Traumatic disorders of pituitary-hypothalamic function. I. Excretion of follicule-stimulating hormone after closed head injury. A preliminary investigation.

In an investigation done in a group of 20 patients with cerebral concussion and skull fracture, 5 of whom showed definite EEG signs of brain-stem function disorder, one patient, a member of this subgroup, was found to have a reduced excretion of FSH. This patient also showed amenorrhoea of 4 months duration and olfactory disturbances.     

Shear Injuries of the Brain

A blow to the head will impart rotational velocity to the brain and, depending on its magnitude, will produce effects ranging from concussion to profound neurological dysfunction. Resultant shear strains distort and rupture axons, blood vessels and major fibre tracts. Thirty-seven patients with head injury that was not complicated by significant hemorrhage or superficial laceration of the brain had coma or severe dementia, spastic quadriparesis, incontinence and autonomic dysfunction. These patients survived 24 hours to 243 days. Gross pathological examination revealed little, but there was microscopic evidence of axonal and small vessel injury in all; this was localized to the basal and midsagittal areas of the diencephalon and mesencephalon, particularly in those less severely injured. Such changes represent the basic pathology of all head injury. Data from this study suggest that concussion depends upon varying degrees of damage to the axon as well as the neuron. The current definition of concussion—immediate loss of consciousness with rapid and complete recovery of cerebral function—should not exclude the fact that a small number of neurons may have been permanently disconnected or have perished.     

尤瑞克林联合依达拉奉治疗进展性脑梗死44例临床研究

目的探讨尤瑞克林联合依达拉奉治疗进展性脑梗死的临床疗效及作用机制。方法选择收治的进展性脑梗死患者132例随机分为3组,每组44例,3组均予改善循环、抗血小板聚集等常规治疗。C组在常规治疗基础上予胞二磷胆碱＋血栓通静滴,波立维口服;B组在C组基础上予依达拉奉静滴;A组在B组基础上加尤瑞克林静滴。均14天为1疗程。并于治疗前后进行临床神经功能缺损程度（CSS）评分与日常生活活动能力量表（BI）评分,观察3组临床疗效,并监测不良反应。结果A组神经功能缺损的治疗效果及控制脑梗死进展优于B、C组,且无明显不良反应。结论尤瑞克林联合依达拉奉对进展性脑梗死具有较好的治疗效果。     

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。     

Plasma Soluble Prion Protein,a Potential Biomarker for Sport-Related Concussions: A Pilot Study

Sport-related mild traumatic brain injury (mTBI) or concussion is a significant health concern to athletes with potential long-term consequences. The diagnosis of sport concussion and return to sport decision making is one of the greatest challenges facing health care clinicians working in sports. Blood biomarkers have recently demonstrated their potential in assisting the detection of brain injury particularly, in those cases with no obvious physical injury. We have recently discovered plasma soluble cellular prion protein (PrP^C) as a potential reliable biomarker for blast induced TBI (bTBI) in a rodent animal model. In order to explore the application of this novel TBI biomarker to sport-related concussion, we conducted a pilot study at the University of Saskatchewan (U of S) by recruiting athlete and non-athlete 18 to 30 year-old students. Using a modified quantitative ELISA method, we first established normal values for the plasma soluble PrP^C in male and female students. The measured plasma soluble PrP^C in confirmed concussion cases demonstrated a significant elevation of this analyte in post-concussion samples. Data collected from our pilot study indicates that the plasma soluble PrP^C is a potential biomarker for sport-related concussion, which may be further developed into a clinical diagnostic tool to assist clinicians in the assessment of sport concussion and return-to-play decision making.     

针对性护理对急性脑梗死患者神经功能及生活质量的影响

为探讨针对性护理干预对急性脑梗死(ACI)患者神经功能及生活质量的影响,本研究选取90例急性脑梗死患者作为研究对象,按照随机分组的方式,分为干预组和对照组,每组45例。其中,将常规治疗与护理方案应用于对照组,干预组在常规治疗与护理的基础上从入院第2天至第30天采用针对性护理干预,观察不同护理模式对患者的神经功能及生活质量影响。结果显示,采用针对性护理干预,干预组第30天FMA运动能力评分明显高于对照组,差异具有统计学意义(p<0.05)。干预组入院第30天的得分高于对照组,差异具有统计学意义(p<0.05)。本研究表明对急性脑梗死(ACI)患者进行针对性护理干预,可促进患者神经功能的恢复和生活质量的提高。     

