Effects of electroacupuncture on microcirculatory blood flow and glucose transporter function in the hippocampus

Nerve cell metabolism in post brain ischemia depends on increased microcirculation perfusion and transport function of microvascular endothelial cells. In the present study, a rat model of middle cerebral artery occlusion was established to investigate the influence of electroacupuncture （EA） on hippocampal CA1 cerebral blood flow and glucose transporter 1 （GLUT1） expression in the microvascular endothelial cells. Following EA at Neiguan （PC 6）, the cerebral blood flow in the ischemic hippocampal CA1 region was significantly elevated, the number and microvascular integrated absorbance of the GLUTl-positive cells were significantly increased, nerve cell damage was ameliorated, and GLUT1 protein expression in the ischemic hippocampus was significantly increased. Results demonstrate that EA increased the cerebral blood flow of the hippocampal CA1 region and improved the glucose transport function, thereby attenuating neuronal injuries.

The effects of anisodamine and dobutamine on gut mucosal blood flow during gut ischemia/reperfusion

AIM: To determine if anisodamine is able to augment mucosal perfusion during gut I/R ischemia-reperfusion. METHODS: A jejunal sac was formed in Sprague Dawley rat. A Laser Doppler probe and a tonometer were inserted into the sac which was filled with saline. The superior mesenteric artery was occluded (SMAO)for 60 minutes followed by 90 minutes of reperfusion. At the end of 60 minutes of SMAO, either 0.2 mg/kg of anisodmine or dobutamine was injected into the jejunal sac. Laser Doppler mucosal blood flow and regional PCO2 (PrCO2)measurements were made. RESULTS: Mucosal blood flow was significantly increased at 30,60 and 90 minutes of reperfusion (R30, R60, R90) when intraluminal anisodamine or dobutamine was present compared to intraluminal saline only(44+/-3.3% or 48+/-4.1% vs 37+/-2.6% at R30, 57+/-5.0% or 56+/-4.7% vs 45+/-2.7% at R60, 64+/-3.3% or 56+/-4.2% vs 48+/-3.4% at R90,respectively P【0.05). Blood flow changes were also reflected by lowering of jejunal PrCO2 measurements after intraluminal anisodamine or dobutamine compared with that of the saline controls (41+/-3.1 mmHg or 44+/-3.0 mmHg vs 49+/-3.7 mmHg at R30,38+/-3.7 mmHg or 40+/-2.1 mmHg vs 47+/-3.8 mmHg at R60,34+/-2.1 mmHg or 39+/-3.0 mmHg vs 46+/-3.4 mmHg at R90, respectively, P【0.05). Most interesting finding was that there were significantly higher mucosal blood flow and lower jejunal PrCO2 in anisodamine group than those in dobutamine group at 90 minutes of reperfusion(64+/-3.3% vs 56+/-4.2% for blood flow or 34+/-2.1 mmHg vs 39+/-3.0 mmHg for PrCO2, respectively, P【0.05), suggesting that anisodamine had a more lasting effect on mucosal perfusion than dobutamine. CONCLUSION: Intraluminal anisodamine and dobutamine can augment mucosal blood flow during gut I/R and alleviate mucosal acidosis. The results provided beneficial effects on the treatment of splanchnic hypoperfusion following traumatic or burn shock.

EFFECT OF ELECTROACUPUNCTURE ON CEREBRAL BLOOD FLOW, VIP AND ET IN RATS WITH VASCULAR DEMENTIA

Objective: To investigate the relationship between electroacupuncture (EA)-induced improvement of regional cerebral blood flow and the alternations of vasoactive intestinal peptide (VIP) and endothelin (ET) in rats with experimental vascular dementia (VD). Methods: 40 Wistar rats were evenly randomized into sham-operation, model, medication (Nimotone) and EA groups. Vascular dementia model was established by repeated cerebral ischemia-reperfusion which was induced by occlusion and reopen of the bilateral common carotid arteries. EA (2～200 Hz, 2～3 mA) was applied to "Baihui"(GV 20), "Dazhui"(GV 14) and "Zusanli"(ST 36) for 30 min, once daily and continuously for 15 days. The regional cerebral blood flow (rCBF) in parietal lobe and hippocampus was determined with method of hydrogen clearance; a step-down avoidance test was adopted to observe the rats’ behavior change; and plasma VIP and ET contents were assayed by radioimmunoassay. Results: In comparison with sham-operation group, the correct rate of step-down avoidance test, rCBF in parietal lobe and hippocampus and plasma VIP level in VD model group lowered significantly (P<0.01) and plasma ET increased considerably (P<0.01). However, compared with model group, the correct rate of step-down avoidance test, rCBF values and plasma VIP in EA group raised obviously while plasma ET declined significantly. No significant differences were found between EA and medication groups in the 4 indexes. Conclusion: EA can raise rCBF in the parietal lobe and hippocampus, elevate plasma VIP level and reduce plasma ET in rats with VD.

