凶狠莫过脑卒中

<正>脑卒中俗称"中风",是严重危害人类健康和生命安全的难治性疾病,其发病率高、致残率高、死亡率高。中国每年约200万人发生脑卒中,幸存者大部分会遗留不同程度的后遗症,残疾率高达60%~80%,严重影响了患者及其家庭成员的生活质量。认识脑卒中脑卒中又称脑血管意外,是由于脑部血管突然破裂或因血管阻塞造成血液循环障碍而引起脑组织损伤的一组疾病。脑卒中分为两种类型:缺血性脑卒中(大约占60%)和出血性脑卒中(大约占40%)。缺血性脑卒中是指局部脑组织因血液循环障碍,缺血、缺     

黑龙江省齐齐哈尔医学院第三附属医院神经内科

脑卒中后运动功能恢复的机制尚未完全阐明。研究表明中风后功能的恢复与大脑可塑性有关,本文旨在阐述近年对一侧脑缺血后双侧大脑半球的活动的研究成果。     

脑卒中诊疗设备的新进展

脑卒中,也称中风,这类疾病包括脑出血、脑梗塞以及短暂脑缺血发作,是常见病、多发病。在我国更是造成死亡的第一、第二位病因,是致残的首位病因,是引起痴呆的第二原因,是当前国内外临床医学防治研究的重大课题。从美国把90年代定为“脑的十年”到至今,又十多年过去了,虽然由于C     

出血性脑卒中患者神经功能预后影响因素分析

目的:探讨出血性脑卒中神经功能预后的相关影响因素。方法:对214例出血性脑卒中患者进行回顾性分析,选择一般情况、既往史、血细胞等27个因素进行单因素及多元回归分析、筛选影响患者神经功能预后的主要因素。结果:入院时NIHSS评分、GLU、ALB、BUN及脑组织移位与出血性脑卒中患者神经功能预后关系密切。结论:入院时NIHSS评分高、血清GLU升高、ALB降低、BUN升高及脑组织移位是出血性脑卒中患者神经功能预后不良的危险因素。     

两种治疗方案对脑出血病人康复的影响

脑卒中是急性的脑部血液循环障碍造成的局部脑损害,又叫中风或脑血管意外,是现代中老年人健康的重要威胁,脑出血是其中的一种情况。采用由引导放松干预治疗的方法对脑出血患者进行护理干预,通过监测患者的血压、呼吸以及心率变化来判定干预效果,同时通过CT扫描来判定康复效果。干预结果表明：引导放松这种护理干预能够通过有效的稳定患者的收缩压和舒张压促进患者的康复。研究表明引导放松干预治疗对脑卒中病人的治疗具有一定的推广应用价值。     

脑-肠轴在缺血性脑卒中及其并发症中的机制探索与应用展望

脑卒中严重危害人类健康,是我国单一病种致死与致残首因.预防脑卒中事件及其并发症,改善患者疾病结局,是神经病学领域的研究重点.肠道菌群可通过免疫、内分泌和神经等通路,直接或间接影响大脑功能和宿主行为.最新研究表明,脑卒中发生前基础疾病,急性期脑缺血事件,以及卒中后并发症,均与肠道菌群紊乱存在因果关联.本综述讨论了肠道菌群在脑卒中危险因素例如肥胖、糖尿病、高血压与动脉粥样硬化等疾病中的病因角色;急性缺血性脑卒中存在由脑到肠,再由肠到脑的因果交互驱动新机制;肠道菌群及其代谢产物参与了脑卒中相关并发症,如脑卒中后抑郁、认知障碍、感染与睡眠障碍等研究进展.此外,益生菌干预等新型疗法有潜力改善脑卒中危险因素、事件与并发症的结局,但仍需进一步的基础与临床研究探究益生菌的作用机制与应用价值.脑卒中系列疾病中大脑与肠道存在互作机制,肠道菌群及其代谢物扮演了重要角色,阐明脑-肠轴相关机制对脑卒中及其并发症的预防、诊断和治疗具有重要意义.     

vWF与IL-6预测肾性高血压大鼠经历人工寒潮发生卒中的研究

目的:观察易卒中型肾血管性高血压大鼠(RHRSP)在经历人工寒潮中风前血液中vWF与IL-6含量变化从而预测中风的发生.方法:双肾双夹法制作RHRSP模型,经历人工寒潮并于寒潮前取血,酶联免疫吸附测定(ELISA)法检测vWF与IL-6含量.结果:脑梗塞组寒潮前vWF的表达明显高于非卒中组,脑梗死组和脑出血组寒潮前的IL-6含量明显高于非卒中组.结论:高血压患者血液中IL-6和vWF的含量可能预测经历寒潮时发生脑卒中的情况.     

