Automated classification of neonatal sleep states using EEG

Objective

To develop a method for automated neonatal sleep state classification based on EEG that can be applied over a wide range of age.

Automated Detection and Quantification of Brain Lesions in Acute Traumatic Brain Injury Using MRI

The purpose of this study is to develop a reproducible method for quantifying brain lesions in traumatic brain injury (TBI). Quantifying the effects of neuropathology is an important goal in the study of brain injury and disease, yet examiners have encountered significant difficulty quantifying brain lesions in neurotrauma where there may exist multiple, overlapping forms of injury including large focal lesions and more subtle, diffuse hemorrhage and/or shear injury. In the current study, we used conventional MRI to quantify brain lesion volume at separate time points in individuals with severe TBI. We present an automated method (ISODATA) for quantifying brain lesions that is compared against a standard semi-automated volumetric approach. The ISODATA method makes no assumptions about the location or extent of brain lesions, instead identifying areas of neuropathology via voxelwise comparisons of MRI signal intensity. The data reveal that ISODATA overlaps significantly with a semi-automated approach, is reliable across multiple observations, and is sensitive to change in lesion size during recovery from TBI. This study validates a reproducible, automated lesion quantification method used here to determine the location and extent of brain pathology following TBI. This approach may be used in conjunction with advanced imaging techniques to characterize the relationship between brain lesions and neurometabolism and function.     

超选择性颅内动脉灌注治疗肺癌脑转移

目的 探讨经皮股动脉穿刺超选择性颅内动脉、支气管动脉插管,区域性动脉内灌注化疗药物治疗肺癌脑转移的临床疗效.方法 62例经影像学检查明确诊断的晚期肺癌脑转移患者,采用Seldinger技术行经皮股动脉穿刺（BALT、SIM或TERUMO导管）分别超选择至颈内动脉、椎动脉和支气管动脉进行造影,证实肿瘤供养动脉后分别依次灌注稀释后的联合化疗药（包括鬼臼噻酚甙、嘧啶亚硝脲、卡铂、羟基喜树碱、5-氟脲嘧啶、吡柔比星）,1次/月,连续治疗3次为1个疗程.治疗后1个月复查胸部CT、头部MRI,然后根据世界卫生组织的疗效判断标准进行疗效评估.治疗期间每月测定1次血象及肝、肾功能,进行化疗药物的毒副反应监测,必要时予以保护性治疗.结果 62例患者动脉内插管均获成功,患者的颅内高压症状于化疗药物灌注后24～48h不同程度减轻.头部MRI及胸部CT检查显示,62例中59例颅内转移瘤不同程度缩小,15例脑肿瘤直径＜3cm,脑水肿消失.治愈好转率（完全缓解＋部分缓解）为80.65%（50/62）.结论 应用颅内动脉灌注化疗药物治疗肺癌脑转移患者的方法操作简单、并发症少,药物可经导管直接进入肿瘤供养动脉,迅速杀死肿瘤细胞,而且全身不良反应（世界卫生组织抗肿瘤药物毒性反应分度标准）低于Ⅱ度.故对不适宜手术治疗的晚期肺癌脑转移患者,颅内动脉区域性化疗药物灌注治疗是有效提高生存质量、延长生存期的首选治疗方法.     

颞叶脑挫裂伤25例临床分析

目的探讨颞叶脑挫裂伤的CT影像特点、手术指征及手术方法,提高治疗效果.方法回顾分析25例颞叶脑挫裂伤的CT影像特点、手术指征及手术方法.结果8例保守治疗成功.6例发生脑疝后开颅,1例术中脑膨出,术后3例合并大面积脑梗死致死亡,余3例存活.11例因神志下降,侧裂池消失,环池受压或伴中线移位而早期手术,均存活.结论颞叶脑挫裂伤后早期应严密观察,适当放宽手术指征.早期CT结果示脑挫裂伤灶＋血肿体积≥20mL以上,侧裂池消失,环池受压和（或）伴中线移位,患者烦躁明显加重或已昏迷即有手术指征,尽量在脑疝发生前采取手术减压挽救生命.标准外伤大骨瓣开颅减压充分,有利于改善预后.     

