To study the kinematics of flow rate and ventricular dilatation,an analytical perturbation approach of hydrocephalus has been devised.This research provides a comprehensive investigation of the characteristics of cere...To study the kinematics of flow rate and ventricular dilatation,an analytical perturbation approach of hydrocephalus has been devised.This research provides a comprehensive investigation of the characteristics of cerebrospinal fluid(CSF)flow and pressure in a hydrocephalic patient.The influence of hydrocephalic CSF,flowing rotationally with realistic dynamical characteristics on pulsatile boundaries of subarachnoid space,was demonstrated using a nonlinear controlling system of CSF.An analytical perturbation method of hydrocephalus has been developed to investigate the biomechanics of fluid flow rate and the ventricular enlargement.In this paper presents a detailed analysis of CSF flow and pressure dynamics in a hydrocephalic patient.It was elaborated with a nonlinear governing model of CSF to show the influence of hydrocephalic CSF,flowing rotationally with realistic dynamical behaviors on pulsatile boundaries of subarachnoid space.In accordance with the suggested model,the elasticity factor changes depending on how much a porous layer,in this case the brain parenchyma,is stretched.It was improved to include the relaxation of internal mechanical stresses for various perturbation orders,modelling the potential plasticity of brain tissue.The initial geometry that was utilised to create the framework of CSF with pathological disease hydrocephalus and indeed the output of simulations using this model were compared to the actual progression of ventricular dimensions and shapes in patients.According to this observation,the non-linear and elastic mechanical phenomena incorporated into the current model are probably true.Further modelling of ventricular dilation at a normal pressure may benefit from the existence of a valid model whose parameters approximate genuine mechanical characteristics of the cerebral cortex.展开更多
BACKGROUND Spontaneous cerebrospinal fluid(CSF)leaks associated with cervical spondylosis are rare.To our knowledge,only a few cases have been reported in which treatment is challenging and varies from case to case.He...BACKGROUND Spontaneous cerebrospinal fluid(CSF)leaks associated with cervical spondylosis are rare.To our knowledge,only a few cases have been reported in which treatment is challenging and varies from case to case.Here,we review the literature and describe the surgical treatment of a 70-year-old woman who presented with a CSF leak due to a cervical spine spur.CASE SUMMARY A 70-year-old female patient who was treated for a cerebral infarction,presented with complains of weakness in the right lower extremity and a feeling of stepping on cotton.The patient underwent regular neck massage and presented with neck and right shoulder pain radiating to the right upper extremity one-month ago.Magnetic resonance imaging showed a strip of leaking cerebrospinal fluid posterior to the C1-4 vertebrae,and computed tomography showed a“sickleshaped”disc prolapse with calcification in C4/5.We chose to perform an anterior cervical discectomy.When the prolapsed C4/5 disc was scraped,clear fluid leakage was observed,and exploration revealed a 1 mm diameter rupture in the anterior aspect of the dura mater,which was compressed continuously with cotton patties,with no significant cerebrospinal fluid leakage after 1 h.CONCLUSION Three months after surgery,the patient was asymptomatic and follow-up imaging demonstrated complete resolution.展开更多
Medulloblastoma(MB)is the most common childhood embryonal malignant tumour in the central nervous system.The diagnosis,prognosis and therapeutic targets of MB depend on the molecular characteristics of the tumor,and i...Medulloblastoma(MB)is the most common childhood embryonal malignant tumour in the central nervous system.The diagnosis,prognosis and therapeutic targets of MB depend on the molecular characteristics of the tumor,and it is a great challenge to obtain the tissue samples from the patients with brain tumor.Genomic changes found in cell-free DNA(cfDNA)of cerebrospinal fluid(CSF)can predict genomic changes present in tumor tissue,fluid biopsy of CSF can detect the genomic profile of tumor-associated cfDNA and evaluate cfDNA as a marker of measurable residual disease(MRD)in a relatively noninvasive manner,which provides the evidence of"individualized precision therapy"for MB patients.In this paper,we reviewed the recent studies in medulloblastoma based on cfDNA Liquid Biopsy of CSF.展开更多
BACKGROUND Meningitis is a life-threatening clinical condition associated with high mortality and morbidity.Early diagnosis and specific treatment may improve outcomes.Lack of specific clinical signs or tests make the...BACKGROUND Meningitis is a life-threatening clinical condition associated with high mortality and morbidity.Early diagnosis and specific treatment may improve outcomes.Lack of specific clinical signs or tests make the diagnosis challenging.AIM To assess the efficacy of cerebrospinal fluid(CSF)lactate in diagnosing meningitis in critically ill patients.METHODS A prospective,observational cohort study was carried out in a neuro-medical intensive care unit(ICU)over a 22 mo period.Adult patients,with suspected meningitis admitted in ICU,were serially recruited.Patients who refused consent,those with peripheral sensorineural deficit,or with any contraindication to lumber puncture were excluded.CSF cytology,bio-chemistry,lactates,culture and polymerase chain reaction based meningo-encephalitis panel were evaluated.Patients were divided in two groups based on clinical diagnosis of meningitis.The efficacy of CSF lactate in diagnosing meningitis was evaluated and compared with other tests.RESULTS Seventy-one patients were included and 23 were diagnosed with meningitis.The mean values of CSF total leucocyte count(TLC),proteins and lactates were significantly higher in meningitis group.There was a significant correlation of CSF lactate levels with CSF cultures and meningo-encephalitis panel.CSF lactate(>2.72 mmol/L)showed good accuracy in diagnosing meningitis with an area under the curve of 0.81(95% confidence interval:0.69-0.93),sensitivity of 82.6%,and specificity 72.9%.These values were comparable to those of CSF TLC and protein.Twelve patients with bacterial meningitis had significantly higher CSF lactate(8.9±4.7 mmol/L)than those with non-bacterial meningitis(4.2±3.8 mmol/L),P=0.006.CONCLUSION CSF lactate may be used to aid in our diagnosis of meningitis in ICU patients.CSF lactate(>2.72 mmol/L)showed good accuracy,sensitivity,and specificity in diagnosing meningitis and may also help to differentiate between bacterial and non-bacterial meningitis.展开更多
An abdominal cerebrospinal fluid pseudocyst is a rare complication of ventriculoperitoneal shunt. Several theories have been suggested to explain its occurrence. The main symptoms are painful abdominal distension and ...An abdominal cerebrospinal fluid pseudocyst is a rare complication of ventriculoperitoneal shunt. Several theories have been suggested to explain its occurrence. The main symptoms are painful abdominal distension and vomiting, abdominal distension on examination, as abdominal ultrasound and computed tomography confirm its diagnosis. The treatment involves drainage associated with drain relocation and resection of the pseudocyst’s wall. We report two patients diagnosed with this condition who underwent surgical treatment. The first patient had an unremarkable 12-month follow-up, while the second died on the seventh postoperative day due to intravascular disseminated coagulation. In these patients, the cause has not been identified;however, an infection cannot be ruled out.展开更多
BACKGROUND Ventriculoperitoneal(VP)shunt placement has become a standard of care procedure in managing hydrocephalus for drainage and absorption of cerebrospinal fluid(CSF)into the peritoneum.Abdominal pseudocysts con...BACKGROUND Ventriculoperitoneal(VP)shunt placement has become a standard of care procedure in managing hydrocephalus for drainage and absorption of cerebrospinal fluid(CSF)into the peritoneum.Abdominal pseudocysts containing CSF are the common long-term complication of this frequently performed procedure,mainly because VP shunts have significantly prolonged survival.Of these,liver CSF pseudocysts are rare entities that may cause shunt dysfunction,affect normal organ function,and therefore pose therapeutic challenges.CASE SUMMARY A 49-year-old man with history of congenital hydrocephalus status post bilateral VP shunt placement presented with progressively worsening dyspnea on exertion,abdominal discomfort/distention.Abdominal computed tomography(CT)scan revealed a large CSF pseudocyst in the right hepatic lobe with the tip of VP shunt catheter into the hepatic cyst cavity.Patient underwent robotic laparoscopic cyst fenestration with a partial hepatectomy,and repositioning of VP shunt catheter to the right lower quadrant of the abdomen.Follow-up CT demonstrated a significant reduction in hepatic CSF pseudocyst.CONCLUSION A high index of clinical suspicion is required for early detection of liver CSF pseudocysts since their presentation is often asymptomatic and cunning early in the course.Late-stage liver CSF pseudocysts could have adverse outcomes on the treatment course of hydrocephalus as well as on hepatobiliary dysfunction.There is paucity of data to define the management of liver CSF pseudocyst in current guidelines due to rare nature of this entity.The reported occurrences have been managed by laparotomy with debridement,paracentesis,radiological imaging guided fluid aspiration and laparoscopic-associated cyst fenestration.Robotic surgery is an additional minimally invasive option in the management of hepatic CSF pseudocyst;however,its use is limited by lack of widespread availability and cost of surgery.展开更多
