补气芳香开窍法治疗神经衰弱45例

神经衰弱是一种临床上常见的、难治的疾病 ,患者常感脑力和体力不足 ,工作效率低下 ,对学习影响较大 ;常伴头晕、头痛、失眠、多梦、心悸等。由于近年高效快节奏的生活方式影响 ,此病的发病率有增加的趋势 ,治疗以药物、心理等综合治疗为主。近年笔者采用补气芳香开窍法治疗 45例 ,取得了较好疗效 ,现介绍如下。1　临床资料　　本组病例为 1996年～ 1999年我院门诊病例 ,男 18例 ,女2 7例 ;年龄 16岁～ 5 0岁 ,其中 16岁～ 2 0岁 12例 ,2 1岁～ 30岁18例 ,31岁～ 40岁 10例 ,41岁～ 5 0岁 5例。全部病例均符合神经衰弱的诊断标准[1] 。 45例…     

醒神液对中枢神经系统兴奋性的影响

目的 :观察醒神液对中枢神经系统 (CNS)兴奋性的影响。方法 :灌胃给药 5次 ,观察睡眠实验、中枢兴奋实验和耐缺氧实验。结果 :醒神液能缩短戊巴比妥钠睡眠持续时间 ,而对苯巴比妥钠睡眠实验无明显影响 ;醒神液有对抗苦味毒兴奋CNS的作用 ,延长惊厥潜伏期、减少惊厥死亡率 ,起镇静抗惊厥作用 ;醒神液能延长小鼠耐缺氧存活时间。结论 :醒神液对CNS兴奋性有双向调节作用。     

活血开窍法对脑缺血再灌注损伤大鼠脑组织兴奋性氨基酸的影响

目的观察活血开窍法对大鼠脑缺血再灌注损伤脑组织兴奋性氨基酸(EAA)的影响。方法以大鼠局灶性脑缺血再灌注模型为研究对象,于缺血2h再灌注48h,取脑组织应用高效液相色谱法测定谷氨酸(Glu)、天门冬氨酸(Asp)的含量。结果缺血2h再灌注48h后,模型组、药物组与正常组大鼠比较,脑组织G1u及Asp含量升高(P0.01);与模型组大鼠比较,醒脑通脉大、小剂量组脑组织中Glu、Asp含量显著降低(P0.01)。结论活血开窍法抗缺血性脑损伤的作用机制可能与其对抗脑缺血再灌注后EAA的升高有关。     

兴奋性氨基酸,兴奋性氨基酸受体及其对HPA轴的影响

兴奋性氨基酸，如谷氨酸和门冬氨酸在下丘脑大部分核中的突触前膨大内浓度很高，这些核团包括弓状核，交叉上核，视上核，室旁核，终板血管器官和视前区。ＥＡＡ受体也分布在相应核团的突触后膜上。ＮＭＤＡ受体和非－ＮＭＤＡ受体在垂体前，中后叶均有分布。ＲＡＡｓ及其受体对ＣＲＨ，ＡＶＰ，ＡＣＴＨ的分泌和ＨＰＡ轴的应激反应有重要影响。     

栀豉汤加豁痰开窍药治疗慢性焦虑症的体会

栀子豉汤源于《伤寒论》太阳病篇第 78条 ,是治疗伤寒余热未尽 ,留扰胸膈 ,以致出现烦热懊证的主方。笔者细心玩味 ,并参考清、尤在泾《伤寒贯珠集》“栀豉二味相合 ,能彻胸中邪气 ,为除烦止躁之良剂”的精辟指导下 ,以此受到深刻启发 ,在《内经》“异病同治”理论指导下 ,从而悟出以本方为基础 ,加入豁痰开窍等药 ,治疗因情志不畅 ,气郁日久 ,化火生痰 ,干扰心神 ,变生烦躁不安的慢性焦虑症 ,取得了显著疗效 ,现将典型辨治病例报告如下。钟某 ,男 ,5 1岁 ,市纸箱厂财务科干部。就诊日期 90年 8月 5日 ,患者平时身体状况尚好 ,祖父母亦无…     

代谢综合征交感神经系统兴奋性增高的机制

代谢综合征(metabolic syndrome,MS)是以多种代谢异常集簇出现为特点的一组临床症候群,可显著增加心血管疾病的发病率及死亡率,成为现在研究的热点问题.MS的发病机制目前学说主要集中在遗传因素、胰岛素抵抗、致动脉粥样硬化性血脂异常、腹型肥胖和慢性低度炎症状态等方面,然而上述机制并不是独立起作用的,而是各种因素间相互影响,致使很难阐述MS的病理生理机制.大量临床研究证实,MS大多组分包括高血压、腹型肥胖、高胰岛素血症均与交感神经活性增强密切相关,因此国外学者提出交感神经活性增强可作为上述发病机制的共同发病的基础.本文就MS患者交感神经系统(sympathetic nervous system,SNS)兴奋性增强的机制作一综述,以指导临床治疗.     

