• 1 Cerebral metastases--a therapeutic update. 复制标题 收藏 收藏

    【脑转移 -- 治疗更新。】 复制标题 收藏 收藏
    DOI:10.1038/ncpneuro0263 复制DOI
    作者列表:Cavaliere R,Schiff D
    BACKGROUND & AIMS: :Cerebral metastases remain a common complication among patients with cancer. Historically, whole-brain radiotherapy has remained the standard of care, with surgery being reserved for selected cases. Recent advances have changed our practice, however. In particular, stereotactic radiosurgery has emerged as a vital treatment modality for this disease. In addition, chemotherapy, including temozolomide, topoisomerase inhibitors and antimetabolites, and treatment sensitizers, such as efaproxiral and motexafin gadolinium, are actively being assessed in clinical trials, and are likely to play an increasing role in the management of cerebral metastases in the future. Nonetheless, many uncertainties remain, such as the optimal combination and timing of therapeutics. As the arsenal of therapeutics expands, it will be increasingly important to select appropriate patients for a particular treatment paradigm. Understanding the efficacy and toxicity of treatment is essential to this task.
    背景与目标: : 脑转移仍然是癌症患者的常见并发症。从历史上看,全脑放疗一直是护理的标准,手术是为选定的病例保留的。然而,最近的进展改变了我们的做法。特别是,立体定向放射外科已成为该疾病的重要治疗方式。此外,化疗,包括替莫唑胺、拓扑异构酶抑制剂和抗代谢物,以及治疗敏化剂,如efaproxiral和motexafin钆,正在临床试验中积极评估,并可能在未来脑转移的管理中发挥越来越大的作用。尽管如此,仍然存在许多不确定性,例如治疗的最佳组合和时机。随着治疗学库的扩展,为特定的治疗范例选择合适的患者将变得越来越重要。了解治疗的疗效和毒性对于这项任务至关重要。
  • 【[肉毒杆菌毒素治疗痉挛性婴儿脑瘫: 一年内27例结果]。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Sánchez-Carpintero R,Narbona J
    BACKGROUND & AIMS: INTRODUCTION AND OBJECTIVES:Positive outcome of patients with spastic cerebral palsy treated with botulinum toxin reported in the last three years has led us to perform this study with the aim to show our experience in the management of spastic cerebral palsy with the toxin, determine its indications, analyze the results and propose new possible indications in the future.

    MATERIAL AND METHODS:We include 10 hemiplegic and 17 diplegic patients with an average age of 6 years and 7 months, followed up between 5 and 17 months. Clinical improvement was monitored using the PRS and EVFEL scales and articular motion range was measured 6 months before and after the injection while continuing physiotherapy. The injected muscles were adductor, hamstrings, triceps and posterior tibialis, and the doses were 1-2 U/muscle/kg body weight.

    RESULTS:The values on PRS improved an average of 24%, adductor angle 66% (p < 0.01), knee angle 40% (p = 0.05) and ankle angle 52% (p < 0.01); 96% of patients could get more physiological static or walking patterns because of the decrease of spasticity and those persisted after the effect of the toxin had worn off. It was maximum at 2 months, stabilized 4 to 6 months later and decreased during further 2 months.

    CONCLUSIONS:This experience leads us to propose higher starting dosage and to take into account the stability of postural pattern of each patient to choice the muscle to be injected. Other therapeutic possibilities are also proposed in children with fixed shortening e.g. combining the toxin with stretching casts.

    背景与目标: 简介和目标 : 最近三年报道的肉毒杆菌毒素治疗痉挛性脑瘫患者的积极结果导致我们进行这项研究,目的是展示我们在治疗痉挛性脑瘫方面的经验毒素,确定其适应症,分析结果并在将来提出新的可能适应症。
    材料和方法 : 我们包括10例偏瘫和17例双瘫患者,平均年龄为6岁7个月,随访5至17个月。使用PRS和EVFEL量表监测临床改善,并在注射前和注射后6个月测量关节运动范围,同时继续理疗。注射的肌肉是内收肌,绳肌,三头肌和胫后肌,剂量为1-2 U/肌肉/kg体重。
    结果 : PRS上的值平均提高了24%,内收角66% (p <0.01),膝角40% (p = 0.05) 和踝角52% (p < 0.01); 96% 患者由于痉挛程度的降低而获得更多的生理静态或行走模式,并且在毒素作用消失后持续存在。在2个月时达到最大值,在4到6个月后稳定下来,在接下来的2个月内下降。
    结论 : 这种经验使我们提出更高的起始剂量,并考虑到每位患者的姿势模式的稳定性,以选择要注射的肌肉。对于固定缩短的儿童,还提出了其他治疗可能性,例如将毒素与拉伸铸型结合使用。
  • 【螺旋ct血管造影对腹主动脉瘤的术前影像学评估。】 复制标题 收藏 收藏
    DOI:10.1016/s0009-9260(97)80132-8 复制DOI
    作者列表:Errington ML,Ferguson JM,Gillespie IN,Connell HM,Ruckley CV,Wright AR
    BACKGROUND & AIMS: PURPOSE:A prospective evaluation of spiral CT angiography (SCTA) as the sole pre-operative imaging modality for abdominal aortic aneurysm repair.

