非心源性缺血性卒中及短暂性脑缺血发作患者的抗栓治疗

与美国心脏协会(American Heart Association,AHA)/美国卒中协会(American Stroke Association,ASA)2006年缺血性卒中及短暂性脑缺血发作(transientischemic attack,TIA)二级预防指南和2008年就非心源性缺血性卒中/TIA的抗栓和他汀二级预防更新版一致,AHA/ASA2011版缺血性卒中/TIA二级预防指南(ASA2011二级预防指南)继续专门阐述非心源性缺血性卒中/TIA的抗栓治疗,并在标题强调所谓"非心源性"主要特指动脉粥样硬化性脑梗死,腔隙性梗死或隐源性梗死[1-3].     

阻塞性睡眠呼吸暂停低通气综合征与非心源性缺血性卒中复发关系探讨

【摘要】 目的 探讨阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndromes,OSAHS）与非心源性缺血性卒中复发之间的关系。 方法 本研究为前瞻性观察研究,通过对2008年3月～2011年7月北京市海淀医院神经内科住院治疗的227例新发非心源性缺血性卒中患者发病2周时情况进行分析,依据患者呼吸暂停低通气指数（apnea hypopnea index,AHI）分为四组,分别为单纯非心源性缺血性卒中组（Ⅰ组,n=52）,非心源性缺血性卒中合并轻度OSAHS组（Ⅱ组,n=60）、非心源性缺血性卒中合并中度OSAHS组（Ⅲ组,n=59）、非心源性缺血性卒中合并重度OSAHS组（Ⅳ组,n=56）。收集患者基线资料并记录其相关危险因素如高血压、吸烟等及患者睡眠呼吸监测结果。入组满12个月时对患者进行随访,比较各组间缺血性卒中事件复发情况及影响因素。 结果 单纯非心源性缺血性卒中组、非心源性缺血性卒中合并轻度OSAHS组、非心源性缺血性卒中合并中度OSAHS组、非心源性缺血性卒中合并重度OSAHS组随访12个月内缺血性卒中复发率分别为3.8%、5.0%、11.9%、16.4%,经卡方检验显示非心源性缺血性卒中合并重度OSAHS组较单纯非心源性缺血性卒中组、非心源性缺血性卒中合并轻度OSAHS组的复发率差异存在显著性（P分别为0.033,0.046）,余各组间复发率比较差异无显著性（P分别为0.768,1.177,0.490,0.123）;将体重指数（body mass index,BMI）、高血压、AHI值、血氧饱和度（oxyhemoglobin saturation,SaO2）纳入多因素Logistic回归分析表明,BMI［优势比（odds ratio,OR）3.126,95%可信区间（confidence interval,CI）2.079～4.700,P<0.001］、高血压病史（OR 3.258,95%CI 1.308～8.111,P=0.011）、AHI（OR 1.071,95%CI 1.038～1.105,P<0.001）、SaO2（OR 0.907,95%CI 0.848～0.969,P=0.004）与缺血性卒中复发相关,且为独立危险因素。 结论 OSAHS、肥胖、高血压可能是缺血性卒中复发的独立危险因素。     

血栓弹力图评价缺血性脑血管病患者服用不同小剂量阿司匹林疗效

抗血小板药物能显著降低非心源性脑缺血性卒中或TIA患者再次严重血管事件的发生率[1].阿司匹林和氯吡格雷是经循证医学证实可常规应用的抗血小板聚集药,2010年中国缺血性卒中或TIA发作二级防治指南及2011年AHA/ASA关于缺血性卒中或TIA发作患者卒中预防指南指出:对于非心源性缺血性卒中和TIA的抗栓治疗,氯吡格雷75mg和阿司匹林50mg～325mg均可作为首选药物[2,3].     

非心源性缺血性卒中及短暂性脑缺血发作患者的抗血小板治疗

在脑血管病患者中,约80%为缺血性卒中患者,多伴有多种危险因素,是卒中复发的高危人群。在非心源性缺血性卒中/短暂性脑缺血发作（transient ischemic attack,TIA）的二级预防中,抗血小板治疗的疗效已被大量临床研究证实,并被各国的指南所推荐。本文结合新近发表的指南以及经典的临床试验,对非心源性缺血性卒中/TIA的抗血小板治疗模式做一综述。     

非心源性缺血性卒中复发危险因素分析

目的 分析非心源性缺血性卒中患者1年复发的危险因素。 方法 连续入选1978例发病7 d内的非心源性缺血性卒中患者。收集患者的人口学信息、血管病危险 因素和发病时的主要症状及体征,评价患者的头颅磁共振成像结果,包括梗死灶的部位、数量、急 性梗死灶的分布特征及责任动脉、责任动脉有无严重狭窄、缺血性卒中的病因分型。随访患者1年内 有无缺血性卒中或短暂性脑缺血发作（transient ischemic attack,TIA）的复发,通过多元Cox回归分析缺 血性卒中患者复发的危险因素。 结果 95例(4.8%)患者1年内缺血性卒中或TIA复发。冠状动脉粥样硬化性心脏病病史、缺血性卒中病 史、缺血性卒中发病前3个月内反复TIA、责任脑动脉狭窄程度≥70%和后循环缺血性卒中是1年内复发 的危险因素。 结论 后循环梗死、有责任脑动脉严重狭窄及缺血性心脑血管病病史的非心源性缺血性卒中患者复 发的风险较高。     

