抗谷氨酸脱羧酶抗体相关小脑共济失调临床特征与预后分析

回顾北京协和医院2015年至2021年11月收治的10例抗谷氨酸脱羧酶(GAD)抗体相关小脑共济失调患者的临床资料、诊疗方案和预后。女性8例, 中位年龄55岁, 主要表现为行走不稳(10/10), 头晕(8/10), 复视(6/10), 构音障碍(5/10)。4例患者合并其他自身免疫性疾病, 包括白癜风(3/4)、桥本甲状腺炎(1/4)、血小板减低症(1/4), 1例患者合并小细胞肺癌。所有患者均接受免疫治疗, 6例临床症状改善, 5例功能预后良好。抗GAD抗体相关小脑共济失调可合并其他自身免疫性疾病, 仅少数患者合并肿瘤。半数以上患者对免疫治疗有效, 功能预后良好。     

Wallenberg综合征12例临床分析

目的：探讨Wallenberg综合征的病因、临床特点及预后。方法：对12例Wallenberg综合征患者的临床资料进行分析。结果：12例患者均为梗死所致，以眩晕、恶心、呕吐起病者多，延髓麻痹和感觉障碍为主要表现，头部MRI阳性率100％，经治疗眩晕、恶心、呕吐、声音嘶哑及吞咽困难恢复较快，感觉障碍恢复最慢。4例基本痊愈，3例显著进步，1例无变化，2例病情恶化，2例病后3d～7d因颅压高、上消化道出血、心跳骤停而死亡。结论：动脉粥样硬化致椎基底动脉血栓形成是Wallenberg综合征的主要病因但不是唯一原因。本病并发症多，致残率高，预后差，应及早严格识别。     

延髓背外侧综合征15例临床分析

目的 讨论延髓背外侧综合征的临床特点和诊断标准及误诊原因和预后.方法 对15例延髓背外侧综合征患者的临床、影像学检查、治疗及预后进行分析.结果 本组好转痊愈9例,4例分别遗留轻度Horner征和交叉性感觉障碍,2例遗留吞咽困难需鼻饲流食.结论 延髓背外侧综合征床以眩晕恶心呕吐、吞咽困难、感觉障碍、同侧肢体共济失调、水平眼震、Horner征为主要临床表现,偶见呃逆、对侧锥体束征等症状,磁共振成像为本病确诊有效手段.该病大多预后较好.     

Wallenberg综合征磁共振诊断及五例误诊原因分析

目的 探讨Wallenberg综合征的临床表现、影像学特点。方法 对11例Wallenberg综合征患者的临床表现、头部CT及MRI特点进行分析，总结5例误诊病例的误诊原因。结果 颅脑CT扫描检查未发现延髓病灶，11例MRI显示延髓长T1，长T2异常信号，临床表现复杂，多以头晕、眩晕或感觉障碍为首发症状。结论 临床特点、MRI是诊断Wallenberg综合征可靠的依据。     

以针刺为主治疗脑梗死所致的延髓背外侧综合征的体会

<正>脑梗死为脑卒中的常见病、多发病,其致残率、致死率及复发率极高,严重危害人类的健康。延髓背外侧综合征(Wallenberg syndrome)为脑梗死所致的一种类型,多表现为眩晕、交叉性的感觉障碍、真性球麻痹及共济失调等一系列的症状,严重影响患者的生活质量。笔者将本科收治的脑梗死致延髓背外侧综合征患者的临床特征及治疗情况分析总结如下。     

针药结合治疗延髓背外侧综合征临床观察

目的：探讨针刺联合中药汤剂治疗延髓背外侧综合征的临床疗效。方法：将符合延髓背外侧综合征诊断标准的5例患者,采用醒脑开窍配合补阳还五汤进行治疗3个月。结果：1例患者共济失调、感觉障碍及吞咽困难症状完全缓解,3例患者仅遗留少许感觉障碍,1例患者仍存在病灶侧的共济失调症状。结论：针药结合治疗延髓背外侧综合征有较好的疗效。     

