IVIG的临床循证
A级证据:在治疗成人格林巴利综合症患者时IVIg和血浆置换同样有效;在慢性炎症性脱髓鞘疾病CIDP的长期治疗中有效。B级证据:IVIG在治疗中度或重度重症肌无力及多灶性运动神经病患者有效。不赞成联合应用IVIG和血浆置换治疗格林巴利综合征。C级证据:IVIg治疗无反应性皮肌炎及Lambert-Eaton肌无力综合征患者可能有效。U级证据:无相关证据证明IVIg治疗IgM异常蛋白相关神经病,包涵体肌炎,多肌炎,糖尿病根性多神经病和Miller Fisher综合征有效。
尼可林对血管认知功能障碍及粗钟后血管性痴呆有效
Citicoline in Vascular Cognitive Impairment and Vascular Dementia After StrokeJose A? lvarez-Sabín, MD; Gustavo C. Roma?n, MDAbstract—Cognitive decline after stroke is more common than stroke recurrence. Stroke doubles the risk of dementia and is a major contributor to vascular cognitive impairment and vascular dementia. Neuropathological studies in most casesof dementia in the elderly reveal a large load of vascular ischemic brain lesions mixed with a lesser contribution of neurodegenerative le
分析模型表明患者在发生脑出血后应该禁用他汀类药物
2011年1月10日在线的《神经病学纪要》研究结果提示,临床医生应该考虑避免对颅内出血(ICH)复发高危患者施用他汀类药物,因为其风险似乎超过收益。面对有ICH病史且有他汀类药物适应证的患者,医生常常感到两难:鉴于ICH的复发风险,应该在哪些临床情况下避免使用他汀类药物?既往一项随机临床试验显示服用他汀类药物的受试者ICH发病率增加。在此背景下,波士顿哈佛医学院及麻省总医院神经科M. Brandon Westover博士及其同事研发了一个数学决策分析模型,模拟了不同情况下他汀类药物对1例假设的65岁男性患者的质量调整生命年(QALY)的影响。分析显示,对于脑叶出血(复发率远高于深部ICH),预计采用他汀类药物治疗(无论是用于一级CV预防还是二级CV预防)可使其基线年复发率由约14%增加至约22%,从而抵消了其心血管(CV)收益。对于既往无缺血性脑血管或心脏事件病史的脑叶出血患者,使用他汀类药物治疗可以产生4.6个质量调整生命年(QALY),而不使用他汀类药物治疗可产生6.8个QALY。从致残和所致生活质量损失的角度看,使用他汀类药物进行一级预防,每1,000例患者1年中因例的心肌梗死(
肥胖与卒中似乎颠倒的结果
The Obesity–Stroke Paradox 肥胖与卒中似乎颠倒的结果Background and Purpose—Limited data exist concerning obesity and survival in patients after acute stroke. The objective of this study was to investigate the association between obesity and survival in patients with acute first-ever stroke.Methods—Patients were prospectively investigated based on a standard diagnostic protocol over a period of 16 years. Evaluation was performed on admission, at 7 days, at 1, 3, and 6 months after discharg
脑炎的管理指南 临床应用中应有的思考
1。The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America(IDSA)Clinical Infectious Diseases 2008; 47:303–27所有病人推荐行MRI检查。MRI of the brain should be performed in all patients, with CT used only if MRI is unavailable, unreliable, or cannot be performed。所有病人推荐行EEG检查。Electroencephalography (EEG) is rarely helpful in establishing an etiology in patients with encephalitis, but it has a role in identifying patients with nonconvulsive seizure activity wh
研究者发现辛伐他汀能阻止帕金森病进一步恶化
