短暂性脑缺血发作后发生脑梗死风险的预测研究

目的 探讨ABCD2评分和ABCD2评分结合MRI弥散加权成像(DWI)和颅内动脉MR血管成像(MRA)对短暂性脑缺血发作(TIA)后脑梗死的预测价值.方法 分别采用ABCD2评分及ABCD2+ DWI+MRA评分对182例TIA患者进行评定,观察TIA后2d、7d和30 d内的脑梗死发生率.采用ROC曲线评估ABCD2及ABCD2+ DWI+ MRA评分对TIA后脑梗死风险的预测准确度.结果 本组56例(30.8％)患者于30 d内发生脑梗死,其中42例(23.1％)发生于7d内,19例(10.4％)发生于2d内,均无脑出血发生.与低危组比较,中危组与高危组各时间点脑梗死发生率显著升高(均P＜0.05).DWI异常患者各时间点脑梗死发生率明显高于正常者(均P＜0.05).30 d时颅内动脉狭窄≥50％的患者脑梗死发生率明显高于颈内动脉狭窄＜50％的患者(P＜0.05).伴DWI异常及颅内动脉狭窄≥50％的低危组患者各时间点脑梗死发生率显著高于DWI正常和颅内动脉狭窄＜50％的患者(均P＜0.05).ABCD2+ DWI+ MRA评分预测TIA第2d、第7d及第30 d的脑梗死率的曲线下面积显著高于ABCD2评分(均P＜0.001).结论 ABCD2评分结合DWI和MRA能进一步提高预测TIA后发生脑梗死的准确性.     

ABCD~2评分结合经颅多普勒和颈部血管超声对TIA患者近期预后的评价

目的分析ABCD2评分结合经颅多普勒和颈部血管超声对短暂性脑缺血发作(TIA)后7 d发生脑梗死的评估价值。方法以2010年1月～2011年1月住院治疗的126例TIA患者作为研究对象,收集其临床、TCD和颈部血管超声检查资料。按ABCD2评分法进行评分,计算TIA后7 d内脑梗死发生率。结果 126例TIA患者7 d内进展为脑梗死者26例,占20.6%。ABCD2评分越高,脑梗死的发生率越高(P<0.05)。TIA后7 d脑供血动脉狭窄≥50%的患者中脑梗死发生率较脑供血动脉狭窄<50%的患者明显升高(P<0.05)。ABCD2评分≥4分、脑供血动脉狭窄≥50%的TIA患者7 d脑梗死发生率为33.8%,与ABCD2评分≥4分、脑供血动脉狭窄<50%的TIA患者(7.7%)比较,其发生脑梗死的风险明显增加(P<0.05)。结论 ABCD2评分法预测7 d发生脑梗死风险的准确性较高,进一步结合经颅多普勒和颈部血管超声检查可提高预测的准确性。     

短暂性脑缺血发作患者ABCD2评分与脑血管狭窄相关性初步研究

目的 评价短暂性脑缺血发作（transient ischemic attack,TIA）患者ABCD2评分和脑血管狭窄之间的关系。方法 回顾性研究了88例TIA患者ABCD2评分和颅脑磁共振血管成像（magnetic resonance angiography,MRA）影像资料,根据ABCD2评分分为评分≥4分组和评分＜4分组,根据MRA评估分为血管狭窄≥50%组和狭窄＜50%组,评价ABCD2评分与脑血管狭窄之间的相关性。结果 血管狭窄≥50%组与狭窄＜50%组比较,ABCD2评分≥4分的比率增高[74.4% vs 44.9%,比值比（odds ratio,OR）3.559,95%可信区间（credibility interval,CI）1.428～8.868,P =0.005];既往有卒中病史的患者比率增高（33.3% vs 10.2%,OR =4.400,95%CI 1.408～4.869,P =0.01）;脑血管狭窄≥50%组与狭窄＜50%组比较,前者TIA后2d内卒中发生率明显增高（10.3% vs 0%,OR =0.417,95%CI 0.324～0.537,P =0.04）。结论 ABCD2评分≥4分MRA示颅内血管狭窄率高,既往有卒中病史的TIA患者颅内血管狭窄率增高,颅内血管狭窄≥50%TIA后2d内发生卒中的风险增高。     

