Assessment of structural brain changes in patients with type 2 diabetes mellitus using the MRI-based brain atrophy and lesion index

Patients with type 2 diabetes mellitus(T2 DM) often have cognitive impairment and structural brain abnormalities.The magnetic resonance imaging(MRI)-based brain atrophy and lesion index can be used to evaluate common brain changes and their correlation with cognitive function,and can therefore also be used to reflect whole-brain structural changes related to T2 DM.A total of 136 participants(64 men and 72 women,aged 55–86 years) were recruited for our study between January 2014 and December 2016.All participants underwent MRI and Mini-Mental State Examination assessment(including 42 healthy control,38 T2 DM without cognitive impairment,26 with cognitive impairment but without T2 DM,and 30 T2 DM with cognitive impairment participants).The total and sub-category brain atrophy and lesion index scores in patients with T2 DM with cognitive impairment were higher than those in healthy controls.Differences in the brain atrophy and lesion index of gray matter lesions and subcortical dilated perivascular spaces were found between non-T2 DM patients with cognitive impairment and patients with T2 DM and cognitive impairment.After adjusting for age,the brain atrophy and lesion index retained its capacity to identify patients with T2 DM with cognitive impairment.These findings suggest that the brain atrophy and lesion index,based on T1-weighted and T2-weighted imaging,is of clinical value for identifying patients with T2 DM and cognitive impairment.Gray matter lesions and subcortical dilated perivascular spaces may be potential diagnostic markers of T2 DM that is complicated by cognitive impairment.This study was approved by the Medical Ethics Committee of University of South China(approval No.USC20131109003) on November 9,2013,and was retrospectively registered with the Chinese Clinical Trial Registry(registration No.Chi CTR1900024150) on June 27,2019.

MK-801 attenuates lesion expansion following acute brain injury in rats: a meta-analysis

OBJECTIVE: To evaluate the efficacy and safety of MK-801 and its effect on lesion volume in rat models of acute brain injury.DATA SOURCES: Key terms were "stroke","brain diseases","brain injuries","brain hemorrhage, traumatic","acute brain injury","dizocilpine maleate","dizocilpine","MK-801","MK801","rat","rats","rattus" and "murine". PubMed, Cochrane library, EMBASE, the China National Knowledge Infrastructure, WanFang database, the VIP Journal Integration Platform(VJIP) and SinoMed databases were searched from their inception dates to March 2018.DATA SELECTION: Studies were selected if they reported the effects of MK-801 in experimental acute brain injury. Two investigators independently conducted literature screening, data extraction, and methodological quality assessments.OUTCOME MEASURES: The primary outcomes included lesion volume and brain edema. The secondary outcomes included behavioral assessments with the Bederson neurological grading system and the water maze test 24 hours after brain injury.RESULTS: A total of 52 studies with 2530 samples were included in the systematic review. Seventeen of these studies had a high methodological quality. Overall, the lesion volume(34 studies, n = 966, MD =-58.31, 95% CI:-66.55 to-50.07;P < 0.00001) and degree of cerebral edema(5 studies, n = 75, MD =-1.21, 95% CI:-1.50 to-0.91;P < 0.00001) were significantly decreased in the MK-801 group compared with the control group. MK-801 improved spatial cognition assessed with the water maze test(2 studies, n = 60, MD =-10.88, 95% CI:-20.75 to-1.00;P = 0.03) and neurological function 24 hours after brain injury(11 studies, n = 335, MD =-1.04, 95% CI:-1.47 to-0.60;P < 0.00001). Subgroup analysis suggested an association of reduction in lesion volume with various injury models(34 studies, n = 966, MD =-58.31, 95% CI:-66.55 to-50.07;P = 0.004). Further network analysis showed that 0–1 mg/kg MK-801 may be the optimal dose for treatment in the middle cerebral artery occlusion animal model.CONCLUSION: MK-801 effectively reduces brain lesion volume and the degree of cerebral edema in rat models of experimental acute brain injury, providing a good neuroprotective effect. Additionally, MK-801 has a good safety profile, and its mechanism of action is well known. Thus, MK-801 may be suitable for future clinical trials and applications.

