Regional and cellular localisation of GABA(A) receptor subunits in the human basal ganglia: An autoradiographic and immunohistochemical study.

The regional and cellular localisation of gamma-aminobutyric acid(A) (GABA(A)) receptors was investigated in the human basal ganglia using receptor autoradiography and immunohistochemical staining for five GABA(A) receptor subunits (alpha(1), alpha(2), alpha(3), beta(2, 3), and gamma(2)) and other neurochemical markers. The results demonstrated that GABA(A) receptors in the striatum showed considerable subunit heterogeneity in their regional distribution and cellular localisation. High densities of GABA(A) receptors in the striosome compartment contained the alpha(2), alpha(3), beta(2, 3), and gamma(2) subunits, and lower densities of receptors in the matrix compartment contained the alpha(1), alpha(2), alpha(3), beta(2,3), and gamma(2) subunits. Also, six different types of neurons were identified in the striatum on the basis of GABA(A) receptor subunit configuration, cellular and dendritic morphology, and chemical neuroanatomy. Three types of alpha(1) subunit immunoreactive neurons were identified: type 1, the most numerous (60%), were medium-sized aspiny neurons that were immunoreactive for parvalbumin and alpha(1), beta(2,3), and gamma(2) subunits; type 2 (38%) were medium-sized to large aspiny neurons immunoreactive for calretinin and alpha(1), alpha(3), beta(2,3), and gamma(2) subunits; and type 3 (2%) were large sparsely spiny neurons immunoreactive for alpha(1), alpha(3), beta(2,3), and gamma(2) subunits. Type 4 neurons were calbindin-positive and immunoreactive for alpha(2), alpha(3), beta(2,3), and gamma(2) subunits. The remaining neurons were immunoreactive for choline acetyltransferase (ChAT) and alpha(3) subunit (type 5) or were neuropeptide Y-positive with no GABA(A) receptor subunit immunoreactivity (type 6). The globus pallidus contained three types of neurons: types 1 and 2 were large neurons and were immunoreactive for alpha(1), alpha(3), beta(2,3), and gamma(2) subunits and for parvalbumin alone (type 1) or for both parvalbumin and calretinin (type 2); type 3 neurons were medium-sized and immunoreactive for calretinin and alpha(1), beta(2, 3), and gamma(2) subunits. These results show that the subunit composition of GABA(A) receptors displays considerable regional and cellular variation in the human striatum but are more homogeneous in the globus pallidus.     

Terminology of psychogenic nonepileptic seizures

Several different terms have been used to describe “psychogenic nonepileptic seizures” (PNES) in the literature. In this study, we evaluated the most common English terms used to describe PNES on Google and in PubMed using multiple search terms ( https://www.google.com and http://www.ncbi.nlm.nih.gov/pubmed ). The information prevalence of the five terms most frequently used to refer to PNES in PubMed were: psychogenic non(‐)epileptic seizure(s), followed by pseudo(‐)seizure(s), non(‐)epileptic seizure(s), psychogenic seizure(s), and non(‐)epileptic event(s). The five most frequently adopted terms to describe PNES in Google were: psychogenic non(‐)epileptic seizure(s), followed by non(‐)epileptic event(s), psychogenic attack(s), non(‐)epileptic attack(s), and psychogenic non(‐)epileptic attack(s). The broad spectrum of synonyms used to refer to PNES in the medical literature reflects a lack of internationally accepted, uniform terminology for PNES. In addition to “seizure(s),” lay people use the word “attack(s)” to describe PNES. Although considered obsolete, some terms, e.g., pseudoseizure(s), are still used in the recent medical literature. Adopting a uniform terminology to describe PNES could facilitate communication between epileptologists, physicians without specific expertise in epilepsy, and patients.     

