脑外伤治疗采用早期颅骨修补和脑室腹腔分流的临床价值探析

目的：探讨分析脑外伤治疗采用早期颅骨修补和脑室腹腔分流的临床价值。方法选取我院收治的脑外伤合并颅骨缺损及脑积水患者70例,按照分层随机法,将70例患者随机分成观察组和对照组,观察组采取早期颅骨修补和脑室腹腔分流治疗,对照组则行脑室腹腔分流治疗,在术后3~6个月时,再行颅骨修补治疗,比较两组治疗效果。结果观察组预后优秀9例,良好19例,较差7例,优良率80.00%,对照组预后优秀6例,良好15例,较差14例,优良率60.00%,观察组患者预后优良率高与对照组,差异有统计学意义(P<0.05)。结论在脑室腹腔分流术的同时进行早期颅骨修补,可明显改善预后,较传统方法更好。     

脑脊液分流流量传感器研发

不同于层析扫描及计算机成像技术,首创基于热传导的用于脑积水患者的脑脊液流量检测技术,国际合作研发脑脊液分流流量传感器。传感器非侵入人体改变脑脊液温度,使脑脊液流速得以通过分流管沿线皮肤的温度变化表征出来。传感器连续采集该温度变化,建立包含时间、空间、温度参数的热传导偏微分方程和互相关函数模型,计算出脑脊液流量。传感器硬件设计采用PID调节和分段优化控制热激发,用PWM波稳定TEC温度,用NTC采集信号。信号被调理放大和AD转换后送MCU处理,MCU为传感器核心控制部件并与计算机通信。传感器软件开发使用有限元计算、查表取值、逻辑判断、分段插值等组合编程,优化后温度精度为0.01℃,检测脑脊液分流流速范围0.3~20.0 mm/s。传感器采用生物相容材料,在人类生理学相似环境中实现测量验证。     

基于电机参数的离心式左心室辅助装置流量估算方法

目的 针对苏州同心医疗器械有限公司研制的CH-VAD型血泵进行研究,利用血泵中可获得的电压、电流、转速、占空比以及流体的黏度作为输入,建立实时估算血泵流量的方法.方法 将血泵系统拆解为电机和离心泵两个模块单独进行分析.首先根据电机的电压、电流、转速以及占空比计算得到电机的输出力矩,然后通过实验测试在不同转速和黏度下流量...     

Development of MEMS-based Cerebrospinal Fluid Shunt System

We have developed a micro cerebrospinal fluid (CSF) shunt system with a MEMS-based micro CSF shunt valve. This valve consists of flow nozzles with membrane connected to anchor by bridges. The up-down movement of the membrane turns the CSF on and off, and the thickness and shape of bridges and membrane determine the valve characteristics, such as opening pressure. The membrane, anchor and bridges were made of micro patterned Parylene^TM film. To make the membrane and bridge not be torn out in the CSF flow, we added a cover layer. The total dimension of the assembled CSF shunt valve is 2.5×2.5 mm², and 0.8 mm in height. The burst pressure and flow rate of the valve were precisely controled by carefully selecting the design parameters, such as the thickness of membrane and bridge, and the width and number of the bridge. The developed CSF shunt system showed good performances in the evaluation test for commercialized CSF shunt systems.     

Cerebrospinal Fluid Cytological Diagnosis in Multiple Myeloma With Leptomeningeal Involvement

Multiple myeloma (MM) with central nervous system (CNS) infiltration is uncommon and the diagnosis is more complicated than that of MM. Here we report two cases of CNS MM that was diagnosed by cerebrospinal fluid cytology examination. Cerebrospinal fluid cytology examination can help to detect malignant cells and immunocytochemistry stain is of great value in identifying an unknown tumor. Diagn. Cytopathol. 2017;45:66–68. © 2016 Wiley Periodicals, Inc.     

脑脊液微管相关蛋白(tau蛋白)在急性淋巴细胞中枢神经系统白血病中表达及其意义

目的:为探讨脑脊液微管相关蛋白(tau蛋白)在急性淋巴细胞中枢神经系统白血病(CNSL)中表达及其意义.方法:分为CNSL患者组(25例)、急性淋巴细胞白血病(ALL)患者组(28例)和正常对照组(30例).分别用酶联免疫试验(ELISA)检测各组脑脊液tau蛋白水平.结果:发现CNSL组的脑脊液tau蛋白含量明显高于...     