Cognitive impairment is a common clinical manifestation of multiple sclerosis,but its pathophysiology is not completely understood.White and grey matter injury together with synaptic dysfunction do play a role.The mea...Cognitive impairment is a common clinical manifestation of multiple sclerosis,but its pathophysiology is not completely understood.White and grey matter injury together with synaptic dysfunction do play a role.The measurement of biomarkers in the cerebrospinal fluid and the study of their association with cognitive impairment may provide interesting in vivo evidence of the biological mechanisms underlying multiple sclerosis-related cognitive impairment.So far,only a few studies on this topic have been published,giving interesting results that deserve further investigation.Cerebrospinal fluid biomarkers of different pathophysiological mechanisms seem to reflect different neuropsychological patterns of cognitive deficits in multiple sclerosis.The aim of this review is to discuss the studies that have correlated cerebrospinal fluid markers of immune,glial and neuronal pathology with cognitive impairment in multiple sclerosis.Although preliminary,these findings suggest that cerebrospinal fluid biomarkers show some correlation with cognitive performance in multiple sclerosis,thus providing interesting insights into the mechanisms underlying the involvement of specific cognitive domains.展开更多
BACKGROUND Bacterial meningitis(BM)is a common central nervous system inflammatory disease.BM may cause serious complications,and early diagnosis is essential to improve the prognosis of affected patients.CASE SUMMARY...BACKGROUND Bacterial meningitis(BM)is a common central nervous system inflammatory disease.BM may cause serious complications,and early diagnosis is essential to improve the prognosis of affected patients.CASE SUMMARY A 37-year-old man was hospitalized with purulent meningitis because of worsening headache for 12 h,accompanied by vomiting,fever,and rhinorrhea.Head computed tomography showed a lesion in the left frontal lobe.Infectious disease screening showed positivity for hepatitis B surface antigen,hepatitis B e antigen,and hepatitis B core antigen.Cerebrospinal fluid(CSF)leak was suspected based on clinical history.Streptococcus pneumoniae(S.pneumoniae)was detected in CSF by metagenomic next-generation sequencing(mNGS)technology,confirming the diagnosis of purulent BM.After treatment,multiplex PCR indicated the presence of hepatitis B virus(HBV)DNA and absence of S.pneumoniae DNA in CSF samples.CONCLUSION We report a rare case of HBV in the CSF of a patient with purulent BM.Multiplex PCR is more sensitive than mNGS for detecting HBV DNA.展开更多
Adult neurogenesis is the life-long process of neural stem cell proliferation,differentiation into neurons,migration,and incorporation into the existing neuronal circuits.After decades of research,it is now widely acc...Adult neurogenesis is the life-long process of neural stem cell proliferation,differentiation into neurons,migration,and incorporation into the existing neuronal circuits.After decades of research,it is now widely accepted that mammals and birds retain the capacity to regenerate neurons even after their subadult ontogeny.Cerebrospinal fluid participates in the regulation of the neurogenic niches of the vertebrate brain through signaling pathways not fully elucidated.Proteomic studies of cerebrospinal fluid have the potential to allow the in-depth characterization of its molecular composition.Comparative studies help to delineate those pathways that are universally critical for the regulation of neurogenesis in adulthood.In this review,we performed literature-based data mining in studies using liquid chromatography-tandem mass spectroscopy that analyzed cerebrospinal fluid samples from healthy adult humans(Homo sapiens);mice(Mus musculus);sheep(Ovis aries);chickens(Gallus gallus);and two parrot species,the budgerigar(Melopsittacus undulatus)and cockatiel(Nymphicus hollandicus).We identified up to 911 proteins represented in cerebrospinal fluid,involved in various pathways regulating adult neurogenesis.However,only 196 proteins were common across humans,mice,and birds.Pathway components involved in nervous system development,cell migration,and axonal guidance were commonly evident in all species investigated so far.Extensive bioinformatic analysis revealed that the universally over-represented pathways involved L1 cell adhesion molecule protein interactions,cell-adhesion molecules,signals regulating extracellular matrix remodeling,regulation of insulin growth factor signaling,axonal guidance,programmed cell death,immune signaling,and post-translational modifications.Most of the reported proteins are part of extracellular vesicles enriched in cerebrospinal fluid.However,the information presently available is still highly fragmentary,and far more questions persist than are answered.Technological advances will allow cerebrospinal fluid comparative proteomic research to delve into the fundamental processes of adult neurogenesis and eventually translate this research into any regenerative interventions.展开更多
Inflammation and coagulation are tightly interconnected in the pathophysiology of neuronal diseases.Thrombin,a pro-coagulant serine protease is associated with neurodegeneration and its indirect inhibitor,activated pr...Inflammation and coagulation are tightly interconnected in the pathophysiology of neuronal diseases.Thrombin,a pro-coagulant serine protease is associated with neurodegeneration and its indirect inhibitor,activated protein C(aPC),is considered neuroprotective.While levels of thrombin and aPC activity are readily measured in the blood,similar assays in the cerebrospinal fluid(CSF)have not been described.The aim of this study was to establish a specific and sensitive enzymatic assay to measure both thrombin and aPC activity in the CSF.CSF was collected from 14 patients with suspected normal pressure hydrocephalus served as a control group,while seven patients with central nervous system infections served as an acute neuro-inflammatory study group and one sample of CSF following traumatic lumbar puncture served as a positive control.Thrombin and aPC activities were measured by fluorescence released by specific proteolytic cleavage in the presence of endopeptidase and amino-peptidase inhibitors to ensure specificity.Specificity of the method was verified by thrombin and serine-protease inhibitors N-alpha-((2-naphthylsulfinyl)glycyl)-DL-p-amidinophenylalanylpiperidine and phenylmethanesulfonyl fluoride.Inhibition of thrombin activity by CSF samples and levels of specific thrombin inhibitors were also assessed.Thrombin and aPC activities were reliably measured and were significantly higher in the CSF of patients with central nervous system infections compared to normal pressure hydrocephalus controls,suggesting the involvement of these factors in neuro-inflammation.CSF thrombin activity levels in the presence of known thrombin concentration were high in patients with central nervous system infections,and low in normal pressure hydrocephalus patients.Quantification of endogenous thrombin inhibitors protease nexin 1,amyloid precursor protein and anti-thrombin III in CSF by western blot indicated a significant elevation of amyloid precursor protein in infectious CSF.In conclusion,this study describes a novel and sensitive assay aimed at the detection of thrombin and aPC activity in CSF.This method may be useful for measuring these factors that reflect degenerative and protective influences of coagulation on neurological disorders.The study procedure was approved by the Ethics Committee of the Chaim Sheba Medical Center(approval No.4245-17-SMC)on October 18,2018.展开更多
