脑小血管病( cerebral small vessel disease,CSVD)在老年患者认知障碍和痴呆的病理生理机制中具有重要的意义[1].其主要影像学表现为脑白质高信号( white matter hyperintensity, WMH)、腔隙性梗死(lacunar infarction,LI)、脑微出血(cerebral microbleeds,CMB)、扩大的血管周围间隙( perivascular spaces, PVS)和脑萎缩.虽然其临床表现通常是隐匿的,但以上脑部病变的存在常与肢体功能障碍、认知障碍、步态异常、膀胱功能障碍和死亡的风险相关[2].高血压、糖尿病等传统危险因素在CSVD发病中起重要作用,但其确切的发病机制尚不清楚.目前研究表明,血脑屏障( Blood-brain barrier BBB)和内皮功能障碍与CSVD有关[3].

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

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

目的 观察神经内镜联合颅内压监测治疗基底节区脑出血的疗效,探讨有效治疗方法.方法 收集68例高血压脑出血患者,分为神经内镜下血肿清除联合对侧脑室穿刺颅内压监测组(A组,20例);锥颅血肿穿刺引流术组(B组,25例);开颅血肿清除术组(C组,23例).比较3组患者术后的甘露醇使用次数、术后监护时间、气管切开率及预后情况.结果 ①甘露醇使用次数:A组使用甘露醇次数(17.25±2.55)明显少于B组(20.32±2.08),差异有统计学意义(P<0.05);②术后监护时间:A组(63.60±11.74)h明显少于B组(104.64±16.80)h和C组(138.78±23.95)h,差异有统计学意义(P<0.05);③气管切开率:A组患者的气管切开率(5.0％)明显低于B组(36.0％)和C组(34.8％),差异有统计学意义(P<0.05);④预后:A组患者的预后(100.0％)优于B组(72.0％)和C组(82.6％),差异有统计学意义(P<0.05).结论 神经内镜联合颅内压监测治疗基底节区脑出血患者,是一种明确有效的手术方法.

心脏黏液瘤相关性颅内动脉瘤非常罕见,目前对于该病的发病机制仍不清楚,诊断和治疗没有统一的标准.通过相关文献资料的复习,分析并总结该疾病可能的发病机制、临床症状、影像学特点、诊断及其治疗进展,旨在以后的研究及临床工作中对该疾病能够早期诊断并预防神经系统并发症,选择合适的治疗方案.

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

脑电双频指数(bispectral index,BIS)是将脑电图信号量化后所得的数字,它能实时反映大脑皮质和皮层下的意识水平,并能迅速反映镇静水平的变化,不仅适用于指导手术患者的麻醉深度及危重症患者的镇静水平,还可应用于早期干预以改善颅脑损伤患者脑缺血缺氧状态、评估预后状态等,在神经外科领域有很好的应用前景.本文主要就BIS技术监测意识水平的基本原理、影响因素及在神经重症监护室(neurological intensive care unit,NICU)的应用进行综述,以促进其在国内神经外科领域的应用发展.

Alfalfa (Medicago sativa L.) is an important forage crop in the world and it is of great significance for the improvement of its salt tolerance. To improve salt tolerance in alfalfa, a rice ascorbate peroxidase gene (OsAPX2) was introduced into alfalfa using Agrobacterium tumefaciens-mediated transformation with marker gene bar. The different T-DNA insertions in T1 transgenic alfalfa were identified by Southern hybridization. Three independent T2 transgenic lines were selected for stress analysis and the results showed that all of them were salt tolerant compared with wild-type plants. The transgenic plants had low levels of H2O2, malondialdehyde and relative electrical conductivity under salt and drought stresses. Moreover, the contents of chlorophyll and proline, and APX activity were high in transgenic plants under salt and drought stresses. Taken together, the overexpression of OsAPX2 enhances salt tolerance in alfalfa through scavenging reactive oxygen species.

The ROS(Reactive oxygen species)is a plant byproduct of aerobic metabolism,environmental stress also makes a large amount of a ROS accumulate in plant cells.Low concentrations of ROS can exist as a signaling molecule to induce the expression of defense genes and plant adaptation to the environment reaction.When the stress force in plant cells produce large amounts of reactive oxygen species,it will cause damage to intracellular macromolecules and other components,to impede normal plant metabolism and growth,and even death.Plants existence of active oxygen scavenging mechanism,the balance can be maintained within a certain range of reactive oxygen species.Studies have shown that the plants active oxygen scavenging mechanism can improve the resistance of plants.In this paper,an overview of the current dynamic of Reactive Oxygen Species,at the same time explore the application of plant active oxygen scavenging mechanism in improving plant stress resistance.

Alfalfa is highly regarded for its feeding value which is due to its high protein content,and it is often called the"Queen of Forages".Alfalfa was cultivated before two thousand years.With the development and application of transgenic technology,alfalfa is also used as a plant bioreactor in recent years.More and more studies on the transgenic alfalfa are reported.This paper reviews briefly the methods and transgenic breeding research.The application of transgenic alfalfa has many advantages and broad prospects.