烟雾病伴血流相关性动脉瘤介入治疗体会

烟雾病（Moyamoyadisease,MMD）又称脑底异常血管网病,是一种原因不明的以颅底动脉进行性狭窄、闭塞,颅底出现异常血管网为特点的慢性脑血管疾病。随着脑血管造影技术的广泛应用,有关烟雾病的报道逐渐增多。MMD的临床表现分为出血型和缺血型,成人MMD患者脑出血多见。通常认为侧支循环血管破裂是造成脑出血的主要原因,而MMD合并血流相关性动脉瘤破裂也是脑出血原因之一。     

烟雾病的显微外科治疗

烟雾病（MMD）是一种慢性进展性闭塞性脑血管疾病,致残率及致死率高,目前显微外科手术成为主要治疗手段,颅内外血管直接重建（即血管吻合）、间接重建及联合血管重建术均取得实质性进展,MMD应早期采取积极有效的血管重建治疗,本文就MMD主要术式、疗效、手术时机和并发症等内容进行综述。     

脑血流重建术治疗出血型烟雾病

目的研究出血型烟雾病(MMD)患者的预后及脑血流重建手术的疗效,减少出血型MMD的再出血率。方法经CT及脑血管造影检查确诊的出血型MMD患者82例,其中合并动脉瘤10例(12.2%),脑内出血为(ICH)18例(21.9%),脑室出血(IVH)20例(24.4%),脑内出血破入脑室38例(46.3%),蛛网膜下腔出血6例(7.3%)。联合血流重建手术(直接血管重建术结合间接血管重建术)治疗出血型MMD 48例,保守治疗34例。对患者的临床表现、影像资料、治疗效果及再出血情况进行分析。结果患者随访0.6~12年(平均7.8年),其中恢复优良56例(68.3%)、良好8例(9.8%)、差4例(4.9%)。14例患者(17.1%)发生再出血,再出血间隔0.3~10年,其中12例患者(85.7%)因再出血死亡。结论 MMD最重要的死亡原因是脑出血,再出血是出血型MMD预后不良和致死的主要原因;血流重建手术治疗降低了患者再出血的危险性,血流重建手术治疗患者的长期预后好于保守治疗者。     

出血型烟雾病的临床特点及治疗现状

烟雾病是一种慢性闭塞性脑血管病,表现为双侧颈内动脉末端的进行性狭窄和闭塞,伴随脑底异常血管网生成。脑血管重建术通过改善颅内供血,对治疗缺血型烟雾病有效。而对于出血型烟雾病的治疗,目前仍未找到确实有效的治疗方法,外科手术治疗仍存在争议。本文总结概括了出血型烟雾病的临床特点和治疗现状。     

烟雾病的外科治疗研究进展

烟雾病病因不明,是以双侧颈内动脉末端及大脑前动脉、大脑中动脉起始部慢性进行性狭窄或闭塞为特征,并在颅底构成异常血管网的一种脑血管疾病。其首选治疗方法是外科手术,主要应用3种血管重建方法:直接血管重建术、间接血管重建术和联合血管重建术。哪种血管重建术效果最佳,尚未有统一定论,本文对烟雾病的外科治疗方法进行综述。     

出血型烟雾综合征侧支血管的研究进展

烟雾综合征(MMS)作为一种进展缓慢的闭塞性脑血管疾病,因其在血管造影图像上发现颅底血管网似"烟雾"状而得名。随着影像检查技术的进步,我国的发病率也逐年增高。其临床表现复杂多样,以出血型和缺血型为主,出血型多见于成年患者,预后极差,是MMS的主要致死原因之一,其进展过程中伴随着侧支血管的异常扩张和破裂。本文通过综述出血型MMS的侧支循环、侧支血管评估方法及研究现状,为临床及影像医师对出血型MMS在诊断、治疗上提供重要的参考价值。     

脑血管重建术与围手术期脑血流监测

脑血管重建术是指采用手术方法重新建立脑的侧支循环通路,包括颅外-颅内动脉吻合术(extracranial -intracranial bypass,EC - IC bypass)等直接血管吻合技术,或头皮动脉-硬脑膜动脉-颞肌-脑皮质血管粘连成形术等间接建立脑血流等方法.其主要目的:(1)在主要颅内血管需要阻断时,起代偿作用,如颅内动脉瘤治疗中阻断载瘤动脉和颅底手术切除侵犯血管的肿瘤时;(2)重建已闭塞的血管,预防进一步发生缺血,常见于脑缺血和烟雾病(Moyamoya)病的治疗中[1].     

