关于发展中医特色的卒中单元的思考

阐述目前中风治疗的概况，介绍国外卒中单元（stroke unit,SU)在中风病人急救和康复治疗中的重要作用和SU的特色、优势及临床实践模式，分析了我国发挥中医优势、建立中西医结合SU的可能性及必要性。     

脑醒冲剂治疗急性缺血性中风的临床研究

[目的]探讨脑醒冲剂（活血开窍方）治疗急性缺血性中风（AIS）的临床疗效及其药理作用机制。[方法]采用随机对照单盲观察法将200例AIS患者分为2组,其中脑醒冲剂组（治疗组）150例,屁莫通组（对照组）50例。观察脑醒冲剂的临床疗效及其对自由基、血栓素A2（TXA2）与前列环素（PGI2）比值的影响。[结果]治疗组和对照组总有效率分别为91.3%和76.0%,显效率分别为62.0%和46.0%,两组比较差异均有显著性意义（P＜0.01或P＜0.05）。实验指标检测结果显示脑醒冲剂能降低患者血浆脂质过氧化物（LPO）含量,提高超氧化物歧化酶（SOD）、谷光苷肽过氧化物酶（GSH－Px）活性;抑制TXA2生成,促进PGI2合成。[结论]脑醒冲剂治疗急性缺血性中风疗效优于尼莫通;并显示该方能促进自由基清除,减轻自由基损伤,保护脑细胞;能纠正TXA2／PGI2失衡,对抗血栓形成,缓解脑缺血。     

Efficacy Of Balneotherapy For Rheumatoid Arthritis: A Meta-analysis

Abstract

Balneotherapy is an accepted therapeutic approach in Europe. However, its efficacy for treating rheumatoid arthritis (RA) remains controversial in North America. This is a meta-analysis of randomized (RCT ) and controlled clinical trials (CCT ), case-control and cohort studies of balneotherapy compared to control (no treatment) or active therapy (head to head studies). All the included studies (n =7) in this review were identified as RCTs. This meta-analysis examines different balneotherapy modalities: Radon-carbon dioxide baths, mud packs, hot sulphur baths, Dead Sea baths, Red Sea baths, and grey sand. Several types of balneotherapy, including radon-carbon dioxide baths, mud packs, hot sulphur baths, combination of hot sulphur baths and mud packs, Dead Sea baths, combination of Dead Sea baths and sulphur baths, and Grey sand and Red Sea baths compared to control were found to be beneficial for RA. These modalities were found to be especially beneficial for pain, grip strength, tender/swollen joints, patient and physician, and global function. These improvements ranged from 5-93% greater improvement relative to the control group. However, methodological considerations including the poor quality of trials impact the conclusions of this review.     

The effects of vestibular stimulaton on hemineglect: implications for rehabilitation

Abstract

Hemineglect poses a significant impediment to functional rehabilitation post brain injury. Caloric stimulation, a form of vestibular stimulation, has been shown to improve neglect. The purpose of this paper is to review the neglect phenomenon, to examine the literature on the effects of vestibular stimulation on hemineglect, and to outline possible treatment strategies for the management of neglect. Of the various models, the majority of the literature supports the theory that neglect is a representational deficit. Manifestations of neglect are affected by vestibular stimulation. All examined studies demonstrated a transient reduction in left neglect following caloric stimulation. This indicates that vestibular stimulation may become a powerful tool in the treatment of patients with hemineglect. The potential of other forms of stimulation are also explored. Based on the results of this review, it is recommended that further studies be conducted to determine the most practical and effective application of vestibular stimulation.     

