Study of clinical features of amyloid angiopathy hemorrhage and hypertensive intracerebral hemorrhage

Objective: The purpose of this study was to differentiate between cerebral amyloid angiopathy (CAA) and hypertension (HTN) based on hemorrhage pattern interpretation. Methods: From June 1994 to Oct., 2000, 83 patients admitted to our service with acute intracerebral hemorrhage (ICH) were investigated retrospectively; 41 patients with histologically proven diagnosis of cerebral amyloid angiography and 42 patients with clear history of hypertension were investigated. Results: Patients with a CAA-related ICH were significantly older than patients with a HTN-related ICH (74.0years vs 66.5 years, P＜0.05). There was a significantly higher number ofhematomas≥30 ml in CAA (85.3%) when compared with HTN (59.5%). No basal ganglional hemorrhage was seen in CAA, but in 40.5% in HTN. In CAA-related ICH, subarachnoid hemorrhage (SAH) was seen in 26 patients (63.4%) compared to only 11 patients (26.2%) in HTN-related ICH.Intraventricular hemorrhage was seen in 24.4% in CAA, and in 26.2% in HTN. Typical features of CAA-related ICH included lobar distribution affecting mainly the lobar superficial areas, lobulated appearance, rupture into the subarachnoid space, and secondary IVH from the lobar hemorrhage. More specifically, multiplicity of hemorrhage, bilaterality, and repeated episodes also strongly suggest the diagnosis of CAA. Multiple hemorrhages, defined as 2 or more separate hematomas in multiple lobes, accounted for 17.1% in CAA-related ICH. Conclusion: There are certain features in CAA on CT and MRI and in clinical settings. To some extent, these features may contribute to distinguishing CAA from HTN related ICH.     

心电图STⅡ/Ⅲ比值在急性下壁心肌梗死相关动脉预测中的价值

目的通过对急性下壁心肌梗死时心电图Ⅱ、Ⅲ导联ST段抬高幅度（STⅡ／Ⅲ比值）的比较分析，来预测梗死相关动脉（infarction related artery IRA）。方法回顾性分析72例首次急性下壁心肌梗死患者的入院心电图与冠状动脉造影资料。结果对急性下壁心肌梗死时心电图指标STⅡ／Ⅲ与IRA关系的统计分析表明，STⅡ／Ⅲ在右冠状动脉（RCA）组绝大多数小于1而左旋支（LCX）组多大于等于1（P〈0．011，排除RCA和LCX皆有显著病变的病例后仍然P〈0．01。结论心电图STⅡ／Ⅲ比值是预测急性下壁心肌梗死患者IRA的较准确的指标。     

Optimal time for mesenchymal stem cell transplantation in rats with myocardial infarction

Background:Bone marrow mesenehymal stem cell(MSC)transplantation is a promising strategy in the treatment of myocardial infarction(MI).However,the time for transplanting cells remains controversial.The aim of this study was to find an optimal time point for cell transplantation.Methods:MSCs were isolated and cultured from Sprague-Dawley(SD) rats.MI model was set up in SD rats by permanent ligation of left anterior descending coronary artery.MSCs were directly injected into the infarct berder zone at 1 h,1 week and 2 weeks after MI,respectively.Sham-operated and MI centrel groups received equal volume of phosphate buffered saline(PBS).At 4 weeks after MI,cardiac function Was assessed by echocardiography;vessel density Was analyzed on hematoxylin-eosin stained slides by light microscopy;the apoptosis of cardiomyocytes Was evaluated by terminal deoxynucleotidy1 transferase-mediated dUTP nick end-labeling(TUNEL) assay;the expressions of proteins were analyzed by Western blot.Results:MSC transplantation improved cardiac function.reduced the apoptosis of cardiomyocytes and increased vessel density.These benefits were more obvious in l-week group than in 1-h and 2-week groups.There are more obvious increases in the ratio of bc1-2/bax and the expression of vascular endothelial growth factor(VEGF)and more obvious decreases in the expression of cleaved-caspase-3 in 1-week group than those in other two groups.Conclusion:MSC transplantation was beneficial for the recovery of cardiac function.MSC transplantation at l week post-MI exerted the best effects on increases of cardiac function,anti-apoptosis and angiogenesis.     

急性心肌梗死早期应用不同剂量辛伐他汀疗效观察

目的：观察不同剂量辛伐他汀对急性心肌梗死患者近期疗效与安全性。方法：将116例急性心肌梗死患者在常规治疗基础上（包括溶栓药物、硝酸酯类药物、血管紧张素转换酶抑制剂、8受体阻滞剂、阿司匹林、低分子肝素），随机分为常规剂量组：辛伐他汀20mg，每晚1次；高剂量组：辛伐他汀40mg，每晚1次。两组均于急性心肌梗死发病后24h内开始用药，观察30d内主要心血管事件联合终点。结果：治疗30d两组比较，高剂量组明显减少心血管事件联合终点：所有原因死亡，心肌再梗死，不稳定心绞痛，卒中（P〈0．05）。结论：对于急性心肌梗死患者，大剂量辛伐他汀在降低主要心血管事件方面的作用优于常规剂量辛伐他汀，且具有良好的安全性。     

