通心络对局灶性脑缺血再灌注损伤大鼠保护作用及机制研究

目的 探讨通心络对脑缺血再灌注损伤大鼠的保护作用及其机制。方法用Zea．Longa方法制作大鼠大脑中动脉缺血．再灌模型,观察不同剂量的通心络（0．5mg／kg,2．0mg／kg）对缺血．再灌脑损伤大鼠行为学、脑组织形态学等的影响,检测线粒体内NDA及FAD氧化呼吸链R3、R4、RCR、P／O等评价呼吸功能的指标,以及对脑组织匀浆中超氧化物岐化酶（SOD）,丙二醛（MDA）,谷胱甘肽过氧化物酶（GSH—Px）的影响。结果通心络（2．0mg／kg）能减轻脑缺血-再灌损伤大鼠神经功能缺损,减少脑水肿,缩小脑梗死面积,改善线粒体呼吸链功能,抑制脑组织匀浆中SOD含量的降低及MDA含量的升高。结论通心络对脑缺血再灌注损伤大鼠有保护作用,其机制与改善线粒体呼吸功能和抗脂质过氧化作用有关。     

新型通心络制剂对大鼠脑缺血再灌注后血-脑屏障损伤的保护作用

目的探讨新型通心络制剂对大鼠脑缺血再灌注后血-脑屏障损伤的保护作用。方法将78只SD大鼠随机分为假手术组(6只)、手术组(36只)、通心络组(36只),后两组根据缺血再灌注时间不同再分为脑缺血2h再灌注0.5h、2h、6h、12h、24h和48h组,每组6只;参照Longa线栓法制作大脑中动脉阻塞再灌注动物模型;采用酶联免疫吸附法检测各组大鼠血清S100β蛋白;采用2,3,5-氯化三苯基四氮唑染色法观察各组大鼠脑梗死体积。结果(1)在缺血再灌注0.5h、2h、6h、12h和24h时,通心络组血清S100β蛋白水平较同期手术组降低,差异有显著性(P<0.05)。(2)在缺血再灌注12h、24h和48h,通心络组脑梗死体积明显小于手术组,差异有显著性(P<0.05)。结论新型通心络制剂在脑缺血再灌注后的早期可以降低血清中S100β蛋白水平,减少脑梗死体积;其机制可能是通过保护血-脑屏障而发挥作用。     

通心络胶囊对大鼠脑缺血再灌注损伤的保护作用及其机制

目的 研究通心络胶囊对大鼠缺血再灌注损伤的保护作用及其作用机制.方法 99只SD大鼠随机分为通心络治疗组、通心络预防组及未用药对照组,线栓法建立缺血2 h再灌注损伤模型,再灌注后1 h、1 d和5 d断头取脑.TTC测定脑梗死体积;干湿法计算脑含水量;电镜观察海马神经元超微结构;羟胺法检测SOD含量;TBA法检测MDA含量;比色法检测GSH-PX、钠-钾-ATP酶、NO含量;免疫荧光观察小胶质细胞活化情况.结果 在通心络药物干预下,大鼠脑梗死侧和梗死对侧含水量减少,脑梗死体积减小,缺血性海马神经细胞坏死肿胀减轻,SOD、GSH-PX和钠-钾-ATP酶含量增加,MDA、NO含量降低(P<0.05),小胶质细胞的表达减少.结论 通心络胶囊可能通过调节自由基、减轻钙内流和抑制炎症反应的作用机制减轻脑缺血再灌注损伤.     

丹参多酚酸盐对缺血再灌注损伤大鼠脑组织BDNF和GDNF的影响

目的观察丹参多酚酸盐对大鼠局灶性脑缺血再灌注损伤后脑组织内脑源性神经营养因子（BDNF）及胶质源性神经营养因子（GDNF）表达的影响,探讨其神经保护作用的机制。方法线栓法制作大鼠大脑中动脉闭塞再灌注损伤模型,SD大鼠随机分为正常对照组、缺血再灌注组、丹参多酚酸盐低剂量治疗组（10mg／kg）和丹参多酚酸盐高剂量治疗组（30mg／kg）,观察各组大鼠的行为学改变,测定脑梗死体积,ELISA法检测脑组织中BDNF和GDNF的含量。结果与缺血再灌组比较,丹参多酚酸盐可以显著降低大鼠神经损伤行为学评分,减少脑梗死体积,增加脑组织内BDNF和GDNF的含量,且呈剂量依赖性。结论丹参多酚酸盐对脑缺血再灌注损伤有明显的保护作用,其机制与促进脑组织合成BDNF及GDNF有关。     

槲皮素对脑缺血再灌后FADD蛋白表达的影响

目的研究大鼠脑缺血/再灌后Fas相关死亡域蛋白（FADD）的表达及槲皮素对其影响。方法用免疫组化法测定缺血2h再灌注不同时相缺血半暗带FADD蛋白的表达。结果缺血半暗带脑皮质内FADD蛋白的表达于再灌注3h明显升高,再灌注12h达高峰（P〈0.01）,至再灌注24h其表达明显下降。槲皮素能显著下调其表达（P〈0.01-0.05）。结论脑缺血/再灌后缺血半暗带FADD蛋白表达明显增加,提示可能在脑缺血/再灌注损伤中发挥重要作用。槲皮素可能通过抑制其表达从而达到脑保护的作用。     