安脑丸对心肝火旺型中风先兆证患者继发中风的预防效果观察

目的观察安脑丸对心肝火旺型中风先兆证患者继发中风的预防效果。方法选择我院中医门诊2008年1月—2012年10月收治的心肝火旺型中风先兆证患者61例,随机分为预防组31例和对照组30例。两组患者均给予血脂康胶囊口服,2粒/次,2次/d,预防组患者加用安脑丸,3 g/次,2次/d;两组患者均连续治疗8周,之后均单纯口服血脂康胶囊40个月。观察两组患者继发中风发病情况,治疗前后颈总动脉内膜中层厚度(IMT)、易损斑块横截面积(VPA),中医症状积分(SS),血清三酰甘油(TG)、总胆固醇(TC)水平。结果对两组患者随访42个月,预防组继发中风发生率为9.7%,低于对照组的26.7%(P0.05)。两组患者治疗前颈总动脉IMT、VPA,SS,血清TG、TC水平及治疗后血清TG、TC水平比较,差异均无统计学意义(P0.05);预防组患者治疗后颈总动脉IMT、VPA,SS均小于对照组(P0.05)。结论安脑丸可有效降低心肝火旺型中风先兆证患者继发中风发生率,减少颈总动脉IMT,缩小颈总动脉VPA,改善患者临床症状,但其无降脂效果,在应用时需配合使用降脂药物。     

Hospitalized osteoporotic vertebral fracture increases the risk of stroke: A population‐based cohort study

The association between osteoporosis and cardiovascular diseases has been demonstrated. Higher cardiovascular risk has also been correlated with vertebral fractures. However, the association between osteoporotic vertebral fracture and the possibly higher risk of stroke remains uncertain. This study aimed to evaluate the incidence, risk, and type of stroke in patients with osteoporotic vertebral fracture. Patients with osteoporotic vertebral fracture were identified (n = 380) and 10 age‐ and sex‐matched controls per case (comparison group, n = 3795) were chosen from a nationwide representative cohort of 999,997 people from 1998 to 2005. Both groups were followed‐up for stroke events for 3 years, matched by propensity scores with adjustments for covariates such as comorbidities (ie, hypertension, diabetes, arrhythmia, or coronary heart diseases) and exposure to medications (ie, aspirin, lipid lowering drug, or nitrates), and assessed by Kaplan‐Meier and Cox regression analyses. The incidence rate of stroke in the osteoporotic vertebral fracture group (37.5 per 1000 person‐years; 95% confidence interval [CI], 27.5–51.2) was significantly higher than in the comparison group (14.0 per 1000 person‐years; 95% CI, 12.0–16.4, p < 0.001). Stroke was more likely to occur in the osteoporotic vertebral fracture patients than in the normal controls (crude hazard ratio [HR] 2.68, 95% CI 1.89–3.79, p < 0.001; adjusted HR 2.71, 95% CI 1.90–3.86, p < 0.001). In conclusion, patients with osteoporotic vertebral fracture have a higher risk of stroke (ie, both ischemic and hemorrhagic) and require stroke prevention strategies. © 2013 American Society for Bone and Mineral Research.     

Cortical stimulation improves skilled forelimb use following a focal ischemic infarct in the rat

Abstract

Improving functional recovery following cerebral strokes in humans will likely involve augmenting brain plasticity. This study examined skilled forelimb behavior, neocortical evoked potentials, and movement thresholds to assess cortical electrical stimulation concurrent with rehabilitative forelimb usage following a focal ischemic insult. Adult rats were trained on a task that required skilled usage of both forelimbs. They then underwent an acute focal ischemic insult to the caudal forelimb area of sensorimotor cortex contralateral to their preferred forelimb. During the same procedure, they also received a stimulation electrode over the infarct area and two depth electrodes anterior to the lesion to record evoked potentials. One week following the surgery, rats received cortical stimulation during performance of the skilled task. Evoked potentials and movement thresholds were also determined. Functional assessment revealed that cortical stimulation resulted in superior performance compared to the no stimulation group, and this was initially due to a shift in forelimb preference. Cortical stimulation also resulted in enhanced evoked potentials and a reduction in the amount of current required to elicit a movement, in a stimulation frequency dependent manner. This study suggests that cortical stimulation, concurrent with rehabilitative training, results in better forelimb usage that may be due to augmented synaptic plasticity.     

Common genetic coagulation variants are not associated with ischemic stroke in a case-control study

Abstract

Objective: Abnormalities in the coagulation pathway are often included in the diagnostic work-up of stroke patients, especially in young adults with cryptogenic stroke.

Methods: Three common genetic variants within the coagulation cascade were investigated in 500 control subjects and in 167 patients with ischemic stroke defined by TOAST subclassification. Analysed variants were factor V Leiden, prothrombin 20210G→A and factor XIII Val34Leu.

