急性脑出血综合治疗的几个问题探讨：附死亡80例分析

通过对８０例急性脑出血死亡组分析,发现死于脑疝的占６２．５％,脑疝与一种或二种以上合并症同存者占７７．５％,显著高于存活组（Ｐ＜０．０１）．它们互为因果,加速死亡。因此,应重视早期或超早期采用简易定向锥颅脑内血肿碎吸术吸除血肿,同时注意维持生命体征稳定,加强脱水降颅压,预防、控制合并症等综合治疗。且要全面分析,相互兼顾,正确处置。这是帮助机体渡过调控障碍难关,挽救生命的有效治疗措施。     

Structural alterations in synaptosomal membrane-associated proteins and lipids by transient middle cerebral artery occlusion in the cat

We have previously reported that ischemia reperfusion injury results from free radical generation following transient global ischemia, and that this radical induced damage is evident in the synaptosomal membrane of the gerbil. [Hall et al, (1995) Neuroscience 64: 81–89] In the present study we have extended these observations to transient focal ischemia in the cat. We prepared synaptosomal membranes from frontal, parietal-temporal, and occipital regions of the cat cerebral cortex with reperfusion times of 1 and 3 hours following 1 hour right middle cerebral artery occlusion. The membranes were selectively labeled with protein and lipid specific paramagnetic spin labels and analyzed using electron paramagnetic resonance spectrometry. There were significant motional changes of both the protein and lipid specific spin labels in the parietal-temporal and occipital regions with 1 hour reperfusion; but, both parameters returned to control values by 3 hours reperfusion. No significant changes were observed in the normally perfused frontal pole at either reperfusion time. These results support the argument that free radicals play a critical role in cell damage at early reperfusion times following ischemia.     

Expression of a novel nuclear protein is correlated with neuronal differentiation in vivo

We report the production of a monoclonal antibody (MAb 526) that recognizes a novel, developmentally regulated nuclear protein expressed in neurons throughout the rat nervous system. Analysis of whole brain and cell nuclear extracts by SDS-PAGE and immunoblotting determined that MAb 526 recognizes a single nuclear protein (np) of apparent molecular weight 42 kD, designated np526, as well as a slightly larger (ca. 44 kD) cytoplasmic protein. Light microscopic immunocytochemistry showed np526 to be present in neurons of all types throughout the central and peripheral nervous systems. Nuclei of both fibrous and protoplasmic astrocytes were also immunoreactive, but oligodendrocyte nuclei were negative. Positive, but highly variable immunocytochemical staining of nonneural cell nuclei in a variety of other tissues was also observed. Electron microscopic (EM) immunocytochemistry using pre-embedding peroxidase methods revealed that np526 is associated with euchromatin or with the edges of condensed chromatin bundles in neurons, indicating that it is likely to be a chromosomal protein. Most interestingly, the expression of np526 was found to be developmentally regulated in brain. Immunocytochemical analysis of the developing cerebral cortex from embryonic day (E) 16 to postnatal day (P) 4 and cerebellum from P4 to P18 revealed that np526 first appears in central neurons following the cessation of mitosis and that the intensity of nuclear staining increases during subsequent neuronal maturation. To our knowledge, np526 is the first presumptive chromosomal protein whose expression has been precisely correlated with the early postmitotic differentiation of mammalian neurons.     

Effect of crab effluent and scent of damaged conspecifics on feeding,growth, and shell morphology of the Atlantic dogwhelk Nucella lapillus (L.)

Juvenile Nucella lapillus of two different shell phenotypes, exposed shore and protected shore, were maintained in running seawater under each of three experimental conditions for 94 d: a) laboratory control, b) exposed to the effluent of crabs (Cancer pagurus) fed frozen fish (fish-crab), and c) exposed to the effluent of crabs fed live conspecific snails (snail-crab). Rates of barnacle consumption and rates of body weight change varied significantly between phenotypes and among experimental conditions. Individuals from the protected-shore consumed consistently fewer barnacles and grew consistently less than those from the exposed shore. Body weight increases in the fish-crab treatments were from 25 to 50% less than those in the controls and body weights in the snail-crab treatment either did not change or actually decreased. The perceived risk of predation thus appears to have a dramatic effect on the rates of feeding and growth of N. lapillus.At the end of the experiment, size-adjusted final shell weights for both phenotypes were consistently higher than controls (no crab) in both the fish-crab and snail-crab treatments. In addition, apertural tooth height, thickness of the lip, and retractability (i.e. the extent to which a snail could withdraw into its shell), with few exceptions all varied in an adaptive manner in response to the various risk treatments. Similar changes in the shell form of starved snails exposed to the same stimuli suggest very strongly that the morphological responses of both phenotypes were not just due to differences in rates of growth. These differences, at least in part, represented a direct cueing of the shell form of Nucella lapillus to differences in the perceived risk of predation. Somewhat surprisingly, the extent of phenotypic plasticity appeared to differ between the populations examined. Both field and laboratory evidence suggest that the exposed-shore population was much more labile morphologically than the protected-shore population.In many instances, particularly among starved snails, the development of antipredatory shell traits was greater in the fish-crab treatment than in the snail-crab treatment. Because the scent of crabs was present in both treatments, these results suggest a) that, at the frequency/concentration used in the experiments, the scent of damaged conspecifics may have been a supernormal stimulus and b) that the morphological response in these treatments might have been greater if the stimulus had been provided at a lower level.     