Association between the fMRI manifestations of activated brain areas and muscle strength in patients with space-occupying lesions in motor cortex

BACKGROUND ： Functional magnetic resonance imaging （fMRI） studies have disclosed the changes of the motor function in the motor cortex of ipsilateral and contralateral hemispheres of tumor, which have special significance for making the surgical planning and most greatly minimizing the postoperative functional damages. OBJECTIVE： To analyze the association between the manifestation characteristics of hand functional area and motor dysfunction using fMRI in patients with space-occupying lesions of tumor in motor cortex. DESIGN ： A case-controlled observation SETTING： Department of Radiology, Second Affiliated Hospital, Shantou University Medical College .PARTICIPANTS： Twenty-three patients （13 males and 10 females） with space-occupying lesions of central sulcus area, aged 21-53 years with a mean age of （47±1） years were selected from the Second Affiliated Hospital of Shantou University Medical College. All the patients were diagnosed by MR scanning as space-occupying lesions of motor area, and pathologically confirmed that the lesions involved central sulcus and central Iobule; Lesions occurred in left and right hemispheres in 13 and 10 cases respectively. The tumor types were astrocytoma （n =8）, metastatic tumours （n =7）, meningiomas （n =5） and oligodendroglioma （n =3）. The muscle strength was normal in 11 cases （grade 5） and obviously decreased in 12 cases （grade 2-3 in 3 cases and grade 4 in 9 cases）; muscle strengths of both upper and lower limbs were decreased in 7 cases, and only that of upper limbs was decreased in 5 cases. Informed consents were obtained from all the subjects. Meanwhile, 9 healthy physical examinees （5 males and 4 females） of 20-56 years old with an average of （34±1） years were taken as controls. All the patients and healthy subjects were right-handed. METHODS： All the enrolled subjects were examined with MR scanning and functional imaging. Twenty cases whose clinical symptoms were mild in the patient group and 9 healthy volunteers adopted simple active finger-tapping movements, and for the 3 cases whose clinical symptoms were severe in the patient group, the simple passive finger-tapping movements were used. The manifestations in the activated brain areas were analyzed in the patients with brain tumor of different muscle strength and the controls. The motor deficit and activation of contralateral primary motor cortex （M1） in simple finger-tapping movements were observed in the patient group. MAIN OUTCOME MEASURES： （1） Brain areas activated by finger-tapping movements in each group： （2） Activated volumes in hemisphere by finger-tapping movements between groups. RESULTS： The contralateral M1 area could not be activated in 1 case in the patient group,, all the other 22 patients and 9 healthy subjects were involved in the analysis of results. （1） In the control group, unilateral finger tapping movement activated the contralateral primary motor cortex （M1）, bilateral SMA and bilateral PMC. The activation volume was the largest in contralateral primary motor cortex （M1）, smaller in the SMA, and the smallest in PMC. The finger tapping movement in healthy subjects could activate contralateral primary motor cortex （M1）, bilateral SMA and bilateral PMC, which had no obvious differences from the manifestations of brain functional area activated by active finger tapping. There was no significant difference in the volume of activated functional areas between right and left hands. In the patient group, the central sulcos around the tumor in the activated M1 area displaced towards dorsal or ventral side, also extended. The distance of displacement in the functional area was determined as compared with the contralateral central sulcus, and the results suggested the M1 displacement, including that there were 10 cases with the M1 displacement larger than 10 mm in the patients with motor deficit, which were obviously more than in those without motor deficit （n =1, P 〈 0.01）, and the activated volume in contralateral M1 area was obvious smaller in the patients with motor deficit than in those without motor deficit （P 〈 0.01）. （2） The M1 activation and changes were observed in contralateral hemisphere in the patient group, and the activated volume was obviously larger than that in the control group （P 〈 0.01）. The activated volumes of M1 and PMC in ipsilateral hemisphere were obviously larger than those in the control group （P 〈 0.05）, but that of SMA had no obvious difference between the two groups （P 〉 0.05）. CONCLUSION： fMRI can be used to observe the activation of the brain motor functional areas of patient with space-occupying lesions in motor area, and evaluate the state of their motor function. The larger the distance of displacement of M1 compressed by tumor, the more obviously the muscle strength decreases in the patients.

