柚皮苷对脑缺血再灌注损伤的保护作用

目的研究柚皮苷(Naringin,NRG)对大鼠局灶性脑缺血再灌注损伤的保护作用及星形胶质细胞是否参与其中。方法柚皮苷连续灌胃7 d后进行大脑中动脉栓塞(middle cerebral artery occlusion,MCAO),缺血2 h后拔出线栓进行再灌注。24 h后TUNEL染色观察凋亡细胞数量,苏木精-伊红(hematoxyli-eosin,HE)染色观察形态学改变,免疫荧光染色分别检测星形胶质细胞标记物胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)和缝隙连接蛋白43(connexin43,Cx43)。结果同模型组相比,柚皮苷预干预后凋亡细胞数量显著减少(P0.05),细胞损伤明显减轻。免疫染色显示柚皮苷可以减轻星形胶质细胞的激活程度,同时Cx43的表达也有所降低(P0.05)。结论柚皮苷预干预可有效减轻脑缺血再灌注损伤,该保护作用同降低星形胶质细胞Cx43表达密切相关。     

癫痫大鼠海马缝隙连接蛋白43的表达及生胃酮的保护作用

目的研究癫痫大鼠海马星形胶质细胞缝隙连接蛋白43(Connexin43,CX43)表达及缝隙连接蛋白阻滞剂生胃酮对其表达的影响。方法用免疫组化法检测癫痫发作后各时间点大鼠海马星形胶质细胞CX43免疫反应阳性表达。同时观察致痫前给予不同剂量生胃酮对大鼠海马星形胶质细胞CX43免疫反应阳性表达的影响。结果对照组大鼠海马星形胶质细胞CX43可见少量散在表达。癫痫组大鼠海马星形胶质细胞CX43表达1h即可见增加,并随时间延长而增加,72h达高峰。生胃酮各组大鼠海马星形胶质细胞CX43免疫反应阳性表达较同一时间点癫痫组低(P<0.01),且与生胃酮剂量呈负相关(P<0.01)。结论癫痫大鼠海马缝隙连接蛋白43的表达与癫痫发病机制密切相关。缝隙连接蛋白阻滞剂生胃酮影响缝隙连接蛋白43表达,具有肯定的神经保护作用。     

星形胶质细胞连接蛋白43及其半通道在脑缺血再灌注损伤中的作用

目的探讨星形胶质细胞连接蛋白43(Cx43)及其半通道在缺血再灌注(IR)损伤中的作用。方法 32只Wistar鼠被随机分为IR 0 h组、IR 4 h组和IR 24 h组和对照组,每组8只鼠。用免疫组化和Western印迹法检测各组大鼠星形胶质细胞Cx43、半通道抗体1(HC1)和半胱天冬酶3(Casp3)的表达。在氧葡萄糖剥夺-再恢复(OGDR)0 h,4 h和24 h,用MTT法检测星形胶质细胞活性,用免疫组化和Western印迹法检测Cx43,HC1和Casp3表达的改变。结果大鼠星形胶质细胞中HC1的表达明显少于Cx43的表达。与对照组比较,IR 4 h组大鼠脑组织中Cx43、HC1和Casp3的表达明显增加(均P0.05),而IR 0 h组和IR 24 h组却没有明显的变化。OGDR后星形胶质细胞cell line和Psup细胞中Cx43、HC1和Casp3的表达在OGDR 4h组明显高于对照组(均P0.05),在OGDR 24 h组则与对照组差异无统计学意义。OGDR后shRNA星形胶质细胞中Cx43、HC1和Casp3的表达无统计学意义上变化。结论 Cx43及HCl在星形胶质细胞凋亡过程中起到了促进作用,这可能是IR损伤发生及发展的机制之一。     

应用激光共聚焦显微镜研究脑缺血再灌注后缝隙连接重分布

目的 探讨脑缺血再灌注对脑神经细胞间缝隙连接分布的影响.方法 应用激光共聚焦显微镜技术观察脑缺血再灌注后不同缺血区缝隙连接分布变化,并探讨其可能机制及变化规律.结果 正常组Cx43分布于星形胶质细胞之间及脑毛细血管周围,分布均匀,光斑较小,在毛细血管周围排列紧密;与正常组比较,缺血2h再灌注24h半影区Cx43光斑较大,分散的小光斑相对较少;坏死区Cx43稀疏、散乱.结论 脑缺血再灌注后半暗带区缝隙连接发生重分布,形成了更大的缝隙连接斑,以加强细胞间物质及信号的传递.

