目的:探讨血栓通联合穴位针灸颈动脉粥样硬化病人易损斑块及对总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)水平的影响.方法:纳入 2020年 6月—2021年 6月 100例颈动脉粥样硬化易损斑块病人,随机分为两组,每组50例,对照组予以阿托伐他汀钙片治疗,研究组在对照组基础上予血栓通及针灸治疗.治疗前后检测 TC、LDL-C、HDL-C水平,治疗前及随访 1年后检测颈动脉内膜中层厚度(IMT)及斑块的个数和厚度,记录不良反应及心脑血管事件发生情况.结果:治疗 4 个疗程后,研究组 TC、LDL-C水平均降低,HDL-C水平升高,而对照组 TC、LDL-C水平降低(P<0.05),HDL-C水平升高差异无统计学意义(P>0.05);研究组 TC、LDL-C水平低于对照组(P<0.05),而 HDL-C水平与对照组比较差异无统计学意义(P>0.05).治疗随访 1年后,两组 IMT值均减小,且研究组小于对照组(P<0.05);研究组斑块数减少,斑块厚度减小,对照组仅斑块厚度减小,研究组斑块厚度小于对照组(P<0.05),而斑块数与对照组比较差异无统计学意义(P>0.05).两组均未出现明显不良反应,随访期间对照组出现短暂性脑缺血发作 1例,两组未见其他心脑血管事件发生.结论:血栓通联合穴位针灸治疗颈动脉粥样硬化易损斑块,具有良好的调脂作用,可有效减小 IMT,减小斑块厚度,提高斑块的稳定性.

目的 探讨电针对帕金森病(PD)大鼠海马组织丝裂原活化蛋白激酶激酶激酶激酶3(MAP4K3)/丝裂原活化蛋白激酶激酶4(MKK4)/c-Jun氨基末端激酶(JNK)通路的影响.方法 大鼠分为对照组、PD模型组(PD造模)及电针干预组(PD造模+电针干预).Morris水迷宫实验记录逃避潜伏期及原平台停留时间,旷场实验统计水平运动得分及垂直运动得分,HE染色观察大鼠海马组织病理改变,TUNEL染色检测大鼠海马组织中细胞凋亡,Western blot法检测大鼠海马组织中MAP4K3/MKK4/JNK通路及凋亡相关蛋白表达.结果 与对照组相比,PD模型组大鼠逃避潜伏期显著延长(P<0.05),原平台停留时间显著缩短(P<0.05),水平运动得分及垂直运动得分显著降低(P<0.05),大鼠海马组织中细胞凋亡率及MAP4K3、p-MKK4/MKK4、p-JNK/JNK、Bax、cleaved caspase-3蛋白表达水平显著升高(P<0.05),海马组织出现明显的病理学改变;与PD模型组相比,电针干预组大鼠逃避潜伏期显著缩短(P<0.05),原平台停留时间显著延长(P<0.05),水平运动得分及垂直运动得分显著升高(P<0.05),大鼠海马组织中细胞凋亡率及MAP4K3、p-MKK4/MKK4、p-JNK/JNK、Bax、cleaved caspase-3蛋白表达水平显著降低(P<0.05),海马组织病理改变较轻.结论 电针可抑制MAP4K3/MKK4/JNK通路激活,减轻PD大鼠海马组织细胞凋亡及病理改变,提高认知、行为功能.

