神经干细胞脑室内移植治疗大鼠脑缺血的实验研究

目的 探讨大鼠胚胎神经干细胞移植治疗局灶性脑缺血再灌注损伤的可行性。方法 取胎龄8～10d大鼠神经干细胞体外扩增．采用免疫组织化学方法检测神经干细胞及其分化后代的特异性标志巢蛋白（nestin）、胶质纤维酸性蛋白（GFAP）和神经元特异性烯醇化酶（NSE）的表达。以Brdu标记神经干细胞，分别于缺血后24h和4周移植至局灶性脑缺血大鼠模型的脑室内和梗死中心，比较不同移植部位和不同移植时间神经干细胞的存活、增殖和迁移情况。结果 移植后可见移植细胞存活至少8周以上．移植部位不同不影响细胞存活。脑室内移植细胞向脑缺血区域迁移．且以缺血后24h移植组较缺血后4周移植组迁移趋向性更强。结论 大鼠胚胎神经干细胞移植至局灶性脑缺血大鼠脑室内和梗死中心均可长期存活并广泛迁移．其迁移趋化能力与缺血后移植时间有关。     

神经干细胞移植治疗大鼠脑缺血再灌注损伤实验研究

目的探讨大鼠胚胎神经干细胞移植治疗局灶性脑缺血再灌注损伤的可行性。方法孕龄8~10d的大鼠神经干细胞在体外扩增后,用免疫组织化学方法分别检测神经干细胞及其分化后代的特异性标志蛋白nestin、胶质纤维酸性蛋白(GFAP)和神经元特异性烯醇化酶(NSE)的表达。分别于缺血后不同时间窗将神经干细胞移植到局灶性脑缺血大鼠模型的缺血半暗带和梗塞中心,移植4w后比较不同移植部位神经干细胞存活、增殖和迁移的差异。结果从胎鼠中成功培养出悬浮生长的可表达nestin的神经球,其在含血清条件下可分化为表达GFAP的胶质细胞和表达NSE的神经元。神经干细胞移植4w后可见所有移植动物的细胞都存活,梗塞中心移植的细胞存活、增殖水平明显低于半暗带移植的细胞。结论大鼠胚胎神经干细胞移植到局灶性脑缺血再灌注损伤大鼠梗塞中心和半暗带均可长期存活,其增殖能力与移植部位密切相关。     

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。     

人胚神经干细胞移植治疗大鼠脑缺血的实验研究

目的　研究人胚神经干细胞(hNSCs)移植治疗脑缺血大鼠的效果及其在缺血大鼠脑内的状况。方法　从自然流产的孕10~13周的人胚脑组织中分离、培养神经干细胞。采用线栓法制作大鼠脑缺血模型,1d后经尾静脉移植未分化的hNSCs入脑缺血大鼠体内,对移植后大鼠进行神经损害严重程度评分(NSS),用免疫组化方法观察移植后hNSCs的存活、迁徙、分化状况。结果　从人胎脑中成功培养出hNSCs,培养条件下呈悬浮状态生长,形成神经球,绝大多数的细胞表达神经干细胞的标记物神经巢蛋白(nestin)。hNSCs移植组大鼠自移植后3周末起其NSS显著低于对照组(P<0 .05);移植后2、3、4、5周脑组织切片中均可见5 溴脱氧嘧啶尿苷(Brdu)染色阳性细胞,缺血侧明显多于对侧(P<0 .05),移植后3、4、5周末明显多于移植后2周(均P<0 .05);移植组各时间点脑组织切片中均可见nestin染色阳性细胞;在Brdu阳性细胞群中, 73 8%为胶质纤维酸性蛋白(GFAP)染色阳性的星形胶质细胞, 16 7%为2, 3 环核苷酸磷酸二脂酶(CNPase)染色阳性的少突胶质细胞, 9 5%为神经元特异性烯醇化酶(NSE)染色阳性的神经元。结论　经静脉移植hNSCs能有效改善脑梗死动物的神经功能,hNSCs体内体外均具有多向分化潜能,受缺血部位微环境信号的影响分化成3种主要类型的神经细胞。     

脑出血大鼠脑内神经干细胞移植的研究

目的分离并克隆新生大鼠神经干细胞,研究其移植入脑出血大鼠脑内的生物学特征,了解神经干细胞移植治疗脑出血的可行性.方法用尾状核注射Ⅶ型胶原酶制作脑出血模型,从Wistar新生大鼠脑室下区分离并克隆神经干细胞,经Brdu(5-溴脱氧尿嘧啶)掺入标记后移植入脑出血同侧的侧脑室或脑出血对侧的尾状核中.经免疫组织化学鉴定了解移植细胞在大鼠脑内的生存、迁移及分化情况.结果将稳定培养的神经干细胞移植入脑出血大鼠脑内,发现移植后4 d移植细胞仍存在.侧脑室移植组中移植细胞多在侧脑室周边区存在,尾状核移植组可见移植细胞开始向对侧迁移.免疫荧光双标证实细胞大多分化成神经元,少部分分化成胶质细胞.结论神经干细胞移植入脑出血大鼠脑内后能够存活,并能有效地穿过室管膜和向脑出血部位迁移.移植细胞在脑内大部分分化成神经元,少部分分化成胶质细胞.     

