Clinical studies on the fibrinolytic action of pentosan polysulfate

The influence on fibrinolysis of the heparin-like substance Polyanion SP 54 is described. In vitro tests showed an increase of fibrinolysis by activation of the endogenous pathway via factor XII and prekallikrein. In vivo an increase of the availability of tissue plasminogen activator was assumed in addition. When different ways of administration of Polyanion SP 54 were tested an enhancement of fibrinolysis was also found after oral application of the substance. In a long term test the stimulation of fibrinolysis after oral therapy did not diminish within 12 months. A trial on patients with cerebral ischemic attacks and diminished fibrinolysis is not yet concluded but permits the assumption of a considerable diminution of ischemic attacks during therapeutic use of Polyanion SP 54.     

Fatal ischaemic brain oedema after early thrombolysis with tissue plasminogen activator in acute stroke.

Two patients with acute major, disabling cerebral infarction with presumed middle cerebral artery occlusion were treated with the clot specific thrombolytic agent tissue plasminogen activator roughly three and a half hours after the onset of symptoms. Both patients had a normal computed tomography (CT) scan before treatment. No appreciable systemic bleeding complications occurred, apart from bruising. One patient had bleeding into the subarachnoid space from a microscopic angioma, which was found at necropsy. Haematological monitoring of the two patients showed pronounced fibrinogenolysis and alpha 2 antiplasmin consumption in one. One patient showed transient improvement during the infusion. In both cases extensive infarction, partly haemorrhagic in one, with massive concomitant oedema was found on repeated CT. Both patients deteriorated and eventually died as a consequence of transtentorial herniation. In the one patient who came to necropsy a moderate, probably pre-existing smooth stenosis of the ipsilateral carotid artery was found, all cerebral vessels being patent. It is concluded that thrombolytic treatment with a clot specific agent such as tissue plasminogen activator started three to four hours after a major ischaemic stroke may be hazardous, not because of haemorrhagic transformation of the original ischaemia but because early reperfusion may promote massive, potentially fatal cerebral oedema.     

早期介入微弹簧圈栓塞治疗脑动脉瘤破裂的疗效及预后分析

目的:研究分析早期介入微弹簧圈栓塞治疗脑动脉瘤破裂的疗效及预后。方法:选取我院2011年至2014年期间收治的脑动脉瘤破裂患者96例作为研究对象。根据数字法随机分成观察组及对照组各48例,观察组患者在入院3d之内实施微弹簧圈栓塞形式介入治疗,对照组治疗时间为入院3 d后。对比两组患者临床治疗疗效、并发症发生情况、以及术后6个月的改良Rankin量表(m RS)、改良型日常生活能力(MBI)评分。结果:观察组的栓塞效果显著好于对照组,差异有统计学意义(P0.05)。观察组术后6个月的m RS评分显著低于对照组,且MBI评分显著高于对照组,差异均有统计学意义(均P0.05)。观察组的并发症发生率均显著低于对照组,差异均有统计学意义(均P0.05)。结论:入院3d之内利用微弹簧圈栓塞对脑动脉瘤破裂实施早期介入治疗,具有较好的疗效及预后,值得临床重视。     

心理干预对老年脑卒中患者神经功能缺损和幸福感的影响

目的：探讨心理干预对老年脑卒中患者神经功能缺损及幸福指数的影响。方法：选择2014 年2 月~2015 年2 月我院收治的 100例老年脑卒中患者,随机分为干预组和对照组,每组各50 例。对照组患者给予常规治疗,干预组在对照组基础上进行心理干 预。采用Barthel指数评估量表、脑卒中患者临床神经功能缺损程度评分标准（MESSS）及总体幸福感量表（GWB）对两组患者干预 效果进行评分。结果：两组患者干预前各项评分无统计学差异（P>0.05）;干预后,两组患者Barthel 指数和GWB 评分均较干预前 提高,且干预组高于对照组,差异具有统计学意义（P<0.05）;干预后,两组患者MESSS 评分较干预前降低,且干预组低于对照组, 差异具有统计学意义（P<0.05）。结论：心理干预能够缓解老年脑卒中患者的神经功能缺损症状,提高患者幸福指数,具有一定的临 床应用价值。     

