Application of technetium-99m hexamethylpropylene amine oxime single-photon emission tomography to neurologic prognosis in patients undergoing urgent carotid surgery

In this study we aimed to work out a quantitative prognostic index for preoperative assessment of brain technetium-99m hexamethylpropylene amine oxime (HMPAO) single-photon emission tomography (SPET) in patients referred for urgent carotid endarterectomy due to acute obstructive disease of the internal carotid artery (ICA) and neurological deficit. To this end we compared data from preoperative SPET studies with the postinterventional changes in neurological status in 20 patients (17 males, three females; mean age 53 years, SD 4 years) with acute ischaemic cerebral disorders induced by obstruction of the ICA. Carotid obstruction was diagnosed by ultrasound B-mode study. All patients underwent urgent carotid endarterectomy from the ICA. Patients were divided into two groups in accordance with the results of postoperative follow-up: group A comprised patients with significant (more than 3 points) postoperative improvement in neurological condition as quantified by the Canadian Neurological Scale (11 patients); group B consisted of patients with minimal improvement or deterioration (nine, three of whom died). All patients were studied preoperatively by^99mTc-HMPAO SPET. The volume of nonperfused tissue (VS, cm³) was quantified using the Mountz technique. Hypoperfused volume (V _hypoperf, cm³) in the affected hemisphere was calculated as the total volume of voxels with^99mTc-HMPAO uptake <90% of the contralateral symmetric voxels. Discriminant prognostic function was calculated by discriminant analysis as:PF = 0.072×VS + 29.46×(VS/V _hypoperf). Patients with preoperativePF values <8.20 demonstrated postoperative improvement in neurological status, while the group withPF>8.90 comprised patients who demonstrated minimal improvement or deterioration. PF values in the range 8.20–8.90 carried an indefinite prognosis. We conclude that the preoperative^99mTc-HMPAO SPET can be used for the selection of patients in whom improvement in neurological status may be expected after urgent surgical correction of acute extracranial obstruction of the ICA.     

床上体操训练对偏瘫患者的效果观察

目的：观察偏瘫患者早期床上训练的效果。方法：对５８例脑血管意外致偏瘫患者随机分成２组：观察组３０例，护理中指导早期床上体操训练；对照组２８例，按常规护理。以上、下肢肌力和日常生活活动能力（ＡＤＬ）为评价指标，于训练开始时、训练４周、训练８周各评价１次。结果：观察组训练４周、８周时患侧上肢肌力以及ＡＤＬ水平明显增加，与对照组比较有显著差异（Ｐ＜００１）。患侧下肢肌力训练４周及８周时均增加，与对照组比较，４周时无明显差异（Ｐ＞００５），８周时有显著性差异（Ｐ＜００１）。结论：对早期偏瘫患者实施床上功能训练，不仅可以提高患者的生命质量，而且可以减少、甚至解除患者及家属的经济和精神负担。     

Effects of interleukin-1α on platelet-derived growth factor release from bovine cerebral microvascular endothelial cells

ThepreviousworkofourlabshowedthatILlastimulatedtheproliferationofbovinecerebralmicrovascularsmoothmusclecells(BCMSMC);",butthemechanismremainsunknown.EarlierreportsshowedthatIL--1stimulatedendothelialcellstosecretesomefactorswhichweremitogenictothevascularsmoothmusclecells[2].Amongthosefactors,platelet--derivedgrowthfactor(PDGF)wasthemainone[3j.OurexperimentwasdesignedtoinvestigatetheeffectofPDGFonproliferationofbovinecerebralmicrovascularsmoothmusclecells(BCMSMC)stimulatedbyIL--la.…     

Studies of the antagonistic effect of BQ-123 on cerebral vasospasm induced by intracisternal injection of endothelin-1 and subarachnoid hemorrhage

Cerebralvasospasm(CVS)remainsoneofthemajorcausesofseriousoutcomeinpatientswithsubarachnoidhemorrhage(SAH);however,themechanismofwhichisstillnotwellunderstood.Sofaralargenumberofputativespasmogenshavebeenproposedandoneofwhichisendothelins(ETs).ETs,akindofverypotentendogenousvasoconstrictorsubstancesknown[1],hasthreeiso-forms:ET-1,2and3,andET-1isthemostpo-tentvasoconstrictorofthem.lnrecentstudies,ET-lhasbeenproposedasamediatorofCVSfol-lowingSAH[2-4j.TheavailabilityofETantagonistprovided…     

