高同型半胱氨酸血症与进展性缺血性脑卒中相关性的临床研究

目的 研究血清同型半胱氨酸(Hcy)水平与进展性缺血性脑卒中发生及其与颈动脉粥样硬化(AS)的关系.方法 收集88例进展性缺血性脑卒中患者(进展组)、112例非进展性缺血性脑卒中患者(对照组)血液标本,采用荧光偏振免疫法测定Hcy,同时对患者进行血压、空腹血糖、血脂和纤维蛋白原测定及颈动脉彩色超声检查,比较进展组与对照组血清Hcy水平变化,对进展组作血清Hey水平与颈动脉内膜中层厚度(IMT)相关分析.结果 进展组和对照组血清Hcy水平升高分别有62例和43例,占70.45%和38.39%,血清Hcy水平分别为22.65±11.29μmol/L/L和15.43±6.23μmol/L,两组比较差异有统计学意义(P＜0.001).进展组Hey水平与颈动脉IMT呈显著正相关性(r=0.691,P＜0.001).结论 高Hey血症与进展性缺血性脑卒中的发生密切相关,与颈动脉粥样硬化及斑块形成有关,为防治发生进展性缺血性脑卒中提供新的理论依据.     

同型半胱氨酸与缺血性脑血管病相关性及控制措施分析

目的探讨同型半胱氨酸(Hcy)与缺血性脑血管病(ICVD)的相关性及控制措施。方法选取ICVD患者85例为ICVD组,选取同期入院体检正常人40例为对照组,检测Hcy水平、叶酸、维生素B12;并观察ICVD患者服用叶酸、维生素B12、维生素B6前后Hcy、叶酸、维生素B12水平变化情况。结果脑梗死组Hcy(17.01±2.96)μmol/L显著高于TIA组、对照组,叶酸为(14.63±7.58)μg/L显著低于TIA、对照组,TIA组、对照组组间差异有统计学意义(P0.05);脑梗死组、TIA组B12水平均低于对照组,但脑梗死组、TIA组间差异无统计学意义(P0.05)。ICVD患者治疗后Hcy水平为(14.64±3.57)μmol/L,显著低于治疗前,叶酸、B12水平分别为(34.05±15.26)μg/L、(724.99±157.67)μmol/L,均显著高于治疗前,差异有统计学意义(P0.05)。结论高Hcy血症与ICVD具有显著相关性,可补充叶酸、B族维生素,降低血浆Hcy水平。     

二级预防老年骨折患者围手术期缺血性脑卒中的临床研究

目的观察二级预防措施在老年骨折患者围手术期缺血性脑卒中临床治疗过程中的作用和效果。方法选取104例老年骨折患者,随机分2组,对照组52例患者围手术期行常规低分子肝素皮下注射抗血小板凝集的二级预防治疗;实验组52例在常规二级预防的基础上联合静滴活血化瘀中药。观察手术前后2组患者围手术期缺血性脑卒中的二级预防效果并进行统计学分析。结果术后,对照组AT占7.7%,SAD占13.5%,正常为78.8%,总发作率为21.2%;实验组AT占1.9%,SAD占5.8%,正常为92.3%,总发作率为7.7%;对照组术后发作率明显高于实验组(P0.05)。治疗前,对照组患者神经功能评分为18.31±1.87,NSE为(23.9±1.7)μg/L;实验组神经功能评分为19.17±2.05,NSE为(24.7±2.1)μg/L。治疗后,对照组神经功能评分为11.02±1.49,NSE为(16.5±2.1)μg/L;实验组神经功能评分为8.16±1.83,NSE为(11.4±1.6)μg/L。实验组神经功能明显高于对照组,实验组NSE水平明显低于对照组,差异有统计学意义(P0.05)。结论二级预防措施在老年骨折患者围手术期缺血性脑卒中临床疗效明确,而在联合使用静滴活血化瘀中药后效果更好,具有一定临床意义。     

