颅内破裂动脉瘤的显微外科治疗

目的探讨颅内破裂动脉瘤的显微手术技巧及治疗策略。方法回顾性分析123例(共134个)颅内破裂动脉瘤的临床资料,Hunt-Hess分级Ⅰ级18例,Ⅱ级61例,Ⅲ级40例,Ⅳ级3例,Ⅴ级1例;早期手术(3 d内)3例,亚急性期手术(4~14 d)115例,延期手术(14 d后)5例;并采用格拉斯哥预后评分(GOS)评估预后情况。结果动脉瘤成功夹闭133个,动脉瘤孤立术1个。术后GOS:5分107例,4分9例,3分4例,2分1例,1分2例;以GOS 4~5分为恢复良好,恢复良好率94.3%。118例随访3~48个月,未见临床复发,失访3例。结论合适的手术时机及熟练的操作技巧可明显提高颅内破裂动脉瘤手术疗效。     

显微手术治疗93例颅内动脉瘤的体会

目的探讨显微手术治疗颅内动脉瘤的方法与疗效。方法本组颅内动脉瘤患者93例,个性化选择恰当的手术时机,分别采用动脉瘤所在侧的翼点入路(91例)或颞下入路(2例)行动脉瘤显微夹闭术。结果 93例动脉瘤均成功手术夹闭。术后随访3～6个月,根据GOS评分:5分(恢复良好)64例,4分(轻度残疾)22例,3分(重度残疾)5例,2分(植物生存)1例及1分(死亡)1例。结论选择适当的手术时机,应用显微手术夹闭瘤颈治疗颅内动脉瘤可以获得良好的临床疗效。     

高分级颅内动脉瘤外科夹闭术手术时机对预后及血流动力学的影响

目的 探讨高分级颅内动脉瘤患者外科夹闭术手术时机对临床预后及血流动力学参数的影响.方法 分析2016年1月至2019年10月期间129例东南大学附属中大医院神经外科接受显微夹闭手术治疗的高分级(Hunt-HessⅣ～Ⅴ级)颅内动脉瘤患者的临床资料,根据手术时机的不同进行分组:发病后24h内手术者32例为超早期组,发病2...     

高级别颅内动脉瘤治疗策略探讨

目的 探讨高级别(Hunt-HessⅣ～Ⅴ级)颅内动脉瘤治疗方法和治疗时机选择.方法 回顾性分析2000年1月至2011年12月Ⅳ～Ⅴ级颅内动脉瘤304例,其中显微手术夹闭216例,血管内栓塞88例.结果 按GOS评分,显微手术夹闭组Ⅳ级192例中5分和4分94例,良好率49％;2分和1分38例,极差率19.8％.Ⅴ级24例中2分和1分19例,极差率79.2％.栓塞组中Ⅳ级78例中良好40例,良好率51.3％;2分和1分14例,极差率17.9％.Ⅴ级10例,1分9例,极差率90％.结论 Ⅳ级在3d内要积极治疗(手术或栓塞),3d后血管痉挛严重者应保守治疗,待病情好转后再治疗.Ⅴ级动脉瘤除非发病时间不长(2h内)或有明显血肿,否则不宜选择手术干预治疗,如要手术则宜选择显微手术夹闭.     

显微开颅夹闭术治疗颅内破裂动脉瘤的效果分析

目的探讨显微开颅夹闭术治疗颅内破裂动脉瘤的效果。方法选取2015-01-2016-06我院收治的120例颅内动脉瘤患者,均有明显的蛛网膜下腔出血,按照Hunt-Hess分级法划分为Ⅰ~Ⅳ级。患者24h、48h及72h不同时间显微开颅夹闭术治疗,每个时间点手术40例。术后半年随访调查,评估动脉瘤夹闭效果,并用GOS评分评估患者的预后情况,观察有无神经功能障碍加重现象。结果所有患者动脉瘤夹闭情况较好,无夹闭失败现象。应用GOS评分恢复良好108例(90.0%),轻度残疾7例(5.8%),重度残疾5例(4.2%)。24h、48h及72h内手术良好率分别为95.0%、92.5%、82.5%,无死亡。结论显微开颅夹闭术在颅内破裂动脉瘤中具有较好的应用效果,且手术治疗越快,预后效果越好。     

