Partial improvement in performance of patients with severe Alzheimer's disease at an early stage of fornix deep brain stimulation

Deep brain stimulation is a therapy for Alzheimer＇s disease（AD） that has previously been used for mainly mild to moderate cases. This study provides the first evidence of early alterations in performance induced by stimulation targeted at the fornix in severe AD patients. The performance of the five cases enrolled in this study was scored with specialized assessments including the Mini-Mental State Examination and Clinical Dementia Rating, both before and at an early stage after deep brain stimulation. The burden of caregivers was also evaluated using the Zarit Caregiver Burden Interview. As a whole, the cognitive performance of patients remained stable or improved to varying degrees, and caregiver burden was decreased. Individually, an improved mental state or social performance was observed in three patients, and one of these three patients showed remarkable improvement in long-term memory. The conditions of another patient deteriorated because of inappropriate antipsychotic medications that were administered by his caregivers. Taken together, deep brain stimulation was capable of improving some cognitive aspects in patients with severe AD, and of ameliorating their emotional and social performance, at least at an early stage. However, long-term effects induced by deep brain stimulation in patients with severe AD need to be further validated. More research should focus on clarifying the mechanism of deep brain stimulation. This study was registered with ClinicalTrials.gov（NCT03115814） on April 14, 2017.

Acute amnesia during pregnancy due to bilateral fornix infarction: A case report

BACKGROUND Stroke is an important cause of maternal morbidity and mortality during pregnancy and puerperium.Isolated amnesia is a rare clinical symptom caused by ischemic stroke during pregnancy.We present the first documented case of acute amnesia during pregnancy due to bilateral fornix infarction.CASE SUMMARY A 32-year-old nullipara presented at 35 wk of gestation with acute amnesia and headache.Brain magnetic resonance imaging and angiography revealed acute infarction in the bilateral anterior fornix.There was no evidence of causative abnormality after extensive work-up,including for vascular abnormality,cardiac disease,coagulopathy,and pregnancy-related conditions.The patient was diagnosed with cryptogenic stroke.Aspirin was administered immediately,and the patient recovered fully without recurrence.CONCLUSION Acute isolated amnesia due to stroke is rare during pregnancy.Early diagnosis of stroke and immediate treatment prevent neurologic sequelae.

Diffusion tensor tractography studies on mechanisms of recovery of injured fornix

The fornix,which connects the medial temporal lobe and the medial diencephalon,is involved in episodic memory as an important part of the Papez circuit.The mechanisms of recovery of an injured fornix revealed by diffusion tensor tractography in the five studies are summarized as follows：1） recovery through the nerve tract from an injured fornical crus to the medial temporal lobe via the normal pathway of the fornical crus;2）recovery through the nerve tract originating from an ipsi-lesional fornical body connected to the ipsi-lesional medial temporal lobe via the splenium of the corpus callosum;3） recovery through the nerve tract from the ipsi-lesional fornical body extending to the contra-lesional medial temporal lobe via the splenium of the corpus callosum;4） recovery through the nerve tract originating from the ipsi-lesional fornical column connected to the ipsi-lesional medial temporal lobe;and 5） recovery through the nerve tract originating from the contra-lesional fornical column connected to the ipsi-lesional medial temporal lobe via the contra-lesional medial temporal lobe and the splenium of the corpus callosum.These diffusion tensor tractography studies on mechanisms of recovery of injured fornical crus appeared to provide useful information for clinicians caring for patients with brain injury,however,studies on this topic are still in the beginning stages.

Perspectives on the neural connectivity of the fornix in the human brain

The fornix is involved in the transfer of information on episodic memory as a part of the Papez circuit. Diffusion tensor imaging enables to estimate the neural connectivity of the fornix. The anterior fornical body has high connectivity with the anterior commissure, and brain areas rele- vant to cholinergic nuclei （septal forebrain region and brainstem） and memory function （medial temporal lobe）. In the normal subjects, by contrast, the posterior fornical body has connectivity with the cerebral cortex and brainstem through the splenium of the corpus callosum. We believe that knowledge of the neural connectivity of the fornix would be helpful in investigation of the neural network associated with memory and recovery mechanisms following injury of the fornix.

