急性青年人脑梗死患者血清hs-CRP水平变化及临床意义

目的探讨急性青年人脑梗死患者血清高敏C-反应蛋白(high-sensitivity C-reactive protein,hs-CRP)含量变化及其在青年人脑梗死发生过程中的作用和意义。方法选择51例急性青年脑梗死患者(初发年龄≤50岁),测量其急性期和恢复期hs-CRP水平变化,并与30例健康对照组做比较。结果51例青年急性脑梗死(ACI)患者急性期与恢复期hs-CRP水平均高于健康对照组,比较均有显著性差异(p<0.01);急性期与恢复期比较差异具有显著性意义(p<0.01)。结论hs-CRP水平升高可作为青年脑梗死急性期的诊断预测指标。     

MRI指导下急性脑梗死降纤治疗规范探讨

目的:探讨在MRI指导下规范化巴曲酶治疗急性脑梗死的临床疗效及安全性评价。方法:符合人选及排除标准的6-72h内急性脑梗死患者30例,根据本研究制定的规范方案分别接受20-30U的巴曲酶治疗(治疗组),并与同期未接受巴曲酶治疗的30例急性脑梗死患者(对照组)对比研究。分别观察治疗前后的ESS评分、Barthel指数评定、MRI和MRA变化并进行安全性评价。结果:①治疗前治疗组的ESS评分是66.98±16.99,对照组的ESS评分是65.32±16.48,无显著差异(P>0.05);治疗7d后两组的ESS评分分别为77.91±18.62和68.14±17.56(P<0.05);治疗21d后两组的ESS评分分别是84.12±17.18和76.89±19.32(P<0.01);治疗90d后两组的ESS分别为91.76±14.05和80.07±15.90(P<0.01),两组之间具有极显著差异。②治疗前治疗组和对照组的梗死面积分别为3.17±2.87cm2和2.81±2.33cm2(P>0.05)。治疗后治疗组和对照组的梗死面积分别为2.43±2.51cm2和2.70±2.41cm2,治疗组治疗前后梗死面积比较有显著差异(P<0.05),对照组治疗前后梗死面积比较无明显差异(P>0.05)。③在治疗组有4例患者在治疗前MRA显示大脑中动脉(MCA)阻塞,治疗后MRA均显示血管再通。④巴曲酶治疗组无一例并发症发生。结论:在MRI指导下,利用巴曲酶进行急性脑梗死的规范化降纤治疗是安全、有效的。     

The influence of epididymal agenesis on the development and maturation of the testis: Experimental model and clinical correlations

Summary The August X Copenhagen (ACI) rat provides an excellent model to study the effect of congenital epididymal anomalies on testicular function. Despite epididymal absense, testicular maturation and function are unchanged until puberty. At puberty, with increased testicular fluid and spermatozoa output, involution of germinal epithelium occurs. This involution is similar to the changes seen with ligation of the efferent ductules of the epididymis. These findings suggest that in this mammalian model the testis functions normally until the pubertal period. At that time, because of proximal epididymal agenesis and failure to reaborb testicular secretions, in tratesticular hydrostatic pressure increases with rapid germinal epithelial atrophy. Clinical correlations are made in patients with epididymal abnormalities, especially in association with undescended testis.     

急性脑梗死患者CISS分型与血同型半胱氨酸、超敏C反应蛋白的相关性研究

目的：探讨符合中国缺血性卒中亚型(CISS)分型的急性脑梗死(ACI)患者血浆同型半胱氨酸(Hcy)、血清超敏C反应蛋白(hs-CRP)水平及其临床意义。方法选择2013-2014年在我院神经内科住院的ACI患者152例(ACI组),同期40例健康体检者为对照组,比较两组受检者的血浆同型半胱氨酸(Hcy)及血清hs-CRP水平。ACI患者按CISS分型分为大动脉粥样硬化(LAA)96例,心源性(CS)17例,穿支动脉疾病(PAD)24例,其他病因(OE)4例,不确定病因(UE)11例。其中LAA患者进一步分为载体动脉堵塞穿支动脉30例,动脉到动脉栓塞38例,低灌注/栓子清除下降17例及混合机制组11例,比较各组间Hcy及血清hs-CRP水平。结果 ACI组患者的Hcy、hs-CRP水平显著高于对照组,差异有显著统计学意义(P<0.01);不同CISS病因分型中,LAA组、CS组患者的Hcy水平高于PAD组、OE组及UE组,差异均有统计学意义(P<0.05);OE组、LAA组患者的hs-CRP水平明显高于UE、CS组和PAD组,差异有显著统计学意义(P<0.01);LAA组患者的不同发病机制的Hcy水平,组间比较差异无统计学意义(P>0.05);载体动脉堵塞穿支组患者的hs-CRP水平显著高于其他各亚组,差异均有显著统计学意义(P<0.01),动脉到动脉栓塞组患者的hs-CRP水平显著高于低灌注/栓子清除下降组,差异有显著统计学意义(P<0.01),动脉到动脉栓塞组患者的hs-CRP水平高于混合机制组,差异有统计学意义(P<0.05)。结论检测血浆Hcy、血清hs-CRP水平有助于明确ACI病因及发病机制。     

