Transient ischemic attack during smoking: The thrombotic state of erythrocytes and platelets illustrated visually

Transient ischemic attack (TIA) is an important predictor of future ischemic events, including stroke. Due to the typically brief period of neurologic dysfunction, patients often overlook the importance of reporting a TIA. We have recently shown that platelet activation plays an important role in TIA pathology. In a similar vein, smoking is associated with a hypercoagulable state and is also one of the important risk factors for stroke. Here we present an interesting case where a 61-year-old male, with hypercholesterolemia, and a previous heart valve replacement, developed a TIA 5 months after he started smoking. Subsequent to the event, Warfarin dosage was monitored monthly using the international normalized ratio (INR). We compared erythrocyte and platelet morphology of healthy individuals, that of smokers, individuals who had a diagnosed TIA (without smoking), and the patient. The erythrocytes from the case study are ultrastructurally similar to that of a smoker, while his platelets are similar to that of smokers and TIA patients who do not smoke. We conclude that smoking exacerbated the chronic inflammation induced by hypercholesterolemia, causing changes in his erythrocyte morphology and platelet activation, and suggest that ultrastructure here explains the clinical manifestations of the thrombotic state of this patient.     

支气管哮喘不同时期证候演变规律的临床调查研究?

目的探讨支气管哮喘急性发作期、慢性持续期、临床缓解期的证候演变规律。方法收集17家三级甲等中医院支气管哮喘患者资料,运用SPSS 18.0统计软件包建立以中医辨证为特征的临床调查研究数据库,并进行频率的统计描述及卡方检验。结果发放表格2 500份,收回表格2 481份,有效2 428份。急性发作期以实证为主,临床表现为外寒内饮证、痰热壅肺证、痰浊阻肺证、风痰阻肺证、血瘀证;慢性持续期以虚实兼杂为主;缓解期以虚证为主,表现为肺气虚证、肺肾气虚证、肺脾气虚证、肺肾气阴两虚证、肺肾阳虚证。结论支气管哮喘中医证候演变有一定的规律性,可为本病的防治提供依据。     

短暂性脑缺血发作患者C反应蛋白和D-二聚体水平变化

目的:探讨短暂性脑缺血发作(TIA)患者C反应蛋白(CRP)和血浆D-二聚体(D-dimer,D-D)水平的变化。方法:99例TIA患者按病程划分为A、B、C三组,所有病例在起病24h内检测血清CRP和D-D的水平,观察72h内头CT或MRI后与正常对照组进行比较,结果进行组间比较。结果:TIA患者血清CRP[A组(11.8±1.4)mg/L,B组(18.4±1.3)mg/L,C组(26.8±1.4)mg/L]和D-D[A组(0.57±0.15)mg/L,B组(1.03±0.19)mg/L,C组(1.38±0.22)mg/L]的水平明显高于正常对照组[CRP(5.0±1.2)mg/L,D-D(0.26±0.11)mg/L](P<0.01),B、C组CRP和D-D的水平均高于A组(P<0.01),而B、C两组之间比较差异也有显著性(P<0.05),TIA各组CRP和D-D水平之间的相关性分析显示CRP与D-D水平均呈显著正相关A组r=0.723,P<0.01;B组r=0.761,P<0.01;C组r=0.768,P<0.01。结论:(1)CRP是D-D水平升高的主要相关因素;(2)CRP和D-D水平的升高可能是TIA患者的危险因素;(3)CRP和D-D水平的升高可以对TIA患者的诊断、治疗和估计预后提供较可靠的实验室指标。     