NO与缺血性脑卒中患者颈动脉粥样硬化斑块的相关性分析

目的分析NO与缺血性脑卒中患者颈动脉粥样硬化斑块的相关性。方法采用随机抽样的方法选择2014-06—2015-06在我院治疗的缺血性脑卒中患者100例,其中50例为缺血性脑卒中出现颈动脉粥样硬化斑块的患者,50例为缺血性脑卒中未出现颈动脉粥样硬化斑块的患者,比较2组NO水平,测得观察组颈动脉内膜中层厚度(IMT),分析NO与IMT的相关性。结果对照组NO水平为(30.19±7.98)mmol/L,观察组为(36.63±9.25)mmol/L,观察组NO水平明显高于对照组(P0.05);2组HDL、TG以及D-D水平相比无明显差异(P0.05)。观察组中NO与IMT存在正向相关性(r=0.541,P0.05)。结论缺血性脑卒中伴颈动脉粥样硬化斑块的患者NO水平明显高于缺血性脑卒中无颈动脉粥样硬化斑块患者,两者具有密切的相关性,临床诊断中可将NO水平作为一个重要观察指标评估患者是否发生颈动脉粥样硬化,也能够为脑卒中患者的治疗提供指导和依据。     

血清同型半胱氨酸水平与青年缺血性脑卒中的关系

目的观察青年缺血性脑卒中患者血清同型半胱氨酸(homocysteine,Hcy)水平,探讨其与颈动脉硬化的相关性。方法青年缺血性脑卒中患者64例,对照组为与脑血管病无关的同期住院患者50例,所有研究对象测空腹血糖(FBS)、血脂及Hcy水平,并应用彩色多普勒超声检测其颈动脉。比较脑卒中组与对照组、颈动脉硬化组与颈动脉正常组血清Hcy水平变化。结果脑卒中组和对照组血清Hcy水平升高者分别有38例和8例,占59.38%和16%;血清Hcy水平分别为(17.07±7.68)μmol/L和(10.12±3.27)μmol/L,2组比较差异有统计学意义(P均0.001)。脑卒中组中伴颈动脉粥样硬化的患者Hcy水平明显高于无颈动脉粥样硬化者(P0.05)。脑卒中患者Hcy水平与血脂无相关性,与颈动脉内膜中层厚度(inti mal—media thickness,I MT)呈显著正相关性(r=0.824,P0.001)。结论高Hcy血症可能是青年缺血性脑卒中的重要独立危险因素之一,与早发性颈动脉粥样硬化的形成有关。测定血清Hcy水平和颈部血管彩超检查有助于其早期诊断和防治。     

替罗非班联合大黄■虫丸对老年急性缺血性脑卒中患者血清PARK7及Sestrin2水平的影响

目的 探讨替罗非班联合大黄■虫丸治疗老年急性缺血性脑卒中（AIS）患者的疗效及对血清人帕金森蛋白（PARK7）、Sestrin2水平的影响。方法 选取2020-08—2022-03山东省文登整骨医院收治的老年AIS患者116例,随机分为观察组（n=58）和对照组（n=58）,对照组采用替罗非班治疗,观察组在对照组的基础上联合大黄■虫丸治疗,从入院当日开始,干预为期4周。比较2组患者入院当日及治疗4周后治疗有效率、血流平均流速（TMV）、收缩期峰值流速（PSV）、阻力指数（RI）,血清同型半胱氨酸酶（Hcy）、PARK7、2Sestrin水平,以及不良反应发生率。结果 治疗4周后观察组血清PARK7、Sestrin2、Hcy水平、RI[分别为（14.47±2.74）μg/L、（11.01±1.64）μg/L、（11.08±1.69）μmol/L、0.62±0.18]均低于对照组[分别为（19.15±2.68）μg/L、（14.37±1.67）μg/L、（16.60±2.73）μmol/L、0.75±0.15](P<0.05),观察组血流TMV[(46.37±6.17)cm/s]、P...     

脑卒中患者血清PARK7及ADMA水平与神经功能缺损的关系

目的研究脑卒中患者血清人帕金森蛋白7(PARK7)、非对称二甲基精氨酸(ADMA)水平与神经功能缺损程度的关系。方法 2017-01-01—2018-01-01至广西中医药大学附属瑞康医院就诊的脑卒中随机选取患者82例,同时随机选择非脑卒中患者82例为对照组。对卒中患者组进行量化评分分为轻、中及重度损害组各48例、20例、14例。所有卒中组患者入院后均给予脱水、降颅压、保持呼吸道通畅及预防并发症等对症处理,分别测定2组血清PARK7、ADMA水平作以参考。结果对比2组血清PARK7水平,轻度、中度及重度损害组分别为(20.19±4.21)μg/L、(27.68±4.53)μg/L及(33.74±5.27)μg/L,均明显高于对照组,差异有统计学意义(P0.05),且3组间对比差异有统计学意义(P0.05);对比2组血清ADMA水平,发现轻、中及重度损害组分别为(50.24±10.28)μmol/L、(74.72±11.84)μmol/L及(91.71±10.49)μmol/L,均明显高于对照组,2组比较差异有统计学意义(P0.05)。Speaman等级相关和Pearson相关性分析显示,2组血清学数据与脑卒中患者神经功能相关评分严重程度呈正相关变化。即神经功能缺损越严重,其血清PARK7、ADMA水平亦越高(r_(PARK7)=0.996 7,P_(PARK7)=0.003 3;r_(ADMA)=0.999 7,P_(ADMA)=0.000 3),差异有统计学意义(P0.05)。结论脑卒中患者通常表现为不同程度的神经功能缺损,其血清PARK7、ADMA水平亦呈正相关变化,或可为脑卒中的早期诊疗提供理论依据,对不同程度脑卒中转归的判断具有一定指导作用,有利于治疗及病情评估。     