D1 receptor‐mediated endogenous tPA upregulation contributes to blood‐brain barrier injury after acute ischaemic stroke

Blood‐brain barrier (BBB) integrity injury within the thrombolytic time window is becoming a critical target to reduce haemorrhage transformation (HT). We have previously reported that BBB damage was initially damaged in non‐infarcted striatum after acute ischaemia stroke. However, the underlying mechanism is not clear. Since acute ischaemic stroke could induce a significant increase of dopamine release in striatum, in current study, our aim is to investigate the role of dopamine receptor signal pathway in BBB integrity injury after acute ischaemia using rat middle cerebral artery occlusion model. Our data showed that 2‐h ischaemia induced a significant increase of endogenous tissue plasminogen activator (tPA) in BBB injury area and intra‐striatum infusion of tPA inhibitor neuroserpin, significantly alleviated 2‐h ischaemia‐induced BBB injury. In addition, intra‐striatum infusion of D1 receptor antagonist SCH23390 significantly decreased ischaemia‐induced upregulation of endogenous tPA, accompanied by decrease of BBB injury and occludin degradation. More important, inhibition of hypoxia‐inducible factor‐1 alpha with inhibitor YC‐1 significantly decreased 2‐h ischaemia‐induced endogenous tPA upregulation and BBB injury. Taken together, our data demonstrate that acute ischaemia disrupted BBB through activation of endogenous tPA via HIF‐1α upregulation, thus representing a new therapeutic target for protecting BBB after acute ischaemic stroke.     

尤瑞克林联合依达拉奉治疗房颤合并脑栓塞的疗效及对神经功能的影响

目的:分析尤瑞克林联合依达拉奉治疗房颤合并脑栓塞的疗效以及对神经功能的影响。方法:选取我院2013年1月至2015年1月收治的房颤合并脑栓塞患者220例,随机分为实验组与对照组,每组各110例。实验组患者采用尤瑞克林联合依达拉奉药物治疗,对照组采用低分子肝素治疗,记录治疗前后两组患者的凝血功能,对比两组患者的临床疗效,采用美国国立卫生研究院卒中量表(NIHSS)评价患者神经功能受损程度,日常生活活动能力量表(Barthel指数)评价患者的神经功能恢复情况。结果:治疗后两组患者的NIHSS评分较治疗前降低,且实验组明显低于对照组,Barthel指数较治疗前升高,且实验组明显高于对照组,差异均有统计学意义(P0.05);治疗后两组患者凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、INR均显著高于治疗前,且实验组显著高于对照组,差异具有统计学意义(P0.05);治疗后实验组患者的总有效率为90.91%,显著高于对照组的60.09%,差异有统计学意义(P0.05)。结论:尤瑞克林联合依达拉奉治疗房颤合并脑栓塞疗效较好,可修复受损的神经系统,值得在临床上大力推广。     

The importance of the intrathecal infusion test in the diagnostics of normal pressure hydrocephalus.

OBJECTIVE: The intrathecal infusion test is a reliable method in diagnosing normal pressure hydrocephalus. METHODS: Between May 1982 and January 1997 we investigated 200 patients suspected for a normal pressure hydrocephalus (NPH) by carrying out an intrathecal infusion test in a constant flow technique. The resistance to cerebrospinal fluid outflow (Rout) in the intrathecal infusion test was the main criterion for grouping patients into these with normal pressure hydrocephalus or those with cerebral atrophy. A further differentiation into early stage and late stage was made by measuring the compliance (Cp)--this being the secondary criterion. RESULTS: In 107 patients (54%) the diagnosis of a NPH could be confirmed. Of these, 102 patients (95%) underwent a shunt operation. Graduation of NPH and cerebral atrophy following the results of the infusion test in an early stage and an advanced stage allows the conclusion of prognostic evaluations about the course of disease to be made. Patients with a NPH in an early stage are reporting in the follow up about an improvement of their symptoms after a shunt operation in 65 percent of cases and those with an advanced stage NPH in 50 percent. CONCLUSION: The computer aided infusion test allows a reliable differentiation between patients with NPH and those with cerebral atrophy.     