急性缺血性中风血液流变学及藻酸双酯钠(PSS)对血液流变学影响的研究

本文对43例急性缺血性中风患者的血液流变学进行了观察,发现急性缺血性中风患者发病时血液流变学指标有明显增高,与对照组比较有显著性差异(P<0.01)。对其中31例病人用藻酸双酯钠(PSS)进行治疗后,病人的血液流变学指标有明显改善,其中全血粘度、血浆粘度、纤维蛋白原及红细胞压积有明显降低,经统计学处理有显著性差异(P<0.05或P<0.01)。研究结果表明,血液流变学异常是缺血性中风的重要危险因素,PSS能够纠正血液流交学异常,对防治缺血性中风是有价值的。     

基层农民对脑卒中危险因素知晓率的调查分析

目的:了解基层农民对脑卒中危险因素及高脂血症相关食物的知晓率,探讨能有效预防脑卒中的可行手段,为基层农民脑卒中的治疗打下基础.方法:随机选取农民600名,其中男性女性各300名,年龄30-70岁.采取问卷调查方式了解这些农民对脑卒中危险因子与高脂血症相关食物的知晓率及其疾病谱,数据计量资料采取百分数处理,统计分析采取单因素分析,分析并建立可行的预防措施.结果:600名农民中对于脑卒中危险因素知晓率仅为16.70%,与高脂血症相关的食物知晓率仅为26.0%,600名农民各种疾病的发病率达18.97%,其中高血压痛发生率高迭5.67%.结论:农民对于脑卒中危险因素知晓率低,对于与高脂血症相关的食物知晓率低,各种疾病患病率较高,如何进行健康教育是亟待解决的问题.     

脑卒中昏迷患者气管切开后并发肺部感染的病原菌分布及预防对策

目的:探讨脑卒中昏迷患者气管切开后并发肺部感染的病原菌分布及危险因素,并提出预防措施。方法:回顾性分析2016年1月至2017年2月我院收治的脑卒中昏迷患者96例,分析脑卒中昏迷患者肺部感染发生率及病原菌分布情况,同时采用单因素和多因素logistic回归分析肺部感染的危险因素,从而提出相应的预防措施。结果:96例脑卒中昏迷患者气管切开术后肺部感染的发生率为48.96%(47/96);共分离培养病原菌104株,包括革兰阴性菌69株(66.35%)、革兰阳性菌20株(19.23%)和真菌15株(14.42%);单因素分析结果显示,脑卒中昏迷患者气管切开术后肺部感染与年龄、基础疾病、气管切开时间、卧床时间、使用广谱抗菌药物、吸烟史、人工气道、吸痰次数及雾化吸入次数密切相关(P0.05),而与患者性别、体重、脑卒中类型无关(P0.05);多因素logistic回归分析结果显示,年龄45岁、合并患有基础疾病、气管切开时间5 d、使用广谱抗菌药物、吸烟史及建立人工气道均为脑卒中昏迷患者气管切开术后肺部感染的危险因素(P0.05),ROC分析结果为:气管切开时间的临界点(阈值C)是4.3天,其灵敏度和特异度将分别为0.851和0.918。结论:脑卒中昏迷患者气管切开后并发肺部感染的病原菌以革兰阴性菌为主,年龄45岁、合并患有基础疾病、气管切开时间5 d、使用广谱抗菌药物、吸烟史及建立人工气道能够导致脑卒中昏迷患者气管切开术后发生肺部感染,并且气管切开时间超过4.3天,脑卒中昏迷患者肺部感染的风险将大大增加,应根据病原学特征及其危险因素,采取针对性措施,降低肺部感染的发病风险。     

High Incidence of Neonatal Danger Signs and Its Implications for Postnatal Care in Ghana: A Cross-Sectional Study

Background

Reducing neonatal mortality is a major public health priority in sub-Saharan Africa. Numerous studies have examined the determinants of neonatal mortality, but few have explored neonatal danger signs which potentially cause morbidity. This study assessed danger signs observed in neonates at birth, determined the correlations of multiple danger signs and complications between neonates and their mothers, and identified factors associated with neonatal danger signs.

Methods

A cross-sectional study was conducted in three sites across Ghana between July and September in 2013. Using two-stage random sampling, we recruited 1,500 pairs of neonates and their mothers who had given birth within the preceding two years. We collected data on their socio-demographic characteristics, utilization of maternal and neonatal health services, and experiences with neonatal danger signs and maternal complications. We calculated the correlations of multiple danger signs and complications between neonates and their mothers, and performed multiple logistic regression analysis to identify factors associated with neonatal danger signs.

Results

More than 25% of the neonates were born with danger signs. At-birth danger signs in neonates were correlated with maternal delivery complications (r = 0.20, p < 0.001), and neonatal complications within the first six weeks of life (r = 0.19, p < 0.001). However, only 29.1% of neonates with danger signs received postnatal care in the first two days, and 52.4% at two weeks of life. In addition to maternal complications during delivery, maternal age less than 20 years, maternal education level lower than secondary school, and fewer than four antenatal care visits significantly predicted neonatal danger signs.

