目的 探讨长链非编码RNA富含核的丰富转录物 1(Lnc-NEAT1)对脊髓损伤(SCI)大鼠骨质流失的调控机制.方法 64 只Wistar大鼠随机分为SCI组[脊髓横断(T10)全切术建立SCI,n =56]和假手术组(sham组)(仅切开皮肤即缝合,n =8).随机选择48 只SCI组的大鼠于术后 10d随机分为6 组进行药物注射,包括SCI+Lnc-NEAT1 过表达载体组(SCI+pcDNA-NEAT1 组)、SCI+pcDNA阴性对照组(SCI+pcDNA-NC组)、SCI+pcDNA-NEAT1+miR-1224 拟似物组(SCI+pcDNA-NEAT1+miR-1224-mimic组)、SCI+pcDNA-NEAT1+mimic 阴性对照组(SCI+pcDNA-NEAT1+mimic-NC 组)、SCI+pcDNA-NEAT1+miR-1224-mimic+NF-κB 抑制剂 QNZ 组(SCI+pcDNA-NEAT1+miR-1224-mimic+QNZ组)、SCI+pcDNA-NEAT1+miR-1224-mimic+DMSO组.治疗 10d后通过micro-CT检测骨体积分数(BV/TV)、骨小梁数目(Tb.N)、骨小梁间距(Tb.Sp)、骨小梁厚度(Tb.Th).qPCR法检测 Lnc-NEAT1、miR-1224、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-1β、干扰素(IFN)-γ、可溶性白细胞介素2 受体(sIL-2R)的表达.Western blot测NF-κB、磷酸化的NF-κB p65(p-NF-κB p65)的表达.荧光素酶基因报告实验检测Lnc-NEAT1 和miR-1224 的直接调控关系.结果 与sham组比,SCI组的miR-1224 表达水平降低(P＜0.05),Lnc-NEAT1、NF-κB p65、p-NF-κB p65 的表达量上调(均P＜0.05).与SCI+pcDNA-NC组相比,SCI+pcDNA-NEAT1 组的miR-1224 表达水平和BV/TV、Tb.N、Tb.Th的值都降低(均P＜0.05),而Tb.Sp的值和Lnc-NEAT1、TNF-α、IL-6、IL-1β、IFN-γ、sIL-2R、NF-κB p65、p-NF-κB p65 的表达量上调(均 P＜0.05).SCI+pcDNA-NEAT1+miR-1224-mimic 组抑制了 SCI+pcDNA-NEAT1 组的上述效果(均P＜0.05),但不影响Lnc-NEAT1 的水平.SCI+pcDNA-NEAT1+miR-1224-mimic+QNZ组进一步增加了SCI+pcDNA-NEAT1+miR-1224-mimic 组的治疗效果,使BV/TV、Tb.N、Tb.Th的值都被上调(均P＜0.05),而Tb.Sp的值和TNF-α、IL-6、IL-1β、IFN-γ、sIL-2R、NF-κB p65、p-NF-κB p65 的表达量都被抑制(均P＜0.05).另外证实,Lnc-NEAT1 通过"分子海绵"机制直接抑制miR-1224 的表达.结论 Lnc-NEAT1 通过抑制miR-1224 激活NF-κB信号抑制SCI大鼠的骨丢失并减轻免疫炎症反应.

目的 分析药物治疗联合支架置人对症状性颅内动脉粥样硬化性狭窄(SICAS)患者脑血流灌注、认知功能及短期预后的影响.方法 选择住院治疗的124例SICAS患者为研究对象,依据治疗方案不同分为单纯组(60例,予以单纯药物治疗)和联合组(64例,在药物治疗基础上联合支架置入术).治疗前、治疗第10天时,采用CT脑灌注成像分析局部脑血流速度(rCBF)、局部脑血容积(rCBV)、平均通过时间(MTr).治疗前和治疗后3、14 d,记录2组蒙特利尔认知评估量表(MoCA)评分、美国国立卫生研究院卒中量表(NIHSS)评分.随访12个月,比较2组患者并发症发生率.结果 与治疗前比较,联合组治疗后rCBF、rCBV均不同程度升高,MTr下降,差异有统计学意义(P＜0.05);治疗后,2组CBF、rCBV、MTr比较,差异有统计学意义(P＜0.05).治疗后,2组MoCA评分均升高,且2组治疗后3、14 d MoCA评分比较,差异有统计学意义(P＜0.05).治疗后3、14 d,2组NIHSS评分下降,且联合组NIHSS评分低于单纯组,差异均有统计学意义(P＜0.05).联合组并发症总发生率低于单纯组,差异有统计学意义(P＜0.05).结论 药物治疗联合支架置入治疗SICAS能较好地改善脑血流和认知功能,提高神经功能,降低并发症发生率.

