睡眠剥夺对大鼠血清MBP及皮质醇含量的影响

目的　测定大鼠睡眠剥夺 ( sleep deprivation,SD)后血清髓鞘碱性蛋白 ( myelin basic protein,MBP)和皮质醇水平变化 ,观察 SD对大脑的损害情况。方法　采用小平台水环境法建立 SD模型 ,以大平台组 ( TC)和正常笼养组 ( CC)作为对照组 ,采用酶联免疫吸附法测定 MBP水平 ,并用双抗体放射免疫法测定皮质醇水平。观察大鼠经 1、3、5 d SD后上述指标变化。结果　与 CC组比较 ,SD 1、3、5 d后血清皮质醇水平均增高 ,与 TC组比较 ,SD3、5 d血清皮质醇水平增高 ,差异有显著性 ;SD5 d后血清 MBP水平增高 ,SD1、3 d水平差异无显著性。TC组与 CC组比较 ,血清皮质醇水平增高而 MBP水平差异无显著性。结论　长时间 SD可引起脑器质性损害。     

快速眼球运动睡眠剥夺及γ-氨基丁酸能药物干预对大鼠认知功能的影响

目的 建立快速眼球运动(REM)睡眠剥夺和下丘脑穹隆周围核微量渗析大鼠模型,研究不同程度REM睡眠剥夺和恢复对SD大鼠认知功能、下丘脑泌素(Hcrt)能系统和γ-氨基丁酸(GABA)能系统的影响及其可能机制.方法 将雄性SD大鼠随机分为对照组和REM睡眠剥夺组,REM睡眠剥夺组又分非手术对照组(nonOP)、假手术对照组(Sham)、GABAA受体拈抗剂SR-95531组(SR)和GABA再摄取抑制剂NO-711组(NO).采用改良多平台水环境法(MMPM)建立REM睡眠剥夺SD大鼠模型,利用Morris水迷宫测定大鼠在不同程度REM睡眠剥夺对认知功能的影响变化,采用免疫荧光技术检测下丘脑Hcrt神经元数量形态和原癌基因(Fos)表达、下丘脑GABA的A型受体α1(GABAA Rα1)亚单位表达累积吸光度值;采用高效液相色谱仪(HPLC)测定下丘脑GABA和谷氨酸(Glu)含量.建立穹隆周围核微量渗析SD大鼠模型,观察GABAA受体拈抗剂SR-95531和GABA再摄取抑制剂NO-711对上述指标的影响.结果 REM睡眠剥夺导致nonOP组和Sham组SD大鼠认知功能下降、下丘脑外侧区Fos阳性细胞总数和Fos-Hcrt双阳性细胞(F+&H+)数量增加、下丘脑GABA含量和GABAA Rα1表达增加,且变化程度均与REM睡眠剥夺时间长短呈正相关.但上述指标的变化都能够在不同程度睡眠恢复后得以修正.NO组与对照组比较,睡眠剥夺期间认知功能下降、下丘脑外侧区Fos阳性细胞总数和F+&H+数量增加(F=9.56、12.14、10.12,P＜0.05),且增加程度均与REM睡眠剥夺时间长短呈正相关;但睡眠恢复后差异无统计学意义.SR组与对照组比较,睡眠剥夺期间差异无统计学意义,但睡眠恢复期间认知功能下降、下丘脑外侧区Fos阳性细胞总数和F+&H+数量增加(F=12.03、11.38、8.36,均P＜0.05).SR组GABA含量和GABAA Rα1表达在全部5个时间点均明显增加(F=11.36、14.67,均P＜0.05),而NO组仅在SD 5d的GABAA Rα1表达明显增加(F=12.06,P＜0.05).结论 在REM睡眠剥夺和恢复过程中,GABA能系统存在自身调节机制,但无论是其再摄取抑制剂NO-711还是受体竞争剂SR-95531,均对认知功能下降产生不利影响,因此GABA能系统并不是治疗失眠的最理想靶点.Hcrt能神经元系统和GABA能系统之间存在相互抑制的作用,可以通过降低Hcrt神经元激活来改善睡眠的效果.并据此推断,Hcrt能系统可能是诱导睡眠和治疗失眠的潜在理想靶点.     