Dazed and Confused: Sports Medicine,Conflicts of Interest,and Concussion Management

Professional sports with high rates of concussion have become increasingly concerned about the long-term effects of multiple head injuries. In this context, return-to-play decisions about concussion generate considerable ethical tensions for sports physicians. Team doctors clearly have an obligation to the welfare of their patient (the injured athlete) but they also have an obligation to their employer (the team), whose primary interest is typically success through winning. At times, a team’s interest in winning may not accord with the welfare of an injured player, particularly when it comes to decisions about returning to play after injury. Australia’s two most popular professional football codes—rugby league and Australian Rules football—have adopted guidelines that prohibit concussed players from continuing to play on the same day. I suggest that conflicts of interest between doctors, patients, and teams may present a substantial obstacle to the proper adherence of concussion guidelines. Concussion management guidelines implemented by a sport’s governing body do not necessarily remove or resolve conflicts of interest in the doctor–patient–team triad. The instigation of a concussion exclusion rule appears to add a fourth party to this triad (the National Rugby League or the Australian Football League). In some instances, when conflicts of interest among stakeholders are ignored or insufficiently managed, they may facilitate attempts at circumventing concussion management guidelines to the detriment of player welfare.     

弱He—Ne激光血管内照射治疗急性缺血性脑血管病疗效及机理探讨

本研究观察了１２０例颈内动脉系统急性缺血性脑血管疾病患者,按单双数随机分入激光综合治疗组（激光组）和常规药物治疗组（药物组）各６０例。均予静脉点滴通脉液５００ｍｌ,川芎嗪１００ｍｇ,每天一次,十天为一疗程,激光组同时予１ＬＬＬ１治疗,照射时间６０分钟,每天一次,十天为一疗程,光纤末端输出功率１．５－２．０ｍＷ,同时予３０例健康志愿者１ＬＬＬ１一次。所有受试者在治疗前后均进行血液流变学指标,纤溶系统指标和ＴＣＤ检测,并评定患者治疗５、１０天的疗效。研究结果证明,１ＬＬＬ１ＩＴ可以提高单一药物治疗的疗效,机制是改善血液流变学性能,改善微循环,增快脑血流速度,而且可能有激活纤溶系统功能的作用。所有接受１ＬＬＬＩＴ者均无明显的不良反应。本临床研究表明,１ＬＬＬＩＴ可作为缺血性脑血管病一项有效的安全的辅助治疗方法。     

冠心病合并脑梗死患者心率变异性及心律失常的变化分析

目的：研究冠心病合并脑梗死患者的心率变异性情况,和心律失常的发生率,分析它们的变化规律,为患者疾病的治疗及预后提供更好的治疗指导。方法：研究对象为2012年2月~2012年12月我院心内科及神经内科的患者,其中Ⅰ组：冠心病合并脑梗死患者40例、Ⅱ组：单纯冠心病患者40例、Ⅲ组：单纯脑梗死患者40例、以及Ⅳ组：健康成人50例,统计全部患24 h心率变异性及心律失常发生情况,并进行对比分析。结果：Ⅰ组患者的心率变异性和心律失常发生明显高于其它组患者,差异均具有统计学意义（P〈0.05）。且心率变异性时域参数下降,心律失常发生率升高。结论：冠心病合并脑梗死患者的心率变异性和心律失常发生率增高,为避免冠心病合并脑梗死的患者突然心律失常及猝死,应积极改变治疗措施。     

Can general practitioners use training in relaxation and management of stress to reduce mild hypertension?

