人参总皂甙对大鼠脑缺血再灌注后MDA、SOD及细胞凋亡的影响

目的:观察人参总皂甙对大鼠脑缺血再灌注的保护作用,探讨其作用机制。方法:将40只大鼠随机分为4 组:假手术组、缺血再灌注组、治疗组1、治疗组2,采用线栓法制备大鼠脑缺血再灌注模型,72h断头取脑,Nissel染色光镜下观察海马CA1区病理形态变化,TUNEL法检测细胞凋亡,同时检测脑组织中丙二醛(MDA)、超氧化物歧化酶(SOD)的含量。结果:与缺血再灌注组相比,人参总皂甙治疗组光镜下病理损伤轻,脑组织中MDA含量降低、SOD含量升高,细胞凋亡数降低。结论:人参总皂甙对大鼠脑缺血再灌注损伤具有保护作用,其机制可能与抑制自由基损伤有关。     

β-七叶皂甙钠对脑缺血-再灌注损伤大鼠自由基的影响

目的探讨β-七叶皂甙钠在大鼠脑缺血-再灌注损伤时对自由基的影响。方法用Wistar大鼠45只制备局灶性脑缺血-再灌注模型,分为假手术组、缺血-再灌注组、β-七叶皂甙钠治疗组,每个组又分为缺血2 h后再灌注6 h、12 h、24 h三个时间点,每组每个时间点5只大鼠,术后观察脑组织梗死面积、大鼠的神经行为学变化评分、脑组织超微病理结构变化、脑组织TTC染色,对缺血区脑组织超氧化物歧化酶(superoxide dismutase,SOD)、丙二醛(malondiadehyde,MDA)含量进行测定和分析。结果假手术组相应时间点神经功能损害评分显著低于缺血-再灌注组和治疗组(P<0.05),治疗组SOD含量明显高于缺血-再灌注组各时间点(P<0.05)。光镜显示假手术组脑组织结构未见明显病理改变,脑缺血-再灌注组神经细胞缺血坏死,细胞水肿明显,胶质细胞弥漫增生,炎性细胞浸润。结论自由基参与了脑缺血-再灌注损伤,β-七叶皂甙钠可降低缺血-再灌注后脑组织中MDA的含量,增加SOD的活性,减轻梗死体积,显著减轻大鼠神经功能损害和脑组织水肿,对局灶性脑缺血-再灌注损伤具有一定的保护作用。     

G-CSF对局灶脑缺血再灌注大鼠脂质过氧化及神经细胞凋亡的影响

目的研究G-CSF对局灶脑缺血再灌注大鼠缺血区域脑组织脂质过氧化及神经细胞凋亡的影响,为G-CSF应用于缺血性脑血管病的治疗提供进一步的理论依据。方法 18只成年雄性Wistar大鼠随机分成3组:假手术组、盐水对照组和G-CSF治疗组,每组各6只大鼠。改良线栓法建立右侧大脑中动脉阻塞模型(t MCAO)。再灌注2 h后,G-CSF治疗组给予50μg/kg粒细胞集落刺激因子皮下注射一次;盐水对照组注入等量生理盐水;假手术组不作任何处理。再灌注24 h后处死大鼠取脑,化学比色法检测缺血区域SOD、GSH-PX、MDA、NO的含量;免疫组化染色计数p-JNK、p-p38MAPK阳性细胞;Tunel染色检测神经细胞凋亡情况。结果再灌注24 h后,G-CSF治疗组缺血区域SOD、GSH-PX的含量高于盐水对照组而低于假手术组(P<0.05),MDA、NO的含量低于盐水对照组而高于假手术组(P<0.05);G-CSF治疗组p-JNK、p-p38MAPK阳性细胞明显少于盐水对照组(P<0.05),tunel染色可见凋亡细胞数较盐水对照组减少。结论 G-CSF可以显著增加大鼠局灶脑缺血再灌注后SOD、GSH-PX的水平,减轻脂质过氧化反应程度,并且可以通过拮抗JNK、p38MAPK途径减轻神经细胞凋亡,发挥神经保护作用。     

