The effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury

Objective To explore effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury. Methods 71 cases were divided into three groups according age: group A( 【 30 years) ,group B ( 30 ～ 50 years) 。

TianmaGouteng yin attenuates ischemic stroke-induced brain injury by inhibiting the AGE/RAGE pathway

Background:Ischemic stroke is characterized by permanent or transient obstruction of blood flow,leading to a growing risk factor and health burden.Tianmagouteng yin(TMG)is commonly used in Chinese medicine to treat cerebral ischemia.The aim of this study was to investigate the neuroprotective effects of TMG against ischemic stroke.Methods:Either permanent middle cerebral artery occlusion(pMCAO)or sham operation was performed on anesthetized Wistar male rats(n=36).Results:Results demonstrated that TMG administration reduced the infarction volume and mitigated the neurobehavioral deficits.Hematoxylin and eosin(HE)staining and Prussian blue staining revealed that TMG attenuated tissue disruption and microbleeds in hippocampus tissues.In addition,TMG down-regulated the receptor of advanced glycation end products(RAGE)and p-JAK2.It also inhibited the concentrations of advanced glycation end products(AGEs),ferritin,malondialdehyde(MDA),and reactive oxygen species(ROS).Conclusion:As repetitive clinical trials of neuroprotectants targeting stroke have failed previously,our results suggested that the natural product,TMG,can probably help in the vicious cycles of ischemic stroke pathology.

Acupuncture Treatment of Facial Paralysis Caused by Craniocerebral Trauma in 50 Cases

Cooperating with doctors in the Department of Brain Surgery, the author have treated 50 cases of facial paralysis caused by craniocerebral trauma in recent 3 years. The results are reported as follows.

Exploring Brain Age Calculation Models Available for Alzheimer's Disease

The advantages of structural magnetic resonance imaging(sMRI)-based multidimensional tensor morphological features in brain disease research are the high sensitivity and resolution of sMRI to comprehensively capture the key structural information and quantify the structural deformation.However,its direct application to regression analysis of high-dimensional small-sample data for brain age prediction may cause“dimensional catastrophe”.Therefore,this paper develops a brain age prediction method for high-dimensional small-sample data based on sMRI multidimensional morphological features and constructs brain age gap estimation(BrainAGE)biomarkers to quantify abnormal aging of key subcortical structures by extracting subcortical structural features for brain age prediction,which can then establish statistical analysis models to help diagnose Alzheimer’s disease and monitor health conditions,intervening at the preclinical stage.

Changes of arginine vasopressin in elderly patients with acute traumatic cerebral injury

Objective: To investigate the changes and clinical significance of arginine vasopressin (AVP) in elderly patients with acute traumatic cerebral injury. Methods: With radioimmunoassay, the plasma levels of AVP were measured in 32 elderly patients with acute traumatic cerebral injury, 30 traumatic patients without cerebral injury and 30 healthy elderly volunteers, respectively. Results: The plasma level of AVP in patients with acute traumatic cerebral injury in the early stage ( 48.30 ng/L±8.28 ng/L ) was much higher than that of the traumatic patients without cerebral injury ( 25.56 ng/L±4.64 ng/L , P< 0.01 ), which was much higher than that of the healthy volunteers ( 5.06 ng/L±4.12 ng/L , P< 0.01 ). The level of AVP in the patients with acute traumatic cerebral injury was negatively related with GCS scores. Conclusions: AVP may play an important role in the pathophysiological process in patients with acute traumatic cerebral injury in the early stage. The severer the cerebral injury is, the higher the level of AVP is, which indicates that the level of AVP may be one of the severity indices of traumatic cerebral injury in elderly patients.

Caspase3和iNOS在人挫伤脑组织中的时序性表达

目的研究人脑挫伤后不同时间半胱氨酸天冬氨酸蛋白酶3(caspase3)和诱导型一氧化氮合酶(inducible nitric oxide synthase,iNOS)表达的变化,为法医实践中脑损伤时间的推断提供依据。方法选择30例因颅脑损伤死亡案例为损伤组,5例非颅脑损伤急死的案例为对照组,应用免疫组织化学和图像分析技术,分别于死亡后2h、4～8h、10～14h、1～2d、3～5d及8～11d检测脑组织标本中caspase3和iNOS的变化规律。结果经统计学分析:(1)caspase3阳性细胞表达在伤后2h以内组开始升高,与对照组相比差异有统计学意义(P<0.05),1～2d组表达强度增高,3～5d组仍见高表达(P<0.05),以后逐渐下降。(2)iNOS阳性细胞表达在2h以内组与对照组比较差异无统计学意义(P>0.05),伤后4～8h开始升高(P<0.05),1～2d组表达强度最高,以后逐渐下降,伤后8～11d仍有弱表达(P<0.05)。结论caspase3和iNOS的表达可能成为实际检案中脑损伤时间推断的有效依据。

