类别特异性命名区脑定位的临床研究

目的 研究人脑内是否存在类别特异性命名区.方法 13例功能区病变患者,术中唤醒状态下,皮层直接电刺激(DES)确定是否存在类别特异性命名区.结果 DES发现命名障碍区28个,错语4个:1个为名人面孔特异性错语,其余为三种类型命名均错语.命名不能24个:(1)名人面孔特异性脑区6个;(2)名人面孔和动物命名共同脑区4个;(3)动物和工具命名共同脑区10个;(4)三种类型命名共同脑区4个;(5)没有单独工具、单独动物或名人面孔和工具共同命名的脑区.结论 人脑内存在名人面孔特异性命名区,提示术中需增加名人面孔命名任务,以减少阴性刺激的发生率.     

Intraoperative brain mapping during awake surgery in symptomatic supratentorial cavernomas

BackgroundComplete resection of symptomatic supratentorial cavernoma (SCA) and removal of the surrounding gliotic area is recommended to minimize the risk of persistent seizures or (re)bleeding. Surgery of SCA located in an eloquent area, can carry out severe postoperative neurological morbidity. We report a study aimed to assess feasibility, extent of resection and outcome after surgical removal of CA by cortico-subcortical intraoperative brain stimulation (ioBS) in the awake patient.MethodsSix patients diagnosed of symptomatic SCA located on an eloquent area and operated on while awake under local anaesthesia ioBS, were included. Preoperative planning included neuropsychologic assessment of language-related functions, sociocognitive functions and executive functions. Intraoperatively, we recorded the results achieved in the planned neuropsychological tasks when stimulation was applied (cortical and subcortical). Postoperative control 3D MRI was scheduled at 1 month after surgery to calculate extent of resection. Neuropsychological assessment at 6 months after surgery was performed in all cases.ResultsSix patients (5 females, 1 male) aged 24–48 years were included in our study. Locations of the lesions were right insular (n = 1), left insular (n = 1), left temporo-insular (n = 1), left temporal (n = 2) and left frontal (n = 1). In all patients, positive findings were obtained during ioBS. In 5 patients, complete surgical resection was achieved. Two patients had postoperative transient neurological deficits, one case of hemiparesis, one case of dysnomia, both cleared over a 6-month period. Clinical follow-up revealed that all patients experienced complete recovery from preoperative symptoms within a year and five patients with seizures showed marked improvement and eventually quit antiepileptic drugs. Neuropsychological assessment at 6 months provided normal results compared to preoperative baseline in all domains.ConclusionsOur study suggests that ioBS in the awake surgery of symptomatic SCA located in eloquent areas, allows to increase the rate of complete resection, minimizing postoperative neurological and neuropsychological deficit, and improving postoperative seizures control.     

Genome scale mapping of brain gene expression.

Two new approaches, voxelation and gene expression tomography (GET), permit multiplex acquisition of gene expression patterns in the brain. Both methods result in volumetric images of gene expression analogous to those produced in biomedical imaging systems. Voxelation employs analysis of spatially registered cubes from the brain, whereas GET entails analysis of parallel slices obtained by rotation about multiple axes. These methods have been used to investigate neurologic diseases and their models in both humans and mice. The results of these studies are discussed, as is the future of high-throughput gene expression mapping in the brain.     

水通道蛋白-4在脑出血大鼠脑组织的分布

目的 观察脑出血大鼠水通道蛋白-4(AQP4)在脑组织的分布变化及其在出血性脑水肿中的作用。方法 采用定量胶原酶注人大鼠尾状核建立脑出血模型，应用免疫组化法观察脑出血后不同时间大鼠脑组织AQP4的表达。结果 AQP4阳性细胞主要分布在脑出血血肿周围区和大脑皮质的星形胶质细胞、脑室周围、视上核和室旁核。脑出血后6h起，AQP4表达增强，出血后72h达高峰，出血1周后仍高于正常水平。结论 脑出血后，AQP4在与水代谢密切相关的部位表达明显增强，提示AQP4在出血性脑水肿的形成过程中起重要作用。     

精神分裂症患者脑电地形图与CT扫描对比分析

对５５例首次入院的精神分裂症或分裂样精神病患者脑电地形图（ＢＥＡＭ）与ＣＴ扫描结果进行对比分析。结果发现，ＢＥＡＭ的阳性检出率显著高于ＣＴ，两者间经一致性检验，Ｋａｐｐａ系数值为０．０３４，说明所观察到的一致性完全是机遇造成。研究表明；两者在功能性和脑器质性精神障碍的辅助诊断研究上各有所长，二者有机结合，应用上才能恰到好处。     

