迁算性植物状态患者血清中多巴胺含量的临床意义

目的：探讨迁延性植物状态患者血清中多巴胺的变化及其临床意义。方法：用高效液相色谱测定长期昏迷的病人,并与正常对照组对比。结果：迁延性植物状态患者的血清中多巴胺显著降低。结论：多巴胺的减少可能是形成迁延性植物状态的重要因素之一。     

持续性植物状态猫体内多巴胺变化的实验研究

目的探讨持续性植物状态猫脑脊液、血液中多巴胺的变化及其意义。方法用高效液相色谱测定持续性植物状态的猫脑脊液、血液中多巴胺含量,并与正常对照组对比。结果持续性植物状态猫的脑脊液、血液中多巴胺含量降低。结论多巴胺的减少可能是形成持续性植物状态的重要因素之一。     

持续性植物状态猫脑脊液中多巴胺变化实验研究

目的 探讨持续性植物状态猫脑脊液中多巴胺的变化及其意义。方法 用高效液相色谱测定持续性植物状态猫脑脊液中多巴胺含量，并与正常对照组对比。结果 持续性植物状态猫的脑脊液中多巴胺含量显降低。结论 多巴胺的减少可能是形成持续性植物状态猫的重要因素之一。     

持续性植物状态

持续性植物状态段云祥，郑文济，段国升严重颅脑疾病常可造成病人大脑皮层功能丧失、昏迷或无意识状态。病人对周围事物无意识反应，但仍存在皮质下和脑干功能。当发病２周后，病人仍处于昏迷状态者，即属于迁延性昏迷（ｐｒｏｌｏｎｇｅｄｃｏｍａ）或迁延性无意识（ｐｒ...     

常氧及低氧条件下胶质源性神经营养因子体外诱导中脑神经干细胞向多巴胺能神经元的分化

背景：神经干细胞的定向诱导分化和扩增受细胞自身基因和外来信号的调控。 目的：观察中脑源性神经干细胞在常氧、低氧和胶质源性神经营养因子诱导下向多巴胺能神经元的分化情况。 方法：无菌条件下分离E12小鼠胚胎腹侧中脑组织,胰酶消化和机械吹打制成单细胞悬液,在无血清培养基中培养扩增;Nestin免疫细胞化学染色方法鉴定神经干细胞。在有血清培养基中对纯化神经干细胞自然分化;神经元特异性烯醇化酶和胶质纤维酸性蛋白免疫细胞化学染色方法分别鉴定神经元和星形胶质细胞。建立常氧和低氧环境,设置常氧组、常氧+胶质源性神经营养因子组、低氧组、低氧+胶质源性神经营养因子组,按实验分组在有血清条件下诱导分化。 结果与结论：在低氧条件下,中脑神经干细胞向多巴胺能神经元分化均高于常氧组;尤其是低氧环境和胶质源性神经营养因子诱导下向多巴胺能神经元分化比例更高,表型更成熟。说明低氧环境下胶质源性神经营养因子可明显促进中脑神经干细胞分化为数量足够、形态及功能成熟的多巴胺能神经元。     

低氧环境下胶质源性神经营养因子体外诱导中脑神经干细胞的分化*

背景：有效的神经干细胞体外增殖与多巴胺能神经元的定向诱导分化是神经干细胞移植治疗帕金森病的关键所在。 目的：观察低氧条件下胶质源性神经营养因子体外诱导中脑源性神经干细胞向多巴胺能神经元的分化。 方法：体外分离培养孕12 d胚鼠腹侧中脑组织,制成单细胞悬液,在含碱性成纤维细胞生长因子和B27的无血清培养基中培养并传代,分别置于常氧(体积分数21%O2)或低氧(体积分数3%O2)环境下增殖5~7 d后,接种于含体积分数10%胎牛血清的DMEM/F12培养基,或含体积分数10%胎牛血清的DMEM/F12+1 µg/L胶质源性神经营养因子。 结果与结论：低氧环境下分化10~12 d,中脑神经干细胞向多巴胺能神经元分化均高于常氧组,在胶质源性神经营养因子诱导下向多巴胺能神经元分化比例更高,表型更成熟。说明低氧环境下胶质源性神经营养因子可明显促进中脑神经干细胞分化为数量足够、形态及功能成熟的多巴胺能神经元。     

