Acrylamide exposure impairs blood-cerebrospinal fluid barrier function

Previous studies show that chronic acrylamide exposure leads to central and peripheral neu- ropathy. However, the underlying mechanisms remained unclear. In this study, we examined the permeability of the blood-cerebrospinal fluid barrier, and its ability to secrete transthyretin and transport leptin of rats exposed to acrylamide for 7, 14, 21 or 28 days. Transthyretin levels in cerebrospinal fluid began to decline on day 7 after acrylamide exposure. The sodium fluorescein level in cerebrospinal fluid was increased on day 14 after exposure. Evans blue concentration in cerebrospinal fluid was increased and the cerebrospinal fluid/serum leptin ratio was decreased on days 21 and 28 after exposure. In comparison, the cerebrospinal fluid/serum albumin ratio was increased on day 28 after exposure. Our findings show that acrylamide exposure damages the blood-cerebrospinal fluid barrier and impairs secretory and transport functions. These changes may underlie acrylamide-induced neurotoxicity.

Continuous cerebrospinal fluid drainage by spinal puncture for cerebrospinal fluid rhinorrhea after pituitary adenoma surgery

Objective： Cerebrospinal fluid （CSF） rhinorrhea may be a serious complication after neurosurgery. Some of them can be treated conservatively by continuous CSF drainage with a lumbar subarachnoid catheter. On the other hand, spinal puncture may result in headache by CSF leakage. Methods： Present a 17-year-old female who suffered from CSF rhinorrhea after pituitary surgery was treated by making use of spinal puncture after failed catheter drainage. Results： The patient was successfully treated by this way. Conclusion： Spinal puncture by 16-gauge Touhy needle seems to be a possible way to substitute the traditional continuous lumbar subarachnoid catheter to drain the CSF in patients with rhinorrhea.

Clinical observation on the changes in excitatory amino acids content in cerebrospinal fluid following acute spinal cord injury

To elucidate the correlation between excitatory amino acids (EAA) and spinal cord injury, we investigat-ed the dynamic changes in excitatory amino acids, aspartate (Asp) and glutamate (Gin ) contents in cerebrospinalfluid (CSF) of 26 patients with acute spinal cord injury by amino acids autoanalyzer. The results showed that con-tent of glutanlate and aspartate was renlarkably elevated in 24 h after trauma and was related to the seventy of injury. The more severe the spinal cord injured, the more remarkable the content of Asp and Gin in CSF increased.The more pronounced the content of EAA in CSF increased, the worse the patient’s prognosis was. Content of EAA in CSF after spinal cord injury may be an indicator to judge injury extent and prognosis. and provide further support for a potential pathophysiological role of EAA in spinal cord injury.

Serum and cerebrospinal fluid tau protein level as biomarkers for evaluating acute spinal cord injury severity and motor function outcome

Tau protein, a microtubule-associated protein, has a high specific expression in neurons and axons. Because traumatic spinal cord injury mainly affects neurons and axons, we speculated that tau protein may be a promising biomarker to reflect the degree of spinal cord injury and prognosis of motor function. In this study, 160 female Sprague-Dawley rats were randomly divided into a sham group, and mild, moderate, and severe spinal cord injury groups. A laminectomy was performed at the T8 level to expose the spinal cord in all groups. A contusion lesion was made with the NYU-MASCIS impactor by dropping a 10 g rod from heights of 12.5 mm(mild), 25 mm(moderate) and 50 mm(severe) upon the exposed dorsal surface of the spinal cord. Tau protein levels were measured in serum and cerebrospinal fluid samples at 1, 6, 12, 24 hours, 3, 7, 14 and 28 days after operation. Locomotor function of all rats was assessed using the Basso, Beattie and Bresnahan locomotor rating scale. Tau protein concentration in the three spinal cord injury groups(both in serum and cerebrospinal fluid) rapidly increased and peaked at 12 hours after spinal cord injury. Statistically significant positive linear correlations were found between tau protein level and spinal cord injury severity in the three spinal cord injury groups, and between the tau protein level and Basso, Beattie, and Bresnahan locomotor rating scale scores. The tau protein level at 12 hours in the three spinal cord injury groups was negatively correlated with Basso, Beattie, and Bresnahan locomotor rating scale scores at 28 days(serum: r =-0.94; cerebrospinal fluid: r =-0.95). Our data suggest that tau protein levels in serum and cerebrospinal fluid might be a promising biomarker for predicting the severity and functional outcome of traumatic spinal cord injury.