血栓通联合依达拉奉对老年急性脑梗死患者氧化低密度脂蛋白和MMPs水平的影响及临床疗效

目的:探讨血栓通联合依达拉奉对老年急性脑梗死患者氧化低密度脂蛋白及MMPs水平的影响及临床疗效。方法:收集我院收治的126例急性脑梗死患者,随机分为实验组和对照组,每组各63例。对照组患者给予血栓通注射液治疗;实验组患者在对照组基础上给予依达拉奉治疗。观察并比较两组患者治疗前后血清氧化低密度脂蛋白(Ox-LDL)、基质金属蛋白酶2(MMP-2)及基质金属蛋白酶9(MMP-9)水平的变化情况以及临床疗效。结果:与治疗前相比,治疗后两组患者Ox-LDL,MMP-2及MMP-9水平均下降,差异具有统计学意义(P0.05);与对照组相比,实验组患者Ox-LDL,MMP-2及MMP-9水平较低,差异具有统计学意义(P0.05);与对照组相比,实验组患者的临床疗效较高,差异具有统计学意义(P0.05)。结论:血栓通联合依达拉奉能够降低老年急性脑梗死患者氧化低密度脂蛋白(Ox-LDL)、基质金属蛋白酶2(MMP-2)以及基质金属蛋白酶9(MMP-9)水平,临床疗效较好。     

盐酸非索非那定片联合胸腺肽对慢性荨麻疹患者风团及瘙痒情况的影响

目的:研究盐酸非索非那定片联合胸腺肽对慢性荨麻疹患者风团及瘙痒情况的影响分析。方法:选择2012年7月至2013年7月在我院接受治疗的慢性荨麻疹患者108例作为研究对象。以数字法随机分成观察组(54例)和对照组(54例)。对照组患者单纯服用盐酸非索非那定片,观察组在此基础上加用胸腺肽。对比两组疗效,风团和瘙痒症状总积分情况及不良反应。结果:观察组的总有效率为72.22%(39/54),显著高于对照组的53.70%(29/54),差异有统计学意义(P0.05)。两组治疗后的症状总积分均显著下降,但观察组治疗2,4周后的症状总积分均显著小于对照组,差异均有统计学意义(P0.05)。观察组的总不良反应率为9.26%(5/54),与对照组的22.22%(12/54)相比,差异无统计学意义(P0.05)。结论:盐酸非索非那定与胸腺肽联合治疗慢性荨麻疹疗效较好,值得推荐。     

阿米洛利对脑梗死急性期患者血清炎症因子水平的影响

目的:探讨阿米洛利对脑梗死急性期患者血清ox-LDL、炎症因子及MMP-9水平影响及其意义。方法:选取我院诊治的急性脑梗死患者120例,随机分为对照组和实验组,每组60例。两组患者均给予常规对症治疗,实验组在对照组的治疗基础上加用盐酸阿米洛利片。采用酶联免疫吸附法(ELISA)及免疫透射比浊法分别测定两组患者血清ox-LDL、炎症因子及MMP-9水平,并对患者神经功能缺损程度进行评分。结果:治疗后,两组患者神经功能均较治疗前明显改善,且实验组明显优于对照组,差异均具有统计学意义(P0.05);治疗后,两组患者血清ox-LDL及MMP-9水平均低于治疗前,且实验组低于对照组,差异具有统计学意义(P0.05);治疗后,两组患者血清炎症因子TNF-α、IL-6及hs-CRP水平均低于治疗前,且实验组低于对照组,差异具有统计学意义(P0.05)。结论:阿米洛利能够降低脑梗死急性期患者ox-LDL、TNF-α、IL-6、hs-CRP及MMP-9水平,减轻炎症反应,改善患者的神经功能。     

