中成药天智颗粒对血管性痴呆大鼠脑内神经细胞增殖的影响

目的观察中成药天智颗粒对血管性痴呆大鼠学习记忆能力和神经前体细胞与星形胶质细胞增殖水平的影响。方法老年雄性SD大鼠192只,随机分为治疗组、模型组、假手术组和正常对照组,每组48只。治疗组、模型组采用双侧颈总动脉结扎方法建立血管性痴呆大鼠模型,于造模60d后治疗组大鼠应用天智颗粒5g/(kg·d)治疗30d。采用三等分Y型电迷宫测试各组大鼠的学习记忆能力,应用免疫组织化学尿嘧啶脱氧核苷(BrdU)和胶质纤维酸性蛋白(GFAP)染色方法标记并观察神经细胞增殖变化,以比较各组大鼠学习记忆能力和神经细胞增殖的变化规律和差异。结果与正常对照组相比,假手术组大鼠的学习记忆能力和免疫组织化学检测结果无明显变化。经天智颗粒治疗30d后,治疗组大鼠学习记忆能力明显改善,与模型组相比差异有统计学意义(P<0.05),BrdU阳性细胞显著增加(P<0.05),而星形胶质细胞明显减少(P<0.05);但与正常对照组相比,其学习记忆能力、BrdU阳性细胞和星形胶质细胞数量仍未恢复至正常水平(P<0.05)。结论天智颗粒可通过促进神经前体细胞的增殖而抑制星形胶质细胞的增殖,从而改善血管性痴呆大鼠的学习记忆能力。     

中成药退药现象分析及探讨

通过对中成药退药处方共计1 296张,按退药原因进行统计,结果退药原因主要集中在不良反应、病人拒服或不要、医生开错、重复开方、禁忌症等11大类,具有一定的规律性。认为提高门诊诊疗质量,加强医患沟通,增强医务人员的责任心和业务技能,重视药物的不良反应及禁忌,可有效减少门诊退药情况,减少医患矛盾,更好地进行合理用药。     

通心络胶囊治疗短暂性脑缺血发作临床观察

目的：观察通心络胶囊治疗短暂性脑缺血发作（ TIA）的临床疗效。方法将72例TIA患者随机分为2组,对照组36例予曲克芦丁片治疗,治疗组36例予通心络胶囊治疗。比较2组治疗前后血脂指标变化,左侧椎动脉、右侧椎动脉和基底动脉血流速度变化。结果治疗组治疗后血脂指标,左侧椎动脉、右侧椎动脉及基底动脉血流速度均较本组治疗前改善（P ＜0．05）,且2组组间比较差异均有统计学意义（P ＜0．05）,治疗组改善优于对照组。结论通心络胶囊可调节 TIA 患者血脂,改善血液流速,降低患者发展为脑梗死的风险。     

新生儿动脉导管未闭10795例筛查和随访分析

目的探讨新生儿动脉导管未闭(patent ductus arteriosus,PDA)的发病率及其自然病程。方法对2006年7月至2009年6月在佛山市妇幼保健院出生2～4 d的10 795例新生儿采用彩色多普勒超声心动图进行PDA筛查,并对诊断为PDA的患儿于出院后3、6、9个月定期进行超声心动图跟踪观察。结果 10 795例新生儿中,筛查出PDA 1 367例,发病率为12.66%。PDA患儿于生后3、6、9个月的自发性闭合率分别为82.1%,94.7%和97.1%。结论绝大多数新生儿PDA能于3个月内自愈。新生儿PDA可不必急于治疗,但应加强随访观察。     

Left atrial disc device thrombosis after atrial defect closure with the Gore® Cardioform septal occluder: A case series

Device thromboses after patent foramen ovale (PFO) and atrial septal defect (ASD) closure are rare but serious complications. They have been reported in different devices of virtually all manufacturers. Here, we report three cases of left atrial device thrombosis after atrial defect closure with the Gore® Cardioform septal occluder (GSO) in our recent institutional experience. All patients were symptomatic with new-onset neurological impairments and evidence of cerebral thromboembolism. Device thromboses have occurred despite antiplatelet therapy in two patients and moreover were observed late, at approximately 2 years after implantation, in two patients. One device was surgically explanted while in two cases, thrombi completely resolved with initiated anticoagulation. All patients had a favorable neurological recovery. Our observations suggest that regular follow-up echocardiography beyond 6 months after device implantation might be advisable in patients with GSO devices to rule out late device thromboses. More long-term follow-up data considering safety and late complications of contemporary PFO and ASD devices is required to establish confident evidence-based recommendations on long-term follow-up management and antithrombotic therapy regimen after PFO and ASD closure.     

Patent foramen ovale

Patent foramen ovale is incriminated in patients with cryptogenic stroke; however, concrete evidence that closure of patent foramen ovale using various devices is superior to continued medical therapy is not yet available. Controlled randomized trials are well underway to address this issue.     

Coronary Embolus: An Underappreciated Cause of Acute Coronary Syndromes

Coronary embolism is the underlying cause of 3% of acute coronary syndromes but is often not considered in the differential of acute coronary syndromes. It should be suspected in the case of high thrombus burden despite a relatively normal underlying vessel or recurrent coronary thrombus. Coronary embolism may be direct (from the aortic valve or left atrial appendage), paroxysmal (from the venous circulation through a patent foramen ovale), or iatrogenic (following cardiac intervention). Investigations include transesophageal echocardiography to assess the left atrial appendage and atrial septum and continuous electrocardiographic monitoring to assess for paroxysmal atrial fibrillation. The authors review the historic and contemporary published data about this important cause of acute coronary syndromes. The authors propose an investigation and management strategy for work-up and anticoagulation strategy for patients with suspected coronary embolism.