加味大承气汤活血攻下法治疗肠梗阻的网络药理学研究

目的:基于网络药理学的方法探讨加味大承气汤治疗肠梗阻(Intestinal obstruction)的作用机制。方法:通过中药系统药理学数据库(TCMSP)来获得加味大承气汤所含中药的主要化学成分,并收集其相对应的靶点;肠梗阻的疾病靶点来源于GeneCards、DrugBank、Home-OMIM-NCBI 数据库。使用Draw Venn Diagrams 工具获得交集基因。结合Cytoscape3.7.1 对所得的交集基因进行PPI 分析、GO 与KEGG 通路富集分析。结果:共获得加味大承气汤活性化学成分121 个,药物靶点1478 个;利用GeneCards、DrugBank、Home-OMIM-NCBI 数据库获得疾病靶点147 个;通过Draw VennDiagrams 工具获得交集基因24 个交集基因;通过PPI 蛋白作用网络及网络拓扑分析,EGFR(表皮生长因子受体)在网络连接程度较高;通过GO 富集分析发现:主要参与了对营养水平的反应、平滑肌细胞增殖的调控、平滑肌细胞增殖等生物学过程;通过KEGG 通路富集分析发现:主要涉及PI3K-Akt 信号通路、JAK-STAT 信号通路以及HIF-1 信号通路等。结论:加味大承气汤活血攻下法治疗肠梗阻是多靶点、多途径的,本次研究为进一步研究其作用机制提供依据。     

Can lower risk patients presenting with transient ischaemic attack be safely managed as outpatients?

This study aimed to examine outcome in low risk transient ischaemic attack (TIA) patients presenting to emergency departments (ED) in a regional Australian setting discharged on antiplatelet therapy with expedited neurology review. All patients presenting to Gosford or Wyong Hospital ED with TIA, for whom faxed referrals to the neurology department were received between October 2008 and July 2010, were included in this prospective cohort study. Classification of low risk was based on an age, blood pressure, clinical features, duration of symptoms and diabetes (ABCD²) score <4 and the absence of high risk features, including known carotid disease, crescendo TIA, or atrial fibrillation. Patients with ABCD² scores ⩾4 or with high risk features were discussed with the neurologist on call (a decision regarding discharge or admission was then made at the neurologist’s discretion). Patients were investigated with a brain CT scan and/or CT angiography, routine pathology, and an electrocardiogram. All discharged patients were commenced on antiplatelet therapy and asked to follow up with their local medical officer within 7 days. The patients were contacted by the neurology department to arrange follow-up. Our primary outcome was the number of subsequent strokes occurring within 90 days. Of 200 discharged patients for whom referrals were received, three patients had a stroke within 90 days. None of these would have been prevented through hospitalisation. In conclusion, medical assessment, expedited investigation with immediate commencement of secondary prevention and outpatient neurology review may be a reasonable alternative to admission for low risk patients presenting to the ED with TIA.     

Factors associated with early recurrence at the first evaluation of patients with transient ischemic attack

We aimed to identify factors easily collected at admission in patients with transient ischemic attack (TIA) that were associated with early recurrence, so as to guide clinicians’ decision-making about hospitalization in routine practice. From September 2011 to January 2013, all TIA patients who were referred to the University Hospital of Dijon, France, were identified. Vascular risk factors and clinical information were collected. The etiology of the TIA was defined according to the results of complementary examinations performed at admission as follows: large artery atherosclerosis (LAA-TIA) TIA, TIA due to atrial fibrillation (AF-TIA), other causes, and undetermined TIA. Logistic regression analyses were performed to identify factors associated with any recurrence at 48 hours (stroke or TIA). Among the 312 TIA patients, the etiology was LAA-TIA in 33 patients (10.6%), AF-TIA in 57 (18.3%), other causes in 23 (7.3%), and undetermined in 199 (63.8%). Early recurrence rates were 12.1% in patients with LAA-TIA, 5.3% in patients with AF-TIA, 4.3% in patients with another cause of TIA, and 1.0% in patients with undetermined TIA. In multivariable analysis, the LAA etiology was independently associated with early recurrence (odds ratio [OR]: 12.03; 95% confidence interval [CI]: 1.84–78.48, p = 0.009). A non-significant trend was also observed for AF-TIA (OR: 3.82; 95% CI: 0.40–36.62, p = 0.25) and other causes (OR: 3.73; 95% CI: 0.30–46.26, p = 0.31). A simple initial assessment of TIA patients in the emergency room would be helpful in targeting those with a high risk of early recurrence and who therefore need to be hospitalized.     