51例大脑中动脉瘤破裂患者的临床特点 影像学 显微手术及预后研究

目的探讨大脑中动脉瘤(MCAA)临床特点、影像学特征及显微手术治疗方法及预后。方法回顾性分析51例MCA动脉瘤的临床特点、影像学特征、手术方法及预后。结果动脉瘤夹闭43例,夹闭加包裹4例,包裹加固3例,孤立1例。随访3~12月,按照GOS评分,其中5分29例,4分11例,3分4例,2分2例,1分5例。预后较差者(重残至死亡)主要为Hunt-HessⅣ、Ⅴ级者。结论及早而准确诊断动脉瘤,熟练掌握手术时机及显微操作技术能够提高颅内动脉瘤疗效,针对不同的病情采用不同的手术方法与策略,术中保护MCA及保持周围相关血管的通畅是手术的关键。     

脑血管痉挛和手术时机对颅内破裂动脉瘤患者预后的影响

目的探讨脑血管痉挛(CVS)和手术时机对颅内破裂动脉瘤患者预后的影响。方法回顾性分析2008年11月至2009年3月经手术夹闭的71例颅内破裂动脉瘤患者的临床资料。利用经颅多普勒超声监测CVS,并分析CVS、手术时机与术中动脉瘤破裂发生率、术后主要并发症(CVS、脑积水)发生率和术后疗效(GOS评分)的关系。结果出院当天按GOS进行术后短期疗效评价,其中良好(GOS4～5分)54例,差(GOS2～3分)12例,死亡(GOS1分)5例。术前不同程度CVS患者术中动脉瘤破裂发生率、术后CVS和脑积水发生率以及患者预后良好率均无明显差异(P>0.05)。不同手术时期患者术中动脉瘤破裂发生率、术后并发症(CVS和脑积水)和患者预后良好率亦无明显差异(P>0.05)。中期手术患者中术前轻度或无CVS患者术后CVS的发生率显著低于术前中、重度CVS患者(P<0.05)。结论术前CVS程度和手术时机对颅内破裂动脉瘤患者总体预后并无显著影响;选择中期手术亦可以获得良好的治疗效果。     

高级别颅内破裂动脉瘤的早期显微手术治疗

目的 评价高级别颅内破裂动脉瘤早期显微手术治疗的疗效.方法 回顾分析2002年1月至2009年11月期间25例高级别(Hunt-Hess Ⅳ～Ⅴ级)动脉瘤患者的资料,他们均在发病后48 h内的早期行显微外科手术治疗,以格拉斯哥转归评分量表(GOS)对患者神经功能评分.结果 25例颅内动脉瘤均显微手术夹闭,术后六个月时的GOS评分:恢复良好10例;中度病残但生活自理8例;重度病残且生活不能自理4例,死亡3例.结论 对高级别颅内破裂动脉瘤患者的早期手术治疗是可行的,结合及时的气管插管控制呼吸,脑室外引流以及去骨板减压等处理可以帮助改善其预后.     

经双侧额外侧入路显微手术同期处理颅内镜像动脉瘤

目的探讨经双侧额外侧入路显微手术同期处理颅内镜像动脉瘤的手术方法、临床效果及手术并发症。方法回顾分析18例前循环镜像动脉瘤患者的临床资料,均经双侧额外侧入路同期行动脉瘤夹闭术,Glasgow预后分级(GOS)评价手术疗效。结果 18例患者共发现36个动脉瘤,其中后交通动脉镜像动脉瘤9例(18个)、大脑中动脉镜像动脉瘤9例(18个)。术后GOS评分5分16例、4分2例,术后并发症包括交通性脑积水(1例)和肺部感染(1例),无死亡患者。术后6个月CTA显示动脉瘤夹闭完全、未复发,载瘤动脉血流通畅。结论采用经双侧额外侧入路同期夹闭颅内镜像动脉瘤手术创伤小、术野合理、安全性高、手术疗效满意、预后良好,是微侵袭神经外科手术的新尝试。     

颅内动脉瘤显微手术治疗临床分析

目的 总结颅内动脉瘤的手术治疗经验。方法 回顾性分析显微手术治疗的68例颅内动脉瘤患者的临床资料,均经翼点入路行动脉瘤夹闭手术。结果 4例术中发生动脉瘤破裂,经处理后完成夹闭术。出院时按GOS评分评估预后,其中恢复良好54例（79.4%）,中残11例（16.2%）,死亡3例（4.4%）。结论 尽早明确颅内动脉瘤的诊断,早期(72 h以内)完成动脉瘤夹闭术有利于改善患者临床预后。     

Neuroimaging in epilepsy in tropics

Epilepsy is a major public health problem in many tropical countries. Also, some of the tropical diseases are major contributors to the higher prevalence of epilepsy in these countries. The etiologic factors responsible for epilepsy in these countries are quite different from those in the developed world. This article discusses the etiologic factors and neuroimaging of epilepsy in light of the conditions in these tropical countries.     

