Objective To investigate the association between altered microstructures of the cingulum bundle and un-cinate fasciculus and depressive disorder in leukoaraiosis (LA) patients by diffusion tensor imaging (DTI).Methods In this prospective study,60 LA patients with Fazekas score of 2 to 3 and 30 controls were recruited.LA patients were divided into depression group (n=33) and non-depression group (n=27).All the subjects were received depression assessment, routine cranial MRI and DTI examination.The values of fractional anisotropy(FA) in bilateral cingulum bundles and unci-nate fasciculi were determined with PANDA software.Results In LA group,the FA values in bilateral cingulum bundle and uncinate fasciculus were significantly lower than that in control group (P<0.05).In LA patients without depression, the FA values of bilateral cingulum bundle and uncinate fasciculus were similar to that in control group(P>0.05).In LA patients with depression,the FA values of bilateral cingulum bundles and right uncinate fasciculus were significantly lower than that in LA patients without depression (P<0.05).The severity of depression was negatively related to the FA values of right uncinate fasciculus(r= -0.27,P=0.037) and bilateral cingulum bundles(left:r= -0.329,P=0.01;right:r=-0.259,P=0.046),but had no relationship with the FA value of left uncinate fasciculus.Conclusion Altered white matter microstructures in cingulum bundle and uncinate fasciculus are associated with the depression in LA patients,but the related degree is not strong.It may indicate that depression with leukoaraiosis has diverse pathophysiological basis.

Objective To investigate the effect of elevated blood pressure(BP) on outcome of patients with acute cerebral watershed infarction(CWI) with systolic blood pressure(SBP) range from 140 to 160 mmHg. <br> Methods Sixty-four successive patients with ifrst onset acute CWI with SBP range from 140 to 160 mmHg were enrolled in this prospective analysis, which was from department of neurology, Tongji hospital, Tongji University between January 2011 and November 2014. Patients were randomly divided into elevated BP treatment group(treatment group, 29 cases) and routine treatment group(routine group, 35 cases), Dopamine was given to elevate SBP about 20 mmHg in the treatment group besides routine ischemic stroke therapy including Aspirin and Atorvastatin etc. in the ifrst three days after admission. National Institutes of Health Stroke Scale(NIHSS) were recorded at admission and 2 weeks after admission or at discharge, modiifed Rankin Score(mRS) was collected for assessment of neurological function defect at 6 months after stroke. More than 46%decrease of NIHSS was deifned as effectivity of elevated BP treatment 2 weeks after admission or at discharge, and mRS≤2 was deifned as good outcome. <br> Results There was no difference in baseline data including age, sex, disease time and NIHSS, etc. between two groups. The effective rate was 27.6%in treatment group and 28.6%in routine group 2 weeks after admission or at discharge. There was no statistic significance between two groups(P=0.930). The proportion of good outcome was higher in treatment group(65.5%) than in routine group(48.6%) at six months after stroke, but there was no statistic signiifcance(P=0.174). <br> Conclusion Elevated BP treatment had no effect on obvious outcome in the patients with acute CWI with SBP ranged from 140 to 160 mmHg.

目的 探讨升压治疗对急性脑分水岭梗死患者近期及远期预后的影响.方法 选择首次发病24 h内收缩压(SBP)在120～140 mmHg的急性脑分水岭梗死患者86例,随机分为升压治疗组和常规治疗组各43例,升压治疗组在阿司匹林、阿托伐他汀药物等常规治疗的基础上给予多巴胺升压治疗,将入院时的SBP上升约20 mmHg,维持3d.于入院时和入院后2周采用NIHSS评分,发病后6个月采用改良Rankin评分(mRS)和Barthel Index(BI)评估患者近期和远期疗效,NIHSS减少16％以上视为升压治疗有效;mRS≤2分定义为功能恢复良好,BI＞75定义为日常生活能力良好.结果 入院2周时升压治疗组有效率为83.7％,高于常规治疗组的62.8％(P＜0.05).发病6个月升压治疗组mRS≤2分和BI＞75者分别占75.o％和82.5％,均高于常规治疗组的51.2％和63.2％ (P＜0.01).结论 短期升压治疗可能会改善SBP在120～140 mmHg的急性脑分水岭梗死患者的近期和远期预后.

