颅内动脉瘤破裂急性期血管内栓塞的疗效分析

目的分析栓塞治疗急性破裂性颅内动脉瘤的疗效及相关影响因素。方法回顾自1994—4～2004—4栓塞治疗33例急性破裂颅内动脉瘤（72h）病人,分析动脉瘤几何形态学、位置、病情严重程度、栓塞材料等对栓塞效果的影响。结果Hunt—Hess分级Ⅰ～Ⅱ级、Ⅲ级、Ⅳ-Ⅴ级者,预后良好率分别为86．9％、57．1％、0％。宽颈、窄颈动脉瘤的完全栓塞率分别为58％、76％。前交通动脉瘤、颈内动脉瘤、大脑中动脉瘤预后良好者分别为90．9％、66．7％、0％。结论动脉瘤的栓塞程度不仅与瘤颈有关,还受瘤体大小、动脉瘤位置的影响。而临床预后与Hunt-Hess分级呈负相关。     

颅内动脉瘤破裂急性期血管内栓塞治疗的疗效分析及影响因素

目的分析栓塞治疗急性破裂的颅内动脉瘤的疗效及相关影响因素。方法回顾自1994年4月至2004年4月急性期(72h)颅内动脉瘤栓塞治疗的33例病人,分析动脉瘤几何形态学、位置、病情严重程度等对栓塞效果及临床治疗的影响。结果Hunt-Hes分级Ⅰ～Ⅱ级、Ⅲ级、Ⅳ级者,预后良好率分别为87.0%(20/23)、57.1%(4/7)、0%(0/3)。宽颈、窄颈动脉瘤的完全栓塞率分别为58.3%(7/12)、76.2%(16/21)。前交通动脉瘤颈内动脉瘤、预后良好者分别为90.9%(10/11)、66.7%(12/18)。结论动脉瘤的栓塞程度受瘤颈、瘤体大小、动脉瘤位置等因素的影响,临床预后与Hunt-Hess分级呈负相关。     

颅内动脉瘤的血管内栓塞治疗

目的探讨应用电解可脱性弹簧圈（GDC）栓塞治疗颅内动脉瘤的临床效果。方法采用GDC栓塞23例患者共动脉瘤25个，其中17个为后交通动脉瘤，4个为前交通动脉瘤，4个为大脑中动脉瘤；Hunt—Hess分级：I级2例，II级17例，III2例，IV级2例。结果25个动脉瘤全部成功栓塞，随访3～30个月无再出血。结论GIDC栓塞颅内动脉瘤是安全、有效和微创的治疗手段。     

脑动脉瘤介入治疗中三维微弹簧圈的临床应用

目的评价三维电解可脱式微弹簧圈(GDC)栓塞颅内动脉瘤的临床应用效果。方法79例患者的82个动脉瘤,动脉瘤大小3～22mm,瘤颈≤4mm57个,>4mm25个,采用三维GDC栓塞治疗,包括常规裸弹簧圈和Matrix弹簧圈,从栓塞后血管造影影像学、临床结局和磁共振造影随访评价疗效。结果82个动脉瘤完全栓塞65个(79.3%),次全栓塞17个(20.7%),无不全栓塞,其中25个瘤颈>4mm的动脉瘤完全栓塞17个(68%);术后并发症7例,随访6个月,严重致疾6人(7.6%),中度致残生活能自理10人(12.7%),恢复良好63人(79.7%)。结论较复杂的颅内宽颈动脉瘤栓塞治疗时,三维GDC做为首枚弹簧圈可达到良好的成篮效果,但栓塞治疗的远期临床和影像学疗效有待长期研究。     

破裂脑动脉瘤的早期治疗——血管内介入与内窥镜辅助下瘤颈夹闭

目的研究血管内介入与内窥镜辅助下瘤颈夹闭在破裂脑动脉瘤早期治疗中的临床应用。方法对68例破裂的脑动脉瘤进行早期治疗。介入组36例,选用Tracker、Excel、Prowler、Rebar或Echelon系列微导管,以GDC、EDC、Orbit或Microplex微弹簧圈填塞动脉瘤。瘤颈夹闭组32例,术中应用蛇牌内窥镜辅助夹闭瘤颈。结果术后二组病人Hunt-Hess分级、不同部位脑梗死的发生以及临床随访无显著差异。结论二种方法总的临床疗效无明显差异。颅内多发动脉瘤,后循环及海绵窦区动脉瘤患者,栓塞治疗较优于瘤颈夹闭。占位效应明显、合并脑内血肿、出血破入脑室者,瘤颈夹闭较优于栓塞。术前Hunt-Hess分级Ⅳ或Ⅴ级者,二种术式预后均较差。     