急性脑梗塞患者血清肿瘤坏死因子水平变化的观察

采用双抗体夹心ＥＬＩＳＡ法对３０例正常对照和３６例急性脑梗塞患者血清肿瘤坏死因子（ＴＮＦ）水平进行了检测。结果显示：急性脑梗塞组血清ＴＮＦ水平显著高于正常对照组，血清ＴＮＦ水平变化与脑梗塞容积大小密切相关，恢复期血清ＴＮＦ水平显著降低。结果提示，ＴＮＦ参与了脑梗塞发生后病理变化过程，检测血清ＴＮＦ对判定脑梗塞容积大小有一定的临床意义。     

Striatal cells containing the Ca2+-binding protein calretinin (protein 10) in ischemia-induced neuronal injury

The present study concerns the vulnerability of striatal interneurons immunopositive for the Ca²⁺-binding protein calretinin to ischemic neuronal injury. An immunohistochemical study was carried out on the striata of rats which had undergone transient middle cerebral artery occlusion. Two weeks after the ischemia, there was a marked reduction in the number of calretinin-positive neurons in the ipsilateral ischemic lesion, although the striatal interneurons positive for parvalbumin, which are a neuronal population distinct from the calretinin-immunoreactive cells in the striatum, were spared in the insulted areas. The present data indicate that the striatal calretinin-positive neurons are less resistant to transient ischemia, suggesting that there may exist vulnerability differences among the striatal interneurons in ischemia-induced neuronal injury.     

NO对兔局灶脑缺血脑水肿和脑梗塞灶的影响

本文在兔MCAO局灶脑缺血模型基础上,利用外源性一氧化氮(NO)前体物质L-精氨酸和NOS抑制剂L-NNA研究NO对脑缺血后脑水肿和脑梗塞的影响。NZW兔42只随机分为7组,每组6只,计对照组、假手术组、MCAO组、MCAO+NS组、MCAO+L-Arg组、MCAO+D-Arg组及MCAO+L-Arg+L-NNA组。结果提示:与单纯MCAO组比较,L-Arg组的脑组织H_2O、Na~+、Ca~(2+)含量明显下降(P<0.01),脑梗塞灶亦明显缩小(P<0.01)。从而显示L-Arg系通过产生NO促使血管舒张而减轻脑水肿和缩小梗塞灶,为临床改进脑缺血的治疗提供依据。     

Stereotactic craniotomy and intraoperative lesion localisation using the Brown-Robert-Wells frame

Summary A simple technique of stereotactic craniotomy and intraoperative lesion localisation that uses the Brown-Robert-Wells (BRW) stereotactic frame is presented. The method optimises craniotomy placement and facilitates localisation of small intracerebral lesions. Using the system, 16 patients have had resection of intracranial neoplasms from deep and/or eloquent areas of the brain with no neurological morbidity.     

热休克反应对大鼠感染性脑水肿脑组织诱生型一氧化氮合酶mRNA表达的影响

:探讨热休克反应 (HSR)对百日咳杆菌所致的大鼠感染性脑水肿诱生型一氧化氮合酶 (iNOS)mRNA表达的影响。方法 :从大鼠左侧颈内动脉注入百日咳菌液制备感染性脑水肿 (感脑 )模型 ,采用组织细胞原位杂交技术检测脑组织iNOSmRNA的表达。结果 :生理盐水组、4h感脑组及 4h热休克处理组均未见iNOSmRNA表达 ,8h ,2 4h时感染性脑水肿组均有明显的杂交信号 ,以 2 4h更为明显 ;而 8h ,2 4h热休克处理组仅有少数细胞有阳性信号。结论 :热休克反应对感染性脑水肿的保护作用可能与抑制iNOSmRNA的表达有关     

深低温停循环逆行脑灌注脑组织自由基变化的实验研究

研究深低温停循环（ＤＨＣＡ）与逆行脑灌注（ＲＣＰ）时脑组织自由基的变化。健康杂种犬１４只，随机等分为ＤＨＣＡ组和ＲＣＰ组，在停循环前（Ａ点）、ＤＨＣＡ／ＲＣＰ３０分（Ｂ点）、ＤＨＣＡ／ＲＣＰ６０分（Ｃ点）ＤＨＣＡ／ＲＣＰ９０分（Ｄ眯）和复温再灌注３０分（Ｅ点）取脑皮层ｌｇ，检测丙二醛（ＭＤＡ）和超氧化物歧化酶（ＳＯＤ）水平。结果见两组在Ａ点ＭＤＡ和ＳＯＤ无差别。在Ｂ、Ｃ、Ｄ、Ｅ点，ＤＨＣＡ组ＭＤＡ