STUDY OF REGIONAL STABILITY OF ECD DISTRIBUTION IN NORMAL BRAIN

Objective To evaluate in vivo stability of ethylenedylbis cysteine diethylester (ECD) brain SPECT. Methods Each of 13 normal volunteers (31. 2 ± 11. 8 years) has 12 dynamic SPECK scans ac-quired in 60min 1h after an injection of 99mTc-ECD using a triple headed gamma camera equipped with ultra high resolution fan beam collimators. Average counts per pixel were measured from frontal, temporal, parie-tal, occipital regions, cerebellum, basal ganglia, thalamus and white matter. Regional ECD clearance rates, regional gray-to-white matter (G/W) ratios and the change of the G/W ratio were calculated. Results The average ECD clearance rate was 4. 2% /h, ranged from 3. 03% /h to 5. 41% /h corresponding to white matter and occipital. There was no significant difference between regional ECD clearance rates. Regional G 7W ratio was between 1.27 to 1.75. The G/W ratio of temporal lobe was lower than the occipital ( P <0.05). The change of regional G/W ratio with time is slow. Conclusion Regional ECD distribution is stable in normal brain. ECD clearance from brain is slow and no significant regional difference.

高频彩超结合E-flow显像对早产儿早期脑血流灌注特点的观察

目的:探讨早产儿出生早期脑组织血流灌注特点。方法:应用高频超声结合E-flow血流显像技术,对体质量≥1 500 g早产儿(早产儿A组)35例、出生体质量<1 500 g(早产儿B组)33例、足月新生儿35例进行研究,在生后72小时内检测大脑中动脉(Middle cerebral artery,MAC)、豆纹动脉(Lenticulostriate artery,LSA)、豆纹动脉终末段(The terminal artery of lenticulostriate artery,LSAt)的血流参数,包括收缩期峰值流速(Vs)、舒张末期速度(Vd)、平均血流速度(Vm)、收缩期峰值流速与舒张末期速度的比值(S/D)、阻力指数(RI)。采用t检验比较各组间的差别。结果:早产儿A组MCA的Vs、Vd、Vm测值低于足月新生儿(P<0.05),且早产儿B组MCA的Vs、Vm低于早产儿A组(P<0.05);S/D、RI三组间比较无统计学差异(P>0.05)。早产儿A组的LSA、LSAt的血流参数Vs、Vd、Vm、S/D及RI均比足月儿组明显减低(P<0.01,P<0.05),且早产儿B组除S/D外,其余测值均低于早产儿A组(P<0.01)。结论:高频超声结合E-flow显像技术对脑实质内细小血管的血流参数进行检测,可更敏感地反映早产儿早期脑实质血流灌注的基础状态,为临床判断早产儿脑损伤时血流动力学变化提供依据。

基于伪连续式动脉自旋标记对原发性三叉神经痛病人疼痛相关脑区血流量的分析

目的应用伪连续式动脉自旋标记(pCASL)技术分析原发性三叉神经痛(PTN)病人疼痛相关脑区局部脑血流量(rCBF)的变化。方法回顾性纳入48例PTN病人,根据疼痛部位将病人分为右侧PTN(RPTN)组28例和左侧PTN(LPTN)组20例,另纳入健康对照(HC)35例。全部研究对象均行常规头颅MRI及动脉自旋标记(ASL)成像检查,选取中央后回、岛叶、前扣带回、眶额皮质、丘脑共5个疼痛相关的感兴趣脑区(ROI)并分析rCBF值。采用配对t检验比较3组内左右两侧的rCBF值,采用SNK校正的单因素方差分析比较3组间的rCBF值。结果RPTN组左侧和LPTN组右侧的中央后回、眶额皮质r CBF均增高(均P<0.05),RPTN组和LPTN组右侧岛叶rCBF均增高(均P<0.05),RPTN组左侧和LPTN组右侧丘脑r CBF均减低(均P<0.05)。3组间比较发现,RPTN组左侧和LPTN组右侧的中央后回、眶额皮质r CBF值均高于其他2组(均P<0.05),RPTN组左侧和LPTN组右侧的丘脑rCBF值均低于其他2组(均P<0.05),RPTN组、LPTN组右侧岛叶rCBF值均高于HC组(均P<0.05)。结论pCASL技术显示PTN病人中央后回、右侧岛叶、眶额皮质、丘脑的rCBF均发生改变,提示PTN的发生可能导致与疼痛相关脑区的脑血流量的改变。