    MATERIALS AND METHODS:Spiral CT angiography was compared with conventional transfemoral angiography in 30 patients and results correlated with surgical findings in 22 patients. The following features were assessed: renal artery number and disease; upper and lower aneurysm extent; aneurysm size; perianeurysmal inflammation; iliac artery disease; radiation dose; and contrast usage.

    RESULTS:Spiral CT angiography agreed with conventional angiography in all cases of severe stenosis or occlusion of renal arteries and had 90% agreement overall for renal artery disease. Two of nine accessory renal arteries seen at conventional angiography were missed. For showing aneurysm extent SCTA was 100% sensitive, and performed better than conventional angiography. Aneurysm size was better shown with SCTA. In iliac disease SCTA, as performed in this study, was poor for mild-moderate disease, but detected four of six severely stenosed/occluded iliac arteries seen at conventional angiography. Prospective sensitivity for perianeurysmal inflammation was 33%. Radiation dose for SCTA was approximately twice and contrast dose approximately three times that for conventional angiography.

    CONCLUSION:Spiral CT angiography can provide all the necessary imaging information to plan aneurysm repair in the non-claudicant.

    背景与目标: 目的 : 对螺旋ct血管造影 (SCTA) 作为腹主动脉瘤修复的唯一术前成像方式的前瞻性评估。
    材料和方法 : 将30例患者的螺旋ct血管造影与常规经股动脉造影进行了比较,结果与22例患者的手术结果相关。评估了以下特征: 肾动脉数量和疾病; 上,下动脉瘤范围; 动脉瘤大小; 动脉瘤周围炎症; 髂动脉疾病; 辐射剂量; 和造影剂使用。
    结果 : 在所有严重肾动脉狭窄或闭塞的病例中,螺旋ct血管造影与常规血管造影一致,并且在肾动脉疾病方面总体上90% 一致。在常规血管造影中观察到的9条副肾动脉中有2条被遗漏。对于显示动脉瘤范围,SCTA 100% 敏感,并且比常规血管造影更好。SCTA能更好地显示动脉瘤大小。在本研究中进行的SCTA在轻度-中度疾病中较差,但在常规血管造影术中发现了六个严重狭窄/闭塞的动脉中的四个。33% 了对动脉瘤周围炎症的前瞻性敏感性。SCTA的辐射剂量约为常规血管造影的两倍,造影剂剂量约为常规血管造影的三倍。
    结论 : 螺旋ct血管造影可以提供所有必要的成像信息,以计划非幽闭者的动脉瘤修复。
  • 4 The cerebral palsied hip. 复制标题 收藏 收藏

    【大脑触诊的臀部。】 复制标题 收藏 收藏
    DOI:10.1097/00003086-199705000-00007 复制DOI
    作者列表:Black BE,Griffin PP
    BACKGROUND & AIMS: Controversy exists regarding the role of pelvic obliquity in hip dysplasia and cerebral palsy. Earlier authors noted such a relationship but did not confirm its existence by scientific study. The current study confirms the association of pelvic obliquity to hip dysplasia in spastic cerebral palsy. At presentation of subluxation or dislocation before surgery, 80 patients were indexed into 5 body alignment types. Reclassifications were performed with passage of time to study the natural history and effects of surgery. Hip dysplasia was found in all cases to be consistent with the forces related to pelvic obliquity.

