缺血性卒中患者动脉狭窄分布及变化趋势

目的 探讨缺血性卒中狭窄的分布及变化趋势。方法 缺血性卒中患者230例行全脑血管造影,根据年龄分为＜60岁组（121例）和≥60岁组（109例）,比较不同组患者脑供血动脉狭窄程度的差异。结果 ≥60岁组颈动脉颅外段和后循环颅外段狭窄的比率较＜60岁组高（P＜0.01）;＜60岁组颅内动脉闭塞较≥60岁组多见（P＜0.01）,＜60岁组颅内动脉闭塞较同组颅外动脉闭塞多见（P＜0.01）。结论 不同年龄缺血性卒中患者狭窄血管的空间分布及变化趋势不同。     

鲁西南地区青年缺血性脑卒中脑血管狭窄分布特征

目的分析鲁西南地区青年缺血性脑卒中患者的脑血管狭窄分布特征。方法收集100例45岁以下青年卒中患者为青年组,>45岁100例中老年患者作为对照,所有患者均经神经影像学、颈部血管彩超、TCD等检查,并进行DSA检查,分析两者脑血管狭窄分布特征。结果青年组及中老年组脑血管狭窄发生率分别为85%及88%。青年组颅内动脉病变60例(70.6%),颅外动脉病变10例(11.8%),颅内外动脉同时受累15例(17.6%);中老年组颅内动脉病变35例(39.8%),颅外动脉病变40例(45.5%),颅内外动脉同时受累13例(14.7%)。青年组轻度狭窄60例(60%),中度狭窄30例(30%),重度狭窄或闭塞10例(10%),中老年组轻度狭窄20例(20%),中度狭窄35例(35%),重度狭窄或闭塞45例(45%)。结论颅内外脑供血动脉狭窄或闭塞是脑梗死最主要的发病原因之一,青年患者以颅内动脉病变多见,中老年患者以颅外动脉病变多见,中老年患者脑血管狭窄程度较青年组重。     

84例缺血性脑卒中患者的CTA结果分析

目的 研究缺血性卒中患者脑血管病变的严重程度、分布以及相关危险因素,为缺血性脑卒中的发病机制、临床诊断、治疗及预防提供可靠的依据.方法 对84例缺血性脑卒中患者的CTA(Computer Tomography angiograph)检查结果进行分析.结果 在84例缺血性脑卒中患者中,颅内动脉狭窄率高于颅外动脉狭窄率,颅内动脉斑块检出率明显多于颅外动脉斑块检出率,颈内动脉颅内段狭窄率(17.5％)大于颈内动脉颅外段(6.6％),两者存在明显差异(P＝0.001),颅内动脉中基底动脉的狭窄率最低(12.2％),大脑后动脉狭窄率最高(42％),两者存在明显差异(P＜0.000).此外,颅内血管发生钙化斑多于颅外动脉,其狭窄率也高于颅外动脉.结论 CTA在诊断和评估方面价值已经逐渐得到重视,对颅内动脉病变及其危险因素进行及时有效的干预,可使缺血性卒中患者的预后得到明显的改善.     

椎-基底动脉夹层致缺血性卒中31例临床分析

目的探讨椎-基底动脉夹层(Vertebrobasilar artery dissection,VBAD)所致缺血性卒中的临床、影像学特点、治疗方法及预后。方法回顾性分析31例VBAD所致缺血性卒中的患者的临床资料。结果短暂性脑缺血发作3例,脑梗死28例,颅内组25例,颅外组6例。28例后循环脑梗死机制比较,血栓栓塞致脑梗死颅内组(0例)和颅外组(3例)比较差异具有统计学意义(P0.05);保守治疗17例,均予抗血小板或抗凝治疗,颅内组抗凝治疗1例,抗血小板聚集治疗12例,颅外组抗凝治疗4例,抗血小板治疗0例,颅内组、颅外组抗凝、抗血小板聚集治疗比较差异具有统计学意义(P0.05);影像学表现中,夹层动脉瘤16例,管壁增厚或双腔5例,狭窄型6例,闭塞型4例,颅外组和颅内组夹层影像学特征比较无统计学意义(P0.05)。结论颅内VBAD与颅外VBAD致缺血性卒中机制不同,颅外主要为栓塞性梗死,颅内主要为穿支闭塞性梗死。VBAD保守治疗中,颅内病变治疗以抗血小板聚集为主,颅外病变治疗以抗凝治疗为主。积极治疗能改善VBAD致脑梗死神经缺损症状。     