内囊区局部脑血流量在少量基底节出血手术指征评估中的临床价值

目的为少量(15~30 mL)高血压性基底节出血(HBGH)手术指征的评估提供一种基于客观指标的方法。方法分析198例少量基底节脑出血患者的病历资料,以入院时所测得的血肿同侧内囊区局部脑血流量(rCBF)数值为标准分为轻度灌注不足组[rCBF≥15 mL/100(g·min)]103例和重度灌注不足组[rCBF<15 mL/100(g‧min)]95例,在两组中再根据患者是否手术,分别分为手术亚组和保守亚组。对比两组中手术与保守2亚组间患者治疗效果的差异,以及术后内囊区rCBF差异,评价rCBF在评估少量HBGH患者手术指征中的应用价值。结果轻度灌注不足组手术亚组与保守亚组的治疗有效、预后良好、术后内囊区rCBF数值等比较,差异无统计学意义(P>0.05),重度灌注不足组手术亚组与保守亚组的治疗有效、预后良好、术后内囊区rCBF数值等比较,差异有统计学意义(P<0.05)。结论内囊区rCBF可作为评估少量HBGH手术指征的客观指标,内囊区轻度灌注不足者,手术不能明显改善脑灌注和预后,故无手术指征。重度灌注不足者,手术可明显改善脑灌注和预后,故有手术指征。

Observation on the effect of acupoint stimulation on regional cerebral blood flow using near-infrared spectroscopy technology

Objective To observe the effect of acupuncture at Kongzui（孔最LU 6）,Sanyinjiao（三阴交 SP 6） and Zusanli（足三里 ST 36） on cerebral blood oxygenation level and explore the relevance between acupuncture and cerebral blood oxygenation level using near-infrared spectroscopy（NIRS）.Methods Quasi-randomized design（random test sequence） was used.In clinical trial ①,placebo acupuncture was applied at Baihui（百会GV 20） of18 adults.In clinical trial ②,54 adults were divided into three groups with 18 each in which acupuncture was applied at LU 6,SP 6 and ST 36 respectively.Before and after acupuncture,verbal fluency test（VFT） was performed and the blood oxygenation level of cerebral cortex was measured using NIRS.Quantized data was processed with JMP10.0.2 software and SPSS software.Results In clinical trial ①,the mean integral values of cerebral blood oxygenation level were 10.8 mMcm·s and 9.2 mMcm·s respectively before and after acupuncture at GV 20 in placebo acupuncture group.There was no significant difference in the cerebral blood oxygenation level after acupuncture.In clinical trial ②,the mean integral values of cerebral blood oxygen level were18.1 mMcm·s and 8.6 mMcm·s respectively before and after acupuncture at LU 6 in[LU 6]acupuncture group,the cerebral blood oxygenation level was significantly decreased after acupuncture（P = 0.001）.The mean integral values of cerebral blood oxygenation level were 16.1 mMcm·s and 17.4 mMcm·s respectively before and after acupuncture at SP 6 in[SP 6]acupuncture group,the cerebral blood oxygenation level was slightly increased after acupuncture,but the increase was not statistically significant.The mean integral values of cerebral blood oxygenation level were 13.8 mMcnvs and 10.1 mMcnvs respectively before and after acupuncture at ST 36 in[ST 36]acupuncture group,the cerebral blood oxygenation level was slightly deceased after acupuncture,but the increase was not statistically significant.Conclusion The cerebral blood oxygenation level of frontal head was decreased by acupuncture at LU 6,the cerebral blood oxygenation level of frontal head was intended to decrease by acupuncture at ST 36.The cerebral blood oxygenation level of frontal head is intended to increase by acupuncture at SP 6.