干燥综合征相关性神经病变的广谱临床表现

作者评估了92例原发性干燥综合征相关性神经病变患者的临床病理学特征(76例女性,16例男性,发病年龄为54.7岁)。大多数(93%)患者都是在神经症状出现后被诊断为干燥综合征。根据主要的神经病变症状,将上述患者分为7种类型神经病变:感觉性共济失调神经病变(n=36)、痛觉神经病变不伴感觉性共济失调(n=18)、多发单一神经病变(n=11)、多发脑神经病变(n=5)、三叉神经病变(n=15)、自主神经病变(n=3)和神经根神经病变(n=4)。多发单一神经病变和多发脑神经病变常见急性或亚急性发病,而其他类型的神经病变常见慢性病情进展。不伴严重运动受累的感觉症状…     

Wallenberg综合征16例

1　临床资料　 Wallenberg综合征 16 (男 12 ,女 4 )例 ;年龄4 2～ 72 (平均 5 9.6 )岁 .既往有高血压病史 8例 ,椎基底动脉供血不足病史 4例 ,冠心病史 5例 . 16例均为急性起病 ,经住院治疗 14例好转出院 ,2例死于中枢性呼吸功能衰竭 .临床表现为眩晕 9例 ,呕吐 7例 ,步态不稳 8例 ,吞咽困难、声音嘶哑、饮水呛咳 6例 ,头痛、复视、呃逆各 2例 ,病变同侧面部痛温觉障碍 2例 ,对侧躯干痛温觉障碍 10例 .同侧肢体共济失调 10例 ,不同程度的同侧软腭麻痹、咽反射减弱或消失 10例 ,同侧 Horner征 10例 .全部病例于病后 2～ 14 d行头颅CT平扫 …     

15例卒中预警综合征的临床分析

目的探讨卒中预警综合征的临床特点、病理生理机制、治疗方案及预后。方法回顾性分析2017年5月至2019年5月收治于朝阳市中心医院神经内科的15例卒中预警综合征患者,分别采集其一般资料(年龄、性别、个人史及既往史)及临床资料(临床症状、影像检查结果、入院时ABCD2评分、发病1周时NIHSS评分、治疗方案、出院时mRS评分)。结果本组15例卒中预警综合征患者年龄45～78岁,男9例,女6例,高血压病6例、糖尿病4例、高脂血症2例、高尿酸血症1例、冠心病1例,吸烟者8例,高同型半胱氨酸血症5例,既往有卒中病史者3例。临床症状表现为构音障碍-手笨拙综合征2例,纯运动性卒中8例,纯感觉性卒中1例,感觉运动性卒中4例。15患者中进展成脑梗死12例,占80%,12例患者在不同部位存在责任病灶,内囊后肢6例,侧脑室旁、半卵圆中心病灶2例,丘脑2例,脑桥2例,3例患者DWI未见异常弥散信号。15例患者的ABCD2评分为(4.20±0.86)分(3～6分),发病1周时NIHSS评分(2.67±1.09)分(0～6分)。本组患者均在不同时间行抗血小板聚集治疗,溶栓3例,扩容3例,抗凝1例。出院时15例患者中3例mRS评分为0分,1～2分4例,3分3例,4分5例。结论卒中预警综合征在治疗方面无明确的指南,需根据患者不同的危险因素、临床症状、影像学表现等多方面结合后选择相应的治疗方案,进行个体化治疗。临床医生需早期发现,尽量减轻患者的神经功能缺损程度,提高其生活质量,改善预后。     

对Wallenberg综合征的CT与MRI特点的探讨

目的探讨Wallenberg综合征的临床、CT与MRI的特点。方法对18例Wallenberg综合征的临床资料及头部CT与MRI检查作回顾性分析。结果18例经头颅CT扫描仅1例显示小脑梗死，余17例未见异常。MRI检查的18例中有2例未见异常，16例可见延髓背外侧梗死，其中9例梗死病变仅限于延髓（其中7例病变仅限于延髓背外侧，2例病变侵及半侧延髓）；6例延髓合并小脑梗死；1例延髓伴桥脑梗死。结论眩晕，交叉性感觉障碍，构音、吞咽困难，同侧Homer征及肢体共济失调是最常见的临床特征，部分病例伴第6、7、8对脑神经或锥体束受累的表现。头颅MRI检查优于CT。但并不是所有Wallenberg综合征MRI检查均有阳性发现。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.