急性脑卒中患者并发肾功能损害的危险因素

目的 探讨急性脑卒中患者并发肾功能损害的危险因素,为早期发现和治疗提供依据.方法 比较分析72例急性脑卒中并发肾功能损害患者(肾功能损害组)和80例肾功能正常的脑卒中患者(对照组)的各项临床资料,对可能影响急性脑卒中患者肾功能的危险因素进行Logistic逐步回归分析.结果 Logistic逐步回归分析显示,GCS评分、大剂量甘露醇、高渗透压血症和SIRS与急性脑卒中患者肾功能损害有关(P＜0.05).结论 急性脑卒中患者并发肾功能损害的主要危险因素是GCS评分低、大剂量甘露醇、高渗透压血症和SIRS.     

脑卒中患者急性肾功能衰竭与高渗透压血症相关性的研究

目的研究脑卒中并发急性肾功能衰竭(急性肾衰)与高渗透压血症的相关性及有关因素。方法总结59例脑卒中并发急性肾衰患者(急性肾衰组)和76例肾功能正常的脑卒中患者(对照组)的临床资料。将两组患者的血浆渗透压与血清肌酐值进行相关分析。用Logistic回归分析确定脑卒中并发急性肾衰的有关因素。结果平均血浆渗透压急性肾衰组[(320.98±30.63)mOsm/L]明显高于对照组[(295.49±17.7)mOsm/L](P<0.001)。平均血清肌酐急性肾衰组[(298.15±94.72)μmol/L]明显高于对照组[(93.47±33.34)μmol/L](P<0.001)。两组患者的血浆渗透压与肌酐均呈正相关(r=0.452,P<0.001)。多因素分析显示,高渗透压血症(OR=4.40,95%C I=1.91~10.14)、全身炎症反应综合征(SIRS)3~4级(OR=4.58,95%C I=2.01~10.43)、静滴甘露醇(OR=8.88,95%C I=1.74~45.27)与脑卒中患者急性肾衰有关联。结论血浆渗透压升高与脑卒中并发急性肾衰有密切关系。高渗透压血症、SIRS 3~4级和静滴甘露醇是脑卒中并发急性肾衰的联合因素或独立因素。     

急性脑血管病伴发肾功能损害的危险因素Logistic回归分析

目的 探讨急性脑血管病并发肾功能损害的有关影响因素。为临床合理治疗急性脑血管病，预防肾功能损害的发生提供依据。方法 回顾分析165例急性脑血管病的肾功能变化。将可能影响肾功能的因素进行多因素条件Logistic回归分析。寻找发生肾功能损害的可能危险因素。结果 脑卒中类型，冠心病，肺部感染，甘露醇日剂量，甘露醇使用时间，意识障碍对肾功能损害的发生有明显影响。结论 多因素条件Logistic回归分析可以较准确寻找出影响肾功能的危险因素。为预防肾功能损害的发生提供依据。     

重症脑卒中患者并发高渗血症的危险因素

目的探讨重症脑卒中患者并发高渗血症的危险因素，为制定干预措施提供依据。方法重症脑卒中患者80例，根据评价生存与死亡的血浆渗透压界值分为高渗组（〉310mmol／L，34例）和非高渗组（≤310mmol／L，46例）。监测可能影响血浆渗透压的危险因素。结果大剂量甘露醇（〉100g／d）、高钠血症和高血糖症是导致高渗血症的3个主要危险因素。高渗组4周生存率（47．1％）明显低于非高渗组（78．3％），两组比较差异有统计学意义（P〈0．01）。结论引起高渗血症的主要危险因素是大剂量甘露醇、高钠血症和高血糖症，高渗血症患者预后差，生存率低。     

脑卒中预后的影响因素分析

目的探讨影响脑卒中患者3个月预后的相关危险因素。方法以首发脑卒中住院的急性患者为研究对象，记录其人口特征，脑卒中危险因素，最初脑卒中严重性如眼球运动障碍、失语、吞咽困难、尿失禁(UI)、格拉斯哥昏迷评分(GCS），神经功能缺损评分(NIHSS)，日常生活能力评分(BI）及脑卒中类型；3月后随访其功能康复情况：牛津残障评分(OHS）．并分析影响脑卒中预后的相关危险因素。结果Logistic回归分析发现：GCS，UI和NIHSS独立地与脑卒中后3个月预后不良显著相关。结论脑卒中急性期尿失禁、GCS评分高及神经功能缺损严重是脑卒中后3个月死亡或严重残疾的独立预测指标。     

脑卒中患者高渗状态的危险因素研究

目的 探讨脑卒中患者高渗状态的危险因素. 方法 收集脑卒中合并高渗状态患者32例做为高渗状态组,抽取同期非高渗状态的脑卒中患者63例为对照组.采用Logistic回归分析确定脑卒中患者高渗状态的危险因素. 结果 高渗状态组平均血浆渗透压[(338.8±12.5)mOsm/L]明显高于对照组[(285.7±11.7)mOsm/L],高渗状态组平均GCS分值[(6.9±2.7)分)]明显低于对照组[(12.7±3.5)分],差异均有统计学意义(P<0.05).多因素Logistic回归分析证实,糖尿病(OR=0.043,95%CI=0.007～0.277,P=0.001)、全身炎症反应综合征(SIRS)(OR=0.550,95%CI=0.388～0.780,P=0.001)、甘露醇用量(OR=0.973,95%CI=0.955～0.991,P=0.004)是脑卒中患者高渗状态的危险因素. 结论 糖尿病、SIRS、甘露醇用量可以联合或单独作用引起高渗状态,治疗过程中重视这三项指标的监测将有助于卒中患者的康复.     

