急性酒精中毒合并中度创伤性脑损伤对大鼠海马NOS2表达和学习记忆的影响

目的:探讨急性酒精中毒合并中度创伤性脑损伤对大鼠海马NOS2表达和学习记忆的影响。方法:健康成年雄性SD大鼠96只,水迷宫训练3天后分为4组:生理盐水组(N组)、急性酒精中毒组(A组)、中度创伤性脑损伤组(T组)和急性酒精中毒合并中度创伤性脑损伤(AT组)。腹腔单注射25%酒精(2.5g/kg),2 h后以重物自由落体击打大鼠头部建立动物模型,存活1、3、5、7、14天。免疫组化方法检测海马CA1区NOS2表达,水迷宫检测大鼠学习记忆。结果:NOS2免疫组化染色发现各实验组阳性细胞数均高于N组。术后1天T组比AT组表达显著增高(P0.01);术后5天AT组比T组表达增高(P0.05);术后14天AT组比T组表达显著增高(P0.05)。水迷宫实验测潜伏期,术后1天AT组比T组延长(P0.05),术后3天AT组比T组缩短(P0.05),术后14天AT组比T组显著延长(P0.01)。结论:大鼠急性酒精中毒合并颅脑外伤后晚期,潜伏期延长,空间位置学习与记忆能力显著下降;在海马CA1区NOS2表达阳性细胞增多,为继发性脑损伤致其表达上调,是酒精急性中毒合并中度颅脑外伤预后欠佳的原因之一。     

凝血与纤溶指标与颅脑损伤后急性创伤性凝血病的关系及对脑心综合征的预测效能研究

摘要 目的：分析凝血与纤溶指标与颅脑损伤（TBI）后急性创伤性凝血病（ATC）的关系及对脑心综合征（CCS）的预测效能。方法：选取2020年1月～2022年12月本院收治的80例TBI患者作为研究对象,分别检测并计算非ATC患者与ATC患者、非CCS患者与CCS患者的凝血酶原时间（PT）、活化部分凝血酶原时间（APTT）、D-二聚体（D-D）、凝血酶-抗凝血酶复合物（TAT）、纤溶酶-α2纤溶酶抑制物复合物（PIC）水平和国际标准化比值（INR）、TAT/PIC比值;并采用双变量Spearman相关性检验凝血与纤溶指标的相关性,建立多因素Logistic模型分析TBI后ATC和TBI合并CCS的影响因素,同时分析凝血与纤溶指标对TBI合并CCS的预测效能。结果：80例TBI患者的ATC发生率为27.50%;与非ATC组比较,ATC组PT、APTT、D-D水平较高,TAT/PIC比值较低（P＜0.05）。PT、APTT、D-D与颅脑损伤后ATC呈正相关性,TAT/PIC与ATC呈负相关性。多因素logistic分析结果显示,TAT/PIC是颅脑损伤后ATC的独立危险因素（P＜0.05）。80例TBI患者的CCS发生率为20.00%;与非CCS组比较,CCS组PT、APTT、D-D水平较高,TAT/PIC比值较低（P＜0.05）。多因素logistic分析结果显示,PT、APTT、D-D、TAT/PIC是TBI合并CCS的独立危险因素（P＜0.05）。TBI合并CCS预测中,PT、APTT、D-D的ACU均＞0.70,TAT/PIC＞0.85。结论：TAT/PIC与TBI后ATC存在一定关联,同时还能预测CCS的发生,在TBI患者预后预测方面具有指导意义。     

The influence of anisotropy on brain injury prediction

Traumatic Brain Injury (TBI) occurs when a mechanical insult produces damage to the brain and disrupts its normal function. Numerical head models are often used as tools to analyze TBIs and to measure injury based on mechanical parameters. However, the reliability of such models depends on the incorporation of an appropriate level of structural detail and accurate representation of the material behavior. Since recent studies have shown that several brain regions are characterized by a marked anisotropy, constitutive equations should account for the orientation-dependence within the brain. Nevertheless, in most of the current models brain tissue is considered as completely isotropic. To study the influence of the anisotropy on the mechanical response of the brain, a head model that incorporates the orientation of neural fibers is used and compared with a fully isotropic model. A simulation of a concussive impact based on a sport accident illustrates that significantly lowered strains in the axonal direction as well as increased maximum principal strains are detected for anisotropic regions of the brain. Thus, the orientation-dependence strongly affects the response of the brain tissue. When anisotropy of the whole brain is taken into account, deformation spreads out and white matter is particularly affected. The introduction of local axonal orientations and fiber distribution into the material model is crucial to reliably address the strains occurring during an impact and should be considered in numerical head models for potentially more accurate predictions of brain injury.     

