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Ataxia,acute mountain sickness,and high altitude cerebral edema

Engineering Sciences 2013年第2期11卷 38-46页

作者： Wu Tianyi Ma Siqing Bian Huiping Zhang Minming High Altitude Medical Research Institute High Altitude Medical Research Center Tibet University Intensive Care Unit of Qinghai Provincial People's Hospital department of Inter. Med. Qinghai Cardio-Cerebral-Vascular Hospital Image Division of Qinghai Provincial People's Hospital

Previous investigations suggest that ataxia is common and often one of the most reliable warning signs of high altitude cerebral edema(HACE). The aim of this study was to investigate the diagnostic role of ataxia in acute mountain sickness(AMS)and HACE among mountain rescuers on the quake areas,and in approaching the relation between AMS and HACE. After the earthquake on April 14,2010,approximately 24 080 lowland rescuers were rapidly transported from sea level or lowlands to the mountainous rescue sites at 3 750 ~ 4 568 m,and extremely hardly worked for an emergency treatment after arrival. Assessments of acute altitude illness on the quake areas were using the Lake Louise Scoring System. 73 % of the rescuers were found to be developed AMS. The incidence of high altitude pulmonary edema(HAPE)and HACE was 0.73 % and 0.26 %,respectively,on the second to third day at altitude. Ataxia sign was measured by simple tests of coordination including a modified Romberg test. The clinical features of 62 patients with HACE were analyzed. It was found that the most frequent,serious neurological symptoms and signs were altered mental status(50/62,80.6 %)and truncal ataxia(47/62,75.8 %). Mental status change was rated slightly higher than ataxia,but ataxia occurred earlier than mental status change and other symptoms. The earliest sign of ataxia was a vague unsteadiness of gait,which may be present alone in association with or without AMS. Advanced ataxia was correlated with the AMS scores,but mild ataxia did not correlate with AMS scores at altitudes of 3 750~4 568 m. Of them,14 patients were further examined by computerized tomographic scanning of the brain and cerebral magnetic resonance imagines were examined in another 15 cases. These imaging studies indicated that the presence of the cerebral edema was in 97 % of cases who were clinically diagnosed as HACE(28/29). Ataxia seems to be a reliable sign of advanced AMS or HACE,so does altered mental status.

关键词：脑水肿高山病高原病失调急性高海拔地区救援人员精神状态

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Cortical Stimulation Concurrent with Upper Extremities Rehabilitative Training for Stroke Recovery

Cortical Stimulation Concurrent with Upper Extremities Rehab...

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中国神经科学学会第十二届全国学术会议

作者： Huan GAO Fang ZHANG Wen-xi Ding Shao-min ZHANG Ke-Di Xu Qiushi Academy for Advanced Studies Zhejiang University department of Biomedical Engineering Key Laboratory of Biomedical Engineering of Education Ministry Zhejiang University Zhejiang Provincial Key Laboratory of Cardio-cerebral vascular detection Technology and Medicinal Effectiveness Appraisal

Objective The study of animal stroke models showed that peri-infarct and infarct cortical stimulation（CS） concurrent with rehabilitative training（RT） could enhance behavioral expressions and cortical reorganization compared to RT alone. It was unclear whether the stimulation from the connected area of infarct cortex had any effects on the stroke recovery. In this study, we explored the effects of primary sensory（S1） cortex stimulation on motor cortex（M1） stroke. Methods Rats were pretrained on singlepellet retrieval task until they could reach 70% success rate for 3 continuous days. Then the rats received unilateral motor cortex stroke modeling and microelectrodes implantation. The stroke model was induced by photothrombosis on the CFA contralateral to the dominant forelimb, which were determined by the single-pellet retrieval task. Two stimulation microelectrodes（positive and negative） were implanted on S1 with a distance of 0.8 mm. RT was delivered alone or concurrently with 50 Hz biphasic CS（RT+CS） at 50% of movement thresholds from the 3 rd day to the 14 th day after surgery. The TTC staining was used to confirm the degree of histological damage and recovery. Results（1） The phototrombosis could cause precise motor cortex stroke for upper extremities.（2） According to the result of TTC staining, the depth of motor cortex stroke caused by phototrombosis was 3 mm and could last for about 7 days.（3）Animals in the CS/RT group showed higher success rate than those in the RT group（p＜0.05）.（4）Some rats could finally achieve similar success rate as that before surgery with the help of nonparetic limb and adjustment of body position according the video recordings. Conclusion The results indicate that CS+RT enhanced the behavioral expressions better than the RT alone. Next Though the results showed CS might be useful on stroke recovery, the stimulation optimization still needs further exploration, such as the stimulation parameters.

