痴呆属中医学"呆病""善忘"等范畴,中医藏象理论认为,脑为元神之府,由精髓汇聚而成,脑的功能通过五脏来完成,发挥神志记忆的功能,由此可见老年性痴呆的病位虽在脑,但与心肝脾肺肾五脏的关系非常密切,因此,老年性痴呆的防治也符合中医的整体观理论,需要全方位的临床观察和科学评价.

目的 系统评价中医疗法对溃疡性结肠炎患者肠道菌群的影响.方法 计算机检索三大英文数据库(PubMed、Embase、Cochrance Library)和四大中文数据库(CNKI、WanFang、CBM、VIP),纳入中医疗法治疗溃疡性结肠炎的临床随机对照试验(RCT),检索时限均为建库至2021年12月15日.由2位研究者独立筛选文献、提取数据和偏倚风险评价,数据分析采用Stata 15.1软件.结果 共纳入33个RCT,共计2597例患者,涉及9种治疗措施,包括西药、中药口服、中药灌肠、中药口服+西药、中药灌肠+西药、中药口服+中药灌肠+西药、中药口服+针灸、中药口服+中药灌肠、西药+中药口服+针灸.数据分析显示,中药口服+针灸疗法在临床有效率、改善双歧杆菌、乳酸菌、大肠埃希菌含量方面效果最佳,中药口服+中药灌肠+西药疗法在降低肠球菌的含量方面具有最佳疗效.结论 通过既有证据可知,中医疗法在有效率、改善患者肠道菌群方面具有一定优势,中药口服+针灸疗法在治疗溃疡性结肠炎中成为最优选择的可能性最大.此外,研究结论依然需要大量设计合理、高质量且方法适宜的RCT予以证实.

Objective:To explore the strategies and key operation points of microsurgery in the treatment of meningioma in sagittal sinus and falx cerebri .Methods:The clinical data of 73 patients with meningioma in sagittal and beside cerebral falx were analyzed retrospectively .The tumors located in the anterior 1/3 segment of sagittal sinus or cerebral falx in 19 cases ,in the central 1/3 segment in 46 cases ,and in the posterior 1/3 segment in 8 cases .The base of tumors originated from the sagit‐tal sinus in 27 cases ,originated from the cerebral falx in 33 cases ,and involved with both the sagittal sinus and the falx cerebri in 13 cases .Microsurgery technique was applied to resect the tumors ,and to treat with sagittal sinus or falx cerebri invaded by tumor .Results:There were 24 cases of Simpson Grade I resection ,46 cases of Simpson Grade II resection ,and 3 cases of Simpson Grade III resection .No case died due to operation .No case suffered from severe cerebral edema or cerebral venous in‐farction .64 cases were followed up for 6 months to 7 years ,and tumors recurred in 6 cases (9 .3% ) .Conclusions:During the microsurgical operation for total resection of the meningioma in sagittal sinus and falx cerebri ,the correct treatment for involved sagittal sinus and falx cerebri ,as well as the protection for bridging venous ,is the key to achieve satisfactory effect of opera‐tion .

Understanding the resistance of glioma cells to chemotherapy has been an enormous challenge. In particular, mechanisms by which tumor cells acquire resistance to chemotherapy under hypoxic conditions are not fully understood. In this study, we have found that miR-497 is overexpressed in glioma and that hypoxia can induce the expression of miR-497 at the transcriptional level by binding with the hypoxia response element in the promoter. Ectopic overexpression of miR-497 promotes chemotherapy resistance in glioma cells by targeting PDCD4, a tumor suppressor that is involved in apoptosis. In contrast, the inhibition of miR-497 enhances apoptosis and increases the sensitivity of glioma cells to TMZ. These results suggest that miR-497 is a potential molecular target for glioma therapy.