癫痫与抑郁关系的研究进展

抑郁是癫痫患者中常见的精神障碍,严重地影响了患者的生活质量。传统的观点认为癫痫患者因为存在着诸多社会学问题易出现抑郁倾向,癫痫和抑郁是单向的联系,但大量的研究已经证明癫痫和抑郁之间存在双向的联系,一种异常状态的存在可能易转化为另一种异常状态的发展。癫痫和抑郁存在着共同的发病机制。本文主要就癫痫和抑郁的双向联系以及抗抑郁药物在癫痫患者中的应用进行阐述。     

Sudanophilic lipid accumulation in astrocytes in periventricular leukomalacia in monkeys

Summary Sudanophilic lipid accumulation is a characteristic feature of periventricular leukomalacia (PVL) of infants. At least two types of lipid-containing cells have been identified, one being the macrophage, the other the pre-myelin glial cell. A third type of lipid-containing cell has been seen in two monkeys with spontaneous PVL. Electron microscopically this cell appears to be an astrocyte. This probably represents a reaction of the astrocyte to hypoxia and may be the equivalent of the hypertrophic astrocytes found in human infants.Supported in part by NIH grant HDO 8633 and the Regional Primate Research Center Grant RR-00166     

Increase in cathepsin D activity in rat brain in aging

Cathepsin D-like activity in homogenates of five brain areas of 3-month-old and 24-month-old Fischer 344 rats was measured. With hemoglobin as substrate at pH 3.2, more than 90% of the activity was inhibited by pepstatin. In each area studied, activity was more than twice as high in the old rat brain: 140-160% higher in the cortex, cerebellum, pons-medulla, and striatum and 90-100% higher in the hippocampus and spinal cord. The greatly increased metabolic capacity in the absence of an increase in protein turnover may have a role in age-related pathological degeneration in the brain.     

Characteristics of nociceptors in the periodontium--an in vitro study in rats

Recent studies have indicated that nociceptors can be classified into various types according to their physiological properties. These studies have clarified that the frequency distribution of various nociceptor types is different among body sites and animal species. In the present study, we investigated the physiological properties of rat's periodontal nociceptors in an in vitro jaw-nerve preparation. Responses were recorded from functional single filaments in the inferior alveolar nerve. To determine the nociceptor type, calibrated von Frey filaments, heat, and bradykinin (BK) stimuli were used. We found five subtypes of nociceptors in the periodontal ligaments of the lower incisor: Adelta-high threshold mechanonociceptors (Adelta-HTM, n=28), Adelta-mechanoheat nociceptors (Adelta-MH, n=6), Adelta-polymodal nociceptors (Adelta-POLY, n=26), C-high threshold mechanonociceptors (C-HTM, n=3) and C-polymodal nociceptors (C-POLY, n=4). Most nociceptors were Adelta-innervated, while only a small number of C-innervated nociceptors were found. The present results suggest that periodontal nociceptors transmit mainly fast pain, and may thus play a role in rapid detection of injure-related stimuli during mastication.     

Gender in Voice Perception in Autism

Deficits in the perception of social stimuli may contribute to the characteristic impairments in social interaction in high functioning autism (HFA). Although the cortical processing of voice is abnormal in HFA, it is unclear whether this gives rise to impairments in the perception of voice gender. About 20 children with HFA and 20 matched controls were presented with voice fragments that were parametrically morphed in gender. No differences were found in the perception of gender between the two groups of participants, but response times differed significantly. The results suggest that the perception of voice gender is not impaired in HFA, which is consistent with behavioral findings of an unimpaired voice-based identification of age and identity by individuals with autism. The differences in response times suggest that individuals with HFA use different perceptual approaches from those used by typically developing individuals.     

Defects in Bioenergetic Coupling in Schizophrenia

Synaptic neurotransmission relies on maintenance of the synapse and meeting the energy demands of neurons. Defects in excitatory and inhibitory synapses have been implicated in schizophrenia, likely contributing to positive and negative symptoms as well as impaired cognition. Recently, accumulating evidence has suggested that bioenergetic systems, important in both synaptic function and cognition, are abnormal in psychiatric illnesses such as schizophrenia. Animal models of synaptic dysfunction demonstrated endophenotypes of schizophrenia as well as bioenergetic abnormalities. We report findings on the bioenergetic interplay of astrocytes and neurons and discuss how dysregulation of these pathways may contribute to the pathogenesis of schizophrenia, highlighting metabolic systems as important therapeutic targets.     

