弥散张量成像在癫痫中的研究进展

癫痫作为多种病因引起的神经系统慢性、发作性疾病,严重影响着患者的生活质量,因此对其及时诊断和早期治疗极为重要。目前已有多种神经影像技术用于癫痫的定位、定侧和病理生理研究。弥散张量成像是利用水分子在组织中弥散的各向异性成像的磁共振技术,是目前唯一能在活体中无创性地显示脑白质纤维束的方法,它能敏感地显示脑部细微结构,并能揭示各个结构间的功能联系,有助于癫痫的研究。本文主要从癫痫的病因诊断、癫痫手术的辅助指导、癫痫的结构网络及其与癫病功能障碍的相关性研究等方面对DTI应用于癫痫的最新研究进展进行综述。     

Game theoretical mapping of white matter contributions to visuospatial attention in stroke patients with hemineglect

White matter bundles linking gray matter nodes are key anatomical players to fully characterize associations between brain systems and cognitive functions. Here we used a multivariate lesion inference approach grounded in coalitional game theory (multiperturbation Shapley value analysis, MSA) to infer causal contributions of white matter bundles to visuospatial orienting of attention. Our work is based on the characterization of the lesion patterns of 25 right hemisphere stroke patients and the causal analysis of their impact on three neuropsychological tasks: line bisection, letter cancellation, and bells cancellation. We report that, out of the 11 white matter bundles included in our MSA coalitions, the optic radiations, the inferior fronto‐occipital fasciculus and the anterior cingulum were the only tracts to display task‐invariant contributions (positive, positive, and negative, respectively) to the tasks. We also report task‐dependent influences for the branches of the superior longitudinal fasciculus and the posterior cingulum. By extending prior findings to white matter tracts linking key gray matter nodes, we further characterize from a network perspective the anatomical basis of visual and attentional orienting processes. The knowledge about interactions patterns mediated by white matter tracts linking cortical nodes of attention orienting networks, consolidated by further studies, may help develop and customize brain stimulation approaches for the rehabilitation of visuospatial neglect.     

A case of congenital herpes simplex virus infection diagnosed at 8 months of age

We present the case of an 8-month-old boy with the repeated recurrence of vesicles from the time of birth and who subsequently manifested psychomotor developmental delay. We retrospectively diagnosed the patient with congenital herpes simplex virus (HSV) infection. Computed tomography showed multiple calcifications in the periventricular white matter and thalami. The bilateral deep white matter showed an abnormally high signal intensity on T2-weighted magnetic resonance imaging. The patient required consecutive, suppressive therapy with valacyclovir to prevent the repeated recurrence of vesicles. This case presented a milder phenotype of congenital HSV infection in comparison to previous reports, and highlights the importance of the careful examination for this disease when neonates present with skin lesions.     

Prenatal opioid exposure: The next neonatal neuroinflammatory disease

The rates of opioid use disorder during pregnancy have more than quadrupled in the last decade, resulting in numerous infants suffering exposure to opioids during the perinatal period, a critical period of central nervous system (CNS) development. Despite increasing use, the characterization and definition of the molecular and cellular mechanisms of the long-term neurodevelopmental impacts of opioid exposure commencing in utero remains incomplete. Thus, in consideration of the looming public health crisis stemming from the multitude of infants with prenatal opioid exposure entering school age, we undertook an investigation of the effects of perinatal methadone exposure in a novel preclinical model. Specifically, we examined the effects of opioids on the developing brain to elucidate mechanisms of putative neural cell injury, to identify diagnostic biomarkers and to guide clinical studies of outcome and follow-up. We hypothesized that methadone would induce a pronounced inflammatory profile in both dams and their pups, and be associated with immune system dysfunction, sustained CNS injury, and altered cognition and executive function into adulthood. This investigation was conducted using a combination of cellular, molecular, biochemical, and clinically translatable biomarker, imaging and cognitive assessment platforms. Data reveal that perinatal methadone exposure increases inflammatory cytokines in the neonatal peripheral circulation, and reprograms and primes the immune system through sustained peripheral immune hyperreactivity. In the brain, perinatal methadone exposure not only increases chemokines and cytokines throughout a crucial developmental period, but also alters microglia morphology consistent with activation, and upregulates TLR4 and MyD88 mRNA. This increase in neuroinflammation coincides with reduced myelin basic protein and altered neurofilament expression, as well as reduced structural coherence and significantly decreased fractional anisotropy on diffusion tensor imaging. In addition to this microstructural brain injury, adult rats exposed to methadone in the perinatal period have significant impairment in associative learning and executive control as assessed using touchscreen technology. Collectively, these data reveal a distinct systemic and neuroinflammatory signature associated with prenatal methadone exposure, suggestive of an altered CNS microenvironment, dysregulated developmental homeostasis, complex concurrent neural injury, and imaging and cognitive findings consistent with clinical literature. Further investigation is required to define appropriate therapies targeted at the neural injury and improve the long-term outcomes for this exceedingly vulnerable patient population.     

