Reye's syndrome: assessment of intracranial monitoring.

Direct measurements of arterial blood pressure and intracranial pressure were recorded in 39 patients aged 3.6 months to 5 years 11 months with Reye''s syndrome judged to be stage 2 or beyond. Of 33 patients who survived, 27 made a full recovery and six were severely handicapped. Measurement of cerebral perfusion pressure, which is greatly reduced in the more severe forms of Reye''s syndrome, was a better guide to prognosis and management than intracranial pressure alone. The findings emphasise that maintenance of cerebral perfusion pressure is essential if mortality and morbidity are to be reduced. Intracranial monitoring is mandatory in all but the mildest cases of Reye''s syndrome.     

Cerebral microinfarct is emergency consequence of Alzheimer's disease: a new insight into development of neurodegenerative diseases

Imbalance of Aβ and tau protein production and clearance are the key factors among many causes of Alzheimer''s disease that leading to neurons degeneration and cognitive disorders. As a novel approach, glymphatic system quickly clear metabolic waste (especially Aβ and tau) from cerebral environment, and dysfunction of glymphatic system may relate to occurrence of Alzheimer''s disease. Microinfarct is a common histopathologic situation occurring in aging brain and leads to dramatic increase the generation of metabolic by-product after neuronal injury, hindering the operation of glymphatic system and suppress cerebral spinal fluid (CSF) and cerebral interstitial fluid (interstitial fluid, ISF) exchange. Microinfarcts destruct the integrity of microvascular and microstructural tissue, result in Aβ deposition and tau phosphorylation that form neurofibrillary tangles and associated with the cause of Alzheimer''s disease. Currently, it has been found that glymphatic system is involved in the pathological process of Alzheimer''s disease. Improving the function of glymphatic system after cerebral microinfarcts could be developed as a new approach for Alzheimer''s disease prevention and treatment. In this review, we will provide in-depth discussion on functional changes of glymphatic system after cerebral microinfarcts, further reveal pathogenesis of Alzheimer''s disease and provide a potentially more effective method for treatment of Alzheimer''s disease.     

Hodgkin's disease following thorium dioxide angiography.

Hodgkin''s disease occurred in a 53-year-old man who, 25 years previously, had undergone cerebral angiography, for which thorium dioxide suspension (Thorotrast) was used. Deposits of throium dioxide were noted in reticuloendothelial cells in various locations. An association between thorium dioxide administration and the subsequent development of malignant tumours and neoplastic hematologic disorders has previously been reported.     

Positron emission tomography in patients with clinically diagnosed Alzheimer's disease.

Fourteen patients who had clinically diagnosed Alzheimer''s disease with mild to severe dementia (mean age 69.1 years) were evaluated by calculation of local cerebral metabolic rate for glucose (LCMR-gl) based on uptake of 18F-2-fluoro-2-deoxyglucose (FDG) detected with positron emission tomography (PET). PET scanning showed that the patients had significantly lower LCMR-gl values than 11 age-matched neurologically normal volunteers (mean age 66.3 years). The differences were most marked in the temporal cortex, followed by the frontal, parietal and occipital cortex. In each case the LCMR-gl value was below the lowest control value in at least one cortical area and usually in several; the reduction in LCMR-gl and the number of regions involved in the patients increased with the severity of the dementia. Deficits noted in neuropsychologic testing generally correlated with those predicted from loss of regional cortical metabolism. The patients with Alzheimer''s disease were also examined with magnetic resonance imaging, computed tomography or both; the degree of atrophy found showed only a poor correlation with the neuropsychologic deficit. Significant atrophy was also noted in some of the controls. A detailed analysis of LCMR-gl values in selected cerebral regions of various sizes refuted the hypothesis that the reduction in cortical glucose metabolism in Alzheimer''s disease is due to the filling by metabolically inert cerebrospinal fluid of space created by tissue atrophy.     