Regional cerebral blood flow in children with autism spectrum disorders： a quantitative 99mTc-ECD brain SPECT study with statistical parametric mapping evaluation

Background Autism spectrum disorders （ASD）, which include autism, asperger syndrome （AS） and pervasive developmental disorder-not otherwise specified （PDD-NOS）, are devastating neurodevelopmental disorders of childhood resulting in deficits in social interaction, repetitive patterns of behaviors, and restricted interests and activities. Single photon emission computed tomography （SPECT） is a common technique used to measure regional cerebral blood flow （rCBF）. Several studies have measured rCBF in children with ASD using SPECT, however, findings are discordant. In addition, the majority of subjects used in these studies were autistic. In this study, we aimed to investigate changes in rCBF in children with ASD using SPECT.Methods A Technetium-99m-ethyl cysteinate dimmer （99mTc-ECD） brain SPECT study was performed on an ASD group consisting of 23 children （3 girls and 20 boys; mean age （7.2±3.0） years） who were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition （DSM-Ⅳ） criteria and an age-matched control group with 8children （1 girl and 7 boys, mean age （5.5±2.4） years）. Image data were evaluated with Statistical Parametric Mapping,5th version （SPM5）. A Student＇s t test for unpaired data was used to compare rCBF and asymmetry in the autism and corresponding control group. The covariance analysis, taking age as covariance, was performed between the ASD and control group.Results There was a significant reduction in rCBF in the bilateral frontal lobe （frontal poles, arcula frontal gyrus） and the bilateral basal ganglia in the autism group, and a reduction in the bilateral frontal, temporal, parietal, legumina nucleus and cerebellum in the AS group compared to the control. In addition, asymmetry of hemispheric hypoperfusion in the ASD group was observed. Inner-group comparison analysis revealed that rCBF decreased significantly in the bilateral frontal lobe （42.7%）, basal nucleus （24.9%） and temporal lobe （22.8%） in the autism group, and in the bilateral cerebellum （22.8%）, basal nucleus （19.3%） and right thalamencephalon （16.6%）in the AS group （P ＜0.05）.Conclusions The decrease in rCBF in ASD is a global event, which involves the bilateral frontal, temporal, limbic system and basal ganglias. Asymmetry of hemispheric hypoperfusion was more obvious in the AS group than the autism group, which indicates a different neurobiological mechanism from that of autism.

Laser Doppler flowmeter study on regional cerebral blood flow in early stage after standard superficial temporal artery-middle cerebral artery bypass surgery for moyamoya disease

Background Standard superficial temporal artery-middle cerebral artery （STA-MCA） bypass surgery is an effective treatment for moyamoya disease, but recent evidence suggests that postoperative cerebral hyperperfusion can occur. In this study, the trendline of changes in regional cerebral blood flow （rCBF） after surgery were continually monitored near the site of anastomosis in order to investigate both the efficacy of the procedure for improving rCBF and the possible risk of hyperperfusion . Methods Standard STA-MCA bypass surgery was performed on 13 patients, rCBF was measured continually using laser Doppler flowmetry （LDF） until the 5th day after the operation with the LDF probe implanted adjacent to the area of the anastomosis. The trendline of rCBF changes postoperatively was recorded for the analysis performed using SPSS 13.0. Results The baseline LDF value of cortical rCBF was （84.68±14.39） perfusion unit （PU）, which was linear relative to absolute perfusion volume before anastomosis and （88.90±11.26） PU immediately after anastomosis （P 〉0.05）. The value changed significantly from before to after anastomosis （P 〈0.05）; it was （417.72±21.35） PU on the 1st day after surgery, and （358.99±18.01） PU, （323.46±17.38） PU, （261.60±16.38） PU and （375.72±18.45） PU on the following 4 days, respectively. The rCBF decreased gradually from the 2nd day until the 4th postoperative day, but still was at a high level （P 〈0.05）. However, on the 5th postoperative day the rCBF increased again to the second highest level, which was significantly different compared with the baseline value （P 〈0.05）, but not significantly different compared with the values on the other 4 days （P〉0.05）. Conclusions STA-MCA anastomosis improves the cerebral blood supply significantly in the early stage after surgery, however, the risk of symptomatic hyperperfusion may exist, which may possibly occur on the 1st day and 5th day after surgery. A LDF is useful for postoperative monitoring for both the efficacy of bypass and possible risk of neurologic deterioration or bleeding from hyperperfusion.

Effect of endothelin and endothelin A receptors on regional cerebral blood flow after traumatic brain injury in rabbits

Objective: To investigate the effect of endothelin and endothelin A receptors (ETAR) on regional cerebral blood flow after traumatic brain injury (TBI). Methods: The changes of endothelin 1 (ET 1) content with radioimmunoassay, mRNA expression and the location of ETAR with in situ hybridization, and the function and effect of antagonist BQ123 on regional cerebral blood flow (rCBF) through intracisternal application were dynamically observed on 130 adult rabbits after TBI. Results: ET 1 increased significantly in regional brain tissues, and the expression of ETAR mRNA increased apparently and predominantly distributed in the cerebromicrovascular endothelium after trauma. The rCBF declined significantly, but by using selective ETAR antagonist BQ123 to treat the rabbits, the decrease of rCBF could be apparently prevented. Conclusions: It demonstrates that ET 1 may primarily contribute to the rCBF decrease after TBI, while providing that the role of ET 1 is mediated through ETAR.