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）.

主穹窿蛋白基因在高原地区癫痫儿童中的多态性分析

目的:探讨分析主穹窿蛋白(MVP)基因三个SNP位点rs4788187、rs3815824、rs3815823多态性与高原地区儿童癫痫的相关性。方法:选取2017年1月~2020年1月青海大学附属医院收治的80例癫痫患儿为研究对象,根据耐药性不同分为耐药组与非耐药组各40例,利用PCR-RELP方法检测rs4788187、rs3815824、rs3815823三个SNP位点的多态性分布,并进行统计分析。结果:两组年龄、性别、民族以及癫痫发作类型比较差异无统计学意义(P>0.05)。癫痫患儿rs4788187、rs3815824的等位基因C频率明显低于T,而rs3815823的等位基因T频率明显低于C;两组患儿SNP位点rs4788187、rs3815824、rs3815823的基因型频率和等位基因频率比较差异均无统计学意义(P>0.05)。结论:MVP基因的SNP位点(rs4788187、rs3815824、rs3815823)与癫痫耐药性不相关。

手术治疗眼球摘除术后结膜囊畸形的下睑外翻

目的:回顾分析治疗眼球摘除术后结膜囊畸形的下睑外翻这类手术的关键技术。方法:回顾性分析2015年3月-2017年12月在笔者医院接受手术治疗的眼球摘除术后结膜囊畸形的下睑外翻患者8例(8只眼),所有患者仅行针对结膜囊畸形的手术矫正,而未采取针对下睑外翻常用的下睑全层楔形切除、外侧睑板条锚定、皮瓣法等术式。结果:8例患者均单纯行二期义眼台植入+结膜囊成形术并穹窿部弧形压管获得了深在、稳定的结膜囊,佩戴义眼片后,下睑缘位置满意,无内外翻。在无需接受任何下睑外翻矫正措施的情况下获得了满意的下睑形态及功能。结论:眼球摘除术后结膜囊畸形的下睑外翻手术关键点在于矫正眼眶凹陷,恢复结膜囊正常形态,尤其是加深下穹窿。

Behavioral Effects of Deep Brain Stimulation of the Anterior Nucleus of Thalamus, Entorhinal Cortex and Fornix in a Rat Model of Alzheimer＇s Disease

Background：Recent clinical and preclinical studies have suggested that deep brain stimulation （DBS） can be used as a tool to enhance cognitive functions.The aim of the present study was to investigate the impact of DBS at three separate targets in the Papez circuit,including the anterior nucleus of thalamus （ANT）,the entorhinal cortex （EC）,and the fornix （FX）,on cognitive behaviors in an Alzheimer＇s disease （AD） rat model.Methods：Forty-eight rats were subjected to an intrahippocampal injection ofamyloid peptides 1-42 to induce an AD model.Rats were divided into six groups：DBS and sham DBS groups of ANT,EC,and FX.Spatial learning and memory were assessed by the Morris water maze （MWM）.Recognition memory was investigated by the novel object recognition memory test （NORM）.Locomotor and anxiety-related behaviors were detected by the open field test （OF）.By using two-way analysis of variance （ANOVA）,behavior differences between the six groups were analyzed.Results：In the MWM,the ANT,EC,and FX DBS groups performed differently in terms of the time spent in the platform zone （F（2.23） =6.04,P ＜ 0.01）,the frequency of platform crossing （F（2,23） =11.53,P ＜ 0.001）,and the percent time spent within the platform quadrant （F（2,23） =6.29,P ＜ 0.01）.In the NORM,the EC and FX DBS groups spent more time with the novel object,although the ANT DBS group did not （F（2,23） =10.03,P ＜ 0.001）.In the OF,all of the groups showed a similar total distance moved （F（1.42） =1.14,P =0.29）and relative time spent in the center （F（2,42） =0.56,P =0.58）.Conclusions：Our results demonstrated that DBS of the EC and FX facilitated hippocampus-dependent spatial memory more prominently thanANT DBS.In addition,hippocampus-independent recognition memory was enhanced by EC and FX DBS.None of the targets showed side-effects of anxiety or locomotor behaviors.

