Ischemic stroke is a common acute cerebrovascular disease in clinical practice,which poses a severe threat to human health.In recent years,with deepening understanding of ischemic stroke,significant progress has been made in the diagnosis and treatment.However,current treatments for ischemic stroke are partially limited due to extremely complex pathological mechanisms.Studies have shown that mitochondrial dysfunction plays an important role in the pathogenesis of ischemic stroke.Therefore,modulation of mitochondrial function through mitochondrial dynamics is essential to ameliorate the damage of cerebral ischemic neuronal cells.In this article,the molecular mechanism of mitochondrial dynamics and its role in ischemic stroke were reviewed,aiming to provide useful reference for the treatment of ischemic stroke.

cerebrovascular diseases are a group of common clinical diseases characterized by abnormal cerebrovascular circulation. Among many common and frequently occurring diseases admitted to emergency and critical care departments, the mortality rate is high and the disability rate of surviving patients is also high. In addition to central injury in acute cerebrovascular diseases, which can lead to poor prognosis in patients, fluctuations in the properties and functions of local and circulating immune mediators can also trigger the body to enter an immune imbalance state, leading to poor prognosis in some patients after receiving systematic symptomatic support treatment. Betahistine hydrochloride is a histamine H-1 receptor agonist that can resist platelet aggregation. The drug has a half-life of 5 h through liver metabolism and will not remain in the body, resulting in high safety. In addition, betahistine hydrochloride also has a diuretic effect, which can promote blood circulation, increase organ blood perfusion, reduce myocardial oxygen consumption, improve patient blood pressure levels and ultimately improve symptoms of cardiovascular and cerebrovascular ischemia and hypoxia. Therefore, this article mainly reviews the treatment of acute cerebrovascular disease with betahistine hydrochloride combined with atorvastatin, providing scientific reference for clinical treatment of acute cerebrovascular disease.

神经重症监护病房的患者通常具有非惊厥性癫痫持续状态发作的高风险,但其症状通常不典型,常导致诊断和治疗延迟,使发生非惊厥性癫痫持续状态患者的残疾率、病死率增加.目前连续脑电图的使用推动了非惊厥性癫痫持续状态的早期识别,并提出了治疗的分步方法.笔者总结了神经重症监护病房中非惊厥性癫痫持续状态早期预防及当前的治疗进展,并概述了进一步研究的领域.

In the electroencephalography (EEG) monitoring of patients with hypoxic-ischemic encephalopathy, generalized periodic discharges are often monitored abnormal waveforms. When there are some features of generalized periodic discharges (e.g., frequency≥1.5 Hz or plus), it indicates that the patient is at high risk for seizures or has a poor prognosis. Compared with conventional EEG, the time of continuous EEG monitoring is longer, so the detection rate of these waveforms is higher. At present, scholars at home and abroad have studied these waveforms, but there is controversy about the significance of these waveforms. In this paper, the definition and characteristics of these waveforms and their significance in determining prognosis and guiding treatment in patients with hypoxic-ischemic encephalopathy are reviewed.

Objective:To investigate the clinical and electrophysiological characteristics of patients with sudden unexpected death of epilepsy (SUDEP).Methods:Using "epilepsy" as the keyword, the relevant cases entered from October 2011 to March 2012 were searched in the database of the Electroencephalogram (EEG) Monitoring Center, Xijing Hospital, the Air Force Military Medical University. Telephone follow-up was conducted for all confirmed epilepsy patients, and for the death cases confirmed by telephone follow-up, the patients identified as consistent with SUDEP diagnosis were included in this study based on their past medical history, clinical data, death details, etc, and their clinical and neuroelectrophysiological characteristics were summarized and analyzed.Results:Among the 1 232 patients who underwent 24-hour video-EEG monitoring during the study period, 354 patients were successfully followed up by telephone interview, of whom 17 patients were died (4.8%), 12 individuals met the diagnosis of SUDEP (7 men, 5 women). The duration of the disease in 9 patients exceeded 10 years. Eight cases presented with focal-bilateral tonic clonic seizures. Nine patients were treated with anti-seizure drug monotherapy. All the 24-hour video EEG of 12 patients were abnormal. There were 8 occasions when the EEG occipital α background rhythm slowed down compared with the standard frequency of peers or was dominated by slow waves. Interictal epileptic discharge (IED) located in temporal lobe were found in 12 EEG records, of which 9 EEG records were found with frontal IED. One of the 12 cases received 24-hour video EEG twice within 6 years, and his EEG background rhythm was significantly slower and the IED region was expanded compared with the first EEG record. At the third year after reexamination of EEG, SUDEP developed in this patient.Conclusions:SUDEP patients have a long course of disease and bilateral tonic-clonic seizure. The interictal EEG shows occipital slow α activity and temporofrontal epileptiform discharges, which may increase the risk of SUDEP.

