神经干细胞与许旺细胞共移植于大鼠损伤脊髓

目的 观察神经干细胞与许旺细胞共移植于大鼠半横断脊髓损伤处神经干细胞的迁移、存活、分化及对损伤脊髓的修复作用.方法 绿色荧光蛋白(GFP)标记脊髓神经下细胞后与许旺细胞共移植于大鼠半横断脊髓损伤处,免疫荧光染色和电镜技术分别观察神经下细胞的迁移、存活、分化及新生的髓鞘.皮层运动诱发电位(CMEPs)及BBB评分分别检测大鼠运动功能的恢复.结果 在神经干细胞与许旺细胞共移植组,损伤脊髓的头端、尾端及对侧町见明显的GFP阳性细胞及GaLC/GFP、GFAP/GFP、NSE/GFP、SYN/GFP舣阳性细胞,电镜下新生的髓鞘最多,CMEPs恢复百分率和振幅明显高于其他两组,但BBB评分与神经干细胞单移植组差异无统计学意义.结论 神经干细胞和许旺细胞体内共移植可促进神经干细胞的辽移、存活、分化及脊髓运动功能的恢复.     

大鼠骨髓间充质干细胞静脉移植对脊髓损伤的修复作用

目的初步探讨骨髓间充质干细胞（BMSCs）静脉移植对脊髓损伤后神经功能恢复和神经修复的影响。方法体外培养BMSCs，改良Allen法制备大鼠脊髓损伤模型，经尾静脉移植Brdu标记的BMSCs，损伤后24h、移植后1、3、5周评价实验动物的神经功能状况，并检测BMSCs在体内迁移、存活以及分化情况，电子显微镜观察组织形态学变化。结果移植的BMSCs在宿主损伤脊髓中聚集并存活，3～5周后有部分移植细胞表达神经元特异性烯醇化酶（NSE）、神经丝蛋白（NF）、微管相关蛋白（MAP2）；BMSCs静脉移植组大鼠运动功能改善，BBB评分高于对照组（P〈0．05）；5周后组织学观察，与对照组相比移植组损伤区脊髓结构较完整。结论BMSCs经静脉移植后可向脊髓损伤处聚集并存活分化，促进神经修复及神经功能的恢复。     

局部注射骨髓间充质干细胞治疗大鼠脊髓损伤：运动功能有改善吗？

背景：目前研究多为骨髓间充质干细胞的体外培养及细胞移植对颅内疾病的治疗,对植入细胞在损伤脊髓中的成活、分化、迁移、结构重建等了解有限。 目的：探讨局部骨髓间充质干细胞移植在脊髓损伤修复中的作用和骨髓间充质干细胞替代治疗的可行性。 方法：成年健康雌性SD大鼠随机分为细胞移植组和对照组,建立SD大鼠脊髓横断损伤模型,伤后即刻分别向损伤区局部移植大鼠骨髓间充质干细胞悬液或无钙镁磷酸缓冲液。在术前和术后1 d,1周,2周,3周,4周和8周进行BBB评分,观测大鼠的运动功能,并于移植后1周免疫组织化学染色法观察BrdU标记的骨髓间充质干细胞在脊髓损伤处的存活情况,移植后4周进行损伤脊髓的大体观察和组织学检测。 结果与结论：移植后第1~8周细胞移植组BBB评分均髙于对照组;术后1周免疫组织化学染色结果显示在细胞移植组大鼠脊髓远端检测到BrdU阳性细胞,术后4周脊髓损伤处发现有神经纤维。证实通过损伤后立即局部注射的方式将骨髓间充质干细胞移植进大鼠脊髓损伤区,细胞可在损伤区存活;存活的骨髓间充质干细胞可分化为神经元,在损伤局部形成神经元通路,从而促进脊髓神经纤维传导功能的恢复,并促进高位脊髓损伤后大鼠后肢运动功能恢复。     