Interaction of neuropeptides and biogenic amines on cyclic adenosine monophosphate accumulation in hypothalamic nuclei

Neuropeptides and biogenic amines known to be present in neurons or afferent terminals in the paraventricular nucleus (PVH), supraoptic nucleus (SON) and/or lateral hypothalamus (LH) were added to small areas of these structures obtained by micropuncture and cyclic adenosine monophosphate (cAMP) levels were measured. cAMP accumulation occurred in PVH, SON and LH in response to neuropeptides of the secretin family, such as vasoactive intestinal peptide (VIP) and in response to catecholamines. Bradykinin, alpha-melanocyte-stimulating (alpha-MSH), luteinizing hormone-releasing hormone (LH-RH), oxytocin and carbamylcholine stimulated cAMP accumulation selectively in one or two of the above structures. Glucagon, cholecystokinin (CCK), somatostatin (SRIF), corticotropin-releasing factor (CRF), thyrotropin-releasing hormone (TRH), adrenocorticotropin (ACTH), melanocyte-stimulating hormone (MSH), methionine enkephalin (Met-Enk), beta-endorphin, neurotensin, bombesin and angiotensin II did not effect cAMP levels while leucine enkephalin (Leu-Enk), arginine vasopressin and gamma-aminobutyric acid (GABA) elicited regionally selective decreases in basal levels of cAMP. When interactions between some of these compounds were measured, VIP and norepinephrine exerted a more than additive effect on cAMP elevation in the PVH, while the effect on cAMP of the SON and LH was additive.     

Spectrum of epilepsy in tuberous sclerosis

Tuberous sclerosis (TS) is an autosomal dominant disease that affects the brain, skin, eye, heart and kidney. The diagnostic criteria for tuberous sclerosis complex (TSC) have recently been revised. There are relatively few Indian studies on this disorder. Twenty-six patients diagnosed as having TS over a period of 18 years are being reported. The onset of seizures ranged from infancy to adolescence. The patterns of epilepsy encountered were generalized tonic clonic seizures (13), complex partial seizures (10), simple partial seizures (9) and myoclonic jerks (4) including infantile spasms (3). Patients often had more than one seizure type. Nineteen patients were mentally subnormal. Cutaneous manifestations were facial angiofibroma i.e. adenoma sebaceum (20), shagreen patches (7), hypopigmented macules (6), ash leaf spots (4), café-au-lait spots (2), facial hypoplasia (2) and periungual fibromas (1). One patient each had retinal phakoma and renal angiomyolipoma. CT scan revealed sub-ependymal calcifications (12), parenchymal tubers (3), cerebral edema (3) and cortical atrophy (1). One patient had enhancement of peri-ventricular sub-ependymal lesions on MRI. Anticonvulsants prescribed were phenobarbitone (20), diphenyl hydantoin (14), carbamazepine (8), sodium valproate (4), benzodiazepines (4), ACTH (2), prednisone (1), mysoline (1) and vigabatrin (1). Most patients were on combinations of anti-convulsants and response to therapy was usually not very satisfactory. However, the child treated with vigabatrin did well.     

Clinical study of patients with persistent orofacial pain

OBJETIVE: To evaluate a sample of patients with persistent facial pain unresponsive to prior treatments. METHODS: Hospital records of 26 patients with persistent facial pain were reviewed (20 female and 6 male). RESULTS: Patients were classified into three groups according to their presenting symptoms: a)Group I, eight patients (30.7%) with severe, diffuse pain at the face, teeth or head; b)Group II, eight patients (30.7%) with chronic non-myofascial pain and; c)Group III, ten patients with chronic myofascial pain (38.4%). We find 11 different diagnoses among the 26 patients: pulpitis(7), leukemia(1), oropharyngeal tumor(1), atypical odontalgia(1), Eagle's syndrome(1), trigeminal neuralgia(4), continuous neuralgia(1), temporomandibular disorders (9), fibromyalgia (2), tension-type headache(1), conversion hysteria(2). After the treatment program all patients had a six-month follow-up period with pain relief, except the patient with tumor. CONCLUSION: The wide variability of orofacial pain diagnosis (benign to life-threatening diseases) indicates the necessity to reevaluate patients presenting recurrent pain that is refractory to the usual treatments.     

