促甲状腺释放激素类似物YM-14673对大鼠脊髓损伤后水肿的影响

目的研究促甲状腺释放激素（ＴＲＨ）类似物,ＹＭ－１４６７３大鼠脊髓损伤后水肿的影响。方法用改良Ａｌｌｅｎ氏法建立大鼠脊髓损伤模型,分设正常组、对照组和治疗组,治疗组在损伤后１５分钟注射ＹＭ－１４６７３,用称重法测量脊髓的水含量,公式：（湿重－干重）÷湿重×１００％。结果对照组示伤后２４小时脊髓水肿,治疗组显示在２４小时脊髓水肿减轻。结论早期应用ＴＲＨ类似物,ＹＭ-１４６７３可减轻脊髓损伤后的脊随水肿。     

猫中脑损伤后EEG,BAEP及SEP的动态监测

目的：研究中脑损伤后猫脑电图（ＥＥＧ）、脑干听觉诱发电位（ＢＡＥＰ）和体感诱发电位（ＳＥＰ）的动态变化及了解其与损伤程度和意识障碍之间的及意义。方法：用三种不同强度的直流电立体定电解损毁猫中脑网状结构造成不同程度的损伤,动态监测猫意识、ＥＥＧ、ＢＡＥＰ和ＳＥＰ的穷期人规律与中脑网状结构损伤和意识的关系。结果：中脑网状结构损伤后随着猫意识障碍的恶化与恢复,ＥＥＧ、ＢＡＥＰ和ＳＥＰ相应地发生变化,且与     

严重脑损伤后意识障碍的临床和电生理评估

脑损伤后意识障碍是临床上常见征象,对意识障碍的转归和预后判断并不容易。本文综述了脑损伤后意识障碍的临床判定和电生理监测方面的经验,为临床上更准确地诊断脑损伤后意识障碍和预后评估提供更多的方法和资料。     

脑损伤后意识障碍神经电生理监测方法研究进展

脑损伤后意识障碍的准确诊断是治疗的基础,既往脑损伤后意识障碍的评价主要基于行为量表测验、影像学检查等,易受主观因素和外界的干扰,发展客观高效的脑损伤后意识障碍评价方法是当前研究热点,神经电生理监测安全、客观、操作简单,可实现实时连续监测。本文总结脑诱发电位和脑电图在脑损伤后意识障碍评价中的应用范式和分析方法,以为改进脑损伤后意识障碍诊断与治疗方案提供新的技术思路。     

尼莫地平对实验性脑损伤的治疗作用

目的研究钙拮抗剂尼莫地平对实验性颅脑创伤的治疗作用及其机制.方法采用家兔落体致伤闭合性颅脑创伤模型,致伤后静脉给予尼莫地平治疗,于电子显微镜下观察脑组织超微结构变化;以干湿法测定脑组织含水量;荧光标记法测定神经细胞胞浆内游离Ca2+水平;经颅多普勒超声仪观察大脑中动脉血流速度变化;并结合颅内压监测综合评定尼莫地平对实验性颅脑创伤的治疗作用.结果尼莫地平治疗组家兔神经细胞胞浆内的游离Ca2+水平显著下降,脑组织毒性损害表现减轻,大脑中动脉痉挛得到改善,脑水肿程度减轻,但颅内压变化与未用药组相比差异无显著性意义(P＞0.05).结论尼莫地平可阻断脑损伤后神经细胞"钙超载"引起的一系列病理过程,解除脑血管痉挛,改善脑血流量,具有保护脑组织的作用.     