急性缺血性脑卒中动脉通畅性恶化的相关因素及预后

目的探讨急性缺血性脑卒中(AIS)动脉通畅性恶化(APD)的相关因素及预后。方法收集778例AIS患者的临床资料。根据是否发生APD将患者分为APD组及非APD组。于入院时和入院24 h对患者进行头颅MRI检查。采用NIHSS评分评价入院24 h神经功能,记录入院48 h的早期缺血性卒中复发率;于3个月和12个月采用mRS评分评估预后;记录第7 d、3个月、12个月的死亡率。结果与非APD组比较,APD组年龄、3个月mRS评分及高血压病史、入院前使用降压药、入院前使用降脂药、脑白质疏松的比率显著降低,入院及24 h NIHSS评分、12个月mRS评分及意识水平下降、颅内动脉狭窄、颅外动脉狭窄和侧支循环状态良好的比率显著升高(均P0.05)。两组间TOAST分型的其他明确病因型卒中(SOE)及不明病因型卒中(SUE)差异有统计学意义(P=0.000,P=0.028)。Logistic回归分析显示,高血压病史(OR=0.46,95%CI:0.30～0.85,P=0.002)、入院NIHSS评分(OR=1.06,95%CI:1.03～1.11,P0.001)、颅内动脉狭窄(OR=4.87,95%CI:3.02～15.21,P0.001)、颅外动脉狭窄(OR=3.61,95%CI:1.59～6.37,P=0.011)和侧支循环状态良好(OR=3.17,95%CI:1.45～9.85,P=0.002)是APD的独立相关因素。与非APD组比较,APD组早期神经功能恶化、早期卒中复发比率显著升高(均P0.001),第7 d、3个月、12个月的死亡率及3个月、12个月的预后不良率显著升高(均P0.05)。结论入院NIHSS评分、颅内和颅外动脉狭窄及侧支循环状态良好与入院24 h APD独立相关,高血压病史具有保护作用。APD早期及长期预后均不佳。     

缺血性脑血管病患者颅外动脉狭窄与肾动脉狭窄的关系

目的 探讨缺血性脑血管病(ICVD)患者颅外动脉狭窄与肾动脉狭窄(RAS)的关系.方法 对310例ICVD患者行全脑数字减影血管造影(DSA)及肾动脉造影检查,分析颅外动脉狭窄程度及数量与RAS率的关系.结果 颅外动脉重度狭窄及闭塞组的RAS率显著高于轻、中度狭窄组及无狭窄组(均P＜0.01);2支及≥3支颅外动脉狭窄患者的RAS率显著高于无狭窄及1支血管狭窄的患者(P ＜0.05 ～0.01).重度颅外动脉狭窄及闭塞、2支、≥3支颅外动脉狭窄是RAS的危险因素(OR=3.025,OR=3.343,OR=5.733;均P＜0.01).结论 重度颅外动脉狭窄及闭塞、≥2支颅外动脉狭窄是ICVD患者RAS的危险因素.     

炎症对颅内外动脉重度狭窄或闭塞影响的临床研究

目的筛查颅内外动脉重度狭窄或闭塞的危险因素,探讨炎症对颅内外动脉狭窄或闭塞部位的影响。方法纳入2018年9月至2019年4月诊断与治疗的100例大动脉粥样硬化型急性缺血性卒中病例,测定血清超敏C-反应蛋白(hs-CRP)水平,参照北美症状性颈动脉内膜切除术试验标准判断颅内外动脉狭窄程度并分为重度狭窄/闭塞组或对照组以及不同亚组;单因素和多因素后退法Logistic回归分析筛查颅内外动脉重度狭窄或闭塞的危险因素。结果 Logistic回归分析显示,糖尿病(OR=11.092,95%CI:2.288～53.774;P=0.003)和血清hs-CRP(OR=1.553,95%CI:1.184～2.036;P=0.001)是急性缺血性卒中患者颅内外动脉重度狭窄或闭塞的危险因素。亚组分析显示,颅内动脉病变(49例)、颅外动脉病变(11例)与颅内合并颅外动脉病变(12例;H=0.652,P=0.722),前循环病变(37例)、后循环病变(18例)与前循环合并后循环病变(17例;H=0.283,P=0.868),单支血管病变(41例)与多支血管病变(31例;Z=-0.530,P=0.596)各亚组患者血清hs-CRP水平差异均无统计学意义,不同责任血管病变亚组(大脑中动脉、大脑前动脉、大脑后动脉、基底动脉、椎动脉颅内段、颈内动脉颅内段、颈动脉颅外段、椎动脉颅外段、锁骨下动脉)患者血清hs-CRP水平升高比例差异亦无统计学意义(χ~2=2.628,P=0.917)。结论血清hs-CRP可以作为颅内外动脉重度狭窄或闭塞的炎性预测因子。但炎症对颅内外动脉狭窄或闭塞部位和病变数目无明显影响,对不同血管的作用机制可能相似。     

