Objectives: 1.To explore the incidence of concurrent gouty arthritis (GA) during hospitalization in patients with different subtypes of acute stroke. 2.To investigate disparities in acute cerebral infarction patients with coexisting GA undergoing various antiplatelet strategies. Materials and methods: Data from acute stroke patients admitted to the Affiliated Panyu Central Hospital of Guangzhou Medical University, from January 2019 to December 2021, underwent screening. The incidence of GA in acute stroke patients of various subtypes were analyzed. Subsequently, we divided cerebral infarction cases into three cohorts based on distinct antiplatelet therapies: the aspirin group, the dual antiplatelet therapy group (DAPT, aspirin plus clopidogrel), and the clopidogrel group. Investigate disparities in acute cerebral infarction patients with coexisting GA undergoing various antiplatelet strategies. Results: A total of 12,381 patients with acute stroke were screened in this study. The incidence of GA in various subtypes of acute stroke was as follows: cerebral infarction (3.56 %, n = 9890), TIA (1.81 %, n = 443), cerebral hemorrhag (0.64 %, n = 1713), and SAH (0.30 %, n = 335). The incidence of GA in patients with ischemic stroke is higher than that of hemorrhagic stroke (chi(2) = 49.258, p<0.001). No significant differences were observed in the incidence of GA among three different antiplatelet therapy groups. But there was marginal statistical difference in the incidence of GA between the aspirin group and the DAPT group (P = 0.051), as well as between the clopidogrel group and the DAPT group (P = 0.059). Conclusions: The incidence of GA in patients with ischemic stroke is higher than that of hemorrhagic stroke. No significant differences were observed in the incidence of GA in acute cerebral infarction across various antiplatelet Strategies. The marginal statistical difference in the incidence of GA between the single antiplatelet group and the DAPT group requires further investigation.

目的 探讨对急性脑梗塞患者采用丁苯酞联合依达拉奉治疗的临床效果及对改善患者神经功能的作用.方法 选择中山一院2020年1月至2020年6月收治急性脑梗死患者30例,按照随机数表法分为采用丁苯酞治疗对照组(n=15)与采用丁苯酞联合依达拉奉治疗实验组(n=15),对比治疗效果、神经功能缺损评分以及炎性因子水平.结果 实验组治疗总有效率高于对照组(P<0.05).治疗后1周、2周实验组NIHSS评分低于对照组(P<0.05).实验组治疗后肿瘤坏死因子-α(TNF-α)、白介素-1(IL-1)水平低于对照组(P<0.05).结论 对急性脑梗死患者采用丁苯酞联合依达拉奉治疗疗效理想,可有效改善患者神经功能,减轻炎性反应,值得推广.

目的:明确宏基因组二代测序技术(metagenomic next-generation sequencing,mNGS)在中枢神经系统感染中的指导意义.方法:选取2019年1月～2019年12月39例疑似中枢神经系统感染患者作为研究对象,分别进行脑脊液mNGS检测(观察组)和常规培养检测(对照组).对比两组诊断符合率、灵敏度、特异度、一致性、AUC曲线下面积.结果:39例疑似患者中,26例患者最终诊断为中枢神经系统感染.观察组诊断符合率为61.54％,明显高于对照组的0％,差异有统计学意义(P<0.05);观察组灵敏度、特异度、一致性、AUC曲线下面积均明显高于对照组,差异有统计学意义(P<0.05).11例患者根据mNGS检测结果进行了用药调整,26例患者均通过治疗好转出院.结论:mNGS可为中枢神经系统感染诊断提供可靠有效的依据,为临床的治疗带来益处.

目的:探讨长春西汀治疗后循环缺血的疗效.方法:将广州市番禺区中心医院收集2016年1月至2019年1月的100例后循环缺血患者,随机分组,常规药物治疗组对后循环缺血患者用常规的药物治疗,常规药物和长春西汀联名治疗组对后循环缺血患者用常规的药物治疗联合长春西汀治疗.比较两组患者康复效果;症状好转时间、血流动力指标改善时间;治疗前后纤维蛋白原.结果:常规药物和长春西汀联合治疗组康复效果、纤维蛋白原、症状好转时间、血流动力指标改善时间方面相较常规药物治疗组更好,差异具有统计学意义(P＜0.05).结论:后循环缺血患者实施常规的药物治疗联合长春西汀治疗效果确切,可改善患者血流动力学和缩短治疗时间.