    背景与目标: 关于骨盆倾斜在髋关节发育不良和脑瘫中的作用存在争议。较早的作者指出了这种关系,但并未通过科学研究证实其存在。目前的研究证实了痉挛性脑瘫中骨盆倾斜与髋关节发育不良的关系。在手术前出现半脱位或脱位时,将80例患者分为5种身体排列类型。随着时间的流逝进行了重新分类,以研究自然史和手术效果。在所有情况下都发现髋关节发育不良与骨盆倾斜相关的力一致。
  • 【脑弥散和T(2): 持续高原缺氧期间急性高山病的MRI预测因子。】 复制标题 收藏 收藏
    DOI:10.1038/jcbfm.2012.184 复制DOI
    作者列表:Hunt JS Jr,Theilmann RJ,Smith ZM,Scadeng M,Dubowitz DJ
    BACKGROUND & AIMS: :Diffusion magnetic resonance imaging (MRI) provides a sensitive indicator of cerebral hypoxia. We investigated if apparent diffusion coefficient (ADC) and transverse relaxation (T(2)) predict symptoms of acute mountain sickness (AMS), or merely indicate the AMS phenotype irrespective of symptoms. Fourteen normal subjects were studied in two groups; unambiguous AMS and no-AMS at 3,800 m altitude (intermediate AMS scores were excluded). T(2) relaxation was estimated from a T(2) index of T(2)-weighted signal normalized by cerebrospinal fluid signal. Measurements were made in normoxia and repeated after 2 days sustained hypoxia (AMS group symptomatic and no-AMS group asymptomatic) and after 7 days hypoxia (both groups asymptomatic). Decreased ADC directly predicted AMS symptoms (P<0.05). Apparent diffusion coefficient increased in asymptomatic subjects, or as symptoms abated with acclimatization. This pattern was similar in basal ganglia, white matter, and gray matter. Corpus callosum behaved differently; restricted diffusion was absent (or rapidly reversed) in the splenium, and was sustained in the genu. In symptomatic subjects, T(2,index) decreased after 2 days hypoxia and further decreased after 7 days. In asymptomatic subjects, T(2,index) initially increased after 2 days, but decreased after 7 days. T(2,index) changes were not predictive of AMS symptoms. These findings indicate that restricted diffusion, an indicator of diminished cerebral energy status, directly predicts symptoms of AMS in humans at altitude.
    背景与目标: 扩散磁共振成像 (MRI) 提供了脑缺氧的敏感指标。我们调查了表观扩散系数 (ADC) 和横向松弛 (T(2)) 是否可以预测急性高山病 (AMS) 的症状,或者仅指示AMS表型而与症状无关。研究了两组中的14名正常受试者; 3,800  m高度的明确AMS和no-AMS (排除中间AMS得分)。T(2) 松弛是根据脑脊液信号归一化的T(2) 加权信号的T(2) 指数估算的。在常氧下进行测量,并在持续缺氧2天 (有症状的AMS组和无症状的no-AMS组) 和缺氧7天 (两组均无症状) 后重复进行。ADC降低直接预测AMS症状 (P<0.05)。在无症状的受试者中,表观扩散系数增加,或者随着症状的适应而减轻。这种模式在基底神经节,白质和灰质中相似。Call体的行为不同; 脾脏中不存在 (或迅速逆转) 受限的扩散,并在基因组中持续存在。在有症状的受试者中,缺氧2 d后T(2,指数) 降低,7 d后进一步降低。在无症状的受试者中,T(2,指数) 在2天后最初增加,但在7天后降低。T(2,指数) 变化不能预测AMS症状。这些发现表明,受限的扩散是大脑能量状态降低的指标,直接预测了人类在海拔地区的AMS症状。
  • 【单胺受体激动剂和拮抗剂对人大脑皮层切片中环状AMP积累的影响。】 复制标题 收藏 收藏
    DOI:10.1139/y77-172 复制DOI
    作者列表:Tsang D,Lal S
    BACKGROUND & AIMS: :In human cerebral cortex slices noradrenaline, isoproterenol (a beta-adrenergic agonist), dopamine, apomorphine (a dopaminergic agonist), and serotonin stimulated cyclic AMP formation: noradrenaline greater than or equal to isoproterenol greater than dopamine = apomorphine = serotonin. Clonidine (and alpha-adrenergic agonist) was ineffective in stimulating cyclic AMP formation in temporal cortex slices. The stimulatory effect of noradrenaline and isoproterenol was blocked by propranolol (a beta-adrenergic blocker) but not by phentolamine (an alpha-adrenergic blocker). Pimozide (a selective dopaminergic antagonist) inhibited the increase of cyclic AMP formation induced by dopamine or apomorphine but not that induced by noradrenaline, isoproterenol, or serotonin. Neither propranolol or phentolamine had any effect on dopamine- or serotonin-stimulated cyclic AMP formation. Chlorpromazine blocked the increase of cyclic AMP formation induced by noradrenaline, dopamine or serotonin, while cyproheptadine, a putative central serotonergic antagonist, was ineffective. These observations suggest that there may be at least two monoamine-sensitive adenylate cyclases in human cerebral cortex which have the characteristics of a beta-adrenergic and a dopaminergic receptor, respectively, and also possibly a serotonergic receptor.