目的 探讨转录因子SOX5对缺血性脑卒中大鼠的神经保护作用及对核因子E2相关因子2(Nrf2)/血红素加氧酶-1(HO-1)通路的影响.方法 将36只大鼠随机分为假手术组、模型组和过表达组,各12只.用线栓法制备大脑中动脉闭塞(MCAO)缺血性脑卒中大鼠模型.造模前1h,用微量进样器将1μl无菌生理盐水、10μl空白阴性对照病毒载体、10μl SOX5过表达慢病毒载体,分别注入假手术组、模型组和过表达组大鼠的侧脑室.用Longa 5级评分法评估神经功能;TUNEL法检测在体细胞凋亡;酶联免疫吸附实验检测脑组织中活性氧(ROS)、丙二醛(MDA)、谷胱甘肽(GSH)、白细胞介素1β(IL-1β)、肿瘤坏死因子α(TNF-α)表达水平;Western-blot检测Nrf2和HO-1表达.结果 假手术组大鼠未见脑梗死,模型组脑梗死体积百分比为(42.09±9.34)％,高于过表达组的(19.34±6.21)％,差异有统计学意义(P＜0.05).再灌注24h和48h时,模型组神经功能评分均高于假手术组和过表达组(P＜0.05).假手术组未见明显细胞凋亡.模型组细胞凋亡率为(44.39±3.27)％,高于过表达组的(17.34±4.39)％,差异有统计学意义(P＜0.05).与假手术组比较,模型组ROS、MDA、IL-1β和TNF-α表达水平较高,而GSH表达水平较低(P＜0.05).与模型组比较,过表达组ROS、MDA、IL-1β和TNF-α表达水平较低,而GSH表达水平较高(P＜0.05).模型组Nrf2蛋白的核质比、HO-1蛋白表达水平均高于假手术组(P＜0.05).过表达组Nrf2蛋白的核质比、HO-1蛋白表达水平也均高于模型组(P＜0.05).结论 SOX5可能通过Nrf2/HO-1信号通路发挥抗氧化应激和抗炎作用,进而改善缺血性脑卒中大鼠的神经功能.

认知功能减退是与年龄相关的疾病,目前仍无有效的治疗手段.白藜芦醇是一种多酚类化合物,可通过多种途径改善大脑的功能状态,SIRT1的激活是白藜芦醇发挥作用的关键.该文对白藜芦醇的作用机制研究进展,包括抗氧化、抗炎、抗凋亡、改善突触可塑性、增加脑血流量及自噬作用进行综述.

Two new mixed-ligand coordination polymers (CPs) with the chemical formulae of [Co(L)(phen)](n) (1, phen = 1,10-phenanthroline and [Co(L)(4,4 '-bipy)(4)center dot 2H(2)O](n) (2, 4,4 '-bipy = 4,4 '-bipyridine) have been successfully synthesized by the solvothermal reaction of 1,4-bis(3-carboxylbenzyl)piperazine acid (H2L) and different N-donor co-ligands with Co(II) salt. In the biological function study, the treatment effect of compounds 1 and 2 on the Alzheimer's disease (AD) was evaluated and the detail mechanism was explored in this research. Firstly, the AD animal model was constructed, and the content of the Amyloid (A beta) in the brain after compounds 1 and 2 treatment was detected. Then the protective activity of compounds 1 and 2 on neurons was evaluated after A beta stimulation.