进展型青年缺血性脑卒中与载脂蛋白A1载脂蛋白B血清肌酐血清尿素氮水平变化的相关研究

目的探讨青年进展型缺血性脑卒中患者载脂蛋白A1(APo-A1)、载脂蛋白B(APo-B)、血清肌酐(Cr)、血清尿素氮(BUN)水平的变化及临床意义。方法收集2012-01—2014-01在本院神经内科住院诊断为脑梗死的125例患者(观察组)及同期门诊健康成年人112例为对照组,对其血清中APo-A1、APo-B、Cr、BUN水平进行测定,分析APo-A1/APo-B比值的变化。结果与正常对照组相比,进展型脑梗死患者血清中Cr、BUN、APo-B水平显著增高(P0.01),APo-A1/APo-B比值明显降低(P0.01),与正常对照组相比差异有统计学意义(P0.01)。结论患者血清Cr、BUN、APo-B水平的增高与青年缺血性脑卒中的进展密切相关。APo-A1/APo-B可能是青年进展型缺血性脑卒中的重要危险因素;血清Cr、BUN水平升高提示预后差。     

血尿酸水平与缺血性脑卒中的相关性

目的探讨血尿酸水平与缺血性脑卒中之间的相关性。方法采用病例对照研究,选择2006-07—2011-03在我院神经内科住院的缺血性脑卒中患者177例（病例组）;对照组202例,为同期我院健康体检者。对所有纳入对象测定禁食12h后静脉血清尿酸值及其他生物化学指标,探讨血尿酸水平与缺血性脑卒中的关系。结果病例组血清尿酸水平（359.47±70.84）μmol/L显著高于对照组（310.26±76.35）μmol/L,2组比较差异有统计学意义（P〈0.01）。多因素Logistic回归分析显示,糖尿病、高血压、LDL-C及血尿酸是缺血性脑卒中发生的独立危险因素,血尿酸水平升高与缺血性脑卒中密切相关（OR=1.183,95%CI1.052～1.331;P=0.018）。结论缺血性脑卒中患者血尿酸水平显著升高,血尿酸与缺血性脑卒中发生密切相关,可能是其独立危险因素。     

替罗非班治疗阿替普酶静脉溶栓后再闭塞的疗效观察

目的观察替罗非班治疗急性缺血性脑卒中阿替普酶静脉溶栓后再闭塞的疗效及安全性。方法发病4.5h内急性缺血性脑卒中患者行阿替普酶静脉溶栓再闭塞的患者60例,随机于再闭塞后予以静脉泵入替罗非班治疗(首剂5μg/kg静脉推注3min,续以0.075μg·kg~(-1)·min~(-1)静脉持续泵入24h)30例(B组)及常规治疗30例(A组)。观察2组溶栓前、溶栓后症状加重时及24h、7d时NIHSS评分,90d改良Rankin量表(mRS)评分及病死率、症状性颅内出血的发生率。结果溶栓前、溶栓后症状加重(再闭塞)时,2组NIHSS评分差异无统计学意义(P0.05)。24h、7d时NIHSS评分2组差异有统计学意义(P0.05)。90d时mRS≤2分2组差异有统计学意义(P0.05);2组病死率差异无统计学意义(P0.05);2组症状性脑出血发生率差异无统计学意义(P0.05)。结论替罗非班治疗急性缺血性脑卒中阿替普酶静脉溶栓后再闭塞是有效的、安全的。     

Neuroimaging in epilepsy in tropics

Epilepsy is a major public health problem in many tropical countries. Also, some of the tropical diseases are major contributors to the higher prevalence of epilepsy in these countries. The etiologic factors responsible for epilepsy in these countries are quite different from those in the developed world. This article discusses the etiologic factors and neuroimaging of epilepsy in light of the conditions in these tropical countries.     

