骨髓增殖性肿瘤与缺血性卒中

【摘要】 骨髓增殖性肿瘤常出现血管并发症，最常累及脑血管，以缺血性卒中最为常见。骨髓增殖性肿瘤作为缺血性卒中的病因之一，其诊断与治疗不同于其他病因所致卒中。白细胞增多、JAK2V617F基因突变等相继被发现与缺血性卒中相关。本文对骨髓增殖性肿瘤伴缺血性卒中的发生、机制及防治的新进展进行综述。     

护理干预对新生儿缺血缺氧性脑病的临床效果

目的探讨护理干预对新生儿缺血缺氧性脑病（HIE）的临床效果。方法选择100例HIE患儿随机分为两组，其中对照组48例给予常规基础护理，观察组52例在常规护理的基础上增加综合护理干预。记录两组治疗前后的SOD活性和MDA水平变化，并比较两组的临床疗效。结果全部患儿治疗后MDA水平与SOD活性与治疗前比较，P〈0．05；观察组l】盏床总有效率明显优于对照组（P〈0．05）。结论新生儿缺血缺氧性脑病病情复杂，对其进行针对性的综合护理干预可以提高临床治疗效果。     

Risk prediction of cerebrovascular events with carotid plaque magnetic resonance analysis: A meta-analysis

Background and purpose

It is not conclusive that magnetic resonance (MR)-based carotid atherosclerotic plaque assessment identifies high-risk features associated with cerebrovascular events. We aimed to systematically summarize the association of MR imaging (MRI)-determined intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), and thinning/rupture of the fibrous cap (TRFC) with subsequent ischemic events.

Carotid webs and ischemic stroke: Experiences in a comprehensive stroke center

Background and purpose

Carotid webs are intraluminal filling defects at the carotid bulb which are considered rare, though possibly underappreciated entities with recent studies demonstrating a likely casual association with ischemic stroke. The purpose of the study is to describe our recent experience with clinical and imaging manifestations of carotid webs.

中风病急性期痰热证与MMP-1和MMP-3表达的影响＊

目的 研究缺血性中风病急性期痰热证与MMP-1和MMP-3表达的相关性，其相关性研究能否形成微观辨证的依据。方法 筛选发病7天内就诊于中国中医科学院西苑医院的缺血性中风痰热证患者45名，非痰热证44名，对每例患者分别作出痰湿证、气虚证、血瘀证、内风证、阴虚证和内火证的量化诊断，并用ELISA法检测血清中MMP1和MMP-3的含量。结果 痰热证组和非痰热证组MMP-1和MMP-3的表达均无明显差异。结论 MMP-1和MMP-3不能作为痰热证的微观指标，需进一步寻找微观指标对中风病痰热证证候诊断及疗效评价提供更加客观支持。     

血清神经元特异性烯醇化酶在缺血性脑卒中患者中的变化及意义

目的通过观察缺血性脑卒患者中血清神经元特异性烯醇化酶(NSE)的动态变化情况,探讨其对患者临床病情监测和预后评估的意义。方法选择2012年3月至2013年6月期间在我院住院治疗的缺血性脑卒患者65例为研究组,并选择同期在我院接受体检的健康者50例为对照组。采用酶联免疫吸附法测定两组患者血清神经元特异性烯醇化酶的动态变化水平。并分析患者血清NSE水平与患者脑损伤程度和预后的关系。结果研究组与对照组入院24h内血清NSE平均水平相比差异显著(t=7.29,P=0.001)。随后在2d、5d和第7d研究组患者血清NSE水平均显著高于对照组,并较24h时亦显著升高(t=21.81,18.56,9.13;P=0.000,0.000.0.001)。入院第2d,脑损伤病情中型重型组患者血清NSE水平与病情轻型组患者比较显著偏高(t=4.06,t=8.58,P=0.002,0.005)。预后不良组患者各时间血清NSE水平检测值均显著高于预后良好组(t=6.46,5.17,6.43,3.83,7.34;P0.05)。结论临床上可以将血清NSE的表达水平作为判断缺血性脑卒患者早期诊断的有力依据和评价预后的重要指标。     

Supporting families in their child's journey with neonatal encephalopathy and therapeutic hypothermia

Neonates and families face challenges in hypothermic therapy, including trauma to parents, extreme emotions, and unfamiliarity with the medical system. Communication is an essential element to supporting parents while their children are in the NICU, and beyond, building the foundation for the ongoing relationship the family has with the medical system. Significant consideration needs to be given to the critical element of integrating the family into the care of a baby being treated with therapeutic hypothermia. Clinicians can promote healing of accumulated traumas of parents through ensuring parent's emotional safety, facilitating a trusting relationship, and promoting parent empowerment. Connecting parents with resources, especially peer support, is an essential part of a hospital stay. In this chapter, we explore best practices to support families during and after hypothermic therapy.     

Intrapartum fetal surveillance: a physiological approach

Continuous utero-placental circulation, and patent umbilical blood vessels ensure an uninterrupted transfer of oxygen and nutrients to the fetus as well as clearance of metabolic waste products. The onset of labour characterized by progressive and strong uterine contractions poses a threat to fetal oxygenation as a result of collapsing the spiral arterioles traversing the myometrium to supply the placental bed, and repetitive compression of the blood vessels within the umbilical cord. Human fetuses are equipped with compensatory mechanisms to cope with transient interruptions of blood supply during labour. The ability to compensate may be blunted in cases of poor fetal reserves, increased metabolic demand (macrosomia or maternal fever), and due to non-hypoxic pathways (e.g. chorioamniontis or fetal hypovolumia-hypotension syndrome). Intrapartum fetal surveillance involves prompt recognition of the features that signal the onset of fetal decompensation on the cardiotocograph (CTG) to ensure a timely intervention to avoid hypoxic-ischaemic encephalopathy (HIE) or perinatal deaths. This article summarises a ‘physiological approach’ to the interpretation of the CTG which, in places, conflicts with other current UK guidance.     

应用计算机流体力学技术评估症状性颅内动脉狭窄患者卒中复发风险的研究

目的 评估基于计算机流体力学（computational fluid dynamics，CFD）技术的无创血流动力学参数与缺血性卒中复发之间的关系。      

Ischemic stroke in Morocco: Prehospital delay and associated factors

ObjectivesThis study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco.Patients and methodsAn observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department.ResultsA total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6 hours (IQR, 4–16). Multiple regression analysis showed that illiteracy (OR 38.58; CI_95%: 3.40–437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI_95%: 1.57–80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI_95%: 0.01–0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI_95%: 0.00–0.36), and direct admission without reference (OR 0.005; CI_95%: 0.00–0.07), were independently associated with late arrival (> 4.5 hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI_95%: 4.37–138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI_95%: 0.03–0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI_95%: 0.00–0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI_95%: 0.03–0.80), distance between 50 and 100 km (OR 10.16; CI_95%: 1.16–89.33), and direct admission without reference (OR 0.03; CI_95%: 0.00–0.14), were independently associated with late arrival (> 6 hours) of patients with acute ischemic stroke.ConclusionPatient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.