风药、补虚药对脑缺血大鼠海马PI3K/Akt信号通路的影响

目的探讨侯氏黑散方中风药、补虚药、风药补虚药联用(以下简称联用药)抗脑缺血损伤的作用机制。方法利用线栓法制备永久性大脑中动脉栓塞(p MCAO)模型。SPF级雄性SD大鼠随机被分为假手术组、模型组、风药组、补虚药组及联用药组。脑缺血72 h后分离缺血侧海马组织,运用双抗体夹心法测定缺血侧海马组织中脑源性神经营养因子(BDNF)的表达,Western blot检测磷脂酰肌醇3-激酶(PI3K)、蛋白激酶B(PKB又称Akt)、环磷酸腺苷反应元件结合蛋白(CREB)蛋白的表达。结果侯氏黑散方中风药对脑缺血大鼠缺血侧海马BDNF、PI3K、Akt及CREB的蛋白表达无明显影响;补虚药可以明显上调脑缺血大鼠缺血侧海马BDNF和Akt蛋白的表达(P0.05);联用药可以明显降低脑缺血大鼠神经功能评分(P0.05),显著上调脑缺血大鼠缺血侧海马BDNF、PI3K、Akt及CREB蛋白的表达(P0.05)。结论风药可以佐助补虚药通过对PI3K/Akt信号通路中关键信号分子进行调控,减轻缺血性脑损伤。     

急性脊髓损伤后脑脊液中兴奋性氨基酸含量在脊髓功能恢复中的临床意义

目的 探讨急性脊髓损伤后脑脊液中兴奋性氨基酸含量变化与脊髓功能恢复的关系及其对预后的影响。方法 采用氨基酸自动分析仪检测32例急性脊髓损伤患者脑脊液（CSF）中天门冬氨基酸（Asp）和谷氨酸（Glu）在损伤后不同时段的含量变化。结果 天门冬氨基酸（Asp）和谷氨酸（Glu）在损伤后16h达到高峰，24h后开始逐渐下降；兴奋性氨基酸在损伤后高峰越早，升高得越多，脊髓损伤越严重；CSF中兴奋性氨基酸含量升高越高、持续的时间越长，脊髓功能恢复越差。结论 CSF中兴奋性氨基酸含量是脊髓损伤的敏感指标，可以作为早期预测脊髓损伤程度和判断其预后的指标之一。     

The effect of botulinum toxin type A injections on the natural history of equinus foot deformity in paediatric cerebral palsy patients

Neuromuscular blockade with botulinum toxin type A (BTX-A) injections was employed to manage equinus foot deformity in the lower extremities of paediatric cerebral palsy patients. The patients were followed to evaluate the effect of the blockade on lower extremity function and to determine the effect of treatment on the need for tendo-Achilles lengthening (TAL) surgery. The average length of follow-up was 3.4 years. Of the 48 patients, 17 (35%) responded to treatment witbin 6 months of initiation of therapy, as determined by a Physician Rating Scale of gait. Overall, 25 (52%) of the 48 patients underwent TAL surgery during the follow-up period, including eight patients who responded to the BTX-A treatment. The average age of the patients at the time of surgery was 7 years. This age compares favourably with the age at surgery reported in the recent literature. There were no significant differences by responder status, age, or gender in those patients who did and did not require TAL surgery. No adverse events relating to BTX-A were reported. These results indicate that patients who respond to BTX-A treatment have improved physical functioning and gait, and are able to sustain these results long term.     

蟒针加指针治疗脑瘫及其刺法的探讨

目的：用蟒针平刺和指针叩击刺激筋络循行部位，对脑瘫（CP）智能提高作用及其刺法的机理探讨。方法：将49例CP分为两组，A组38例用蟒针、指针平刺、叩击刺激筋络循行部位，B组11例不治疗，3个月结束进行疗效评定。结果：A组38例中显效21例（55.3%)，有效16例（42.1%)，总有效37例（97.4%)；B组11例未达到有效分数线，经统计学处理，A组比B组智能提高差异均有极显著性意义。结论：蟒针、指针刺激表浅筋络可使机体产生一种气化效应作用。自我调理、平衡阴阳，或协助体内固有的调节系统，调节提高CP智能的作用。     

Localization of the Origin of Self-Sustained Afterdischarges (SSADs) in the Rat

The genesis of the thalamocortical self-sustained afterdischarge (SSAD) composed of spike-and-wave (S + W) rhythm was studied in adult male albino rats. Under control conditions, rhythmic electrical stimulation of the specific somatosensory nucleus of the thalamus always elicited type S + W SSAD. An electrolytic lesion of the nonspecific thalamic nuclei did not prevent generation of type S + W SSAD, while stimulation of the ventrobasal complex evoked both type S + W SSAD and another type of SSAD composed of large waves with superimposed fast activity. Elimination of the cortex (by suction or spreading depression) ipsilateral to the stimulated thalamus completely suppressed any possibility of the formation of type S + W SSAD; elimination of the contralateral cortex did not affect it. Our results suggest that the cortex is the decisive factor in the genesis of S + W rhythm, while the thalamus markedly influences the conditions of its formation.     

