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Analysis of related factors for restless legs syndrome in hemodialysis patients 血液透析患者不宁腿综合征的相关因素分析
Q4 Medicine Pub Date : 2018-01-25 DOI: 10.3969/cjcnn.v18i1.1721
Ying-ying Shi, Ji-jun Li, Yanli Song, J. Zhang
Objective To investigate the incidence of restless legs syndrome (RLS) in hemodialysis patients and to analyze the related risk factors.  Methods There were 220 cases of hemodialysis as hemodialysis group and 40 cases of chronic nephrosis as control group. The severity of RLS was measured by International Restless Legs Syndrome Study Group Rating Scale (IRLS). Beck Depression Inventory (BDI) was used to evaluate the status of depression, Epworth Sleepiness Scale (ESS) was used to evaluate excessive daytime sleepiness (EDS), and Insomnia Severity Index (ISI) was used to evaluate the status of insomnia. Univariate and multivariate forward Logistic regression analysis was used to analyze the related risk factors for RLS in hemodialysis patients. Results In hemodialysis group duration ( Z =-9.837, P = 0.000), serum ferritin ( t = 2.847, P = 0.005), incidence rate of RLS ( χ 2 = 10.918, P = 0.001), the proportion of using hypnotic drugs ( χ 2 = 7.669, P = 0.006), IRLS ( t = 2.322, P = 0.020) and ISI ( Z = 4.117, P = 0.001) were significantly higher than control group. Univariate and multivariate forward Logistic regression analysis showed diabetes ( OR = 3.387, 95% CI: 1.538-7.461; P = 0.002), BDI > 9 score ( OR = 2.643, 95% CI: 1.457-4.795; P = 0.001) and ISI > 7 score ( OR = 3.542, 95%CI: 1.939-6.468; P = 0.000) were independent risk factors for RLS in hemodialysis patients.  Conclusions Hemodialysis patients have a high incidence of RLS and insomnia. RLS is closely related with insomnia. Depression plays an important role therein. DOI: 10.3969/j.issn.1672-6731.2018.01.009
目的调查血液透析患者不宁腿综合征(RLS)的发生率,并分析其相关危险因素。方法血透组220例,慢性肾病组40例。采用国际不宁腿综合征研究组评定量表(IRLS)测量RLS的严重程度。采用Beck抑郁量表(BDI)评估抑郁状态,Epworth嗜睡量表(ESS)评估日间过度嗜睡(EDS),失眠严重程度指数(ISI)评估失眠状态。采用单因素和多因素正向Logistic回归分析血液透析患者发生RLS的相关危险因素。结果血透析组患者持续时间(Z =-9.837, P = 0.000)、血清铁蛋白(t = 2.847, P = 0.005)、RLS发生率(χ 2 = 10.918, P = 0.001)、使用催眠药物比例(χ 2 = 7.669, P = 0.006)、IRLS (t = 2.322, P = 0.020)、ISI (Z = 4.117, P = 0.001)均显著高于对照组。单因素和多因素正向Logistic回归分析显示:糖尿病(OR = 3.387, 95% CI: 1.538-7.461;P = 0.002), BDI bbb9评分(OR = 2.643, 95% CI: 1.457-4.795;P = 0.001)和ISI >7评分(OR = 3.542, 95%CI: 1.939 ~ 6.468;P = 0.000)是血液透析患者RLS的独立危险因素。结论血液透析患者有较高的RLS和失眠发生率。RLS与失眠密切相关。抑郁症在其中扮演着重要的角色。DOI: 10.3969 / j.issn.1672-6731.2018.01.009
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引用次数: 1
Clinical study on lorazepam for treating postoperative pain of wound after spinal meningioma surgery 劳拉西泮治疗脊膜瘤术后伤口疼痛的临床研究
Q4 Medicine Pub Date : 2017-12-25 DOI: 10.3969/cjcnn.v17i12.1709
Yi‐peng Wang, Wen-bin Wang