Orbitofrontal extensions of the insular glioma based on subdivision of the uncinate fasciculus

The insular gliomas were classified based on their locations and extensions to the adjacent areas.The insular and orbitofrontal cortices with underlying fiber tracts were studied on ten (20 sides) human cadaveric brains and two heads. Twenty patients with insular gliomas with the orbitofrontal or septal region extensions were studied on preoperative magnetic resonance imaging (MRI).Insular gliomas can extend to the orbitofrontal area dorsolaterally and/or ventromedially through the subdivision of the uncinate fasciculus. The dorsolateral part of the uncinate fasciculus interconnects the temporopolar area to the lateral orbitofrontal cortex through insula, and the ventromedial part of the uncinate fasciculus interconnects the temporopolar area to the medial orbital cortex, gyrus rectus, and septal region. The gyrus rectus infiltration on MRI indicates a ventromedial involvement by passing through the ventromedial part of the uncinate fasciculus. Diffusion tensor imaging (DTI) MRI demonstration of the UF is difficult due to the interruption of the fiber tracts by tumor. Tumor infiltration extending to the gyrus rectus requires a 15° lateral tilting with vertex toward contralateral side, as well as 70° head rotation to the contralateral side of lesion, for exposure of frontal base, septal region, and lateral border of the anterior perforating substance at the same time with the exposure of whole sylvian fissure via transsylvian approach of the insular tumors.An understanding of the orbitofrontal extension of the insular tumor based on the subdivisions of UF is useful in preoperative surgical planning and can assist for gross total resection.     

The association between pineal gland calcification and white matter hyperintensities of presumed vascular origin in older adults. A population-based study

Pineal gland calcification (PGC) has been associated with low melatonin production, a hormone with anti-oxidant, anti-inflammatory, and neuro-protective effects. Therefore, melatonin deficiency may play a role in the development of cerebral small vessel disease (cSVD), a condition that is partly related to upregulation of oxidative and inflammatory mechanisms leading to endothelial dysfunction, breakdown of the blood-brain barrier, and impaired interstitial fluid drainage. In this study, the association between PGC (a surrogate for melatonin deficiency) and white matter hyperintensities (WMHs) of presumed vascular origin (a biomarker of cSVD) was assessed in Atahualpa cohort individuals aged ≥60 years undergoing head CT and brain MRI. PGC was rated as none-to-mild and moderate-to-severe. WMHs were classified according to the modified Fazekas scale. A logistic regression model was fitted to assess the independent association between moderate-to-severe PGC and WMHs. Inverse probability of exposure weighting was used to estimate the effect of PGC on WMH. Of 373 individuals, 96 (26%) had moderate-to-severe PGC and 86 (23%) had moderate-to-severe WMHs. Moderate-to-severe PGC and WMH were independently associated in a fully-adjusted logistic regression model (OR: 2.21; 95% C.I.: 1.19–4.11; p = 0.012). Inverse probability of exposure weighting showed an estimate for the proportion of moderate-to-severe WMH among those with none-to-mild PGC of 20.5%, and the exposure-effect was 13.2% higher among those with moderate-to-severe PGC (β: 0.132; 95% C.I: 0.036–0.229; p = 0.007). The association found in this study provides grounds for further evaluation of the role of melatonin deficiency in cSVD development.     

血常规在感染判定的价值

感染性疾病是儿科最常见的疾病之一,是由病原体侵入机体引起的局部组织损伤或全身炎性反应。儿童免疫力低下,病情进展快,需早期诊断及时治疗。各种感染性疾病的临床症状无显著特异性,尤其在早期阶段,而作为诊断金标准的病原学检测,因对检验环境要求高、耗时长、阳性率低及易污染等缺点,不利于早期诊断。血常规是临床上最基本及廉价易行的检验项目,具有操作简单、用时短等优点,主要检测白细胞、红细胞、血小板等血液有形成分的质和量及形态变化,特别是白细胞检测对感染性疾病的早期诊断、鉴别诊断,评估严重程度及治疗效果均具有重要价值,是目前儿科临床诊断感染性疾病的首选辅助检查方法。     