目的 探讨极低频电磁场对局灶性脑缺血大鼠神经功能缺失恢复的影响及机制.方法 180只清洁级成年SD雄性大鼠随机分为对照组(假手术)、模型组(局灶性脑缺血模型)、极低频电磁场治疗组,每组60只.根据实验设计将3组进一步随机分为6个亚组,分别为治疗前及治疗后3、7、14、21、30 d,每个亚组10只.采用大鼠大脑中动脉栓塞模型(MCAO)模拟脑缺血再灌注损伤;造模成功后进行极低频电磁场刺激治疗,分别于治疗前及治疗后3、7、14、21、30 d进行水迷宫实验,称量脑组织含水量,TUNEL染色观察大鼠海马CA1区神经元凋亡情况;分别于治疗前、治疗30 d后检测大鼠脑组织匀浆中超氧化物歧化酶(SOD)、丙二醛、过氧化氢酶表达水平.结果 治疗后极低频电磁场治疗组达到高台所需时间明显短于治疗前和模型组(P<0.01);其中治疗后3、7、4、21 d随着治疗时间的延长大鼠达到高台所需时间逐渐缩短.治疗后极低频电磁场治疗组脑组织含水量、海马CA1区凋亡阳性神经元数目明显低于治疗前和模型组,差异有统计学意义(P<0.05);随着治疗时间的延长大鼠脑组织含水量、海马CA1区凋亡阳性神经元数目逐渐减少.治疗后30 d极低频电磁场治疗组SOD、过氧化氢酶水平明显高于模型组,丙二醛水平明显低于模型组(P<0.05).结论 极低频电磁场对局灶性脑缺血大鼠神经功能缺失恢复有积极的促进作用,可能与减少海马CA1区神经元凋亡,抑制过氧化反应有关.

Objective:To investigate the effect of Extremely low frequency electromagnetic fields（ELFEF） on rats with ischemic stroke（IS）.Methods:48 adult SD male rats were randomly divided into blank group（sham operation group）, control group（IS group） and treatment group（ELFEF treatment）, with 16 rats in each group.The treatment group received ELFEF treatment for 30 consecutive days, while the blank group and the control group did not receive ELFEF exposure. Neurological function score, cerebral infarction volume, water content and biochemical indexes of brain tissue were compared among three groups after intervention.Results:The neuroprotection score, cerebral infarction volume and cerebral tissue water content in three groups show that: blank group＜treatment group＜control group（P＜0.05）.The SOD,GSH-Px, CAT in three groups show that: treatment group＞control group（P＜0.05）,while there was no significant difference between treatment group and blank group（P＞0.05）.The MDA in three groups show that: blank group＜treatment group＜control group（P＜0.05）.Conclusion:ELFEF treatment can improve neurological function and reduce the severity of cerebral infarction in IS rats, and the mechanism may be related to the improvement of oxidative stress injury.

目的:探讨养血清脑颗粒对帕金森综合征(PD)大鼠认知功能障碍及PERK/ATF4/CHOP通路的影响.方法:SD大鼠颈背部皮下注射鱼藤酮诱导PD大鼠模型,随机分为模型组、养血清脑低剂量(1.6 g·kg-1)组、养血清脑中剂量(3.2 g·kg-1)组、养血清脑高剂量(6.4 g·kg-1)组、美多芭(100 mg·kg-1)组,每组12只.另取12只大鼠颈背部皮下注射等剂量葵花油,设为对照组.给药后,以阿扑吗啡诱导大鼠旋转行为,比较其转圈次数;以Morris水迷宫实验评测大鼠认知功能,比较其逃避潜伏期与跨越原平台次数;以试剂盒测量大鼠脑组织多巴胺转运体(DAT)、酪氨酸羟化酶(TH)及血清炎症因子γ-干扰素(IFN-γ)、白细胞介素-18(IL-18)含量;HE染色检测大鼠海马神经细胞病理形态;蛋白质印迹(Western blotting)实验检测大鼠脑组织PERK/ATF4/CHOP通路蛋白表达.结果:与对照组相比,模型组大鼠海马神经细胞皱缩变小,细胞核形状不规则,排列散乱且数目显著减少,整体神经细胞损伤严重,转圈次数,血清IFN-γ及IL-18含量,脑组织PERK、ATF4及CHOP蛋白表达水平,逃避潜伏期显著升高,脑组织DAT及TH含量、跨越原平台次数显著降低,差异有统计学意义(P＜0.05);与模型组相比,养血清脑低、中、高剂量组及美多芭组大鼠海马神经细胞损伤减轻,转圈次数,血清IFN-γ 及IL-18含量,脑组织PERK、ATF4及CHOP蛋白表达水平,逃避潜伏期降低,脑组织DAT及TH含量、跨越原平台次数升高,养血清脑各组之间呈剂量依赖性,差异有统计学意义(P＜0.05);养血清脑高剂量组与美多芭组相比,大鼠各指标均无明显差异(P＞0.05).结论:养血清脑颗粒可抑制炎症发生,减轻PD大鼠海马及脑组织多巴胺能神经细胞损伤,改善大鼠运动功能,提高其认知能力,该作用机制可能与抑制PERK/ATF4/CHOP通路有关.

