考虑零售商和技术提供商的二元结构,本文构建理论模型分析零售商嵌入专业技术的营销策略选择问题,并探讨技术嵌入以及技术营销策略对决策结果的影响.研究发现,技术提供商作为博弈的领导者在获取边际利润方面具有优势且相对稳定;并且对技术提供商而言,让零售商进行技术营销的策略是最优的.然而,对于零售商而言,不同技术营销渠道下的利润大小会受到技术产出、技术营销、以及营销努力博弈的影响,因此零售商的策略选择较为复杂.在一定的条件下,零售商可以嵌入产出贡献度较大的专业技术,并优先选择自己进行技术营销以增加技术营销贡献度.这一策略有利于零售商快速实现利润最大化,并与技术提供商实现双赢.

目的 探讨Onyx胶主导栓塞脑动静脉畸形(arteriovenous malformation,AVM)的疗效.方法 2015年9月 ～2017年10月我科应用Onyx胶栓塞84例AVM,其中Speztler-Martin(S-M)分级Ⅰ级10例,Ⅱ级32例,Ⅲ级22例,Ⅳ级18例,Ⅴ级2例.单纯Onyx胶栓塞67例,联合Glubran胶和(或)弹簧圈栓塞17例.结果 S-MⅠ级完全栓塞治愈率60.0％(6/10),Ⅱ ～ Ⅲ级33.3％(18/54),Ⅳ ～ Ⅴ级25.0％(5/20),完全栓塞率34.5％(29/84).术中微导管断管、留置各1例,术中出血1例,术后出血4例((3例保守治疗成功,1例死亡),无新发神经功能障碍,并发症发生率8.3％(7/84).83例随访3～30个月,中位随访时间7.5月,再次出血4例,其中死亡1例;完全栓塞的29例无一例复发或再生;栓塞导致出血的5例除1例死亡外,其余均恢复良好.结论 Onyx胶联合不同栓塞材料个体化治疗脑AVM,可以获得较为满意的效果.

Objective To investigate the medium- and long-term effects and safty of Pipeline embolization device ( PED) for the treatment of large and giant intracranial anterior circulation aneurysms. Methods From December 2014 to December 2016,the data of 36 consecutive patients with large and giant aneurysm ( 36 large and giant intracranial anterior circulation aneurysms ) treated with PED in Donglei Brain Doctor Group were analyzed retrospectively. The diameter of the aneurysms was 12 -33 mm, (mean16.6±4.5mm),andthenecksizewas4-10mm(mean6.1±1.5mm).Eightaneurysmswere located in the carotid cavernous sinus segment,22 in the ophthalmic artery segment,5 in the internal carotid artery posterior communicating segment, and 1 in the M1 segment of middle cerebral artery. Seven aneurysms were only treated by PED,28 aneurysms were treated by PED in combination with coil embolization,and 1 aneurysm was treated by double PEDs. The modified Rankin scale ( mRS) score was used to evaluate the prognosis of the patients. Results (1) The clinical prognosis of the patients was followed up by telephone and outpatient department for 6-33 months. Twenty-five patients were followed up by DSA,23 aneurysms (92%) were occluded totally (Raymond gradeⅠ) and 2 (8％) were occluded near totally ( Raymond grade Ⅱ) . ( 2 ) Seven patients were treated with PED alone. Four patients were cured totally after 6 months follow-up,1 was occluded subtotally,2 were not cured;6 were cured in the last follow-up (33 months),and the other aneurysm was gradually reduced;17 of 28 patients treated with PED in combination with coils received DSA follow-up. They were followed up for 6-8 months. All the aneurysms were totally occluded ( Raymond grade Ⅰ) . 1 aneurysm was treated by 2 PEDs, DSA revealed micro-aneurysm-like development at 8 months after procedure. The aneurysms were basically occluded after 15-month follow-up. (3) MRI confirmed after operation that 10 patients had asymptomatic scattered spotted ischemic foci,4 had cerebral parenchymal hemorrhage,1 of them died,1 recovered well after treatment (mRS 1),and the other 2 were asymptomatic cerebral hemorrhage. The occupying effect of 24 cases disappeared, 8 had obvious improvement,and 3 did not have any obvious change. Conclusions The occlusion rate of the treatment of large and giant intracranial aneurysms with PED was high. The results of medium-term follow-up showed that the occlusion rate of PED in combination with coils in the treatment of aneurysms was higher than that of PED alone. The long-term follow-up results showed that the occlusion rate of patients treated with PED alone (including one or more) was gradually increased with time. The safety of the surgery needs to be further confirmed by a large sample study.

