Objective:To summarize the clinical and imaging characteristics of patients with ipsilateral hemiparesis caused by acute cerebral infarction, and to explore possible pathophysiological mechanisms. Methods:This is a retrospective case series study. Clinical data of 11 patients with ipsilateral hemiparesis caused by acute cerebral infarction admitted to the Neurology Department, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine from January 1, 2021 to March 30, 2025 were collected. Descriptive analysis was conducted on the patients' neurological symptoms and signs, magnetic resonance imaging (MRI), blood tests, and other examination results. Results:Among the 11 patients with acute cerebral infarction, the onset time was between 6 and 48 h. Nine patients did not undergo thrombolysis, two patients underwent thrombolysis, five patients had left hemiparesis, and six patients had right hemiparesis. There were 6 cases of hemiparesis with muscle strength level 4, 3 cases with muscle strength level 5-, 1 case with proximal muscle strength level 2 and distal muscle strength level 4, and 1 case with upper limb muscle strength level 4 and lower limb muscle strength level 3-. In terms of combining other neurological symptoms, there were 6 cases of speech impairment, 2 cases of hemihypesthesia, 3 cases of facial paralysi, and 4 cases without neurological symptoms. There were 10 cases of anterior circulation and 1 case of posterior circulation, involving infarcted areas such as thalamus, basal ganglia, corona radiata (adjacent to or centrum semiovale), frontal lobe, cerebral peduncle of midbrain, and responsible blood vessels involving involving large artery disease in 7 cases and perforating arteries in 4 cases. Based on the Chinese Ischemic Stroke Subclassification (CISS), the main etiological types are atherosclerosis, perforating artery disease, and other causes (cerebrovascular malformation).

ObjectiveThis study aimed to investigate the characteristics of positional nystagmus in patients with cupulolithiasis of the posterior semicircular canal-benign paroxysmal positional vertigo (PC-BPPV-cu) to improve clinical diagnostic accuracy.MethodsThis study retrospectively analyzed 128 cases of PC-BPPV-cu and 128 cases of canalolithiasis of BPPV (PC-BPPV-ca). General data, intensity, distribution, and the correlation of positional nystagmus were compared between the two groups.ResultsCompared to the PC-BPPV-ca group, more cases from the PC-BPPV-cu group initially presented in the emergency department (P < 0.05). The most frequent positional nystagmus induced by PC-BPPV-cu was torsional-upbeat nystagmus, characterized by the upper pole of the affected eye beating toward the lower ear and vertically upward (387 cases, 59.7%). It was followed by torsional-downbeat nystagmus, characterized by the upper pole of the unaffected eye beating toward the lower ear and vertically downward (164 cases, 25.3%). The former represented posterior canal excitatory nystagmus (PC-EN), while the latter represented posterior canal inhibitory nystagmus (PC-IN). In the PC-BPPV-cu group, PC-EN was most easily caused by the Half Dix–Hallpike (HH) maneuver on the affected side, while PC-IN was most easily induced by a face-down position (FDP) on the unaffected side at approximately 45° angle (45° FDP). The vertical slow phase velocity (v-SPV) of positional nystagmus was more potent in the affected HH than in other positions with PC-EN (all P < 0.05); the v-SPV of positional nystagmus was greater in the 45° FDP than in different positions with PC-IN (all P < 0.05); the v-SPV of the affected Dix–Hallpike (DH) maneuver in the PC-BPPV-ca group was significantly greater than that of the affected HH maneuver in the PC-BPPV-cu group (P < 0.05). The a priori analysis showed that the strongest correlation with HH positional nystagmus was observed in the affected side roll test, followed by the DH maneuver.ConclusionIn the PC-BPPV-cu group, the HH maneuver most easily induced PC-EN on the affected side, and PC-IN was most easily induced by the 45° FDP. In some cases of PC-BPPV-cu, significant nystagmus was not observed to be induced in the DH position on the affected side; however, vertical rotation nystagmus was induced in the roll-test position on the affected side. In such cases, PC-BPPV-cu diagnosis should be considered, and HH and 45° FDP tests should be conducted to support the diagnosis.

Objective To explore the curative effect of the modified barbecue(BBQ)for horizontal canal benign paroxysmal positional vertigo(HC-BPPV).Methods A total of 465 patients with unilateral HC-BPPV in the Dongzhimen Hospital,Beijing from January 2019 to December 2022 were selected,and were divided into Gufoni group(166 cases)and modified BBQ group(299 cases)according to the manual reduction method.Gufuni group was treated with Gufuni reduction method,and improved BBQ group was treated with modified BBQ reduction method.The therapeutic effect and displacement test time were compared between the two groups.Results Among the 465 patients,there were 140 males and 325 females,aged from 16 to 89 years,with an average age of(55.2±13.7)years.There were no significant differences in therapeutic effect,follow-up visit and dix-hallpike time between the two groups(P＞0.05),and the roll-test time in the modified BBQ group[288.0(230.0,370.0)s]was shorter than that in the Gufoni group[315.0(189.0,425.0)s],the difference was statistically significant(P＜0.05).Conclusions The effect of modified BBQ reduction method on HC-BPPV is similar to that of Gufoni,but it takes shorter time and relieves the pain of patients to some extent.

