羟乙基淀粉联合奥扎格雷钠治疗急性分水岭脑梗死的疗效

目的观察羟乙基淀粉联合奥扎格雷钠治疗急性分水岭脑梗死的疗效。方法87例急性分水岭脑梗死患者随机分为治疗组46例,对照组41例。治疗组用羟乙基淀粉联合奥扎格雷钠治疗,对照组用奥扎格雷钠治疗。治疗前及治疗后14d神经功能缺损程度评分并判断疗效。结果治疗后14d两组患者神经功能缺损评分较治疗前均有改善（均P〈0.01）,治疗组神经功能缺损评分明显低于对照组（P〈0.01）;治疗组患者神经功能缺损评分减少值明显高于对照组（P〈0.01）。两组均无明显不良反应。结论羟乙基淀粉联合奥扎格雷钠治疗急性分水岭脑梗死疗效显著,安全有效。     

双功能彩超和经颅多普勒超声对分水岭脑梗死发病机制的分析

目的 分析脑梗死患者的双功能彩超(CDI)和经颅多普勒(TCD)表现,探讨其对分水岭脑梗死(CWI)的诊断价值.方法 回顾性分析经MRI诊断的142例CWI患者(研究组)和150例其他类型脑梗死(对照组)患者的CDI和TCD结果,对比两组患者血管狭窄情况、斑块检出率、斑块性质、斑块积分、发病前低血容量诱因情况、交通支的开放情况,分析CWI的发病机制.结果 研究组142例,血管重度狭窄或闭塞72例,中度狭窄21例,轻度狭窄31例,无狭窄18例;对照组150例,其中重度狭窄或闭塞19例,中度狭窄41例,轻度狭窄23例,无狭窄67例,两组比较差异有统计学意义(x2=66.583,P=0.000).研究组检出斑块115例(80.99％),对照组74例(49.33％),两组斑块检出率比较差异有统计学意义(x2=32.010,P=0.000).研究组斑块积分为(11.47 ±3.78)分,对照组为(6.57 ±3.53)分,组间比较差异有统计学意义(t=4.019,P=0.001).研究组78例(54.93％)发病前有明确低血容量病因,与对照组[11.33％ (17/150)]比较差异有统计学意义(x2 =63.164,P=0.000).研究组有交通支开放共50例(35.31％),与对照组[25.33％ (38/150)]比较差异无统计学意义(x2 =3.381,P=0.066).结论 血管狭窄、不稳定粥样硬化斑块形成的微栓子、低血容量造成的脑局部低灌注均是CWI的发病机制.CDI和TCD联合应用可为临床血管评价及治疗提供很大帮助.     

舌下络脉诊断中舌背区域自动撷取算法的研究

舌背区域自动撷取算法是为了获得舌下络脉特征所在的焦点区域,对于舌下络脉诊断自动的实现具有重要意义。采用基于形态学标记的水域分割算法大致确定了舌背所在区域,藉由分析舌背和剩余的背景彩色分量的差异性进行后处理。实验结果表明,该算法所撷取的舌背区域效果良好,健壮性好。此结果为实现后续舌下络脉特征分析奠定了基础。     

烟雾病导致皮质型分水岭梗死的低场MRI特征分析

目的分析烟雾病导致皮质型分水岭脑梗死(CWI)的低场磁共振成像(MRI)表现特征,探讨侧支循环异常和皮质型CWI的关系。方法搜集11例经MRI及临床证实为烟雾病导致皮质型分水岭梗死的MRI资料。采用西门子concerto型0.2T磁共振,常规梯度回波T1WI(GRE-T1WI)、T2WI液体衰减反转恢复序列(FLAIR)和增强GRE-T1WI、后文(TOF-MRA)检查(11例)以及增强FLAIR检查(4例),分析其影像特征。结果缺血病变位于皮层分水岭区及基底神经节区,包括皮质前型CWI(8例)和皮质后型CWI(6例),及基底节区皮质型CWI(2例)。MRI平扫显示分水岭区皮质萎缩(3例),分水岭区皮质水肿(8例),及基底神经节区水肿(2例)。FLAIR显示基底节区病变周围深穿支血管高信号征(2例)。增强FLAIR显示病变区柔脑膜增厚强化(4例)。增强T1WI显示病变区皮层强化(2例)。结论 皮质型分水岭脑梗死的MRI表现特征和侧支循环重建机制有关。微循环障碍及血流动力学障碍和皮质型分水岭梗死密切相关。皮质型分水岭脑梗死的MRI特征性表现对烟雾病的诊断具有重要意义。     