CEREBRAL ATROPHY — Clinical Manifestations in Adults

A study was made of the cases of 200 patients with demonstrated cerebral atrophy. In patients under 70 years of age cerebral atrophy was twice as common in men as women. Over 70 years the ratio was reversed. The incidence of cerebral atrophy was relatively high in the age group 35 to 50.Convulsions were present in more than a third of the 200 patients. Neurological abnormalities were present in 51 per cent of the entire series. Significant personality deviations were observed in 31 per cent. Although the electroencephalogram was abnormal in many patients, it appeared to be of little aid in the diagnosis of the cerebral atrophy. The spinal fluid did not seem to be consistently altered in any significant or diagnostic manner.Most of the patients in the 35 to 50 year age group did not have the symptoms characteristic of Alzheimer''s disease, and in only a few cases did the symptoms resemble those of other recognized disease entities.     

首发缺血性脑卒中患者血清Hcy和EPO水平的变化及临床意义

目的:探究首发缺血性脑卒中患者血清同型半胱氨酸(Hcy)和红细胞生成素(EPO)水平的变化和意义。方法:于2013年10月-2015年4月我科收治的首发缺血性脑卒中患者中随机选取98例作为观察组,另选取同期健康体检者98例作为对照组,检测患者的血小板、血浆纤维蛋白原(Fib)以及血白细胞水平,比较两组血清Hcy、EPO、血小板、Fib及血白细胞水平,使用Logistic回归分析法评价缺血性脑卒中病发的危险因素,采用Spearman法对血清Hcy与EPO间相关性进行分析。结果:观察组的Hcy(23.52±12.15)m IU/L与EPO(34.61±11.25)m IU/L水平显著高于对照组的(10.57±2.18)m IU/L、(17.54±5.83)m IU/L;观察组血小板、血浆纤维蛋白原(fibrinogen,Fib)及血白细胞水平均高于对照组;差异均有统计学意义(均P0.05)。经Logistic回归分析法分析可知,Hcy为缺血性脑卒中病发的独立因素,经Spearman相关性分析显示,首发缺血性脑卒中患者EPO水平与Hcy呈正相关。结论:缺血性脑卒中病发与血清Hcy和EPO水平升高密切相关,且Hcy是导致缺血性脑卒中病发的高危因素。     

The decline and resurgence of vascular dementia.

Arteriosclerotic narrowing of cerebral arteries was once viewed as the key to mental decline. As Alzheimer''s disease gained recognition and the concept of multi-infarct dementia achieved acceptance, vascular dementia came to be regarded as uncommon. The changing nature of cerebral vascular disease, the aging of the population and the widespread use of brain imaging techniques have brought new prominence to vascular dementia, chiefly in the form of an epidemic of "Binswanger''s disease". Growing evidence suggests that not only grey matter lesions but also white matter lesions contribute to dementia, that vascular factors commonly coexist and interact with Alzheimer changes and that Alzheimer''s disease has a vascular and potentially treatable component. Vascular dementia needs to be redefined, reappraised and reinvestigated.     

高压氧预处理对大鼠局灶性脑缺血再灌注损伤的保护作用

目的:研究高压氧预处理对大鼠脑缺血再灌注损伤的保护作用。方法:36只SD大鼠随机分为假手术组、模型组及高压氧预处理组,每组12只。高压氧预处理组大鼠在造模前5天给予高压氧预处理。采用线栓法建立大鼠脑缺血再灌注模型,观察高压氧预处理对脑缺血再灌注损伤大鼠神经功能缺损评分、脑梗死面积的影响,检测大鼠缺血脑组织COX-2 mRNA和蛋白的表达以及IL-1β、TNF-α、MDA的含量。结果:高压氧预处理可明显改善脑缺血再灌注大鼠神经功能缺损评分,减少脑梗死面积,降低COX-2m RNA和蛋白表达量,抑制IL-1β、TNF-α的表达,降低MDA水平。结论:高压氧预处理对大鼠脑缺血再灌注损伤具有明显的保护作用,其机制可能与抑制IL-1β、TNF-α、COX-2的表达以及减弱脂质过氧化反应有关。     

Subarachnoid haemorrhage: older patients have low cerebral blood flow.