缺血性卒中患者颅内外动脉狭窄与高血压、糖尿病的研究

目的 探讨缺血性卒中患者的颅内外动脉狭窄特点及程度与高血压病、糖尿病的病史及控制水平的 关系。 方法 回顾性分析住院治疗的存在颅内外动脉狭窄且并发高血压或糖尿病的大动脉粥样硬化性急 性缺血性卒中患者资料。将高血压患者分为高年限组（病史>5年）和低年限组（病史≤5年）,血压 控制良好组和不良组;将糖尿病患者也分为高年限组（病史>5年）和低年限组（病史≤5年）,血糖 控制良好组和不良组。比较不同组间颅内外动脉狭窄分布情况、血管狭窄程度。 结果 共入组216例急性缺血性卒中患者,其中57例颅外动脉狭窄,105例颅内动脉狭窄,54例颅内 外动脉均狭窄。轻度狭窄发生73例,中度狭窄发生101例,重度狭窄及闭塞发生42例。高血压病患者 共140例,高年限组动脉狭窄最常见于颅内动脉（54.5%）,低年限组血管狭窄的部位多见于颅外动脉 （51.3%）,差异有统计学意义（P＜0.001）。两组间动脉狭窄程度差异也有统计学意义。糖尿病患者共 76例,高年限组发生动脉狭窄最常见于颅内动脉（72.2%）,低年限组血管狭窄的部位多见于颅外动脉 （65%）,差异有统计学意义,两组间动脉狭窄程度差异也有统计学意义。高血压控制不良组发生重度 狭窄或闭塞的概率高于血压控制良好组（20.7% vs 8.6%）;血糖控制情况不良组发生重度狭窄或闭 塞的概率高于血糖控制良好组（40.9% vs 6.3%）。 结论 随着高血压病年限的增长,急性缺血性卒中患者颅内动脉狭窄的发生率增高,其中以中度狭 窄程度多见;血压控制不良的患者发生重度狭窄或闭塞的比率高。随着糖尿病年限的增长,颅内动 脉狭窄的发生率增高,其中以中度狭窄程度多见,血糖控制不良者发生重度狭窄或闭塞的比例高。     

血清CysC对缺血性卒中患者颅内外动脉粥样硬化性病变的影响

目的探讨血清胱抑素C(CysC)与缺血性卒中患者颅内外动脉粥样硬化性病变的关系。方法选取2013-03—2014-09于我院住院治疗的缺血性卒中患者130例,均行头颅高分辨CT血管造影(CTA)、胱抑素C和常规生化检查。根据血管病变程度、部位及斑块性质进行分组,分别比较各组间血清CysC水平。根据血清CysC水平分为血清CysC正常组和高血清CysC组,将2组间颅内外动脉发生狭窄的例数进行比较。结果颅内外动脉狭窄组血清CysC水平显著高于无颅内外动脉狭窄组(P<0.05);与重度狭窄及闭塞组相比较,轻度狭窄组及中度狭窄组CysC水平较低,差异有统计学意义(P<0.05);与无斑块组相比,稳定斑块及不稳定斑块组的血清CysC值显著升高(P<0.05)。与CysC正常组相比,高CysC组中颅内外动脉狭窄率为87.18%,较正常CysC组(57.14%)显著升高(P<0.05)。Logistis多元回归分析显示,CysC水平升高是颅内外动脉粥样硬化性病变的独立危险因素。结论血清CysC水平升高与颅内外动脉粥样硬化的严重程度密切相关,是颅内外动脉粥样硬化性病变的独立危险因素。     