Fas蛋白表达与大鼠脑损伤时间推断的研究

目的:探讨Fas蛋白在大鼠脑损伤后不同时间的表达规律。方法:建立大鼠脑损伤模型。应用免疫组织化学染色方法和图片分析软件Image-ProPlus6.0对脑损伤后不同时段皮质和海马区的Fas蛋白表达进行检测,并做Fas表达高峰时的稳定性实验。结果:伤后0.5 h Fas开始表达,此后浓度逐渐升高,至伤后48 h达峰值,其后开始下降,至伤后14 d左右表达基本消失。结论:Fas有望成为脑损伤后损伤时间推断的可靠指标。

大鼠脑挫伤后基质金属蛋白酶3的表达

目的检测脑挫伤修复过程中基质金属蛋白酶3(matrixmetalloproteinase-3,MMP-3)的表达,探讨其表达规律与损伤时间的相关性。方法将大鼠分成对照组、假手术组和脑挫伤组。应用免疫组织化学技术和蛋白质印迹(Westernblot)方法检测脑挫伤后不同时间脑组织中MMP-3的表达变化。结果免疫组化结果:对照组及假手术组脑组织未见MMP-3阳性染色;伤后6h组脑组织出现MMP-3阳性染色,此后24h内染色逐渐增强,伤后5d阳性细胞数及染色强度均达高峰,随之下降,伤后14d仍有少量MMP-3表达。Westernblot结果:对照组及假手术组脑组织未见MMP-3阳性染色;挫伤后6h组出现MMP-3表达,随后表达量逐渐上升,5d达到高峰,以后逐渐下降,14d仍有表达。结论大鼠脑挫伤修复过程中MMP-3的表达呈时序性变化规律,可望用于脑挫伤时间的推断。

大鼠弥漫性脑损伤神经元HSP70表达及神经髓鞘的病理变化

目的探讨脑神经元HSP70表达变化和神经髓鞘病变在弥漫性脑损伤(DB I)诊断及其损伤时间判断的价值。方法将50只SD大鼠分为正常对照组和DB I组,后者按DB I后处死大鼠的时间不同又分为0.5h、1h、3h、6h、12h、1d、3d、7d及10d组。然后复制大鼠DB I模型,脑组织常规取材后进行HSP70免疫组化及劳克坚牢蓝(LFB)髓鞘染色,观察神经元HSP70的变化和神经髓鞘病变。结果大鼠DB I后0.5h,脑干及海马处见HSP70免疫组化染色阳性的神经元;伤后1h明显,12h达到高峰,1d下降,7d基本恢复正常。神经髓鞘于伤后0.5h开始逐渐出现水肿,分层、碎裂及聚集成团块状,伤后1d最明显,3d后开始逐渐减退,10d基本正常。结论神经元HSP70表达变化和神经髓鞘病变程度对DB I诊断及其损伤时间判断具有一定的参考价值。

创伤性脑损伤后细胞凋亡的时相性研究

目的探讨创伤性脑损伤中细胞凋亡的发生发展过程,为脑损伤后的神经系统保护提供实验资料以及为法医学损伤经过时间推断提供帮助。方法以Feeney自由落体脑损伤大鼠模型为对象,采用DNA缺口末端标记法（TUNEL）染色观察不同损伤时间时脑损伤组脑组织、假手术对照组脑组织和正常对照组脑组织中细胞凋亡的情况。结果创伤性脑损伤后2h即可在伤侧皮层以及同侧的海马区可见细胞凋亡发生,随着损伤经过时间的延长,凋亡细胞逐渐增多,在48~72h凋亡达到高峰,随之逐渐减少,至7d时凋亡数仍显著高于正常对照组和假手术组,正常对照组和假手术组在伤侧对应区和海马区仅偶见凋亡细胞。结论检测损伤区凋亡细胞数对损伤经过时间的推断有重要价值,为法医学损伤诊断起重要作用。