Results: The factor V Leiden mutation was over-represented in patients with cardioembolic stroke for trend, whereas the prothrombin 20210G→A variant and the factor XIII polymorphism Val34Leu were not associated with stroke of any subtype. The three polymorphisms showed no association with stroke in subgroups of patients defined by age (<40, 40–49, 50–59, ≥60 years).

Discussion: This study suggests that the analysis of prothrombin 20210G→A and factor XIII Val34Leu is not a useful diagnostic procedure in the work-up of ischemic stroke.     

Outcome of extracranial cervicocephalic arterial dissections: A follow-up study

Abstract

Cervicocephalic arterial dissections (CCAD) are an increasingly recognized cause of ischemic stroke in young adults. Various treatments have been suggested but no controlled trial has ever been performed. Medical treatment has included anticoagulant or platelet antiaggregant therapy. Surgical correction has been proposed for selected patients who have failed medical therapy. Percutaneous balloon angioplasty and stenting have been increasingly used in some patients, although long-term results are unknown. The objective of the study was to review our recent experience with the management and outcome of extracranial CCAD. We identified 27 patients with extracranial CCAD who were evaluated, treated and/or followed by our Stroke Service from September 1995 to August 2001. Clinical presentation, diagnostic evaluation, management, and outcome were reviewed. There were 15 men (56%) and 12 women (44%) with mean ages of 38 and 43 years respectively. Diagnosis was made by cerebral angiography in 15 (56%) patients and by MRI/ MRA only in 12 (44%) patients. Twenty-two patients had spontaneous and five had traumatic extracranial CCAD. Most common associated disorders were arterial hypertension (37%) and migraine (26%). One patient presented only with a painful post-ganglionic Horner syndrome, another patient with neck pain and post-ganglionic Horner syndrome, another patient solely with protracted unilateral headaches, three with transient ischemic attacks (TIA), and 21 with ischemic strokes. The internal carotid artery (ICA) was the most frequently involved vessel (63%), followed by the vertebral artery (30%), and multivessel involvement in two patients (7%). Eighteen patients received anticoagulant therapy and nine platelet anti-aggregants. Follow-up extended from 2 to 115 months, with a mean of 58 months. At the end of follow-up, 23 (85%) patients had either no disability or only minor sequelae (modified Rankin score: 0 to 1), and four (15%) patients had moderate limitations (modified Rankin score: 2 to 3). Two patients had a recurrent ischemic stroke, one unrelated to recurrent CCAD, and the other following percutaneous balloon angioplasty/stenting for treatment of a persistent vertebral artery pseudoaneurysm. Most CCAD involved the extracranial ICA. The clinical presentation is variable, most patients having an ischemic stroke or TIAs. The short- and long-term outcome are usually favorable with either anticoagulant or platelet antiaggregant therapy. A medical initial approach to the management of extracranial CCAD is recommended for most patients. [Neurol Res 2002; 24: 395-398]     

Preparation of Gelatin Microspheres Encapsulated with bFGF for Therapeutic Angiogenesis in a Canine Ischemic Hind Limb

There is urgent need for the treatment of limb ischemia. In order to avoid the risk of genetic materials or injury in collection of implanted cells, a basic fibroblast growth factor (bFGF) sustained release system using cross-linked gelatin microspheres was developed for therapeutic angiogenesis. In this study, gelatin microspheres (MSs) and the complex of MSs and bFGF (MSs–bFGF) were prepared. MSs and MSs–bFGF were analyzed for morphology, particle size, in vitro bFGF release and the bioactivity of the released medium. MSs–bFGF was intramuscularly implanted into the ischemic hind limb of a dog and free bFGF, empty MSs and untreated animals were used as controls. Histological examination was performed for angiogenesis evaluation. After immersion in an aqueous solution, the un-cross-linked MSs became deformed and adhered together. The cross-linked MSs showed a more stable character both in vivo and in vitro. The bFGF released from MSs remained bioactive. The histological examination indicated that the densities of micro-vessels in the MSs–bFGF-treated hind limb muscle were significantly greater than that in the untreated control, free bFGF and empty MSs groups. The MSs–bFGF sustained release system was a simple, safe and effective way to achieve therapeutic angiogenesis in an ischemic limb.