关键词： motor cortex stroke recovery rehabilitative training single-pellet retrieval task photothrombosis cortical stimulation TTC staining

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Transthoracic arterial bypass for the treatment of severe cerebral ischemia induced by brachiocephalic arteritis: A report of 15 cases

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Neural Regeneration Research 2007年第11期2卷 692-697页

作者： Chenxi Ouyang Bi Jin Yiqing Li Weici Wang Guofu Hu deying Hu Fen Xie department of vascular Surgery Union Hospital Affiliated to Tongji Medical College Huazhong University of Science and Technology Wuhan430022 Hubei Province China

BACKGROUND： Carotid arterial reconstruction is hard to cure the extensive lesions of carotid arteries and subclavian arteries in patients with brachiocephalic arteritis; however, transthoracic arterial bypass surgery provides an opportunity for the treatment of brachiocephalic arteritis. OBJECTIVE： To report the improving effects of transthoracic arterial bypass surgery on the clinical symptoms of severe cerebral ischemia induced by brachiocephalic arteritis and observe the occurrence of complications after the intervention. deSIGN： Case observation. SETTING： department of vascular Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology. PARTICIPANTS： Fifteen patients with Takayasu arteritis, including 1 male and 14 females, were selected from department of vascular Surgery, Wuhan Union Hospital from June 2003 to June 2007. Their ages ranged from 16 to 37 years. All patients were finally diagnosed by clinical histories, health examinations and color Doppler detection. All patients provided the confirmed consent. METHODS： All patients had received transthoracic artificial vascular bypass surgery. Among them, 6 patients had the bridge from ascending aorta to bilateral axillary arteries to lateral internal carotid artery; 3 from ascending aorta to bilateral axillary arteries; 5 from ascending aorta to lateral axillary artery to lateral internal carotid artery; In particular, one patient combining with abdominal aorta occlusion had received two step surgical interventions. In the first step, bridging surgery was performed from ascending aorta to bilateral axillary arteries to lateral internal carotid artery; in the second step, patients received left axillofemoral bypass. MAIN OUTCOME MEASURES：① detecting blood velocity in variously intracranial-arterial systoles by using transcranial Doppler postoperatively; ② following-up the improve of clinical symptoms at 40 months after surgery; ③ observing postoperative c

关键词： Takayasu arteritis cerebral ischemia vascular bypass surgery

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Eosinophilia complicated with venous thromboembolism:A case report

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World Journal of Clinical Cases 2022年第6期10卷 1952-1960页

作者： Wei-Qiang Su Yan-Zhong Fu Shu-Yan Liu Meng-Jie Cao Ya-Bin Xue Fei-Fei Suo Wen-Chao Liu department of vascular Surgery The Second People’s Hospital of Jiaozuo CityJiaozuo 454000Henan ProvinceChina department of Endocrine The Second People’s Hospital of Jiaozuo CityJiaozuo 454000Henan ProvinceChina department of Neurology The Second Hospital of Hebei Medical UniversityShijiazhuang 050000Hebei ProvinceChina Clinical Laboratory The Second People’s Hospital of Jiaozuo CityJiaozuo 454000Henan ProvinceChina

BACKGROUND Eosinophilia is an increase of more than 0.5×109/L in the number of eosinophils;it is a systemic condition with an unknown etiology and is often accompanied by multiple impaired organ *** clinical manifestations of the disease are highly variable and diverse,rendering identification of the diagnosis challenging;hence,diagnosis and treatment are often *** few reports of this disease exist globally,especially with rare manifestations of cerebral venous sinus thrombosis and *** SUMMARY A 32-year-old woman with eosinophilia presented to the hospital with bilateral lower-limb edema as the first clinical manifestation,followed by an extensive maculopapular rash throughout the *** subsequently developed cerebral venous sinus thrombosis along with bilateral lower-limb deep vein *** weeks earlier,she had received a single course of antibiotics from a local hospital for a low-grade fever and sore *** various treatments were administered for anticoagulation,maintaining blood circulation,and relieving blood stasis,the lower extremity edema improved significantly;however,the patient’s eosinophil count gradually *** experienced cerebral venous sinus thrombosis,cerebral hemorrhage,and deep vein thrombosis of the lower limbs before being declared brain *** this case report,we have elaborated the diagnosis and management of deep vein thrombosis manifested as eosinophilia,thrombocytopenia,and elevated D-dimer *** Because proper diagnosis is challenging,clinical vigilance is required for patients with eosinophilia,as it can lead to thrombus formation.

