诱导分化、化疗和免疫治疗在荷人脑胶质瘤动物体内序贯组合研究

目的：探讨胶质瘤诱导分化治疗方案和机制，为进一步临床研究打基础。方法：采用诱导分化剂苯丁酸钠（SPB）分别与化疗药卡氮芥（BCNU）、顺铂（CDDP）和活化的人外周血单个核细胞（PBMC）组合，对荷低分化人脑胶质瘤裸小鼠（NC）或严重联合免疫缺陷鼠（SCID）进行治疗。结果：先用BCNU，接着用SPB，最后用PBMC序贯组合治疗效果最佳，表现为肿瘤生长抑制；细胞异形性降低；G0/G1期比例、GFAP、MHC-1表达增加和c-myc表达下降。结论：胶质瘤的诱导分化治疗需与化疗和免疫治疗等组合方可提高疗效。     

海洋单细胞海藻体外对人脑胶质瘤干细胞生物学活性的影响

背景：海藻具有广阔的药理活性前景,加强其研究对有目的进行应用开发有重要的指导意义。 目的：观察海洋单细胞海藻在体外对人脑胶质瘤干细胞生物学活性的影响。 方法：以酶消化法培养人脑胶质瘤干细胞,流式细胞分选出CD133阳性细胞,细胞传代获得第3代细胞。流式细胞仪检测海洋单细胞海藻作用前后细胞CD133表达变化,免疫组织化学检测贴壁细胞巢蛋白及胶质纤维酸性蛋白的表达。实验组分别加入不同质量浓度的海洋单细胞海藻,阴性对照加不含药的PBS,将稀释成4,6,8,10 g/L的海洋单细胞海藻加入细胞培养液中并作用24,48,72 h,流式细胞仪检测胶质瘤干细胞生长周期,应用酶标仪检测细胞生长抑制情况。 结果与结论：随着浓度和时间的增加,与对照组相比倒置显微镜下可见实验组胶质瘤干细胞不易聚团成球,出现贴壁分化,并逐渐明显;加药后胶质瘤干细胞CD133表达量明显减少;出现的贴壁细胞免疫组织化学染色巢蛋白及胶质纤维酸性蛋白表达阳性;流式细胞仪检测显示,停滞在S、G2/M期细胞数增加,而G0/G1期细胞数减少;随着浓度和时间的增加,胶质瘤干细胞增殖明显抑制,与对照组相比差异有显著性意义(P < 0.05~0.01)。提示海洋单细胞海藻能够抑制人脑胶质瘤干细胞的增殖,并促进其分化,且作用具有浓度和时间依赖性。     

RA/IFN-γ协同诱导C6胶质瘤细胞分化的研究

目的 探索诱导分化新策略对脑胶质瘤的潜在治疗作用。方法 观察协同诱导分化处理前后C6胶质瘤细胞形态改变并应用免疫组化染色法检测其胶质纤维酸性蛋白（GFAP）表达变化。结果 维甲酸（RA）及干扰素－γ（IFN－γ）诱导分化可使C6细胞出现的一步向星形细胞分化的特异性形态学改变；空白对照组细胞大多数呈GFAP弱阳性反应；而RA组与RA／IFN-γ组细胞的GFAP表达量显增加（P1，P2＜0．01），RA／IFN－γ组相比增加更显（P＜0．01）。结论 协同诱导分化疗法能促使胶质细胞进一步成熟分化。     

人胶质瘤干细胞内在自我更新能力

目的 了解胶质瘤干细胞内在的自我更新和增殖能力。方法 观察原代胶质瘤细胞在单纯改良Eagle/F12培养液（DMEM/F12）中胶质瘤干细胞球的形成,并检测其CD133、胶质纤维酸性蛋白（GFAP）、微管相关蛋白（MAP2）、髓磷脂碱性蛋白（MBP）的表达。通过二代球体形成、细胞增殖测定、分化实验分析其自我更新、增殖、多能分化能力。通过裸鼠移植瘤实验观察所分离细胞球细胞与原代培养胶质瘤细胞成瘤能力的差异。结果 在单纯DMEM/F12培养液中形成的胶质瘤细胞球细胞表达神经干细胞标记CD133,不表达分化标志GFAP、MAP2,少数细胞表达MBP。分离出的胶质瘤细胞球细胞可在单纯DMEM/F12培养基中增殖,并能形成CD133阳性的二代细胞球,可分化为GFAP、MAP2、MBP阳性表达的肿瘤细胞。裸鼠成瘤实验显示其成瘤能力显著高于原代胶质瘤细胞。结论 胶质瘤干细胞能在无血清、无外源性细胞因子培养基中形成肿瘤干细胞球,胶质瘤干细胞的自我更新和增殖不依赖于外源性生长因子,它可能拥有自我更新的自身活化机制。     

