颈内动脉粥样硬化斑块及脑组织低灌注相关指标与分水岭脑梗死的关系

目的 研究颈内动脉粥样硬化斑块及脑组织低灌注相关指标与分水岭脑梗死的关系.方法 (1)分别对68例分水岭脑梗死患者(A组)和72例颈内动脉TIA患者(B组)进行颅内外多普勒、头部MRI、MRA检查,并记录两组患者颈内动脉系统粥样硬化斑块的部位、性质和不同狭窄率出现患病率.(2)对梗死组中38例重度狭窄患者(C组)和对照组中32例重度狭窄患者(D组)的血液流、血脂、血糖、纤维蛋白原、发病时血压、左心室射血指数、颅内侧支循环开放等指标进行比较.结果 (1)A组颈内动脉系统粥样硬化斑块检出率为97.05%、以大脑中动脉(79.41%)、软斑(67.64%)、重度狭窄(58.88%)患者为常见,与B组(75.00%、36.11%、43.05%、44.44%)比较有显著差异(P<0.05);其中A组狭窄率越大,分水岭脑梗死患病率越高(χ2=8.47,<0.05).(2)C组与D组之间甘油三脂、低密度脂蛋白、全血粘度高切、血浆粘度、餐后2h血糖、纤维蛋白原比较有显著差异(P<0.05);左心室射血指数、发病时收缩压、颅内侧支循环开放率比较有显著差异(P<0.005).结论分水岭脑梗死与颈内动脉系统粥样硬化斑块及性质关系密切,与狭窄率呈正向关系,其中以大脑中动脉多见.并存的低灌注相关因素是诱发分水岭脑梗死的主要原因,但较少发生在侧支循环开放丰富的患者.     

前、后循环脑梗死患者的颈动脉超声对照研究

目的通过对前循环及后循环脑梗死患者颈总动脉、颈内动脉及无名动脉分叉处的超声比较,探讨颈动脉及无名动脉病变与脑梗死部位的关系。方法利用彩超及B-flow技术对88例后循环梗死及109例前循环梗死病人进行检测,比较2组动脉硬化斑块的位置、性质及血管有无重度病变。结果 2组患者斑块（包括稳定性斑块及不稳定斑块）不同部位的发生率比较差异均无统计学意义（P〉0.05）;前循环梗死组不同部位不稳定斑块的发生率比较差异有统计学意义（P〈0.05）。而后循环梗死组不同部位不稳定斑块的发生率比较差异无统计学意义（P〉0.05）;2组血管重度病变比较差异有统计学意义（P〈0.05）。结论不稳定性斑块尤其是颈动脉及无名动脉均存在不稳定斑块,更易导致前循环梗死,动脉重度病变是导致脑梗死的重要危险因素。     

前循环梗死亚型与血管内皮损伤因子ACA、hsCRP关系

目的探讨前循环梗死亚型与ACA、hsCRP的关系及形成机制。方法采用彩色多普勒超声对前循环梗死各亚型患者双侧颈总及颈内动脉进行探查,并测定各组血清hs-CRP及ACA水平。结果(1)皮质支 动脉主干型脑梗死组血清hsCRP高于其他3组(P<0.05);(2)皮质支 动脉主干型脑梗死组血清ACA-IgG高于其他3组(P<0.05);(3)各组ACA-IgA、ACA-IgM无明显差异(P>0.05);(4)皮质支 动脉主干型脑梗死组不稳定斑块明显高于其他3组。结论斑块稳定性不同导致血清hsCRP、ACA-IgG的浓度及脑梗死亚型不同,从而形成本次实验结果。     

脑血管病颈动脉粥样硬化14例病理研究

目的探讨颈动脉粥样硬化与脑血管病的关系。方法对１４例脑血管病死亡病例（脑出血及脑梗死各７例）的颈动脉进行病理观察及形态定量分析。结果脑血管病患者颈动脉粥样硬化导致管腔狭窄的程度，轻度占６３％，中、重度狭窄约占３７％。脑梗死患者颈动脉粥样硬化导致管腔狭窄的程度比脑出血患者严重；７例脑梗死患者中２例的病因为颈内动脉栓塞，脑梗死患者颈动脉粥样硬化斑块具备不稳定的组织学特性，常见质地松散、密度不均易脱落的斑块。脑出血组出血灶同侧的颈内动脉较对侧显著狭窄。结论颈内动脉栓塞是大面积脑梗死的常见病因之一；不稳定的颈动脉粥样硬化导致的斑块脱落可能也是脑梗死的病因之一。     