目的 基于网络药理学方法分析葛根汤治疗急性脑梗死的作用机制.方法 通过中医药系统药理学数据库与分析平台(TCMSP平台)逐一查询葛根汤所包含的七味中药各自所含主要化学成分、靶点信息,根据ADME筛选中药活性组分,并应用网络图像化软件CytoScape 3.7.2对生物活性成分及作用靶点进行相关网络构建;以急性脑梗死为关键搜索词在Gencards数据库得到相应靶点信息并进行筛选;应用CytoScape 3.7.2中Bisogenet插件构建蛋白质与蛋白质间相互作用网络,将网络提取的关键靶点提交至STRING 11.0数据库,分析其参与的生物学过程.将上述获取的所有药物靶点与所有疾病靶点取交集,利用Metascape数据库进行进一步数据分析,其中包括KEGG通路富集分析、基因功能GO分析等,同时采用平台分析最终获得葛根汤有效成分-急性脑梗死靶点-通路网络图.结果 葛根汤治疗急性脑梗死的核心活性成分为槲皮素、地黄黄酮、山柰酚、柚苷配基、β-胡萝卜素、谷固醇、谷甾醇、芒柄花黄素等,核心靶点为ESR1、AR、NOS2、PPARG、PTGS1、F10、SCN5A、DPP4、ADRB2等.葛根汤治疗急性脑梗死的生物学通路主要作用于缺氧诱导因子-1、P53、核因子-κB等信号通路,其功能主要为调节炎症及免疫相关细胞因子的表达.结论 葛根汤治疗急性脑梗死的作用机制具有多通路、多靶点、多成分的特点,为葛根汤在临床进一步开发利用提供药理学基础.

不典型良性阵发性位置性眩晕(Benign paroxysmal positional vertigo,BPPV)是指具有不典型的位置性眩晕及眼震的BPPV,不能依据现有的BPPV诊断标准进行诊断.不典型BPPV并不罕见,其诊断较为复杂,国内报道较少,本文主要就不典型BPPV的机制、诊断及手法复位治疗方法作一综述.

Ischemic stroke is a leading cause of death and long-term disability worldwide. The aim of this study is to explore the potential function of ephedrine in ischemic stroke and the underlying molecular mechanism. A middle cerebral artery occlusion (MCAO) rat model was established. The potential effects of ephedrine on MCAO rats and LPS-stimulated BV2 microglial cells were evaluated. Ephedrine reduced the infarct volume, cell apoptosis, brain water content, neurological score, and proinflammatory cytokines (TNF-α and IL-1β) production in MCAO rats. Ephedrine treatment also suppressed TNF-α and IL-1β production and NOD-like receptor pyrin domain 3 (NLRP3) inflammasome activation in BV2 microglial cells. The expression of NLRP3, caspase-1, and IL-1β was suppressed by ephedrine. Moreover, ephedrine treatment increased the phosphorylation of Akt and GSK3β and nuclear NRF2 levels in LPS-treated BV2 microglial cells. Meanwhile, LY294002 attenuated the inhibitory effects of ephedrine on NLRP3 inflammasome activation and TNF-α and IL-1β production. In addition, the level of pAkt was increased, while NLRP3, caspase-1, and IL-1β were decreased by ephedrine treatment in MCAO rats. In conclusion, ephedrine ameliorated cerebral ischemia injury via inhibiting NLRP3 inflammasome activation through the Akt/GSK3β/NRF2 pathway. Our results revealed a potential role of ephedrine in ischemic stroke treatment.

目的 观察三才封髓丹加味治疗肾虚肝郁型失眠的临床疗效.方法 将64例肾虚肝郁型失眠患者按照随机数字表法分为2组,治疗组32例予三才封髓丹加味治疗,对照组32例予艾司唑仑片每晚睡前口服治疗.2组均治疗4周.比较2组疗效;观察2组治疗前后精神分裂症患者生活质量量表(SQLS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、匹兹堡睡眠质量指数(PSQI)评分及中医证候评分变化;观察2组不良反应.结果 治疗组总有效率93.75％(30/32),对照组总有效率71.88％(23/32),治疗组疗效优于对照组.2组治疗后SQLS、HAMA、HAMD评分,PSQI各项评分及总评分,中医证候各项评分及总评分均较本组治疗前降低(P<0.05),且治疗组降低更明显(P<0.05).治疗组不良反应发生率9.37％(3/32),对照组不良反应发生率31.25％(10/32).结论 三才封髓丹加味治疗肾虚肝郁证型失眠,能提高患者睡眠质量,改善中医症状及生活质量,疗效优于艾司唑仑片治疗,且毒副作用较低.

