1 病例资料 1 .1 入院资料 患者,男 ,72岁 ,右利手 ,因"突发反应迟钝1 d"入院.入院前一天17时45分,患者与家人通话时声音低沉 ,对答仅部分切题 ,后失去联系.次日7时30分 ,家人于警局找到患者 ,发现患者小便失禁 ,右侧小腿外伤,右侧额部外伤 ,且不能回忆发病经过 ,伴记忆力下降.急诊头颅CT 示左侧基底节区脑梗死;心电图示房颤伴快速心室率.入院查体 :语速缓慢 ,定向力、记忆力粗测可 ,计算力略差 ,无法回忆发病过程.左侧鼻唇沟稍浅 ,余无殊.

A patient with multiple ischemic stroke due to spontaneous bilateral internal carotid artery dissection (ICAD) was reported and the epidemiology, neuroimaging, clinical characteristics and treatment of spontaneous bilateral ICAD were reviewed.Spontaneous bilateral ICAD mostly occurs in young and middle-aged individuals and the clinical manifestations are mainly stroke(71.1%), headache and neck pain(62.2%), Horner's syndrome(15.6%) and cranial nerve palsy(11.1%).Cervical axial T1-weighted fat-suppressed image is an alternative to DSA to make the definite diagnosis.Antithrombotic therapy is regularly used and the general clinical outcome is good.Cervical arterial dissection is one of the most common causes of stroke in young and middle-aged patients.Cervical MRI T1-weighted fat suppressed image is crucial for timely diagnosis and initiation of appropriate clinical intervention.

轻度认知功能障碍(mild cognitive impairment,MCI)是介于正常老化和阿尔茨海默病之间的一种过渡阶段,现无有效治疗药物,但早期进行生活方式干预、包括饮食治疗或能降低MCI向痴呆症的转化率.本文介绍MCI患者的饮食治疗相关研究现状,以期能为改善MCI的风险因素提供一定的参考.

The adaptive evolution of the rbcL gene in 14 species of Ephedra and 9 other gymnosperms was tested by the PAML program. Three large-scale selections were found in the catalytic region of the RbcL protein by branch model. Species in Ephedra with positive selection at the 365th codon site in rbcL gene were detected by branch-site model. 3D structure modeling showed that the 365th codon could change the spatial structure of the β-sheet (βG, βH, or βE) of the RbcL protein. These changes may be associated with the adaptation of the protein in Ephedra to the environment.

Araucariaceae is one of the most primitive families of the living conifers, and its phylogenetic relationships and divergence times are critically important issues. The DNA sequences of 8 genes, i.e., nuclear ribosomal 18S and 26S rRNA, chloroplast 16S rRNA, rbcL, matK and rps4, and mitochondrial coxI and atp1, obtained from this study and GenBank were used for constructing the molecular phylogenetic trees of Araucariaceae, indicating that the phylogenetic relationships among the three genera of this family should be ((Wollemia, Agathis), Araucaria). On the basis of the fossil calibrations of Wollemia and the two tribes Araucaria and Eutacta of the genus Araucaria, the divergence time of Araucariaceae was estimated to be (308 ± 53) million years ago, that is, the origin of the family was in the Late Carboniferous rather than Triassic as a traditional view. With the same gene combination, the divergence times of the genera Araucaria and Agathis were (246 ± 47) and (61 ± 15) Ma, respectively. Statistical analyses on the phylogenetic trees generated by using different genes and comparisons of the divergence times estimated by using those genes suggested that the chloroplast matK and rps4 genes are most suitable for investigating the phylogenetic relationships and divergence times of the family Araucariaceae.