TIA进展成脑梗死的脑梗死模式和血管病变特征

目的分析前循环TIA进展成脑梗死的脑梗死模式和血管病变特征,试探讨其发病机制。方法利用DSA、颈动脉超声和TCD综合定位责任血管狭窄(≥50%)或闭塞及症状侧颈动脉斑块性质,常规MRI研究前循环TIA进展成脑梗死的梗死模式。结果 51例TIA进展成脑梗死患者的MRI脑梗死模式和血管病变特征:皮层下梗死最常见37例(69.8%),其次是分水岭梗死8例(15.1%),区域性梗死5例(9.4%),皮层梗死3例(5.7%)。统计严重血管病变(≥50%狭窄或闭塞)如下:(1)皮层下梗死组血管严重病变17例(45.9%),检出责任侧不稳定斑块6例(16.2%);(2)分水岭梗死组血管严重病变7例(87.5%),检出责任侧不稳定斑块2例(25%);(3)区域性梗死组血管严重病变5例(100%),检出责任侧不稳定斑块2例(40%);(4)皮层梗死血管严重病变3例(100%),检出责任侧不稳定斑块2例(66.7%)。结论前循环TIA进展成脑梗死的梗死类型以皮层下梗死最常见,血流动力学和动脉-动脉栓塞机制均为TIA进展成脑梗死的主要机制。     

脑梗死患者颈动脉粥样硬化斑块形成的研究

目的 探讨脑梗死(CI)患者颈动脉粥样硬化斑块形成的状况.方法 对138例CI患者行颈动脉彩色多普勒超声检查,观察其颈动脉斑块形成、性质及部位,并与正常对照组比较.结果 CI组138例中120例(87.7%)检出颈动脉粥样硬化斑块175块,正常对照组140人检出斑块为36人(25.7%)(P＜0.01).CI组中不稳定性斑块比率(80.8%)显著高于稳定性斑块(19.2%)(P＜0.01);斑块位于颈总动脉(CCA)(81.1%)显著高于颈内动脉(ICA)(18.9%)(P＜0.01);位于CCA分叉处(66.3%)又显著高于主干(14.9%)(P＜0.05).结论 CI患者颈动脉粥样硬化斑块的发生率高,多位于CCA分叉处,且大多为不稳定性斑块.提示CI与颈动脉粥样硬化有密切关系.     

血清MMP-9与脑梗死患者及其颈动脉粥样硬化斑块稳定性的关系研究

目的检测具有不同性质颈动脉粥样硬化斑块的脑梗死患者的血清基质金属蛋白酶-9（MMP-9）水平,探讨颈动脉粥样硬化斑块稳定性及相关炎性标志物MMP-9水平与脑梗死的关系。方法采用彩色多普勒超声检查48例颈内动脉系统的急性脑梗死患者（CI组）颈动脉粥样硬化斑块,同时检测患者血清MMP-9水平,并与20例慢性脑供血不足患者（CCCI组）及20例体检健康者（对照组）比较;根据斑块性质将CI组分为不稳定斑块组、稳定斑块组及无斑块组3个亚组,并进行组内比较。结果脑梗死组斑块检出率、不稳定斑块率及血清MMP9水平均明显高于慢性脑供血不足组及对照组（P〈0．05）;脑梗死不稳定斑块组MMP-9水平显著高于脑梗死稳定斑块组,脑梗死稳定斑块组高于脑梗死无斑块组（P〈0．01）。结论颈动脉粥样硬化斑块及其稳定性与脑梗死发生有密切关系,具有不同性质颈动脉斑块的脑梗死患者的血清MMP-9水平存在差异,MMP-9可能是不稳定性粥样硬化斑块及脑梗死的一个潜在的血清标志物。     