睡眠剥夺小鼠海马中BDNF、IL-4变化的研究

目的探究睡眠剥夺过程中小鼠海马组织内脑源性神经营养因子(brain derived neurotrophic factor,BDNF)、白细胞介素4(Interleukin-4,IL-4)的动态变化及相关性,从而为睡眠剥夺对海马学习记忆功能的影响提供可能的理论依据。方法 (1) 6～8周龄C57BL/6J雄性小鼠随机分为正常对照组(Cage control,CC)、快速眼球运动(REM)睡眠剥夺1 d组(REM sleep deprivation 1 day,SD 1 d)、REM睡眠剥夺2 d组(SD 2 d)、REM睡眠剥夺3 d组(SD 3 d),每组12只小鼠。CC组同笼饲养1 w后于9:00AM灌注处死,SD 1 d组、SD 2 d组、SD 3 d组经睡眠剥夺1 d、2 d和3 d后均于9:00AM灌注处死。(2)采用ELISA方法观察各组小鼠海马组织中BDNF、IL-4的表达水平。结果 (1) ELISA显示SD 1 d组小鼠海马中BDNF、IL-4较CC组表达水平升高,差异具有统计学意义(P值分别为0. 029、0. 001); SD 2 d组BDNF、IL-4较CC组表达无明显差异(P值分别为 0. 5、0. 13); SD 3 d组BDNF、IL-4较CC组表达水平明显降低,差异具有统计学意义(P值均为0. 001)。(2) Pearson相关性分析显示睡眠剥夺过程中小鼠海马中IL-4、BDNF蛋白表达变化呈正相关性,P 0. 001,相关系数r=0. 863。结论睡眠剥夺后BDNF、IL-4表达量的变化可能是睡眠剥夺后造成神经损伤的可能机制之一。     

快速动眼睡眠剥夺对大鼠学习、记忆能力及海马组织自噬的影响

目的 探讨快速动眼(rapid eye movement,REM)睡眠剥夺后与大鼠认知相关的行为学变化及脑内海马组织中自噬相关蛋白的表达水平。方法 健康成年雄性大鼠经过筛选后分为空白对照组(CC组)、环境对照组(TC组)、睡眠剥夺组(SD组),每组各6只; 采用改良多平台睡眠剥夺法(modified multiple platform method,MMPM)建立睡眠剥夺模型,连续剥夺5 d后利用Morris水迷宫检测大鼠认知功能; 用蛋白质印记法(Western Blot,WB)检测自噬相关微管蛋白(LC3)及SQSTM1/P62的表达水平变化。结果 与CC组和TC组比较,SD组大鼠毛色无光泽、易激惹、体重下降(P<0.05)。SD组与其他2组比较,逃逸潜伏期延长、目标象限时间减少(P<0.05)。WB显示SD组与其他2组比较,大鼠脑内海马组织自噬相关蛋白LC3-II表达水平上升,P62水平下降(P<0.05)。CC组与TC组大鼠比较,体重、学习记忆能力、海马组织自噬蛋白表达水平均无明显差异(P>0.05)。结论 睡眠剥夺后可损害大鼠学习及记忆功能,海马组织中自噬水平上调提示自噬活动可能参与睡眠剥夺介导的认知功能障碍过程。     