脑损伤后发作性自主神经功能障碍的临床特点

目的探讨脑损伤后发作性自主神经功能障碍的临床特点。方法回顾性分析22例脑损伤后发作性自主神经功能障碍患者的临床资料。结果22例患者均处于植物状态,其原发损伤为重型颅脑外伤14例,脑或小脑出血血肿清除术后2例,海洛因中毒性脑病1例,重度一氧化碳中毒2例,电击伤心肺复苏术后1例,冠状动脉造影支架植入术心脏骤停复苏后1例,麻醉意外致心脏骤停心肺复苏后1例。全组患者均出现发作性躁动、发热、多汗、呼吸急促、心动过速、血压升高、肌张力障碍、抽搐等症状中的多项表现。发作时脑电图未见癫疒间放电;听觉诱发电位或体感诱发电位显示各波潜伏期延长、波幅下降甚至未引出。神经影像学检查提示大脑皮质、皮质下、脑干等部位有不同程度的损害。治疗上应用多巴胺受体激动剂或阻滞剂、苯二氮艹卓类及肌松剂等药物对症处理;22例中10例在起病后1~13个月脱离植物状态。结论脑损伤后发作性自主神经功能障碍临床主要表现为发作性自主神经功能紊乱伴肌张力障碍,重症者多处于植物状态;药物治疗仅限于对症处理。     

抽动障碍患者血清单胺类神经递质的变化及意义

目的了解抽动障碍患者血清多巴胺、去甲肾上腺素等单胺类神经递质的水平,探讨各亚型之间血清神经递质的水平是否存在差别。方法采用化学荧光法测定46例抽动障碍患者（病例组）血清多巴胺、去甲肾上腺素水平,并与40例正常儿童（对照组）进行比较。结果病例组血清多巴胺为0.315μg/ml,对照组为0.210μg/ml;病例组血清去甲肾上腺素为0.192μg/ml,对照组为0.127μg/ml,两组各均值比较,病例组血清多巴胺和去甲肾上腺素均显著高于对照组（P〈0.05）。病例组各亚型血清多巴胺水平分别为0.239μg/ml,0.310μg/ml,0.451μg/ml,三者比较有显著性差异（P〈0.05）;病例组各亚型血清去甲肾上腺素水平分别为0.181μg/ml,0.193μg/ml,0.212μg/ml,三者比较差异无显著性（P〉0.05）。结论抽动障碍患者存在多巴胺和去甲肾上腺素的水平异常,且各亚型血清多巴胺水平有明显差异,但去甲肾上腺素水平无显著差异。     

帕金森病患者IL-2、IL-6、IL-10的检测及临床意义

目的：检测帕金森病（PD）患者血清及脑脊液（CSF）中IL-2、IL-6和IL-10含量,为深入研究细胞免疫与PD的关系及从炎症角度干预提供实验依据.方法：采用双抗体夹心ELISA法测定PD组血清及CSF中IL-2、IL-6和IL-10的含量,并与对照组（同期体检健康者）比较.结果：PD组血清IL-2、IL-6和IL-10含量均高于对照组（ P〈0.01,P〈0.05）;PD组CSF中IL-6含量高于对照组（ P〈0.05）.新发PD患者、服左旋多巴制剂及服非左旋多巴制剂组PD患者血清及CSF中 IL-2、IL-6、IL-10含量与对照组比较,差异均无统计学意义（ P〉0.05）.PD组血清及CSF中IL-2、IL-6、IL-10含量与年龄、病程、Webster评分、Hoehn-Yahr分级分期、UPDRS-Ⅱ和UPDRS-Ⅲ评分间均无相关性.结论：①PD患者存在血清及CSF中IL-2、IL-6和IL-10水平的改变,PD发病与细胞免疫功能失调有关; ②PD细胞免疫状态的改变不能归因于外源性多巴胺的摄入.     