棓丙酯对大鼠急性脑缺血再灌注损伤的保护作用

目的探讨棓丙酯注射液对大鼠急性脑缺血-再灌注损伤的保护作用及其可能机制。方法采用线栓法制备大鼠右侧大脑中动脉栓塞所致的缺血-再灌注模型。观测神经功能学评分、脑梗死面积、光镜和电镜下形态结构、超氧化物歧化酶活性及丙二醛含量变化。结果与模型组相比,棓丙酯注射液能降低大鼠急性脑缺血-再灌注后神经功能学评分、梗死面积、缺血区脑组织MDA含量,并且能够减轻脑组织形态学和超微结构损伤、升高SOD活性。结论棓丙酯注射液对大鼠急性局灶性脑缺血-再灌注损伤有保护作用,其机制可能与升高SOD活性、清除自由基有关。     

丁苯酞对大鼠局灶性脑缺血再灌注损伤后caspase-3表达的影响

目的:观察丁苯酞(NBP)对脑缺血再灌注损伤后的神经保护作用及caspase-3表达的影响。方法:SD大鼠46只随机分成假手术组(n=6)、缺血再灌注组(n=10)、NBP大剂量组(80mg·kg-1,n=10)、NBP中剂量组(40mg·kg-1,n=10)和NBP小剂量组(20mg·kg-1,n=10),采用ZeaLonga法制作局灶性脑缺血再灌注大鼠模型,观察NBP对大鼠脑缺血再灌注后的神经功能症状、组织形态学改变、以及对caspase-3表达的影响。结果:与假手术组相比,缺血再灌注组大鼠出现严重的神经功能缺失症状,光镜下脑组织出现明显的梗死缺血灶,皮质和海马区caspase-3表达增强;与缺血再灌注组比较,NBP治疗组能显著改善大鼠神经功能缺失症状,减少脑组织的梗死缺血损伤,降低caspase-3的表达,其中以NBP大剂量组的神经保护作用最为显著(P<0.001)。结论:NBP对大鼠局灶性脑缺血再灌注损伤具有保护作用,其作用机制可能与抑制caspase-3表达相关。     

垂体腺苷酸环化酶激活肽对大鼠脑缺血-再灌注后IL-1β表达的影响

目的 探讨PACAP对大鼠局灶性脑缺血-再灌注损伤后脑保护作用及保护机制.方法 采用大脑中动脉线栓法建立局灶性脑缺血-再灌注模型,对36只大鼠随机分为假手术组、缺血-再灌注组和PACAP组,在大鼠脑缺血2h后进行12h、24h再灌注,比较光镜下细胞损伤变性程度,应用免疫组化法检测IL-1β的表达.结果 PACAP组大鼠脑标本光镜下细胞损伤变性程度与缺血-再灌注组相比明显减轻;IL-1β灰度值PACAP组分别为120±5、114±4,与缺血-再灌注组178±4、162±6比较,有显著性差异(P<0.01).结论 PACAP能抑制大鼠局灶性脑缺血-再灌注时IL-1β的表达,可能是其脑保护作用之一.     

IGF-1对大鼠局灶性脑损伤c-fos表达的影响

目的研究胰岛素样生长因子-1(IGF-1)对大鼠局灶性脑缺血再灌注后c-fos表达的影响及与缺血时间关系,探讨IGF-1对脑缺血再灌注损伤的保护作用。方法制作SD大鼠大脑中动脉缺血再灌注模型。将55只SD雄性大鼠随机分为假手术组(n=5)、对照组(n=25)、IGF-1治疗组(n=25),其中后2组按缺血再灌时间(6h、12h、1d、3d、7d)不同可分为5个亚组,每组5只,治疗组于缺血2h再灌注1h后经腹腔注入40μg/kg稀释为1 ml的IGF-1,假手术组及对照组同时腹腔注入生理盐水1 ml。以上动物均在再灌注后规定时间点用4%多聚甲醛经心脏灌注固定,取大鼠脑组织,应用免疫组化S-P法和HE染色检测c-fos蛋白表达及脑组织结构病理变化。结果与对照组相比,治疗组大鼠脑组织c-fos表达明显减少,神经细胞坏死程度明显减轻。结论IGF-1在大鼠局灶性脑缺血再灌注损伤中起保护作用,其作用机制包括降低c-fos的表达,发挥神经保护作用。     

血塞通对缺血再灌注大鼠脑细胞凋亡的影响

目的 观察血塞通预处理对大鼠脑缺血再灌注损伤脑细胞凋亡的影响.方法 采用线栓法复制大鼠大脑中动脉脑缺血再灌注损伤模型,检测再灌注后缺血脑细胞凋亡情况, 并测定脑组织Ca2 含量变化.结果 血塞通能减轻缺血脑组织脑细胞的凋亡(P<0.01),能降低脑组织Ca2 含量(P<0.01).结论 血塞通对大鼠大脑中动脉缺血再灌注损伤具有保护作用,可能与其降低脑组织钙含量、减轻脑细胞凋亡有关.     

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.