目的 观察丁苯酞软胶囊联合马来酸桂哌齐特注射液对急性脑梗死患者脑血流、神经功能及炎性指标等的影响.方法 选取2017年3月—2018年3月海南省干部疗养院/海南省老年病医院内科收治急性脑梗死患者100例,按照随机数字表法分为对照组和观察组,各50例.对照组给予马来酸桂哌齐特注射液治疗,观察组在此基础上给予丁苯酞软胶囊治疗.比较2组治疗效果;检测2组患者治疗前及治疗后14 d大脑中动脉(MCA)、大脑前动脉(ACA)血流速度及神经生长因子(NGF)、神经元特异性烯醇化酶(NSE)、脑源性神经营养因子(BDNF)、星形胶质源性蛋白(S100-β)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、白介素-10(IL-10)、单核细胞趋化蛋白-1(MCP-1)水平,并比较ADL评分、NIHSS评分及治疗过程中不良反应.结果 治疗后,观察组患者治疗总有效率显著高于对照组(96.00％vs.80.00％,χ2/P=6.061/0.014);2组患者治疗后MCA、ACA血流速度,血清NGF、BDNF、IL-10水平,ADL评分均高于治疗前,NSE、S100-β、TNF-α、CRP、MCP-1水平,NIHSS评分均低于治疗前(P<0.05);观察组患者治疗后MCA、ACA血流水平,血清NGF、BDNF、IL-10水平,ADL评分均高于对照组(t/P=4.450/0.001,4.317/0.001,3.315/0.001,10.420/0.001,6.274/0.001,7.507/0.001),NSE、S100-β、TNF-α、CRP、MCP-1水平,NIHSS评分均低于对照组(t/P=7.963/0.001,5.212/0.001,13.450/0.001,14.840/0.001,11.650/0.001,6.385/0.001).结论 丁苯酞软胶囊联合马来酸桂哌齐特注射液治疗急性脑梗死患者效果显著,能改善脑血流动力,通过调控NGF、NSE、BDNF水平,促进患者脑神经功能恢复,抑制炎性反应,达到治疗目的.

目的 探讨强筋健骨胶囊联合常规治疗对老年骨质疏松症患者的临床疗效.方法 100例患者随机分为对照组和观察组,每组50例,对照组给予常规治疗(维D钙、骨化三醇),观察组在对照组基础上加用强筋健骨胶囊,疗程6个月.检测临床疗效、VAS评分、Oswestry指数、骨密度[腰椎(L2-4)、Ward三角区、股骨颈、大转子]、骨代谢指标(β-CTX、OC、血钙、血磷)变化.结果 观察组总有效率高于对照组(P＜0.05).治疗后,2组骨密度、OC、血钙、血磷升高(P＜0.05),VAS评分、Oswestry指数、β-CTX降低(P＜0.05),以观察组更明显(P＜0.05).结论 强筋健骨胶囊联合常规治疗可提高老年骨质疏松症患者骨密度,调节骨代谢水平,减轻疼痛程度.

