目的:比较分析快速恢复与缓慢恢复的急性运动轴索性神经病(AMAN)的临床及神经电生理学特点.方法:收集我院收治的AMAN患者50例的临床资料,根据发病高峰期的Hughes评分,将得分≥3分者纳入缓慢恢复组,得分<3分者纳入快速恢复组;回顾性分析比较2组的临床及电生理特点.结果:纳入缓慢恢复组27例,纳入快速恢复组23例.缓慢恢复组在发病高峰时Hughes评分4～6分,发病年龄大,前驱感染以腹泻多见,伴有延髓受累,肢体瘫痪完全,可累及呼吸肌,需机械辅助通气.快速恢复组发病高峰时Hughes评分2～4分,发病年龄小,临床症状轻,肢体瘫痪轻,多伴肢体麻木.AMAN肌电图特点:感觉神经的感觉神经动作电位波幅(SNAP)和感觉神经传导速度(SCV)正常.正中神经、尺神经、胫神经的复合肌肉动作电位运动末端潜伏期(DML)和运动神经传导速度(MCV)均在正常值范围内;腓总神经DML高于正常值(P<0.05),而MCV低于正常值(P<0.05),但2组间差异无统计学意义.复合肌肉动作电位(CMAP)波幅第1周内就开始下降,且除胫神经外,缓慢恢复组的正中神经、尺神经及腓总神经的CMAP波幅均低于快速恢复组(均P<0.05).AMAN患者的各运动神经F波引出比率降低,缓慢恢复组上肢尺神经和下肢胫神经的F波未引出率均高于快速恢复组(均P<0.05).结论:AMAN为单纯运动神经受累,感觉神经正常,运动神经以轴索损害为主,伴有传导阻滞,运动神经CMAP波幅越低,F波未引出比例越高,恢复越慢,预后越差.

目的:比较腹横肌平面阻滞(TAPB)与手术部位局部浸润麻醉(LIA)对卵巢癌患者开腹肿瘤细胞减灭术后的镇痛效果.方法:择期行开腹肿瘤细胞减灭术的卵巢癌患者 80 例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级,随机分为TAPB组和LIA组,术后分别行TAPB和LIA,术毕行静脉自控镇痛(PCIA).采用视觉模拟量表(VAS)评估术前及术后 2、12、24 h静息和咳嗽时疼痛程度,记录术后PICA的按压次数、爆发性疼痛挽救治疗的次数以及术后不良反应.结果:两组术前疼痛VAS评分差异无统计学意义(P＞0.05);两组术后VAS评分均先升高,至12 h达最高,然后均下降,且TAPB组术后 2、12、24 h静息和咳嗽时VAS评分均明显低于LIA组(P＜0.05);术后PICA按压次数和挽救性治疗次数明显少于LIA组(P＜0.05).TAPB组和LIA组术后不良反应发生率分别是46.1％(18 例)和 69.2％(27 例),两组比较差异无统计学意义(χ2=3.788,P＞0.05),但TAPB组恶心发生率明显低于LIA组(P＜0.05).结论:开腹卵巢癌肿瘤细胞减灭术后应用TAPB减轻术后疼痛的效果要优于LIA,并且与LIA比较,术后阿片类药物用药量少.

Regional cerebral oxygen saturation (rScO 2) monitoring can reflect the oxygenation of local brain tissue in real time, continuously and non-invasively. Although most studies showed negative effects of one-lung ventilation (OLV) on rScO 2 which correlated with an increased incidence of perioperative neurocognitive disorders (PND), some investigators demonstrated that the relatively decreases of rScO 2 were highly dependent upon what the baseline conditions were, and the current definition of low rScO 2 is still unclear. Also, a lack of clear definition of cerebral desaturation was considered a major contributing factor to the discrepancies between the related studies. This review will summarize the changes of rScO 2 and its influencing factors during OLV, the occurrence of PND in OLV patients, and the controversies and limitations of related studies on OLV and rScO 2 changes. The numerous application of rScO 2 monitoring still needs in-depth research and exploration. It is believed that with more experience acquired in clinical use, rScO 2 is expected to provide more non-cerebral information to improve patients' outcome.

With the rapid development of thoracic surgery, the proportion of difficult operation has been gradually increasing, which stimulates staff capacity building and technology development of anesthesiology. Also, the contents of thoracic anesthesia training for residents are getting more complicated. The theory, standards and techniques involved are constantly updated, so it is of great value to establish a standardized thoracic anesthetic training program. It should include airway management, ventilation strategy, multimodal analgesia and post-operative enhanced recovery management. This paper reviews the current situation of thoracic anesthesia training to fill the gap in this field. The research focuses on the development of a competent faculty, the training cycle, evaluation and feedback mechanism. By establishing a standardized training program which may achieve the goal of training qualified anesthesiologists, improve peri-operative safety and accelerate post-operative rehabilitation.

目的:将快速康复外科(enhanced recovery after surgery,ERAS)理念应用于甲状腺癌手术,评估术腔不放置引流的可行性及ERAS的临床效果.方法:自2018年3月至2019年2月中国医学科学院肿瘤医院头颈外科序列收治的患者169例,采用ERAS的理念进行住院前和术前宣教、术中采用精细化的被膜解剖技术、术后康复指导,术腔常规不放置引流管,观察入组患者手术的并发症及临床效果.结果:169例患者中女性119例(70.4％),男性50例(29.6％),男女比例(1:2.38),患者中位年龄42岁(18～73岁),术式采用一侧腺叶+峡部切除113例(66.9％),甲状腺全切除56例(33.1％),一侧中央区清扫134例(79.3％),双侧中央区清扫35例(20.7％).全组患者中位总住院时间4天(1～8天),其中1天(24 h出入院)8例;术后中位住院时间2天(1～4天),一侧腺叶切除和全切除的平均住院时间分别为1.74天和2.15天(P=0.01).56例甲状腺全切除术后患者中有28例术后第一日甲状旁腺激素(parathyroid hormone,PTH)低于正常,平均值为8.18pg/mL(1.45～14.37 pg/mL);28例正常PTH的平均值为24.19pg/mL(15.09～51.51pg/mL).术后1月复查时PTH水平低于正常的28例中有26例恢复正常,2例仍然低于正常(1.2％),平均值为28.32pg/mL(6.87～60.5pg/mL).术后皮下积液3例(1.8％),局部抽液1～2次后愈合良好;术后出血1例(0.6％),发生于术后6 h,清创止血后放置引流管患者恢复良好.结论:不放置引流的甲状腺乳头状癌手术是安全可行的,利用ERAS理念指导甲状腺癌手术患者缩短了患者的住院时间,有利于患者术后尽早康复.

