脑动脉微栓子与颈动脉硬化的关系

目的探讨急性脑梗死患者脑动脉系统微栓子（MES）与颈动脉硬化的关系。方法收集急性脑梗死患者146例,进行脑动脉和颈动脉彩色多普勒超声检测,对有脑动系统微栓子的病例进行监测。结果（1）82例有颈动脉斑声,64例无颈动脉斑块;（2）有颈动脉斑块者MES阳性率（46．34）较无斑块者MEs阳性率（21．88）高（P〈0．05）;（3）颈动脉不稳定斑块MES阳性率（80％）较稳定性斑块MES阳性率（26．92％）高（P〈0．01）;（4）MES与颈动脉的狭窄程度、内膜增厚及斑块的个数无相关性。结论颈动脉粥样硬化斑块的存在及不稳定性是导致脑动脉系统微栓子的重要因素之一,应高度重视,稳定颈动脉斑块是防治动脉栓塞的重要措施。     

急性脑梗死患者微栓子信号的影响因素及其与近期预后的关系研究

目的 探讨急性脑梗死患者微栓子信号的影响因素及其与近期预后的关系。方法 前瞻 性连续纳入2019 年1 月至2020 年1 月皖南医学院第二附属医院神经内科接诊的118 例急性脑梗死患者 作为研究对象,均经颅多普勒监测微栓子信号,根据微栓子信号是否阳性,分为阳性组和阴性组。采用单因 素和多因素Logistic回归分析微栓子信号的影响因素;随访6个月,观察脑梗死复发情况,通过Kaplan-Meier 生存曲线分析微栓子信号阳性与脑梗死复发的关系。结果 118例急性脑梗死患者中,36 例（30.51%）微 栓子信号阳性;阳性组有颈动脉斑块占比［69.44%（25/36）］、颈动脉重度狭窄率［55.56%（20/36）］、血小 板［（278.84±26.93）×109/L］、超敏C 反应蛋白水平［（13.87±3.58）mg/L］、美国国立卫生研究院卒中量 表（NIHSS）评分［（5.93±1.17）分］均明显高于阴性组,高密度脂蛋白胆固醇水平［（0.91±0.33）mmol/L］ 低于阴性组［分别为29.27%（24/82）、20.73%（17/82）、（215.48±16.53）×109/L、（9.87±2.07）mg/L、（4.88± 0.58）分、（1.23±0.65）mmol/L］,差异均有统计学意义（均P ＜ 0.05）。经多因素Logistic 回归分析,颈动 脉斑块（OR=7.425,95%CI：2.892～28.882）、重度狭窄（OR=2.692,95%CI：1.362～8.736）、高水平血小板 （OR=8.462,95%CI：1.425～16.465）均是微栓子信号阳性的独立危险因素（均P＜ 0.05）。 所有患者获得 随访,脑梗死复发15 例,其中阳性组脑梗死复发率为22.22%（8/36）,高于阴性组的8.54%（7/82）,差异有 统计学意义（χ2=4.223,P=0.040）;经Kaplan-Meier 生存曲线分析和Log-rank 检验,阳性组较阴性组患者 更易出现脑梗死复发（P＜ 0.05）。结论 急性脑梗死患者微栓子信号阳性与颈动脉斑块、重度狭窄和高 水平血小板有关,提示这部分患者近期预后更差,需要更加密切的随访,严格控制危险因素。     

伴有颈动脉斑块的急性前循环脑梗死患者的微栓子研究

目的 探讨颈动脉斑块、微栓子和急性前循环脑梗死的关系。方法 选择住院的急性前循环脑梗死患者65例,经颈动脉超声检查分为伴有颈动脉斑块组45例和不伴有颈动脉斑块组20例,2组均行微栓子监测。结果 伴有颈动脉斑块组与不伴有颈动脉斑块组吸烟、高血压病、糖尿病、高脂血症相比无明显差异(P>0.05); 伴有颈动脉斑块患者的微栓子阳性率为38%,不伴有颈动脉斑块患者为13%,2组相比有明显差异(P<0.05); 软斑组微栓子阳性率为45%,硬斑组微栓子阳性率为18%,2组相比有明显差异(P<0.05)。结论 急性前循环脑梗死患者多有颈动脉斑块,软斑块是微栓子的主要来源,微栓子是急性脑梗死发病的重要危险因素,对二者早期干预是防治脑卒中的重要措施之一。     

