Inhibition of miR-429 improves neurological recovery of traumatic brain injury mice and attenuates microglial neuroinflammation

BackgroundNeuroinflammation is a common therapeutic target for traumatic brain injury (TBI) due to its contribution to delayed secondary cell death and has the potential to occur for years after the initial insult. Previous studies demonstrate that miR-429 is up-regulated in the brain lesions of TBI mice, while its role in regulating neuroinflammation and brain injury remains largely unknown.MethodThe expression of miR-429 in LPS-activated microglia and microglia in TBI model was detected by RT-PCR. The effects of miR-429 inhibitors on LPS-activated microglia in vitro as well as neurological recovery and post-traumatic neuroinflammatory response in TBI model mice were detected in vivo.ResultsLPS and TBI significantly induce the up-expression of miR-429, inflammatory cytokines, MAPK-p38 and phosphorylated NF-κB in microglia, which were all inhibited by miR-429 inhibitors. Meanwhile, miR-429 inhibitors also attenuated the neurological impairment in TBI mice. Bioinformatics analysis showed that miR-429 could target and inhibit the expression of dual specificity protein phosphatase 1 (DUSP1), thus inhibiting the expression of MAPK-p38 and phosphorylated NF-κB.ConclusionmiR-429 plays a pro-inflammatory role in activated microglia by targeting DUSP1 signaling pathway. Inhibiting miR-429 can attenuate the inflammatory response of microglia and TBI-mediated brain damage.     

缺血预适应训练对缺血性脑血管疾病患者脑氧代谢及血供状态的影响

目的探讨缺血预适应训练对缺血性脑血管疾病患者脑氧代谢及血供状态的影响。方法选取阆中市人民医院七里院区2016年11月—2018年8月收治的缺血性脑血管疾病患者84例,采用随机数字表法分为对照组和观察组,各42例。对照组进行常规治疗,观察组在对照组基础上进行缺血预适应训练。两组均治疗12个月。比较两组治疗前和治疗后3、6、12个月颈静脉球血氧饱和度(SjvO2)、脑氧摄取率(O2ER)、动脉内氧含量(CaO2)、收缩期峰值流速(PSV)、阻力指数(RI)、搏动指数(PI)、不良反应发生率。结果治疗前两组SjvO2、O2ER、CaO2比较,差异无统计学意义(P>0.05);治疗后3、6、12个月观察组SjvO2高于对照组,O2ER、CaO2低于对照组(P<0.05)。治疗前两组颈内动脉、椎动脉PSV、RI、PI比较,差异无统计学意义(P>0.05);治疗后3、6、12个月观察组椎动脉、颈内动脉PSV高于对照组,RI、PI低于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论缺血预适应训练可有效改善缺血性脑血管疾病患者脑氧代谢及血供状态,且安全性较高。     

Functional Gains in Children Receiving Inpatient Rehabilitation After Brain Tumor Resection

ObjectiveTo examine whether children with brain tumors treated with resection benefit from inpatient rehabilitation and to explore what factors present at admission may predict better functional outcomes.DesignRetrospective cohort design.SettingPediatric inpatient rehabilitation unit.ParticipantsForty patients (N=40; ages 3-21y; 42.5% female) admitted to the rehabilitation unit between 2003 and 2015 after brain tumor resection.InterventionsPatients received multidisciplinary rehabilitation therapies as part of their admission to inpatient rehabilitation, including occupational, physical, and speech-language therapy.Main Outcome MeasuresFunctional outcomes included the FIM for Children (WeeFIM) at discharge and 3-month follow-up as well as WeeFIM efficiency.ResultsA repeated-measures analysis of variance using patient WeeFIM Developmental Functional Quotients (DFQs) at admission, discharge, and 3-month follow-up showed significant gains in total WeeFIM DFQ scores across time. Admission WeeFIM DFQ, time from surgery to admission, and age at admission provided the strongest model for predicting discharge and 3-month follow-up WeeFIM DFQ scores. Admission WeeFIM DFQ and time from surgery to admission provided the strongest model for predicting WeeFIM efficiency. Total Neurological Predictor Scale (NPS) at admission did not add predictive power to any of the 3 models over and above patient characteristics (admission WeeFIM DFQ, age at admission, time from surgery to admission).ConclusionsPatients admitted to inpatient rehabilitation after brain tumor resection made significant functional gains (as measured by the WeeFIM) during inpatient rehabilitation and continued to make significant gains 3 months after discharge. Age and timing of admission provided the strongest models for predicting patient outcomes. The NPS did not predict functional outcomes after rehabilitation when controlling for other variables known to influence rehabilitation outcomes.     

压力性损伤居家老年患者医院-社区-家庭三元联动护理实践

总结压力性损伤居家老年患者医院-社区-家庭三元联动护理实践经验。护理要点包括：明确医院及社区职责,成立医院-社区联动护理合作团队,加强组织管理;加强社区医护人员培训,提高伤口管理能力;制订压力性损伤居家老年患者评估记录单,提高社区医护人员伤口评估能力;及时会诊,指导社区医护人员进行伤口管理;建立医院-社区双向转诊,实施分级治疗;加强多学科协作,促进伤口愈合;开展延续性居家护理,提高患者及其照护者配合治疗、护理的依从性。经医院-社区-家庭三元联动护理,30例压力性损伤居家老年患者中,治愈26例,好转4例,治愈率达86.67%。     

