Atorvastatin in prevention of stroke and transient ischaemic attack

Besides blood pressure-lowering drugs and, in certain circumstances, antithrombotic agents, statins are among the most effective drugs in reducing the risk of stroke in populations of patients at high vascular risk, as well as the risk of major coronary events. In secondary prevention of stroke, statins clearly reduced the risk of major coronary events. In the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial, compared with placebo, the patients with a recent stroke or transient ischaemic attack without coronary heart disease randomised to atorvastatin 80 mg/day had a significant 16% relative risk reduction of stroke and a 35% reduction in the risk of major coronary events. This was obtained despite the fact that 25% of patients allocated to the placebo arm were prescribed a commercially available statin outside the trial. A post-hoc analysis used blinded low-density lipoprotein cholesterol (LDL-C) measurements (taken at study visits during the trial) as a marker of adherence to lipid-lowering therapy. Compared with the group with no change or an increase in LDL-C (the group adherent to placebo or not taking a statin), the group with >or= 50% reduction in LDL-C had a significant 31% reduction in the risk of stroke. The next step is to define whether or not achieving a LDL-C of < 70 mg/dl is better than a standard dose of statin (LDL approximately 100 - 110 mg/dl) in the secondary prevention of stroke. Statins are effective in reducing both first-ever and recurrent stroke, and this effect seems driven by the extent of LDL-C lowering.     

Atorvastatin in prevention of stroke and transient ischaemic attack

Besides blood pressure-lowering drugs and, in certain circumstances, antithrombotic agents, statins are among the most effective drugs in reducing the risk of stroke in populations of patients at high vascular risk, as well as the risk of major coronary events. In secondary prevention of stroke, statins clearly reduced the risk of major coronary events. In the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial, compared with placebo, the patients with a recent stroke or transient ischaemic attack without coronary heart disease randomised to atorvastatin 80 mg/day had a significant 16% relative risk reduction of stroke and a 35% reduction in the risk of major coronary events. This was obtained despite the fact that 25% of patients allocated to the placebo arm were prescribed a commercially available statin outside the trial. A post-hoc analysis used blinded low-density lipoprotein cholesterol (LDL-C) measurements (taken at study visits during the trial) as a marker of adherence to lipid-lowering therapy. Compared with the group with no change or an increase in LDL-C (the group adherent to placebo or not taking a statin), the group with ≥ 50% reduction in LDL-C had a significant 31% reduction in the risk of stroke. The next step is to define whether or not achieving a LDL-C of < 70 mg/dl is better than a standard dose of statin (LDL ～ 100 – 110 mg/dl) in the secondary prevention of stroke. Statins are effective in reducing both first-ever and recurrent stroke, and this effect seems driven by the extent of LDL-C lowering.     

能谱CT前瞻及回顾性门控冠状动脉成像辐射剂量对比研究

目的对比能谱CT前瞻性门控及回顾性门控冠状动脉成像扫描辐射剂量,寻找更安全有效的扫描方式。方法筛选113名病人进行前瞻性门控及回顾性门控冠脉扫描,计算扫描中患者有效辐射剂量,并将两者进行对比。统计学分析采用两独立样本t检验,以P0.05为有统计学意义。结果前瞻性门控扫描患者所接受辐射剂量(3.45±0.92)mSv远低于回顾性门控扫描辐射剂量(13.25±2.95)mSv。两组数据有统计学意义,P0.05。结论能谱CT前瞻性门控冠脉扫描在保证图像质量的前提下,大幅降低了患者辐射剂量,是一种可靠的检查方法。     

Further evidence that behavioral tests and neuropeptide mRNA and tissue level alterations can differentiate between typical and atypical antipsychotic drugs.