An analog of ACTH/MSH (4–9), ORG-2766, reduces cerebral uptake of morphine

The uptake of morphine was significantly reduced in most regions of the brains of conscious, unrestrained rats within 10 minutes after treatment with an analog of ACTH/MSH (4–9), ORG-2766. The effect was most obvious in regions with significant densities of enkephalin receptors, namely basal ganglia, hippocampus and cortex. The results explain, in part, how some fragments and analogs of ACTH/MSH may antagonize behavioral actions of morphine, even though some of these peptides lack significant opiate receptor binding properties. We believe that this effect of ORG-2766 is related to an action on the permeability characteristics of the brain microvasculature. The underlying mechanism is unknown.     

依托咪酯联合右美托咪定对高血压基底节区脑出血患者脑糖氧代谢和氧化应激的影响

摘要 目的：观察依托咪酯联合右美托咪定对高血压基底节区脑出血患者脑糖氧代谢和氧化应激的影响。方法：纳入2020年1月-2022年12月期间我院收治的90例高血压基底节区脑出血患者,采用随机数字表法将患者分为对照组和研究组,各为45例。对照组患者接受依托咪酯乳状注射液麻醉,研究组患者接受依托咪酯乳状注射液联合右美托咪定注射液麻醉。对比两组血流动力学[心率（HR）、平均动脉压（MAP）]、糖氧代谢指标[氧饱和度（SjvO₂）、脑氧摄取率（CEO₂）、脑动静脉氧差（AVDO₂）]、氧化应激指标[丙二醛（MDA）和超氧化物歧化酶（SOD）]和不良反应。结果：麻醉诱导后5 min（T1）~手术完毕时（T4）时间点,研究组心率（HR）、平均动脉压（MAP）低于对照组（P<0.05）。T4时间点,研究组SjvO₂高于对照组,CEO₂、AVDO₂低于对照组（P<0.05）。T4时间点,研究组SOD高于对照组,MDA低于对照组（P<0.05）。两组不良反应总发生率对比未见差异（P>0.05）。结论：依托咪酯联合右美托咪定可更好维持机体血流动力学,改善脑糖氧代谢,减轻氧化应激,对高血压基底节区脑出血患者发挥出良好的麻醉效果。     

外科手术在高血压脑出血治疗中的应用

高血压脑出血是当今社会一种发病率及死亡率都非常高的神经科疾病,对于它的治疗,则是神经内外科的重点难点。目前治疗高血压脑出血的方法分为内科保守治疗和外科手术治疗两种,作者阅读了大量国内外临床相关文献,综述了高血压脑出血相关内外科治疗的方法,以及具体应用,望能为其相关研究提供有益的思路。     

不同剂量阿加曲班联合丁苯酞对急性脑梗死患者效果及预后的影响因素分析

摘要 目的：本研究旨在探讨不同剂量阿加曲班联合丁苯酞对急性脑梗死患者效果及预后的影响因素。方法：以自2019年6月到2022年8月在我院收治的90例急诊急性脑梗死为研究对象,采用随机数字表法将其分为高剂量组（给予高剂量阿加曲班联合丁苯酞治疗）和低剂量组（给予低剂量阿加曲班联合丁苯酞治疗）各45例。对比治疗7 d后两组临床疗效及预后,分析治疗前及治疗7 d后两组神经功能[中国卒中量表（CSS）评分、神经功能（NIHSS）评分],根据不同预后将患者分为预后良好组和预后不良组,采用单/多因素Logisitic回归分析急性脑梗死预后的影响因素。结果：（1）将两组的临床疗效纳入研究并实施组间差异性比较,结果显示,高剂量组总有效率高于低剂量组（P＜0.05）。（2）将两组的神经功能采用CSS评分、NIHSS评分评估纳入研究并实施组间差异性比较,结果显示治疗前,两组采用CSS评分、NIHSS评分比较（P＞0.05）;治疗7 d后,高剂量组采用CSS评分、NIHSS评分高于低剂量组（P＜0.05）。（3）将两组的预后采用mRS评分评估纳入研究并实施组间差异性比较,结果显示,高剂量组预后良好2.22%（1/45）高于低剂量组15.56%（7/45）（P＜0.05）。（4）预后良好组患者年龄、治疗前CSS评分及治疗前NIHSS评分与预后不良组存在差异（P＜0.05）。（5）以急性脑梗死预后为因变量,以单因素中对比有差异的指标为自变量,经多因素Logisitic回归分析急性脑梗死预后的影响因素为治疗前CSS评分及治疗前NIHSS 评分。结论：高剂量阿加曲班联合丁苯酞能够有效治疗急性脑梗死患者,而急性脑梗死预后的影响因素为治疗前CSS评分及治疗前NIHSS 评分。     

Layilin,A Novel Talin-binding Transmembrane Protein Homologous with C-type Lectins,is Localized in Membrane Ruffles

Changes in cell morphology and motility are mediated by the actin cytoskeleton. Recent advances in our understanding of the regulators of microfilament structure and dynamics have shed light on how these changes are controlled, and efforts continue to define all the structural and signaling components involved in these processes. The actin cytoskeleton-associated protein talin binds to integrins, vinculin, and actin. We report a new binding partner for talin that we have named layilin, which contains homology with C-type lectins, is present in numerous cell lines and tissue extracts, and is expressed on the cell surface. Layilin colocalizes with talin in membrane ruffles, and is recruited to membrane ruffles in cells induced to migrate in in vitro wounding experiments and in peripheral ruffles in spreading cells. A ten–amino acid motif in the layilin cytoplasmic domain is sufficient for talin binding. We have identified a short region within talin''s amino-terminal 435 amino acids capable of binding to layilin in vitro. This region overlaps a binding site for focal adhesion kinase.