Review of Thoracic Endovascular Aneurysm Repair (TEVAR), Spinal Cord Ischemia (SCI), Cerebrospinal Fluid (CSF) Drainage and Blood Pressure (BP) Augmentation

The object of this review is to examine the role of TEVAR in causing SCI. The anatomy and physiology of blood flow to the spinal cord is examined. The role of auto regulation of blood flow within the spinal cord is also examined. This review examines the reported results from the scientific literature of the effect of thoracic aortic aneurysm repair on spinal cord blood flow. In the light of the-se findings several conclusions can reasonably be reached. These conclusions are that the development of SCI can reasonably be predicted based on complexity and extent of the TEVAR procedure performed and BP augmentation and CSF drainage can significantly reduce the impact of SCI.

Concentrations of propofol in cerebral spinal fluid: target-controlled infusion

Background Although the performance of target-controlled infusion (TCI) have been studied extensively, the accuracy and safety of a TCI system that targets the effect site remains to be demonstrated. This study was to investigate the relations of TCI of propofol to its concentrations in cerebral spinal fluid (CSF), the effect-site concentrations and bispectral index (BIS).Methods Twelve mongrel dogs were used for investigations. The target effect-site concentration was set at 3μg/ml and the infusion was lasted for 15 minutes. CSF and blood samples were then collected and propofol concentrations were determined by using high performance liquid chromatography with fluorescence detection. BIS and hemodynamic data were monitored continuously.Results The predicted plasma concentrations were generally overestimated. Median performance error (MDPE) and absolute median performance error (MDAPE) were -10.0% and 29.9% respectively. Propofol CSF concentrations were much lower than its effect-site concentrations. Changes in BIS were consistent with propofol concentrations in CSF, both of which changed direction at 5 minutes while the effect-site concentrations relatively lagged behind. Better correlation ( r2 = 0. 9195) was found between BIS and CSF concentrations, when compared with that between BIS and effect-site concentrations (r2=0. 554).Conclusion With 1% enflurane inhaled, the inconsistency of drug effect to the effect-site concentrations may result from inaccuracy of pharmacokinetic parameters. CSF may show effect-site concentrations more accurately than plasma when using target effect-site concentration infusion.

Changes of cerebrospinal fluid pressure after thoracic endovascular aortic repair

Background Decreasing the intracranial pressure has been advocated as one of the major protective strategies to prevent spinal cord ischemia after endovascular aortic repair. However, the actual changes of cerebrospinal fluid （CSF） pressure and its relation with spinal cord ischemia have been poorly understood. We performed CSF pressure measurements and provisional CSF withdrawal after thoracic endovascular aortic repair, and compared the changes of CSF pressure in high risk patients and in patients with new onset paraplegia and paraparesis.

The translational importance of establishing biomarkers of human spinal cord injury

The evaluation of such novel therapies for acute spinal cord injury in clinical trials is extremely challenging.Our current dependence upon the clinical assessment of neurologic impairment renders many acute SCI patients ineligible for trials because they are not examinable.Furthermore,the difficulty in predicting neurologic recovery based on the early clinical assessment forces investigators to recruit large cohorts to have sufficient power.Biomarkers that objectively classify injury severity and better predict neurologic outcome would be valuable tools for translational research.As such,the objective of the present review was to describe some of the translational challenges in acute spinal cord injury research and examine the potential utility of neurochemical biomarkers found within cerebrospinal fluid and blood.We focus on published efforts to establish biological markers for accurately classifying injury severity and precisely predict neurological outcome.

脊柱肿瘤手术病人脑脊液漏影响因素的Meta分析

目的:明确脊柱肿瘤手术病人脑脊液漏的影响因素,为减少脑脊液漏的发生提供参考。方法:计算机检索中英文数据库有关脊柱肿瘤手术病人脑脊液漏影响因素的研究,检索时限为建库至2022年12月1日。由2名研究者独立进行文献筛选、质量评价、数据提取,采用Stata 12.0软件对数据进行Meta分析。结果:共纳入7篇文献,其中5篇病例对照研究,2篇回顾性队列研究,包括8319例病人。Meta分析结果显示,年龄>60岁[OR=1.78,95%CI(1.14,2.79)]、吸烟史[OR=1.50,95%CI(1.05,2.14)]、二次手术[OR=2.95,95%CI(1.80,4.82)]、手术时间长[WMD=22.71,95%CI(6.11,39.32)]、术中出血量多[WMD=113.92,95%CI(97.19,130.65)]是脊柱肿瘤手术病人术后出现脑脊液漏的危险因素(P<0.05)。结论:发生脑脊液漏的危险因素多,关键在于预防,术前应当对病人进行全面评估,并制订周密计划,从而减少不良后果。

Giant pseudomeningocele after spinal surgery:A case report

Very few reports have described giant pseudomeningoceles ≥ 8 cm in diameter. We report this case of the biggest giant pseudomeningocele at the unusual cervicothoracic level. A 59 year old man who underwent cervicothoracic laminectomy had a giant pseudomeningocele detected and the lesion gradually grew to about 15 cm in diameter by 2 years postoperatively. Cerebrospinal fluid leak closure was performed and the postoperative course was favorable. We present this case, review the literature and discuss the size and portion, mechanism of formation, symptoms and treatments of giant pseudomeningocele.

