti-thyroglobulin and anti-thyroid peroxidase antibodies and our patient was concurrently diagnosed with Hashimoto''s thyroiditis.This case aims to highlight the rare co-occurrence of Hashimoto''s thyroiditis with Parsonage-Turner Syndrome in an otherwise healthy patient. A 2014 study published by Nugent et al. had also shed light on brachial neuritis in a patient suffering from autoimmune connective tissue disease, and through this case study, we hope to add to the growing literature regarding the correlation between PTS and autoimmune diseases. Symptoms of PTS can easily be misdiagnosed given its similarity to other peripheral neuropathies, and careful assessment and thorough understanding of the disease is required to successfully distinguish it from other neurological pathologies.     

Validity of apparent diffusion coefficient (ADC) value in diagnosis and follow-up of multiple sclerosis patients in different clinical subtypes

Background

Multiple sclerosis (MS) is a chronic disease with a wide range of pathologic changes that modify the apparent diffusion coefficient (ADC) value.

脑梗死患者血清同型半胱氨酸检测的临床意义

目的：探讨脑梗死患者血清同型半胱氨酸（Hcy）水平的变化及临床意义。方法：应用比色法对44例脑梗死患者（脑梗死组）进行血清Hcy水平测定,并与40例健康正常人（对照组）作比较。结果：脑梗死组血清Hcy水平（21.42±3.19μmol/L）明显高于对照组（12.04±2.46μmol/L）。结论：脑梗死患者血清Hcy水平明显升高,可作为预测脑梗死发生、发展的敏感指标。     

强直性脊柱炎80例临床研究

1985年,我院内科对800例患腰背痛,其中部分为外院疑有强直性脊柱炎(AS)的病人,进行了临床及HLA-B_(27)检查。根据纽约诊断标准,确诊为AS病者80例,其发病年龄多在12～30岁之间,男女之比例为6.3∶1;72例AS病人之HLA-B_(27)阳性,5例病人有家族史,提示本病与遗传因素有关。部分病人做到了早期诊断。我们认为,对患腰背痛的病人进行HLA-B_(27)检查,可提高医生对AS发病之警觉。     

Humane metapneumovirus (HMPV) associated pulmonary infections in immunocompromised adults—Initial CT findings,disease course and comparison to respiratory-syncytial-virus (RSV) induced pulmonary infections

Aim

To describe computed tomography (CT)-imaging findings in human metapneumovirus (HMPV)-related pulmonary infection as well as their temporal course and to analyze resemblances/differences to pulmonary infection induced by the closely related respiratory-syncytial-virus (RSV) in immunocompromised patients.

Materials and methods

Chest-CT-scans of 10 HMPV PCR-positive patients experiencing pulmonary symptoms were evaluated retrospectively with respect to imaging findings and their distribution and results were then compared with data acquired in 13 patients with RSV pulmonary infection. Subsequently, we analyzed the course of chest-findings in HMPV patients.

Results

In HMPV, 8/10 patients showed asymmetric pulmonary findings, whereas 13/13 patients with RSV-pneumonia presented more symmetrical bilateral pulmonary infiltrates. Image analysis yielded in HMPV patients following results: ground-glass-opacity (GGO) (n = 6), parenchymal airspace consolidations (n = 5), ill-defined nodular-like centrilobular opacities (n = 9), bronchial wall thickening (n = 8). In comparison, results in RSV patients were: GGO (n = 10), parenchymal airspace consolidations (n = 9), ill-defined nodular-like centrilobular opacities (n = 10), bronchial wall thickening (n = 4). In the course of the disease, signs of acute HMPV interstitial pneumonia regressed transforming temporarily in part into findings compatible with bronchitis/bronchiolitis.

Conclusions

Early chest-CT findings in patients with HMPV-related pulmonary symptoms are compatible with asymmetric acute interstitial pneumonia accompanied by signs of bronchitis; the former transforming with time into bronchitis and bronchiolitis before they resolve. On the contrary, RSV-induced pulmonary infection exhibits mainly symmetric acute interstitial pneumonia.     

Comparison of double inversion recovery magnetic resonance imaging (DIR-MRI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in detection of prostate cancer: A pilot study

IntroductionDCE-MRI is established for detecting prostate cancer (PCa). However, it requires a gadolinium contrast agent, with potential risks for patients. The application of DIR-MRI is simple and may allow cancer detection without the use of an intravenous contrast agent by differentially nullifying signal from normal and abnormal prostate tissue, creating contrast between the cancer and background normal prostate. In this pilot study we gathered data from DIR-MRI and DCE-MRI of the prostate for an equivalence trial. We also looked at how the DIR-MRI appearance varies with the aggressiveness of PCa.MethodDIR-MRI and DCE-MRI were acquired. The images were assessed by an experienced Consultant Radiologist and a novice reporter (Radiographer). The potential PCa lesions were quantified using a lesion to normal ratio (LNR). Radiological pathological correlation was made to identify the MRI lesions that represented significant PCa. A Wilcoxon sign rank was used to compare DCE-LNR and DIR-LNR for PCa containing lesions. Pearson's correlation was used to look at the relationship between DIR-LNR and PCa grade group (aggressiveness).ResultsDCE-LNR and DIR-LNR were found to be significantly different (Z = −5.910, p < 0.001). However, a significant correlation was found between PCa grade group and DIR-LNR.ConclusionDIR and DCE sequences are not equivalent and significant cancer is more conspicuous on the DCE sequence. However, DIR-LNR does correlate with PCa aggressiveness.Implications for practiceWith the correlation of PCa grade group with DIR-LNR this may be a useful sequence in evaluation of the prostate; stratifying the risk of there being clinically significant PCa before biopsy is performed. Furthermore, given that DIR-LNR appears to predict PCa aggressiveness DIR might be used as part of a multiparametric MRI protocol designed to avoid biopsy.     

CT and MR features of nasopharyngeal carcinoma in children and young adults

AIM: To clarify CT and MR features of nasopharyngeal carcinoma (NPC) in children and young adults. METHOD: CT and MR findings of 13 patients (30 years old or younger) with a histopathologic diagnosis of NPC were reviewed. RESULTS: Skull base invasion (12/13), lymphadenopathy (10/13), and infiltrative growth (8/8) were common findings. The signal intensity of tumours was slightly higher than that of muscles in six cases and isointense to that of muscles in two cases on T1-weighted images; it was higher than that of muscle and lower than that of cerebellar grey matter on T2-weighted images in all cases. Internal signals were homogeneous in both pre- and post-Gd-enhanced MR images in all cases. CONCLUSIONS: Despite its rarity in this age group, NPC should be included in a differential diagnosis when CT and MR imaging reveal these features.