Sleep-related hypoxemia aggravates systematic inflammation in emphysematous rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sleep disturbance is common in patients with emphysema. This study aimed to develop a novel model of sleep-related hypoxemia (SRH) in emphysema (SRHIE) with rats, and to explore the inflammatory status of SRHIE in lung, liver, pancreas, carotid artery and whole blood.</p><p><b>METHODS</b>Seventy-five male Wistar rats were assigned to 5 groups with 15 per group according to the exposure conditions. The protocols varied with the degree of hypoxia exposure and severity of pre-existing emphysema caused by cigarette smoke exposure: (1) SRH control (SRHCtrl) group, sham smoke exposure (smoke exposure, exposed to smoke of 15 cigarettes twice everyday, 16 weeks) and SRH exposure (12.5% O2, 3 hours, SRH exposure, divide total hypoxia time (1.5 hours or 3 hours) into 4 periods evenly (22.5 minutes or 45 minutes) and distribute these hypoxia periods evenly into physiological sleep time of rats identified by electroencephalogram, week 9 to week 16); (2) Emphysema control (ECtrl) group, smoke exposure and sham SRH exposure (21% O2, 3 hours); (3) Short SRH in emphysema (SRHShort) group, smoke exposure and short SRH exposure (12.5% O2, 1.5 hours); (4) Mild SRH in emphysema (SRHMild) group, smoke exposure and mild SRH exposure (15% O2, 3 hours); (5) Standard SRH in emphysema (SRHStand) group, smoke exposure and SRH exposure (12.5% O2, 3 hours). ECtrl, SRHShort, SRHMild and SRHStand groups were groups with emphysematous rats. Two days before the end of exposure, 5 rats in each group were randomly selected for arterial blood gas analysis. In the rest 10 rats in each group, we obtained blood samples and bronchoalveolar lavage fluid (BALF) for routine tests. We also obtained tissue blocks of lung, liver, pancreas, and right carotid artery for pathologic scoring and measurements of liver oxidative stress (measuring hepatic oxidative stress enzymes, superoxide dismutase (SOD) activity, catalase (CAT) activity and malondialdehyde (MDA) concentration).</p><p><b>RESULTS</b>Emphysematous groups had higher mean linear intercept (MLI) and mean alveolar number (MAN) values than SRHCtrl group. MLI values in SRHStand group were the highest (all P < 0.05). O2Sat in SRHStand rats when SRH exposure was (83.45 ± 1.76)%. Histological scores of lung, liver, pancreas and right carotid artery were higher in emphysematous groups than SRHCtrl group, and SRHStand group were the highest (all P < 0.05) (SOD and CAT values were lower and MDA values were higher in groups with emphysema than without and in SRHStand group than in ECtrl group (all P < 0.05)). MDA values were the highest in SRHStand group (all P < 0.05). Total cellular score in BALF and White blood cell (WBC) in whole blood were the highest in SRHStand group (all P < 0.05). Lymphocyte ratios were the highest in SRHStand group both in BALF and blood (all P < 0.05). Red blood cell (RBC) and hemoglobin in emphysematous groups were higher than that in SRHCtrl group, and SRHStand group were higher than ECtrl group (all P < 0.05).</p><p><b>CONCLUSIONS</b>With a proper novo model of SRHIE with Wistar rats, we have demonstrated SRH may aggravate the degree of emphysematous changes, polycythemia, oxidative stress and systematic inflammation. SRH and emphysema may have a synergistic action in causing systematic damages, and lymphocyte may be playing a central role in this process. Longer duration and more severe extent of SRHIE exposure also seem to result in more serious systematic damages. The mechanisms of all these concerned processes remain to be studied.</p>

Study on hypersynchronous discharge based on the cross-correlation analysis of EEG phases of temporal lobe epilepsy / 中华神经医学杂志

Objective To study the bilateral temporal EEG phases of the temporal lobe epilepsy (TLE) patients to support that the hypersynchronous discharge is one of the causes of seizure.Methods Thirty human subjects participated in the study.TLE group(n=20)were TLE patients with left epileptogenic focus.Control group(n=10)were healthy Volunteers.Bilateral temporal EEGs were recorded with MR-95 Recorder(Oxford Company).Four Ag/Agcl electrodes were placed bilaterally on the subject's temporal areas, the distance of any adjacent electrodes was 20 mm. The phases of these EEGs were extracted with Hilbert transform. We compared cross-correlation coefficients of all subjects.Statistical analysis was carried out with SPSS 10.0. Results The statistical analysis of the mean EEG phases cross-correlation coefficients between adjacent recording electrodes showed that there was significant difference in the left and right temporal areas between the TLE group and the control group (P＜0.01,P＜0.05),and also significant difference between left(epileptic focus)and right(non-focus)temporal areas in the TLE group (P＜0.05),while there was no significant difference between left and right temporal areas in the control group.Maximum phases cross-correlation coefficients were situated at adjacent recording electrodes in the control group, while 37.5% were separated in the TLE group.Conclusions There were the occurrences of hypersynchronous discharge in the epileptic focus and inferior hypersynchronous discharge in the non-focus.

Stereotactic combined amygdala and hippocampus lesions for treatment of medial temporal lobe epilepsy / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the techniques of stereotactic combined amygdalohippocampotomy for management of medial temporal lobe epilepsy (MTLE).</p><p><b>METHODS</b>The Leksell stereotactic frame was used for all cases, and which almost paralleled the long axis of hippocampus. Stereotactic amygdalohippocampotomy was performed in 23 patients with unilateral medial temporal lobe seizures by using magnetic resonance imaging (MRI) localization for target planning, depth electrode for the electroencephalogram (EEG) monitoring and radiofrequency techniques for lesion production. All procedures were completed under local anesthesia.</p><p><b>RESULTS</b>Pre-lesion spikes or polyspike-waves complex were recorded by a depth electrode in the amygdala and hippocampus region in all patients, and the epileptiform discharges disappeared after the amygdalohippocampotomy. The MRI appearance of the lesion areas after 1 - 2 weeks surgical operation showed that mutiple areas of coagulation necrosis corresponding to the lesion sites were surrounded by zones of edema. Twenty-three patients were followed-up to 8 - 32 months with seizure free 43.48% (10/23), and the general efficiency (seizure reduction >or= 50%) was 91.30% (21/23 cases).</p><p><b>CONCLUSIONS</b>Stereotactic combined lesions of unilateral amygdala and hippocampus for minimally invasive treatment of MTLE is safe and effective, and it is worth to spread in clinical application.</p>