The superior olivary complex and audition: a comparative study

The sizes of the three major nuclei of the mammalian superior olivary complex were examined in a number of different species and variations in size were related to the relative prominence of haring and vision in each species. Size was measured by counting neurons in the several nuclei and by measuring the diameter of the eyes. The lateral superior olive was large in Microchiroptera(3850–4340 cells), guinea pig (3780), cat (3360) and chinchilla (3220); of intermediate size in macaque (1830), rat (1430) and squirrel monkey (1300); and small in gerbil (1220), mouse (1190), hedgehog (1090), squirrel (1000) and hamster (980). These data suggest that this nucleus is necessary for complex auditory discriminations (echolocation in Microchiroptera, for example) and that its size is not primarily determined by the taxonomic order of the animal. The medial nucleus of the trapezoid body was large in cat (5910), guinea pig (5840), hedgehog (4620) and chinchilla (4590); of intermediate size in rat (3870), Microchiroptera (3700) and macaque (3120); and small in squirrel monkey (2600), squirrel (2700), gerbil (2680), mouse (2270), and hamster (2130). The size of the nucleus was not related to sensory development or the size of the other olivary nuclei. The size of the medial superior olive was found to be highly correlated with the size of the VIth nucleus and eye diameter.     

Long-term abnormalities in brain glucose/energy metabolism after inhibition of the neuronal insulin receptor: implication of tau-protein

The triplicate intracerebroventricular (icv) application of the diabetogenic compound streptozotocin (STZ) in low dosage was used in 1-year-old male Wistar rats to induce a damage of the neuronal insulin signal transduction (IST) system and to investigate the activities of hexokinase (HK), phosphofructokinase (PFK), glyceraldehyde-3-phosphate dehydrogenase (GDH), pyruvate kinase (PK), lactate dehydrogenase (LDH) and alpha-ketoglutarate dehydrogenase (alpha-KGDH) in frontoparietotemporal brain cortex (ct) and hippocampus (h) 9 weeks after damage. In parallel, the concentrations of adenosine triphosphate (ATP), adenosine diphosphate (ADP), guanosine triphosphate (GTP) and creatine phosphate (CrP) were determined. We found reductions of HK to 53% (ct) and 60% (h) of control, PFK to 63/64% (ct/h); GDH to 56/61% (ct/h), PFK to 57/59% (ct/h), alpha-KGDH to 37/35% (ct/h) and an increase of LDH to 300/240% (ct/h). ATP decreased to 82/87% (ct/h) of control, GTP to 69/81% (ct/h), CrP to 82/81% (ct/h), approximately P to 82/82% (ct/h), whereas ADP increased to 189/154% (ct/h). The fall of the activities of the glycolytic enzymes HK, PFK, GDH and PK was found to be more marked after 9 weeks of damage when compared with 3- and 6-week damage whereas the diminution in the concentration of energy rich compound was stably reduced by between 20 and 10% relative to control. The abnormalities in glucose/energy metabolism were discussed in relation to tau-protein mismetabolism of experimental animals, and of sporadic AD.     

Hepatocyte growth factor in cerebrospinal fluid in neurologic disease

OBJECTIVE: To investigate hepatocyte growth factor (HGF) concentration in cerebrospinal fluid (CSF) in neurologic disease. MATERIALS AND METHODS: We determined CSF concentration of HGF with human-HGF-specific enzyme-linked immunosorbent assays (ELISA) in 121 patients: Alzheimer's disease (AD) (33), amyotrophic lateral sclerosis (ALS) (10), Parkinson's disease (PD) (5), progressive supranuclear palsy (PSP) (3), spinocerebellar degeneration (7), acute disseminating encephalomyelitis (ADEM) (6), human T-lymphotropic virus-1 (HTLV-1)-associated myelopathy (HAM) (6), multiple sclerosis (MS) (7), aseptic meningitis (AM) (12), and peripheral neuropathy and myopathy as control diseases (32). RESULTS: HGF concentrations in CSF were significantly higher with diseases of the central nervous system (CNS) than control diseases and were slightly higher with AD than other neurodegenerative diseases. Values were highest with ADEM but decreased during corticosteroid treatment. We found no relationship between HGF in CSF and CSF cells or protein, immunoglobulin index, or Q albumin. CONCLUSION: It is suggested that high concentrations of HGF in CSF may be partially related to CNS pathology, especially to demyelinating disease.     

Ligands for the investigation of 5-HT autoreceptor function

The existence of multiple 5-HT autoreceptors in the central nervous system is now firmly established and they have been pharmacologically identified as belonging to the 5-HT(1A), 5-HT(1B), and 5-HT(1D) receptor subtypes. In addition, 5-HT(1F), 5-HT(5A), and 5-HT(7) receptors remain as potential candidates for additional autoreceptors. The emergence of selective ligands, such as SB-224289 (5-HT(1B) receptor antagonist), BRL 15572 (5-HT(1D) receptor antagonist), GR 127935 (a mixed 5-HT(1B/1D) receptor antagonist), LY 334370 (5-HT(1F) receptor agonist), and SB-269970 (5-HT(7) receptor antagonist), has aided the characterisation of 5-HT autoreceptors and has highlighted the complexity of mechanisms which modulate the release of 5-HT.     