医学英语是一门在整体英语教学体系中基于医学需求为专业学生延伸开展的英语应用技能型培养课程.随着信息时代的不断发展与变化,对于医学生的医学英语书籍阅读能力、国际学术交流能力、英语医学论文撰写能力等的要求也越来越高.在医学英语教学中应用基于微课的教学模式,对医学生这些能力的培养可能更为合理而高效.

目的 探讨术后24 h内继续静脉使用昂丹司琼预防乳腺癌术后恶心呕吐(postoperative nausea and vomiting,PONV)的效果.方法 选取2019年4～10月全麻下行乳腺癌手术的女性患者140例,随机分为观察组和对照组,每组70例.观察组术后2、8、14 h静脉给予昂丹司琼4 mg,对照组相应时刻静脉给予生理盐水2 ml.观察2组术后2、6、12、24及36 h发生PONV的例数.重度PONV给予甲氧氯普胺10 mg进行补救治疗.结果 观察组PONV发生率明显低于对照组[11例(15.7％)vs.23例(32.9％),χ2=5.594,P=0.018],其中重度PONV发生率观察组亦明显低于对照组[4例(5.7％)vs.13例(18.6％),χ2=5.423,P=0.020].术后2～6 h和6～12 h PONV发生率观察组显著低于对照组[术后2～6 h 8例(11.4％)vs.20例(28.6％),χ2=6.429,P=0.011;术后6～12 h 4例(5.7％)vs.13例(18.6％),χ2=5.423,P=0.020],术后2 h内、12～24 h和24～36 h 2组PONV发生率差异无统计学意义(P>0.05).结论 对于全麻乳腺癌手术的女性患者,术后12 h内继续给予昂丹司琼对预防PONV具有临床意义,可以进一步降低PONV的严重程度及发生率,而12 h后继续使用没有显著意义.

目的 探索超声引导下竖脊肌平面阻滞(erector spinae plane block,ESPB)联合腹横肌平面阻滞(transversus abdominis plane block,TAPB)用于右胸及上腹两切口食管癌根治术后镇痛的效果及其对患者满意度的影响.方法 择期行两切口食管癌根治术的患者40例,男23例,女17例,年龄30～65岁,BMI 18～30 kg/m2,ASAⅠ或Ⅱ级.所有患者随机分为ESPB联合TAPB镇痛组(ET组)和单纯患者自控静脉镇痛(PCIA)组(IA组).ET组全麻诱导前行超声引导下ESPB、超声引导下TAPB,分别于操作结束20 min后测定阻滞范围,IA组不予阻滞,两组术毕均采用PCIA.记录患者入手术室后(T0)、气管插管时(T1)、手术切皮时(T2)、手术30 min(T3)、60 min(T4)、90 min时(T5)、手术结束时(T6)的HR、MAP;术后1、6、12、24、48 h静息和咳嗽时VAS评分;镇痛泵按压次数;镇痛泵药液输注总量;术后不良反应发生情况和患者总体满意度.结果 ESPB 20 min后可阻滞T3—T9脊神经支配区域,TAPB 20 min后可阻滞T9—L1脊神经支配区域.与T0时比较,T2时IA组HR明显增快、MAP明显升高(P<0.05),T0和T2时ET组HR和MAP差异无统计学意义.T2—T6时IA组HR明显快于ET组、MAP明显高于ET组(P<0.05).ET组术后1、6、12、24、48 h静息和咳嗽时VAS评分明显低于IA组(P<0.05),术后0～24 h和0～48 h镇痛泵按压次数和药液输注总量明显少于IA组(P<0.05),术后恶心、呕吐发生率明显低于IA组(P<0.05),患者满意度评分明显高于IA组(P<0.05).结论 超声引导下单次竖脊肌平面阻滞联合腹横肌平面阻滞用于经右胸及上腹两切口食管癌根治术可有效抑制术中血流动力学波动,其术后镇痛效果优于单纯患者自控静脉镇痛,患者总体满意度更高.