目的 随访观察颈动脉狭窄脑梗死患者支架置入术后的颅内血流动力学及脑血管反应性(cerebral vascular reactivity,CVR)的变化,比较介入治疗对颈动脉狭窄患者临床预后的影响.方法 选取本院收治的103例颈动脉狭窄的脑梗死患者,根据患者及家属的治疗意愿分为手术组50例和药物组53例;手术组均接受颈动脉支架置入术(carotid artery stenting,CAS)及药物的治疗,药物组仅接受药物治疗,记录2组的NIHSS评分变化、脑卒中和死亡事件;所有手术患者均在术前、术后3d、1、3、6、12个月进行CDFI和TCD检查,测量颈动脉狭窄局部管径、狭窄段收缩期峰值流速(peak systolic velocity,PSV)、阻力指数(resistance index,RI)及同侧大脑中动脉(MCA)的PSV、搏动指数(pulsatilityt index,PID及CVR,比较手术前后的血流动力学变化.结果 2组NIHSS评分变化均呈下降趋势(P＜0.05),术后3、6、12个月手术组NIHSS评分明显低于药物组(P＜0.05);术后颈动脉原狭窄处内径明显增宽,PSV及RI低于术前,患侧大脑中动脉PSV、PI及CVR高于术前(P均＜0.05);手术组手术前后的CVR与美国国立卫生研究院卒中量表评分呈负相关(r=-0.84,-0.75,-0.66,-0.78,-0.61,P＜0.05).结论 CAS治疗后颈动脉狭窄患者颈部血管结构及血流动力学明显改善,可有效改善脑梗死患者的中远期预后,且术后CVR的改变可用于预测CAS治疗后的中远期疗效.

Objective Based on Chinese guidelines for the management of ischemic stroke, a standardized stroke management program was performed to provide intensive education and training for medical physicians, aiming to enhance their knowledge and ability for ischemic stroke prevention and treatment, thereby reducing patients′ in-hospital cost and length of stay, and improving patients′ clinical prognosis. Methods This study was conducted in 20 general hospitals throughout Hainan province. A total of 163 physicians from 20 hospitals involved in the management of stroke patients were trained by highly experienced physicians based on the Chinese guidelines for diagnosis and treatment of acute ischemic stroke 2014 and the Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack 2014. Prior to and post the standardized stroke management training, the data of 3218 and 3367 patients with ischemic stroke were respectively collected. Quality of life assessments including the Barthel index (BI) and the modified Rankin Scale (mRS) score of all patients were recorded at baseline and after discharge. The length of stay and in-hospital cost were directly collected from the hospital information system. Results Physicians′ knowledge and ability manifested as testing scores were significantly improved after training (78.2 ± 15.5 vs 55.6 ± 10.7, t=69.1, P<0.01). The average length of stay of post-training patients was significantly shorter than that of pre-training patients ((8.7 ± 0.9) vs (11.7 ± 1.5) days, t=97.9, P<0.01). The average in-hospital cost of post-training patients was significantly less than that of pre-training patients ((7681.7 ± 1397.7) vs (11846.2 ± 2514.6) Yuan, t=82.5, P<0.01). Both BI (68.2 ± 3.2 vs 43.5 ± 5.3, t=227.7, P<0.01) and mRS score (2.74±0.51 vs 3.65±0.71, t=59.5, P<0.01) were significantly improved for post-training patients. Multivariate linear regression analysis illustrated that standardized stroke management was negatively associated with in-hospital cost (r=-0.461, P<0.01), length of stay (r=-0.357, P<0.01) and mRS score (r=-0.298, P<0.01), and was positively associated with levels of BI (r=0.376, P<0.01). Conclusion Standardized stroke management program might be a cost-effective choice for the management of ischemic stroke as it reduces the in-hospital cost and improves patients′BI and mRS levels.

