1 病例报告 患者男,37 岁.因"头痛伴左侧肢体麻木 1 d"于 2018-12-2 入作者医院神经外科.入院前 1 d 开始出现右侧颞部及头顶阵发性疼痛,左侧偏身麻木,无发热呕吐,无明显抽搐及意识障碍,无二便失禁等.起病以来精神稍差,睡眠饮食尚可,二便如常.2008 年在作者医院行右顶叶胶质瘤切除术,无高血压、糖尿病、高血脂、心脏病等基础疾病史.入院后 1d患者头痛缓解,仍有左侧肢体麻木,并出现发作性左侧面部及左侧肢体抽搐,每次持续 1～2 min,不伴意识丧失.

目的:调查中青年脑卒中患者的性生活质量,探讨导致卒中患者性生活受损的可能原因.方法:从2014年10月至2015年1月在门诊复诊的73例(18岁≤年龄≤55岁)脑出血或脑梗死患者中,共获得49份问卷,调查患者对性生活的态度、卒中前后性生活情况,比较患者在卒中发病前后性生活状态改变情况,并通过收集患者医疗信息了解造成性生活受损的可能原因.结果:多数患者在卒中后出现性生活质量受损,包含性欲下降、性生活频率降低,男性勃起功能及女性阴道润滑情况均有不同程度降低,患者对性生活满意度下降,并对性生活重视程度降低.合并高血压病、服用ACEI/ARB类降压药及对卒中复发的担心等因素与性生活受损显著相关.结论:在中青年卒中患者中,性生活受损现象严重,与多种因素相关.

Objective To analyze hematoma characteristics of hemorrhagic moyamoya disease,and report a familial moy-amoya disease pedigree.Methods In total,110 patients with hemorrhagic moyamoya disease were retrospectively re-searched.The general clinical data and morphological characteristics of hematoma were collected.The bleeding characteristics of cerebral hemorrhage caused by this special cause were explored.Meanwhile,morbidity of a Han moyamoya family with a muta-tion of the ring finger protein(RNF)213 was reported.Results There were 50 males and 60 females,with a ratio of 1:1.2,and the average age was(38.65 ± 7.85)years.The main symptoms were headache,consciousness and hemiplegia.There were 82 (74.5%)cases of hemorrhage in the basal ganglia,33(30.0%)cases with lobar hemorrhage and 81(73.6%)cases with hemor-rhages in the ventricular/subarachnoid space.Sixty-seven cases(60.9%)had the irregular hematoma,15 cases(13.6%)aneu-rysms.Recurrent bleeding occurred in 21 cases(19.1%),of which 6 patients had re-bleeding in acute stage,and the other 15 pa-tients re-bleed in the recovery period.Univariate analysis showed that age and irregular hematoma were related to repeated hem-orrhage(t=2.149,P=0.034;χ2=4.379,P=0.047).In addition,there were 7 patients in the familial moyamoya disease pedi-gree of four generations.Genetic testing found the RNF213 p.R4810K(rs112735431:G> A)mutation,the most common type included ventricular hemorrhage and cerebral infarction;among them,sudden death happened in 3 patients.Symptoms onset in early age and the disease was recurrent frequently.Bypass revascularization surgery reduced frequency of attacks.Conclusion Hemorrhagic moyamoya disease is characterized by typical hematoma and high risk of re-bleeding.Older age and irregular hema-toma were related to re-bleeding.Identifying the characteristics of hematoma could contribute to early diagnosis.At the same time,RNF213 p.R4810K mutation is a potential pathogenic factor in Han population of familial moyamoya disease.

Objective:To study if the combined use of aspirin and clopidogrel increases the risk of hemorrhage transformation (HT) and the prognostic value of early rehabilitation treatment in ischemic stroke patients .Method:654 patients with ischemic stroke were collected to descriptively analyze the rate of HT ,and to observe if the com‐bined use of aspirin and clopidogrel increased the HT risk .Thirty patients were screened in all 55 HT patients and divided into two groups according to the illness degree and age factors :15 not subject to rehabilitation therapy as control group ,and 15 subject to rehabilitation therapy as observation group .The national institute of health stroke scale (NIHSS) and modified Rankin scale (mRS) were compared in two groups before and 14 days after treatment . Results:HT occurred in 55 cases out of 654 patients (8 .41% ) .The combined use of aspirin and clopidogrel could not increase the HT risk .NIHSS scores were significantly decreased in both groups after 14‐day treatment (P<0 .05) without inter‐group differences .The mRS scores were significantly increased after 14‐day rehabilitation thera‐py in observation group as compared with the control group (P<0 .05) .Conclusion:HT is one of common compli‐cations in acute ischemic stroke possibly affecting the prognosis .Rehabilitation therapy can promote the neurological function recovery to some extent .

Objective: To discuss risk factors of gastrointestinal hemorrhage in acute ischemic stroke patients. Methods: Six hundred and fifty-four ischemic stroke patients were enrolled. The risk factros were analyzed. Re-sults: Forty-four patients (6.73%) were experienced gastrointestinal hemorrhage in total 654 patients. The average age, propotion of large area infarction, propotion of previous stroke, propotion of using anticoagulant in the gas-trointestinal hemorrhage patients were higher than those of patients without gastrointestinal hemorrhage(P<0.05). And there was no difference in the propotion of combined use of clopidogrel and aspirin in the patients without gastrointestinal hemorrhage. Conclusion: Gastrointestinal hemorrhage is common and poor the outcome in stroke, prophylaxis and treatment should be rational.

目的:探讨鼠神经生长因子注射液联合奥拉西坦注射液对脑出血(ICH)患者的疗效.方法:选取我院收治的60例ICH患者,随机分为2组:对照组30例给予奥拉西坦注射液治疗14d,实验组30例给予鼠神经生长因子注射液联合奥拉西坦注射液治疗14 d.观察治疗前后2组患者的美国国立卫生研究院卒中量表(NIHSS)评分差值、肢体肌力分级差值.结果:实验组治疗14 d后NIHSS评分差值、肢体肌力分级差值均显著优于对照组(P＜0.05).结论:鼠神经生长因子注射液联合奥拉西坦注射液对ICH患者的疗效显著,可以有效改善ICH患者的NIHSS评分、肢体肌力分级,疗效优于单用奥拉西坦注射液.

Objective: To study the effect of different trypsin sequential method on the culture of mice-derived induced pluripotent stem(iPS) cell. Methods: Mouse iPS cells were digested by the different trypsin sequential method. The percentage of iPS cells was determined by flow cytometry and compared with that treated by the single trypsin method. Result: The percentage of iPS cells cultured with different trypsin sequential method is higher than that with single trypsin method. Conclusion: The different trypsin sequential method could improve the purity of iPS cells. Mouse iPS cells culture could be optimized in this way.