蛛网膜下腔出血后脑脊液细胞因子水平与脑血管痉挛的关系

脑血管痉挛是蛛网膜下腔出血(SAH)的一种常见并发症。目前,脑血管痉挛的确切发生机制还不完全清楚,也缺乏有效控制脑血管痉挛发生和发展的方法。近年来,一些学者发现,SAH后脑脊液和血清某些细胞因子水平可能发生改变,细胞因子所引起的炎症反应可能与脑血管痉挛有一定关联。因此,检测脑脊液和血清细胞因子水平对预测SAH的严重程度、转归和及早治疗均有重要意义。     

蛛网膜下腔出血患者血清与脑脊液中NO和CGRP水平变化及意义

目的观察伴和不伴脑血管痉挛蛛网膜下腔出血（SAH）患者血清与脑脊液中一氧化氮（NO）和降钙素基因相关肽（CGRP）水平的变化。方法根据是否合并脑血管痉挛,将53例SAH患者分为有症状脑血管痉挛组、无症状脑血管痉挛组和非痉挛组。72h及1、2、3和4周时分别抽血和采取脑脊液,分别测定血清和脑脊液中NO和CGRP水平。结果出血后,三组患者脑脊液和血清NO与CGRP水平逐渐降低,1～2周时降低最明显,随后逐步回升;1、2、3周时痉挛组血清和脑脊液中NO和CGRP水平较非痉挛组明显降低。结论SAH后脑脊液和血清NO与CGRP水平降低可能是引起脑血管痉挛的重要因素。     

人工脑脊液脑池内冲洗防治蛛网膜下腔出血患者的脑血管痉挛

目的 探讨应用人工脑脊液脑池内冲洗引流防治动脉瘤破裂后SAH导致的脑血管痉挛的治疗方法,以提高疗效,改善预后.方法 对132例动脉瘤合并SAH Fisher Ⅲ～Ⅳ级的患者,3d内急诊行动脉瘤夹闭术.脑池内冲洗组67例,夹闭术中视交叉池置入冲洗管,在外侧裂池置入引流管.夹闭术后开始进行人工脑脊液脑池内冲洗,腰椎穿刺组65例,夹闭术后腰椎穿刺引流血性脑脊液.夹闭术后动态监测脑脊液中红细胞数量的变化及行经颅多普勒(transcranial Doppler,TCD)监测脑血管痉挛的情况.结果 两组患者夹闭术后脑脊液红细胞数均呈下降趋势,经t检验,第1天两组差异无统计学意义,第3天后脑池内冲洗组红细胞数均低于腰椎穿刺组,差异均有统计学意义,P＜0.01.两组症状性脑血管痉挛的发生率,脑池内冲洗组为4%,低于腰椎穿刺组的26%,P＜0.01;夹闭术后各时期TCD报告的脑血管痉挛发生率,脑池内冲洗组均低于腰椎穿刺组,P＜0.01.夹闭术后脑池内冲洗组偏瘫的发生率低于腰椎穿刺组,x2=8.335,P＜0.01.脑池内冲洗组较腰椎穿刺组SAH清除快,血管痉挛的发生率明显减少,致残率下降.结论 急性期动脉瘤夹闭术后人工脑脊液脑池内冲洗防治脑血管痉挛的方法简单、安全,疗效显著.     

CTA联合CTP对蛛网膜下腔出血所致脑血管痉挛与迟发性脑缺血的相关性探讨

目的利用CT血管造影(CTA)联合CT灌注成像(CTP)方法探讨蛛网膜下腔出血(SAH)所致脑血管痉挛(CVS)与迟发性脑缺血(DCI)的相关性。方法利用CTA与CTP技术分析116例SAH病人,CTP指标包括脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)等,在病人入院时、病情恶化时间段及入院后14 d记录CTA图像显示的脑血管痉挛程度和迟发性局灶脑缺血的发生情况,评估发生痉挛的脑血管支配区域与脑灌注图上血流灌注面积间的相关性及不同程度脑血管痉挛导致脑血流灌注和DCI发生之间的差异。结果 45例病人无脑血管痉挛,占38.8%;51例病人发生中等程度脑血管痉挛,占44.0%;20例病人发生严重脑血管痉挛,占17.2%。61.2%脑血管痉挛病人,最少的脑缺血灌注区域与痉挛严重血管的血流区域一致,无血管痉挛区域与严重脑缺血区域CBF明显不同。20例发生严重脑血管痉挛病人中14例出现迟发性局灶脑缺血;51例发生中等程度的脑血管痉挛病人中7例出现迟发性局灶脑缺血;45例无脑血管痉挛病人中4例出现迟发性局灶脑缺血。血管痉挛降低脑血流灌注,但只有66.67%病人脑血管痉挛与乏血供的灌注区域相一致,33.33%严重脑血管痉挛的病人无迟发性脑缺血。结论虽然严重脑血管痉挛能降低脑血流的灌注水平,但血管痉挛不会直接导致迟发性脑缺血。     

