急性脑梗死及其高危人群血栓前状态指标的测定

目的 探讨血栓前状态(PTS)指标在脑梗死及其高危人群防治中的作用和意义.方法 使用酶联免疫吸附法和凝固法检测33例急性脑梗死,35例脑梗死高危和25例正常对照组患者外周血小板a颗粒膜蛋白(GMP-140)、组织型纤溶酶原激活物(t-PA)、组织型纤溶酶原激活物的抑制物(PAI-1)和纤维蛋白原(Fg) 的水平变化.结果 与对照组相比,脑梗死组、高危组血浆GMP-140、PAI-1水平显著升高、t-PA显著降低(P＜0.01),Fg升高(P＜0.05),脑梗死组与高危组之间无显著性差异.结论 脑梗死及其高危患者存在PTS,在控制原发病的同时给予抗凝、降低血液黏稠度治疗可能会降低血栓的发生率.     

老年人TIA与血栓前状态

目的　探讨 6 0岁以上老年人短暂性脑缺血发作 (TIA)患者凝血纤溶系统的功能状态。方法　随机选出 TIA患者 6 0岁以上 30例 ,6 0岁以下 30例 (为对照组 ) ,采用双抗体夹心 EL ISA法测定血浆血小板颗粒膜糖蛋白 (GMP- 140 )和 D-二聚体 (DD)浓度。结果　老年 TIA组血浆 GMP- 140浓度低于对照组 (P<0 .0 5 ) ,但两组浓度均略高于正常值。老年 TIA组 DD浓度明显高于对照组 (P<0 .0 5 ) ,发病 3个月内随访 ,老年 TIA组中 6例发展成脑梗死 ,对照组有 2例 ,均为 DD增高者。结论　老年 TIA组患者体内凝血纤溶系统比较活跃 ,并且持续时间较长 ,故对老年人 TIA的治疗除给予抗血小板活化剂药物治疗外 ,还应适当给予降纤、抗纤溶药物治疗     

脑梗死患者血浆氧化低密度脂蛋白与一氧化氮、假性血友病因子及血浆颗粒膜蛋白的关系研究

目的探讨动脉粥样硬化性脑梗死患者血浆氧化低密度脂蛋白与血管内皮损伤及血小板活化程度的关系。方法用酶联免疫吸附测定（ELISA）的方法检测49例脑梗死患者和50例相匹配的对照组血浆氧化低密度脂蛋白（OX-LDL）、血管性假血友病因子（VWF）、血浆颗粒膜蛋白（GMP-140）水平，同时用硝酸还原酶比色法测定血清一氧化氮（NO）水平，并把、VWF、GMP-140、NO与OX-LDL作相关分析。结果脑梗死组血浆OX-LDL、、VWF、GMP-140明显高于对照组（t=2．91，P〈0．01；t=3．94，P〈0．001；t=2．08，P〈0．05），而脑梗死组血清NO水平明显低于对照组（t=4．02，P〈0．001）；相关分析表明血浆OX-LDL水平与血清NO水平呈负相关（r=-0．204，P〈0．05），与血浆懈呈正相关（r=0．60，P〈0．01），与血浆GMP-140呈正相关（r=0．430，P〈0．01）。结论脑梗死患者的血浆OX-LDL明显增高，而OX-LDL增高可能是脑梗死的危险因素。     