癫痫与抑郁关系的研究进展

抑郁是癫痫患者中常见的精神障碍,严重地影响了患者的生活质量。传统的观点认为癫痫患者因为存在着诸多社会学问题易出现抑郁倾向,癫痫和抑郁是单向的联系,但大量的研究已经证明癫痫和抑郁之间存在双向的联系,一种异常状态的存在可能易转化为另一种异常状态的发展。癫痫和抑郁存在着共同的发病机制。本文主要就癫痫和抑郁的双向联系以及抗抑郁药物在癫痫患者中的应用进行阐述。     

Sudanophilic lipid accumulation in astrocytes in periventricular leukomalacia in monkeys

Summary Sudanophilic lipid accumulation is a characteristic feature of periventricular leukomalacia (PVL) of infants. At least two types of lipid-containing cells have been identified, one being the macrophage, the other the pre-myelin glial cell. A third type of lipid-containing cell has been seen in two monkeys with spontaneous PVL. Electron microscopically this cell appears to be an astrocyte. This probably represents a reaction of the astrocyte to hypoxia and may be the equivalent of the hypertrophic astrocytes found in human infants.Supported in part by NIH grant HDO 8633 and the Regional Primate Research Center Grant RR-00166     

Increase in cathepsin D activity in rat brain in aging

Cathepsin D-like activity in homogenates of five brain areas of 3-month-old and 24-month-old Fischer 344 rats was measured. With hemoglobin as substrate at pH 3.2, more than 90% of the activity was inhibited by pepstatin. In each area studied, activity was more than twice as high in the old rat brain: 140-160% higher in the cortex, cerebellum, pons-medulla, and striatum and 90-100% higher in the hippocampus and spinal cord. The greatly increased metabolic capacity in the absence of an increase in protein turnover may have a role in age-related pathological degeneration in the brain.     

Characteristics of nociceptors in the periodontium--an in vitro study in rats

Recent studies have indicated that nociceptors can be classified into various types according to their physiological properties. These studies have clarified that the frequency distribution of various nociceptor types is different among body sites and animal species. In the present study, we investigated the physiological properties of rat's periodontal nociceptors in an in vitro jaw-nerve preparation. Responses were recorded from functional single filaments in the inferior alveolar nerve. To determine the nociceptor type, calibrated von Frey filaments, heat, and bradykinin (BK) stimuli were used. We found five subtypes of nociceptors in the periodontal ligaments of the lower incisor: Adelta-high threshold mechanonociceptors (Adelta-HTM, n=28), Adelta-mechanoheat nociceptors (Adelta-MH, n=6), Adelta-polymodal nociceptors (Adelta-POLY, n=26), C-high threshold mechanonociceptors (C-HTM, n=3) and C-polymodal nociceptors (C-POLY, n=4). Most nociceptors were Adelta-innervated, while only a small number of C-innervated nociceptors were found. The present results suggest that periodontal nociceptors transmit mainly fast pain, and may thus play a role in rapid detection of injure-related stimuli during mastication.     

Defects in Bioenergetic Coupling in Schizophrenia

Synaptic neurotransmission relies on maintenance of the synapse and meeting the energy demands of neurons. Defects in excitatory and inhibitory synapses have been implicated in schizophrenia, likely contributing to positive and negative symptoms as well as impaired cognition. Recently, accumulating evidence has suggested that bioenergetic systems, important in both synaptic function and cognition, are abnormal in psychiatric illnesses such as schizophrenia. Animal models of synaptic dysfunction demonstrated endophenotypes of schizophrenia as well as bioenergetic abnormalities. We report findings on the bioenergetic interplay of astrocytes and neurons and discuss how dysregulation of these pathways may contribute to the pathogenesis of schizophrenia, highlighting metabolic systems as important therapeutic targets.     

Gender in Voice Perception in Autism

Deficits in the perception of social stimuli may contribute to the characteristic impairments in social interaction in high functioning autism (HFA). Although the cortical processing of voice is abnormal in HFA, it is unclear whether this gives rise to impairments in the perception of voice gender. About 20 children with HFA and 20 matched controls were presented with voice fragments that were parametrically morphed in gender. No differences were found in the perception of gender between the two groups of participants, but response times differed significantly. The results suggest that the perception of voice gender is not impaired in HFA, which is consistent with behavioral findings of an unimpaired voice-based identification of age and identity by individuals with autism. The differences in response times suggest that individuals with HFA use different perceptual approaches from those used by typically developing individuals.     