Acute Fornix Deep Brain Stimulation Improves Hippocampal Glucose Metabolism in Aged Mice

Background： A beneficial memory effect of acute formix deep brain stimulation （DBS） has been reported in clinical studies. The aim of this study was to investigate the acute changes in glucose metabolism induced by fornix DBS. Methods： First, the Morris water maze test and novel object recognition memory test were used to confirm declined memory in aged mice （C57BL/6, 20-22 months old）. Then, four groups of mice were used as follows： aged mice with stimulation （n = 12）, aged mice with sham-stimulation （n = 8）, adult mice （3-4 months old） with stimulation （n = 12）, and adult mice with sham-stimulation （n = 8）. lpsilateral hippocampal glucose metabolism and glutamate levels were measured in vivo by microdialysis before, during, and after fornix DBS treatment. Histological staining was used to verify the localization of electrodes and mice with inaccurate placement were excluded from subsequent analyses. The effects of fornix DBS on extracellular glucose, lactate, pyruvate, and glutamate levels over time were analyzed by repeated-measures analysis of variance followed by Fisher＇s least significant difference post hoc test. Results： The aged mice had a higher basal lactate/pyruvate ratio （LPR） and lactate/glucose ratio （LGR） than the adult mice （LPR： 0.34 ± 0.04 vs. 0.13 ± 0.02, t = 4.626, P 〈 0.0001 ; LGR： 6.06± 0.59 vs. 4.14 ± 0.36, t = 2.823, P 〈 0.01 ）. Fomix DBS decreased the ipsilateral hippocampal pyruvate and lactate levels （P 〈 0.05）, but the glucose levels were not obviously changed in aged mice. Similarly, the LGR and LPR also decreased in aged mice after fornix DBS treatment （P 〈 0.05）. Glucose metabolism in adult mice was not significantly influenced by tbrnix DBS. In addition, fornix DBS significantly decreased the ipsilateral hippocampal extracellular levels of glutamate in aged mice （P 〈 0.05）, while significant alterations were not found in the adult mice. Conclusions： The present study provides experimental evidence that fornix DBS could significantly improve bippocampal glucose metabolism in aged mice by promoting cellular aerobic respiration activity.

EFFECT OF ARGININE VASOPRESSIN ON LEARNING PROCESS FOLLOWING TRANSECTION OF FIMBRIA-FORNIX IN MICE

Arginine vasopressin (AVP) is an endogenous neuropeptide that has been reported to enhance the acquisition of active avoidance behavior in mice and light-dark discrimination learning in rats. In addition, our previous work reported the modulating effect of AVP on hippocampal neuronal activity. Thus, it was suggested that hippocampus may be one of the CNS sites mediating the enhancing effect of AVP on acquisition. As we know, the fimbria-fornix is the main afferent and efferent pathways of hippocampus. Accordingly,