Objective To estimate the effect of lorazepam in relieving postoperative wound pain and anxiety after spinal meningioma surgery.  Methods A total of 106 patients underwent spinal meningioma resection with endotracheal general anesthesia. They were randomly divided into lorazepam group (N = 53) and control group (N = 53). Patients in lorazepam group were given lorazepam 0.50 mg one night before surgery and 6 h after surgery, while control group were given compound vitamin B at the same time. Operation time, intraoperative bleeding and wound healing after surgery were recorded. McCormick grade and Self-Rating Anxiety Scale (SAS) were used to evaluate the spinal function and anxiety. At 48 h after surgery, Visual Analogue Scale (VAS) was used to evaluate the degree of postoperative pain.  Results All patients underwent tumor total resection, and spent the perioperative period safely. No complications such as infection happened. Neurological function were relieved to varying degrees and there was no worsening case. Compared with control group, SAS score in lorazepam group was significantly decreased at 48 h after surgery ( P = 0.000). Compared with before surgery, SAS score in lorazepam group was significantly decreased at 48 h after surgery ( P = 0.000). The VAS score at 48 h after surgery in lorazepam group was significantly lower than control group [(5.40 ± 1.24) score vs. (7.15 ± 1.12) score; t = 7.593, P = 0.000].  Conclusions Lorazepam as an antianxiety agent can effectively relieve postoperative pain after spinal meningioma resection. DOI: 10.3969/j.issn.1672-6731.2017.12.011
目的评价劳拉西泮对脊膜瘤术后创伤疼痛和焦虑的缓解作用。方法对106例脊膜瘤患者行气管内全麻下脊膜瘤切除术。他们被随机分为劳拉西泮组(N=53)和对照组(N=53)。劳拉西泮组患者在术前1晚和术后6小时给予劳拉西泮0.50 mg,对照组同时给予复合维生素B。记录手术时间、术中出血和术后伤口愈合情况。采用麦考密克评分和焦虑自评量表(SAS)评定脊柱功能和焦虑。术后48小时,采用视觉模拟量表(VAS)评估术后疼痛程度。结果所有患者均行肿瘤全切除术,安全度过了围手术期。没有发生感染等并发症。神经功能得到不同程度的缓解,没有恶化的病例。劳拉西泮组术后48h SAS评分较对照组明显下降(P=0.000),劳拉西泮组术后48h SAS评分显著下降(P=0.000),术后48h VAS评分显著低于对照组[(5.40±1.24)分与(7.15±1.12)分;t=7.593,P=0.000]。DOI:10.3969/j.issn.1672-6731017.12.011
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引用次数: 0
Research progress of cerebral hyperperfusion syndrome 脑过度灌注综合征的研究进展
Q4 Medicine Pub Date : 2017-12-25 DOI: 10.3969/CJCNN.V17I12.1701
Guangquan Zhang, Shiyi Zhu, Zhi-yong Ji, Pei-quan Zhou, Shancai Xu, Huaizhang Shi
Cerebral hyperperfusion syndrome (CHS) is a rare syndrome deriving from carotid endovascular treatment with a high mortality. CHS can be derived by carotid endarterectomy (CEA), carotid artery stenting (CAS) and intracranial artery stenting. This review aims to summarize the progress of clinical manifestations, risk factors, pathogenesis, diagnostic criteria, prevention and treatment for CHS in recent years. DOI: 10.3969/j.issn.1672-6731.2017.12.003
脑过度灌注综合征(CHS)是一种罕见的颈动脉血管内治疗综合征,死亡率很高。CHS可通过颈动脉内膜切除术(CEA)、颈动脉支架术(CAS)和颅内动脉支架术获得。本文就近年来CHS的临床表现、危险因素、发病机制、诊断标准、防治等方面的进展进行综述。DOI:10.3969/j.issn.1672-6731017.12.003
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引用次数: 1
Risk factors for in-stent restenosis of vertebral artery origin after stent implantation: a Meta-analysis 支架植入术后椎动脉源性支架内再狭窄的危险因素Meta分析
Q4 Medicine Pub Date : 2017-12-25 DOI: 10.3969/cjcnn.v17i12.1702
Fangfang Hao, Wenhui Teng, Qingting Hu, Lei Fu, W. Gong, Xian-jun Zhang, Naidong Wang, Yong Zhang