头颅CT灌注成像对烟雾病行间接血流重建术的疗效评价

目的研究探讨头颅CT灌注成像（CTP）技术对缺血型或出血型烟雾病（MMD）患者行间接血流重建术（indirect revascularisation）的总体疗效评价。方法 47例缺血性或出血卒中起病并由数字减影血管造影（DSA）证实的MMD患者,采用颅骨多点钻孔术（MBHT）、脑-颞肌贴敷术（EMS）、脑-颞肌-动脉贴敷术（EDAMS）、脑-硬脑膜-动脉贴敷术行间接血流重建术。并于术前、术后1周、术后3个月分别行头颅CT灌注成像检查,分别对脑血流量（CBF）、脑血容量（CBV）、达峰时间（TTP）进行定量和定性检查分析,并对手术前后及随访的CBF、CBV、TTP进行对比分析。结果 MMD患者术前与术后早期（1周）CTP各参数比较,额颞叶CBF、CBV变化无统计学差异,TTP显著降低,差异有统计学意义（P〈0.05）;术后3个月CTP与术后1周比较,额、颞叶rTTP、rCBV降低;差异有统计学意义（P〈0.05）。慢性缺血型MMD患者术后症状改善明显。结论 CT灌注成像作为一项快速简便的脑血流状况的检测技术,能反映脑微循环信息的功能成像,尤其是其TTP等时间参数对区分缺血程度具有很高的敏感性,能显示早期细微的缺血变化,MMD间接血流重建术后侧支血管的形成和脑血流的改善远早于造影上新生血管的形成,可以解释间接血流重建术后早期在造影可见的吻合血管出现之前就出现临床症状的明显改善。该检查有助于判断MMD脑缺血的部位和程度、选择手术侧别和手术方式,更为了解间接血流重建术后缺血程度是否改善提供较客观的评判依据。     

血管重建术治疗缺血型烟雾病的疗效分析

目的 探讨血管重建术治疗缺血型烟雾病的疗效。方法 回顾性分析2015年5月至2017年7月收治的26例缺血型烟雾病的临床资料，26例均在经颅多普勒超声辅助下行血管重建术。结果 22例术后症状明显改善，1例肌力较前下降，1例恢复期发生脑出血，2例言语功能无明显改善。22例复查DSA示烟雾血管均不同程度减少，侧支循环形成，其中2例烟雾血管完全消失。结论 血管重建术可明显改善缺血型烟雾病的局部脑血流灌注，改善临床症状，是治疗烟雾病的有效方法     

蛛网膜对儿童缺血型烟雾病间接颅内外血管重建术疗效的影响

目的探讨儿童缺血型烟雾病行间接颅内外血管重建术时打开蛛网膜对术后血管重建疗效的影响。方法回顾性分析2010年8月至2015年11月21例(28侧)行间接颅内外血管重建术的儿童缺血型烟雾病患者临床资料,术中打开蛛网膜组12例(18侧),术中未打开蛛网膜组9例(10侧);术后12个月时复查MRI和DSA以及结合临床症状来评价打开蛛网膜与未打开蛛网膜组颅内外血管重建术后疗效。结果两组术后均有不同程度侧支循环形成及PWI改善,术中打开组术后12月时DSA侧支循环的良好及一般率达94.44%明显优于未打开组的60%,且构成的差异有统计学意义(P0.05);两组术后临床症状改善差异无统计学意义,而术中打开蛛网膜组的优秀及良好率达88.89%,高于未打开组的60%;两组并发症差异无统计学意义。结论术中打开蛛网膜较未打开者可能更有利于改善儿童缺血型烟雾病间接颅内外血管重建术的疗效。     

Neuroimaging in epilepsy in tropics

Epilepsy is a major public health problem in many tropical countries. Also, some of the tropical diseases are major contributors to the higher prevalence of epilepsy in these countries. The etiologic factors responsible for epilepsy in these countries are quite different from those in the developed world. This article discusses the etiologic factors and neuroimaging of epilepsy in light of the conditions in these tropical countries.     

