亚低温抑制大鼠弥漫性脑损伤后细胞凋亡的研究

目的：探讨大鼠不同程度弥漫性脑损伤后脑组织的凋亡变化过程及亚低温治疗对脑细胞凋亡的抑制作用。方法：采用大鼠Marmarou颅脑创伤装置制作弥漫性脑损伤模型,然后将128只Wistar大鼠分为未损伤组（对照组）、重度损伤组、轻度损伤组和亚低温治疗组。通过电子显微镜、组织切片原位末端标记DNA片段（TUNEL染色）、琼脂糖凝胶电泳（DNA Ladder法）等方法,观察和比较不同程度脑损伤后,大鼠脑皮层及海马区凋亡细胞的形态、特点和数量。结果：（1）损伤后24-48h,皮层及海马区可见大量细胞皱缩、核碎裂、核不规则等细胞凋亡现象,48h较24h更为严重;亚低温治疗后24-48h,电子显微镜观察皮层及海马区未见细胞皱缩、核碎裂等细胞凋亡现象。（2）TUNEL染色结果显示,随着损伤程度的加重凋亡明显加重,损伤后48h达高峰,然后逐渐下降。轻度损伤组细胞凋亡主要限于海马CA2和CA3区;重度脑损伤组细胞凋亡涉及整个海马结构,同时还广泛累及额顶区皮质。损伤后第24、48、72h,皮层及海马区的凋亡细胞数量较同期未治疗组明显减少。（3）重度损伤后48h,海马和皮层区细胞琼脂糖电泳可见典型的DNA梯状带,其他时间未见梯状带。亚低温治疗组、轻度脑损伤组及未损伤组亦未见梯状带。结论：轻度弥漫性脑损伤后,脑细胞凋亡多发生于海马CA2和CA3区;重度脑损伤后皮层及海马区细胞可发生广泛凋亡。细胞调亡随着损伤程度的加重而加重,高峰位于伤后第2d。亚低温治疗可有效地抑制大鼠弥漫性脑损伤的细胞凋亡。     

亚低温对大鼠弥漫性脑损伤后海马CA3区HSP70表达及细胞凋亡的影响

目的 观察亚低温对大鼠弥漫性脑损伤(DBI)后海马CA3区HSP70在蛋白质和mRNA水平的表达及细胞凋亡上的影响,探讨亚低温脑保护分子生物机制。方法 将大鼠随机分成空白对照、假手术、单纯DBI和DBI后亚低温治疗四组,按Marmarou氏方法制作大鼠DBI模型,采用免疫组化法、逆转录聚合酶链反应(RT-PCR)及流式细胞仪(FCM),分别观察各组动物脑海马CA3区HSP70在蛋白质和mRNA水平的表达及细胞凋亡率。结果 与对照组相比,大鼠DBI后海马CA3区HSP70表达水平及细胞凋亡率均升高(P<0.05);亚低温治疗后,大鼠脑海马CA3区HSP70表达水平较单纯DBI组显著增高(P<0.01),而细胞凋亡率则明显降低(P<0.05)。结论 亚低温对创伤性脑损伤的脑保护机制可能与促进HSP70表达,并减少神经细胞凋亡有关。     

亚低温对大鼠脑创伤后海马区凋亡相关蛋白表达的影响

目的观察亚低温对大鼠创伤性脑损伤(TBI)后海马CA3区细胞凋亡及相关蛋白Bcl-2、Bax及Caspase-3表达的影响,探讨亚低温脑保护的分子生物学机制.方法将大鼠随机分成假手术、单纯脑损伤和脑损伤后亚低温治疗3组,应用改良Marmarou方法制作大鼠TBI模型,分别用流式细胞仪(FCM)和免疫组化法检测各组动物脑海马CA3区细胞凋亡率和Bcl-2、Bax及Caspase-3蛋白的表达.结果与假手术组相比,大鼠TBI后海马CA3区细胞凋亡率及Caspase-3表达增高(P<0.05),Bcl-2/Bax表达比下降(P<0.05).亚低温治疗后,大鼠脑海马CA3区细胞凋亡率及Caspase-3表达较单纯脑损伤组降低(P<0.05),而Bcl-2/Bax表达比升高(P<0.05).结论亚低温对TBI的脑保护作用机制可能与干预伤后凋亡相关基因表达并减少神经细胞凋亡有关.     

