高原低氧环境中颅脑损伤患者的病情加重,出现继发脑损伤,其机制主要有低氧血症、凝血功能障碍、脑血管自身调节功能失常、脑组织氧化应激反应增强及脑细胞结构和功能障碍.高原低氧环境中颅脑损伤患者出现低氧血症,低氧血症可加重颅脑损伤,颅脑损伤又会影响肺功能,加重低氧血症;凝血纤溶系统激活,最终促使DIC的发生,影响血液向脑组织提供营养,血小板被激活,释放5-羟色胺等生物活性因子,破坏血管基底膜,产生微循环障碍,导致继发脑损伤;脑血管的自动调节功能失常,引起脑静脉压增高和脑血管通透性增加,引发创伤性颅脑损伤患者出现继发脑损伤;脑组织严重受损,机体通过自身的调节作用对外源性损伤做出应对,表现为神经递质过度释放和聚集、具有组织损伤活性的蛋白分泌增加和炎性因子释放增加,从而引发继发脑损伤;脑细胞结构和功能障碍,出现细胞毒性脑水肿和线粒体自噬,最终导致继发脑损伤.

线粒体中的沉默信息调节因子同源蛋白3(SIRT3)具有重要的去乙酰化酶,可影响线粒体的乙酰化水平,进一步调控许多信号通路,在细胞内形成密切的调控关系网络.迄今为止,SIRT3已被证实参与了几乎所有与线粒体代谢和稳态相关的病理生理过程,并且保护线粒体免受各种损伤.只有了解SIRT3如何调节各类病理生理过程,才能熟知如何扩大SIRT3的保护作用、优化病理代谢、氧化应激、生物衰老等过程.因此,重点综述线粒体SIRT3的功能及其在中枢神经系统疾病中的作用研究进展,以期在未来的药物发现中明确其治疗靶点,为临床提供科学指导意义.

目的 探讨清醒麻醉下切除脑功能区胶质瘤时术中癫痫的危险因素.方法 回顾性分析2020-09-2022-09在西京医院神经外科收治的183例脑功能区胶质瘤病例,根据术中有无癫痫可分为术中癫痫组36例和术中无癫痫组147例,并对2组进行Logistic危险因素分析.结果 Logistic回归分析显示肿瘤在中央前回、术前有癫痫、术前MMSE评分低和术中刺激电流＞3 mA为术中癫痫发作的独立危险因素(OR=2.521、2.893、3.867、2.671,均P＜0.05),ROC曲线结果显示术前MMSE评分＜24分对术中癫痫有预测价值.结论 肿瘤在中央前回、术前有癫痫、术前MMSE＜24分和术中刺激电流＞3 mA为术中癫痫的独立危险因素,针对危险因素提前采取精准防治,对改善患者预后意义重大.

目的 比较清醒麻醉开颅和全麻开颅对脑功能区胶质瘤术后的疗效.方法 回顾性分析80例脑胶质瘤病例资料,其中清醒麻醉(awake anesthesia,AA)开颅40例(AA组),全身麻醉(general anesthesia,GA)开颅40例(GA组).结果 两组在术中失血量、手术时间、术后癫疒间发生率、术后1周语言和肢体功能改善率无明显差异.术后AA组肿瘤全切程度比GA组高,住院时间比GA组短,恶心呕吐发生率比GA组低,术后2个月的KPS比GA组高.结论 AA下行开颅脑功能区胶质瘤切除术安全可行,可提高肿瘤全切程度,为临床肿瘤切除提供指导.

目的 探讨非典型脑膜瘤的磁共振成像(MRI)特征及病理基础.方法 回顾性分析20例经手术和病理证实的非典型脑膜瘤患者的MRI资料,包括影像特点(囊变、分叶状、强化方式与程度、瘤脑界面、邻近颅骨征象)及病理基础.结果 肿瘤位于大脑凸面12例,大脑镰旁6例,乙状窦旁2例,典型MRI结果呈边界清晰的软组织肿块.病变部位T1WI结果呈等信号或者低信号,T2WI表现为高信号,占位效应比水肿更显著,肿瘤内部囊变坏死,增强扫描显示不均质强化.结论 非典型脑膜瘤发病率低,其MRI具有一定的特征性.MRI平扫联合增强扫描可以对肿瘤进行术前定位及定性诊断.