彩色多普勒超声检测颈动脉粥样硬化斑块在预防脑梗死中的应用

目的探讨颈动脉粥样硬化斑块与脑梗死的关系。方法对69例急性脑梗死患者(脑梗死组)及29例非脑梗死患者(对照组)分别进行颈动脉彩色多普勒超声检测,记录动脉粥样硬化斑块的数量、性质和部位。结果脑梗死组颈动脉粥样硬化斑块检出率(72%)明显高于对照组(34%)。不稳定性斑块的发生率(86%)也明显高于对照组不稳定性斑块发生率(50%)。脑梗死组颈动脉粥样硬化斑块位于颈动脉窦部最多(49%),其次是颈总动脉(31%)、颈内动脉(20%)。结论颈动脉粥样硬化斑块与脑梗死密切相关,早期发现并早期干预对于减少和推迟脑梗死发生有重要指导意义。     

探讨彩色多普勒超声在急性前循环脑梗死患者颈动脉粥样硬化检测中的应用价值

目的探讨彩色多普勒超声在急性前循环脑梗死患者颈动脉粥样硬化检测中的应用价值。方法选择符合标准的急性前循环脑梗死患者80例(梗死组),以及同期健康体检者80例(体检组),均行颈动脉超声检查,了解有无斑块、斑块性质及血管狭窄程度,测量内-中膜厚度(IMT)及血流参数。结果梗死组IMT增厚发生率、各种类型斑块检出率、颈动脉中度及重度狭窄发生率均高于体检组,差异有统计学意义(P0.05)。梗死组颈总动脉、颈内动脉峰值流速(PSV)、舒张末期流速(EDV)明显低于体检组,差异有统计学意义(P0.05);二者颈总动脉阻力指数(RI)、搏动指数(PI)及收缩早期加速时间(AT)相似,差异无统计学意义(P0.05),但颈内动脉AT低于体检组,PI、RI高于体检组,差异有统计学意义(P0.05)。结论颈动脉粥样硬化与急性前循环脑梗死关联密切,彩色多普勒超声检查可以确定颈动脉粥样斑块特点、狭窄程度及血流参数,具有较高的临床应用价值。     

脑梗死与颈动脉粥样硬化斑块的关系

目的探讨脑梗死与不同程度颈动脉粥样硬化斑块的相关性。方法对105例脑梗死患者进行颈动脉彩色多普勒超声检测,观察其梗死侧和非梗死侧颈动脉内中膜厚度、斑块的部位、大小及其数目、动脉狭窄程度以及血流动力学改变等,并与34例对照组患者（无神经功能缺损体征的脑供血不足患者）的颈动脉粥样硬化斑块检出情况进行比较。所有患者均经头颅CT或MRI扫描确定有无责任病灶。结果脑梗死组患者的颈动脉粥样硬化斑块检出率62.9%,高于对照组41.2%（P〈0.05）;脑梗死组患者2级以上斑块检出率41%,与对照组相比有非常显著的统计学差异20.6%（P〈0.01）。颈动脉粥样硬化斑块多发生在梗死病灶的同侧占72%,以颈总动脉分叉处居多占52%。非均质斑块,峰值流速、搏动指数与脑梗死有明显的相关性（P〈0.05）。结论脑梗死与颈动脉粥样硬化斑块密切相关,彩色超声多普勒检查简便易行,安全可靠,可作脑梗死的预警检测。     

Mechanisms of the suppression of the nociceptive reflex of the opening of the mouth during stimulation of the structures of the limbic brain

The comparative effectiveness of the inhibitory influence of tetanic stimulation of hypothalamus, amygdala and limbic cortex on EMG-response of m. digastricus evoked by electrical stimulation of tooth pulp nociceptive afferents was studied in cats anesthetized with a mixture of chloralose and nembutal. It was found that inhibition of the EMG-component of the jaw-opening reflex is most pronounced in case of stimulation of medial and lateral region of the hypothalamus, the inhibitory effect of central and medial nuclei of the amygdala is less pronounced and the effect of the limbic cortex is the weakest. It was shown that the mechanism of the antinociceptive effect of tetanic stimulation of the hypothalamus is not related to the concomitant increase of the blood pressure. After stabilization of the blood pressure the suppressive effect of the hypothalamus remains without changes, that points out to a direct, primary, not baro-afferent mechanism of the inhibition of the activity of nociceptive neurons of the trigeminal sensory nuclei. Noradrenaline, injected intravenously, induced a large increase of the blood pressure accompanied by a pronounced inhibition of the pain reflex. Angiotensin causes the same degree of blood pressure elevation without changes in the amplitude of the EMG-response of the pain reflex. Hypothalamic and noradrenergic mechanisms for control of pain sensitivity are discussed.     