人脐血干细胞移植治疗大鼠脑缺血的实验研究

目的研究人脐血干细胞(HUCBCs)移植治疗脑缺血大鼠的疗效及HUCBCs在缺血大鼠脑内的状况。方法采集足月新生儿脐带血60～100ml,分离出其中的单个核细胞,体外培养并予5溴脱氧嘧啶尿苷(Brdu)标记48h。采用线栓法制作大鼠脑缺血再灌注模型,1d后将3×106HUCBCs经缺血侧侧脑室注射入大鼠脑内。在移植后不同时间对大鼠进行神经损害严重程度评分(NSS),用免疫组化技术观察移植后的HUCBCs的存活、迁徙、分化状况。结果HUCBCs在体外具有增殖能力;移植组大鼠自移植后3周起其NSS显著低于对照组(均P<0.05);移植后2周、4周、6周脑组织切片中均可见Brdu染色阳性细胞,缺血侧明显多于对侧(均P<0.05),移植后4周、6周明显多于移植后2周(均P<0.05);移植组各时间点脑组织切片中均可见神经巢蛋白阳性细胞;植入的HUCBCs在大鼠脑内能向损伤区域迁徙并能分化为星形胶质细胞、少突胶质细胞和神经元。结论HUCBCs能在缺血大鼠脑内存活、迁徙和分化,并能改善其神经功能。HUCBCs移植可作为脑梗死的有效治疗手段。     

小鼠胚胎神经干细胞在猫全脑缺血再灌注损伤模型中的存活、迁移及分化

目的 观察小鼠神经干细胞在猫全脑缺血再灌注损伤模型中的存活、迁移及分化。方法 参照四血管阻塞法建立猫全脑缺血再灌注损伤模型,将原代培养的小鼠神经干细胞移植入模型动物脑中。一个月后,以免疫荧光技术检测移植干细胞的存活、迁移及分化情况。结果 缺血再灌注损伤模型制作成功7例,成功率70%;免疫荧光法检测小鼠神经干细胞移植到猫前脑后一个月仍有大量存活,部分细胞分化为神经元或神经胶质细胞,并向脑组织中迁移。结论 小鼠神经干细胞在猫全脑缺血再灌注损伤模型中能够存活、迁移并分化。     

脂肪源性γ-氨基丁酸能神经元移植治疗帕金森病大鼠的疗效观察

目的 研究脂肪来源的间充质干细胞诱导为γ-氨基丁酸(GABA)能神经元的方法 ,探讨GABA能神经元移植治疗帕金森病模型大鼠的疗效. 方法 取大鼠脂肪组织.利用本单位自行配制的神经干细胞培养基诱导分化为神经干细胞,利用GABA能神经元定向诱导培养基对神经干细胞进行二次定向诱导,并对其进行特异性鉴定.将诱导成功的神经干细胞、GABA能神经元分别移植入帕金森病大鼠模型的丘脑底核,在移植后2周、4周、8周观察大鼠行为学变化情况.结果 体外扩增的脂肪间充质干细胞经过神经干细胞培养基培养后,细胞定向诱导并表达巢蛋白、神经元烯醇化酶(NSE)等神经干细胞标志.经GABA能神经元定向分化培养基二次诱导后,免疫荧光鉴定细胞GAD65阳性.立体定向移植细胞4周后,神经干细胞组与GABA能神经元组的大鼠行为学均得到改善,且GABA能神经元组的疗效更加显著. 结论 脂防来源的间充质干细胞可诱导分化为GABA能神经元,将其移植人大鼠的丘脑底核可以明显改善帕金森病大鼠的运动功能.     

神经干细胞移植治疗脊髓损伤

目的:探讨神经干细胞移植对脊髓损伤大鼠后肢运动功能修复的影响。方法:SD大鼠36只,制成T10脊髓全横断损伤模型。于造模成功后1周采用局部微量注射法移植。随机分三组：A损伤对照组（n=12）仅打开椎管暴露脊髓;B移植对照组（n=12）：注射10μl DMEM/F12培养液;C细胞移植组（n=12）：移植1.0?06/ml的神经干细胞悬液10μl。移植后通过不同时间点BBB行为评分、病理组织学、免疫荧光技术评价大鼠大鼠脊髓功能修复情况及移植细胞在体内的存活、迁移、分化。 结果:在体外成功建立SD大鼠海马源性神经干细胞培养体系;B、C两组大鼠随着时间延长BBB评分均不同程度提高,从移植后2W起C组大鼠评分明显高于B组,两组比较差异有统计学意义（P<0.05）;神经干细胞移植后能够在体内继续存活、迁移并且分化为NF-200、GFAP表达阳性的神经元及星形胶质细胞。 结论:神经干细胞移植治疗脊髓损伤是一种有效的方法。     

神经干细胞移植治疗暂时性脑缺血的实验研究

目的:探讨神经干细胞移植治疗暂时性脑缺血的价值。方法:从孕14 d SD胎鼠海马组织中分离培养出神经干细胞,将BrdU标记的神经干细胞经立体定向移植到SD大鼠暂时性大脑中动脉梗死模型(tMCAO)纹状体缺血半暗区。移植后2～12周以神经损害严重程度评分(NSS)评价各组动物神经功能状况。移植后12周,免疫荧光染色观察移植后神经干细胞的分化、迁徙和整合情况。结果:分离和纯化出大鼠胚胎神经干细胞,呈nestin阳性,并具有自我更新及多向分化潜能。移植后的神经干细胞在宿主脑内迁徙,部分分化并表达神经元特异性标记Neurofilament。移植后8周起,神经干细胞移植组大鼠NSS评分明显低于其他2组。结论:神经干细胞移植能改善缺血后大鼠的神经功能状况。     

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.