散血明目片对非缺血型视网膜静脉阻塞患者血液流变学的影响

目的探讨散血明目片对非缺血型视网膜静脉阻塞患者血液流变学及血清相关生化指标的影响及作用机制。方法将34例非缺血型视网膜静脉阻塞患者随机分为治疗组（17例17眼）与对照组（17例18眼）,治疗组口服散血明目片,对照组口服血栓通片,两组均同时配合其他中西医常规治疗方法。治疗2个月后比较两组临床疗效、血液流变学及血清相关生化指标的差异。结果治疗组总显效率与对照组比较,差异有显著统计学意义（P〈0.01）;治疗组治疗前后低切和高切全血比黏度、红细胞电泳、血浆黏度、红细胞聚集指数、AT-Ⅲ、lp（a）、NO、A-CL IgG阳性率、ACL IgM阳性率、LA阳性率差异有显著统计学意义（P〈0.01）;ET-1、ACL IgA阳性率差异有统计学意义（P〈0.05）。结论散血明目片是治疗非缺血型视网膜静脉阻塞的有效药物,其作用机制可能与升高AT-Ⅲ、降低lp（a）、APL在血浆中的含量、稳定ET-1/NO比值有关,在外可反映于血液流变学指标的变化。     

温病活血化瘀法与糖尿病血管病变相关性研究

活血化瘀法作为温病常用治疗大法之一,在温病血分证中发挥了举足轻重的作用。将此法运用到糖尿病血管病变中,充分发挥其较为广泛的作用机理,对减少糖尿病及其并发症的产生,延长糖尿病患者寿命,提高生活质量有重要的意义。     

益气活血中药复方与CVB3对乳鼠心肌细胞葡萄糖转运体2表达的影响

目的研究益气活血中药复方与CVB3对乳鼠心肌细胞葡萄糖转运体2表达的影响,以期从基因水平揭示CVB3心肌炎的发病机制及益气活血中药复方治疗病毒性心肌炎的作用机制,并进一步证实益气活血中药复方是治疗CVB3病毒性心肌炎的有效方剂。方法通过改良的抑制性消减杂交技术（suppressionsubtractivehybridization,SSH）,分离大鼠心肌细胞CVB3感染组和益气活血中药复方给药组差异表达的基因,并通过荧光RT-PCR对上述结果进行验证。结果 SSH结果显示益气活血中药复方治疗组中葡萄糖转运体2基因的表达比CVB3病毒组中低,这一结果通过荧光RT-PCR得到验证。结论核糖体蛋白S20基因表达上调可能是CVB3致病毒性心肌炎机制之一;益气活血法能够通过下调核糖体蛋白S20基因的表达而实现治疗病毒性心肌炎的目的。     

Functional Impact of Shoulder Taping in the Hemiplegic Upper Extremity

Few methods have been validated for treatment of the painful hemiplegic shoulder. Harness slings and other methods of support have traditionally been applied in an attempt to prevent pain and subluxation, but supports often lead to complications. This paper describes shoulder taping in a patient with right hemiplegia following a cerebrovascular accident and evaluates taping efficacy through measures of activities of daily living, range of motion, and pain before, during, and after treatment. Taping significantly reduced pain and relieved excessive tension on the involved structures. The positive outcome obtained in this patient, in conjunction with other case reports, suggests shoulder taping may be more useful than traditional immobilization methods in the treatment of hemiplegic shoulders.     

Three blistering diseases

The three blistering conditions described in this article—dermatitis herpetiformis, pemphigus vulgaris, and bullous pemphigoid—are unusual but not rare. Proper management is critical and should include supervision by a physician thoroughly familiar with treatment and potential complications. Dr Wooldridge discusses the primary care physician's role in diagnosis, treatment, and follow-up of these diseases.     

Establishing biennial paramedic experience benchmarks

Objective. Since stroke symptoms are often vague, and acute therapies for stroke are more recently available, it has been hypothesized that stroke patients may not be treated with the same urgency as myocardial infarction (MI) patients by emergency medical services (EMS). To examine this hypothesis, EMS transport times were examined for both stroke and MI patients who used a paramedic-level, county-based EMS system for transportation to a single hospital during 1999. Methods. Patients were first identified by their hospital discharge diagnosis as stroke (ICD-9 430–436, n = 50) or MI (ICD-9 410, n = 55). Trip sheets with corresponding transport times were retrospectively obtained from the 911 center. A separate analysis was performed on patients identified by dispatchers with a chief complaint of stroke (n = 85) or MI (n = 372). Results. Comparing stroke and MI patients identified by ICD-9 codes, mean EMS transport times in minutes did not meaningfully differ with respect to dispatch to scene arrival time (8.3 vs 8.9, p = 0.61), scene time (19.5 vs 21.4, p = 0.23), and transport time (13.7 vs 16.2, p = 0.10). Mean total call times in minutes from dispatch to hospital arrival were similar between stroke and MI patients (41.5 vs 46.4, p = 0.22). Results were similar when comparing patients identified by dispatchers with a chief complaint indicative of stroke or MI. Conclusion. In this single county, EMS response times were not different between stroke and MI patients. Replication in other EMS settings is needed to confirm these findings.     

Reduction of disability after stroke is a more informative predictor of long-time survival than initial disability status

Purpose. Few studies have evaluated the roles of reducing disability after stroke in predicting survival. This study aimed to investigate the effects of improvement in the Barthel Index (BI) and other prognostic factors on survival in patients with first-time noncardioembolic ischemic stroke.

Method. BI effectiveness was defined as the improvement of BI between initial stroke (within 3 days) and 2 months after stroke. Cox regression analysis and Kaplan-Meier methods were used to evaluate the predictive roles of various prognostic factors.

Results. A total of 111 patients were enrolled. Mean age at the time of stroke was 68 (±11.2) years. Median follow-up time was 77.4 months. Mean initial BI was 36.1 (±28.5) and mean BI effectiveness was 46.9 ± 29.0. Overall, 55 deaths (49.5%) of the cohort were ascertained. The BI effectiveness had significant effects on long-time survival while initial BI was not a significant predictor. Higher BI effectiveness led to lower risk of mortality (hazard ratio = 0.44, 95% CI 0.24 – 0.80, p = 0.007). Elder age was correlated with poor survival (overall p = 0.006). Subjects in the eldest age group (≧70 years) showed a significant elevated risk for death (hazard ratio = 3.42, 95% CI 1.18 – 9.92). There was a trend indicating that the smaller the lesion size, the more favourable the prognosis (overall p = 0.057).

Conclusions. BI effectiveness in the first 2 months after first-time noncardioembolic stroke was more informative than initial disability status for predicting long-time mortality. It highlights the potential benefit in maximizing functional performance in patients with stroke.     

Significance of haemorrhagic lacunes on MRI in patients with hypertensive cerebrovascular disease and intracerebral haemorrhage

Our purpose was to determine the frequency and signifcance of haemorrhagic lacunes (HL) on MRI in patients with a history of, or at risk for intracerebral haemorrhage. We examined 72 patients with old spontaneous intracerebral haemorrhage (ICH) using T1-and T2-weighted spin-echo sequences. MRI studies of 137 consecutive patients with cerebrovascular disease but no known ICH were also reviewed. Both groups showed about the same degree of age-related white matter change and nonhaemorrhagic lacunar infarcts, whereas the ICH group had a higher frequency of HL (12/72 patients) than the non-ICH group (6/131 patients,p<0.01). These results correlate well with reported pathological findings. We conclude that haemorrhagic lacunes found on MRI studies of patients with cerebrovascular disease may suggest a higher risk of intracerebral haemorrhage.