颅内静脉血栓形成( cerebral venous thrombosis,CVT)是指各种病因导致的颅内静脉或静脉窦的血栓形成,从而进一步导致一系列脑损害的一类脑血管疾病,约占脑血管疾病的0. 5％ ～1％ [1].据报道,60％的 CVT发生在妊娠期和产褥期[2].围生期的 CVT 发生机制及治疗方案相比非围生期CVT较特殊,本文总结了围生期CVT的发病机制及治疗的现状,以期对临床工作做出参考.

目的 总结妊娠合并结核性脑膜炎继发脑梗死和下丘脑综合征(HTS)的有效诊断及治疗方法.方法 对1例妊娠合并结核性脑膜炎继发脑梗死及HTS患者的临床资料作回顾性分析.结果 1例18岁中期妊娠患者,因"头痛16天,左侧肢体无力2天"就诊.入院前患者颅脑MR检查提示右侧颞顶叶、岛叶及双侧基底节区多发梗死灶,曾出现摄食增加现象.入院后患者发热、呼吸衰竭、休克,意识由浅昏迷进展为中度昏迷,考虑颅内感染,予阿昔洛韦、丙戊酸钠、脱水降颅压、肠内营养支持及对症处理等治疗.患者颅脑MRA检查显示双侧颈内动脉、大脑中动脉、大脑前动脉、大脑后动脉及其分支走行纤细、局部略显僵硬,远端分支稀疏,考虑为脑积水.行锥颅穿刺脑室引流术后进行脑脊液化验,脑脊液无色、透明,抗酸染色、墨汁染色、一般细菌真菌涂片均为阴性.患者颅脑MR检查提示多发性脑梗死,多根血管存在不同程度狭窄纤细,临床诊断结核性脑膜炎,加用异烟肼、利福平、吡嗪酰胺、乙胺丁醇四联抗结核及阿司匹林抗血小板聚集治疗.患者后期病情迅速恶化,出现水电解质代谢紊乱、胰岛素抵抗、宫内死胎等,结核病原体DNA定量测定为阳性,明确诊断为妊娠合并结核性脑膜炎继发脑梗死及HTS,停用抗病毒药物.后期病原微生物高通量检测结果印证诊断,利福平/异烟肼耐药基因检测显示利福平耐药,拟使用二线抗结核药物治疗.因患者病情危重、预后差,家属放弃治疗,自动出院,患者出院3日后死亡.结论 妊娠合并结核性脑膜炎继发脑梗死及HTS少见,早期缺乏特征性临床表现且易归结于妊娠反应,早期诊断困难.妊娠合并结核性脑膜炎病情进展迅速,当孕妇出现头痛、发热、神经功能缺损及影像学改变时,应警惕脑梗死及HTS可能,及时行脑脊液化验、脑脊液病原学检测确诊,早期应用足量抗结核药物进行治疗.

