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干细胞移植治疗脑梗死的现状
干细胞移植是近年来医学领域的研究热点,随着来源于胚胎和成体干细胞的分离成功、纯化、培养、传代、建立细胞系及体外定向诱导分化等技术的成熟,为脑梗死患者的治疗提供了新的思路.现就干细胞移植治疗脑梗死的研究进展综述如下.
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可疑腔隙性脑梗死CT薄层扫描与常规扫描的对比
我院对可疑腔隙性脑梗死76例患者,在发病24 h内进行常规扫描,66例可明确诊断,10例不能排除,在可疑之处再行CT薄层扫描(5 mm)和窗口技术应用,10例均能确诊.通过2种扫描方法的对比,对可疑腔隙性脑梗死患者,确诊率为100%.从而减少了误诊,为临床提供了诊断和治疗依据.
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无症状脑梗死临床及影像学分析
无症状脑梗死(silent brain infarction,SBI)的发现源于神经影像学发展,CT问世使之得到认识,MRI的应用对其了解得到深入.所谓"无症状性脑梗死"是指无脑卒中病史,无神经系统症状及体征,而影像学检查(头颅CT或MRI)却发现脑梗死病灶;或虽有脑卒中,但影像学发现了非责任病灶,所以又称之为静止脑梗死(silent cerebral infarction,SCI)[1].现就56例有不同危险因素的病人进行临床分析.
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血管紧张素转换酶基因多态性与高血压病早期腔隙性脑梗死的关系
AIM:To investigate the relationships between angiotensin converting enzyme gene polymorphism and lacunar infarction in patients with essential hypertension.METHODS:Polymerase chain reaction(PCR) was used to determine the genotypes for an insertion/deletion polymorphism of 287 pb fragment of ACE gene in 50 healthy persons,50 patients with simple essential hypertension and 30 patients with essential hypertension and lacunar infarction.RESULTS:There was no significant difference of genotype and allele between healthy persons and patients with simple essential hypertension;but there was significant difference of D allele and DD genotype of ACE gene between esential hypertensive patients with lacunar infarction and patients with simple essential hypertension and healthy persons.CONCLUSION:There is a significant relation between ACE gene polymorphism and essential hypertensive patients with lacunar infarction.
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脑梗死患者血浆组织型纤溶酶原激活物和纤溶酶原激活物抑制物活性的变化与神经功能缺损的相关性
AIM:To explore the dynamic changes of the activity of tissue type plasminogen activator (t PA) and type 1 plasminogen activator inhibitor (PAI 1)and its clinical significance by observing the activity of t PA and PAI 1 in patients in acute and recovery phases of arteriosclerotic cerebral infarction.METHODS:Testing the activity of plasma t PA and PAI 1 of 91 patients with arteriosclerotic cerebral infarction and 80 healthy old ages by Chromgenic substrate methods and controlling them.RESULTS:The activity of t PA in acute and recovery stage of arteriosclerotic cerebral infarction patients were apparently lower than that of control and the activity of PAI 1 were higher than that of control.Volume of cerebral infarction was negatively related to the activity of t PA and positively related to the activity of PAI 1. CONCLUSION:The plasma fibrinolytic activities of the acute and recovery stage patients with arteriosclerotic cerebral infarction declined.
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兔急性脑梗死介入治疗动物模型的建立
AIM: To establish a model of cerebral infarction in order to study the interventional treatment.METHODS: An improved 3.0F SP Cobra catheter was introduced to the internal carotid artery by puncturing the femoral artery. After internal carotid arteriography thrombus was injected to embolize its MCA. 3 hours later, clinic observe and computed tomography was examined to analyze results.RESULTS: Clinic observation confirmed that the rabbit had some nerve defect symptoms and CT exam proved cerebral infarction.CONCLUSION: This technique is convenient for application and the model can meet the standard of study of clinical interventional treatment.
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血栓通对脑梗死患者神经功能恢复的疗效观察
Background:Xueshuantong is extracted from dried root of Panax notoginsen,its functioning elements is general saponin. Modern medical science indicates Xueshuantong is capable of inhibiting platelet aggregation, enhancing fibre lytic ability, elongating prothrombin time and clotting time, promoting metamorphotic ability and oxygen carrying ability of red cells, relieving blood vasospasm, improving microcirculation, supplementing blood flow and anticoagulation,accelerating thrombolysis and preventing thrombosis. Objective:To observe effect of Xueshuantong on functional recovery of nerves in patients following brain infarction.
