Effect of brain functional recovery decoction on expression of vascular endothelial growth factor and Ang-1 protein in a rat cerebral ischemia reperfusion model

OBJECTIVE

To investigate the effect of brain functional recovery decoction (BFRD) on expression of vascular endothelial growth factor (VEGF) and angiopoietin-1 (Ang-1) protein in rats with cerebral ischemia reperfusion injury, and to explore the mechanism of action of BFRD.

我国城镇脑卒中患者住院卫生服务利用情况及住院费用的影响因素研究

背景　作为全球第二大常见致死病因，脑卒中给患者带来了极大的经济负担和家庭负担。患者的卫生服务利用状况会影响其医疗费用的支出，但目前关于我国城镇脑卒中患者住院卫生服务利用情况的研究较少。目的　了解我国城镇脑卒中患者的住院服务利用情况，并探讨住院费用的影响因素，为降低患者疾病经济负担、加强患者经济保护、控制医疗费用过快增长提供理论支持和现实依据。方法　数据来源于“全国基本医疗保险卫生服务利用调查数据库”（2010-2015年），于2018年10月采用机械抽样法在数据库中抽取城镇缺血性脑卒中患者56 485例，收集其基本情况和住院服务利用情况（住院次数、住院天数、住院费用）。采用单因素分析比较不同基本情况脑卒中患者的住院服务利用差异，采用多元线性回归分析脑卒中患者住院费用的影响因素。结果　我国城镇脑卒中患者的年均住院次数为1（0）次，次均住院天数为11.0（6.0）d，次均住院费用为6 070.06（8 289.87）元。不同性别、年龄、险种类型、卒中类型、医院级别、地区、城市类别的患者，年均住院次数、次均住院天数、次均住院费用比较，差异有统计学意义（P<0.05）。多元线性回归分析结果显示：性别、年龄、险种类型、卒中类型、医院级别、地区、城市类别、次均住院天数是患者住院费用的影响因素，其中男性患者住院费用较女性高1.8%，年龄每增长1岁患者住院费用上升0.07%，职工医疗保险患者住院费用较居民医疗保险患者高20.1%，卒中类型为入脑前动脉未特指的闭塞或狭窄引起的脑梗死（I63.2）、大脑动脉血栓形成引起的脑梗死（I63.3）患者住院费用分别较脑梗死（I63）患者高40.8%、38.8%，二级、三级医院就诊患者住院费用分别较基层医院就诊患者高72.1%、121.1%，东部地区患者住院费用分别较中部、西部地区高23.5%、34.0%（P<0.05）；住院次数也是患者住院费用的影响因素，住院次数每增加1次患者住院费用上升57.7%（P<0.05）。结论　不同特征脑卒中患者的住院卫生服务利用状况存在差异，住院费用与多种因素有关；应通过提高医院诊疗技术、缩短住院天数、加强对患者的健康教育等方式来实现费用控制，降低患者负担。     

GDNF基因修饰的NSCs移植对暂时性缺血性脑卒中大鼠的神经保护作用研究

目的　探讨移植胶质细胞源性神经营养因子（glial cell line derived neurotrophic factor,GDNF）基因修饰的神经干细胞（neural stem cells,NSCs）对暂时性缺血性脑卒中大鼠的神经保护。 方法　用GDNF重组腺病毒载体转染新生大鼠NSCs（GDNF/NSCs）,分化培养7 d后,行免疫细胞化学染色检测微管相关蛋白2（MAP2）。采用改良的插线法制作暂时性脑缺血再灌注模型,3 d后经脑室分别移植生理盐水、NSCs和GDNF/NSCs。于再灌注后1、2、3、5、7周末处死大鼠,行免疫组织化学染色观察移植细胞在脑内的神经元分化及星形胶质细胞在缺血区形成胶质界膜情况,行Luxol fast blue（LFB）染色显示神经纤维损伤情况。 结果　GDNF/NSCs体外分化为MAP2+细胞的比例显著高于NSCs的分化。移植细胞在脑内分化为MAP2+细胞,于再灌注第5周分化达高峰,GDNF/NSCs组于再灌注第3~7周,其MAP2+细胞显著高于NSCs组。各组缺血区由星形胶质细胞形成的血管胶质界膜存在不同程度的破坏,其连续性中断。对照组在各个时间点,血管胶质界膜损伤严重,完整性差,两细胞移植组,其胶质界膜随时间延长逐渐完整,GDNF/NSCs组早于NSCs组完善对胶质界膜的修复。此外,GDNF/NSCs组的神经纤维损伤修复优于NSCs组。 结论　GDNF/NSCs比NSCs对暂时性缺血性脑卒中大鼠模型有更好的神经保护作用,可能是与GDNF提高了NSCs在脑内的神经元分化,增强了NSCs对胶质界膜及神经纤维修复有关。     

