随着老龄化的加剧和脑血管疾病的增多,血管性认知功能障碍(VCI)已成为继阿尔茨海默病(AD)后导致中老年人认知障碍的第二大原因.VCI是神经系统比较常见的老年病,以进行性认知功能障碍为主要表现,其主要原因与脑内小血管病变直接相关.目前尚无特异而有效的药物进行干预治疗和阻止病程及改善患者的症状.VCI的诊断,虽然目前广泛采用头颅磁共振等技术手段,但仍然缺乏特异而针对性好的标志物来诊断,即目前仍然缺少诊断VCI的金标准.由于VCI病理类型的复杂性,部分研究转向具有良好均质性的皮质下缺血性脑血管病(SIVD).

原发性进行性失语(primary progressive aphasia,PPA)是一组以特定语言功能进行性丧失,而其他认知功能相对保留为特点的综合征.2010年提出的分类方法将PPA分为3种亚型:非流利型/语法缺失型、语义变异型和寡语型.其中寡语型PPA(logopenic primary progressive aphasia,LPA),也称为“LV-PPA”或“PPA-L”,是由Mesulam在1982年最早描述的,其核心特征为词语提取障碍和语句复述能力受损.目前,越来越多的研究关注LPA患者语言损害及机制,本综述将对LPA语言损害特点及其形成机制的最新研究进展进行讨论,希望能增进人们对LPA的认识和研究.

Objective To investigate spontaneous recanalization rate, course, infarct pattern, and recanalization mechanism of responsible artery in patients with acute stroke. Methods We conducted a retrospective review of 441 pa-tients (male/female, 279/162;age 31-90 years, mean age 63.17±10.10 years) with acute stroke in the territory of the internal carotid artery (ICA) system from May 2015 to May 2016 in Tianjin Medical University General Hospital. All patients with cerebral infarction undergo routine MRI, DWI and MRA examinations.According to the MRA showed whether there is any stenosis or not in the infarct responsibility vessel, the whole patients are divided into recanalization group and non recanaliza-tion group. The differences in age and time interval from the onset to the MRA examination were compared with the two sam-ple t test between the 2 groups, and the patient's gender, lesion side, and other clinical data were compared with chi square test. Results There were 300 of 441 patients (68.03%, male 192 and female 108) with responsible arterial stenosis or occlu-sion, which were classified into recanalization group, whereas 141 patients (31.97%, male 87 and female 54) without respon-sible arterial stenosis or occlusion were classified into non recanalization group. The rate of spontaneous recanalization was 31.97%. There was no significant difference between the two groups in terms of age, sex, lesion side, and other clinical data (all P>0.05). The time interval from onset to MRA in the recanalization group was significantly shorter than that in the non-recanalization group (P=0.002). Most patients of both groups had single infarction, and the most common pattern was perforat-ing artery infarction. The recanalization ratio within 3 days was 90.07%in the recanalization group, and within 3-7 days the recanalization ratio was 9.93%. Conclusion The incidence of early spontaneous recanalization is about 30%. Spontaneous recanalization usually occurs approximately within the first 3 days. The recanalization rate is 90.07%. The spontaneous re-canalization of small terminal arteries is high. Understanding the spontaneous recanalization after cerebral infarction may help clinicians to avoid aggressive treatment.

Objective By using 3D T1WI SPACE sequenceto investigate whether the acute ischemic cerebral attack-has relation with the enhancement of intracranial plaques and remodeling pattern of intracranial artery wall. Method Twen-ty-nine patientswith acute ischemic cerebral attack admitted to Tianjin Medical University General Hospital from April 2016 to December 2016 were recruited. All patients performed 3D T1WI SPACE. Enhanced features of intracranial plaques, re-modeling pattern of intracranial artery wall, and plaque burden were assessed. The difference sinenhanced degree, plaque burden, and remodeling rate of artery wall were compared between culprit and non-culprit plaques by independent t-test. The incidence of 2 grade enhancementand artery positive remolding were compared between the culprit and non-culprit plaques by chi-square test. Results Eighty-one intracranial plaques were identified in 29 patients (29 culprit and 52 non-culprit plaques). The culprit plaques presented a higher incidence of 2 grade enhancement than non-culprit plaques (χ2=30.73,P=0.001). The culprit plaques had a significantly higher degree of enhancement than the non-culprit plaques(t=7.30, P<0.001). The incidence of artery positive remolding and remolding rate of artery showed no significant differences (χ2=3.23, P=0.072;t=-1.19, P=0.241, respectively) between the culprit plaques and non-culprit plaques, but the culprit plaques had a larger burden than the non-culpritplaques (t=4.59, P<0.001). Conclusion Most of intracranial culprit plaques show great contrast enhancement.Enhancement of intracranial plaques may serve as an important marker of its stability, and may provide insight into risk for acute cerebral infarction and improve prognosis.