急性脑卒中并发全身炎症反应综合征致多脏器功能障碍综合征分析

目的探讨急性脑卒中并发全身炎症反应综合征（SIRS）致多器官功能障碍综合征（MODS）的可能机制。方法分析586例急性脑卒中患者的临床资料，其中199例急性脑卒中患者伴SIRS．病人至少符合2个SIRS标准，包括发热、体温过低、心动过速、呼吸急促或白细胞计数异常；MODS则符合在机体遭受打击24h后连续出现2个以上器官功能不全及各器官功能障碍标准。结果586例急性脑卒中发生SIRS 199例，SIRS的发生率是33，96％，其中76例合并有MODS，MODS的发生率12．97％，病死率42％。结论急性脑卒中并发SIRS，并能引起MODS的发生，SIRS死亡者均并发多器官功能障碍综合征；病兄率随SIRS标准的项数增加而增高，有显著性差异（x^2=12．41，P〈0．01），病死率随MODS器官衰竭数目的增加而增高，有显著性差异（x^2=35．89，P〈0．01）。受累器官越多，病死半愈高。     

急性缺血性脑卒中患者静脉溶栓后不同部位出血转化的影响因素

目的分析急性缺血性脑卒中患者静脉溶栓后不同部位出血转化的影响因素。方法回顾性分析我院于2010-03—2013-09接受静脉溶栓治疗的300例急性缺血性脑卒中患者,按溶栓治疗后2个疗程内行头颅CT检查,根据脑内有无出血性转化分为HT组及无HT组,根据出血部位的不同HT组分为深部位HT组和浅部位HT组。采用单因素和Logistic回归多因素分析静脉溶栓治疗后出血性转化的危险因素。结果经Logistic回归单因素分析可知,发病到治疗时间/既往糖尿病史、梗死面积大小、TOAST分型、入院时GCS评分与入院时NIHSS评分等均是影响急性缺血性脑卒中患者溶栓治疗后出血转化的影响因素;经Logistic回归多因素分析可知,入院时NIHSS评分是影响深部位缺血性脑卒中患者出血转化的最危险因素,其次是既往糖尿病史、心源性栓塞型等,入院时GCS评分影响最小;既往糖尿病史是影响浅部位缺血性脑卒中患着出血转化的最危险因素,其次是入院时NIHSS评分、心源性栓塞型等,入院时GCS评分影响最小。结论既往糖尿病史、入院时NIHSS评分、心源性栓塞型等均是影响深部位和浅部位缺血性脑卒中患着出血转化的独立性因素,为临床诊断治疗提供参考依据。     

基于GCS评分的Nomogram图预测急性脑出血后卒中相关性肺炎的发生风险

目的 通过构建Nomogram预测模型,探讨急性脑出血后发生卒中相关性肺炎（SAP）的危险因素。方法 回顾性分析2018-01—2022-12平顶山学院第一附属医院神经外科、重症医学科及神经重症的1 050例急性脑出血患者的临床资料,先根据GCS评分进行感染率的分层分析,然后运用组间差异性比较及多因素Logistic回归分析筛选SAP的独立危险因素,应用R语言构建Nomogram预测模型,并对构建的模型进行评价。结果 急性脑出血患者中SAP发生率为35.9%,其中GCS评分3～8分患者为77.21%,GCS评分9～12分患者为30.81%,GCS评分13～15分患者为6.50%,各组间感染率差异有统计学意义（P<0.05）。多因素Logistic回归显示,年龄、GCS评分、入院时随机血糖、淋巴细胞绝对值及手术治疗均为SAP独立危险因素,以这5个危险因素构建的Nomogram预测模型可帮助临床医师预测急性脑出血后SAP发生风险,具有较高的准确性和临床适用性。结论 基于GCS评分构建的Nomogram预测模型能够在疾病早期阶段准确高效地对急性脑出血患者发生SAP的风险进行分层,识别出...     

动脉瘤性蛛网膜下腔出血患者急性肺损伤的危险因素及其对预后的影响

目的 探讨蛛网膜下腔出血(SAH)患者中急性肺损伤或急性呼吸窘迫综合征(ALI/ARDS)的发生率,研究ALI/ARDS发生的危险因素及其对患者预后的影响。方法 回顾性分析2018年1月—2021年12月苏州大学附属第一医院收治的167例SAH患者的临床资料。收集患者相关临床资料,多变量Logistic回归模型用于分析影响ALI/ARDS发生以及导致患者不良预后的危险因素。结果 167例患者中,有45例发生ALI/ARDS,49例预后不良。在多变量Logistic回归分析中,高龄患者、较低格拉斯哥昏迷(GCS)评分、较高Hunt-Hess分级、较高简化急性生理学评分(SAPS)Ⅱ、误吸、低氧血症和呼吸急促与ALI/ARDS的发病率增加有关。而高Fisher分级、低GCS评分、高Hunt-Hess分级、机械通气时间以及ALI/ARDS则是导致患者不良预后的危险因素。结论 ALI/ARDS是SAH患者常见并发症,与神经功能预后不良相关,高龄患者、较低GCS、较高Hunt-Hess分级、较高SAPSⅡ评分、误吸、低氧血症和呼吸急促则是其危险因素。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.