颅脑损伤死亡案例的法医病理学分析

目的探讨颅脑损伤（BI）死亡的法医病理学特点,以及继发性脑干损伤、并发症的发生与死亡之间的因果关系。方法从性别、年龄、致伤方式、损伤类型、生存时间、死亡原因等方面,对四川大学华西法医学鉴定中心1998年1月2008年12月127例BI死亡尸检案例进行回顾性统计研究分析。结果 127例法医病理学检案中,原发性BI死亡51例（40.2%）,继发性脑干损伤死亡61例（48.0%）,并发症死亡15例（11.8%）,其中伤后12h内死亡者直接死因均为严重原发性脑损伤,存活12h～1周者直接死因以继发性脑干损伤居多,生存时间超过1周者约半数死于并发症。结论在BI案例的死亡原因确定时,应在全面系统的病理学检验基础上,结合案情及临床资料进行综合分析。     

Brain metastasis from ovarian carcinoma: Analysis of eight cases from a single radiotherapy center

ObjectiveBrain metastasis from epithelial ovarian carcinoma (EOC) is rarely seen having rate of 1–3% with very poor prognosis. Studies on brain metastatic EOC is limited with low number of participants. An increasing trend in EOC related to brain metastasis has been reported recently confronting managing clinicians with new challenges. Therefore, more information on this issue is needed. We aimed to analyze a single radiotherapy center experience on EOC related brain metastases.Materials and methodsData of all patients treated between January 1998 and December 2016 at a radiation center of a university hospital were reviewed retrospectively. Clinicopathological characteristics, treatment details and outcome were analyzed.ResultsWe identified only ten cases with EOC related brain metastasis in our department during 18-year period. Two patients were excluded because of data unavailability and therefore our study was performed among 8 patients. The median time between EOC diagnosis and detection of brain metastasis was 19.8 months. Brain metastasis was multiple in majority (75%). Extracranial metastasis at the time of brain metastasis was 62.5%. All patients died in the follow-up. The median survival time after the diagnosis of brain metastasis was 4.5 months. The median overall survival (OS) after the diagnosis of EOC was 28.9 months. The interval between the initial diagnosis and brain metastasis was negatively correlated with survival after brain metastasis (B-OS) occurred as time interval (p = 0.047). Presence of extracranial metastasis at time of occurrence of brain metastasis and application of multimodal treatment after brain metastasis were positively correlated with B-OS time (p = 0.007, p = 0.046, respectively).ConclusionPrognosis of brain metastasis from EOC remains poor. The factors associated with better B-OS were the longer time between initial diagnosis and brain metastasis, absence of extracranial disease at time of brain metastasis, and application of the multimodal treatment.     

肺炎支原体肺炎合并脑梗死三例分析

目的 分析探讨儿童肺炎支原体肺炎合并脑梗死的病例特点和诊断方法.方法 总结3例肺炎支原体肺炎合并脑梗死患儿的临床表现、影像学改变,并复习相关文献.结果 3例患儿均为学龄或学龄前期儿童,以呼吸道感染起病,出现急性偏瘫,伴或不伴抽搐发作.血清肺炎支原体抗体IgM测定阳性.肺部影像学提示大片炎性实变,有合并肺不张或胸腔积液,头颅影像学提示大脑中动脉栓塞及相应供血区脑梗死.予阿奇霉素抗感染治疗及抗凝、溶栓等对症治疗,神经系统症状、体征有不同程度好转.结论 根据3例患儿呼吸道症状及肺部影像学改变,肺炎支原体肺炎诊断成立,同时神经系统症状体征及头颅影像学改变,诊断合并脑梗死.     

Brain positron emission tomography in preterm and term newborn infants

Objective

To study the clinical values of positron emission tomography (PET) in preterm and term newborn infants through observing brain glucose metabolism by ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET.

Method

To observe the brain ¹⁸F-FDG PET imaging in 9 term and 7 preterm newborn infants in the same condition after administration of 0.1 mCi/kg ¹⁸F-FDG.

Result

The brain ¹⁸F-FDG PET imaging showed that the uptake of ¹⁸F-FDG was relatively more in the thalamus, and less in the cerebral cortex in preterm and term newborn infants. The uptake of ¹⁸F-FDG of cerebral cortex in preterm infants was less than that in term infants, so the structure of brain ¹⁸F-FDG PET imaging was a little fainter in preterm neonates as compared with that in term newborns.

Conclusion

¹⁸F-FDG PET imaging could show different glucose metabolisms of brain in preterm and term infants. Brain ¹⁸F-FDG PET imaging might be a useful tool for estimating the brain function in newborn infants, and its clinical values need further investigation.     

新生小鼠兴奋毒性脑损伤的神经行为功能研究

目的：探讨兴奋毒性脑损伤模型小鼠神经行为功能改变情况,为围生期脑损伤的神经保护研究提供新的实验方法。方法：生后5日ICR种小鼠55只,采用完全随机的方法分为空白组、生理盐水组和鹅膏蕈氨酸（ibotenic acid,IA）组,用IA建立兴奋毒性脑损伤模型,小鼠生后第6,7,8,9,10日进行平面翻正实验、生后第8,10,12日进行游泳实验、生后第33和34日进行Y-迷宫分辨学习实验。结果：IA组小鼠生后第6～10日翻正实验时间为2.12±0.61、1.86±0.65、1.50±0.51、1.28±0.29、1.01±0.15,明显长于空白组和生理盐水组（P<0.05）,生后第8～12日游泳实验评分为6.33±0.98、6.87±0.74、7.13±0.64,明显低于空白组和生理盐水组（P<0.05）;IA组Y-迷宫分辨学习实验“学会”次数为19.79±2.42,明显多于空白组和生理盐水组的 16.29±2.48,16.30±2.37（P<0.05）、正确反应率86.7%,明显低于空白组和生理盐水组的96.5%,95.0%（P<0.05）。结论：新生小鼠兴奋毒性脑损伤模型发育反射和学习记忆功能都受到损伤,可以用行为学的方法对兴奋毒性脑损伤小鼠早期发育反射和远期行为进行评估。［中国当代儿科杂志,2009,11（3）：191-193］     