体感诱发电位联合改良昏迷恢复量表对儿童重症脑损伤恢复期意识障碍的预后评价

目的 探讨体感诱发电位（SEP）、改良昏迷恢复量表（CRS-R）及其联合指标对重症脑损伤恢复期意识障碍患儿的预后评价作用。方法 选取51例重症脑损伤恢复期意识障碍患儿为研究对象,所有患儿均在入康复中心时完成SEP检查和CRS-R评分,并动态追踪评估患儿意识水平变化,以病程满6个月、神志转清或死亡为评估止点。以患儿病程满6个月时意识恢复作为预后判断金标准,根据病程6个月内患儿意识恢复与否分为意识清醒组和意识未清醒组,分别分析SEP分级、CRS-R评分与意识障碍患儿预后之间的相关性,并采用ROC曲线评估SEP分级、CRS-R评分及其联合指标对意识障碍患儿预后的预测作用。结果 CRS-R评分与意识障碍患儿预后呈正相关（r=0.450,P<0.01）,SEP分级与意识障碍患儿预后呈负相关（r=—0.340,P<0.05）。CRS-R评分的ROC曲线下面积（AUC）为0.761,SEP分级的AUC为0.683,SEP分级联合CRS-R评分的AUC为0.809,且SEP分级联合CRS-R评分的AUC大于SEP分级单一指标的AUC,差异有统计学意义（Z=2.054,P<0.05）。...     

Effects of peripheral stimulation on the activity of neurons in the ventral tegmental area, substantia nigra and midbrain reticular formation of rats

Extracellular recordings were obtained from neurons in the ventral tegmental area (VTA), the substantia nigra, including the zona compacta (SNC) and the zona reticulata (SNR), and the midbrain reticular formation (FOR) of adult female albino rats anesthetized with urethane and chloral hydrate. Based on electrophysiological characteristics the neurons were divided into two types. Type I neurons, with relatively long spike durations and slow discharge rates, were confined to the VTA and SNC. Type II neurons, with shorter spike durations and faster discharge rates, were observed in the SNR and FOR as well as the VTA and SNC. The effects of foot pinch (FP), tail pinch (TP) and stimulation of the vaginal cervix (VC) on the activity of the two types of neurons were investigated. Previously it was demonstrated that FP was aversive, TP elicited locomotion, sniffing and gnawing responses and VC lordosis response, vocalization and immobility. For approximately two-thirds of the neurons the effects of the three peripheral stimuli were similar; either they were activated or suppressed. Approximately 8 percent of the neurons were suppressed by FP and TP and activated by VC whereas a similar number were activated by FP and TP and suppressed by VC. Type 1 and Type II neurons in the VTA and SN were activated and suppressed by the peripheral stimuli with suppression being the most common response to FP and TP. The results are consistent with the view that VTA and SN neurons integrate a number of central and peripheral inputs.     

CT中脑背侧脑池出血对原发性脑干损伤的早期诊断价值

目的 分析颅脑外伤急诊CT中脑背侧脑池出血的表现,探讨其对临床原发性脑干损伤的早期诊断价值.方法 回顾性分析52例颅脑外伤患者临床表现及影像学资料,并依据GCS评分分为轻、中、重及特重型.所有患者均在伤后48 h内接受CT检查,CT采用常规程序扫描.MRI检查则根据病情变化在伤后1周内完成,采用自旋回波T1WI、T2WI序列.结果 所有病例的CT表现均与MRI的T1WI、T2WI序列行比较研究,其中39例颅脑损伤患者的急诊CT有中脑背侧环池或四叠体池出血表现,合并弥漫性脑肿胀19例,脑实质出血灶单发或多发点状出血灶11例,直径小于2 cm;37例MRI检查存在不同程度的脑干组织损伤表现.结论 重型和特重型颅脑外伤(GCS<9分)伤后早期CT的中脑背侧脑池出血表现高度提示原发性脑干损伤可能,对提高原发性脑干损伤早期诊断水平具有重要的参考价值.     