化疗联合冷循环射频消融术治疗原发性肝癌的效果分析

目的：探讨化疗联合冷循环射频消融术治疗原发性肝癌的疗效及安全性。方法：108例原发性肝癌患者随机分为两组,均给予灌注化疗,每4周进行一次灌注化疗,对照组（n=54）进行3次,治疗组（n=54）只进行一次。治疗组给予冷循环射频消融术。评价生活质量Kamofsky评分,治疗前后检查患者的血、尿、便常规,肝肾功能（包括天冬氨酸转氨酶、丙氨酸转氨酶（AVr）、白蛋白（ALB）、总胆红素、肌酐及尿素氮等指标）,甲胎蛋白（AFP）,T细胞亚群和加强肝脏CT扫描。随访1年,经CT确定肝癌复发。结果：治疗组Kamofsky评分有效率为59．26％,对照组Kamofsky评分有效率为37．03％,两组Kamofsky评分有效率相比较,差异有统计学意义（P〈0．05）。两组治疗后症状变化相比较,除腹胀外其余各项指标差异均有统计学意义（P〈O．05）。治疗后两组相比较,ALT和AFP差异有统计学意义（P〈0．05）。治疗后两组T细胞亚群变化相比较,治疗组各项指标均变化显著（P〈0．05）。治疗后随访一年,治疗组复发率为22．22％;对照组复发率为53．70％。两组治疗一年后复发率相比较,差异有统计学意义（P〈0．05）。结论：化疗结合冷循环射频消融术治疗原发性肝癌疗效肯定,并发症及副作用小,复发率低。     

Knock-down of POSH expression is neuroprotective through down-regulating activation of the MLK3-MKK4-JNK pathway following cerebral ischaemia in the rat hippocampal CA1 subfield

We investigated the expression and subcellular localization of the multidomain protein POSH (plenty of SH3s) by immunohistochemistry and western blot analysis, as well as its role in the selective activation of mixed-lineage kinases (MLKs) 3, MAP kinase kinase (MKK) 4, c-Jun N-terminal kinases (JNKs) and the c-Jun signalling cascade in the rat hippocampal CA1 region following cerebral ischaemia. Our results indicated that the cytosol immunoreactivity of POSH was strong in the CA1-CA3 pyramidal cell but weak in the DG granule cell of the rat hippocampus both in sham control and after reperfusion. Co-immunoprecipitation experiments showed that the interactions of MLK3, MKK4 and phospho-JNKs with POSH were persistently enhanced during the early (30 min) and the later reperfusion period (from 1 to 3 days) compared with sham controls. Consistently, MLK3-MKK4-JNK activation was rapidly increased with peaks both at 30 min and 3 days of reperfusion. Intracerebroventricular infusion of POSH antisense oligodeoxynucleotides (AS-ODNs) not only significantly reduced the protein level of POSH, markedly decreased its interactions with MLK3, MKK4 and phospho-JNKs, but also attenuated the activation of the JNK signalling pathway. In addition, infusion of POSH AS-ODNs significantly increased the neuronal density in the CA1 region at 5 days of reperfusion. Our results suggest that POSH might serve as a scaffold mediating JNK signalling activation in the hippocampal CA1 region following cerebral ischaemia, and POSH AS-ODNs exerts its protective effects on ischaemic injury through a mechanism of inhibition of the MLK3-MKK4-JNK signalling pathway, involving c-Jun and caspase 3 activation.     

尤瑞克林联合尿激酶超早期治疗改善脑梗死患者预后

目的：观察尤瑞克林联合尿激酶超早期治疗对改善脑梗死患者预后的疗效,探讨其临床适用性。方法：选择从2009年3月至2012年8月于我院住院治疗的48例超早期急性脑梗死患者,随机分为实验组25例和对照组23例,对照组患者使用尿激酶进行溶栓治疗,实验组在此基础上加用尤瑞克林联合治疗。观察两组患者治疗后神经功能的恢复情况,治疗有效率及预后稳定性情况。结果：两组患者治疗后NIHSS评分均较治疗前改善（P〈0．05）;与对照组比较,实验组治疗后NIHSS较治疗前下降更多（P〈0．05）;实验组治疗有效率高于对照组（X2=-4．69,P〈0．05）;实验组患者服药后的治疗安全性与对照组的相当,差异无明显统计学意义（X2=0．33,P〉0．05）。结论：尤瑞克林联合尿激酶超早期治疗较单用尿激酶疗效好,安全性好。     

