目的 分析急性脑出血患者血清细胞间黏附分子1(ICAM-1)、细胞纤维连接蛋白(cFN)水平与炎性因子的相关性及预后危险因素.方法 选取2017年10月—2018年10月吉林大学第二医院神经外科诊治急性脑出血患者126例作为脑出血组,其中存活104例(存活亚组),死亡22例(死亡亚组),另选取同期在医院体检的健康志愿者50例作为健康对照组.比较2组血清ICAM-1、cFN水平及与炎性因子的相关性,分析患者死亡的危险因素.结果 脑出血组患者各个时间点的血清ICAM-1、cFN、肿瘤坏死因子-ɑ(TNF-ɑ)、白介素-1β(IL-1β)、C反应蛋白(CRP)水平均高于健康对照组(F/P=4319.339/0.000、3692.312/0.000、3862.029/0.000、621.021/0.000、899.166/0.000);患者发病3 d时的血清ICAM-1、cFN、TNF-ɑ、IL-1β、CRP水平最高,高于发病1、5 d(F/P=90.498/0.000、589.890/0.000、185.613/0.000、10.920/0.001、11.634/0.001);Pearson分析结果显示,血清ICAM-1、cFN与TNF-ɑ、IL-1β、CRP均呈正相关(ICAM-1:r/P=0.532/0.007、0.489/0.012、0.581/0.000;cFN:r/P=0.453/0.024、0.422/0.041、0.501/0.010);死亡亚组和存活亚组临床资料比较显示,血肿量、GCS评分、ICAM-1、cFN、TNF-ɑ、IL-1β、CRP差异均有统计学意义(P均<0.05),多因素Logsitic回归分析结果显示,血肿量以及血清ICAM-1、cFN、CRP水平是急性脑出血患者死亡的独立危险因素(P<0.05).结论 急性脑出血患者血清ICAM-1、cFN水平与炎性因子呈正相关,血肿量以及血清ICAM-1、cFN、CRP水平是急性脑出血患者死亡的独立危险因素.

Objective To study the classification of the abnormal muscle response (AMR) waveform in hemifacial spasm, and analyze the morphological characters and variety of AMR. Methods Clinical data of 56 patients with hemifacial spasm undergoing microvacular decompression were analyzed retrospectively. AMR examination was performed preoperatively. Muscle contraction named AMR was induced by stimulating the facial nerve branches, then, evoked potential waveforms were recorded. Different waveform morphologies were analyzed and the compression situation of the facial nerve was judged by comparing with uninjured side. Results AMR waveforms were showed in hemifacial spasm patients with microvascular compression. The classification of AMR waveform was as follows:typical waveform in 34 patients, time-limit delay type waveform in 6, scattering type waveform in 8, discontinuity scattering type waveform in 4, incremental incubation period following the stimulation intensity type waveform in 2 and diversity transmission type waveform in 2. Conclusions Preoperative AMR including many kinds of waveforms is helpful for the diagnosis of hemifacial spasm after microvascular compression, and can be used as one of indexes for judging surgery.

The combination of Endostatin (ES) and Herpes Simplex Virus thymidine kinase (HSV-TK) gene therapy is known to have antitumor activity in bladder cancer. The potential effect of ES and TK therapy in glioma has not yet been investigated. In this study, pTK-internal ribosome entry site (IRES), pIRES-ES, and pTK-IRES-ES plasmids were constructed; pIRES empty vector served as the negative control. The recombinant constructs were transfected into human umbilical vein endothelial cells (HUVECs) ECV304 and C6 rat glioma cell line. Ganciclovir (GCV) was used to induce cell death in transfected C6 cells. We found that ECV304 cells expressing either ES or TK-ES showed reduced proliferation, decreased migration capacity, and increased apoptosis, as compared to untransfected cells or controls. pTK-IRES-ES/GCV or pTK-IRES/GCV significantly suppressed cell proliferation and induced cell apoptosis in C6 cells, as compared to the control. In addition, the administration of pIRES-ES, pTK-IRES/GCV, or pTK-IRES-ES/GCV therapy improved animal activity and behavior; was associated with prolonged animal survival, and a lower microvessel density (MVD) value in tumor tissues of C6 glioma rats. In comparison to others, dual gene therapy in form of pTK-IRES-ES/GCV had a significant antitumor activity against C6 glioma. These findings indicate combined TK and ES gene therapy was associated with a superior antitumor efficacy as compared to single gene therapy in C6 glioma.