BACKGROUND: In recent years, new stem cell transplantation therapies for cerebral hemorrhage have emerged, but little is reported on human umbilical cord blood mononuclear cells (HUCB-MNCs), especially on micro PET-CT evaluation of HUCB-MNCs effects. OBJECTIVE: To evaluate the therapeutic effect of HUCB-MNCs in a rat model of cerebral hemorrhage by Longa and micro PET-CT and to explore the therapeutic mechanism. METHODS: Models of cerebral hemorrhage were established in rats using secondary blood injection/needle retraction method. The rats in the experimental group were treated with HUCB-MNCs via left ventricular transplantation, and those in the control group received no treatment. Before and after transplantation (3, 7, 14, 21 days), the rats in the two groups were evaluated using Longa 5 scores and micro PET-CT images. ELISA was used to detect the level of angiotensin 1 in the brain homogenate. RESULTS AND CONCLUSION: Longa 5 scores in the two groups were gradually decreased with time (P < 0.05). Compared with the control group, the Longa 5 scores in the experimental group decreased more significantly (P < 0.05). The standard absorption value (SUV%) in the center of hematoma and perihematomal region increased gradually in the two groups at 7, 14, 21 days after transplantation, but it was significantly higher in the experimental group than the control group (P < 0.05). The volume of hematoma and surrounding tissues was gradually reduced in the two groups, especially in the experimental group, at 7, 14, 21 days after transplantation (P < 0.05). The level of angiotensin 1 in the control group increased gradually with time (P < 0.05), while the level of angiotensin 1 in the experimental group gradually increased, peaked at 14 days and then reduced at 21 days after transplantation (P < 0.05). The level of angiotensin 1 was higher in the experimental group than the control group (P < 0.05). Overall, these findings reveal that HUCB-MNCs via left ventricular transplantation can improve neurologic function of rats, reduce hematoma, recover hematoma metabolism, and increase the level of angiotensin 1 in the rat brain, indicating that HUCB-MNCs transplantation can promote the repair of cerebral hemorrhage through neo-angiogenesis regulation. Subject headings: Cerebral Hemorrhage; Cord Blood Stem Cell Transplantation; Tissue Engineering Funding: the National Natural Science Foundation of China, No. 81360189 0 引言 Introduction 脑出血的高死亡率和发病率给家庭和社会造成严重负 担,其潜在的治疗策略包括以下方面:脑出血后血肿的 清除、血红蛋白毒性的抑制、抑制凝血酶反应、免疫抑制 剂及干细胞移植治疗。传统治疗方式有以下几种:一般 治疗如手术清除颅内血肿、减轻脑水肿和降低颅内压等; 预防性治疗如神经保护、维持血压稳定和抗炎药物的使用; 后遗症期的康复锻炼、中医针灸理疗等。近年出现了针 对脑出血的新型干细胞移植疗法,其中人脐血单个核细胞 以其来源丰富、易于采集及保存、低免疫原性与移植耐受 性好等优点脱颖而出,不单是脑血管疾病,脐血单个核 细胞更是为多种疾病的治疗带来新的希望,然而其效果 和作用机制尚不完全清楚,因此还未大量应用于临床治疗 中。小动物 PET(micro-PET)能较清楚地显示大鼠脑正常 结构及血肿、血肿周围组织的代谢变化,PET-CT可由CT 提供解剖定位,PET提供功能代谢等信息,使动物疾病模 型的基础研究获得了质的飞跃。血管生成是脑出血后机 体愈合的基本生命变化,血管紧张素1(Ang-1)是内皮细胞 生长因子的新家族,其作为内皮特异性受体酪氨酸激酶 (Tie-2)的配体起作用,它并不刺激细胞增殖,而是介导内 皮和周围基质的相互作用,引起血管成熟和稳定。 实验通过micro PET-CT观察人脐血单个核细胞经左 心室途径移植前后脑出血模型大鼠脑损伤部位代谢变化, 并测定脑匀浆中血管紧张素1水平,试图探究人脐血单个核 细胞移植治疗脑出血的疗效及机制。 1 材料和方法 Materials and methods 1.1 设计 动物实验,分组对比观察。 1.2 时间及地点 实验于2016年6月至2017年4月在内蒙 古医科大学基础研究实验室完成。 1.3 材料 1.3.1 脐血取材 脐血由内蒙古医科大学附属医院妇产 科医师采集,经医院伦理委员会批准,向产妇及家属交代 脐血实验用途及相关风险,签署自愿捐献脐血志愿书,采 集健康足月儿脐血100-150 mL。 1.3.2 实验动物 清洁级Wistar大鼠56只,五六个月龄, 体质量300-350 g,由内蒙古大学实验动物学部提供,合 格证号SCXK(蒙)2015-0001。饲养及实验过程符合国家 《实验动物管理条例》的规定。 1.3.3 实验试剂 脐血干细胞处理试剂盒 (Wealthlin Science Technology lnc.Canada);大鼠血管紧张素1 ELISA试剂盒(武汉新启迪生物科技有限公司)。 1.3.4 实验仪器 层流超净工作台(YJ-1450,苏州净化设 备厂);低温离心机(RJ-TGL-16B台式高速离心机,上海之 信仪器有限公司);大鼠立体定位仪(淮北正华生物仪器设 备有限公司);小动物microPET-CT(SIEMENS Inveon MM) 等。 1.4 实验方法 1.4.1 大鼠脑出血模型的制备 以二次注血/退针法制作 大鼠脑出血模型 。