40例颅内动脉瘤介入治疗临床分析

目的 总结GDC治疗难治性颅内动脉瘤的经验。方法 共治疗40例40个动脉瘤，其中8例在蛛网膜下腔出血急性期进行栓塞。术前H-H分级Ⅳ级3例，Ⅲ级6例，Ⅰ-Ⅱ级31例。采用GDC进行栓塞。结果 致密填塞动脉瘤33例，不全填塞7例。均保持载瘤动脉通畅。无死亡及永久并发症。结论 GDC是治疗颅内动脉瘤比较理想的方法，但对于宽颈及梭形动脉瘤疗效欠佳。     

颅内动脉瘤栓塞术中“三圈模式”对瘤颈闭合的应用研究

目的探讨颅内动脉瘤栓塞术中应用"三圈模式"技术对动脉瘤颈闭合的价值。方法 2015年10月至2016年3月期间在河北医科大学第二医院神经外科经介入栓塞治疗的116例患者共计135个囊性动脉瘤,将入组动脉瘤按收治顺序随机分为"三圈模式"组(66个动脉瘤)和传统栓塞组(69个动脉瘤),动脉瘤大小平均为4.67+1.85mm;其中包括单纯栓塞46个动脉瘤,支架辅助栓塞89个;应用VFC圈91枚,纤毛圈93枚,水凝胶涂层圈73枚,填塞圈324枚;选用支架均为Microvention公司生产的LVIS支架。依据Raymond分级评价即刻栓塞效果,比较两组病例6个月随访时瘤颈闭合率。结果 135例动脉瘤均实现成功栓塞,其中66例动脉瘤采用三圈模式治疗,即刻栓塞效果:Raymond分级Ⅰ级47个,Ⅱ级7个,Ⅲ级12个,其中45例动脉瘤采用支架辅助,经6个月共随访55例患者,没有瘤颈、瘤体残留及复发病例,瘤颈闭合率100%;传统栓塞治疗组的69例动脉瘤应用支架辅助栓塞44例,栓塞后即可造影均获得Raymond分级Ⅰ级疗效,经随访6个月共56例患者,6例动脉瘤颈残留并给予再次栓塞治疗,瘤颈闭合率89.3%。两组病例瘤颈闭合率具有统计学差异(P0.05)。两组病例在使用支架类型、数量比较差异无统计学意义(P0.05)。结论瘤颈闭合是动脉瘤栓塞的核心理念,三圈模式对于颅内动脉瘤栓塞术后瘤颈闭合较传统栓塞模式具有更高瘤颈闭合率。     

介入栓塞与开颅瘤颈夹闭术治疗颅内动脉瘤的术前评估研究

目的评估介入栓塞与开颅瘤颈夹闭术治疗颅内动脉瘤的术前相关危险因素。方法回顾性分析颅内动脉瘤患者120例,根据手术方式分为开颅夹闭组及介入栓塞组各60例;记录术前相关影响因素及术后恢复情况,分析比较性别、年龄、Fisher分级、Hunt-Hess分级、动脉瘤部位、动脉瘤长轴与颈宽比(AR)、高血压及高血糖等术前影响因素对开颅夹闭术和血管内介入栓塞术治疗颅内动脉瘤疗效的影响。结果年龄是手术治疗的影响因素,60岁以上患者预后明显差于60岁以下患者(P0.05);Fisher分级中Ⅰ、Ⅱ级患者的预后明显优于Ⅲ、Ⅳ级患者(P0.05);Hunt-Hess分级越高,预后效果越差,但开颅夹闭术与介入栓塞术2组比较无明显差异(P0.05);动脉瘤的部位对预后有显著影响(P0.05),动脉瘤长颈和瘤颈比值(AR)对介入栓塞术组影响较大(P0.05),随着AR值增大采用介入栓塞术的疗效明显好转(P0.05);高血压及高血糖对介入栓塞术治疗的影响较小(P0.05);不同年龄对临时阻断载瘤动脉时间的耐受能力不同,导致其预后疗效有显著差异(P0.05)。结论年龄、Fisher分级、Hunt-Hess分级及动脉瘤部位是颅内动脉瘤患者开颅夹闭术和血管介入栓塞术术后疗效的共同影响因素。     