血管源性脑白质病变的研究进展

脑白质病变(WML)在是一种在老年人群中常见的影像学改变,是脑小血管病的影像学特征之一,病因复杂,临床表现不一,若未能及时干预,可进展为脑卒中、精神情感异常、运动功能障碍以及认知功能障碍等,严重影响患者生活质量。本研究从病理组织学、病理生理机制及年龄、高血压、睡眠质量、体力活动及认知障碍等方面与WML的相关性进行综述,进一步分析老年患者发生WML的影响因素,以为相关诊断、治疗及预后提供数据参考。

脑白质病变及大脑皮层厚度与老年轻型卒中后认知功能障碍的相关性研究

目的探讨老年轻型卒中后认知功能障碍(PSCI)与脑白质病变、大脑皮层厚度的关系。方法回顾性分析158例老年轻型卒中病人的临床资料,根据MoCA评估结果分为非PSCI组和PSCI组(MoCA<26分),比较2组的基线资料、MRI影像改变、大脑皮层厚度,并采用多因素Logistic回归分析老年轻型卒中病人发生PSCI的影响因素。结果PSCI组与非PSCI组的腔隙性缺血灶、脑微出血、DWI阳性病变及血管间隙扩大检出率差异无统计学意义(P>0.05)。PSCI组年龄大于非PSCI组,脑白质病变较非PSCI组严重(P<0.05)。2组的左额下回三角部及右额下回三角部皮质厚度差异无统计学意义(P>0.05),但PSCI组左眶额部、右眶额部、左额中回及右额中回的皮质厚度均明显低于非PSCI组(P<0.05)。多因素分析显示,年龄、中重度脑白质病变均为老年轻型卒中病人发生PSCI的危险因素(OR=1.704、1.826,均P<0.05),前额叶脑皮质厚度(左眶额部、右眶额部、左额中回、右额中回)为老年轻型卒中病人发生PSCI的保护因素(OR=0.820、0.838、0.834、0.827,均P<0.05)。结论年龄、脑白质中重度病变及前额叶脑皮质厚度变薄均与PSCI密切相关,通过头颅MRI检查脑白质及大脑皮质厚度变化,可为临床预测PSCI的发生提供参考依据。

BDNF和HDL-C与老年帕金森病患者脑白质病变的关系

目的探讨血清脑源性神经营养因子(BDNF)和高密度脂蛋白胆固醇(HDL-C)与老年帕金森病(PD)患者脑白质病变(WML)的关系。方法筛选116例老年PD患者为研究组,依据Fazckas分级分成PD-WML组和PD组,另选取同期人口学资料匹配的40例健康体检者为对照组。比较不同组别的相关资料,应用多因素Logistic分析PD患者WML的影响因素,受试者工作特征(ROC)曲线分析血清BDNF、HDL-C与PD患者WML的关系。结果116例PD患者WML发生率为72.41%(84/116),Ⅰ、Ⅱ、Ⅲ级分别43、30、11例。PD-WML组年龄、高血压患病率、统一帕金森病评定量表Ⅲ(UPDRS-Ⅲ)评分均高于PD组(P<0.05),血清BDNF[(4.83±1.15)μg/L比(6.12±1.20)μg/L]、TC[(4.37±0.96)mmol/L比(4.84±1.04)mmol/L]和HDL-C[(1.07±0.29)mmol/L比(1.23±0.32)mmol/L]明显低于PD组(P<0.05)。年龄、高血压、BDNF和HDL-C是PD患者发生WML的独立影响因素(P<0.05)。对照组、PD组、WML轻度组(Ⅰ级)、WML中重度组(Ⅱ~Ⅲ级)血清BDNF、HDL-C均呈依次下降趋势(P<0.05),WML中重度组血清BDNF、HDL-C水平均明显低于WML轻度组(P<0.05)。血清BDNF、HDL-C以及联合诊断PD患者发生WML的曲线下面积(AUC)为0.834、0.768、0.899,单独诊断的截断值分别为5.70μg/L、1.15 mmol/L。血清BDNF、HDL-C以及联合诊断PD发生中重度WML的AUC为0.820、0.766、0.833,单独诊断的截断值分别为4.79μg/L、1.02 mmol/L。结论血清BDNF、HDL-C是PD患者发生WML的保护因素,可有效预测PD患者发生WML和评估病情严重程度。