Objective To explore the effects and related mechanism of amniotic mesenchymal stem cells (AMSCs) for rats myocardial injury induced by severe burns.Methods The AMSCs were obtained by the method of collagenasepancreatic enzyme digestion.Biological markers were assayed with flow cytometry.The activity of AMSCs was identified using adipogenic and osteoplastic differentiation.24 healthy male SD rats were randomly divided into sham group,burn group and AMSCs group.The dorsal skin of rats in burn group and AMSCs group were exposed to 98℃ water for 15 s which led to the third degree,30％ TBSA burns,while the rats in the sham group were exposed to 37℃ water for 15 s.Rats in bum group and AMSCs group were given 0.9％ 10 mL (50 mL/kg) saline intraperitoneally immediately after bums.PBS or AMSCs were injected through caudal vein 3 hours later.48 hours later,rats were sacrificed and the myocardium and blood from aorta abdominalis were collected.The levels of creatine kinase (CK),lactic dehydrogenase (LDH) were detected by ELISA.The mRNA levels of caspase-3,TNF-α,IL-1β and IL-10 were detected by RT-PCR.The data were analyzed through A VONA and LSD-t test by SPSS.Results The positive rates of CD29,CD44,CD90,CD105 were very high in the third generation of AMSCs,however,the positive rate of CD34 was low.AMSCs underwent osteogenic and adipogenic differentiation after induction.The levels of CK and LDH in rats of the bum group were significantly increased compared with the sham group (P ＜ 0.05).The levels of CK and LDH in AMSCs group were significantly lower than those in the bum group (P ＜ 0.05).The mRNA levels of caspase-3,IL-1β and TNF-oα in the myocardium of the bum group were significantly increased compared with the sham group (P ＜ 0.05).The mRNA levels of caspase-3,IL-1β and TNF-α in myocardium of the AMSCs group were significantly lower than those in the bum group (P ＜ 0.05).The mRNA level of IL-10 in the bum group was significantly lower than that in the sham group (P ＜ 0.05).In the AMSCs group,the expression of IL-10 mRNA was significantly higher than that in the bum group (P ＜ 0.05).Conclusion AMSCs can protect against myocardial injury induced by severe burns.The levels of CK and LDH decreased,indicating that the injury of myocardial decreased.During which,the inflammatory factors,IL-1β and TNF-α mRNA decreased and anti-inflammatory factor IL10 mRNA increased.

Objective To explore the effects and related mechanism of bone marrow stromal stem cells (BMSCs) on protecting rats myocardial injury induced by severe burns.Methods (①)Ten healthy male SD (Sprague-Dawley)rats were used to separate BMSCs through whole bone marrow adherent.The biological markers were assayed with flowcytometry.②)Twenty-four healthy male SD rats were randomly divided into control group,model group and treatment group.Except for control group,abdominal skin of rats were exposed to 95℃ water for 18 seconds which led to the third degree,30％ TBSA burns while the rats in control group were exposed to 37℃ water for 18 seconds.Rats in burn model group and treatment group were given 10 mL(50 mL/kg) saline intraperitoneally immediately after burns.Three hours later,Saline (100 μL)or BMSCs (100 μL,2.5×107/mL) were given through caudal vein.Forty-eight later,rats were sacrificed and the myocardium and blood from aorta abdominalis were collected.The expression levelsof ereatine kinase (CK),lactic dehydrogenase (LDH) were detected by ELISA.The mRNA level of caspase-3,Bcl-2,Bax,TNF-α,IL-1βand IL-10 were detected by RT-PCR.Results The positive rates of CD44,CD90,CD105 were 96.8％,99.72％ and 95.93％ separately in BMSCs.However,the positive rates of CD34 and CD45 were 1.42％ and 2.17％ separately.The expression level of CK and LDH in rats in model group were significantly higher than that in control group (P ＜ 0.05).The expression level of CK and LDH in treatment group were higher than those in control group (P ＜ 0.05).The mRNA level of caspase-3 and Bax in the myocardium in treatment group were significantly decreased compared with control group (P ＜ 0.05).The mRNA level of Bcl-2 in myocardium of treatment group was higher than that in control group (P ＜ 0.05).The mRNA levels of TNF-α and IL-1β in model group were higher than that in control group (P ＜ 0.05).However,in treatment group,these two were lower than in the model group (P ＜ 0.05).The mRNA level of IL-10 was significantly lower than that in control group (P ＜ 0.05).While in treatment group,the mRNA level of IL-10 was significantly higher than that in model group (P ＜ 0.05).Conclusion BMSCs could protect against myocardial injury induced by severe burns.The expression of CK and LDH decreased,indicating that the injury of myocardial decreased.During which,the inflammatory factors,IL-1β and TNF-α decreased and anti-inflammatory factor IL-10 increased.

