补阳还五汤和依达拉奉联用对小鼠急性脑缺血损伤后脑保护机制的研究

目的探讨补阳还五汤和依达拉奉联用对急性脑缺血损伤后神经细胞凋亡及凋亡相关蛋白表达的影响,探讨其可能的脑保护机制。方法将60只小鼠随机分假手术组、模型组、补阳还五汤组、依达拉奉组以及补阳还五汤+依达拉奉组,每组12只。采用改良线栓法制作小鼠大脑中动脉缺血再灌注模型,给予补阳还五汤及依达拉奉药物干预。分别于再灌注后1d和7d,采用TUNEL法观察小鼠脑皮质缺血区神经细胞凋亡率,采用免疫组化方法观察小鼠脑皮质缺血区B淋巴细胞瘤2基因(bcl-2)、bcl-2相关X蛋白(bax)和半胱氨酸蛋白酶3(caspase-3)表达的阳性细胞数。结果与假手术组比较,模型组小鼠脑皮质缺血区凋亡指数升高(P0.01),且bcl-2、bax和caspase-3表达的阳性细胞亦均升高(P0.01);经补阳还五汤和(或)依达拉奉干预后,各药物组小鼠脑组织的凋亡指数及bax和caspase-3阳性细胞均较模型组下降(P0.01),而脑组织bcl-2阳性细胞均较模型组增加(P0.01),且补阳还五汤+依达拉奉联合用药组较单一用药组改变明显(P0.05)。结论补阳还五汤与依达拉奉联用能抑制脑缺血再灌注损伤后脑细胞中促凋亡蛋白bax、caspase-3的表达;促进具有神经元保护作用的bcl-2蛋白的表达,从而抑制神经细胞凋亡,协同发挥脑保护作用。     

大鼠局灶性脑缺血预处理的抗细胞凋亡作用机制的研究

目的研究大鼠短暂局灶性脑缺血预处理对再次脑缺血神经细胞凋亡的保护作用,及bcl-2、bax与脑缺血耐受的关系.方法用开颅方法阻断大鼠大脑中动脉(MCA)20分钟,3天后再次阻断6小时.观察大鼠脑梗死体积及组织病理学改变,采用TUNEL法观察神经细胞凋亡状况,采用免疫组织化学方法观察bcl-2、bax蛋白表达的改变.结果与假预处理组和缺血组相比,预处理后缺血组梗死灶体积明显减小(均P＜0.01),半影区凋亡细胞数明显减少(P＜0.01),bax蛋白表达下降(P＜0.05),bcl-2蛋白表达显著上升(P＜0.01).结论 20分钟局灶性脑缺血预处理能够通过bcl-2表达增加及bax表达下降对再次脑缺血神经细胞起保护作用.     

GM_1对大鼠脑缺血再灌注后bcl-2、bax表达的影响

目的:探讨神经节苷脂GM_1对大鼠急性局灶性脑缺血再灌注损伤后凋亡相关基因bcl-2、bax表达的影响。方法:用线栓法制成大鼠大脑中动脉(MCA)闭塞及再通模型,利用免疫组化,观察一侧MCA缺血30分钟,再灌注5小时后病变侧海马CA1区bcl-2、bax表达的情况以及GM_1对其表达的影响。结果:假手术对照组海马区CAI可见bcl-2及少量bax表达。缺血/再灌注后,该区bcl-2及bax表达增加(分别P<0.01),且以bax表达明显占优势,bax染色阳性细胞以小体积,核固缩的凋亡细胞为主。应用GM_1后bcl-2表达进一步增加(P<0.01),而bax蛋白水平变化不明显,bcl-2与bax蛋白比值增加,bax染色阳性细胞胞体趋于正常,但核仍大而圆。结论:GM_1确实可以通过调节脑局灶性缺血/再灌注后bcl-2、bax表达而发挥神经保护作用。     