不同来源成体神经干细胞促进大鼠脊髓损伤功能修复的比较研究

目的 评价大脑、骨髓和脂肪组织3种不同来源的神经干细胞对大鼠脊髓挫伤的治疗效果.方法 选取来源于同一大鼠成体中大脑、骨髓和脂肪的3个部位的组织,分离、诱导分化为不同来源的神经干细胞;应用自由落体损伤模型装置造成大鼠脊髓挫伤.将不同来源的神经干细胞分别移植入大鼠脊髓损伤部位,通过BBB评分比较修复脊髓损伤功能的效果,应用免疫荧光染色检测不同移植细胞在损伤脊髓中的存活、分布、迁移的情况.另设假手术对照组和生理盐水对照组.结果 与假手术对照组和生理盐水对照组比较,3个细胞处理组BBB评分在2～8周开始增加,9周以后更加明显,差异开始有统计学意义(P<0.05).在移植后1周和4周,细胞移植组中脑源性神经干细胞(SVZ-NSs)组Brdu/nestin+>神经元存活的数目明显高于其他2组.但差异没有统计学意义(P>0.05);到了第8周,3组均仅有少量Brdu/nestin+>细胞存活,相互之间比较差异无统计学意义(P>0.05).结论 植入来源于大脑、骨髓和脂肪组织的神经干细胞都可以在一定程度上提高脊髓损伤后运动功能恢复,但SVZ-NSs组的脊髓损伤大鼠运动功能恢复要比脂肪来源的神经干细胞(AD-NSs)组及骨髓来源的神经干细胞(BM-NSs)组更好.AD-NSs由于来源广泛和强有力的增殖能力,相比其他来源的神经干细胞,可能是更好的选择.     

体外转染绿色荧光蛋白基因的肌源性干细胞移植修复大鼠脊髓损伤

背景：肌源性干细胞易于提取、分离及扩增,在特定条件下可分化为骨、软骨、肌肉等中胚层组织细胞,还可以跨胚层分化为神经细胞等,是组织工程临床用于脊髓损伤修复的理想种子细胞。 目的：观察肌源性干细胞移植对脊髓半切损伤大鼠运动功能的修复作用。 方法：40只成年SD大鼠随机数字表法分为移植组和对照组,每组20只。均进行脊髓半切损伤,伤后9 d,移植组于伤处移植体外转染绿色荧光蛋白基因的大鼠肌源性干细胞,而对照组仅注射等量PBS,于移植后1,2,3,4周用斜板实验和BBB评分测大鼠的运动功能,同时进行损伤脊髓取材、快速冰冻切片进行荧光显微镜观察。 结果与结论：所有大鼠脊髓半切损伤手术均成功,术后无动物死亡。肌源性干细胞移植后1周,移植组与对照组均有所恢复,斜板实验和BBB评分差异无显著性意义(P > 0.05);2~4周移植组恢复明显较好,斜板实验和BBB评分显著高于对照组(P < 0.05),移植组后肢活动与前后肢活动的协调性明显优于对照组。荧光显微镜观察经诱导分化和基因标记的肌源性干细胞在损伤脊髓组织局部生长良好,并且有沿着脊髓神经束向头尾两侧迁移的趋势。提示脊髓半切损伤大鼠经肌源性干细胞移植后能在损伤脊髓组织局部长期存活并明显改善其运动功能,肌源性干细胞移植对脊髓半切损伤大鼠有修复作用。 关键词：肌源性干细胞;移植;脊髓损伤;绿色荧光蛋白;大鼠     