药物治疗与合并认知行为治疗对强迫症疗效的比较

目的探讨认知行为心理治疗(CBT)在强迫症(OCD)患者各亚型治疗中的有效性和规律性。方法本研究为临床对照研究。符合入组标准的强迫症患者按患者自愿原则分为两组,治疗观察3、6、12个月。疗效评定分别运用Yale-Brown强迫量表,自拟的自评好转程度量表和临床疗效评定。结果认知行为心理治疗合并药物治疗组31例,临床有效率70.9%,其中治愈率1.8%。单纯药物治疗组24例,临床有效率33.3%。Yale-Brown强迫量表和自评量表得分在6个月和12个月两组有显著差异(P<0.05)。其中强迫症亚型(怕脏型、反复检查型和反复担心型)的疗效比较,怕脏型在治疗3个月末两组间自评量表评分有显著性差异(P<0.05);反复担心型在治疗6个月末两组间Yale-Brown强迫量表总分有显著性差异(P<0.05);反复检查型两组间无统计学差异。结论认知行为心理治疗合并药物治疗强迫症的疗效明显优于单纯药物治疗。强迫症的亚型在治疗中的有效性次序为:反复担心型>怕脏型>反复检查型。     

Characteristics of the sympathetic innervation of the nictitating membrane and of the vasculature of the nose and tongue of the cat

Summary Vasomotor responses from the nasal mucosa and tongue, and contractions of the nictitating membrane, were recorded on stimulation of the cervical sympathetic or internal carotid nerves.Preganglionic sympathetic nerve fibres which elicited a membrane response possessed a lower threshold than those which evoked nasal vasoconstriction, while the latter displayed a lower threshold than fibres which evoked tongue vasoconstriction. The sympathetic vasodilator fibres to the tongue, whose activity was revealed after-receptor blockade, had a similar threshold to the vasoconstrictor fibres.Membrane contraction, nasal vasoconstriction and occasionally tongue vasoconstriction could be evoked by stimulating the internal carotid nerve. The postganglionic fibres innervating the nasal mucosa had a similar threshold to those of the nictitating membrane, which may indicate that there are small myelinated fibres innervating the mucosa.The preganglionic compound nerve action potential had four major components, S₁–S₄. S₁, S₂ and usually S₃ fibres were associated with membrane contraction; S₂, S₃ and sometimes S₁ fibres were associated with nasal vasoconstriction; and S₃, usually S₂ and occasionally S₁ fibres were associated with vasoconstriction in the tongue. It is concluded that each of these three groups of nerve fibres, but not S₄ fibres, may include fibres associated functionally with the three effectors.There was a considerable difference between the relative amplitude of the responses of the three effectors elicited by stimulation of the cervical sympathetic nerve at frequencies between 0.2 and 2 Hz. Vasoconstrictor responses were relatively larger than membrane contractions suggesting differences in the mechanisms of neurotransmission at the neuroeffector junctions.     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

A contribution to the study of the architecture of the autonomic nervous system of the digestive tract of the rat

Summary The distribution of aminergic and non-aminergic nerve fibres to the different constituents of the wall of the digestive tract in various regions is described. Aminergic fibres synapse with all nervous perikarya. Densely interlacing networks of nerve fibres are found in both layers of the tunica muscularis and in the lamina muscularis mucosae. A finely meshed plexus is observed in relation to the wall of the blood vessels in the wall of the gut. There are many fibres connecting the muscular and the vascular plexus. No nerve fibres have been observed in direct relation to the epithelium.The functional implications of these findings are discussed.