不同透析膜进行血液透析对血浆支链氨基酸和芳香氨基酸的影响

支链氨基酸（ＢＣＡＡ）和芳香氨基酸（ＡＡＡ）在体内存在一定含量和比例。它们在通过血脑屏障时具有竞争性。ＢＣＡＡ减少或者ＢＣＡＡ与ＡＡＡ比例失调不仅影响机体蛋白质的代谢，还可引起神经系统功能的变化。我们旨在研究应用不同透析膜对病人进行透析时，血浆ＢＣＡ...     

益气活血开窍法对缺血性中风患者血脂和血黏度的影响

目的探讨益气活血开窍法对缺血性中风恢复期患者血脂和血黏度的影响。方法选取120例缺血性中风恢复期患者,随机分为治疗组和对照组,各60例。对照组采用常规西药疗法,治疗组在西药常规治疗基础上采用益气活血开窍方治疗。观察两组患者神经功能缺损和生活行为能力评分、血脂及血黏度的变化。结果与治疗前比较,两组治疗后神经功能缺损评分和生活行为能力评分明显降低,三酰甘油(TG)、总胆固醇(TC)、全血高切黏度、全面低切黏度、血浆比黏度显著降低(P<0.01);治疗后治疗组神经功能缺损评分和生活行为能力评分明显低于对照组(P<0.01);TG、TC、全血高切黏度、低切黏度明显低于对照组(P<0.05)。结论益气活血开窍法可调节缺血性中风恢复期患者血脂代谢,降低血黏度,提高缺血性中风恢复期患者神经功能,改善生活行为能力。     

心脑舒通对血管性痴呆大鼠脑兴奋性氨基酸含量的影响

目的观察心脑舒通对血管性痴呆大鼠脑内谷氨酸(Glu)、天门冬氨酸(Asp)含量的影响,探讨心脑舒通治疗血管性痴呆的作用机制。方法采用高效液相色谱和紫外分光光度计比色法检测。结果模型组大鼠脑组织内Glu、Asp含量(8.34 nmol/mg±0.65 nmol/mg;3.46 nmol/mg±0.59 nmol/mg)明显低于假手术组(12.06 nmol/mg±0.96 nmol/mg;5.15 nmol/L±0.77 nmol/mg,P0.01);心脑舒通组Glu、Asp含量明显高于模型组(P0.05),但与假手术组比较无统计学意义。结论升高血管性痴呆大鼠脑内兴奋性氨基酸水平可能是心脑舒通治疗血管性痴呆的作用机制之一。     

中药复方962对老年大鼠学习记忆功能及兴奋性的影响

目的 研究中药复方９６２胶囊改善老年大鼠学习记忆功能下降的作用及对中枢兴奋性的影响。方法 研究采用２４月龄Ｗｉｓｔａｒ雌、雄性大鼠,实验分为青年对照、老年模型、脑复康（０．５６ｇ／ｋｇ）,９６２中剂量（０．９ｇ／ｋｇ）和９６２大剂量（１．８ｇ／ｋｇ）５组,采用灌胃给药途径给药１～２个月,分别用水迷宫及旷场分析对动物学习记忆功能及兴奋性进行评价。结果 中药复方９６２中剂量及大剂量能显著改善老年雌、雄     

Diagnosis and pathogenesis of CNS lupus

Summary The central nervous system (CNS) is clinically involved in approximately 40% of all systemic lupus erythematosis (SLE) patients. Minor psychiatric symptoms and abnormalities on neuropsychological testing are being detected with increasing frequency. This review summarizes current thinking concerning the diagnosis and pathogenesis of CNS lupus. The main symptoms of CNS lupus can be diffuse (generalized seizures, psychosis) or focal (stroke, peripheral neuropathies). Neuropsychiatric symptoms often occur in the first year of SLE, but are rarely the presenting symptoms of the disease. In studies on the pathology of CNS lupus, vasculopathy, infarcts and haemorrhages are often observed, whereas vasculitis is rare. Endocardial lesions and mural thrombi have also been reported in 33–50% of CNS lupus patients. In fliagnostic imaging of the CNS, magnetic resonance imaging (MRI) scans often provide evidence for edema or small infarcts, both in focal and diffuse CNS lupus, whereas computerized tomography (CT) scans only show gross abnormalitites. The first reports on position emission tomography (PET) scans in CNS lupus patients show decreased glucose uptake in the brain. The cerebral blood flow decreases during active diffuse and focal CNS lupus. The blood-brain barrier is somewhat more frequently impaired in diffuse CNS lupus. Intrathecal IgG and IgM production is observed in 25–66% of all CNS lupus patient. Various specificities of autoantibodies have been observed in CNS lupus. Of these, anticardiolipin (ACA) antibodies show a well-documented association with focal involvement of the CNS in SLE. These antibodies could cause thrombosis by interfering with the protein C pathway of fibrinolysis. In addition, they are associated with endocardial and valvular heart disease, which is often observed in SLE and which could cause ombolism. The relation between ACA and diffuse CNS lupus is not yet clear. Low-avidity anti-DNA antibodies are also found in CNS lupus, possibly because of their fross-reaction with cardiolipin. Antineuronal antibodies and lymphocytotoxic antibodies have been associated with diffuse CNS lupus and abnormalities on neuropsychological testing. However, the population of these antibodies is rather heterogeneous and it has not been possible to assess a common target antigen. Therefore, it is still obscure whether there is also a second immune-mediated mechanism responsible for the development of the diffuse form of CNS lupus.     