小脑幕褶皱脑膜瘤的分型与手术治疗

目的探讨小脑幕褶皱脑膜瘤的分型,并对预后结果进行回顾性分析研究。方法回顾性分析近11年间在我院经手术证实的起源于天幕褶皱的连续21例脑膜瘤。肿瘤最大直径1~6 cm,平均值为2.76 cm。症状包括瞳孔大小不等、复视、上睑下垂、偏盲和共济失调等。随访周期1~36个月不等。根据肿瘤生长部位,分为三种不同亚型。结果肿瘤切除程度达到SimpsonⅡ级19例,Ⅲ级1例,Ⅳ级1例。术后出现新的暂时性神经功能障碍2例,永久性神经功能障碍7例。2例神经功能障碍患者复查时得到恢复。结论小脑幕褶皱脑膜瘤术后永久性动眼神经、外展神经障碍的发生率较高,术前应予以充分考虑。并且寻找相对的平衡点,最大限度的提高患者的术后生活质量。     

缺血性卒中患者颈动脉粥样硬化斑块高分辨磁共振成像研究进展简

脑卒中是严重危害人类生命健康的主要疾病之一,而以动脉粥样硬化性病变为病理基础的缺血性卒中为其最常见的临床发病类型。因此,及时识别粥样硬化斑块易损性即显得愈发重要。颈动脉MRI作为一项无创性检查手段,对动脉粥样硬化斑块性质的检测具有独特优势,对显示斑块形态和成分具有较高的敏感性和特异性,可以对粥样硬化斑块破裂的潜在危险进行评价和分层,进而为临床制定有效治疗方案提供影像学诊断依据。     

miR-21海绵吸附载体在脑胶质瘤细胞中的应用简

目的探讨微小RNA-21（miR-21）海绵吸附载体在脑胶质瘤细胞中发挥的作用。方法采用microRNA（miRNA）海绵技术构建人源miR-21（has—miR-21）反义片段（miR-21AS）,并串联重复8个构建至真核表达载体（pCMV）,转染脑胶质瘤细胞U251,实时荧光定量聚合酶链式反应（qRT-PCR）检测miR-21的表达,四甲基偶氨唑盐（MTT）实验检测细胞增殖能力,并检测miR-21肿瘤密切相关靶基因肿瘤抑制基因原肌球蛋白1（tumor suppressor gene tropomyosin 1, TPM1）、第10号染色体缺失的磷酸酶和张力蛋白同源基因（phosphate and tension homology deleted on chromsome ten, PTEN）、生长素B受体（transforming growth factor-beta, TGF-β）、人MutS蛋白同基因2（Human mutS homolog2,hMSH2）、程序性细胞死亡4基因（programmed cell death protein4,PDCD4）的表达。结果U251细胞转染重组pCMV-miR-21AS质粒后显著下调了miRNA-21的水平,也显著降低了细胞增殖能力,显著提高了TPM1、PTEN、TGF—β、hMSH2、PDCIM的mRNA水平。结论构建的miR-21海绵吸附载体可显著下调miR-21水平,从而降低肿瘤细胞学效应,为肿瘤miRNA基因治疗提供理论基础。     

神经导航和神经电生理辅助下脑功能区肿瘤手术

目的 探讨脑功能区肿瘤治疗的策略和技巧.方法 分析2008年5月至2009年5月手术治疗的脑功能区41例肿瘤.使用神经导航和神经电生理辅助的有23例(辅助组),未使用18例(未辅助组).未辅助组直接行显微手术切除肿瘤.辅助组采用神经导航、皮层神经电刺激(MEP)、体感诱发电位(SEP)、术中唤醒麻醉等技术确定肿瘤和脑功能区,根据肿瘤和功能区的关系切除肿瘤.结果 未辅助组肿瘤全切4例(22%),3例(17%)次全切,11例(61%)大部切除.术后功能良好6例(33%),无变化2例(11%),10例(56%)功能障碍加重.辅助组肿瘤全切12例(52%),4例(17%)次全切,7例(31%)大部切除.术后功能良好16例(70%),无变化3例(13%),4例(17%)功能障碍加重.两组肿瘤全切率及术后功能障碍发生率差异有统计学意义(P<0.05).结论 在神经导航和神经电生理监测的辅助下,可以做到精确的病灶解剖和脑功能区定位,加上运用娴熟的显微手术技巧,脑功能区的肿瘤也能取得良好疗效.     

