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国际脑血管病杂志 2014年第4期22卷 241-257页

作者： Eelco F. M. w.jdicks Kevin N. Sheth Bob S. Carter David M. Greer Scott E. Kasner w. taylor kimberly Stefan Schw.b Eric E. Smith Rafael J. Tamargo Max w.ntermark 王玉琴牛牧柯开富美国心脏协会卒中委员会南通大学附属医院神经内科 226001

背景和目的关于缺血性卒中后脑肿胀患者的最佳管理方案，仍有许多尚未确定的问题。需要制定相关指南来指导如何处理这种严重并发症，如何提供最佳的综合性神经科和内科治疗，以及在患者病情恶化时如何与面临外科干预复杂决策的家属进行... 详细信息

背景和目的关于缺血性卒中后脑肿胀患者的最佳管理方案，仍有许多尚未确定的问题。需要制定相关指南来指导如何处理这种严重并发症，如何提供最佳的综合性神经科和内科治疗，以及在患者病情恶化时如何与面临外科干预复杂决策的家属进行良好的沟通。本科学声明为大脑或小脑半球缺血性卒中伴脑肿胀的患者提供了早期的管理方案。方法写作组利用系统文献综述，参考公开发表的临床和流行病学研究、发病率和死亡率报告、临床与公共卫生指南、权威声明、个人文件以及专家意见，对现有证据进行总结并指出与当前知识水平的差距。写作组通过对MEDLINE、EMBASE和w.b of Science数据库进行医学文献计算机检索（最后检索时间为2013年3月，研究对象为成年人）回顾最相关的文献。在美国心脏协会（American Heart Association，ARIA）框架背景下对证据进行组织，根据AHA／美国心脏病学学会基金会以及AHA卒中委员会的证据强度分级方案进行分类。这份声明经过AHA内部的广泛同行评议。结果已有适用于由缺血性梗死引起的半球（累及整个大脑中动脉供血区或更大范围）和小脑（累及小脑后下动脉或小脑上动脉供血区）肿胀的临床标准。幕上半球缺血性卒中伴脑肿胀发生恶化的临床表现包括新发意识障碍或意识障碍加重、脑性上睑下垂以及瞳孔大小变化。在小脑梗死伴肿胀患者中，意识水平下降是脑干受压的结果，因此可能出现早期角膜反射丧失和瞳孔缩小。应制定标准化定义以促进多中心和基于人群的发病率、患病率、危险因素和转归研究。脑肿胀高危患者的识别应包括临床和神经影像学资料。如果大面积卒中患者有必要进入全面复苏状态，则需要收入具备神经监护功能的病房。这些患者最好被收入由技术熟练和经验丰富的医生（如神经重症监护医生或神经血管科医生）负责的重症监护室或卒中单元。综合性医疗管理包括气道管理和机械通气、血压控制、液体管理以及血糖和体温控制。在幕上半球缺血性卒中伴肿胀患者中，不需行常规颅内压监测或脑脊液引流，但神经功能继续恶化的患者应考虑行去骨瓣减压和硬脑膜切开术。去骨瓣减压术在≥60岁的患者中的疗效尚不确定。在神经功能恶化的小脑卒中伴肿胀患者中，应行枕骨下颅骨切除和硬脑膜切开术。当应用脑室造瘘术缓解小脑梗死后梗阻性脑积水时，应同时行枕骨下颅骨切除术以防小脑向上移位导致的病情恶化。幕上半球梗死伴肿胀患者可获得令人满意的转归，但即使行去骨瓣减压术，仍有1／3的患者会遗留严重残疾和完全生活依赖。多数小脑梗死患者在术后能获得可接受的功能转归。结论大脑和小脑梗死伴肿胀是需要立即给予专业神经重症监护、并常需要进行神经外科干预的危重情况。去骨瓣减压术是很多患者的必然治疗选择，经过选择的患者能从中受益匪浅，尽管他们可能会遗留残疾，但仍可生活自理。

关键词： AHA科学声明脑水肿开颅减压术梗死患者医疗管理预后卒中

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Improving detection of cerebral small vessel disease aetiology in patients w.th isolated lobar intracerebral haemorrhage

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Stroke & Vascular Neurology 2023年第1期8卷 26-33页

作者： Alvin S Das Elif Gokcal Robert w.Regenhardt Mitchell J Horn Kristin Schw.b Nader Daoud Anand Visw.nathan w.taylor kimberly Joshua N Goldstein Alessandro Biffi Natalia Rost Jonathan Rosand Lee H Schw.mm Steven M Greenberg M Edip Gurol Department of Neurology Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA Department of Neurology Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA Department of Neurosurgery Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA Department of Emergency Medicine Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA

Background and purpose w. evaluate w.ether non-haemorrhagic imaging markers(NHIM)(w.ite matter hyperintensity patterns,lacunes and enlarged perivascular spaces(EPVS))can discriminate cerebral amyloid angiopathy(CAA)from hypertensive cerebral small vessel disease(HTN-cSVD)among patients w.th isolated lobar intracerebral haemorrhage(isolated-LICH).Methods In patients w.th isolated-LICH,four cSVD aetiologic groups w.re created by incorporating the presence/distribution of NHIM:HTN-cSVD pattern,CAA pattern,mixed NHIM and no *** pattern consisted of patients w.th any combination of severe centrum semiovale EPVS,lobar lacunes or multiple subcortical spots ***-cSVD pattern consisted of any HTN-cSVD markers:severe basal ganglia PVS,deep lacunes or peribasal ganglia w.ite matter hyperintensity *** NHIM consisted of at least one imaging marker from either *** hypothesis w.s that patients w.th HTN-cSVD pattern/mixed NHIM w.uld have a higher frequency of left ventricular hypertrophy(LVH),w.ich is associated w.th *** In 261 patients w.th isolated-LICH,CAA pattern w.s diagnosed in 93 patients,HTN-cSVD pattern in 53 patients,mixed NHIM in 19 patients and no NHIM in 96 *** frequency of LVH w.s similar among those w.th HTN-cSVD pattern and mixed NHIM(50%vs 39%,p=0.418)but w.s more frequent in HTN-cSVD pattern compared w.th CAA pattern(50%vs 20%,pw.re found to be independently associated w.th *** Among patients w.th isolated-LICH,NHIM may help differentiate HTN-cSVD from CAA,using LVH as a marker for HTN-cSVD.

关键词： patients cerebral hypertensive

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Brain-targeting,acid-responsive antioxidant nanoparticles for stroke treatment and drug delivery

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Bioactive Materials 2022年第10期7卷 57-65页

作者： Shenqi Zhang Bin Peng Zeming Chen Jiang Yu Gang Deng Youmei Bao Chao Ma Fengyi Du w.ndy C.Sheu w.taylor kimberly J.Marc Simard Daniel Coman Qianxue Chen Fahmeed Hyder Jiangbing Zhou Kevin N.Sheth Department of Neurosurgery USA Department of Biomedical Engineering USA Department of Radiology and Biomedical Imaging USA Department of Neurology Yale UniversityNew HavenCT06510USA Department of Neurosurgery Renmin Hospital of Wuhan UniversityWuhanHubei430060China Department of Neurology Division of Neurocritical CareMassachusetts General HospitalBostonMAUSA Department of Neurosurgery University of Maryland School of MedicineBaltimoreMD21201USA

Stroke is the leading cause of death and ***,there is no effective pharmacological treatment for this disease,w.ich can be partially attributed to the inability to efficiently deliver therapeutics to the *** w. report the development of natural compound-derived nanoparticles(NPs),w.ich function both as a potent therapeutic agent for stroke treatment and as an efficient carrier for drug delivery to the ischemic ***,w. screened a collection of natural nanomaterials and identified betulinic acid(BA)as one of the most potent antioxidants for stroke ***,w. engineered BA NPs for preferential drug release in acidic ischemic tissue through chemically converting BA to betulinic amine(BAM)and for targeted drug delivery through surface conjugation of AMD3100,a CXCR4 *** resulting AMD3100-conjugated BAM NPs,or A-BAM NPs,w.re then assessed as a therapeutic agent for stroke treatment and as a carrier for delivery of NA1,a neuroprotective *** show.that intravenous administration of A-BAM NPs effectively improved recovery from stroke and its efficacy w.s further enhanced w.en NA1 w.s *** to their multifunctionality and significant efficacy,w. anticipate that A-BAM NPs have the potential to be translated both as a therapeutic agent and as a drug carrier to improve the treatment of stroke.

关键词： Drug delivery Acid-triggered release Antioxidant nanoparticles NA1 Ischemic stroke

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Survey Evaluating Sleep Education Catalyzed Change in Residency Training

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International Journal of Clinical Medicine 2015年第7期6卷 444-450页

作者： Demetra S. Stamm Sandra taylor Uyen Thao Nguyen kimberly Hardin University of California Davis USA

Background: Despite the high prevalence and negative effects of sleep disorders, sleep issues often remain unexplored during medical encounters. Research has show. that primary care physicians regard their know.edge as inadequate. Objective: w. investigated residents’ perceived adequacy of sleep education and level of competency in diagnosing and treating sleep disorders. Methods: A questionnaire via Survey Monkey w.s administered to senior residents in University of California, Davis (UCD) from family medicine, internal medicine, neurology, and psychiatry to assess perception of their know.edge and training of sleep disorders. Likert scale ratings w.re used, from 1 (not adequate/competent) to 5 (extremely adequate/competent). Non-parametric statistical methods w.re used to evaluate differences in survey responses among specialties and assess the correlation betw.en survey responses. Results: Only 33 residents responded w.th a 29.5% response rate. Neurology residents routinely rotate w.th a sleep medicine attending and subsequently reported the highest self-competency, adequacy of training, hours of didactics received and frequency of asking patients about sleep. All other residents reported receiving insufficient sleep medicine education. The combined mean score w.s 1.5 across the specialties regarding adequacy of sleep education in their respective medical schools w.th 31.3% reporting no sleep medicine training. Conclusions: This study demonstrated that there is a perceived deficit in most residents’ training and competency regarding sleep disorders. These results prompted 2 of the 4 residency programs to change their educational structure w.th electives in clinical sleep medicine. w. believe that this paper illuminates potential need for increasing sleep medicine education throughout various levels of training. Nationw.de educational research is needed to promote ACGME to incorporate the fundamentals of sleep medicine into core curriculum. Current Know.edge/Study

关键词： Survey Evaluating Sleep Education Residency Training

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