目的 探讨经颅多普勒超声(TCD)评价重度颈内动脉狭窄患者接受颈动脉支架植入术(CAS)后脑血流动力学参数的变化情况及对术后近期转归的预测效果.方法 纳入接受CAS的50例颈内动脉狭窄患者为对象,采用TCD技术检测手术前后患者脑血流动力学参数.对患者持续随访1年,观察不良转归事件发生情况,测评脑血流动力学参数对预测不良转归事件的效能.结果 50例患者中12例在术后1年内出现不良转归.不良转归组患侧大脑中动脉(MCA)平均血流速度(Vm)及搏动指数(PI)在手术前后的变化量均明显低于转归良好组,差异有统计学意义(P＜0.05).手术前后MCA Vm和MCA PI均与美国国立卫生研究院卒中量表(NIHSS)评分呈正相关(P＜0.05).手术前后MCA Vm和MCA PI的增加量均能够有效预测不良转归,ROC曲线下面积分别为0.656、0.884.结论 动脉狭窄患者经CAS治疗后,患侧MCA Vm和MCA PI明显提升,且提升量能够预测患者的近期转归.

Population Health ManagementVol. 21, No. 3 Letter to the EditorCost-Effectiveness Analysis of a Standardized Management Program for Ischemic Stroke Patients in Hainan Province, ChinaZhongqin Wan, Chaoyun Li, Faqing Long, Yuhui Zhang, Bufei Wang, Yingman Wu, Mingming Dai, Desheng Wang, Bin Chen, Yangyang Duan, and Qingjie SuZhongqin WanSearch for more papers by this author, Chaoyun LiSearch for more papers by this author, Faqing LongSearch for more papers by this author, Yuhui ZhangSearch for more papers by this author, Bufei WangSearch for more papers by this author, Yingman WuSearch for more papers by this author, Mingming DaiSearch for more papers by this author, Desheng WangSearch for more papers by this author, Bin ChenSearch for more papers by this author, Yangyang DuanSearch for more papers by this author, and Qingjie SuSearch for more papers by this authorPublished Online:1 Jun 2018https://doi.org/10.1089/pop.2017.0205AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Cost-Effectiveness Analysis of a Standardized Management Program for Ischemic Stroke Patients in Hainan Province, China." Population Health Management, 21(3), pp. 253–254FiguresReferencesRelatedDetailsCited byReview of cost-effectiveness of antithrombotic alternatives in patients with atrial fibrillation1 July 2021 | Revista da Associação Médica Brasileira, Vol. 67, No. 7 Volume 21Issue 3Jun 2018 InformationCopyright 2018, Mary Ann Liebert, Inc.To cite this article:Zhongqin Wan, Chaoyun Li, Faqing Long, Yuhui Zhang, Bufei Wang, Yingman Wu, Mingming Dai, Desheng Wang, Bin Chen, Yangyang Duan, and Qingjie Su.Cost-Effectiveness Analysis of a Standardized Management Program for Ischemic Stroke Patients in Hainan Province, China.Population Health Management.Jun 2018.253-254.http://doi.org/10.1089/pop.2017.0205Published in Volume: 21 Issue 3: June 1, 2018Online Ahead of Print:March 12, 2018PDF download

目的:探讨血清同型半胱氨酸(HCY)联合神经元特异性烯醇化酶(NSE)检测对进展性脑梗死(PCI)的预测价值.方法:200例急性脑梗死患者,根据发病24h内头颅磁共振(MRI-DWI)结果分为大梗死灶组(n=39)、中梗死灶组(n=83)及小梗死灶组(n=78),根据病情进展情况分为进展组(n=78)及非进展组(n=122),分别于发病第1、2、3、7及14天时检测患者血清HCY、NSE水平,发病第1及7天时采用NIHSS评分、改良Barthel指数(MBI)评分评估患者神经功能缺血症状;比较3组不同大小脑梗死灶患者第1天的血清HCY、NSE水平,比较进展组及非进展组患者发病第1、2、3、7及14天时的血清HCY、NSE水平,采用Pesrson相关法分析进展性脑梗死患者NIHSS评分、MBI评分与NSE、HCY水平的相关性.结果:脑梗死各组第1天时的血清HCY、NSE水平随病灶的增大而升高(P＜0.05),进展组患者第1、2、3及7天时血清HCY、NSE水平高于非进展组(P＜0.05),第14天时2组患者HCY、NSE水平比较,差异无统计学意义(P＞0.05);进展组患者在发病后第1、2及3天时血清HCY、NSE水平逐渐升高,第7天后逐渐降低;Pearson相关分析结果显示,进展性脑梗死患者发病第1及7天时的血清HCY、NSE水平与患者NHISS、MBI评分呈正相关(P＜0.01).结论:血清HCY、NSE联合检测能可反映脑梗死神经功能损害程度,可作为进展性脑梗死的有效预测指标.