Pre-and postoperative changes of regional cortical cerebral blood flow in patients with cerebral arteriovenous malformation

Objective To investigate pre- and postoperative changes of regional cerebral cortical blood flow in patients with cerebral arteriovenous malformation. Method Twenty-two adult patients with arteriovenous malformation(AVM) were recruited into this study at Beijing Tiantan Hospital from September 2001 to May 2002. Eight patients had giant cerebral AVM and the other 14 had a small one. Cortical cerebral blood flow (CBF) was measured by laser Doppler flowmetry (LDF) before and after AVM resections. After surgery,the probe of LDF was implanted adjacent to the area of AVM and monitored for 24 hours.Results CBF increased significantly after the resection in all patients regardless of AVM size. In patients with small AVM,CBF returned to the baseline level within 4 hours,but in patients with giant AVM,CBF remained high even after 24 hours.Conclusions Monitoring CBF is helpful to understand pre- and postoperative changes of regional cortical CBF in patients with cerebral AVM.

Correlation between special brain area and blood perfusion in patients with cerebral infarction at convalescent period Feasibility for quantitative determination and estimation of learning and memory function

BACKGROUND： Presently, clinic memory scale is used to evaluate learning memory ability in most studies, and the influence of difference in measurement condition of individuals exists. OBJECTIVE： To study the correlation between regional cerebral blood flow （rCBF） perfusion and learning memory function in special brain regions of patients with cerebral infarction at convalescent period, and to try to find out a method which can quantitatively evaluate learning ability. DESIGN： Case observation, and correlation analysis. SETTINGS： Shandong Institute for Behavioral Medicine; the Affiliated Hospital of Jining Medical College. PARTICIPANTS： Totally 70 patients with cerebral infarction admitted to Department of Neurology, Jining Medical College between January 2004 and December 2005 were involved. The involved patients, 58 male and 12 female, were averaged （52±3） years, and they were all right handed. They all met the diagnosis criteria instituted by the Fourth National Conference on Cerebrovascular Disease, and were confirmed as cerebral infarction by skull CT or MRI. Informed consents of detected items were obtained from all the patients and relatives. METHODS： When the patients were at convalescent period, their learning and memory ability were measured with “ clinic memory scale （set A）”. The 18 patients whose total mark over 100 were regarded as good learning memory function group; The 23 cases whose total mark less than 70 were regarded as poor learning memory function group. RCBF of hippocampus, nucleus amygdalae, temporal cortex and prefrontal lobe of patients between two groups were measured and compared by single photon emission computed tomography （SPECT）. The total scores of the 18 good learning memory patients and 23 poor learning memory patients were taken as dependent variable Y, and their rCBFs of hippocampus, nucleus amygdale, temporal cortex and prefrontal lobe respectively as independent variable X for linear correlation analysis. MAIN OUTCOME MEASURES： Correlation of rCBF in different brain regions and learning memory ability in patients with cerebral infarction. RESULTS： ①The rCBF of hippocampus, nucleus amygdale, temportal cortex and prefrontal cortex of good learning memory function group were significantly higher than those of poor learning memory function group （P 〈 0.05）. ②In the good learning memory function group, rCBF of hippocampus, nucleus amygdale, temportal cortex and prefrontal cortex were significantly positively correlated with memory scale scores （ r = 0.961, 0.926, 0.954, 0.907, P 〈 0.05 ） , and also in the poor learning memory function group （r = 0.979, 0.976, 0.991, 0.953, P 〈 0.05 ） . CONCLUSION： The rCBF of hippocampus, nucleus amygdale, temportal cortex and prefrontal cortex of patients with cerebral infarction are significantly positively correlated with memory scale scores. Predicting learning memory ability of patients by quantitative determination of rCBF provides a quantitative and objective method for evaluating learning memory ability.

