Background: Recent studies have suggested that cerebral ischemic infarction may contribute to the development of restless legs syndrome (RLS). This study analyzed the clinical and radiological profiles of RLS with onset after acute lacunar infarction. Methods: In this retrospective study we enrolled 244 consecutive patients with acute lacunar infarction between January 2012 and June 2014. RLS was identified and evaluated based on the International RLS Rating Scale (IRLS-RS). Individual sleep quality was assessed using the Epworth Sleepiness Scale (ESS). Psychological state was also assessed using the Hamilton Depression Scale (HDS) and the Hamilton Anxiety Scale (HAS). Results: The incidence of RLS in patients with lacunar infarction was 5.33%. Our participant group consisted of nine males and four females. Three patients had symptoms in bilateral limbs, and 10 patients had symptoms only contralateral to the cerebral infarction. The infarctions were localized to the pons, centrum semiovale, thalamus, putamen, medulla, and occipital lobe. Contralateral paralysis was found in 13 patients, and contralateral sensory deficit in seven patients. The average IRLS-RS, ESS, HDS, HAS scores were 19.07 +/- 8.70, 4.69 +/- 5.82, 4.38 +/- 4.68, and 3.85 +/- 4.76, respectively. Nine patients had diabetes mellitus. After administration of dopaminergic drugs, patients' RLS significantly improved. Conclusions: The incidence of RLS after acute lacunar infarction was 5.33%. Pons, centrum semiovale, and basal ganglia were the common locations of responsible lesions. Compared to idiopathic RLS, symptoms of RLS after acute lacunar infarction appeared more unilateral and more likely involved the arm. Moreover, diabetes mellitus may be a risk factor for RLS in stroke patients. (c) 2018 Elsevier B.V. All rights reserved.

Objective To investigate the role of peroxisome proliferator-activated-receptor-γ coactivator-1α (PGC-1α) in carotid atherosclerosis due to human cytomegalovirus (HCMV) infection.Methods Thirty-three samples of carotid arterial sclerosis plaques after carotid endarterectomy (CEA) were collected in the experiment group,and 12 pieces of normal intracranial arteries were collected in the control group.The plaques of carotid artery were studied using in situ hybridization (ISH) and immunohistochemistry (IHC) for the role of PGC-1α in HCMV related atherosclerosis.HCMV immediate early (IE) gene of two groups was detected using ISH,and the expression of PGC-1α using IHC.Results HCMV IE gene was positive 72.7％ in the atherosclerotic plague group,while 16.6％ in the control group,there was significant difference between the two groups (P＜0.05).As to PGC-1α expression,in the atherosclerosis group,8/33 (24.2％) were strongly positive (+ + +),9/33 (27.2％) were positive (+ +),6/33(18.2％) were weakly positive (+),and 10/33(30.3％) were negative (-).While in the control group,1/12(8.3％) was strongly positive (+++),2/12(16.7％) were positive (++),and 1/12 (8.3％)was weakly positive (+),and 8/12 (66.7％) were negative (-).The differences between the two groups were statistically significant (P＜0.05).Conclusions HCMV immediate early gene and PGC-1α were both related to athersclerotic plaque formation,suggesting that PGC-1α may play an important role in as the plaque formation due to HCMV infection.

Objective To investigate the role of lectin-like Ox-LDL receptor-1 (LOX-1) in the activation and oxidative stress of cultured human umbilical vein endothelial cell (HUVEC) after human cytomegalovirus(HCMV) infection.Methods HUVEC were divided into four groups:HCMV,Control,Carrageenan,and HCMV+Carrageenan.After HCMV AD169 infection,the supernatant of the culture was extracted,and cells were lysed.The levels of LOX-1 mRNA,intercellular adhesion molecule-1 (ICAM-1)mRNA and vascular cellular adhesion molecule-1 (VCAM-1) in HUVEC were measured by real-time PCR.And the content of nitrogen monoxidum (NO) of the supernatant was detected by nitrate reductase method accordingly.Results 24 h after infection,the mRNA expression of LOX-1,ICAM-1 and VCAM-1 in HUVEC of HCMV infected group increased obviously compared to control,and NO quantity increased accordingly.The mRNA expression of LOX-1,ICAM-1 and VCAM-1 and the quantity of NO decreased after adding the LOX-1 inhibitor carrageenan.There was significant difference between groups (P ＜ 0.05).Conclusions HCMV may increase the mRNA expression of ICAM-1 and VCAM-1 and quantity of NO by upregulating the mRNA expresion of LOX-1,which may contribute to the formation of a therosclerosis(AS).