Daily estimations of hemispheral cerebral blood flow using the xenon-133 inhalation technique was made in 116 patients during the first three weeks after subarachnoid haemorrhage. The patients'' cerebral perfusion on average remained less than the normal perfusion expected for their age (based on a single estimation of cerebral blood flow in 67 volunteers). On each separate day after subarachnoid haemorrhage cerebral blood flow was inversely related to the patient''s age. Older patients seem especially at risk of developing cerebral ischaemia after subarachnoid haemorrhage. The clinical outcome was more often unfavourable in older patients--that is, in those who tended to have the lowest cerebral blood flow. Present results support the view that episodes of low cerebral blood flow lead to a poor outcome after subarachnoid haemorrhage. Because of the risk of inducing cerebral ischaemia great care should be exercised by physicians administering hypotensive drugs to older patients after subarachnoid haemorrhage.     

Micro-MRI Study of Cerebral Aging: Ex Vivo Detection of Hippocampal Subfield Reorganization,Microhemorrhages and Amyloid Plaques in Mouse Lemur Primates

Mouse lemurs are non-human primate models of cerebral aging and neurodegeneration. Much smaller than other primates, they recapitulate numerous features of human brain aging, including progressive cerebral atrophy and correlation between regional atrophy and cognitive impairments. Characterization of brain atrophy in mouse lemurs has been done by MRI measures of regional CSF volume and by MRI measures of regional atrophy. Here, we further characterize mouse lemur brain aging using ex vivo MR microscopy (31 µm in-plane resolution). First, we performed a non-biased, direct volumetric quantification of dentate gyrus and extended Ammon''s horn. We show that both dentate gyrus and Ammon''s horn undergo an age-related reorganization leading to a growth of the dentate gyrus and an atrophy of the Ammon''s horn, even in the absence of global hippocampal atrophy. Second, on these first MR microscopic images of the mouse lemur brain, we depicted cortical and hippocampal hypointense spots. We demonstrated that their incidence increases with aging and that they correspond either to amyloid deposits or to cerebral microhemorrhages.     

Evaluation of Flow Velocity in Unilateral Middle Cerebral Artery Stenosis by Transcranial Doppler

To determine the optimal velocity values in diagnosing unilateral middle cerebral artery (MCA) stenosis by Transcranial Doppler (TCD), and improve the diagnostic accuracy using magnetic resonance angiography (MRA), a total of 302 unilateral MCA stenosis patients undergoing TCD also consented to a MRA of the intracranial arteries. The peak systolic velocity (PSV) and each MCA spectrum for each patient were recorded. Using the MRA to confirm, the degree of middle cerebral artery stenosis was categorized into four groups: normal (normal caliber and signal), mild (<50 %), moderate (50–69 %), severe (70–99 %, or no flow detected). The velocity difference among these four groups was significant (P < 0.001). The optimal PSV values for normal and stenosis were 160 cm/s. For mild and moderate were 200 cm/s, for moderate and severe were 280 cm/s. Using PSV as the diagnostic criteria, the Kappa number was >0.668. The optimal PSV differential value for mild and moderate was 70 cm/s, for moderate and severe at 120 cm/s. Optimal combined criteria for moderate stenosis were PSV >200 cm/s and PSV differential value >70 cm/s (specificity 87.2 %), for severe stenosis were PSV >280 cm/s and PSV differential value >120 cm/s (sensibility 81.6 %). Transcranial Doppler distinguishes normal and MCA stenosis with a reduced lumen diameter of less than 50 %. Using the PSV criteria, TCD has a high coincidence rate with MRA in the diagnosis of MCA stenosis. Combined PSV differential value and the abnormal spectrum may improve the accuracy of TCD in diagnosing moderate or severe stenosis.     

