皮质下缺血性血管病患者血清基质金属蛋白酶9水平的检测及其临床意义

目的　探讨皮质下缺血性血管病（SIVD）患者血清基质金属蛋白酶9（MMP-9）的表达水平及临床意义。方法　选取2016年10月—2017年7月安徽医科大学附属省立医院神经内科收治的SIVD患者115例为SIVD组,选取同期于安徽医科大学附属省立医院体检且颅脑磁共振成像（MRI）未见明显异常的69例体检者为对照组。采集一般临床资料,检测总胆固醇、三酰甘油、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）;根据颅脑MRI表现进行脑白质病变（WML）Fazekas评分和腔隙性脑梗死（LI）计数;采用酶联免疫吸附法检测血清MMP-9水平;比较两组间MMP-9水平、脑损伤程度,并分析MMP-9与脑损伤程度的相关性。结果　SIVD组患者高血压、糖尿病所占比例、血清MMP-9水平、Fazekas评分、LI数量均高于对照组（P<0.05）。SIVD组患者血清MMP-9水平与Fazekas评分、LI数量均呈正相关（rs=0.301、0.395,P<0.001）。多因素Logistic回归分析结果显示,高血压〔OR=5.349,95%CI（2.449,11.685）〕、糖尿病〔OR=3.008,95%CI（1.265,7.154）〕、血清MMP-9水平〔OR=1.014,95%CI（1.009,1.019）〕均是SIVD的独立影响因素（P<0.05）。结论　血清MMP-9水平升高可能是SIVD的独立危险因素,且血清MMP-9水平与SIVD的严重程度具有一定的相关性,可能为脑血管疾病的防治提供新的方向。     

脑梗死/短暂性脑缺血发作住院患者二级预防依从性研究及90天随访

目的 了解北京住院脑梗死/短暂性脑缺血发作(TIA)患者对于住院期间及出院90 d二级预防药物及行为修正的依从性现状.方法 调查2006年10月1日至2007年5月1日参加研究医院的符合入组标准的连续住院脑梗死及TIA患者对于肾素-血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)、他汀药物、抗血小板药物治疗的使用率,戒烟、控制体重等行为修正率并随访90 d.结果 入组患者中使用抗血小板及他汀等药物及行为修正率偏低,并且在出院90 d这一比例进一步降低.结论 医生应关注患者有明确循证医学依据的二级预防药物及行为修正的依从性,并采取行之有效的措施提高患者药物治疗及行为修正的依从性.     

神经干细胞和神经生长因子联合移植对大脑中动脉阻塞大鼠的影响

目的 将神经干细胞(NSCs)移植和神经生长因子(NGF)单独及联合应用于大脑中动脉阻塞(MCAo)模型大鼠,观察NGF和NSCs移植对大鼠缺血性脑卒中神经功能恢复的作用及NGF对自体和移植NSCs的影响.方法 体外分离、培养新生大鼠海马NSCs,BrdU标记.实验动物随机分为A组(MCAo组)、B组(MCAo NGF组)、C组(MCAo NSCs组)及D组(MCAo NGF NSCs组),每组16只,移植后进行神经功能损害评分(NSS),用免疫组化行BrdU、槽蛋白检测,分析结果.结果 移植后的2周、4周神经功能评分显示D组显著好于其他3组(P<0.05),B组与C组显著好于A组(P<0.05).B组的槽蛋白及BrdU阳性细胞数最著多于A组(P<0.05),D组的BrdU阳性细胞数显著多于C组(P<0.05).结论 NSCs移植和NGF单独及联合应用对MCAo大鼠的神经功能恢复均有作用,二者联合具有协同作用.NGF对自体NSCs的激活、增殖有促进作用,对移植NSCs的增殖有促进作用.     

疏血通注射液对高卒中风险短暂性脑缺血发作患者纤溶系统及预后的影响

目的探讨疏血通注射液对高卒中风险的短暂性脑缺血发作（transient ischemic attack,TIA）患者凝血-纤溶系统及短期预后的影响。方法 70例ABCD2评分6分～7分TIA患者随机分为两组。所有患者均接受标准的综合治疗,治疗组加用疏血通注射液。所有患者诊断后24h内行凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、纤维蛋白原（Fg）、D-二聚体（DD）及组织型纤溶酶原激活物（t-PA）和纤溶酶原激活物抑制剂（PAI）浓度测定,在入院后3d、5d、7d、10d重复测定上述指标。随访时间为3个月。主要转归指标为急性脑梗死和死亡。结果两组患者基线均存在t-PA下降及Fg、PAI水平增高。治疗组患者Fg水平于第5天下降,PAI浓度于第7天下降;对照组观察期内Fg、PAI浓度无显著差异。治疗组短期转归明显优于对照组（P〈0.05）。结论疏血通注射液治疗能有效降低Fg和PAI水平,改善高卒中风险的TIA患者近期转归。     