BACKGROUND: Cerebrospinal fluid can be an inducer for neural stem cells in vitro, but few studies employ cerebrospinal fluid to culture olfactory ensheathing cells. OBJECTIVE: To investigate the growth of nasal mucosa...BACKGROUND: Cerebrospinal fluid can be an inducer for neural stem cells in vitro, but few studies employ cerebrospinal fluid to culture olfactory ensheathing cells. OBJECTIVE: To investigate the growth of nasal mucosa olfactory ensheathing cells in normal cerebrospinal fluid, and to analyze the feasibility of cerebrospinal fluid for culturing olfactory ensheathing cells used for transplantation. DESIGN, TIME AND SETTING: A completely randomized, block design study was performed at the Cell Laboratory, Wuxi Third People's Hospital, and Jiangsu Institute of Parasitic Diseases, China, in August 2008. MATERIALS: Dulbecco's modified Eagle's medium/F12 (DMEM/F12) and fetal bovine serum (Gibco BRL, USA), mouse anti-rat P75 monoclonal antibody and rabbit anti-glial fibrillary acidic protein polyclonal anti body (Santa Cruz Biotechnology, USA), mouse anti-rat myelin basic protein monoclonal antibody (Cymbus, UK), mouse anti-rat microtubule-associated protein-2 monoclonal antibody (Transduction Laboratories, USA), FITC conjugated rabbit anti-mouse monoclonal antibody (Boster, China), TRITC conjugated goat anti-rabbit monoclonal antibody (Sigma, USA) were used. METHODS: Nasal mucosa olfactory ensheathing cells were separately incubated in DMEM/F12, cerebrospinal fluid, and changing DMEM/F12 into cerebrospinal fluid. Adult female Sprague Dawley rat models of spinal hemisection were established. Nerve injury was repaired by transplantation of nasal mucosa olfactory ensheathing cells cultured in cerebrospinal fluid or DMEM/F12. MAIN OUTCOME MEASURES: The proliferative ability of olfactory ensheathing cells cultured in cerebrospinal fluid was determined by a 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide assay. The morphology and purity of olfactory ensheathing cells were detected using immunohistochemistry. Animal behavior was evaluated by the Basso, Beattie and Bresnahan locomotor rating scale. Morphological repair was assessed by a horseradish peroxidase-tetramethylbenzidine retrograde tracer technique and immunohistochemistry. RESULTS: Changing from DMEM/F12 to cerebrospinal fluid did not change overall culture morphology and purity on day 14. These cells also contributed to myelinization and the conduction velocity of regenerated axons, and improved motor abilities of denervated muscle fibers in rats with spinal cord injury. The recovery of behavioral function and neuronal regeneration was similar in the two groups. CONCLUSION: Cerebrospinal fluid culture prior to autologous olfactory ensheathing cell transplantation is feasible for clinical use.展开更多
BACKGROUND: Guillain-Barre syndrome (GBS) is an autoimmune disease which is characterized by demyelination of peripheral nerve and nerve root, and inflammatory reaction of lymphocyte and macrophage. Neuroelectrophysio...BACKGROUND: Guillain-Barre syndrome (GBS) is an autoimmune disease which is characterized by demyelination of peripheral nerve and nerve root, and inflammatory reaction of lymphocyte and macrophage. Neuroelectrophysiological examination and cerebrospinal fluid (CSF) analysis are of significance for its diagnosis. OBJECTIVE: To study the association of neuroelectrophysiology and cerebrospinal fluid immunoglobulin (CSF-Ig) with pathogenetic conditions of patients with GBS. DESIGN: Case control study. SETTING: Department of Neurology, Shenzhen Municipal Shekou Group Hospital; Department of Neuroelectrophysiology, People’s Hospital of Guangdong Province. PARTICIPANTS: A total of 32 GBS patients including 18 males and 14 females who aged from 17 to 72 years were selected as experimental group from the Department of Neurology, People’s Hospital of Guangdong Province from January 2004 to December 2005. All cases conformed with GBS diagnostic criteria established by Asbury in 1990 and they were divided into three types according to neurological criteria established by Chinese Neurology and Psychology Journal in 1993: mild, moderate and severe types. Another 30 patients with vascular headache were selected as control group from the same hospital including 14 males and 16 females who aged from 17 to 79 years. METHODS: ① Neuroelectrophysiological examination: Multiple-functional electromyography device provided by Nicolet Company, USA was used to measure nerve conduction velocity (NCV), including motor nerve conduction velocity (MCV) and sensory nerve conduction velocity(SCV); meanwhile, electromyologram (EMG), somatosensory evoked potential (SEP) and electroencephalogram (EEG) were also measured. ② Detection of CSF-Ig: Concentrations of IgG, IgA and IgM were measured with immunofixation electrophoresis. ③ Follow-up: Among 32 GBS patients, 14 cases received follow-up after treatment and the longest follow-up time was 1 year after onset. Among them, 8 cases were reexaminined with neuroelectrophysiological and CSF examinations. MAIN OUTCOME MEASURES: Results of NCV, EMG, SEP and EEG; comparison of CSF-Ig content; results of follow-up examinations. RESULTS: All 32 GBS cases and 30 patients with vascular headache were involved in the final analysis. ① Abnormal rate of neuroelectrophysiological test: 75% of NCV, 88% of F-wave, 53% of MCV, 25% of SEP, 47% of EMG and 31% of EEG. There were no significant differences among various types (P > 0.05). ② Results of CSF-Ig test: There were no significant differences among various types (P > 0.05); however, abnormalities in experimental group was higher than those in control group (P < 0.01). CONCLUSION: Results of follow-up study suggest that improvement of clinical symptom is earlier than neuroelectrophysiological recovery; MCV and EMG recoveries are faster than that of NCV; the earlier the abnormality of EMG, the poorer the recovery. CSF-Ig recovers normally along improvement of clinical symptoms. It is of significance for neuroelectrophysiology and abnormality of CSF-Ig to determine degree of peripheral nerve demyelination and prognosis.展开更多
<strong>Objective: </strong>To explore the clinical effect of and the method and nursing strategy for sellar reconstruction for intraoperative cerebrospinal fluid (CSF) leakage in pituitary adenoma resecti...<strong>Objective: </strong>To explore the clinical effect of and the method and nursing strategy for sellar reconstruction for intraoperative cerebrospinal fluid (CSF) leakage in pituitary adenoma resection under neuroendoscopy. <strong>Methods:</strong> The data from 20 cases of intraoperative CSF leak caused by transsphenoidal pituitary adenoma resection were retrospectively analyzed. Six patients were treated with mucosal flap and artificial dural reconstruction of sellar (simple sellar floor reconstruction). In 45 patients, autologous fat, fascia lata, and artificial dura were used to repair and reconstruct the sellar floor (multilayer sellar floor reconstruction). After the operation, all patients underwent follow-up for 6 - 24 months. <strong>Results:</strong> Fifty patients were followed up without CSF leakage. One patient was cured after leakage of CSF through the lumbar cistern 1 month after discharge. <strong>Conclusion: </strong>For patients with CSF leakage during neuroendoscopic transsphenoidal pituitary adenoma resection, individualized sellar floor reconstruction should be adopted according to the degree of CSF leakage and the size of the sellar floor defect. Strict nursing measures can effectively prevent CSF leakage and reduce postoperative complications.展开更多
Bacterial meningitis (BM) is a life-threatening condition which affects the central nervous system (CNS). Its incidence rate is estimated between 0.22 - 2.66 and 0.81 - 6.1 cases/1000 lives worldwide and in Africa res...Bacterial meningitis (BM) is a life-threatening condition which affects the central nervous system (CNS). Its incidence rate is estimated between 0.22 - 2.66 and 0.81 - 6.1 cases/1000 lives worldwide and in Africa respectively. The objective of this study was to determine the frequency of bacterial organisms isolated from CSF of children less than five years old in Windhoek. A retrospective analysis was performed on 784 results of CSF submitted to the Namibia Institute of Pathology (NIP) from January 2010 to August 2014. The results showed that out of the suspected meningitis cases, 18 (28.6%) were due to Streptococcus pneumoniae, making it the frequently isolated organism, followed by Staphylococcus aureus 7 (11.1%), Escherichia coli 5 (7.9%) and Haemophilus influenzae 4 (6.3%). Streptococcus pneumoniae showed high resistance to penicillin 17 (70.5%) & cotrimoxazole 16 (93.7%) and 100% susceptibility to ciprofloxacin (5), vancomycin (13) & ceftri-axone (8). Haemophilus influenzae showed moderate resistance to cotrimoxazole 3 (66%) & tet-racycline 2 (50%). It showed 100% sensitivity to chloramphenicol (4), cefuroxime (2) & ceftriaxone (3). Neisseria meningitidis showed high resistance to cotrimoxazole by 100% (n = 2) and high sensitivity to chloramphenicol (n = 2), ceftriaxone & penicillin by 100% (n = 2). Streptococcus agalactiae was resistant to tetracycline and sensitive to penicillin & erythromycin by 100% (n = 1). Streptococcus pneumoniae was isolated the most in this current study and it had high resistance to penicillin & cotrimoxazole. There was a significant difference between results CSF culture and PCR, Gram stain, CSF cell count, protein & glucose, as all comparisons yielded in P values less than 0.05, indicating a significant statistical association.展开更多