癫痫与抑郁关系的研究进展

抑郁是癫痫患者中常见的精神障碍,严重地影响了患者的生活质量。传统的观点认为癫痫患者因为存在着诸多社会学问题易出现抑郁倾向,癫痫和抑郁是单向的联系,但大量的研究已经证明癫痫和抑郁之间存在双向的联系,一种异常状态的存在可能易转化为另一种异常状态的发展。癫痫和抑郁存在着共同的发病机制。本文主要就癫痫和抑郁的双向联系以及抗抑郁药物在癫痫患者中的应用进行阐述。     

Sudanophilic lipid accumulation in astrocytes in periventricular leukomalacia in monkeys

Summary Sudanophilic lipid accumulation is a characteristic feature of periventricular leukomalacia (PVL) of infants. At least two types of lipid-containing cells have been identified, one being the macrophage, the other the pre-myelin glial cell. A third type of lipid-containing cell has been seen in two monkeys with spontaneous PVL. Electron microscopically this cell appears to be an astrocyte. This probably represents a reaction of the astrocyte to hypoxia and may be the equivalent of the hypertrophic astrocytes found in human infants.Supported in part by NIH grant HDO 8633 and the Regional Primate Research Center Grant RR-00166     

Increase in cathepsin D activity in rat brain in aging

Cathepsin D-like activity in homogenates of five brain areas of 3-month-old and 24-month-old Fischer 344 rats was measured. With hemoglobin as substrate at pH 3.2, more than 90% of the activity was inhibited by pepstatin. In each area studied, activity was more than twice as high in the old rat brain: 140-160% higher in the cortex, cerebellum, pons-medulla, and striatum and 90-100% higher in the hippocampus and spinal cord. The greatly increased metabolic capacity in the absence of an increase in protein turnover may have a role in age-related pathological degeneration in the brain.     

Gender in Voice Perception in Autism

Deficits in the perception of social stimuli may contribute to the characteristic impairments in social interaction in high functioning autism (HFA). Although the cortical processing of voice is abnormal in HFA, it is unclear whether this gives rise to impairments in the perception of voice gender. About 20 children with HFA and 20 matched controls were presented with voice fragments that were parametrically morphed in gender. No differences were found in the perception of gender between the two groups of participants, but response times differed significantly. The results suggest that the perception of voice gender is not impaired in HFA, which is consistent with behavioral findings of an unimpaired voice-based identification of age and identity by individuals with autism. The differences in response times suggest that individuals with HFA use different perceptual approaches from those used by typically developing individuals.     

Increase in noradrenaline-synthesizing enzyme activity in medulla oblongata in Parkinson's disease

Summary Dopamine beta hydroxylase (DBH), the noradrenaline-synthesizing enzyme, and phenylethanolamine-N-methyltransferase (PNMT), the adrenaline-synthesizing enzyme, were assayed in 18 areas of brain stem in eight cases of parkinsonian syndromes and of four age- and postmortem delay-matched controls. Dissection was performed by the punch technique and enzyme activities assayed by radiometric methods. No significant change was found for PNMT activity. DBH activity was significantly increased in the A2-C2 area of the medulla oblongata (including the nucleus tractus solitarius) in the cases of Parkinson's disease.The A2-C2 area is known to be implicated in the control of blood pressure in rats. These findings are discussed in relation to orthostatic hypotension and the influence ofl-dopa therapy.Supported by grants from INSERM ATP 657897, ATP 8179113, CRL 79-1-356-6, DGRST (80 E 0882), FRMF, and Sandoz-France France     

Changes in parasympathetic system in medulla oblongata in male pigs in the course of tachycardia-induced cardiomyopathy

Background

Autonomic imbalance constituting a fundamental feature of heart failure (HF) has been assessed mainly at the periphery. Changes in the functioning of autonomic centers in the brain remain unclear. We investigated the molecular elements of parasympathetic system, i.e. α7 nicotinic acetylcholine receptor (α7nAChR) and enzymes metabolizing acetylcholine (acetylcholinesterase, AChE, choline acetyltransferase, ChAT) in medulla oblongata (MO) of male pigs with chronic tachycardia-induced cardiomyopathy.