Effects of regional cerebral blood flow perfusion on learning and memory function and its molecular mechanism in rats

Objective:To study the effects of regional cerebral blood flow(r CBF)perfusion on learning and memory function in special brain areas and its molecular mechanism in rat.Methods:Sixty-four adult male healthy Sprague-Dawley(SD)rats were randomly divided into two groups:A false operation group and an operation group.The false operation group was randomly divided into four subgroups(A_0,B_0,C_0,and D_0)and the operation group was randomly divided into four subgroups(A,B,C,and D),with eight rats in each subgroup.The operation group underwent bilateral common carotid artery permanent ligation,while the other group only underwent a skin incision without the bilateral common carotid artery permanent ligation.Learning memory function of rats in each subgroup was measured using a Y-maze at 4 h,8 h,24 h,and 3 days after surgery.The r CBF in the right frontal lobe and hippocampus was detected using the Periflux PF model laser Doppler flowmetry and c-fos,c-jun,Bcl-2,and Bax protein expression in the right frontal lobe and hippocampus was measured using immunohistochemistry.Results:The r CBF in the right frontal lobule division and right hippocampus division was significantly lower in the operation group than in the false operation group(P<0.05).The error number(EN),time to reach the target,and total reaction time(TRT)for the learning index using the Y-type labyrinth test in the operation group were significantly higher than that in the false operation group(P<0.05);however,the active avoid rate in the operation group was significantly lower than that of the false operation group.Expression of c-fos and c-jun as well as the average absorbency in the right frontal lobule division and right hippocampus division in the operation group were significantly higher than those in the false operation group(P<0.05).The number of Bax and Bcl-2-positive cells was significantly higher in the operation group,and the expression ratio of Bax/Bcl-2 in the operation group was significantly higher than that in the false operation group(P<0.01).Conclusions:r CBF decrease can impair learning and memory function in rats,which may be related to the increased expression of c-fos,c-jun,Bcl-2,and Bax proteins in the frontal cortex and hippocampus.

高度近视合并视盘旁脉络膜空腔患者患眼黄斑区视网膜血流密度与厚度的相关性

目的研究高度近视(HM)合并视盘旁脉络膜空腔(PICC)患者患眼黄斑区视网膜血流密度与厚度的相关性。方法以回顾性分析为法,观察对象为2020年1月至2023年1月眉山市人民医院收治的108例(108只眼)HM合并PICC患者,将其设为A组;同时,选取同一时期入院的单纯HM患者(108只眼)与108名体检健康者(108只眼)分别设为B组与C组。3组受检者均行光相干断层扫描血管成像仪(OCTA)检查,扫描范围为受检眼黄斑区3 mm×3 mm。比较3组受检者黄斑区全层视网膜厚度(上半侧、下半侧、整体平均值)、视网膜神经节细胞复合体(mGCC)厚度(上半侧、下半侧、平均值)、视网膜浅层毛细血管层(SCP)血流密度(上半侧、下半侧、整体平均、中心凹区、旁中心凹区、鼻侧、颞侧、上方、下方区域)、深层毛细血管层(DCP)血流密度(上半侧、下半侧、整体平均、中心凹区、旁中心凹区、鼻侧、颞侧、上方、下方区域),并分析A组患眼黄斑区各区域SCP、DCP血流密度与对应区域全层视网膜厚度、mGCC厚度的相关性。结果(1)3组受检者全层视网膜厚度比较:A组、B组全层视网膜厚度上半侧、下半侧、平均值均明显低于C组;A组全层视网膜厚度下半侧明显低于B组,差异均有统计学意义(P<0.05)。(2)3组mGCC厚度比较:A组mGCC厚度上半侧、下半侧、平均值均明显低于B、C组,差异均有统计学意义(P<0.05)。(3)3组黄斑区SCP血流密度比较:A组黄斑区上半侧、下半侧、整体平均、旁中心凹区、鼻侧、颞侧、上方、下方区域SCP血流密度均明显低于B、C组,中心凹区SCP血流密度明显高于C组,中心凹区SCP血流密度明显低于B组,差异均有统计学意义(P<0.05)。(4)3组黄斑区DCP血流密度比较:A组黄斑区上半侧、下半侧、整体平均、旁中心凹区、鼻侧、颞侧、上方、下方区域DCP血流密度明显低于C组,中心凹区DCP血流密度明显高于C组;A组黄斑区中心凹区DCP血流密度明显低于B组,差异均有统计学意义(P<0.05)。(5)黄斑区视网膜血流密度与厚度相关性分析:A组患眼黄斑区各区域SCP血流密度与对应区域全层视网膜厚度、mGCC厚度呈正相关(P<0.05)。A组患眼黄斑区下半侧区域DCP血流密度与下半侧区域全层视网膜厚度呈正相关(P<0.05)。结论HM合并PICC患者患眼黄斑区各个区域mGCC厚度、SCP血流密度与下半侧区域全层视网膜厚度明显低于单纯HM患者患眼,变化最为明显的为黄斑区下半侧区域SCP血流密度、mGCC厚度,且黄斑区视网膜血流密度与厚度呈正相关。