Protective Effect of Naringenin in Experimental Ischemic Stroke: Down-Regulated NOD2, RIP2, NF-κB,MMP-9 and Up-Regulated Claudin-5 Expression

Inflammatory damage plays a pivotal, mainly detrimental role in cerebral ischemic pathogenesis and may represent a promising target for treatment. Naringenin (NG) has gained growing appreciation for its beneficial biological effects through its anti-inflammatory property. Whether this protective effect applies to cerebral ischemic injury, we therefore investigate the potential neuroprotective role of NG and the underlying mechanisms. Focal cerebral ischemia in male Sprague–Dawley rats was induced by permanent middle cerebral artery occlusion (pMCAO) and NG was pre-administered intragastrically once daily for four consecutive days before surgery. Neurological deficit, brain water content and infarct volume were measured at 24 h after stroke. Immunohistochemistry, Western blot and RT-qPCR were used to explore the anti-inflammatory potential of NG in the regulation of NOD2, RIP2 and NF-κB in ischemic cerebral cortex. Additionally, the activities of MMP-9 and claudin-5 were analyzed to detect NG’s influence on blood–brain barrier. Compared with pMCAO and Vehicle groups, NG noticeably improved neurological deficit, decreased infarct volume and edema at 24 h after ischemic insult. Consistent with these results, our data also indicated that NG significantly downregulated the expression of NOD2, RIP2, NF-κB and MMP-9, and upregulated the expression of claudin-5 (P < 0.05). The results provided a neuroprotective profile of NG in cerebral ischemia, this effect was likely exerted by down-regulated NOD2, RIP2, NF-κB, MMP-9 and up-regulated claudin-5 expression.     

Crohn's disease of the appendix

Granulomatous inflammation typifying Crohn''s disease was centred within or confined to appendices in six patients, two of whom developed lesions attributable to Crohn''s disease elsewhere in the gut. The remaining four patients have remained symptom-free for periods varying from two to six years. Histological evidence of Crohn''s disease was also present in five of 46 appendices available for re-examination in a survey of 63 cases of Crohn''s enterocolitis. It is adduced that appendiceal involvement in Crohn''s disease is not uncommon.     

Epigenetic Signature of Chronic Cerebral Hypoperfusion and Beneficial Effects of S-adenosylmethionine in Rats

Chronic cerebral hypoperfusion is associated with cognitive decline in aging and age-related neurodegenerative disease. Epigenetic mechanisms are involved in the maintenance of long-term hypoxia-adapted cellular phenotypes. In the present study, the epigenetic signatures such as DNA methylation and histone acetylation, as well as S-adenosylmethionine (SAM) cycle using chronic cerebral hypoperfusion rat model were explored. Chronic cerebral hypoxia-induced global DNA hypermethylation associated with the increase of DNA methyltransferase (DNMT) 3A as well as alteration of SAM cycle. Meanwhile, an enhanced level of global histone H4 acetylation accompanied with the upregulation of histone acetyltransferase, p300/CREB-binding protein (CBP), and the downregulation of histone deacetylases (HDACs), was also observed. SAM could improve spatial capacity through the upregulation of acetylcholine and brain-derived neurotrophic factor (BDNF) rather than alteration of DNA methylation levels. In conclusion, we have demonstrated a genome-wide adjustment of DNA methylation and histone acetylation under chronic cerebral hypoxic conditions in a rat’s brain. These epigenetic signatures may represent an additional mechanism to promote and maintain a hypoxic-adapted cellular responds with a potential role in memory deficits.     

Smoker's face: an underrated clinical sign?

In a prospective survey of patients attending a general medical outpatient clinic roughly half the current cigarette smokers who had smoked for 10 years or more were identified, using defined criteria, by their facial features alone. These facial features, designated "smoker''s face," were present in three (8%) of those who had smoked cigarettes for 10 years or more in the past and in none of the non-smokers. The association of smoker''s face with current smoking that had continued for 10 years or more was significant (p less than 0.001) and remained after the patient''s age, social class, exposure to sunlight, recent change of weight, and estimated lifetime consumption of cigarettes were controlled for. Smoker''s face may be a helpful indicator in antismoking campaigns.     

Raynaud's phenomenon in forestry workers in Quebec.

A survey of 1540 forestry workers in Quebec found a prevalence of Raynaud''s phenomenon of 30.5% among chain-saw users and 8.7% among nonusers. Prevalence was related directly to duration of use of the chain-saw. The mean interval (+/- the standard deviation) between the time the chain-saw was first used and the onset of Raynaud''s phenomenon was 7.8 +/- 5.6 years. After 20 years of chain-saw use over 50% of the population had Raynaud''s phenomenon. Relative risks among those using a chain-saw for more than 10 years were 3.60 for nonsmokers and 6.55 for smokers. Other factors associated with the phenomenon included a family history of nonoccupational Raynaud''s phenomenon, previous injuries to the arms, climate and type of residence during the wood-cutting season. Decreased work capacity, interference with leisure activities and changes in professional orientation often resulted from this disease. These problems should be taken into account when disability compensation is being considered.     

Lung Transplantation in a Patient with Fibrosing Alveolitis

The transplantation of the right lung into a man aged 40 who was suffering from cryptogenic fibrosing alveolitis is described. Before transplantation he had been dependent on oxygen, even at rest, for 24 hours a day for almost two years. The donor was a boy of 16 years who had had a fatal cerebral haemorrhage. The transplanted lung functioned perfectly from the time of operation until the patient''s sudden death two months later from an overwhelming haemoptysis apparently from a small peribronchial abscess rupturing into the pulmonary artery. By the third postoperative week the patient had been able to walk unaided and without distress outdoors. The problem of differentiating infection from incipient rejection is discussed. We conclude that clinically successful lung transplantation can be achieved, but only if the problems of lung function, infection, and immunosuppression can all be overcome.     

肠道菌群与阿尔茨海默病的研究进展

阿尔茨海默病(Alzheimer′s disease,AD)是一种神经退行性疾病,呈进行性发展趋势,严重影响患者的生活质量,给社会和家庭带来了沉重的经济负担。随着人口老龄化进程的不断加剧,AD患者数量不断增加,而其发病原因、发病机制仍不明确,缺乏有效的防治方法。近年来,研究表明肠道菌群通过多种途径参与AD的发生发展,调整肠道菌群有望成为预防和治疗AD的有效措施之一,其可能的作用机制包括减轻AD的病理改变、改善脑内炎症、影响血脑屏障及神经递质的产生。     

Parkinson's disease and Alzheimer's disease as disorders of the isodendritic core.

Parkinson''s disease and Alzheimer''s disease may represent two parts of a spectrum of disease characterised by a primary loss of cells of the isodendritic core. Secondary cell loss from the striatum and cerebral cortex therefore occurs as a consequence of the loss of ascending projections from the isodendritic cells. The anatomy of this system should provide a unique opportunity for therapeutic intervention. Neurotransmitter replacement treatment may be provided either by enhancing transmitter release by any remaining neurones or by direct agonists. The wide dispersal of the isodendritic projection systems affected in Parkinson''s and Alzheimer''s disease and the possibility that they are tonically active create an opportunity for neurotransmitter replacement treatment. Animal studies should be able to show whether such treatment can delay secondary cell loss, and, together with human postmortem studies, whether the hypothesis that the primary lesion is a loss of isodendritic cells is correct.     

颈总动脉周围交感神经网剥脱切除术治疗学龄前脑瘫患儿的疗效及对患儿认知状况的影响

目的:探讨颈总动脉周围交感神经网剥脱切除术治疗学龄前脑瘫患儿的临床效果及对患儿认知状况影响。方法:选取2014年12月~2016年12月我院收治的学龄前脑瘫患儿84例,根据治疗方式的不同分为观察组与对照组,每组42例。对照组给予常规非手术治疗,观察组给予颈总动脉周围交感神经网剥脱切除术治疗,两组患儿均进行为期24周的随访观察。观察和比较两组的综合功能改善情况,治疗前后发育商、智商以及C因子值水平的变化。结果:观察组综合功能改善总有效率为95.24%(40/42),显著高于对照组的78.57%(33/42)(P0.05)。治疗后24周,观察组患儿的发育商值为(84.5±11.3),显著高于对照组(62.2±12.4)(P0.05);观察组患儿的智商值为(80.7±11.4),显著高于对照组(67.3±12.1)(P0.05);观察组患儿的C因子值为(12.8±4.0),显著高于对照组(9.9±3.3)(P0.05)。结论:颈总动脉周围交感神经网剥脱切除术治疗学龄前脑瘫患儿的临床效果显著,可有效改善患儿的认知状况。