亚低温联合依达拉奉治疗脑出血93例临床观察

目的 观察亚低温联合依达拉奉治疗脑出血的临床治疗效果.方法 收集2005-2009年的脑出血患者93例,随机分为亚低温联合依达拉奉治疗组47例,对照组(常规治疗组)46例;治疗组在入院后常规治疗基础上予以冰帽局部亚低温治疗7 d,同时静滴依达拉奉30 mg/d,qd,连续14 d;于入院时、发病21 d行头CT检查,计算血肿体积、水肿体积;于入院时和21 d进行神经功能评分并进行疗效分析.结果 在治疗前2组患者的血肿及水肿体积差异无统计学意义(P>0.05),而在治疗21 d后,联合治疗组的血肿体积(11.32±7.56)ml较对照组的(15.01±3.95)ml有所减少,但差异无统计学意义(P>0.05),水肿体积在治疗后(15.33±12.65)ml则较对照组(21.64±13.71)ml明显降低;治疗组的有效率为89.36%,较对照组的69.57%明显提高.结论 亚低温联合依达拉奉治疗脑出血可获得较好的疗效,适于基层广泛应用.     

亚低温联合依达拉奉治疗急性脑出血患者临床疗效观察

目的 观察依达拉奉联合亚低温治疗急性脑出血的近期疗效.方法 54例急性脑出血随机分成2组,对照组26例采用依达拉奉30mg静滴,2次/d,疗程14d.亚低温组28例采用依达拉奉治疗的同时给予亚低温治疗72h,治疗14d后评定疗效.结果 观察组和对照组的有效率分别是82.1%和73.1%,对照组与观察组比较差异有统计学意义(P<0.05);治疗3d、7d、14d分别进行NIHSS评分,发现3d和7d无明显差异(P>0.05),14d亚低温组明显低于常规治疗组(P<0.05).结论 依达拉奉联合脑亚低温治疗急性脑出血是一种更有效的治疗方法 ,值得推广.     

依达拉奉对急性脑出血患者脑水肿及自由基的影响

目的观察依达拉奉对急性脑出血患者脑水肿及自由基的影响。方法 72例急性脑出血患者随机分为对照组和观察组,对照组采用常规对症治疗,观察组加用依达拉奉治疗。观察治疗前后脑水肿面积、神经功能及自由基改善情况。结果 2组治疗后脑水肿面积显著小于治疗前,观察组治疗后脑水肿面积显著小于对照组(P0.05)。观察组治疗后神经功能缺损评分、GCS评分及APACHE?Ⅱ评分显著优于对照组(P0.05)。观察组治疗后7dNO、LPO水平显著低于对照组,SOD、GSHPX水平显著高于对照组(P0.05)。结论依达拉奉治疗急性脑出血可显著缩小脑水肿面积,促进神经功能恢复。     

大鼠实验性脑出血后脑水肿与MMP-9表达的关系及依达拉奉干预效应的研究

目的 探讨脑出血后脑水肿和MMP-9表达的动态变化及依达拉奉的干预效应.方法 采用立体定向技术制作大鼠脑出血模型,干湿重法测量脑组织含水量和免疫组化法测定脑组织MMP-9的表达.结果 与假手术组比较,脑出血12h时脑组织含水量明显增加(P＜0.05), 72h时达到高峰,随后逐渐下降, 7d时仍高于假手术组(P＜0.05).出血组大鼠脑含水量与血肿周围MMP-9阳性细胞数呈正相关(r=0.846, P=0.034),且差异有统计学意义.(3)治疗组脑含水量和MMP-9阳性细胞数与假手术组比较差异有统计学意义,与出血组比较差异亦有统计学意义(P＜0.05).结论 MMP-9参与了脑出血后脑水肿的形成,依达拉奉对脑水肿有抑制作用.     

依达拉奉治疗急性脑出血疗效观察

目的 观察依达拉奉注射液对急性脑出血的临床疗效.方法 将170例急性脑出血患者随机分为治疗组和对照组,治疗组在常规治疗的基础上,给予依达拉奉注射液30 mg加生理盐水100 mL静滴,30 min内滴完,2次/d,2周为1个疗程.观察14 d时2组脑血肿、脑水肿的变化、疗效评定、神经功能缺损程度（CSS）及日常生活活动量（ADL）评分,并进行统计学分析.结果 2周后治疗组与对照组相比脑血肿和脑水肿体积比较差异均有统计学意义（P＜0.05）;治疗组显效率和有效率分别为50.0%和87.5%,高于对照组的22.6%和61.3%（P＜0.05）;治疗组与对照组在治疗14 d的CSS及ADL评分差异有显著统计学意义（P＜0.01）.结论 依达拉奉能促进血肿吸收,抑制水肿形成,可明显促进脑出血患者神经功能康复,临床应用安全有效.     

