The survival of microglia depends on the colony-stimulating factor-1 receptor (CSF1R) signaling pathway under physiological conditions. Ki20227 is a highly selective CSF1R inhibitor that has been shown to change the morphology of microglia. However, the effects of Ki20227 on the progression of ischemic stroke are unclear. In this study, male C57BL/6 mouse models of focal cerebral ischemic injury were established through the occlusion of the middle cerebral artery and then administered 3 mg/g Ki20227 for 3 successive days. The results revealed that the number of ionized calcium-binding adaptor molecule 1/bromodeoxyuridine double positive cells in the infarct tissue was reduced, the degree of edema was increased, neurological deficits were aggravated, infarct volume was increased, and the number of peri-infarct Nissl bodies was reduced. The number of terminal deoxynucleotidyl transferase dUTP nick-end labeling-positive cells in the peri-infarct tissue was increased. The expression levels of Bax and Cleaved caspase-3 were up-regulated. Bcl-2 expression was downregulated. The expression levels of inflammatory factors and oxidative stress-associated factors were increased. These findings suggested that Ki20227 blocked microglial proliferation and aggravated the pathological progression of ischemia/reperfusion injury in a transient middle cerebral artery occlusion model. This study was approved by the Animal Ethics Committee of Lanzhou University Second Hospital (approval No. D2020-68) on March 6, 2020.

Traumatic brain injury (TBI) is still the leading cause of mortality and morbidity in young adults worldwide. As a non-invasive continuous monitoring technology, brain near-infrared spectroscopy (NIRS) is mainly used in the field of TBI for non-invasive and continuous monitoring of brain tissue oxygenation, but the reliability of related technologies is still uncertain. This article reviews the relevant literature on the application of NIRS in TBI, and discusses whether NIRS can replace the invasive cerebral oxygen monitoring technology, as well as the research progress in monitoring intracranial hematoma, mild TBI and cerebral vascular autoregulation function.

目的 探讨重度脑外伤(sTBI)后,动态监测局部脑氧饱和度(SctO2)的临床意义.方法 2017年12月至2019年1月,sTBI后24 h内患者33例,采用近红外光谱技术每6小时监测SctO2、颅内压(ICP)和脑灌注压(CPP),共7d,记录入院时格拉斯哥昏迷评分(GCS)和伤后6个月格拉斯哥预后评分(GOS).结果 SctO2于监测第3天最低,随后逐渐升高;SctO2与ICP呈负相关(r＜-0.857,P＜ 0.001),与GCS、CPP、GOS呈正相关(r＞0.697,P＜0.001).结论 sTBI后SctO2监测可早期识别部分继发性损伤,判断疾病严重程度,并部分预测疾病结局.

OBJECTIVE:To explore the clinical significance of dynamic monitoring of cerebrospinal fluid (CSF) and serum Lactic acid（Lac), neuron-specific enolase (NSE), and the blood-brain barrier (BBB) index in evaluating the condition and prognosis after a severe traumatic brain injury (TBI). METHODS:A total of 52 severe TBI patients admitted to the Department of Neurosurgery within 24 hours after injury were dynamically monitored. CSF and serum samples were collected on the 1st, 3rd, and 7th day after a severe TBI to monitor the changes in Lac, NSE, and the BBB index. Intracranial pressure (ICP), Glasgow coma scale (GCS), and 6-month Glasgow outcome scale-extended (GOS-E) were tested. According to the results of GOS-E, the patients were divided into two groups (i.e. the poor prognosis group and good prognosis group). Statistical analysis was conducted to investigate the clinical significance of dynamic monitoring of CSF and serum Lac, NSE, and BBB index after a severe TBI. RESULTS:After a severe TBI, the levels of Lac, NSE, and BBB in CSF and serum were significantly higher than those in the normal range. Lac, NSE, and the BBB index did not correlate with ICP (except serum Lac) but had correlations with GCS and post-injury 6 months post-injury (except serum Lac). Moreover, the correlations between Lac, NSE, and BBB index were statistically significant (p < 0.05): CSF Lac and CSF NSE; CSF Lac and serum NSE; Lac and BBB index of CSF; Lac and BBB index of CSF; NSE and CSE of serum; CSF NSE and BBB index; and serum NSE and BBB index. Additionally, serum NSE is correlated with NSE in CSF (p < 0.05). CONCLUSION:After a severe TBI, dynamic monitoring of CSF and serum Lac, NSE, and BBB index has the potential to assess the condition, predict the prognosis, and have clinical significance.

壳聚糖季铵盐是壳聚糖的衍生物,不但拥有季铵盐的抗菌、抑菌、保湿性,还保留了壳聚糖的降解性及生物相容性,被广泛应用于各领域.将壳聚糖季铵盐引入生物材料中可有效提高生物材料抗菌等性能.本文将对壳聚糖季铵盐在骨组织工程支架材料、医用钛合金及生物载体近几年的研究做一综述,以期为壳聚糖季铵盐在生物材料中的应用提供参考.

目的 探讨Helsinki CT评分和Stockholm CT评分对中、重型颅脑损伤(TBI)预后的预测能力.方法 回顾性分析2017年9月至2018年9月收治的51例中、重型TBI的临床资料.选取人院后72 h内或术前最差的头颅CT影像进行Stockholm和Helsinki评分.伤后3个月按GOS评分评估预后,使用受试者工作特征(ROC)曲线确定两个CT评分的预测预后的能力.结果 伤后3个月,GOS评分5分13例,4分12例,3分5例,2分1例,1分20例;预后良好25例,预后不良26例;病死率为39.2％ (20/51).预后不良组Helsinki CT评分和Stockholm CT评分较预后良好组均明显增高(P＜0.05).根据ROC曲线分析结果,Helsinki CT评分曲线下面积(AUC)为0.922(95％置信区间0.848～0.996;P＜0.001),以Helsinki CT评分=7.5分判断预后不良的敏感性为73.1％,特异性为100.0％;Stockholm CT评分AUC为0.905(95％置信区间0.826～0.985;P＜0.001),Stockholm CT评分=1.75分判断预后不良的敏感性为84.6％,特异性为84.0％.结论 HelsinkiCT和Stockholm CT评分都能很好地预测中、重型TBI的近期预后,两种评分系统的预测性能相当.

The clinical monitoring methods of severe traumatic brain injury (sTBI) are mainly physical examination and imaging examination, but these methods can not quickly and effectively diagnose and monitor the pathophysiological process of sTBI. Transcranial Doppler ultrasound (TCD) can measure the blood flow status of the great cerebral artery in a noninvasive and real-time manner, obtain the information of cerebral hemodynamics, and monitor the degree of cerebral stenosis and spasm, identify brain death and evaluate intracranial pressure by analyzing the velocity and direction of cerebral blood flow, the function of vascular self-regulation and the change of distal vascular resistance. This article focuses on the clinical application of TCD in sTBI treatment. Key words: Severe traumatic brain injury; Transcranial Doppler ultrasound; Intracranial pressure; Brain death