Objective:To investigate the effect of acupuncture on brain derived neurotrophic factor (BDNF) expression and receptor tyrosine kinase B (TrkB) activity after moderate traumatic brain injury (TBI).Methods:Forty-two adult SD male rats were randomly divided into TBI group (21 rats) and TBI+acupuncture group (21 rats) according to random number table method. The moderate TBI model was established by fluid percussion instrument in both groups. The TBI group was only modeled, and the TBI+acupuncture group was given acupuncture treatment after the TBI model was established. Tissue homogenates and sections were harvested 21 d after moderate TBI. The level of BDNF was examined by ELISA. Immunofluorescence staining was used to detect the expression level of TrkB protein at 6 and 12 h after moderate TBI, Western blot was used to detect the expression levels of TrkB protein at 48, 96, and 168 h after moderate TBI, and the expression of protein kinase B (Akt) and extracellular regulated protein kinase 1/2 (ERK1/2) at 12 and 48 h.Results:The expression level of BDNF protein in two groups of rats reached its peak at 12 h after moderate TBI and gradually decreased at 48 h. The BDNF protein levels in the TBI+acupuncture group were higher than those in the TBI group at 6, 48, 96, 168 h after TBI, with statistical significance (P<0.05), there was no statistically significant difference in BDNF protein levels at 12 h (P>0.05). The levels of p-TrkB protein in the TBI+acupuncture group were higher than those in the TBI group at 6, 12, 48, 96, 168 h, while p-Akt and p-Erk1/2 protein levels were higher than those in the TBI group at 12, 48 h, with statistical significance (P<0.05).Conclusion:Acupuncture therapy can upregulate the expression level of BDNF protein after moderate TBI, and activate TrkB protein by phosphorylation, ultimately activating its downstream signaling pathway.

慢性创伤性脑病(CTE)是一种以脑内磷酸化tau蛋白异常积聚为特征的神经病理学疾病.目前公认的神经病理学标准仍只是初步的,一方面因为该标准基于数量有限的选定样本,另一方面目前很少有研究将CTE的病理与其他神经退行性疾病(如阿尔兹海默病)进行比较.此外, CTE被广泛认为是反复头部受击的结果,但一次中度或重度的颅脑创伤(TBI)也可诱发CTE.基于不同的观点,本文结合国内外文献就CTE特点、研究历史以及TBI与CTE的相关性作一综述.

3D打印技术已成为再生医学领域研究人员广泛使用的多功能支架制造技术,特别是生物材料与3D打印技术的组合使复杂器官制造成为可能.本研究首先对3D打印技术原理及分类进行介绍,并详细探讨液相结合喷墨技术、熔融沉积成型技术、选择性激光烧结技术、光同化立体造型术、生物打印等5种最具代表性3D打印技术在生物材料领域中的应用实例和不足.3D打印技术将使生物材料制造朝着“人工智能”支架的方向发展,使生物支架材料能够响应宿主变化而动态地改变自身属性,必将为组织修复提供很好的思路.

重型颅脑创伤(severe traumatic brain injury,sTBI)急性期管理的关键是减少因颅内压(intracranial pressure,ICP)升高、脑灌注压不足引起的继发性损伤, 故ICP监测成为sTBI患者管理的重要部分[1,2].本次结合文献和笔者30余年对sTBI后ICP管理经验和教训, 与大家学习交流ICP监测临床应用的演变及ICP轨迹建模的临床研究.

颅脑创伤是人类致残、致死的主要原因之一.由于受伤机制和脑组织的复杂性,颅脑创伤可诱发广泛的病理生理学改变.代谢组学可提供颅脑创伤患者单一时间点生理、生化状态的"瞬时快照".目前,高通量、高灵敏度的代谢组学分析工具能够检测和定量小浓度的代谢物,使客观化、精细化评估颅脑创伤成为可能.本文就代谢组学的概况及其在颅脑创伤诊疗、预后评估等方面的研究进展做一综述.