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痴呆与白质疏松诊断的相关性分析
Background: Clinical doctors and radiographers have found the phenomenon that the density of white matter decrease particularly in some patients,and Hachinski called it as Leuko araeosis(LA).LA is a imageological diagnosis,and there were a lot of contentions about the LA substances and the clinical significance of LA.Some considered the neural pathological basis was demyelination of white matter and proliferation of glyocytes.Other persons suggested that the lower density focuses were combined appearances of incomplete ischemia micro infarction and demyelination of white matter .Recently some have observed the phenomenon was similar to Binswanger's disease(BD) in autopsy, but it has been contentious whether BD is same disease entity as the LA and the relationship between LA and brain infarction. So we analyzed the clinical and imaging data of 84 patients with LA revealed by CT and MRI, and discussed the diagnosis of LA with the help of recent international and national literatures. Objective: To explore the relativity of diagnosis between dementia and leuko araeosis.
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自由基损害与红细胞免疫功能状态对急性脑血管病预后的影响
Background: Recent studies show free radicals play an important role in pathogenesis of brain infarction. Over formation of free radicals damage neurons primarily and secondly. A series of free radical reaction accounts from the most part during generation and necrosis due to brain ischemia and reperfusion. Changes in free radicals and immunological state of red cells will affect prognosis in patients with cerebral infarction.
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脑梗死医院感染2758例调查分析
Background: Brain infarction patients were prone to infections among inpatients. Patients of acute phase were even more susceptible to infection. Infections significantly increased mortality and severely impacted rehabilitation. Objective: To investigate relative factors associated with infections of brain infarction inpatients.
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脑梗死急性期合并抑郁障碍的康复与功能预后
Objective To observe rehabilitation and functional prognosis of patients suffered from brain infarction of acute phase complicated by depression. Method We selected 38 cases of acute brain infarct complicated with depression disorder as depression group, 40 cases of non- depression patient admitted at the same period were selected as non depression group.Antidepressants drugs administration and rehabilitation therapy were performed.We evaluated patients according to functional independence measure(FIM)of Chinese edition. HAMD grading comparison was carried out in depression group. Result Before treatment,two groups score nearly the same,compared with pretreatment. After treatment,patients in depression group and non depression group showed significant improvement esp non- depression group (P<0.01).11 cases with severe depression in the depression showed no changes in FIM score before and after treatment. Conclusion Compared with non- depression patients,functional recovery of patients with depression following brain infarction of acute stage is much slower,especially for patients with severe depression.
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无症状脑梗死的CT及MRI表现
无症状脑梗死(silent brain infarction,SBI)的发现源于神经影像学发展.CT问世使之得到认识,MRI的应用对其了解得到深入.所谓“无症状性脑梗死”是指无脑卒中病史,无神经系统症状及体征,而影像学检查(头颅CT或MRI)却发现脑梗死病灶;或虽有脑卒中,但影像学发现了非责任病灶,所以又称之为静止脑梗死(silent cerebral infarction,SCI).1 影像学检查对AI的检出率Jorgensen等[1]曾对各种缺血性脑血管病检查得出,缺血性脑血管病中CT发现AI占10%~38%,MRI发现占47%.欧洲学者Corea等[2]提出,房颤病人CT检查,48%可发现有SBI病灶;有卒中史患者行MRI检查,85%可发现有SBI病灶.而梁氏等[3]综述国内外文献提出,人群SBI的检出率,CT为50%,MRI更为敏感达70%.随近年CT/MRI软件技术提高,如灌注加权、弥散加权等技术应用及人们就医意识增强,对SBI的诊断及检出必将进一步提高.
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无症状脑梗死的危险因素
既往没有卒中病史,神经系统检查没有定位体征,而同时在头CT或头MRI检查中发现脑实质内有梗死灶的存在.这种无症状脑梗死(silent brain infarction)对于以后首次脑卒中发病的短期和长期结局的影响,目前还不清楚.无症状脑梗死可能与一些特殊的危险因素相关,也能影响到患者是否遗留残疾的存活质量.在不同设计的研究中,不同危险因素可能产生不同趋向的无症状脑梗死.同时无症状脑梗死也是广泛脑血管病的标志性特征.