Decreased hyperintense vessels on FLAIR images after endovascular recanalization of symptomatic internal carotid artery occlusion

Background and purpose

Hyperintense vessels (HV) on fluid-attenuated inversion recovery (FLAIR) images were assumed to be explained by slow antegrade or retrograde leptomeningeal collateral flow related to extracranial or intracranial artery steno-occlusion. The aim of this study was to investigate the effect of recanalization after endovascular therapy of symptomatic internal carotid artery (ICA) occlusion on the presence of HV.

Methods

Eleven patients with symptomatic ICA occlusion were retrospectively enrolled. Changes in the HV on FLAIR images were examined in affected hemisphere of each patient after successful treatment with endovascular recanalization (angioplasty, n = 3; stent-assisted angioplasty, n = 8). The relationship between postoperative changes in the HV and Thrombolysis In Cerebral Ischemia (TICI) scale (I-III) was assessed.

Results

After operation, HV of the 11 affected hemispheres were showed to be decreased (n = 3) or disappeared (n = 8) in treated side. The median interval between pre- and postoperative MRI examinations was 97.0 h (range, from 69. to 48.7 h). Of the 8 patients with disappeared HV, 7 achieved high TICI grade flow (III) and 1 had relatively low TICI grade flow (IIc) in treated side. However, all the 3 patients with decreased HV were found to be relatively low TICI grade flow (IIc).

Conclusion

Our data indicate that endovascular recanalization of ICA occlusion was effective for decreasing HV. Postoperative decrease in HV can be considered as a marker for hemodynamic improvement.     

老年脑卒中患者的康复需求及影响因素研究

目的:了解老年脑卒中患者的康复需求,并分析其相关影响因素。方法:对我院门诊收治的100例老年脑卒中患者进行问卷调查,调查患者对健康教育、运动训练、吞咽训练等方面的康复需求。根据调查结果,将其分为需求组和无需求组,采用单因素和多因素Logistic回归分析影响康复需求的相关因素。结果:研究对象对健康教育、运动训练、吞咽训练、针灸按摩、康复支具、心理干预、日常生活能力训练等7个方面的康复需求评分为(3. 07±0. 58)分、(3. 25±0. 67)分、(3. 12±0. 61)分、(2. 98±0. 54)分、(2. 76±0. 51)分、(2. 93±0. 56)分、(3. 02±0. 59)分。以运动训练康复需求得分最高。多因素Logistic回归分析显示,年龄、文化程度、家庭月收入、病程、神经功能缺损评分、日常生活能力评分、残疾程度是影响老年脑卒中患者康复需求的因素(P 0. 05)。结论:老年脑卒中患者的康复需求存在差异,年龄、文化程度、经济状况、病程、神经功能和日常生活能力、残疾程度等为其影响因素。     

基于冲脉理论针刺治疗联合康复训练在脑卒中患者吞咽功能障碍中的临床研究

目的 探讨基于冲脉理论针刺治疗联合康复训练在脑卒中患者吞咽功能障碍中的应用价值。方法 选取2017年5月-2019年5月期间因脑卒中后吞咽功能障碍在解放军联勤保障部队桂林康复疗养中心进行救治的80例患者作为研究对象,按就诊顺序单双号分为观察组（n=40,基于冲脉理论针刺联合康复训练）和对照组（n=40,常规针刺联合康复训练）。比较两组患者疗效、治疗前后吞咽功能量表（SSA）评分和电视透视吞咽功能（VFSS）评分。结果 治疗后,观察组SSA评分（22.10±7.21）和VFSS评分（8.93±1.88）均显著优于对照组（26.08±8.11）分和（5.46±2.12）分,（均P<0.05）,观察组治疗总有效率97.50%显著高于对照组82.50%（P<0.05）。结论 基于冲脉理论针刺治疗联合康复训练对脑卒中患者吞咽功能障碍有积极的影响,可改善吞咽功能,提高治疗效果,值得推广应用。     

