携带GAD65的永生化神经前体细胞移植治疗癫痫大鼠

目的 将构建好的携带GAD65的永生化神经前体细胞(INPCs-GAD65)移植到癫痫大鼠的脑内,观察这些细胞在癫痫大鼠脑内的存活及对癫痫大鼠的治疗作用.方法 INPCs-GAD65用超顺磁性氧化铁纳米粒子(SPIO)标记后,MRI扫描追踪观察细胞的存活状况;观察对照组、实验组大鼠在行为学、脑电图的改变;免疫组织化学观察其分化.结果 行1.5T MRI检查,见移植处在T2WI呈低信号改变,移植后7周仍可见移植处的低信号改变,随时间延长信号变浅;与对照组比较,行为学观察发现自发痫性发作次数减少差异有统计学意义;脑电图改善,痫波发放减少;移植INPCs-GAD65可分化为神经元和胶质细胞.结论 在癫痫大鼠脑内移植合成和分泌GABA的永生化神经前体细胞能在脑内存活及分化,并能改善痫性发作.

Abstract：

Objective Transplant genetically engineered cell lines to synthesize and release GABA by immortalized neural progenitor cells (INPCs) in rats, can survive and differentiate in the hippocampus in the epileptic rats model induced by pilocarpine, have ability to suppress spontaneous seizures. Methods The INPCs were transfected with the GABA-synthesizing enzyme GAD (65) cDNA( INPCs-GAD65), Labeled INPCs-GAD65 with superparamagnetic iron oxide (SPIO), SPIO-labeled cells were tracked with 1.5T MRI scanner in vivo; Behavior were monitored for 6 days after surgery;The change examined with the electroencephalogram recording;The differentiation of transplanted cells was observed with immunohisochemistry. Results Animals that received genetically engineered GABA-producing cells had significantly fewer spontaneous seizures than did that the control animals, Epileptiform spikes was suppressed significantly in the electroencephalogram recording; 1.5 Tesia MRI in vivo displayed that remarkable low signal area on T2WI was seen in the fight brain which transplanted with SPIO-labeled cells. SV40Tag-positive cell can change into neurons and astrocytes in the hippocampus. Conclusion These data demonstrate that genetically engineered cells could suppress spontaneous seizures in an accepted model of temporal lobe epilepsy. This is an important step toward defining a clinical potential for this approach in epilepsy.     

理想的抗癫痫治疗：传统和新型抗癫痫药物的特性与应用

癫痫的治疗以药物为主,近年来随着新型抗癫痫药物的不断涌现,癫痫的治疗目标由强调发作的控制转为强调生活质量提高的个体化治疗,因此抗癫痫药物的选择必须以发作类型为基础,同时考虑药物的疗效、耐受性等特性,本文对传统及新型抗癫痫药物的特性及其在癫痫治疗中的合理应用进行综述。     

吞咽障碍评价标准评定脑卒中后吞咽障碍患者的信度和效度分析

目的探讨吞咽障碍评价标准评定脑卒中后吞咽障碍患者吞咽功能的信度和效度。 方法采用洼田饮水试验筛查出128名脑卒中后吞咽障碍患者,并根据吞咽障碍严重程度分为轻、中、重度,利用吞咽障碍评价标准和视频吞咽造影检查（VFSS）同时对其吞咽功能进行评价,后者作为效度标准。采用Spearman相关分析进行信度和效标效度评价。 结果吞咽障碍评价标准评分与VFSS结果具有显著相关性（r=0.84,P<0.01）;吞咽障碍评价标准在同一评定者及不同评定者间均有良好的信度;可对吞咽障碍的患者是否发生误吸和住院期间是否发生肺炎进行预测。 结论吞咽障碍评价标准适用于脑卒中患者的吞咽功能评价,是一种简单、方便、安全、有效的评估工具。     

α-突触核蛋白寡聚体经氧化应激途径致帕金森病小鼠模型多巴胺能神经元损伤

目的:通过鱼藤酮持续灌胃构建的帕金森病小鼠模型研究α-突触核蛋白寡聚体(α-Syn)的毒性作用机制。方法:48只老年雄性C57小鼠随机分为鱼藤酮组和对照组,每组24只,鱼藤酮组灌注0.01 mL/g鱼藤酮氯仿溶液,对照组灌注0.01 m L/g氯仿溶液,均连续灌胃12周。于灌胃后取脑,行蛋白质印迹实验检测α-Syn表达水平、透射电镜观察中脑黑质神经元超微结构;于灌胃前、后取脑,免疫组化染色观察黑质部位酪氨酸羟化酶(TH)阳性细胞密度,并检测脑组织中超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)和丙二醛(MDA)水平。结果:灌胃12周后,Western blot显示鱼藤酮组中脑α-Syn的表达较对照组明显增多(P0.05)。免疫组化染色显示鱼藤酮组中TH阳性细胞数量较对照组明显减少(P0.05)。透射电镜显示鱼藤酮组小鼠黑质部可见线粒体、高尔基体不规则肿胀。鱼藤酮组SOD、GSH-PX水平较对照组明显下降(P0.05),MDA水平较对照组显著增多(P0.05)。结论:鱼藤酮小剂量持续灌胃可在脑内诱发形成α-Syn寡聚体,α-Syn寡聚体可能经氧化应激途径导致多巴胺神经元损伤。     

笑气吸入后神经系统损害：1例病例报告及文献复习

正笑气的化学名为一氧化二氮(N_2O),作为吸入性镇痛麻醉药应用于临床,常见于口腔科拔牙及产科分娩镇痛等。近几年,有报道指出青少年吸食笑气后出现成瘾、致残等并发症。但目前笑气并未得到严格管制,本文报道我科收治1例笑气吸入后出现神经损伤的临床病例,并复习相关文献。1临床资料患者,男,19岁,留美大学生,因"双下肢无力1月余"于2016年6月9日收入我院。患者于1月前     

