经颅磁刺激(TMS)是一种通过高强度脉冲磁场对中枢神经系统产生作用的治疗方法,可调节脑内代谢和神经电生理活动,从而在脑卒中运动、感觉和情绪等方面的功能障碍起调节作用.近年来国内外医疗研究机构采用TMS联合康复训练的方法对脑卒中患者进行治疗,积累了一定经验.检索2005-2020年万方、中国知网(CNKI)及PubMed数据库,以TMS、康复训练、脑卒中和运动功能为关键词,排除混有其他治疗方式、脑外伤及其他并发症的患者治疗研究,共检索到100篇文献(中文33篇,外文67篇).结果表明,TMS可通过高强度脉冲磁场对大脑中枢神经系统产生作用,调节脑内代谢和神经电生理活动;根据电磁感应原理,电流产生的磁场通过线圈作用于脑部运动皮质区,刺激大脑皮层使其兴奋,达到改善运动功能的效果;TMS可结合镜像疗法、虚拟现实疗法和康复机器人改善脑卒中患者的运动功能,有助于早期预测与评估脑卒中患者运动恢复情况,增强康复训练效果.

研究脑胶质瘤LINC01116高表达的临床价值及其促进瘤细胞的恶性增殖.通过GEO及TCGA数据库分析筛选出差异基因,利用TCGA临床数据分析LINC01116表达水平与脑胶质瘤病人预后的关系.qRT-PCR检测LINC01116在脑胶质瘤和非瘤脑组织中的表达,分析与临床病理资料的相关性.qRT-PCR检测LINC01116在U251、Ln229、U87和SVG细胞系中的表达;构建LINC01116干扰序列和真核pcDNA3.1(-)为载体的过表达质粒.在U251细胞系中,下(和上)调、Ln229和U87细胞系中下调LINC01116表达,进行CCK8、克隆形成、EDU实验检测其对瘤细胞增殖能力的影响.通过给免疫缺陷裸鼠皮下注射U87细胞,观察下调LINC01116表达水平后对体内胶质瘤生长的影响.GEO及TCGA数据分析示:LINC01116在脑胶质瘤中显著高表达(P＜0.01).生存分析提示,LINC01116表达越高越不利于病人的生存;qRT-PCR结果提示,LINC01116在脑胶质瘤中的表达显著高于非瘤脑组织,结果具有统计学意义(P＜0.01);脑胶质瘤临床病理级别越高,组织类型恶性度较高,LINC01116表达越高,结果具有统计学意义(P＜0.01).细胞水平qRT-PCR结果显示:LINC01116在U251、Ln229、U87细胞系中表达显著高于SVG细胞系,结果具有统计学意义(P＜0.01);干扰U251、Ln229和U87细胞中LINC01116的表达后,进行CCK8、克隆形成、EDU实验显示:敲低LINC01116的表达抑制胶质瘤细胞的增殖能力,结果具有统计学意义(P＜0.05);裸鼠成瘤结果显示:敲低LINC01116表达,裸鼠皮下瘤体生长减缓,重量及体积均较对照组下降,结果具有统计学意义(P＜0.01);qRT-PCR检测瘤体LINC01116的表达显示:敲低组LINC01116表达明显下降,与对照组相比有统计学意义(P＜0.01).U251系细胞中过表达LINC01116后进行CCK8、克隆形成、EDU实验显示:LINC01116过表达促进胶质瘤细胞的增殖,结果具有统计学意义(P＜0.05).综上所述,LINC01116在脑胶质瘤中高表达,其临床病理级别与LINC01116表达量正相关;细胞水平及裸鼠成瘤提示,LINC01116促进脑胶质瘤细胞的恶性增殖,促进瘤细胞的发生发展.LINC01116可能为未来临床治疗脑胶质瘤的病理诊断和分子药物治疗提高新的候选位点.

目的:通过检测血清脂联素(APN)并评估急性脑梗死(ACI)患者神经功能缺损程度,探讨两者的关系.方法:选择从2017年4月至2019年03月收治的86例ACI患者为研究组;同时段健康体检者80例为对照组;两组均行APN检测,并根据NIHSS评分分组ACI.结果:研究组24h APN低于对照组;研究组的72h、7d APN高于24h;重度组的24h、72h及7d的APN低于轻、中度组;中度组的24h、72h及7d APN低于轻度组,均有统计学差异(P<0.05).结论:APN与ACI患者神经功能缺损程度呈反比,可作为评估病情严重程度的指标.