不同AISA分级急性脊髓创伤患者血清炎症因子和脑脊液生化指标的变化及其临床意义

目的探讨不同美国脊髓损伤协会(AISA)分级急性脊髓创伤(SCI)患者血清炎症因子和脑脊液生化指标的变化及其临床意义。方法选取2019年9月—2021年9月成都市第二人民医院120例SCI患者作为SCI组,根据AISA分级将患者分为神经功能正常组(34例)、脊髓不完全损伤组(58例)和脊髓完全损伤组(28例)。另选取同期该院体检的健康者50例作为对照组。在SCI组和对照组入院时测定血清炎症因子[白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、转化生长因子β1(TGF-β1)]和脑脊液生物学指标[神经元特异性烯醇化酶(NSE)、神经胶质纤维酸性蛋白(GFAP)]。比较对照组与SCI组血清炎症因子和脑脊液生化指标。对比不同AISA分级患者血清炎症因子和脑脊液生物学指标。绘制受试者工作特征(ROC)曲线分析IL-6、TNF-α、CRP、TGF-β1、NSE、GFAP水平对SCI的诊断效能。采用Spearman分析SCI患者AISA分级与IL-6、TNF-α、CRP、TGF-β1、NSE、GFAP水平的相关性。结果SCI组血清炎症因子和脑脊液生物学指标高于对照组(P<0.05)。脊髓不完全损伤组、脊髓完全损伤组IL-6、TNF-α、CRP、TGF-β1、NSE、GFAP水平较神经功能正常组高,脊髓完全损伤组较脊髓不完全损伤组高(P<0.05)。ROC曲线分析结果显示,IL-6、TNF-α、CRP、TGF-β1、NSE、GFAP水平诊断SCI发生的敏感性分别为89.10%(95%CI:0.847,0.946)、92.00%(95%CI:0.833,0.974)、97.10%(95%CI:0.911,0.981)、91.00%(95%CI:0.871,0.958)、76.70%(95%CI:0.506,0.855)、85.80%(95%CI:0.767,0.898),特异性分别为51.20%(95%CI:0.436,0.794)、44.60%(95%CI:0.224,0.720)、62.40%(95%CI:0.514,0.799)、60.30%(95%CI:0.436,0.721)、92.00%(95%CI:0.833,0.972)、70.00(95%CI:0.597,0.820),曲线下面积分别为0.897(95%CI:0.882,0.973)、0.814(95%CI:0.725,0.931)、0.946(95%CI:0.911,0.983)、0.914(95%CI:0.876,0.924)、0.915(95%CI:0.882,0.959)、0.833(95%CI:0.714,0.936)。Spearman相关性分析显示,SCI患者AISA分级与IL-6、TNF-α、CRP、TGF-β1、NSE、GFAP水平均呈负相关(rs=-0.542、-0.486、-0.487、-0.536、-0.517和-0.467,均P<0.05)。结论不同AISA分级SCI患者血清IL-6、TNF-α、CRP、TGF-β1水平有差异,敏感性较高但特异性较低,脑脊液NSE、GFAP可作为诊断SCI发生的生化指标,其水平与AISA分级具有相关性。

小儿椎管内神经鞘瘤误诊为髋关节一过性滑膜炎1例及相关文献复习

通过脊柱神经鞘瘤患儿不同医院3次漏诊、误诊,未及时对症处理缓解其痛苦,到术后因脑脊液漏而出现头痛呕吐、虚脱等症状,再到该手术方案是否会影响该患儿今后生长发育及脊柱稳定性等方面,探讨总结该病例并进行文献回顾性学习,希望能为临床工作者提供借鉴及相关处理经验。