目的 探究血塞通联合盐酸文拉法辛治疗短暂性脑缺血发作(TIA)和轻型卒中患者卒中后躯体化症状的临床疗效.方法 将84例TIA和轻型卒中患者随机分为对照组和研究组,每组各42例.对照组给予盐酸文拉法辛缓释胶囊治疗,研究组给予血塞通软胶囊联合盐酸文拉法辛缓释胶囊治疗.比较两组治疗前后健康问卷躯体症状群量表(PHQ-15)、汉米尔顿抑郁量表(HAMD)、汉米尔顿焦虑量表(HA-MA)评分及治疗期间不良反应发生情况.结果 治疗前两组患者PHQ-15、HAMD、HAMA量表评分差异无统计学意义(P>0.05);治疗2、4、6周,研究组患者PHQ-15、HAMD、HAMA量表评分均低于对照组(P<0.05).两组患者不良反应发生率比较差异无统计学意义(P>0.05).结论 血塞通软胶囊联合盐酸文拉法辛缓释胶囊治疗TIA和轻型卒中患者卒中后躯体化症状的疗效肯定,无明显不良反应.

目的 探讨痰热清注射液治疗急性脑卒中伴发卒中相关性肺炎患者的临床疗效.方法 选取急性脑卒中伴发卒中相关性肺炎患者103例,根据随机数字表法分为观察组52例与对照组51例.对照组给予常规治疗,观察组在对照组治疗的基础上加用痰热清注射液治疗,两组治疗时间为7d.结果 发现观察组总有效率明显高于对照组(P＜0.05).两组治疗3d及7d,降钙素原(PCT)、C反应蛋白(CRP)水平均明显降低,观察组在治疗7d时,PCT、CRP水平明显低于对照组(均P＜0.05).两组治疗后肺部感染评分(CPIS)及美国国立卫生研究院卒中量表(NIHSS)均明显降低,且观察组评分降低程度更明显(均P＜0.05).观察组胸部影像恢复时间、住NICU时间、体温恢复正常及白细胞计数恢复正常时间均明显短于对照组(均P＜0.05).结论 痰热清注射液治疗急性脑卒中伴发卒中相关性肺炎,能明显降低血清PCT、CRP水平,改善患者NIHSS及CPIS评分,并明显缩短患者胸部影像恢复时间、住NICU时间、体温恢复正常及白细胞计数恢复正常时间.

癫痫是一种常见的难治性中枢神经系统疾病,其发病机制涉及控制神经递质信号、离子通道、突触结构、神经元死亡、胶质增生和炎症基因表达的大规模改变.对癫痫患者基因网络的研究有助于识别新的治疗靶点和生物标志物.微小RNA(miRNA)是一类通过降低信使RNA的稳定性和转译来控制多种蛋白表达的非编码小RNA,可能是癫痫的关键调控机制和治疗靶点,并且细胞外miRNA可能是潜在的理想生物标志物.

缺血性脑卒中是神经内科的常见病,以神经功能缺损为主要表现,存活者多留有后遗症或丧失自理能力,给社会带来巨大的经济负担.在我国缺血性脑卒中占所有脑卒中类型的69 .6％ [1] ,其发病机制复杂繁多,由多种致病因素共同参与其发生发展.近年来随着研究的深入,越来越多的研究表明昼夜节律与缺血性脑卒中的发病有密切关系,本研究就围绕昼夜节律在缺血性脑卒中发病中的作用机制进行总结分析,以期为缺血性脑卒中的预防与治疗提供新的视角.

Objective:To evaluate the effect and safety of monoclonal antibodies to calcitonin gene-related peptide and its receptor (CGRP-mAbs) on migraine.Methods:Database of PubMed, Embase, Cochrane, CNKI, Wangfang digital journals were searched for randomized controlled trials (RCTs) of CGRP-mAbs in treatment of migraine. Quality of enrolled literature was assessed by the software of Review Manager 5.3 and software of StataMP14 was employed to conduct meta analysis.Results:A total of 13 RCTs were included, including 6 218 adult migraine patients (experimental group: 2 679 patients, placebo group: 3 539 patients). Meta analysis suggested that CGRP-mAbs for preventive treatment of migraine significantly reduced the monthly migraine days from baseline (standardized mean difference (SMD)=-0.35, 95% CI-0.4--0.3) and monthly acute migraine-specific medication consumption from baseline (SMD=-0.38, 95% CI-0.43--0.32), as compared with placebo group. CGRP-mAbs for preventive treatment of migraine significantly increased the ≥50% reduction from baseline in migraine days per month ( RR=1.65, 95% CI 1.54-1.76). The adverse events were similar between the CGRP-mAbs group and placebo group ( RR=1.06, 95% CI 1.01-1.10). Conclusion:CGRP-mAbs are effective and safe for preventive treatment of migraine.