Abstract：

Objective To investigate the effect of the redistribution of gap junction after reperfusion subsequent to cerebral ischemia. Methods In the test laser scanning confocal microscope (LSCM) was used to investigate the change of Cx43 distribution, and to study its possible mechanism. Results Compared to the control group, the Cx43 expression formed into bigger plagues and remained linear disposition in the penumbra in 24h of reperfusion after cerebral ischemia and changed sparse and messy in the infarction core of ischemia. Conclusion Gap junctions were redistributed in the penumbra after reperfusion subsequent to cerebral ischemia.     

氧糖剥离对星形胶质细胞CX43蛋白表达及分布的影响

目的探讨氧糖剥离(oxygen-glucose deprivation,OGD)对星形胶质细胞缝隙连接蛋白Cx43蛋白表达及分布的影响,为急性脑缺血早期临床治疗提供理论基础。方法通过OGD模拟缺血缺氧诱导激活培养的原代星形胶质细胞,采用免疫印迹及荧光显微镜观察缝隙连接蛋白Cx43的蛋白表达变化及细胞内亚分布特点。结果星形胶质细胞经OGD诱导后在再灌12h Cx43表达上调约1.5倍(P0.01),有统计学意义;再灌24h时Cx43表达轻度下调(P=0.13),无统计学意义;在再灌48h其下降约34%,与对照组相比,有统计学意义(P0.01)。同时在再灌24h时可见部分Cx43定位分布到细胞核。结论 OGD导致星形胶质细胞Cx43蛋白表达呈先升高后下降的动态变化并且有部分Cx43蛋白定位到细胞核,提示针对Cx43蛋白的干预治疗应考虑治疗时间窗。     

缝隙连接蛋白-43阻断剂辛醇对小鼠脑缺血再灌注损伤的神经保护作用

目的观察小鼠脑缺血再灌注后缝隙连接蛋白-43(Cx43)表达变化及缝隙蛋白阻断剂辛醇对小鼠梗死体积的影响。方法采用线栓法制备小鼠大脑中动脉阻塞模型(MCAO模型),应用免疫印迹(Western blot)方法观察脑缺血再灌注损伤前后Cx43表达变化和辛醇对Cx43表达的影响,并计算各组死亡率及脑梗死体积。结果小鼠脑缺血2h再灌注损伤24h条件下,缺血区Cx43表达在损伤前后无明显变化(P>0.05)。辛醇能显著抑制脑缺血再灌注损伤后Cx43表达,降低死亡率及减少脑梗死体积,具有统计学差异(P<0.05)。结论由Cx43组成的缝隙连接蛋白在脑缺血再灌注损伤过程中具有重要作用,缝隙蛋白-43阻断剂辛醇通过抑制海马及皮质Cx43表达,进而降低死亡率及梗死体积,从而发挥神经保护作用。     

七氟醚预处理对脑缺血再灌注损伤后含核转录因子κB反应元件相关蛋白的影响

目的 探讨七氟醚预处理对大鼠脑缺血再灌注损伤后含核转录因子κB（NF-κB）反应元件的蛋白细胞黏附分子[细胞间黏附分子-1（ICAM-1）和血管细胞黏附分子-1（VCAM-1）]、基质金属蛋白酶-2（MMP-2）和基质金属蛋白酶-9（MMP-9）的影响.方法 雄性SD大鼠随机分为假手术组、缺血组和七氟醚预处理组.采用线栓法制备大脑中动脉栓塞大鼠模型.Western blot检测缺血再灌注6、24、48和72 h后缺血侧ICAM-1、VCAM-1、MMP-2和MMP-9表达.伊文思蓝（EB）染色观察血脑屏障的通透性.结果 七氟醚预处理组缺血侧脑组织中EB含量显著低于缺血组（P＜0.01）.缺血组各再灌注时间点ICAM-1、VCAM-1、MMP-2和MMP-9表达均显著高于七氟醚预处理组.结论 七氟醚预处理可能通过抑制再灌注损伤后含NF-κB反应元件的ICAM-1、VCAM-1、MMP-2和MMP-9的上调起神经保护作用.     