背景 本声明旨在复习目前脑动静脉畸形(brain arteriovenous malformations, bAVMs)的临床资料，为破裂或未破裂bAVMs的诊断和治疗提供建议。 方法 写作组通过面谈和电话会议的方式确定搜索关键词，讨论描述性文字和制定建议。作者通过PubMed、Medline或Embase完成各自相关章节的文献检索，时间截止到2015年1月底。声明草稿由同行评议专家以及卒中委员会科学监督委员会和卒中委员会领导委员会进行预先审查。 结果 本科学声明的重点细分为流行病学、诊断、自然史、治疗方案(包括开颅手术、立体定向放射外科和栓塞治疗的作用)以及破裂和未破裂bAVMs的处理，并且确定了需要更多证据支持的领域。 结论 bAVMs是一种相对少见但非常重要的出血性卒中病因，尤其是在年轻成人中。本声明描述了目前关于破裂和未破裂bAVMs的自然史和治疗方法的知识现状，同时提供了处理建议以及对将来研究的提示。

目的：对蛛网膜囊肿患者手术效果及术后并发症相关因素进行分析。方法选取我院2010‐07－2015‐01收治的蛛网膜囊肿病人19例为研究对象，分析治疗效果及术后并发症。结果行蛛网膜囊肿壁切除＋脑池造瘘术15例，行囊肿‐腹腔分流术4例，手术均取得良好治疗效果。术后发热3例，CSF细胞数增高，给予抗生素及腰穿治疗后好转；1例儿童患者术后出现脑膜‐肌肉膨出，经腰穿治疗及局部穿刺放液，出院1a后复位；无死亡病例。结论蛛网膜囊肿切除＋脑池造瘘及囊肿‐腹腔分流术均能取得良好疗效，需根据具体病例选择手术方式；无菌操作、严密缝合硬膜、适当选择抗菌药物、儿童局部骨瓣复位等措施能有效减少术后并发症的发生。

1 临床资料<br>　　1.1 一般资料 急性蛛网膜下腔出血56例患者，男23例，女33例；年龄28～84岁；一次出血者49例，二次出血者5例，三次出血者2例；有高血压史10例。按 Hunt‐Hess 分级，Ⅰ级13例，Ⅱ级19例，Ⅲ级15例，Ⅳ级7例，Ⅴ级2例。

目的：分析急性脑血管病并发多脏器衰竭死亡患者的临床病例以发现其临床特征。方法：从2011年10月～2012年10月这段时间内我院神经内科收治的因急性脑血管病并发多脏器衰竭综合征而死亡的患者中抽取208例作为本次研究的分析对象，对所选对象的临床资料进行回顾性分析，观察所选患者的临床特点以及死亡相关因素，同时采用统计学软件处理，得到的结果差异以P＜0．05为有意义。结果：基础疾病为脑出血的患者并发多脏器衰竭的死亡率明显高于脑梗死患者（P＜0．05），高龄（60岁以上）患者并发多脏器衰竭的死亡率明显高于低龄（60岁以下）患者（P＜0．05），合并至少2种原发性慢性疾病患者并发多脏器衰竭的死亡率明显高于无慢性疾病的患者（P＜0．05）。结论：急性脑血管病并发多脏器功能衰竭的病死率高、变化较快、起病突然，临床工作者们应加强对患者的预防和干预治疗，减少患者的死亡率。

