Primary and Secondary Prevention of Ischemic Stroke and Cerebral Hemorrhage: JACC Focus Seminar

Stroke is a leading cause of permanent disability. Therefore, primary prevention of first stroke and secondary prevention of recurrent stroke are a high priority. Primary prevention of ischemic stroke includes lifestyle modification and diet, treatment of risk factors including hypertension, diabetes mellitus and lipid disorders, antiplatelet therapy for high vascular risk patients, and anticoagulation in atrial fibrillation. Secondary prevention of ischemic stroke includes additional carotid surgery or stenting in selected symptomatic patients, closure of patent foramen ovale after cryptogenic stroke, treatment of insulin resistance, and best medical treatment of intracranial stenosis. The most important preventive strategies in the primary and secondary prevention of cerebral hemorrhage include the treatment of hypertension, reduction in alcohol intake, and occlusion of the left atrial appendage in patients with atrial fibrillation and permanent contraindications for oral anticoagulation.     

膜攻击复合物C5b-9在大鼠肝脏缺血再灌注损伤中的表达

目的探讨膜攻击复合物C5b-9在大鼠肝脏缺血再灌注损伤中的表达。方法健康雄性SD大鼠60只,180²00 g,随机分为5组(n=12):假手术组(S组)、全肝再灌组1 h组(I/R1 h组)、3 h组(I/R 3 h组)、6 h组(I/R 6 h组)和24 h组(I/R 24 h组)。制备大鼠全肝缺血再灌注模型,再灌注1、3、6、24 h末,取血测定谷丙转氨酶(ALT)和总胆红素(TBIL)浓度。取肝脏组织,检测C5b-9 mRNA和C5b-9蛋白的表达。结果与对照组比较,I/R各组大鼠ALT和TBIL水平均明显升高,I/R 3 h组达到高峰(P<0.05);I/R各组C5b-9的mRNA表达和C5b-9蛋白含量均有显著升高,且随着缺血再灌注时间的延长而逐渐升高,其中I/R 24 h组最高(P<0.05)。结论补体C5b-9参与肝缺血再灌注的损伤,尤其是在再灌注24 h时达到高峰。     

HPLC法测定蒡芩慢咽滴丸中酯蟾毒配基及华蟾酥毒基的含量

目的:建立用HPLC测定蒡芩慢咽滴丸中蟾酥内酯含量的方法。方法:采用十八烷基键合硅胶色谱柱(250mm×4.6mm,5μm),以乙腈-0.5%磷酸二氢钾溶液(用磷酸调pH值为3.2)(32∶68)为流动相,检测波长为296nm,柱温40℃。结果:酯蟾毒配基及华蟾酥毒基的线性范围分别为0.2～1.0μg(r=0.9997)及0.224～1.12μg(r=0.9996),平均回收率(n=6)分别为99.91%(RSD=0.7960%)和99.84%(RSD=1.0023%)。结论:该方法简单可靠。     

数字减影血管造影分析缺血性脑血管病的责任动脉

目的 分析缺血性脑血管病患者的责任供血动脉狭窄或闭塞的发生特点.方法 回顾性分析304例缺血性脑血管病患者的DSA资料,其中短暂性脑缺血发作(transient ischemic attack,TIA)188例,脑梗死116例,判断责任动脉,测量其狭窄段长度和狭窄程度.结果 在304例患者中,227例(74.7%)可见脑供血动脉狭窄或闭塞,193例(85.0%)可判断责任动脉,其中104例(53.9%)为单纯颅外动脉、70例(36.3%)为单纯颅内动脉、19例(9.8%)为颅内外动脉串联病变.脑梗死组脑供血动脉狭窄或闭塞发生率(97/116,82.9%)显著高于TIA组(130/188,68.8%)(P<0.01).TIA组后循环颅外血管病变发牛率(26/107,24.3%)显著高于脑梗死组(6/86,7.0%)(P<0.01),脑梗死组前循环颅内血管病变发生率(28/86,32.6%)显著高于TIA组(22/107,20.6%)(P<0.01),但IIA组责任动脉狭窄长度和程度与脑梗死组无显著差异.结论 脑梗死组脑供血动脉狭窄或闭塞较IIA组更多见,TIA组以后循环颅外血管病变多见,脑梗死组以前循环颅内血管病变多见,而脑缺血程度与责任动脉狭窄程度和长度无关.     