低分子肝素联合踝泵运动对脊柱术后脑脊液漏患者下肢深静脉血栓的预防作用

目的探讨低分子肝素联合踝泵运动对脊柱术后脑脊液漏患者下肢深静脉血栓的预防作用。方法收集2019年2月至2022年4月首都医科大学附属北京积水潭医院收治的126例脊柱术后脑脊液漏患者的临床资料,根据术后干预方式的不同将患者分为对照组(n=69,给予常规术后处理)和联合组(n=57,在常规术后处理的基础上给予低分子肝素联合踝泵运动)。比较两组患者的手术相关指标,以及住院期间下肢深静脉血栓的发生情况、出院前D-二聚体水平升高情况、凝血功能。结果两组患者脊柱疾病类型、手术部位、全身麻醉的使用率及手术时间比较,差异均无统计学意义(P﹥0.05)。住院期间,联合组患者D-二聚体水平升高的比例、下肢深静脉血栓的发生率均低于对照组患者,差异均有统计学意义(P﹤0.05)。两组患者的凝血酶原时间和国际标准化比值比较,差异均无统计学意义(P﹥0.05)。两组患者住院期间均未发生出血、感染等并发症。结论低分子肝素联合踝泵运动对脊柱术后脑脊液漏患者下肢深静脉血栓具有较好的预防作用,值得临床推广。

灌洗液温度对脊柱内镜手术患者体温及炎症反应的影响

目的探讨在脊柱内镜手术过程中,不同温度的灌洗液对患者核心体温及炎症反应的影响。方法纳入2021年9月至2021年12月于全身麻醉下行单侧双通道脊柱内镜手术的患者80例,按照随机数字表法分为2组(每组患者40例),观察组使用等温37℃生理盐水灌洗,对照组使用室温23℃生理盐水灌洗。比较2组患者围手术期不同时点的核心体温和低体温、寒颤的发生比例,以及术后0h、3h、6h引流液中TNF-α、IL-1、IL-6、IL-10水平。结果两组患者的核心体温均随手术时间的延长持续下降,尤其是手术60min后,对照组患者核心体温下降趋势明显,显著低于观察组(P<0.05)。观察组出现低体温及寒颤事件的患者比例明显低于对照组,差异有统计学意义(P<0.05)。观察组术后0h、3h、6h引流液中TNF-α、IL-1、IL-6、IL-10水平明显低于对照组,差异有统计学意义(P<0.05)。结论等温灌洗液可以显著降低脊柱内镜手术中低体温、寒颤等不良事件的发生率,有效的减弱局部炎症反应。

脊柱化脓性骨髓炎致抗利尿激素不适当分泌综合征1例

脊柱化脓性骨髓炎临床少见,合并抗利尿激素不适当分泌综合征(syndrome of inappropriate antidiuretic hormone,SIADH)者更是未见报道,本文报道内蒙古自治区人民医院1例脊柱化脓性骨髓炎致SIADH患者的临床特点及诊治经过,探讨脊柱化脓性骨髓炎导致SIADH的病理生理机制,以提高临床医务人员对该病的关注。

神经外科患者脑脊液细菌流行病学和耐药性监测

目的监测神经外科患者脑脊液致病菌流行病学分布及耐药状况。方法收集北京天坛医院神经外科2000年1月～2004年12月，送检脑脊液标本中分离的致病菌及药敏鉴定结果，统计致病菌分布和抗菌药物敏感率。结果分离到致病菌438株，其中革兰阳性球菌316株，占72．1％；革兰阴性杆菌122株，占27．9％；排名前5位的致病菌分别为凝固酶阴性葡萄球菌（53．7％）、金黄色葡萄球菌（10．5％）、肠杆菌属（6．2％）、不动杆菌（6．2％）、铜绿假单胞菌（3．7％）；对革兰阴性菌的总体敏感率为亚胺培南86．9％、哌拉西林／他唑巴坦77．4％、阿米卡星68．0％、头孢吡肟63．9％、头孢他啶63．1％，其余抗菌药物的敏感率均〈60％。结论神经外科患者颅内感染以革兰阳性菌多见，尤其是凝固酶阴性葡萄球菌和金黄色葡萄球菌，本研究结果将为神经外科手术部位感染的预防和经验性抗菌药物治疗提供基本数据资料。

颅脑手术后发生颅内感染的危险因素探讨

目的:探讨颅脑手术后发生颅内感染(intracranialinfections,ICI)的危险因素及预防措施。方法:回顾性分析1994年1月至2002年12月我科4877例颅脑手术患者临床资料。结果:术后发生颅内感染141例,感染率2.89%。术后有脑脊液漏、刀口皮下积液及术后急症再次手术者,术后颅内感染的发生率分别为35.34%、24.60%及15.78%,明显高于平均感染率(P<0.05);有颅脑手术史者术后ICI发生率为5.10%,幕下手术后为6.40%,手术时间4～8h为4.40%,8h以上为7.09%,术前使用糖皮质激素者为4.80%。结论:术后脑脊液漏、局部皮下积液及急症再次手术是术后ICI发生的危险因素。