Background: Cerebrospinal fluid analysis is a very important tool in the diagnosis of bacterial meningitis in the new born. Bacterial meningitis is a potent cause of morbidity and mortality in the neonatal age group, ...Background: Cerebrospinal fluid analysis is a very important tool in the diagnosis of bacterial meningitis in the new born. Bacterial meningitis is a potent cause of morbidity and mortality in the neonatal age group, with a very high incidence of neurological complications. Aim: To identify the bacterial pathogens isolated from the cerebrospinal fluids of neonates at the University of Port Harcourt Teaching Hospital (UPTH) and their sensitivity patterns. This will assist the neonatologist in the choice of empirical antibiotic treatment. Study Design: Retrospective, descriptive, cross sectional study. Place and duration of study: University of Port Harcourt Teaching Hospital, from 1 January 2009 to 31 December 2014. Methods: Records of bacterial analysis of cerebrospinal fluid from neonates seen at the special care baby unit of the University of Port Harcourt Teaching Hospital with clinical suspicion of meningitis between 1 January 2009 and 31 December 2014 were retrieved from the microbiology record book. Data on patients age, sex, appearance of Cerebrospinal fluid, cell count, microscopy/gram stain, culture and antibiotic sensitivity were retrieved from laboratory record books and entered into a Microsoft? excel spread sheet and analysed using SPSS version 20.0. Results: One hundred and thirteen neonates: 70 (61.95%) of these patients were male while 43 (38.05%) were females. Only 1 (0.89%) was positive for culture yielding a growth of Escherichia coli which was sensitive to Imipenem, moderately sensitive to Ampicillin, Gentamicin, ceftazidime, cefuroxime, ciprofloxacin and Amoxicillinclavulanic acid. It was resistant to cefotaxime. 112 (99.11%) of the neonates had presumed neonatal meningitis while only 1 (0.89%) had proven neonatal meningitis. Conclusions: There is a low yield of organisms in cerebrospinal fluid of neonates at the University of Port Harcourt Teaching Hospital.展开更多
BACKGROUND Rapid molecular testing has revolutionized the management of suspected viral meningitis and encephalitis by providing an etiological diagnosis in<90 min with potential to improve outcomes and shorten inp...BACKGROUND Rapid molecular testing has revolutionized the management of suspected viral meningitis and encephalitis by providing an etiological diagnosis in<90 min with potential to improve outcomes and shorten inpatient stays.However,use of molecular assays can vary widely.AIM To evaluate current practice for molecular testing of pediatric cerebrospinal fluid(CSF)samples across the United Kingdom using a structured questionnaire.METHODS A structured telephone questionnaire survey was conducted between July and August 2020.Data was collected on the availability of viral CSF nucleic acid amplification testing(NAAT),criteria used for testing and turnaround times including the impact of the coronavirus disease 2019 pandemic.RESULTS Of 196/212(92%)microbiology laboratories responded;63/196(32%)were excluded from final analysis as they had no on-site microbiology laboratory and outsourced their samples.Of 133 Laboratories included in the study,47/133(35%)had onsite facilities for viral CSF NAAT.Hospitals currently undertaking onsite NAAT(n=47)had much faster turnaround times with 39 centers(83%)providing results in≤24 h as compared to those referring samples to neighboring laboratories(5/86;6%).CONCLUSION Onsite/near-patient rapid NAAT(including polymerase chain reaction)is recommended wherever possible to optimize patient management in the acute setting.展开更多
Objective To analyze the causes and prevention and treatment of cerebrospinal fluid leak during transsphenoidal pituitary adenoma surgery. Methods Retrospective study of 260 cases of microscopic transsphenoidal surger...Objective To analyze the causes and prevention and treatment of cerebrospinal fluid leak during transsphenoidal pituitary adenoma surgery. Methods Retrospective study of 260 cases of microscopic transsphenoidal surgery and 274 cases of endoscopic surgery for resection of the pituitary adenomas was performed. CSF leak occurred展开更多
BACKGROUND: At present, suppurative meningitis is mainly treated through anti-infection with antibiotics, depressing encephalic pressure with mannitol , lowering body temperature with drugs , supporting treatment, etc...BACKGROUND: At present, suppurative meningitis is mainly treated through anti-infection with antibiotics, depressing encephalic pressure with mannitol , lowering body temperature with drugs , supporting treatment, etc. However, it takes a long course of treatment and has poor therapeutic effect. Successive irrigation of subarachnoid cavity maybe have better effect on suppurative meningitis. OBJECTIVE: We compared the successive irrigation of subbarachnoid cavity with routine therapeutic methods to observe the effect of successive irrigation of subarachnoid cavity on the body temperature, cerebrospinal fluid pressure, the number of white blood cell and the level of protein of suppurative meningitis dogs. DESIGN: A randomized and controlled animal experiment. SETTING: Institute of Neuroscience, Taihe Hospital Affiliated to Yunyang Medical College. MATERIALS: Totally 17 healthy adult male Beagle dogs, of common grade, weighing 9 to 10 kg, were involved in the experiment, and raised in the 20 ℃ temperature with relative humidity of 50% for 1 week. They were randomized into 3 groups: normal group (n=5), control group (n=5) and irrigation group (n=6). Artificial cerebrospinal fluid was prepared according to the level of glucose and chloride of cerebrospinal fluid of normal dogs, and then it was sterilized with high pressure. METHODS: This experiment was carried out in the experimental animal center of Yunyang Medical College from April to August 2001. ① After the dogs were anesthetized,1 mL fresh staphylococcus aureus liquid [(1.5-1.6)×109 L-1] was injected into medullary cistern to establish suppurative meningitis models. ② After models were successfully established, intravenous drip infusion of 1.2 ×106 U/(kg·d), muscular injection of sulfadiazine sodium of 100 mg/(kg·d)and intravenous injection of 200 g/L mannitol of 5 g/(kg·time) for 3 times a day were performed in the control group. The irrigation of subarachnoid meningitis was conducted in the irrigation group besides the routine treatments in the control group: Artificial cerebrospinal fluid was successively injected into the epidural catheter in the waist part. The mixtures of artificial cerebrospinal fluid and inflammatory cerebrospinal fluid flowed out incessantly from epidural catheter of medullary cistern. Irrigation was ended 48 hours later. Dogs were routinely raised in the control group. ③ From the first day after being modeled to the 14th day after treatment, the rectal temperatures were daily measured in the morning, at noon and in the evening respectively, then the mean temperatures were calculated . From the 2nd day after being modeled to the 14th day after treatment, puncture at waist was given once, and the cerebrospinal fluid pressure, the number of white blood cells and the level of protein were measured. MAIN OUTCOME MEASURES: The body temperature, cerebrospinal fluid pressure, the number of white blood cells and the level of protein were measured on suppurative meningitis model dogs. RESULTS: Totally 17 Beagle dogs were involved in this study. ①The body temperatures of dogs were significantly reduced in the control group and in irrigation group on the 1st day after treatment and lower than suppurative meningitis model dogs on the 2nd day after being modeled (P < 0.05). The body temperatures were gradually decreased in control group from the 2nd day after being modeled to the 14th day after treatment (P < 0.01), but were significantly higher than those of dogs in normal group on the 14th day after treatment (P < 0.05). The body temperatures of dogs were gradually decreased in irrigation group on the 2nd day or 3rd day after treatment (P < 0.01) and then were close to the normal body temperature on the 14th day after treatment. ②There was the same cerebrospinal fluid pressure in control group as in irrigation group on the 2nd day after being modeled (P > 0.05), but significantly decreased in two groups from the 1st day or 2nd day after treatment (P < 0.01), and cerebrospinal fluid pressure was close to the normal level in irrigation group. Although the cerebrospinal fluid pressure raised a little on the 3rd day or 4th day after treatment in the irrigation group (P < 0.05), but recovered to the normal level on the 9th day after treatment again. It decreased slowly in the control group and still was significantly higher than normal group on the 14th day after treatment (P < 0.01). ③No significant difference existed in number of white blood cell and the level of protein between control group and irrigation group on the 2nd day following modeled. Both of them began to significantly decrease on the 1st and 2nd day after treatment (P < 0.01). Although the number of white blood cell and the level of protein rebounded a little in irrigation group 3 or 4 days after treatment (P < 0.05), they were gradually decreased and recovered to normal levels on the 13th day after treatment. The number of white blood cell and the level of protein slowly decreased in the control group compared with irrigation group and were still significantly higher than normal group on the 14th day (P < 0.01). CONCLUSION: Irrigation of subarachnoid cavity can decrease the body temperature, cerebrospinal fluid pressure, the number of white blood cells and the level of protein at early stage of suppurative meningitis , and the therapeutic effect is better than that of routine treatment.展开更多