    背景与目标: : 在人大脑皮层切片中去甲肾上腺素,异丙肾上腺素 (β-肾上腺素能激动剂),多巴胺,阿扑吗啡 (多巴胺能激动剂) 和5-羟色胺刺激的环状AMP形成: 去甲肾上腺素大于或等于异丙肾上腺素大于多巴胺 = 阿扑吗啡 = 5-羟色胺。可乐定 (和 α-肾上腺素能激动剂) 在刺激颞叶皮质切片中的环状AMP形成方面无效。去甲肾上腺素和异丙肾上腺素的刺激作用被普萘洛尔 (一种 β-肾上腺素能阻滞剂) 阻断,而酚妥拉明 (一种 α-肾上腺素能阻滞剂) 则不能。Pimozide (一种选择性多巴胺能拮抗剂) 抑制多巴胺或阿扑吗啡诱导的环AMP形成的增加,但不能抑制去甲肾上腺素,异丙肾上腺素或5-羟色胺诱导的环AMP形成。普萘洛尔或酚妥拉明均不会对多巴胺或5-羟色胺刺激的环状AMP形成产生任何影响。氯丙嗪阻止了由去甲肾上腺素,多巴胺或5-羟色胺引起的环状AMP形成的增加,而被认为是中枢5-羟色胺能拮抗剂的赛庚啶无效。这些观察结果表明,人大脑皮层中可能至少存在两种单胺敏感的腺苷酸环化酶,它们分别具有 β-肾上腺素能受体和多巴胺能受体的特征,也可能具有血清素能受体的特征。
  • 【3-羟基-3-甲基戊二酰辅酶a还原酶 (HMGCR) 途径通过异戊烯化依赖的信号通路调节发育性脑血管稳定性。】 复制标题 收藏 收藏
    DOI:10.1016/j.ydbio.2012.11.024 复制DOI
    作者列表:Eisa-Beygi S,Hatch G,Noble S,Ekker M,Moon TW
    BACKGROUND & AIMS: :Spontaneous intracranial hemorrhage is a debilitating form of stroke, often leading to death or permanent cognitive impairment. Many of the causative genes and the underlying mechanisms implicated in developmental cerebral-vascular malformations are unknown. Recent in vitro and in vivo studies in mice have shown inhibition of the 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) pathway to be effective in stabilizing cranial vessels. Using a combination of pharmacological and genetic approaches to specifically inhibit the HMGCR pathway in zebrafish (Danio rerio), we demonstrate a requirement for this metabolic pathway in developmental vascular stability. Here we report that inhibition of HMGCR function perturbs cerebral-vascular stability, resulting in progressive dilation of blood vessels, followed by vessel rupture, mimicking cerebral cavernous malformation (CCM)-like lesions in humans and murine models. The hemorrhages in the brain are rescued by prior exogenous supplementation with geranylgeranyl pyrophosphate (GGPP), a 20-carbon metabolite of the HMGCR pathway, required for the membrane localization and activation of Rho GTPases. Consistent with this observation, morpholino-induced depletion of the β-subunit of geranylgeranyltransferase I (GGTase I), an enzyme that facilitates the post-translational transfer of the GGPP moiety to the C-terminus of Rho family of GTPases, mimics the cerebral hemorrhaging induced by the pharmacological and genetic ablation of HMGCR. In embryos with cerebral hemorrhage, the endothelial-specific expression of cdc42, a Rho GTPase involved in the regulation of vascular permeability, was significantly reduced. Taken together, our data reveal a metabolic contribution to the stabilization of nascent cranial vessels, requiring protein geranylgeranylation acting downstream of the HMGCR pathway.
    背景与目标: 自发性颅内出血是中风的一种衰弱形式,通常导致死亡或永久性认知障碍。与发育性脑血管畸形有关的许多致病基因和潜在机制尚不清楚。最近在小鼠中进行的体外和体内研究表明,抑制3-羟基-3-甲基戊二酰-coa还原酶 (HMGCR) 途径可有效稳定颅骨血管。使用药理学和遗传学方法相结合的方法来特异性抑制斑马鱼 (Danio rerio) 中的HMGCR途径,我们证明了这种代谢途径在发育血管稳定性中的需求。在这里,我们报告了HMGCR功能的抑制会干扰脑血管的稳定性,导致血管进行性扩张,然后血管破裂,模仿人和鼠模型中的脑海绵状畸形 (CCM) 样病变。通过事先补充香叶基焦磷酸 (GGPP) (HMGCR途径的20碳代谢产物) 来挽救脑部出血,这是Rho GTPases膜定位和激活所必需的。与该观察结果一致,吗啉代诱导的香叶基转移酶I (GGTase I) 的 β 亚基耗竭,该酶促进了GGPP部分翻译后转移到Rho gtp酶家族的C末端,模拟了HMGCR的药理和遗传消融引起的脑出血。在脑出血的胚胎中,参与调节血管通透性的Rho GTPase cdc42的内皮特异性表达显着降低。总之,我们的数据揭示了对新生颅骨血管稳定的代谢贡献,需要在HMGCR途径下游起作用的蛋白质香叶基。
  • 【TNFSF4基因多态性rs3861950而非rs3850641与中国人群脑梗死风险相关。】 复制标题 收藏 收藏
    DOI:10.1007/s11239-012-0849-9 复制DOI
    作者列表:Feng J,Liu YH,Yang QD,Zhu ZH,Xia K,Tan XL,Xia J,Gu WP,Zhou L,Xiao B,Tang BS,Huang Q
    BACKGROUND & AIMS: :Tumor necrosis factor superfamily member 4 (TNFSF4) plays a key role in the process of atherosclerosis, a common risk factor for both myocardial and cerebral infarctions. Recent studies indicate that the single nucleotide polymorphism (SNP) rs3850641 in TNFSF4 is associated with higher risk of myocardial infarction, but little is known about the association between TNFSF4 variation and cerebral infarction (CI). A case-control study involving 385 CI patients and 385 age-matched, sex-matched non-CI controls was conducted in a Chinese population, only the most common subtype, atherosclerosis CI, was recruited. Two SNPs of TNFSF4, rs3850641 and rs3861950, were genotyped by the TaqMan SNP genotyping method, and