目的：比较腰椎穿刺与腰大池引流结合鞘内注射万古霉素治疗高血压性脑出血（ HICH）患者开颅术后颅内感染的疗效。方法选取该院2010年9月至2014年3月HICH开颅术后发生颅内感染患者40例，将采用腰椎穿刺并鞘内注射万古霉素治疗的患者作为A组，共19例，将采用腰大池引流并鞘内注射治疗颅内感染的患者作为B组，共21例，均按照颅内感染常规治疗进行基础治疗，A组每12 h行腰椎穿刺放出感染脑脊液40 ml，完成后鞘内注射万古霉素浓度为4 mg／ml生理盐水混合液5 ml；B 组每12 h向引流管内注入万古霉素浓度为4 mg／ml生理盐水混合液5 ml，夹闭引流管2 h后打开引流管进行引流，每24 h视脑脊液压力控制引流量在150～250 ml，拔管后若感染未被完全控制可视患者具体情况行腰穿鞘内给药治疗。结果脑脊液培养结果阳性 A组中表皮葡萄球菌感染2例、屎肠球菌感染1例，B 组中表皮葡萄球菌感染4例、鲍曼不动杆菌感染2例；B组治愈率明显高于A组，B组治疗时间明显短于A组；B组腰部疼痛比例明显低于A组（均P＜0．05）。结论采用腰大池引流结合鞘内注射万古霉素治疗HICH患者开颅术后颅内感染操作简便，效果确切，不良反应少，临床应用价值有待进一步观察。

Objective To analyze the efficacy between optic canal decompression and high-dose corticosteroid. Methods A retrospective study of 51 optic canal fracture patients who were diagnosed by CT between Aug,2005 and Jun, 2014. 24 patients were supposed to treat with optic canal decompression while the other 27 patients were treated with high-dose corticosteroid. Then we contrast the efficacy between these two methods. Results In the optic canal decompression group,7 days after surgery,10 out of 24 had improved vision and the effective rate was 42% . And in the high-dose corti-costeroid group,all patients were treated with Methyprednisolon through intravenous instillation,500mg/ d for 3 days and then 300mg/ d for 3 days. Then oral hydroprednisone was used with 0. 8mg per kilo of weight and the dosage was reduced individually. 7 days after high-dose corticosteroid,9 of 27 had improved vision and the effective rate was 33% . There is no significant difference between the two methods (P = 0. 539 > 0. 05). Conclusion The prognostic vision has no significant difference between optic canal decompression and high-dose corticosteroid in treating the optic canal fracture patients in a short period.

Objective To explore the impact of the distal cerebral protection devices combined with the periop‐eration management on interventional stent implantation in the treatment of unilateral internal carotid artery stenosis . Methods 23 patients with unilateral internal carotid artery stenosis more than or equal to 75% confirmed by the dig‐ital subtraction angiography(DSA) ,including 15 cases of C1 segment stenosis and 8 cases of C2 segment stenosis . Under the protection of the distal cerebral protection umbrella ,the interventional stent implantation was performed . After operation the corresponding medication was given for preventing complications .Results In 23 cases of unilat‐eral internal carotid artery stenosis ,the postoperative stenosis was confirmed by DSA and the postoperative stenosis rate was lower than 30% ,the success rate of operation was 100% ,in which 1 case of vascular spasm occurred during intraoperative balloon expansion(4 .3% ) ,2 cases had the skin and nasal bleeding at the puncture point and 3 cases ap‐peared different degrees of headache ,nausea ,vomiting and other symptoms ,the symptoms disappeared after symp‐tomatic treatment .Postoperative follow‐up lasted for 6 months ,no embolism and other complications occurred .Before and after intervention and during 6‐month follow up ,the systolic blood pressure and diastolic blood pressure were significant‐ly decreased(P<0 .05) .The clinicopathologic characteristics of age(60 years as boundary) ,sex ,old cerebral infarction ,diabe‐tes ,dyslipidemia ,smoking(over three years) ,etc .had no statistically signification differences(P>0 .05) .Conclusion Inter‐ventional stent implantation is effective in the treatment of unilateral internal carotid artery stenosis ,intraoperatively applying the protective umbrella and strengthening the observation during perioperative period and symptomatic treatment can effec‐tively reduce and control the operation complications ,and improve the operative prognosis .

重度颅脑损伤患者早期基础代谢率增高,消耗量大,机体处于负氮平衡状态;尤其是老年重度颅脑损伤者,机体处于一种严重的代谢紊乱状态,免疫功能极度下降;加之临床上脱水药物及大剂量激素的应用,常发生严重并发症,为老年患者继发死亡的主要原因[1].因此,合理的营养支持对于患者能否安全渡过围术期和顺利康复至关重要.近年来的研究结果显示,肠内营养(EN)能很好地改善颅脑损伤患者营养状态,缩短临床恢复时间和外伤后并发症,是未来的发展趋势[2,3].然而,各种不同的EN制剂由于其组成成分不同,临床应用效果也不尽相同.本文比较康全甘和能全力两种制剂的临床应用效果,以求寻找出老年重度颅脑损伤患者早期EN支持的合适制剂.