用10%水合氯醛腹腔麻醉大鼠 (3 mL/kg),固定于大鼠立体定位仪上,消毒后在双眼连线 Wei LH, Yao XY, Zhang GH, Yang LM, Li JB, Liu J, Jin N, Duan R. Left ventricular transplantation of human umbilical cord blood mononuclear cells in the treatment of cerebral hemorrhage in rats: micro PET-CT evaluation and therapeutic mechanism. Zhongguo Zuzhi Gongcheng Yanjiu. 2018;22(25):4059-4064 DOI:10.3969/j.issn.2095-4344.0928 P.O. Box 10002, Shenyang 110180 www.CRTER.org 4061 后0.5 cm处正中线切开头顶部皮肤,露出颅骨骨缝及前囟。 选取右侧尾状核(中线旁开3.5 mm,前囟向前0.5 mm,皮 质腹侧5.5 mm)作为移植点,牙科钻垂直于骨面钻孔,骨 蜡迅速封闭骨孔。用肝素化微量注射器行左心室穿刺,抽 取自体动脉血120 μL,在此微量注射器上安装自制定位器, 与大鼠一起固定于立体定位仪上,去除骨蜡,暴露骨孔, 垂直进针至尾状核,先缓慢注血50 μL,停针2 min,再缓 慢注血50 μL,停针4 min,然后退针约2 mm,停针4 min, 最后拔针,骨蜡封闭骨孔。缝合切口并消毒,回笼饲养。 1.4.2 造模筛选及成功标准 Longa5级评分筛选:大鼠术后意识转清即进行 Longa5级评分。无神经缺损为0分,对侧肢体不能伸直为1 分,出现转圈为2分,行走时身体向偏瘫侧倾倒为3分,意 识丧失、完全不能行走为4分,评分1-3分者进入PET-CT 筛选程序。 PET-CT筛选:造模后12 h内扫描头部PET-CT,观察 脑内血肿,剔除血液经针道反流、血肿形状极不规则、血 液进入脑室、脑组织机械损伤及颅内积气大鼠,余大鼠纳 入实验。 1.4.3 动物分组方法 将成功造模的50只脑出血模型大 鼠采用随机数字表法,选择其中20只进行神经Longa5级评 分数据分析,10只行micro PET-CT扫描,20只采用ELISA 法测定脑匀浆中血管紧张素1水平。以上各评估指标中大鼠 又随机分为实验组及对照组,每组数量各半。 1.4.4 人脐血单个核细胞的取材、分离及活性检测 采集 健康足月儿脐血100-150 mL,在层流超净工作台操作环境 下,按脐血干细胞处理试剂盒说明书行人脐血单个核细胞 的分离。取细胞悬液10 μL,用生理盐水稀释至1 mL,加 入0.5%锥虫蓝3 μL摇匀,加到细胞计数板上观察,细胞透 明即为有活性细胞,细胞蓝染为失活细胞,镜下观察活性 细胞占比98%以上可用以移植。 1.4.5 人脐血单个核细胞的移植 造模24 h内行细胞移 植,水合氯醛腹腔麻醉后,仰卧位固定脑出血大鼠,实验 组用医用4.5号头皮针穿刺左心室,缓慢注入200 μL已调整 好细胞密度为1×10的人脐血单个核细胞悬液,缓慢拔针, 回笼饲养。对照组不予治疗,自行转归。 1.5 主要观察指标 1.5.1 Longa5级评分 共20只大鼠,实验组和对照组各 10只大鼠。对每只成功造模大鼠,在人脐血单个核细胞移 植前1 d及移植后3,7,14,21 d 5个时间点进行大鼠神经 Longa5级评分。 1.5.2 micro PET-CT扫描及分析 共10只大鼠,实验组和 对照组各5只大鼠。对每只成功造模大鼠,在人脐血单个核 细胞移植前1 d及移植后3,7,14,21 d 5个时间点进行 18 F-FDG造影后micro PET-CT头部扫描,调整图像,选取 大小为10 plxels的球形感兴趣区ROI,测量血肿中心感兴 趣区ROI1、血肿周围区域感兴趣区ROI2、镜相侧血肿中 心感兴趣区ROI1′、镜相侧血肿周围区域感兴趣区ROI2′的 葡萄糖代谢(SUV)值,并计算ROI1/ ROI1′×100%及 ROI2/ ROI2′×100%的比值(SUV%)。调整横切面、冠状面和矢状 面图像,找到血肿最大层面,测量血肿长、宽、高并计算 其体积,血肿体积≈π/6(长×宽×高)。 1.5.3 ELISA法测血管紧张素1水平 共20只大鼠,实验 组和对照组各10只大鼠。人脐血单个核细胞移植前1 d及移 植后3,7,14,21 d,大鼠断头取脑,切取0.8 g病灶侧尾 状核区脑组织,加入8 mL PBS并冰水浴匀浆,4 °C、5 00010 000 r/min离心10 min,取上清液,ELISA试剂盒测定血 管紧张素1水平。每个时间点实验组和对照组各2只大鼠。 1.6 统计学分析 使用SPSS 19.0软件包统计分析,检验 水准a=0.05(双侧检验),以P < 0.05为差异有显著性意义。 首先进行正态分布检验及方差齐同检验,组内不同时间点 多个样本均数之间的比较采用单因素方差分析法,两组间 相同时间点的差别采用配对t 检验。 2 结果 Results 2.1 大鼠脑出血模型建立情况 大鼠均在造模后三四个 小时内意识转清,并出现神经功能缺损症状(图1),PET-CT 扫描显示右侧尾状核区脑出血(图2)。在56只脑出血模型 中,6只大鼠造模失败,50只大鼠造模成功。 2.2 不同时间点大鼠神经Longa5级评分 实验组和对照 组各时间点Longa5级评分均随时间逐渐降低,各时间点差 异有显著性意义(F实验组=28.08,P实验组=0.000 3;F对照组= 13.83,P对照组=0.000 1);实验组较对照组Longa5级评分降 低更明显,除移植前及移植后第3天外,各时间点两组大鼠 Longa5级评分差异均有显著性意义(P < 0.05),见表1。 2.3 microPET-CT扫描及数据分析 2.3.1 两组大鼠移植前后不同时间点PET-CT血肿图像比 较 见图3。移植后第3天两组大鼠血肿体积均增大,第7, 14,21天两组血肿体积均逐渐减小,移植后相同时间点实 验组大鼠血肿体积均小于对照组大鼠。 2.3.2 两组大鼠移植前后不同时间点PET-CT血肿中心代 谢(SUV%)情况比较 实验组及对照组血肿中心代谢有随 时间变化的趋势,均表现为移植后第3天较移植前血肿中心 代谢水平降低,移植后第7,14,21天血肿中心代谢水平 逐渐升高,各时间点差异有显著性意义(F实验组=18.71, P实验组=0.000 2;F对照组=4.57,P对照组=0.009);实验组较对照 组血肿中心代谢水平高,除移植前及移植后第3天外,各时 间点两组大鼠血肿中心代谢水平差异均有显著性意义(P < 0.05),见表2。 2.3.3 两组大鼠移植前后不同时间点PET-CT血肿周围代 谢(SUV%)水平比较 实验组及对照组血肿周围代谢水平 有随时间逐渐升高的趋势,各时间点差异有显著性意义 (F实验组=19.02,P实验组=0.000 3;F对照组=7.69,P对照组=0.001)。 实验组较对照组血肿周围代谢水平高,除移植前外,各时 间点两组大鼠血肿周围代谢水平差异均有显著性意义(P < 0.05),见表3。 2.3.4 两组大鼠移植前后不同时间点PET-CT血肿及周围 体积变化比较 实验组及对照组大鼠血肿及周围体积有随 时间变化的趋势,表现为移植后第3天较移植前血肿及周围 体积更大,移植后第7,14,21天血肿及周围体积逐渐减 魏林洹,姚星宇,张国华,杨丽敏,李剑波,刘婕,靳娜,段瑞. 左心室移植人脐血单个核细胞治疗大鼠脑出血的 microPET-CT评价及机制[J]. 中国组织工程研究,2018,22(25):4059-4064. DOI:10.3969/j.issn.2095-4344.0928 ISSN 2095-4344 CN 21-1581/R CODEN: ZLKHAH 4062 图 1 脑出血模型大鼠 Figure 1 A rat model of cerebral hemorrhage 图注:大鼠左侧肢体不能伸直,行走时身体向右侧倾倒。 图 2 PET-CT 示造模成功大鼠右侧尾状核出血 Figure 2 PET-CT showed hemorrhage of the right caudate nucleus in a successful rat model 图注:箭头所示为颅内血肿。血肿区域糖代谢率明显降低,表现为血 肿周边出现红色、血肿中心出现黄色及绿色。 移植前 移植后 3 d 移植后 7 d 移植后 14 d 移植后 21 d 移植前 移植后 3 d 移植后 7 d 移植后 14 d 移植后 21 d 对照组