Stroke surveillance: population-based estimates and projections for New Zealand

OBJECTIVE: To estimate the incidence, prevalence and mortality of stroke in New Zealand (NZ) in 2001, projected to 2011. METHODS: Multistate lifetable models were constructed using smoothed rates of first-ever stroke incidence and relative risks of mortality estimated from the most recent Auckland Regional Community Stroke (ARCOS) Study. Estimates of the burden of stroke in NZ were calculated by applying rates output by the model to the 2001 population. Stroke incidence, prevalence and mortality were then projected to 2011, assuming similar trends in stroke incidence and case fatality to those estimated between the 1991/92 and 2002/03 studies. RESULTS: A total of 5,200 first-ever strokes were estimated to have occurred in NZ in 2001. Rates of stroke rose exponentially with increasing age and were 20% higher among males than females at most ages. Nevertheless, the lifetable risk of stroke was lower for males (16%) than females (18%). On average, males survived a year longer than females after a first-ever stroke (9.0 vs. 8.2 years). The incidence rates of first-ever stroke declined by approximately 1% per year between 1991 and 2003. The lifetable risk of stroke remained stable for females but increased for males (from 14% to 16%) over this period. Stroke prevalence also increased by approximately 1% per year, whereas stroke-related mortality fell by 4% per year. If these trends continue, approximately 6,000 first-ever strokes (2% annual increase), 45,000 stroke survivors (2% annual increase) and 2,000 stroke-related deaths (1% annual decline) are expected in 2011. CONCLUSION: Stroke mortality is falling faster than stroke incidence. This, together with population growth and ageing, will lead to a rising burden of stroke-related disability over the next decade.     

The prognostic impact of the stroke unit concept after transient ischemic attack

Background and purpose

Transient ischemic attack (TIA) is associated with high short-term risk of stroke, especially in the early phase following the event. Data about the impact of the early hospitalization in a stroke unit on patients with TIA are sparse. This study compares the prognostic impact of the stroke unit concept with conventional care on patients with TIA.

Methods

During a 30-month period (beginning April 2005), 878 patients (mean age, 70 ± 12 years; 44.3% female) with TIA admitted within 24 h of symptom onset were prospectively evaluated. The adjusted logistic regression analyses were used to estimate the odds ratio for the stroke risk during hospitalization and the 90-day mortality.

Results

Of 878 patients, 591 (67.3%) were treated in the stroke unit, and 287 (32.7%) underwent conventional care. Patients receiving stroke-unit care had significantly higher rates of cranial computed tomography (96.3% vs. 88.1%; P < .001) and brain-supplying artery ultrasound (97.1% vs. 91.3%; P < .001) investigations. The stroke risk during hospitalization was 1.7% in patients treated in stroke unit and 2.4% in patients received a conventional care. A relevant difference between the groups was not found (1.7% vs. 2.4%; P = .45). The 90-day mortality rate was 1.7% in the stroke unit group compared to 2.2% in the conventional care group (1.7% vs. 2.2%; P = .66). The adjusted logistic regression analyses revealed no difference in stroke rates (odds ratio, 0.68; 95% confidence interval, 0.24–1.9) and in the 90-day mortality (odds ratio, 0.63; 95% confidence interval, 0.2–1.96) between the stroke unit concept and conventional care.

Conclusion

The prognostic impact of the stroke unit care for patients with transient ischemic attack appears to be similar to that of the conventional care. Further randomized studies are needed to investigate the impact of stroke-unit care on patients with transient ischemic attack.     

缺血性卒中的病因学分型

缺血性卒中病因分型是流行病学调查、危险因素筛查、个体化治疗方案和预后措施制定的基础。TOAST、CCS和ASCO是目前比较公认的病因学分型方法。文章从诊断标准和临床应用的优缺点进行了综述。