抗癫痫药物与认知功能障碍

全世界有超过6000万的癫痫患者，认知功能障碍的发生率在癫痫患者中明显高于一般人群。导致癫痫患者容易出现认知功能障碍的原因是多方面的。一方面，癫痫的反复发作容易导致大脑皮层受损从而导致认知功能障碍；另外，某些特殊的癫痫类型本身即会导致认知功能障碍；抗癫痫药物也可以有相关认知功能障碍的不良反应。认知功能障碍在特定癫痫人群中造成的致残性可能远远超过了癫痫本身。     

骨髓间充质干细胞移植对大鼠慢性癫痫模型腺苷系统的重建作用

目的 探讨骨髓间充质干细胞(MSC)移植对大鼠慢性癫痫模型腺苷系统的重建作用.方法 Wistar大鼠腹腔注射氯化锂及硝酸毛果芸香碱制作癫痫模型.将取自正常Wistar大鼠的MSC在培养后移植入癫痫模型大鼠的海马CA3区(MSC组).以腹腔注射生理盐水及海马区注射磷酸盐缓冲液的正常Wistar大鼠为对照(对照组).移植前和移植后3个月时进行大鼠脑电图检测,移植后3个月检测大鼠脑内腺苷A1及A2a受体的表达情况.结果 移植后3个月时,MSC组大鼠腺苷A1受体表达水平高于对照组.A2a受体表达水平低于对照组.MSC组A1受体升高在颞叶及海马尤为明显,A2a受体降低在丘脑尤为明显.MSC组中,移植前(慢性癫痫大鼠模型)的棘波频率为(19.65±2.18)次/页,波幅为(297.43±25.37)mV,移植后大鼠棘波发放的频率明显减少,为(7.48±0.91)次/页,且波幅明显降低,为(86.27±7.72)mV.结论 骨髓间充质干细胞移植可改善大鼠脑内腺苷受体的表达,重建功能异常的腺苷系统,并使大鼠脑内海马和顶叶皮层的痫样放电得到显著改善.     

Do Neuroimaging Results Impact Prognosis of Epilepsy Surgery? A Meta-analysis

The neuroimaging results of drug-resistant epilepsy patients play an important role in the surgery decision and prognosis. The aim of this study was to evaluate the impact of these results on the efficacy of epilepay surgery, and then to explore surgical benefit for epilepsy patients with negative magnetic resonance (MR) images. Twenty-four subgroups describing the outcomes of 1475 epilepsy patients with positive-neuroimaging results and 696 patients with negative-neuroimaging results were involved in the meta-analysis. Overall, the odds of postoperational seizure-free rate were 2.03 times higher in magnetic resonance imaging-positive (MRI-positive) patients than in MRI-negative patients [odds ratio (OR)=2.03,95% CI (1.67,2.47),P<0.00001]. For patients with temporal lobe epilepsy (TLE), the odds were 1.76 times higher in those with MRI-positive results than in those with MRI-negative results [OR=1.76,95% CI (1.34,2.32), P<0.0001]. For patients with extra-temporal lobe epilepsy (extra-TLE), the odds were 2.88 times higher in MRI-positive patients than in MRI-negative patients [OR=2.88,95% CI(1.53,5.43),P=0.001]. It was concluded that the seizure-free rate of MRI-positive patients after surgery was higher than that of MRI-negative patients. For patients with negative results, an appropriate surgery should be concerned for TLE.     

颅内血肿微创穿刺清除技术治疗基底节区脑出血

目的 介绍一种经过改良的血肿抽吸和引流方法 治疗基底节区脑出血--颅内血肿微创穿刺清除技术.方法 在CT辅助下对颅内血肿进行人工定位后,将直径3 mm的导管插入血肿,谨慎抽吸.之后反复复查CT并注入尿激酶引流,直至引流管尖端周围血肿消失.记录患者的临床特征,比较术前和拔管前的血肿体积、中线位移,格拉斯哥昏迷量表(GCS)评分.结果 接受该方法 治疗的16例患者拔管前血肿体积明显小于术前血肿(P<0.01),血肿清除率平均为87%;术前和拔管前中线位移的平均长度分别为(10.96±2.78)、(3.30±1.85)mm,拔管前中线位移明显小于术前(P<0.01);拔管前患者GCS评分平均为(14.25±1.00),较术前(8.25±2.24)增加了6分(P<0.01).术后6个月随访,14例患者(87.5%)神经功能恢复良好,2例患者(12.5%)遗留严重残疾.结论 颅内血肿微创穿刺清除技术是大面积基底节区脑出血切实可行的、安全的微创治疗方法 .     

Intracranial Hypertension Syndrome in Systemic Lupus Erythematosus： Clinical Analysis and Review of the Literature

In order to better understand the clinical manifestation of systemic lupus erythematosus （SLE） with intracranial hypertension syndrome （IHS）, we analyzed the clinical features and treatment of a typical SLE patient with IHS. SLE is one of the most unpredictable autoimmune diseases involving multiple organ systems that is defined clinically and associated with antibodies directed against cell nuclei. IHS is an uncommon manifestation of neuropsychiatric SLE （NPSLE） and is characterized by an elevated intracranial pressure, papilledema, and headache with occasional abducens nerve paresis, absence of a space-occupying lesion or ventricular enlargement, and normal cerebrospinal fluid chemical and hematological constituents. IHS has been reported in a few sporadic cases in patients with SLE worldwide, but rarely has been reported in China. In this study, a 34-year-old female SLE patient with IHS was. reported and pertinent literature reviewed. The clinical presentation, image logical features, and investigatory findings were discussed.