目的 探讨人尿激肽原酶联合依达拉奉治疗脑栓塞的治疗效果及对患者神经功能产生的影响.方法 选取2016年3月-2017年8月我院收治的116例脑栓塞患者作为研究对象,采用随机数字表法将其分为联合组与对照组,各58例,对照组采用人尿激肽原酶进行治疗,联合组采用人尿激肽原酶联合依达拉奉进行治疗,对比两组患者的疗效及治疗后的神经功能变化.结果 联合组的治疗总有效率(96.55％)显著高于对照组(82.76％)(P＜0.05);联合组治疗后的NIHSS和BI评分均明显优于对照组(P＜0.05);联合组的不良反应发生率(5.17％)与对照组(12.06％)相比差异无统计学意义(P＞0.05).结论 人尿激肽原酶联合依达拉奉治疗脑栓塞患者的疗效显著,可有效改善患者的神经功能,且安全性较好.

Objective To observe the effect and safety of urinarykallid combined with edaravone in treating acute massive cerebral infarction(AMCI). Methods 180 patients with AMCI were randomly divided into 3 groups:control group(n=60) , treatment group A(n=60) and treatment group B(n=60). Besides a basic 14‐day therapy ,patients in treatment group A were given edaravone ,treatment group B received urinarykallid based on treatment group A. We recorded the change of CRP ,Na‐tional Institutes of Health Stroke Scale(NlHSS) scores and Barthelindex score(BI) before treatment and after 14‐and 90‐day&nbsp;treatment.Results After 14-day treatment ,The CRP of group B decreased more significantly than that of group A and the contol group(P<0.05);And likewise ,the lower NIHSS scores and the higher BI scores in group B (P<0.05). All groups had no severe adverse events in the whole period. Conclusion Urinarykallid combined with edaravone in the treatment of acute massive cerebral infarction were proved to be effective and safe.

Objective:To discuss the risk factors,the distribution and drug resistance of multiple drug resistant(MDR)bacteria of elderly stroke-associated pneumonia(SAP)patients with multiple drug-resistant bacterial infections,so as to provide guidance for clinical treatment of SAP.Methods:A retrospective study was designed to analyze the clinical data of elderly patients with SAP from June 2010 to June 2014.Univariate analysis and multivariable regression analysis were taken for risk factors of MDR infections,and the distribution and drug resistance of MDR were investigated.Results:There were 162 patients with SAP,in which 93 cases got MDR bacteria infection,the rate was 57.4%;MDR infection had close relationship with levels of consciousnesss,deglutition disorders,prophylactic antibiotics and late-onset pneumonia and the difference was significant(P0.05).There were 147 MDR strains in 93 patients,the first 5MDR strains were Acinetobacter baumannii,Klebsiella pneumoniae,Staphylococcus aureus,Pseudomonas aeruginosa and Escherichia coli.Conclusion:SAP patients with MDR bacterial infections are closely related to the following risk factors:levels of consciousnesss,deglutition disorders,prophylacticantibiotics and late-onset pneumonia.The rate of MDR bacterial infections is high,which shows widely different degrees of resistance to many antibiotics.

Objective To investigate the clinical value of serum homocysteine(Hcy),high-sensitivity C-reactive protein(hs-CRP)and fibrinogen(Fbg)in middle-aged and young patients with cerebral infarction. Methods Hcy,hs-CRP and Fib levels were measured in 86 middle-aged and young patients with cerebral in-farction as well as in56 controls. Results The levels of serum Hcy,hs- CRP and Fbg in middle- aged and young patients with cerebral infarction were significantly higher than those in controls(P < 0. 01),and positive rate were also higher than controls(P < 0. 01). Conclusion Serum levels of Hcy,hs-CRP and Fbg increased obviously in middle-aged and young patients with cerebral infarction,joint detection can be used as sensitive markers in predicting its development.

目的：通过测定中青年脑梗死患者颈动脉内－中膜厚度（IMT）和血清同型半胱氨酸（Hcy）、高敏C反应蛋白（hs-CRP）及纤维蛋白原（Fib）水平，探讨Hcy、hs-CRP、Fib 与中青年脑梗死患者颈动脉粥样硬化及其严重程度的关系。方法：86例住院的中青年脑梗死患者为脑梗死组，根据IMT厚度分为：内膜正常亚组19例，内膜增厚亚组31例，斑块形成亚组36例，另选中青年健康体检者56例为正常对照组。两组均分别进行颈动脉超声检查测定IMT和血Hcy、hs-CRP和Fib水平检测，并进行相关性分析。结果：脑梗死组血Hcy、hs-CRP和Fib水平及IMT均显著高于正常对照组（P ＜0．05）；各实验亚组间比较差异有统计学意义（P＜0．05）；血Hcy、hs-CRP和Fib水平与IMT呈线性相关。结论：Hcy、hs-CRP和Fib参与了颈动脉粥样硬化的进程和发展，在中青年脑梗死中起着重要作用。