verified partly by genomic DNA sequencing. The results revealed a significant allelic association between rs3861950 and CI (Odds ration = 1.733, 95 % confidence interval = 1.333-2.254, P = 0.000). Genotypic association analysis demonstrated that the CC genotype of rs3861950 confers susceptibility to CI (Odds ration = 2.896, 95 % confidence interval = 1.368-6.132), and it was associated with a significantly higher risk of ischemic stroke (Odds ration = 3.520, 95 % confidence interval = 1.546-8.015, P = 0.003) after adjusting for the other confirmed risk factors such as the history of hypertension, diabetes, CAD, smoking and alcohol drinking. While the odds ratio of the T allele to the C allele was 1.733 (95 % confidence interval: 1.333-2.254). However, there was no significant association between rs3850641 and CI (Odds ration = 1.288, 95 % confidence interval = 0.993-1.670, P = 0.056). TNFSF4 gene polymorphism rs3861950, but not rs3850641, is associated with the risk of atherosclerosis CI in a Chinese population.
    背景与目标: : 肿瘤坏死因子超家族成员4 (TNFSF4) 在动脉粥样硬化过程中起关键作用,动脉粥样硬化是心肌和脑梗塞的常见危险因素。最近的研究表明,TNFSF4中的单核苷酸多态性 (SNP) rs3850641与心肌梗死的高风险相关,但对TNFSF4变异与脑梗死 (CI) 之间的关系知之甚少。在中国人群中进行了385例CI患者和385年龄匹配,性别匹配的非CI对照的病例对照研究,仅招募了最常见的亚型动脉粥样硬化CI。TNFSF4的两个SNP,rs3850641和rs3861950,通过TaqMan SNP基因分型方法进行了基因分型,并通过基因组DNA测序进行了部分验证。结果显示rs3861950和CI之间存在显着的等位基因关联 (赔率 = 1.733,95% 置信区间 = 1.333-2.254,P = 0.000)。基因型关联分析表明,rs3861950的CC基因型赋予CI易感性 (赔率 = 2.896,95% 置信区间 = 1.368-6.132),并且与缺血性中风的风险显着增加相关 (赔率 = 3.520,95% 置信区间 = 1.546-8.015,P = 0.003) 在调整其他已确认的危险因素 (例如高血压,糖尿病,CAD,吸烟和饮酒史) 后。而T等位基因与C等位基因的比值比为1.733 (95% 置信区间: 1.333-2.254)。然而,rs3850641与CI之间没有显着关联 (赔率 = 1.288,95% 置信区间 = 0.993-1.670,P = 0.056)。TNFSF4基因多态性rs3861950 (而非rs3850641) 与中国人群动脉粥样硬化CI的风险相关。
  • 【“PICA交通动脉” 动脉瘤: 病例报告。】 复制标题 收藏 收藏
    DOI:10.1097/00006123-199112000-00024 复制DOI
    作者列表:Hlavin ML,Takaoka Y,Smith AS
    BACKGROUND & AIMS: :We present an unusual case of an aneurysm of the distal posterior inferior cerebellar artery (PICA). The aneurysm was associated with a unilateral PICA that supplied both cerebellar hemispheres and arose from an anastomotic vessel to the contralateral circulation, a branch of the contralateral PICA. Such an aneurysm has not been reported previously. The associated of vascular anomalies with aneurysms of the PICA is discussed.
    背景与目标: : 我们介绍了一个不寻常的小脑后下动脉 (PICA) 动脉瘤病例。动脉瘤与单侧PICA有关,该PICA提供了两个小脑半球,并从吻合血管出现到对侧PICA的分支对侧循环。这种动脉瘤以前没有报道过。讨论了血管异常与PICA动脉瘤的相关性。
  • 【全反式维甲酸 (维a酸) 治疗复发性脑胶质瘤。】 复制标题 收藏 收藏
    DOI:10.1023/a:1005743707803 复制DOI
    作者列表:Kaba SE,Kyritsis AP,Conrad C,Gleason MJ,Newman R,Levin VA,Yung WK
    BACKGROUND & AIMS: Malignant gliomas continue to be a significant source of mortality in young and middle aged adults. The introduction of new treatment strategies and multidisciplinary approaches has improved the outcome of patients with these tumors only slightly. Because retinoic acid has growth inhibitory activity against glioma and neuroblastoma cells in cultures, we assessed the efficacy of all-trans-retinoic acid in the treatment of recurrent cerebral gliomas. Thirty-six patients with recurrent cerebral gliomas were entered in the study and treated with 120 or 150 mg/ m2/day of all-trans-retinoic acid as a single agent. The drug was given for 3 weeks followed with one week of rest. Two blocks of 4 weeks constituted one course of treatment. One (3%) of 34 evaluable patients had a minor response and 14 (41%) had stable disease. In the rest of the patients (56%), tumors continued to progress despite treatment. The median time to progression of all evaluable patients was 8 weeks, and for the responders was 17 weeks. The higher dose level (150 mg/m2) was associated with high incidence of headache, which responded to dose reduction. The lower dose level was very well tolerated, with mild, mainly dermatological toxicity. All-trans-retinoic acid as a single agent has no significant activity against recurrent cerebral gliomas.