中青年与老年脑梗死患者脑动脉狭窄分布的DSA分析

目的应用数字减影血管造影对中青年与老年脑梗死患者脑动脉狭窄的分布特征进行分析。方法选择脑梗死患者86例,根据患者年龄分为中青年组（年龄〈60岁）48例,老年组（年龄≥60岁）患者38例,应用数字减影血管造影技术（DSA）对患者脑动脉病变血管狭窄程度及分布进行分析。结果 1老年组患者在颅外动脉病变以及前循环狭窄发生率明显高于中青年组（P〈0.05）,而颅内动脉病变以及后循环狭窄发生率却明显低于中青年组（P〈0.05或P〈0.01）,在脑血管病变及颅内外动脉同时受累发生率上,两组差异无统计学意义（P〉0.05）;2中青年组最常见为重度狭窄,发生率高于轻度及中度狭窄（P〈0.05）,好发部位为椎动脉开口处,发生率高于颈内动脉起始段及大脑中动脉MI段（P〈0.05）;老年组最常见为重度狭窄（P〈0.05）,好发部位为椎动脉开口处及颈内动脉起始段,发生率高于大脑中动脉MI段（P〈0.05）。结论中青年患者最常受累血管为颅内血管,病变发生部位多以椎动脉起始处居多;老年患者最常受累血管为颅外血管,最常受累血管为椎动脉起始处及颈内动脉。     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Satellite cells and myonuclei in young and elderly women and men

The overall aim of this study was to assess the effects of aging on the satellite cell population. Muscle biopsies were taken from the tibialis anterior muscle of healthy, moderately active young (age range, 20-32 years; n = 31) and elderly (age range, 70-83 years; n = 27) women and men with comparable physical activity pattern. Satellite cells and myonuclei were visualized using a monoclonal antibody against neural cell adhesion molecule and counterstained with Mayer's hematoxylin. An average of 211 (range, 192-241) muscle fibers were examined for each individual. Compared with the young women and men, the elderly subjects had a significantly lower (P < 0.011) number of satellite cells per muscle fiber but a significantly higher (P < 0.004) number of myonuclei per muscle fiber. The number of satellite cells relative to the total number of nuclei [satellite cells/(myonuclei + satellite cells)] was significantly lower in the elderly than in the young women and men. These results imply that a reduction in the satellite cell population occurs as a result of increasing age in healthy men and women.     

Opiate and digitalis receptor assays distinguish between neuroexcitant and inactive organochlorines and between anesthetics and convulsants

Specific binding of [3H]naloxone to rat brain tissue in vitro was inhibited by the excitant organochlorinated insecticides (OCI), by ether (E) and octanol (OCT), and by the convulsant indoklon (IND) and its anesthetic isomer, isoindoklon (ISO). In the presence of 100 mM NaCl the inhibition of naloxone binding by E, OCT and ISO was greatly potentiated, whereas that by OCI and IND was attenuated. KCl (100 mM) was equally effective as NaCl on the action of anesthetics, but the effect of the excitant drugs was, in contrast to NaCl, unaffected by KCl. Specific binding of [3H]ouabain in the absence of Na, was depressed by anesthetics and enhanced by neuroexcitants. In the presence of NaCl, which by itself inhibits ouabain binding to brain, both anesthetics and excitants enhanced ouabain binding. DDE, a non-insecticidal analog of DDT, and the dimethyl derivative of the OCI, lindane, were inactive in the receptor assays. These observations point to a unique isolated system which responds consistently to anesthetic agents as a class and, in a different way, to neuroexcitant compounds.     

Learning and forgetting new names and objects in MCI and AD

We studied how subjects with mild cognitive impairment (MCI), early Alzheimer's disease (AD) and age-matched controls learned and maintained the names of unfamiliar objects that were trained with or without semantic support (object definitions). Naming performance, phonological cueing, incidental learning of the definitions and recognition of the objects were tested during follow-up. We found that word learning was significantly impaired in MCI and AD patients, whereas forgetting patterns were similar across groups. Semantic support showed a beneficial effect on object name retrieval in the MCI group 8 weeks after training, suggesting that the MCI patients’ preserved semantic memory can compensate for impaired episodic memory. The MCI group performed equally well as the controls in the tasks measuring incidental learning and recognition memory, whereas the AD group showed impairment in this respect. Both the MCI and the AD group benefited less from phonological cueing than the controls. Our findings indicate that word learning is compromised in both MCI and AD, whereas long-term retention of newly learned words is not affected to the same extent. Incidental learning and recognition memory seem to be well preserved in MCI.     