Tau protein, a microtubule-associated protein, has a high specific expression in neurons and axons. Because traumatic spinal cord injury mainly affects neurons and axons, we speculated that tau protein may be a promis...Tau protein, a microtubule-associated protein, has a high specific expression in neurons and axons. Because traumatic spinal cord injury mainly affects neurons and axons, we speculated that tau protein may be a promising biomarker to reflect the degree of spinal cord injury and prognosis of motor function. In this study, 160 female Sprague-Dawley rats were randomly divided into a sham group, and mild, moderate, and severe spinal cord injury groups. A laminectomy was performed at the T8 level to expose the spinal cord in all groups. A contusion lesion was made with the NYU-MASCIS impactor by dropping a 10 g rod from heights of 12.5 mm(mild), 25 mm(moderate) and 50 mm(severe) upon the exposed dorsal surface of the spinal cord. Tau protein levels were measured in serum and cerebrospinal fluid samples at 1, 6, 12, 24 hours, 3, 7, 14 and 28 days after operation. Locomotor function of all rats was assessed using the Basso, Beattie and Bresnahan locomotor rating scale. Tau protein concentration in the three spinal cord injury groups(both in serum and cerebrospinal fluid) rapidly increased and peaked at 12 hours after spinal cord injury. Statistically significant positive linear correlations were found between tau protein level and spinal cord injury severity in the three spinal cord injury groups, and between the tau protein level and Basso, Beattie, and Bresnahan locomotor rating scale scores. The tau protein level at 12 hours in the three spinal cord injury groups was negatively correlated with Basso, Beattie, and Bresnahan locomotor rating scale scores at 28 days(serum: r =-0.94; cerebrospinal fluid: r =-0.95). Our data suggest that tau protein levels in serum and cerebrospinal fluid might be a promising biomarker for predicting the severity and functional outcome of traumatic spinal cord injury.展开更多
基金supported by the government of the Basque Country for the ELKARTEK21/10 KK-2021/00014 and ELKARTEK22/85 research programs,respectively。
文摘To study the kinematics of flow rate and ventricular dilatation,an analytical perturbation approach of hydrocephalus has been devised.This research provides a comprehensive investigation of the characteristics of cerebrospinal fluid(CSF)flow and pressure in a hydrocephalic patient.The influence of hydrocephalic CSF,flowing rotationally with realistic dynamical characteristics on pulsatile boundaries of subarachnoid space,was demonstrated using a nonlinear controlling system of CSF.An analytical perturbation method of hydrocephalus has been developed to investigate the biomechanics of fluid flow rate and the ventricular enlargement.In this paper presents a detailed analysis of CSF flow and pressure dynamics in a hydrocephalic patient.It was elaborated with a nonlinear governing model of CSF to show the influence of hydrocephalic CSF,flowing rotationally with realistic dynamical behaviors on pulsatile boundaries of subarachnoid space.In accordance with the suggested model,the elasticity factor changes depending on how much a porous layer,in this case the brain parenchyma,is stretched.It was improved to include the relaxation of internal mechanical stresses for various perturbation orders,modelling the potential plasticity of brain tissue.The initial geometry that was utilised to create the framework of CSF with pathological disease hydrocephalus and indeed the output of simulations using this model were compared to the actual progression of ventricular dimensions and shapes in patients.According to this observation,the non-linear and elastic mechanical phenomena incorporated into the current model are probably true.Further modelling of ventricular dilation at a normal pressure may benefit from the existence of a valid model whose parameters approximate genuine mechanical characteristics of the cerebral cortex.
文摘BACKGROUND Spontaneous cerebrospinal fluid(CSF)leaks associated with cervical spondylosis are rare.To our knowledge,only a few cases have been reported in which treatment is challenging and varies from case to case.Here,we review the literature and describe the surgical treatment of a 70-year-old woman who presented with a CSF leak due to a cervical spine spur.CASE SUMMARY A 70-year-old female patient who was treated for a cerebral infarction,presented with complains of weakness in the right lower extremity and a feeling of stepping on cotton.The patient underwent regular neck massage and presented with neck and right shoulder pain radiating to the right upper extremity one-month ago.Magnetic resonance imaging showed a strip of leaking cerebrospinal fluid posterior to the C1-4 vertebrae,and computed tomography showed a“sickleshaped”disc prolapse with calcification in C4/5.We chose to perform an anterior cervical discectomy.When the prolapsed C4/5 disc was scraped,clear fluid leakage was observed,and exploration revealed a 1 mm diameter rupture in the anterior aspect of the dura mater,which was compressed continuously with cotton patties,with no significant cerebrospinal fluid leakage after 1 h.CONCLUSION Three months after surgery,the patient was asymptomatic and follow-up imaging demonstrated complete resolution.
基金Key Social Development Project in Hainan Province(No.ZDYF2019173)。
文摘Medulloblastoma(MB)is the most common childhood embryonal malignant tumour in the central nervous system.The diagnosis,prognosis and therapeutic targets of MB depend on the molecular characteristics of the tumor,and it is a great challenge to obtain the tissue samples from the patients with brain tumor.Genomic changes found in cell-free DNA(cfDNA)of cerebrospinal fluid(CSF)can predict genomic changes present in tumor tissue,fluid biopsy of CSF can detect the genomic profile of tumor-associated cfDNA and evaluate cfDNA as a marker of measurable residual disease(MRD)in a relatively noninvasive manner,which provides the evidence of"individualized precision therapy"for MB patients.In this paper,we reviewed the recent studies in medulloblastoma based on cfDNA Liquid Biopsy of CSF.
文摘BACKGROUND Meningitis is a life-threatening clinical condition associated with high mortality and morbidity.Early diagnosis and specific treatment may improve outcomes.Lack of specific clinical signs or tests make the diagnosis challenging.AIM To assess the efficacy of cerebrospinal fluid(CSF)lactate in diagnosing meningitis in critically ill patients.METHODS A prospective,observational cohort study was carried out in a neuro-medical intensive care unit(ICU)over a 22 mo period.Adult patients,with suspected meningitis admitted in ICU,were serially recruited.Patients who refused consent,those with peripheral sensorineural deficit,or with any contraindication to lumber puncture were excluded.CSF cytology,bio-chemistry,lactates,culture and polymerase chain reaction based meningo-encephalitis panel were evaluated.Patients were divided in two groups based on clinical diagnosis of meningitis.The efficacy of CSF lactate in diagnosing meningitis was evaluated and compared with other tests.RESULTS Seventy-one patients were included and 23 were diagnosed with meningitis.The mean values of CSF total leucocyte count(TLC),proteins and lactates were significantly higher in meningitis group.There was a significant correlation of CSF lactate levels with CSF cultures and meningo-encephalitis panel.CSF lactate(>2.72 mmol/L)showed good accuracy in diagnosing meningitis with an area under the curve of 0.81(95% confidence interval:0.69-0.93),sensitivity of 82.6%,and specificity 72.9%.These values were comparable to those of CSF TLC and protein.Twelve patients with bacterial meningitis had significantly higher CSF lactate(8.9±4.7 mmol/L)than those with non-bacterial meningitis(4.2±3.8 mmol/L),P=0.006.CONCLUSION CSF lactate may be used to aid in our diagnosis of meningitis in ICU patients.CSF lactate(>2.72 mmol/L)showed good accuracy,sensitivity,and specificity in diagnosing meningitis and may also help to differentiate between bacterial and non-bacterial meningitis.
文摘An abdominal cerebrospinal fluid pseudocyst is a rare complication of ventriculoperitoneal shunt. Several theories have been suggested to explain its occurrence. The main symptoms are painful abdominal distension and vomiting, abdominal distension on examination, as abdominal ultrasound and computed tomography confirm its diagnosis. The treatment involves drainage associated with drain relocation and resection of the pseudocyst’s wall. We report two patients diagnosed with this condition who underwent surgical treatment. The first patient had an unremarkable 12-month follow-up, while the second died on the seventh postoperative day due to intravascular disseminated coagulation. In these patients, the cause has not been identified;however, an infection cannot be ruled out.