To see whether general practitioners could effectively carry out training in relaxation and management of stress to reduce mild hypertension a study was carried out with a subsample of phase 2 of the Medical Research Council''s treatment of mild hypertension trial.¹ In the main mild hypertension trial patients had been receiving either an active drug or placebo for six years. In phase 2 a subsample of these patients were randomly allocated either to continue or to stop receiving the active drug or placebo. In a further subsample patients were again randomised to receive or not to receive relaxation therapy. This factorial design presented an additional opportunity to assess whether patients controlled with active drugs might have their blood pressure maintained by this behavioural therapy once drug treatment was stopped and to assess whether blood pressure might be further reduced by this therapy in patients who had been under regular medical supervision for as long as six years and who had already received non-pharmacological advice. The therapy was conducted by general practitioners in group sessions once a week for eight weeks. The training in relaxation was accompanied by galvanic skin resistance biofeedback. At one year follow up blood pressure in the relaxation subgroups was either maintained (in the group who had stopped receiving drugs) or reduced further (in the group who had continued receiving drugs and in both placebo groups), while in the control group it had increased in all the subgroups, but particularly in those who had stopped receiving drugs. Differences in changes in blood pressure between the relaxation and control groups were significant. There were five new cardiovascular events, including evidence of myocardial ischaemia in blindly coded electrocardiograms in the control group, compared with one in the treatment group.General practitioners, if motivated, can successfully apply this technique of training those with mild hypertension in relaxation and management of stress.     

小儿脑瘫数字化社区康复系统在拇内收畸形中的应用研究

目的:探讨数字化康复系统对于小儿脑瘫拇内收畸形的康复效果。方法:选择普陀区残联系统下脑瘫患儿21例及上海市儿童医院康复门诊家庭康复每月随访的脑瘫患儿21例,将其分成两组,每组21例。对照组由家长行常规OT训练后佩戴为患儿定制的拇外展支具进行治疗,治疗组除以上治疗外加用数字化康复系统随访治疗。三个月后,对疗效进行评估和比较。结果:经3个月治疗后,两组拇指内收肌肌张力改善总有效率(显效率与有效率之和)分别为90.5%和81%,治疗组显著高于对照组(P0.05)。两组患儿治疗后PROM均较治疗前有所改善(P0.01),且治疗组治疗后PROM显著高于对照组(P0.05)。两组FMFM比较两组治疗后FMFM均较治疗前显著升高(P0.01),且治疗组治疗后FMFM显著高于(P0.01)。结论:家庭(社区)数字化康复系统干预可有效提高小儿脑瘫拇内收畸形的康复效果。     

丁苯酞氯化钠注射液治疗急性脑梗死临床疗效观察

目的观察丁苯酞氯化钠注射液治疗急性脑梗死的临床疗效。方法将124例急性脑梗死患者随机分为治疗组和对照组各62例,对照组给予常规治疗,治疗组在常规治疗基础上加用丁苯酞氯化钠注射液治疗,观察比较两组的临床疗效、神经功能缺损评分(NIHSS)和日常生活能力(ADL)。结果治疗组的总有效率为96.8%,明显高于对照组的80.6%,两组比较差异有统计学意义(P0.05)。治疗后,两组患者的NIHSS评分均低于治疗前,ADL评分高于治疗前,差异均有统计学意义(均P0.05);而且两组患者的NIHSS评分、ADL评分比较,治疗组改善明显优于对照组,差异均有统计学意义(均P0.05)。结论丁苯酞氯化钠注射液治疗急性脑梗死能明显提高临床疗效,改善患者的神经功能,提高日常生活能力。     

早期颈内动脉支架置入对动脉粥样硬化脑梗患者血清Lp-PLA2和Hcy水平的影响

摘要 目的：探讨早期颈内动脉支架置入（carotid artery stenting,CAS）对动脉粥样硬化脑梗死患者血清脂蛋白相关磷脂酶2（lipoprotein-associated phospholipase 2,LP-PLA2）和同型半胱氨酸（Homocysteine,Hcy）水平的影响。方法：选择2018年8月到2021年4月在在西安交通大学第一附属医院诊治的颈动脉重度狭窄性脑梗死患者86例作为研究对象,根据治疗方法将患者分为早期CAS组与对照组各43例,对照组给予药物保守治疗,2周后脑梗死稳定后再给予手术,CAS组在对照组基础上治疗3~5 d后给予颈内动脉支架置入治疗,检测两组患者血清Lp-PLA2和Hcy水平变化情况。结果：CAS组治疗后7 d的总有效率为97.7 %,高于对照组的86.0 %（P<0.05）。CAS组治疗后7 d的高灌注综合征、脑出血、低血压、心动过缓等并发症发生率为4.7 %,对照组无出现高灌注综合征、脑出血、低血压、心动过缓等并发症,对比差异无统计学意义(P>0.05)。两组治疗后7 d的颈内动脉相对脑血流量与脑血容量高于治疗前(P<0.05),CAS组高于对照组(P<0.05)。两组治疗后7 d的血清Lp-PLA2、Hcy含量低于治疗前（P<0.05）,CAS组低于对照组（P<0.05）。结论：早期颈内动脉支架置入在动脉粥样硬化脑梗死患者的应用能抑制Lp-PLA2、Hcy的表达,改善患者的血流动力学变化,从而促进提高治疗效果,在临床上的应用具有很好的安全性。     