Methods

The mRNA levels of AChE, ChAT, α7nAChR and X-box binding protein 1 (spliced form, XBP1s) in MO were analyzed using qPCR, AChE and ChAT activities using spectrophotometry, proteasome activity using fluorometry, and the protein level of α7nAChR using Western blotting.

Results

The development of systolic HF was accompanied by an increase in circulating catecholamines, a decrease in the AChE and α7nAChR mRNA in MO, an increase in AChE activity (all p < 0.05), and no change in either the mRNA or activity of ChAT. Both circulating catecholamine levels and AChE activity were inversely related to systolic function of left myocardial ventricle (p < 0.05). The level of α7nAChR protein in MO and its cytoplasmatic fraction were higher in pigs with moderate and severe HF as compared to the other animals (p < 0.01). There was no difference in proteasome activity in MO between diseased and healthy animals, whereas the XBP1s mRNA decreased during HF progression (p < 0.05).

Conclusions

Molecular elements of parasympathetic system are changed within the medulla oblongata during the progression of systolic non-ischemic heart failure in male pigs, indicating a functional link between MO and heart in HF.     

Issues in evaluation of cognition in the elderly in developing countries

Background:

Developing regions of the world host the majority of elderly subjects who are at risk for dementia. Reliable epidemiological data from these countries is invaluable in tackling this global problem. Scarcity of such data in literature is largely attributable to problems that are unique to developing communities worldwide.

Objective:

To classify and describe the problems that interfere with the collection of reliable epidemiological data on cognitive impairment in the elderly in developing communities, and to suggest practical solutions for some of them.

Methods:

Inferring from the experiences of a large, ongoing, population-based study on the cognitive impairments in the elderly in South India and from the review of literature.

Conclusion:

A fatalistic attitude regarding aging in the communities, significant heterogeneity in educational abilities and activities of daily living, high illiteracy among rural subjects, and lack of an organized health care system and updated demographic figures are some of the major factors that contribute to technical, namely, methodology-related problems and practical, namely, subject-related problems in such epidemiological studies.     

Suicide in the elderly in Austria

In most countries men and women have the highest suicide rates in age groups over 60 years. We investigated suicide rates for the elderly in Austria, a country with one of the highest suicide rates in the world, for the period 1980–1991, using data from the Federal Statistical Division. Suicide rates remained stable over the last decade at a very high level. The mean rate for men was 85.2, for women 28.6/100 000. In men and women rates rise with age. The mean rate of men rises from 51.2 (60–64 years) to 117.3/100 000 (over 85 years); in women there is an increase from 21.4 (60–64 years) to 32.8/100 000 (over 85 years). We did not confirm findings in other countries, where suicide rates have increased in recent years.     

Characteristics of nociceptors in the periodontium--an in vitro study in rats

Recent studies have indicated that nociceptors can be classified into various types according to their physiological properties. These studies have clarified that the frequency distribution of various nociceptor types is different among body sites and animal species. In the present study, we investigated the physiological properties of rat's periodontal nociceptors in an in vitro jaw-nerve preparation. Responses were recorded from functional single filaments in the inferior alveolar nerve. To determine the nociceptor type, calibrated von Frey filaments, heat, and bradykinin (BK) stimuli were used. We found five subtypes of nociceptors in the periodontal ligaments of the lower incisor: Adelta-high threshold mechanonociceptors (Adelta-HTM, n=28), Adelta-mechanoheat nociceptors (Adelta-MH, n=6), Adelta-polymodal nociceptors (Adelta-POLY, n=26), C-high threshold mechanonociceptors (C-HTM, n=3) and C-polymodal nociceptors (C-POLY, n=4). Most nociceptors were Adelta-innervated, while only a small number of C-innervated nociceptors were found. The present results suggest that periodontal nociceptors transmit mainly fast pain, and may thus play a role in rapid detection of injure-related stimuli during mastication.