目的 研究CD<,105>和缺氧诱导因子-la (HIF-la)在侵袭性垂体瘤中的表达水平,并探讨CD<,105>标记的MVD密度及HIF-la在侵袭性垂体瘤中的生物学意义和作用.方法 收集2005-2010年的侵袭性垂体瘤手术标本25例,非侵袭性垂体瘤15例,用免疫组化方法检测CD<,105>及HIF-la的表达,并对CD<,105>标记的MVD进行计数,结果进行对照分析.结果 所有垂体瘤标本均有CD<,105>表达,40例标本CD<,105>MVD均值为(16.2±6.1),侵袭性组为(21.8±2.8),非侵袭性组为(10.6±2.2);HIF-la表达情况:侵袭性组为14例阳性,11例阴性;非侵袭性组为3例阳性,12例阴性.经统计学分析侵袭性与非侵袭性垂体瘤中CD<,105>和HIF-la的表达存在显著差异,有统计学意义(F<0.05).结论 侵袭性垂体瘤中CD<,105>和HIF-la的表达明显增高,CD<,105>和HIF-la参与侵袭性垂体瘤的发生、发展.CD<,105>和HIF-la可以作为预测垂体瘤侵袭性的免疫检测指标.

目的探讨脑膜瘤中低氧诱导因子1α（HIF-1α）、血管内皮生长因子（VEGF）和基质金属蛋白酶9（MMP-9）表达与脑膜瘤组织学分级、复发的关系。方法采用免疫组化方法检测脑膜瘤标本中HIF-1α、VEGF和MMP-9表达情况,分析它们相互间以及与脑膜瘤组织学分级、复发的关系。结果（1）52例脑膜瘤标本中HIF-1α、VEGF和MMP-9的阳性表达率分别为78.8%、84.6%和73.1%;表达强度均与脑膜瘤的病理级别呈正相关（rs=0.499、0.448、0.583,P＜0.01）;（2）VEGF表达强度与HIF-1α的表达强度呈正相关（rs=0.714,P＜0.01）,MMP-9表达强度与HIF-1α、VEGF的表达强度无关（rs=-0.0066,rs=-0.095,P＞0.05）;（3）52例脑膜瘤中有7例复发,复发率为13.5%;脑膜瘤复发与性别、发病年龄不相关（P＞0.05）;而与病理分级以及HIF-1α、VEGF和MMP-9表达强度相关（P＜0.01）。结论HIF-1α、VEGF和MMP-9表达与脑膜瘤分级及术后复发密切相关。HIF-1α可有诱导血管生成的作用。

Objective In order to investigate the expression of hypoxia inducible factor-1α (HIF-1α) and its relationship with prognosis of patients with gliomas. Methods The expression levels of HIF-1α in gliomas were detected by immunohistochemistry assay, and analyzed the relationship of the HIF-1α expression to clinical pathologic characters and prognosis of the patients. Results There was a positive HIF-1α expression in the glioma specimens, and the positive HIF-1α expression rate for the glioma specimens was 71.67% (43/60). It was mostly observed in the cytoplasm and (or) the nucleus with obvious heterogeneity. Enhanced expression could be clearly seen in the surroundings of the edges of the infiltration areas of the tumor. It was shown that HIF-1α expression in gliomas with higher pathological classification grade (Ⅲ～Ⅳ) was much more evident than those with lower pathological classification grade (Ⅰ～Ⅱ) (x2=18.123, P0.01). The expression intensities were positively correlated with the pathological grades (rs=0.620, P0.01); The mean postoperative survival times of HIF-lα (-), (+), (++) and (+++) groups were 46.11±3.54,37.99±3.72, 23.27±2.76 and 16.96±4.32 months respectively. There was significantly difference in the mean postoperative survival times among different groups (x2=22.190, P 0.01). Conclusions There were overexpressions of HIF-1α in gliomas, and the HIF-1α expression intensities were correlated with the glioma pathological grades. The HIF-1α expressions were negtively correlated with the postoperative survival times of the patients with gliomas.

Objective:To explore the effectiveness of microsurgery through lateral fissure approach for treating hypertensive hemorrhage of basal ganglia region.Methods:The surgical data of microsurgery through lateral fissure approach for 27 cases were retrospectively analyzed from January 2003 to June 2005 in our hospital.Results:The CT re-examination within postoper- ative 24 hours showed that the hematoma was removed by over 80% in 24 cases and 70% in 3 cases.However,one case had rebleeding 10 hours after operation.After 6 months follow-up,the good ADL ration was 74.1% and the mortality was 11.1%.Conclusion:Ultra-early microsurgery through lateral fissure approach is a kind of minimally invasive method for trea- ting hypertensive hemorrhage of basal ganglia region with little secondary brain damage,desirable effect of decompressing the mass effect and favorable recovery of neurological function as well as low morbidity and mortality.

