Protection by free oxygen radical scavenging enzymes against glucose-induced embryonic malformations in vitro

Summary This study addresses the possibility that the teratogenic effects of a diabetic pregnancy are associated with increased embryonic activities of free oxygen radicals. Rat embryos were cultured in 50 mmol/l glucose for 48 h and subsequently showed pronounced growth retardation and severe malformations. The enzyme inducer citiolone and the free oxygen radical scavenging enzymes Superoxide dismutase, catalase and glutathione peroxidase protected against the disturbed growth and development of the embryos at 50 mmol/l glucose when added to the culture media. Enzymatic measurements indicated that citiolone induced an increased activity of superoxide dismutase in the embryonic tissues and that the added enzymes were taken up by both the yolk sac and the embryo proper. The protection against embryonic maldevelopment was thus conferred by agents that increased the free oxygen radical scavenging capacity of the embryonic tissues. The results suggest that a high glucose concentration in vitro causes embryonic dysmorphogenesis by generation of free oxygen radicals. An enhanced production of such radicals in embryonic tissues may be directly related to the increased risk of congenital malformations in diabetic pregnancy.This study was presented in part at the 26th Annual Meeting of the European Association for the Study of Diabetes, Copenhagen, Denmark, 10–14 September 1990     

An unusual case of aortic dissection in Turner's syndrome

Cardiovascular malformations are common in patients with Turner's syndrome. Aortic coarctation and bicuspid aortic valve are the most frequently occurring abnormalities, and are associated with cystic medial necrosis of the aortic wall. Aortic dissection is an uncommon but catastrophic complication of the 'aortopathy' of Turner's syndrome. We report the unusual case of a Turner's syndrome patient (with a bicuspid aortic valve and previous coarctation repair) who died following an intramural haemorrhage of the aortic root that was complicated by dissection and rupture, with no evidence of aortic intimal tear. The role of intramural haemorrhage in the pathogenesis of acute aortic syndromes in Turner's syndrome patients is unclear. The condition may be associated with atypical clinical presentations, it can be difficult to confirm with imaging techniques, and it carries a high risk of progression to classical aortic dissection and death. This case therefore highlights the need for a high index of suspicion when assessing Turner's syndrome patients presenting with chest pain syndromes. Furthermore, the effective management of Turner's syndrome patients with cardiovascular abnormalities requires the development of evidence-based preventive (such as echocardiographic surveillance of aortic dilatation) and interventional strategies.     

老年性痴呆与血管性痴呆智能障碍的比较研究

本文应用长谷川痴呆评定量表、MMSE及Kohs立方体组合测验,对32例老年性痴呆、74例血管性痴呆及82例非痴呆老人进行了智能测查。结果发现,痴呆组三项测验成绩均显著低于非痴呆老人组。痴呆组成绩比较,同一严重程度的老年性痴呆与血管性痴呆三项测验得分比较均无显著性差异。不同严重程度的痴呆应用MMSE、长谷川痴呆量表的得分比较有显著性差异。轻度痴呆组得分最高,中度组次之,重度痴呆组得分最低。Kohs测验结果发现,轻度痴呆组得分显著低于非痴呆老人组。轻度与中度痴呆组、中度与重度痴呆组比较无显著性差异。这提示Kohs测验仅可作为轻度痴呆的筛查工具,对鉴别痴呆严重程度的临床价值不大。 本文结果还表明,三项测验有较好的正相关。测验成绩与诊断、疾病严重程度、文化程度有密切关系,与性别、年龄、职业、婚姻状况及病程等因素无关。     