替米沙坦改善2型糖尿病合并高血压、缺血性脑卒中患者血管内皮功能

目的比较替米沙坦治疗前后2型糖尿病合并高血压、缺血性脑卒中患者血流介导内皮依赖性血管舒张功能（flow—mediateddilation,FMD）,探讨其对血管内皮功能的影响。方法24例2型糖尿病合并高血压、缺血性脑卒中患者服用替米沙坦40~80mg,1次／d,治疗12个月;比较其治疗前后患者FMD、血压、血糖、血胰岛素水平等。结果2型糖尿病合并高血压、缺血性脑卒中患者替米沙坦治疗后,收缩压／舒张压较治疗前显著降低（128±6／74±4）与（147±7／86±4）mmHg比较,P〈O．05;FMD较治疗前显著增加（5．5±0．5与4．0±0．4）比较,P〈0．05。空腹血糖（118．5±7．1与148．5±9．4mg／dI。比较,P〈0．05）、血胰岛素（12．4±1．1与16．1±1．4mU／L比较,P〈0．05）、糖化血红蛋白（7．24士0．26与8．26±0．36比较,P〈O．05）、C反应蛋白（2．89±0．30与5．45±0．87mg／dL比较,P〈0．01）水平较治疗前降低。结论替米沙坦改善2型糖尿病合并高血压、缺血性脑卒中患者血流介导内皮依赖性血管舒张功能,其心脑血管保护作用值得重视。     

阿托伐他汀对自发性高血压大鼠动脉血压和血管内皮功能的影响

目的探讨阿托伐他汀对自发性高血压大鼠(SHR)动脉血压和血管内皮功能的影响。方法选用8周龄SHR12只,随机分为阿托伐他汀治疗组(ATV组,n=6)、蒸馏水组(DW组,n=6),另选6只WKY大鼠作为正常对照。ATV组大鼠给以阿托伐他汀50mg/(kg·d)加适量蒸馏水灌胃。DW组和WKY组每天同时用等量蒸馏水灌胃。观察给药前后大鼠尾动脉血压的变化,测定大鼠血清总胆固醇(TC)、甘油三酯(TG)和高密度脂蛋白胆固醇(HDL-C)浓度,观察血浆内皮素1(ET-1)水平、主动脉组织一氧化氮合酶(NOS)活性的变化特点。结果ATV组大鼠动脉血压显著低于DW组(P＜0．01)；与DW组和WKY组比较,ATV组血清TC、TG和HDL-C浓度显著降低(P＜0．01,P＜0．05)；DW组血清ET-1水平显著高于WKY组(P＜0．05),主动脉组织NOS活性显著低于WKY组(P＜0．05),经ATV治疗后血清ET-1水平明显降低(P＜0．05),而主动脉组织NOS活性显著增高(P＜0．01)。结论长期应用阿托伐他汀可以显著降低动脉血压。阿托伐他汀通过改善血管内皮功能延缓高血压的病理过程。     

辛伐他汀对高血压并颈动脉粥样硬化血管内皮功能的影响

目的研究合并颈动脉粥样硬化的原发性高血压患者血管内皮舒张功能与颈动脉硬化,hsCRP的关系以及辛伐他汀对其的影响。方法选取40例合并颈动脉粥样硬化的高血压患者（研究组）和40例无颈动脉斑块的高血压患者（对照组）,于给药前和给药3个月后采用彩色多普勒超声检查颈动脉内膜中层厚度（IMT）、粥样硬化斑块积分、血管内皮依赖性舒张功能（FMD）、非内皮依赖性舒张功能（NMD）、测定血超敏C反应蛋白（hsCRP）、血脂水平和空腹血糖（FBG）等,研究组予以辛伐他汀20mg／晚口服。结果2组比较,研究组FMD低于对照组,而IMT,hsCRP值高于对照组,差异有统计学意义（P〈0．05）;研究组辛伐他汀治疗后FMD显著改善,IMT、粥样硬化斑块积分、hsCRP减低（P〈0．05）;FMD与IMT,hsCRP、TG呈负相关（P〈0．05）。结论合并颈动脉粥样硬化的原发性高血压患者存在内皮功能障碍,辛伐他汀可显著改善血管内皮功能,稳定动脉斑块。     