Functional magnetic resonance imaging and the brain: A brief review

Functional magnetic resonance imaging(fMRI) is em-ployed in many behavior analysis studies, with blood oxygen level dependent-(BOLD-) contrast imaging being the main method used to generate images. The use of BOLD-contrast imaging in f MRI has been refined over the years, for example, the inclusion of a spin echo pulse and increased magnetic strength were shown to produce better recorded images. Taking careful precautions to control variables during measurement, comparisons between different specimen groups can be illustrated by f MRI imaging using both quantitative and qualitative methods. Differences have been observed in comparisons of active and resting, developing and aging, and defective and damaged brains in various studies. However, cognitive studies using f MRI still face a number of challenges in interpretation that can only be overcome by imaging large numbers of samples. Furthermore, f MRI studies of brain cancer, lesions and other brain pathologies of both humans and animals are still to be explored.

立体定向脑核团毁损术治疗老年帕金森病的有效性及安全性

目的:探讨立体定向脑核团毁损术治疗老年帕金森病患者的有效性及安全性。方法:选取某医院44例老年原发性帕金森病患者为研究对象,采用随机数字表法将其分为对照组和研究组,各22例。对照组采用多巴丝肼片治疗,研究组在对照组基础上进行立体定向脑核团毁损术治疗,6个月后评估治疗结果。比较两组治疗前后帕金森氏病综合评分量表(UPDRS)、自主神经症状量表(SCOPA-AUT)及Berg平衡量表(BBS)评分、神经功能相关指标因子水平和治疗后临床疗效,记录两组术后并发症发生情况。结果:与治疗前比较,治疗6个月后两组患者UPDRSⅠ、Ⅱ、Ⅲ部分评分均降低,研究组低于对照组(P<0.05);研究组治疗后总有效率高于对照组(P<0.05)。与治疗前比较,治疗6个月后两组SCOPA-AUT评分均下降,BBS评分均增加,且研究组优于对照组(P<0.05)。与治疗前比较,治疗6个月后两组血清BDNF水平均增加,S-100β、NSE水平均降低,且研究组优于对照组(P<0.05)。研究组术后出现构音障碍或语言含糊1例,谵妄1例,经相应的康复后患者均顺利出院。结论:立体定向脑核团毁损术可以改善高龄帕金森病患者神经功能,提高患者术后日常生活能力及运动功能,效果好,安全性高,可在老年帕金森病患者中推广使用。

3D-T1WI表面形态学分析在学龄前无灶性癫痫患儿脑结构评估中的应用

目的:采用表面形态学分析(surface-based morphometry,SBM)技术对学龄前无灶性癫痫(non-lesional epilepsy,NLE)患儿的3D-T_(1)WI脑结构影像进行分析,评估患儿脑结构的改变。方法:选取2021年1月至2022年9月某院神经内科确诊为无灶性癫痫的35例学龄前患儿纳入NLE组,选取同时期的35例学龄前健康儿童纳入对照组。对比2组患儿的脑皮层厚度、脑沟深度、脑回指数、脑脊液体积、脑灰质体积及脑白质体积。采用SPSS 25.0统计学软件对数据进行分析。结果:与对照组相比,NLE组患儿左侧大脑半球下侧颞叶皮层厚度变薄、右侧大脑半球后扣带回皮层厚度增厚、右侧大脑半球下侧颞叶皮层厚度变薄,差异有统计学意义(P<0.05);与对照组相比,NLE组患儿右侧大脑半球舌回和额中回脑沟深度变浅,差异有统计学意义(P<0.05);与对照组相比,NLE组患儿左侧大脑半球距状回皮层脑回指数增大,差异有统计学意义(P<0.05)。2组患儿在脑脊液、脑灰质及脑白质方面比较,差异无统计学意义(P>0.05)。结论:NLE患儿的皮层结构异常可能是其致病主要因素,SBM技术对3D-T_(1)WI脑结构影像的分析结果可以评估NLE患儿局部脑结构异常,是探索儿童NLE潜在发病机制的有效工具。