BACKGROUND:Current pharmacological research has administrated that Ginkgo biloba and its extracts can eliminate loss and apoptosis of dopamine neurons by antioxidation and nerve growth factor activation. <br> OBJECTIVE:To confirm the effects of Ginkgo biloba Pingchan Recipe on loss and apoptosis of dopamine neurons as wel as proliferation of neuroblastoma derived cel lines SH-SY5Y in mice with Parkinson’s disease. <br> METHODS:(1) C57BL mice were randomly divided into three groups:20 mice were modeled into Parkinson’s disease by intraperitoneal injection of MPTP for 6 weeks, and at 30 minutes before each intraperitoneal injection, mice in model group were given gavage of normal saline, mice in treatment group given Ginkgo biloba Pingchan Recipe. The other 10 mice received no any interventions as normal group. The loss and apoptosis of dopamine neurons were observed by immunohistochemistry at 15 and 30 days after modeling. (2) In vitro cultured SH-SY5Y cel lines were treated with Ginkgo biloba Pingchan Recipe. Subsequently, the cel proliferation and apoptosis were detected using MTT assay and flow cytometry, respectively;PARP and PTEN mRNA and protein levels were measured through real-time PCR and western blot assay. <br> RESULTS AND CONCLUSION:(1) Compared with the model group, the number of tyrosine hydroxylase-positive neurons at the substantia nigra compacta of midbrain was significantly increased in a time-dependant manner in the normal and treatment groups (P<0.05). (2) The apoptosis rate and mRNA and protein levels of PARP and PTEN in the treatment group were lower than those in the model group. These results suggest that Ginkgo biloba Pingchan Recipe can partly inhibit midbrain neuron apoptosis that may be by decreasing PTEN level. As a result, it becomes possible to prevent and treat Parkinson’s disease via protecting dopamine neurons from loss.

Objective To investigate the association between lecithin cholesterol acyltransferase (LCAT) gene 511C/T polymorphism and cerebral infarction, and it's early warning value for cerebral infarction. Methods A total of 317 patients with cerebral infarction from January 2014 to March 2015 in the Department of Neurology of Hainan Prov-ince Cadre Sanatorium were chosen as the study group, and 305 healthy people for medical physical examination were chosen as the control group. All the samples were analyzed by biotechnology company for the typing information of LCAT gene 511C/T polymorphism locus. SPSS21.0 software was used for statistical analysis. Results Genotype TT was not de-tected in 511C/T locus in the two groups. The frequency of genotypes CC, CT were 80.8%(256/317), 19.2%(61/317) in the study group and 77.7%(237/305), 22.3%(68/305) in the control group, with no statistically significant difference be-tween the two groups (P>0.05). There was also no statistically significant difference between the two groups in the fre-quency of allele C and T. Conclusion There is no correlation between LCAT gene 511C/T polymorphism and cerebral infarction in patients of Han population in Hainan.

目的：了解海南省老年人对养老模式的需求，并探讨其影响因素。方法2013年6月至2014年5月选择海口周边地区70岁以上的357名机构养老老人及402名居家养老老人进行问卷调查，比较两种养老模式人群的性别、年龄、工作类型、收入、家庭平均收入以及老年人对养老模式的看法和对养老服务的需求，同时还比较老年人子女的健康状况及其与老人的相处情况，利用统计学软件SPSS19.0对组间差异性进行分析。结果两种养老模式人群的年龄、性别比较差异均无统计学意义(P>0.05)；机构养老人群的脑力劳动者占57.4%(205/357)，明显高于居家养老人群的48.5%(195/402)，机构养老人群中有退休金者251名(70.3%)，明显高于居家养老人群的164名(40.8%)，差异均有统计学意义(P<0.05)；两组养老模式人群中老人退休收入超过3000元群体的居家养老者的子女健康状况较好，老人与子女及孙辈的关系比较融洽。本次调查的759名老人中仅有59名(7.8%)老人表示愿意享受机构养老生活。结论老年人文化程度及工作类型决定了老人的个人收入，子女的健康状况及人均家庭收入在很大程度上决定了老年人的养老去处，而老人的性格特点及与子女的相处情况也是重要影响因素之一。绝大部分海南老年人群希望居家养老，在条件允许的情况下聘请专业护理人员介入。