Management Options for Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is associated with diverse pathophysiologic mechanisms. These mechanisms include increased abnormal colonic motility or transit, intestinal or colorectal sensation, increased colonic bile acid concentration, and superficial colonic mucosal inflammation, as well as epithelial barrier dysfunction, neurohormonal up-regulation, and activation of secretory processes in the epithelial layer. Novel approaches to treatment include lifestyle modification, changes in diet, probiotics, and pharmacotherapy directed to the motility, sensation, and intraluminal milieu of patients with IBS. Despite recent advances, there is a need for development of new treatments to relieve pain in IBS without deleterious central or other adverse effects.     

不同类型急性缺血性脑血管病患者脑微出血的对比研究

目的:探讨不同类型急性缺血性脑血管病患者脑微出血(CMBs)的发生率及严重程度。方法:收集急性缺血性脑血管病患者852例,其中短暂性脑缺血发作(TIA)46例,急性脑梗死806例[根据TOAST分型标准分为动脉粥样硬化性血栓形成(A组)484例,心源性脑栓塞(B组)92例,小动脉性脑梗死(C组)166例,不明原因脑梗死(D组)64例)]。另选择同期健康体检者102例作为对照。比较各组CMBs发生率、严重程度及比较初发、复发患者的发生率。结果:与对照组比较,A组、C组的年龄及高血压病史、糖尿病史、吸烟史、脑白质病患者的比例明显增高(P<0.05);B组糖尿病史患者的比例明显高于对照组(P<0.05);TIA组的年龄明显高于对照组(P<0.05)。急性脑梗死患者4个分组CMBs发生率明显高于对照组(P<0.05);A组CMBs分布在Ⅱ、Ⅲ、Ⅳ级的比例接近,B组集中分布于Ⅱ级,C组Ⅳ级多见,D组及TIA组以Ⅱ级多见。初发急性梗死患者的CMBs发生率明显低于复发患者(P<0.05)。A组、C组初发急性梗死患者CMBs发生率明显低于复发患者(P<0.05)。结论:不同类型的急性脑缺血性脑血管病患者的CMBs发生率及严重程度差异较大,另外在初发、复发型脑梗死患者中的CMBs发生率也不尽相同,这可能与CMBs不同的影响因素差别大有关。     

Spontaneous regression of congenital leukaemia with an 8;16 translocation

Congenital leukaemia (CL) is a rare disorder that presents with extramedullary infiltrates and a myeloid phenotype. CL can progress rapidly without adequate treatment, but, paradoxically, may also remit spontaneously. Because of the significant toxicity involved in delivering chemotherapy to newborns, it is important to identify those newborns who may not require treatment. We describe an infant who presented at 1 week of age with congenital myeloid leukaemia. Cytogenetic analysis revealed a t(8;16)(q11;p13) translocation. The infant's leukaemia underwent a spontaneous regression. This case further confirms the possibility of spontaneous remission in congenital leukaemia. Moreover, it suggests that the presence of a clonal cytogenetic aberration does not preclude the possibility of a spontaneous regression in CL.     

Hemochromatosis: pathophysiology,evaluation, and management of hepatic iron overload with a focus on MRI

Introduction: Hereditary hemochromatosis (HH) is an autosomal recessive disorder that occurs in approximately 1 in 200–250 individuals. Mutations in the HFE gene lead to excess iron absorption. Excess iron in the form of non-transferrin-bound iron (NTBI) causes injury and is readily uptaken by cardiomyocytes, pancreatic islet cells, and hepatocytes. Symptoms greatly vary among patients and include fatigue, abdominal pain, arthralgias, impotence, decreased libido, diabetes, and heart failure. Untreated hemochromatosis can lead to chronic liver disease, fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Many invasive and noninvasive diagnostic tests are available to aid in diagnosis and treatment. MRI has emerged as the reference standard imaging modality for the detection and quantification of hepatic iron deposition, as ultrasound (US) is unable to detect iron overload and computed tomography (CT) findings are nonspecific and influenced by multiple confounding variables. If caught and treated early, HH disease progression can significantly be altered.

Area covered: The data on Hemochromatosis, iron overload, and MRI were gathered by searching PubMed.

Expert commentary: MRI is a great tool for diagnosis and management of iron overload. It is safe, effective, and a standard protocol should be included in diagnostic algorithms of future treatment guidelines.