急诊绿色通道护理流程优化对急性缺血性脑卒中静脉溶栓的影响

目的 探究急诊绿色通道护理流程优化对提高急性缺血性脑卒中静脉溶栓的效果。方法 此次研究的观察对象为2019年1月至2020年5月期间我院急诊科收治并接受静脉溶栓治疗的80例急性缺血性脑卒中患者,根据急诊流程的不同进行分组,即40例实施常规急诊绿色通道护理的患者作为参照组,而40例实施优化急诊绿色通道护理流程的患者作为研究组。统计两组急诊就诊至应用阿普替酶的时间（DNT）与溶栓前、溶栓后7d美国国立卫生研究院卒中量表（NIHSS）评分、格拉斯哥昏迷评分（GCS）。结果 在DNT时间比较上,研究组显著短于参照组（P<0.05）。两组溶栓后7d,NIHSS评分均低于溶栓前,GCS评分均高于溶栓前,对比发现研究组NIHSS评分低于参照组,GCS评分高于参照组（P<0.05）。结论 急诊绿色通道护理流程优化可缩短急性缺血性脑卒中患者的DNT时间,促进其神经功能缺损与意识障碍程度的显著改善。     

重组组织型纤溶酶原激活剂对急性脑梗死患者溶栓后mRS评分与NIHSS评分的影响

目的探讨mRS评分和NIHSS评分对重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓对急性脑梗死(ACI)的评价价值。方法选取93例拟行溶栓治疗的ACI患者作为研究对象,随机分为对照组(n=45)和研究组(n=48)。对照组患者采用尿激酶溶栓治疗,研究组患者采用rt-PA溶栓治疗,对比两组患者治疗有效率、治疗前后mRS评分、NIHSS评分及并发症发生情况。结果研究组治疗有效率(97.92%)高于对照组(86.67%)(P0.05)。治疗前两组mRS评分对比无统计学差异,治疗后14 d与治疗前比较仍无统计学差异(P0.05);治疗后28 d与治疗前比较有显著性差异(P0.05),且研究组显著低于对照组(P0.05)。治疗前两组患者NIHSS评分未见明显差异,治疗后两组患者NIHSS评分均有所改善(P0.05),研究组治疗后24 h、7 d、14 d均显著低于对照组(P0.05)。研究组并发症发生率(8.33%)显著低于对照组(26.67%),差异均有显著性(χ2=8.437,P0.05)。结论按照溶栓指南进行规范化操作和严格掌握溶栓适应证,发病4.5 h内给ACI患者进行rt-PA静脉溶栓可明显提高临床疗效,改善mRS评分和NIHSS评分。     

急性缺血性脑卒中患者血清微小RNA-590水平变化及意义

目的]探究急性缺血性脑卒中(AIS)患者血清微小RNA-590(miR-590)水平变化及与预后的关系。[方法]选取2019年2月—2020年10月接受静脉溶栓和动脉取栓治疗的176例AIS患者作为研究对象,根据治疗后90天的改良Rankin量表(mRS)评分将其分为预后良好组(n＝123;mRS评分0～2分)、预后不良组(n＝53;mRS评分3～6分)。用实时荧光定量PCR法检测AIS患者血清miR-590水平;用受试者工作特征(ROC)曲线评价miR-590预判AIS预后的价值;用Logistic回归分析AIS预后的风险因素。[结果]预后不良组的年龄、男性占比、糖尿病史占比、空腹血糖(FPG)、总胆固醇(TC)、美国国立卫生研究院卒中量表(NIHSS)评分和入院至溶栓时间(DNT)均高于预后良好组(P＜0.05)。按1∶1进行倾向性评分匹配后,治疗前预后不良组的miR-590相对水平低于预后良好组,预后不良组和预后良好组的治疗后miR-590相对水平均高于治疗前,治疗后预后不良组的miR-590相对水平升高程度高于预后良好组,差异均有统计学意义(P＜0.05)。治疗前miR-590预判AIS预后的ROC曲线下面积为0.793,高于miR-590差值(治疗前和治疗后血清miR-590相对水平的差值)(P＜0.001)。Logistic回归分析结果显示FPG、TC、NIHSS评分和DNT是AIS预后的独立危险因素(P＜0.05),治疗前血清miR-590水平是AIS预后的独立保护因素(P＜0.001)。[结论]AIS患者静脉溶栓和动脉取栓治疗前血清miR-590水平低与AIS预后不良有关。     

后交通动脉类型与急性缺血性脑卒中静脉溶栓早期疗效的相关性

目的探讨后交通动脉(PCoA)类型及开放与否与急性缺血性脑卒中(AIS)患者经重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗后早期疗效的相关性。方法经rt-PA静脉溶栓治疗的AIS患者67例,筛选出43例。CT血管成像(CTA)或头部核磁共振血管显像(MRA)作为评估PCoA是否开放的标准,静脉溶栓后14 d美国国立卫生研究院脑卒中量表(NIHSS)评分作为疗效评价。结果 PCoA开放的AIS患者静脉溶栓治疗后14 d NIHSS评分明显低于未开放者(P0.05)。结论 PCoA开放的AIS患者经rt-PA静脉溶栓治疗较未开放患者早期疗效明显改善。     

急性缺血性脑卒中患者静脉溶栓治疗后预后不良危险因素的研究

目的 探讨急性缺血性脑卒中(AIS)患者应用重组组织型纤维蛋白酶原激活剂(rt-PA)静脉溶栓治疗后预后不良的危险因素.方法 收集接受rt-PA静脉溶栓治疗的AIS患者97例,根据预后将其分为预后良好组(77例)和预后不良组(20例),记录并比较其一般资料、发病至溶栓时间(ONT)、门诊到溶栓开始时间(DNT)、溶栓前...     

不同年龄急性缺血性脑卒中患者应用阿替普酶静脉溶栓治疗的临床疗效及预后比较

目的比较不同年龄急性缺血性脑卒中(AIS)患者应用阿替普酶静脉溶栓治疗的临床疗效及预后。方法选取2015年4月—2017年5月皖南医学院弋矶山医院神经内科收治的AIS患者84例,根据患者年龄分为低龄组44例(≤60岁)和高龄组40例(61~85岁)。两组患者均给予注射用阿替普酶静脉溶栓治疗(0.9 g/kg),治疗1d后口服阿司匹林肠溶片100 mg/d,持续治疗3周。比较两组患者临床疗效、治疗前后美国国立卫生研究院卒中量表(NIHSS)评分及改良Rankin量表(mRS)评分、溶栓治疗相关并发症发生情况。结果低龄组患者临床疗效优于高龄组(P0.01)。治疗前两组患者NIHSS评分、mRS评分比较,差异无统计学意义(P0.05);治疗后低龄组NIHSS评分、mRS评分低于高龄组(P0.05)。高龄组患者溶栓治疗相关并发症发生率高于低龄组(P0.05)。结论与高龄AIS患者相比,阿替普酶静脉溶栓治疗低龄AIS的患者临床疗效较好,对神经功能和预后的改善效果更佳,安全性更高。     

PDCA管理模式在急性缺血性脑卒中静脉溶栓中的应用

目的评估计划-执行-检查-处理(PDCA)管理模式的应用,对提高急性缺血性脑卒中(AIS)患者静脉溶栓率,缩短AIS患者从入院到静脉溶栓治疗时间(DNT)的影响。方法选取金华市中心医院从2016年9月至2018年8月接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓(IVT)治疗的AIS患者381例,其中男222例,女159例,年龄32～92岁,平均(67.8±12.8)岁。根据是否应用PDCA管理模式将患者分为两组,其中应用PDCA管理模式前138例,应用PDCA管理模式后243例。回顾性分析两组患者的临床资料,比较两组患者总溶栓率、时间窗内溶栓率、DNT及DNT≤60 min比例的差异。结果应用PDCA管理模式后,总溶栓率由9.50%提高至14.52%,发病时间窗内溶栓率由54.34%上升至89.71%,中位DNT由原来的75 min缩短至43 min,DNT≤60 min比例由33.33%提高至84.77%。结论应用PDCA管理模式可不断优化AIS静脉溶栓流程,提高AIS患者总溶栓率及时间窗内溶栓率,并显著缩短DNT,改善AIS患者预后。     