重组组织型纤溶酶原激活剂静脉溶栓治疗发病4.5小时内急性脑梗死近期疗效的回顾性研究

目的:研究发病4.5小时内的急性脑梗死患者早期应用重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的临床效果。方法:回顾性分析2018年07月1日到2020年10月31日我院神经内科收治的发病在4.5小时内的652例急性脑梗死患者的临床资料,其中使用rt-PA静脉溶栓治疗的患者285例为溶栓组,未溶栓仅使用抗血小板聚集、他汀类降脂、脑保护等常规治疗的患者367例为对照组。记录两组患者治疗前及治疗后24小时、7天、14天的美国国立卫生研究院卒中量表(NIHSS)评分和治疗3个月后的改良Rankin量表(mRS)评分。对于有吞咽障碍的患者,收集洼田饮水试验结果。统计两组患者出血情况和死亡率。结果:溶栓组治疗后24小时、7天、14天的NIHSS评分以及治疗后3个月的mRS评分改善明显,与对照组相比,差异有统计学意义(P<0.05);对于有吞咽障碍的患者,溶栓组的治疗有效率高于对照组(P<0.05);溶栓组轻微出血的概率大于对照组(P<0.05);两组在症状性及致死性脑出血方面的差异无统计学意义(P>0.05);溶栓后大量及致死性脑出血部位多在梗死的中心区、出血量多大于10 mL,患者临床NIHSS评分≥24分。溶栓组死亡率较对照组下降(P<0.05)。结论:发病4.5小时内的急性脑梗死患者接受rt-PA静脉溶栓治疗的近期治疗效果良好,轻微出血风险较高,但是死亡率下降。临床神经功能缺损重、NIHSS评分≥24分、出血风险大的患者预后不良,不推荐溶栓治疗。     

护理干预对脑出血并发症发生率的影响

目的探讨护理干预对脑出血并发症发生率的影响。方法选取2013年1月~2015年6月在我院治疗的脑出血患者82例作为研究对象,随机分为观察组41例和对照组41例,观察组实施有目的、有计划的综合性护理干预,对照组给予常规护理,比较两组患者的并发症发生率及护理满意度情况。结果两组患者的并发症发生率比较,差异有统计学意义(P0.05);两组患者的护理满意度比较,差异亦有统计学意义(P0.05)。结论实施高效合理的护理干预对脑出血患者的病情康复有辅助作用,能有效降低并发症发生率,提高患者对护理工作的满意度。     

瑞舒伐他汀治疗颈动脉粥样硬化斑块的临床研究

目的:研究瑞舒伐他汀对颈动脉粥样硬化斑块的治疗效果。方法:将在本院接受治疗的250例颈动脉粥样硬化斑块患者随机分成治疗组125例和对照组125例,治疗组服用瑞舒伐他汀10mg/晚,对照组行其他非瑞舒伐他汀药物治疗,进行为期6个月的观察对比。结果:治疗组治疗后总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)水平显著下降,高密度脂蛋白(HDL)水平显著升高(P<0.05),颈动脉内膜-中层厚度(IMT)、斑块面积变小,与治疗前比较,差异有统计学意义(P<0.05);对照组治疗前后无显著性差异(P>0.05)。结论:瑞舒伐他汀对降低血脂、减缓不稳定型心绞痛早期动脉粥样硬化、稳定斑块和预防脑血管疾病起到非常重要的作用。     