ABCD~2评分法对短暂脑缺血发作患者的卒中风险分析

目的探讨ABCD~2评分法对短暂脑缺血发作(TIA)患者短期内进展为脑梗死的预测价值。方法按照Johnston等[4-6]对TIA的ABCD~2评分标准,测定98例TIA患者的评分并危险分组,观察其2、7d内脑梗死的发生率,比较各危险组之间卒中率的差异,分析ABCD~2评分中预测因子的作用。结果评分≤3分的TIA患者有40例,2、7d发生脑梗死的例数分别为0例(0%)、2例(5%);评分为4~5分的患者46例2、7d进展为脑梗死的例数分别为4例(8.7%)、11例(23%);评分≥6分的患者12例2、7d进展为脑梗死的例数分别为3例(25%)、4例(33.3%),不同ABCD~2评分值的TIA患者,其脑梗死发生率差异有统计学意义(P0.05);ABCD~2评分中的各预测因子Logistic回归分析症状持续时间≥10min及具有局灶体征可以进入回归方程,以此建立的回归方程有效性差异有统计学意义(P=0.000)。结论 ABCD~2评分能够预测TIA患者2、7d内卒中发生率,是临床预测TIA短期进展为脑梗死的一种简便、有效的方法。ABCD~2评分值不同的TIA患者,脑梗死的发生率不同,分值越高,发生率越高;ABCD~2评分中的卒中预测因子,最重要的是局灶体征及症状持续时间萁次为年龄、糖尿病等。     

ABCD2评分结合管腔狭窄程度对TIA发展为脑梗死的预测价值

目的 探讨ABCD2评分结合颈内动脉粥样硬化(ICAS)所致管腔狭窄程度对短暂性脑缺血发作(TIA)后7d内发展为脑梗死的预测价值. 方法 选取北京水利医院神经内科自2008年9月至2011年3月收治的171例TIA患者作为研究对象,应用ABCD2评分法进行评分,彩色多普勒超声检查ICAS所致管腔狭窄程度,筛选出TIA发生后7d内发生脑梗死的患者并分析ABCD2评分、管腔狭窄程度对脑梗死发生率的影响. 结果 TIA后7d内发生脑梗死者39例(22.8％);ABCD2评分、颈内动脉狭窄程度不同患者脑梗死发生率不同,差异有统计学意义(P＜0.05).中危组、高危组患者TIA后7d脑梗死发生率高于低危组,中度狭窄组和重度狭窄或闭塞组脑梗死发生率高于与正常或轻度狭窄组,差异均有统计学意义(P＜0.05). 结论 ABCD2评分、ICAS所致管腔狭窄程度可以影响TIA后7d内脑梗死的发生,两者结合对于TIA后7d内发展为脑梗死更有预测价值.     

短暂性脑缺血发作患者短期发生脑梗死的危险因素分析

目的分析短暂性脑缺血发作(TIA)患者7d和30d内进展为脑梗死的危险因素。方法以119例住院TIA患者为研究对象,收集其临床资料和磁共振血管成像(MRA)结果,并按Johnston提出的7分"ABCD2"评分法给予评分,随访发生TIA后7d和30d内脑梗死的发生率。结果 TIA发生后50例(42.0%)患者于30d内发生脑梗死,其中29例(24.4%)发生于7d内。Logistic回归分析发现,症状持续时间≥10min、ABCD2评分≥4分是TIA后7d发生脑梗死的独立危险因素;发作次数≥3次、颅内动脉狭窄≥50%是TIA后30d发生脑梗死的独立危险因素。抗凝治疗是TIA进展为脑梗死的保护因素。结论发作持续时间长、次数多、颅内动脉狭窄重和"ABCD2"评分高的TIA患者短期内脑梗死发生危险性较高,抗凝治疗可使TIA患者有降低脑梗死发生的风险性。     

ABCD2评分结合hs-CRP对短暂性脑缺血发作后发生脑梗死的评估价值

目的 探讨短暂性脑缺血发作（transient ischemic attack,TIA）患者ABCD2评分与血清超敏C反应蛋白（hs-CRP）水平的关系,及ABCD2评分法预测TIA进展为脑梗死的价值.方法 测定79例TIA患者（TIA组）和40例健康体检者（对照组） 血清hs-CRP水平,TIA组按ABCD2评分分为高危组、中危组和低危组,比较3组间hs-CRP水平,并观察其2 d、7 d内脑梗死的发生率.结果 TIA组血清hs-CRP水平高于对照组（P〈0.05）;高、中、低危组间血清hs-CRP水平差异均有统计学意义（P〈0.05）,评分≤3分的TIA患者22例,2 d、7 d发生脑梗死分别为1例（4.5%）、2例（9.1%）;评分为4或5分的患者31例,2 d、7 d进展为脑梗死分别为3例（9.7%）、5例（16.1%）;评分≥6分的患者26例,2 d、7 d进展为脑梗死分别为7例（26.9%）、10例（38.5%）.不同ABCD2评分值的TIA患者,其脑梗死发生率差异均有统计学意义（P均〈0.05）.结论 TIA患者ABCD2评分与血清hs-CRP水平关系密切,两者呈正相关.ABCD2评分值不同,脑梗死的发生率不同,分值越高,发生率越高,联合二者更有助于TIA的指导治疗和风险评估.     