术中获得性压力性损伤危险因素评估量表的编制及信效度检验

目的 编制术中获得性压力性损伤危险因素评估量表并进行信效度检验,旨在为手术室护理人员提供科学、客观的压力性损伤评估工具。 方法 在循证的基础上结合2轮专家函询形成量表初稿;采用便利抽样法,于2019年11月—2020年1月选取7所三级甲等医院的6 713例择期手术患者为调查对象,对术中获得性压力性损伤风险评估量表的信效度进行检验并绘制受试者工作特征曲线确定最佳临界值。结果 术中获得性压力性损伤危险因素评估量表包括2个维度、10个危险因素;2轮函询专家积极系数均为100%,权威系数为0.874、0.885,肯德尔和谐系数为0.164、0.170;量表整体的Cronbach’s α系数为0.648,折半信度为0.705,内容效度为0.989;2个维度的最佳临界值为8.5分、7.5分,受试者工作特征曲线下面积分别为0.779、0.776。 结论 术中获得性压力性损伤危险因素评估量表具有良好的信效度,可在临床推广使用。     

人工膨肺技术在颈髓损伤气管切开患者肺康复中的应用

目的 探讨人工膨肺技术在颈髓损伤气管切开患者肺康复中的应用效果。 方法 将2017年1月—2019年9月收治的66例颈髓损伤并行气管切开的患者按SPSS系统产生区组随机数字表分为试验组和对照组,每组33例,试验组在雾化吸入、震动排痰、腹部挤压后吸痰等常规肺康复护理的基础上增加人工膨肺技术,对照组采用常规肺康复护理。比较实施肺康复前和实施肺康复4周后两组的肺活量、第1秒用力呼气容积、最大呼气量以及干预期间两组的肺不张发生率。 结果 干预4周后,试验组的肺活量、第1秒用力呼气容量、最大呼气量分别是（4.17±0.70） L、（3.86±0.94） L、（266.67±36.70） L均高于对照组的（3.06±0.73） L、（2.91±0.72） L、（221.73±19.53） L,差异有统计学意义（P<0.05）;试验组、对照组的肺不张发生率分别为3.03%、24.24%,两组比较,差异有统计学意义（P<0.05）。 结论 人工膨肺技术应用于颈髓损伤气管切开患者中能够有效提高患者的肺功能,增加患者肺部的顺应性,减少患者肺不张、肺塌陷的发生,明显改善患者肺康复的效果。     

间歇经口至食管管饲法对重型颅脑损伤患者功能恢复的影响

目的 观察间歇经口至食管管饲法(IOE)对重型颅脑损伤伴气切患者功能恢复的影响。 方法 采用随机数字表法将98例重型颅脑损伤伴气切患者分为观察组及对照组。2组患者均常规给予营养神经、抗感染、物理因子治疗、针灸及运动干预等,观察组患者入科评估后采用IOE管进行间歇置管营养支持,对照组患者入科后采用鼻胃管管饲法(NGT)进行营养支持。于入组时、治疗4周后对2组患者营养状况、并发症发生率、气切套管拔管时间和拔管率、格拉斯哥昏迷量表（GCS）评分进行比较。 结果 治疗4周后观察组患者血红蛋白、白蛋白、前白蛋白含量［分别为（119.69±12.85）g/L、（40.30±3.43）g/L和（234.88±46.31）mg/L］及体重指数［（20.71±2.38）kg/m2］均显著优于对照组水平(P<0.05);同时观察组并发症总体发生率、气切套管拔管率（87%）、气切套管保留时间［（16.93±3.64）d］及GCS评分［（8.65±1.95）分］亦显著优于对照组水平(P<0.05)。 结论 IOE较NGT能更有效改善重型颅脑损伤伴气切患者营养状况及意识水平,有助于尽早拔除气切套管及抑制并发症发生。     

Primary Composite Angiogenic Leiomyosarcoma?Epithelioid Angiosarcoma of the Brain

The authors describe a primary sarcoma of the brain with immunohistochemical and ultrastructural features of leiomyosarcoma as well as epithelioid hemangiosarcoma. The leiomyosarcomatous component consisted of spindle cells with well-developed external lamina, subsarcolemmal densities composed of microfilaments, pinocytic vesicles, and abundant intermediate filaments, and showed immunohistochemical reactions for smooth muscle actin. The epithelioid part of the tumor contained scattered cells reactive for alkaline phosphatase as well as CD31 and factor VIII. Many epithelioid cells were lipidized and remarkably similar to "stromal cells" of a hemangioblastoma. Occasional Weibel-Palade bodies, indicating endothelial differentiation, were present in scattered neoplastic cells. There were also cells with features intermediate between endothelium, pericytes and smooth muscle cells, and undifferentiated mesenchymal cells. The brain at the periphery of sarcoma showed conglomerates of well-differentiated capillaries, telangiectasias and small dysplastic arteries, features that raise the possibility of origin of this tumor from a preexisting vascular developmental abnormality.     

Verbal learning in Alzheimer's disease and mild cognitive impairment: fine-grained acquisition and short-delay consolidation performance and neural correlates

The aim of this study was to examine correlations between acquisition and short-delay consolidation and brain metabolism at rest measured by fluorodeoxyglucose positron emission tomography (FDG-PET) in 44 Alzheimer's disease (AD) patients, 16 patients with mild cognitive impairment (MCI) who progressed to dementia (MCI-AD), 15 MCI patients who remained stable (MCI-S, 4–8 years of follow-up), and 20 healthy older participants. Acquisition and short-delay consolidation were calculated respectively as mean gained (MG) and lost (ML) access to items of the California Verbal Learning Task. MG performance suggests that acquisition is impaired in AD patients even at predementia stage (MCI-AD). ML performance suggests that short-delay consolidation is deficient only in confirmed AD patients. Variations in acquisition performance in control participants are related to metabolic activity in the anterior parietal cortex, an area supporting task-positive attentional processes. In contrast, the acquisition deficit is related to decreased activity in the lateral temporal cortex, an area supporting semantic processes, in patients at an early stage of AD and is related to metabolic activity in the hippocampus, an area supporting associative processes, in confirmed AD patients.