文摘BACKGROUND Ventriculoperitoneal(VP)shunt placement has become a standard of care procedure in managing hydrocephalus for drainage and absorption of cerebrospinal fluid(CSF)into the peritoneum.Abdominal pseudocysts containing CSF are the common long-term complication of this frequently performed procedure,mainly because VP shunts have significantly prolonged survival.Of these,liver CSF pseudocysts are rare entities that may cause shunt dysfunction,affect normal organ function,and therefore pose therapeutic challenges.CASE SUMMARY A 49-year-old man with history of congenital hydrocephalus status post bilateral VP shunt placement presented with progressively worsening dyspnea on exertion,abdominal discomfort/distention.Abdominal computed tomography(CT)scan revealed a large CSF pseudocyst in the right hepatic lobe with the tip of VP shunt catheter into the hepatic cyst cavity.Patient underwent robotic laparoscopic cyst fenestration with a partial hepatectomy,and repositioning of VP shunt catheter to the right lower quadrant of the abdomen.Follow-up CT demonstrated a significant reduction in hepatic CSF pseudocyst.CONCLUSION A high index of clinical suspicion is required for early detection of liver CSF pseudocysts since their presentation is often asymptomatic and cunning early in the course.Late-stage liver CSF pseudocysts could have adverse outcomes on the treatment course of hydrocephalus as well as on hepatobiliary dysfunction.There is paucity of data to define the management of liver CSF pseudocyst in current guidelines due to rare nature of this entity.The reported occurrences have been managed by laparotomy with debridement,paracentesis,radiological imaging guided fluid aspiration and laparoscopic-associated cyst fenestration.Robotic surgery is an additional minimally invasive option in the management of hepatic CSF pseudocyst;however,its use is limited by lack of widespread availability and cost of surgery.
文摘Cognitive impairment is a common clinical manifestation of multiple sclerosis,but its pathophysiology is not completely understood.White and grey matter injury together with synaptic dysfunction do play a role.The measurement of biomarkers in the cerebrospinal fluid and the study of their association with cognitive impairment may provide interesting in vivo evidence of the biological mechanisms underlying multiple sclerosis-related cognitive impairment.So far,only a few studies on this topic have been published,giving interesting results that deserve further investigation.Cerebrospinal fluid biomarkers of different pathophysiological mechanisms seem to reflect different neuropsychological patterns of cognitive deficits in multiple sclerosis.The aim of this review is to discuss the studies that have correlated cerebrospinal fluid markers of immune,glial and neuronal pathology with cognitive impairment in multiple sclerosis.Although preliminary,these findings suggest that cerebrospinal fluid biomarkers show some correlation with cognitive performance in multiple sclerosis,thus providing interesting insights into the mechanisms underlying the involvement of specific cognitive domains.
文摘BACKGROUND Bacterial meningitis(BM)is a common central nervous system inflammatory disease.BM may cause serious complications,and early diagnosis is essential to improve the prognosis of affected patients.CASE SUMMARY A 37-year-old man was hospitalized with purulent meningitis because of worsening headache for 12 h,accompanied by vomiting,fever,and rhinorrhea.Head computed tomography showed a lesion in the left frontal lobe.Infectious disease screening showed positivity for hepatitis B surface antigen,hepatitis B e antigen,and hepatitis B core antigen.Cerebrospinal fluid(CSF)leak was suspected based on clinical history.Streptococcus pneumoniae(S.pneumoniae)was detected in CSF by metagenomic next-generation sequencing(mNGS)technology,confirming the diagnosis of purulent BM.After treatment,multiplex PCR indicated the presence of hepatitis B virus(HBV)DNA and absence of S.pneumoniae DNA in CSF samples.CONCLUSION We report a rare case of HBV in the CSF of a patient with purulent BM.Multiplex PCR is more sensitive than mNGS for detecting HBV DNA.
基金supported by the Charles University (No.PRIMUS/17/SCI/12)by the Czech Science Foundation (No.P502/19-20152Y)through the Institutional Research Support (No.260571/2021)(to MV)
文摘Adult neurogenesis is the life-long process of neural stem cell proliferation,differentiation into neurons,migration,and incorporation into the existing neuronal circuits.After decades of research,it is now widely accepted that mammals and birds retain the capacity to regenerate neurons even after their subadult ontogeny.Cerebrospinal fluid participates in the regulation of the neurogenic niches of the vertebrate brain through signaling pathways not fully elucidated.Proteomic studies of cerebrospinal fluid have the potential to allow the in-depth characterization of its molecular composition.Comparative studies help to delineate those pathways that are universally critical for the regulation of neurogenesis in adulthood.In this review,we performed literature-based data mining in studies using liquid chromatography-tandem mass spectroscopy that analyzed cerebrospinal fluid samples from healthy adult humans(Homo sapiens);mice(Mus musculus);sheep(Ovis aries);chickens(Gallus gallus);and two parrot species,the budgerigar(Melopsittacus undulatus)and cockatiel(Nymphicus hollandicus).We identified up to 911 proteins represented in cerebrospinal fluid,involved in various pathways regulating adult neurogenesis.However,only 196 proteins were common across humans,mice,and birds.Pathway components involved in nervous system development,cell migration,and axonal guidance were commonly evident in all species investigated so far.Extensive bioinformatic analysis revealed that the universally over-represented pathways involved L1 cell adhesion molecule protein interactions,cell-adhesion molecules,signals regulating extracellular matrix remodeling,regulation of insulin growth factor signaling,axonal guidance,programmed cell death,immune signaling,and post-translational modifications.Most of the reported proteins are part of extracellular vesicles enriched in cerebrospinal fluid.However,the information presently available is still highly fragmentary,and far more questions persist than are answered.Technological advances will allow cerebrospinal fluid comparative proteomic research to delve into the fundamental processes of adult neurogenesis and eventually translate this research into any regenerative interventions.
文摘Inflammation and coagulation are tightly interconnected in the pathophysiology of neuronal diseases.Thrombin,a pro-coagulant serine protease is associated with neurodegeneration and its indirect inhibitor,activated protein C(aPC),is considered neuroprotective.While levels of thrombin and aPC activity are readily measured in the blood,similar assays in the cerebrospinal fluid(CSF)have not been described.The aim of this study was to establish a specific and sensitive enzymatic assay to measure both thrombin and aPC activity in the CSF.CSF was collected from 14 patients with suspected normal pressure hydrocephalus served as a control group,while seven patients with central nervous system infections served as an acute neuro-inflammatory study group and one sample of CSF following traumatic lumbar puncture served as a positive control.Thrombin and aPC activities were measured by fluorescence released by specific proteolytic cleavage in the presence of endopeptidase and amino-peptidase inhibitors to ensure specificity.Specificity of the method was verified by thrombin and serine-protease inhibitors N-alpha-((2-naphthylsulfinyl)glycyl)-DL-p-amidinophenylalanylpiperidine and phenylmethanesulfonyl fluoride.Inhibition of thrombin activity by CSF samples and levels of specific thrombin inhibitors were also assessed.Thrombin and aPC activities were reliably measured and were significantly higher in the CSF of patients with central nervous system infections compared to normal pressure hydrocephalus controls,suggesting the involvement of these factors in neuro-inflammation.CSF thrombin activity levels in the presence of known thrombin concentration were high in patients with central nervous system infections,and low in normal pressure hydrocephalus patients.Quantification of endogenous thrombin inhibitors protease nexin 1,amyloid precursor protein and anti-thrombin III in CSF by western blot indicated a significant elevation of amyloid precursor protein in infectious CSF.In conclusion,this study describes a novel and sensitive assay aimed at the detection of thrombin and aPC activity in CSF.This method may be useful for measuring these factors that reflect degenerative and protective influences of coagulation on neurological disorders.The study procedure was approved by the Ethics Committee of the Chaim Sheba Medical Center(approval No.4245-17-SMC)on October 18,2018.