Ethnic disparities in problem behaviour in adolescence contribute to ethnic disparities in social class in adulthood

BACKGROUND: It is important for prevention of social class disparities to know how ethnic disparities in social class arise among migrant children. We contribute to this understanding by examining the role of problem behaviour in adolescence. METHODS: Prospective observational study with 753 Dutch native and 217 Turkish migrant adolescents (11-18 year) followed for 10 years. Internalising and externalising problems were assessed in adolescence and employment status and occupational level were assessed in adulthood. The difference in odds ratios (OR) before and after adjustment for internalising and externalising problems was an indication of the predictive value of disparities in internalising and externalising problems for the development of social class disparities. RESULTS: A total of 135 (62%) of the Turkish and 602 (80%) of the Dutch adults were employed. Internalising and externalising problems were not associated with employment status. Of the employed, 65 (48%) Turkish and 179 (30%) Dutch adults worked in low-level occupations (p < 0.0001). Internalising and externalising problems were associated with both ethnicity and occupation. The OR for low-level occupation for Turkish adults was 1.78 (1.19-2.65), indicating ethnic disparities. Adjustment for internalising problems lowered the OR with 36% to 1.50 (0.97-2.31), and adjustment for externalising problems lowered it with 8% to 1.72 (1.15-2.57). Findings were similar for men and women and did not vary by age. CONCLUSIONS: Ethnic disparities in occupational level in adulthood could partly be attributed to disparities in mental health between Turkish migrants and Dutch natives in adolescence. Prevention of ethnic disparities in mental health at young age may therefore also contribute to the prevention of occupational differences in adulthood.     

Progress in neuroprotection in Parkinson's disease

Slowing or aborting the progress of neurodegeneration in Parkinson's disease (PD) remains the most important unmet need of this disorder. There are several recent developments in trial design and also in drugs under investigation for possible neuroprotective effect. Emphasis has been placed on clinical as opposed to imaging end-points and these include change in a clinical rating scale, e.g. United Parkinson's disease Rating Scale (UPDRS), or time to additional therapy. The introduction of the delayed-start, or wash-in, trial design adds an additional dimension to drug evaluation for neuroprotection. Compounds that have been recently tested in clinical trial include the monoamine oxidase-B inhibitor rasagiline, the anti-apoptotic agents TCH346 and CEP1347, and the promitochondrial agent creatine. The dopamine agonists have been evaluated for a neuroprotective effect using imaging end-points. Perhaps the most important and simplest concept for neuroprotection has been the theory that early dopaminergic support for the degenerating dopaminergic system per se provides significant long-term clinical benefit for PD patients.     

Changes in parasympathetic system in medulla oblongata in male pigs in the course of tachycardia-induced cardiomyopathy

Background

Autonomic imbalance constituting a fundamental feature of heart failure (HF) has been assessed mainly at the periphery. Changes in the functioning of autonomic centers in the brain remain unclear. We investigated the molecular elements of parasympathetic system, i.e. α7 nicotinic acetylcholine receptor (α7nAChR) and enzymes metabolizing acetylcholine (acetylcholinesterase, AChE, choline acetyltransferase, ChAT) in medulla oblongata (MO) of male pigs with chronic tachycardia-induced cardiomyopathy.

Methods

The mRNA levels of AChE, ChAT, α7nAChR and X-box binding protein 1 (spliced form, XBP1s) in MO were analyzed using qPCR, AChE and ChAT activities using spectrophotometry, proteasome activity using fluorometry, and the protein level of α7nAChR using Western blotting.

Results

The development of systolic HF was accompanied by an increase in circulating catecholamines, a decrease in the AChE and α7nAChR mRNA in MO, an increase in AChE activity (all p < 0.05), and no change in either the mRNA or activity of ChAT. Both circulating catecholamine levels and AChE activity were inversely related to systolic function of left myocardial ventricle (p < 0.05). The level of α7nAChR protein in MO and its cytoplasmatic fraction were higher in pigs with moderate and severe HF as compared to the other animals (p < 0.01). There was no difference in proteasome activity in MO between diseased and healthy animals, whereas the XBP1s mRNA decreased during HF progression (p < 0.05).

Conclusions

Molecular elements of parasympathetic system are changed within the medulla oblongata during the progression of systolic non-ischemic heart failure in male pigs, indicating a functional link between MO and heart in HF.