Bilateral involvement of a single cranial nerve: analysis of 578 cases

The author reviewed 34 years of personal experience with inpatients in a large municipal hospital to analyze the seats and causes of involvement of single pairs of cranial nerves. Among 578 cases, the sixth (n = 234) and second (211) nerves predominated, followed by the fourth (48), seventh (30), third (27), and eighth (18) cranial nerves. Trauma (99), infection (94), tumor (92), increased intracranial pressure (85), vascular disease (74), and demyelination (66) were common causes.     

Three dimensional analysis of retinal neuropeptides and amine in the chick

Three dimensional analysis of retinal neuropeptides and monoamine-containing amacrine cells were performed on flat-mount preparations of the chick retina by using indirect immunofluorescence method. somatostatin (SOM), neurotensin (NT), leu-enkephalin (ENK), vasoactive intestinal polypeptide (VIP), substance P (SP), corticotropin releasing factor (CRF), avian pancreatic polypeptide (APP), glucagon (GLC), 5-hydroxytryptamine (5HT) and tyrosine hydroxylase (TH) were examined with specific antisera. To localize these substances in the amacrine cells, and to see in which layers their processes arborize, frozen sections were examined. There were four patterns of distribution. (1) Substances with more immunoreactive cells in the central than in the peripheral portions (SOM, NT, VIP, SP, GLC, 5HT), (2) Substances with more immunoreactive cells in the peripheral portion than in the central portion (APP), (3) Substances for which such cells were evenly distributed (TH), and (4) Substances with more immunoreactive cells in the inferior than in the superior portion (CRF). Subtypes were identified among the amacrine cells containing single peptides or monoamine.     

The evaluation of thyroid functions, thyroid antibodies, and thyroid volumes in children with epilepsy during short-term administration of oxcarbazepine and valproate

PURPOSE: The aim of this study was to evaluate the effects of short-term oxcarbazepine (OXC) and valproate (VPA) monotherapy on thyroid functions in children. METHODS: Fifty-five newly diagnosed epileptic children with normal thyroid functions (confirmed with the thyrotropin releasing hormone stimulation test) participated in this study. VPA treatment was started in 30 patients and OXC in 25 patients. Serum thyroxine (T(4)), free thyroxine (fT(4)), triiodothyronine (T(3)), free triiodothyronine (fT(3)), reverse T3 (rT(3)), thyroid peroxidase antibodies (TPO-ab), and urine iodine levels were evaluated at baseline and at the third and sixth months of therapy. RESULTS: In the OXC group, serum T(4), fT(4), T(3), fT(3), and rT(3) levels were found to be decreased at the third and sixth months, the differences were significant compared to the baseline values except for fT(3) levels at the third month and fT(4) and rT(3) levels at the sixth month (p < 0.05). At the sixth month, serum T(4) level dropped below the normal reference value in 8 (32%), fT(4) in 5 (20%), T(3) in 4 (16%), and fT(3) in 3 (12%) patients. In the VPA group, mean T(4), fT(4), T(3), fT(3), and rT(3) levels at 3 and 6 months remained similar compared to the baseline values (p > 0.05). Mean serum thyroid stimulating hormone levels increased significantly at the sixth month compared to the baseline values in the VPA group (p < 0.05) while it remained unchanged in the OXC group (p > 0.05). There was no effect of either drug on urinary iodine excretion and serum TPO-ab levels remained in normal ranges throughout the study. CONCLUSIONS: In this prospective study, it is documented that children under short-term OXC or VPA therapy showed altered thyroid functions similar to the changes observed after long-term treatment. Although, the clinical significance of these results need to be evaluated with future studies, this observation of altered thyroid functions points out that thyroid functions may need to be monitored closely in children receiving antiepileptic treatment, even in the short-time interval.     