细胞型朊蛋白介导的海马神经元轴突延伸障碍可能参与睡眠剥夺后认知障碍

目的 研究快速眼动睡眠剥夺后大鼠空间记忆功能和海马细胞型朊蛋白(cellular prion protein,PrPC)表达的变化及沉默细胞型朊蛋白对体外培养的海马神经元轴突延伸的影响,探讨睡眠剥夺后认知功能变化的机制.方法 成年SD大鼠按体重大小排序,完全随机法分为3组,分别为正常笼养对照组、水槽对照组、睡眠剥夺组.采用改良多平台睡眠剥夺法进行连续72 h快速眼动睡眠剥夺.采用Moms水迷宫评估空间记忆.用蛋白质印迹法检测睡眠剥夺后各组大鼠海马PrPC表达的变化.使用原代培养的海马神经元,用RNA干扰技术沉默PrPC,观察神经元轴突延伸的变化.结果 大鼠睡眠剥夺后空间记忆受损,睡眠剥夺组穿越平台次数(3.17±0.95)较笼养对照组(7.17±0.95)和水槽对照组(6.50 ±0.62)明显减少(Z =2.026 6,Z=2.026 6,P＜0.05),平台接近平均值(mm)睡眠剥夺组(711.74 ±33.99)较笼养对照组(592.32±31.31)和水槽对照组(580.86±11.36)明显增大(Z=-2.001 6,Z=-2.482 0,P＜0.05).睡眠剥夺后海马PrPC的表达睡眠剥夺组(0.33±0.10)较笼养对照组(1.01±0.33)和水槽对照组(0.96±0.27)明显下调(Z =2.152 9,Z=2.152 9,P＜0.05).沉默PrPC导致原代培养的海马神经元轴突延伸障碍,感染组神经元(326.28±12.53)与未感染组(555.00±30.43)和感染阴性对照组(558.70±23.10)比较,轴突长度(μm)明显变短(Z =4.768 4,Z=4.877 0,P＜0.05).结论 睡眠剥夺后PrPC介导的海马新生神经元轴突延伸障碍可能是睡眠剥夺后认知障碍发生的潜在机制之一.     

异相睡眠剥夺对大鼠脑内质网应激相关蛋白ATF4表达的影响

目的 研究异相睡眠(REM 睡眠)剥夺对大鼠海马及额叶内质网应激相关蛋白转录活化因子4(ATF4)表达的影响.方法 大鼠采用完全随机数字表法分为6组:空白对照组(CC组)、环境对照组(TC)、睡眠剥夺(SD)6h、12 h、1 d、3 d组,每组10只.采用改良多平台睡眠剥夺法建立REM 睡眠剥夺大鼠模型,免疫组织化学及Westemblot方法测定不同时间点大鼠额叶及海马ATF4蛋白的表达.结果 CC组大鼠海鸟及额叶均未检测出ATF4.TC组海马、额叶均有ATF4表达,SD组海马、额叶6 h时开始表达ATF4,12 h后达到高峰,1 d、3 d呈逐渐下降趋势.结论 REM睡眠剥夺可诱发内质网应激,睡眠剥夺后大鼠海马与额叶发生内质网应激的时间及发展趋势基本相同.     

大鼠中枢神经系统中神经肽S的表达及对睡眠功能的影响

目的研究剥夺睡眠大鼠的神经肽S表达水平,探讨其与睡眠的关系。方法共对27只大鼠进行实验,分别为CC组(正常对照组)、TC组(环境对照组)及SD组(睡眠对照组),在相应的环境中饲养1d、3d和5d,对大鼠下丘脑中神经肽S的表达水平进行研究并比较。结果大鼠睡眠剥夺后出现体质量降低、皮毛蓬乱、潮湿无光滑。部分大鼠尾巴和爪子出现磨损,大鼠情绪烦躁不安,较容易发怒且具有较强的攻击性,这些表现在睡眠剥夺5d后表现得更加明显;CC组和TC组在实验第1天、第3天和第5天的下丘脑神经肽S mRNA的表达水平差异无统计学意义(P0.05);SD组第3天和第5天下丘脑神经肽S mRNA的表达水平均高于第1天,差异具有统计学意义(P0.05);SD组第3天和第5天下丘脑神经肽S mRNA的表达水平均高于CC组和TC组,差异具有统计学意义(P0.05)。结论神经肽S可能具有促进觉醒的作用,对人体的睡眠与觉醒产生一定的调节作用,可能与失眠等多种疾病的发生具有密切的相关性,值得更加深入的研究。     