血清胰岛素样生长因子-1与帕金森病关系的研究

帕金森病是中老年人群中最常见的神经系统退行性疾病之一,其主要病理特征是黑质致密部多巴胺能神经元的变性丢失,引起多巴胺分泌不足。胰岛素样生长因子-1能促进多巴胺能神经元的存活,且相关实验证实帕金森病患者血清胰岛素样生长因子-1水平发生了变化。文中对血清胰岛素样生长因子-1与帕金森病的关系作一综述。     

Effect of Yishen Qiqiao Fang on dopamine content in serum and cerebrospinal fluid of patients in persistent vegetative statec

BACKGROUND: It has been demonstrated that the attack of persistent vegetative state is associated with the damaged neuron, which produces dopamine, and nervous pathway, the reduce of dopamine or malfunction of dopamine. OBJECTIVE: To observe the effect of self-made traditional Chinese medicine (TCM) Yishen Qiqiao Fang, which has the functions of supplementing qi and nourishing blood, resolving phlegm by promoting blood circulation, restoring consciousness and inducing resuscitation, on the contents of dopamine in serum and cerebrospinal fluid of patients in persistent vegetative state. DESIGN: An open randomized controlled clinical trial. SETTINGS: Nanjing University of Traditional Chinese Medicine, Nanjing Zijin Hospital. PARTICIPANTS: Thirty-eight inpatients of persistent vegetative state were selected from the Department of Neurology, Nanjing Zijin Hospital from August 2005 to November 2006. The patients were diagnosed according to the diagnostic standards set by the summary of a meeting for specialists in Nanjing. Informed contents were obtained from their relatives. According to the order of admission, the enrolled patients were divided into control group (n =20) and TCM treated group (n =20). METHODS: In the control group, the patients were treated with routine treatments for the symptoms. In the TCM treated group, the patients were treated with Yishen Qiqiao Fang besides the same treatments in the control group. TCM dispensing granules: each bag of mongolian milkvetch root, Chinese angelica and peach seed equaled to 10 g crude drug respectively; each bag of grassleaf sweetflag rhizome and dahurian angelica root equaled to 6 g crude drug respectively; Musk 0.05 g. The daily dosage for adults: 4 bags of mongolian milkvetch root, 2 bags of Chinese angelica, 0.05 g musk, 1 bag of peach seed, 2 bags of grassleaf sweetflag rhizome and 2 bags of dahurian angelica root, which should be given though nasal feeding or gastrostogavage before breakfast and supper every day, the course lasted for 2 months. The contents of dopamine in serum and cerebrospinal fluid were determined with enzyme immunoassay analyzer before and after treatment in both groups. MAIN OUTCOME MEASURES: Contents of dopamine in serum and cerebrospinal fluid before and after treatment in both groups. RESULTS: Totally 38 patients of persistent vegetative state were enrolled, 33 of them were involved in the final analysis of results, and the other 5 missed. The contents of dopamine in serum and cerebrospinal fluid had no obvious differences between the two groups both before and after treatment (P > 0.05). In the control group, the contents of dopamine in serum and cerebrospinal fluid had no obvious differences before and after treatment (P > 0.05). In the TCM treated group, the contents of dopamine in serum and cerebrospinal fluid after treatment were obviously higher than those before treatment (t =2.174, 2.485, P < 0.05). CONCLUSION: Yishen Qiqiao Fang can significantly increase the contents of dopamine in serum and cerebrospinal fluid of patients in persistent vegetative state, which may be one of the mechanisms for ameliorating persistent vegetative state.     