目的 比较支架置入术(GAS)对不同年龄段颈动脉狭窄患者血流动力学的影响.方法 回顾性分析2015年6月～2017年6月在海南医学院第二附属医院神经内科住院接受CAS治疗的50例患者的临床资料,按年龄分为3组:中年组(＜ 60岁)20例,老年组(60～＜ 80岁)18例,高龄组(≥80岁)12例.采用彩色多普勒影像(CDFI)联合经颅多普勒超声(TCD)测量各组CAS治疗前后颈动脉狭窄局部管径(D)、狭窄段收缩期峰值流速(PSV)、血管阻力指数(RI)及患侧大脑中动脉收缩期峰值流速(PSV)、血管搏动指数(PI)、脑血管反应性(CVR),将术前及术后l周指标进行对比,并比较不同年龄组手术前后血流动力学变化程度.结果 颈动脉狭窄患者行CAS术后,原狭窄处内径明显增宽,PSV、RI较术前明显降低(P＜0.05),患侧MCA的PSV、PI较术前升高,CVR明显改善(P＜0.05).此外,中年组患者术后血流动力学改善最为明显,与老年组、高龄组比较,差异有统计学意义(P＜0.05),中年与老年组比较,差异无统计学意义(P＞0.05).结论 CAS在各年龄段治疗颈动脉狭窄都是有效的,但＜60岁组患者血流动力学改善明显.

Objective To investigate the improvement of antiplatelet therapy for secondary prevention of ischemic stroke (IS) in Hainan Province.Methods Application of antiplatelet therapy was investigated in 1300 IS patients readmitted to 10 class B or A hospitals of Hainan Province from January 2011 to March 2012.Physicians involved in scientific project of 10 hospitals were trained.Application of antiplatelet therapy in 1279 patients was investigated once more in 2015.The improvement of antiplatelet therapy was analyzed.Results The awareness rate and curative rate of antiplatelet therapy for second prevention of IS were significantly increased in IS patients,accounting for 60.4％ and 49.2％ in 2011,86.5％ and 76.9％ in 2015 (P＜0.01).The low dose/drug withdrawal ratio was significantly decreased,accounting for 20.1 ％ and 5.3 ％ in 2011,2.7 ％and 3.5％ in 2015 (P＜0.05,P＜0.01).The knowledge test score of antiplatelet drugs was significantly increased in neurologists of 10 hospitals,which was 55.6 in 2011 and 78.2 in 2015 (P＜0.01).The difference in antiplatelet therapy for second prevention of IS was disappeared in class B and A hospitals (r=0.092,P=0.405).Conclusion Involvement in scientific project and guideline training can improve antiplatelet therapy for secondary prevention of IS and reduce the gap between hospitals at different levels.

Survivors of ischemic stroke are still at a significant risk for recurrence. Antiplatelet agents are the treatment of first choice for long-term secondary prevention of vascular events. This study aims to assess a health promotion program on medication adherence to antiplatelet therapy among ischemic stroke patients in Hainan province, China. In five hospitals from the intervention group, four highly experienced physicians trained 62 neurologists, who in turn trained 613 stroke patients to improve their awareness and adherence to antiplatelet therapy. Physicians and patients of the control group received usual stroke management programs. After one-year follow-up, the proportion of patients who took the antiplatelet therapy increased significantly in the intervention group, reaching 73.2%, with a pre–post difference between two arms of 22.9% ( P < 0.01). There was also a significant net increase in the proportion of patients with awareness of antiplatelet therapy (24.4%, P < 0.01). Multivariate analysis illustrated health promotion program, higher education, annual household income, insurance, and medical status affected antiplatelet drug use in stroke patients. In conclusion, the health promotion program, based on a train-the-trainer approach, showed positive effects on awareness of and adherence to antiplatelet therapy, which has the potential to be scaled up to other resource-limited areas.