他汀类药物对急性缺血性卒中预后影响的临床研究

目的 评估发病前使用他汀类药物对急性缺血性卒中发病时症状严重程度及出院时功能转归的影响.方法 回顾性分析2006年1月至10月上海交通大学医学院附属新华医院神经内科住院治疗的185例急性缺血性卒中患者的临床资料,依据发病前是否已使用他汀类药物分为他汀治疗组(57例)与非他汀治疗组(128例),对比两组的一般资料、血管危险因素、牛津郡临床分型、入院时美国国立卒中量表(NIHSS)评分、治疗方法、出院时Barthel指数等.结果 他汀治疗组入院时NIHSS评分低于非他汀治疗组(6.0对13.0,P＜0.01),出院时功能转归良好病例百分比高于非他汀治疗组(77.2%对41.1%,P＜0.01).非他汀治疗组中服用抗血小板药物者与未合并用药者比较,入院时NIHSS评分和出院时达到功能转归良好的病例百分比差异均有显著性意义(P均＜0.05).出院时功能转归良好与发病前使用他汀类药物相关(OR=5.784,P＜0.01).结论 发病前使用他汀类药物能减轻急性缺血性卒中症状及改善出院时功能转归.     

血管成像的隐性海绵状血管瘤并发脑实质出血15例

目的观察手术治疗15例血管成像隐性海绵状血管瘤引起颅内出血的临床效果。方法15例复发性脑出血患者经CT／MRI证实。全部患者均采用显微手术治疗，12例只采用病变切除，1例病变在桥脑经第四脑室基底人路并经面神经上三角切除了海绵状血管瘤，2例颞叶海绵状血管瘤有顽固癫痫，做颞叶及病灶切除。所有手术标本均经病理证实为海绵状血管瘤。结果15例全部切除了病变，获得良好的效果，组织病理学证实为海绵状血管瘤。结论手术有效而安全，即使在脑功能区也能获得优良效果。     

Economic burden of cardiovascular diseases in the enlarged European Union.

AIMS: Cardiovascular disease (CVD), together with its main components, coronary heart disease (CHD), and cerebrovascular diseases, is the main source of morbidity and mortality in the European Union (EU), but to date, there has not been any systematic cost-of-illness study to assess the economic impact of CVD in the EU. METHODS AND RESULTS: CVD-related expenditure was estimated using aggregate data on morbidity, mortality, and healthcare resource use. Healthcare costs were estimated from expenditure on primary, outpatient, emergency, and inpatient care, as well as medications. Costs of unpaid care and lost earnings due to morbidity and premature death were included in the study. CVD was estimated to cost the EU Euro 169 billion annually, with healthcare accounting for 62% of costs. Productivity losses and informal care represented 21% and 17% of costs, respectively. CHD represented 27% and cerebrovascular diseases 20% of overall CVD costs. CONCLUSION: CVD is a leading public health problem. Our study is the first to assess the economic burden of CVD across the EU, and our results should help policy makers evaluate policy impact and prioritize research expenditures. However, because of data unavailability, our study has important limitations, which highlight the need for more accurate and comparable CVD-specific information.     

2270例卒中患者延误诊治时间的因素分析

目的 分析延误卒中患者诊治时间的院前、院后因素以及对溶栓治疗的影响。方法 采用问卷调查方法，收集2002年6月30日至2003年4月30日在全国35家医院就诊、资料完整的卒中患者2270例，输入数据库。对卒中发生时间、发病后就诊时间、就诊后查检时间、检查方式、医疗方式及到达医院的方式等影响因素进行单因素分析。结果2270例患者中1039例在3h内到达医院，占45．8％；就诊到头部CT或MRI检查时间在30min内的患者为1084例，占47，8％；CT、MRI检查到读出结果所用时间在30min内有1221例，占53，8％；就诊后60min内得到治疗的患者为1250例，为55．1％；家庭运送为1652例，占72．8％，其中有811例，占49、1％，是在发病后6h以内到达医院；救护车运送为618例，占27．2％，使用急救车的患者在6h内到达医院494例，占79，9％；急诊作MRI检查的患者为1178例，占51．9％；无条件作MRI检查者为1092，占48．1％。发病后就诊时间≤6h患者，下列影响因素差异具有显著意义：即到达医院的方式(P＜0．01)、生活方式(P＜0．05)、医疗状况(P＜0．001)、知晓是否为高危个体(P＜0．001)、发病地点(P＜0，01)、居住地点(P＜0．001)、发病地点到医院的距离(P＜0．001)。结论 就诊前延误因素主要为途中延误，求助于120／999急救运送，可缩短医院前延误的时间。     

