Recovery of injured cingulum in a patient with traumatic brain injury

The cingulum is the neural fiber bundle that connects the basal forebrain and medial temporal lobe. The cingulum contains the medial cholinergic pathway, which originates from the basalis nucleus of Meynert in the basal forebrain. Therefore, it is important for memory function （Malykhin et al., 2008; Hong and Jang, 2010）. In the past, identification of the cingulum on conventional brain MRI has been impossible because it cannot discern the cingulum from other adjacent structures. Diffusion tensor tractography （DTT）, derived from diffusion tensor imaging （DTI）, allows three-dimensional visualization and estimation of the cingulum （Malykhin et al., 2008）.

Co-culture of astrocytes with neurons from injured brain A time-dependent dichotomy

As supportive cells for neuronal growth and development, much effort has been devoted to the role of astrocytes in the normal state. However, the effect of the astrocytes after injury remains elusive. In the present study, neurons isolated from the subventricular zone of injured neonatal rat brains were co-cultured with astrocytes. After 6 days, these astrocytes showed a mature neuron-like appearance and the number of surviving neurons, primary dendrites and total branches was significantly higher than those at 3 days. The neurons began to shrink at 9 days after co-culture with shorter and thinner processes and the number of primary dendrites and total branches was significantly reduced. These experimental findings indicate that astrocytes in the injured brain promote the development of neurons in the early stages of co-culture while these cells reversely inhibit neuronal growth and development at the later states.

Recovery of injured fornical crura following neurosurgical operation of a brain tumor: a case report

The fornix, which is involved in transfer of episodic memory, is an important structure of the Papez circuit between the medial diencephalon and the medial temporal lobe. Many studies using DTI have reported on injury of the fornix in patients with brain injury （Nakayama et al., 2006; Sugiyama et al., 2007; Wang et al., 2008; Chang et al., 2010）. However, only a few studies on recov- ery of an injured fornix in patients with brain injury, including traumatic brain injury and stroke, have been reported （Yeo et al., 2011; Yeo and Jang, 2013a, b）. In this study, using follow up DTT images, we reported on a patient who showed recovery of injured fornical crura following a neurosurgical operation for a brain tumor.

Recovery of an injured anterior cingulum to the basal forebrain in a patient with brain injury: a 4-year follow-up study of cognitive function

~[he cingulum, a long neural tract extending from the orbitof- rontal cortex to the medial temporal lobe, obtains cholinergic innervation from three cholinergic nuclei in the basal fore- brain （the nucleus basalis of Meynert [Ch 4], the medial septal nucleus [Ch 1 ], and the vertical nucleus of the diagonal band [Ch 2]）, and is the passage of the medial cholinergic pathway which supplies cholinergic innervation from the basal forebrain to the cerebral cortex （Folstein et al., 1975; Selden et al., 1998; Lucas-Meunier et al., 2003）. Therefore, it is important for cog- nition, especially memory function （Selden et al., 1998）.

Unusual neural tract between injured fornix and pedunculopontine nucleus in a patient with traumatic brain injury

It has been known that four cholinergic nuclei are located in the septal region and basal forebrain （Ch 1： medial septal nucleus, Ch 2： vertical nucleus of the diagonal band, Ch 3： horizontal limb of the diagonal band and Ch 4： nucleus basalis of Meynert） and two are located in the brainstem （Ch 5： pedunculopontine nucleus and Ch 6： laterodorsal tegmental nucleus） （Selden et al., 1998; Lucas-Meunier et al., 2003; Mesulam, 2004; Nieuwenhuys et al., 2007）. The fornix transfers information on episodic mem- ory between the medial diencephalon and the medial temporal lobe （Afifi and Bergman, 2005; Wolk and Budson, 2010）. The fornix is known to obtain cholinergic innervation from Ch 1 and Ch 2, and to project to the hippocampal formation （Selden et al., 1998; Lucas-Meunier et al., 2003; Mesulam, 2004; Nieu- wenhuys et al., 2007; Dere et al., 2008; Naidich and Duvernoy, 2009; Isaacson and Pribram, 2013）.

Appearance of a neural bypass between injured cingulum and brainstem cholinergic nuclei of a patient with traumatic brain injury on follow-up diffusion tensor tractography images

The human brain is known to contain a maximum of eight cholinergic nuclei： the basal forebrain region： the medial septal nucleus （Ch 1）, the vertical nucleus of the diagonal band （Ch 2）, the horizontal limb of the diago- nal band （Ch 3）, and the nucleus basalis of Meynert （Ch 4）; the brainstem： the pedunculopontine nucleus （Ch 5）, the laterodorsal tegmental nucleus （Ch 6）, and the para- bigeminal nucleus （Ch 8）; and the thalamus： the medial habenular nucleus （Ch 7） （Nieuwenhuys et al., 2008; Naidich and Duvernoy, 2009）. The cingulum is the neu- ral tract extending from the orbitofrontal cortex to the medial temporal lobe （Mufson and Pandya, 1984）. The cingulum plays an important role in memory because it is a passage of the medial cholinergic pathway, which pro- vides cholinergic innervations to the cerebral cortex after originating from Ch 1 and Ch 2 as well as Ch 4 （mainly） （Selden et al., 1998; Nieuwenhuys et al., 2008; Hong and lang, 2010）.

MRS and diffusion tensor image in mild traumatic brain injuries

Objective:To analyze characters of magnetic resonance spectroscopy(MRS) and diffusion tensor imaging(DTI) in the diagnosis of mild trauma brain injuries(MTBI) in frontal lobe and to compare with conventional magnetic resonance imaging(MRI).Methods:A total of 21 patients were selected,who all aged 12-51 years old and had injury within 24 hours.Computer tomography (CT) and the Glasgow Coma Scale were used to evaluate the degree of injury.All patients were diagnosed as MTBI,and 19 had conventional MRI,MRS and DTI.The major parameters of MRS were Probe-P sequence,TE= 144 or 35 ms,and both single voxel spectrum and chemical shift imging were included.The major parameters of DTI were diffusion directions =15,b value = 1000 s/mm^2. Frational anisotropic(FA) map and average ADC map were obtained to evaluate DTI result. Positive deletion ratio was observed and the imaging changes were compared between injured side and normal side.Results:All 21 patients had CT scan and Glasgow scale.A total of 19 patients had conventional MRI.DTI and MRS.Results of CT and conventional MRI showed no significant abnormality in lobe,and Glasgow scale showed mild type.MRS result showed significant decrease in N-acetyl aspartate(NAA) and NAA/creatine(Cr) in 13 cases(68.4%) (P【0.001),and increase in lactic acid(Lac) in 7 cases(36.8%).FA mapping of the frontal lobe displayed significant changes in 7 cases(36.8%),with 5 out of the 7 cases having increase in FA value.And there was no significant difference in average ADC.Conclusions:MRS and DTI might be more sensible than other methods,such as CT and conventional MRI in diagnosis of MTBI.The particular changes were reduced NAA and increased Lac for MRS.and increased FA values for DTI.

EFFECTS OF ACUPUNCTURE ON AMINO ACID CONTENTS IN CEREBROSPINAL FLUID AFTER BRAIN INJURY

Objective To probe into the mechanism on acupuncture treatment for brain injury. Methods Thirty cases of acute craniocerebral injury were divided into two groups according to the sequence of visiting. In the control （15 cases）, the routine western medicine was applied. In the experimental group （15 cases）, on the basis of routine western medicine, acupuncture was applied on Neiguan （ 内关 PC 6） and Zusanli （足三时 ST 36）. Before the treatment and on the 1^st and 5^th days after the treatment, the contents of aspartic acid （Asp）, glutamic acid （Glu） and 7-amino butyric acid （GABA） were observed successively and the relevant analysis was done. Results There was no significant difference in the concentrations of Asp, Glu and GABA before and on the 1^st day after the treatment between two groups （P〉0.05）. The difference had not been presented between the concentrations on the 1^st day and before the treatment. But, the difference was significant or very significant between the concentrations on the 5^th days and before the treatment （P〈0.05, P 〈 0.01 ）. In the experimental group, the concentration of Asp in the cerebrospinal fluid was lower obviously compared with that in the control （P〈0.05） and the concentration of GABA was higher compared with the control （P 〈 0.01）. Conclusion Acupuncture lowered the contents of Asp and Glu and increased the level of GABA in the cerebrospinal fluid rapidly so that the excitation and inhibition in the nervous system could be rebalanced. It was further indicated that acupuncture worked on the treatment of craniocerebral injury.

Cognitive disorder and changes in cholinergic receptors, N-methyl-D aspartate receptors, neural cell adhesion molecule, and brain-derived neurotrophic factor following brain injury

BACKGROUND： Learning and memory damage is one of the most permanent and the severest symptoms of traumatic brain injury; it can seriously influence the normal life and work of patients. Some research has demonstrated that cognitive disorder is closely related to nicotine cholinergic receptors, N-methyl-D aspartate receptors, neural cell adhesion molecule, and brain-derived neurotrophic factor. OBJECTIVE： To summarize the cognitive disorder and changes in nicotine cholinergic receptors, N-methyl-D aspartate receptors, neural cell adhesion molecule, and brain-derived neurotrophic factor following brain injury. RETRIEVAL STRATEGY： A computer-based online search was conducted in PUBMED for English language publications containing the key words ＂brain injured, cognitive handicap, acetylcholine, N-methyl-D aspartate receptors, neural cell adhesion molecule, brain-derived neurotrophic factor＂ from January 2000 to December 2007. There were 44 papers in total. Inclusion criteria： ① articles about changes in nicotine cholinergic receptors, N-methyl-D aspartate receptors, neural cell adhesion molecule, and brain-derived neurotrophic factor following brain injury; ② articles in the same researching circle published in authoritative journals or recently published. Exclusion criteria： duplicated articles. LITERATURE EVALUATION： References were mainly derived from research on changes in these four factors following brain injury. The 20 included papers were clinical or basic experimental studies. DATA SYNTHESIS： After craniocerebral injury, changes in these four factors in brain were similar to those during recovery from cognitive disorder, to a certain degree. Some data have indicated that activation of nicotine cholinergic receptors, N-methyl-D aspartate receptors, neural cell adhesion molecule, and brain-derived neurotrophic factor could greatly improve cognitive disorder following brain injury. However, there are still a lot of questions remaining; for example, how do these factors change at different time points after brain injury, and what is the relationship between associated factors and cognitive disorder. CONCLUSION： It is necessary to comprehensively study some associated factors, to analyze their changes and their relationship with cognitive disorder following brain injury, and to investigate their effects at different time points after brain injury.

认知康复在重型颅脑损伤失语症治疗中的作用

目的探讨认知康复在重型颅脑损伤失语症治疗中的作用。方法将40例重型颅脑损伤失语症患者随机分为单纯语言组(n=20)和语言认知组(n=20)。两组均给予常规治疗和语言治疗,语言认知组在此基础上给予认知康复。每次治疗30 min,每天1次,共1个月。语言功能采用中国康复研究中心失语症检查表(CRRCAE)进行评定,认知功能采用中文洛文斯顿作业疗法认知量表(LOTCA)电脑版进行评定。结果两组治疗后CRRCAE中的各项指标分值均明显高于治疗前(P<0.01);CRRCAE中除听写(P>0.05)外,语言认知组治疗后其他指标分值均高于单纯语言组(P<0.05)。失语症患者CRRCAE及LOTCA中各项指标的相关性分析显示,听理解与定向、视知觉、空间知觉、动作运用、视运动组织及思维运作均存在相关性。结论认知康复可改善颅脑损伤后失语症的语言功能。

重型颅脑损伤术后患者的预后因素分析

目的探讨重型颅脑损伤患者术后预后的临床影响因素。方法回顾性分析2009年12月～2011年11月我科收治的56例重型颅脑损伤经手术治疗的患者的临床资料,出院时根据患者格拉斯哥预后评分(GOS)分为预后良好组(4～5分)和预后不良组(1～3分),比较患者性别、年龄、颅脑损伤类型、GCS评分、血肿量、有无脑疝、伤后血压、血氧饱和度、ISS评分、有无误吸、有无低体温、有无酸中毒、有无凝血改变、血糖、白蛋白、手术距受伤时间、住院日、住ICU日、通气带管日、气管切开否、白细胞、鼻胃管否、是否使用肠外营养、有无肺炎等指标在2组间的差异。结果与预后良好组相比,预后不良组单因素分析发现患者年龄、ISS分值、血糖偏高,体温、GCS分值较低,脑干伤、脑疝、误吸、血肿量多,差异有统计学意义(P<0.05);多因素分析原发性脑干损伤为影响患者预后的独立因素。结论原发性脑干损伤可独立判断重型颅脑损伤手术后患者的预后;综合应用年龄、GCS、血肿量、有无脑疝、ISS、入院是否误吸、低体温、血糖等因素,可有效预测预后。

动态颅内压监测对重型颅脑损伤标准大骨瓣减压术后治疗的意义

目的探讨动态颅内压(ICP)监测对重型颅脑损伤(sTBI)标准大骨瓣减压术治疗的指导意义。方法对62例(监测组)sTBI标准大骨瓣减压患者术后行ICP监测,根据ICP值调整治疗方案,并与同期未行ICP监测的46例(常规组)sTBI标准大骨瓣减压患者的疗效、并发症及甘露醇应用的时间和计量作比较。结果监测组脱水剂应用时间及剂量较未监测组低,监测组急性肾功能损伤和电解质紊乱发生率较未监测组低,而肺部感染、尿路感染和上消化道出血等三种并发症方面差异无统计学意义;监测组预后优于常规组。结论动态ICP监测能较好地反应sTBI标准大骨瓣减压术后ICP的变化,通过个体化治疗能有效控制ICP,维持脑灌注压,减少并发症,降低sTBI的致残率和病死率。

恐伤孕鼠对其仔鼠脑发育的影响及其机制研究

目的:观察恐伤孕鼠对其仔鼠大脑海马区组织形态学和血清甲状腺激素含量的影响,以探求肾虚对脑发育的影响及其机制。方法:采用恐伤孕鼠的方法造模,造模时间为整个妊娠期间。孕鼠分娩后,在仔鼠生后14天观察大脑海马区的组织结构;另断头取血,采用化学发光法检测血清FT3、FT4、TSH的含量。结果:光学显微镜下可见模型组仔鼠大脑皮质包括海马区脑组织有散在片状水肿,水肿区域神经细胞数目减少,细胞较松散,部分组织结构模糊,神经细胞树突减少。另外,模型组与正常组和补肾组比较,血清FT4的含量显著降低(P<0.05)。结论:恐伤孕鼠可以导致仔鼠肾虚,脑组织结构的异常,引起脑发育障碍,其可能机制为血清甲状腺激素含量下降。

脑源性神经营养因子对缺氧胚脑神经元保护作用的信号传递途径初探

目的研究胚鼠脑皮质神经元遭受缺氧刺激时,脑源性神经营养因子(BDNF)发挥保护作用的信号传递途径。方法采用免疫荧光技术结合激光扫描共聚焦显微镜观察不同缺氧时间点(3h和5h)实验组(分别于缺氧培养前24h和缺氧培养即刻加入BDNF100ng/mL)和对照组(缺氧培养,无BDNF干预)体外培养脑皮质神经元胞内酪氨酸激酶B(TrkB)、磷酸化TrkB和丝裂原活化蛋白激酶(MAPK)水平的变化并进行半定量分析。结果与对照组相比,实验组在缺氧后不同时间点神经元胞浆内TrkB及磷酸化TrkB水平均出现上调(P<0.05),MAPK在胞浆内和核内的表达也增加(P<0.05),且缺氧培养前24h加入BDNF者三种蛋白的表达强于缺氧培养即刻加入BDNF者(P<0.05)。结论BDNF对缺氧神经元的保护作用可能通过诱导TrkB表达上调来实现,以TrkB受体酪氨酸磷酸化起始,经Ras-MAPK途径完成。