Proximal humeral fracture is a common bone fracture in clinical setting,usually associated with osteoporosis in epidemiological features.For the past few years,clinical cognition of proximal humeral fracture has achieved significant progress along with the continuous development of the anatomy,pathophysiology,and biomechanics of the shoulder joint.There are two therapeutic strategies for proximal humeral fracture-conservative treatment and surgical treatment,the latter has gone a long development road since 1950s.The principles of treatment include striving for the ideal reduction,keeping blood supply of the humeral head as far as possible,maintaining stability of the fracture segment,and doing early functional exercise as well.In this paper,the progress in treatment of proximal humeral fracture is summarized in order to offer help in selecting the therapeutic strategies for proximal humeral fracture.

Objective:To assess the impact and effectiveness of zero-stage diagnostic technology on the serum concentration level of IL-1β,6-keto-PGF1 α and TNF-α in discogenic low back pain recruits Methods:Total of 596 recruits enrolled in 2015 were randomly selected from two military units,306 of them were distributed to experiment group and the rest of 290 recruits to control group.Before they were enrolled into army,allthe participants had received physical examinations and the results were recorded in a health file.During the time of military training,the zero-stage diagnostic technique were adopted to screen for discogenic low back pain in the experiment group on week 2nd,4th,6th 8th,10th,12th,respectively.And preventive measures were taken correspondingly.In the control group,discogenic low back pain was screened by the STANDARD published in 2002.All the positive cases detected by either the zero-stage diagnostic technique or the STANDARD received blood test for 6-keto-PGF1α、TNF-α and IL-1 [β.Results:The incidence of discogenic low back pain in experiment group (2.94 ％) was much lower than that in control group (9.66 ％)(xZ=11.527,P＜0.001) during the 12-week military training.On week 8th,10th,12th after the military training,the incidence of low back pain in experiment group was much lower than that in control group (P＜0.05).No difference was found in the serum level of 6-keto-PGF1 α,TNF-α and IL-1β between the two groups.But for the positive cases detected by either the zero-stage diagnostic technique or the STANDARD,the serum level increased significantly after the military training (P＜0.05).The serum level of positive cases detected by the zero-stage diagnostic technique was significantly lower than that of the rest of the experiment group and the positive recruits detected by the STANDARD in the control group (P＜0.05).Conclusions:The zero-stage technique for discogenic low back pain could effectively prevent the occurrence of discogenic low back pain.By means of monitoring the serum level change of IL-1β,6-Keto-PGF1α and TNF-α,the zero-stage diagnostic technique was further proved as an effective and feasible method of preventing discogenic low back pain.

目的 对0期诊断技术对新兵军事训练所致下腰痛的预防效果的评价.方法 抽取某部2014年度新兵一营308名新兵为实验组,新兵二营286名新兵为对照组.对实验组采用0期诊断技术,分别在新兵训练开始后的2、4、6、8、10、12周末进行0期训练性下腰痛的筛查,并实施相应的防治措施,同时,按照《军事训练伤诊断标准及防治原则》对所有实验对象进行训练性下腰痛的常规诊治及录入统计.结果 实验组训练性下腰痛总发生率明显低于对照组,差异有高度统计学意义(P＜0.01);在新训开始后的第4、6、8、10、12周末,实验组训练性下腰痛的发生率均明显低于对照组,差异有统计学意义(P＜0.05);0期下腰痛发生率存在双高峰现象;肌源性和椎间盘源性下腰痛发生率,实验组均明显低于对照组,差异有高度统计学意义(P＜0.01),实验组骨关节源性下腰痛发生率与对照组比较,差异无统计学意义(P＞0.05).结论 0期诊断技术作为一种诊断技术,同时结合其他干预技术和方法,对新兵训练性下腰痛的预防作用效果明显,操作简便,适合在基层部队推广应用.

目的 探讨γ-分泌酶抑制剂(GSI)对神经元机械性损伤的保护作用.方法 原代培养小鼠皮层神经元,培养基中加入10 μmol/L GSI共同孵育24h后,使用微量移液器枪头做机械性划伤.测定培养液中乳酸脱氢酶(LDH)活力的变化;Hochest染色测定神经元凋亡情况;Western blot方法检测切冬酶-3(caspase-3)蛋白表达情况.结果 GSI预处理可抑制因细胞损伤引起的LDH的释放,可降低损伤后Hochest阳性细胞的数量以及活化caspase-3的表达.结论 GSI对神经元机械性损伤有保护作用.