Neuropsychological evaluation in transient ischaemic attack and minor stroke

Summary Two groups of patients with transient ischaemic attack and minor stroke without detectable haemodynamic stenotic lesions were evaluated by neuropsychological tests and compared with a control group. The mean values of the scores adjusted for age and educational background demonstrated that (a) the patients with transient ischaemic attack did not have a worse performance than normal subjects in any of the tests, (b) the patients with minor stroke had a worse performance than normals, particularly in Rey's figure-copying test (P<0.025), and (c) the latter test was not affected by educational background or age of the subjects. The results are discussed with reference to other case series, and the importance of age and cerebral damage in causing intellectual impairment evaluated by neurophysiological tests is stressed.     

Anterior, Total, and Two-Stage Corpus Callosum Section: Differential and Incremental Seizure Responses

Summary: Published reports suggest that control of generalized seizures is improved by callosotomy but do not necessarily indicate that completion of failed anterior callosotomy is beneficial. We studied 42 patients after anterior callosotomy and 22 after total callosotomy, of whom 14 underwent a two-stage procedure. Cure or marked diminution of seizures was most dramatic for atonic and tonic-clonic seizures after anterior callosotomy (100 and 83%), and for tonic-clonic and tonic seizures after total callosotomy (68 and 57%). For the 14 patients who failed to improve after anterior section and then underwent total section, incremental responses were noted for all seizure types, with cure or marked diminution of partial seizures in 2 of 14 patients, of tonic-clonic seizures in 6 of 10, of tonic seizures in 2 of 4, of atonic seizures in 2 of 5, and of myoclonic seizures in 1 of 1. More than two seizure types, verbal IQ <80, and diffuse ictal EEG patterns were significantly more common in the anterior callosotomy failures. Total callosotomy can be of benefit when anterior callosotomy fails, especially for persistent tonic- clonic and tonic seizures, and will most often be necessary in patients with diffuse cerebral abnormalities.     

中风病急性期综合治疗方案研究与评价--附522例临床研究报告

目的研究中风病急性期综合治疗方案的临床疗效。方法在前期研究基础上,开展了通治、辨治、针灸方案与西医治疗方案的多中心、随机对照研究,建立以辨证论治为特点的综合治疗方案,并进行验证和评价,共观察522例中风病急性期患者。结果缺血性中风综合治疗方案临床疗效优于西医组;通治方案、辨治方案和针灸方案在不同时间点对患者的神经功能、日常生活能力和认知功能都有不同程度的改善作用。结论以辨证论治为核心的综合治疗方案有其自身的优势与特点,对中风病具有积极的综合治疗作用,贴近临床实际,便于推广应用,各种评价量表在中风病不同时点具有不同的评价作用。     

Blood Pressure Changes in Migraine Patients before,during and after Migraine Attacks

Migraine attacks are characterized by headaches associated with neurological, gastrointestinal, and autonomic symptoms. A relationship between migraine and hypertension or hypotension is controversial. In this study, we aimed to determine if blood pressure changes were related to migraine attacks. From the outpatient clinic of our neurology department, 62 normotensive migraine patients with and without aura were chosen for study in accordance with the International Headache Society 2004 criteria. A questionnaire including general and specific questions was given to the patients to be filled out during 6 consequent migraine attacks. The patients received a fully automatic digital brachial upper arm sphygmomanometer (Omron M 4‐1) to measure the changes in their blood pressure during attacks. The patients were asked to record their blood pressure changes 3 times: (1) just before or very early, (2) during (when headache peaks), and (3) 1 hour after the attack. Twenty‐three of the 62 patients (57 women, 5 men) had migraine with aura (22 women and 1 man), and 39 of them did not have aura (35 women and 4 men). There was no statistically significant difference between systolic and diastolic values obtained before or very early, during the peak level, and 1 hour after the end of the attacks (P > 0.05). Although diastolic hypotensive values were not different statistically between groups, when all the patients were considered, diastolic hypotensive values were detected in a considerable number of patients (a total of 115 measurements). In this normotensive migrainous population, we observed that diastolic hypotension before or very early, during, and after migraine attack was the most significant result (5.1%). Although it was not statistically significant, the total number of hypotensive values was remarkable.