大鼠尾壳核内注射凝血酶对AQP4蛋白表达的影响

目的研究凝血酶对水孔蛋白-4(aqaporin-4,AQP4)表达的影响及引起脑出血后脑水肿形成的机制.方法在立体定向仪下向大鼠右侧尾壳核注射15 U凝血酶,在不同时间段对注射部位邻近脑组织AQP4蛋白进行免疫组化检测.结果注射凝血酶6 h后尾壳核AQP4蛋白表达开始增高,在第1 d达高峰,并维持到第3 d,以后逐渐下降到正常水平.结论凝血酶能促进脑微血管周围的AQP4蛋白表达的增加,加速水分的跨膜流动,引起星形胶质细胞水肿和血脑屏障的破坏,导致脑出血早期阶段脑水肿的发生.     

皮层电刺激定位功能区的有效刺激参数研究

目的 探讨手术治疗中央区癫痫时,皮层电刺激功能区定位的有效刺激参数.方法 回顾性分析2006年10月至2008年3月北京功能神经外科研究所连续收治的21例中央区癫痫患者的临床资料,研究皮层电刺激功能定位时,感觉、运动及后放电阈值之间的差异以及与阈值相关的因素.结果 运动、感觉、后放电的平均阈值分别为:(3.48±0.87)mA、(3.86±1.31)mA和(4.84±1.38)mA.后放电阈值高于运动、感觉阈值(P＜0.05),且与病史呈负线性关系.结论 以频率50 Hz、脉宽0.2 ms、刺激强度8 mA以下等刺激参数行皮层电刺激定位功能区是安全可靠的;皮层功能定位应个体化实施.

Abstract：

Objective The purpose of the study was to investigate the effective parameters of electric cortex stimulation (ECS)for functional brain mapping.Method We collected 21 subjects who underwent epilepsy surgeries consecutively in Beijing Institute of Functional Neurosurgery with the epileptogenic zone located in perirolandic areas from October 2006 to March 2008.With retrospective study, we systematically analyzed the information about threshold of motor and sensory response and afterdischarge.Results The average threshold of motor and sensory response and afterdischarge were (3.48 ± 0.87 ) mA, ( 3.86 ± 1.31 )mA, (4.84 ± 1.38) mA respectively.The average threshold of afterdischarge was higher than that of motor and sensory response.The difference was significant ( P ＜ 0.05 ).The threshold of afterdischarge was in negative linear correlation with illness duration.Conclusions The ECS parameters of 50 Hz, 0.2 ms for functional brain mapping are effective and safety; ECS should be performed respectively.     

Technique for casting chronic extradural and intracerebral cannula arrays

A technique for fixing multiple brain cannulae in uniform arrays by embedding guide cannulae in molded plastic pedestals is described. Methods for producing corresponding threaded caps for protection of the outer ends of the cannulae, and procedures for reducing mortality and morbidity when large number of cannulae are implanted in brain tissue, are presented.     

实验性脑出血大鼠脑水肿的动态变化

目的研究大鼠脑出血后脑水肿的动态变化。方法应用立体定向技术,用大鼠自体股动脉血液100μl缓慢注入大鼠尾状核,制成脑出血模型,动态观察脑水肿的时空变化。脑水肿的测定应用干/湿重法。结果脑出血血肿周围组织含水量与对照组间差别有显著性意义,出血侧脑组织含水量与出血对侧脑组织含水量间差别有显著性意义,以出血后24-72h最明显, 至脑出血后第7d大致恢复正常。24h出血侧基底节脑组织含水量为(77．80±0．53)％,出血对侧为(77．53±0．43)％;72h出血侧基底节为(79.42±0．89)％,出血对侧为(77．64±0．34)％;假手术组手术侧基底节为(76．86±0．88)％,手术对侧为(76．89± 0．87)％。结论脑出血后脑水肿的变化是导致疾病恶化的主要原因之一。     

脑出血大鼠脑红蛋白表达与脑含水量变化

目的：观察脑出血大鼠脑组织内脑红蛋白（Ngb）的表达,探讨其与脑出血后脑水肿之间的关系。方法：将大鼠随机分为3组：正常对照组,假手术组和脑出血组。脑出血组和假手术组动物在模型建立后1、6、24、48、72h5个时间点各随机分为5个亚组。采用立体定向技术将自体血注入大鼠尾状核建立脑出血模型（假手术组注入生理盐水）,用干湿重法测定脑出血后脑含水量的变化,用Western blot检测脑出血后不同时间脑组织内Ngb的表达。结果：与假手术组或正常对照组比较,脑出血组1h时血肿周围脑组织内Ngb表达开始增高（P〈0.05）,24h时脑含水量开始升高（P〈0.05）,二者均在48h时达到高峰并持续至72h（P〈0.01）。结论：脑出血后脑组织内Ngb表达上调。脑出血后Ngb表达水平的变化与脑水肿的发生、发展在时间上不完全同步。     