Evaluation of the effectiveness of Er: YAG laser and calcium sodium phosphosilicate (Novamine) prophylaxis paste on remineralization of incipient enamel lesions in primary teeth: An in-vitro study

AimThe aim of this study was to evaluate the potential remineralization effect of Novamine and Er:YAG laser on artificial enamel lesions in primary teeth.Materials and methodsIn this in vitro study, 30 sound buccal and lingual surfaces of human primary canines were randomly divided (6 per group) into 5 groups (Novamine, Laser, Novamine+ Laser, Positive control, and a negative control). Remineralization agents were applied for 1 min to teeth using a rubber cup after creating artificially demineralised lesions. EDX analysis was performed to evaluate the Ca/P ratio and take Scanning electron microscope images.ResultsData were analyzed using Kruskal Wallis analysis. Ca/P ratio was higher in all 4 groups than the negative control group, and higher in Novamine+ Laser group than the positive control group with a statistically significant difference between groups. Overall Ca/P ratio was found to be highest in the Novamine group followed by the laser then positive control group. There were no significant differences between groups regard to Ca/P Ratios.ConclusionBased on these result Er:YAG laser combined with Novamine was provided the greatest contribution to remineralization process of primary teeth.     

The total number of white matter interstitial neurons in the human brain

In the adult human brain, the interstitial neurons (WMIN) of the subcortical white matter are the surviving remnants of the fetal subplate zone. It has been suggested that they perform certain important functions and may be involved in the pathogenesis of several neurological and psychiatric disorders. However, many important features of this class of human cortical neurons remain insufficiently explored. In this study, we analyzed the total number, and regional and topological distribution of WMIN in the adult human subcortical white matter, using a combined immunocytochemical (NeuN) and stereological approaches. We found that the average number of WMIN in 1 mm³ of the subcortical white matter is 1.230 ± 549, which translates to the average total number of 593 811 183.6 ± 264 849 443.35 of WMIN in the entire subcortical telencephalic white matter. While there were no significant differences in their regional distribution, the lowest number of WMIN has been consistently observed in the limbic cortex, and the highest number in the frontal cortex. With respect to their topological distribution, the WMIN were consistently more numerous within gyral crowns, less numerous along gyral walls and least numerous at the bottom of cortical sulci (where they occupy a narrow and compact zone below the cortical‐white matter border). The topological location of WMIN is also significantly correlated with their morphology: pyramidal and multipolar forms are the most numerous within gyral crowns, whereas bipolar forms predominate at the bottom of cortical sulci. Our results indicate that WMIN represent substantial neuronal population in the adult human cerebral cortex (e.g. more numerous than thalamic or basal ganglia neurons) and thus deserve more detailed morphological and functional investigations in the future.     

枸橼酸咖啡因与氨茶碱对早产儿神经行为发育影响分析

目的 比较枸橼酸咖啡因和氨茶碱对早产儿神经行为发育的影响,为早产儿早期合理干预提供临床依据。方法 选择2014年6月-2018年6月在中国西电集团医院新生儿科住院接受枸橼酸咖啡因治疗的原发性呼吸暂停(AOP)早产儿62例作为研究组;2011 年 12 月-2014年5月同在中国西电集团医院新生儿科住院采用氨茶碱治疗的AOP患儿69例作为对照组。出生3~8 d及矫正胎龄40周时分别行头颅MRI检查,评估脑白质损伤(WMD)并进行两组比较;6个月及12个月时应用Gesell婴幼儿发育量表测试比较两组神经行为发育水平。结果 两组患儿在性别、出生胎龄及体重、产前孕母糖皮质激素应用及分娩方式、5 min Apgar评分、辅助通气和表面活性物质的应用等方面差异均无统计学意义(P>0.05)。首次头颅MRI显示两组患儿WMD差异无统计学意义(P>0.05)。矫正胎龄40周时头颅MRI显示,咖啡因组WMD较氨茶碱组明显改善,差异有统计学意义(P<0.05);且6个月及12个月时Gessell婴幼儿发育量表测试,随访至校正6月龄时,咖啡因组患儿的大运动、精细运动及个人-社交评分均高于氨茶碱组(P<0.05);随访至校正12月龄时,咖啡因组患儿的大运动、精细运动、语言、适应性评分均高于氨茶碱组(P<0.05)。结论 枸橼酸咖啡可明显改善AOP患儿6个月及12个月时的神经行为发育。