    背景与目标: 恶性神经胶质瘤仍然是中青年成年人死亡的重要来源。新的治疗策略和多学科方法的引入仅略微改善了这些肿瘤患者的预后。由于视黄酸对培养物中的神经胶质瘤和神经母细胞瘤细胞具有生长抑制活性,因此我们评估了全反式视黄酸在治疗复发性脑胶质瘤中的功效。36例复发性脑胶质瘤患者进入研究,并以120或150 mg/ m2/天的全反式维甲酸作为单一药物进行治疗。给药3周,然后休息一周。两个为期4周的块构成一个疗程。34名可评估患者中有1名 (3% 名) 反应轻微,14名 (41% 名) 疾病稳定。在其余患者 (56%) 中,尽管进行了治疗,但肿瘤仍在继续发展。所有可评估患者的中位进展时间为8周,应答者为17周。较高的剂量水平 (150 mg/m2) 与头痛的高发生率相关,头痛对剂量减少有反应。较低的剂量水平耐受性良好,具有轻度 (主要是皮肤病学毒性)。全反式维甲酸作为单一药物对复发性脑胶质瘤没有显着活性。
  • 【早产儿气管内吸痰过程中行为状态对脑氧合的影响。】 复制标题 收藏 收藏
    DOI:10.1055/s-2007-973682 复制DOI
    作者列表:Bernert G,von Siebenthal K,Seidl R,Vanhole C,Devlieger H,Casaer P
    BACKGROUND & AIMS: :Near infrared spectroscopy (NIRS) was used to investigate the effect of behavioural states on changes of oxygenated (O2Hb), deoxygenated haemoglobin (HHb) and total haemoglobin (tHb), during endotracheal suctioning. In an open prospective design, NIRS measurements have been done during 20 suctioning episodes in 13 preterm neonates. Heart rate, arterial oxygen saturation, and carbon dioxide tension were monitored continuously. Behavioural state (BS) observations were made and documented as well. The statistical analysis showed that in patients who were active, with crying periods during suctioning (behavioural states 4-5), changes of oxygenated (p < 0.005) and deoxygenated haemoglobin (p < 0.05), as well as of arterial oxygen saturation (p < 0.05) and heart rate (p < 0.05) were significantly greater than in patients who were quiet with predominant behavioural state 1, 2 and 3. These results underline the influence of behavioural states on the physiological answers to endotracheal suctioning. NIRS proved to be a valuable tool to evaluate possible harmful effects of different suctioning techniques.
    背景与目标: : 近红外光谱 (NIRS) 用于研究行为状态对气管内抽吸过程中含氧 (O2Hb),脱氧血红蛋白 (HHb) 和总血红蛋白 (tHb) 变化的影响。在开放的前瞻性设计中,已在13例早产新生儿的20次吸痰发作中进行了NIRS测量。连续监测心率,动脉血氧饱和度和二氧化碳张力。还进行了行为状态 (BS) 观察并记录在案。统计分析显示,在活动的患者中,在吸痰过程中有哭闹期 (行为状态4-5),氧合 (p < 0.005) 和脱氧血红蛋白 (p < 0.05) 的变化,动脉血氧饱和度 (p < 0.05) 和心率 (p < 0.05) 均显着高于以主要行为状态1、2和3安静的患者。这些结果强调了行为状态对气管内抽吸的生理答案的影响。事实证明,NIRS是评估不同抽吸技术可能产生的有害影响的宝贵工具。
  • 【在未成熟的绵羊胎儿中,与长期低氧血症相关的酸血症期间,脑氧输送减少。】 复制标题 收藏 收藏
    DOI:10.1159/000244440 复制DOI
    作者列表:McCrabb GJ,Harding R
    BACKGROUND & AIMS: Our aim was to determine the effects of 12 h of hypoxaemia on cerebral blood flow (CBF) and cerebral O2 delivery in ovine fetuses at 0.6 gestation. During fetal hypoxaemia, induced by reduced uterine blood flow, fetal SaO2 and PaO2 were reduced (p < 0.01) from control values of 77.0 +/- 1.6% and 27.3 +/- 1.0 mm Hg, respectively, to 28.4 +/- 3.4% and 15.6 +/- 0.6 mm Hg; fetal pHa decreased from control values of 7.37 +/- 0.01 to 7.20 +/- 0.02 at 3 h, but returned to control values before 12 h. CBF (ml/min/100 g) was 2.0- to 2.6-fold higher (p < 0.01) than control values during hypoxaemia, but only 1.7-fold higher (p < 0.01) at 3 h when pHa was lowest. Cerebral O2 delivery (ml/min/100 g) was lower (p < 0.01) than control values of 3.15 +/- 0.29 at 1.5h (2.09 +/- 0.36) and 3h (1.84 +/- 0.22) of hypoxaemia and higher 1 h after hypoxaemia had ceased (3.81 +/- 0.22, p < 0.01). We conclude that the ovine fetus at 0.6 gestation is unable to sustain increased CBF and hence maintain cerebral O2 delivery during the first 6 h of hypoxaemia, a time which coincides with acidaemia; in contrast, at 6 and 12 h of hypoxaemia, when pHa was normal, cerebral O2 delivery was similar to control values. Reduced cerebral O2 delivery during the early, acidaemic, stages of hypoxaemia may lead to impaired neural development.