磁共振3D各向同性T2加权图像在宫颈癌侵犯阴道穹隆评估中的应用价值

目的探讨基于磁共振三维各向同性(3D isotropic,3D-ISO)T_(2)加权(T_(2)WI)成像的曲面重建技术在宫颈癌侵犯阴道穹窿评估中的应用价值。方法收集经病理证实的33例宫颈癌患者资料,在磁共振下行2D T_(2)WI、3D-ISO T_(2)WI扫描,对3D-ISO图像进行曲面重建。两位医师分别在3D-ISO的曲面重建图及2D图中评估宫颈癌患者穹窿是否受累,并将结果与术后病理进行比较,观察3D-ISO序列曲面重建在诊断阴道穹窿受累情况的准确性。采用χ^(2)检验对两组结果进行比较。结果同2D T_(2)WI图像比较,基于3D-ISO T_(2)WI成像的曲面重建图像在对穹隆受累情况进行评估的结果中能检出更多的真阳性例数和真阴性例数,以及更少的假阳性例数和假阴性例数。3D-ISO序列的准确率、敏感性与特异性均高于传统2D序列,差异均无统计学意义(P>0.05)。结论术前基于3D-ISO T_(2)WI成像的曲面重建结果对于宫颈癌阴道穹窿受累的诊断有较高的临床价值,为临床病理分期、治疗方案的选择提供可靠的参考依据。

腹腔镜子宫肌瘤剔除术中经阴道后穹隆取瘤法的应用效果

目的:探讨多孔腹腔镜子宫肌瘤剔除术后经阴道后穹隆取标本的安全性和有效性。方法:收集2020年9月-2022年8月在贵州省安顺市人民医院妇科行腹腔镜子宫肌瘤剔除术患者42例临床资料,采用经阴道后穹隆取瘤法取出标本。手术常规瘤体挖除缝合子宫后,经脐孔穿刺器置入普通标本袋,将瘤体装入袋中,横形切开阴道后穹隆约30mm,直视下经道阴道后穹隆切口牵出,拉出阴道口在袋内缩减取出,腹腔镜下缝合阴道后穹隆切口。结果:42例手术均顺利完成,手术时间191.2±171.4min,自置入标本袋开始计时直至取出瘤体为取瘤时间为7.7±5.3min,阴道后穹隆缝合时间3.4±0.5 min,挖除肌瘤个数2.44±1.83枚,瘤体最大直径65.83±19.62mm,其中粘膜下2例、肌壁间37例、特殊部位3例,总出血量为191.2±171.4ml。术后病理证实为子宫平滑肌瘤40例、子宫腺肌瘤2例,阴道感染病例2例,无直肠损伤病例发生;术后随访11.6±3.4个月,阴道后穹隆切口愈合良好,生活无不适。结论:经阴道后穹隆取瘤法经济快捷、安全可行,值得在临床应用。

双侧穹隆柱梗死1例报道并文献复习

穹隆柱梗死是一种以急性认知障碍为主要临床表现的特殊类型脑梗死,临床少见,因其神经系统阳性体征较少及解剖位置特殊,容易误诊及漏诊。现报道山东省日照市人民医院2022年3月收治的青年起病的双侧穹隆柱梗死患者1例,主因“记忆力减退2 d”入院,临床表现为急性顺行性遗忘、言语重复,头颅磁共振成像显示双侧穹隆柱梗死,给予改善认知及脑梗死常规治疗后症状明显改善。本文结合影像学检查和神经心理量表,梳理其病历资料,以期提高对此病的认识。

穹窿部切口斜视手术与干眼的相关性研究

目的:探讨穹窿部切口斜视手术对术后干眼发生的影响。方法:选取2017年10月—2018年3月期间在汕头大学·香港中文大学联合汕头国际眼科中心行单眼共同性斜视矫正手术的患者39例(78只眼),行斜视手术的39只眼为手术组,39只非手术眼为对照组。斜视手术采用结膜穹窿部切口,分别于术前1 d、术后第1天、术后第7天、术后第30天对患者进行泪膜破裂时间、角膜荧光素染色等眼部检查,统计术后符合干眼诊断的眼数。结果:手术组患者术后第1天符合干眼诊断的有12例(30.7%),术后第7天10例(25.6%),术后第30天2例(5%)。手术组术后第1、7、30天的泪膜破裂时间低于对照组(P值均<0.001),也低于术前1 d(P值均<0.001)。手术组术后第1、7天的角膜荧光染色评分高于对照组(P值均<0.01),也高于术前1 d(P值均<0.01),术后第30天与术前1 d比较差异无统计学意义(P<0.05)。结论:穹窿部切口斜视手术可能会引起患者术后泪膜稳定性的下降和眼表功能的破坏,但大部分患者的眼表功能会在短期内恢复到正常范围。