目的 探讨帕金森病(PD)患者血清人软骨糖蛋白39(YKL-40)水平变化及其对患者病情的评估价值.方法 62例 PD患者(研究组)及60例健康者(对照组);检测两组研究对象血清YKL-40水平,采用蒙特利尔认知评估(MoCA)评价认知功能,采用帕金森综合评分量表(UP-DRS)评价患者PD病情,并分析三组间的关系.结果 研究组血清YKL-40水平明显高于对照组,MoCA 评分明显低于对照组(均 P<0.05);相关性分析显示,YKL-40与UPDRSⅡ评分、UPDRSⅢ评分均存在正相关(r=0.883,0.810;均P<0.01),YKL-40 与 MoCA评分存在负相关关系(r=-0.711,P<0.001).结论 PD患者血浆YKL-40水平较健康者显著升高,其水平与PD患者病情和认知功能密切相关,可诊断PD及判断病情.

目的 探讨评判性思维对临床医生处理老年医疗事件的作用,为临床医师培训内容提供参考.方法 依据2011年1月至2014年12月三年的工作表现将113名医师分为优异组(三年内患者满意度调查均为良好及以上且年均工作差错次数不大于1次)和非优异组,利用中文版批判性思维能力测量表(CTDI-CV)对两组医师进行评判性思维的评价并分为评判性思维能力强(A)、中(B)、弱(C)三组,利用SPSS19.0分析评判性思维能力与老年医疗事件处理能力的关联性.结果 本次调查的113名医师中,优异组医师共51人,评判性思维能力为强、中、弱组人数分别为28人、21人、2人,而非优异组医师62人,评判性思维评价为强、中、弱组人数分别为7人、24人、31人.统计学分析结果显示,优异组和非优异组的评判性思维能力比较差异有显著统计学意义(P<0.01).男性医师评判性思维得分为(362.8±21.98)分,明显高于女性医师的(317.4±53.07)分,差异有显著统计学意义(P<0.01).结论 临床医师的评判性思维能力在老年医疗事件的处理中具有重要地位,良好的评判性思维能力是提升医疗人员工作能力的重要基础,建议加强对临床医师及助理医师的思维评价并针对性的进行培训以提高其评判性思维意识及能力,提高临床服务水平.

目的 探讨疏血通联合依达拉奉治疗急性脑梗死的临床疗效.方法 将135例急性脑梗死患者按随机数字表法分为疏血通组、依达拉奉组和联合用药组三组,所有患者每天常规服用100 mg阿司匹林肠溶片,辛伐他汀片20mg,疏血通组采用疏血通静脉滴注,每天1次,依达拉奉组采用依达拉奉静脉滴注,每天2次;联合用药组采用疏血通联合依达拉奉静脉滴注,14d为1个疗程.患者住院治疗14d进行疗效比较.结果 45例疏血通组中有效率为80.0％,45例依达拉奉组中,有效率为77.8％,45例联合用药组中有效率为95.5％.联合用药组临床疗效与其他两组比较存在统计学差异(P＜0.05),联合用药组疗效最好.结论 疏血通联合依达拉奉治疗急性脑梗死临床疗效显著,且安全性高.

OBJECTIVE To discuss the effect of winter environment in Hainan Province on the life quality and health status of the ecdemic seniors by observing the results before and after recuperation and to provide some data for arranging the "migratory seniors".METHODS Based on randomized sampling,selected 710 ecdemic seniors with age≥65 years from sanitariums and senior apartments in Haikou and Sanya Districts from 2007 to 2010,and recuperated for 3 months.Investigated the following indexes such as blood fat,hemorheology,blood sugar,blood pressure,weight and vital capacity by SF-36 Scale and ADL scale to assess their physiological and psychological health status.RESULTS The scores of life quality after the recuperation were higher than those before recuperation,especially for those with chronic diseases.There were significant differences in ADL scores before and after recuperation.The differentiations of blood fat,hemaorheology,blood sugar,blood pressure,weight and vital capacity were statistically significant.CONCLUSION The life quality and health status of ecdemic seniors are increased after recuperation in Hainan Province,suggesting that the winter environment in Hainan is of great benefit to ecdemic seniors and Hainan has an advantage on winter recuperation.