This study was designed to compare some behavioral and biochemical effects of chronic treatment with a range of antipsychotic drugs. Gene expression of enkephalin, chromogranin A, chromogranin B, and secretogranin II and their respective peptide products were studied with in situ hybridization and radioimmunoassays after daily oral administration of haloperidol, clozapine, risperidone, or zotepine for 21 days. In behavioral tests, significant catalepsy was induced by haloperidol only. All four antipsychotic drugs increased hind paw retraction time but only haloperidol also increased forelimb retraction time. In the caudate putamen, haloperidol increased both enkephalin mRNA expression and enkephalin tissue levels. Neither of these parameters was altered by the other three drugs. In the prefrontal cortex, antipsychotic drugs generated a distinct pattern of gene expression in two regards. First, the dopamine D(2) receptor antagonist, haloperidol, did not significantly alter synaptic protein levels or their encoding mRNAs. Secondly, there was a differential change in tissue levels and mRNA expression since secretogranin II was not affected by any tested antipsychotic drug. This study shows that different types of antipsychotic drug induce distinct behavioural effects as well as differential changes in the biosynthesis of synaptic proteins and their encoding mRNAs. The data reinforce the notion that haloperidol can be classed as a typical antipsychotic drug whilst clozapine, zotepine, and risperidone reflect their atypical classification.     

Value of ultrafast CT scanning in cardiology

Computed tomography became available in 1973 and within a few years was accepted as a useful diagnostic technique in nearly every organ system. The heart, however, was the exception because long exposures (over 1 second) produced motion blurred images. Although ECG gating was possible it proved impractical. Conventional CT nevertheless has been undervalued by most radiologists and cardiologists who have little or no experience with cardiac CT. The recent development of Ultrafast CT should rapidly change this concept.     

CT结肠成像中病变显示清晰程度与扫描体位的关系

目的探讨不同部位的结直肠癌病变显示清晰程度与扫描体位（仰卧位/俯卧位）的关系,为减少CT结肠成像（CT colonography,CTC）检查时患者所受剂量,选择最佳单体位扫描提供理论依据。方法对104例结直肠癌术前初诊患者行CTC检查,均行仰卧位及俯卧位检查,将CTC结果与纤维肠镜和手术病理对照。结果 104例患者中,病灶位于直肠54例,肛管6例,乙状结肠18例,降结肠6例,横结肠8例,升结肠12例,均为单发病灶。病变位于直肠与乙状结肠：直肠50/54（92.59%,χ2=32.72,P〈0.05）,乙状结肠18/18（100%,χ2=8.42,P〈0.05）。在俯卧位上肠管充气明显,病变显示清晰,优于仰卧位;位于横结肠的病变8/8（100%,χ2=4.5,P〈0.05）,仰卧位肠管充气明显,病变显示清晰,优于俯卧位。升降结肠病变在仰卧位18/18（100%）及俯卧位18/18（100%）上肠管充气效果相同,均显示清晰,差异无统计学意义（P〉0.05）。肛管癌在仰卧位（0/6）及俯卧位（0/6）上均显示欠佳。结论 CTC中不同位置的结直肠肠管在不同体位上充气效果不同,根据病变所处的位置,采取最佳单体位扫描,可使患者接受的射线剂量减半,而肠管的充气效果最佳,有利于病变的显示。     

两种CT扫描方式在体部立体定向放射治疗中的对比研究

目的探讨CT螺旋扫描与常规扫描在体部立体定向放射治疗中的异同点,分析CT螺旋扫描的优势。方法将40例患者随机分为两组,在CT扫描一致的情况下,分别用常规扫描和螺旋扫描方式进行。并事先在CT定位体架上不同位置放置3个金属小球测出真实坐标值。将CT图象通过联网传到Star-1000型治疗计划系统进行分析。结果体架上3个小球的X、Y坐标值两种扫描影响均很小,Z坐标值进行统计学处理,两组无显著差异(P>0.05),但与实际值比较都存在同向偏差,常规组好于螺旋组。从图象对比看,螺旋扫描增强效果明显好于常规组,靶区显示率及对比性更清晰,但其密度相似。结论CT螺旋扫描明显优于常规扫描,更有利于确定准确的靶区范围;同时应注意框架坐标的修正。     

脑出血108例临床及CT表现与预后关系分析

目的：通过分析108例脑出血的临床及CT表现与预后的关系,旨在加强对脑出血各种员害的认识。方法：对108例脑出血症人的出血部位、出血量、意识障碍程度及其严重并发症与近期预后关系进行回顾性分析。结果：该组病例急性期病死率24．07％,存活率68．52％,血肿破入脑室者病死率47．6％,合并肺部感染者病死率54．54％,出现应激性溃疡者病死率87．5％。结论：脑出血预后主要取决于血肿部位、出血量、意识障碍程度、血肿是否破入脑室及蛛网膜下腔及有无严重并发症。出血量大、脑干小脑出血、血肿破入脑室时预后极差,合并严重并发症时预后更差,基底节及脑叶、丘脑出血预后较好。     