Autonomic impairment in painful neuropathy

OBJECTIVES: 1) To determine the degree and distribution and quantitate the severity of autonomic impairment in painful neuropathy (PN). 2) To assess the role of autonomic testing in evaluating PN. METHODS: The authors studied 92 patients with PN (60 women and 32 men, age 56.9 +/- 12.4 years) using: 1) autonomic reflex testing (ART), Quantitative Sudomotor Axon Reflex Test (QSART), cardiac-vagal, head-up tilt, and surface skin temperature; 2) autonomic symptoms questionnaire; 3) nerve conduction (NCS) and laboratory studies; 4) quantitative sensory testing; 5) skin biopsy; and 6) Composite Autonomic Symptoms Score (CASS) scale to grade ART results from 0 (normal) to 10 (autonomic failure). RESULTS: Autonomic involvement in PN had characteristic features. Main symptoms were pain, secretory and skin vasomotor signs, hypertension, and impotence. ART results were abnormal in 86 (93.5%) (CASS < 4), QSART in 67 (72.8%), cardiac-vagal index in 58 (63%), skin temperature in 51 (55.4%), orthostatic hypertension in 39 (42.3%), and family history of PN in 26 (21%) of patients. Group 1 (abnormal NCS) (n = 45) had more severe ART and sensory abnormalities than the Group 2 (normal NCS) (n = 47): 1) CASS 2.0 +/- 0.96 vs 1.55 +/- 0.88 (p < 0.01), cardiac-vagal index (p < 0.02), skin temperature (p < 0.02), hypertension (p < 0.03), cooling (p < 0.002), and vibration (p < 0.0005) thresholds. CONCLUSIONS: Autonomic symptoms in painful neuropathy are predominantly cholinergic and form a unique constellation of features that are distinct from other autonomic neuropathies.     

Proteomics analysis of the Alzheimer's disease hippocampal proteome

Alzheimer's disease (AD) is characterized by the presence of intracellular neurofibrillary tangles (NFT), extracellular senile plaques (SP), and synaptic loss. The hippocampus is a region that plays an important role in memory and cognitive function, and it is severely affected in AD. The levels of proteins in the hippocampus may provide a better understanding of the pathological changes known. In the present study we used two-dimensional gel electrophoresis and mass spectrometry techniques to determine changes in protein levels in AD and control hippocampus. We identified 18 proteins with altered protein levels that are involved in regulating different cellular functions. Protein levels were found to be significantly decreased for peptidyl prolyl cis/trans-isomerase (Pin 1) (0.6-fold compared to control, p<0.03), dihydropyrimidinase-like protein 2 (DRP-2) (0.74-fold compared to control, p<0.02), phosphoglycerate mutase 1 (PGM1) (0.7-fold compared to control, p<0.01), beta-tubulin (0.34-fold compared to control, p<0.01), and aldolase A (0.87-fold compared to control, p<0.0002), whereas the protein levels were found to be significantly increased for enolase (1.35-fold compared to control, p<0.05), ubiquitin carboxyl terminal hydrolase L-1 (UCH L1) (1.31-fold compared to control, p<0.02), triosephosphate isomerase (TPI) (1.38-fold compared to control, p<0.05), carbonic anhydrase II (CAH-II) (1.24-fold compared to control, p=0.05), heat shock protein 70 (1.14-fold compared to control, p<0.03), fructose bisphosphate aldolase (1.38-fold compared to control, p<0.05), ferritin heavy chain (1.23-fold compared to control, p=0.05), 2',3'-cyclic nucleotide 3' phosphodiestrase (CNPase) (1.12-fold compared to control, p<0.02), peroxiredoxin II (1.39-fold compared to control, p<0.05), and adenylate kinase I (1.19-fold compared to control, p<0.03). We found 2 proteins spots that were identified as glyceraldehyde 3-phosphate dehydrogenase (GAPDH). One of the spots showed a 1.28-fold increase in protein level compared to control (p<0.01), and the other spot showed a similar 1.26-fold increase in protein level compared to control (p<0.04). Thus, proteomics has provided knowledge of the levels of key proteins in AD brain. We discuss the functions regulated by these proteins with respect to AD pathology.     

Etiology of epilepsy. A prospective study of 210 cases.