Objective To systematically review the risk factors for in-stent restenosis (ISR) of vertebral artery origin after sent implantation to provide theoretical foundation for clinical prevention and treatment.  Methods Taking vertebral artery, vertebrobasilar insufficiency, stents, drug-eluting stents, self expandable metallic stents in English and Chinese as key words, retrospective clinical studies about risk factors for ISR of vertebral artery origin were searched by using PubMed, EMBASE/SCOPUS, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Data and VIP database from January 1, 1966 to March 30, 2017. Quality assessment and Meta-analysis were made by using Newcastle-Ottawa Scale (NOS) and Stata 12.0 software.  Results The research enrolled 3468 articles in all, from which 11 studies were chosen after excluding duplicates and those not meeting the inclusion criteria. A total number of 1352 patients were divided into ISR group (N = 440) and non-ISR group (N = 912). The ISR incidence rate of smokers was significantly higher than non-smokers ( OR = 2.179, 95%CI: 1.373-3.458; P = 0.001). The differences of bare metal stents (BMS) utilization rate ( OR = 2.072, 95% CI: 1.560-2.753; P = 0.000) and drug-eluting stents (DES) utilization rate ( OR = 0.483, 95% CI: 0.363-0.641; P = 0.000) between ISR group and non-ISR group were statistically significant.  Conclusions Smoking and using BMS are risk factors for ISR of vertebral artery origin, and using DES is protective factor. Due to limited study quality, more high-quality studies are needed to verify this conclusion. DOI: 10.3969/j.issn.1672-6731.2017.12.004
目的系统评价椎动脉支架置入术后发生支架内再狭窄的危险因素,为临床防治提供理论依据。方法采用PubMed、EMBASE/SCOPUS、Cochrane Library、中国生物医药(CBM)、中国知识基础设施(CNKI)等检索工具,以中英文关键词椎动脉、椎基底动脉供血不足、支架、药物洗脱支架、自膨胀金属支架为关键词,对椎动脉源性ISR危险因素进行回顾性临床研究,1966年1月1日至2017年3月30日的万方数据和VIP数据库。采用Newcastle Ottawa量表(NOS)和Stata 12.0软件进行质量评估和Meta分析。结果本研究共收录3468篇文章,其中11篇研究是在排除重复和不符合纳入标准的研究后选择的。1352名患者被分为ISR组(N=440)和非ISR组(N=912)。吸烟者的ISR发生率显著高于非吸烟者(OR=2.179,95%CI:1.373-3.458;P=0.001)。ISR组与非ISR组的裸金属支架(BMS)利用率(OR=2.772,95%CI:1.560-2.753;P=0.000)和药物洗脱支架(DES)利用率差异有统计学意义(OR=0.483,95%CI:0.63-0.641;P=0.0000)。结论吸烟和BMS是椎动脉源性ISR的危险因素,DES是其保护因素。由于研究质量有限,需要更多高质量的研究来验证这一结论。DOI:10.3969/j.issn.1672-6731017.12.004
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引用次数: 0
A preliminary fMRI study on activiation pattern and functional reorganization of motor cortex in acute ischemic stroke patients 急性缺血性脑卒中患者运动皮质激活模式及功能重组的fMRI初步研究
Q4 Medicine Pub Date : 2017-12-25 DOI: 10.3969/cjcnn.v17i12.1703
Fanyong Zeng, Zhiqiang Zhang, Fang Yang, Jianping Hu, Qiang Xu, G. Lu
Objective To observe and explore the activation pattern and functional reorganization mechanism of motor cortex in acute ischemic stroke patients.  Methods A total of 22 patients with first-ever acute ischemic stroke were included in this study. Functional magnetic resonance imaging (fMRI) was used to observe the changing of activation pattern and functional reorganization of motor cortex in finger-tapping task. National Institutes of Health Stroke Scale (NIHSS) and Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE) were used to evaluate motor function, and neuroelectrophysiology monitored resting motor threshold (RMT). Spearman rank correlation analysis was used to analyze the correlation between activation of region of interest (ROI) and neurological function, motor function and neuroelectrophysiology. Moreover, dynamic causal