Thalamic proton magnetic resonance spectroscopy in vegetative state induced by traumatic brain injury

OBJECTIVES: To determine whether proton magnetic resonance spectroscopy (MRS), a newer radiographic technology, would be useful in the evaluation of the thalamus of patients in vegetative states resulting from traumatic brain injury. METHODS: 14 victims of severe traumatic brain injury who were in the vegetative state and whose magnetic resonance images of the thalamus were normal underwent bilateral thalamic proton (MRS) studies. The N-acetyl aspartate to creatine (NAA:Cr) and choline to creatine (Cho:Cr) ratios were obtained for each patient. The proton thalamic MRS findings of patients who were in a persistent vegetative state (n = 8) and in patients who had regained awareness after being in the vegetative state (n = 6) were compared with proton thalamic MRS findings in five healthy volunteers. RESULTS: While conventional magnetic resonance imaging suggested that each patient had a normal thalamus, proton MRS indicated that the thalamus of each patient in the series was damaged. The NAA:Cr ratio was significantly lower in the thalami of both the patients who remained in a persistent vegetative state for the duration of the study and in those who regained awareness after being in the vegetative state (p < 0.001). In addition, NAA:Cr ratios were lower in the group of patients who remained in a persistent vegetative state than in the group of patients who regained awareness after being in the vegetative state (p < 0.001). CONCLUSIONS: Results suggest that the NAA:Cr ratio within the thalamus is significant and that thalamic MRS may be helpful when attempting to determine the degree of severity of neuronal and axonal injury in patients in the vegetative state.     

Persistent vegetative state. Extension of the syndrome to include chronic disorders

Twenty-nine institutionalized patients had the vegetative state as a sequela of chronic progressive neurologic disorders. During three years, the state was persistent; none improved, ten died. Eight similar patients were reviewed retrospectively post mortem. Eight patients with severe dementia, while acutely ill or sedated, temporarily met the criteria for persistent vegetative state (PVS) but improved when the underlying condition was treated. Abnormalities on electroencephalography or computed tomographic scan are not specific for the PVS. Electroencephalograms were normal in three patients with PVS. The computed tomographic scans showed extensive destruction of the brain parenchyma but were not different from those of severely demented patients without the PVS. The PVS is a feature of the terminal phase of several progressive neurologic disorders. Patients should be treated without excessive intervention.     

唑吡坦对脑损伤植物状态患者促醒疗效的观察

目的 观察非常规促醒药物唑吡坦对脑损伤昏迷植物状态患者的促醒作用,分析该作用是否存在干预时间相关性. 方法 采用单光子发射型计算机体层摄影技术观察7例服用唑吡坦的持续性植物状态患者服药0.5 h前后及1周后99Tcm-双半光乙酯(ECD)脑灌注显像.做可视化分析;应用脑状态监测仪(CSM)进行检测,对比用药前后脑状态指数、肌电指数、爆发抑制指数的变化;观察患者临床指标变化,包括语言功能、肢体运动功能、肌张力、睡眠质量等的变化. 结果 (1)患者服药后脑状态指数、肌电指数均高于服药前爆发抑制指数低于用药前,差异均有统计学意义(P<0.05).(2)服药后7例患者脑损害区血流较服药前明显增加.(3)7例患者中3例成功促醒,表现为服药后0.5 h能与家人及医生进行简单的交流,用药后第2天便能做简单的数学运算,下肢可遵嘱做屈曲运动.其中1例原有的肢体震颤及扭转痉挛明显缓解:余4例肌张力及睡眠质量改善. 结论 唑吡坦能恢复部分脑损害持续性植物状态患者的脑功能,脑功能的改善与服药时间长短无关,脑功能的改善是"一步到位"而非"逐步改善".     

A case of ornithine transcarbamylase deficiency presenting severe symptoms in adulthood]

An adult female case of ornithine transcarbamylase (OTC) deficiency is presented in the following. The patient had had past episodes of drowsiness with a duration less than a few minutes several times a year during childhood. She suddenly became comatose at 25 years of age, and died after 13 months of persistent vegetative state. Blood chemistry showed hyperammonemia with no liver cirrhosis or portal-systemic shunt. Plasma amino acid analysis indicated elevated glutamate and glycine levels, and plasma levels of citrulline and arginine to be low. The urinary orotic acid level was high. OTC activity of a liver specimen was 65 percent of the normal level. This is a rare case demonstrating hyperglycinemia and an elevated level of serum OTC. The importance of ruling out defective ureagenesis in adults with disturbed consciousness should be emphasized.     