Objective:To investigate the clinical features and possible mechanisms of attention function in patients with episodic headache and chronic headache.Methods:Through a total of 18 patients with Episodic Headache (EH),20 patients with chronic headache (CH)and 21 healthy controls,respectively,neuropsychological assessment including mini mental state assessment scale (mini mental state exam,MMSE),Montreal cognitive assessment (China-Beijing edition Beijing Chinese version of Montreal Cognitive Assessment,MoCA-C),digital span test (digit span test,DS),frontal lobe function rating scale (frontal assessment battery,FAB),the hospital anxiety and Depression Scale(hospital Anxiety and depression subscales,HADS)and Pittsburgh Sleep Scale(Pittsburgh sleep quality index,PSQI)and attention network test (attention networks test,ANT),and comparative analysis.Results:There were significant differences in MoCA-C (P＜ 0.001 or P＜ 0.001),DS (P=0.002 or P=0.004),HADS (anxiety:P＜ 0.001 or P=0.002;depression:P＜ 0.001 or P=0.001)and PSQI(P＜ 0.001 or P=0.001)between chronic headache and episodic headache or healthy controls.Significant difference was also found in FAB between chronic headache and healthy control (P=0.021).ANT showed that there were no significant differences in alerting,orienting or accuracy among three groups,but median response time was prolonged significantly in patients with chronic headache than those with episodic headache or healthy controls (P=0.002 or P=0.035),and compared with healthy controls,executive control function was also disrupt in chronic headache patients (P=0.042).Conclusion:Headache does disrupt attention function,especially in chronic headache,mainly for the average reaction time to perform tasks related to CH patients with prolonged attention,executive function decreased,suggesting that CH damaged the attention network-executive function,and these might be one of the key mechanisms of headache disrupting attention.

目的:探讨肌电图检测在2型糖尿病并发周围神经病变诊断中的价值.方法:选取2014年7月至2016年2月期间在我院就诊的2型糖尿病患者100例,分为临床症状组54例,肌电图正常组26例和肌电图异常组20例,运用肌电图检测四肢运动神经传导速度(mcv)、感觉神经传导速度(scv).结果:临床症状组正中神经、尺神经、腓总神经及腓浅神经的MCV、SCV值明显低于肌电图正常组(P＜0.05);肌电图异常组的正中神经和腓浅神经的SCV以及正中神经、尺神经和腓总神经的MCV值亦低于肌电图正常组(P＜0.05);临床症状组和肌电图异常组相比,临床症状组的正中神经的MCV、SCV和腓总神经的MCV值低于肌电图异常组(P＜0.05).结论:肌电图检查有助于量化诊断2型糖尿病并发周围神经病变患者,有一定的临床应用价值.

Objective:To observe the clinical efficicy of the ultrasonic treatment in the treating of hemiplegic limb move-ment function in patients with cerebral infarction. Methods:Sixty-eight cases of limb movement dysfunction after cerebral infarction patients were randomly divided into treatment group(36 cases)and control group(32 cases). The control group was given routine therapy while the treatment group was given the ultrasonic treatment on the basis of the control group. Af-ter 20 daysˊ treatment,the changes of the clinical curative effect,NIHSS and ADL scores were compared. Results:Com-pared with control group,difference in the clinical curative effect of treatment group was statistically significant( P <0. 05);compared with those before and after treatment in the two groups NIHSS and ADL scores had significant difference (P < 0. 01);after treatment,NIHSS and ADL scores became better in treatment group than those in the control group. There were differences(P < 0. 05). Conclusion:Conventional treatment combined with ultrasonic treatment can obviously improve limb movement function in patients after cerebral infarction.