轻型颅脑创伤(mTBI)可导致大脑结构或功能改变,表现为局灶性神经、认知或行为功能障碍.目前mTBI的诊断标准是非常有限的、可变的,且多基于主观的自我报告,因此限制了临床医生的准确诊断、治疗方案制订和预后评估等.高级神经影像学技术的发展,使客观化评估mTBI成为可能.本文将综述几项颇有前景的成像技术及其应用,以了解mTBI后的大脑异常改变.这些成像方式包括理解大脑结构和组织结构、监测局部血流、评估微出血、测量脑功能及代谢情况的技术.

一、重型颅脑创伤特点 重型颅脑创伤 (severe traumaic brain injury, sTBI)具有高致残率和高致死率特点.sTBI的死亡患者占全部创伤患者的76％[1]. 国内不同地域和不同层次医院对sTBI临床救治差异很大,特别是对部分地县级以下的创伤中心,sTBI救治仍有很大的提升空间. 为规范护理和指导治疗, 国内外相关指南相继更新. 本次结合新指南和笔者30余年sTBI临床管理经验和教训,整体阐述sTBI患者全程医疗管理中的实际问题和具体措施, 目的 是推动和促进我国sTBI医疗管理的规范化.

目的 探讨脂肪间充质干细胞分泌组(ASC-ST)对大鼠颅脑创伤(TBI)后继发脑水肿的影响及其潜在机制.方法 将70只SD大鼠随机分为Sham组(n=18)、TBI组(n=26)和TBI+ST组(n=26).应用电子颅脑损伤仪(eCCI)建立TBI大鼠模型,Sham组只开骨窗;TBI组经尾静脉注射0.3 mL生理盐水,TBI+ST组经尾静脉注射0.2 mLASC-ST和0.1 mL生理盐水,连续注射7d.在TBI后3、7、14和21 d对TBI和TBI+ST组8只大鼠行神经功能评分(mNSS);每组选取6只大鼠在TBI后3、7和14d行头颅核磁(MRI)测量表观弥散系数(ADC);采用干湿比重法测量脑水含量并提取损伤周围脑组织总RNA,采用实时定量多聚酶链反应(qRT-PCR)检测肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1β和IL-6的mRNA表达水平.结果 TBI后14、21 d时,TBI+ST组mNSS评分均低于TBI组(P＜0.05).TBI后3d,TBI组和TBI+ST组损伤周围皮层(IC)和损伤对侧皮层(CC)的ADC值均高于Sham组(P＜ 0.05);TBI后7d,TBI+ST组IC和损伤侧海马(IH)的ADC值均低于TBI组(P＜ 0.05);TBI后14 d,TBI+ST组IC和CC的ADC值均低于TBI组(P＜0.05).TBI后3d和7d,TBI+ST组大鼠脑组织水含量与TBI组差异无统计学意义(P＞ 0.05);TBI后14d,TBI+ST组大鼠脑组织水含量低于TBI组(P＜0.05).TBI后3d,Sham组大鼠损伤周围脑组织中IL-6表达显著低于TBI组和TBI+ST组,TBI+ST组TNF-α表达显著低于Sham组和TBI组,TBI组高于Sham组;TBI+ST组与TBI组IL-1β表达均低于Sham组(均P＜0.05).TBI后7d,TBI+ST组与Sham组IL-6表达均低于TBI组,TBI+ST组低于Sham组;TBI组TNF-α表达高于Sham组;TBI组IL-1β表达高于其余两组,Sham组高于TBI+ST组(均P＜0.05).TBI后14 d,TBI+ST组与Sham组IL-6表达均低于TBI组;TBI+ST组TNF-α表达仍低于其他组;TBI组IL-1β表达仍高于其余两组(均P＜ 0.05).结论 ASC-ST可通过减少TBI后炎症反应和炎性因子表达,显著改善大鼠TBI后脑水肿状况和神经功能预后,是一种具有较高临床推广价值的生物治疗药物.