Objective To evaluate the clinical efficacy and safety of urinary kallidinogenase injection in patients with acute cerebral infarction. Methods One hundred patients with acute cerebral infarction were included in this trial, which were randomly divided into two groups. Patients in the control group (n=50) were treated with basic therapy, while those in the treatment group (n=50) were treated with urinary kal1idinogenase injection and basic therapy. NIHSS score were evaluated before treatment, 7 days and 14 days after treatment, respectively. Hepatic function, renal function, coagulation function and hemorrhagic event were recorded before and after treatment. Results No significant difference was in NIHSS sore found 7 d after treatment (P0.05), while 14 days after treatment, NIHSS score in the treatment group was significantly lower than that in the control group (P0.05). No significant difference was found before and after treatment on hepatic, renal, coagulation impairment and hemorrhagic event (P0.05). Conclusion Urinary kallidinogenase injection is effective and safe for patients with acute cerebral infarction, which is better than single use of basic therapy.

Objective To explore a more convenient and reliable method of primary cortex neuron culture.Methods On the basis of previous methods,syringe pumping cortex in and out was used to make neuron homogenate.Secondly,0.125% trypsin with 0.2‰ EDTA was add into the neuron homogenate to digest the connective tissue for 3~5 minutes.Neuron homogenate was seeding onto poly-D-lysine coated six-well plates with DMEM and 10% fetal bovine serum.Twenty-four hours after seeding,the medium was replaced and 10 μm arabinofuranoside cytosine(Ara-C) was added into the cultured medium.Forty-eight hours after seeding,the cultured medium changed again to stop the effect of Ara-C.Lastly,the cultured medium was changed every 2~3 days until neuron culture was incubated with 95% CO2 for 7 days into confluence.Neuron-specific enolase(NSE) staining was used to identify the purity of cultured neurons.Results More than 95% of neuron purity was detected by NSE staining.Conclusion The improved primary neuron culture method with low concentration of trypsin and short digestive time can reduce the quantity of animal used,cell lesions and pollution chance.It is a convenient and reliable method to get primary neuron culture in vitro.

Objective To observe the effects of Guizhi Fuling Capsule in the treatment of patients with carotid atherosclerosis (CAS). Methods One hundred and thirty-eight CAS patients with carotid intima-media thickening and / or plaque formation confirmed by ultrasonic from March 2011 to June 2012 were involved in this study. The patients were randomly divided into three groups: the treatment group (50 cases, treated with Guizhi Fuling Capsule 3 times daily, 4 granules for each time), the western medicine control group (the control group 1, 46 cases, treated with aspirin enteric-coated tablets 100 mg, once daily), and the Chinese medicine control group (the control group 2, 42 cases, treated with compound Danshen Dripping Pill 3 times daily, 10 pills for each time). All groups were treated for 6 months. The concentration of serum lipids, plasma endothelin (ET-1) and nitric oxide (NO), the changes of Platelet CD41, CD63, CD62P, the changes of bilateral carotid artery intima-media thickness (IMT), plaque morphology before treatment and 6 months after treatment were detected respectively. Results ① No significant difference was found in serum lipids, ET, NO concentration between the three groups before treatment and after treatment (P>0.05). ② CD41, CD63, CD62P levels in the treatment group after treatment were significantly lower than those before treatment (P<0.05), while no significant difference were found in both control group 1 and control group 2 (P>0.05). ③ IMT, unstable plaque and plaque area in the treatment group were significantly better than those in the control group 1 and control group 2 (P<0.05). ④No serious adverse reactions were found in the treatment group group. Conclusion Guizhi Fuling Capsule could reduce the number of unstable plaque in the carotid artery and its area, decrease IMT, and improve endothelial function and anti-platelet activity in patients with CAS.

10.3969/j.issn.1674-4985.2013.17.061

Objective To explore the Influence of urinary kallidinogenase on plasma endothelin-1 of patients with a cute cerebral infarction.Methods According to the diagnostic criteria developed by the 1995 Fourth National Confer ence on cerebrovascular disease,100 patients with acute cerebral infarction were randomly divided into two groups.50 patients in control group were treated with basic therapy,while 50 cases in treatment group were treated with urinary kal1idinogenase injection 0.15 PNA and basic therapy.Plasma endothelin-1 concentration was mesured before treat ment,14 days after treatment respectively,and NIHSS score was evaluated at the same time.Results There was no significant difference of plasma endothelin-1 concentration and NIHSS score between control group and treatment group before treatment.While after treatment 14 d,plasma endothelin-1 concentration and NIHSS score in treatment group decreased significantly than that in control group.Conclusion Plasma endothelin-1 concentration in patients with acute cerebral infarction could be significantly lowered by Urinary Kallidinogenase injection than that of basic therapy.Lowered plasma endothelin-1 concentration might be involved in the efficacy of Urinary Kallidinogenase in jection.