依达拉奉治疗脑出血的疗效观察

目的观察依达拉奉治疗脑出血的疗效。方法122例脑出血患者随机分为依达拉奉组(61例)和常规治疗组(61例),两组均予常规治疗,在此基础上,依达拉奉组给予依达拉奉30 mg加入生理盐水100 ml静脉滴注,每日2次,共14 d。分别于治疗前、治疗后3 d、7 d、14 d检测血清S-100β蛋白(S-100β)、神经元特异性烯醇化酶(NSE)浓度;治疗前、治疗后7 d、14 d、28 d进行神经功能缺损程度评分(NDS);治疗前、治疗后7 d、21 d行头部CT检查,计算血肿和水肿体积;治疗后28 d和90 d进行疗效及Barthel指数(BI)的评价。结果与治疗前相比,治疗后各时间点两组血清S-100β及NSE水平、NDS、血肿及水肿体积较治疗前显著改善(均P<0.01);依达拉奉组较常规治疗组改善更明显(均P<0.01);依达拉奉组总有效率(86.89%)和显效率(21.34%)显著优于常规治疗组(63.93%,9.84%)(均P<0.01)。结论依达拉奉通过减少神经细胞损伤促进神经功能的恢复,治疗脑出血具有较好的近期和远期疗效。     

依达拉奉联合吡拉西坦治疗急性脑出血的疗效观察

目的 观察依达拉奉联合吡拉西坦治疗急性脑出血的临床疗效.方法 96例脑出血患者随机分为治疗组和对照组各48例,对照组常规治疗,治疗组在常规治疗基础上加用依达拉奉针联合吡拉西坦静滴.观察2组治疗前后神经功能、颅内血肿大小变化.结果 经过统计学处理,治疗组的神经功能恢复、血肿吸收均显著优于对照组（P〈0.05）,差异有统计学意义.结论 依达拉奉联合吡拉西坦能促进脑血肿吸收,具有明显的神经保护作用,治疗早期脑出血安全可靠、疗效显著.     

依达拉奉对急性脑出血患者ICAM-1和MMP-9的影响作用

目的 观察依达拉奉对急性脑出血患者血清细胞间黏附分子-1(ICAM-1)和基质金属蛋白酶-9(MMP-9)表达的影响.方法 将56例急性脑出血内科治疗患者随机分为常规治疗组26例和依达拉奉治疗组30例,统计两组患者治疗前和治疗后3、7、14 d血清ICAM-1、MMP-9含量,并对脑出血患者在相应时间检查头部CT,计算脑水肿大小,对结果进行分析.结果 治疗后3、7d,依达拉奉组患者血清ICAM-1、MMP-9含量显著低于常规治疗组(P<0.05);治疗后14d两组患者血清ICAM-1、MMP-9含量下降到大致相同水平(P>0.05).治疗后3,7、14d,依达拉奉组脑水肿体积小于常规治疗组(P<0.05).结论 依达拉奉可显著降低急性脑出血患者ICAM-1和MMP-9的表达,减轻脑血肿周围脑组织炎症反应和继发性脑组织损伤,改善神经功能缺损,对脑出血患者起到保护作用.     

依达拉奉治疗急性高血压脑出血30例疗效观察

目的 观察依达拉奉治疗高血压脑出血的疗效.方法 高血压脑出血患者60例,随机分为2组,依达拉奉治疗组(30例),在常规治疗基础上加用依达拉奉30 mg加入生理盐水100 ml静滴,2次/d,连用14 d;对照组(30例)常规治疗加生理盐水100 ml静滴,2次/d,连用14 d,2组均在治疗前及治疗后2周、4周进行神经功能缺损评分(ESS)和日常生活活动量表评分(ADL).结果 治疗组ESS及ADL评分均显著高于对照组(P<0.01).结论 依达拉奉治疗脑出血安全、有效.     

依达拉奉联合舒血宁注射液在脑出血急性期应用的临床研究

目的探讨依达拉奉联合舒血宁治疗原发性急性脑出血(ICH)的临床疗效。方法将100例ICH患者随机分为两组,常规治疗组50例,治疗组50例,在常规治疗的基础上加用依达拉奉和舒血宁静脉滴注称为治疗组,疗程均为14 d。两组分别于治疗前及治疗后14d进行CT检查及神经功能缺损评分,比较两组神经功能缺损恢复程度、血肿体积及血肿周围水肿面积。结果与常规组相比,治疗组较常规组血肿体积明显缩小(P<0.01);血肿周围低密度区明显缩小(P<0.01);神经功能缺损评分明显改善(P<0.05);血小板计数和凝血功能无明显差异(P>0.05)。结论依达拉奉联合舒血宁治疗能促进ICH的血肿吸收、血肿周围水肿带的缩小及神经功能缺失改善。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

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     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of Legislation of 1933 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -