人骨髓间充质干细胞在脊髓损伤模型大鼠体内的存活与分化研究

目的观察人骨髓间充质干细胞（hBMSCs）在脊髓损伤大鼠体内存活与分化情况。方法采用全骨髓贴壁培养法，分离来自hBMSCs并进行流式细胞鉴定。制作大鼠脊髓半横断模型，按照实验分组为单纯损伤组与hBMSC移植组。6周后处死大鼠，用免疫荧光方法观察移植的hBMSCs在大鼠体内的存活及分化情况。结果本研究中所使用hBMSCs呈CD44，CD73，CD90和CD105阳性，CD11b、CD19、CD34和CD45表达为阴性。动物体内实验表明，移植后6周，免疫荧光激光共聚焦观察到由5-溴-2-脱氧尿苷（BrdU）标记的、存活的移植hBMSCs。移植的hBMSCs部分显示BrdU＋／NeuN＋与BrdU＋／GFAP＋的表达，与对照组相比较有显著性差异。结论移植到大鼠脊髓损伤部位的hBMSCs在局部存活并有分化成为神经元以及神经胶质细胞的潜能，为hBMSCs移植治疗脊髓损伤的临床应用提供理论依据。

小儿颅内胚胎癌1例

胚胎癌是最原始的生殖细胞肿瘤，有分化为成熟畸胎瘤和非成熟畸胎瘤的潜能。即使采用手术结合术后放化疗的综合治疗，其预后仍不理想。2012年6月．我院收治1例5岁女性颅内胚胎癌，现报道如下：

间充质干细胞-透明质酸-多聚赖氨酸治疗脊髓损伤的实验研究

目的研究间充质干细胞—透明质酸—多聚赖氨酸复合物治疗脊髓损伤的可行性,评价其治疗效果并探讨其可能机制。方法从人骨髓中分离、培养人骨髓间充质干细胞(human bone marrow mesenchymal stem cell,hBMSC);制作大鼠脊髓半横断模型,按照实验分组分别将hBMSC、透明质酸-多聚赖氨酸(hyaluronic acid-poly-L-lysine,HA-PLL)、hBMSC-HA-PLL复合物注入损伤区域,单纯损伤组作为对照。术后按照不同时间点评价损伤和移植后的大鼠运动功能。8周后杀死大鼠,观察不同移植组体内轴突和血管生长的情况,对不同细胞、材料及复合物移植对大鼠脊髓损伤修复效果进行评估。结果 hBMSC移植组和hBMSC-HA-PLL移植组的大鼠运动功能的改善显著好于单纯损伤及HA-PLL移植组。电镜结果证实复合物移植组可显著促进轴突和血管生长,新生的轴突和血管结构较为完整。结论 hBMSC具有促进神经功能恢复的作用,将其与HA-PLL相结合,可以促进大鼠脊髓损伤修复,其机制可能包括材料框架作用和hBMSC在体内对大鼠神经细胞的营养作用以及促进微血管的生成。

聚吡咯/聚乳酸生物材料联合骨髓基质细胞移植治疗脊髓损伤的基础研究

目的研究聚吡咯(polypyrrole,PPy)/聚乳酸(PLA)/骨髓基质细胞(bone marrow stromal cells,BMSCs)复合治疗脊髓损伤的可行性,并探讨其可能机制。方法制备聚吡咯/聚乳酸支架材料。从大鼠骨髓中分离、培养BMSCs;制作大鼠脊髓全横断模型,在T8水平脊髓头尾端完全横断脊髓,用虹膜剪刀去除长度约2.5 mm的脊髓组织。根据植入材料的不同将实验分为PPy/PLA组、PPy/PLA/BMSCs组及损伤组,损伤组无材料及细胞植入。术后6周处死大鼠,观察不同移植组体内轴突和血管生长情况。结果免疫荧光、电镜及q PCR结果证实复合移植可以显著促进轴突和血管生长,同时也提供了神经保护作用。结论 PPy/PLA/BMSCs可以促进大鼠脊髓损伤修复,其机制可能包括材料支架作用和BMSCs在体内促进血管生成,改善局部的微环境,因此促进新轴突生长而保护局部的神经元。

Mechanical thrombectomy with combined stent retriever and contact aspiration versus stent retriever alone for acute large vessel occlusion:data from ANGEL-ACT registry

Background and purpose An analysis of the ASTER 2 trial revealed similar final recanalisation levels and clinical outcomes in acute large vessel occlusion(LVO)stroke between stent retrieval(SR)alone as a first-line mechanical thrombectomy(MT)technique(SR alone first-line)and concomitant use of contact aspiration(CA)plus SR as a first-line MT technique(SR+CA first-line).The purpose of the present study was to compare the safety and efficacy of SR+CA first-line with those of SR alone first-line for patients with LVO in China.Methods We conducted the present study by using the data from the ANGEL-ACT registry.We divided the selected patients into SR+CA first-line and SR alone first-line groups.We performed logistic regression and generalised linear models with adjustments to compare the angiographic and clinical outcomes,including successful/complete recanalisation after the first technique alone and all procedures,first-pass successful/complete recanalisation,number of passes,90-day modified Rankin Scale,procedure duration,rescue treatment and intracranial haemorrhage within 24 hours.Results Of the 1233 enrolled patients,1069(86.7%)received SR alone first-line,and 164(13.3%)received SR+CA first-line.SR+CA first-line was associated with more thrombectomy passes(3(2-4)vs 2(1-2);β=1.77,95%CI=1.55 to 1.99,p<0.001),and longer procedure duration(86(60-129)min vs 80(50-122)min;β=10.76,95%CI=1.08 to 20.43,p=0.029)than SR alone first-line group.Other outcomes were comparable(all p>0.05)between the two groups.Conclusions Patients undergoing SR+CA first-line had more thrombectomy passes and longer procedure duration than patients undergoing SR alone first-line.Additionally,we suggested that SR+CA first-line was not superior to SR alone first-line in final recanalisation level,first-pass recanalisation level and 90-day clinical outcomes in the Chinese population.

Endovascular treatment for acute ischaemic stroke due to medium vessel occlusion:data from ANGEL-ACT registry

Objectives To investigate the safety and efficacy of endovascular treatment(EVT)for acute medium vessel occlusion(MeVO)in the anterior circulation and to explore the independent predictors of the 90-day good outcome for such patients.Methods Data from ANGEL-ACT Registry were analysed in our study.The outcomes,such as the modified Rankin Scale(mRS)at 90 days,successful recanalisation rate and symptomatic intracranial haemorrhage(SICH)rate,were compared between MeVO and acute large vessel occlusions(LVO).Then,the independent predictors of the good outcome at 90 days in MeVO patients were determined by the logistic regression analyses.Results We included 1032 subjects in the analysis,of which,147 were MeVO and 885 were LVO.mRS at 90 days distribution(3(0-4)vs 3(0-5),common odds ratio(OR)=1.00,95%confidence interval(CI)0.73 to 1.38,p=0.994),SICH rate(4.8%vs 8.9%;OR=0.59,95%CI 0.26 to 1.34,p=0.205)and successful recanalisation rate(89.8%vs 89.7%;OR=1.0095%CI 0.51 to 1.93,p=0.992)were similar between the MeVO and LVO groups after adjusting for the confounders.We identified that baseline neutrophil-to lymphocyte ratio≤4.1(OR=2.13,95%CI 1.14 to 3.99,p=0.019),baseline National Institutes of Health Stroke Scale≤14(OR=1.96,95%CI 1.02 to 3.80,p=0.045)and mechanical thrombectomy passes≤1(OR=2.16,95%CI 1.14 to 4.11,p=0.021)were independent predictors of the 90-day good outcome in MeVO patients undergoing EVT.Conclusions Patients with MeVO achieved similar 90-day mRS,SICH rate and successful recanalisation rate after EVT compared with patients with LVO.Several independent predictors of 90-day good outcome in MeVO patients undergoing EVT were determined,which should be highly considered in MeVO stroke management.