目的探讨治疗ChiariⅠ畸形手术疗效及术后并发症的方法。方法 40例ChiariⅠ型畸形患者均采用手术治疗。随机分成2组,其中观察组20人（A组）:单纯后颅窝骨性减压+环枕筋膜松解术。对照组20人（B组）:后颅窝减压加小脑扁桃体疝切除术。结果 2组手术方法均可达到治疗ChiariⅠ畸形的目的,并无明显疗效差异。但术后观察组并发症明显少于对照组,两组相较,差异显著（P＜0.05）。结论 2组后颅窝减压术均可达到治疗Arnold-ChiariⅠ畸形的目的,且疗效无明显差异;但单纯后颅窝骨性减压+环枕筋膜松解术可明显减少相关并发症的发生,值得推广。

随现代医学影像检查方法的进步,颅内多发性胶质瘤检出率逐年提高,但仍属少见病例,现将我们收治的2例患者报告如下. 1临床资料 例1,女,74岁,左下肢无力伴头痛持续加重2w于2012年1月3日入院.检查:神清合作,左侧肢体瘫痪,上肢肌力Ⅲ级,下肢肌力IV级,腱反射活跃,Babinski征阳性.头部MRI扫描显示右额顶部、左侧枕叶占位性病变.临床诊断:脑胶质瘤多发性.于2012年2月3日在全麻下施右额顶部开颅,切除肿瘤,病理诊断:胶质母细胞瘤.对侧枕叶病灶未予处理,术后头痛症状消失,左侧肢体瘫痪程度有改善,术后7d拆线,好转出院.追踪观察,出院后3m左右,因肿瘤复发死于高颅压、脑疝(见图l～图4).

Objective: To build oxygen glucose deprivation/reperfusion(OGD/R) model in vitro to mimic ischemia and reperfusion inducing apoptosis of SH-SY5Y cells, to detect differential proteins by employing proteomics technique and to reveal the potential mechanisms of neuronal apoptosis. Methods: SH-SY5Y cells were employed and divided into control group and experimental group in which the cells treated with OGD10h/R24h to set up apoptosis model. After the proteins were extracted from SH-SY5Y cells in control and OGD10h/R24h groups, 2D-DIGE techniques was used to detect differential proteins. Results: By DeCyder software mean (1 800 ± 156) protein spots were displayed on 2D-DIGE image. In OGD10h/R24h group, 30 protein spots were detected to differentially express compared with control group, of which 22 spots were up-regulated and 8 spots were downregulated. Compared with control groups at the same time, the differences were significant (P<0.05 or P<0.01). Conclusion: By employing 2D-DIGE proteomics techniques to analyse OGD/R model, the protein spots are detected to differentially express.

Objective To explore time window of inducing neuronal apoptosis successfully via building and evaluating oxygen glucose deprivation/reperfusion(OGD/R) model in vitro to mimic ischemia and reperfusion inducing apoptosis of SH-SY5Y cells,and to build a basis for revealing the potential mechanisms of neuronal apoptosis.Methods SH-SY5Y cells were employed and divided into control group and experimental group treated with OGD/R for different time.The cell viability was calculated by the method of MTT method.The OGD10h/R groups in which the cell viability was decreased approximately 50% 24 h after reperfusion and control groups were selected for further assay.With light microscope,fluorescence microscope and transmission electron microscope the variation of structure and morphous in cells at different time were observed.The changes in lactate dehydrogenase(LDH) levels,malondialdehyde(MDA) contents,superoxide dismutase(SOD) activities were detected at different time of reperfusion.Flow cytometry was used to analyze the cell cycle distribution and the apoptotic rates at different time of reperfusion.Results The MTT results showed that the cell viabilities were decreased significantly with the prolongation of OGD time.At reperfusion 24 h,the cell viability was(44.91±1.21)% in OGD10h/R groups.The cell viabilities in other different OGD groups had significant differences(P0.05 or P0.01).In OGD10h/R groups the inverted microscope and HE staining results showed that the cell densities were decreased following varied shape and deep blue pycnotic nuclei.The AO/EB fluorescence staining results showed the apoptotic body emerged.Under electron microscope,the cells showed heterochromatin fringe agglutinated in nucleus which were viewed as the appearance of apoptosis and autophagia.The level of LDH in culture fluid and the contents of intracytoplasm MDA at different reperfusion time were increased with the prolonged time and at reperfusion 24 h respectively reached the peak and platform phase,compared with control groups the differences were significant(P0.01).The intracytoplasm SOD activities at different reperfusion time were declined at first and recovered later with the prolonged reperfusion time,compared with control groups the differences were significant(P0.01).By flow cytometry analysis on cell cycle phase at different reperfusion time,in OGD 10h/R groups with the prolonged reperfusion time,the percentage of the cells in G0/G1 phase was increased at first and was decreased later with its peak of(74.09±2.62)% at reperfusion 24 h.The percentage of the cells in G2/M phase reached its peak of(26.85±1.35)% at R 0 h and was declined gradually later.The percentage of the cells in S phase was declined gradually and reached the lowest level of(19.2±1.58)% at reperfusion 24 h.Compared with control groups at the same time,the differences were significant(P0.05 or P0.01).Conclusion OGD10h and reperfusion(OGD10h/R) to mimic cerebral ischemia and reperfusion in vitro is a reliable model that induces SH-SY5Y cells apoptosis,which provide a basis for the futher study on neuronal apoptotic mechanisms.