model (DCM) was used to analyze the intrahemispheric and interhemispheric effective connectivity between brain regions in finger-tapping task. Results Movements of the affected hand showed significant signal activation in the ipsilesional primary motor cortex (M1), premotor cortex (PMC) and bilateral supplementary motor area (SMA), while the contralesional PMC, posterior parietal cortex (PPC) and bilateral cerebellar hemisphere also showed slight activation. Movements of the unaffected hand showed significant activation in the contralesional M1, PMC and SMA, while the ipsilesional SMA and inferior parietal lobule also showed slight activation. The activation value of ipsilesional M1 was negatively correlated with neurological function (NIHSS score; r s = -0.452, P = 0.035) and positively correlated with motor function of upper extremity (FMA-UE score;  r s = 0.543, P = 0.009). The activation value of ipsilesional sensorimotor cortex (SMC) was positively correlated with RMT ( r s = 0.718, P = 0.001). The advantage model of DCM showed bidirectional suppressive influence of connectivity between bilateral M1, negative effective connectivity from contralesional SMA to M1, positive effective connectivity from contralesional SMA to ipsilesional M1 and from ipsilesional SMA to contralesional SMA. The intensity of effective connectivity from contralesional to ipsilesional M1 was negatively correlated with motor function (FMA-UE score;  r s = -0.461, P = 0.047). The intensity of effective connectivity from contralesional SMA to contralesional M1 was positively correlated with motor function (FMA-UE score;  r s = 0.533, P = 0.041).  Conclusions fMRI combined with neurological function, motor function and electrophysiology can be used to observe activation pattern and functional reorganization mechanism of motor cortex in acute ischemic stroke patients, and provide new insights into understanding the motor impairment and functional reorganization after stroke and rehabilitation therapy. DOI: 10.3969/j.issn.1672-6731.2017.12.005
目的观察和探讨急性缺血性脑卒中患者运动皮层的激活模式及功能重组机制。方法选取22例首次急性缺血性脑卒中患者作为研究对象。应用功能磁共振成像(fMRI)观察了手指敲击任务中运动皮层的激活模式和功能重组的变化。采用美国国立卫生研究院卒中量表(NIHSS)和Fugl-Meyer上肢评估量表(FMA-UE)评估运动功能,神经电生理监测静息运动阈值(RMT)。采用Spearman秩相关分析分析感兴趣区(ROI)激活与神经功能、运动功能和神经电生理的相关性。此外,采用动态因果模型(DCM)分析了手指敲击任务中脑内和脑间的有效连通性。结果患手运动时,同侧初级运动皮层(M1)、运动前皮层(PMC)和双侧辅助运动区(SMA)信号明显激活,对侧初级运动皮层、后顶叶皮层(PPC)和双侧小脑半球也有轻微激活。未患手的运动在对侧M1、PMC和SMA中表现出明显的激活,而同侧SMA和顶叶下小叶也表现出轻微的激活。同侧M1的激活值与神经功能呈负相关(NIHSS评分;r s = -0.452, P = 0.035),与上肢运动功能呈正相关(FMA-UE评分;r s = 0.543, P = 0.009)。同侧感觉运动皮层(SMC)的激活值与RMT呈正相关(r s = 0.718, P = 0.001)。DCM的优势模型显示双侧M1之间的连通性、从对侧SMA到M1的负有效连通性、从对侧SMA到同侧M1以及从同侧SMA到对侧SMA的正有效连通性具有双向抑制作用。从对侧到同侧M1的有效连接强度与运动功能呈负相关(FMA-UE评分;r s = -0.461, P = 0.047)。从对侧SMA到对侧M1的有效连接强度与运动功能呈正相关(FMA-UE评分;r s = 0.533, P = 0.041)。结论fMRI结合神经功能、运动功能和电生理可以观察急性缺血性脑卒中患者运动皮层的激活模式和功能重组机制,为认识脑卒中及康复治疗后的运动损伤和功能重组提供新的见解。DOI: 10.3969 / j.issn.1672-6731.2017.12.005
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引用次数: 1
Comparison of far lateral approach versus presigmoidal approach for exposing inferior clivus by virtual reality technique 虚拟现实技术下斜坡显露远侧入路与乙状窦前入路的比较
Q4 Medicine Pub Date : 2017-12-25 DOI: 10.3969/CJCNN.V17I12.1706