Primary CNS angiitis presenting as short‐term memory loss: a case report and literature review

Primary angiitis of the central nervous system (PACNS) is an idiopathic vasculitis of the small to medium vessels that often eludes diagnosis because of its variable signs and symptoms. A 36‐year‐old woman presented with a 4‐week history of progressive memory loss. Neurological examination revealed only severe cognitive deficits including anterograde amnesia. Magnetic resonance imaging demonstrated multiple ring‐enhancing lesions involving the left frontal lobe and uncus and bilateral thalami. Stereotactic biopsy showed findings consistent with CNS angiitis. Further workup revealed no evidence of systemic disease. We report the first case of biopsy‐proven PACNS presenting as profound isolated anterograde amnesia.     

CNS relapse in a low risk acute promyelocytic leukemia patient treated with ATRA-based regimen: is there a role for prophylactic CNS therapy in acute promyelocytic leukemia?

Though the incidence of CNS relapse in acute promyelocytic leukemia (AML-M3 FAB classification) has increased following the advent of all-trans retinoic acid (ATRA), still CNS relapse accounts for only 2–3% of all relapses in AML-M3 trated with standard ATRA plus chemotherapy regimen. We report a case of low risk AML-M3 treated with standard therapy, developing CNS relapse while on maintenance therapy with ATRA + 6-mercaptopurine (6-MP) + methotrexate (MTX).     

Combined CNS and pituitary involvement as a primary manifestation of Wegener granulomatosis

Wegener granulomatosis (WG) is a systemic vasculitis of small and medium vessels. It predominantly affects the upper and/or lower respiratory airway and kidneys. Its pathogenesis is not fully understood. WG relatively frequently affects the nervous system (in 30–50% according to the different studies). Most frequently, it manifests as necrotizing vasculitis that leads to the peripheral neuropathies or to the cranial nerves palsy. Impairment of the central nervous system (CNS) is less frequent and occurs in 2–8% of patients. Three major pathogenetic mechanisms were described: CNS vasculitis, spreading of granulomas from the adjacent anatomical areas (paranasal cavities, orbit etc.), and new formation of granulomas in brain tissue. This case report describes patients in whom WG manifested in the form of localized skin involvement and combined CNS involvement that included pituitary gland. Atypical presentation of WG impedes and slows down the process of diagnosis and emphasizes the need for collaboration between medical specialists.     

Absence of Predictive Parameters for CNS Involvement in Adult non-Lymphocytic Leukaemia at Time of Diagnosis

13 patients with adult non-lymphocytic leukemia (ANLL) who developed central nervous system (CNS) involvement during the course of their illness are reported and compared with a control group of 26 ANLL patients without CNS involvement. The incidence of CNS involvement was 13/510 patients (2.5%). Initial symptoms and signs and routine laboratory data were not helpful in predicting which patients would ultimately develop CNS involvement. Almost 1/2 of the patients were in clinical and haematological remission at the time of the diagnosis of CNS involvement. Specific treatment to the CNS including intrathecal cytotoxic drugs and/or radiotherapy failed to increase the survival rate significantly. Whether the establishment of an early diagnosis of CNS involvement and the institution of appropriate treatment may improve the prognosis of this complication is a question which presently remains unanswered.     

Combining MYD88 L265P mutation detection and clonality determination on CSF cellular and cell-free DNA improves diagnosis of primary CNS lymphoma