目的 比较股骨近端抗旋转髓内钉(PFNA)及动力髁螺钉(DCS)治疗老年人不稳定粗隆间骨折的效果.方法 本研究回顾性分析2012年6月～2014年6月入住解放军第一五零中心医院并以PFNA及DCS治疗的不稳定股骨粗隆间骨折的老年患者,术后随访时间至少1年,共有66例人组,其中32例给予PFNA治疗,34例给予DCS治疗.比较两组性别、年龄、合并症、AO分型、受伤至住院及受伤至手术时间、麻醉方式、住院时间、手术时间、术中失血量、部分负重时间、术后Harris髋关节评分、1年内死亡率、术后并发症情况.结果 两组性别、年龄、合并症、AO分型、受伤至住院时间、受伤至手术时间、麻醉方式、住院时间、术后并发症、1年内死亡率比较,差异无统计学意义(P＞ 0.05);PFNA组平均手术时间[(90.76±14.53)min]短于DCS组[(115.67±27.43)min],术中失血量[(239.78±170.54)mL]少于DCS组[(426.96±172.51)mL],部分负重时间PFNA组[(11.96±2.86)d]短于DCS组[(14.68±3.18)d],差异均有高度统计学意义(均P＜0.01).在Harris髋关节评分中功能、畸形、活动度评分两组差异无统计学意义(P＞ 0.05),而在疼痛评分PFNA组[(38.38±8.78)分]优于DCS组[(32.29±10.14)分],差异有统计学意义(P＜0.05).结论 由于小切口、失血量少、生物力学固定等优势,PFNA是治疗老年人不稳定粗隆间骨折较好的选择.

目的:检测JMJD6蛋白在胃癌组织及相应癌旁正常组织中的表达情况,并分析JMJD6蛋白表达与胃癌患者临床病理参数及预后的关系.方法:应用免疫组织化学方法检测JMJD6蛋白在胃癌组织及相应癌旁正常组织中的表达情况,进一步用Kaplan-Meier生存分析、COX比例风险回归模型等统计学方法研究JMJD6表达与胃癌患者临床病理参数及预后的关系.结果:JMJD6在胃癌组织中的表达阳性率显著高于癌旁正常组织(P=0.001);JMJD6在胃癌组织的高表达与肿瘤临床分期(P=0.008)、病理分级(P=0.001)、局部浸润深度(P=0.028)、有无淋巴结转移(P=0.001)等显著相关;Kaplan-Meier生存分析结果表明JMJD6高表达的胃癌患者术后总体生存率显著低于JMJD6低表达的患者(P=0.023).结论:JMJD6在胃癌的发生发展中可能发挥了癌基因样作用,可能作为胃癌治疗的潜在靶点.

Objective:To exPlore the migration and invasion ability of gastric cancer cells after silencing IKKα ex-Pression. Methods:We used Western blot to detect the IKKα exPression in different gastric cancer cells,and then transfected IKKα shRNA lentivirus and control lentivirus into MKN - 28 cells exPressing high level of IKKα. Western blot and RT - PCR were Performed to verified the silencing effect. And then we conducted transwell migration and in-vasion assay and the wound - healing assay to deliberate the role of IKKα in GC metastasis. Results:Western blot showed that the exPression level of IKKα in MKN28 cells were higher than other gastric cancer cell lines. After trans-fection of IKKα shRNA,the Protein and mRNA level of IKKα in the MKN28 - LV - shIKKα was significantly de-creased. The migration and invasion ability of MKN28 - LV - shIKKα was significantly decreased comPared with MKN28 - LV - shcontrol. Conclusion:Silencing of IKKα significantly decreased the invasion and migration ability of gastric cancer cells. Targeting IKKα may therefore Provide a Promising theraPeutic strategy for gastric cancer Patients.

目的:检测FOXP1蛋白在胃癌组织及癌旁正常组织中的表达情况,并探讨其与胃癌患者病理参数及预后的关系.方法:采用免疫组织化学染色方法检测90例胃癌组织和相应癌旁正常组织中FOXP1的表达情况并进行评分,进一步统计分析FOXP1表达与胃癌患者临床病理参数以及预后的关系.结果:FOXP1在胃癌组织中的表达显著低于癌旁正常组织(P＜0.01)；对临床资料进行统计分析表明,在临床Ⅲ期和Ⅳ期患者的胃癌组织中FOXP1的表达显著低于临床Ⅰ期和Ⅱ期的患者(P＜0.05); FOXP1在低分化胃癌中的表达显著低于高、中分化胃癌(P＜0.01)；FOXP1表达阳性者术后总体生存率较表达阴性者高(P=0.145),中位生存期长.结论:FOXP1表达的减少可能参与了胃癌的发生发展,FOXP1在胃癌中可能扮演抑癌基因的角色,FOXP1可作为胃癌治疗的潜在靶点.

<正>转录因子FoxM1(Forkhead box M1)对肿瘤细胞的生长和存活有重要的调节作用,从而在肝细胞癌的发生发展中扮演着重要的角色。然而,上调FoxM1表达的确切分子机制仍然不甚明了。本研究中我们发现,肿瘤坏死因子α(tumor necrosis factorα,TNF-α)可以转录激活FoxM1,上调其表达。我们通过5’端序列截断以及位点突