支气管动脉灌注化疗与栓塞治疗中晚期肺癌的疗效观察

目的：对比分析支气管动脉灌注化疗与支气管动脉灌注化疗十栓塞术治疗中晚期肺癌的临床疗效。方法：将我院2011年1月-2013年1月期间收治的76例中晚期肺癌患者随机分为两组,即观察组38例,对照组38例。观察组患者行支气管动脉灌注化疗联合栓塞术治疗,对照组患者行单纯支气管动脉灌注化疗治疗。分别对两组患者治疗后的临床治疗效果进行评价,同时观察两组患者治疗后的不良反应及并发症的发生情况。结果：观察组患者临床治疗的总有效率为84．21％,对照组为64．78％．两组比较,差异具有统计学意义（P〈0．05）。两组患者治疗后,观察组患者总不良反应率为23．67％,对照组为21．04％,两组比较．差异无统计学意义（P〉0．05）。且经对症处理后,均得到有效改善。结论：支气管动脉灌注化疗联合栓塞术治疗中晚期肺癌的,临床疗效明显优于单纯支气管动脉灌注化疗,且无明显不良反应及并发症的发生,安全性好,值得临床推广与应用。     

依达拉奉联合法舒地尔应用于急性脑梗死患者的治疗效果观察

目的:观察依达拉奉联合法舒地尔应用于急性脑梗死(acute cerebral infarction,ACI)患者的治疗效果及其安全性。方法:选取我院2011年1月-2014年1月收治的急性脑梗死患者96例,随机分为观察组和对照组,每组48例。观察组患者应用盐酸法舒地尔联合依达拉奉静脉滴注,对照组患者单独应用盐酸法舒地尔静脉滴注射。观察并比较两组患者的治疗效果、神经功能缺损的变化情况及不良反应的发生情况等。结果:治疗前,两组患者NIHSS、BI评分及NSE水平比较无明显差异(P0.05);治疗后,两组患者NIHSS、BI评分及NSE水平均较治疗前明显改善,且观察组改善更明显,差异具有统计学意义(P0.05);观察组治疗总有效率高于对照组,差异具有统计学意义(P0.05);两组不良反应发生率无明显差异(P0.05)。结论:依达拉奉联合法舒地尔对急性脑梗死患者的临床效果显著,不仅可以改善患者的神经功能缺损情况,而且能够改善NSE水平,值得临床推广应用。     

rt-PA静脉溶栓治疗急性大脑中动脉脑梗死的临床疗效

目的:探讨rt-PA静脉溶栓治疗在急性大脑中动脉脑梗死的临床疗效及安全性。方法:选取我院急性大脑中动脉脑梗死患者70例,随机分为实验组和对照组,每组35例。对照组给予保护神经、清除自由基及抗血小板抑制等治疗,实验组在对照组基础上联合阿替普酶静脉滴注。观察并比较治疗前后两组患者血清BNP,CRP及NSE水平的变化情况,以及临床疗效和并发症的发生率。结果:与治疗前相比,治疗后两组患者血清BNP,CRP及NSE水平均降低,差异具有统计学意义(P0.05);与对照组比较,实验组患者治疗后血清BNP,CRP及NSE水平较低,差异具有统计学意义(P0.05);实验组总有效率(85.71%)明显高于对照组(65.71%),差异具有统计学意义(P0.05)。两组患者颅内出血、再灌注损伤、血管再闭塞等并发症的发生率比较,差异无统计学意义(P0.05)。结论:rt-PA静脉溶栓治疗急性大脑中动脉脑梗死的临床疗效显著,能够降低患者血清BNP,CRP及NSE水平。     

亚低温治疗对重型颅脑损伤患者颅内压、脑血流及氧代谢的影响

目的:探讨亚低温治疗对重症颅脑损伤(sTBI)患者颅内压(ICP)、脑血流及氧代谢的影响。方法:收集50例sTBI患者随机分为实验组和对照组,每组25例,均给予常规治疗,观察组在常规治疗基础上给予亚低温辅助治疗,检测患者治疗前、治疗第3、5、7天ICP动态变化以及治疗前和治疗7天后脑血流和氧代谢等指标变化。结果:治疗第3、5、7天ICP组间差异均具有统计学意义(P0.05),随着治疗时间增加两组ICP均逐渐降低,差异具有统计学意义(P0.05);治疗前Qmean、Vmean、Wv、DR等组间差异无统计学意义(P0.05),治疗7天后Qmean、Vmean均升高,Wv、DR均降低,差异具有统计学意义(P0.05);治疗前SjvO_2、CjvO_2、CaO_2、CERO_2组间差异无统计学意义(P0.05),治疗7天后SjvO_2、CjvO_2、CERO_2均升高,CaO_2降低,差异具有统计学意义(P0.05)。结论:亚低温治疗可以显著降低患者颅内压,改善脑血流和氧代谢水平。     