K. Tang, Ya-qun Zhao, Qing Zhou, Ce Liu
Objective To compare the three-dimensional anatomic differences of far lateral approach versus presigmoidal approach to expose inferior clivus by virtual reality technique.  Methods CT and MRI image data of 15 cadaver heads (30 sides) were inputted into Vitrea virtual reality system to establish three-dimensional anatomy model of posterior cranial fossa. Three points including anterior edges of bilateral tubercula jugulare and tubercula pharyngeum were selected to form a plane. The region of inferior clivus was defined as area under the aforementioned plane. The anterior edge of intersection curve between the plane and the clivus was selected as skull base landmark to expose. The mastoidale and posterior edge of occipital condyle articular surface were selected as craniotomy landmarks of presigmoidal and far lateral approaches. Cylinder with 1 cm diameter was outlined to simulate surgical approach, of which the axis passed through the aforementioned craniotomy landmarks. The superior edge of bottom surface of cylinder on the side of skull base was located in the aforementioned landmark of skull base. Anatomic exposures of the above two approaches were compared by paired t test.  Results The far lateral approach located at the lateral edge of foramen magnum, anterior to the cerebellum, lateral to the brain stem, medial to the jugular bulb, lateral and inferior to the accessory nerve, involved hypoglossal nerve and reached inferior clivus. Bone drilling through presigmoidal approach began with mastoidale. The approach passed through inferior edge of jugular bulb, anterior to the sigmoid sinus, inferior to the accessory nerve, involved hypoglossal nerve at the lateral edge of foramen magnum, reached inferior clivus anterior to the brain stem. The volumes of surgical route [(4629.80 ± 81.00) mm 3 vs. (2622.60 ± 72.58) mm 3 ; t = 91.532,  P = 0.000] and route involving hypoglossal nerve [(10.15 ± 0.17) mm 3 vs. (7.15 ± 0.20) mm 3 ;  t = 52.413, P = 0.000] through presigmoidal approach were more than those through far lateral approach. Osseous structures involved in far lateral approach was more than that in presigmoidal approach [(2362.90 ± 80.18) mm 3 vs. (1851.60 ± 63.62) mm 3 ;  t = 25.714, P = 0.000].  Conclusions Passing through hypoglossal nerve and drilling partial osseous structures will help to avoid cerebellum and brain stem and expose inferior clivus through far lateral approach and presigmoidal approach. DOI: 10.3969/j.issn.1672-6731.2017.12.008
目的比较应用虚拟现实技术显露下斜坡的远外侧入路与乙状窦前入路的三维解剖差异。方法将15具(30侧)尸头的CT和MRI图像数据输入到Vitrea虚拟现实系统中,建立后颅窝的三维解剖模型。选择双侧颈结节前缘和咽结节前缘三个点形成一个平面。下斜坡区域被定义为上述平面下的区域。选择平面与斜坡相交曲线的前缘作为颅底标志进行暴露。选择乳突和枕髁关节面的后缘作为窦前入路和远外侧入路的开颅标志。勾勒出直径为1cm的圆柱体以模拟手术入路,其中轴线穿过上述开颅术标志。颅底侧圆柱体底面的上缘位于上述颅底标志处。通过配对t检验比较上述两种入路的解剖暴露。结果远外侧入路位于大孔外侧缘、小脑前方、脑干外侧、颈静脉球内侧、副神经外侧及下方,累及舌下神经,到达下斜坡。通过乳突窦前入路进行骨钻孔。入路经颈静脉球下缘,乙状窦前,副神经下,累及大孔外侧缘舌下神经,到达脑干前下斜坡。经乙窦前入路的手术径路[(4629.80±81.00)mm3 vs.(2622.60±72.58)mm3;t=91.532,P=0.000]和经舌下神经[(10.15±0.17)mm3 vs(7.15±0.20)mm3,t=52.413,P=0.0000]的体积大于经远侧入路的体积。远侧入路的骨性结构较乙状窦前入路多[(2362.90±80.18)mm3 vs.(1851.60±63.62)mm3;t=25.714,P=0.000]。DOI:10.3969/j.issn.1672-6731017.12.008