大豆异黄酮可减轻大鼠脑缺血/再灌注损伤:基于抑制铁死亡及炎症级联反应

目的基于大豆异黄酮(SI)对区域脑血流(rCBF)、铁死亡、炎症反应和血脑屏障(BBB)通透性的级联调控作用,探讨SI抗脑缺血/再灌注损伤机制。方法将120只雄性SD大鼠随机分为假手术组(Sham组)、缺血/再灌注组(I/R组)和大豆异黄酮预处理组(SI组),40只/组。采用改良线栓法合并激光多普勒血流仪(LDF)建立大鼠局灶性脑缺血/再灌注损伤模型。术中各组大鼠通过LDF实时监测脑皮层血流动态变化;术后通过光镜和透射电镜观察脑组织病理形态、神经元和BBB超微结构变化,评估神经缺损程度,量化脑梗死、脑水肿和BBB破坏程度,分光光度法检测缺血半暗带Fe^(2+)、谷胱甘肽(GSH)、丙二醛(MDA)、髓过氧化物酶(MPO)含量,ELISA法测定血清TNF-α和IL-1β活性,Western blot法和IHC法检测病灶周围GPX4、MMP-9和Occludin表达。结果插线成功后I/R组和SI组大鼠rCBF均呈现骤降趋势,而拔线后I/R组rCBF上升慢于SI组;rCBF存在插线后不稳定和拔线后未复流状况。I/R组神经细胞固缩严重,线粒体变小、膜密度增加、嵴减少,紧密连接松散、基底膜厚薄不均,SI组各结构损伤相较于I/R组呈不同程度减轻。与Sham组相比,I/R组神经缺损评分、脑梗死体积、脑含水量和伊文思蓝渗透量明显增加(P<0.01),Fe^(2+)和MDA含量增多、GSH含量及GPX4表达降低(P<0.01),MPO含量和血清TNF-α、IL-1β活性增高(P<0.01),MMP-9表达增多、Occludin表达减少(P<0.01);与I/R组相比,SI组神经缺损评分、脑梗死体积、脑含水量和伊文思蓝渗透量降低(P<0.05或P<0.01),Fe^(2+)和MDA含量减少、GSH含量及GPX4表达升高(P<0.05或P<0.01),MPO含量和血清TNF-α、IL-1β活性降低(P<0.05或P<0.01),MMP-9表达下调、Occludin表达上调(P<0.05,P<0.01)。结论SI预处理可能通过改善脑血流,抑制铁死亡、炎症反应和保护BBB,进而减轻脑缺血/再灌注损伤。

尼卡地平对冠状动脉旁路移植术患者脑血流和功能的影响

目的探讨冠状动脉旁路移植术(CABG)患者在心肺转流(CPB)期间输注小剂量尼卡地平对脑血流和功能的影响。方法选择CPB下CABG患者64例,男41例,女23例,年龄60~79岁,BMI 18~29 kg/m^(2),ASAⅡ或Ⅲ级,NYHA分级Ⅱ或Ⅲ级,左室射血分数≥50%。采用随机双盲数字表法将患者分为两组:尼卡地平组(N组)和生理盐水组(C组),每组32例。N组在CPB开始后输注尼卡地平0.2~0.5μg·kg-1·min^(-1),于CPB停机后停止输注。C组于相同时点输注同等容量生理盐水。记录麻醉诱导前(T_(0))、外科切皮时(T_(1))、CPB 30 min(T_(2))、60 min(T 3)、停CPB 30 min(T_(4))、60 min(T 5)的动脉血气、心输出量(CO)、颈内动脉血流量(Q-ICA)、颈内动脉直径(D-ICA)和局部脑氧饱和度(rScO_(2))。记录术中去氧肾上腺素用量、术后拔管时间、ICU停留时间和术后住院时间。结果与C组比较,T_(2)—T 5时N组Q-ICA和D-ICA明显增加,rScO_(2)明显升高(P<0.05)。两组T_(0)—T 5时动脉血气指标、T_(0)、T_(1)时Q-ICA、D-ICA和rScO_(2)、术中去氧肾上腺素用量、术后拔管时间、ICU停留时间和术后住院时间差异均无统计学意义。结论在CABG患者CPB期间输注小剂量尼卡地平可以增加颈内动脉血流量,升高rScO_(2),减轻围术期神经功能损伤。