Distribution of Peripherally Injected Peptide YY ([<Superscript>125</Superscript>I] PYY (3–36)) and Pancreatic Polypeptide ([<Superscript>125</Superscript>I] hPP) in the CNS: Enrichment in the Area Postrema

The mechanism by which blood-borne peptide YY (3-36) (PYY(3-36)) and pancreatic polypeptide (PP) inhibit food intake is not clear and could implicate peripheral (vagal afferent pathways) and/or central (direct action on specific brain nuclei) mechanisms. To identify the primary brain structure(s) that could be activated after a peripheral injection of neuropeptide Y-related peptides, we investigated the distribution of radioactive materials using whole body autoradiography and coronal brain sections. Rats were injected with [125I] porcine (p) PYY(3-36) (i.p., 10 microCi) and killed after 30 min, 1, 2, or 4 h. After i.p. administration, significant amounts of radioactive materials were rapidly (<30 min) detected in the blood circulation and various tissues including the kidneys, liver, lung, heart, bone marrow, gastrointestinal tract, and thyroid gland, whereas in the brain, low but significant amounts of radioactive materials were detected at the level of the area postrema. Next, we investigated the distribution of radioactive labeling in the brain after i.v. injections of [125I]pPYY(3-36) (Y2 and Y5 subtypes), [125I] human (h) PP (Y4 and Y5 receptors), and [125I][Leu(31), Pro(34)] pPYY (Y1, Y4 and Y5 classes) in the rat brain. Fifteen minutes post injection, autoradiograms revealed positive signals only in the area postrema after the injection of [125I]-hPP and [125I][Leu(31), Pro(34)]pPYY. Whereas the presence of [125I]pPYY(3-36)-related labeling was detected in the area postrema, subfornical organ, and median eminence. In all other brain structures, including all hypothalamic nuclei and other circumventricular organs, near background level signals were detected. These data suggest that the inhibition of food intake observed after peripheral injections of pPYY(3-36) and hPP could involve receptor activation preferentially located at the level of the area postrema, a structure well-known to be involved in the modulation of food intake.     

无创性脑电阻抗测定在脑出血患者脑水肿监测中的应用

目的 应用无创性脑电阻抗测定探讨急性脑出血患者脑水肿的变化规律及意义.方法 分别检测200名健康志愿者和78例脑出血患者的脑电阻抗扰动系数及其动态变化,通过多媒体图像分析系统计算头颅CT上血肿和血肿周围水肿的体积,并进行相关分析.结果 ①健康志愿者左、右大脑半球扰动系数分别为(7.98±0.95)和(8.02±0.71),基本对称(P＞0.05).性别、年龄及3～6 h连续检测前后对其无明显影响(P＞0.05).②脑出血患者的总体检测阳性率为73.1%.血肿位于基底节区时阳性率最高(83.3%),病灶体积大于20 ml者阳性率(80.0%～88.9%)明显高于体积小于20 ml者(48.1%).③脑出血患者血肿侧扰动系数由低于血肿对侧至逐渐升高并超过血肿对侧,这个"交叉"时间平均为起病后(19.67±11.52)h,在该时间点后血肿周围水肿体积较前明显增大(P＜0.05),同时扰动系数亦明显升高(P＜0.01).④起病24h内的血肿侧扰动系数变化与血肿体积及血肿周围组织水肿体积无相关关系(P＞0.05);而病后3 d的血肿侧扰动系数变化与血肿周围组织水肿体积具有显著正相关关系(r=0.5977,P＜0.01).结论 脑电阻抗测定可较敏感地反映脑出血患者脑水肿的变化,扰动系数越高,则提示脑水肿越重.病灶位于基底节区时检测阳性率最高.该方法为临床上进行动态、床旁连续无创性脑水肿监测提供了新的有意义的手段.     