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引用次数: 0
Clinical analysis of cerebral venous sinus thrombosis and its combined treatment of anticoagulation and endovascular thrombolysis 脑静脉窦血栓形成临床分析及抗凝与血管内溶栓联合治疗
Q4 Medicine Pub Date : 2017-12-25 DOI: 10.3969/CJCNN.V17I12.1704
Yun Jiang, X. Chu, Kun-peng Chen, Juan Chen, Daming Wang
Objective To investigate the clinical and imaging manifestations of cerebral venous sinus thrombosis (CVST), and the clinical effect of combined treatment of anticoagulation and endovascular thrombolysis.  Methods and Results The clinical manifestations of 22 CVST patients were highly variable. Headache (90.91%, 20/22) was the most frequent symptom, and conscious disturbance, seizure and focal neurological deficits were commonly present. Plasma D-dimer level was elevated in 12 patients (54.55%). Lumbar puncture was performed in 14 patients, in whom intracranial hypertension was present in 9 patients (9/14) with no characteristic changes in routine and biochemical examination of cerebrospinal fluid (CSF). Brain CT/MRI and CTV/MRV showed direct signs of CVST in all 22 patients, involving superior sagittal sinus, transverse sinus, sigmoid sinus, straight sinus and cortex veins, parenchymal lesions (infarction, hemorrhage and white matter abnormalities) in 13 patients (59.09%), subarachnoid hemorrhage (SAH) in 2 patients (9.10%) and subdural hematoma in one patient (4.55%). The involved cerebral sinuses revealed by DSA were superior sagittal sinus in 13 patients (59.09% ), transverse sinus in 17 patients (77.27%), sigmoid sinus in 14 patients (63.64%), inferior sagittal sinus in 2 patients (9.10%), straight sinus in 4 patients (18.18%), vein of Galen in one patient (4.55%) and jugular vein in one patient (4.55%). Two thrombosed sinuses were found in 9 patients (40.91% ) and 3 or more thrombosed sinuses in 8 patients (36.36% ). As no clinical improvements and progressive exacerbation were observed several days after heparin sodium intravenous drip or lower molecular weight heparin (LMWH) hypodermic injection with oral warfarin anticoagulant therapy, urokinase thrombolysis in venous sinus or artery was applied in 21 patients (95.45%). After (25.70 ± 12.18) d treatment with anticoagulation, the modified Rankin Scale (mRS) score of 13 patients (59.09% ) reached 0-1, 4 patients (18.18% ) 2 and 5 patients (22.73% ) 3-4, with the total effective rate reaching 77.27% (17/22). Conclusions The severely affected CVST usually have multiple sinus thromboses, deep venous thrombosis and parenchymal lesions. Endovascular thrombolysis together with primary anticoagulation may result in good outcomes in these patients. DOI: 10.3969/j.issn.1672-6731.2017.12.006
目的探讨脑静脉窦血栓形成(CVST)的临床及影像学表现,探讨抗凝与血管内溶栓联合治疗的临床效果。方法与结果22例CVST患者临床表现差异较大。头痛(90.91%,20/22)是最常见的症状,通常存在意识障碍、癫痫发作和局灶性神经功能障碍。血浆d -二聚体水平升高12例(54.55%)。14例患者行腰椎穿刺,其中9例(9/14)出现颅内高压,脑脊液常规及生化检查无特征性改变。22例患者均有颅脑CT/MRI及CTV/MRV直接征象,包括上矢状窦、横窦、乙状窦、直窦及皮质静脉,实质病变(梗死、出血及白质异常)13例(59.09%),蛛网膜下腔出血2例(9.10%),硬膜下血肿1例(4.55%)。DSA显示受累的脑窦为上矢状窦13例(59.09%)、横窦17例(77.27%)、乙状窦14例(63.64%)、下矢状窦2例(9.10%)、直窦4例(18.18%)、盖伦静脉1例(4.55%)、颈静脉1例(4.55%)。2个血栓形成的鼻窦9例(40.91%),3个及以上血栓形成的鼻窦8例(36.36%)。由于静脉滴注肝素钠或低分子肝素(LMWH)皮下注射联合口服华法林抗凝治疗后数天临床无改善,病情加重,21例(95.45%)患者采用静脉窦或动脉尿激酶溶栓。经(25.70±12.18)d抗凝治疗后,改良Rankin量表(mRS)评分0-1分13例(59.09%),2分4例(18.18%),3-4分5例(22.73%),总有效率77.27%(17/22)。结论重度CVST患者多有多发窦性血栓、深静脉血栓及实质病变。在这些患者中,血管内溶栓联合初级抗凝可能会产生良好的结果。DOI: 10.3969 / j.issn.1672-6731.2017.12.006