脑脊液病原菌变迁和耐药性分析

目的了解临床脑脊液培养阳性患者病原菌分布及其耐药情况。方法对2002—2008年临床脑脊液培养病原菌阳性患者标本进行回顾性统计分析;按常规方法进行细菌分离和鉴定;细菌药物敏感试验采用Kirby—Bauer纸片扩散法。结果分离出细菌97株,其中革兰阳性球菌占54．63％,革兰阴性菌占28．87％：新型隐球菌占13．40％。最常见的6种感染菌分别为凝固酶阴性葡萄球菌（40．21％）、不动杆菌属（8．25％）、铜绿假单胞菌（6．19％）、金黄色葡萄球菌（5．15％）、肺炎克雷伯菌（5．15％）、肠球菌属（5．15％）;耐甲氧西林凝固酶阴性葡萄球菌（MRSCN）和耐甲氧西林金黄色葡萄球菌（MRSA）的检出率分别是89．7％和80．0％。细菌对常用抗生素耐药性较高,未见万古霉素耐药的葡萄球菌;美洛培南以及头孢哌N／舒巴坦对革兰氏阴性杆菌有良好的抗菌活性。结论近6年来细菌性脑膜炎患者病原菌以革兰阳性球菌为主,主要为医院获得性细菌性脑膜炎感染。检出病原菌对常用抗生素耐药性较高,临床需警惕新型隐球菌的高发病趋势。     

Naive and Memory CD4+ T-cells in the Cerebrospinal Fluid of Children with Aseptic Meningitis Following Measles-Mumps-Rubella Vaccination and Enteroviral Meningitis

We investigated the distribution of memory (CD45RO⁺) and naive (CD45RA⁺CD62L⁺) CD4⁺ T-cells as well as CD8⁺ T-cells and total T-cells in the CSF of children with aseptic meningitis following measles-mumps-rubella (MMW) vaccination and those with enteroviral meningitis. Flow cytometric analysis of CSF cells was performed in 12 children with MMR vaccine-associated meningitis and 11 children with enteroviral meningitis. Percentages of total T-cells, CD4⁺ and CD8⁺ T-cells and monocytes in CSF of patients from the two groups were not significantly different. The majority of CD4⁺ T-cells in the CSF of both patient groups were of memory phenotype. Percentages of CSF naive CD4⁺ T-cells were increased in children with aseptic meningitis following MMR vaccination. Further studies focused on the more detailed immunophenotyping of CSF cells are needed to fully establish the usefulness of flow cytometry in the diagnostic workup of inflammatory CNS diseases in children.     

Coagulase-negative Staphylococci: Emerging Pathogen in Central Nervous System Shunt Infection

Central nervous system (CNS) shunts are commonly used to treat patients with hydrocephalus. Its placement is associated with increased risk of infection. The study was intended to evaluate infection rate associated with CNS shunt surgeries and identify risk factors for shunt infection. The frequency and characterisation of aetiological agents along with their antibiotic resistance pattern were also studied. A prospective study of 86 patients who underwent 97 surgeries over a period of 18 months was conducted. One hundred seventy-six cerebrospinal fluid samples and 44 shunt tips obtained were processed using standard microbiological techniques. Of 86 patients, 39 (45.35%) operated for shunt revision were infected while 47 patients operated for shunt insertion were not found to be infected. Methicillin-resistant Staphylococcus epidermidis was the predominant isolate. 57.58% isolates of Staphylococci were found to be biofilm producers. Mortality of 15% was observed among infected patients. Shunt infection remains a serious issue in the patients undergoing shunt surgery. Accurate diagnosis, treatment and prevention of infection are essential in such patients.     