蒙成药扎冲十三味丸对大鼠脑缺血组织细胞凋亡的影响

目的 探讨扎冲十三味丸对缺血性脑组织损伤的保护机制.方法 利用线栓法制作大鼠大脑中动脉闭塞模型,采用Elisa法和流式细胞技术Annexin V fitc/pi细胞双染法,检测凋亡细胞相关蛋白和神经细胞凋亡百分率,观察扎冲十三味丸对脑缺血组织bcl-2和bax蛋白表达水平以及缺血组织细胞凋亡程度的影响.结果 扎冲十三味丸能减低缺血脑组织Bax蛋白含量和上调Bcl-2蛋白含量以及降低缺血脑组织细胞凋亡百分率.结论 扎冲十三味丸通过降低缺血脑组织细胞凋亡百分率,对脑组织缺血损伤有保护作用.     

pep-1-sod对缺血再灌注沙鼠脑组织凋亡相关蛋白表达的影响

目的 研究pep-1-sod对缺血再灌注沙鼠脑组织凋亡相关蛋白表达的影响及其意义.方法 将84只蒙古沙鼠随机分为假手术组、缺血再灌注组、pep-1-sod组及sod组,采用免疫组织化学方法测定各组不同时相bcl-2及caspase-3的表达.结果 与假手术组及pep-1-sod组相比,缺血再灌注组及sod组在不同时点海马CA1区锥体细胞bcl-2阳性表达细胞数显著减少(P＜0.05或P＜ 0.01).再灌注后6h,12h及24 h,pep-1-sod组的caspase-3阳性表达率均显著低于缺血再灌注组及sod组(P＜0.05或P＜0.01).pep-1-sod组与假手术组在不同时点的海马CA1区bcl-2及caspase-3的表达之间未发现显著差异(P＞0.05).结论pep-1-sod可通过促进脑组织bcl-2蛋白表达,抑制caspase-3蛋白表达来实现抗凋亡作用,进而保护脑组织.     

大鼠脑缺血预处理后脑组织Caspase-3蛋白的表达

目的探讨凋亡相关基因caspase-3蛋白在脑缺血预处理过程中的表达和意义.方法用免疫组织化学染色技术分别检测假手术对照组(S组)、缺血预处理对照组(A组)、缺血组(B组)和缺血预处理组(C组)大鼠脑组织石蜡切片中caspase-3蛋白的表达情况.结果缺血组(B组)和缺血预处理组(C组)各组CA1区caspase-3蛋白免疫反应强度明显高于假手术对照组(S组)(P＜0.01);末次再灌注48h的B2组和C2组以及末次再灌注72 h的B3和C3组比较caspase-3蛋白表达均有显著性增高(P＜0.05,P＜0.01).结论脑缺血预处理的保护机理可能与抑制caspase-3蛋白表达、减少脑细胞凋亡有关.     

GRP78、CHOP、caspase-3和caspase-9蛋白在缺血预处理大鼠脑组织中的表达及意义

目的探讨GRP78、CHOP、caspase-3和caspase-9蛋白在缺血预处理大鼠脑组织中的表达及意义。方法 SD大鼠随机分为脑缺血预处理、2-脱氧葡萄糖(2-deoxyglucose,2-DG)预处理组、脑缺血/再灌注组和对照组,2-DG预处理组于术前7d腹腔注射2-DG 100mg.kg-1.d-1,采用线栓法阻断大脑中动脉制备大鼠局灶性脑缺血/再灌注模型,然后进行神经行为学评分、脑梗死体积和脑含水量测定,免疫组织化学方法检测缺血区脑组织GRP78、CHOP、caspase-3和caspase-9蛋白的表达。结果与缺血/再灌注组相比,预处理缺血组和2-DG预处理组神经行为学评分明显降低,脑梗死体积和脑组织含水量明显减少(P<0.01,P<0.05),GRP78蛋白表达细胞数明显增加(P<0.01),CHOP、caspase-3和caspase-9蛋白表达的细胞数明显减少(P<0.01);而两组间比较无统计学差异(P>0.05)。结论脑缺血预处理可能触发了体内的内质网应激过程,对随后发生缺血/再灌注所造成损伤的具有神经保护作用。其机制可能是增加GRP78蛋白的表达和降低CHOP、caspase-3和caspase-9蛋白的表达,减轻了神经细胞的凋亡。     