An evaluation of methods for the isolation of Yersinia enterocolitica from surface waters in the Grand River watershed

Yersinia enterocolitica is a foodborne pathogen, but the importance of water as a route of exposure for human infection is not well known. Y. enterocolitica isolation methods were developed primarily for food and clinical samples, and may not be effective for use with environmental samples. The objective of this study was to assess the recovery of Y. enterocolitica from surface water used for drinking water treatment. Four enrichment broths and an alkaline treatment protocol were compared for the isolation of Y. enterocolitica bioserogroup 4/O:3 spiked into surface water samples. Results showed that the methods tested were not effective for the recovery of Y. enterocolitica, primarily due to inadequate inhibition of interfering background microorganisms. Using one method that showed the most potential for recovery, Yersinia spp. were isolated from rivers in southwestern Ontario, Canada, over a 17-month period. Of 200 samples analysed, Yersinia spp. were isolated from 52 samples. All river isolates belonged to non-pathogenic sub-groups, including Y. enterocolitica biotype 1A, Y. aldovae, Y. bercovieri, Y. frederiksenii, Y. intermedia, Y. kristensenii and Y. mollaretii. Results of this study show that method improvements are required to more fully understand the role of water as a source of clinically important Yersinia strains.     

脑分水岭梗塞80例临床分析

目的 探讨脑分水岭梗塞(CWI)的病因、类型及临床特点。方法 分析80例经头颅CT证实的幕上CWI患者的临床及影深学资料。结果 CWI的病因为体循环低血压、脑的大动脉狭窄或闭塞、心脏疾患、血流变学异常等。皮层前型28例(33％)。在大脑前动脉与大脑中动脉皮层支的边缘带,呈楔形,临床表现为偏瘫、偏身感觉障碍、经皮层运动性失语等;皮层后型32例(40％),在大脑中动脉与大脑后动脉皮层支边缘带,表现为视野缺损、经皮层感觉性失语、皮层型感觉障碍、轻瘫等;皮层下型20例(25％),在大脑中动脉皮层支与深穿支边缘带,表现为偏瘫、偏身感觉障碍,优势半球病变可有言语障碍等。结论 CWI的主要病因为体循环低血压、颈动脉狭窄或闭塞及心脏疾患,多数预后良好。     

脑分水岭梗死急性期血压与预后相关性研究

目的 探究脑分水岭梗死 （cerebral watershed infarction, CWI） 患者急性期血压与病情转归的关系。 方法 连续纳入发病48 h内入院的脑分水岭梗死患者。 对入选患者进行血压监测, 记录入院后前 3 d血压, 收集患者基本资料、 卒中危险因素及辅助检查结果。 出院3个月时随访评估改良的Rankin量表 （modified Rankin scale, mRs） 作为预后评价。 结果 本研究总共纳入脑分水岭梗死患者110例, 完成随访106例。 收缩压以间距10 mmHg分组后分 析显示脑分水岭梗死患者急性期收缩压与预后呈U型曲线关系。 收缩压最适水平在150～160 mmHg。 在调整其他预后相关因素后, 多因素logistic分析显示, 当收缩压＜150 mmHg时, 收缩压每降低10 mmHg, 预后不良的危险率增加73.3%[比值比 （odds ratio, OR ） 1.733, 95%可信区间 （confidence interval, CI ） 1.073～2.799, P =0.024]; 当收缩压≥160 mmHg时, 收缩压与预后无明显相关。 结论 脑分水岭梗死急性期血压偏低提示预后不良, 收缩压150～160 mmHg可能为最适血压。     

A new sulcus-corrected approach for assessing cerebellar volume in spinocerebellar ataxia