基金the National Trauma Program (973 Program), No. 2005CB522600
文摘BACKGROUND: Cerebrospinal fluid can be an inducer for neural stem cells in vitro, but few studies employ cerebrospinal fluid to culture olfactory ensheathing cells. OBJECTIVE: To investigate the growth of nasal mucosa olfactory ensheathing cells in normal cerebrospinal fluid, and to analyze the feasibility of cerebrospinal fluid for culturing olfactory ensheathing cells used for transplantation. DESIGN, TIME AND SETTING: A completely randomized, block design study was performed at the Cell Laboratory, Wuxi Third People's Hospital, and Jiangsu Institute of Parasitic Diseases, China, in August 2008. MATERIALS: Dulbecco's modified Eagle's medium/F12 (DMEM/F12) and fetal bovine serum (Gibco BRL, USA), mouse anti-rat P75 monoclonal antibody and rabbit anti-glial fibrillary acidic protein polyclonal anti body (Santa Cruz Biotechnology, USA), mouse anti-rat myelin basic protein monoclonal antibody (Cymbus, UK), mouse anti-rat microtubule-associated protein-2 monoclonal antibody (Transduction Laboratories, USA), FITC conjugated rabbit anti-mouse monoclonal antibody (Boster, China), TRITC conjugated goat anti-rabbit monoclonal antibody (Sigma, USA) were used. METHODS: Nasal mucosa olfactory ensheathing cells were separately incubated in DMEM/F12, cerebrospinal fluid, and changing DMEM/F12 into cerebrospinal fluid. Adult female Sprague Dawley rat models of spinal hemisection were established. Nerve injury was repaired by transplantation of nasal mucosa olfactory ensheathing cells cultured in cerebrospinal fluid or DMEM/F12. MAIN OUTCOME MEASURES: The proliferative ability of olfactory ensheathing cells cultured in cerebrospinal fluid was determined by a 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide assay. The morphology and purity of olfactory ensheathing cells were detected using immunohistochemistry. Animal behavior was evaluated by the Basso, Beattie and Bresnahan locomotor rating scale. Morphological repair was assessed by a horseradish peroxidase-tetramethylbenzidine retrograde tracer technique and immunohistochemistry. RESULTS: Changing from DMEM/F12 to cerebrospinal fluid did not change overall culture morphology and purity on day 14. These cells also contributed to myelinization and the conduction velocity of regenerated axons, and improved motor abilities of denervated muscle fibers in rats with spinal cord injury. The recovery of behavioral function and neuronal regeneration was similar in the two groups. CONCLUSION: Cerebrospinal fluid culture prior to autologous olfactory ensheathing cell transplantation is feasible for clinical use.
文摘BACKGROUND: Guillain-Barre syndrome (GBS) is an autoimmune disease which is characterized by demyelination of peripheral nerve and nerve root, and inflammatory reaction of lymphocyte and macrophage. Neuroelectrophysiological examination and cerebrospinal fluid (CSF) analysis are of significance for its diagnosis. OBJECTIVE: To study the association of neuroelectrophysiology and cerebrospinal fluid immunoglobulin (CSF-Ig) with pathogenetic conditions of patients with GBS. DESIGN: Case control study. SETTING: Department of Neurology, Shenzhen Municipal Shekou Group Hospital; Department of Neuroelectrophysiology, People’s Hospital of Guangdong Province. PARTICIPANTS: A total of 32 GBS patients including 18 males and 14 females who aged from 17 to 72 years were selected as experimental group from the Department of Neurology, People’s Hospital of Guangdong Province from January 2004 to December 2005. All cases conformed with GBS diagnostic criteria established by Asbury in 1990 and they were divided into three types according to neurological criteria established by Chinese Neurology and Psychology Journal in 1993: mild, moderate and severe types. Another 30 patients with vascular headache were selected as control group from the same hospital including 14 males and 16 females who aged from 17 to 79 years. METHODS: ① Neuroelectrophysiological examination: Multiple-functional electromyography device provided by Nicolet Company, USA was used to measure nerve conduction velocity (NCV), including motor nerve conduction velocity (MCV) and sensory nerve conduction velocity(SCV); meanwhile, electromyologram (EMG), somatosensory evoked potential (SEP) and electroencephalogram (EEG) were also measured. ② Detection of CSF-Ig: Concentrations of IgG, IgA and IgM were measured with immunofixation electrophoresis. ③ Follow-up: Among 32 GBS patients, 14 cases received follow-up after treatment and the longest follow-up time was 1 year after onset. Among them, 8 cases were reexaminined with neuroelectrophysiological and CSF examinations. MAIN OUTCOME MEASURES: Results of NCV, EMG, SEP and EEG; comparison of CSF-Ig content; results of follow-up examinations. RESULTS: All 32 GBS cases and 30 patients with vascular headache were involved in the final analysis. ① Abnormal rate of neuroelectrophysiological test: 75% of NCV, 88% of F-wave, 53% of MCV, 25% of SEP, 47% of EMG and 31% of EEG. There were no significant differences among various types (P > 0.05). ② Results of CSF-Ig test: There were no significant differences among various types (P > 0.05); however, abnormalities in experimental group was higher than those in control group (P < 0.01). CONCLUSION: Results of follow-up study suggest that improvement of clinical symptom is earlier than neuroelectrophysiological recovery; MCV and EMG recoveries are faster than that of NCV; the earlier the abnormality of EMG, the poorer the recovery. CSF-Ig recovers normally along improvement of clinical symptoms. It is of significance for neuroelectrophysiology and abnormality of CSF-Ig to determine degree of peripheral nerve demyelination and prognosis.
文摘<strong>Objective: </strong>To explore the clinical effect of and the method and nursing strategy for sellar reconstruction for intraoperative cerebrospinal fluid (CSF) leakage in pituitary adenoma resection under neuroendoscopy. <strong>Methods:</strong> The data from 20 cases of intraoperative CSF leak caused by transsphenoidal pituitary adenoma resection were retrospectively analyzed. Six patients were treated with mucosal flap and artificial dural reconstruction of sellar (simple sellar floor reconstruction). In 45 patients, autologous fat, fascia lata, and artificial dura were used to repair and reconstruct the sellar floor (multilayer sellar floor reconstruction). After the operation, all patients underwent follow-up for 6 - 24 months. <strong>Results:</strong> Fifty patients were followed up without CSF leakage. One patient was cured after leakage of CSF through the lumbar cistern 1 month after discharge. <strong>Conclusion: </strong>For patients with CSF leakage during neuroendoscopic transsphenoidal pituitary adenoma resection, individualized sellar floor reconstruction should be adopted according to the degree of CSF leakage and the size of the sellar floor defect. Strict nursing measures can effectively prevent CSF leakage and reduce postoperative complications.
文摘Bacterial meningitis (BM) is a life-threatening condition which affects the central nervous system (CNS). Its incidence rate is estimated between 0.22 - 2.66 and 0.81 - 6.1 cases/1000 lives worldwide and in Africa respectively. The objective of this study was to determine the frequency of bacterial organisms isolated from CSF of children less than five years old in Windhoek. A retrospective analysis was performed on 784 results of CSF submitted to the Namibia Institute of Pathology (NIP) from January 2010 to August 2014. The results showed that out of the suspected meningitis cases, 18 (28.6%) were due to Streptococcus pneumoniae, making it the frequently isolated organism, followed by Staphylococcus aureus 7 (11.1%), Escherichia coli 5 (7.9%) and Haemophilus influenzae 4 (6.3%). Streptococcus pneumoniae showed high resistance to penicillin 17 (70.5%) & cotrimoxazole 16 (93.7%) and 100% susceptibility to ciprofloxacin (5), vancomycin (13) & ceftri-axone (8). Haemophilus influenzae showed moderate resistance to cotrimoxazole 3 (66%) & tet-racycline 2 (50%). It showed 100% sensitivity to chloramphenicol (4), cefuroxime (2) & ceftriaxone (3). Neisseria meningitidis showed high resistance to cotrimoxazole by 100% (n = 2) and high sensitivity to chloramphenicol (n = 2), ceftriaxone & penicillin by 100% (n = 2). Streptococcus agalactiae was resistant to tetracycline and sensitive to penicillin & erythromycin by 100% (n = 1). Streptococcus pneumoniae was isolated the most in this current study and it had high resistance to penicillin & cotrimoxazole. There was a significant difference between results CSF culture and PCR, Gram stain, CSF cell count, protein & glucose, as all comparisons yielded in P values less than 0.05, indicating a significant statistical association.
文摘Background: Cerebrospinal fluid analysis is a very important tool in the diagnosis of bacterial meningitis in the new born. Bacterial meningitis is a potent cause of morbidity and mortality in the neonatal age group, with a very high incidence of neurological complications. Aim: To identify the bacterial pathogens isolated from the cerebrospinal fluids of neonates at the University of Port Harcourt Teaching Hospital (UPTH) and their sensitivity patterns. This will assist the neonatologist in the choice of empirical antibiotic treatment. Study Design: Retrospective, descriptive, cross sectional study. Place and duration of study: University of Port Harcourt Teaching Hospital, from 1 January 2009 to 31 December 2014. Methods: Records of bacterial analysis of cerebrospinal fluid from neonates seen at the special care baby unit of the University of Port Harcourt Teaching Hospital with clinical suspicion of meningitis between 1 January 2009 and 31 December 2014 were retrieved from the microbiology record book. Data on patients age, sex, appearance of Cerebrospinal fluid, cell count, microscopy/gram stain, culture and antibiotic sensitivity were retrieved from laboratory record books and entered into a Microsoft? excel spread sheet and analysed using SPSS version 20.0. Results: One hundred and thirteen neonates: 70 (61.95%) of these patients were male while 43 (38.05%) were females. Only 1 (0.89%) was positive for culture yielding a growth of Escherichia coli which was sensitive to Imipenem, moderately sensitive to Ampicillin, Gentamicin, ceftazidime, cefuroxime, ciprofloxacin and Amoxicillinclavulanic acid. It was resistant to cefotaxime. 112 (99.11%) of the neonates had presumed neonatal meningitis while only 1 (0.89%) had proven neonatal meningitis. Conclusions: There is a low yield of organisms in cerebrospinal fluid of neonates at the University of Port Harcourt Teaching Hospital.