丁苯酞对脑缺血再灌注大鼠神经细胞超微结构及细胞凋亡的影响

目的探讨丁苯酞对脑缺血再灌注大鼠神经细胞超微结构及细胞凋亡因子bcl-2、bax和caspase-3表达的影响。方法采用大脑中动脉线栓法造缺血再灌注模型,分为假手术组、模型组和丁苯酞组,丁苯酞组大鼠在造模前3d给予80mg/(kg·d)丁苯酞,其他组大鼠给予同剂量的生理盐水。使用透射电镜观察神经细胞超微结构,并使用TUNEL法检测细胞凋亡情况,使用免疫组化法检测bcl-2、bax和caspase-3表达情况。结果丁苯酞组脑细胞超微结构损伤轻于模型组,大部分线粒体膜较完整,空泡少,内质网形态较正常,高电子密度颗粒较少,染色质出现轻度聚集,核仁可见;假手术组、丁苯酞组和模型组凋亡细胞指数依次升高,各组间比较差异有统计学意义(P0.05);假手术组、丁苯酞组和模型组bax和caspase-3依次升高,各组间相互比较差异有统计学意义(P0.05);假手术组、模型组和丁苯酞组bcl-2依次升高,各组间相互比较差异有统计学意义(P0.05)。结论丁苯酞可有效改善脑缺血再灌注大鼠神经细胞超微结构,使细胞凋亡减少,其发挥药效可能是通过对bcl-2、bax和caspase-3水平的调节实现的。     

ACEI对肾性高血压大鼠脑缺血再灌注后细胞凋亡的影响

目的观察血管紧张素转化酶抑制剂(ACEI)对肾性高血压大鼠脑缺血再灌注后神经功能和细胞凋亡的影响,探讨ACEI的脑保护机制。方法采用狭窄肾动脉方法建立肾性高血压大鼠模型,随机分依那普利组(A组)和高血压缺血再灌注组(B组);正常血压组分为假手术组(C组)和缺血再灌注组(D组)。用线栓法造成大脑缺血再灌注模型,缺血时间为2h,再灌注时间22h。用免疫组织化学技术检测脑组织bcl-2、bax的表达,TUNEL法检测细胞凋亡。结果(1)脑缺血再灌注后神经功能评分:A组神经功能评分较B组和D组降低(P<0.05,);D组神经功能评分低于B组(P<0.05)。(2)A组与B组和D组比较bcl-2表达明显增多(P<0.05),bax表达显著降低(P<0.05),神经细胞凋亡明显减少(P<0.05);B组与D组比较,bcl-2表达明显降低(P<0.05),bax表达明显增加(P<0.05),而神经细胞凋亡明显增多(P<0.05)。结论ACEI明显改善局灶性脑缺血大鼠的神经功能,减少神经细胞凋亡,上调脑组织bcl-2表达,抑制bax表达,提示对脑缺血再灌注损伤有脑保护作用。     

人参总皂苷对大鼠脑外伤后神经细胞凋亡的影响

目的 研究人参总皂苷对脑外伤大鼠神经细胞凋亡的影响,探讨其抑制创伤性脑损伤(TBI)后继发性损伤的作用机制.方法 采用改良的Feeney自由落体法建立脑外伤模型,将Sprague-Dawley大鼠54只按照随机数字表法分为假手术组、脑外伤组、人参总皂苷治疗组(治疗组),每组18只.模型建立后24h处死大鼠,采用干湿重法测量脑水含量,光镜下观察尼氏染色海马细胞形态,凋亡细胞原位末端标记法(TUNEL)和免疫组织化学方法观察大脑皮质、海马神经细胞凋亡及凋亡基因bax、bcl-2、caspase-3的蛋白表达情况.结果 与脑外伤组比较,人参总皂苷治疗后的治疗组脑含水量明显减低,损伤侧海马病理学改变明显减轻,神经细胞凋亡减少,bcl-2的表达增高,bax、caspase-3的表达减少,差异均有统计学意义(P＜0.05).结论 人参总皂苷可以减轻脑外伤后继发性损伤,其机制可能是升高bcl-2的表达,抑制bax、caspase-3的表达,从而阻滞TBI后神经细胞凋亡.     

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.