目的 探讨海南冬季自然环境对异地抑郁老年人群健康状况、日常生活能力的影响.方法 采用整群随机抽样的方法抽取2007～2010年间海口、三亚地区各个疗养院、老人公寓的异地疗养的老年人(≥65岁)共710例,疗养时间3个月.利用CES-D量表、SF-36量表、ADL量表进行面对面调查,评价其生理和心理健康状况.结果 海南异地疗养老年人群抑郁患者的检出率达20％.抑郁人群与非抑郁人群疗养前后SF-36量表、CES-D量表、ADL量表评分及差值比较有统计学意义.各个维度与抑郁的相关性分析提示PF、RE、VT、MH这4个维度为抑郁的保护因素.结论 海南异地疗养老年人群中有相当部分存在抑郁情绪,疗养后健康状况、日常生活能力均有提高,抑郁情绪有改善.海南冬季自然环境对异地老年人群健康状况、日常生活能力有益处,对有抑郁情绪的人群益处显著.

OBJECTIVE:To investigate the effect of Breviscapine injection on neurologic impairment and blood rheology in patients with cerebral infarction.METHODS:158 patients with acute cerebral infarction in our hospital from Jan.2006 to Feb.2010 were randomly divided into control group and treatment group.78 cases in control group were given Xueshuantong injection(450 mg,bid)on the basis of conventional treatment,while 80 cases in treatment group were given Breviscapine injection(15 mL,qd).Both groups were treated with 2 weeks for a treatment course.Their clinical effect,neurologic impairment,hemorheology indexes and adverse drug reactions were observed and analyzed statistically.RESULTS:The total effective rate of treatment group was 90.0%,which was obviously higher than control group(79.5%),there was statistical significance(P0.05).The neurologic impairment score and hemorheology indexes of treatment group were superior to control group,the difference had statistical significance(P0.05).No obvious adverse drug reactions occurred in both groups.CONCLUSION:Breviscapine injection has obvious effect in the treatment of cerebral infarction with less adverse drug reactions.

目的 观察老年短暂性脑缺血发作(TIA)患者发病后90 d的预后及其与各种危险因素的相关性.方法 对51例临床确诊为老年TIA患者随访90 d并对其相关危险因素进行分析;比较头颅MR弥散加权成像(DWI)异常与正常患者的预后.结果 51例患者发病后90 d内发生各种严重心脑血管事件8例(15.7%),其中DWI异常者发生率为54.5%(6/11),DWI正常者发生率为5.3%(2/38),差异有统计学意义(P<0.01);伴有糖尿病的老年TIA患者预后较差(OR值为7.560,P=0.022).结论 DWI异常、伴有糖尿病的老年TIA患者预后差.DWI对老年TIA预后的判断有较大帮助.

Objective: To explore the clinic character and treatment of acute large area cerebral infarction.Methods: Retrospectively analyzed clinical data of 96 cases with acute large area cerebral infarction.Results: 85 cases survived with survive rate as 88.5 %,8 cases had automatic discharge,and 3 cases were dead.Conclusion: Employing effective intervention,diagnosing with CT examination at earliest,treating with consideration of other systematic diseases,and preventing occurrence of complications can lower mortality and boost the life quality.

目的 观察奥扎格雷钠对老年人急性脑梗死的疗效.方法 140例急性脑梗死患者随机分为两组,治疗组70例给予奥扎格雷钠针治疗,对照组给予复方丹参注射液,均为1次/d,疗程14d;其余常规治疗相同. 结果治疗组总有效率为91.4%,对照组总有效率为77.1%,两组疗效比较差异有统计学意义(P<0.05).治疗组治疗后神经功能缺损评分较对照组改善更明显.结论 奥扎格雷钠治疗老年人急性脑梗死安全有效.