Persistent vegetative state with high cerebral blood flow following profound hypoglycemia

A persistent vegetative state (severe dementia) developed in a 30-year-old man following hypoglycemic coma. Despite the poor clinical outcome, sensory evoked response recovered between 6 and 34 months after the insult. The cerebral blood flow level at rest after 34 months was slightly above the normal range. This finding contrasts with the low cerebral blood flow regularly reported in patients who are comatose or stuporous following severe brain hypoxia-ischemia.     

Ethics, brain damage and ending lives

The problem of patients in the persistent vegetative state is beset by complex ethical and philosophical issues to do with the nature of persons and our ethical duties towards them. Many discussions obscure the main ethical considerations. In this paper, I approach the problem through a philosophical analysis of the concept of a person and the attributes that ground our ethical responsibilities to persons. I argue that we are under no ethical obligation to continue lifesustaining treatment for patients properly diagnosed as being in the persistent vegetative state or with other severe brain damaged conditions. This, of course, is compatible with our trying to do our best for such patients until the prognosis is clear.     

Heterotopic ossification in childhood and adolescence

Heterotopic ossification, or myositis ossificans, denotes true bone in an abnormal place. The pathogenic mechanism is still unclear. A total of 643 patients (mean age, 9.1 years) admitted for neuropediatric rehabilitation were analyzed retrospectively with respect to the existence of neurogenic heterotopic ossification. The purpose of this study was to obtain information about incidence, etiology, clinical aspect, and consequences for diagnosis and therapy of this condition in childhood and adolescence. Heterotopic ossification was diagnosed in 32 patients (mean age, 14.8 years) with average time of onset of 4 months after traumatic brain injury, near drowning, strangulation, cerebral hemorrhage, hydrocephalus, or spinal cord injury. The sex ratio was not significant. In contrast to what has been found in adult studies, serum alkaline phosphatase was not elevated during heterotopic ossification formation. A persistent vegetative state for longer than 30 days proved to be a significant risk factor for heterotopic ossification. The incidence of neurogenic heterotopic ossification in children seems to be lower than in adults. A genetic predisposition to heterotopic ossification is suspected but not proven. As a prophylactic regimen against heterotopic ossification we use salicylates for those patients in a coma or persistent vegetative state with warm and painful swelling of a joint and consider continuous intrathecal baclofen infusion and botulinum toxin injection for those patients with severe spasticity. We prefer to wait at least 1 year after trauma before excision of heterotopic ossification.     

Dopamine levels after repetitive transcranial magnetic stimulation of motor cortex in patients with Parkinson's disease: preliminary results.

BACKGROUND: Repeated session of repetitive transcranial magnetic stimulation (rTMS) over motor cortex have been reported to produce significant improvement of motor performance in patients with parkinson's disease (PD). In addition, it is known that a single session of rTMS over motor cortex transiently increases DA in striatum. Here, we test whether repeated sessions of rTMS increase serum dopamine in PD patients and whether this correlates with changes in clinical rating scales. MATERIAL AND METHODS: Twenty untreated PD patients with moderate to severe symptoms (Hoehn & Yahr state III-V 1967) were assessed on the Unified Parkinson's Disease Rating Scale (UPDRS), and with an enzyme immunoassay for quantitative determination of plasma dopamine before and after six daily sessions of 25 Hz rTMS with 3,000 stimuli over the right and left hand and leg motor cortex. RESULTS: There was significant improvement in UPDRS compared with the baseline. Serum dopamine level also was significantly elevated over the same interval. There was a significant correlation between UPDRS and serum dopamine level before and after treatment. CONCLUSION: Improved motor performance in PD after repeated session of rTMS may be related to an elevation of serum dopamine concentration.