Penetration of fusidic acid and rifampicin into cerebrospinal fluid in low-grade inflammatory meningitis caused by Staphylococcus epidermidis

Cerebrospinal fluid (CSF) concentration-time curves of rifampicin and fusidic acid were studied in a patient with post-operative meningitis caused by Staphylococcus epidermidis. The patient was treated with this combination of antimicrobial agents because of a severe hypersensitivity reaction to vancomycin. Peak CSF concentrations of rifampicin exceeded the MIC by > 60-fold, while those of fusidic acid just reached the MIC. CSF concentrations of fusidic acid were relatively stable within the range reported for patients with uninflamed meninges, but serum levels were surprisingly low. An increase in the metabolism of fusidic acid induced by rifampicin cannot be excluded.     

载脂蛋白E基因多态性与脑梗死的相关性分析

目的　探讨载脂蛋白 E基因多态性与脑梗死的关系。方法　通过聚合酶链反应 -限制性片段长度多态性 (PCR- RFL P)分析结合 DNA直接银染技术检测 6 6例脑梗死 (CI)患者的载脂蛋白 E(Apo E)基因型 (其中家系中有明确脑梗死先证者的家族聚集性脑梗死 (FMACI)亚组 2 6例 ,家系中无脑卒中史的非家族聚集性脑梗死 (NF-MACI)亚组 4 0例 ) ,并与 90例健康对照组比较 ,同时检测血脂、脂蛋白 (a) [L P(a) ]及部分载脂蛋白。结果　脑梗死组ε3/4基因型频率明显高于对照组 (P<0 .0 1) ,ε3/3基因型频率明显低于对照组 (P<0 .0 1) ;两脑梗死亚组之间的ε3/4/ε3/3基因型频率虽有上升 /下降趋势 ,但未发现明显的统计学差异 ;FMACI组高密度脂蛋白 (HDL )水平明显低于 NFMACI组 (P<0 .0 5 )。结论　 Apo E基因多态性与脑梗死的发生有关 ,ε4等位基因是脑梗死的易感因子 ,ε3等位基因对脑梗死的发生有保护作用 ;Apo E基因多态性和 HDL水平双重作用于家族聚集性脑梗死的发生。     

A New and Alternative Leads Positioning for Complex Regional Pain Syndrome Treatment: Paraforaminal Stimulation

We present a case of a female patient suffering from type I complex regional pain syndrome (CRPS) who developed “mirror imaging” of her CRPS and was successfully treated with dual spinal cord stimulation (SCS) in the paraforaminal epidural space. This patient initially had unilateral pain that was unsuccessfully treated with midline SCS and single‐lead lateral epidural lead placement “paraforaminally.” One year later, because we believed that paraforaminal stimulation would preferentially stimulate primary sensitized afferents innervating the painful area, we reperformed SCS with two leads positioned laterally and paraforaminally close to the roots within the epidural space. After repositioning and after 1 year of paraforaminal stimulation, there was significant improvement in the patient's symptoms, resolving all unilateral and “mirrored” symptoms. We conclude that paraforaminal stimulation may be a valid therapeutic option for the treatment of CRPS.     

脊髓损伤后中枢性疼痛的实验模型和机制研究进展

中枢性疼痛(central pain,CP)是脊髓损伤(spi-nal cord injury,SCI)的顽固性合并症,为患者主观上感到损伤平面以下皮肤痛觉消失区一种以自发痛为主的疼痛,发生率为11%~94%,严重者为5%~30%。近年来其发生率逐年增高,使很多患者陷于抑郁、药物成瘾、甚至自杀的悲惨境地。许多疼痛     

颅骨钻孔颅内血肿抽吸术治疗高血压脑出血的临床研究

目的　探讨应用颅骨钻孔颅内血肿抽吸术治疗高血压脑出血。方法　总结分析血量在 30ml以上的高血压脑出血患者 60例经微创手术治疗的情况及预后 ,并设传统开颅手术为对照组进行比较。结果　微创组 60例中 ,总有效率达 83 % ,其中完全恢复生活能力和部分恢复生活能力占 48.3 % ,均明显优于对照组。结论　微创颅内血肿清除术对高血压脑出血患者的治疗效果明显优于传统开颅血肿清除术     