Effects of hyperglycaemia on sorbitol and myo-inositol contents of cultured embryos: treatment with aldose reductase inhibitor and myo-inositol supplementation

Summary To demonstrate the myo-inositol depletion hypothesis in hyperglycaemia-induced embryopathy, rat conceptuses of 9.5 days of gestation in the early head-fold stage were grown in vitro during neural tube formation for 48 h with increasing amounts of glucose. The effects of an aldose reductase inhibitor and the myo-inositol supplementation were also investigated. Sorbitol and myo-inositol contents were measured in separated embryos and extra-embryonic membranes including yolk sac and amnion at the end of culture. After addition of 33.3 mmol/l and 66.7 mmol/l glucose to the culture media, the myo-inositol content of the embryos was significantly decreased by 43.1% (p<0.05) and 64.6% (p < 0.01) of the control group, while a marked accumulation of sorbitol was observed (25 and 41 times that of the control). Although the addition of an aldose reductase inhibitor (0.7 mmol/l) to the hyperglycaemic culture media containing an additional 66.7 mmol/l glucose significantly reduced the sorbitol content of embryos to approximately one-eighth, the myo-inositol content of embryos remained decreased and the frequency of neural lesions was unchanged (23.1% vs 23.9%, NS). Supplementation of the myo-inositol (0.28 mmol/l) completely restored the myo-inositol content of the embryos and resulted in a significant decrease in the frequency of neural lesions (7.1% vs 23.9%, p < 0.01) and a significant increase in crown-rump length and somite numbers. Much less significantly, sorbitol accumulation was also observed in the extra-embryonic membrane in response to hyperglycaemia, neither hyperglycaemia nor the myo-inositol supplementation modified the myo-inositol contents of the extra-embryonic membrane. We conclude that the mechanism of hyperglycaemia-induced teratogenicity was mediated by the myo-inositol depletion of the embryo at a critical stage of organogenesis.     

动态血压周节律的临床观察

目的 探讨人体血压一周动态节律（周节律）的存在及其在临床中的作用。方法 对33例健康人和高血压病患者进行一周动态血压监测（ambulatory blood pressure monitoring,ABPM)；另外对70例高血压合并急性脑卒中患者的发病时间进行统计。结果 健康人和高血压病患者血压的一周波动多呈现双峰双谷型，模式为周一为第一个高峰，周四或周五血压为第二个高峰，周日为最低值，高血压病患者周节律更为明显，血压一周节律性波动与急性脑卒中患者发病时间基本一致。结论 人体动态血压存在周节律，急性脑卒中患者一周发病时间规律与血压周节律密切相关，血压高峰日的发现对预防高血压及其并发症具有重要意义。     

脑动静脉畸形合并动脉瘤的血管内治疗

目的：探讨脑动静脉畸形（ Cerebral arteriovenous malformation,AVM）合并动脉瘤治疗策略、治疗方法。方法：经全脑数字减影血管造影（ Digital subtraction angiography DSA）检查确诊出血的10例患者,根据AVM血流动力学及动脉瘤特点,取不同栓塞策略,先栓塞动脉瘤后栓塞动静脉畸形。结果：畸形团内型5例,用Onyx胶、弹簧圈栓塞,单纯弹簧圈栓塞2例;与供血动脉相关型4例,与畸形团无关型1例,弹簧圈栓塞动脉瘤,再Onyx胶栓塞畸形血管。复查DSA,动脉瘤全部栓塞,AVM完全消失5例,3例栓塞80％,2例栓塞60％~80％,1例术后出现病变对例肢体轻度偏瘫。后期再次栓塞畸形血管团2例,行开颅切除畸形血管团1例,立体定向放射治疗2例。结论：动静脉畸形合并动脉瘤的血管内栓塞治疗可取得较好的效果,畸形团供血动脉瘤优先栓塞动脉瘤和载瘤动脉,畸形团内动脉瘤则以闭塞该部血流为主,如技术条件允许也尽量先栓塞带瘤血管巢。