脑源性神经生长因子和神经干细胞联合移植对大脑中动脉阻塞大鼠神经功能恢复的作用

目的 将脑源性神经生长因子(BDNF)和神经干细胞(NSCs)单独及联合移植应用于大脑中动脉阻塞(MCAo)模型大鼠,观察BDNF和NSCs移植对大鼠缺血性脑卒中神经功能恢复的作用及BDNF对内源性和外源性NSCs增殖、迁移及分化的影响.方法 体外分离、培养新生大鼠海马NSCs,BrdU标记.实验动物随机分为A组(MCAo组);B组(MCAo+BDNF组);C组(MCAo+NSCs组);D组(MCAo+BDNF+NSCs组),每组16只,移植后进行神经功能损害评分(NSS),用免疫组织化学行BrdU、nestin、BrdU/NSE检测,分析结果.结果 移植后的2、4周神经功能评分分别为:A组5.3±0.5、5.3±0.5;B组4.0±0.8、3.8±0.5;C组3.5±0.6、3.5±0.6;D组2.0 ±0.8、1.8±1.0,D组显著好于其他3组(P<0.05),B组与c组显著好于A组(P<0.05).nes.tin阳性细胞数:A组1.24±1.13,B组2.59±1.44(P<0.05),BrdU阳性细胞数:A组0.52±0.68,B组1.65±1.10(P<0.05).BrdU阳性细胞数:C组6.08±1.52,D组10.26±1.96(P<0.05),BrdU/NSE双阳性细胞数:C组1.74±1.04,D组3.58±1.20(P<0.05).结论 BDNF和NSCs移植单独及联合应用对MCAo大鼠的神经功能恢复均有作用,两者联合具有协同作用.BDNF对内源性NSCs的激活、增殖有促进作用,对外源性NSCs的增殖、迁移及分化有促进作用.     

动脉血质子自旋标记与动态磁敏感对比MRI在急性脑缺血患者中的应用价值

目的对比研究动脉血质子自旋标记（ASL）与动态磁敏感对比（DSC）MRI在急性脑缺血诊断中的应用价值。方法27例发病3d内的急性脑卒中患者，均采用3．0TMR行脉冲式ASL和DSCMR检查。观察2种技术的灌注表现，包括灌注不足、正常灌注、延迟灌注、过度灌注等，采用Mann—Whitney检验做定性分析。在扩散加权成像显示的病变部位及对侧正常半球的镜像区域分别确定3个感兴趣区（ROI），测量信号强度并计算信号强度比（病侧／对照侧），并将结果做配对t检验。结果定性分析显示27例患者中，2l例2种技术检查结果一致（灌注不足14例，正常灌注5例，过度灌注2例）。6例2种技术不一致，其中4例ASL显示灌注不足而DSC显示延迟灌注，2例ASL显示正常灌注而DSC显示延迟灌注，两者间差异无统计学意义（P〉0．05）。定量分析示，2种技术的病侧与对照侧信号强度比值ASL为0．7l±0．46，DSC为0．73±0．42，两者间差异无统计学意义（P〉0．05）。结论无创性ASL技术在检测灌注异常时与DSCMRI有相似的敏感性；ASL可与常规MR检查相结合，为临床诊断急性缺血性卒中提供有价值的信息。     

Multiple pilocytic astrocytomas of the cerebellum in a 17-year-old patient with neurofibromatosis type I

Objective Approximately 10% of patients with neurofibromatosis I (NFI) patients will have central nervous system (CNS) tumors. The most common of these are hypothalamic–optic gliomas, followed by brainstem and cerebellar pilocytic astrocytomas. While isolated pilocytic astrocytomas in NFI are well described, the appearance of multiple pilocytic astrocytomas in an individual patient is less common. The most frequent combination in NFI patients with more than one pilocytic astrocytoma is optic tract/hypothalamic and brainstem. Other combinations are exceedingly rare; multiple pilocytic astrocytomas have only been reported once in the cerebral hemispheres in a patient with NFI. This report presents the first documented case, to our knowledge, of multiple pilocytic astrocytomas in the cerebellum of a patient with NF1. Methods Case report. Conclusion The finding of multiple cerebellar pilocytic astrocytomas in a patient with NF1 is important because it expands the spectrum of presentations for patients with NF1 and also highlights specific diagnostic and therapeutic challenges faced by the treating physicians. The genetic and molecular basis of NF1 is reviewed. Strategies of diagnosis and treatment outlined here are relevant to both patients with NF1 and all patients with multiple posterior fossa tumors.     

颅脑损伤患者脑疝前驱期特征性临床征象的研究

目的分析总结外伤性脑疝前驱期特征性临床征象及意义。方法回顾分析我科近5年238例脑疝发生前2h内的临床表现和辅助检查特点，并与同期198例未发生脑疝的重型颅脑损伤患者进行对比分析。结果脑疝组前驱期征象如昏迷加深、烦躁加重、尿失禁、侧脑室和外侧裂受压变窄伴脑基底池受压变窄、生命体征改变具有特征性，其发生率明显高于非脑疝组，两组差异有显著性意义（P〈0．01）。结论颅脑损伤患者出现脑疝前驱期特征性临床征象应作为超早期开颅的重要依据，是特殊的、迫切的手术指征。     

骨髓基质细胞移植促进大鼠局灶性脑损伤血管生成的实验研究

目的研究骨髓基质细胞（BMSCs）移植对大鼠局灶性脑损伤血管生成的影响，探讨BMSCs移植修复大鼠脑损伤的机制。方法制备大鼠局灶性脑损伤动物模型，进行BMSCs移植，通过免疫组织化学、电镜等观察移植局部内皮细胞及微循环的变化。结果BMSCs移植后，局部凝血因子FⅧ染色阳性细胞数增加，染色加深，出现血管样结构；局部微血管内膜较光滑，内皮细胞间可见紧密连接，细胞核形态较规则，基底膜较完整，微血管管腔受压缓解。结论BMSCs移植促进损伤区周围内皮细胞增殖和新生血管形成。损伤区局部微循环得以改善进而修复脑损伤。     

Growth fraction in human brain tumors defined by the monoclonal antibody Ki-67

Summary The monoclonal antibody Ki-67, which reacts with cells in the active part of the cell cycle, was used to evaluate immunocytochemically the growth fraction in 22 primary brain neoplasms. The percentage of labelled cells reflected the histological grade of malignancy of each neoplasms. High percentage of Ki-67-positive cells were observed in one choroid plexus carcinoma (60%), one primary melanoma of meninges (40%), three medulloblastomas (40%–50%), one anaplastic astrocytoma and six glioblastomas (10%–40%). One ependymoma had 7% positive cells. Rare positive cells (1%) were present in one pilocytic astrocytoma and one ganglioglioma. Except one negative case, the meningiomas (five cases) had values of positivity ranging from 1% to 6%. Two acoustic schwannomas were negative. These results suggest that immunocytochemical staining with the Ki-67 may be a useful method for measuring the growth fraction in brain neoplasms.Supported in part by Associazione Italiana Ricerca sul Cancro and Ministero Italiano della Pubblica Istruzione