皮质刺激用于脑损伤治疗与康复的研究进展

皮质刺激治疗脑损伤是近几年逐渐受到重视的治疗手段之一,发展较快。皮质刺激可以激活活动减退的组织结构,抑制过度激活的组织结构,增强皮质重组的自然过程,调节皮质及皮质下网状构造的同步化活动,从而促进脑损伤后的康复。皮质刺激包括重复经颅磁刺激、经颅直流电刺激和直接皮质电刺激,每种方法又各具特点。本文就其应用现状及进展作一综述。     

运动皮质刺激治疗慢性疼痛的研究进展

运动皮质刺激(motorcotexstimulation,MCS)是上个世纪80年代出现的一种针对慢性顽固性神经性疼痛的治疗方法,因为其对疼痛良好的控制效果而被越来越多的用于临床。迄今其治疗作用的机制仍不清楚,但这些年来在术中电极定位和疗效预测上有了较大的进展。本文就MCS的发展经过和现状作一综述。     

脑深部刺激和皮质刺激治疗中风后运动障碍和中风后疼痛

目的与方法本研究对脑深部刺激(DBS)和运动皮质刺激(MCS)治疗中风后运动障碍及中风后疼痛的经验进行总结。结果丘脑腹嘴后及中间核的刺激能够缓解70%病人中风后的不自主运动,包括偏身投掷、偏身舞蹈-手足徐动症、肢体远端的静止性及运动性震颤、姿势性震颤。丘脑腹尾核或内囊DBS治疗中风后疼痛疗效常不满意,而MCS可对50%病人取得较好的效果,同时伴随的中风后不自主运动(偏侧舞蹈症-手足徐动症、静止性震颤)也能得到控制。中风后不自主运动病人,尤其是丘脑综合征病人常伴有中风后疼痛,对其进行丘脑腹嘴后及中间核DBS治疗时,发现不自主…     

细胞周期机制在创伤性脑损伤中的研究进展

创伤性脑损伤后诱导继发性损伤,导致神经元凋亡、神经炎症和神经功能障碍,一个重要的损伤机制是细胞周期激活。细胞周期再进入机制可能是神经元凋亡性细胞死亡的共同通路,通路可能是p53依赖性或p53非依赖性的。创伤性脑损伤也导致星形胶质细胞和小胶质细胞中细胞周期激活。细胞周期抑制剂,在创伤性脑损伤后可以提供强有力的神经保护作用,为颅脑损伤的治疗提供新的研究靶点。     

症状前期鼻咽癌放射性脑损伤的神经影像学研究进展

放射性脑损伤是鼻咽癌放疗后的一种严重并发症,对患者生活质量影响极大。目前临床治疗效果不佳,因而,早期诊断并积极预防放射性脑损伤具有重要的临床意义。近年来,神经影像技术作为一种崭新的成像技术出现已广泛应用于鼻咽癌症状前期放射性脑损伤的研究中。本文就各种神经影像技术在鼻咽癌症状前期放射性脑损伤的脑结构和/或功能中的研究应用进行综述。     

低温治疗脑损伤引起的生理病理变化研究进展

低温治疗是一种简单易行的治疗措施,其以多种机制减少脑损伤后有害因素的产生,维护脑内环境的稳定,是一种有效的脑保护途径。但是,随着低温治疗在临床上应用越来越多,低温治疗导致的一系列全身性的或某些系统为主的反应也逐渐受到关注。这些反应涉及心血管系统、免疫系统、能量和药物代谢以及其他全身改变,对低温治疗的应用提出了更全面的要求和注意事项。本文就低温治疗脑损伤时容易出现的生理、病理变化及不良反应作一综述,以期为低温治疗更为有效地开展提供指导帮助。     

骨髓间充质干细胞的分化潜能及其对创伤性脑损伤治疗的研究进展

骨髓间充质干细胞(Bone Marrow Derived Mesenchymal Stem Cells,MSCs）是一种存在于骨髓中的组织干细胞,能够分泌多种造血调控因子及细胞外基质的组织干细胞,具有自我增殖和多向分化潜能,可以向中枢神经细胞分化,包括神经元细胞、星形胶质细胞和少突胶质细胞等。骨髓间充质干细胞还具有易于培养,免疫性低等特点,已被广泛应用于治疗创伤性脑损伤疾病的细胞移植研究。     

脑运动区皮质慢性电刺激治疗顽固性中枢性疼痛

目的 探讨运动区皮质电刺激(motor cortex stimulation，MCS)治疗顽固性中枢性疼痛的手术细节及关键。方法 用条形电极对1例右侧丘脑出血后左侧肢体顽固性疼痛患者行运动区皮质慢性硬膜下刺激并分期植入电子脉冲发生器。结果 患者取得满意疗效，无癫痫、偏瘫等并发症。结论 运动区皮质慢性电刺激是目前治疗顽固性中枢性疼痛的有效方法，中央沟的精确定位和选择合适的刺激参数是手术成功的关键。     