Objective To observe the clinical efficacy of radiofrequency ablation for treatment of discogenic lumbar spinal nerve posterior branch neuralgia after vertebral column endoscope operation. Methods Thirty-six patients with discogenic lumbar spinal nerve posterior branch neuralgia after vertebral column endoscope surgery admitted to the Affiliated Hospital of Logistics University of People's Armed Police from December 2011 to December 2017 were enrolled. According to difference in therapeutic methods, they were randomly divided into two groups, 18 cases in each group. The radiofrequency ablation group was treated with X-ray imaging guided lumbar spinal nerve posterior branch radiofrequency thermo-coagulation; the drug group received oral diclofenac sodium conservative treatment, 75 mg twice daily for 3 weeks. Both groups were followed up for 6 months, visual analogue scores (VAS) were used to evaluate the pain before and after treatment, the Oswestry dysfunction index was used to assess the degree of lumbar function recovery, and the surgical complications and adverse drug reactions were observed. Results The VAS scores in the two groups were similar before treatment; after treatment for 1 month, the VAS scores in both groups were significantly lower than those before treatment (radiofrequency ablation group: 1.83±0.71 vs. 5.67±0.77; drug group: 2.22±0.43 vs. 5.28±0.67, both P < 0.05); after treatment for 3 months and 6 months, the VAS scores were increased gradually, however, the scores of radiofrequency ablation group were significantly lower than those in the drug group (3 months was 2.00±0.59 vs. 3.39±0.70, 6 months was 2.17±0.51 vs. 3.61±0.50, both P < 0.05), moreover, the excellent and good rates of postoperative pain efficacy and of Oswestry dysfunction index improvement in the radiofrequency ablation group were significantly higher than those in the drug group [excellent and good rates of postoperative pain efficacy: 94.44% (17/18) vs. 22.22% (4/18), excellent and good rates of Oswestry dysfunction index improvement: 77.78% (14/18) vs. 44.44% (8/18), both P < 0.05]. There were no complications of infection and spinal nerve anterior branch injury in the radiofrequency ablation group, and 6 patients in the drug group presented mild gastric discomfort, which was relieved after symptomatic treatment. Conclusion The radiofrequency ablation is an effective method for treatment of discogenic lumbar neuralgia after vertebral column operation, compared with the conservative therapy, the ablation is more effective to relieve pain for a long time, promote the recovery of neural function, and the operation is safe with very few adverse reactions.

颅脑创伤(traumaic brain injury,TBI)被称为"最复杂器官中最复杂的疾病",患者会经历大范围的继发性颅内或颅外损伤,将加重原发性损伤. TBI 后全身血流动力学明显改变、 身体和大脑温度的微小变化对缺血缺氧或 TBI 后的神经元易损性起着关键作用.基础实验及临床研究显示,多种类型脑损伤后的核心温度轻度升高将对大脑产生不利影响, 亚低温可通过阻断多个破坏性程序起到脑保护作用, 并通过稳定 TBI 后体循环和脑循环功能,减少高灌注、脑水肿、 肺水肿和血管痉挛发生率, 从而改善远期预后. 因此,了解 TBI 后体循环和脑循环的变化情况、亚低温治疗在 TBI 救治中的作用、 亚低温对 TBI 后体循环和脑循环的影响等问题, 有助于解决和避免低温治疗 TBI 患者期间所面临的问题.

Objective:To preliminarily screened the protein molecules and biological processes that may be involved in PM2.5 increases the rate of adverse pregnancy by affecting the placental trophoblast cells using proteomic technology.Methods:HTR-8/SVneo cells were exposed to 0,30,60,120 and 200 μg/mL PM2.5 for 24 h and 48 h,respectively,to observe the cell proliferation;finally,we selected 120 μg/mL PM2.5 treated with HTR-8/SVneo cells for 24 h and 48 h for follow-up experiments.After extraction of intracellular protein and enzyme digestion,peptides and differentially expressed proteins were analyzed and identified by isobaric tags for relative and absolute quantitation (iTRAQ) combined with two-dimensional liquid chromatography tandem mass spectrometry (2D LC-MS/MS) technology.Finally,bioinformatics analysis of the data was carried out.Results:The survival rates of cells treated with 120 μg/mL PM2.5 for 24 h and 48 h were 86.09％ and 52.36％,respectively,which were also remarkably decreased compared with that of control cells (P＜0.05).There were 182 differentially expressed proteins in the cells exposure to 120 μg/mL PM2.5 for 24 h,involved in 22 cell biological processes (BP);meanwhile,cells exposed for 48 h had 486 differential proteins,involving 217 BP.Conclusions:PM2.5 can affect a large number of BP in HTR-8/SVneo cells.iTRAQ with LC-MS/MS 2D technology is an effective way for high sensitivity and throughput screening of differentially expressed proteins in cells after exposure to PM2.5,which provides a basis for the future research on the mechanism of PM2.5 increased the risk of adverse pregnancy outcomes.

Objective To observe growth and differentiation of rat neural stem cells (NSCs) on collagen-chitosan (CG-CS) composite scaffold fabricated by three-dimensional(3 D) printing.Methods Cerebral cortex was taken from 14-16 d SD rat embryo and NSCs were isolated,cultured and identified.CG-CS composite biological scaffolds were fabricated by 3 D printing and freeze-drying technique.Three control groups had routine suspension culture NSCs;three observation groups had NSCs cocultured with CG-CS scaffolds.Cell growth and differentiation on scaffolds were observed by inverted phase contrast microscope,scanning electron microscope,Cell Counting Kit-8 (CCK-8) assay and immunofluorescence assay.Results In the 3rd generation of NSCs,expressions of Nestin protein,neuron specific nuclear protein(NeuN) and glial fibrillary acidic protein(GFAP) were positive in immunofluorescence tests.CG-CS composite scaffolds were successfully made by porous spatial structures with quadrilateral aperture of (510 ± 63) μm.NSCs grew and differentiated well on CG-CS scaffolds under microscope and scanning electron microscope;absorbance values in observation group after l,4,7,11,14 d of culture were significantly higher than those in control group [(0.34 ± 0.04) vs (0.21 ± 0.03),(0.70±0.08) vs (0.35±0.04),(0.92±0.11) vs (0.67±0.08),(0.75 ±0.09) vs (0.42± 0.05),(0.53 ±0.07) vs (0.27 ±0.03)] (P ＜0.05).NeuN and GFAP positive NSCs could be observed outside and inside of biological scaffolds.Conclusion 3D printing technology can fabricate microstructure-controllable CG-CS composite biological scaffolds,which have good biocompatibility and benefit growth and differentiation of NSCs.

颅底骨折是常见的颅脑创伤(traumatic brain injury,TBI)伴发症,外伤性颅底骨折可致颅神经和脑血管损伤[1,2]. 其中,创伤性颈内动脉(internal carotid artery,ICA)闭塞在临床上较为罕见,但因其可导致急性颅脑缺血性损伤而使其临床发病凶险,致死率及致残率高,且预后较差,故及时发现和正确处理,对抢救该类患者生命非常重要[3,4]. 武装警察部队后勤学院附属医院脑科中心成功救治了一例创伤性ICA闭塞患者,现报告如下.