脑出血是导致成人高死亡率和发病率的严重脑血管病.ICH的全球发病率逐年增加,年龄较大的发病率呈上升趋势,对家庭和社会造成严重负担[1].ICH的管理包括内科和外科治疗,以阻止出血、去除凝块并减轻大脑的压力.尽管已经采用标准治疗方法,但脑出血患者预后仍差,存活的患者也会存在神经退化[2].神经恢复疗法旨在增加脑内诸如神经发生,血管生成和突触发生的过程,可以使大量卒中患者受益.不同来源的细胞,如骨髓间充质基质细胞(MSC)和骨髓单核细胞(BMMNCs)已被应用于临床前研究中,在动物卒中模型中已证明有益治疗效果[3].然而,干细胞使用的最佳移植途径仍在确定[4].

神经系统疾病已成为全球第二大死因,其中脑卒中位居所有神经系统疾病之首[1].在我国部分脑血管疾病高发的城市,脑出血占脑卒中患者的26.7%~51.5%,是我国致死亡和残疾的主要疾病之一[2].然而目前对脑出血的治疗仅限于脱水降颅压等对症治疗,无法修复、填充脑坏死区域死亡的神经细胞,导致脑出血预后不良,往往造成难以治愈的瘫痪甚至危及生命[3].因此,很多学者将注意力转移至脑出血后的神经保护与修复治疗,干细胞因其自我更新和多向分化潜能得到了广泛关注.人脐血间充质干细胞(human umbilical cord blood mesenchymal stem cells, hUCB-MSCs)不仅来源广泛、采集方便,而且细胞含量更丰富、更原始,移植抗宿主反应轻[4-5],相对无菌,被视为细胞治疗的最理想来源.目前hUCB-MSCs移植的实验性治疗已经应用于许多神经系统疾病,如阿尔茨海默病、帕金森病[6-7]、自身免疫性脑脊髓膜炎、肌萎缩侧索硬化[8-9]和脊髓损伤[10].一些研究发现,hUCB-MSCs对大鼠脑缺血损伤有治疗作用[11],而对于脑出血的研究却鲜有报道.我们旨在观察局部hUCB-MSCs移植治疗脑出血大鼠的疗效,为hUCB-MSCs移植治疗脑出血提供更多的理论依据.