Ethnic disparities in problem behaviour in adolescence contribute to ethnic disparities in social class in adulthood

BACKGROUND: It is important for prevention of social class disparities to know how ethnic disparities in social class arise among migrant children. We contribute to this understanding by examining the role of problem behaviour in adolescence. METHODS: Prospective observational study with 753 Dutch native and 217 Turkish migrant adolescents (11-18 year) followed for 10 years. Internalising and externalising problems were assessed in adolescence and employment status and occupational level were assessed in adulthood. The difference in odds ratios (OR) before and after adjustment for internalising and externalising problems was an indication of the predictive value of disparities in internalising and externalising problems for the development of social class disparities. RESULTS: A total of 135 (62%) of the Turkish and 602 (80%) of the Dutch adults were employed. Internalising and externalising problems were not associated with employment status. Of the employed, 65 (48%) Turkish and 179 (30%) Dutch adults worked in low-level occupations (p < 0.0001). Internalising and externalising problems were associated with both ethnicity and occupation. The OR for low-level occupation for Turkish adults was 1.78 (1.19-2.65), indicating ethnic disparities. Adjustment for internalising problems lowered the OR with 36% to 1.50 (0.97-2.31), and adjustment for externalising problems lowered it with 8% to 1.72 (1.15-2.57). Findings were similar for men and women and did not vary by age. CONCLUSIONS: Ethnic disparities in occupational level in adulthood could partly be attributed to disparities in mental health between Turkish migrants and Dutch natives in adolescence. Prevention of ethnic disparities in mental health at young age may therefore also contribute to the prevention of occupational differences in adulthood.     

Progress in neuroprotection in Parkinson's disease

Slowing or aborting the progress of neurodegeneration in Parkinson's disease (PD) remains the most important unmet need of this disorder. There are several recent developments in trial design and also in drugs under investigation for possible neuroprotective effect. Emphasis has been placed on clinical as opposed to imaging end-points and these include change in a clinical rating scale, e.g. United Parkinson's disease Rating Scale (UPDRS), or time to additional therapy. The introduction of the delayed-start, or wash-in, trial design adds an additional dimension to drug evaluation for neuroprotection. Compounds that have been recently tested in clinical trial include the monoamine oxidase-B inhibitor rasagiline, the anti-apoptotic agents TCH346 and CEP1347, and the promitochondrial agent creatine. The dopamine agonists have been evaluated for a neuroprotective effect using imaging end-points. Perhaps the most important and simplest concept for neuroprotection has been the theory that early dopaminergic support for the degenerating dopaminergic system per se provides significant long-term clinical benefit for PD patients.     

Changes in parasympathetic system in medulla oblongata in male pigs in the course of tachycardia-induced cardiomyopathy

Background

Autonomic imbalance constituting a fundamental feature of heart failure (HF) has been assessed mainly at the periphery. Changes in the functioning of autonomic centers in the brain remain unclear. We investigated the molecular elements of parasympathetic system, i.e. α7 nicotinic acetylcholine receptor (α7nAChR) and enzymes metabolizing acetylcholine (acetylcholinesterase, AChE, choline acetyltransferase, ChAT) in medulla oblongata (MO) of male pigs with chronic tachycardia-induced cardiomyopathy.

Methods

The mRNA levels of AChE, ChAT, α7nAChR and X-box binding protein 1 (spliced form, XBP1s) in MO were analyzed using qPCR, AChE and ChAT activities using spectrophotometry, proteasome activity using fluorometry, and the protein level of α7nAChR using Western blotting.

Results

The development of systolic HF was accompanied by an increase in circulating catecholamines, a decrease in the AChE and α7nAChR mRNA in MO, an increase in AChE activity (all p < 0.05), and no change in either the mRNA or activity of ChAT. Both circulating catecholamine levels and AChE activity were inversely related to systolic function of left myocardial ventricle (p < 0.05). The level of α7nAChR protein in MO and its cytoplasmatic fraction were higher in pigs with moderate and severe HF as compared to the other animals (p < 0.01). There was no difference in proteasome activity in MO between diseased and healthy animals, whereas the XBP1s mRNA decreased during HF progression (p < 0.05).

Conclusions

Molecular elements of parasympathetic system are changed within the medulla oblongata during the progression of systolic non-ischemic heart failure in male pigs, indicating a functional link between MO and heart in HF.