BACKGROUND:Biological scaffolds should be gradually degraded with the formation of new tissues, so the degradation rate is an important index for evaluating scaffold materials. Conventional testing methods make an impact on the assessment of the scaffold degradation rate at different sites due to some limitations. OBJECTIVE:To evaluate the degradation rate of col agen-chitosan (CG-CS) composite implanted into the subcutaneous, spinal cord and brain tissues of Sprague-Dawley rats and to explore the underlying mechanism. METHODS:A 3 mm×3 mm disc-shaped CG-CS composite scaffold was prepared, and its microstructure was observed under scanning electron microscope. Nerve stem cel s were co-cultured with CG-CS scaffold, and then the cel viability was detected through cel counting kit-8 assay to assess the biocompatibility. Sprague-Dawley rats were randomly divided into three groups:cortex, spinal cord, and subcutaneous groups. The CG-CS scaffold was implanted into cortex, spinal cord T9, or back T9, respectively. The rats were sacrificed at different time points, and three rats in each group were subjected to the scaffold removal to evaluate the scaffold degradation rate. The resting rats were used to prepare the tissue sections for histological observation of the scaffold and the surrounding tissues. RESULTS AND CONCLUSION:Scanning electron microscope revealed that the CG-CS composite scaffold had a three-dimensional porous structure with a pore size that met the biological requirements of in vivo transplantation. The in vivo experiments showed that no graft rejection occurred, suggesting that the scaffold has good biocompatibility. The degradation rate was fastest in the subcutaneous group, and the scaffold was degraded completely with 12 days, which was significantly higher than that in the spinal cord and brain groups (P<0.05). The degradation rate in the spinal cord group was significantly higher than that in the brain group since the 3rd week (P<0.05);the scaffold degraded completely in the spinal cord group, while the partial scaffold could still be found in the brain group. The number of blood vessels and the scores of macrophage infiltration were as fol ows:subcutaneous group>spinal cord group>brain group (P<0.05). Our findings suggest that the CG-CS scaffold holds a good biocompatibility and its degradation rate differs significantly among groups. In the field of tissue engineering, the complex microenvironment of target tissues and the host response after stent implantation should have effects on the balance between the biodegradation rate and reconstitution rate of the organism.

一、神经创伤概述<br>　　神经创伤包括颅脑创伤、脊髓损伤、周围神经损伤和自主神经损伤，主要的救治环节是现场与院前转运、急诊室救治和院内手术及神经危重症监护单元（neurointensive care unit，NICU）/康复治疗。颅脑创伤（traumatic brain injuries，TBI）发生率为150~200人/10万人，占全身创伤的10%~15%，但是死亡率占全部创伤患者的70%~80%。脊髓损伤（spinal cord injury，SCI）发生率为15~60人/100万人，占全身损伤的0.2%~0.5%。 SCI发生率是TBI的1/15~1/50，约2.6%TBI患者伴有急性SCI。在SCI中，大约55%发生在颈脊髓，30%在胸段脊髓，15%在腰段脊髓，其中有43%~46%患者出现SCI平面以下完全性运动和感觉功能丧失[1,2]。

神经系统损伤因其高死亡率和高致残率，是所有年龄阶段人群共同面临的一个严峻的公共健康问题。神经再生成为了医学界在理论研究和临床实践上的关注点。随着组织工程学的发展，三维（three-dimensional，3D）打印技术已被逐渐用于神经外科中，如制造术前模型、组织工程支架、制造个性化植入物等[1]。今天主要简析3D打印技术发展历史、技术原理及分类、医学领域应用现状、神经修复中的应用及其未来发展方向等五个方面。

Nervous system injury is a serious public health problem for all the people.In recent years, the research on nerve bionic scaffold has become a hot point.The new three dimensional (3D) printing technology has lead to the innovation of bionic scaffold.This article discussed the structure and material of nerve regeneration, and reviewed the application of scaffold structure design and material selection which are two core content of 3D printing technology, so as to provide a new way of nerve repair.

目的 模拟脑组织弹性模量制备相应二维培养基,比较亚低温联合温敏脐带间充质干细胞(tsUC)与常温下脐带间充质干细胞(UC)的分化特性.方法 应用单、双丙烯酰胺的聚合作用,制备弹性模量为0.5 kPa的聚丙烯酰胺(PA)水凝胶,用于模拟脑组织的生物力学环境,并测其弹性模量.从新生儿脐带中分离培养脐带间充质干细胞,通过感染携温度敏感型猿猴病毒40大T抗原(ts-SV40LT)基因的逆转录病毒来制备tsUC.实验分为3组:UC+常温+玻片组(A组)、UC+常温+0.5 kPa组(B组)、tsUC+亚低温+0.5 kPa组(C组).动态观察各组细胞的生长情况和形态变化,并于7d后行细胞免疫荧光检测各组细胞的分化水平并计算分化神经元的轴突长度.结果 PA水凝胶弹性模量的检测结果为(0.50±0.03)kPa.B、C两组部分细胞出现细长的胞突,并存在β-tubulinⅢ阳性细胞,A组细胞镜下无明显神经元形态,也无β-tubulinⅢ阳性表达.B、C两组的神经元分化率以及荧光下轴突长度均明显高于A组,但组间差异无统计学意义(P＞0.05).结论 在模拟脑组织弹性模量的环境中,tsUC具有向神经元分化的能力,可应用于亚低温治疗下脑损伤修复的细胞移植研究.