托吡酯对大鼠脑缺血再灌注后血清超氧化物歧化酶活性、丙二醛含量及神经功能的影响

目的探讨托吡酯(TPM)对大鼠脑缺血再灌注后血清超氧化物歧化酶(SOD)活性、丙二醛(MDA)含量和神经功能的影响。方法将SD大鼠随机分为缺血再灌注组、TPM组及假手术组;采用线栓法建立大鼠大脑中动脉闭塞模型,TPM组动物分别于插线和再灌注时腹腔注射TPM混悬液(8mg/ml,80mg/kg);各组术后24h时进行神经功能评分后处死动物。采用羟胺氧化法测定血清SOD活性及硫代巴比妥酸法测定血清MDA含量。结果血清SOD活性及MDA含量缺血再灌注组分别为(157.72±19.04)U/ml及(7.45±0.84)nmol/ml,TPM组分别为(171.25±15.72)U/ml及(6.10±0.98)nmol/ml,假手术组分别为(179.74±7.95)U/ml及(5.90±0.72)nmol/ml;与TPM组及假手术组相比,缺血再灌注组大鼠血清SOD活性明显降低,MDA含量明显升高(均P<0.05)。TPM组及假手术组间血清SOD活性和MDA含量差异无显著性。TPM组神经功能评分较缺血再灌注组有显著改善(P<0.05)。结论TPM能减少脑缺血再灌注大鼠脑组织中抗氧化酶的消耗,有效抑制氧自由基的产生及其毒性,具有减轻脑缺血神经功能障碍的作用。     

血管紧张素-(1-7)对大鼠局灶性脑缺血再灌注损伤的神经保护作用

目的 探讨血管紧张素-(1-7)[Ang-(1-7)]对大鼠局灶性脑缺血再灌注损伤的保护作用.方法 对Sprague-Dawley(SD)大鼠制备大脑中动脉梗死(MCAO)模型和假手术模型,并于再灌注24 h和48 h以微型渗透泵从侧脑室给予Ang-(1-7)(100 pmol,0.5 μL/h)或人工脑脊液(aCSF)(0.5 μL/h),由此分组为假手术组(假手术+aCSF)、Ang-(1-7)治疗组[MCAO+Ang-(1-7)]和aCSF治疗组(MCAO+aCSF).检测实验大鼠神经功能评分、再灌注48 h后脑水肿以及再灌注24 h后脑梗死体积,并以试剂盒测定再灌注24 h和48 h后缺血脑组织中超氧化物歧化酶(SOD)活性和丙二醛(MDA)含量,以原位末端标记法(TUNEL)检测再灌注48 h后脑梗死灶周围组织神经细胞凋亡数.结果 Ang-(1-7)治疗MCAO模型大鼠,能显著改善神经功能评分(P<0.05)、缩小脑梗死体积(P<0.05)、降低组织MDA含量(P<0.05)、提高组织SOD活性(P<0.01),并明显减少脑梗死灶周围组织神经细胞凋亡数(P<0.01),但对脑组织含水量无明显影响作用.结论 Ang-(1-7)可能通过抗氧化应急反应、减轻神经细胞凋亡程度等实现治疗缺血再灌注损伤、神经保护作用.     

尼莫地平对大鼠急性脑缺血再灌注损伤早期保护作用的研究

目的探讨尼莫地平对急性脑缺血再灌注损伤的早期保护作用。方法线栓法复制大鼠急性脑缺血模型。30只雄性Wistar大鼠随机分为假手术、模型、尼莫地平3组。模型组采取缺血2h再灌注2h。尼莫地平组大鼠在缺血0时刻起每小时腹腔注射给药一次,剂量为5mg/kg。各组大鼠在手术4h后实验结束后,行腹主动脉采血,同时取完整脑组织。脑组织切片进行TTC染色,并比较各组脑组织梗死面积。检测各组大鼠血清及脑组织匀浆中SOD、MDA、NO含量。结果与模型组相比,尼莫地平组大鼠脑组织梗死面积显著减少。血清生化指标显示,模型组SOD含量显著低于假手术组,给予尼莫地平治疗后,SOD含量增加明显。模型组MDA、NO含量明显高于假手术组,尼莫地平组明显降低血清中MDA、NO。结论尼莫地平对大鼠急性脑缺血再灌注损伤有保护作用,这种保护作用与NO和氧化应激密切相关。     