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脑血管损伤类型与无症状脑梗死
近年来,随着CT、MRI等神经影像学检查技术的不断发展,新的脑血管病类型不断被提出和认识,无症状脑梗死就是其中一种.国外学者对无症状脑梗死临床和病理的研究近年来日益增多,而国内有关这方面的报道较少.本文结合近几年的国内外文献,就脑血管损伤类型与无症状脑梗死的关系作一综述.无症状脑梗死(silent brain infarction SBI)[1,2]在美国1990年脑血管病新的分类标准中被列为第一种脑血管损害,但至今为止,尚无确定的诊断标准.一般认为SBI包括两种情况:第一种是指无卒中病史,无神经系统的症状和体征,而在尸检或CT、MRI等影像学检查时,意外地发现原已存在的脑梗死灶.第二种是指影像学检查发现与已知梗死症状、体征无解剖关系的(责任灶以外的)脑梗死灶,即初次卒中发作者,CT或MRI发现与神经系统局灶体征相应的病灶以外,在其它部位还存在1个或1个以上的梗死灶.需要注意的是,在第一种情况中,有时患者并非真的没有脑缺血的症状,而可能是以下几种情况:(1)在一些病人中,脑缺血的症状未被认识或注意到,如轻微肢体麻木,动作笨拙,注意力不集中,构音障碍,头晕等,而误认为是其它原因造成的;(2)在一些病人中,可能曾有过脑缺血症状,但稍后便被遗忘了;(3)一些病人对病史提供不全或不满意.这些情况也归于SCI的范畴.
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无症状脑梗死的部位和类型
无症状脑梗死(silent brain infarction,SBI)是20世纪70年代以来因头颅CT和MRI等神经影像学技术广泛应用于临床,在对从未出现过脑缺血症状的正常人群做神经影像学检查时,发现脑组织内存在不同时期产生的大小不一的缺血病灶,这些病灶随着年龄增长有逐渐增多的趋势.另外,在一部分首次发生短暂性脑缺血发作(TIA)、脑梗死、脑栓塞或脑出血的患者中,头颅CT和MRI检查可发现与本次发病无关的陈旧性的缺血病灶,为进一步与导致患者神经系统症状和体征的责任病灶进行区别,将这些非责任病灶称为SBI.我国1995年在四川成都召开的第四届全国脑血管病学术会议上将SBI正式归入脑血管病分类中[1].
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无症状脑梗死的临床意义
无症状脑梗死( silent brain infarction,SBI )是指无卒中病史,无明确神经系统定位体征,由影像学或尸检发现的梗死灶,包括2种情况:一是无卒中史人群中存在的脑梗死灶;二是卒中患者中存在的不能解释其症状体征的梗死灶.
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Objective: To observe the effect of balancing yin-yang needling manipulation on post-stroke upper limb spasticity and changes of electromyography (EMG) after treatment.
Methods: A total of 60 eligible cases were randomly allocated into an observation group and a control group, 30 in each group. Based on routine medication, cases in the control group were treated with conventional needling manipulation, whereas cases in the observation group were treated with balancing yin-yang manipulation. After the courses of treatment were completed, the therapeutic efficacies were evaluated using modified Ashworth scale and clinical spasticity index (CSI), coupled with the integrated electromyography (IEMG) and root mean square (RMS) value of biceps in passive flexion of the elbow joint during isokinetic testing recorded with the surface EMG.
Results: The total effective rate in the observation group was 86.7%, versus 53.3% in the control group, showing a statistical significance (P < 0.05). After treatment, there was between-group statistical significance in severity of elbow spasticity (P<0.05); there were intra-group (P<0.01, P<0.05) and inter-group (P<0.05) statistical significances in CSI index;and there were intra-group (P<0.01, P<0.05) and inter-group (P<0.01, P<0.05) statistical significances in IEMG and RMS values.
Conclusion:Balancing yin-yang and conventional needling manipulations can both improve upper limb spasm and reduce CSI as well as IEMG and RMS values in stroke patients;however, balancing yin-yang manipulation is better than conventional manipulation in clinical effect. -
无症状性脑卒中的研究现状
无症状性脑梗死(silent brain infarction,SBI)指临床上缺乏相应的神经系统症状与体征,经影像学检查或尸解所发现的病灶.随着影像学技术的发展,发现SBI广泛存在于中老年患者之中,且随着年龄的增长而逐渐增高[1,2].也有越来越多的研究表明,SB1是发生严重的症状性脑梗死的危险因素[3,4],而且绝大多数SBI患者都有不同程度的认知功能障碍,终将演变成血管性痴呆[5].
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无症状脑梗死的临床分析
无症状性脑梗死(silent brain infarction,SBI)定义为临床上缺乏相应的神经系统症状与体征,经影像学检查(头颅CT或MRI)或尸解发现的梗死灶[1].本研究收集自2000-2004年在我院神经内科住院,年龄>60岁非脑卒中患者130例中发现的44例(33.8%)SBI患者的临床资料,回顾性分析其发生率、危险因素、影像学特征,并探讨其临床意义.
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颅脑外伤后大面积脑梗塞的临床相关因素分析
外伤性脑梗塞(traumatic cerebral infarction,TCI)是颅脑损伤的并发症之一,特别是大面积梗塞,其致死率和致残率极高,是颅脑损伤预后不良的一个重要因素.因此研究脑外伤后大面积脑梗塞的临床相关因素,对于改善颅脑损伤病人的预后具有重要的意义.