关键词： Eosinophilia Venous thromboembolism Diagnosis Management Venous thrombosis Case report

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Carotid endarterectomy for ameliorating the symptoms of transient ischemic attack A six-month postoperative follow-up

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Neural Regeneration Research 2007年第12期2卷 764-768页

作者： Chenxi Ouyang Bi Jin Yiqing Li Jianyong Liu Weici Wang department of vascular Surgery Union Hospital Affiliated to Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 Hubei Province China

BACKGROUND： Carotid endarterectomy has certain risks, but it has obvious effects on preventing the occurrence of stroke. OBJECTIVE： To identify the effects of carotid endarterectomy on ameliorating the clinical symptoms and physical signs of patients with cerebral ischemia. deSIGN： A follow-up study. SETTING： Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology. PARTICIPANTS： Sixteen patients with carotid atherosclerotic stenosis accompanied by ischemic symptoms were selected from the department of vascular Surgery, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from March 2005 to May 2007. There were 11 males and 5 females, aged from 40 to 81 years old with a mean age of 60 years old, and they were all clearly diagnosed by carotid color Doppler ultrasound. Informed consent was obtained from all the patients. The study was approved by the hospital ethical committee. METHODS：（1） All the 16 patients were performed with unilateral stripping of arteriosclerotic plaque and Carotid endarterectomy, and 6 of them with bilateral stenosis was operated on the side with more serious stenosis. （2） The clinical symptoms, physical signs before and after operation, and the operative complications were observed. （3） The patients were followed up for 6 months postoperatively. The smoothness of carotid arteries was detected with color Doppler ultrasound. The degrees of satisfaction to the quality of living were evaluated. MAIN OUTCOME MEASURES：（1） Amelioration of clinical symptoms postoperatively; （2） Smoothness of carotid arteries postoperatively; （3） degrees of satisfaction to the quality of living; （4） Postoperative complications. RESULTS： All the 16 patients were involved in the final analysis of results. （1） Amelioration of clinical symptoms and physical signs： The postoperative muscle strengths of 3 patients with stroke history were significantly ameliorated; For the

关键词： carotid endarterectomy cerebral ischemia stroke

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Efficacy of Surgical Therapy for Carotid Body Tumors

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Chinese Medical Sciences Journal 2011年第4期26卷 241-245页

作者： Li-shan Lian Chang-wei Liu Heng Guan Yue-hong Zheng Xing-ming Chen Yong-jun Li department of vascular Surgery Peking Union Medical College Hospital ChineseAcademy of Medical Sciences ＆ Peking Union Medical College Beijing 100730 China

Objective To evaluate the efficacy of surgical therapy for carotid body tumors. Methods A retrospective analysis was conducted, covering the diagnosis, surgical procedure, postoperative complications, and prognosis of 120 cases of carotid body tumors in Peking Union Medical College Hospital from 1949 to May, 2011. Results Surgical excision was successfully performed in 111 cases with 117 tumors. In all those cases, 50 underwent simple tumor resection, 42 underwent resection of tumors and ligation of the external carotid arteries, 7 underwent co-resection of tumors and common carotid arteries, internal carotid arteries, as well as external arteries without vascular reconstruction, and the other 12 cases experienced tumor resection and vascular reconstruction as internal carotid arteries were involved. After operation, 3 cases developed cerebral infarction, 30 cases showed cranial nerve palsy, including 15 cases of hypoglossal nerve damage, 10 cases of vagus paralysis, and 5 cases of Horner's syndrome. Conclusion It is essential to make a proper surgical strategy, which can reduce postoperative com- plications.

关键词：颈动脉体手术治疗疗效神经麻痹外科手术手术切除神经损伤并发症

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Rosmarinic acid elicits neuroprotection in ischemic stroke via Nrf2 and heme oxygenase 1 signaling

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Neural Regeneration Research 2018年第12期13卷 2119-2128页

作者： Hai-Ying Cui Xiang-Jian Zhang Yi Yang Cong Zhang Chun-Hua Zhu Jiang-Yong Miao Rong Chen department of Neurology Second Hospital of hebei Medical university Shijiazhuang Hebei Province China Hebei Key Laboratory of vascular Homeostasis and Hebei Collaborative Innovation Center for Cardiocerebrovascular Disease ShijiazhuangHebei Province China