神经干细胞移植治疗大鼠脑缺血再灌注损伤的实验研究

目的探讨胎鼠皮质培养的神经干细胞移植治疗大鼠脑缺血再灌注损伤的可行性及疗效。方法取孕龄15d Sprague-Dawley(SD)胎鼠皮质细胞培养为神经干细胞;用线栓法制备大鼠脑缺血再灌注损伤模型;将24只健康SD大鼠分为假手术组、缺血对照组、缺血移植组,在移植后2周、4周依据Garcia的18分评分法对各组大鼠的神经功能进行评分;行脑灌注固定取材,免疫组化染色观察移植后神经干细胞的分化、迁移和整合情况。结果用胎鼠皮质培养的细胞nestin表达阳性;缺血移植组大鼠的神经功能评分明显高于缺血对照组(P<0.05);缺血移植组免疫组织化学染色能够检测到存活的BrdU阳性细胞,移植后4周时可见移植细胞向周围迁移、分化、参与血管形成,并可见梗死区边缘微血管明显增生;缺血移植组大鼠脑GFAP阳性细胞数较缺血对照组明显增多(P<0.05)。结论分离、培养胎鼠皮质细胞Nestin表达阳性,即是大鼠的神经干细胞;移植体外培养的神经干细胞能在脑缺血大鼠脑内存活、迁移、分化,并且对脑梗死大鼠的神经功能修复起到了积极作用。     

骨髓间充质干细胞不同移植途径治疗大鼠脊髓损伤的比较

背景：在适当的生长环境下，中枢神经系统内的一些受损的神经元轴突有少许再生，并能与靶细胞形成功能性的突触联系。 目的：比较局部注射和尾静脉注射途径移植骨髓间充质干细胞对大鼠脊髓损伤神经功能恢复的作用。 设计、时间及地点：细胞组织学对照观察，于2007-03/2008-04在承德医学院完成。 材料：健康成年雄性SD大鼠40只，由解放军军事医学科学院动物中心（北京）提供。 方法：取4只大鼠，采用密度梯度离心法和贴壁法体外分离培养骨髓间充质干细胞，传至第2代于临用前24 h行BrdU标记。余36只大鼠均建立T12脊髓损伤模型，1周后随机分为3组，局部注射组于损伤部位上下位点注射1×106个骨髓间充质干细胞至损伤大鼠体内；尾静脉注射组通过尾静脉移植等量骨髓间充质干细胞至损伤大鼠体内；模型对照组不行细胞移植。 主要观察指标：神经功能缺损BBB评分，苏木精-伊红染色病理学检测，细胞分化免疫组化染色结果。 结果：细胞移植后2，4，6周，模型对照组神经功能缺损BBB评分均显著低于局部注射组、尾静脉注射组（F=721.373，F=1 114.450，F=1 004.099，P均 < 0.01）；局部注射组神经功能缺损BBB评分均显著高于尾静脉注射组（t=55.261，t=71.385，t=78.135，P均 < 0.01）。苏木精-伊红染色结果显示，模型对照组损伤脊髓组织有较多空腔，横断处形成大量空泡；局部注射组无明显空腔，空泡小而少，间质水肿较轻。移植后4，6周，部分植入的骨髓间充质干细胞呈微管相关蛋白2及胶质纤维酸性蛋白双阳性表达。 结论：局部注射和尾静脉注射两种途径移植的骨髓间充质干细胞均可在脊髓损伤处存活、分化并改善神经功能，且局部注射的效果优于尾静脉注射。     

胎鼠神经干细胞局部注射移植大鼠高位脊髓损伤缺损处：体感及运动诱发电位与后肢运动功能评价

背景：如何促进脊髓损伤后的神经再生和功能恢复始终是医学界一大难题,胚胎神经干细胞有利于神经元的存活,并能促进轴突再生。 目的：观察胚胎鼠神经干细胞局部注射移植治疗高位脊髓损伤大鼠的可行性,以神经电生理及后肢运动功能评分评价其效果。 设计、时间及地点：细胞学体内实验,于2007-06/2008-06在哈尔滨医科大学动物实验中心完成。 材料：健康成年雌性SD大鼠40只,随机分为生理盐水组、细胞移植组,20只/组。另取孕14 d的SD大鼠5只用于制备胚胎神经干细胞。 方法：生理盐水组、细胞移植组大鼠均建立高位脊髓损伤模型,取双侧第8~10对肋间神经各2 cm,交叉植入脊髓缺损处(近端白质与远端灰质、远端白质与近端灰质),细胞移植组局部注射鼠胚胎神经干细胞2×106个,生理盐水组局部注射等量无菌生理盐水。 主要观察指标：通过体感诱发电位和运动诱发电位的检测,观察神经电生理恢复情况;通过BDA顺行神经示踪,观察运动传导束恢复情况;BBB后肢运动功能评分结果。 结果：细胞移植组大鼠体感诱发电位及运动诱发电位的潜伏期、波幅明显优于生理盐水组(P < 0.01);细胞移植组大鼠在损伤区有较多BDA标记阳性神经纤维通过,而生理盐水组未见BDA标记阳性神经纤维;细胞移植组大鼠BBB后肢运动功能评分较生理盐水组明显提高(P < 0.01)。 结论：胎鼠神经干细胞局部注射可以较好地恢复高位脊髓损伤后的神经电生理及后肢运动功能。     