高龄急性缺血性脑卒中患者静脉溶栓后出血性转化的危险因素

目的探讨高龄急性缺血性脑卒中(AIS)患者静脉溶栓后出血性转化(HT)的危险因素。方法收集2016年1月至2019年3月海口市第三人民医院急诊科收治的高龄AIS患者326例。根据其静脉溶栓后是否发生HT,分为HT组(51例)和无HT组(275例)。采用SPSS 20.0统计软件进行数据分析。应用单因素分析及多因素logistic回归分析,评价影响高龄AIS患者静脉溶栓后发生HT的危险因素。结果单因素分析显示,HT组的心房颤动、尿蛋白阳性、溶栓后24 h收缩压、血糖、国际标准化比值、溶栓前美国国立卫生研究院卒中量表(NIHSS)评分、溶栓后24 h NIHSS评分及发病至溶栓时间3 h明显高于无HT组,差异有统计学意义(P0.05)。多因素logistic回归分析显示,溶栓后24 h收缩压(OR=1.935,95%CI 1.226～4.162)、血糖(OR=2.240,95%CI 1.638～5.237)、溶栓前NIHSS评分(OR=2.435,95%CI 1.805～5.726)、溶栓后24 h NIHSS评分(OR=3.381,95%CI 2.216～7.250)及发病至溶栓时间3 h(OR=2.703,95%CI 1.914～6.116)是高龄AIS患者静脉溶栓后发生HT的独立危险因素(P0.05)。结论溶栓后24 h收缩压、血糖、溶栓前NIHSS评分、溶栓后24 h NIHSS评分及发病至溶栓时间3 h是高龄AIS患者静脉溶栓后发生HT的独立危险因素,可为临床溶栓治疗提供参考。     

重组组织型纤溶酶原激活剂静脉溶栓治疗急性脑梗死的临床研究

目的:探讨重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗急性脑梗死(ACI)患者的疗效及安全性。方法:将发病在4.5 h内ACI患者139例,且均符合静脉溶栓适应证,按入院顺序分为rt-PA组(61例)和对照组(ACI)(78例),分别给予rt-PA静脉溶栓和奥扎格雷钠治疗。采用NIHSS及mRS评分比较2组患者治疗后24 h、7 d、90 d的疗效及安全性。结果:rt-PA组治疗后7 d,NIHSS评分较对照组改善更显著。rt-PA组90 d mRS评分优于对照组。2组病死率、症状性颅内出血发生率无统计学差异。结论:ACI患者4.5 h内给予rt-PA静脉溶栓,疗效优于奥扎格雷钠,且较为安全。     

应用移动卒中单元对急性缺血性卒中行院前静脉溶栓的疗效分析

目的 对比分析应用移动卒中单元(MSU)行院前静脉溶栓与常规静脉溶栓对急性缺血性卒中(AIS)的治疗效果。方法 回顾性连续纳入曲靖市第一人民医院神经内科2022年2月至2022年12月行静脉溶栓的AIS患者。收集患者的一般资料及临床资料,包括年龄、性别、吸烟史、高血压病、糖尿病、高脂血症、既往卒中史、心房颤动史、发病时间、静脉溶栓时间、基线美国国立卫生研究院卒中量表(NIHSS)评分、静脉溶栓后48 h症状性颅内出血、静脉溶栓后7 d NIHSS评分、静脉溶栓后90 d改良Rankin量表(mRS)评分、静脉溶栓后90 d死亡及静脉溶栓过程中是否发生任何过敏反应或其他系统出血等。应用MSU进行院前静脉溶栓的AIS患者为MSU溶栓组,院内阿替普酶静脉溶栓(普通急救车入院或自行来院)的AIS患者为常规溶栓组。观察终点指标包括时间指标、疗效指标和安全性指标。时间指标为发病至静脉溶栓时间;疗效指标为静脉溶栓后7 d NIHSS评分、90 d mRS评分;安全性指标包括静脉溶栓后48 h症状性颅内出血、静脉溶栓过程中发生任何过敏反应或其他系统出血及静脉溶栓后90 d患者死亡。结果 共纳入151例...     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.