BACKGROUND:Currently, morphological observations of brain cavity after traumatic brain injury (TBI) via cadavers or animal specimen are difficult to obtain dynamic changes. OBJECTIVE:To explore the application effect of MRI-based three-dimensional (3D) reconstruction for evaluating the prognosis of TBI. METHODS:Five male Sprague-Dawley rats were enrol ed to establish TBI models by Electronic Cortical Contusion Injury (eCCI), and scanned by 3.0T MRI with Rat-coil to obtain the DICOM date of brain at 1 day, 1, 2 and 3 months after modeling. Brain cavities were 3-dimensional y reconstructed by Mimics16.0 software, and analyzed in the Meshmixer software. RESULTS AND CONCLUSION:(1) The outline of reconstruction model image was clear, and could be observed and measured from different sides and perspectives. (2) The cavity volume and surface area at different time points after TBI showed significant differences between each other except that at 2 and 3 months (P<0.05). (3) The results of cavity change suggested that the cavity tended to be regular after 3 months of TBI. (4) In conclusion, 3D reconstruction software Mimics combining with model analysis software Meshmixer can conveniently and quickly obtain the cavity model, and provide an intuitive way for evaluating the dynamic variations of the brain cavity after TBI.

Objective To evaluate the clinical results of percutaneous transforaminal endoscopic bilateral decompression (PTED)via unilateral approach for lumbar spinal stenosis (LSSS) caused by lumbar disc herniation (LDH).Methods From January 2014 to January 2016,35 cases of LSS caused by LDH were treated with PTED via unilateral approach at Affiliated Hospital of Logistics University of Chinese Armed Police Force,and their data were used for a retrospective analysis.The surgical effect was evaluated using the Macnab score at 3 months post-operation.Visual analogue scale (VAS) and Oswestry disability index (ODI)were used to assess the outcomes at 6 month post-operation.MxLiteView DICOM Viewer software was used to measure the change of spinal canal area before and after operation based on the parameters of axial MRI images.Results The mean operation time was (89.1 ± 8.7) min in 35 patients.The preoperative and 6-month postoperative VAS values were (7.9 ± 0.8) and (2.1 ± 0.5) points,respectively,and the ODI were(61.5 ±3.7) and(21.3 ± 2.1)points,respectively.Both differences were statistically significant (P ＜0.05).As per the Macnab criteria,19 patients (54.4％) reported excellent effect,13 (37.1％) demonstrated good outcome,2 (5.7％) reported faireffect,and 1 (2.9％) demonstrated poor result.The excellent/good rate reached 91.4％.Compared with the preoperative conditions,the cross sectional areas of spinal canal at the levels of L3-4,L4-5 and L5-S1 were increasedby (35.7 ± 8.5) mm2,(40.9 ± 4.1) mm2 and (42.5 ± 9.1) mm2,respectively.No postoperative rupture of spinal dura,or injury of nerves,blood vesselsas well as intestines,or infection occurred in this series.The most frequently observed complication was transient paresthesia due to irritation of nerve root.Conclusions The procesure of PTED via unilateral approach demonstrate satisfactory short-term effect in the treatment of LSS caused by LDH.Further long-term observations are needed to investigate postoperative stability of lumbar spinal canal,the risk of restenosis,and possibility of re-operation in case of restenosis.