More "mapping" in brain mapping: statistical comparison of effects

The term "mapping" in the context of brain imaging conveys to most the concept of localization; that is, a brain map is meant to reveal a relationship between some condition or parameter and specific sites within the brain. However, in reality, conventional voxel-based maps of brain function, or for that matter of brain structure, are generally constructed using analyses that yield no basis for inferences regarding the spatial nonuniformity of the effects. In the normal analysis path for functional images, for example, there is nowhere a statistical comparison of the observed effect in any voxel relative to that in any other voxel. Under these circumstances, strictly speaking, the presence of significant activation serves as a legitimate basis only for inferences about the brain as a unit. In their discussion of results, investigators rarely are content to confirm the brain's role, and instead generally prefer to interpret the spatial patterns they have observed. Since "pattern" implies nonuniform effects over the map, this is equivalent to interpreting results without bothering to test their significance, a practice most of the experimentally-trained would eschew in other contexts. In this review, we appeal to investigators to adopt a new standard of data presentation that facilitates comparison of effects across the map. Evidence for sufficient effect size difference between the effects in structures of interest should be a prerequisite to the interpretation of spatial patterns of activation.     

Decreased NPY innervation of the hypothalamic nuclei in rats with cancer anorexia

Whether the decrease in food intake that occurs at the onset of anorexia in tumor bearing (TB) rats is related to a change in the hypothalamic neuropeptide Y (NPY) system was tested by comparing NPY expression in sham operated Fischer Control and anorectic TB rats. Coronal cryocut sections of their fixed brain were processed by the peroxidase-antiperoxidase method with NPY polyclonal antibodies. NPY-immunoreactive fibers were widely distributed throughout the forebrain, but were most prominent in the hypothalamic paraventricular, suprachiasmatic, arcuate and periventricular nuclei. NPY-immunoreactive neurons were visualized in Control and anorectic TB rats in the preoptic region, the arcuate nucleus, and occasionally in the lateral hypothalamus. Semiquantitative image analysis showed a significant decrease in the NPY immunostaining in some hypothalamic nuclei of the anorectic TB rats, most prominently in the supraoptic nucleus, the parvocellular portion of the paraventricular nucleus, and, to a lesser extent, the suprachiasmatic and arcuate nuclei. No changes in NPY innervation were seen in the ventromedial nucleus and the lateral hypothalamus. The data support the hypothesis of an altered hypothalamic NPY system at the onset of anorexia in TB rats and also reveal the hypothalamic nuclei through which NPY influences food intake.     

红细胞在实验性脑出血后脑水肿形成中的作用

目的研究红细胞在脑出血后脑水肿形成中的作用。方法向大鼠尾状核分别注入浓缩红细胞（PRBC）、溶解红细胞（LRBC）及不同浓度的大鼠血红蛋白（Hb）,并比较鼠脑不同部位脑水肿形成的特点。结果红细胞对脑水肿的影响要在脑出血后第3d,其水肿的严重程度与Hb的浓度呈正相关。结论红细胞对脑出血后脑水肿形成的影响主要在脑出血后第3d,可能与红细胞溶解释放血红蛋白有关。     

红细胞对创伤性脑内出血大鼠脑含水量及HO-1表达的影响

目的研究大鼠创伤性脑内出血(TICH)中红细胞对脑含水量和血红素氧合酶-1(HO-1)表达的影响,并分析二者的关系,以探讨红细胞在TICH后脑水肿形成中的作用机制。方法120只大鼠随机分为创伤性脑损伤组(TBI组),TBI加注全血组(WB组),TBI加注溶解红细胞组(LRBC组)和TBI加注压积红细胞组(PRBC组),每组30只。4组均采用自由落体打击法造成大鼠脑外伤。后3组借助立体定向仪分别向伤区脑皮质内注射全血、溶解红细胞或压积红细胞,造成TICH模型。每组于伤后1、3、5d分别处死10只大鼠,5只测伤区脑组织含水量,5只用免疫组化法检测HO-1的表达。结果4组组内比较:TBI、WB和PRBC3组第3d的脑含水量最高(分别为82.85%±0.60%,85.00%±1.12%,84.93%±1.21%),LRBC组第1d的含水量最高(84.44%±0.85%;4组间比较,1d时LRBC组含水量最高,3d时WB和PRBC组含水量最高。在WB、PRBC和LRBC组,HO-1阳性表达的强弱与脑含水量的高低变化相一致。结论红细胞在TICH后迟发性脑水肿的形成中有重要作用,其机制涉及红细胞的降解产物。     

Depressive mood in pre-dialytic chronic kidney disease: Statistical parametric mapping analysis of Tc-99m ECD brain SPECT