DWI联合DCE-MRI鉴别呈环形强化的脑GBM和感染性病变

目的:探讨MR扩散加权成像(DWI)和3D肝脏容积快速采集(LAVA)序列动态对比增强(DCE)MRI扫描对颅内呈环形强化的胶质母细胞瘤(GBM)和感染性病变的鉴别诊断价值。方法:回顾性搜集2015年9月-2020年9月在本院经病理证实的23例脑GBM和17例颅内感染性病变(脑脓肿11例,结核瘤6例)患者的临床和MRI资料。所有患者在术前2周内行3.0T颅脑MRI扫描,扫描序列包括常规序列、对比增强T_(1)WI、DWI和LAVA序列DCE-MRI扫描。分别使用Firevoxel软件和GE Omni-Kinetics软件在每例患者的表观扩散系数(ADC)图和DCE图像中选取病灶最大层面于病灶内环形强化区域手动勾画ROI,测量并比较两组病变的ADC第一四分位数(ADC-P25)、容积转移常数(K_(trans))、血管外细胞外体积分数(V_(e))、增强曲线下初始面积(IAUGC)、速率常数(K_(ep))、血浆容积分数(V_(p))、达峰时间(TTP)和最大斜率(S_(MAX))测量值的差异。K_(trans)、V_(p)和IAUGC的组间比较采用独立样本t检验,ADC-P25、K_(ep)、V_(p)、TTP和S_(MAX)的组间比较采用Mann-Whitney U检验。对组间差异有统计学意义的参数,绘制其受试者工作曲线(ROC),评估单个参数和多参数联合后对GBM和感染性病变的鉴别诊断效能。将AUC<0.7、0.7~0.9和>0.9分别定义为具有低、中和高度诊断效能。结果:GBM的K_(trans)、IAUGC和S_(MAX)值均显著高于感染性病变,差异均有统计学意义(P=0.004、0.045、0.011),而ADC-P25显著低于感染性病变(P=0.042)。K_(trans)、ADC-P25和S_(MAX)值对两种病变均达到了中度以上的鉴别诊断效能,单一参数诊断效能最佳的是K_(trans),联合ADC-P25、K_(trans)和S_(MAX)三个参数的诊断效能最佳,其ROC曲线下面积、敏感度和特异度分别为0.967、0.900和1.000。结论:DWI和DCE-MRI定量及半定量参数对呈环形强化的GBM和感染性病变均具有一定的鉴别能力,两类参数联合可显著提高鉴别诊断效能。

hs-CRP、NT-proBNP及NAR对急性冠状动脉综合征患者诊断价值分析

目的 探讨超敏C反应蛋白(hs-CRP)、氨基末端脑钠肽前体(NT-proBNP)及中性粒细胞与白蛋白比值(NAR)对急性冠状动脉综合征(ACS)患者的诊断价值。方法 选取2020年6月—2022年9月收治的ACS 71例作为研究组,同期健康体检者56例作为对照组,并依照不同疾病类型和血管病变支数将研究组分为ST段抬高型心肌梗死(STEMI)组、非ST段抬高型心肌梗死(NSTEMI)组、不稳定型心绞痛(UAP)组及单支、双支、多支病变组各3个亚组。比较研究组与对照组、不同疾病类型和血管病变支数各3个亚组hs-CRP、NT-proBNP及NAR,探讨hs-CRP、NT-proBNP及NAR单独或联合对ACS的诊断价值。结果 研究组hs-CRP、NT-proBNP及NAR均高于对照组;STEMI组、NSTEMI组和UAP组hs-CRP、NT-proBNP及NAR逐渐降低,单支、双支和多支病变组hs-CRP、NT-proBNP及NAR逐渐升高(P<0.05)。受试者工作特征曲线分析显示,hs-CRP、NT-proBNP和NAR单独或联合诊断ACS的曲线下面积分别为0.820、0.815、0.883及0.914,三者联合诊断ACS的曲线下面积高于单独诊断(P<0.05,P<0.01)。结论 hs-CRP、NT-proBNP及NAR三者联合对ACS的诊断价值较高。