Objective]To study the effects and safety of the combination of ezetimibe and rosuvastatin on the levels of blood‐lipids in elderly patients with acute cerebral infarction .[Methods]A total of 89 patients with acute cerebral infarction were recruited and randomly assigned to group A (rosuvastatin 10mg/d ,ezetimibe 10 mg/d ,n = 46) and group B(rosuvastatin 10 mg/d ,n = 43) .The observation targets of all patients were assessed after 2 weeks and 12 weeks of treatment .The changes of blood‐lipids ,alanine ami‐notransferase (ALT ) ,aspartate aminotransferase (AST ) ,and creatine kinase (CK ) were com‐pared before and after treatment .[Results] Compared to before treatment ,the levels of low‐density lipoproteins (LDL‐C) after 2 weeks of treatment in both groups were decreased ,dropping at ratios of 32 .7% and 17 .3% ,respectively .However ,after 12 weeks of treatment ,the decreasing ratios were 48 .4% and 27 .2% .respectively ;the levels of LDL‐C in group A dropped earlier and more quickly than in group B .There was a statistically significant difference ( P < 0 .001) .No correlation existed between improvement of liver enzyme level (ALT and AST ) and muscle enzyme level (CK) .The rate of reaching guideline target of LDL‐C 12 weeks after treatment was 56 .5% (26 cases) in group A and 20 .9% (9 cases) in group B ;there was a statistically significant difference ( P = 0 .002) .The levels of total cholesterol (TC) fell by about 45% and 28% after 12 weeks of treat‐ment ,with significant difference between group A and group B ( P = 0 .003) .After 12 weeks of treatment the levels of triglyc‐erides (TG) decreased ,while levels of high‐density lipoproteins (HDL‐C) increased ,but showed no statistical significance compared to before treatment .[Conclusion]Our study demonstrated that it is feasible to initiate combination therapy in elderly patients with acute cerebral infarction ,which can shorten the time it takes for LDL‐C levels to reach the guideline target and in‐crease the rate of reaching the guideline target while not increasing liver or muscle toxicity .

目的 探讨瑞舒伐他汀对H型高血压患者血压水平的影响.方法 H型原发性高血压患者100例,血同型半胱氨酸均＞ 10 μmol/L,采用抽签法将患者随机分为对照组及治疗组各50例,分别检测两组治疗前、治疗后1、3、6个月时的血压水平,观察两组患者血压降低幅度.结果 治疗后1、3、6个月,治疗组的收缩压及舒张压的降低幅度,均高于对照组(P＜0.05);两组收缩压及舒张压的降低幅度随观察时间延长而降低(P＜0.05);时间与组间有交互效应(P＜0.05).结论 瑞舒伐他汀对H型高血压患者的血压具有一定的降压作用.

Objective:To investigate the clinical characteristics and treatment characteristics of large area cerebral infarction. Methods:retrospective analysis of 56 cases of acute and large area cerebral infarction of department of neurology of our hospital. Results: Among the 56 cases, the rate of survival was 83.9%, and the survivors were left neurological symptoms in different degree, and the life cannot provide for oneself. Conclusion:early diagnosis, timely treatment is the key to the most suitable for large area cerebral infarction patients.

Objective:To observe the therapeutic effect of the insulin pump intensive therapy of Newly-diagnosed type 2 diabetes mellitus(T2DM) patients merge with obesity and hyperlipidemia.Methods:The indices of blood sugar and glycated hemoglobin,blood Lipid,body mass index,insulin and c-peptide were observed respectively after 15 days of Insulin pump intensive treatment and after 90 days when the patients insulin pump was removed to.Results:The blood glucose decreased obviously in from pump and treat patients after 90 days.And glycated hemoglobin,blood Lipid,body mass index,pancreatic beta cells function got obviously better results after 90 days of treatment.Conclusion:Early insulin pump strengthening treatment of type 2 diabetes mellitus(T2DM) patients,not only can make its blood sugar standard as soon as possible,but also can obviously decrease the blood lipid and body mass index,and to make some cases with pancreatic beta cells function recovery,a period seprating theirself from drug therapy,improve life quality.

目的:探讨应用胰岛素泵在治疗老年人2型糖尿病合并肺部感染中的临床价值。方法:88例老年2型糖尿病合并肺部感染的患者,分为普通胰岛素组(治疗组)及口服降糖药组(对照组),对比观察了两组血糖变化、肺部感染有效率、低血糖发生率、患者的有关生化指标,了解应用胰岛素泵治疗老年2型糖尿病的临床价值。结果:治疗组的血糖控制,肺部感染治愈率,肺部感染的有关生化结果,低血糖发生率等优于对照组(P<0.05)。结论:2型糖尿病合并肺部感染以老年人占多数,降血糖是糖尿病合并肺部感染治疗的首要措施。胰岛素模拟了胰岛素的生理分泌,更能平衡、快速降血糖,更适合于老年人2型糖尿病合并肺部感染的患者。