    背景与目标: 我们的目的是确定12小时低氧血症对0.6妊娠的绵羊胎儿脑血流量 (CBF) 和脑O2输送的影响。在胎儿低氧血症期间,由子宫血流量减少引起的胎儿SaO2和PaO2从77.0 +/- 1.6% 和27.3 +/-1.0毫米Hg的对照值分别降低到28.4 +/- 3.4% 和15.6 +/-0.6毫米Hg (p <0.01); 胎儿pHa在3小时从7.37 +/- 0.01的对照值降至7.20 +/- 0.02,但在12小时前恢复到对照值。在低氧血症期间,CBF (ml/min/100g) 比对照值高2.0至2.6倍 (p <0.01),但在3小时pHa最低时仅高1.7倍 (p <0.01)。低氧血症1.5小时 (2.09 +/- 0.36) 和3小时 (1.84 +/- 0.22) 时,脑O2递送 (ml/min/100g) 低于3.15 +/- 0.29的对照值 (p <0.01),低氧血症停止后1小时更高 (3.81 +/- 0.22,p <0.01)。我们得出的结论是,0.6妊娠的绵羊胎儿无法维持CBF的增加,因此在低氧血症的前6小时 (与酸血症相吻合) 中维持脑O2的输送; 相反,在低氧血症的6和12小时,当pHa正常时,脑O2输送与对照值相似。低氧血症的早期,酸血症阶段的脑O2输送减少可能导致神经发育受损。
  • 【哌替啶和阿芬太尼在清醒绵羊中的脑药代动力学。】 复制标题 收藏 收藏
    DOI:10.1097/00000542-199706000-00013 复制DOI
    作者列表:Upton RN,Ludbrook GL,Gray EC,Grant C
    BACKGROUND & AIMS: BACKGROUND:Different opioids have different delays (hysteresis) between their concentrations in blood and their cerebral effects. Possible mechanisms include differences in their rate of penetration into the brain and differences in their distribution volume in the brain. There have been few in vivo studies of the cerebral kinetics of opioids to differentiate these mechanisms.