头孢曲松对大鼠弥漫性轴索损伤后细胞凋亡的影响

目的探讨头孢曲松对大鼠弥漫性轴索损伤后海马CA1区神经元凋亡的影响。方法选择雄性Wistar大鼠120只,随机分为药物干预组(n=36):制作弥漫性轴索损伤模型,于制作模型后即刻给予头孢曲松200 mg·kg-1。假手术组(n=36):仅行头皮切开缝合处理,给予等量生理盐水腹腔注射。脑损伤组(n=36):制作弥漫性轴索损伤模型,给予等量生理盐水腹腔注射。正常对照组(n=12):不给予任何干预措施。采用免疫组化技术检测干预后12、24和36h时相海马CA1区凋亡蛋白酶激活因子-1(Apaf-1)蛋白的表达水平。结果脑损伤组和药物干预组大鼠海马CA1区Apaf-1蛋白表达水平均于12 h开始增加,24 h达高峰,此后逐渐下降。药物干预组大鼠海马CA1区Apaf-1蛋白表达水平在各个时相点均低于脑损伤组,均差异有统计学意义。结论弥漫性轴索损伤可引起大鼠海马CA1区神经元凋亡,头孢曲松可改善凋亡的发生、发展。     

大鼠脑创伤后海马CA3区细胞凋亡及相关基因表达研究

目的研究弥漫性脑损伤后不同时间,大鼠海马CA3区细胞凋亡及相关基因Bcl-2、Bax和Caspase-3蛋白的表达情况,探讨脑创伤后神经细胞凋亡的分子生物学机制.方法应用流式细胞仪和免疫组化法,分别检测脑创伤后不同时间海马CA3区细胞凋亡率及Bcl-2,Bax和Caspase-3基因在蛋白质水平的表达情况.结果脑创伤后海马CA3区存在不同程度细胞凋亡,Bcl-2在脑损伤后表达下降,而Bax和Caspase-3在脑创伤后表达升高;Caspase-3表达的峰值时间(72 h)出现在Bax之后(48 h).结论弥漫性脑损伤后,大鼠海马CA3区存在细胞凋亡及Bcl-2,Bax和Caspase-3的表达变化.Bcl-2/Bax表达比值下降早于Caspase-3的上升,Bcl-2/Bax表达比值改变可能与Caspase-3活化有关,进而启动并加重脑损伤后神经细胞凋亡.     

亚低温抑制大鼠创伤性神经细胞凋亡的实验研究

目的 研究创伤性脑损伤后神经细胞凋亡机理及其时序空间分布,并探讨亚低温脑保护机理。方法 末端标记法(TUNEL)、琼脂糖凝胶电泳、流式细胞技术检测大鼠重度脑损伤后不同脑区神经细胞凋亡的动态变化过程。实验分假手术组、常温脑伤组、亚低温治疗6、12、24h三组。结果 创伤后12h皮层、皮层下、白质、海马等脑区神经细胞凋亡明显增加,其高峰在伤后12～72h,持续可达14d,与对照组相较,相差显著或非常显著。琼脂糖凝胶电泳显示创伤脑组织DNA出现特异凋亡电泳带。流式细胞检测呈现典型亚二倍体核型峰(AP峰)。亚低温治疗明显抑制创伤性神经细胞凋亡。结论 创伤性脑损伤后存在神经细胞凋亡现象。亚低温对创伤性神经细胞凋亡具有明显抑制作用。     

亚低温对创伤性脑损伤后线粒体α-酮戊二酸脱氢酶活性的影响

目的研究亚低温对脑损伤后病理学，α-酮戊二酸脱氢酶（α—ketoglutarate dehydrogenase complex，α-KGDHC）活性以及Caspase-3活性的影响。方法雄性SD大鼠50只随机分七组：假手术组（n=5），液压脑损伤常温组（1．8～2．2atm）（n=25），液压脑损伤亚低温组（n=20）。常温组伤后6h，24h，72h，7d检测创伤侧皮层、海马及丘脑线粒体α—KGDHC活性及Caspase-3的活性。伤后15min应用亚低温，30min内脑温降至33℃并维持4h，检测24h及72h酶活性以及Caspase-3的活性。以及亚低温对损伤后24h皮层丘脑及海马CA3区神经病理的影响。结果Fluoro—jade染色显示亚低温显著减少损伤后24h坏死神经元数目（P〈0．05），伤后24h及72hKGDHC酶的活性显著增加（P〈0．05）。伤后24hCaspase-3的活性显著降低（45％）。结论创伤性脑损伤后早期亚低温能够恢复能量代谢酶的活性，抑制神经元凋亡，减轻损伤后神经元的变性。     