目的 探讨中-高强度的体育活动对综合性医院焦虑障碍患者治疗的积极效应.方法 采取自愿方式,鼓励广泛性焦虑障碍患者参与为期1年的中-高强度的体育活动.分别应用Hamiliton焦虑量表(HAMA)及 17项Hamiliton抑郁量表(HAMD-17)评分判断焦虑与抑郁的严重程度.163例患者中,99例单纯服用SSRI类抗抑郁药(简称药物组),64例在服用SSRI类抗抑郁药的基础上,坚持每周定期进行体育活动(简称运动药物组).分别于12周及12个月后,对两组HAMA、HAMD分值进行评估.结果 治疗前,两组总体情况及HAMA、HAMD分值差异无统计学意义(P＞0.05).12周后,运动药物组对总体焦虑及精神性焦虑的改善明显优于药物组(P＜0.05),但在躯体性焦虑和抑郁症状改善方面,两组差异无统计学差异.经过12个月治疗后,运动药物组在改善抑郁症状、精神性及躯体性焦虑方面则均明显优于药物组(P＜0.05).结论 在药物治疗的基础上,长期的中-高强度的体育活动可以进一步改善焦虑障碍患者的焦虑和抑郁症状,提高临床治愈率.

Objective To study the risk factors and pathogenesis for depression,a common complication among stroke patients,after first-ever cerebral infarction.Methods Two hundred and two patients after first-ever ischemic stroke were investigated prospectively to evaluate the prevalence of depressive disorder,the relationship between depression and stroke subtypes and severity of neurological function deficits.Risk factors of depressive disorder were studied by Logistic regression.Results Prevalence of depressive disorder after first-ever cerebral infarction was 18.8%.Old patients were likely to the develop depression(P=0.024).Patients with total anterior cerebral infarction(TACI) showed a higher occurrence and severity score of depressive disorder than those with other oxfordshire community stroke project(OCSP) subtypes.Some risk factors,including female(P=0.048),many coexisting risk factors of stroke(P=0.018),dysphasia(P=0.005)and severity of neurological function deficits(P=0.000) were considered as independent predictors of depression occurrence by Logistic regression.It showed no association between depression and territorial infarction in dominant hemisphere or in two different cerebral artery systems.Conclusions Depressive disorder associated with severity of neurological function deficits is found to be an important complication in patients with first-ever cerebral infarction.Biopsychosocial medical model may play an important role in the development of poststroke depression.

1986年Reimer等发现,间断的短暂缺血对后续的长时间缺血非但不产生累积损伤效应,反而起一定的保护效应.Murray等经研究证实了这一结果,并首次提出了"缺血预处理"的概念.嗣后,人们对缺血预处理的机制进行了广泛研究,并证实缺血预处理后机体释放内源性信号物质,通过一些中介物的介导从而产生保护作用.现从信号转导的角度对脑缺血预处理保护作用的分子机制综述如下.

Objective To study the activation of Caspase-3 in rat brain subjected to cerebral ischemic preconditioning.Methods Using Ac-DEVD-AMC as a substrate.,caspase-3 enzymatic activity was measured in rat brain sections obtained from the following groups:the sham group,the preconditioning group,the cerebral ischemic group and the cerebral preconditioning-ischemic group.Results The Caspase-3 enzymatic activity in both cerebral ischemic group and cerebral preconditioning-ischemic group were significantly higher than that in sham group (P0.01);the Caspase-3 enzymatic activity in cerebral ischemic group was significantly higher than that in cerebral preconditioning-ischemic group (P 0.01). Conclusion The protective mechanism of ischemic preconditioning may contribute to inhibiting Caspase-3 enzymatic activity and subsequently inhibiting cerebral cell apoptosis.

Objective To study the expression of caspase-3 protein in rat brain subjected to cerebral ischemic preconditioning.Methods Immunohistochemical technique was used to detect caspase-3 expression in rat brain sections obtained from the following groups:the sham operation group,the preconditioning group,the cerebral ischemic group and the cerebral preconditioning-ischemic group.Results The caspase-3 expression in both cerebral ischemic group and cerebral preconditioning-ischemic group was significantly higher than that in sham operation group (P0.01).The caspase-3 expression in cerebral ischemic group after reperfusion for 48 h and 72 h was significantly higher than that in cerebral preconditioning-ischemic group after reperfusion for 48 h and 72 h,respectively(P0.05,P0.01).Conclusions The protective mechanism of ischemic preconditioning may contribute to inhibiting caspase-3 expression and subsequently inhibiting cerebral cell apoptosis.