目的：探讨新生儿化脓性脑膜炎在临床表现、药物疗效上的性别差异。方法收集就诊于天津市儿童医院新生儿科具有典型化脓性脑膜炎脑脊液改变的80例化脓性脑膜炎新生儿病例，其中男性患儿42例，女性患儿38例。对临床资料进行回顾性分析，分析临床表现、既往史、并发症等临床特征及药物疗效的性别差异。结果临床表现方面，女性患儿惊厥和前囟门饱满胀紧症状出现比例分别为36．84％和50％，高于男性患儿的33．33％和47．62％（P＜0．05），而男性患儿出现呕吐和黄疸症状的比例分别为7．14％和16．67％，高于女性患儿的5．26％和13．16％（P＜0．01）。疗效方面，头孢曲松组和头孢吡肟组的药物治愈率没有明显差别（P＞0．05），头孢吡肟组的好转率（10．64％）高于头孢曲松组（9．09％）（P＜0．05）。头孢曲松组女性患儿平均退热时间长于男性患儿（P＜0．01），男女性患儿治愈率没有明显差别（P＞0．05），但是男性患儿的好转率（11．11％）高于女性患儿（6．67％）（P＜0．05）；头孢吡肟组女性患儿退热时间长于男性患儿（2．14 d）（P＜0．05），而男性患儿的治愈率和好转率分别为87．5％、12．5％，均高于女性患儿的82．62％、8．69％（ P＜0．05）。结论女性化脓性脑膜炎新生儿神经系统症状突出，而男性患儿消化道表现更突出，且并发症较多。相较于头孢曲松，头孢吡肟用于治疗男性新生儿化脓性脑膜炎的疗效较好。

Objebtive To investigate the clinical characteristics and MR imaging features of nonalcoholic Wernicke encephalopathy (WE). Methods We retrospectively reviewed clinical characteristics and MR imaging features of 10 patients with nonalcoholic WE. Results The main predisposing factors included recurrent vomiting as a result of gastrointestinal disease, acute pancreatitis, and hyperemesis gravidarum. The most frequent neurologic finding was change in consciousness or mental status. On the MR images of the 10 patients, single area was involved in one cases, and multiple areas were involved in the remain 9 cases. The locations of lesions included the medial thalami and the periventricular region of the third ventricle (8 patients), the periaqueductal area (7 patients), the tectal plate (6 patients), the mamillary bodies (4 patients), the floor of forth ventricle (4 patients), and cerebellar vermis (1 patients). The findings were symmetric hyperintensity on T 2-weighted or fluid-attenuated inversion recovery images in all lesions. Eight patients who underwent diffusion-weighted imaging demonstrated increased signal intensities in the affected areas. Contrast medium was administered in one patient, and the lesions showed slight enhancement. Four patients underwent follow-up MRI after therapy, all lesions shrunked or disappeared. Conclusion Nonalcoholic WE has characteristic MRI findings. Combining with clinical characteristics, MR features are useful in early diagnosis.

目的 通过探讨天津地区急性脑梗死发生与血管紧张素转化酶(ACE)rs4646994和rs35397082基因多态性及血浆浓度的相关性,找出天津地区脑梗死发生的危险因素,为预防脑梗死的发生提供相应的检测指标.方法 用基因测序技术以及ELISA方法分别检测88例急性脑梗死患者和81例健康志愿者的ACE的单核苷酸多态性(SNP)以及血浆浓度.结果 正常对照组中rs4646994的插入型SNP与急性脑梗病人组比较,差异无统计学意义.但是rs35397082的插入型SNP却只存在于脑梗死病人组中,比例高达40.91％,插入型的rs35397082与急性脑梗死的发生存在着显著的相关性(P＜0.05).同时病人组的ACE浓度明显高于正常对照组(P＜0.001).结论 天津地区rs35397082的插入型似乎为脑梗死发生的一个相对独立的危险因素,同时血浆中ACE的浓度也与脑梗死的发生存在着一定的相关性,该初步研究结果可为今后预防天津地区的脑梗死发生提供一定的检验指标.