脑血管痉挛动物模型的制作

脑血管痉挛按有无症状分为症状性脑血管痉挛和无症状性脑血管痉挛。目前，大多数脑血管痉挛的动物模型均为无症状性脑血管痉挛模型，只有少数几种为症状性脑血管痉挛模型。现将各种脑血管痉挛动物模型的制作方法、特点和适用范围综述如下。     

细胞因子级联反应与蛛网膜下腔出血引起的脑血管痉挛

蛛网膜下腔出血引起的脑血管痉挛的发生机理目前尚不清楚，近年来的研究表明，白细胞介素－6等细胞因子是导致脑血管痉挛的重要物质基础。     

老年蛛网膜下腔出血患者脑脊液改变与脑血管痉挛的关系

目的分析老年蛛网膜下腔出血(SAH)患者脑脊液改变及与脑血管痉挛的关系。方法 89例老年SAH患者均于SAH后7 d接受双侧大脑中动脉(MCA)血流速度检查,测得平均流速为(168.6±25.3)cm/s,并依据MCA血流速度的中位数分为观察组(MCA血流≥167.2 cm/s,n=45)及对照组(MCA血流<167.2 cm/s,n=44)观察脑脊液改变,分析其与脑血管痉挛关系。结果观察组脑脊液内皮素(ET)-1、氧合血红蛋白(Oxy Hb)及白细胞介素(IL)-6水平均显著高于对照组(P<0.05)。观察组MAC血流量与脑脊液ET-1(r=0.779,P<0.01)、IL-6(r=0.681,P<0.01)及Oxy Hb(r=0.771,P<0.01)均呈正相关。结论老年SAH后脑血管痉挛可能与氧化应激、炎症及血管损伤等多种因素相关。     

蛛网膜下腔出血后海马区微血管痉挛及血管内转染一氧化氮合酶基因的影响

目的研究蛛网膜下腔出血(SAH)后海马CA1区神经元及微血管的变化,观察血管内转染内皮型一氧化氮合酶(eNOS)基因后,海马CA1神经元及微血管改变,探讨eNOS基因转染预防脑血管痉挛的作用。方法 24只兔随机分为对照组、SAH组、转染携带eNOS基因重组腺病毒组(AdeNOS组)。每组8只。采用枕大池二次注血法制备兔SAH后脑血管痉挛模型。兔于首次注血后7d进行灌注固定,留取海马区脑组织标本,在电镜和光镜下观察海马神经元及微血管的变化。结果光镜下SAH组海马CA1区神经元较对照组明显减少,微血管周围间隙增宽,管腔狭窄,管壁增厚;电镜下SAH组海马神经元细胞肿胀,结构不完整,细胞核固缩,线粒体空泡化;AdeNOS组损伤较SAH组明显减轻。结论 SAH后脑血管痉挛可引起海马CA1区神经元变性,可能与海马区微血管痉挛改变有关,eNOS基因转染可明显减轻海马神经元损伤,预防SAH后脑血管痉挛的发生。     

脑血管痉挛动物模型的制作

脑血管痉挛按有无症状分为症状性脑血管痉挛和无症状性脑血管痉挛。目前,大多数脑血管痉挛的动物模型均为无症状性脑血管痉挛模型,只有少数几种为症状性脑血管痉挛模型。现将各种脑血管痉挛动物模型的制作方法、特点和适用范围综述如下。     

蛛网膜下腔出血后脑脊液中的致痉原与脑血管痉挛

脑血管痉挛是自发性蛛网膜下腔出血患者发生脑梗死和迟发性缺血性神经功能缺损的主要原因.对脑血管痉挛的研究目前相对集中于血性腩脊液中的致痉原方面.文章对蛛网膜下腔出血后血性脑脊液中的主要致痉原诱发脑血管痉挛的机制进行了综述.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.