BDNF-GFP转染神经干细胞修复大鼠脊髓损伤：发挥干细胞与神经因子的双重效应？

摘要 背景：神经干细胞移植入大鼠脊髓损伤模型可以促进功能恢复,基因治疗已被广泛用于治疗脊髓损伤。 目的：确定BDNF-GFP转染后神经干细胞移植对大鼠脊髓损伤的修复效果。 设计,时间和背景：本实验是在中国医科大学基础医学院发育生物学实验室与2009年5月至2010年1月完成。 材料：10只新生Wistar大鼠和88只2-3个月大,雌雄不限的Wistar大鼠。 方法：以携带BDNF-GFP基因的腺病毒转染神经干细胞。88只Wistar大鼠中假手术组8只, 80只大鼠制成T9左侧横断模型,并随机分成四组：BDNF和GFP修饰的神经干细胞移植组,GFP修饰的神经干细胞移植组;单纯神经干细胞移植组和模型组。在各神经干细胞移植组,脊髓损伤后向横断处显微注射等体积细胞,模型组在相同的部位注射等体积的PBS。 主要观察指标： BBB评分检测脊髓损伤模型运动功能恢复情况;制备脊髓损伤模型2周后取材,免疫组化评估BDNF-GFP转染的神经干细胞移植后的细胞学特点;制备脊髓损伤模型2、4、6、8周Real-time PCR检测脊髓横断处BDNF表达情况。 结果： BDNF-GFP转染后神经干细胞在脊髓半切模型中存活并表达BDNF和GFP,移植该细胞后的大鼠体内高表达具有生物活性的BDNF,且脊髓损伤动物运动功能较对照组明显恢复。 结论：移植BDNF-GFP转染后神经干细胞可能是一种修复脊髓损伤的有效的方法。 关键词：神经干细胞,脑源性神经营养因子;绿色荧光蛋白;脊髓损伤;移植。     

再程序化脂肪干细胞移植治疗大鼠脊髓损伤的机制

目的制备再程序化脂肪干细胞(ADSCs),并在体研究再程序化ADSCs移植入大鼠脊髓损伤模型后促进损伤脊髓神经功能恢复的作用和机制。方法体外培养、纯化和鉴定大鼠ADSCs,并利用慢病毒包装神经元生成素2(Ngn2)基因转染ADSCs制备再程序化干细胞。体内实验将48只雌性SD大鼠随机分成3组:SCI对照(A)组、单纯ADSCs移植(B)组和Ngn2-ADSCs移植(C)组。采用BBB评分评价大鼠运动功能,并通过HE染色、免疫组化和免疫荧光等方法检测脊髓组织学改变和相关蛋白的表达水平,进而观察实验动物脊髓功能恢复情况。结果 Ngn2-ADSCs移植组在运动功能评分、胶质瘢痕的形成、脊髓损伤后病理变化和分泌神经营养因子BDNF和VEGF蛋白含量明显优于其他组。结论 Ngn2-ADSCs移植后能有效地存活,并分化为神经细胞,抑制胶质瘢痕形成,减小脊髓损伤空洞,增加BDNF和VEGF表达,最终促进SCI大鼠的运动功能恢复,较单纯应用ADSCs能更好地促进SCI修复。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.