大鼠C6脑胶质瘤模型的建立

目的通过不同方法建立大鼠脑胶质瘤模型,观察其生长特性,比较各种方法的优劣。方法体外培养大鼠C6胶质瘤细胞,分别取浓度为1.0×105个/10μl、1.0×106个/10μl、1.0×107个/10μl细胞悬液,立体定向接种于Wistar大鼠脑右侧尾状核区,观察不同接种量实验鼠的生存状态、成瘤情况及脏器转移灶,并采用免疫组织化学方法检测其胶质纤维酸性蛋白(GFAP)、血管内皮生长因子(VEGF)的表达。结果各种接种量的实验组成瘤率均为100%,未见颅外转移病灶,在组织病理学上接近人脑胶质瘤,瘤细胞病理性核分裂像多见,GFAP蛋白呈散在阳性表达,VEGF蛋白呈强阳性表达,瘤组织内有出血和坏死以及丰富的微血管。实验周期短,重复性高。结论C6细胞接种Wistar大鼠脑胶质瘤动物模型,肿瘤成瘤率高,颅内生长稳定,肿瘤组织病理学特性与人脑胶质瘤相似,可作为临床胶质瘤基础研究的理想模型。实验范围内部分时段不同接种剂量肿瘤生长速度有显著性差异,可根据病因学、实验治疗或药效学等不同研究需要选择不同接种量。     

胶质细胞源性神经营养因子在人脑胶质瘤中的表达

目的：探讨胶质细胞源性神经营养因子（GDNF）表达与人脑胶质细胞瘤恶性程度的关系。方法：分别应用原位杂交、免疫组化、流式细胞仪的方法检测GDNF在人脑胶质瘤中的表达水平。结果：GDNF在人脑胶质瘤和正常脑组织中均有表达，胶质瘤中的表达水平显高于正常脑组织，且随着胶质瘤恶性程度的增加表达水平也增加。结论：GDNF可能作为一种重要的因素参与了胶质瘤的发生、发展及分化，可作为胶质瘤病理分级检测的补充指标。     

无血清培养基体外分离培养人胶质瘤干细胞与鉴定

背景：最近有研究者采用神经干细胞的无血清培养基从脑肿瘤组织中培养出肿瘤干细胞。 目的：探讨利用无血清培养基从原发胶质母细胞瘤组织中分离培养胶质瘤干细胞的可行性。 设计、时间及地点：细胞学体外观察,于2008-08在山东省青岛市脑科研究所完成。 材料：胶质瘤组织来自青岛大学医学院附属医院神经外科手术切除标本,DMEM/F12培养基、B27为GIBCO公司产品,碱性成纤维细胞生长因子、表皮生长因子为Peprotech公司产品。 方法：无菌条件下取肿瘤深部无坏死囊变、未电凝组织,剪切消化成单细胞悬液后,加入含碱性成纤维细胞生长因子、表皮生长因子、B27添加剂的无血清DMEM/F12培养基,体外分离培养获得胶质瘤干细胞。待培养孔中细胞团数量增多、培养液刚刚变色时,吸取含有细胞团的培养液进行传代。取第3代胶质瘤干细胞,加入巢蛋白和CD133抗体行免疫荧光检测;加入含体积分数为0.1胎牛血清的DMEM/F12培养基诱导5 d,行胶质纤维酸性蛋白免疫荧光染色观察分化情况。 主要观察指标：原代与传代培养的胶质瘤干细胞形态及生长情况,胶质瘤干细胞巢蛋白、CD133的表达及其分化。 结果：原代培养7~10 d可形成大小不一的细胞团,球形或近似球形,呈悬浮或半悬浮状态生长,细胞形态均一,折光性好;传代24 h后次代细胞团形成,细胞的大小、形态与原代无明显差别,连续传代5次后细胞团增殖活跃。第3代胶质瘤干细胞呈巢蛋白和CD133阳性表达,加入胎牛血清后细胞球贴壁分化,呈胶质纤维酸性蛋白阳性。 结论：人脑胶质瘤组织中存在胶质瘤干细胞,在体外无血清条件下可保持未分化的悬浮状态;加入血清后贴壁分化呈胶质瘤细胞样或神经元样,符合干细胞的自我繁殖和多向分化特征。     