Rosmarinic acid（RA） can elicit a neuroprotective effect against ischemic stroke, but the precise molecular mechanism remains poorly understood. In this study, an experimental ischemic stroke model was established in CD-1 mice（Beijing Vital River Laboratory Animal Technology, Beijing, China） by occluding the right middle cerebral artery for 1 hour and allowing reperfusion for 24 hours. After intraperitoneally injecting model mice with 10, 20, or 40 mg/kg RA, functional neurological deficits were evaluated using modified Longa scores. Subsequently, cerebral infarct volume was measured using TTC staining and ischemic brain tissue was examined for cell apoptosis with TUNEL staining. Superoxide dismutase activity and malondialdehyde levels were measured by spectrophometry. Expression of heme oxygenase-1（HO-1）, nuclear factor erythroid 2-related factor 2（Nrf2）, Bcl-2, Bax, Akt, and phospho-Ser473 Akt proteins in ischemic brain tissue was detected by western blot, while mRNA levels of Nrf2, HO-1, Bcl-2, and Bax were analyzed using real time quantitative PCR. In addition, HO-1 enzyme activity was measured spectrophotometrically. RA（20 and 40 mg/kg） greatly improved neurological function, reduced infarct volume, decreased cell apoptosis, upregulated Bcl-2 protein and mRNA expression, downregulated Bax protein and mRNA expression, increased HO-1 and Nrf2 protein and mRNA expression, increased superoxide dismutase activity, and decreased malondialdehyde levels in ischemic brain tissue of model mice. However, intraperitoneal injection of a HO-1 inhibitor（10 mg/kg zinc protoporphyrin IX） reversed the neuroprotective effects of RA on HO-1 enzyme activity and Bcl-2 and Bax protein expression. The PI3 K/Akt signaling pathway inhibitor LY294002（10 mM） inhibited Akt phosphorylation, as well as Nrf2 and HO-1 expression. Our findings suggest that RA has anti-oxidative and anti-apoptotic properties that protect against ischemic stroke by a mechanism involving upregulation of Nrf2 and HO

关键词： cerebral ischemia/reperfusion rosmarinic acid cellular apoptosis oxidative injury neuroprotection Bcl-2 Bax Nrf2 heme oxygenase 1 PI3K/Akt signal pathway neural regeneration

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Combined Common Femoral Artery Endarterectomy with Superficial Femoral Artery Stenting Plus Shuxuening Injection(舒血宁注射液) Infusion for Chronic Lower Extremity Ischemia:3-Year Results

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Chinese Journal of Integrative Medicine 2012年第6期18卷 417-422页

作者：冯海陈学明李晨宇朱仁明房杰王天佑 department of vascular Surgery Beijing Friendship HospitalCapital Medical University

Objective： To investigate the efficacy and safety of combined common femoral artery （CFA） endarterectomy with superficial femoral artery （SFA） stenting plus Shuxuening Injection （舒血宁注射液） infusion in patients with complex multifocal arterial steno-obstructive lesions of the lower extremities. Methods： From March 2006 to March 2011, 104 lower limbs in 96 patients with multilevel peripheral arterial steno-occlusive disease, involving SFA as well as CFA and deep femoral artery （DFA） orifice, were treated by combined surgical with endovascular therapy, such as SFA stenting as an adjunct to CFA endarterectomy and patch angioplasty with the great saphenous vein. Before the end of the operation, 20 mL of Shuxuening Injection was infused through the catheter located in the treated artery. Technical and hemodynamic success, as well as primary and primary-assisted patency, was determined according to the Society for vascular Surgery Guidelines. During follow-up, clinical status assessment, ankle-brachial index （ABI） test, and duplex Doppler ultrasound were administered every 6 months, and computed tomography angiography or magnetic resonance angiography was performed at 12, 24, and 36 months after discharge. Results： All patients underwent successful combined CFA endarterectomy with SFA stenting treatment. The average ABI after the combination treatment increased from pretreatment of 0.32 ± 0.21 to 0.82±0.24 （P〈0.01）. No perioperative death and major limb amputations occurred. The mean duration of follow-up for 104 limbs from 96 patients was 1,180 days （range, 196-2,064 days）. During follow-up, 5 patients died due to myocardial infarction, cerebral infarction, or pneumonia, and 5 patients were lost to follow-up. There were 21 cases （21.4%） of restenosis, with 15 that occurred in-stent and 6 near the dJstal end of the stent. A total of 18 （18.3%） reinterventions were performed, including 6 balloon angioplasty, 8 restenting procedures, 2 bypass surgeries, and 2 major limb amputa

关键词： chronic lower extremity ischemia endarterectomy stenting angioplasty Shuxuening Injection,hybrid technique