硫辛酸对大鼠脑缺血再灌注损伤的神经保护作用

目的研究硫辛酸对大鼠局灶性脑缺血再灌注损伤的保护作用,进一步探讨其机制。方法 54只雄性清洁SD大鼠按照随机原则平均分成3组:假手术组(18只)、脑缺血再灌注组(对照组18只)、脑缺血再灌注+硫辛酸治疗组(治疗组18只)。大鼠大脑中动脉局灶性缺血2 h(MCAO),再灌注24 h。治疗组在再灌注同时经颈外静脉给予硫辛酸20 mg/kg,假手术组和对照组给予相同体积的溶媒。采用TTC染色法检测大鼠脑组织梗死体积;采用RT-PCR法检测大鼠脑组织TNF-α的表达;采用TUNEL法检测大鼠脑组织凋亡细胞数。结果与假手术组相比,对照组和治疗组大鼠脑组织梗死体积,TNF-α的表达和凋亡细胞数均明显增加(均P0.05)。与对照组相比,治疗组大鼠脑组织梗死体积,TNF-α的表达以及凋亡细胞数均明显减少(均P0.05)。结论我们的研究结果表明,硫辛酸对大鼠脑缺血再灌注损伤具有保护作用,可能机制为减轻脑缺血再灌注引起的炎症反应和细胞凋亡。     

乌司他丁对脑缺血再灌注大鼠脑组织JNK及细胞凋亡的影响

目的探讨乌司他丁对脑缺血再灌注大鼠缺血侧脑组织c-Jun氨基末端激酶(JNK)蛋白表达及凋亡细胞数的影响。方法 36只雄性清洁SD大鼠按随机平均原则分成3组:假手术组(12只)、脑缺血再灌注组(对照组,12只)、脑缺血再灌注+乌司他丁治疗组(治疗组,12只)。大鼠局灶性脑缺血再灌注损伤模型采用大脑中动脉线栓法制作。采用RT-PCR法检测大鼠脑组织JNK的表达,采用TUNEL法检测大鼠脑组织凋亡细胞数。结果与假手术组相比,对照组和治疗组大鼠脑组织皮质区JNK的表达明显升高,凋亡细胞数均明显增加(P均0.05)。与对照组相比,治疗组大鼠脑组织JNK的表达明显下降,凋亡细胞数均明显减少(均P0.05)。结论乌司他丁可下调缺血再灌注大鼠脑组织JNK的表达并抑制其细胞凋亡,乌司他丁抑制细胞凋亡可能与抑制JNK传导通路相关。     

依达拉奉对脑缺血再灌注大鼠脑组织及血清超氧化物歧化酶、一氧化氮、丙二醛水平的影响

目的探讨依达拉奉对局灶性脑缺血再灌注损伤的影响。方法将SD大鼠分为假手术组,脑缺血再灌注组和依达拉奉干预组(干预组),采用线栓法制备大脑中动脉缺血再灌注模型;缺血1h后,设再灌注2h、6h、12h、24h组,采用化学比色法检测各组脑组织及血清超氧化物歧化酶(SOD)、一氧化氮(NO)、丙二醛(MDA)浓度。结果缺血再灌注组脑组织SOD下降,血清SOD先升后降;脑组织NO浓度先降后升,血清NO浓度持续升高;脑组织及血清MDA浓度均先升后降;与缺血再灌注组比,干预组SOD下降幅度小(均P<0·01),NO、MDA浓度明显降低;干预组6h、12h脑组织含水量明显低于缺血再灌注组(均P<0·01)。结论依达拉奉可降低羟自由基水平,对脑缺血再灌注损伤有保护作用。     

EGb761对大鼠局灶性脑缺血再灌注损伤的保护作用

目的 :观察 EGb76 1对大鼠局灶性脑缺血再灌注损伤的保护作用。方法 :45只大鼠随机分为假手术组 (A组 ) ,脑缺血再灌注损伤组 (B组 ) ,EGb76 1治疗组 (C组 ) ,每组 15只。以线栓法制作大鼠脑缺血再灌注损伤模型。每组 10只缺血 6 0 min再灌注 6 0 min后断头处死 ,取脑测定 NO、NOS、MDA和 SOD变化 ,其余 5只缺血 3h再灌注 2 4h后断头处死 ,观察常规病理、Niss小体及凋亡细胞变化。C组于实验前 3天开始灌胃给 EGb76 1(15 0 mg/ kg,每日 2次 ,术前 1h、术后 12 h灌 EGb76 115 0 mg/ kg)。结果 :脑缺血再灌注后 ,B组 NO、MDA含量 ,NOS活性较 A组升高 ,SOD活性降低 (P<0 .0 5 ) ,病理变化明显 ,凋亡细胞增多。C组 NO、MDA含量及 NOS活性降低 ,SOD活性升高 (P<0 .0 5 ) ,C组病理变化减轻 ,凋亡细胞减少 (P<0 .0 5 )。结论 :EGb76 1对大鼠局灶性脑缺血再灌注损伤具有保护作用。     

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.     

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.