静脉溶栓对脑梗死合并脑白质病变发生认知障碍的风险及疗效分析

目的 分析脑梗死合并脑白质病变(WML)患者静脉溶栓后认知障碍的发生风险及疗效。方法 回顾性分析静脉溶栓治疗的220例脑梗死合并WML患者临床资料。根据静脉溶栓治疗后认知功能情况分为障碍组(n=53)和无障碍组(n=167)。经多因素logistic回归分析,明确影响脑梗死合并WML患者静脉溶栓后认知功能的危险因素。结果 障碍组患者年龄≥60岁、卒中量表(NIHSS)评分≥9分、中度或重度WML占比及血清水通道蛋白(AQP4)水平高于无障碍组,miR-29b表达量低于无障碍组(P<0.05)。ROC曲线分析显示,血清miR-29b、AQP4均能预测脑梗死合并WML溶栓治疗后认知功能障碍的发生,曲线下面积分别为0.842、0.840(P<0.05)。经多因素logistic回归分析显示,年龄≥60岁、中度或重度WML、NIHSS评分≥9分、miR-29b表达量<0.895、AOP4水平≥33.695μg/L为脑梗死合并WML溶栓治疗后认知功能障碍的危险因素。结论 脑梗死合并WML静脉溶栓后认知功能障碍受年龄、WML程度、NIHSS评分、miR-29b表达量、AQP4水平的影响。

多模态磁共振成像在脑软化灶继发癫痫诊断中的应用价值

目的:通过分析磁共振弥散张量成像(DTI)、磁共振波谱成像(1H-MRS)在诊断软化灶继发癫痫中的灵敏度和特异度,探索多模态磁共振成像在诊断脑软化灶继发癫痫中的应用价值。方法:收集2021年10月—2023年9月在菏泽医学专科学校附属医院就诊并通过常规磁共振扫描证实有脑软化灶患者140例,其中软化灶继发癫痫患者40例(软化灶癫痫组)、软化灶非癫痫患者100例(软化灶非癫痫组),均进行多模态磁共振扫描。结果:软化灶癫痫主要病因为胶质瘤手术、脑外伤手术,软化灶非癫痫主要病因为脑梗死、脑出血;两组分数各向异性(FA)、平均弥散率(MD)、N-乙酰天冬氨酸(NAA)/[胆碱(Cho)+肌酸(Cr)]、NAA/Cr及NAA/Cho值比较,差异均有统计学意义(P<0.05);FA、MD、NAA/(Cho+Cr)、NAA/Cr及NAA/Cho值诊断脑软化灶继发癫痫相的ROC曲线下面积分别为0.897、0.868、1.000、0.997及0.993,诊断效能均较高(P<0.05)。结论:多模态磁共振成像在诊断脑软化灶继发癫痫中具有应用价值,通过检测FA、MD、NAA/(Cho+Cr)、NAA/Cr及NAA/Cho值可为脑软化灶继发癫痫的早诊断、治疗和预防提供依据和方向。