Necdin蛋白与神经元的生长分化

在神经系统 ,Necdin只在成熟神经元的细胞核中表达 ,可能与成熟神经元分裂静止状态的保持有关。近年的研究表明 ,Necdin是一种生长抑制蛋白 ,能与多种因子如SV4 0大T抗原 ,腺病毒E1A ,转录因子E2F1以及肿瘤抑制蛋白p5 3等结合 ,在功能上类似于成视网膜瘤蛋白Rb。necdin基因缺陷时 ,会引起脑内 ,特别是下丘脑神经元分化障碍。人类necdin基因位于PWS综合征的基因缺失区 ,可能与PWS的一些症状有关。本文从Necdin蛋白的基本概况 ,生物功能以及Necdin与疾病三个方面进行了综述     

Dissociation and Counterdissociation: Nuanced and Binary Perceptions of Good and Evil

Dissociated experiences are often communicated to analysts. Clinicians may absorb patients' dissociation, thereby creating “counterdissociated” states. Counterdissociation contributes to binary thinking in the analyst similar to black- and-white thinking commonly seen in patients' dissociated states. This can have both positive and negative effects: Counterdissociation may help therapists identify with patients' experience, thereby cementing the therapeutic bond. If analysts remain counterdissociated, however, patients may remain dissociated. As analysts identify their counterdissociation, they may gain insight into patients' needs for dissociation. As they overcome counterdissociation, patients may concurrently overcome dissociation. This allows both to have a more nuanced view of inner experience. With two extended case studies of sexually abused men, this article tracks how an analyst deals with counterdissociation created through intimate contact with dissociated positive and negative introjects of victimizers, thus forming identifications or overidentifications with the patients' abused parts.     

Oxytocin and vasopressin agonists and antagonists as research tools and potential therapeutics

We recently reviewed the status of peptide and nonpeptide agonists and antagonists for the V(1a), V(1b) and V(2) receptors for arginine vasopressin (AVP) and the oxytocin receptor for oxytocin (OT). In the present review, we update the status of peptides and nonpeptides as: (i) research tools and (ii) therapeutic agents. We also present our recent findings on the design of fluorescent ligands for V(1b) receptor localisation and for OT receptor dimerisation. We note the exciting discoveries regarding two novel naturally occurring analogues of OT. Recent reports of a selective VP V(1a) agonist and a selective OT agonist point to the continued therapeutic potential of peptides in this field. To date, only two nonpeptides, the V(2) /V(1a) antagonist, conivaptan and the V(2) antagonist tolvaptan have received Food and Drug Administration approval for clinical use. The development of nonpeptide AVP V(1a), V(1b) and V(2) antagonists and OT agonists and antagonists has recently been abandoned by Merck, Sanofi and Pfizer. A promising OT antagonist, Retosiban, developed at Glaxo SmithKline is currently in a Phase II clinical trial for the prevention of premature labour. A number of the nonpeptide ligands that were not successful in clinical trials are proving to be valuable as research tools. Peptide agonists and antagonists continue to be very widely used as research tools in this field. In this regard, we present receptor data on some of the most widely used peptide and nonpeptide ligands, as a guide for their use, especially with regard to receptor selectivity and species differences.     

Hemodynamic and serum cardiac markers and risk of cognitive impairment and dementia

Introduction

Cardiac function is a key player in maintaining energy homeostasis in the brain. Heart failure is closely related to higher risk of neurocognitive disorders. Recent evidence shows that this relationship might not be limited to patients with advanced heart failure, and even suboptimal cardiac functioning is associated with accelerated brain aging. Hence, hemodynamic and serum cardiac markers may provide valuable information about the risk of dementia.

Necdin蛋白与神经元的生长分化

在神经系统,Necdin只在成熟神经元的细胞核中表达,可能与成熟神经元分裂静止状态的保持有关.近年的研究表明,Necdin是一种生长抑制蛋白,能与多种因子如SV40大T抗原,腺病毒E1A,转录因子E2F1以及肿瘤抑制蛋白p53等结合,在功能上类似于成视网膜瘤蛋白Rb.necdin基因缺陷时,会引起脑内,特别是下丘脑神经元分化障碍.人类necdin基因位于PWS综合征的基因缺失区,可能与PWS的一些症状有关.本文从Necdin蛋白的基本概况,生物功能以及Necdin与疾病三个方面进行了综述.