对急性脑血管病(ACVD)死亡患者医院感染及相关的危险因素进行分析。方法选取该院接收的急性脑血管病死亡患者118例作为研究对象，并对医院感染情况加以分析。结果在该组患者中，有31例出现了医院感染，占26.27%，脑出血医院感染15（26.31%），脑梗死医院感染11例（32.35%）；意识障碍医院感染24例（35.82%）；18例患者在10 d以内出现医院感染(58.06%)，9例在11~20 d出现医院感染(29.03%)；年龄在60岁以上的患者医院感染发生率最高，所占比例为48.39%。结论脑血管病患者有较高的医院感染发生率，并且感染患者的死亡率呈现逐渐上升趋势。其中脑血管病患者发生医院感染的相关危险因素主要为住院时间较长、高龄、意识障碍、脑出血、感染部位等。

目的：探讨血清超敏C反应蛋白（hs-CRP）水平变化与急性脑血管疾病患者病情严重程度及预后的关系。方法选取我院2012-03-2013-01收治的60例急性脑血管疾病患者（脑出血组和脑梗死组）与40例非急性脑血管疾病患者（对照组），采用免疫比浊法动态监测2组患者hs-CRP变化，观察hs-CRP、病情严重程度与预后的关系。结果观察组hs-CRP水平明显高于对照组，且hs-CRP水平越高，对神经功能的影响越大，预后越差。结论 hs-CRP与急性脑血管疾病的病情及预后密切相关。

目的 探讨卒中危险因素与脑血管血液动力学指标(CVHI)之间的关系及影响.方法 选择1200例进行卒种危险因素调查,患者年龄在35岁到65岁,其中男性供890例,女性310例.对者1200例的脑血管血液动力血指标检测,根据检测结果进行积分处理,分析卒中危险因素对脑血管血液动力血指标的影响.结果 检测结果发现高血压、心脏病、糖尿病、遗传以及吸烟和年龄对脑血管血液动力指标都有影响.结论 高血压高血压、心脏病、糖尿病、遗传以及吸烟和年龄脑血管血液动力指标影响程度不一.

Objective To explore the effect of comprehensive treatment on the acute ruptured aneurysms of anteriorcommunicating arteries (ACA). Methods The clinical data of 39 patients with ruptured ACA aneurysms, who were treated in our hospitalfrom October, 2002 to May, 2009, were analyzed retrospectively. Of 34 patients with ACA aneurysm were diagnosed by DSA, 26 weretreated by endovascular embolization, and 8 by microsurgery through pterion approach for clipping the ACA aneurysms. The hematomaswere evacuated and the intracranial aneurysms were clipped by emergent craniotomy in 5 patients, in whom DSA was not performed dueto their critical conditions. All the patients were treated by calcium ionic channel blocker and 3H (hypertension, high blood volume andhigh blood dilution) therapy after the operation. Results According to Glasgow Outcome Scale (GOS), of 39 patients, 27 patientsbelonged in GOS gradeⅤ (69.2%), 5 in gradeⅣ (12.8%), 4 in gradeⅢ (10.3%), and 3 in gradeⅠ (7.7%). The postoperative CTexamination showed that there was focal cerebral ischemia in different degree in 7 patients. The postoperative hydrocephalus, which wastreated by ventriculoperitoneal shunt, occurred in 1 patient. Conclusions The craniotomy for clipping ACA aneurysms and endovascularembolization should be performed as early as possible in the patients with ruptured aneurysms of ACA diagnosed as by DSA. Thepatients with critical condition due to intracerebral hematomas should be treated by emergeng craniotomy for evacuation of hematomasand clipping the aneurysm. The postoperative treatment including 3H therapy, calcium ionic channel blocker and so on is helpful toimprovement of the prognosis in the patients with ruptured ACA aneurysms.

<正>去骨瓣减压术是临床抢救颅脑损伤的常见手术方式,挽救了大量患者的生命,但也出现了一些并发症,其中硬膜下积液是其常见并发症,如治疗不及时,甚至会危及患者生命,针对不同病情选择合适治疗方式至关重要,回顾我科自2002年5月～2007年出现的40