BACKGROUND: Mononuclear cells isolated from umbilical cord blood (UCB-MNCs) are rich in cell types which are of great benefit in cell replacement therapy, gene therapy and tissue engineering. OBJECTIVE: To evaluate the efficacy of human UCB-MNCs (HUCB-MNCs) in the treatment of intracerebral hemorrhage rats by microPET-CT and Longa scores, and to discuss the therapeutic mechanism. METHODS: We made a rat intracerebral hemorrhage model by autologous blood injection. After modeling, rats were randomly divided into two groups: transplantation group and control group. The HUCB-MNCs were transplanted into the rats in the transplantation group via the tail vein. Control group received no treatment. Before and at 3, 7, 14, 21 days after transplantation, brain metabolic changes and neurological function scores of rats in the two groups were evaluated by microPET-CT and Longa scores. Levels of tumor necrosis factor-α and interleukin-6 in the rat serum of two groups were measured by ELISA method. RESULTS AND CONCLUSION: (1) At 7, 14 and 21 days after HUCB-MNCs transplantation, the rates of brain metabolism in the hematoma center as well as around the hematoma in the transplantation group were significantly higher than that in the control group (P < 0.05), while the volume of hematoma and surrounding ischemic tissues as well as Longa scores were significantly reduced in the transplantation group as compared with the control group (P < 0.05). The levels of tumor necrosis factor-α and interleukin-6 in the serum in the transplantation group were significantly lower than those in the control group at 3, 7, 14 days after transplantation, and further lowered to the normal levels at 21 days after transplantation. These findings suggest that transplantation of HUCB-MNCs through the tail vein can promote the neurologic recovery of cerebral hemorrhage rats, and one of the therapeutic mechanisms may be related to the reduction of inflammatory factors and the inhibition of inflammatory response. Subject headings: Tissue Engineering; Stem Cells; Tumor Necrosis Factor-alpha; Interleukin-6 Funding: the National Natural Science Foundation of China, No. 81360189 0 引言 Introduction 脑出血是中老年人致残和死亡的主要原因之一,导致 了巨大的经济和社会负担。然而目前内科的治疗手段仍 局限于降低颅高压以及营养脑神经等对症支持疗法,外科 治疗办法即为开颅或者微创术式清除颅内血肿,但因受损 的脑组织被破坏不能发挥原有的生理功能,就会遗留难以 治愈的后遗症。国内外大量研究均发现干细胞具有自我更 新和多向分化潜能,可在特定环境下定向分化成不同的神 经细胞类型,产生神经细胞替代作用,且有学者经统计 学分析发现,干细胞疗法与中风患者的行为和功能显著改 善相关,为脑血管病的治疗带来了新的希望。而脐血干 细胞因其含量丰富、取材安全、免疫原性低,且较其他细 胞更原始,增殖能力更强等大量优点成为极具潜力的生物 资源。实验所用移植细胞——人脐血单个核细胞即来源 于脐血,且课题前期实验组成员发现,从脐血中分离出的 新鲜的单个核细胞经培养后利用免疫荧光法在倒置荧光显 微镜下发现有Nestin及NSE表达,并观察到有类似轴突和 树突粗长突起的神经样细胞。然而因其治疗脑血管病的 疗效及其治疗机制还不十分明确,故国内外对于脐血单个 核细胞移植治疗脑出血的动物及临床实验报道仍较少。 microPET-CT是专门为研究人类疾病的小动物模型而 设的临床前影像设备,实现了功能影像学与解剖影像学的 完美统一,空间分辨率显著提高,能在较小的体积容量上 对目标组织进行动态分析,可以准确反映小动物脑组织损 伤程度,更早、更灵敏的判断疾病的转归。早有研究认 识到炎症反应是脑出血后脑组织二次损伤过程中重要的病 理过程,而大量产生的不同类型的炎性因子则是启动和调 节炎症反应的关键介质。 实验的目的在于通过microPET-CT观察人脐血单个核 细胞移植前后不同时间点脑损伤部位血流及代谢变化,联 合神经功能评分变化,评价人脐血单个核细胞移植治疗脑 出血的疗效。并通过酶联免疫法(ELISA)检测大鼠人脐血单 个核细胞移植前后血清中炎性因子肿瘤坏死因子α、白细胞 介素6表达水平的变化,探讨其是否具有抗炎机制进而发挥 治疗脑出血的作用。 1 材料和方法 Materials and methods 1.1 设计 随机对照动物实验。 1.2 时间及地点 于2017年4至10月在内蒙古医科大学 病原生物与免疫学研究中心完成。 1.3 材料 1.3.1 人脐血 脐血由内蒙古医科大学附属医院产科健 康足月新生儿提供,由产科医师通过新生儿脐静脉采血。 产妇纳入标准:1足月生产产妇;2经内蒙古医科大学附 属医院伦理委员会批准,产妇及家属知情同意。产妇排除 标准:1患有心、肝、肾和其他脏器严重的器质性疾病者; 2有传染病感染史者;3过敏体质者。 1.3.2 实验动物 健康成年Wistar清洁级大鼠76只,由内 靳娜,姚星宇,张国华,杨丽敏,李剑波,刘婕,魏林洹,段瑞. 静脉移植人脐血单个核细胞治疗脑出血大鼠疗效的 microPET-CT 评价及抗炎机制[J]. 中国组织工程研究,2018,22(25):4014-4020. DOI:10.3969/j.issn.2095-4344.0958 ISSN 2095-4344 CN 21-1581/R CODEN: ZLKHAH 4016 蒙古医科大学动物实验室提供,合格证号:SCXK(蒙) 2015-0001,体质量300-350 g,饲养及实验过程符合国家 《实验动物管理条例》的规定。 1.4 实验方法 1.4.1 脑出血模型大鼠的构建 参照杨亚萍等报道方 法,66只健康成年大鼠采取自体血二次注血/退针法制作大 鼠脑出血模型,术前禁食8 h,体积分数10%水合氯醛腹腔 麻醉(3 mL/kg)后将头部固定于立体定位仪(淮北正华生物 仪器设备有限公司)上,暴露颅骨前囟及冠状缝,设定右侧 尾状核坐标原点(距右侧中线3.5 mm,前囟前0.5 mm,深 度5.5 mm),电钻(Makita Corporation,Japan)穿透头骨后, 用微量注射器于左心室采血120 μL,由创口进针至右侧尾 状核,先注血50 μL,等候2 min,再次缓慢注入50 μL,停 针4 min后退针2 mm,继续停针约4 min,观察无血液返流, 将注射器缓慢退出,骨蜡封闭创口,可吸收缝线缝合头皮。 术后大鼠电暖风照射保暖直至麻醉清醒。大鼠行Longa评 分进行初筛:0分记为大鼠未见明显神经功能缺损体征;1 分记为大鼠左前肢伸展受限;2分记为大鼠行走时逆时针方 向打转;3分记为大鼠站立及行走时向病灶对侧倾倒;4分 记为大鼠出现意识不清,完全不能行走;5分为大鼠死亡。 评分1-3分的大鼠初步判定造模成功,继续于本院小动物实 验室行头PET-CT扫描确诊脑出血。其中6只于造模过程中 血液经针道返流或者死亡,实验过程中10只大鼠死亡。最 终共50只造模成功大鼠存活。 1.4.2 分离及移植人脐血单个核细胞 将采集的脐血按 照脐血干细胞处理试剂盒(Wealthlin Science Technology Inc.Canada)操作步骤在4-8 h内分离出人脐血单个核细 胞,加锥虫蓝观察细胞活性后,将细胞浓度调整为 1×10 10 L 备用。 1.4.3 实验大鼠分组情况 实验共分为3部分:第1部分, 从50只造模成功大鼠中随机取10只大鼠均分为移植组与 对照组各5只,行microPET-CT检查;第2部分:从剩余的 40只模型大鼠中随机挑出20只均分为移植组与对照组各 10只,行神经功能评分;第3部分:剩余20只大鼠随机均 分为移植组及对照组各10只,另取10只健康成年大鼠作为 空白对照组,行ELISA分析。 造模成功24 h内,移植组大鼠用乙醇反复消毒鼠尾, 以微量注射器经尾静脉缓慢移植备用的细胞浓度为 1×10 10 L 的细胞悬液1 mL,注射完毕停顿数10 s后拔针, 无菌棉球按压2 min,避免出血及细胞悬液反流,对照组不 接受任何特殊治疗。 1.4.4 Micro-PET-CT扫描 移植组(n=5)及对照组(n=5) 组内每只大鼠均于移植前及移植后第3,7,14,21天进行 microPET-CT(SIEMENS Inveon MM,北京,中国)扫描。 PET-CT扫描之前,大鼠禁食12 h,扫描前40 min称质量后 在非麻醉状态下尾静脉注射示踪剂:800 uCi/400 g 18 F-FDG,待30 min的药物分布后,大鼠进行麻醉后行头 部扫描。采集图像上示踪剂分布稀少或缺失区为血肿及周 围缺血组织区,将摄取减低区最大截面确定为测量平面, 在血肿中心及周围缺血组织各选取一处作为感兴趣区,分 别标注为ROI1和ROI2,计算相应的SUV值;选取对侧大 脑的对称区域为镜像的感兴趣区,分别标注为ROI1,和 ROI2,测量相应的SUV值,最终计算SUV%(患侧感兴趣 区SUV值/对侧镜像SUV值×100%)记为血肿中心及周围的 代谢率。在扫描图像横断面、矢状面及冠状面测量出血肿 最长、最宽和上下径得到的立体椭圆形体积作为血肿及周 围缺血组织体积。 1.4.5 神经功能评分 移植组(n=10)及对照组(n=10)大鼠 分别于移植前及移植后的3,7,14,21 d,采用Longa 5 级评分对神经功能恢复情况进行比较。 1.4.6 ELISA法检测血清炎性因子水平 另取10只健康 大鼠作为空白对照组,移植组(n=10)及对照组(n=10)组内 每只大鼠分别于移植前及移植后第3,7,14,21天,于左 心室采血,收集血清存于-70 °C冰箱备用。待标本收集完 毕后,采用ELISA法检测不同时间点血清肿瘤坏死因子α、 白细胞介素6水平,检测方法严格按照试剂盒(武汉依莱瑞 特生物科技有限公司)操作步骤逐步进行。用酶标仪在 450 nm波长处分别测量各孔的吸光度值,计算各检测指标 的质量浓度。 1.5 主要观察指标 1两组大鼠血肿中心脑代谢率变化 情况;2两组大鼠血肿周围脑代谢率变化情况;3两组大 鼠不同时间点血肿及周围缺血组织体积变化情况;4两组 大鼠不同时间点神经功能评分变化;5各组大鼠不同时间 点血清炎性因子肿瘤坏死因子α及白细胞介素6水平变化。 1.6 统计学分析 使用SPSS 20.0统计学软件进行数据 分析,符合正态分布的数据采用x _ ±s表示;经正态分布检验 且方差齐,多组不同时间点之间的比较采用单因素方差分 析,两组间相同时间点之间的比较采用两样本t 检验分析,