儿童功能独立检查在脑瘫残疾组测量的效度研究

目的探讨修订的儿童功能独立检查表及方法的有效性。方法在脑瘫（ｃｅｒｅｂｒａｌｐａｌｓｙ,ＣＰ）残疾组３４例儿童中进行儿童功能独立检查的结构效度和实证效度检验。结果儿童功能独立检查表与适应商数（ａｄａｐｔｉｖｅｄｅｖｅｌｏｐｍｅｎｔｑｕｏｔｉｅｎｔ,ＡＤＱ）、神经肌肉系统缺陷程度、美国脑瘫学会（Ａｍｅｒｉｃａｎａｓｓｏｃｉａｔｉｏｎｏｆｃｅｒｅｂｒａｌｐａｌｓｙ,ＡＡＣＰ）障碍分类和治疗性分级的等级相关分析显示,大多数参数的相关系数在统计学上有显著意义。结论儿童功能独立检查是一种有较好效度指标的医疗康复儿童残疾测量工具。     

A multilevel approach to botulinum toxin type A treatment of the (ilio)psoas in spasticity in cerebral palsy

In spasticity, flexion deformity of the hip is frequently associated with contracture or hyper-reflexia of the psoas muscle. Botulinum toxin type A (BTX-A) has been used for some considerable time in the management of paediatric gait disorders. We have been using a multilevel approach to manage spasticity in cerebral palsy for several years, the combination of gait analysis and clinical evaluation being important for the selection of target muscles for BTX-A injections. Twenty cerebral palsy children (12 female) with spasticity were treated with BTX-A injections (BOTOX® mean dose, 2 U/kg body weight) into the psoas muscle. Patients were monitored using range of motion measurements of maximal hip extension, clinical estimates of hypertonia in the hip flexors, gait analysis (three-dimensional kinematics and kinetics) and surface electromyography of major lower limb muscles. Full gait analysis was carried out on 12 of the patients. Significant clinical improvements were observed following 15 of the 21 psoas treatments. Furthermore, the kinematics results of gait analysis showed improvement in one or more parameters in nine of the 12 patients. In conclusion, we have demonstrated the value of a multilevel approach to BTX-A treatment in the management of spasticity in children with cerebral palsy.     

ACE基因多态性与脑梗死、脑出血发病的关系

目的探讨血管紧张素转换酶(ACE)基因多态性(I/D)与脑梗死、脑出血发病的关系。方法采用聚合酶链反应(PCR)技术,对323例脑梗死患者、340例脑出血患者和55例正常人进行血管紧张素转换酶基因型检测。结果脑梗死组DD,ID和II基因型频率分别为20.7%,37.8%和41.5%,与正常对照组比较差异无显著性(χ2=1.918,1.781,0.043和P >0.05),脑出血组DD,ID和II基因型频率分别为21.8%,41.4%和36.5%,与正常对照组比较差异无显著性(χ2=2.506,0.653和0.253,P >0.05)。脑梗死组D和I等位基因型频率分别为39.6%和60.4%,与正常对照组比较差异无显著性(χ2=0.421和0.421,P >0.05),脑出血组D和I等位基因型频率分别为42.5%和57.5%,与正常对照组比较差异无显著性(χ2=1.608和1.608,P >0.05)。结论血管紧张素转换酶基因多态性与脑梗死、脑出血的发病无相关。     

缺血后适应减轻树鼩缺血性脑水肿及脑梗死的机制

目的 观察缺血后适应对树鼩血栓性脑缺血时大脑皮层脑水含量、局部脑血流、梗塞面积及神经元超微结构的影响,探讨其对树鼩脑缺血时神经保护的可能机制。 方法 将88只健康成年树鼩随机分为对照组、脑缺血4 h组、脑缺血24 h组、后适应4 h组及后适应24 h组（每组n=8）,另取8只动物做HE染色（n=3）及电子显微镜观察（n=5）。本实验采用光化学反应诱导树鼩血栓性脑缺血而建立脑缺血动物模型,在脑缺血模型建成后4 h夹闭缺血侧颈总动脉5 min,再灌注5 min,如此交替进行3个循环以建立缺血后适应模型。测定大脑皮层局部脑血流,脑组织含水量,脑梗死范围,并观察皮层及海马CA1区神经元超微结构改变。 结果 脑缺血时神经元固缩,线粒体肿胀,嵴溶解或形成空泡,内质网肿胀,内质网池形成。缺血后适应能使海马CA1区神经元固缩减少,线粒体和内质网的病理改变减轻,细胞水肿改善。随着缺血时间的延长,缺血24h组脑水含量明显增加86.81%±1.08%,此时脑梗塞面积明显扩大33.00%±3.03%,局部脑血流明显降低（134.27±28.75）ml/min。缺血后适应24h组脑组织含水量明显减少（81.04%±1.04%,P＜0.01）;脑梗塞面积缩小（16.79%±1.29%,P＜0.01）;而局部脑血流明显增加［（195.25±21.18）ml/min,P＜0.01］。 结论 缺血后适应可缓解树鼩缺血性脑水肿并缩小梗死范围,其机制可能与改善局部脑血流有关。     

微弹簧圈血管内栓塞治疗颅内动脉瘤

１例颅内动脉瘤，采用血管内微弹簧圈栓塞治疗，除１例因瘤颈过小，微导管不能送入动脉瘤腔而改行手术夹闭外，其余１０例均栓塞治疗成功，效果良好。并就动脉瘤栓塞技术和如何保持载瘤动脉通畅进行了讨论。