大鼠脑外伤后星形胶质细胞及血清中相关蛋白随时间表达变化研究

目的:检测大鼠弥漫性脑损伤(DBI)后不同时间点A1型星形胶质细胞(A1s,其标记物为C3d)、A2型星形胶质细胞(A2s,其标记物为S100A10)的表达情况,以期探索其与损伤时间的关系。方法:采用改良的Marmarou方法制造大鼠DBI模型,将48只SD大鼠随机分为正常对照组(Control组),DBI后4、8、12 h,1、3、5、7 d组,采用免疫荧光染色实验检测大鼠DBI后海马组织中A1s、A2s表达变化,采用酶联免疫吸附(ELISA)实验检测大鼠DBI后血清中神经胶质纤维酸性蛋白(GFAP)、C3d、S100A10蛋白的表达变化。结果:免疫荧光染色结果显示,Control组大鼠海马组织仅见少量A1s分布,DBI 4 h后表达呈上升趋势,DBI 1 d后达高峰,随后逐渐减少;正常大鼠星形胶质细胞主要以A2s形式存在,DBI后4 h其表达减少,至1 d时最低,随后表达逐渐升高(均P<0.05)。ELISA检测结果显示:与Control组相比,GFAP、C3d在DBI 4 h后表达呈上升趋势,DBI 1 d左右两者表达呈现高峰,后逐渐下降;而S100A10在DBI 4 h后也呈上升趋势,3 d左右达高峰,后逐渐下降,DBI后7 d仍高于Control组(均P<0.05)。结论:大鼠DBI后,海马组织中A1s、A2s及血清中GFAP、C3d、S100A10的表达呈现一定规律性,有望为弥漫性脑损伤的时间推断及临床治疗提供一定的依据。

Bystanders or not?Microglia and lymphocytes in aging and stroke

As the average age of the world population increases,more people will face debilitating aging-associated conditions,including dementia and stroke.Not only does the incidence of these conditions increase with age,but the recovery afterward is often worse in older patients.Researchers and health professionals must unveil and understand the factors behind age-associated diseases to develop a therapy for older patients.Aging causes profound changes in the immune system including the activation of microglia in the brain.Activated microglia promote T lymphocyte transmigration leading to an increase in neuroinflammation,white matter damage,and cognitive impairment in both older humans and rodents.The presence of T and B lymphocytes is observed in the aged brain and correlates with worse stroke outcomes.Preclinical strategies in stroke target either microglia or the lymphocytes or the communications between them to promote functional recovery in aged subjects.In this review,we examine the role of the microglia and T and B lymphocytes in aging and how they contribute to cognitive impairment.Additionally,we provide an important update on the contribution of these cells and their interactions in preclinical aged stroke.

Burr-hole craniotomy treating chronic subdural hematoma： a report of 398 cases

Objective： To investigate the treatment of chronic subdural hematoma （CSDH） with burr-hole craniotomy in our hospital. Methods： From January 2004 to December 2009, 398 patients with CSDH, 338 males and 60 females （male/ female=5.63/1）, received burr-hole craniotomy in our hospital. The median age was 60 years with the mean age of （58.1± 18.1） years, （65.0±14.5） years for females and （57.0± 8.2） years for males. Trauma history was determined in 275 patients （69.1%）. Burr-hole craniotomy was performed under local anesthesia in 368 patients and general anesthesia in 30 patients. CSDH was classified into 3 groups according to the density on CT scan. Clinical data concerning etiologies, symptoms and signs, concomitant diseases, diagnosis, therapies and outcomes were investigated retrospectively. Patients＇ neu- rological status on admission and at discharge was also classified to judge the outcomes. Results： Generally, trauma history showed few dif- ferences between those over 60 years old and under 60 years old, but showed obvious differences when gender was taken into account. Totally 123 male patients （60.0% of 204 cases） suffering from head injuries were under 60 years, whereas 35 female patients （85.4% of 41 cases） with trauma histories were over 60 years. The duration from trauma to appearance of clinical symptoms was （84.0±61.7） days （range, 0-1493 days）. Traumatic accident was the leading etiology, other accompanying diseases such as cerebral vascular disease, hypertension, etc, were also predisposing factors. Commonly, the elderly presented with hemiplegia/ hemidysesthesia/hemiataxia and the young with headache. Most CSDH patients （95.6%） treated with burr-hole cran- iotomy successfully recovered. However, postoperative complications occurred in 17 cases, including recurrence of CSDH in 15 cases, subdural abscess in 1 case and pneumonia in 3 cases. Conclusion： Burr-hole craniotomy is an easy, efficient and reliable way to treat CSDH.

轻度脑损伤病人任务态fMRI脑区激活:元分析

目的运用激活似然估计(activation likelihood estimation,ALE)元分析探讨轻度创伤性脑损伤(mild traumatic brain injury,mTBI)病人认知相关脑区激活特点,并试图阐明mTBI病人认知功能改变的神经机制。方法系统检索中文及外文数据库,检索时间从建库开始至2020年3月2日。运用软件Ginger-ALE 3.0.2进行坐标统一化与元分析。计算出的脑区ALE分布图通过Mango软件与Brainnet Review软件呈现。结果共纳入7项研究,其中mTBI病例174例,健康对照者140例。元分析结果显示:与健康被试者相比,mTBI病人左前叶角回、左枕叶视觉联合、左侧中脑、右颞叶角回、右侧小脑扁桃体等脑区激活增强,而右背外侧前额叶、左小脑前叶、左背外侧前额叶、右侧额中回、右侧后扣带回等脑区激活减弱。进一步联合分析发现:右侧额中回背外侧前额叶为共激活减弱脑区。结论右侧额中回背外侧前额叶激活减弱是区分mTBI病人与健康被试者的主要脑区。此外,认知障碍可能与右侧额中回背外侧前额叶激活减弱有关,这可能与控制注意力的神经网络的募集能力下降有关。

小鼠脑挫伤后CB2R的表达变化与损伤时间的关系

目的检测小鼠脑挫伤后不同时间点大麻素2型受体(cannabinoid type 2 receptor,CB2R)的表达情况,并探索其与损伤时间的相关性。方法通过PCI3000精密颅脑损伤撞击器建立小鼠脑挫伤模型,利用免疫组织化学染色、免疫荧光染色和Western印迹法检测不同损伤时间点损伤区周围CB2R的表达变化。结果免疫组织化学染色结果显示,假手术组脑皮质中仅少量细胞呈CB2R阳性表达,脑挫伤后CB2R阳性细胞率逐渐升高,于伤后12h和伤后7d两次达到高峰,随后逐渐下降,至伤后28d基本恢复至正常水平。Western印迹法检测结果与免疫组织化学染色结果一致。免疫荧光染色结果显示,脑挫伤后CB2R阳性神经元、CB2R阳性单核细胞、CB2R阳性星形胶质细胞数与总细胞数的比值变化均呈单峰模式,分别于伤后12h、1d、7d达到高峰。结论小鼠脑挫伤后CB2R在神经元、单核细胞及星形胶质细胞中的表达提示,其可能参与调节这些细胞的生物学功能。脑挫伤后CB2R的动态表达存在时间规律性,有望成为法医学脑挫伤损伤时间推断的生物学指标。

Clinical studies on diffuse axonal injury in patients with severe closed head injury

OBJECTIVE: To discuss the clinical criteria for diagnosing diffuse axonal injury (DAI). METHODS: Clinical and computed tomographic features of 117 patients with severe closed head injury were analyzed. The authors preliminarily put forward CT diagnostic criteria of DAI, that is, 1) single or multiple small intraparenchymal hemorrhages in the cerebral hemispheres (

大鼠钝力性脑挫伤后PSD-95的表达

目的检测脑挫伤修复过程中突触后致密蛋白(postsynaptic density protein 95,PSD-95)的表达,探讨其变化规律与损伤时间的相关性。方法雄性SD大鼠50只,随机分为8个实验组,1个对照组,每组5只。制作大鼠脑挫伤模型,于伤后3、6、12h和3、5、7、10d取脑组织,应用免疫组织化学技术和免疫蛋白印迹(Western blot)方法检测脑挫伤后不同时间脑组织中PSD-95的表达变化。结果对照组脑组织仅有少量PSD-95阳性细胞;实验组中,伤后3h、6h组脑组织出现较多PSD-95阳性细胞,12h组阳性细胞数量持续升高,伤后1d阳性细胞数下降,5d后又升高并达到高峰,7d、10d恢复;计算阳性率,统计分析结果显示,阳性细胞数与相邻上组比较,存在显著性差异。Western blot结果:挫伤后,3～12h表达量上升,1d下降,随后又逐步上升,5d达到高峰,7d、10d下降;应用Fluorchem V2.0 Stand Alone软件获取感光条带的平均灰度值,经统计分析,各组与相邻上组比较,存在显著性差异。结论大鼠脑损伤后损伤周边区PSD-95呈现升高→下降→再升高→再下降的表达规律,对损伤时间推断有一定的参考意义。