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引用次数: 1
Sellar/suprasellar extraventricular neurocytoma 鞍/鞍上室外神经细胞瘤
Q4 Medicine Pub Date : 2017-12-25 DOI: 10.3969/CJCNN.V17I12.1707
Li Zhang, Xueyong Liu, S. Zhang, Yupeng Chen, Xingfu Wang
Objective To explore the clinicopathological features of extraventricular neurocytoma located in the sellar/suprasellar region.  Methods The clinical manifestations, neuroimaging, histopathological, immunohistochemical and molecular genetic features were retrospectively analyzed in one case of sellar/suprasellar extraventricular neurocytoma, and the related literatures were reviewed.  Results A 27-year-old female presented with intermittent headache, accompanied by blurred vision for 5 months. Head MRI demonstrated a mass with a well-defined margin measuring 3.80 cm × 2.50 cm × 3.40 cm located in the sellar/suprasellar region. The tumor showed isointense to hyperintense signals on T 1 WI and hyper-hypointense mixed signals on T 2 WI, and slightly hyperintense signal on diffusion-weighted imaging (DWI). The pituitary was not shown. A transsphenoidal sellar tumor resection, cerebrospinal fluid (CSF) rhinorrhea repairing and optic decompression were performed. The mass was lightly yellow and tough with abundant blood supply and filled with old hemorrhage. The pituitary tissue was pushed to the left rear. Microscopy examination showed a diffuse invasive growth pattern with neuropil background in some area. The tumor cells were uniform on size and shape with round to oval, exquisite and hyperchromatic nuclei. No mitosis was found. Immunohistochemical staining showed the tumor cells were positive for neuronal nuclei (NeuN) and thyroid transcription factor-1 (TTF-1) in nuclei, calretinin (CR) in nuclei and cytoplasm, synaptophysin (Syn), chromogranin A (CgA), E-cadherin, matrix metalloproteinase-9 (MMP-9) in cytoplasm, and focally positive for S-100 protein (S-100) in nuclei, and neurofilament protein (NF), cytokeratin 8 (CK8) and vimentin (Vim) in cytoplasm. The Ki-67 labeling index was about 3%. The tumor tissue was negative for reticular fiber staining. Molecular genetic analysis showed that isocitrate dehydrogenasel (IDH) gene was not mutated, and 1p/19q was intact in tumor cells. The final pathological diagnosis was extraventricular neurocytoma, WHO grade Ⅱ.  Conclusions Extraventricular neurocytoma located in the sellar/suprasellar region is very rare. The histological features are similar to central neurocytoma in ventricle. Tumor cells were in diffusely invasive growth and were uniform in size and shape, with round nuclei. Fibrillary areas mimicking neurophil and branching thin-walled capillaries can be seen. The differential diagnosis includes pituitary adenoma, oligodendroglioma, clear cell ependymoma, and so on. DOI: 10.3969/j.issn.1672-6731.2017.12.009