糖尿病患者视盘周围血流和视网膜神经纤维层厚度变化及相关性分析

目的观察无糖尿病视网膜病变的2型糖尿病患者(NDR)及增生型糖尿病视网膜病变(PDR)治疗后的视盘周围血流密度和神经纤维层(pRNFL)厚度变化并进行相关性分析。方法回顾性病例对照研究。选取确诊为PDR(IV或V期)并治疗后稳定3个月的患者25例(25只眼)、NDR患者38例(38只眼),同期纳入年龄匹配的健康成年人24例(24只眼)作为对照组。受检者均行相干光层析血管成像术(OCTA)检查,将视盘周围分为颞侧上方(TU)、上方颞侧(ST)、上方鼻侧(SN)、鼻侧上方(NU)、鼻侧下方(NL)、下方鼻侧(IN)、下方颞侧(IT)、颞侧下方(TL)8个象限,观察三组在不同区域视盘旁放射状毛细血管网(RPC)血流密度和pRNFL厚度的差异,运用Spearman相关分析两者之间的相关性。结果与正常对照组比较,NDR组盘周整体、上半侧、下半侧以及TU象限RPC血流密度降低(P<0.05),而PDR组在各区域的RPC血流密度均进一步减少(P<0.05)。NDR组与对照组在各区域pRNFL厚度差异均无统计学意义(P>0.05),PDR组IN、IT和ST象限pRNFL厚度均小于对照组且IT和ST象限pRNFL厚度小于NDR组(P<0.05)。PDR组SN和IN象限pRNFL厚度和RPC血流密度呈高度正相关(r=0.743、0.719,P<0.001),NDR组鼻侧象限(NU和NL)pRNFL厚度和RPC血流密度呈中度正相关(r=0.658、0.672,P<0.001)。结论OCTA在糖尿病视神经微循环形态评价中具有重要价值。糖尿病患者未发生DR时视盘周围微循环改变可能早于神经纤维的损害,以颞侧上方最为显著。当病情发展至PDR时,pRNFL明显变薄且视盘旁RPC血流密度进一步减少,两者密切相关。

局部脑血流量在少量基底节出血手术决策中的应用

目的分析血肿同侧内囊局部脑血流量(region cerebral blood flow,rCBF)在少量(15~30 mL)高血压性基底节出血(hypertensive basal ganglia hemorrhage,HBGH)手术决策中的应用价值。方法回顾性分析少量基底节出血患者的病历资料,以入院时CT灌注(CT perfusion,CTP)检查所测得的血肿同侧内囊区rCBF数值及内囊区发生坏死的阈值[150 mL/(kg·min)]为标准,分为高于阈值的轻度灌注不足组[rCBF≥150 mL/(kg.min)]和低于阈值的重度灌注不足组[rCBF<150 mL/(kg·min)],在两组中再根据患者是否手术,分别分为手术亚组和药物治疗亚组。对比两组中手术与药物治疗两亚组间患者治疗效果的差异,以及术前术后内囊区rCBF差异,评价rCBF在决策少量基底节脑出血患者手术指征中的应用价值。结果共纳入患者212例,轻度灌注不足组115例,重度灌注不足组97例。轻度灌注不足组手术亚组与药物治疗亚组比较,治疗有效、预后良好、术后内囊区rCBF数值分别为65.2%vs.63.2%、66.7%vs.67.3%、294(233,325)mL/(kg·min)vs.291(228,336)mL/(kg·min),差异无统计学意义(P>0.05)。重度灌注不足组手术亚组治疗有效、预后良好、术后内囊区rCBF数值均显著优于药物治疗亚组,分别为59.1%vs.37.7%、61.4%vs.39.6%、266(198,311)mL/(kg·min)vs.3215(146,258)mL/(kg·min),差异有统计学意义(P<0.05)。结论内囊区rCBF可作为少量高血压性基底节出血手术指征的标准,高于内囊区发生坏死的阈值无手术指征,低于阈值,有手术指征。

磁共振动脉自旋标记脑血流灌注在抑郁症中的研究进展

抑郁症是一种严重和普遍的精神疾病,尽管它被认为与大脑相关的变化有关,但基于大脑的生物标志物尚未被建立起来,缺乏客观的诊断标准和治疗决策,而神经成像仍然是一种越来越重要的工具。神经元活动与局部脑血流量密切相关,动脉自旋标记(ASL)成像技术可以定量反映局部脑血流量,无需静脉对比剂,并提供标准单位每分钟mL·100^(-1)·g^(-1)的脑组织血流测量。本文论述了抑郁症脑血流变化的机制和假说、ASL技术原理及特点以及抑郁症脑血流的变化。