"癫痫"诊断对个体心理健康和睡眠质量状况的影响

目的探讨癫痫诊断对个体心理健康与睡眠质量状况的影响。方法采用症状自评量表(Symptom Checklist 90,SCL-90)和匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI),对100例确诊癫痫患者和74例可疑癫痫患者的心理健康水平和睡眠质量状况进行评价。结果确诊癫痫组的心理健康水平较常模水平低,SCL-90的总分、总均分、强迫症状、焦虑、恐怖和精神病性因子的差别具有非常显著性意义(P＜0．01或P＜0．001),躯体化、抑郁、敌对因子的差别具有显著性意义(P＜0．05),但人际关系敏感和偏执因子的差别无显著性意义(P＞0．05)。可疑癫痫组SCL-90评分水平更高,除人际关系敏感和偏执因子的差别无显著性意义外(P＞0．05),其余SCL-90全部指标的差别均具有非常显著性意义(P＜0．01或P＜0．001)。但两组SCL-90相应指标的差别无显著性意义(P＞0．05)。与正常人相比,确诊癫痫组除睡眠时间和睡眠障碍因子的差别无显著性意义外(P＞0．05),其余所有PSQI指标的差别均具有显著性意义(P＜0．01或P＜0．05)。可疑癫痫组的PSQI评分水平更高,与正常人相比,除睡眠效率因子的差别无显著性意义外(P＞0．05),其它所有指标的差别均具有显著性意义(P相似文献   

急性脑梗塞患者血小板膜糖蛋白研究

利用同位素标记的抗人血小板单克隆抗体SZ-2、SZ-21及SZ-51经直接放免法评估22例急性脑梗塞患者体内血小板的活化程度。结果:1.血浆内血小板α-颗粒膜蛋白(GMP-140)的分子数在脑梗塞急性期呈显著增高(P<0.01),缓解期可恢复正常;2.血小板膜糖蛋白Ib在质膜上分子数显著升高(P相似文献   

急性脑梗死患者血中一氧化氮、内皮素、6-酮-前列腺素浓度测定及意义

目的探讨一氧化氮(NO)、内皮素(ET)、6-酮-前列腺素(6-K-PGF1α)在脑梗死发病过程中的意义以及与病情、伴发症之间的关系.方法采用比色法及放射免疫分析法测定60例急性脑梗死患者发病后1周内、2、4周时的血清NO浓度,血浆ET及6-K-PGF1α浓度,并与对照组比较.结果急性脑梗死组血清NO、血浆ET、6-K-PGF1α浓度均明显升高(P＜0.02～0.001);高血脂组NO浓度高于非高血脂组(P＜0.05);病情重、中型ET浓度高于轻型(P＜0.05),高血压病组高于非高血压病组(P＜0.001),冠心病组ET浓度高于非冠心病组(P＜0.001);糖尿病组6-K-PGF1α浓度高于非糖尿病组(P＜0.05).结论 NO、ET、6-K-PGF1α在脑梗死的发生、发展中具有一定作用,并与高血脂、高血压病、冠心病、糖尿病存在一定关系,ET含量变化与病情有关.     

抑郁症患者血管内皮功能的异常改变

目的:探讨抑郁症患者血管内皮功能的改变。方法:运用日立-图腾彩色多普勒超声诊断仪高频探头检测24例抑郁症患者(抑郁症组)和20名健康对照者(健康对照组)肱动脉反应性充血前后血管内径的变化(即血流介导的内皮依赖性血管扩张,FMD)及舌下含服硝酸甘油后的内径变化(即非内皮依赖性舒张功能,NMD);同时测定两组血浆一氧化氮水平(NO);采用汉密尔顿抑郁量表(HAMD)和Beck抑郁量表(BDI)评定抑郁症组患者抑郁的严重程度。结果:与健康对照组相比,抑郁症组FMD较健康对照组明显降低(t=3.62,P0.01);两组NMD比较差异无统计学意义(t=1.55,P0.05)。抑郁症组的血浆NO水平明显低于健康对照组(t=3.63,P0.01)。相关分析显示,抑郁症组HAMD及BDI得分与FMD负相关(r=-0.687,r=-0.621;P均0.05);两组血浆NO水平与FMD正相关(r=0.726,r=0.743;P均0.05)。结论:抑郁症患者血管内皮功能受损可能与血浆NO水平减低及抑郁严重程度有关。     

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.     

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.     

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.     

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.     

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.     

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.