急性脑卒中患者医院感染分析

目的为探明急性脑卒中患者医院感染的特点及危险因素,以便采取有效控制措施。方法对温州医学院附属第一医院1997年1月1日～2002年12月31日6年间收治的4730例急性脑卒中患者进行监测。结果医院感染率为1252%。女性高于男性(P<005),感染率随年龄增大而升高(P<001)。医院感染多发生在入院2周内,感染部位以呼吸道为主(4796%),其次为泌尿道(3481%)。病原菌以G-菌为主(4309%),其次为G+菌(3091%)和真菌(2600%)。耐药菌株不断增加。结论免疫功能低下、侵袭性操作、滥用抗生素和激素是急性脑卒中患者医院感染的主要危险因素。加强对细菌耐药性的监测,合理选用抗生素,是减少或延缓耐药菌株产生的关键措施。     

缺血性中风患者脑血管支架植入最佳时机的分析

目的:探讨缺血性中风患者脑血管支架植入的最佳时机。方法:选取我院收治的缺血性脑血管疾病患者90例,依据发病时间分为三组并进行脑血管支架植入术。对比三组患者治疗前后脑血管血流速度、认知功能评分及血管内皮细胞生长因子(VEGE)、碱性成纤维细胞生长因子(b FGF)、神经生长因子(NGF)的含量变化。结果:1三组患者手术后的脑血管血流速度与手术前相比明显改善,差异有统计学意义(P0.05),但三组之间比较无明显差异(P0.05);2三组患者手术后的认知功能均较手术前有所改善,与A组和C组比较,B组认知功能评分明显升高,差异有统计学意义(P0.05),而A组和C组比较无明显差异(P0.05);3三组患者手术后的血清VEGE、b FGF、NGF含量均较手术前升高,且B组明显高于A组和C组,差异有统计学意义(P0.05),而A组和C组间比较无明显差异(P0.05)。结论:脑血管支架植入时机与缺血性中风患者的临床疗效及预后可能有一定相关性,发病后1个月为脑血管支架植入最佳时机。     

Mice lacking the β2 adrenergic receptor have a unique genetic profile before and after focal brain ischaemia

The role of the β2AR (β2 adrenergic receptor) after stroke is unclear as pharmacological manipulations of the β2AR have produced contradictory results. We previously showed that mice deficient in the β2AR (β2KO) had smaller infarcts compared with WT (wild-type) mice (FVB) after MCAO (middle cerebral artery occlusion), a model of stroke. To elucidate mechanisms of this neuroprotection, we evaluated changes in gene expression using microarrays comparing differences before and after MCAO, and differences between genotypes. Genes associated with inflammation and cell deaths were enriched after MCAO in both genotypes, and we identified several genes not previously shown to increase following ischaemia (Ccl9, Gem and Prg4). In addition to networks that were similar between genotypes, one network with a central core of GPCR (G-protein-coupled receptor) and including biological functions such as carbohydrate metabolism, small molecule biochemistry and inflammation was identified in FVB mice but not in β2KO mice. Analysis of differences between genotypes revealed 11 genes differentially expressed by genotype both before and after ischaemia. We demonstrate greater Glo1 protein levels and lower Pmaip/Noxa mRNA levels in β2KO mice in both sham and MCAO conditions. As both genes are implicated in NF-κB (nuclear factor κB) signalling, we measured p65 activity and TNFα (tumour necrosis factor α) levels 24 h after MCAO. MCAO-induced p65 activation and post-ischaemic TNFα production were both greater in FVB compared with β2KO mice. These results suggest that loss of β2AR signalling results in a neuroprotective phenotype in part due to decreased NF-κB signalling, decreased inflammation and decreased apoptotic signalling in the brain.     