颅内宽颈动脉瘤出血急性期的血管内治疗

目的探讨出血急性期血管内栓塞治疗颅内宽颈动脉瘤的临床效果。方法回顾性分析出血后72h内经血管内栓塞治疗的28例破裂的颅内宽颈动脉瘤患者的临床资料。结果28例中完全致密栓塞20例,栓塞程度达90％以上者6例,栓塞程度在80％-90％者2例。术后无再出血发生,死亡1例。结论Hunt—Hess分级I～Ⅳ级颅内宽颈动脉瘤出血急性期患者实施血管内治疗安全可靠,可避免动脉瘤再次破裂出血,明显降低患者的死亡率和致残率。     

颅内Hunt－Hess分级Ⅲ-Ⅳ级动脉瘤早期栓塞治疗临床分析

目的 探讨早期血管内栓塞颅内Hunt－Hess分级Ⅲ-Ⅳ级动脉瘤的临床疗效及应用价值。方法 回顾性分析早期血管内栓塞治疗颅内动脉瘤32例的临床疗效。结果 完全栓塞22例,大部分栓塞10例。1例死亡,并发动脉瘤破裂3例、脑血管痉挛6例、缺血性卒中4例、4例再次栓塞后痊愈。结论 早期血管内栓塞是治疗颅内Hunt－Hess分级Ⅲ-Ⅳ级动脉瘤较理想方法。     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

The organization of the connections between the cortex and the claustrum in the monkey

The distribution of labelled cells and of extracellular granules in the claustrum has been studied after injections of horseradish peroxidase in several areas of the neocortex. The frontal and parietal lobes are related to the anterior and posterior halves respectively of the claustrum, and the occipital and temporal cortex to the posterior and inferior margins. Parts of the claustrum related to areas of the cortex in the frontal lobe overlap considerably in the antero-posterior dimension with parts related to widely separated but interconnected areas of the parieto-temporal cortex. Areas of cortex within one lobe which are interconnected are related to parts of the claustrum which overlap in the dorsoventral dimension.     

A projection to the striatum from the medial subdivision of the posterior group of the thalamus in the cat

Injections of wheat germ agglutinin-conjugated horseradish peroxidase in the lateral part of the caudate nucleus or the putamen of the cat result in retrograde thalamic cell-labeling in the rostral extension of the medial subdivision of the posterior group (POM). Autoradiography after [³H]amino acid injection of POM reveals a dense and discontinuous distribution of axons in the lateral half of the caudate and putamen concentrated at their middle rostrocaudal levels. This newly discovered thalamostriatal projection of POM may account for somatosensory activity observed in striatal cells.     

Sexual pheromones and the evolution of the reward system of the brain: the chemosensory function of the amygdala

The amygdala of all tetrapod vertebrates receives direct projections from the main and accessory olfactory bulbs, and the strong similarities in the organization of these projections suggest that they have undergone a very conservative evolution. However, current ideas about the function of the amygdala do not pay sufficient attention to its chemosensory role, but only view it as the core of the emotional brain. In this study, we propose that both roles of the amygdala are intimately linked since the amygdala is actually involved in mediating emotional responses to chemical signals. The amygdala is the only structure in the brain receiving pheromonal information directly from the accessory olfactory bulbs and we have shown in mice that males emit sexual pheromones that are innately attractive for females. In fact, sexual pheromones can be used as unconditioned stimuli to induce a conditioned attraction to previously neutral odorants as well as a conditioned place preference. Therefore, sexual pheromones should be regarded as natural reinforcers. Behavioural and pharmacological studies (reviewed here) have shown that the females' innate preference for sexual pheromones is not affected by lesions of the dopaminergic cells of the ventral tegmental area, and that the systemic administration of dopamine antagonists do not alter neither the attraction nor the reinforcing effects of these pheromones. Anatomical studies have shown that the vomeronasal amygdala gives rise to important projections to the olfactory tubercle and the islands of Calleja, suggesting that these amygdalo-striatal pathways might be involved in the reinforcing value of sexual pheromones.     