南洋杉科是最原始的松杉纲类群之一,其系统发育关系与起源(分支)时间研究具有极为重要的意义.利用自行测定和GenBank中获得的核核糖体18S和26S,叶绿体16S,rbcL,matK和rps4以及线粒体cox 1和atp1等8个基因的DNA序列,构建了南洋杉科的分子系统树,确定该科属间系统发育关系应为((瓦勒迈杉属,贝壳杉属),南洋杉属).以瓦勒迈杉属和南洋杉属Araucaria族和Eutacta族的化石记录作为时间标定,估计南洋杉科的起源在(308±53)百万年前,即该科在石炭纪晚期起源,而非以往认为的三叠纪.用相同基因组合还估计出南洋杉属起源于(246±47)百万年前,贝壳杉属起源于(61±15)百万年前.对不同基因所构建的系统树进行统计分析并对它们所估计的起源时间进行比较表明,叶绿体matK和rps4基因较为适合南洋杉科的系统发育与起源时间估计研究.

Wilson病,亦称肝豆状核变性,是少数可治性、常染色体隐性遗传铜代谢障碍性疾病[1],exon8是突变热区之一,首发症状多样,常累及肝、脑、肾、骨骼等,易延误诊治.在我们近200例患者资料中,仅1例表现为肝占位而行手术探查,现报告如下.

目的观察添加雌激素后海人藻酸(Kainic acid,KA)致癎大鼠皮层和海马的雌激素β受体(ER-β)的变化.方法用荧光免疫组化法.结果ER-β免疫阳性细胞广泛分布于大鼠的皮层、海马、下丘脑以及杏仁核区域,主要位于细胞核.单纯添加雌激素(17-βestradiol,E2)组、海人藻酸致癎(KA)组、添加雌激素后海人藻酸致癎(E2加KA)组海马的ER-β免疫阳性细胞数较对照组(OIL组)明显减少(P＜0.05),以DG(齿状回,Dentate Gyrus)区的变化最明显;皮层(Cortex)的ER-β免疫阳性细胞表达变化不显著.E2+KA组的ER-β免疫阳性细胞与KA组相比减少,(P＜0 05).结论大剂量雌激素下调ER-β免疫阳性细胞的表达,且此作用有区域性.添加雌激素后致癎,ER-β免疫阳性细胞下调更显著,雌激素可能是通过下调DG区ER-β的表达加重癫癎的发作.

目的观察尼莫地平联合甲磺酸二氢麦角碱对血管性痴呆患者认知和生活能力改善效果。方法选择2003年10月至2006年6月门诊诊治的血管性痴呆患者60例,随机分为单用尼莫地平治疗的对照组(尼莫地平片30 mg,每日3次,口服),尼莫地平联合甲磺酸二氢麦角碱的观察组(尼莫地平片30 mg,每日3次,甲磺酸二氢麦角碱2.0 mg,每日3次,均口服),分别用药前及治疗后45 d 和90 d 采用简易智能量表、长谷川痴呆量表评定患者认知功能。采用简易智能量表评定智能改善效果。采用日常生活能力量表评定患者的生活能力改善情况。结果治疗前及治疗后45 d 时,两组间各量表分值差异无显著性(P>0.05)。治疗90 d 后两组认知功能及日常生活能力量表评分比较差异有显著性意义(P<0.05)。结论尼莫地平与甲磺酸二氢麦角碱联合用药在改善患者认知功能,提高日常生活能力方面优于单用尼莫地平。

Objective: 1. To investigate the serum hormone concentrations changes in patients with epilepsy, 2. To evaluate serum hormone changes of the anti-epileptic drugs effects. Methods: All the participants were drawn blood sample for the analysis of serum prolactin (PRL), estradiol (E2), progesterone( PG) and Totol testosterone( TTes ). Results: 1. The study was performed in 71 epileptic patients (male 32 female 39). The levels of PRL and E2 were high in most patients, the radio was 50. 70%(36/71) and 43. 66%(35/71) respectively. The concentrations of PG and TTes were reduced in 18(25. 35% ,18/71)patients and 13(18. 31% ,13/71)patients. 2. The incidence of elevation of serum E2concentration was 77. 78% in women patients with anti-epilepitic drug, meanwhile,41. 67% in those without the treatment, which showed significant differences. TTes were low in 5(33. 33%) men patients with the antiseizure treatment, it is 5. 90%(1/17) in patients without treatment, the difference is significant. The varies of PG and PRL between the patients with or without medical treatment showed no differences. Conclusions ;1)There were changes of the serum hormone concentration in patients with epilepsy. 2)Antiepilep-tic drug affected the serum hormone concentrations.