Role of wake inducing brain stem area on rapid eye movement sleep regulation in freely moving cats

Some of the characteristic symptoms associated with rapid eye movement (REM) sleep are opposite to, while some apparently resemble, those of wakefulness. Therefore, it was hypothesised that the neurons present in the wakefulness inducing area(s) in the brain are likely to communicate with the REM sleep related neurons. Brain stem neurons were classified based on their firing rates in relation to electrophysiological correlates associated with spontaneous sleep and wakefulness recorded from freely moving, normally behaving cats. Thereafter, the responses of those classified neurons to stimulation of brain stem reticular wakefulness inducing area were studied. Results from 63 neurons showed that the wake inducing area affected 62% of the neurons. Fifty-eight percent of the neurons which increased firing during wakefulness, including the REM-OFF neurons, were excited, while 70% of the neurons which decreased firing during wakefulness, including the REM-ON neurons, were inhibited. These observations support our hypothesis and, along with their physiological significance, are discussed.     

Medical aspects of the minimally conscious state in children

The minimally conscious state is a condition of severely altered consciousness in which minimal but definite behavioral evidence of self or environmental awareness is demonstrated. This must be established on a reproducible or sustained basis by one or more of four types of behaviors including simple command-following, gestural or verbal ‘yes/no' responses, intelligible verbalizations, or purposeful behaviors. The minimally conscious state can occur in children and usually is due to acquired brain injuries (traumatic and non-traumatic), central nervous system degenerative and neurometabolic disorders or congenital or developmental disorders. It is assumed that the lower limit of the minimally conscious state occurs when patients emerge from a vegetative state. What remains uncertain is how we can assess the upper limits, that is the degree of improvement that indicates that an individual is no longer minimally conscious. It also is unknown if, when and to what extent children can emerge from a minimally conscious state and whether their prognosis is better than children who are vegetative. It is assumed that the minimally conscious state may become ‘permanent' 12 months after traumatic brain injury and 3 months after non-traumatic injury although there have been no studies that have examined this issue. Medical and rehabilitative treatment of children in a minimally conscious state should be provided to maintain comfort, reduce complications, and optimize functional recovery.     

The Generalized Convulsive Seizure State Induced by Daily Electrical Stimulation of the Amygdala in Split Brain Cats

Daily unilateral electrical stimulation of amygdala in forebrain bisected cats provoked the development of the final stage of the kindled convulsion with remarkable rapidity regardless of presence or absence of anterior commissure. The chronological and spatial pattern of propagation of afterdischarge, interictal spike discharge, and clinical manifestations strongly suggest the significant role played by the midbrain reticular formation and possibly other brainstem structures in the progressive electroclinical seizure development. This assumption was supported by the results of a lesion study in which placement of a destructive lesion in the ipsilateral midbrain reticular formation markedly increased the generalized seizure triggering threshold, lateralized the afterdischarge to the stimulated hemisphere when induced with increased intensity stimulation, fragmented clinical seizure manifestations, and failed to produce progression of clinical and electrographic events with prolonged daily stimulation. This is in contrast to the insignificant effect produced by a peduncular lesion. Our findings suggest that vertical (limbic-brainstem), but not horizontal (transhemispheric interlimbic) connection is critically involved in the amygdaloid seizure development while the forebrain commissures may play a role in the development of bisynchronous and bisymmetrical ictal and interictal electrographic and clinical manifestations. Finally, possible differential effect of forebrain bisection depending on developing in contrast with a established (cerebral) hemispheric epileptogenic process is postulated to explain the "facilitatory" effect observed in our series in contrast to the beneficial effects reported on some intractable seizure patients.     