50岁以下短暂性脑缺血发作患者单纯舒张期高血压与颈动脉溃疡斑块的相关性分析

目的探讨50岁以下短暂性脑缺血发作(TIA)患者单纯舒张期高血压(IDH)与颈动脉溃疡斑块(CAPU)的相关性。方法选取132例50岁以下TIA患者,根据颈动脉彩超检查结果分为颈动脉溃疡斑块组(CAPU组,n=70)和非溃疡斑块组(非CAPU组,n=62)。检测患者血压情况,利用Logistic回归模型,分析患者临床资料及IDH与CAPU的相关性。结果 CAPU组高血压病、饮酒史比率、空腹血糖、糖化血红蛋白水平及舒张期血压水平显著高于非CAPU组(P0.05~0.001),IDH患者的比例(58.57%)也显著高于非CAPU组(40.32%)(P=0.0364)。CAPU组IDH者与神经系统局灶症状对侧CAPU的检出率(85.37%)明显高于非IDH的患者(75.86%)(P=0.0224)。多因素分析结果显示,IDH是CAPU形成的独立危险因素(OR=1.052,95%CI:1.137~3.254,P=0.013)。结论 IDH可能导致50岁以下TIA患者CAPU的形成。     

合并糖尿病对后循环短暂性脑缺血发作患者脑干听觉诱发电位的影响

目的使用诱发电位仪检测后循环短暂性脑缺血发作（transient ischemic attack,TIA）患者脑干听觉诱发电位（Brainstem auditory evoked potential,BAEP）的变化,探讨合并糖尿病（DM）的后循环TIA患者受损部位的特点。方法入组后循环TIA病例共58例,其中合并糖尿病组20例,无糖尿病组38例,使用诱发电位仪分别检测其BAEP的变化。结果2组后循环TIA患者的Ⅲ波、Ⅴ波波峰潜伏期（Peaklatency,PL）,Ⅰ～Ⅲ波、Ⅲ～Ⅴ波峰间潜伏期（Interpeak latency,IPL）均较正常值延长,其中合并DM组Ⅲ波PL、Ⅰ～Ⅲ波IPL与无DM组的Ⅲ波PL、Ⅰ～Ⅲ波IPL比较有显著性差异（P〈0.05）,而无DM组的Ⅲ-Ⅴ波IPL与合并DM组的Ⅲ～Ⅴ波IPL比较有显著性差异（P〈0.05）。结论合并DM的后循环TIA患者听神经及脑桥下段较无DM的TIA患者更容易受到缺血性损伤。     

阿托伐他汀联合阿司匹林对中风发作期痰瘀互结型患者hs-CRP、GMP140的影响

目的 通过分析阿托伐他汀联合阿司匹林治疗对于中风发作期痰瘀互结型患者超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、P-选择素(P-selectin 140,GMP140)的影响,探讨阿托伐他汀联合阿司匹林的治疗价值.方法 选取2013年5月～2013年12月南阳市中心医院治疗的175例中风发作期痰瘀互结型患者作为观察对象,根据治疗方案分为观察组89例(采取阿托伐他汀联合阿司匹林治疗),对照组86例(采取阿司匹林治疗),选取同期体检的60例健康人作为健康对照组,采用ELISA法检测各组血清hs-CRP及GMP140表达水平,比较各组hs-CRP、GMP140表达差异性.结果 与健康人群比较,中风发作期痰瘀互结型患者血清hs-CRP及GMP140显著升高(P＜0.05);经治疗后,2组患者血清hs-CRP及GMP140显著下降,治疗后观察组hs-CRP和GMP水平显著低于对照组(P＜0.05);观察组治疗总有效率93.26％,显著高于对照组(P＜0.05).结论 阿托伐他汀联合阿司匹林能够显著降低中风发作期痰瘀互结型患者hs-CRP、GMP140表达水平,是治疗痰瘀互结型中风发作期较为理想的方案之一.