阵发性交感神经过度兴奋综合征(Paroxysmal sympa-thetic hyperactivity PSH)是一种突发的交感神经兴奋性增加为特征的临床综合征,主要发生于中重度脑损伤的患者,表现为心动过速、血压升高、呼吸急促、发热、大汗以及姿势或肌张力障碍,以上症状多同时出现,反复发生,一般可持续数周或者数月不等[1].因 PSH 临床表现缺乏特异性,所以早期诊断困难,容易误诊.现临床用药多以经验为主,目前药物主要通过抑制传入感觉通路的超敏化反应、减少中枢交感神经流出、阻滞末梢器官对于交感神经的反应来起作用.临床上对于PSH 患者应做到及早发现,及时治疗.

目的 评价乌灵胶囊联合盐酸文拉法辛缓释胶囊治疗脑梗死后患者躯体化症状的临床疗效.方法将68例脑梗死后患者随机分为对照组和研究组,每组各34例.对照组给予盐酸文拉法辛缓释胶囊治疗,研究组给予乌灵胶囊联合盐酸文拉法辛缓释胶囊治疗.比较两组治疗前及治疗后第2、4及6周汉米尔顿抑郁量表(HAMD)、汉米尔顿焦虑量表(HAMA)、健康问卷躯体症状群量表(PHQ-15)评分及治疗期间不良反应发生情况.结果治疗前两组HAMD、HAMA、PHQ-15评分比较,差异无统计学意义(P>0.05);治疗后第2、4及6周研究组HAMD、HAMA及PHQ-15评分低于对照组(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05).结论乌灵胶囊联合盐酸文拉法辛缓释胶囊治疗脑梗死后患者躯体化症状的临床疗效肯定,安全可靠.

Objective To study the association between single-nucleotide polymorphisms (SNPs) ofrs11833579/rs12425791 in Ninjurin 2 (NINJ2) gene and risk ofischemic stroke in Chinese Han population.Methods PubMed,CBM,The Cochrane Library,CNKI,CBM,VIP and Wanfang Data were searched from inception to August 2016 to collect case-control studies about SNPs of rs11833579/rs12425791 in NINJ2 gene and risk ofischemic stroke in Chinese Han population.Then,Meta-analysis was performed using Stata 12.0 software to extract the data and assess the risk of bias of included studies.This Meta analysis revealed the association between SNPs ofrs11833579/rs12425791 and ischemic stroke.Results Eleven independent publications,including 6125 cases and 6067 controls for rs1183379,and 5989 cases and 6145 controls for rs12425791,were chosen.Overall,large artery atherosclerotic ischemic stroke risk was associated with rs11833579 A allele when all studies were pooled into the Meta-analysis [AA/(GA+GG):OR=1.594,95％CI:1.155-2.201,P=0.05;AA/GG:OR=1.731,95％CI:1.240-2.416,P=0.001].However,rs12425791 was not associated with increased stroke risk in any genetic models.No publication bias was found in our Meta-analysis by Egger's and Begg's test.Sensitivity analysis confirmed the stability of results.Conclusion The rs11833579 SNPs may be a susceptibility marker of large artery atherosclerotic of ischemic stroke in Chinese Han population and further studies are warranted to verify this association.