Conclusions

Over a quarter of neonates are born with danger signs. Maternal factors can be used to predict neonatal health condition at birth. Management of maternal health and close medical attention to high-risk neonates are crucial to reduce neonatal morbidity in Ghana.     

基于GIS的辽河干流饮用水源地生态安全演变趋势

在调查辽河干流饮用水源地生态安全隐患因素并进行生态安全状态评价的基础上,选取辽宁省境内辽河干流饮用水源地共59个县市区,运用安全风险评价理论,借助GIS格网赋值技术,完成饮用水源地的生态安全演变趋势评价.结果表明:生态安全高隐患区(安全得分≤0.3)有19个,安全状态恶化演变趋势较大;生态安全中等隐患区(0.3<安全得分≤0.7)有32个,安全状态恶化演变趋势不大;生态安全低隐患区(安全得分>0.7)有8个,安全状态恶化演变趋势较小.根据评价结果提出了相应的生态保护措施.     

Disentangling the roles of frequency-vs. state-dependence in generating individual differences in behavioural plasticity

Theoretical work suggests that both negative frequency-dependent payoffs and state-dependent payoffs can lead to individual variation in behavioural plasticity. We investigated the roles of both frequency- and state-dependence on the occurrence of individual variation in behavioural plasticity in a series of experiments where we manipulated perceived predation danger for red knots (Calidris canutus islandica). We found individual variation in plasticity in a trait with negative frequency-dependent payoffs (vigilance), but not in a trait with positive frequency-dependent payoffs (escape flights). Furthermore, there was no correlation between the average level of vigilance under low predation danger and the magnitude of response to increased predation danger, as would be expected under state-dependence. Thus, our results provide support for the hypothesis that negative-frequency dependence favours individual variation in plasticity. However, negative-frequency dependence alone cannot explain why plasticity would be consistent within individuals, and future studies should address the factors that might favour individual consistency.     

Men’s Knowledge of Obstetric Danger Signs,Birth Preparedness and Complication Readiness in Rural Tanzania

BackgroundMen’s involvement in reproductive health is recommended. Their involvement in antenatal care service is identified as important in maternal health. Awareness of obstetric danger signs facilitates men in making a joint decision with their partners regarding accessing antenatal and delivery care. This study aims to assess the level of knowledge of obstetric complications among men in a rural community in Tanzania, and to determine their involvement in birth preparedness and complication readiness.MethodsA cross-sectional survey was conducted where 756 recent fathers were invited through a two-stage cluster sampling procedure. A structured questionnaire was used to collect socio-demographic characteristics, knowledge of danger signs and steps taken on birth preparedness and complication readiness. Data were analyzed using bivariate and multivariable logistic regression to determine factors associated with being prepared, with statistically significant level at p<0.05.ResultsAmong the invited men, 95.9% agreed to participate in the community survey. Fifty-three percent could mention at least one danger sign during pregnancy, 43.9% during delivery and 34.6% during the postpartum period. Regarding birth preparedness and complication readiness, 54.3% had bought birth kit, 47.2% saved money, 10.2% identified transport, 0.8% identified skilled attendant. In general, only 12% of men were prepared. Birth preparedness was associated with knowledge of danger signs during pregnancy (AOR = 1.4, 95% CI: 1.8-2.6). It was less likely for men living in the rural area to be prepared (AOR=0.6, 95% CI; 0.5-0.8).ConclusionThere was a low level of knowledge of obstetric danger signs among men in a rural district in Tanzania. A very small proportion of men had prepared for childbirth and complication readiness. There was no effect of knowledge of danger signs during childbirth and postpartum period on being prepared. Innovative strategies that increase awareness of danger signs as well as birth preparedness and complication readiness among men are required. Strengthening counseling during antenatal care services that involve men together with partners is recommended.     

抗生素不合理广泛应用是医院感染的第一位危险因素

调查了某医院591例住院患者,对医院感染有关的10项危险因素进行了相对危险度分析。结果表明,广谱抗生素的广泛应用是医院感染的首位危险因素。     

Health and the avoidance of macroparasites: a preliminary cross-cultural study

Some evolutionary explanations of cross-cultural differences propose that human personality is caused by pathogen stress. Both xenophobia and ethnocentrism evolved under conditions with high parasite prevalence. Further, inter-individual variation in disgust or fear of parasites is expected to be influenced by human health, where healthy people should express lower disgust sensitivity to parasites. We examined inter-individual variation of children’s fear, disgust and self-perceived danger between two distinct cultures differing in overall pathogen prevalence. We found that children were able to distinguish between disease-relevant and disease-irrelevant groups of invertebrates and that children in regions with high pathogen prevalence expressed greater fear, disgust and self-perceived danger of all animals, irrespective of disease threat. After controlling for confounding factors, better health of children was associated with lower perceived danger of disease-relevant animals. Gender differences were found only in conditions with low pathogen stress. Our results support the idea that cross-cultural differences in human perception of animals are mediated by pathogen threat. Further research is necessary to investigate causal relationship between human health and avoidance of potentially hazardous animals.     