急性脑梗死患者微栓子监测与颈动脉硬化的相关性分析

目的探究微栓子、颈动脉粥样硬化斑块与急性脑梗死的相关性分析。方法选择2012-09—2014-09我院收治的77例急性脑梗死住院患者,斑块组46例,无斑块组31例。采集静脉血行TC、TG、LDL-C、HDL-C检测,行脑动脉微栓子监测与动脉彩色超声检查。结果斑块组高血压、吸烟、糖尿病、高TC血症、高LDL-C血症显著高于无斑块组;不稳定性斑块微栓子阳性率显与稳定性斑块微栓子阳性率比较;单发微栓阳性率与多发微栓子阳性率比较,差异具有统计学意义(P0.05)。结论大部分急性脑梗死患者并发颈动脉粥样硬化斑块,其中微栓子主要来自不稳定斑块。微栓子存在即易导致脑梗死,应及时对症治疗。     

急性脑梗死患者脑微栓子与颈动脉硬化的关系

目的 探讨急性脑梗死患者脑动脉系统微栓子(MES)与颈动脉硬化的关系.方法 收集急性脑梗死患者73例,进行脑动脉微栓子监测和颈动脉彩色多普勒超声检测,观察有脑动脉系统微栓子的病例数.结果 (1)41例有颈动脉斑块,32例无颈动脉斑块;(2)有颈动脉斑块者MES阳性率(46.34%)较无斑块者MES阳性率(21.88%)高(P<0.05);(3)颈动脉不稳定斑块MES阳性率(80%)较稳定性斑块MES阳性率(26.92%)高(P<0.01);(4)MES与颈动脉的狭窄程度、内膜增厚及斑块的个数无相关性.结论 颈动脉粥样硬化斑块的存在及不稳定性是导致脑动脉系统微栓子的重要因素之一,应高度重视,稳定颈动脉斑块是防治动脉至动脉栓塞的重要措施.     

急性脑梗死患者脑血流中微栓子与颈动脉粥样硬化斑块的关系

目的 探讨急性脑梗死患者脑血流中微栓子与颈动脉粥样硬化斑块的关系.方法 67例急性脑梗死患者依据颈动脉超声检测分为颈动脉无斑块组(27例)和斑块组(40例),后者再分为不稳定斑块亚组(19例)和稳定斑块亚组(21例);对所有患者应用经颅多普勒仪进行脑血流中微栓子监测;比较各组间微栓子阳性率.结果 脑血流中微栓子阳性率颈动脉斑块组(30%)显著高于无斑块组(3.7%),不稳定斑块亚组(47%)显著高于稳定斑块亚组(14.3%)(均P<0.05).结论 颈动脉粥样硬化脑梗死患者脑血流中微栓子阳性率高;不稳定斑块更易脱落形成微栓子.     

缺血性脑血管病与颈动脉粥样硬化的关系

目的 探讨颈动脉粥样硬化与缺血性脑血管病的关系。方法 以2001年6月至2004年12月在我院住院的1583例急性缺血性脑血管病患者为研究对象，应用超声诊断仪检测双侧颈动脉，采用非条件Logistic回归分析颈动脉粥样硬化的危险因素及与缺血性脑血管病的关系。结果 86．5％（1369／1583）患者存在不同程度颈动脉粥样硬化；脑梗死组颈动脉粥样硬化患病率（1087／1266，85．9％）较短暂性脑缺血发作组（198／317，62．5％）高。颈动脉粥样硬化病变特点以斑块居多（1286／1583，81．2％），而中重度狭窄发生率较低（214／1583，13．5％）；颈动脉斑块以颈总动脉分叉处最多见（665／1286，51．7％）。斑块发生率及颅外段颈动脉狭窄程度与脑血管病危险因素有明显相关性。结论 佛山地区缺血性脑血管病患者颈动脉粥样硬化病变可能以斑块居多，颈动脉粥样硬化与缺血性脑血管病有关。     