眩晕是指以头晕眼花为主症的一种病证,包含了西医学中以头晕或眩晕为主诉的一类疾病.在中医临床辨治眩晕时,应掌握以下4个原则:衷中参西,发挥中西医各自优势;祛除诱因,调理脏腑;辨证方法因病而异;功能训练,生活有节.眩晕的诊断过程可按定眩晕、定病位、定病性、定证候4个步骤进行.在发作期和缓解期的治疗原则不同.治疗方法主要有4种,包括中药、中医适宜技术、西医药物及技术和护理调摄,需根据疾病特点优化使用.

辨病论治与辨证论治均为中医临床诊治疾病的常用方法,二者各有所长.“病”反映的是疾病发展过程中的一般规律,代表了该病的基本矛盾,“证”是机体在疾病发展过程中的某一阶段的病理概括.肾病临床表现往往较少或无,这种情况可以称之为“寡证”或者“无证”,临床实际诊疗过程中,肾病患者常常面临无证可辨的境地,而同一种疾病往往有自己独特的规律,此时辨病论治起到了更好的效果,因而相对于辨证论治,辨病论治在肾病方面具有更为重要的地位.临床诊疗中,对于症状不明显的肾病患者,可以依照“无证遵从有证,寡证遵从多证”的原则,注重“病”的不同进行辨病论治,可以得到更可靠的临床疗效.在肾病的临床治疗中,以辨病为主,与辨证治疗相结合应作为主要治疗思路.

目的:客观评价舌七针在治疗脑卒中后吞咽障碍中的疗效.方法:将60例脑卒中后存在吞咽障碍的患者纳入研究,以治疗第14天为疗效评价时点,对治疗组(针刺加吞咽功能训练)30例与对照组(单纯吞咽功能训练)30例,进行平行、随机、对照临床研究,采用统一疾病严重程度判定标准和疗效判定标准,客观评价舌七针的疗效与实用性.结果:治疗后,治疗组治愈6例,显效8例,有效10例,有效率为80.00％,对照组治愈3例,显效7例,有效8例,有效率为60.00％,两组有效率比较,治疗组优于对照组,经治疗后,两组饮水试验评分均较治疗前降低,治疗组评分结果显著低于对照组,差异具有统计学意义(P＜0.05),且观察组的吞咽功能障碍评分,较之对照组下降明显,差异具有显著统计学意义(P＜0.01).治疗后两组日常生活能力量表得分,差异具有统计学意义(P＜0.05),实验组低于对照组.治疗组在治疗后0、4、6分水平阶段的患者的吞咽能力均较对照组有显著性的提高.治疗组与对照组相比并无明显不良反应产生.结论:舌七针治疗脑卒中后吞咽障碍,临床疗效明显具,有临床推广价值.

目的 观察舌七针联合耳穴压豆治疗中风后吞咽障碍的临床疗效.方法 将202例发病半年内的中风后吞咽障碍患者,采用随机数字法分为观察组和对照组各101例.观察组给予舌七针联合耳穴压豆加康复治疗,对照组给予单纯康复治疗,均以14天为1个疗程.比较2组的临床疗效,并用洼田饮水试验评定效果.结果 观察组总有效率为96.88％,对照组为45.28％,2组比较差异有统计学意义(P＜0.05).治疗后2组洼田饮水试验评定分级差异有统计学意义(P＜0.05).结论 舌七针联合耳穴压豆加康复治疗中风后吞咽障碍疗效显著.

舌七针疗法是一种采用毫针、电针、三棱针点刺出血等多种方法综合治疗中风后吞咽障碍的中医疗法,其临床疗效确切,但舌七针疗法治疗中风后吞咽障碍的机理研究文献报道较少.本文通过详细介绍中风后吞咽障碍的中医病因病机、舌针疗法治疗中风后吞咽障碍相关文献及相关研究成果、舌七针疗法选穴依据及其穴位释义、舌七针疗法具体取穴及操作、舌七针疗法适应症、舌七针疗法注意事项及禁忌症、舌七针疗法不良反应、舌七针疗法治疗中风后吞咽障碍的典型案例分析,初步探析“舌七针疗法”治疗中风后吞咽障碍的机理.

