Is vascular imaging valuable prior to administration of intravenous tissue plasminogen activator?

Our goals were to explore whether performing computerized tomography angiography (CTA) prior to administration of tissue plasminogen activator (tPA) delays treatment and impacts outcome in patients with proximal middle cerebral artery occlusions (pMCAO). Patients with pMCAO with a National Institutes of Health Stroke scale (NIHSS) score >10 were identified from a prospective Stroke Registry. Patients underwent multi-parametric imaging studies whenever possible. Patients who underwent CTA were compared to those who only had non-contrast CT scan. Disability was measured with the modified Rankin Scale. Logistic regression was used to determine outcome modifiers. We included 73 patients (median age 73 years, 52% men) with moderate-severe stroke (median admission NIHSS 14). Of those, 44 underwent CTA and 29 did not. There were no differences between the groups in risk factor profile or baseline characteristics including stroke severity and door to needle, door to imaging or imaging to treatment times. At 90 days post-stroke there were no statistically significant differences in outcomes between the groups. On multivariate analysis, performing CTA had no impact on the chance of obtaining favorable outcome. In conclusion, CTA does not have a major impact on outcome in patients with pMCAO treated with tPA. Therefore, performing CTA should be considered on an individual basis prior to administration of tPA.     

The role of lipids in the pathogenesis of glomerulosclerosis in the rat following subtotal nephrectomy

Abstract. Similarities between atherosclerosis and glomerulosclerosis suggest that hyperlipidaemia may contribute to glomerular injury. Dietary supplementation with 4% cholesterol +1% cholic acid was administered to rats 4 weeks after 1 1/3 nephrectomy and continued for 7 weeks. There was a significant increase in serum cholesterol (peak= 11.52 ±1.09 mmol 1^-1 vs. 4.73 ± 0.31 on control diet, < 0.001) and triglyceride concentrations (peak = 2.31 ± 0.27 mmol 1^-1 vs. 1.41 ±0.29, <0.05) and a marked increase in βmigrating lipoproteins. The severity of hypercholester-olaemia was significantly correlated with proteinuria (control diet: r = 0.600, cholesterol diet: r = 0.672, < 0.0001) as was hypertriglyceridaemia (control diet: r = 0.544, cholesterol diet: r = 0.678, <0.0001). The percentage of glomeruli containing lipid deposits was increased from 21% to 60% (<0.05). The kidney total cholesterol content was increased from 29.2 ±0.8 to 47.7 ± 3.3 μmols g^-1 dry weight (<0.0001), with esterified cholesterol increasing from 7.5 ± 0.4% to 14.5 ± 2.1% of total (<0.01). Serum cholesterol concentration was significantly correlated with both glomerular lipid deposition ( r _s= 0.7195, <0.0001) and tissue total cholesterol content ( r _s= 0.6053, <0.001). Lipid vacuolation was prominent in the paramesangium and within mesangial cells. Despite these changes hypertension, uraemia, proteinuria and glomerulosclerosis were not significantly increased on the cholesterol diet. Cholesterol deposition in the glomeruli occurs secondary to hyperlipidaemia in rats following subtotal nephrectomy but over 7 weeks no exacerbation of glomerulosclerosis is detectable.     

脑震荡大鼠海马CA1区P-CREB的表达

目的观察磷酸化CREB（p-CREB）在脑震荡大鼠海马区的表达。方法在多聚甲醛固定的海马脑薄片上，用免疫组化法观察p-CREB在海马CA1区的表达。结果p-CREB在脑震荡大鼠海马结构CA1区的表达，1～72h增多（P〈0．05），7d后降至正常。结论p-CREB在脑震荡大鼠海马内伤后早期表达增多，P-CREB可能具有神经保护因子的作用。     

立体定向手术与内科治疗中小量基底核区高血压性脑出血的对比研究

目的研究中小量（15～40m1）基底核区高血压性脑出血应用立体定向治疗与内科保守治疗对患者病死率、运动功能及预后的影响。方法2003年1月～2013年1月,我院收治中小量基底核区高血压性脑出血164例,其中82例行立体定向手术抽吸结合尿激酶引流治疗,另82例行内科保守治疗。比较2组血肿清除时间、30d病死率、患侧肢体运动功能和90d格拉斯哥预后评分（Glasgow outcome score,GOS）。结果立体定向治疗组血肿消散时间（3.8±1.1）d,明显短于内科治疗组的（19.9±3.5）d（t=-39.463,P=0.000）。2组30d病死率差异无显著性。立体定向组治疗30d病肢肌力4～5级[43.9％（36／82）vs.28.0％（23／82）,X^2=4.474,P=0.034]和90 d GOS 5分者的比例明显高于内科治疗组[53.7％（44／82）vs.36.6％（30／82）,X^2=4.826,P=0.028]。结论对于中小量高血压性脑出血,行立体定向手术治疗比内科治疗能明显加快血肿清除时间,改善患者的功能预后。