血浆蛋白C、蛋白S与脑梗死的相关性研究

目的研究血浆蛋白C、蛋白S与脑梗死发病的关系。方法对64例脑梗死患者及15例正常对照组进行血浆蛋白C(PC)、蛋白S(PS)检测,并分析其与脑梗死严重程度、年龄及其它脑梗死危险因素之间的关系。结果实验组血浆PC浓度(4.97±1.82μg/ml)与对照组血浆PC浓度(4.74±1.95μg/ml)之间差别无统计学意义;首发组血浆PC浓度(5.28±1.85μg/ml)与复发组血浆PC浓度(4.03±1.40μg/ml)之间差别有统计学意义(P=0.016);实验组血浆PS浓度(7.47±3.87μg/ml)与对照组血浆PS浓度(12.06±3.99μg/ml)之间差别有统计学意义,中老年组血浆PS浓度(6.58±3.33μg/ml)与青年组血浆PS浓度(9.28±4.33μg/ml)之间差别有统计学意义。结论PC降低是复发性脑梗死的危险因素之一;游离PS降低是脑梗死的危险因素;PS水平的降低导致PC功能的降低,进而凝血功能障碍,导致脑梗死的发生。     

一种基于血管内皮细胞损伤的大鼠局灶性脑梗死模型

目的：建立一种因血管内皮细胞损伤而诱导的大鼠局灶性脑梗死模型。方法：取S—D大鼠11只，分离左侧颈总动脉、颈外动脉和颈内动脉。结扎左颈外动脉远心端，夹闭左翼腭动脉和颈总动脉，经颈外动脉逆行插管并缓慢注入月桂酸钠至颈内动脉系统，造成大脑中动脉血管内皮细胞受损。结果：从模型动物的行为表现、梗死灶形态学和病理学进行考察，10只大鼠均产生一定程度的脑梗死表现，造模成功率为90．9％。结论：该模型的稳定性和重复性较好，能在大脑中动脉的供血区产生恒定的梗死灶，适合进行脑缺血损伤的有关实验研究。     

中医药结合红外热像仪治疗286例脑供血不足

目的 探讨红外热像仪产生的热图与中医学的辨证施治相结合治疗脑供血不足。方法 使用红外热像仪对286例脑供血不足患者进行检查，然后中医分型治疗，再每隔1个月用红外热像仪随访疗效。结果 1个月后平均总有效率85．6％，2个月后平均总有效率91．2％，3个月后平均总有效率达95．7％。结论 红外热像仪对早期诊断脑供血不足及疗效跟踪有很大帮助，为临床提供了一种新颖的检查方法。     

二氮嗪对大鼠脑缺血再灌注细胞凋亡的影响

目的研究二氮嗪开放线粒体ATP敏感性钾通道对大鼠脑缺血再灌注细胞凋亡的影响。方法采用线栓法建立大鼠局灶性脑缺血再灌注损伤模型,将20只大鼠随机分成4组,假手术组、缺血组、缺血＋二氮嗪治疗组和缺血＋二氮嚷＋MitoK（ATP）通道特异性抑制剂5-HD组。观察各组凋亡细胞数和凋亡相关蛋白Bcl-2、Bax的变化。结果与缺血组比较,二氮嗪使凋亡细胞数明显减少（83．2±9．04 vs 123．96±13．45）,Bcl-2表达增高（0．17±0．01 vs 0．13±0．01）,Bax表达下降（0．15±0．02 vs 0．20±0．03）,差异具有显著性（P＜0．05）。5-HD能取消这些作用（P＜0．05）。结论局灶性脑缺血再灌注损伤时,二氮嗪能通过上调半暗带区Bcl-2蛋白表达,下调Bax蛋白表达,减少神经元凋亡,对脑缺血损伤起保护作用。     

A prospective study of the association of cerebrospinal fluid monoamine metabolite levels with lethality of suicide attempts in patients with bipolar disorder

Objectives:  Bipolar disorder is a severe illness that is associated with suicidal behavior. A biological predictor of highly lethal suicide attempts in patients with bipolar disorder would be valuable. We hypothesized that cerebrospinal fluid (CSF) monoamine metabolite levels are related to lethality of suicide attempts in bipolar patients and examined the relation between CSF 5-hydroxyindolacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) levels and maximum lethality of suicide attempts at baseline and during a 2-year follow up.
Methods:  Twenty-seven bipolar depressed patients participated in the study. Demographic and clinical parameters were examined and recorded. Lumbar punctures were performed and CSF 5-HIAA, HVA, and MHPG were assayed by high-performance liquid chromatography with electrochemical detection. Following discharge, patients were evaluated after 3 months, 1 year, and 2 years. Each follow-up interview included an in-depth assessment of suicidal behavior during the intervening time period.
Results:  Six subjects made suicide attempts during the 2-year follow-up. Bipolar patients who attempted suicide during the follow-up period had higher aggression and hostility scale scores compared to bipolar subjects who did not make a suicide attempt during the follow-up period. CSF 5-HIAA, HVA, and MHPG levels were negatively correlated with the maximum lethality of suicide attempts during the 2-year follow-up period.
Conclusions:  Our finding is the first observation that CSF monoamine metabolite levels may be predictors of lethality of suicide attempts in patients with bipolar disorder. Further studies are necessary to answer the question whether CSF monoamine metabolite levels are clinically useful biochemical predictors of highly lethal suicide attempts or completed suicides.