Effect of Reperfusion Following Cerebral Ischaemia on the Activity of the Mitochondrial Respiratory Chain in the Gerbil Brain

Abstract: The effect of reperfusion following 30 min of cerebral ischaemia on brain mitochondrial respiratory chain activity has been studied in the gerbil. The state 3 respiration rates with both FAD- and NAD-linked substrates were reduced after ischaemia. After 5 min of reperfusion, state 3 respiration with FAD-linked substrates was restored, but levels of NAD-linked substrates did not return to control values until 30 min of reperfusion. By 120 min of reperfusion state 3 respiration decreased relative to control values with all substrates studied. Measurement of the individual respiratory chain complexes showed that complex I, complex II–III, and complex V activities were reduced after ischaemia. By 5 min of reperfusion complex II–III activity was restored, but the activities of complexes I and V did not return to control values until 30 min of reperfusion. In contrast, complex IV activity was unaffected by ischaemia or 5 and 30 min of reperfusion but was significantly reduced after 120 min of reperfusion, possibly owing to free radical production and lipid peroxidation.     

丁苯酞联合低剂量阿替普酶治疗急性脑梗死的疗效及对患者神经内分泌因子的影响

目的:探讨丁苯酞联合低剂量阿替普酶治疗急性脑梗死的疗效及对患者神经内分泌因子的影响。方法:按照随机数表法将105例患者分为对照组(n=52)和研究组(n=53)。对照组患者采用低剂量阿替普酶治疗,研究组患者在对照组基础上加用丁苯酞治疗。评价并比较两组临床疗效,比较两组治疗前后美国国立卫生研究院卒中量表(NIHSS)评分和血清S-100蛋白(S100B)、神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)水平,比较两组治疗14 d内的颅内出血发生率和病死率。结果:研究组的临床总有效率为94.34%(50/53),明显高于对照组的76.92%(40/52),且差异具有统计学意义(x2=6.502,P=0.011)。与治疗前相比,两组治疗后NIHSS评分均明显降低,且研究组治疗后的NIHSS评分明显低于对照组,差异有统计学意义(P<0.05)。与治疗前相比,两组治疗后血清S100B、NSE及MBP水平均明显降低(P<0.05),且研究组治疗后血清S100B、NSE及MBP水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗14 d内,研究组的颅内出血发生率和死亡率均明显低于对照组,差异有统计学意义(P<0.05)。结论:丁苯酞联合低剂量阿替普酶治疗急性脑梗死的疗效显著,能够明显改善神经功能,降低神经内分泌因子水平,且安全性较好。     

中药熏蒸对挂线引流术后肛瘘患者血清免疫球蛋白水平及预后的影响

目的:探讨中药熏蒸对经挂线引流术后肛瘘患者血清免疫球蛋白水平及预后的影响。方法:收集我院治疗的94例肛瘘患者,随机分为实验组和对照组,每组47例。所有患者行肛瘘挂线术,对照组患者术后采用左氧氟沙星注射液治疗,实验组患者在对照组基础上给予中药熏洗治疗。观察并比较两组患者治疗前后血清IgA及IgG水平,疼痛持续时间及恢复时间以及临床疗效。结果:与治疗前相比,两组患者治疗后血清IgA及IgG水平均下降,差异具有统计学意义(P0.05);与对照组相比,实验组患者治疗后血清IgA及IgG水平较低,差异具有统计学意义(P0.05);实验组患者疼痛持续时间及恢复时间均少于对照组,差异具有统计学意义(P0.05);实验组临床治疗有效率高于对照组,差异具有统计学意义(P0.05)。结论:中药熏蒸能够降低经挂线引流术后肛瘘患者血清IgA及IgG水平,缩短术后疼痛时间,促进术后康复,临床疗效较好。