急性脑梗死患者血清血栓素B_2、6-酮-前列环素F_（1α）水平与颈动脉粥样硬化的关系

目的探讨急性脑梗死（ACI）患者血清血栓素B2（TXB2）、6-酮-前列环素F1α（6-K-PGF1α）与动脉粥样硬化（CAS）斑块及其硬化程度的关系。方法对入选的ACI患者进行血清TXB2、6-K-PGF1α的监测,并行颈动脉超声,测量颈动脉内中膜厚度（IMT）并观察有无斑块之间的相关性分析。结果急性脑梗死合并颈动脉粥样硬化的患者血清TXB2水平明显高于无颈动脉硬化患者,6-K-PGF1α水平显著低于无颈动脉硬化患者（均P〈0.01）。有CAS斑块的患者血清TXB2水平显著高于颈动脉内中膜正常与增厚患者,6-K-PGF1α水平显著低于颈动脉内中膜正常与增厚患者,差异有统计学意义（均P〈0.05）。结论血清TXB2、6-K-PGF1α水平与急性脑梗死（ACI）患者颈动脉粥样硬化的发生有一定相关性,CAS程度愈重,相关性愈大。     

黄连素对颈动脉粥样硬化斑块的干预研究

目的探讨黄连素对颈动脉粥样硬化斑块干预的效果及机制。方法将92例伴有颈动脉粥样硬化斑块的缺血性脑血管病患者随机分成研究组及对照组;研究组口服黄连素,对照组口服氟伐他汀;于治疗前、治疗后2及4个月进行颈动脉超声检查,测量颈动脉TMT、颈动脉粥样硬化斑块面积及数量,以及检查治疗前、治疗后2及4个月sICAM-1、sVCAM-1、sE-selectin数值。结果与治疗前相比,治疗后4个月2组颈动脉IMT及颈动脉粥样硬化斑块面积、数量减小,差异有显著性（P〈0.05）,2组之间差异无显著性（P〉0.05）。与治疗前相比,治疗后2组sICAM-1、sVCAM-1、sE-selectin均降低,有显著差异（P〈0.05）,2组之间差异无显著性（P〉0.05）。结论黄连素可用于治疗颈动脉粥样硬化斑块,从而可应用于缺血性脑血管病的二级预防。     

急性脑梗死与高敏C反应蛋白水平及颈动脉斑块性质关系的临床研究

目的研究急性脑梗死与高敏C反应蛋白(hs-CRP)水平及颈动脉斑块性质关系。方法选择2012-08—2014-08本院诊治的61例急性脑梗死患者为研究组,另选取同时期内63例行健康体检者为对照组,2组均给予彩色多普勒超声及血液检查,观察并比较2组颈动脉斑块检出率、hs-CRP水平及颈动脉内膜平均厚度,研究组患者斑块不同分布的hs-CRP水平检测情况。结果研究组斑块检出率及hs-CRP水平均显著高于对照组,且颈动脉内膜平均厚度厚于对照组,差异均具有统计学意义(P0.05,P0.01);另外研究组患者中斑块不稳定组hs-CRP水平检测值均显著高于无斑块组和斑块稳定组,差异均具有统计学意义(P0.05)。结论急性脑梗死与高敏C反应蛋白水平及颈动脉斑块性质关系密切,临床科学检测hs-CRP水平及颈动脉斑块性质对急性脑梗死诊治具有积极影响。     

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.