椎基底动脉供血不足(vertebrobasilar insuffi-ciency VBI)是由于各种病因引起的椎基底动脉狭窄或闭塞而导致脑干、小脑或枕叶皮层的缺血.为中老年人常见的脑血管病,但至今对它的概念、分类及病因等仍缺乏足够地认识.为此,笔者根据自己既往的研究,结合文献复习予以介绍.

目的:观察凯时注射液治疗椎基底动脉供血不足的疗效.方法:41例椎基底动脉供血不足患者随机分为凯时治疗组(20例)和低分子右旋糖酐加复方丹参注射液对照组(21例).结果:治疗组治疗显效率(65.0%)明显高于对照组显效率(14.3%),治疗组有效率(100%)高于对照组有效率(76.2%).结论:应用凯时治疗椎基底动脉供血不足疗效显著,值得推广使用.

Objective To evaluate the clinical value of dipyridamole cerebral blood flow stress test in ischemic cerebrovascular diseases (CVD). Methods Twenty-four CVD patients and 8 controls received both rest and stress cerebral blood flow perfusion imaging within one week of each other using Elscint Apex SP-6 SPECT. The dose of dipyridamole was 0.56 mg/kg. The semiquantitative methods were used for result analysis and the sensitivity of rest and stress test were compared.The asymmetric indexes at both tests were analyzed using paired-t test. Results For CVD patients, the sensitivity was improved from 58.3% to 83.3% in dipyridamole stress test. For the evaluation of vertebrobasilar ischemia (VBI) and tranient ischemia attack (TIA), the sensitivity was improved from 46.7% to 73.3%. The asymmetric indexes before and after dipyridamole were of no significant difference for the controls,but it had significant difference between two tests for the 24 patients.In dipyridamole stress test, we found different reaction patterns also. Conclusions Dipyridamole stress test is helpful to finding more le-sions in CVD patients and may be it could reflect the cerebrovascular reaction.

近年来,我国的脑血管的发病率越来越高.脑血管病的致死、致残率很高.对于脑缺血的研究日益受到重视.脑缺血损伤的病理生理机制比较复杂.目前提出了损伤级联反应理论--兴奋性毒性、梗死周围去极化、炎症、程序性死亡(即细胞调亡)[1].在这些过程中,有许多因素参与,其中细胞因子起了重要的作用.

椎基底动脉缺血性脑血管病是脑卒中的主要原因之一,而椎基底动脉系统梗塞的死亡率亦可高达20%～30%[1,2],因此早期诊断椎基底动脉缺血性脑血管病,对于脑卒中的预防和减少卒中后的死亡率、致残率均有很重要的意义.

目的分析腔隙性脑梗死(LI)的影像学特点及其临床意义,比较MRI和CT在LI诊断中的价值.方法对157例经临床、MRI诊断明确为LI患者的病灶形态大小、部位、数量进行统计,其中115例患者行2次或以上MRI检查,68例患者同时行CT检查.结果①157例行MRI检查患者共发现LI灶1 459个,最多见于豆状核(占40.8%),其次为放射冠、丘脑、内囊、尾状核、桥脑,可为圆形、椭圆形、条索状病灶.②68例既做CT,又做MRI患者中,MRI检出的病灶数为CT的4.3倍,其中绝大多数CT漏检病灶直径≤5 mm或位于幕下.③115例行2次或以上MRI检查患者中有77例(67.0%)急性期后复查病灶较前缩小.结论①LI常为多发,且第一次临床发病时多数患者颅内已存在无症状性LI病灶.②LI灶易为CT忽略,尤其是幕下病灶或≤5 mm的病灶,这是造成既往文献报道LI好发部位差异较大的一个主要原因.③尽管LI病灶较小(≤20 mm),但大部分(67.0%)急性期存在在周边水肿,需要相应的临床治疗.