MEWS评分与APACHEⅡ评分在脑外伤患者预后预测中的对比研究

目的探讨改良早期预警评分(MEWS)应用于急诊入院的脑外伤患者预后预测的可行性。方法依据事先设定的入组及排除标准,选取2007年1月～2008年3月经我院急诊收入院的连续脑外伤患者共计94例。入院即刻作为观察起点,采集相关数据或化验标本。其后对每一位患者分别进行APACHEⅡ评分及MEWS评分;3个月后为观察终点;预后作为观察指标。资料收集完后进行统计分析。结果以死亡作为预测指标时,APACHEⅡ评分界值是21分,敏感度100%,特异度94.81%;ROC曲线下面积Az=0.9809;U=39.0337;P=0.0000。MEWS评分界值是5分,特异度100%,敏感度88.31%,ROC曲线下面积Az=0.9756;U=35.2844;P=0.0000。均有较强的预测价值。在存活组中,以致残为预测目标时,APACHEⅡ评分界值是16分,Az=0.8653,U=4.2115,P=0.0000,敏感度85.10%,特异度76.00%。MEWS评分界值是3分,Az=0.8255,U=3.8424,P=0.0001。敏感度85.71%,特异度75.71%;均有中等强度预测价值。结论APACHEⅡ评分及MEWS评分对脑外伤患者愈后均具有同等预测价值,但MEWS评分结构简单,获取数据方便,省时、节省费用,故可在急诊入院脑外伤患者预后预测中推广应用。

急性低压缺氧脑损伤大鼠脑组织海马区HIF-1α时序性变化及意义

目的观察急性低压缺氧大鼠脑组织海马区缺氧诱导因子1α(HIF-1α)表达的时序性变化,探讨其与缺氧性脑损伤的关系。方法将100只成年雄性SD大鼠随机分为常氧对照组、低压缺氧6 h组、低压缺氧12 h组、低压缺氧18 h组和低压缺氧24 h组,每组20只。各低压缺氧组置于低压氧舱模拟海拔7 000 m高原环境。采用HE染色法观察各组脑组织海马区形态学改变,检测脑组织含水量,一氧化氮合酶(NOS)活性及NO含量,反转录聚合酶链反应(RT-PCR)检测HIF-1αmRNA,免疫荧光化学染色法定位HIF-1α蛋白。结果 1与常氧对照组比较,各低压缺氧组脑组织海马区神经细胞均有不同程度的水肿、坏死或凋亡,细胞质不规则红染,核仁碎裂或消失,且海马各区损伤程度不同,以CA1区最为严重;2与常氧对照组比较,各低压缺氧组脑组织含水量均显著上升(P均<0.01),且随缺氧时间的延长呈递增趋势;3与常氧对照组比较,各低压缺氧组脑组织NOS活性均显著升高(P均<0.01);除低压缺氧6 h组外,其余各组脑组织NO含量均随缺氧时间的延长而显著增加(P均<0.01);4常氧对照组中未检测到HIF-1αmRNA表达,各低压缺氧组HIF-1αmRNA相对表达均显著增加,且具有时间依赖性(P<0.01或<0.05);常氧对照组脑组织海马各区均未见HIF-1α蛋白阳性标记的绿色荧光,低压缺氧损伤后先在部分神经细胞胞质中出现微弱荧光信号,随着缺氧时间的延长荧光强度逐渐增强,并明显呈向胞核聚集的趋势。结论急性低压缺氧可导致脑含水量升高,引发脑水肿,且损伤程度随缺氧时间的延长而加重;HIF-1α的应激性表达对急性低压缺氧性脑损伤有保护性调控作用。

促红细胞生成素联合头部亚低温治疗新生儿脑损伤的评价

目的:探讨促红细胞生成素(EPO)联合头部亚低温治疗新生儿脑损伤(NBD)的疗效。方法:脑损伤新生儿86例随机分为治疗组46例和对照组40例。治疗组应用重组人促红细胞生成素(rhEPO)100 U/kg肌肉或静脉注射,每周3次,应用2周;治疗组同时采用FX-2000亚低温治疗仪(深圳)头部亚低温治疗持续72 h,亚低温治疗结束后自然复温。对照组按HIE治疗方案进行。对各组于生后7 d、14 d、21 d、28 d进行新生儿行为神经测定(NBNA),并对生后3个月、6个月智能发育评估(CDCC)及6个月的随访情况进行分析。结果:生后7 d、14 d、21 d、28 d时治疗组NBNA评分高于对照组(t分别为2.008、5.341、6.238、7.485,P均<0.05);治疗组3个月与6个月智力发育指数(MDI)、心理运动发育指数(PDI)均高于对照组(P<0.05)。结论:头部亚低温与EPO的联合治疗新生儿脑损伤短期和远期效果优于常规治疗。