目的:观察舌七针联合耳穴压豆治疗中风后吞咽障碍的临床疗效.方法:将100例发病半年内中风后吞咽障碍患者,采用随机对照法分为两组各50例.治疗组采用舌七针联合耳穴压豆加康复治疗,对照组单纯康复治疗,14天为1个疗程,采用统一疾病严重程度判定标准和疗效判定标准,客观评价舌七针联合耳穴压豆的疗效.结果:治疗组总有效率94.0％,对照组42.0％,差异有统计学意义(P＜0.05).结论:舌七针联合耳穴压豆加康复治疗中风后吞咽障碍疗效显著.

1 临床资料 患者，女，35岁，2015年9月15日因发作性眩晕2天就诊，每次眩晕发作持续40~60 s，可自行缓解。自诉右侧卧位时症状明显，无耳鸣、无听力下降，无明显诱发因素。孕37周，初次妊娠。既往体健。专科体检：双侧外耳道通畅，鼓膜完整，光锥标志清，位置试验：右侧Dix-hallpike体位诱发眩晕及扭转向上向地眼震，持续时间30 s，滚转实验阴性。诊断为右侧后半规管良性阵发性位置性眩晕（benign positional paroxysmal vertigo，BPPV）。行改良Epley手法复位1次，2天后复查，痊愈，3天后顺产女婴2680 kg，随访至今未见复发。

突发性耳聋是指突然发生的,可在数分钟、数小时或3d以内,原因不明的感音神经性听力损失,至少在相连的2个频率听力下降20dB以上. 该病病因很多,治疗方案更是多种多样,治疗效果也是有很大差异,就突发性聋现阶段研究发现的病因与治疗进展进行综述.

畸胎瘤为来源于生殖细胞的由多胚层构成的肿瘤。多发于身体中线两旁，以盆腔、腹腔、胸腔常见，耳部畸胎瘤临床少见。1临床资料患者，男性，25岁。主因“发现左耳后肿物4年”于门诊就诊。患者4年前发现左耳后沟近耳尖处肿物，无明显疼痛，逐渐增大，曾于2015-04-12我院外科就诊，考虑“左耳后皮脂腺囊肿”，建议手术。但患者因工作关系未能及时手术，近1个月该肿物明显增大，局部轻微压痛，皮肤无破溃，未影响听力，患者于2015-05-15日于我科门诊就诊，检查见右耳后可见肿物大小4 cm×3 cm，皮肤无破溃，表面光滑，波动感（+），无明显触痛。考虑“耳后肿物待查，皮脂腺囊肿？”再次建议手术治疗，术前查血常规、血凝四项、乙肝五项均正常，次日于局麻下行肿物切除术。术中见肿物表面有毛发生长，被膜完整，内含淡黄色液体，考虑畸胎瘤可能性大。术后病理诊断：皮样囊肿（图1）。2讨论畸胎瘤是具有多潜能生殖细胞异位发生或潜入，因分化程度不一，排列不规则，形成由多胚层（2或3个）所构成的肿瘤。大体由成熟型（良性）与非成熟型（恶性）之分，发生于耳部的畸胎瘤较少见，多为成熟型囊性畸胎瘤，又称皮样囊肿，由于其分化程度高，故又称分化型畸胎瘤，其组织来源以外胚层最常见，以囊性多见，成熟型实性畸胎瘤较少见[1]。由于细胞分化排列差异大，故囊性畸胎瘤表现形式多样，多为椭圆形囊性，表面有毛发，切面可见充满黄色液体，有皮脂样分泌物及毛发、脂肪、皮肤及骨组织等结构，因其来源的特点，肿瘤多发生于卵巢、睾丸及前纵隔、腹膜后、骶尾部等，文献报道发病率为1/4000，其中发生于头颈部占2%~9%[2]。

目的 观察电针刺激听宫穴治疗暴聋的临床疗效.方法 将60例暴聋患者,按就诊顺序采用随机数字表法分为观察组与对照组各30例,观察组采用电针刺激听宫穴治疗,对照组采用静脉滴注舒血宁注射液治疗,1个疗程后观察比较疗效.结果 观察组总有效率89.66％,对照组65.52％,差异有统计学意义(P＜0.05).结论 电针刺激听宫穴疗效较好,适宜临床推广应用.

暴聋,西医学称为突发性耳聋(sudden sensorineural hearing los ,SSHL),是指突然发生的,可在数分钟、数小时或3天以内,原因不明的感音神经性听力损失,至少在相连的2个频率听力下降20dB以上。本文对暴聋现阶段研中医临床研究进展进行综述。

目的:探讨多功能内窥镜显像系统在中医耳鼻咽喉科临床教学中的重要作用.方法:通过应用多功能内窥镜显像系统辅助教学与否,观察学生学习成绩和满意度变化.结果:通过多功能内窥镜显像系统在临床教学中的应用,让学生更容易理解和掌握中医耳鼻咽喉科疾病的病因病机、辩证论治,同时提高了学生满意度.结论:多功能内窥镜显像系统在中医耳鼻咽喉科临床教学中作用突出.