The objective of this study was to establish the etiology of epilepsy in 210 chronic epileptics (110 female, 100 male), aged 14-82 years (34.2 +/- 13.3). Patients less than 10 years-old and alcoholism were excluded. All underwent neurological examination, routine blood tests, EEG and CT-scan. Twenty patients (10.5%) were submitted to spinal tap for CSF examination. Neurological examination was abnormal in 26 (12.4%), the EEG in 68 (45.5%), and CT-scan in 93 (44.3%). According to the International Classification of Epileptic Seizures (1981), 101 (48.1%) have generalized seizures, 66 (31.4%) partial seizures secondarily generalized, 25 (11.8%) simple partial and complex partial seizures, and 14 (6.6%) generalized and partial seizures. Four patients (2.0%) could not be classified. In 125 (59.5%) patients the etiology was unknown. Neurocysticercosis accounted for 57 (27.1%) of cases, followed by cerebrovascular disease 8 (3.8%), perinatal damage 5 (2.4%), familial epilepsy 4 (1.9%), head injury 4 (1.9%), infective 1 (0.5%), and miscelanea 6 (2.8%).     

血液透析患者透析间期颅内动脉血流动力学变化的临床研究

的   探讨血液透析患者透析间期颅内动脉血流动力学动态变化特征。 方法  本研究采用病例对照研究方法。以经颅多普勒超声（transcranial duplex sonography,TCD）对30例血液透析患者透析间期大脑前动脉（anterior cerebral artery,ACA）、大脑中动脉（middle cerebral artery,MCA）、大脑后动脉（posterior cerebral artery,PCA）以及基底动脉（basilar artery,BA）血流动力学变化进行评估,检测双侧动脉平均流速（mean velocity,MV）、阻力指数（resistant index,RI）及搏动指数（pulsatile index,PI）;以肾功能正常、年龄、性别匹配的28例门诊TCD检查患者为对照组。分析两组间差异并采用Logistic回归方法分析颅内动脉血流动力学改变的相关风险因素。 结果  血液透析组ACA、MCA、PCA、BA的MV分别为（67.3±12.7）cm/s（P＝0.03）、（76.5±13.4）cm/s（P＝0.04）、（66.7±12.5）cm/s（P＝0.04）及（51.3±10.7）cm/s（P＝0.03）,与对照组比较均增加;血液透析组RI、PI与对照组差异无显著性。多因素Logistic回归结果显示,血液透析患者ACA、MCA、PCA、BA的MV增加与贫血相关,其比值比（odds ratio,OR）及95%可信区间（confidence interval,CI）分别为：1.2（1.1～2.9）、2.2（1.8～3.6）、1.9（1.7～3.2）和1.6（1.5～3.1）;上述颅内动脉MV亦与高血压相关,OR值及95%CI分别为：2.4（1.9～3.9）、2.9（1.7～4.2）、2.1（1.7～3.9）和2.6（1.8～3.1）。 结论  血液透析患者透析间期颅内动脉平均血流速度增加,此改变与贫血及高血压相关。     

A double mutation of MBP(83-99) peptide induces IL-4 responses and antagonizes IFN-gamma responses

A number of treatment options are available to multiple sclerosis patients, however this needs to be improved. Herein, we designed and synthesized a number of peptides by mutating principal TCR contact residues based on MBP(83-99) peptide epitope. Immunization of SJL/J mice with MBP(83-99) and mutant [A(91)]MBP(83-99), [E(91)]MBP(83-99), [F(91)]MBP(83-99), [Y(91)]MBP(83-99), and [R(91), A(96)]MBP(83-99) peptides, induced IFN-gamma, and only [R(91), A(96)]MBP(83-99) mutant peptide was able to induce IL-4 secretion by T cells. T cells against the native MBP(83-99) peptide cross-reacted with all peptides except [Y(91)]MBP(83-99) and [R(91),A(96)]MBP(83-99). The double mutant [R(91), A(96)]MBP(83-99) was able to antagonize IFN-gamma production in vitro by T cells against the native MBP(83-99) peptide. Antibodies generated to [R(91), A(96)]MBP(83-99) did not cross-react with whole MBP protein. Molecular modeling between peptide analogs and H2 I-A(s) demonstrated novel interactions. The [R(91), A(96)]MBP(83-99) double mutant peptide analog is the most promising for further therapeutic studies.     