    METHODS:The cerebral kinetics of meperidine and alfentanil were examined using conscious sheep that were fitted with long-term monitoring equipment to measure relative changes in cerebral blood flow and opioid concentration gradients across the brain through frequent sampling of arterial and sagittal sinus blood. The data were compared using hybrid physiologic modeling with membrane-limited (consistent with mechanism 1) and flow-limited (consistent with mechanism 2) models of cerebral kinetics.

    RESULTS:Alfentanil had a variable effect on relative cerebral blood flow, whereas meperidine induced a transient increase. The arteriovenous concentration gradients were small after alfentanil but large after meperidine. The flow-limited model gave acceptable descriptions of observed sagittal sinus concentrations for alfentanil and meperidine, whereas the membrane-limited model collapsed to a flow-limited model. The half-lives of equilibrium between blood and brain were 6.3 and 0.8 min for meperidine and alfentanil, respectively:

    CONCLUSIONS:The rate of penetration of both opioids into the brain was rapid and not rate-limiting. Large differences in the cerebral distribution volume of meperidine and alfentanil accounted for the respective delays in their peak brain concentration relative to blood.

    背景与目标: 背景 : 不同的阿片类药物在血液中的浓度与大脑作用之间具有不同的延迟 (滞后)。可能的机制包括它们渗透到大脑的速率的差异以及它们在大脑中的分布体积的差异。关于阿片类药物的脑动力学的体内研究很少,可以区分这些机制。
    方法 : 使用配备了长期监测设备的有意识的绵羊检查了哌替啶和阿芬太尼的脑动力学,以通过频繁采样动脉和矢状窦血来测量整个大脑中脑血流量和阿片类药物浓度梯度的相对变化。使用混合生理模型与脑动力学的膜受限模型 (与机制1一致) 和流量受限模型 (与机制2一致) 进行数据比较。
    结果 : 阿芬太尼对相对脑血流量有不同的影响,而哌替啶诱导了短暂的增加。阿芬太尼后动静脉浓度梯度较小,而哌替啶后动静脉浓度梯度较大。限流模型对观察到的阿芬太尼和哌替啶的矢状窦浓度给出了可接受的描述,而膜限流模型崩溃为限流模型。对于哌替啶和阿芬太尼,血液和大脑之间的平衡半衰期分别为6.3和0.8分钟:
    结论 : 两种阿片类药物进入大脑的速率是快速的,而不是限速。哌替啶和阿芬太尼的脑分布体积差异很大,导致其峰值脑浓度相对于血液的延迟。
  • 【[自发性双侧VA夹层动脉瘤伴SAH的病例]。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Nishimu YA,Ikeda A,Sugita R,Maeda K,Nakamua S,Takerroto M,Shibuya M
    BACKGROUND & AIMS: :We report a case of bilateral vertebral artery (VA) dissecting aneurysm presenting subarachnoid hemorrhage (SAH). It was difficult to decide which side was responsible for SAH because the patient's symptom and head CT suggested that the left VA aneurysm had ruptured, but angiography and MRA showed an irregular pearl and string sign on the right side. He was successfully treated by trapping of the right VA dissecting aneurysm and we confirmed by intraoperative evaluation that the right VA dissecting aneurysm had ruptured. The left unruptured aneurysm decreased its size spontaneously. In the treatment of the bilateral VA dissecting aneurysms, angiography needs to be performed over and over again because contralateral unruptured aneurysm may grow or rupture due to increased hemodynamic stress. Various combinations of direct sugery with or without arterial reconstruction and endovascular treatment should be considered when treating bilateral VA dissecting aneurysms.
    背景与目标: : 我们报告一例双侧椎动脉 (VA) 夹层动脉瘤,表现为蛛网膜下腔出血 (SAH)。由于患者的症状和头部CT提示左VA动脉瘤破裂,因此很难确定是哪一侧引起SAH的原因,但是血管造影和MRA在右侧显示不规则的珍珠和弦征。通过捕获右VA夹层动脉瘤成功治疗了他,我们通过术中评估确认右VA夹层动脉瘤破裂。左未破裂的动脉瘤会自发减小其大小。在双侧VA夹层动脉瘤的治疗中,由于血流动力学压力增加,对侧未破裂的动脉瘤可能会生长或破裂,因此需要一遍又一遍地进行血管造影。在治疗双侧VA夹层动脉瘤时,应考虑直接切除有或没有动脉重建以及血管内治疗的各种组合。
  • 【MRI上睡眠呼吸障碍和大脑变化的关联。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Robbins J,Redline S,Ervin A,Walsleben JA,Ding J,Nieto FJ
    BACKGROUND & AIMS: STUDY OBJECTIVES:Population-based studies have demonstrated associations between sleep-disordered breathing (SDB), hypertension, and cardiovascular disease; few large-scale studies have examined associations of SDB with objective measures of cerebrovascular disease. This study tested the significance of associations of SDB with evidence of brain injury or ischemia determined by cerebral magnetic resonance imaging (MRI) studies. DESIGN:Cross-sectional and longitudinal analyses in a nested sample of Cardiovascular Health Study participants in the Sleep Heart Health Study. PARTICIPANTS:The 843 individuals (mean age 77, SD 4.3 years, 58% women) who had MRI studies as part of the Cardiovascular Health Study before and after polysomnography obtained as part of the Sleep Heart Health Study. MEASUREMENTS:A 12-channel polysomnogram was used to derive indexes of sleep-disordered breathing. Repeated MRI measurements provided indexes of infarct (presence and size) and white matter disease. Logistic regression analyses were used to model MRI changes of infarct-like lesions and white matter disease as a function of age, baseline white matter grade, and indexes of central and obstructive sleep-disordered breathing. RESULTS:Individuals who showed progression in white matter disease compared to those who did not were significantly more likely to show a Cheyne-Stokes respiration pattern and to have an increased number of central but not obstructive apneas. CONCLUSIONS:An association between change in white matter grade and measures of central sleep apnea was demonstrated that was consistent with a causal pathway in which central sleep apnea contributes to the progression of white matter disease; alternatively, central sleep apnea may be a marker of subclinical cerebrovascular or cardiovascular disease.
    背景与目标:

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