目的 分析总结颞叶内侧癫痫的临床特点,探讨前颞叶内侧切除术的手术方法,并对手术效果进行评价.方法 回顾性分析2003年4月至2007年6月诊断为颞叶内侧癫痫行前颞叶内侧切除术21例患者的临床资料.手术方式:标准前颡叶内侧切除术,部分加做皮层热灼术.结果 21例患者中,术后早期3例出现一过性失语,2例出现短暂的肢体力弱,1例复视,均在术后1～2周恢复正常.1例术后出现永久性轻偏瘫.术后病理检查发现,18例颞叶内侧硬化,其中1例伴灰质异位;1例伴右颞叶隐匿性脑动静脉畸形(AVM);3例无异常发现.随访4个月至4年,所有患者术后服用抗癫痫药物较术前减少或停药.Engel I级11例(52.4%),EngelⅡ级6例(28.6%),EngelⅢ级2例(9.5%),EngelⅣ级2例(9.5%),手术总有效率为90.5%,优良率为81.0%.结论 颞叶内侧癫痫行前颞叶内侧切除术效果良好.

目的探讨小脑幕切迹脑膜瘤的显微外科手术治疗技巧。方法对9例经显微外科治疗的小脑幕切迹脑膜瘤的临床资料进行回顾性分析。结果9例患者中肿瘤全切除8例,1例次全切除,无手术死亡病例。无脑脊液漏及颅内感染发生。9例患者平均随访9个月,术后均恢复良好,生活能够自理,未见肿瘤复发。结论显微外科手术是治疗小脑幕切迹脑膜瘤的有效方法。根据患者术前影像学资料的特征,选择恰当的手术入路,术中良好的病变显露及术后并发症的及时处理是小脑幕切迹脑膜瘤显微外科手术治疗成功的关键。

Objective:To study the expression of bcl-2 gene and its correlation with cell apoptosis in human astrocytic tumor tissues.Methods:Tumor tissues of sixty patents were studied by TUNEL and immunohistochemical SABC methods to determine apoptotic cells density(AD) and the expression of bcl-2 gene.Results:The positive rate of bcl-2 expression was fifty percent in astrocytic tumor tissues of sixty cases.No significance was found among variant malignant tumors(P0.05).But the extent of bcl-2 expression had significant differences among different grades astrocytic tumors(P0.05).High grade astrocytic tumors had a strong extent expression of bcl-2 gene.As the mean time,with the astrocytic tumors′ grade increasing,tumor cell apoptosis density(AD) was gradually increasing,the AD in astrocytoma was significant higher than that in gliocytoma(P0.01).Significant negative correlation was found between the AD and the extent of bcl-2 gene expression in human astrocytic tumor tissues.Conclusions:The high expression of bcl-2 gene might be an important cause for the inhibition of cell apoptosis in human astrocytic tumor tissues.The expression of bcl-2 gene being regulated up might play a key role in tumor growth and its further anaplasia.

我们对经翼点入路采用显微外科技术实施全切除术的三脑室型颅咽管瘤30例实施了术后并发症的综合性防治,效果较好,现报道如下.

Objective:TO study The relationships between the expression of bcl-2 gene in human astrocytic tumor tissues and the degree of malignancy and prognosis of this disease. Methods;Tumor tissues of sixty patents were examined by immunohistochemical SABC method to detect the expression of bcl-2 gene and to study the relationships between the expression of bcl-2 gene and the degree of malignancy and prognosis of this disease. Results:The positive rate of bcl-2 expression was fifty percent in the sixty cases. No significant difference was found among different grade tumors (P 0. 05). But the extent of bcl-2 expression showed significant differences among different grade astrocytic tumors (P 0. 05). High grade astrocytic tumors had a strong expression of bcl-2 gene and patients with strong expression of bcl-2 gene always had poor prognosis(P0. 01). Conclusions :The up-regulated expression of bcl-2 gene might play an important role in the occurrence , development and anaplasia of astrocytic tumor . The extent of bcl-2 gene expression could act as one important marker to reflect the prognosis of astrocytic tumor.

弥漫性轴索损伤(DAI)属原发性闭合性脑损伤,是外伤直接引起的脑白质广泛性轴索损伤[1].本文收集了我科3年来作出DAI诊断的病例7例,现报告如下:

多发性损伤定义为两个或两个以上脏器的严重损伤.我科近2年来收治的重型颅脑损伤并其他脏器严重损伤31例,存活27例,死亡4例.本文拟就其诊断及治疗谈谈自己的体会.

本文回顾我科自1994～2001年24例手术中出现急性脑膨出的病人的临床资料,就其原因及防治措施分析如下.