Precise volumetry of the cerebellum still remains challenging, due to thin sulci and gyri. We present a new fast and reliable sulcus-corrected approach for quantitative assessment of cerebellar atrophy, evaluated on patients with spinocerebellar ataxia (SCA). Thin-sliced T1-weighted magnetic resonance images (MPRAGE) were acquired in 11 genetically confirmed SCA6 patients and in a group of age-matched control subjects (n = 14). Post-processing involves a morphological image segmentation pipeline as a basis for a sulcus-corrected cerebellar volume measurement. Cerebellar volumes and intra-rater, inter-rater and scan-rescan reproducibility were quantified. Reliability of the measurements was validated using an anatomical preparation of the cerebellum. Repeatability coefficients (RC: intra-rater/inter-rater/scan-rescan) of the method were 1.07%/1.11%/1.35%. Absolute cerebellar volumes showed good agreement with the actual volume of the anatomical preparation. The cerebellar volume of the SCA 6 was 96.3 ± 12.1 ml (mean ± S.D.), which was significantly lower than the results of the corresponding control groups. The cerebellar volume correlated significantly to clinical dysfunction in SCA6. This is the first study to demonstrate the feasibility of a new sulcus-corrected approach to assess cerebellar volume. In contrast to currently used methods, this new approach may be more sensitive even to small atrophic changes affecting sulcal widening.     

生津益气颗粒联合阿托伐他汀钙治疗分水岭脑梗死的临床疗效观察

目的观察生津益气颗粒联合阿托伐他汀钙治疗分水岭脑梗死的临床疗效及安全性。方法选取宁晋县医院2010年12月-2013年5月收治的分水岭脑梗死患者90例,随机分为治疗组（45例）和对照组（45例）。对照组患者入院后卧床休息,相继完善各项相关检查,给予对症支持治疗。治疗组口服生津益气颗粒,10g加入温开水250mL,2次／d;并于每天18：00点左右口服阿托伐他汀钙,10-20mg／次,1次／d,其他同对照组,两组均治疗28d。治疗前后使用NIHSS评分比较两组神经功能障碍程度,ADL评分评价日常生活活动能力,统计两组临床治疗的总有效率,同时观察两组患者的不良反应。结果两组治疗28d后与治疗前比较NIHSS评分均明显降低,差异有统计学意义（P〈0．05）,治疗后,治疗组较对照组降低更明显,两组差异有统计学意义（P〈0．05）;两组治疗后ADL评分较治疗前均明显提高,治疗前后差异有统计学意义（P〈0．05）,且治疗后治疗组高于对照组,差异有统计学意义（P〈0．05）。治疗组与对照组总有效率分别为100．00％、93．33％,两组比较差异有统计学意义（P〈0．05）。两组均无不良反应发生。结论生津益气颗粒联合阿托伐他汀钙对分水岭脑梗死有较好的治疗效果,且无不良反应发生,值得进一步推广。     

Brain magnetic resonance imaging and outcome after hypoxic ischaemic encephalopathy

Objective: To correlate pattern of injury on neonatal brain magnetic resonance imaging (MRI) with outcome in infants ≥36?+?0 weeks gestation with hypoxic ischaemic encephalopathy.

Methods: Prospective cohort study. Images were blindly reviewed. Children were assessed using a variety of standardised assessments.

Results: MRI brain was performed on 88 infants. Follow up was available in 73(83%) infants. Eight of 25(32%) children with normal imaging had below normal assessment scores. Eight infants (12%) had isolated punctate white matter lesions and five of these had abnormal assessment scores. Death and cerebral palsy were seen only in children with imaging scores ≥3 on basal ganglia/thalami (BGT) score or ≥4 on watershed score. No developmental concerns were raised in 3/7(43%) infants with isolated watershed injury. Ten of 13(77%) infants with isolated BGT injury died or developed cerebral palsy. All 23 children with posterior limb of the internal capsule (PLIC) injury displayed developmental difficulties.

Conclusions: Almost one-third of infants with a normal MRI brain may be at risk of developmental problems. Punctate foci of white matter injury are common and not always benign. PLIC involvement is usually associated with neurological sequelae including isolated cognitive deficits. Worst outcomes are associated with basal ganglia injury.