全身放疗在造血干细胞移植中的研究进展

全身照射疗法(TBI)是一种姑息治疗,该方法已经成功地应用在慢性淋巴细胞白血病或滤泡性淋巴瘤等无干细胞支持的放射敏感的疾病中。目前,在血液系统恶性疾病中造血干细胞移植是较为有效的治疗手段之一,其中全身放射治疗与大剂量化疗是造血干细胞移植疗法的经典预处理方案。TBI方法主要应用在造血移植环境中,具有较强的周期非特异性抗肿瘤效应和免疫抑制效能。TBI给予干细胞移植病人超过正常骨髓的辐射耐受量,通过重建病人的造血和免疫来达到治疗目的。     

A computational study of influence of helmet padding materials on the human brain under ballistic impacts

The results of a computational study of a helmeted human head are presented in this paper. The focus of the work is to study the effects of helmet pad materials on the level of acceleration, inflicted pressure and shear stress in a human brain model subjected to a ballistic impact. Four different closed cell foam materials, made of expanded polystyrene and expanded polypropylene, are examined for the padding material. It is assumed that bullets cannot penetrate the helmet shell. Finite element modelling of the helmet, padding system, head and head components is used for this dynamic nonlinear analysis. Appropriate contacts and conditions are applied between the different components of the head, as well as between the head and the pads, and the pads and the helmet. Based on the results of simulations in this work, it is concluded that the stiffness of the foam has a prominent role in reducing the level of the transferred load to the brain. A pad that is less stiff is more efficient in absorbing the impact energy and reducing the sudden acceleration of the head and consequently lowers the brain injury level. Using the pad with the least stiffness, the influence of the angle of impacts as well as the locations of the ballistic strike is studied.     

Impact of chronic smoking on traumatic brain microvascular injury: An in vitro study

Traumatic brain injury (TBI) is a major reason of cerebrovascular and neurological damage. Premorbid conditions such as tobacco smoking (TS) can worsen post-TBI injuries by promoting vascular endothelial impairments. Indeed, TS-induced oxidative stress (OS) and inflammation can hamper the blood-brain barrier (BBB) endothelium. This study evaluated the subsequence of chronic TS exposure on BBB endothelial cells in an established in vitro model of traumatic cell injury. Experiments were conducted on confluent TS-exposed mouse brain microvascular endothelial cells (mBMEC-P5) following scratch injury. The expression of BBB integrity–associated tight junction (TJ) proteins was assessed by immunofluorescence imaging (IF), Western blotting (WB) and quantitative RT-PCR. We evaluated reactive oxygen species (ROS) generation, the nuclear factor 2–related (Nrf2) with its downstream effectors and several inflammatory markers. Thrombomodulin expression was used to assess the endothelial haemostatic response to injury and TS exposure. Our results show that TS significantly decreased Nrf2, thrombomodulin and TJ expression in the BBB endothelium injury models while increased OS and inflammation compared to parallel TS-free cultures. These data suggest that chronic TS exposure exacerbates traumatic endothelial injury and abrogates the protective antioxidative cell responses. The downstream effect was a more significant decline of BBB endothelial viability, which could aggravate subsequent neurological impairments.     

Finite element modelling of equestrian helmet impacts exposes the need to address rotational kinematics in future helmet designs

Jockey head injuries, especially concussions, are common in horse racing. Current helmets do help to reduce the severity and incidences of head injury, but the high concussion incidence rates suggest that there may be scope to improve the performance of equestrian helmets. Finite element simulations in ABAQUS/Explicit were used to model a realistic helmet model during standard helmeted rigid headform impacts and helmeted head model University College Dublin Brain Trauma Model (UCDBTM) impacts.

Current helmet standards for impact determine helmet performance based solely on linear acceleration. Brain injury-related values (stress and strain) from the UCDBTM showed that a performance improvement based on linear acceleration does not imply the same improvement in head injury-related brain tissue loads. It is recommended that angular kinematics be considered in future equestrian helmet standards, as angular acceleration was seen to correlate with stress and strain in the brain.     

创伤性脑损伤对大鼠海马骨架蛋白及学习记忆功能影响

创伤性脑损伤（traumatic brain injury,TBI）是极为常见的外伤性疾病,致死率和致残率很高。存活者伴随的空间认知功能障碍,给患者家庭和社会造成了极大的负担。目前,对TBI造成的空间记忆障碍缺乏系统研究。脑损伤后海马组织与记忆有关的分子以及组成神经元骨架的分子如何变化研究甚少。本研究采用Wistar大鼠为研究对象,并随机将其分为假手术（sham）组和创伤性脑损伤（TBI）组。TBI组再按致伤后时间长短分为6 h、12 h、24 h、72 h、15 d五个亚组。TBI组应用PinPointTM颅脑撞击器撞击而致伤,sham组不撞击。采用Morris水迷宫评价实验动物空间记忆能力;干湿重法测定脑含水量,评估脑水肿与海马水通道蛋白4（aquaporin-4,AQP-4）的相关性;海马神经元特异性核蛋白（neuron specific nuclear protein,NeuN）标记和免疫荧光检测评估TBI致大鼠神经元丢失情况;通过Western印迹检测TBI致海马骨架相关蛋白质和记忆相关蛋白质含量变化。本研究证实,与sham组相比,TBI组大鼠潜伏期明显增加［（61.98±12.82) s vs.(28.32±8.52) s,n=5,P<0.01,day 15］,探索时间明显缩短［（36.98±0.37) s vs. (73.68±5.09) s,n=5,P<0.01,day15］,表明脑创伤损害了动物的空间参考记忆能力和空间工作记忆能力。与sham组相比,TBI组大鼠海马AQP-4在蛋白质水平上的表达和脑含水量持续升高,15 d恢复正常;在12 h［（3.78±0.74),(83.78±0.35)%］和72 h［（3.49±0.85),(82.28±0.63)%］均形成两个波峰,n=5,P均<0.01,表明继发性脑损伤与持续脑水肿和海马AQP-4在蛋白质上的高表达有关。与sham组相比,NeuN标记和免疫荧光检测发现,TBI后24 h 致大鼠海马神经元丢失严重［（198.2±8.002) vs.(297.2±6.866) cells/mm2, n=5,P<0.01］,表明TBI动物的海马功能受损。与sham相比,TBI组海马神经元树突标志物微管结合蛋白2（microtubule associated proein 2,MAP2）和突触前终末特异性标记物突触素（synaptophysin,SYN）在蛋白质水平均伤后逐步降低（n=5,P均<0.01）,72 h［（0.55±0.05) vs.(1.27±0.08), (0.52±0.14) vs.(1.06±0.16), n=5,P均<0.01］降低最明显;TBI组形成神经元纤维缠结主要成分的过度磷酸化tau（ser404）,伤后逐步升高,72 h［（1.25±0.11)vs. (0.33±0.07), n=5,P<0.01］升高最明显。 MAP2、SYN和过度磷酸化的tau（ser404）检测指标的改变,表明脑损伤致神经元受损,神经元生长和损伤修复能力减弱,最终导致神经元骨架破环,TBI损害了动物的海马空间记忆能力。与sham组相比,TBI组大鼠海马环磷酸腺苷反应元件结合蛋白（cAMP response element binding protein,CREB）和磷酸化CREB ser133(phosphorylated CREB Ser133, pCREB Ser133)含量降低明显（n=5,P均<0.05）,表明脑损伤动物海马的存储记忆能力减弱;TBI组大鼠海马一般调控阻遏蛋白激酶2(general control nonderepressible 2 kinase,GCN2)蛋白质升高明显（n=5,P均<0.05）,表明脑损伤动物海马将新信息转化成长期记忆能力下降。本研究提示,创伤性脑损伤可使大鼠海马神经元骨架破坏,进而导致在学习记忆过程中起重要作用的分子蛋白质下调,抑制记忆储存的蛋白质（GCN2）上调,促使学习记忆功能障碍。