目的 对比观察经内镜逆行胰胆管造影(ERCP)置入金属支架与经皮经肝胆管穿刺引流术(PTCD)治疗肝外胆管恶性肿瘤致梗阻性黄疸的临床疗效.方法 采用前瞻性研究方法,选取2016年1月至2018年1月首都医科大学附属北京友谊医院收治的90例肝外胆管恶性肿瘤致梗阻性黄疸患者,采用简单随机分组方法,分为对照组和观察组,每组各45例.对照组患者采用PTCD治疗,观察组患者采用ERCP置入金属支架治疗.比较两组患者的住院天数、术后黄疸缓解率、术后腹痛、术后发热、支架通畅时间、术后并发症发生情况及总生存期等差异.结果 观察组患者的住院天数[(12.53±3.98)d]较对照组[(18.77±4.26)d]明显缩短,差异具有统计学意义(P<0.01).观察组和对照组患者的术后黄疸缓解率(93.33％vs.84.44％)和发热发生率(24.44％vs.33.33％)比较,差异均无统计学意义(P>0.05);观察组患者的术后腹痛发生率(8.89％)较对照组(31.11％)明显下降,差异具有统计学意义(P<0.05);观察组和对照组患者的腹痛消失时间(6.95±1.35 d vs.7.38±1.46 d)和体温恢复正常时间(2.48±0.69 d vs.2.74±0.83 d)比较,差异均无统计学意义(P>0.05).观察组患者的支架通畅时间[(224.85±48.95)d]和总生存期[(331.14±46.84)d]较对照组[(157.89±42.16)d、(223.16±39.80)d]明显延长,差异具有统计学意义(P<0.01).观察组患者的术后并发症总发生率(6.67％)较对照组(26.67％)明显降低,差异具有统计学意义(P<0.05).结论 对肝外胆管恶性肿瘤致梗阻性黄疸患者而言,ERCP置入金属支架与PTCD的效果相当,均可有效缓解胆道梗阻性黄疸.但相比于PTCD,ERCP置入金属支架治疗后胆道通畅时间延长,住院时间缩短,并发症发生率低,可促进患者肝功能恢复,延长生存时间,因此,ERCP置入金属支架治疗可作为临床治疗此类患者的一种安全、有效的方法.

目的 分析联合氨基末端脑钠肽前体(NT-proBNP)水平与QRS波群时限对慢性心力衰竭致心源性猝死的预测价值.方法 回顾性分析2015年1月至2016年12月首都医科大学附属北京友谊医院收治的106例慢性心力衰竭患者的临床资料,检测患者血浆NT-proBNP和QRS波群时限.比较不同心功能分级(NYHA分级)的患者血浆NT-proBNP和QRS波群时限的差异;记录患者终点事件,并比较存活者、心源性猝死者及非心源性猝死者血浆NT-proB-NP和QRS波群时限的差异;比较不同血浆NT-proBNP和QRS波群时限的患者心源性猝死的发生情况.结果 106例患者中,NYHA分级Ⅱ级者27例,Ⅲ级者49例,Ⅳ级者30例;NYHA分级Ⅱ、Ⅲ、Ⅳ级的患者NT-proBNP分别为(489.76±95.13) pg/ml、(1 712.75±119.85) pg/ml、(2 935.06±139.55) pg/ml,QRS波群时限分别为(101.95±20.85)ms、(109.98±24.76) ms、(126.98±25.96) ms.NYHA分级为Ⅳ级组血浆NT-proBNP的水平和QRS波群时限较Ⅱ、Ⅲ级者明显升高(P＜0.05);NYHA分级为Ⅲ级血浆NT-proBNP的水平较Ⅱ级者明显升高(P＜0.05).106例患者中,存活79例,死亡27例(包括心源性猝死11例,非心源性猝死16例);存活、非心源性猝死、心源性猝死患者NT-proBNP分别为(384.87±79.98) pg/ml、(810.87±123.21) pg/ml、(2 432.09±236.87)pg/ml,QRS波群时限分别为(387.65±94.24) ms、(424.87±89.77) ms、(835.87±99.94)ms.心源性猝死者血浆NT-proBNP的水平和QRS波群时限较非心源性猝死者、存活者明显升高(P＜0.05).106例患者中,47例NT-proBNP＜ 900 pg/ml,59例NT-proBNP≥900 pg/ml;血浆NT-proBNP≥900 pg/ml者死亡率(37.29％)和心源性猝死率(16.95％)较NT-proBNP＜ 900 pg/ml者(10.64％、2.13％)明显升高(P＜0.05).106例患者中,66例QRS波群时限＜120 ms,40例QRS波群时限≥120 ms;QRS波群时限≥120 ms者死亡率(40.00％)和心源性猝死率(22.50％)较QRS波群时限＜120 ms者(16.67％、3.03％)明显升高(P＜0.05).结论 血浆NT-proBNP、QRS波群时限与慢性心力衰竭诱发心源性猝死的发生存在密切关系,因此联合检测血浆NT-proBNP与QRS波群时限对监测慢性心力衰竭患者病情具有重要的临床意义.