Objective To prospectively investigate the correlation between different anesthetic techniques and the proportion of neutrophils as well as lymphocyte after breast cancer surgery.Method 80 patients who underwent surgery in our hospital from February to August in 2016 were selected for breast cancer treatment. Were randomly divided into total intravenous anesthesia and intravenous anesthesia combined group, each group of 40 cases. The ratio of neutrophil, lymphocyte and neutrophil lymphocyte in peripheral blood of the two groups were compared before and after operation.Result Besides,there was no significant difference in the change of neutrophil, lymphocyte and ratio between the two groups before and after operation (P>0.05).Conclusion Total intravenous anesthesia resulted in no difference in peripheral blood neutrophil,lymphocyte and its ratio compared with inhalational anesthesia in patients with breast cancer after operation.Can be based on the specific circumstances of patients with anesthesia to personalize the choice.

Objective:To analyze early clinical characteristics and electrophysiology in patients with the acute inflammatory demyelinating polyneuropathies(AIDP). and discuss. the main predictors relating to the progression of disease. Methods:We adopt retrospective analysis method to assess 82 cases of AIDP patients, admitted in Inner Mongolia medical university affiliated hospital between January 2010 and March 2016 , and Hughes scale was used to evaluate the clinical status of patients with AIDP. And the Level of patients were divided into light and heavy AIDP. Results:the clinical features with heavy AIDP:>50 years old, Choking cough of drinking water, ataxia, and there was significant difference(P<0.05)compared with light AIDP. The electrophysiological data with Heavy AIDP:upper limb sensory nerve action potential ( SNAP ) amplitude reduced, slow onset of sensory conductive velocity( SCV) ,The SCV of Suralis and Sup-peroneal was compared with patients with light AIDP,and there was significant difference(P<0. 05),Onset of the MCV was slowing down,The motor conduction velocity( MCV) of Peroneus and Tibialis had slowed significantly,and there was significant difference(P<0. 05)compared with light AIDP,CMAP amplitude was significantly reduced,and there was significant difference(P<0. 05)compared with light AIDP. Conclusion:The severe AIDP patients more frequently had a higher Hughes score,>50years old,Choking cough of drinking water,ataxia,the condition was worse,restore was slower,prognosis was poor. The electrophysiological characteristics with AIDP was priority to nerve segments around sexual demyelinating lesions,and had axonal damage at the same time,Motor nerve and sensory nerves were affected,the injury of distal motor nerve is more severe than the sensory nerve. The damage of nerve in the lower limbs is more severe than the upper limbs. The neural electrophysiological data of AIDP showed:abnormal F wave was sensitive marker to early di-agnosis. slower MCV and the decrease degree of CMAP amplitude were the most reliable indicators to assess condition and were correlated positively with the disease severity and prognosis.

Brain edema is a pathological process that is bound to occur after cerebral hemorrhage.The formation of brain edema after cerebral hemorrhage can aggravate the secondary injury of the brain,which is one of the main causes of death.After cerebral hemorrhage,hematoma mass effect,coagulation cascade,erythrocyte degradation products,inflammatory reaction,various types of molecular media are involved in the formation of brain edema.Different factors promoting each other and mutual regulation,eventually lead to further deterioration of neurological deficits symptoms and cause irreversible damage to the brain cells.Timely and correct treatment before irreversible nerve function defect,prevention and treatment of following complications can reduce mortality and disability rates and reduce the recurrence.Currently new progress has been made in both the formation mechanisms of cerebral edema after cerebral hemorrhage and the corresponding treatment strategies.

Objective To analyze clinical characteristics and electrophysiology of patients with acute motor axonal neuropathy (AMAN) and compare the similarities and differences with acute inflammatory demyelinating polyneuropathy (AIDP).Methods Twenty-five cases of AMAN were retrospectively analyzed,who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from January 2010 to March 2016,whose Hughes scale were 3～6 points.At the same period,30 cases of AIDP,whose Hughes scores were 3～6 points,were compared with AMAN.Results AMAN patients were under 50 years old,had preceding diarrhoea more frequently.Electrophysiological features showed that the sensory nerve action potential (SNAP) amplitude and sensory conduction velocity (SCV) were normal,the motor conduction velocity (MCV) of the peroneus nerve lightly slowed down,the distal motor latency (DML) of the peroneus nerve extended,the compound muscle action potential (CMAP) amplitude decreased significantly,the incubation period ofF wave was normal,the proportion that F wave was not elicited was higher in patients with AMAN.For the AIDP patient,the SNAP and SCV of were decreased,the DML was extended,the MCV was slowed down,F wave latency extended in the lower limb tibial nerve.Conclusion AMAN is a pure motor neuropathy and the sensory nerve remains intact.The characteristics of AMAN is axonal injury.The electrophysiological features of AMAN are reduced CMAP amplitude,motor nerve conduction block,the higher proportion that F wave is not elicited.The electrophysiological characteristics of AIDP is that both motor nerve and sensory nerves can be affected,both SCV and MCV become slow down,the DML is extended,the incubation period of F wave is extended,the occurrence rate of F wave is decreased.