3种“鸡尾酒疗法”治疗急性脑梗死的成本-效果分析

目的:比较3种"鸡尾酒疗法"治疗急性脑梗死的效果及成本。方法:141例急性脑梗死患者按照不同药物治疗方案分为3组,分别给予奥扎格雷钠+桂哌齐特+依达拉奉(A组)、长春西汀+棓丙酯+小牛血去蛋白提取物(B组)、阿魏酸钠+丁咯地尔+肌氨肽苷(C组)治疗14d,进行成本-效果分析。结果:A、B、C组人均治疗总成本分别为5970.67、4865.11、3939.72元,显效率分别为82.98%、63.04%、64.58%,成本-效果比分别为7195.31、7717.50、6100.53。结论:A组方案为较佳方案。     

活血荣络片对急性脑梗死患者血浆CF6及线粒体游离Ca~(2+)浓度水平的影响

目的:探讨活血荣络片对急性脑梗死患者血浆中CF6及线粒游离Ca~(2+)浓度水平的影响。方法:将60例急性脑梗死患者随机分为治疗组和对照组,每组各30例。两组均给予奥扎格雷钠、疏血通注射液、小牛血清去蛋白注射液,并同时口服阿司匹林肠溶片作为常规治疗。治疗组在常规治疗基础上加用活血荣络片,每次6片,口服,每日3次;对照组在常规治疗基础上加用磷酸吡哆醛丁咯地尔胶囊,每次1粒,口服,每日2次。观察两组患者临床疗效及治疗前后中医证候学变化、CSS评分变化、ADL评分、CF6及线粒游离Ca~(2+)浓度水平变化情况。结果:对照组有效率为83.33%,治疗组有效率为93.33%,两组有效率比较,差异具有统计学意义(P0.05)。两组患者治疗后CSS评分、ADL评分、血浆CF6及线粒体游离Ca~(2+)浓度水平均较治疗前得到改善,且治疗组优于对照组,差异均有统计学意义(P0.05)。结论:活血荣络片治疗急性脑梗死疗效确切,能有效降低血浆CF6水平,抑制Ca~(2+)内流,从而有效地抗血小板聚集、降低血栓形成风险,并能较好地清除氧自由基减轻脑缺血损伤。     

基于Meta分析的注射用丹参多酚酸治疗急性脑梗死临床评价

目的:系统评价注射用丹参多酚酸辅助西医常规治疗急性脑梗死有效性、安全性,及对急性脑梗死患者运动和认知功能的影响。方法:计算机检索Cochrane library,Pubmed,Embase,中国生物医学文献数据库,中国知网,维普期刊数据库和万方数据库有关注射用丹参多酚酸治疗不稳定型心绞痛的随机对照临床试验文献,采用Cochrane风险评价表评价其研究质量,提取资料通过Rev Man 5.3进行Meta分析。结果:共纳入7个随机对照试验,累计622名患者。Meta分析显示注射用丹参多酚酸辅助西医常规治疗急性脑梗死具有很好的疗效,能促进神经功能恢复[MD=-2.56,95%CI(-3.19,-1.93),P0.000 01],降低残疾程度[MD=-0.54,95%CI(-0.89,-0.19),P0.000 01],提高患者日常生活能力[MD=9.90,95%CI(7.21,12.59),P0.000 01],改善患者的认知学习能力,提高生活质量,还能显著提高临床疗效总有效率,降低C反应蛋白。有1篇文献明确无不良反应,2篇研究报道了共7例不良反应,其他文献均未对安全性做出说明。结论:急性脑梗死患者使用注射用丹参多酚酸治疗,能够明显提高临床疗效,有效促进神经功能恢复,提高日常生活行为能力,并显著改善卒中后认知功能,值得临床推广。因安全性尚不能得到确切的结论,安全性有待扩大临床试验样本量进一步研究。     

InVitro Evaluation of Optimal Inhalation Flow Patterns for Commercial Dry Powder Inhalers and Pressurized Metered Dose Inhalers With Human Inhalation Flow Pattern Simulator

This study aimed at developing a novel analytical method to identify optimal inhalation flow patterns for commercial dry powder inhalers (DPIs) and pressurized metered dose inhalers (pMDIs). As typical commercial DPI and pMDI, Pulmicort^® Turbuhaler^®, and Sultanol^® Inhaler were evaluated by an in vitro inhalation performance testing system with a flow pattern simulator. An 8-stage Andersen cascade impactor (ACI) or twin stage liquid impinger (TSLI) was applied to determine the inhalation performance. The peak flow rate (PFR) of the inhalation flow pattern was set from 15 to 80 L/min in reference to our previous study. From TSLI test results, a higher PFR improved the inhalation performance of the DPI, while the performance of the pMDI was less affected by the PFR. Conversely, from ACI test results, the pMDI performance decreased with a higher PFR, while the DPI followed a similar pattern as in the TSLI test results, because ACI is a finer aerodynamic classification apparatus than TSLI. These results suggested that our in vitro system using a human inhalation flow pattern simulator successfully detected different optimal inhalation patterns between DPI and pMDI. That is, the higher PFR is better for Pulmicort^® Turbuhaler^® (DPI). Conversely, lower PFR is desirable for Sultanol^® Inhaler (pMDI).     

Effects of inhalable microparticle of flower of Lonicera japonica in a mouse model of COPD

Ethnopharmacological relevance: Flower of Lonicera japonica (FLJ) is a traditional herbal medicine widely used in East Asia as an anti-inflammatory and anti-oxidative agent. The purpose of this study is to develop an inhalable powder formulation of FLJ and to evaluate its biological effects in a mouse model of chronic obstructive pulmonary disease (COPD).