误诊为急性阑尾炎的不典型异位妊娠临床分析

目的 探讨不典型异位妊娠的临床特点、诊断和鉴别诊断方法及误诊原因、防范措施。方法 对2021年4月—2022年7月收治曾误诊的不典型异位妊娠9例的临床资料进行回顾性分析。结果 本组出现突发性腹痛6例,持续性隐痛突然加剧3例;麦氏点压痛6例,右下腹压痛3例,反跳痛5例,腹肌紧张4例;肠鸣音减弱9例,Rovsing’s征阳性4例;腹腔移动性浊音3例。血白细胞升高6例,轻度贫血3例;腹部B超检查均提示右下腹低回声。就诊初期外院均初步诊断急性阑尾炎,拟行手术治疗,遂转我院。误诊时间(14.2±3.1)h。入我院后经进一步询问病史,5例经腹腔穿刺、4例经阴道后穹隆穿刺确诊异位妊娠。9例确诊后皆急行腹腔镜右侧输卵管切除术,术后予抗感染治疗,术后2~3 d痊愈出院。结论 不典型异位妊娠早期易误诊。基层医院接诊医师应加强对其认识,提高对育龄期急腹症女性警惕性,详细问诊,对怀疑异位妊娠者,要及时行相关检查,并需全面分析病情,以减少或避免该病误诊误治。

北祁连石照子锰矿矿床地质特征及成矿规律研究

研究区位于华北板块与柴达木板块的碰撞带上,而华北板块南缘地壳在经历“开裂”和“俯冲”的构造活动中,为热水喷流沉积作用形成矿床提供了极为有利的地质构造环境。通过对石照子锰矿的成矿规律研究,认为该锰矿主要是白银厂铜多金属硫化物热泉成矿作用的延续产物,成矿空间主要分布于古火山机构块状隆起的边缘,而白银矿田矿床的分布则在古火山机构块状隆起的中心部位,矿床垂向分布特征是:顶部为铁锰,中部为铅锌,铜则产于下部。古火山穹隆构造外围、含矿地层、热水沉积岩等可作为主要的找矿标志。

穹窿海马伞切割侧海马提取液对神经干细胞分化为神经元的促进作用

目的 探讨穹窿海马伞切割侧海马提取液对神经干细胞分化为神经元和AChE阳性神经元的影响。 方法 切割SD大鼠右侧穹窿海马伞 ,14d后取两侧海马制成提取液 ;将神经干细胞接种于 3块 2 4孔培养板中 ,每板分成切割组、正常组和对照组各 8孔 ,前 2组分别加入切割侧和正常侧海马提取液。第 1、2块分别于第 7d和14d时行MAP 2免疫荧光检测 ;第 3块于 10d时行AChE组织化学染色。计数MAP 2和AChE阳性神经元数 ,观察胞体大小和突起长度。 结果 切割组第 7d时MAP 2阳性神经元较多 ,胞体大、突起长 ,14d时细胞进一步迁移、成熟 ;正常组第 7d时仅见少量突起短的MAP 2阳性神经元 ,14d时细胞稍增多 ,突起稍增长 :对照组第 7d时未见MAP 2阳性神经元 ,14d时仅有少量胞体小、突起短的MAP 2阳性神经元。第 10d切割组AChE阳性神经元较多 ,突起多而长 ,正常组仅见少量无突起的AChE阳性神经元 ,对照组未见AChE阳性神经元。 结论 穹窿海马伞切割侧海马提取液可明显促进神经干细胞分化为神经元和AChE阳性神经元。