节细胞胶质瘤:以伸长细胞型室管膜瘤为胶质成分的病理特点

目的探讨以伸长细胞型室管膜瘤为胶质成分的节细胞胶质瘤的组织病理学特点。方法对1例节细胞胶质瘤患者的肿瘤组织标本进行常规石蜡切片、HE染色、免疫组织化学染色,以及光学显微镜观察。结果临床主要表现为间断性肢体抽搐、头晕。MRI检查显示右侧顶叶占位性病变。术中可见肿瘤位于右侧顶叶,大小4.50 cm×4.00 cm×4.00 cm,质地柔韧,血运一般,大部分肿瘤组织边界清楚,呈灰红色,分块切除肿瘤后可见术腔与侧脑室相通。HE染色,肿瘤组织由肿瘤性胶质成分和散在其中的神经细胞构成,胶质成分为伸长细胞型室管膜瘤,呈伸展形束状排列,可见血管周围假"菊形团"结构;神经细胞分布疏密不均匀,多分化良好。免疫组织化学染色,伸长细胞型室管膜瘤成分胶质纤维酸性蛋白、波形蛋白和上皮膜抗原表达阳性;而神经细胞则表达神经元核抗原和神经微丝蛋白。结论节细胞胶质瘤为分化良好、生长缓慢的临床罕见神经上皮来源肿瘤,由肿瘤性成熟节细胞和肿瘤性胶质细胞混合构成。大多数肿瘤性胶质成分为星形细胞,以伸长细胞型室管膜瘤为胶质成分的节细胞胶质瘤十分罕见。掌握其组织病理学特点,对诊断和治疗具有指导作用。     

节细胞胶质瘤：以伸长细胞型室管膜瘤为胶质成分的病理特点

目的探讨以伸长细胞型室管膜瘤为胶质成分的节细胞胶质瘤的组织病理学特点。方法对1例节细胞胶质瘤患者的肿瘤组织标本进行常规石蜡切片、HE染色、免疫组织化学染色,以及光学显微镜观察。结果临床主要表现为间断性肢体抽搐、头晕。MRI检查显示右侧顶叶占位性病变。术中可见肿瘤位于右侧顶叶,大小4．50cm×4．00cm×4．00cm,质地柔韧,血运一般,大部分肿瘤组织边界清楚,呈灰红色,分块切除肿瘤后可见术腔与侧脑室相通。HE染色,肿瘤组织由肿瘤性胶质成分和散在其中的神经细胞构成,胶质成分为伸长细胞型室管膜瘤,呈伸展形束状排列,可见血管周围假“菊形团”结构;神经细胞分布疏密不均匀,多分化良好。免疫组织化学染色,伸长细胞型室管膜瘤成分胶质纤维酸性蛋白、波形蛋白和上皮膜抗原表达阳性;而神经细胞则表达神经元核抗原和神经微丝蛋白。结论节细胞胶质瘤为分化良好、生长缓慢的临床罕见神经上皮来源肿瘤,由肿瘤性成熟节细胞和肿瘤性胶质细胞混合构成。大多数肿瘤性胶质成分为星形细胞,以伸长细胞型室管膜瘤为胶质成分的节细胞胶质瘤十分罕见。掌握其组织病理学特点,对诊断和治疗具有指导作用。     

GDNF在人脑胶质瘤中的表达

目的　探讨胶质细胞源性神经营养因子 (GDNF)的表达与人脑胶质细胞瘤恶性程度的关系。方法　应用流式细胞仪检测GDNF在 5 9例脑胶质瘤中的表达水平 ,并与 2 0例正常脑组织对照。结果　GDNF在人脑胶质瘤和正常脑组织中均有表达 ,胶质瘤中的表达水平显著高于正常脑组织 ,且随着胶质瘤恶性程度的增加表达水平也增加。结论　GDNF可能作为一种重要的因素参与胶质瘤的发生、发展及分化 ,其可以作为胶质瘤的检测指标 ,提示胶质瘤的病理分级。     

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.