Metastatic Signet‐Ring Cell Carcinoma of the Bladder in Cerebrospinal Fluid

Primary bladder signet‐ring cell carcinoma (SRCC) is extremely rare and associated with an aggressive course. To our knowledge, we describe the first metastatic bladder SRCC identified in cerebrospinal fluid (CSF). A 68‐year‐old male with 1 year history of primary bladder SRCC with spinal metastasis presented with multiple falls and loss of consciousness. Brain imaging showed high signal in the frontoparietal sulci and superior cerebellum. CSF analysis was significant for increased leukocytes with monocyte predominance while protein and glucose values were within normal range. There was a hypercellular population of pleomorphic tumor cells with signet‐ring morphology, similar to those seen in his diagnostic bladder biopsies. The signet‐ring cells were positive for cytokeratin 7 and 20 and negative for CDX‐2 and prostate‐specific antigen. The patient's clinical condition rapidly deteriorated and he died less than a week after presentation. At autopsy, brain sections revealed signet ring cells in the meninges overlying the cerebrum, cerebellum, brainstem, spinal cord, and pituitary with superficial invasion of the brain parenchyma. No brain parenchymal lesions were present. This case illustrates a unique complication of primary bladder SRCC. Diagn. Cytopathol. 2017;45:73–76. © 2016 Wiley Periodicals, Inc.     

神经垂体分泌物释放入脑脊液主要途径结构基础的电镜研究

目的探讨神经垂体分泌物直接释放入脑脊液途径的结构基础。方法透射电镜和扫描电镜观察大鼠神经垂体。结果神经垂体无髓神经纤维终止于毛细血管或垂体细胞周围,垂体细胞突起与神经纤维膨体及终末之间形成细胞间池。有孔型毛细血管内皮外有基膜与血管周隙分隔,血管周隙内可见到完整的膜包分泌颗粒(100~300 nm)。神经垂体表面的囊上皮孔(2~5μm)附近经常可见分泌颗粒。结论细胞间池-血管周隙-囊上皮孔,构成了神经垂体分泌物释放入脑脊液主渠道的结构基础。     

Genes Involved in Cerebrospinal Fluid Production as Candidate Genes for Late-Onset Alzheimer's Disease: A Hypothesis

Abstract: In rare patients with autosomal dominant, early-onset Alzheimer's disease (AD), pathogenic mutations in the genes encoding β-amyloid precursor protein, and the γ-secretase-complex components presenilin-1 and presenilin-2 appear to result in β-amyloid (Aβ) overproduction. The pathological accumulation of Aβ in the far more common late-onset AD is more likely to be the result of deficient clearance of Aβ. There is evidence that production and turnover of cerebrospinal fluid (CSF) help to clear toxic molecules such as Aβ from the interstitial fluid space of the brain to the bloodstream. CSF production and turnover have been shown to be decreased in aging and in pathological conditions, such as normal pressure hydrocephalus and AD. Reduced formation of CSF, with diminished clearance of Aβ, may play an important role in the onset and progression of AD. If reduced CSF turnover is a risk factor for AD, then its incidence ought to be increased under conditions of CSF circulatory failure. In this paper, the authors hypothesize that genes and variations of genes involved in the CSF production and absorption may contribute to the pathogenesis of late-onset AD.     

Cerebrospinal Fluid Cytokine Expression Profile in Multiple Sclerosis and Chronic Inflammatory Demyelinating Polyneuropathy

Background: Cerebrospinal fluid (CSF) analysis in patients with particular neurologic disorders is a powerful tool to evaluate specific central nervous system inflammatory markers for diagnostic needs, because CSF represents the specific immune micro-environment to the central nervous system. Methods: CSF samples from 49 patients with multiple sclerosis (MS), chronic inflammatory demyelinating polyneuropathy (CIDP), and non-inflammatory neurologic disorders (NIND) as controls were submitted to protein expression profiles of 47 inflammatory biomarkers by multiplex Luminex bead assay to investigate possible differences in the inflammatory process for MS and CIDP. Results: Our results showed differences in CSF cytokine levels in MS and CIDP; in particular, IL12 (p40) was significantly highly expressed in MS in comparison with CIDP and NIND, while SDF-1α and SCGF-β were significantly highly expressed in CIDP cohort when compared to MS and NIND. IL-9, IL-13, and IL-17 had higher expression levels in NIND if compared with the other groups. Conclusions: Our study showed that, despite some common pathogenic mechanisms, central and peripheral nervous system demyelinating diseases, such as MS and CIDP, differ in some specific inflammatory soluble proteins in CSF, underlining differences in the immune response involved in those autoimmune diseases.