ABCD2评分及责任血管狭窄对短暂性脑缺血发作进展为脑梗死的预测价值

目的 探讨ABCD2评分与责任血管狭窄对短暂性脑缺血发作(TIA)后脑梗死发生的预测价值. 方法 将焦作市人民医院神经内科自2008年至2011年收治的93例TIA患者根据ABCD2评分分为低危组(20例)、中危组(48例)、高危组(25例),并行DSA检查,根据责任血管狭窄程度分为正常或轻度狭窄(狭窄率＜50％)、中度狭窄(狭窄率50％～69％)、重度狭窄(狭窄率70％～100％).根据Logistic β回归系数分别对ABCD2评分及责任血管狭窄程度进行危险因素赋分,通过线性函数转换建立危险评分系统. 结果 发病7d内低危组脑梗死发生率为5.0％,中危组为10.4％,高危组为36.0％;中、低危组的脑梗死率发生率均明显低于高危组,差异有统计学意义(P＜0.05).65例(69.9％)患者有不同程度的责任血管狭窄或闭塞,其中正常或轻度狭窄54例、中度狭窄22例及重度狭窄17例;中度狭窄组及重度狭窄组脑梗死发生率(27.3％、47.1％)均明显高于正常或轻度狭窄组(1.9％),差异有统计学意义(P＜0.05).基于入院危险因素建立的预测模型性能良好(拟合优度检验P＞0.05,C统计值为0.887).利用危险评分系统成功地将TIA患者分为低危、中危和高危脑梗死组,模型建立数据中患者进展性脑梗死发生率分别为1.9％、25.0％和47.1％. 结论 ABCD2评分及责任血管狭窄程度对TIA患者进展为脑梗死的预测有重要意义.根据ABCD2评分及责任血管狭窄程度建立的预测模型可以早期、方便、准确地预测TIA后脑梗死的发生,开发的预测工具可辅助临床决策的制定.     

短暂性脑缺血发作后短期内发生脑梗死的风险分析

目的分析ABCD2评分结合MRA对短暂性脑缺血发作(TIA)后7~30d脑梗死发生的评估价值。方法以2008年12月~2009年10月住院的TIA患者为研究对象,收集其临床资料和磁共振血管成像(MRA)检查结果,按Johnston提出的7分"ABCD2"评分法给予评分,随访TIA后7d和30d内脑梗死的发生率,并分析"AB-CD2"评分、MRA与TIA后短期内发生脑梗死的关系。结果 50例(42.0%)TIA患者于30d内发生脑梗死,其中29例(24.4%)发生于7d内;"ABCD2"评分与TIA后7d和30d脑梗死发生率之间呈直线相关,"ABCD2"评分越高,脑梗死的发生率越高(P0.001);TIA后7d和30d颅内动脉狭窄≥50%的患者中脑梗死发生率比50%的患者明显增高(P0.05)。结论 "ABCD2"评分法对TIA后脑梗死发生有预测价值,"ABCD2"评分结合MRA检查能进一步提高预测的准确性。     

采用ABCD评分预测短暂性脑缺血发作短期进展为脑梗死的价值

目的探讨采用ABCD评分预测短暂性脑缺血发作（Transient Ischemic Attack，TIA）短期进展为脑梗死的价值。方法按照Rothwell对TIA的ABCD评分标准，测定103例TIA患者的评分和观察7d内脑梗死的发生率。结果评分≤3分的TIA患者有41例，脑梗死的发生率为零；评分4分的TIA患者有27例，脑梗死的发生率为18％；评分5分的TIA患者有22例，脑梗死的发生率为40％；评分5分的TIA患者13例，脑梗死的发生率为85％。在年龄≥60岁、血压140／90mmHg、偏瘫伴口齿含糊、症状持续时间≥60min的患者中脑梗死的发生率明显增高，而在单纯偏瘫和单纯口齿含糊的患者中脑梗死的发生率无明显增高。结论TIA患者不同的ABCD评分值7d内脑梗死的发生率不同，分值越高，发生率越高；反之，分值越低，发生率越低；Rothwell的ABCD评分标准是临床上预测TIA短期进展为脑梗死的一种比较有效的方法。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

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     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.