移植人骨髓间充质干细胞促进大鼠脊髓损伤后的神经功能恢复

【目的】研究人骨髓间充质干细胞(human bone marrow stromal cells,h BMSCs)治疗大鼠脊髓损伤的可行性。【方法】从人的骨髓中分离、培养骨髓间充质干细胞。制作大鼠脊髓半横断模型,按照试验分组分为单纯损伤组和h BMSC移植组。术后按照不同时间点评价损伤和移植后的大鼠运动功能。6周后处死大鼠,分别观察两组大鼠损伤区域血管生长情况、营养因子表达情况以及移植细胞的轴突生长情况。【结果】免疫荧光检测发现,移植后6周,病变部位产生新轴突,h BMSCs移植组比单纯损伤组有更多的神经丝蛋白(neurofilaments,NF)的信号。透射电镜检查发现h BMSCs组有大量的新生轴突和血管。单纯损伤组中,仅检测到极少量的新轴突生长。采用Real-time PCR检测脊髓组织里的神经营养因子,显示移植h BMSCs可以使脊髓组织中神经营养因子的表达增加。移植h BMSCs后脊髓组织转录神经营养因子3(neurotrophin-3,NT-3)与血管内皮生长因子,(vascular endothelial growth factor,VEGF)的m RNA量在移植术后第2、3周明显高于单纯损伤组。移植h BMSCs的大鼠的BBB评分从损伤后第1周至第8周都比单纯损伤组大鼠的评分高,二者具有统计学差异。在损伤后的第4、6周所做的运动诱发电位结果表明,移植h BMSCs得大鼠的潜伏期与对照组相比明显缩短。【结论】h BMSCs具有促进神经功能恢复作用,其机制可能为h BMSCs在体内促进营养因子和VEGF表达和分泌,进而促进轴突再生和血管生成,使损伤的神经功能更好地恢复。

Performance of automated CT ASPECTS in comparison to physicians at different levels on evaluating acute ischemic stroke at a single institution in China

Background:Our aim was to evaluate the sensitivity and specificity of the automated computer-based Alberta Stroke Program Early CT Score(e-ASPECTS)for acute stroke patients and compare the result with physicians at different levels.Methods:In our center,e-ASPECTS and 9 physicians at different levels retrospectively and blindly assessed baseline computed tomography(CT)images of 55 patients.Sensitivity,specificity,receiver-operating characteristic curves,Bland–Altman plots with mean score error,and Matthews correlation coefficients were calculated.Comparisons were made between the scores by physicians and e-ASPECTS with diffusion-weighted imaging(DWI)being the ground truth.Two methods for clustered data were used to estimate sensitivity and specificity in the region-based analysis.Results:In total,1100(55 patients×20 regions per patient)ASPECTS regions were scored.In the region-based analysis,sensitivity of e-ASPECTS was better than junior doctors and residents(0.576 vs 0.165 and 0.111,p<0.05)but inferior to senior doctors(0.576 vs 0.617).Specificity was lower than junior doctors and residents(0.883 vs 0.971 and 0.914)but higher than senior doctors(0.883 vs 0.809,p<0.05).E-ASPECTS had the best Matthews correlation coefficient of 0.529,compared to senior doctors,junior doctors,and residents(0.463,0.251,and 0.087,respectively).Conclusions:e-ASPECTS showed a similar performance to that of senior physicians in the assessment of brain CT of acute ischemic stroke patients with the Alberta Stroke Program Early CT score method.

Safety and efficacy of oral antiplatelet for patients who had acute ischaemic stroke undergoing endovascular therapy

Background and purpose To investigate the safety and efficacy of oral antiplatelet therapy(APT)for patients who had acute ischaemic stroke(AIS),receiving endovascular therapy(EVT).Methods Patients were divided into non-APT group and APT(single APT or dual APT(DAPT)group.The safety and efficacy endpoints at 3-month follow-up were symptomatic intracranial haemorrhage(sICH),recanalisation rate,clinical outcome and mortality.Results Among 915 patients who had AIS,those in APT group(n=199)showed shorter puncture-to recanalisation time,lower frequency of intravenous thrombolysis and more use of tirofiban compared with those in non-antiplatelet group(n=716)(p<0.05 for all).Oral APT was found to be associated with superior clinical outcome compared with non-APT(APT(44.2%)versus non-APT(41.1%)),adjusted OR=2.605,95% CI 1.244 to 5.455,p=0.011).DAPT showed superior clinical outcome compared with non-APT(DAPT(56.5%)versus non-APT(41.1%),adjusted OR=5.405,95% CI 1.614 to 18.102,p=0.006)and lower risk of mortality at 3-month follow-up(DAPT(4.8%)versus non-DAPT(17.7%),adjusted OR=0.008,95%CI 0.000 to 0.441,p=0.019).There was no significant difference in sICH between the two groups.Conclusions Oral APT prior to undergoing EVT is safe and may accompany with superior clinical outcomes.DAPT may associate with superior clinical outcomes and lower risk of mortality.