机器人辅助立体定向活检术在脑深部病变临床诊断的应用

目的 探讨机器人辅助立体定向脑活检技术在深部病变的临床诊断应用。方法 回顾性分析22例脑深部病变患者的病例资料,利用机器人辅助完成立体定向脑活检手术。结果 22例患者行27个靶点活检(其中5例行2个靶点)。患者均通过常规病理检查,获得最终病理诊断,阳性诊断率为100%,其中:侵袭性B细胞淋巴瘤1例,弥漫性B细胞淋巴瘤4例,高级别胶质瘤(Ⅲ~Ⅳ级)5例,低级别胶质瘤(Ⅰ~Ⅱ级)7例,生殖细胞瘤2例,转移瘤2例,炎性肉芽肿1例。1例出现穿刺靶点血肿,但无临床症状。结论 机器人辅助立体定向脑病变活检术是一项可通过微创切口实现的脑活检技术,具有穿刺精度高、诊断率高、操作灵活、并发症发生率低等优点,值得在临床应用推广。

The studies on neurogenesis induced by brain injury inadult ring dove

It was the first time demonstrated by us that the number of newborn neurons was increajsed after making lesion in forebraill of adult ring dove (Streptopelia risoria)by means of autoradiography and immunohistochemistry.Neurogenesis in the adult avian is restricted to the telencephalon. In doves with bilateral electrolytic lesion of nucleus ectostriatum (E), the mean number of proliferating cells in the lateral ventricular zone (LVZ) and newborn neurons in the forebrain increased by 1.95 times and 2.38times respectively as compared with that in intact doves. The most relllarkable increase of neurogenesis induced by nucleus ectostriatum lesions was found at the anteriorposterior level 3 (L3), where the lesion site was located.These results showed that the electrolytic brain lesion altered the distribution pattern of proliferating cells in theLVZ and resulted in increase of the number of newborn neurons in the non-VZ areas of forebrain. The changes in number and distribution pattern of proliferating cells in LVZ and newborn neurons in forebrain may be dependent on site of lesion. Studies on the relationship between proliferating cells in LVZ and newly generated neurons in non-VZ areas may help to understand the mechanism of brain plasticity and development.

肝移植术后缺血性胆道病变诊断与治疗中国实践指南

我国肝移植历经多年的探索发展,其技术及预后已得到显著提高,术后并发症发生率也随之降低,但缺血性胆道病变仍是一个不容忽视的问题。中山大学附属第三医院于2015年制订并发表《中国大陆地区肝移植后缺血性胆道病变诊断及治疗专家共识》,现结合现阶段情况及文献报道进行更新并形成指南。本指南从缺血性胆道病变的定义、发生率、发病机制、诊断、高危因素的预防以及治疗等方面进行详细阐述,旨在为肝移植术后缺血性胆道病变的诊断与治疗提供标准化、规范化的指导,以降低再移植率和病死率,提高肝移植受者的整体生存质量。

PLT、NT-pro BNP、D-二聚体对川崎病合并冠脉病变的预测价值

目的:探讨PLT、NT-pro BNP及D-二聚体对川崎病(KD)合并冠状动脉病变(CAL)的预测价值。方法:将纳入研究的110例患儿分为冠状动脉病变组(CAL组)和非冠状动脉病变组(NCAL组),分析其实验结果,探讨KD合并CAL的独立危险因素,并绘制构建受试者工作特征曲线(ROC),计算PLT、NT-pro BNP、D-二聚体的预测效能。结果:PLT(OR=1.018,95%CI=1.003~1.033,P=0.016)、NT-pro BNP(OR=1.016,95%CI=1.006~1.026,P=0.002)及D-二聚体(OR=2.280,95%CI=1.268~4.100,P=0.006)为KD合并CAL的独立危险因素(P<0.05)。PLT、NT-pro BNP、D-二聚体三者联合预测CAL的ROC曲线下面积为0.866,敏感度为80.5%,特异度为79.7%。结论:PLT、NT-pro BNP和D-二聚体是KD合并CAL的独立危险因素,且三者联合较单独使用预测价值更高。