急性缺血性卒中患者血管性认知障碍及其亚型的相关因素分析

目的探讨急性缺血性卒中患者血管性认知障碍(vascular cognitive impairment,VCI)及其亚型非痴呆性血管性认知障碍(VCI-no dementia,VCIND)与血管性痴呆(vascular dementia,Va D)发生的主要相关因素。方法选择2014年6月至2015年6月就诊于天津医科大学总医院神经内科的491例急性缺血性卒中患者为研究对象,应用前期已建立的血管性认知障碍数据库记录患者的一般人口学信息、病史、体格检查、血管危险因素、生化及影像检查信息,对患者进行美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、Essen评分及低分子肝素治疗急性卒中试验(the Trial of Org 10172 in Acute Stroke Treatment,TOAST)分型,于发病(10±2)d进行蒙特利尔认知量表(Montreal Cognitive Assessment,Mo CA)、临床痴呆量表(Clinical Dementia Rating,CDR)、日常生活能力量表(Activities of Daily Living,ADL)评分,依据血管性认知障碍诊治指南中VCI的诊断及分类诊断标准将患者分为认知正常组(no cognitive impairment,NCI)和VCI组,VCI组包括VCIND组和Va D组,分析上述各项因素的组间差异及相关性。结果 491例急性缺血性卒中患者中VCI占69.86%,其中包括37.68%的VCIND和32.18%的Va D患者。1VCI组低受教育程度(P0.001)、糖尿病(P=0.005)、心脏病(P=0.045)、卒中家族史(P=0.005)、幕上病变(P0.001)的比例及卒中次数(P=0.014)、D-二聚体水平(P=0.001)、Essen评分(P=0.024)、NIHSS评分(P0.001)显著高于NCI组,女性(P=0.004)、幕下病变(P0.001)的比例及受教育年(P0.001)显著低于NCI组,差异均有显著性;Logistic回归分析显示低受教育程度、糖尿病、幕上病变和高D-二聚体水平是VCI的独立危险因素。2与VCIND组比较,Va D组患者既往卒中史(P=0.013)、TOAST分型中大动脉粥样硬化型梗死(P0.001)的比例及卒中次数(P=0.001)、Essen评分(P=0.032)、神经功能缺损程度(P=0.005)显著高于VCIND组,TOAST分型中小动脉闭塞型梗死(P0.001)、幕下病变(P0.001)的比例显著低于VCIND组,差异均有显著性;Logistic回归分析显示卒中次数、神经功能缺损程度、大动脉粥样硬化型梗死是Va D的独立危险因素,而幕下病变患者发生Va D的风险明显小于幕上病变患者。结论 VCI及其亚型的影响因素不同,与NCI比较,低受教育程度、糖尿病、幕上病变和高D-二聚体水平是VCI的独立危险因素;与VCIND比较,卒中次数、严重的神经功能缺损、TOAST分型中大动脉粥样硬化型梗死是Va D的独立危险因素。     

Organotypic hippocampal cultures. A model of brain tissue damage in Streptococcus pneumoniae meningitis

Hippocampal slices of newborn rats were exposed to either heat-inactivated Streptococcus pneumoniae R6 (hiR6) equivalent to 10(6) and 10(8) CFU/ml, lipoteichoic acid (LTA) (0.3 microg/ml and 30 microg/ml), peptidoglycans (PG) (0.3, 30, 50 and 100 microg/ml), pneumococcal DNA (pDNA) (0.3 and 30 microg/ml) or medium only (control). Cell injury was examined by Nissl staining, Annexin V and NeuN immunohistochemistry, and quantified by propidium iodide (PI) uptake and by determining neuron-specific enolase (NSE) concentration in the culture medium. Necrotic and apoptotic cell damage occurred in all treatment groups. Overall damage (Nissl and PI staining) was most prominent after hiR6 (10(8) CFU/ml), followed by LTA (30 microg/ml), pDNA (30 microg/ml), and not detectable after PG (30 microg/ml) exposure. PG (100 microg/ml) induced severe damage. Apoptotic cells were most frequent after exposure to LTA and hiR6. Damage in the neuronal cell layers (NeuN, NSE) was most severe after treatment with hiR6 (10(8) CFU/ml), followed by PG (100 microg/ml), pDNA (30 microg/ml), and LTA (30 microg/ml).