最近Hladky SB等的研究发现,脑组织中气体与离子的运输不仅与血脑屏障的完整性有关,还与脉络丛有着很大关系,而脉络丛又是产生脑脊液的源泉之一.脑脊液(cerebrospinal fluid,CSF)是由脑实质与脉络丛等产生的流动于颅脑四个脑室与蛛网膜下腔回流至静脉的无色透明的细胞外液.其不仅给脑组织提供一定的营养与内环境,还缓冲脑与脊髓的压力及运送其代谢产物.急危脑卒中无论出血性还是缺血性,都会导致脑组织严重的缺血缺氧、酸碱变化及产生过量的代谢产物,这些指标对于急危脑卒中脑损伤的评估、治疗乃至预后都有着一定的临床指导价值和意义.但近些年CSF气体张力、pH值及其代谢产物测定与研究进展有所放缓.本文通过复习及整理相关文献,总结CSF气体张力、pH值及其代谢产物变化的临床意义和目前存在的问题,为其进一步发展与改良提供参考信息.

目的 探讨左右侧大面积大脑中动脉(MCA)急性梗死继发心电图改变的预后.为临床早期评估及干预提供参考数据.方法 选择兰州大学第二医院自2014年12月至2016年3月收治的54例急性MCA大面积脑梗死患者,按梗死部位分为左侧脑梗死组(n=20)和右侧脑梗死组(n=34),分别对两组患者入院时、1月、3月及6月时的美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)及改良Rankin(mRS)评分进行比较.结果 左侧脑梗死组和右侧脑梗死组在1月内病死率比较,差异无统计学意义(r=1.975,P＞0.05).两组患者发病6月时BI评分比较,差异有统计学意义(t=-3.161,P＜0.05).两组患者在1月、3月及6月时的NIHSS评分比较,无论是否继发心电图改变,差异均有统计学意义(P＜0.05).结论 不同侧大面积MCA梗死继发心电图改变的预后可能不同.

BACKGROUND:The methods to treat intertrochanteric fracture are controversial. A large number of clinical&nbsp;studies concern the therapeutic effects of several popular methods to repair intertrochanteric fracture, but these results lack of independence, and may have bias that cannot be measured in the variable and observational studies. Thus, relevant studies have been limited. OBJECTIVE:To compare the repair effects of proximal femoral nail anti-rotation, dynamic hip screw and total hip arthroplasty on intertrochanteric fracture in aged patients by meta-analysis. METHODS: Four electronic databases were searched, including Cochrane library, PubMed, Web of Science and Chinese BioMedical Literature Database, to colect al randomized controled trials concerning the treatment of intertrochanteric fractures in the elderly with proximal femoral nail anti-rotation, dynamic hip screw and total hip arthroplasty. Using meta-analysis of evidence-based medicine, X-ray exposure time, postoperative complication rate, postoperative bed time, postoperative wound infection rate, Harris hip scores, mean operation time, intraoperative blood loss, length of hospital stays and length of the incision were compared and evaluated. Standard and methodology quality of the trials were criticaly assessed and relative data were extracted. This study used the Review Manager 5.0 software provided by Cochrane colaboration network. RESULTS AND CONCLUSION:Twelve randomized controled trials with 1 454 patients were included. Significant differences in mean operation time, intraoperative blood loss, X-ray exposure time, postoperative complication rate, and postoperative bed time were detected between the proximal femoral nail anti-rotation and dynamic hip screw groups (P < 0.05). Significant differences in length of hospital stays, postoperative complication rate, and postoperative bed time were observed between the proximal femoral nail anti-rotation and total hip arthroplasty groups (P < 0.05). Significant differences in postoperative complication rate, postoperative bed time, and Harris hip scores were detectable between the dynamic hip screw and total hip arthroplasty groups (P < 0.05). These data confirm that proximal femoral nail anti-rotation was apparently better than dynamic hip screw and total hip arthroplasty in operation time, intraoperative blood loss, length of hospital stays, postoperative complication rate, and postoperative bed time. Dynamic hip screw was better than proximal femoral nail anti-rotation in X-ray exposure time. Total hip arthroplasty was better than dynamic hip screw and proximal femoral nail anti-rotation in length of hospital stays, postoperative complication rate and postoperative bed time.