Brain Complications with Influenza Infection in Children

Objectives: To summarize the characteristics and research progress of influenza-associated brain complications in children and provide references for early diagnosis and brain protection treatment. Methods: Studied published articles of influenza-associated neurocomplications in children from PubMed and summarizes them from epidemiology, clinical manifestations, diagnosis and treatment, and basic research progress. Results: Common brain complications in flu-children include febrile seizures, influenza-associated encephalopathy (IAE), acute or post-influenza encephalitis, and the most severe condition is acute necrotizing encephalopathy (ANE). However, the mechanism and relevant factors of influenza-associated brain damage have not been elucidated. Conclusion: Influenza could be accompanied by various brain lesion complications in dif ferent stages of the disease, some of which are life-threatening or leave severe neurological sequelae, such as ANE. Due to different brain injury mechanisms, specific early diagnosis and brain protection treatment for different complications are unclear or unanimous. Therefore, further classification and basic research are needed.

Role of brain-derived neurotrophic factor during the regenerative response after traumatic brain injury in adult zebrafish

Several mammalian animal models of traumatic brain injury have been used, mostly rodents. However, reparative mechanisms in mammalian brain are very limited, and newly formed neurons do not survive for long time. The brain of adult zebrafish, a teleost fish widely used as vertebrate model, possesses high regenerative properties after injury due to the presence of numerous stem cells niches. The ventricular lining of the zebrafish dorsal telencephalon is the most studied neuronal stem cell niche because its dorso-lateral zone is considered the equivalent to the hippocampus of mammals which contains one of the two constitutive neurogenic niches of mammals. To mimic TBI, stab wound in the dorso-lateral telencephalon of zebrafish was used in studies devoted to fish regenerative properties. Brain-derived neurotrophic factor, which is known to play key roles in the repair process after traumatic brain lesions, persists around the lesioned area of injured telencephalon of adult zebrafish. These results are extensively compared to reparative processes in rodent brain. Considering the complete repair of the damaged area in fish, it could be tempting to consider brain-derived neurotrophic factor as a factor contributing to create a permissive environment that enables the establishment of new neuronal population in damaged brain.

血清PC、hs-CRP及NT-proBNP在冠心病不同冠脉病变中的表达及临床意义

目的探讨血清血浆蛋白C(PC),高敏C反应蛋白(hs-CRP)及氨基末端B型脑钠肽原(NT-proBNP)在冠心病(CHD)不同冠脉病变中的表达及临床意义。方法选取80例CHD患者和80例进行健康体检的健康人群设为观察组和对照组。依据CHD临床分型将其分为稳定型心绞痛组(n=24)、不稳定型心绞痛组(n=31)和心肌梗死组(n=25)。对所有患者的血清PC、hs-CRP、NT-proBNP水平进行检测,观察组开展冠状动脉造影检查,依据冠脉病变支数将其分为单支病变组(n=22)、双支病变组(n=34)和多支病变组(n=24)。分别比较对照组和观察组、不同临床分型(稳定型心绞痛组、不稳定型心绞痛组、心肌梗死组相比较)以及不同冠脉病变支数(单支病变组、双支病变组、多支病变组)的血清PC、hs-CRP、NT-proBNP水平;建立风险评估模型,经受试者工作特征曲线(ROC)评估血清PC、hs-CRP、NT-proBNP检测冠心病心肌梗死的诊断效能。结果与对照组相比较,观察组血清PC水平较低,hs-CRP、NT-proBNP水平较高(P<0.05);与不稳定型心绞痛组、心肌梗死组相比较,稳定型心绞痛组血清PC水平较高,hs-CRP、NT-proBNP水平较低(P<0.05);多支病变组血清PC水平明显低于单支、双支病变组,且多支病变组hs-CRP、NT-proBNP水平较高(P<0.05);由ROC曲线分析,经构建风险评估模型血清PC、hs-CRP、NT-proBNP联合检测的AUC值最高,为0.958,灵敏度、特异度分别为96.00%、84.00%。结论CHD患者冠脉病变程度越严重,其血清PC水平越低,hs-CRP、NT-proBNP水平越高。血清PC、hs-CRP、NT-proBNP指标水平在评估CHD不同冠脉病变程度方面具有一定的临床价值。且血清PC、hs-CRP、NT-proBNP联合检测在诊断冠心病心肌梗死方面具有较高的诊断效能。