腺苷预处理对脑缺血再灌注脑内星形胶质细胞的影响

目的 探讨腺苷预处理对脑缺血再灌注损伤脑内星形胶质细胞的影响.方法 制作大鼠脑缺血再灌注损伤模型.60只SD大鼠随机分为3组:假手术组(F组)、缺血再灌注组(IR组)、腺苷预处理组(AP组),再按缺血再灌注后不同时间把各组随机分成4个亚组,每组5只大鼠.应用Zeal Longa 5级评分法进行神经功能评分,并通过免疫组织化学法检测脑组织内胶质纤维酸性蛋白(glial fibrillary acid protein,GFAP)的表达.结果 (1)神经功能评分AP组各亚组均小于IR组各亚组(P均＜0.05),但大于F组各亚组(P均＜0.05);(2)F组GFAP阳性表达均较弱,IR组和AP组在脑缺血再灌注后2h开始出现GFAP阳性表达的细胞数量增多,AP组在6h、24h AP组GFAP阳性表达比IR组增强(P均＜0.05),在72h时AP组GFAP阳性表达较IR组减少(P＜0.05).结论 腺苷预处理能在大鼠局灶性脑缺血再灌注损伤早期阶段促进GFAP的表达,72h后抑制GFAP的过度表达.     

自由基清除剂预处理对大鼠脑缺血再灌注损伤后脑组织细胞凋亡及其相关蛋白表达的影响

目的探讨自由基清除剂依达拉奉预处理对大鼠脑缺血再灌注损伤后神经细胞凋亡及其相关蛋白Bcl-2、Bax、热休克蛋白70(HSP70)表达的影响。方法将45只雄性SD大鼠随机分为假手术组、对照组、依达拉奉预处理组,每组15只。采用线栓法制作大鼠缺血2h再灌注24h模型。预处理组大鼠建模前12h腹腔注射依达拉奉(3mg/kg),对照组给予等容量生理盐水。再灌注24h后断头取脑,应用免疫组织化学法检测Bcl-2、Bax、HSP70蛋白表达,末端脱氧核糖核酸转移酶介导的原位缺口末端标记法检测凋亡细胞。结果依达拉奉预处理组和对照组大鼠缺血周围脑组织中凋亡细胞和Bcl-2、Bax及HSP70阳性细胞数比假手术组均明显增加(P<0.01);与对照组比较,其凋亡细胞和Bax阳性细胞数均明显减少(P<0.01),而Bcl-2和HSP70阳性细胞数明显增加(P<0.01)。结论细胞凋亡在缺血再灌注损伤中起着重要作用;依达拉奉可能通过上调Bcl-2、HSP70蛋白表达、下调Bax蛋白表达减轻大鼠脑缺血再灌注后的细胞凋亡,增加脑缺血再灌注损伤耐受性,从而起到神经保护作用。     

缺血后处理对大鼠脑缺血再灌注后缝隙连接蛋白43的影响

目的 观察缺血后处理对脑缺血再灌注后缝隙连接蛋白43(Cx43)的影响.方法 30只Wistar雄性大鼠随机分为假手术(Sham)组、缺血再灌注(I/R)组、缺血后处理(IP)组.采用线栓法建立大鼠大脑中动脉缺血模型,脑缺血2h后,I/R组予再灌注,IP组给予大脑中动脉血流再通30s,之后阻断血流30s,如此进行3个循环之后予永久再灌注.于脑缺血再灌注后24h行TTC染色观察脑梗死体积、神经功能缺损评分,应用激光共聚焦显微镜观察Cx43蛋白表达量及分布的变化,行各组间比较.结果 IP组脑梗死体积明显小于I/R组,IP组神经缺损评分低于I/R组,与Sham组相比,I/R组Cx43数量明显减低、分布紊乱,IP组Cx43表达数量及分布明显好于I/R组.结论 缺血后处理可减小脑梗死体积、减轻神经功能缺损,缺血后处理能抑制Cx43表达减少、改善Cx43分布情况.     

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.     

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.     

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.     

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.     

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.     

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.