术中皮质电刺激联合皮质脑电图治疗功能区肿瘤继发性癫(癎)

目的 总结术中唤醒麻醉下,皮质电刺激(CS)联合皮质脑电图(ECoG)监测治疗功能区肿瘤继发癫(癎)的临床经验.方法 回顾性分析功能区28例胶质瘤及13例脑膜瘤继发癫(癎)病人的临床资料,采用唤醒麻醉下开颅,通过CS定位感觉、运动及语言区,ECoG定位致(癎)区,显微手术切除肿瘤及处理致(癎)灶.结果 术中CS定位功能区33例,阴性8例;ECoG发现致(癎)灶29例,无异常12例.胶质瘤全切21例,次全切7例;脑膜瘤全切12例,次全切1例.术后暂时性神经功能障碍加重或新发障碍25例,均于1个月内恢复.随访41例,时间6个月～5.5年.癫(癎)发作消失29例,明显减少12例.结论 唤醒麻醉下联合CS、ECoG治疗功能区肿瘤继发性癫(癎),能最大限度保护脑功能,安全处理致(癎)灶.     

外泌体应用于创伤性脑损伤诊断及治疗的研究进展

创伤性脑损伤（TBI）是常见的致残和死亡原因,已经成为世界性的公共卫生问题。当前对于TBI的诊断主要依赖于完整的病史、体格检查和影像学检查,传统的实验室检测很少发挥作用。外泌体作为细胞分泌的囊泡,含有大量亲代细胞的信息物质,是细胞间通讯的重要组成部分。得益于其穿过血脑屏障（BBB）的能力,外泌体用于TBI的诊断具有非常大的潜力。当前用于TBI的主要治疗方式包括外科手术、康复训练和有限的自发功能恢复,尚无明确有效药物治疗方案。越来越多的研究证明,外泌体能够调节TBI后炎症,促进神经、血管再生和维持血脑屏障完整性,从而改善TBI预后。该文旨在对外泌体应用于TBI诊断及治疗的最新研究进展进行综述。     

IMPROVEMENT IN CEREBRAL METABOLISM IN CHRONIC BRAIN INJURY AFTER HYPERBARIC OXYGEN THERAPY

While no research study has yet demonstrated convincing evidence for the efficacy of Hyperbaric Oxygen Therapy (HBOT); in patients with chronic neurological disorders (CND), anecdotal studies have been suppor -tive of its use in improving healing of the damaged brain. The current study hypothesized that (1) individuals with CND show increases in cerebral blood flow and metabolism as measured by Single Positron Emission Computed Tomography (SPECT) in the cerebral hemispheres, but not on measures of cerebellar and pons blood flow; and (2) younger patients show more improvement than older patients. The study used archival data to compare 25 older and 25 younger subjects who were given SPECT scans pretherapy, midtherapy, and posttherapy. ANOVAs using the SPECT scans as a within subjects variable and age as a between subjects variable confirmed the hypothesis that the cerebral measures all changed but that the cerebellar and pons measures did not. Post-hoc t-tests confirmed that there was improvement in blood flow from the beginning to the end of the study. An age effect was found on only two of the five measures; however, there were no interactions. Analysis by post-hoc t-tests showed that the younger group had higher blood flows, but not more improvement than the older group. The results provided the first statistical research data to show the effectiveness of HBOT in improving blood flow in CND. These results indicate that HBOT can be an effective part of the treatment for such clients. The implications of these findings and future research directions were discussed.     

MATURATION OF THE CORTICAL EVOKED RESPONSE TO POSTERIOR-NERVE STIMULATION IN THE PRETERM NEONATE

Short-latency somatosensory evoked potentials elicited by stimulation of the posterior tibial nerve at the ankle were studied in 75 preterm infants. Normative data for the latency of the first cortical component (P1) were obtained for infants from 27 weeks gestation to term, and showed a linear decrease with increasing gestational age. As the pathway of this response traverses areas of the brain likely to be affected by ischaemic and haemorrhagic lesions, abnormalities in the response might indicate later motor disorder.     

尼莫地平和丹参联合用药治疗外伤性脑血管痉挛的临床研究

目的:通过对60例外伤性脑血管痉挛的病人随机分为两组进行前瞻性对照研究,实验组为尼莫地平和丹参联合用药组,对照组为尼莫地平单独用药组,评价两种治疗方法的疗效。方法：实验组,30例病人发病后第三天始口服国产尼莫地平片剂40mg,每日3次,连续用药14～21天,从第三天开始同时静滴国产丹参注射液16mL,每日1次,连续用药14～21天。对照组：30例病人单独使用尼莫地干片剂,剂量、用药途径及用药时间与实验组相同。结果：脑功能恢复率,实验组为93．33％,对照组为73．33％,P＜0．05。结论：尼莫地平和丹参联合用药的疗效要优于单独用尼莫地平。     