缺血性卒中或短暂性脑缺血发作患者的卒中预防指南美国心脏协会/美国卒中协会卒中委员会向医疗卫生专业人员的声明心血管放射学与介入委员会共同倡导

这份新声明旨在为缺血性卒中或短暂性脑缺血发作存活者的缺血性卒中预防提供全面和及时的循证推荐.循证推荐包括对危险因素的控制、动脉粥样硬化性疾病的干预措施、心源性栓塞的抗栓治疗以及非心源性栓塞性卒中抗血小板药的应用.另外,还为其他多种特殊情况下复发性卒中的预防提供了推荐,包括动脉夹层分离、卵圆孔未闭、高同型半胱氨酸血症、高凝状态、镰状细胞病、脑静脉窦血栓形成、女性卒中(特别是与妊娠和绝经后激素替代治疗相关卒中)、脑出血后抗凝药的应用,以及该指南在高危人群中执行和应用的特殊措施.     

氯吡格雷在非心源性缺血性卒中二级预防中的疗效观察

目的 观察氯吡格雷和阿司匹林肠溶片在非心源性缺血性卒中二级预防中的疗效和安全性。方法 连续收集非心源性缺血性卒中患者并随机分为氯吡格雷组和阿司匹林组,每组55例患者,两组均给予卒中基础治疗。氯吡格雷组加用硫酸氢氯吡格雷口服,50 mg/d。阿司匹林组加用阿司匹林肠溶片口服,75 mg/d。随访1年内两组缺血性卒中复发率和药物不良反应发生率。结果 阿司匹林组卒中复发率为13.5%,而氯吡格雷组复发率为1.8%,差异有统计学意义（P =0.04）;阿司匹林组不良反应发生率为36.4%,氯吡格雷组不良反应发生率为5.5%,差异有统计学意义（P =0.001）。结论 氯吡格雷在非心源性缺血性卒中二级预防中的疗效优于阿司匹林,安全性较高。     

缺血性卒中或短暂性脑缺血发作的Ⅱ级预防指南

本文目的在于为预防卒中提供综合及时的循证医学建议,预防缺血性卒中患者或短暂性脑缺血发作患者发生缺血性卒中。循证医学建议包括控制危险因素、动脉粥样硬化的介入治疗、心源性脑栓塞的抗凝治疗、非心源性栓塞性卒中的抗血小板药物治疗,提出了一系列特定情况下防止卒中复发的建议,如动脉夹层、卵圆孔未闭、高同型半胱氨酸血症、高凝状态、镰状细胞病、脑静脉窦血栓形成、女性卒中特别是妊娠妇女及绝经后激素替代治疗及脑出血后如何使用抗凝药物等。     

氯吡格雷/阿司匹林双抗预防非心源性缺血性脑卒中的效果观察

目的观察氯吡格雷联合阿司匹林双抗防治非心源性缺血性脑卒中的临床效果。方法选取2011-05—2014-05收治的非心源性缺血性脑卒中患者114例,随机分为观察组与对照组,2组均常规卒中治疗,在此基础上对照组单纯应用阿司匹林,观察组使用氯吡格雷联合阿司匹林治疗,观察2组临床效果。结果观察组3个月、1a内复发率均明显低于对照组,总不良反应率低于对照组,差异均有统计学意义(P0.05)。结论对非心源性缺血性脑卒中患者使用氯吡格雷联合阿司匹林进行双抗防治,能够有效降低其卒中复发率,减少不良反应,在临床防治中有较理想的效果。     

淋巴毒素α多态性位点与中国汉族非心源性缺血性卒中的关联研究

目的 在中国汉族人群中研究淋巴毒素α（lymphotoxinα,LTA）基因多态性位点是否为非心源性缺血性卒中的危险因素。方法 采用Taqman-MGB探针法在558名非心源性缺血性卒中患者和557名健康成人中对LTA的rs1800683、rs909253、rs1041981三个多态性位点进行基因分型。在单核苷酸多态性水平和单体型水平进行关联分析,并使用Bonferroni法进行多重检验校正。结果 LTA的三个单核甘酸多态性的不同等位基因和基因型在非心源性缺血性卒中组和对照组分布未见统计学差异。以最常见的单体型AGA作为参照,在校正传统危险因素后,GGC携带者有0.381倍卒中发病风险（95%CI：0.198～0.733,P =0.003）。结论 GGC单体型可能是非心源性缺血性卒中发病的保护性因素,有待于在前瞻性研究中进一步证实。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