Researchers show Simvastatin prevents Parkinson's disease from progressing further30. 十月 2009 01:29 Simvastatin, a commonly used, cholesterol-lowering drug, may prevent Parkinson's disease from progressing further. Neurological researchers at Rush University Medical Center conducted a study examining the use of the FDA-approved medication in mice with Parkinson's disease and found that the drug successfully reverses the biochemical, cellular and anatomical changes caused by the
糖尿病合并既往卒中的急性卒中患者在溶栓治疗获益
糖尿病合并既往卒中或许不是溶栓的禁忌症Patients with Diabetes and Prior Stroke Benefit from Thrombolytic Therapy for Treatment of Acute StrokeThis finding will expand eligibility for thrombolysis in the U.S.Concomitant diabetes mellitus and prior stroke is thought to potentially mitigate the benefits of thrombolytic therapy for acute stroke. In Europe, concomitant diabetes and prior stroke is considered a contraindication to thrombolytic therapy, whereas in the U.S., it is considered a contraindication only for pat
急性卒中降压治疗,SCAST研究结果公布
降压治疗对急性卒中患者无显著获益. 斯堪的纳维亚坎地沙坦(ARB)急性卒中研究(SCAST)的主要研究者Berge医生在2月11日的国际卒中会议新闻发布会上公布了这项研究的结果:对于急性缺血性或出血性卒中患者,常规降压治疗无明显远期获益。该研究2月11日刊《柳叶刀》杂志(Lancet)上发表。既往研究中也曾评估不同抗高血压药物对卒中预后的影响,其中有10项研究的结果与SCAST相符,无一发现急性卒中患者降压治疗可显著获益,但这10项研究均为针对其他降压药物的小型研究,纳入患者不超过100例。兼任奥斯陆大学医院内科医师的Berge说,SCAST研究是迄今为止此类研究中规模最大的一项,并且是惟一一项对坎地沙坦进行评估的研究。 该研究共纳入2,029例缺血性或出血性卒中患者。所有患者在症状发作后30 h内收缩压>140 mm Hg,平均年龄71岁;基线时,平均收缩压为171 mmHg,平均舒张压为90 mmHg。约85%的患者发生缺血性卒中,14%发生出血性卒中,其余患者发生短暂脑缺血发作。患者随机接受坎地沙坦(1,017例)或安慰剂(1,012例)治疗7天,接受有
脑血管造影DSA
临床工作中常遇到脑血管病患者及家属问一些基本的DSA的问题,有的过于夸大了DSA的作用,也有对DSA过度担心害怕的。所以利用个人网站,发布一些基本的DSA知识的介绍。全脑血管造影术【适应证】1.颅内外血管性病变。 如出血性或闭塞性脑血管病变。2.自发性脑内血肿或蛛网膜下腔出血(SAH)病因检查。3.头面部富血性肿瘤,术前了解血供状况。4.观察颅内占位性病变的血供与邻近血管的关系及某些肿瘤的定性。5.头面部及颅内血管性疾病治疗后复查。【禁忌证】1.对碘过敏者(需经过脱敏治疗后进行,或使用不含碘的造影剂)。2.有严重出血倾向或出血性疾病者。3.有严重心、肝或肾功能不全者。4)脑疝晚期,脑干功能衰竭者。【术前准备】1.常规术前检查:包括血、尿常规 ,出、凝血时间, 肝、肾功能 , 心电图及胸部X 线片。2.术前8h禁饮食,特殊情况,如急诊可经麻醉师酌情适当缩短。3.碘过敏试验:造影拟使用的造影剂1ml,静脉推注。无心慌|、气短、荨麻疹及球结膜充血等过敏体征,注射前后测量血压搏动低于10~20mmHg者为阴性。碘过敏试验阳性而必须行造影者,应术前3d进行激素治疗,并尽量使用非离子碘水溶液造影制
2012神经病学十大进展
Medscape为大家总结出了2012年神经病学研究进展TOP10,大家一起来看看吧。TOP1. 皮质下小卒中的二级预防(SPS3)试验:避免使用双抗SPS3试验是一项在近期发生腔隙性脑梗死的患者中进行的一项双盲对照研究,比较阿司匹林与阿司匹林联合氯吡格雷治疗卒中复发的效果。SPS3研究表明双抗治疗并没有显著减少卒中复发的风险,但与单独使用阿司匹林相比,其大出血风险却成倍增加,总体死亡率也接近单独使用阿司匹林患者的两倍。入选理由:SPS3试验可能为腔隙性脑梗死患者双重抗血小板治疗研究得出最终结论。本研究的主要研究者——美国俄勒冈州健康与科学大学教授、神经内科 副主任Helmi L. Lutsep博士说:“SPS3试验抗血小板治疗的结果传达了一个非常明确的信息,应该避免联合使用氯吡格雷和阿司匹林作为腔隙性卒中患者的长期卒中预防,该方案具有严重出血风险,且预防卒中复发缺乏疗效。这一结果将强化相关临床实践。研究原文:氯吡格雷联合阿司匹林对近期腔隙性梗死患者的影响相关阅读:脑卒中二级预防,双抗不优于单用阿司匹林[ESC 2012]SPS3双联抗血小板二级预防研究被提前中止[ESC 2012]腔
晨峰血压增高与颅内动脉粥样硬化密切相关