老年H型高血压合并急性缺血性脑卒中患者血清omentin-1、Irisin水平与病情及预后的关系研究

目的:探讨老年H型高血压合并急性缺血性脑卒中患者血清网膜素-1(omentin-1)、鸢尾素(Irisin)水平与病情及预后的关系。方法:选择2017年6月-2019年9月我院收治的老年H型高血压合并急性缺血性脑卒中患者92例,记作合并脑卒中组,根据美国国立卫生研究院卒中量表(NIHSS)评分将患者分为轻症组28例(NIHSS评分≤4分)、中症组39例(5分≤NIHSS评分≤20分)和重症组25例(NIHSS评分>20分),根据改良Rankin量表(mRS)评分将患者分为预后不良组28例(mRS评分>2分)和预后良好组64例(mRS评分≤2分)。另选择同期我院收治的单纯老年H型高血压患者90例作为单纯H型高血压组,分析合并脑卒中组患者血清omentin-1、Irisin水平及omentin-1、Irisin与NIHSS评分、mRS评分的相关性,并应用ROC曲线分析血清omentin-1、Irisin水平对患者预后的预测价值。结果:合并脑卒中组血清omentin-1、Irisin水平显著低于单纯H型高血压组(P<0.05),随脑卒中神经缺损严重程度的升高,H型高血压合并急性缺血性脑卒中患者血清omentin-1、Irisin水平逐渐降低(P<0.05),预后不良组血清omentin-1、Irisin水平显著低于预后良好组(P<0.05)。老年H型高血压合并急性缺血性脑卒中患者血清omentin-1、Irisin水平与NIHSS评分及mRS评分均呈负相关(P<0.05)。omentin-1最佳临界值为105.36 ng/ml,敏感度为78.23%,特异度为83.44%;Irisin最佳临界值为90.77 ng/L,敏感度为71.00%,特异度为61.43%。结论:老年H型高血压合并急性缺血性脑卒中患者血清omentin-1、Irisin水平异常降低,其水平与神经缺损程度和预后呈负相关,血清omentin-1、Irisin对老年H型高血压发生急性缺血性脑卒中的预后评估具有一定价值。     

Gamma frequency activation of inhibitory neurons in the acute phase after stroke attenuates vascular and behavioral dysfunction

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Irradiation to the immature brain attenuates neurogenesis and exacerbates subsequent hypoxic‐ischemic brain injury in the adult

Cranial radiotherapy is common in pediatric oncology. Our purpose was to investigate if irradiation (IR) to the immature brain would increase the susceptibility to hypoxic‐ischemic injury in adulthood. The left hemisphere of postnatal day 10 (P10) mice was irradiated with 8 Gy and subjected to hypoxia‐ischemia (HI) on P60. Brain injury, neurogenesis and inflammation were evaluated 30 days after HI. IR alone caused significant hemispheric tissue loss, or lack of growth (2.8 ± 0.42 mm³, p < 0.001). Tissue loss after HI (18.2 ± 5.8 mm³, p < 0.05) was synergistically increased if preceded by IR (32.0 ± 3.5 mm³, p < 0.05). Infarct volume (5.1 ± 1.6 mm³) nearly doubled if HI was preceded by IR (9.8 ± 1.2 mm³, p < 0.05). Pathological scoring revealed that IR aggravated hippocampal, cortical and striatal, but not thalamic, injury. Hippocampal neurogenesis decreased > 50% after IR but was unchanged by HI alone. The number of newly formed microglia was three times higher after IR + HI than after HI alone. In summary, IR to the immature brain produced long‐lasting changes, including decreased hippocampal neurogenesis, subsequently rendering the adult brain more susceptible to HI, resulting in larger infarcts, increased hemispheric tissue loss and more inflammation than in non‐irradiated brains.     

Brain microvasculature has a common topology with local differences in geometry that match metabolic load

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A new method to elicit and measure movement illusions in stroke by means of muscle tendon vibration: the Standardized Kinesthetic Illusion Procedure (SKIP)

Abstract

Purpose: Muscle tendon vibration (MTV) strongly activates muscle spindles and can evoke kinaesthetic illusions. Although potentially relevant for sensorimotor rehabilitation in stroke, MTV is scarcely used in clinical practice, likely because of the absence of standardised procedures to elicit and characterise movement illusions. This work developed and validated a Standardised Kinaesthetic Illusion Procedure (SKIP) to favour the use of MTV-induced illusions in clinical settings.

Materials and methods: SKIP scores were obtained in 15 individuals with chronic stroke and 18 age- and gender-matched healthy counterparts. A further 13 healthy subjects were tested to provide more data with the general population. MTV was applied over the Achilles tendon and SKIP scoring system characterised the clearness and direction of the illusions of ankle dorsiflexion movements.

Results: All healthy and stroke participants perceived movement illusions. SKIP scores on the paretic side were significantly lower compared to the non paretic and healthy. Illusions were less clear and sometimes in unexpected directions with the impaired ankle, but still possible to elicit in the presence of sensorimotor deficits.

Conclusions: SKIP represents an ancillary and potentially useful clinical method to elicit and characterise illusions of movements induced by MTV. SKIP could be relevant to further assess the processing of proprioceptive afferents in stroke and their potential impact on motor control and recovery. It may be used to guide therapy and improve sensorimotor recovery. Future work is needed to investigate the metrological properties of our method (reliability, responsiveness, etc.), and also the neurophysiological underpinnings of MTV-induced illusions.