快速眼动睡眠剥夺后大鼠皮质及海马 HSP70表达的研究

目的探讨不同时间的快速眼动(REM)睡眠剥夺对大鼠皮质及海马各区的热休克蛋白70(HSP70)表达的影响及意义。方法60只Wistar大鼠，随机分为睡眠剥夺组(SD)、环境对照组(TC)和空白对照组(CC)。其中SD组又分为1d、3d、5d、7d4个时点。用改良多平台睡眠剥夺法进行REM睡眠剥夺，运用免疫组织化学方法观察REM睡眠剥夺后大鼠额叶、顶叶皮质及海马各区HSP70表达的分布规律及时空变化；同时结合蛋白质免疫印记(Western Blot)实验对额叶皮质及全海马HSP70蛋白作了选择性的半定量分析。结果REM睡眠剥夺后1d脑内HSP70表达一过性增强。以后逐渐下降。Western Blot实验印证了这一结果。结论REM睡眠剥夺能够引起大鼠皮质及海马神经元内HSP70表达增强，可能是一种自身稳定调节的保护机制。     

睡眠剥夺对小鼠脑组织超微结构和晚期糖基化终末产物受体表达的影响

目的 研究睡眠剥夺对小鼠脑组织超微结构晚期糖基化终末产物受体表达的影响。方法 30只3月龄健康昆明小鼠随机分为3组:睡眠剥夺组(SD)、平台对照组(TC)和空白对照组(BC),每组10只。应用无应激刺激物体识别试验(ORT)检测小鼠的学习和记忆能力,透射电镜观察小鼠海马CA1区和前额叶皮质的超微结构变化,免疫组织化学方法检测小鼠大脑海马CA1区和前额叶皮质的RAGE蛋白的表达。结果 神经行为学结果:SD组小鼠对新物体C的探索时间与探索A物体的时间无明显差异,而与TC、BC组比较下降明显(P0.05)。电镜结果:SD组海马和前额叶皮层神经元的数量减少,排列紊乱,部分轴索膜和髓鞘溶解、断裂,线粒体数量明显减少,突触囊泡形态不规则、稀疏。免疫组化结果:SD组海马CA1区和前额叶皮质RAGE蛋白免疫组化染色阳性细胞数明显增加(P0.05)。结论 睡眠剥夺可损害小鼠的认知功能,可能对小鼠海马CA1区及前额叶皮质脑组织超微结构造成损害,以及可能增加小鼠海马CA1区及前额叶皮质晚期糖基化终末产物受体(RAGE)的表达,致小鼠神经行为学改变。     

慢性睡眠剥夺对小鼠海马胶质细胞α7-nAChR影响的研究

目的探讨慢性睡眠剥夺对小鼠海马组织α7-nAChR表达及星形胶质细胞和小胶质细胞表面α7-n AChR的表达的影响。方法成年C57BL/6J小鼠随机分为3组:正常对照(control,CC)组、慢性睡眠剥夺(sleep deprivation,SD)组、慢性睡眠剥夺后腹腔注射α7-nAChR激动剂PHA-543613(SD+PHA-543613)组。采用Western印迹、实时荧光定量PCR分别检测各组小鼠海马组织α7-nAChR蛋白及基因的表达;使用免疫荧光染色法观察各组小鼠海马组织星形胶质细胞、小胶质细胞表面α7-nAChR的表达变化。结果 SD组与CC组比较,SD组海马组织的α7-nAChR蛋白表达、mRNA表达和星形胶质细胞表面α7-nAChR的表达均明显低于CC组(P=0.001,P=0.038,P=0.003);SD组与SD+PHA-543613组比较,SD+PHA-543613组海马组织的α7-nAChR蛋白表达、mRNA表达和星形胶质细胞表面α7-nAChR的表达较SD组升高(P=0.037,P=0.002,P=0.027)。结论慢性睡眠剥夺不仅抑制海马组织α7-nAChR基因及蛋白的表达,同时降低α7-nAChR在星形胶质细胞表面的表达,海马组织胶质细胞α7-nAChR的减少可能是慢性睡眠剥夺后认知功能下降的危险因素。     

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.     

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.     

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.     

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.     

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.     

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.