Diagnosis of primary central nervous system lymphoma (PCNSL) is challenging, and although brain biopsy remains the gold standard, cerebrospinal fluid (CSF) constitutes a less invasive source of lymphomatous biomarkers. In a retrospective cohort of 54 PCNSL cases tested at diagnosis or relapse, we evaluated the contribution of immunoglobulin heavy chain (IGH) gene clonality and MYD88 L265P detection on both CSF cell pellets and supernatants, in comparison with cytology, flow cytometry, interleukin (IL)-10 and IL-6 quantification. Clonality assessment included a new assay to detect partial IGH-DJ rearrangements. Clonal IGH rearrangements and/or MYD88 L265P mutation were detected in 27 (50%) cell pellets and 24 (44%) supernatant cell-free (cf) DNA. Combining analyses on both compartments, 36 (66%) cases had at least one detectable molecular marker, present only in cfDNA for 9 (16%) of them. While cytology and flow cytometry were positive in only 7 (13.0%) and 9 (17.3%) cases respectively, high IL-10 levels were observed in 36 (66.7%) cases. Overall, taking into account molecular and cytokine results, 46/54 (85%) cases had at least one lymphomatous biomarker detectable in the CSF. These results show that this combination of biomarkers evaluated on both cell pellet and supernatant CSF fractions improves significantly the biological diagnosis of PCNSL.     

Prophylactic CNS directed therapy in systemic diffuse large B cell lymphoma

Overall survival in diffuse large B-cell lymphoma (DLBCL) has significantly improved in the last decade, especially after the incorporation of rituximab. Involvement of the central nervous system (CNS) at presentation or at recurrence is an uncommon event, but carries a dismal prognosis with median survival of less than 6 months. Although prophylactic CNS directed therapy is a widely used approach to prevent this complication, randomized clinical trials have been very limited. CNS prophylaxis has inherent toxicities; therefore, identifying the population of patients who would receive most benefit is of utmost importance. From an extensive review of current literature, we report the incidence of CNS relapse in DLBCL and describe the role of CNS prophylaxis in the post-rituximab compared to the pre-rituximab era. We also review the current modalities of CNS prophylaxis and attempt to identify the high-risk patients who would benefit. Lastly, we present a treatment algorithm that defines the role of CNS prophylaxis in the management of patients with DLBCL.     

Stand-alone intrathecal central nervous system (CNS) prophylaxis provide unclear benefit in reducing CNS relapse risk in elderly DLBCL patients treated with R-CHOP and is associated increased infection-related toxicity

Central nervous system (CNS) relapse following R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) occurs in 2–5% of patents with diffuse large B-cell lymphoma (DLBCL). Many patients aged ≥70 years are unsuitable for high-dose methotrexate (HDMTX) prophylaxis and therefore often receive stand-alone intrathecal prophylaxis. The CNS international prognostic index (CNS-IPI) is a clinical CNS relapse risk score that has not specifically been validated in elderly patients. The value of CNS prophylaxis in patients aged ≥70 years remains uncertain. Data on 690 consecutively R-CHOP-treated DLBCL patients aged ≥70 years were collected across 8 UK centres (2009–2018). CNS prophylaxis was administered per physician preference. Median age was 77·2 years and median follow-up was 2·8 years. CNS-IPI was 1–3 in 60·1%, 4 in 23·8%, 5 in 13·0% and 6 in 3·3%. Renal and/or adrenal (R/A) involvement occurred in 8·8%. Two-year overall CNS relapse incidence was 2·6% and according to CNS-IPI, 1–3:0·8%, 4:3·6%, 5:3·8% and 6:21·8%. Two-year CNS relapse incidence for R/A was 10·0%. When excluding HDMTX (n = 31) patients, there remained no change in unadjusted/adjusted CNS relapse for intrathecal prophylaxis effect according to CNS-IPI. CNS-IPI is valid in elderly R-CHOP-treated DLBCL patients, with the highest risk in those with CNS-IPI 6 and R/A involvement. We observed no clear benefit for stand-alone intrathecal prophylaxis but observed an independent increased risk of infection-related admission during R-CHOP when intrathecal prophylaxis was administered.     

Plasmablastic lymphoma: CNS involvement, coexistence of other malignancies, possible viral etiology, and dismal outcome

The clinical and pathological findings of plasmablastic lymphoma (PBL) have been described in the literature but the etiology is not well established, and treatment options are poorly defined. We reviewed patients with PBL in our institution to characterize the clinicopathologic features in our patient population. In this retrospective analysis from a single academic institution, five patients with PBL were identified and analyzed. Human immunodeficiency virus and human herpesvirus 8 (HHV-8) were identified in 40% (two out of five) and 80% (four out of five) of these patients, respectively. Central nervous system (CNS) involvement was identified in four out of five (80%) patients. Interestingly, three out of five patients had a concurrent or preceding second primary malignancy including small lymphocytic lymphoma, endometrial cancer, and nonsmall cell lung cancer. Most of the patients had advanced disease and a poor performance status at diagnosis. Only two of the patients received systemic chemotherapy with an initial partial response. All five patients died; the median overall survival was 1 month. Our experience in patients with PBL indicates that CNS involvement is more common than reported in the literature. Coexistence of a second primary malignancy may be frequent, and prognosis remains dismal with standard lymphoma therapy. Lastly, the role of HHV-8 in the etiopathogenesis needs further trials.