亚低温对缺血性神经元凋亡、细胞色素C释放的影响

通过大鼠短暂全脑缺血模型来探讨亚低温对大鼠脑缺血后细胞色素C(CytochromeC ,CytC)释放及缺血性神经元凋亡的影响 ,揭示亚低温的部分神经保护机制。用原位细胞凋亡检测法 (TUNEL染色 )检测及电镜观察脑缺血后大鼠脑海马CA1区神经元凋亡发生情况 ;免疫组织化学法测定脑缺血后大鼠脑海马区神经元中细胞色素C释放情况。结果显示 :①低温缺血组海马CA1区凋亡神经元数明显少于常温缺血组 (P <0 .0 1) ;②低温缺血3h组海马CA1区神经元CytC阳性表达低于常温缺血 3h组 (P <0 .0 1)。据此认为 ,全脑缺血后的迟发性神经元死亡很可能经由凋亡途径 ,而CytC激活、释放是缺血性神经元凋亡的一个关键事件。亚低温可抑制CytC的释放 ,推测经此途径减少缺血性神经元凋亡而发挥一定的神经保护作用。     

亚低温对大鼠全脑缺血再灌注损伤后海马CA1区c-Jun蛋白表达的影响

目的研究亚低温对大鼠全脑缺血再灌注损伤后海马CA1区神经元的保护作用,并探讨其可能的机制。方法采用四血管阻断法建立大鼠全脑缺血模型。SD大鼠,随机分为假手术组(SH组)、常温组(IR组)和亚低温组(HIR组)。各组在全脑缺血15min后分别再灌注6h、12h、1d、3d,采用苏木素-伊红(HE)染色观察各时间点海马CA1区细胞形态学变化和TUNEL法检测海马CA1区神经元凋亡,免疫印迹检测c-Jun蛋白表达。结果(1)HE染色结果 IR组和HIR组于全脑缺血再灌注后6h,HE染色未见明显改变,IR组缺血再灌注1d时CA1区出现严重改变,3d时损伤最严重,出现细胞数目减少,细胞胞体缩小、胞核固缩深染,损伤严重,排列紊乱,核膜不清,核仁消失。而HIR组海马存活的锥体细胞数较之IR组12h、1d、3d时间点均明显增加(P<0.05)。(2)TUNEL标记IR组于缺血再灌注后6h在海马CA1区阳性细胞开始增多,缺血再灌注1 d时阳性细胞数最多。而HIR组各时间点阳性细胞数均较IR组明显减少(P<0.01)。(3)免疫印迹结果全脑缺血再灌注后6h c-Jun蛋白在IR组海马CA1区表达开始增加,12h达高峰,持续到3d;HIR组在各时间点的表达均弱于IR组(P<0.01)。结论亚低温通过减少海马CA1区c-Jun的表达,抑制海马CA1区神经元的凋亡,可能是亚低温脑保护作用的机制之一。     

Cyt-C Bcl-XL和Bcl-XS在大鼠创伤性脑损伤模型中的表达意义

目的 观察大鼠创伤性脑损伤(TBI)后细胞色素C释放及凋亡因子Bcl-XL和Bcl-XS的表达意义.方法 采用大鼠自由落体建立脑损伤模型,分别于伤后2h、6h、12 h、24 h、72 h、120 h、168 h检测大鼠脑挫裂伤侧海马CA2-CA3区细胞色素C染色阳性细胞(免疫组化法),应用Bcl-XL和Bcl-XS原位杂交法检测Bcl-XL和Bcl-XS mRNA表达.结果 脑挫裂伤后,海马CA2-CA3区Cyt-C阳性染色的神经细胞出现具有明显时相性,脑损伤后大鼠脑组织内Bcl-XL、Bcl-XS mRNA出现相应改变.结论 大鼠脑挫裂伤后海马CA2-CA3区细胞有相应变化并出现细胞凋亡.     

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.     

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.     

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.     

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.     

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.     

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.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.