儿童鼻窦低剂量CT扫描的应用及适宜扫描参数

目的比较传统制片与液基制片在乳腺肿块细针穿刺中的诊断准确率的差异,探讨细针穿刺细胞学在乳腺疾病早期诊断中的应用价值。方法选择2009年6月—2011年6月在安徽医科大学第一附属医院门诊和住院在肿瘤细胞室行细针细胞学检查并同时采用传统和液基两种制片方法制片的患者268例,有术后病理对照患者的99例,无病理对照的随访大于6个月的患者169例,对两种制片方法所得玻片进行分别阅片得出结果,分别与术后病理结果及随访结果进行对比,比较两种制片方法在对乳腺肿块诊断符合率的大小;对乳腺恶性肿瘤诊断敏感性、特异性及阳性准确率等方面的优劣。结果液基制片方法对乳腺肿块有更高的诊断符合率,对乳腺恶性肿瘤有更高的诊断敏感性及阳性准确率（P〈0.05）。结论传统制片和液基制片方法均能应用于检测乳腺肿块的性质,鉴别其良恶性。液基制片方法有对乳腺肿块有更高的诊断符合率（传统制片79.9%,液基制片90.7%;P〈0.001）;对乳腺恶性肿瘤有更高的诊断敏感性（传统制片75.0%,液基制片92.6%;P〈0.05）和阳性准确率（传统制片87.8%,液基制片96.3%;P〈0.05）。     

小儿结节性硬化症的平扫CT影像和临床价值

目的 总结CT平扫在小儿结节性硬化症中的影像表现和临床诊断价值.方法 回顾性分析我院41例结节性硬化症患儿的颅脑CT表现,并经临床共同确诊.结果 41例小儿结节性硬化症CT平扫表现为颅内钙化和/(或)非钙化结节.结节发生于室管膜下40例(97.5%),在首次扫描或复诊扫描中,结节钙化发现率100%;结节发生于皮质或皮质下11例(26.8%);脑实质内可见孤立的斑片状钙化10例(24.3%);双侧侧脑室扩大20例(48.8%).结论 小儿结节性硬化症的颅内结节多为室管膜下钙化或高密度结节.CT平扫对颅内高密度或钙化结节具有高度特异性,是诊断小儿结节性硬化症的首选方法.     

Effect of garlic on platelet aggregation in patients with increased risk of juvenile ischaemic attack

Summary A platelet-inhibiting effect is described for garlic. In this double-blind, placebo-controlled study on 60 voluntary subjects with cerebrovascular risk factors and constantly increased platelet aggregation it was demonstrated that the daily ingestion of 800 mg of powdered garlic (in the form of coated tablets) over 4 weeks led to a significant inhibition of the pathologically increased ratio of circulating platelet aggregates and of spontaneous platelet aggregation. The ratio of circulating platelet aggregates decreased by 10.3%, from 1.17±0.08 to 1.05±0.11 (P<0.01), and spontaneous platelet aggregation by 56.3%, from 40.7±23.3 to 17.8±23.2 degrees (P<0.01) during the garlic phase. There were no significant changes in the placebo group. The parallel group comparison (garlic versus placebo) revealed a significantly different ratio of circulating platelet aggregates after 4 weeks of treatment (P<0.05).After the 4-week wash-out phase the values increased again to 1.19±0.32 and 34.9±28.7°, reaching the initial values (run-in phase prior to the ingestion of garlic). Since garlic is well tolerated it would be worth testing it in a controlled clinical trial for usefulness in preventing disease manifestations associated with platelet aggregation.     

CT检查对甲状腺癌的诊断价值

目的 对甲状腺癌进行螺旋CT增强扫描,根据其强化改变评价其诊断价值.方法 22例甲状腺癌均行CT检查,对病灶行薄层(2～5 mm)增强扫描,动态分析增强扫描变化,评价CT强化方式及特点.结果 甲状腺癌各型CT影像强化密度不同,有助于对病变的定性诊断.结论 甲状腺癌CT增强扫描可反映病变的血液供应变化过程及强化特征,对临床手术方案的制定有一定意义.