颅内转移性恶性黑色素瘤：一例报告并文献复习

目的探讨颅内转移性恶性黑色素瘤临床组织病理学及免疫组织化学特征。方法应用组织病理学及免疫组织化学检测方法对1例颅内多发转移性恶性黑色素瘤患者的两次手术标本进行观察,通过复习文献分析其组织病理学和免疫组织化学特征,提出诊断与鉴别诊断要点。结果男性患者,48岁。因颅内多发占位性病变、肿瘤卒中而行右侧额颞叶肿瘤切除术。两次手术标本组织病理学表现不一：首次右侧额叶病灶表现为异型性上皮样肿瘤细胞围绕毛细血管和纤维组织呈乳头状排列;再次手术标本为右侧颞叶,病灶表现为梭形细胞呈片巢状或束状排列,胞质丰富、淡染或透亮,胞核异型性明显、核仁呈明显嗜酸性。左侧腹股沟淋巴结活检提示肿瘤转移,且肿瘤组织局部可见大量黑色素颗粒。免疫组织化学染色肿瘤细胞弥漫表达S一100蛋白、人黑色素细胞瘤抗原45、Melan—A和波形蛋白,部分表达上皮膜抗原,而细胞角蛋白、高分子角蛋白、低分子角蛋白、胶质纤维酸性蛋白、突触素、神经微丝蛋白等表达阴性。结论颅内转移性恶性黑色素瘤的组织学表现复杂多样,临床病史和影像学资料对诊断具有重要参考价值,但明确诊断仍需依靠免疫组织化学检测结果。需注意与转移癌、脑膜肿瘤、淋巴瘤及其他含黑色素的颅内肿瘤相鉴别。     

Gyrification,cortical and subcortical morphometry in neurofibromatosis type 1: an uneven profile of developmental abnormalities

Background

Neurofibromatosis type 1 (NF1) is a monogenic disorder associated with cognitive impairments. In order to understand how mutations in the NF1 gene impact brain structure it is essential to characterize in detail the brain structural abnormalities in patients with NF1. Previous studies have reported contradictory findings and have focused only on volumetric measurements. Here, we investigated the volumes of subcortical structures and the composite dimensions of the cortex through analysis of cortical volume, cortical thickness, cortical surface area and gyrification.

Methods

We studied 14 children with NF1 and 14 typically developing children matched for age, gender, IQ and right/left-handedness. Regional subcortical volumes and cortical gyral measurements were obtained using the FreeSurfer software. Between-group differences were evaluated while controlling for the increase in total intracranial volume observed in NF1.

Results

Subcortical analysis revealed disproportionately larger thalami, right caudate and middle corpus callosum in patients with NF1. Cortical analyses on volume, thickness and surface area were however not indicative of significant alterations in patients. Interestingly, patients with NF1 had significantly lower gyrification indices than typically developing children primarily in the frontal and temporal lobes, but also affecting the insula, cingulate cortex, parietal and occipital regions.

Conclusions

The neuroanatomic abnormalities observed were localized to specific brain regions, indicating that particular areas might constitute selective targets for NF1 gene mutations. Furthermore, the lower gyrification indices were accompanied by a disproportionate increase in brain size without the corresponding increase in folding in patients with NF1. Taken together these findings suggest that specific neurodevelopmental processes, such as gyrification, are more vulnerable to NF1 dysfunction than others. The identified changes in brain organization are consistent with the patterns of cognitive dysfunction in the NF1 phenotype.