-phenyl-tert-butyl-nitrone inhibits free radical release in brain concussion

Traumatic brain injury (TBI) is one of the important causes of mortality and morbidity. The pathogenesis of the underlying brain dysfunction is poorly understood. Recent data have suggested that oxygen free radicals play a key role in the primary and secondary processes of acute TBI. We report direct electron spin resonance (ESR) evidence of hydroxyl (·OH) radical generation in closed-head injury of rats. Moderate brain concussion was produced by controlled and reproducible mechanical, fixed, closed-head injury. A cortical cup was placed over one cerebral hemisphere within 20 min of the concussion, perfused with artificial cerebrospinal fluid (aCSF) containing the spin trap agent pyridyl-N-oxide-tert-butyl nitrone (POBN, 100 mM), and superfusate samples collected at 10 min intervals for a duration up to 130 min post brain trauma. In addition, POBN was administered systematically (50 mg/kg body wt.) 10 min pretrauma and 20 min posttrauma to improve our ability to detect free radicals. ESR analysis of the superfusate samples revealed six line spectra (_N = 15.4 and ^β_H = 2.5 G) characteristic of POBN-OH radical adducts, the intensity of which peaked 40 min posttrauma. The signal was undetectable after 120 min. Administration of -phenyl-tert-butyl-nitrone (PBN), a spin adduct forming agent systemically (100 mg/kg body wt. IP 10 min prior to concussion) alone or along with topical PBN (100 mM PBN in aCSF),6significantly (P< 0.001) attenuated the ESR signal, suggesting its possible role in the treatment of TBI.     

丁苯酞氯化钠注射液联合神经节苷脂治疗急性脑梗死的临床效果观察

目的:探讨丁苯酞和神经节苷酯治疗急性脑梗死的临床效果,为临床治疗提供可借鉴的方法。方法:选取2011年8月-2013年5月在我院接受治疗的94例急性脑梗死患者,随机分为治疗组和对照组,每组47例。对照组患者采取抗血小板制剂及活血药物进行常规治疗,治疗组患者在此基础上给予丁苯酞氯化钠注射液联合单唾液酸神经节甘酯进行治疗。采用NlHSS评定各组患者神经功能缺损程度,应用改良Rankin量表评定残障水平,并对两组患者的治疗效果进行对比分析。结果:两组患者治疗前的NIHSS与mRs评分无明显差异(P0.05)。两组患者治疗后的NIHSS及mRs评分较治疗前均获得改善,治疗组患者改善更为明显,治疗效果明显优于对照组,差异具有统计学意义(P0.05)。对照组患者治疗的总有效率为93.61%;治疗组患者治疗的总有效率为97.87%。治疗组的治疗总有效率明显高于对照组,差异具有统计学意义(P0.05)。结论:丁苯酞联合神经节苷酯治疗急性脑梗死具有明显的治疗效果,患者治疗后的NIHSS及mRs评分得到改善,值得临床推广采用。     

拉萨地区血浆同型半胱氨酸水平与脑梗死的相关性研究

目的:探讨在高原缺氧环境下,研究血浆同型半胱氨酸水平与脑梗死的相关性及临床意义,为高原地区脑梗死的防治提供依据。方法:随机选取西藏自治区人民医院2011年04月-2012年12月入院治疗的急性脑梗死患者166例作为观察组,选择同期就诊的150例健康检查者作为对照组,患者就诊第二日清晨采空腹静脉血送检。血浆同型半胱氨酸水平应用循环酶法测定,分析同型半胱氨酸水平与脑梗死的相关性。结果:观察组患者血浆中同型半胱氨酸水平明显高于对照组,差异显著具有统计学意义(P0.01)。结论:高原环境下,高同型半胱氨酸血症是脑梗死的独立危险因素,血浆同型半胱氨酸水平可作为脑血管疾病一级预防的常规检查指标,以及对缺血性脑卒中的指导治疗有重要意义。     

拉萨地区血浆同型半胱氨酸水平与脑梗死的相关性研究

目的：探讨在高原缺氧环境下,研究血浆同型半胱氨酸水平与脑梗死的相关性及临床意义,为高原地区脑梗死的防治提供依据。方法：随机选取西藏自治区人民医院2011年04月-2012年12月入院治疗的急性脑梗死患者166例作为观察组,选择同期就诊的150例健康检查者作为对照组,患者就诊第二日清晨采空腹静脉血送检。血浆同型半胱氨酸水平应用循环酶法测定,分析同型半胱氨酸水平与脑梗死的相关性。结果：观察组患者血浆中同型半胱氨酸水平明显高于对照组,差异显著具有统计学意义（P〈0．01）。结论：高原环境下,高同型半胱氨酸血症是脑梗死的独立危险因素,血浆同型半胱氨酸水平可作为脑血管疾病一级预防的常规检查指标,以及对缺血性脑卒中的指导治疗有重要意义。