文摘BACKGROUND Rapid molecular testing has revolutionized the management of suspected viral meningitis and encephalitis by providing an etiological diagnosis in<90 min with potential to improve outcomes and shorten inpatient stays.However,use of molecular assays can vary widely.AIM To evaluate current practice for molecular testing of pediatric cerebrospinal fluid(CSF)samples across the United Kingdom using a structured questionnaire.METHODS A structured telephone questionnaire survey was conducted between July and August 2020.Data was collected on the availability of viral CSF nucleic acid amplification testing(NAAT),criteria used for testing and turnaround times including the impact of the coronavirus disease 2019 pandemic.RESULTS Of 196/212(92%)microbiology laboratories responded;63/196(32%)were excluded from final analysis as they had no on-site microbiology laboratory and outsourced their samples.Of 133 Laboratories included in the study,47/133(35%)had onsite facilities for viral CSF NAAT.Hospitals currently undertaking onsite NAAT(n=47)had much faster turnaround times with 39 centers(83%)providing results in≤24 h as compared to those referring samples to neighboring laboratories(5/86;6%).CONCLUSION Onsite/near-patient rapid NAAT(including polymerase chain reaction)is recommended wherever possible to optimize patient management in the acute setting.
文摘Objective To analyze the causes and prevention and treatment of cerebrospinal fluid leak during transsphenoidal pituitary adenoma surgery. Methods Retrospective study of 260 cases of microscopic transsphenoidal surgery and 274 cases of endoscopic surgery for resection of the pituitary adenomas was performed. CSF leak occurred
文摘BACKGROUND: At present, suppurative meningitis is mainly treated through anti-infection with antibiotics, depressing encephalic pressure with mannitol , lowering body temperature with drugs , supporting treatment, etc. However, it takes a long course of treatment and has poor therapeutic effect. Successive irrigation of subarachnoid cavity maybe have better effect on suppurative meningitis. OBJECTIVE: We compared the successive irrigation of subbarachnoid cavity with routine therapeutic methods to observe the effect of successive irrigation of subarachnoid cavity on the body temperature, cerebrospinal fluid pressure, the number of white blood cell and the level of protein of suppurative meningitis dogs. DESIGN: A randomized and controlled animal experiment. SETTING: Institute of Neuroscience, Taihe Hospital Affiliated to Yunyang Medical College. MATERIALS: Totally 17 healthy adult male Beagle dogs, of common grade, weighing 9 to 10 kg, were involved in the experiment, and raised in the 20 ℃ temperature with relative humidity of 50% for 1 week. They were randomized into 3 groups: normal group (n=5), control group (n=5) and irrigation group (n=6). Artificial cerebrospinal fluid was prepared according to the level of glucose and chloride of cerebrospinal fluid of normal dogs, and then it was sterilized with high pressure. METHODS: This experiment was carried out in the experimental animal center of Yunyang Medical College from April to August 2001. ① After the dogs were anesthetized,1 mL fresh staphylococcus aureus liquid [(1.5-1.6)×109 L-1] was injected into medullary cistern to establish suppurative meningitis models. ② After models were successfully established, intravenous drip infusion of 1.2 ×106 U/(kg·d), muscular injection of sulfadiazine sodium of 100 mg/(kg·d)and intravenous injection of 200 g/L mannitol of 5 g/(kg·time) for 3 times a day were performed in the control group. The irrigation of subarachnoid meningitis was conducted in the irrigation group besides the routine treatments in the control group: Artificial cerebrospinal fluid was successively injected into the epidural catheter in the waist part. The mixtures of artificial cerebrospinal fluid and inflammatory cerebrospinal fluid flowed out incessantly from epidural catheter of medullary cistern. Irrigation was ended 48 hours later. Dogs were routinely raised in the control group. ③ From the first day after being modeled to the 14th day after treatment, the rectal temperatures were daily measured in the morning, at noon and in the evening respectively, then the mean temperatures were calculated . From the 2nd day after being modeled to the 14th day after treatment, puncture at waist was given once, and the cerebrospinal fluid pressure, the number of white blood cells and the level of protein were measured. MAIN OUTCOME MEASURES: The body temperature, cerebrospinal fluid pressure, the number of white blood cells and the level of protein were measured on suppurative meningitis model dogs. RESULTS: Totally 17 Beagle dogs were involved in this study. ①The body temperatures of dogs were significantly reduced in the control group and in irrigation group on the 1st day after treatment and lower than suppurative meningitis model dogs on the 2nd day after being modeled (P < 0.05). The body temperatures were gradually decreased in control group from the 2nd day after being modeled to the 14th day after treatment (P < 0.01), but were significantly higher than those of dogs in normal group on the 14th day after treatment (P < 0.05). The body temperatures of dogs were gradually decreased in irrigation group on the 2nd day or 3rd day after treatment (P < 0.01) and then were close to the normal body temperature on the 14th day after treatment. ②There was the same cerebrospinal fluid pressure in control group as in irrigation group on the 2nd day after being modeled (P > 0.05), but significantly decreased in two groups from the 1st day or 2nd day after treatment (P < 0.01), and cerebrospinal fluid pressure was close to the normal level in irrigation group. Although the cerebrospinal fluid pressure raised a little on the 3rd day or 4th day after treatment in the irrigation group (P < 0.05), but recovered to the normal level on the 9th day after treatment again. It decreased slowly in the control group and still was significantly higher than normal group on the 14th day after treatment (P < 0.01). ③No significant difference existed in number of white blood cell and the level of protein between control group and irrigation group on the 2nd day following modeled. Both of them began to significantly decrease on the 1st and 2nd day after treatment (P < 0.01). Although the number of white blood cell and the level of protein rebounded a little in irrigation group 3 or 4 days after treatment (P < 0.05), they were gradually decreased and recovered to normal levels on the 13th day after treatment. The number of white blood cell and the level of protein slowly decreased in the control group compared with irrigation group and were still significantly higher than normal group on the 14th day (P < 0.01). CONCLUSION: Irrigation of subarachnoid cavity can decrease the body temperature, cerebrospinal fluid pressure, the number of white blood cells and the level of protein at early stage of suppurative meningitis , and the therapeutic effect is better than that of routine treatment.
基金supported by the National Natural Science Foundation of China,No.81671211,81672251(both to HLL)
文摘Tau protein, a microtubule-associated protein, has a high specific expression in neurons and axons. Because traumatic spinal cord injury mainly affects neurons and axons, we speculated that tau protein may be a promising biomarker to reflect the degree of spinal cord injury and prognosis of motor function. In this study, 160 female Sprague-Dawley rats were randomly divided into a sham group, and mild, moderate, and severe spinal cord injury groups. A laminectomy was performed at the T8 level to expose the spinal cord in all groups. A contusion lesion was made with the NYU-MASCIS impactor by dropping a 10 g rod from heights of 12.5 mm(mild), 25 mm(moderate) and 50 mm(severe) upon the exposed dorsal surface of the spinal cord. Tau protein levels were measured in serum and cerebrospinal fluid samples at 1, 6, 12, 24 hours, 3, 7, 14 and 28 days after operation. Locomotor function of all rats was assessed using the Basso, Beattie and Bresnahan locomotor rating scale. Tau protein concentration in the three spinal cord injury groups(both in serum and cerebrospinal fluid) rapidly increased and peaked at 12 hours after spinal cord injury. Statistically significant positive linear correlations were found between tau protein level and spinal cord injury severity in the three spinal cord injury groups, and between the tau protein level and Basso, Beattie, and Bresnahan locomotor rating scale scores. The tau protein level at 12 hours in the three spinal cord injury groups was negatively correlated with Basso, Beattie, and Bresnahan locomotor rating scale scores at 28 days(serum: r =-0.94; cerebrospinal fluid: r =-0.95). Our data suggest that tau protein levels in serum and cerebrospinal fluid might be a promising biomarker for predicting the severity and functional outcome of traumatic spinal cord injury.