Objective To investigate the role of the activation and oxidative stress of cultured human umbilical vein endothelial cells (HUVEC) after HCMV infection.Methods HUVECs were divided into four groups:control,HCMV(+),after HCMV AD169 infection,and the supernatant of the culture was extracted,and the cells were lysed.The levels of vascular cellular adhesion molecule-1 (VCAM-1) in HUVEC were measured by real-time PCR.And the content of nitrogen nonoxide (NO) of the supernatant was detected by nitrate reductasemethod accordingly.Results Twenty-four hours after infection,the mRNA expression of VCAM-1 in HUVECs of HCMV infected group increased obviously compared to control,and NO quantity increased accordingly and time-dependently.There was significant difference between groups(P＜0.01).Conclusions HCMV increases the mRNA expression of VCAM-1 and quantity of NO,which may contribute to the formation of AS.

喉及喉部以下的呼吸道任何部位(气管、支气管或肺组织)出血,从口腔咯出均称为咯血. 咯血可表现为痰中带血、满口鲜血到致命性的大咯血,在量上有很大的差别. 咯血是患者在急诊就诊的常见原因,咯血量大小目前尚无统一明确的界定. 一般认为,每日咯血量<100 m1为小量,100~500 m1为中等量,>500 m1或1次咯血100 ~500 m1为大量. 大咯血是急诊的危重情况之一. 应该注意的是如果患者咯血前由于基础疾病肺功能低下,即使出血量不大也有致死可能. 咯血需与口腔、鼻腔、上消化道出血相鉴别. 另外,肺出血可能淤存在肺中或咽下,咯出的血量并不能反映实际的出血量,应根据患者生命体征情况,采取适当紧急措施. 虽然大咯血发生率并不高,但易引起气道阻塞发生窒息而危及患者生命. 临床上采取紧急措施的同时,尽快明确病因十分重要.

Objective To investigate the prevalence and risk factors of restless leg syndrome (RLS) in hemodialysis patients after kidney transplantation failure.Methods Patients of hemodialysis after kidney transplantation failure were investigated by face-to-face interviews,from March to July,2015,at four dialysis units in Beijing.RLS was diagnosed according to the International RLS Study Group (IRLSSG) criteria.The severity of RLS was assessed using International RLS Rating scale.Besides,three validated sleep disorder questionnaires (Hamilton anxiety and depression scale,Epworth sleepiness scale and Pittsburgh sleep quality index) were completed by the patients at the same time.Results Ninety-four hemodialysis patients after kidney transplantation failure were enrolled;46 patients (48.94％) met the diagnosis of RLS,the average age was 53.44±l 1.89 years,and the median time of RLS onset after kidney transplantation failure was 46 months.The International RLS Rating scale scores of the patients were 17.26±7.81;76.0％ patients were above moderate.As compared with the non-RLS patients,patients with RLS used more erythropoietin (44/48 vs.46/46),less ferrila (30/48 vs.19/46),and few hypnotic medicine (10/48 vs.3/46),with significant differences (P＜0.05).The serum ion,serum ferritin and serum Vitamin B12 of patients with RLS were significantly lower as compared with non-RLS patients (P＜0.05);and poorer sleep quality and higher depression scale scores in the patients with RLS were noted as compared with those in the non-RLS patients (P＜0.05).Conclusion The prevalence of RLS in hemodialysis patients after kidney transplantation failure is high,low iron protein content,low serum iron content and low vitamin B12 levels may be risk factors for RLS.

DOI：10.3969/j.issn.1672⁃6731.2012.02.026