Objective To investigate the influence of total intravenous anesthesia (TIVA) with propofol plus remifentanil and inhalational anesthesia with sevoflurane plus fentanyl on intraoperative recurrent laryngeal nerve (RLN) monitoring.Methods Fifty female patients,ASA Ⅰ-Ⅱ,aged between 18-60 year,scheduled for elective thyroidectomy were randomly allocated into two groups:Group P and Group S.Anesthesia was maintained with TIVA or inhalational anesthetics in Groups P and S,respectively.Rocuronium 0.6mg/kg was given to facilitate the electromyographic (EMG) endotracheal tube insertion.Rocuronium was not added during operation.Bispectral index (BIS) was used to monitor anesthesia depth and kept between 40-50 during operation.Accelerometry (％ TW) was applied for monitoring neuromuscular transmission of the thumb.0％ TW corresponds to complete muscular blockade.Duration of 0％ TW (T0) and recovery time from 0％ TW to 5％ TW (T5),10％ TW (T10),20％ TW (T20) and 30％ TW (T30) were recorded,respectively.The time interval from 0％ TW to initial successful elicitation of EMG signals was measured in both groups.EMG signals were obtained under 0％ TW (EMG0),5％ TW (EMG5),10％ TW (EMG10),20％ TW (EMG20),30％ TW (EMG30).The numbers of patients experiencing involuntary body movement,coughing and swallowing were noted in the two groups.Hemodynamic changes were also observed.Results T0,T5,T10,T20 and T30 were significantly shorter in Group P than in Group S (P ＜0.05).EMG signals cannot be successfully elicited until the degree of neuromuscular blockade recovered to 10％ TW in all patients.The patients in Group p required less time for EMG signals to be initially elicited compared with Group S(35.6 ± 4.7min vs 44.4 ± 4.5min)(P ＜ 0.05).Involuntary body movement,coughing and swallowing were more likely to occur in Group P(in 2 patients) than in Group S(in 9 patients) (P ＜ 0.05).Both the maximum systolic blood pressures (SBP) and maximum changing percent of SBP rising were significantly lower in Group P than in Group S (147.3 ±11.8mmHg vs 157.2±10.9mmHg;12.5％ ±8.6％ vs 18.0％ ±9.4％)(P＜0.05),respectively.Conclusion Compared withinhalational anesthesia,TIVA is able to allow earlier detection of EMG signals for RLN monitoring,and to provide better hemodynamics with less involuntary movements.TIVA seems to be a more suitable anesthetic method for the patients requiring RLN monitoring.

Objective To clinical value of iron deposition in brain of Parkinson disease (PD) by susceptibility weighted imaging (SWI).Methods From June 2010 to June 2016,in Department of Neurology,Affiliated Hospital of Inner Mongolia Medical University,40 PD patients were selected as PD group,20 healthy volunteers were enrolled into the control group (NC group) at the same time.All PD patients were graded by Hoehn&Yahr,stage ≤ 1.5 as early phase group (PD1 group) 23 cases,stage ＞ 1.5 as middle and advanced phase (PD2 group) 17 cases.brain nuclei of each group were examinated by MRI and SWI with 3.0TMR system,and the results were compared and analyzed.Results The phase values of caudate nucleus (CN),globus pallidus (GP),putamen (PU),red nucleus (RN) and substantia nigra (SN) of patients in PD group increased compared with NC group,which indicated there was more iron deposits.The phase values of SN,GP and RN in PD1 group,PD2 group and NC group were compared,the differences were statistically significant (P＜ 0.05),but the phase values of PU,CN in three groups were compared,the differences were not statistically significant (P ＞ 0.05);the phase values of SN,GP,CN in PD2 group were compared with NC group,the differences were statistically significant (P ＜ 0.05),but these in PD1 group and PD2 group were compared,the differences were not statistically significant (P ＞ 0.05).Conclusion SWI can reflect the iron deposition in the brain,and it can be used to evaluate the brain iron deposition by measuring the signal intensity of related brain nuclei and calculating the phase value.It can provide some help for diagnosis and treatment of the patients.

BACKGROUND: Studies have confirmed that umbilical cord blood stem cells can improve the neurologicalfunction after stroke, but the mechanism of umbilical cord blood stem cells in the treatment of stroke is unclear.OBJECTIVE: To review the effect and mechanism of umbilical cord blood stem cells in the treatment of stroke.METHODS: The first author searched PubMed and CNKI databases for relevant articles published from January2005 to December 2015 using key words of "umbilical cord blood stem cells, stroke" in English and Chinese,respectively. RESULTS AND CONCLUSION: With the further research on the neural differentiation of umbilical cord blood stem cells,umbilical cord blood stem cells have become a hot research topic in the field of neural system disease therapy. Atpresent, some experimental studies on cell transplantation for stroke have achieved ideal curative effects. However, themechanism of umbilical cord blood stem cells in the treatment of stroke is not clear. Known therapeutic mechanismsinclude the recombination of blood vessels, nerve loops and other damage tissue structures, secretion of variousnutritional factors to reduce endogenous apoptosis, promotion of endogenous blood vessels and nerve regeneration, etc.But the following problems need to be further studied, including whether the transplanted cells can be fully filled toreplace necrotic nerve cells and promote recovery of nerve function; how these survived stem cells establish the neuralconnections; how these transplanted cells reduce the apoptosis and necrosis of the host cells to restore the cell function.

Objective To investigate the effects of lower doses of fentanyl combined with propofol on rate and extent of cerebral cortical suppression.MethodSixty female patients, were randomly allocated into four groups, group P(propofol only), F1(fentanyl 1μg/ kg+propofol), F2(fentanyl 2μg/kg+propofol) and F3 (fentanyl 3μg/kg+propofol). Normal saline, fentanyl 1, 2, 3μg/kg were given respectively. Thereafter propofol was infused at a constant rate of 100mg/min until loss of consciousness. Bispectral index (BIS) monitor was used to assess the cerebral cortical suppression. Time to loss of consciousness (LOC), BIS values at LOC, time to BIS value of 60(BIS60), the lowest BIS values and time to those were all recorded. The propofol consumption was calculated for each group.Result Time to LOC was significantly shortened and BIS values at LOC were significantly higher in the fentanyl/propofol groups compared to group P (P<0.05, respectively). Time to BIS60and propofol consumption were greater in group F1 than in groups F2 and F3 (P<0.05, respectively). The lowest BIS values and time to those were similar among three fentanyl/propofol groups.ConclusionThe suppressed rate of cerebral cortex caused by small doses of fentanyl combined with propofol tended to become slower with the higher dose of fentanyl, but the maximal extents of cerebral cortex suppression were comparable among the three fentanyl/propofol groups. This indicated that BIS monitoring failed to reflect the consciousness changes induced by small doses of fentanyl, and seemed to have time lag effect. This should arouse our alert in clinical practice.