急性脑梗死溶栓后静点巴曲酶对凝血机制的影响

目的:研究急性脑梗死家兔尿激酶溶栓后静点巴曲酶对凝血机制的影响。方法:雄性健康新西兰大白兔随机分对照组、治疗1组、治疗2组。采用颈内动脉自血栓塞法建立脑梗死模型。治疗1组尿激酶静脉溶栓;治疗2组尿激酶溶栓后静点巴曲酶;对照组用等量生理盐水替代。分别测定不同时间段3组纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)。治疗后22h断头取脑,冰冻切片观察有无脑出血,2%氯化三苯基四氮唑(TTC)染色观察有无脑梗死病灶。结果:治疗1、2组各有2例出血、TTC染色,治疗1组2例正常,治疗2组3例正常。对照组造模后FIB升高,PT、APTT缩短,与造模前比较差异有显著性(P<0.05)。治疗后6h,2个治疗组FIB下降,PT、APTT延长,与造模后2h或对照组比较,差异均有显著性(P<0.05),治疗2组FIB、PT、APTT与治疗1组比较,差异也有显著性(P<0.05)。结论:急性脑梗死家兔尿激酶溶栓后静点巴曲酶在一定剂量范围内是安全的,不增加出血发生率。通过凝血四项检测发现两药同时应用凝血机能下降明显,因此必须严格控制药物剂量,同时监测凝血—纤溶指标,减少出血事件发生。     

AMI患者PCI术后BNP相关分析及应用研究

目的:观察PCI术对AMI患者血浆中BNP的水平变化,探讨PCI对AMI患者预后的影响.方法:采用快速荧光免疫测定法对50例AMI患者PCI治疗前、治疗后7d内每日同一时间取静脉血进行BNP的测定和50例对照组血浆BNP水平进行检测.结果:AMI患者血浆BNP在行PCI术后与对照组比较有显著性差异(P<0.05),PCI治疗后呈明显下降趋势.结论:AMI患者经PCI治疗血浆BNP水平变化说明PCI术对改善AMI患者的预后有重要意义.     

潘南金对急性心肌梗塞心律失常影响的对比研究

目的观察潘南金(门冬氨酸钾镁)对急性心肌梗塞后心律失常、泵功能及死亡率的影响.方法本文对我院1998.3～1999.10月收入CCU病房的40例患者进行单盲、随机分为治疗组和对照组,治疗组第1～5天给予潘南金静脉输注,第6～15天改为口服,检测两组治疗前、第5、10天的血清钾、镁离子浓度,记录治疗前后血压及第一天24hHolter,统计两组并发症及死亡率,所得数据进行统计学处理.结果两组间在年龄、性别、发病时间及合并用药等方面无差异,所有资料具有可比性.治疗组第5、10天的血镁较治疗前及对照组显著增高(P＜0.01),治疗组的心衰、室早、室速较对照组明显减少(P值分别为＜0.05、＜0.01及＜0.05),治疗组再灌注心律失常发生率较对照组减少(P＜0.05),死亡率两组间无显著差异(P＜0.05).治疗组治疗前后血压变化较对照组明显(P＜0.05).结论潘南金可以减少AMI后心衰的发生,改善心功能,减少AMI后室性心律失常的发生.在溶栓的患者,潘南金能减少再灌注心律失常的发生,减小再灌注损伤.但潘南金对血压有较大的影响,尤其血压在正常低限时,静脉输注潘南金可使低血压发生率增加,因此临床应用时需注意.     

脑瘫儿童攻击性行为的个案研究

本研究以积极行为支持为理论基础,选取一名具有攻击性行为问题的脑瘫儿童作为研究对象,采用观察法和访谈法收集资料,使用功能评估的方法进行分析,并在此基础上对儿童的攻击性行为问题提出功能性假设,制定并实施初步的干预方案,最终取得了良好的干预效果。     

运动训练治疗对脑梗死患者平衡功能和运动功能恢复的研究

目的:研究运动配合药物对脑梗死患者平衡功能和运动功能的恢复作用。方法:所有90名患者被随机分为运动组和对照组,共治疗12周。治疗后进行Fugl-Meyer平衡积分、Sheikh躯干控制积分、简式Fugl—Meyer运动功能评分等指标进行评价。结果:运动治疗配合药物治疗在对急性脑梗死患者Fugl-meyer平衡积分、Sheikh躯干平衡积分、日常生活指数等各指评价中均有明显的改善,而基础治疗配合针刺治疗优于基础治疗组。结论:运动疗法对脑梗死者平衡功能和运动功能有积极的恢复作用。     

Combinatorial Determination of Ischemia Modified Albumin and Protein Carbonyl in the Diagnosis of NonST-Elevation Myocardial Infarction

Ischemia modified albumin (IMA) and Protein Carbonyl (PC) have known as proteins that are modified on the similar basis of oxidative stress induced protein modification and may have diagnostic potential in acute myocardial infarction. This study aims to evaluate the ability of using IMA and PC content to diagnose Non-ST elevation myocardial infarction (NSTEMI) and efficiency of combining these two markers. Serum from NSTEMI and healthy control were determined for serum IMA and PC content. The results showed that both of serum IMA level and PC content in NSTEMI was significantly higher than that of healthy controls. However, the PC content showed greater diagnostic performance than IMA. Combinatorial determination of serum IMA level with PC content level was enhanced test efficiency. In conclusion, our finding demonstrated that IMA and PC content can be used as a diagnostic marker for NSTEMI.