颅咽管瘤动物模型的初步建立

目的建立颅咽管瘤（CP）动物模型，鉴定移植瘤的性质。方法收集人脑颅咽管瘤组织，异种异位移植到BALB／c-nu／nu裸小鼠皮下，观察移植瘤的组织学特点，并应用免疫组化法鉴定肿瘤性质。结果12例颅咽管瘤手术标本先后接种在24只BALB／c-nu／nu裸小鼠双侧腋部皮下形成48个移植组织块，成功建立了10只动物模型，成活19个肿瘤组织块。总的移植成功率为39．58％，釉质上皮型为58．33％，鳞形乳头瘤型为20．83％。结论采用异种异位移植方法，可在裸小鼠皮下初步建立人脑颅咽管瘤动物模型。     

颅咽管瘤鸡胚绒毛尿囊膜移植瘤模型的建立

目的初步建立颅咽管瘤鸡胚绒毛尿囊膜(chorioallantoic membrane CAM)移植瘤模型,并评估移植瘤血管生成能力及细胞增殖能力。方法利用术中所得颅咽管瘤组织,异种移植到鸡胚CAM表面,建立移植瘤模型。对移植瘤瘤体周围CAM血管进行测定,评估移植瘤CAM血管生成能力,同时利用免疫组化法以CD34标记移植瘤微血管密度(microvessel density,MVD),以PCNA检测移植瘤细胞增殖活性。结果成功建立颅咽管瘤CAM移植瘤模型,造釉细胞型颅咽管瘤成瘤率为47.14%,鳞状上皮型颅咽管瘤成瘤率为43.33%,两者无显著差异(χ2=0.123,P=0.726);造釉细胞型移植瘤瘤周CAM血管生成能力,微血管密度及细胞增殖活性均高于鳞状上皮型移植瘤。移植瘤PCNA的表达与MVD(Pearson r=0.639,P0.001)及CAM血管评分(Spearman r=0.490,P=0.001)呈正相关。结论采用异位异种移植的方法可在鸡胚CAM上建立颅咽管瘤移植瘤模型。移植瘤可不同程度地刺激CAM上血管生成,移植瘤自身可建立微循环,具有一定的增殖能力。     

蛇毒解聚素在裸鼠胶质瘤模型中的干预治疗作用研究

目的研究蛇毒解聚素（CN）对裸鼠人脑胶质瘤动物模型的治疗可行性,探讨蛇毒解聚素抑制U87胶质瘤裸鼠移植瘤生长的作用机制。方法建立BALB／c裸鼠U87胶质瘤移植瘤模型,将荷瘤裸鼠随机分为2组,采用间质内注射给药方法。蛇毒解聚素按40μg每次给药。定期观察肿瘤生长情况,测量肿瘤体积,绘制肿瘤生长曲线并计算抑瘤率。全部BALB／c裸鼠移植瘤石蜡标本用SP法免疫组化染色,检测移植瘤组织中的微血管计数（MVD）,Ki-67标记指数以及碱性成纤维细胞生长因子（bFGF）。结果与溶媒对照组相比,蛇毒解聚素组均能抑制肿瘤生长（P〈0．01）,其体积抑瘤率为50％,并能明显降低肿瘤微血管密度、能下调移植瘤组织中bFGF的蛋白表达及Ki-67标记指数。结论蛇毒解聚素能明显抑制U87裸鼠移植瘤生长。     

颅咽管瘤中β-catenin基因的表达及临床意义

目的探讨β-catenin基因和颅咽管瘤病理类型及预后的关系。方法用免疫组化技术检测β-catenin基因在50例颅咽管瘤细胞和20例正常脑组织标本中的表达。结果颅咽管瘤组织中β-catenin蛋白的异常表达率高于正常对照组（P〈0．05），釉质上皮型颅咽管瘤组织中β-catenin蛋白的异常表达率高于鳞状乳头型颅咽管瘤（P〈0．05），颅咽管瘤复发者β-catenin蛋白的异常表达率高于非复发者（P〈0．05）。结论β-catenin基因的异常表达激活的异常Wnt通路改变可能在釉质上皮型颅咽管瘤的发生中起重要作用，同时颅咽管瘤细胞中β-catenin基因的异常表达，增加了肿瘤细胞的侵袭能力，使肿瘤的复发率增高。     