目的探讨鞍区/鞍上区室外神经细胞瘤的临床病理特征。方法回顾性分析1例鞍/鞍上脑室外神经细胞瘤的临床表现、神经影像学、组织病理学、免疫组织化学和分子遗传学特征,并复习相关文献。结果一位27岁的女性表现为间歇性头痛,并伴有5个月的视力模糊。头部MRI显示鞍区/鞍上区有一个边界清晰的肿块,尺寸为3.80 cm×2.50 cm×3.40 cm。肿瘤T1WI表现为等高信号,T2WI表现为高-低混合信号,DWI表现为轻度高信号。垂体未显示。经蝶鞍区肿瘤切除术、脑脊液鼻漏修补术和视神经减压术。肿块呈浅黄色,质地坚硬,血供充足,并充满陈旧性出血。垂体组织被推到左后方。显微镜检查显示在某些区域有弥漫性浸润性生长模式,并伴有神经膜背景。肿瘤细胞大小、形状均匀,细胞核从圆形到椭圆形,细腻、深染。没有发现有丝分裂。免疫组化染色显示肿瘤细胞细胞核内神经元细胞核(NeuN)和甲状腺转录因子-1(TTF-1)阳性,细胞核和细胞质内钙视网膜蛋白(CR)阳性,细胞质内突触素(Syn)、嗜铬粒蛋白A(CgA)、E-钙粘蛋白、基质金属蛋白酶-9(MMP-9)阳性,细胞角蛋白8(CK8)和波形蛋白(Vim)。Ki-67标记指数约为3%。肿瘤组织网状纤维染色阴性。分子遗传学分析表明,异柠檬酸脱氢酶(IDH)基因在肿瘤细胞中未发生突变,1p/19q完整。最终病理诊断为室外神经细胞瘤,世界卫生组织Ⅱ级。结论位于鞍区/鞍上区的室外神经细胞瘤非常罕见。其组织学特征与脑室中枢神经细胞瘤相似。肿瘤细胞呈弥漫性侵袭性生长,大小形状均匀,细胞核呈圆形。可以看到类似神经门和分支薄壁毛细血管的纤维区域。鉴别诊断包括垂体腺瘤、少突胶质瘤、透明细胞室管膜瘤等。DOI:10.3969/j.issn.1672-731.2017.12.009
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引用次数: 0
Interhemispheric (pericallosal) lipoma 半球间(球周)脂肪瘤
Q4 Medicine Pub Date : 2017-12-25 DOI: 10.3969/CJCNN.V17I12.1712
T. Han
2005, 26:1222⁃1223.] Hernandez J, Lackner A, Aye P, Mukherjee K, Tweardy DJ, Mastrangelo MA, Weinstock J, Griffiths J, D'Souza M, Dixit S, Robinson P. Substance P is responsible for physiological alterations such as increased chloride ion secretion and glucose malabsorption in cryptosporidiosis. Infect Immun, 2007, 75:1137⁃1143. (收稿日期:2017⁃11⁃04) [17] anxiety of patients receiving renal biopsy. Dang Dai Yi Xue, 2016, 22:117⁃118. [曾艳. 术前综合护理干预对肾穿刺活检术 患者焦虑的影响. 当代医学, 2016, 22:117⁃118.] Xie GZ. Effect of psychological intervention on anxiety and pain in patients undergoing breast cancer operation. Qiqihaer Yi Xue Yuan Xue Bao, 2005, 26:1222⁃1223. [谢桂珍. 心理干预对乳腺 癌手术病人焦虑与疼痛的效果观察. 齐齐哈尔医学院学报, [16]
2005,26:1222-1223.]Hernandez J,Lackner A,Aye P,Mukherjee K,Tweardy DJ,Mastrangelo MA,Weinstock J,Griffiths J,D’Souza M,Dixit S,Robinson P。P物质负责隐孢子虫病的生理变化,如氯离子分泌增加和葡萄糖吸收不良。Infect Immun,2007,75:1137-1143。(收稿日期:2017-11-04)[17]接受肾活检患者的焦虑。党代一学,2016,22:117-118。[曾艳. 术前综合护理干预对肾穿刺活检术 患者焦虑的影响. 当代医学, 2016,22:117-118.]谢GZ。心理干预对癌症手术患者焦虑和疼痛的影响。齐齐哈尔医学院学报,2005,26:1222-1223。[谢桂珍. 心理干预对乳腺 癌手术病人焦虑与疼痛的效果观察. 齐齐哈尔医学院学报, [16]
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引用次数: 0
The role of butyrylcholinesterase in the pathogenesis of Alzheimer's disease 丁胆碱酯酶在阿尔茨海默病发病机制中的作用
Q4 Medicine Pub Date : 2017-12-25 DOI: 10.3969/CJCNN.V17I12.1711
Hao-bin Wu, Xu-dong Li, D. Peng, J. Jiao, Yan-feng Li, P. Yu, Yong Ji
Alzheimer's disease (AD) is a neurodegenerative disease of unknown etiology and pathogenesis. The typical pathological changes of AD include neuritic plaques [NPs, senile plaques (SPs)] with deposition of β-amyloid protein (Aβ) and neurofibrillary tangles (NFTs) due to abnormal aggregation of tau protein. Researches show that cholinergic system is related to AD, and butyrylcholinesterase (BChE) plays an important role in AD. This article reviews the important role of BChE in the pathogenesis of AD. DOI: 10.3969/j.issn.1672-6731.2017.12.013
阿尔茨海默病(AD)是一种病因和发病机制尚不清楚的神经退行性疾病。AD的典型病理改变包括β-淀粉样蛋白(Aβ)沉积的神经性斑块[NPs,老年斑(SPs)]和由于tau蛋白异常聚集导致的神经原纤维缠结(nft)。研究表明,胆碱能系统与AD有关,而丁酰胆碱酯酶(BChE)在AD中起重要作用。本文就BChE在AD发病机制中的重要作用进行综述。DOI: 10.3969 / j.issn.1672-6731.2017.12.013
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引用次数: 1
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中国现代神经疾病杂志
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