Pathogenesis of brain lesions caused by experimental epilepsy

Summary Status epilepticus with a duration of 1 or 2 h was induced in rats by i. v. injection of the GABA receptor blocking agent, bicuculline. Immediately there-after, or following a 2 h recovery period, the brains were fixed by vascular perfusion and processed for light and electron microscopy to characterize the type and distribution of morphological changes in the hippocampal formation.In a previous study (Söderfeldt et al. 1981) astrocytic edema and wide-spread neuronal changes of two different kinds occurred in the fronto-parietal cortex of the same animals. Type 1 injured neurons were characterized by condensation of karyoplasm and cytoplasm (type 1a), which in some neurons became so intense that the nucleus could no longer be clearly discerned (type 1b). The type 2 injured neurons had slitformed cytoplasmic vacuoles chiefly caused by dilatation of the rough endoplasmic reticulum.In the hippocampus the most conspicuous alteration was astrocytic edema which was most marked around the perikarya of pyramidal neurons in CA1-CA4 and subiculum. In the dentate gyrus the edema was less pronounced and, when present, affected particularly the hilar zone of the stratum granulosum. The nerve cell changes were less pronounced than in the cerebral cortex. The vast majority of the hippocampal pyramidal neurons in CA1-CA4 showed minor configurational and tinctorial abnormalities (incipient type 1a change). Severe nerve cell alterations (type 1b) were present but very rarely affected the pyramidal neurons of CA1-CA4 and subiculum, whereas in the dentate gyrus pyramidal basket neurons of stratum granulosum and pyramidal nerve cells in stratum polymorhe showed the severe type 1b changes. As compared with the frontoparietal cortex (Söderfeldt et al. 1981) the type 2 changes were extremely rare. In the early recovery period after 1 h of status epilepticus the astrocytic edema and the incipient type 1a changes had almost entirely disappeared, whereas a few condensed and dark-staining type 1b injured neurons remained.Thus, in this model of status epilepticus the most marked response in the hippocampal formation is astrocytic edema in the layers where pyramidal perikarya are located. Incipient, mild nerve cell changes which appear to be reversible were frequent and widespread in the entire hippocampal formation.Supported by grants from the Swedish Medical Research Council projects 12X-03020, 14X-263, from the US Public Health Service via NIH, from the Finnish Medical Research Council, and from Margarethahemmet Society     

GABA injected into the anterior dorsal tegmentum (ADT) of the midbrain blocks stepping initiated by stimulation of the hypothalamus

Previous work showed that the activity rates of certain neurons in the anterior dorsal tegmentum (ADT) of the midbrain correlated with the onset of stepping elicited by hypothalamic stimulation. This study determined if reversible inactivation of the ADT would block locomotion elicited by hypothalamic stimulation of anesthetized rats (urethane, 800 mg/kg). GABA (concentrations 0.25–1.0 mg/μl in saline) were injected in 52 sites in 21 rats. GABA at volumes of 0.1 or 0.2 μl blocked hindlimb stepping in 18 cases. Locomotor blocks occurred within 5 min of the injection, and typically recovered within 10–20 min. The effective blocking sites were clustered around the interstitial nucleus of the medial longitudinal fasciculus. Sites more dorsal and more anterior were not as effective as sites in and ventral to this nucleus. The data are consistent with a role for the ADT of the midbrain in locomotor initiation.     

液压性脑损伤后室下区神经干细胞的分离培养与鉴定

目的分离液压性脑损伤室下区巢蛋白（nestin）和胶质酸性纤维蛋白（GFAP）阳性（nestin^＋／GFAP^＋）共存细胞进行培养和诱导分化，观察其分裂、增殖和分化能力，以阐明损伤反应性星形胶质细胞增生过程中nestin^＋／GFAP^＋共存细胞是否具有神经干细胞特性。方法用液压冲击法建立动物模型，分离损伤成年SD大鼠室下区nestin^＋／GFAP^＋共存细胞，制成单细胞悬液，培养和诱导分化，以免疫荧光化学方法对原代和传代培养形成的神经球以及原代和传代培养诱导分化的细胞进行鉴定。结果结果显示培养及传代的细胞不断分裂增殖，可以形成悬浮生长nestin阳性的神经球；神经球诱导分化后可以分化为少突胶质细胞、神经元和星形胶质细胞。结论成年大鼠液压性脑损伤后分离的室下区细胞具有自我更新能力和多向分化潜能，是中枢神经系统神经干细胞。