Méthode de contrôle visuel des infestations d'arthropodes ravageurs du pommier

Summary The method of visual control proposed in this note consists of a periodic count of the principal pests and their antagonists occuring on some selected vegetative organs of trees that are representative of the culture. The percentage of infestation obtained in this manner corrected by an evaluation of other factors influencing the destructive potential of the pests is then translated into a ?degree of danger?. The results of this control indicate, therefore, the danger each of the pests holds for the culture and give an account of the critical level of tolerance.      

Watch out! How a fearful face adds credibility to warnings of danger

People display facial expressions of fear to communicate danger to others and sometimes to exaggerate danger to manipulate an audience. Here we test whether fear expressions add credibility to a speaker's warnings of danger. Participants played an incentivized lie detection game in which they guess whether a confederate partner is lying or telling the truth. Participants viewed a video of their partner's message, after reading that there was a good chance (75%) their partner was instructed to lie. We manipulated across conditions whether the partner stated the message with a neutral or fearful expression. Experiment 1 finds that participants were more likely to believe the speaker's warning of danger when it was conveyed with a fear expression compared to a neutral expression. Experiment 2 finds that when a speaker instead claimed that a danger was absent, a fearful expression no longer added credibility to their message. These findings provide evidence that fear expressions add credibility to statements of danger, specifically, rather than any claim.     

Phagocytosis of apoptotic cells by macrophages induces novel signaling events leading to cytokine-independent survival and inhibition of proliferation: activation of Akt and inhibition of extracellular signal-regulated kinases 1 and 2

Recent evidence indicates that phagocytic clearance of apoptotic cells, initially thought to be a silent event, can modulate macrophage (M phi) function. We show in this work that phagocytic uptake of apoptotic cells or bodies, in the absence of serum or soluble survival factors, inhibits apoptosis and maintains viability of primary cultures of murine peritoneal and bone marrow M phi with a potency approaching that of serum-supplemented medium. Apoptotic uptake also profoundly inhibits the proliferation of bone marrow M phi stimulated to proliferate by M-CSF. While inhibition of proliferation is an unusual property for survival factors, the combination of increased survival and decreased proliferation may aid the M phi in its role as a scavenger during resolution of inflammation. The ability of apoptotic cells to promote survival and inhibit proliferation appears to be the result of simultaneous activation of Akt and inhibition of the mitogen-activated protein kinases extracellular signal-regulated kinase (ERK)1 and ERK2 (ERK1/2). While several activators of the innate immune system, or danger signals, also inhibit apoptosis and proliferation, danger signals and necrotic cells differ from apoptotic cells in that they activate, rather than inhibit, ERK1/2. These signaling differences may underlie the opposing tendencies of apoptotic cells and danger signals in promoting tolerance vs immunity.     

Caffeic acid phenethyl ester reduces neurovascular inflammation and protects rat brain following transient focal cerebral ischemia

Ischemic stroke is a neurovascular disease treatable by thrombolytic therapy, but the therapy has to be initiated within 3 h of the incident. This therapeutic limitation stems from the secondary injury which results mainly from oxidative stress and inflammation. A potent antioxidant/anti-inflammatory agent, caffeic acid phenethyl ester (CAPE) has potential to mitigate stroke's secondary injury, and thereby widening the therapeutic window. We observed that CAPE protected the brain in a dose-dependent manner (1-10 mg/kg body weight) and showed a wide therapeutic window (about 18 h) in a rat model of transient focal cerebral ischemia and reperfusion. The treatment also increased nitric oxide and glutathione levels, decreased lipid peroxidation and nitrotyrosine levels, and enhanced cerebral blood flow. CAPE down-regulated inflammation by blocking nuclear factor kappa B activity. The affected mediators included adhesion molecules (intercellular adhesion molecule-1 and E-selectin), cytokines (tumor necrosis factor-alpha and interleukin-1beta) and inducible nitric oxide synthase. Anti-inflammatory action of CAPE was further documented through reduction of ED1 (marker of activated macrophage/microglia) expression. The treatment inhibited apoptotic cell death by down-regulating caspase 3 and up-regulating anti-apoptotic protein Bcl-xL. Conclusively, CAPE is a promising drug candidate for ischemic stroke treatment due to its inhibition of oxidative stress and inflammation, and its clinically relevant wide therapeutic window.