背景与目的:岩斜区脑膜瘤在后颅窝并非罕见,其可广泛生长,累及颅底诸结构,且手术全切率低,复发率较高,本文结合我们的临床经验,探讨岩斜区复发性脑膜瘤的临床特点及治疗.方法:分析2例岩斜区复发性脑膜瘤的有关临床资料及治疗过程.结果:2例岩斜区复发性脑膜瘤再手术都做到肿瘤全切除,并获满意的临床效果,1例术后出现脑脊液耳漏,保守治疗后愈合.另1例术后出现迁延性肺炎,治疗后痊愈.结论:岩斜区复发性脑膜瘤应争取及早诊断,手术是积极有效的治疗方法.

目的探索改进经蝶窦垂体腺瘤切除术中的鞍底处理方法。方法对本院1995年以来82例经蝶窦显微手术的垂体腺瘤患者,按鞍底处理分为三类。术中满意切除腺瘤,鞍隔蛛网膜囊满意贴向鞍底者,用明胶海绵加EC胶单纯封闭鞍底(29例);术中蛛网膜破损有脑脊液漏出者,用明胶海绵加EC胶封堵(37例);对肿瘤刮除不满意或刮除肿瘤后鞍隔蛛网膜下降不满意者,鞍内填入明胶海绵或速即纱等止血物质,鞍底敞开不封闭(16例)。结果患者术后均无不良反应,也没有并发症。结论本方法与目前传统方法的最大区别在于处理鞍底不用自体游离组织,而用明胶海绵、EC胶。其方法简便,安全,疗效可靠,且减少患者的痛苦。

Objective To evaluate the risk factors for gastrointestinal bleeding after severe head trauma.Method 153 cases of severe craniocerebral injury were retrospectively analysed.Results Gastrointestinal bleeding was found in 49 cases(30%).This analysis indicated 4 significant risk factors for predicting the development of gastrointestinal bleeding:1.GCS,2.decereberate rigidity,3.high fever,4.hyperglycemia.Conclusion We must be constantly on our guard against gastrointestinal bleeding among ICU patients with severe craniocereral injury,especially among those with risk factors. [

Objective:To introduce the microsurgical experience of improving the rate of total removal in medial sphenoid ridge meningiomas.Methods:A series of 21 cases operated microsurgically on with vigorous attempts at total removal of the tumor were analysed retrospectively.Result:Total removal (Grade Ⅰ、Ⅱ of Simpson system) was achieved in 14 (67%) of the 21 patients, and subtotal in 5, partial in 2. After operation, one patient (4.8%) died of pulmonary infection. Postoperative paresis were seen in 2 patients, and aphasia in 1.Conclusion:The interfacing arachnoid membranes is present between the tumor capsule and the cerebral vessels in most of the cases. Microsurgical technique is recommended to totally remove the tumor with vigorous attempts during the initial operation.

The present study was designed to prospectively investigated the prostaglandin (PG) levels and extent of peritumoral edema in 30 cases of glioma by using methods of radioimmunoassay and imaging. Both TXB2 and 6-keto-PGF10 levels in all glioma groups went up over that in the control group. TXB2 level and ratio of TXB2/6-keto-PGF10 were markedly increased with the extent of tumor malignancy. Water concentration in anaplastic astrocytoma and glioblastoma were significantly elevated. Difference in TXB2 level and TXB2/6-keto-PGF10 ratio among three edema grades were statistically significant. TXB2 level and ratio of TXB2/6-keto-PGF10 were closely correlated with water concentration (r1 = 0. 53, r2 = 0. 72,P <0. 01). Our findings suggested that the metabolism of PG in glioma were in the state of disorder, and that the imbalance between PGI2 and TXA2 may be one of factors which affect the formation of peritumoral edema.