人脑肿瘤组织块裸小鼠原位移植方法研究及移植瘤的亲本特征分析

目的 用肿瘤组织块直接接种法建立人脑肿瘤裸小鼠原位移植模型,通过分析移植瘤的生物学特征来证明本操作方法 的可行性. 方法 取人肺腺癌脑转移瘤的新鲜组织或人脑多形性胶质母细胞瘤(GBM)裸小鼠皮下移植瘤组织,剪成小块,置入专用套管针,通过事先钻好的颅骨孑孔,徒手推入裸小鼠右尾状核.观察致瘤率、移植瘤的组织细胞形态、相关标志物、MRI图像特征和荷瘤鼠生存期. 结果肺腺癌脑转移瘤和GBM组织在鼠与鼠之间分别传了6代和13代.荷瘤鼠生存期分别为(38.0±0.9)d和(19.0±1.3)d.肺腺癌脑转移瘤移植瘤不向周围正常鼠脑组织侵袭,分泌酸性粘液及表达癌胚抗原等生物学特征与其亲本肿瘤一致:而GBM移植瘤具有向周围正常鼠脑组织高度侵袭及高表达表皮生长因子受体的生物学特征也与其亲本肿瘤一致. 结论 肿瘤组织块直接注入裸小鼠脑内建立的实验动物模型比肿瘤细胞悬液接种方法 相对简易.且移植瘤能更好地保持亲本肿瘤的特征.此法可进一步在各种腩肿瘤动物原位移植实验中推广应用.     

人脑转移癌组织裸小鼠脑内移植模型的建立

目的 建立人肺腺癌脑转移瘤的裸小鼠原位移植模型,并分析移植瘤的生物学特征.方法 取人肺腺癌脑转移瘤组织块,接种于裸小鼠右尾状核.致瘤后即用裸小鼠的瘤组织进行其原位传代接种,观察致瘤率及荷瘤鼠生存期;MRI观察移植瘤在鼠脑内的大体形态;HE染色分析各代移植瘤的组织学形态;免疫组化染色观察移植瘤中CEA的表达;Alcian blue/PAS特殊染色检测移植瘤中粘液的性质.结果 移植瘤组织在裸小鼠右尾状核已连续传至6代,共65只鼠.荷瘤鼠生存期原代为(47.6±1.8)d,2～3代有所缩短,4～6代稳定在(38.0±0.9)d;移植瘤MRI类圆形,瘤周无水肿.移植瘤病理为低分化腺癌,不向周围正常鼠脑组织浸润;移植瘤中CEA表达阳性,有酸性粘液存在.结论 人肺腺癌脑转移瘤组织块接种于鼠脑内建立的原位移植模型能更好地模拟临床原发肿瘤的病理学特征,本方法为研究人肺腺癌脑转移瘤的生物学特性及实验治疗提供了一个可靠的动物模型.     

骨髓基质细胞移植促进大鼠局灶性脑损伤血管生成的实验研究

目的研究骨髓基质细胞（BMSCs）移植对大鼠局灶性脑损伤血管生成的影响，探讨BMSCs移植修复大鼠脑损伤的机制。方法制备大鼠局灶性脑损伤动物模型，进行BMSCs移植，通过免疫组织化学、电镜等观察移植局部内皮细胞及微循环的变化。结果BMSCs移植后，局部凝血因子FⅧ染色阳性细胞数增加，染色加深，出现血管样结构；局部微血管内膜较光滑，内皮细胞间可见紧密连接，细胞核形态较规则，基底膜较完整，微血管管腔受压缓解。结论BMSCs移植促进损伤区周围内皮细胞增殖和新生血管形成。损伤区局部微循环得以改善进而修复脑损伤。     