The purpose of this study was to investigate depression-related regions in pre-dialytic patients with chronic kidney disease (CKD) patients. Participants comprised 33 patients with stage 4 and 5 CKD (age, 55 [42–63]) and 32 healthy volunteers (age, 53.5 [49.5–57]). Depressed mood was assessed in the patients, and both groups underwent Tc-99m-labeled ethylcysteinate dimer (Tc-99m ECD) single photon emission computed tomograpy (SPECT). Statistical parametric mapping identified 18 areas of hypoperfusion in the patients in comparison with the normal controls. The largest clusters were areas including left precentral gyrus, right superior and middle temporal gyrus, both cerebellar posterior lobes, both inferior frontal gyrus, right superior and middle frontal gyrus, right cuneus, right inferior parietal lobule, and right putamen. However, there were no specific hypoperfusion areas in CKD patients with depression compared with CKD patients without depression. Interestingly, several hypoperfusion areas in CKD patients (inferior frontal gyrus [BA46], superior temporal gyrus [BA42], anterior cingulate gyrus [BA24]) were concordant with hypoperfusion areas found in patients with major depression who were free of kidney disease. In conclusion, this study did not demonstrate specific depression-related cerebral hypoperfusion areas. However, the cerebral blood flow pattern in CKD patients was similar to that of patients with major depression in some areas. Although further investigations are needed in the future, we suggest that the causes of the higher prevalence of depression in CKD might be associated with this finding.     

大鼠脑出血后行为学、组织学及脑水肿相关性研究

目的 探讨胶原酶诱导大鼠脑出血(ICH)后大鼠行为学的改变及其与脑水肿、组织学改变之间的关系.方法 纹状体区立体定向注射胶原酶建立大鼠纹状体ICH模型,动态观察大鼠ICH后28 d内的行为学、组织学及脑含水量改变.行为学评分采用前肢放置实验、Berderson评分法及角落转向实验,组织学观察采用HE染色,脑含水量测定采用干-湿重法.结果 (1)三种行为学试验结果均提示ICH后第2天大鼠出现严重的神经功能障碍,并在4周内神经功能逐渐恢复;(2)组织学观察显示ICH后存在组织损伤和修复过程;(3)脑含水量测定显示ICH后第2天脑水肿最为明显.在14 d内基本消退;(4)ICH后大鼠前肢放置实验评分和脑水肿之间存在负相关(20.774,P<0.05).结论 (1)大鼠ICH后神经功能存在损伤和修复过程;(2)大鼠ICH后神经功能改善仞期与脑水肿消退相关,而后期则可能与组织自身修复过程相关.     

The effectiveness of low-frequency stimulation for mapping cortical function

OBJECTIVE: To establish the efficacy and safety of low-frequency electrical stimulation for cortical brain mapping. METHODS: Cortical function was mapped using electrical stimulation in epilepsy patients with chronically implanted intracranial subdural electrodes. Contacts overlying motor, sensory, visual, and language cortex were stimulated at frequencies of 5, 10, and 50 Hz, using current levels ranging from 1 to 17.5 mA for 3-5 s. The current intensity and incidence at which functional alterations and afterdischarges (ADs) occurred were recorded. The modified McNemar test for nonindependent measures was used to analyze the data. RESULTS: 122 electrode contact pairs were electrically stimulated at least two different frequencies in 14 patients. Functional alterations were obtained at all stimulation frequencies (5, 10, and 50 Hz) at generally similar rates. The likelihood of producing an AD correlated with stimulation frequency, and lower-frequency stimulation was less likely to provoke an AD. Higher current intensity was required to induce both functional responses and ADs at low-frequency stimulation than high-frequency stimulation. While overall rates of producing functional changes were similar, differences in functional response with regard to frequency were noted at individual cortical sites. CONCLUSION: 5- and 10-Hz stimulation are as effective for mapping cortical function as 50-Hz stimulation and produce fewer ADs. We recommend that mapping of cortical function be started with 5-Hz-frequency stimulation. Higher frequencies should be used in suspect cortex if no symptoms or signs are produced with 5-Hz stimulation.     

Behavioural structure and mechanisms of anorexia: calibration of natural and abnormal inhibition of eating

The study of experimentally induced anorexia poses a problem for investigations of the processes controlling food intake. Inhibition of food consumption may arise from a specific intervention in a physiological system controlling nutritional requirements or from non-specific changes leading to the suppression or contamination of behaviour. The present experiment used the analysis of the structure of behaviour to distinguish between normal anorexia (natural development of satiation) and pathological anorexia brought about by intestinal discomfort (injection of lithium chloride) or adulteration of food (quinine added to diet). The treatments produced marked changes in parameters of feeding and in the frequencies of behaviours associated with eating. Both lithium chloride and quinine treatments gave rise to a slow rate of eating accompanied by a disordered temporal sequence of eating, grooming and resting. This behavioural calibration of anorexia can contribute to the behavioural pharmacology of feeding by helping to diagnose drugs which facilitate normal processes of satiation and those which act via a non-specific disruption of behaviour.