穹窿海马伞损伤对大鼠学习记忆和海马GFAP阳性神经胶质细胞的影响

为探讨穹隆海马伞损伤鼠学习记忆能力与海马胶质纤维酸性蛋白阳性细胞之间的关系 ,切断 SD成年大鼠左侧穹窿海马伞 ,用 Y迷宫和免疫组织化学结合图像分析系统测试大鼠学习记忆能力和海马胶质纤维酸性蛋白阳性细胞的变化状况及它们的相互关系。结果显示 :损伤 2周后 ,损伤组损伤侧海马 CA1 区辐射层和齿状回分子层胶质纤维酸性蛋白阳性细胞的数密度较正常组分别增多 3 0 .2 9%和 3 0 .15 % (都为 P<0 .0 1) ,胞体面积分别增加 16.0 4%和 19.42 % (都为 P<0 .0 1) ,齿状回分子层胶质纤维酸性蛋白阳性细胞体密度增大 19.40 % (P<0 .0 5 )。经相关分析 ,大鼠学习记忆能力与海马 CA1 区胶质纤维酸性蛋白阳性细胞数密度呈负相关 (r=-0 .83 6,P<0 .0 1) ,与齿状回数密度呈负相关 (r=-0 .792 ,P<0 .0 1)。

穹窿海马伞切割侧海马对植入神经干细胞分化为神经元的影响

为观察成鼠神经干细胞移植入切割穹窿海马伞侧海马和正常侧海马后存活和分化为神经元的状况 ,用无血清培养和单细胞克隆技术获取成年 SD大鼠前脑室下带神经干细胞 ,进行 Brd U标记和扩增。切割 SD大鼠右侧穹窿海马伞 ,术后 2周将标记有 Brd U的神经干细胞植入双侧海马齿状回。 2月后 ,行 Nissl染色、Brd U免疫荧光、NF -2 0 0 / Brd U免疫荧光、β-tubulin- / Brd U免疫组织化学染色和 ACh E组织化学染色。结果发现 ,移植的神经干细胞在海马齿状回中存活并沿颗粒下层迁移 ,切割侧海马齿状回中有较多的 Nissl深染的大胞体神经元样细胞 ,而正常侧多为小胞体胶质样细胞。切割侧海马齿状回颗粒下层中见有数个NF-2 0 0 / Brd U、β-tubulin- / Brd U双标神经元和 ACh E阳性神经元 ,而正常侧海马中则未能见到。上述结果提示 ,移植到海马中的神经干细胞能存活、迁移 ,穹窿海马伞切割侧海马中某些物质的表达增强 ,可诱导植入其内的神经干细胞向神经元或 ACh E阳性神经元分化。

神经生长因子促进老年痴呆鼠学习记忆恢复和海马突触重建

切断老年鼠（２４月龄）左侧穹窿海马伞（ＦＦ），造成隔－海马胆碱能系统损伤的痴呆模型。用Ｍｏｒｒｉｓ水迷宫和体视学分析ＮＧＦ对模型鼠学习记忆和突触的影响。实验１个月后显示：（１）定位航行试验中，损伤组大鼠寻找平台的潜伏期，稳定后的平均值为４０ｓｅｃ，而ＮＧＦ治疗组为２２ｓｅｃ，相互间具有显著性差异（Ｐ＜０．０５）；（２）空间搜索试验中，损伤组在原平台象限跨越相应平台位置次数为１．９次，ＮＧＦ治疗组为５．９次，两者间有统计学意义（Ｐ＜０．０１）；（３）损伤组损伤侧齿状回分子层突触数密度和面密度分别下降２９％和１９．０３％，平均面积增大１１．４％。ＮＧＦ治疗组，突触数密度和面密度与损伤组相比，有显著升高（Ｐ＜０．０５），而平均面积显著下降（Ｐ＜０．０５），都接近于正常组；（４）损伤组损伤侧齿状回分子层突触前终末内线粒体的体密度和数密度分别下降３０．７％和５６．５％，体积增大３７．０９％。ＮＧＦ治疗组的体密度、数密度和体积与正常组相比，差异无显著性（Ｐ＞０．０５）。提示ＮＧＦ能够改善老年痴呆模型鼠学习记忆能力和促进海马突触重建。