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Molecular signaling of 5-HT<sub>1A</sub>and presence of serotonergic cells in the fetal cerebral cortex

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World Journal of Neuroscience 2013年第2期3卷 76-82页

作者： Alfonso B. M. de Oca Gabriel M. Gutiérrez Jorge H. Rodríguez laboratorio de Neurontogenia Departamento de Fisiología Biofísica y Neurociencias Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional Ciudad de México México Unidad de Investigación Biomolecular Hospital de Cardiología Centro Médico Nacional Siglo XXI Instituto Mexicano del Seguro Social Ciudad de México México

Early appearance of the serotonergic system in the fetal brain and the various effects of serotonin (5-HT) on brain morphogenesis, have given support to a neurotrophic role of serotonin. This function of serotonin is accomplished through a system of serotonin nerve terminals in the target regions that involves various 5-HT receptors. In visual, auditory and somatosensory cortex an early and intense serotonergic innervation is particularly important. The neuronal somata of these terminals are normally located in the mesencephalon and they have not been observed in the maturing cerebral cortex, neither in the adult brain. By using immunolabeling techniques, fluorescence and confocal microscopy, we observe the presence of both, 5-HT terminals and 5-HT cells in mesencephalon (Me, E17) and in the neopallium (Np, E13-E16) cocultures. Cells immunopositive to 5-HT and to tryptophan-5-hydroxilase are also observed in the Np on day 12 of culture. These results concerning the unexpected presence of serotonergic cells in the fetal cerebral cortex are interesting and may be of importance in corticogenesis. As it happens with other elements of the serotonergic system, the presence of these phenotypically serotonergic cells in the early cerebral cortex may be transitory and probably supporting cortex maturation processes. The molecular signaling path of the 5-HT1A receptor has also been identified.

关键词： Serotonergic System Serotonin Receptor 5-HT1A Molecular Signaling Paths

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Chinese Stroke Association guidelines for clinical management of ischaemic cerebrovascular diseases:executive summary and 2023 update

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Stroke & vascular Neurology 2023年第6期8卷 I0087-I0133页

作者： Liping Liu Zixiao Li Hongyu Zhou Wanying Duan Xiaochuan Huo Weihai Xu Shujuan Li Ximing Nie Huihui Liu Jinjie Liu Dapeng Sun Yufei Wei Guitao Zhang Weizhuang Yuan Lina Zheng Jingyi Liu David Wang Zhongrong Miao Yongjun Wang department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina National Center for Healthcare Quality Management in Neurological Diseases BeijingChina Research Unit of Artificial Intelligence in Cerebrovascular Disease Chinese Academy of Medical SciencesBeijingChina Chinese Institute for Brain Research BeijingChina Neurological Disease Center Cerebral Vascular Disease DepartmentBeijing Anzhen HospitalCapital Medical UniversityBeijingChina department of Neurology State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina department of Neurology National Clinical Research Center for Cardiovascular DiseasesFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina department of Neurology and Suzhou Clinical Research Center of Neurological Disease the Second Affiliated Hospital of Soochow UniversitySuzhouChina department of General Medicine Dalian Municipal Central Hospital Affiliated Dalian University of TechnologyDalianChina Interventional Neuroradiology Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina Neurovascular Division Department of NeurologyBarrow Neurological InstituteSt.Joseph's Hospital and Medical CenterPhoenixArizonaUSA Advanced Innovation Center for Human Brain Protection Capital Medical UniversityBeijingChina

Background China is one of the countries with the highest burden of *** multidimensional management guidelines will help clinicians practise evidence-based care,improve patient outcomes and alleviate societal *** update of the 2019 edition will provide the latest comprehensive recommendations for the diagnosis and treatment of ischaemic cerebrovascular *** We conducted a comprehensive search on MEDLINE(via PubMed)up to 31 August *** writing team established the recommendations through multiple rounds of online and offline *** recommendation was graded using the evidence grading algorithm developed by the Chinese Stroke Association(CSA).The draft was reviewed and finalised by the CSA Stroke Guidelines Writing *** This update included revisions of 15 existing recommendations and 136 new recommendations in the following areas of stroke care:emergency assessment and diagnosis of ischaemic cerebrovascular disease,acute-phase reperfusion therapy,evaluation of underlying mechanisms,antithrombotic therapy,prevention and treatment of complications,and risk factor *** This guideline updated the recommendations for the clinical management of ischaemic cerebrovascular disease from 2019.

关键词： diagnosis prevention discussions

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