It is unclear at what time-window of the day blood pressure (BP) is most closely associated with cerebrovascular damage. In this cross-sectional study, we examined the strength of association between intracranial arterial stenosis (ICAS) and systolic BP (SBP) across different time-windows using 24-hour ambulatory BP monitoring in 757 consecutively recruited patients with hypertension. ICAS was diagnosed with computerized tomographic angiography in 127 (16.8%) patients, of whom 64 (50.4%) had ste
抑郁与帕金森病
目的:该研究的目的是评价台湾全民健康保险研究资料库(NHIRD)中抑郁患者发生帕金森病的发病风险情况。Methods: We conducted a retrospective study of a matched cohort of 23,180 participants (4,634 patients with depression and 18,544 control patients) who were selected from the NHIRD. Patients were observed for a maximum of 10 years to determine the rates of new-onset PD, and Cox regression was used to identify the predictors of PD. We also examined the risk of PD after excluding patients who were diagnosed with PD within 2 or 5 years after their
适运动能治疗和预防抑郁
Depression treated and even prevented by moderate exercisePhysical activity is being increasingly recognized as an effective tool to treat depression. PhD candidate George Mammen's review published in the October issue of the American Journal of Preventive Medicine has taken the connection one step further, finding that moderate exercise can actually prevent episodes of depression in the long term.This is the first longitudinal review to focus exclusively on the role that exer
适运动能治疗和预防抑郁
Depression treated and even prevented by moderate exercise
颈动脉闭塞和认知功能(RECON)试验
RandomizedEvaluation of Carotid Occlusion and Neurocognition (RECON) trial: Main results.颈动脉闭塞和认知功能(RECON)试验的随机评估:主要结果OBJECTIVE: To determine whether extracranial-intracranial (EC-IC)bypass can improve cognition over 2 years compared to best medical therapyalone in patients with symptomatic internal carotid artery (ICA) occlusion andincreased oxygen extraction fraction (OEF) on PET.目的:旨在观察对于症状性颈内动脉(ICA)闭塞且PET测量的氧摄取指数(OEF)增高的患者,相比于单纯最佳药物治疗,颅内外血管(EC-IC)搭桥手术能否改善患者2年后的认知功能。METHODS: Patients underwen
水果和蔬菜摄入与卒中风险之间关联
一项Meta分析水果和蔬菜摄入与卒中风险之间关联总结的前瞻性队列研究的证据。 方法:通过对截止到2014年1月的Embase和Pubmed数据库进行检索,我们鉴别出了相关研究。应用随机效应模型汇总了研究特异的相对风险及95%可信区间。通过限制性立方样条评估了剂量效应关系。 结果:总共纳入了20项前瞻性队列研究,包括760629名患者中的16981个卒中事件。最高vs最低水果和蔬菜总摄入量的卒中的多变量相对风险(95% CI)为0.79(0.75~0.84),水果摄入量的效应为0.77(0.71~0.84),蔬菜摄入量的效应为0.86(0.79~0.93)。亚组和Meta回归表明,水果和蔬菜总摄入量与卒中风险的负相关性的结果在亚组分析中也是一致的。柑橘类水果、苹果/梨和叶类蔬菜具有保护作用。线性剂量效应关系表明,每天水果和蔬菜摄入量多增加200g,卒中风险分别降低32%(0.68(0.56~0.82))和11%(0.89(0.81~0.98))(非线性P=0.62)。 结论:水果和蔬菜摄入量与卒中风险呈负相关。
版权所有:杭州微医健康科技有限公司 浙B2-20200356 浙卫(03)网审[2014]015号 (浙)-经营性-2014-0022