早期肠内营养和延期肠内营养对重型颅脑外伤患者术后营养状况和并发症的影响

目的探讨早期肠内营养和延期肠内营养对重型颅脑外伤患者术后营养状况和并发症的影响。方法 2014年6月至2016年6月,便利抽样法选取在仁济医院神经外科监护室(intensive care unit,ICU)治疗的重型颅脑外伤患者80例为研究对象。按入院先后将其分为早期肠内营养组(40例)和延期肠内营养组(40例)。早期肠内营养组患者于术后24~48h开始肠内营养,而延期肠内营养组于术后48h至5d开始肠内营养。记录患者住院期间的相关数据,包括入院当天、肠内营养开始后14d时的白蛋白、前白蛋白、血红蛋白浓度,发症发生情况,比较两组患者入住ICU的时间和出院时格拉斯哥预后评分(Glasgow outcome scale,GOS)。结果在开始肠内营养后第14天,早期肠内营养组患者的白蛋白、前白蛋白、血红蛋白水平均高于延期肠内营养组患者,且腹泻、肺部感染、电解质紊乱的发生率明显低于延期肠内营养患者,且住院时间短于延期肠内营养患者,出院时GOS高于延期肠内营养患者,差异均统计学意义(均P<0.05)。结论早期肠内营养能够有效、及时改善重型颅脑外伤患者的营养状况,纠正患者低蛋白血症;同时还能降低腹泻、肺部感染、电解质紊乱等并发症的发生率,缩短患者ICU住院时间,改善患者预后。

左归丸对惊恐伤肾MCAO大鼠BDNF及其受体的影响

目的:观察左归丸对惊恐伤肾脑缺血大鼠缺血后BDNF、Trk B表达的影响及补肾名方左归丸的治疗作用,探讨左归丸的作用机制及"肾通于脑"中医理论的生物学实质。方法:Wistar大鼠56只,雌性,随机分为假手术组、模型组、"猫吓鼠"模型组、治疗组,每组14只大鼠。除假手术组外,其余各组均采用线栓法建立大鼠大脑中动脉栓塞(MCAO)模型,并于MCAO术后2h实施再灌注。"猫吓鼠"模型组、治疗组于MCAO手术前10天开始用"猫吓鼠"法恐吓大鼠,制备"恐伤肾"肾虚模型,左归丸组于MCAO手术前3天开始给予左归丸汤剂灌胃,每日1次,连续灌胃10天。采用免疫组化法检测BDNF、Trk B表达水平。结果:与假手术组比较,模型组BDNF表达及p-Trk B/Trk B比值增加。与模型组比较,"猫吓鼠"组BDNF表达及p-Trk B/Trk B比值下调。与"猫吓鼠"组比较,治疗组BDNF表达及pTrk B/Trk B比值增加。结论:脑缺血后BDNF及其受体表达增加可能是机体损伤后的一种保护性反应,惊恐伤肾可削弱机体的自我保护功能。左归丸可以改善惊恐伤肾大鼠抗脑缺血损伤能力的低下,并且这种作用可能通过上调BDNF表达及活化Trk B实现。

脑电图、经颅多普勒超声、体感诱发电位检测对昏迷患者脑功能评判的价值

目的探讨脑电图(EEG)、经颅多普勒超声(TCD)、体感诱发电位(SEP)检测对昏迷患者脑功能评判的价值。方法采用EEG、TCD、SEP3种检测方法,对72例昏迷患者(浅昏迷12例,中度昏迷17例,睁眼昏迷4例,深昏迷39例)进行检测脑功能并评分。结果首次检测EEG25例呈电静息、TCD28例无血流信号、SEP26例P14皮质电位消失,均在深昏迷组。复查EEG时17例最终为电静息;另有24例TCD具有振荡波、钉子波频谱改变。脑功能评分:EEGV级42例、Ⅳ级10例、Ⅲ级14例;TCDV级28例、Ⅳ级9例、Ⅲ级6例、Ⅱ级9例;SEPⅢ级27例。死亡28例及多种原因放弃治疗的25例患者以深昏迷组为多。结论昏迷程度越深,EEG、TCD、SEP分级越高,预后越差;EEG、TCD、SEP检测对评价昏迷患者脑功能状态、预测预后提供了客观、可靠的依据。