Evidence for the collateral innervation of the esophagus and the heart from neurons in the compact formation of the nucleus ambiguus of the rat

We investigated whether the heart receives collateral projections from the neurons which innervate the esophagus with a retrograde double-labeling method using two fluorescent tracers. Following injections of True Blue (TB) into the esophagus and Diamidino Yellow (DY) into the heart, about 21.9% of the labeled esophageal motoneurons in the compact formation of the nucleus ambiguus (AmC) were retrogradely double labeled. No single-labeled cardiac motoneurons were found in the AmC. The present results provide anatomical substrates for the esophagocardiac reflex.     

Role of the paraventricular nucleus in the projection from the nucleus of the solitary tract to the olfactory bulb

Electrophysiological experiments were performed on anesthetized rats to determine the effects of lesions of the paraventricular nucleus on the amplitude of evoked potentials recorded in the periglomerular layer of the olfactory bulb after nucleus of the solitary tract electrical stimulation. Lesions of the paraventricular nucleus enhance the amplitude of both the positive and negative components of the evoked potential in the olfactory bulb. The pathway from the paraventricular nucleus to the olfactory bulb seems to exert a suppressive influence over the projection from the nucleus of the solitary tract to the olfactory bulb under these conditions.     

On the origin of the serotonergic input to the intermediate lobe of the rat pituitary

Single stimulations of the vagina and cervix were performed between proestrus and the first day of diestrus with a stimulator designed to grade the intravaginal penetration of a rod. The percent incidence of pseudopregnancy after this stimulation was exponentially related to the extent of intravaginal penetration and was also affected by the stage of the cycle at which the stimulation was performed. At 10.00 h on proestrus, an exponential increase in the incidence of pseudopregnancy was observed with shallow penetrations, while an exponential decrease was found when deeper penetrations were applied. Such negative exponential correlation had disappeared at 22.00 h on proestrus. At that time, also, some responses were elicited by very shallow penetrations (17 mm) and all the animals responded to penetrations of 20 mm or more. Sensitivity to cervicovaginal stimulation at 10.00 h on estrus was lower than that at 22.00 h on proestrus and it was even lower at 10.00 h on the first day of diestrus. The response to 18 mm of penetration was studied every 3 h between 10.00 h on proestrus and 10.00 h on estrus, and then every 12 h until 10.00 h on the first day of diestrus. This stimulation was usually ineffective to induce pseudopregnancy, except for a brief period encompassing the night between proestrus and estrus, when a peak in the incidence of responses was reached. This peak sensitivity could be advanced following the s.c. administration of 250 and 500 ng of LH-RH at 11.00 h on proestrus. Other doses were ineffective. The peptide (500 ng) was unable to induce pseudopregnancy in rats that received no cervicovaginal stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)     

On the development of the stratification of the inner plexiform layer in the chick retina

This study investigated the development of the subdivision of the chick inner plexiform layer (IPL). The approach included an immunohistological analysis of the temporal and spatial expressions of choline acetyltransferase, of the neural-glial-related and neural-glial cell adhesion molecules (NrCAM and NgCAM, respectively) and axonin-1, and of inwardly rectifying potassium (Kir) channels in 5- to 19-day-old (E5-E19) embryos. Ultrastructural investigations evaluated whether synaptogenesis accompanies the onset of differentiation of the IPL. We found that the differentiation of the IPL started at E9. Distinct cholinergic strata appeared, NrCAM immunoreactivity showed a poorly defined stratification, and Kir3.2 was expressed in the IPL and in the inner nuclear layer. From E10 until late E14, NgCAM- and axonin-1-immunoreactive strata emerged in an alternating sequence from the outer to the inner IPL. During this period, the NrCAM pattern sharpened, and eventually five bands of weaker and stronger immunoreactivity were found. Conventional synapses formed at the beginning of E9, and stratification of the IPL also began on the same day at the same location. Synaptogenesis and stratification followed a gradient from the central to the peripheral retina. The topographic course of differentiation of the IPL generally corresponded to the course of maturation of ganglion and amacrine cells. Synaptogenesis and the expression of G-protein-gated Kir3.2 channels accompanied the onset of stratification. These events coincide with the occurrence of robust and rhythmic spontaneous neuronal activity. The subsequent differentiation of the IPL seemed to be orchestrated by several mechanisms.