雷尼替丁在预防小儿重度颅脑损伤并发上消化道出血的作用

目的：探讨H2受体阻滞剂(雷尼替丁)预防小儿颅脑损伤合并应激性溃疡、上消化道出血的确切疗效。方法：1996年1月--2002年11月收治的重度颅脑损伤32例为预防组，年龄3～14岁，在常规颅脑损伤治疗的同时早期采用(伤后4h内)雷尼替丁3～5mg／kg，每12h静脉输入1次。对照组为1990--1996年重度颅脑损伤20例，年龄为3～14岁，进行常规治疗。结果：预防组32例中，并发上消化道出血3例，发生率为9．4％(3／32)，对照组20例，并发上消化道出血9例，发生率为45．0％(9／20)(P：0．005)。结论：H2受体阻滞剂～雷尼替丁在预防重度颅脑损伤合并应激性溃疡、上消化道出血有显著疗效，而且此方法应用简便，成本低廉，容易推广。     

磷脂酶A2激活在急性缺血性脑损伤中的作用机制及尼莫地平的保护作用

目的 探讨磷脂酶A2(PLA2)激活在急性缺血性脑损伤中的作用机制及尼莫地平的保护作用。方法 将局灶性脑缺血模型大鼠分为假手术组、缺血组及尼莫地平干预组，测定PIA活力、脑细胞游离ca^2 浓度、脑含水量及脑组织PLA2表达量的改变。结果 尼莫地平可使缺血后脑细胞游离ca^2 浓度、PIA2活性及脑组织含水量明显降低，但对脑缺血后脑组织PIA2mRNA表达降低不明显。结论 PIA2激活参与了急性脑损伤的病理过程，尼莫地平能抑制PLA2活性、降低细胞游离ca^2 浓度，减轻脑水肿的病理改变，对缺血性脑细胞损害有一定的保护作用。     

CT and MRI in haemolytic uraemic syndrome with central nervous system involvement: distribution of lesions and prognostic value of imaging findings

Background: Central nervous system (CNS) involvement is a common complication in haemolytic uraemic syndrome (HUS). Various imaging findings have been described, mostly as case reports. Although there are a few retrospective studies on larger patient groups there is no report that focuses on MRI. Objective: To analyse the CT and MRI studies of patients with neurological complications of HUS, to describe the typical imaging findings, and to evaluate their predictive character with regard to follow-up examinations and clinical outcome. Materials and methods: Of 57 patients with clinically proven HUS who were referred to our hospital between 1995 and 2003, 17 had signs of serious CNS involvement and 10 underwent neuroimaging. Nine MRI and seven CT studies were performed in the acute phase and five MRI and two CT studies were done for follow-up. Results: In six patients, pathological imaging findings were seen on CT or MRI performed in the acute phase of the disease whereas CT and MRI scans were completely normal in four patients. All patients with positive imaging findings had pathological changes within the basal ganglia. Additional findings were seen in the thalami (n=2), cerebellum (n=2) and brain stem (n=1). On follow-up imaging performed in five cases, the pathological imaging findings had resolved completely in two and partially in three patients. All patients had a good neurological outcome. Comparing the various MRI findings, a haemorrhagic component within an acute lesion was the most reliable parameter predicting residual pathologic findings on follow-up imaging. Conclusions: Basal ganglia involvement is a typical finding in patients with neurological complications of HUS. Even in patients with severe CNS involvement on acute imaging studies, prognosis was favourable for clinical outcome and resolution of pathological imaging findings.     

气象因素对南昌市居民脑血管病发病影响的研究

目的 探讨气象因素对脑血管病发病的影响.方法 收集南昌大学第一附属医院神经内科2006-2008年3年期间1972例家住南昌市居民的急性卒中住院病例资料,对脑梗死、脑出血和蛛网膜下腔出血(subarachnoid hemorrhage,SAH)住院患者进行卒中发病时间的特征分析,找出其发病规律;同时,根据南昌市气象局提供的月平均气温、月平均最高气温、月平均最低气温、月平均气压、月平均最高气压、月平均最低气压、月平均日照时间、月平均最大温度差以及月平均最大气压差等主要月气象指标,分析气象因素对各种脑血管病发病的影响.结果 脑梗死、脑出血和SAH发病年龄男性略早于女性;脑梗死和脑出血男性发病高于女性,而SAH女性发病高于男性.脑梗死夏季高发,脑出血春冬季高发,夏季低发,SAH冬季发病人数更多.以60～80岁的患者居多.结论 脑出血冬季发病人数更多,而脑梗死发病季节规律不明显.脑梗死与高气温和日照多有关,而脑出血与高气压和冷气团有关.多种气象因素相互协同或拮抗共同影响发病,气象要素异常波动,气温与气压配置失衡易诱发急性卒中发病.     

咬合蛋白在血脑屏障通透性改变中的作用

作为脑微血管内皮细胞紧密连接中的重要跨膜蛋白,咬合蛋白(occludin)在血脑屏障通透性调节和维持方面起着重要作用,其表达异常可使血脑屏障通透性增高.文章就咬合蛋白在血脑屏障紧密连接中的分子组成、功能维持以及在缺氧时脑微血管通透性改变中所起的作用做了综述,以便为深入研究咬合蛋白在血脑屏障通透性改变相关疾病发生机制和药物治疗靶点中的作用提供理论帮助.