UP-REGULATION OF A KERATAN SULFATE PROTEOGLYCAN FOLLOWING CORTICAL INJURY IN NEONATAL RATS

The up-regulation of the keratan sulfate proteoglycan (ABAKAN) was examined using indirect immunohistochemical methods. Previous studies indicate that the keratan sulfate proteoglycan is associated with astrocytes in the optic nerve and in the developing rat brain. In model culture systems, this proteoglycan is capable of inhibiting the growth of neurites over laminin. To determine whether the proteoglycan is up-regulated specifically during reactive gliosis, stab wounds were made in the cerebral cortex of early postnatal rats, and the up-regulation of the proteoglycan was related to the developmentally regulated gliotic response to injury. Following a stab wound in the cortex of the late postnatal rat, reactive gliosis was consistently observed along with an up-regulation of ABAKAN. When the cortex was injured on postnatal day 2, there was a variable gliotic response and considerable variation in the regulation of proteoglycan expression. Biochemical analysis revealed that ABAKAN is a large proteoglycan with multiple keratan sulfate side-chains, at least one chondroitin sulfate side-chain and at least one additional carbohydrate chain with a terminal 3-sulfoglucuronic acid. Taken together, these data demonstrate that the boundary proteoglycan ABAKAN is also associated with reactive gliosis during early postnatal development. Copyright ©1996 ISDN. Published by Elsevier Science Ltd.     

凝血酶对脑出血后脑损伤的作用机制

凝血酶在对脑出血后脑组织的损伤中起着重要作用。本文通过介绍凝血酶的化学结构及其受体的分布，从脑水肿，炎症反应，脑缺血损伤，神经元损伤四个方面，对凝血酶在脑出血后脑损伤的作用机制进行综述。最后对小剂量凝血酶 预处理在脑组织中的保护作用进行了展望。     

EFFECT OF HYPOTHERMIA ON BLOOD-BRAIN BARRIER PERMEABILITY FOLLOWING TRAUMATIC BRAIN INJURY IN CHRONICALLY ETHANOL-TREATED RATS

The objective of this study was to investigate the effect of hypothermia on the blood-brain barrier (BBB) disruption caused by traumatic brain injury (TBI) in chronically ethanol-treated rats. BBB permeability was measured using Evans blue (EB) dye. Arterial blood pressure levels of animals in hypothermic groups decreased significantly. The EB dye extravasation into the brain significantly increased in hypothermia and at 6 and 24 h after TBI. In ethanol-treated rats that were subjected to TBI, hypothermia led to a significant decrease in EB dye content in the brain at 24 h but not at 6 h after TBI when compared with TBI alone.     

脑内缝隙连接

缝隙连接普遍存在于动物组织中，具有重要的生理功能。近年来，由于分子生物学等技术的应用，对许多组织的缝隙连接蛋白的特性及其功能的研究取得了很大进展。本文重点介绍脑内缝隙连接蛋白的类型，分布及其生物物理学和药理学特性，并阐述胶质细胞之间、神经元之间缝隙连接的作用，以及缝隙连接与脑发育和癫痫等神经系统疾病的关系。     

COORDINATION IN THE DYNAMICS OF THE BRAIN AS INFERRED FROM EEG ANALYSIS

The present study observed the coordination between cortical areas during no task conditions as well as for the pathological condition of epilepsy, by application of the phase synchronization technique to the EEG signal in a multichannel recording. The index obtained from the phase entrainment investigation was properly scaled by a novel method to take into account the effect of nearest neighbor interactions. This scaled index was analyzed temporally to learn about the behavior of regional interactions in time. The results obtained not only corroborate earlier known results, but also give deeper insight into actual brain functioning.     

电刺激黑质对脑干伤害性单位放电的影响

本实验采用单细胞外记录神经元单位放电的方法，在Ｗｉｓｔａｒ大鼠上观察到网状巨细胞核。一区伤害性神经元５７个，其中伤害兴奋性神经元（ＮＥＮ）４２个，伤害抑制性神经元（ＮＩＮ）１５个。电刺激黑质对ＮＥＮ（２９）和ＮＩＮ（８的放电呈抑制作用，其反应百分率分别由刺激黑质第１分钟时的１．０±２．１％和－２０．４±６．２％，降到第５分钟时的－８３．６±１２．３％和－６５．４±１０．７％（Ｐ＜０．０１）。刺激黑质对少数ＮＥＮ（１３）和ＮＩＮ（７）的放电有兴奋作用，其值分别由第］分钟时的２０．５±７．３％和１．０±３．４％，升高到第５分钟时的７４．５±１０．７％和２１，５±８．６％（Ｐ＜０．０５）。氟哌啶醇注入ＰＡＧ腹外侧部可阻断刺激黑质的效应，这提示从黑质到网状巨细胞核α－区存在着一条痛调制通路，而且这种通路的递质是多巴胺能的。