星形胶质细胞的形态变化与损伤时间的关系

目的通过检测小鼠脑挫伤后不同时间点星形胶质细胞的树突数目、长度、复杂程度等形态学特征,探索星形胶质细胞形态与损伤时间的相关性。方法采用PCI3000颅脑打击器制作小鼠可控皮质打击模型,应用免疫荧光染色法标记星形胶质细胞,并应用Sholl分析测量伤后1d、3d、7d、14d、21d、28d不同时间点星形胶质细胞形态的变化。结果免疫荧光染色显示,假手术(sham)组皮质未见GFAP阳性细胞。脑挫伤后3d损伤周边区观察到阳性细胞,伤后7d数量到达峰值,随后降低,其中A1亚型星形胶质细胞损伤后3d开始出现,损伤后7d占比最高。损伤后,树突数目3d最多,之后逐渐减少,树突长度3d最短,之后逐渐增加。Sholl分析结果显示,距离胞体20μm~40μm范围内细胞复杂程度在伤后逐渐加大,7d到达高峰,之后降低。结论小鼠脑皮质损伤后星形胶质细胞内GFAP呈动态表达,星形胶质细胞的树突数目、树突长度、树突复杂程度等形态学指标与损伤经过时间存在相关性,提示星形胶质细胞的形态变化有望成为推断脑挫伤时间的辅助指标。

低环境压力下超声造影剂微泡高频次谐波散射特性的实验研究

超声造影剂微泡非线性次谐波散射与环境压力之间的相关性有望用于局部脑组织压力的监测。尽管高频超声实现了颅内微血管的高分辨成像,但是当前对微泡的高频次谐波散射特性研究不充分,制约了基于微泡高频次谐波散射估测局部脑组织压力的研究进展。因此,本研究以离体方式探索了在10 MHz高频超声激励下,不同声压和环境压力对声诺维(SonoVue)、示卓安(Sonazoid)和华声显三种超声造影剂微泡高频次谐波散射特性的影响。结果显示,在696、766、817 kPa的峰负声压下,三种微泡的次谐波散射幅度均随着环境压力的增加而增长,且次谐波幅值与压力之间具有良好的线性相关性。在上述三个声压下,声诺维的相关性系数最高可达0.948(P=0.03),测压灵敏度最高为0.248 dB/mm Hg,均方根误差(RMSE)最小为2.64 mm Hg;示卓安的相关性系数最高可达0.982(P<0.01),测压灵敏度最高为0.052 dB/mm Hg,RMSE最小为1.51 mm Hg;华声显的相关性系数最高可达0.969(P=0.02),测压灵敏度最高为0.098 dB/mm Hg,RMSE最小为2.00 mm Hg。以上离体实验结果表明,通过选择超声造影剂微泡并优化声压,可以改进微泡的高频次谐波散射与环境压力之间的相关关系、提高测压灵敏度、减小测量误差,以满足临床对局部脑组织压力测量的需求,这为后续在体研究提供了重要的实验依据。

星形胶质细胞在创伤性颅脑损伤中的研究进展

星形胶质细胞是中枢神经系统的主要稳态细胞,其对正常的神经元发育、功能、代谢及对损伤和炎症的反应至关重要,在中枢神经系统的生理和病理过程中发挥着不可或缺的作用。近期研究发现,星形胶质细胞在颅脑损伤后至少活化为两种不同的反应性星形胶质细胞,即A1型(神经毒性)和A2型(神经保护性)。不同分型的星形胶质细胞在颅脑损伤后不同时间点表达并发挥不同作用。文章重点从反应性星形胶质细胞的分型、作用、颅脑损伤后表达时间及机制等方面予以综述。