小鼠气管异位移植后模拟肺移植慢性排斥反应模型的建立*☆

目的：闭塞性细支气管炎是引起肺移植后移植物功能异常的主要并发症，原位肺移植动物模型技术难度高且费时，限制了其在闭塞性细支气管炎研究中的应用。通过小鼠的气管异位移植来建立模拟肺移植慢性排斥反应模型，以期为国内的闭塞性细支气管炎研究提供一种新的模型选择。 方法：①实验材料及分组：实验于2007-07/08在上海市肺科医院动物实验室完成，动物实验方法符合动物伦理学要求。实验组采用10只C57BL/6小鼠为供体，10只BALB/c小鼠为受体；对照组10只供体、10只受体均采用BALB/c小鼠。②实验方法：取供体小鼠的气管、左右主支气管连续气道作为供体，两端结扎后异位移植到受体小鼠背部皮下。③实验评估：移植28 d后获取移植气管标本，石蜡包埋，行苏木精-伊红染色观察移植气管病理变化；比较两组小鼠的移植气管闭塞性细支气管炎发生率。 结果：20例模型动物全部存活，无感染。①模型动物手术时间（12±2）min。②苏木精-伊红染色病理切片示实验组小鼠移植气管管腔闭塞，慢性炎细胞浸润广泛，气管上皮完全脱落，纤维组织增生明显，呈现闭塞性细支气管炎表现；对照组小鼠移植气管的组织形态未见明显异常。③实验组小鼠移植气管闭塞性细支气管炎发生率高于对照组（P=0.000）。 结论：小鼠气管异位移植后模拟肺移植慢性排斥反应模型作为研究闭塞性细支气管炎的动物模型具有诸多优点。     

颅咽管瘤钙化与CD44V6的关系

目的分析颅咽管瘤组织中CD44V6的表达与颅咽管瘤钙化的关系。方法收集2004年5月～2006年3月经手术治疗的颅咽管瘤标本54例。根据术中所见及影像学表现确定肿瘤钙化程度，采用苏木精一伊红染色分析肿瘤组织类型，免疫组化法检测CD44V6在肿瘤组织中的表达情况。结合临床资料分析钙化程度与CD44V6表达强度的关系。结果成釉细胞型颅咽管瘤41例，鳞状细胞型颅咽管瘤13例。经Mann—Whitney U检验分析，成釉细胞型颅咽管瘤CD44V6的表达显著高于鳞状细胞型颅咽管瘤（Z=-4．813，P〈0．001）。经Spearman相关分析，在成釉细胞型中随着钙化程度的增加，CD44V6表达程度显著增强（rs=0．527，P〈0．01）。结论CD44V6与颅咽管瘤的钙化密切相关，可能是影响其钙化程度的重要因素。     

Fas L转基因神经细胞异种移植治疗癫痫

目的以Fas配体转基因小鼠的胚胎海马神经细胞作为供体，异种移植治疗大鼠癫痫模型，研究Fas-配体表达对异种神经组织移植免疫排斥反应的影响。方法脑室注射海人酸损伤海马CA3区建立癫痫模型。转基因小鼠胚胎15d的海马组织移植到癫痫大鼠的双侧海马区。大鼠-大鼠同种移植组和野生型小鼠-大鼠异种移植组及生理盐水移植组作为对照。在移植后8周进行三等分臂迷宫和跳台实验检测癫痫模型的行为改善情况。结果RT-PCR检测移植的神经细胞中有人Fas配体的表达。转基因移植组与移植前相比有显著地改善（P〈0．01），异种移植及生理盐水组行为学无改善，转基因移植组与异种移植及生理盐水组相比有显著地改善（P〈0．01），但没有同种移植恢复的效果好。结论Fas配体的表达可以抑制或延缓宿主脑内对异种神经细胞的排斥反应。     

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.     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

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.     

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.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

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.