<正>我科曾收治1例右侧面肌痉挛、三叉神经痛及高血压三者共同发生的女性患者,行显微血管减压术(MVD)后取得良好的临床效果,该病例较少见,故进行临床分析。

我们近年收治非血管源性面肌痉挛3例,分析如下. 1 病历摘要 例1:女,18岁.以右侧面部肌肉间断抽搐10 a为主诉入院.患者于入院前10 a出现右面部肌肉抽搐,由右下眼睑开始并逐渐扩展至整个右面部.3 a来,右面部抽搐逐渐加重,查体:右侧颜面部频繁抽搐,先天性胸廓畸形.神经放射学检查:MRI显示枕骨畸形.入院诊断为右侧面肌痉挛,入院后局麻下行右侧面神经根探查术.术中见枕骨发育畸形,压迫面听神经根向脑干腹侧面移位,面听神经移至枕骨上缘,垫入Teflon棉.术后患者右侧面肌痉挛消失,出院前面肌抽搐消失,未出现并发症.随访6 a后,患者面肌抽搐消失.

视神经损伤是在颅脑损伤中虽不多见但较为严重的并发症之一,手术治疗效果较好。闭合性颅脑损伤合并视神经损伤患者多数为单侧视神经损伤,发病率约为0.5%-4.0%[1],损伤程度较轻者可出现视力下降,视神经萎缩,损伤程度重者甚至可出现

脑血管病是导致人类死亡的三大病因之一,而其中缺血性脑血管病约占75%～80%,其发病机制涉及多方面复杂因素;蛋白质组学作为新兴学科从整体角度,系统地研究动态变化的蛋白质组成分构成及其活动规律,为探索该病机制开辟了新途径.本文旨在综述蛋白质组学概念和主要研究技术,以及脑缺血个体体液、脑缺血个体脑组织、体外模拟缺血的细胞模型三方面的脑缺血性疾病蛋白质组学研究现状,为进一步开展该病蛋白质水平研究奠定基础.

【目的】总结面肌痉挛手术常见并发症的预防及治疗。【方法】回顾115例血管减压手术治疗面肌痉挛的临床资料。【结果】责任血管小脑后下动脉占51%。其次为小脑前下动脉与椎动脉。总有效率98%。并发症20例中主要为面瘫(暂时性、迟发性、永久性)、听力损伤(耳聋、耳鸣)、术后头晕、脑脊液漏、小脑脑内血肿。治疗后永久并发症小于1%。【结论】显微血管减压术是根治面肌痉挛最有效方法,减少并发症是手术重点。掌握正确的治疗方法绝大多数并发症可得到治愈。

垂体脓肿(pituitary abscess)十分少见,文献报道垂体脓肿不足100例.笔者现将1997年6月至2005年4月期间曾收治的4例垂体脓肿进行分析,并结合文献加以讨论.

三叉神经痛微血管减压术已被证明是一种安全有效的方法，但随着术后随访病例的增多，随访时间的延长，病情复发率随之增高。本文就三叉神经痛致病因素及外科治疗体会做经验总结。 1 临床资料 1.1 一般资料：本组男5例，女16例，年龄37岁～72岁，平均52岁。症状：牙痛为首发症状3例，Ⅱ支分布区疼痛11例，Ⅰ支～Ⅱ支6例，Ⅱ支～Ⅲ支4例，疼痛分布区感觉明显减退4例。 1.2 手术方法：手术常规枕下乳突后开颅，剪开三叉神经周围蛛网膜，明确三叉神经根部压迫血管，在桥脑、神经根、血管之间垫入teflon棉片，三叉神经出桥脑至小脑幕段有血管压迫及增厚网膜粘连者均行松解分离，充分舒展三叉神经，无血管压迫者应重视神经根部网膜粘连，沿三叉神经纤维束走行方向行三叉神经贯穿梳理术。注意小脑、面听神经的牵拉保护。术中见小脑上动脉压迫7例，小脑下前动脉压迫4例，静脉压迫3例，原因不明确4例。 1.3 治疗结果：术后症状完全缓解19例，部分缓解2例，其中1例再次手术治愈。