目的探讨黛力新联用乌灵胶囊治疗脑卒中后抑郁(PSD)的临床疗效。方法选择92例脑卒中后抑郁患者,将患者分为两组,治疗组采用黛力新加乌灵胶囊治疗,对照组单纯使用乌灵胶囊治疗,两组间临床资料无统计学差异(P>0.05)。治疗2、4、6周末应用汉密尔顿抑郁量表、CSS评分、Barthel指数(BI)进行评定。结果治疗前两组间HAMD、CSS评分、BI评分无显著性差异(P>0.05),治疗2周末治疗组与对照组比较有明显差异(HAMD、CSS评分、BI评分P<0.05),治疗4、6周末各项评分改善更明显,与对照组比较均有极显著差异(P<0.01)。组内比较:治疗组HAMD、CSS评分、BI评分于4、6周末显著改善(P<0.01)。结论通过应用黛力新联用乌灵胶囊治疗PSD为治疗脑卒中后抑郁的一种有效方法。

目的探讨短暂性脑缺血发作(TIA)进展至脑梗死的相关因素。方法对230例TIA患者的临床资料进行回顾性分析。结果 TIA进展至脑梗死与性别、吸烟、饮酒、有脑卒中病史、冠心病及高脂血症无密切相关(P>0.05),与高龄(60岁以上)、高血压、糖尿病及脑动脉狭窄密切相关(P<0.05);TIA发作持续时间>30min,发作次数>3次和首次发作距治疗时间>24 h的TIA患者,脑梗死发生率明显增高,差异有统计学意义(P<0.05)。结论高龄(60岁以上)、高血压、糖尿病、脑动脉狭窄、TIA发作持续时间>30 min,发作次数>3次和首次发作距治疗时间>24 h等是TIA进展至脑梗死的危险因素。

Objective To explore the incidence and related factors for post-stroke depression (PSD).Methods An evaluation was made of depression degree,nerve function damage degree and activities of daily living(ADL) in 356 cases of initial stroke.Statistical analysis was based on sexuality, location of injury, nature of injury, literacy and nerve function damage degree.Results The incidence of PSD was 36.2%,and most were mild and moderate depression.A significant correlation was observed between PSD and the factors such as frontotemporal and basal ganglia lesions,literacy,economic situation,nerve function damage degree and ADL.Conclusion PSD is a common complication in patients with stroke,and has a close correlation with many factors.

Objective To analyze the clinical features of vertebral dissecting aneurysni,and to evaluate the therapeutic effect of endovascular covered stent graft on vertebral dissecting aneurysm.Methods Restrospectively analyse the clinical data,the treatment,therapeutic effect in 5 case of vertebral dissecting aneurysms.Results The stent grafts were successfully deployed into the target artearies in 5 cases,leading to total obliteration of the aneurysms with the parent arteries patent and favorable clinical outcomes,no complication related to operation occurred,and no recurrence of symptoms were observed during the follow-up period of 1-3 yerars.Conclusion Endovascular covered stent is effective treatment for vertebral dissecting aneurysms.

目的了解帕金森病(Parkinson’s disease,PD)患者伴发的抑郁和焦虑的发生率并对其相关因素进行分析。方法采用汉密尔顿抑郁量表(HAMD)和焦虑自评量表(SAS)对98例PD患者和51例对照者进行评定,用帕金森病定量表(UPDRS)评定PD者病情严重程度。结果PD组抑郁和焦虑的发生率分别为44.9%和46.9%,明显高于对照组;PD组抑郁与焦虑共病发生率为28.6%,明显高于对照组。回归分析发现PD患者伴发的抑郁和焦虑与病程、Hoehn-Yahr分级和Webster评分呈正相关,与患者的性别、受教育程度无相关性。结论PD患者有较高的抑郁和焦虑发生率,与PD病程、病情分期密切相关。

目的:观察克林澳联合银杏叶注射液治疗急性脑梗死的疗效及安全性。方法:将急性脑梗死患者150例随机分为两组,治疗组给予克林澳和银杏叶注射液,对照组单独给予克林澳治疗,两组其他治疗相同,以治疗第14天时的CSS神经功能缺损评分及1个月时的Barthel指数评分为标准观察疗效。并比较两组治疗14 d前后红细胞比容、纤维蛋白原等血液流变学及各项血脂指标改变。结果:治疗组CSS神经功能缺损评分及Barthel指数差异明显优于对照组(P<0.05),无明显不良反应。且治疗组治疗前后血液流变学及血脂等各项指标改变差异有统计学意义(P<0.05)。结论:克林澳联合银杏叶注射液治疗急性脑梗死安全有效,可明显改善脑梗死患者的血液流变学及血脂异常。