帕金森病患者体液免疫功能的变化

目的探讨帕金森病(PD)患者体液免疫功能的变化。方法采用终点散射比浊法测定20例PD患者和20名正常对照者的血液IgA、IgG、IgM、IgE、C3、C4、C反应蛋白(CRP)、循环免疫复合物(CIC)和CSF IgG、CRP、白蛋白的含量。结果与正常对照组比较,PD组血IgM、IgE、CRP水平显著升高(均P<0.05),而IgA、IgG、C3、C4、CIC水平差异无统计学意义;CSF IgG、CRP水平显著升高(均P<0.05),白蛋白水平差异无统计学意义。结论 PD患者可能存在体液免疫功能失调。

小儿急性淋巴细胞白血病IgH和Vδ_2Dδ_3基因重排的研究

目的探讨ＩｇＨ和Ｖδ２Ｄδ３基因重排在初诊儿童急性淋巴细胞白血病（ＡＬＬ）中的分布频率及其在中枢神经系统白血病（ＣＮＳＬ）早期诊断与脑脊液（ＣＳＦ）微量残留病（ＭＲＤ）监测中的意义。方法对初诊ＡＬＬ患者的骨髓标本及不同病期ＣＳＦ标本采用聚合酶链反应（ＰＣＲ）检测ＩｇＨ基因重排和巢式聚合酶链反应（Ｎｅｓｔｅｄ－ＰＣＲ）检测Ｖδ２Ｄδ３基因重排。结果３２份ＡＬＬ患者骨髓标本中有２３份存在克隆特异性ＩｇＨ基因重排和／或Ｖδ２Ｄδ３基因重排。在骨髓标本存在异常基因重排的诱导缓解治疗期患儿的２３份ＣＳＦ中，９份检出Ｖδ２Ｄδ３基因重排，４份检出ＩｇＨ基因重排。而完全缓解期患儿的３７份ＣＳＦ中，３份检出ＩｇＨ基因重排，７份检出Ｖδ２Ｄδ３基因重排。结论在所检初诊ＡＬＬ患者的骨髓标本中，ＩｇＨ重排片段的阳性检出率为４７％，Ｖδ２Ｄδ３基因的阳性检出率为３８％；ＡＬＬ患者脑脊液中ＩｇＨ和Ｖδ２Ｄδ３基因重排的ＰＣＲ动态监测较ＣＳＦ常规、生化及细胞学检测更灵敏，更有助于ＣＮＳＬ的早期诊断，对ＣＮＳＬ的预防及预后的判断有指导意义。

右美托咪定对颅内肿瘤手术患者脑脊液中氨基酸的影响

目的：探讨右美托咪定对颅内肿瘤手术患者脑脊液中兴奋性和抑制性氨基酸的影响和右美托咪定在神经外科手术中的脑保护机制。方法选择择期脑肿瘤手术患者60例,年龄18-64岁,ASA Ⅰ或Ⅱ级,性别不限,体重50-90 kg。随机均分为两组：右美托咪定组（D 组）和对照组（C 组）。麻醉诱导前 D 组静脉输注右美托咪定1μg/kg,10 min 注完,C 组静脉注射咪达唑仑0.03-0.05 mg/kg。D 组持续静脉泵注右美托咪定0.2-0.7μg·kg-1·h-1,C 组间断给予咪达唑仑0.03-0.05 mg/kg。维持 BIS 值在40-50。记录麻醉诱导前（T0）、切开硬脑膜（T1）、切除肿瘤时（T2）、手术结束时（T3）的 MAP、HR。并于 T0、T3、术后6 h（T4）、12 h （T5）、24 h（T6）收集脑脊液,用高效液相色谱法检测脑脊液中兴奋性氨基酸谷氨酸（Glu）、天门冬氨酸（Asp）和抑制性氨基酸γ-氨基丁酸（GABA）的浓度。结果 T1-T3时 D 组 MAP 明显低于,HR 明显慢于 T0时和 C 组（P 〈0.05）。T3-T6时脑脊液中 C 组 Glu、Asp 浓度明显高于 T0时和 D 组（P 〈0.05）,GABA 浓度明显低于 D 组（P 〈0.05）。与 T0时比较,T3-T5时 D 组 Glu、Asp 浓度有升高、GABA 浓度有降低趋势,但差异无统计学意义,T6时恢复到 T0时水平。结论右美托咪定用于颅内肿瘤手术中可维持血流动力学稳定性,降低脑脊液中兴奋性氨基酸 Glu 和 Asp 浓度,有一定的脑保护作用。