他汀类药物的使用和颅内动脉瘤破裂相关性分析

目的 探讨他汀类药物对颅内动脉瘤破裂的影响。方法 2010年3月至2014年3月收治颅内囊状动脉瘤67例,其中破裂者32例,未破裂者35例。采用多变量Logistic回归评估他汀类药物的使用和颅内动脉瘤破裂的关系。结果 破裂组术前使用他汀类药物4例（12.5%,4/32）,未破裂组16例（45.7%,16/35）。破裂组服用他汀类药物的百分比显著低于未破裂组（P<0.01）。纠正潜在的混杂干扰后（or值: 0.30,95%可信空间:0.12~="" 0.64）显示,颅内动脉瘤破裂与他汀类药物的使用呈显著负相关,也与高血清总胆固醇浓度有关。结论 本结果提示他汀类药物对颅内动脉瘤破裂有一定的预防效果。     

失匹配负波在意识障碍评估中的临床价值探讨

自失匹配负波(MMN)于20世纪70年代被发现以来,我们对规律性声音被打破后所诱发的前注意检测有了进一步认识,而MMN成为了开启认知大门的钥匙。至今为止,MMN的研究范围从产生机制发展到神经精神疾病相关的临床试验,特别是对于急性脑损伤(ABI)昏迷以及进展后的慢性意识障碍(DoC)患者,MMN被认为是一个可靠的预后预测指标。然而,由于MMN难以用于个体评估,目前在临床实践中的应用仍十分有限,广大临床医师对MMN的了解甚少。因此,本文就MMN的产生机制、在意识障碍中的临床意义、判读方法及其影响因素做一综述。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Modelling of movement of the lamprey: Control of oscillators

This article discusses the control methods of the central pattern generator (CPG). First a control model of the CPG is presented using 2 oscillators, and we suggest that phasic modulation to the CPG by means of phasic information is effective for controlling the phase difference between oscillators. Next, two models for controlling the CPG of a lamprey are proposed. One model describes a control system from the brain stem, in which the reticulospinal neurons control the CPG by receiving feedback signals and sending control signals to the neck region of the CPG. The other is a model for learning an localized control system to generate a desired motor pattern. By means of these models, a role of the efference copy is suggested.     

Application of Coregistration for Imaging of Animal Models of Epilepsy

Summary:  The past decade has seen a surge in the utilization of small animal imaging for epilepsy research. In vivo imaging studies have the potential to provide important insights into the structural and functional correlates of the development and progression of epilepsy in these models. However, the small size of the rodent brain means that anatomic resolution is often relatively poor for many imaging modalities, particularly those providing functional information such as positron emission tomography. Coregistration of these images with those of higher structural resolution, such as MRI, provides an attractive approach to this problem, and also allows correlations between structural and functional imaging data. Image coregistration is commonly utilized in clinical research and practice. However, its application for small animal images has been, to date, relatively under utilized and largely unvalidated. The current review aims to provide an overview of image coregistration methods, particularly for MRI and PET, and their application to imaging of small animal models of epilepsy. Methodological advantages and potential traps are highlighted.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

Quantitative pharmacohistochemistry of acetylcholinesterase in neostriatum of inbred strains of mice

A quantitative pharmacohistochemical technique has been used in the present study to assay acetylcholinesterase (AChE) activity in the neostriatum of C57BL/6 and DBA/2 mice. This technique permits the measurement of enzyme activity into microscopically defined compartments and is suitable for the study of striatal AChE-containing, putatively cholinergic, neurons. Microphotometric measurements have been performed in the cytoplasm of AChE-containing perikarya and in the striatal matrix: in both compartments, AChE activity was significantly higher in DBA/2 than in C57BL/6 mice. The present data show that AChE quantitative pharmacohistochemistry is suitable for studying the enzyme activity in nervous tissue and, particularly, in the cytoplasm of individual AChE-containing neurons. In addition, interstrain comparison indicates the presence of a genetically determined higher AChE content in striatal neurons of the DBA/2 strain.     

Effect of high simple dose of cisplatinum and of radiation on the brain of rabbit

Abstract

In former studies of intracarotid and intravenous administration of cisplatinum, separate and combined with brain irradiation, we found no cerebral damage. In this study! gradually increasing high doses (above the therapeutic ones) of cisplatinum were administered intravenously to one series of rabbits arid increasing high amounts of irradiation (above the therapeutic amounts) were given to another series. Although the rabbits that received highest doses of irradiation developed areas of alopecia and skin ulcers on the head! the general clinical and histopathologic examination of the rabbits brains in both series was normal. The purpose of this study was to establish the effects of high doses of intravenous cisplatinum and irradiation on the rabbits brains. [Neural Res 1997; 19: 216–218]