目的 探究颈动脉狭窄程度对机械取栓后颅内侧支循环状态的影响.方法 选取邯郸市中心医院2019年1月至2020年12月80例急性缺血性脑卒中(AIS)病人作为研究对象,根据颈动脉狭窄程度分为轻度狭窄组(n=23)、中度狭窄组(n= 39)、重度狭窄及闭塞组(n=18),均行机械取栓,比较三组临床资料、机械取栓前后颅内侧支循环状态[神经介入和治疗神经放射学会/介入放射学会(ASTIN/SIR)、基底动脉CT血管造影(BATMAN)评分],分析颈动脉狭窄程度与ASTIN/SIR、BATMAN评分相关性,随访90 d,统计三组预后情况,评价颈动脉狭窄程度对颅内侧支循环状态、预后的影响,并采用KM曲线进行生存分析.结果 机械取栓后轻度狭窄组、中度狭窄组、重度狭窄及闭塞组ASTIN/SIR评分分别为(3.42±0.28)分、(3.05±0.22)分、(2.63±0.17)分和BATMAN评分分别为(8.24±0.71)分、(7.13±0.63)分、(5.29±0.42)分均高于机械取栓前(1.31±0.36)分、(0.87±0.21)分、(0.52±0.17)分和(4.78±1.12)分、(3.36±0.87)分、(2.09±0.54)分(P＜0.05);且重度狭窄及闭塞组机械取栓前、机械取栓后ASTIN/SIR、BATMAN评分均低于中度狭窄组、轻度狭窄组,中度狭窄组均低于轻度狭窄组(P＜0.05);Spearman相关性分析,颈动脉狭窄程度与机械取栓前、机械取栓后ASTIN/SIR、BATMAN评分呈负相关(P＜0.05);单因素分析,颈动脉狭窄程度与颅内侧支循环状态、预后的显著相关(P＜0.05);随访90 d,重度狭窄及闭塞组预后不良率61.11％高于中度狭窄组35.90％、轻度狭窄组13.04％,中度狭窄组预后不良率高于轻度狭窄组(P＜0.05);KM曲线分析,重度狭窄及闭塞组90 d生存率55.56％(10/18)低于中度狭窄组89.74％(35/39)、轻度狭窄组95.65％(22/23)(P＜0.05).结论 颈动脉狭窄程度对AIS病人机械取栓后颅内侧支循环状态与预后均有重要影响,术前准确判断颈动脉狭窄程度并采取针对性治疗措施有利于改善颅内侧支循环状态,强化机械取栓效果,降低预后不良及死亡风险.

目的 观察超高龄急性缺血性脑卒中病人行可回收支架机械取栓的效果及安全性.方法 选择 2018 年6 月至2020 年12 月本院收治的133 例老年急性缺血性脑卒中病人为研究对象,根据年龄将≥90 岁的病人作为超高龄组(47 例),年龄＜90 岁的病人作为老年组(86 例).所有病人均接受静脉溶栓和可回收支架机械取栓治疗.比较 2 组临床疗效、治疗不同时点中国脑卒中临床神经功能缺损量表(CSS)评分、取栓时间、取栓次数、是否植入支架、血管再通率、改良脑梗死溶栓(mTICI)分级、术后并发症发生情况及术后 3 个月内死亡率.结果 2 组总有效率差异无统计学意义(74.47％比 84.88％,P＞0.05).治疗后 3d至 4 周,2 组CSS评分均呈下降趋势(P＜0.05),但 2 组间差异均无统计学意义(P＞0.05).2 组血管再通率、mTICI分级差异无统计学意义(P＞0.05).与老年组相比,超高龄组取栓时间较长、取栓次数较少、植入支架率较高(P＜0.05).2 组术后并发症总发生率差异无统计学意义(17.02％比 11.63％,P＞0.05).术后 3 个月内超高龄组死亡 7 例(14.89％),老年组死亡 10 例(11.63％),差异无统计学意义(P＞0.05).结论 超高龄急性缺血性脑卒中病人发病时也可接受可回收支架机械取栓治疗,不应只因年龄因素放弃治疗.

表皮样囊肿属于颅内常见肿瘤,单侧发病多见,双侧发病少见,且双侧桥小脑角(CPA)区表皮样囊肿继发面肌痉挛病例临床罕见.本文通过报道1例双侧CPA区表皮样囊肿继发面肌痉挛患者的诊疗经过,总结如下:对于年轻的面肌痉挛患者可考虑进行神经影像学检查,以排除CPA区肿瘤病变的可能;双侧CPA区表皮样囊肿继发面肌痉挛患者可考虑行一侧手术切除双侧囊肿,但需要术者掌握娴熟精细的显微手术技巧及扎实的局部显微解剖基本功,术中还需甄别神经血管并最大程度地保护其功能,以提高手术成功率,降低术后并发症发生率.

颅内显微血管减压术是临床治疗特发性面肌痉挛的唯一手术方式,术后小脑梗死发生率极低,且症状不典型,较易被忽视,但极易危及患者生命.本文通过分析3例颅内显微血管减压术后继发小脑梗死的面肌痉挛患者的临床资料,探讨其发生原因及治疗体会,以便为后期预防及处理方案的制定提供参考依据.

目的 探讨脑蛋白水解物联合脑心通胶囊治疗缺血性脑血管病患者的疗效观察及对其血浆脑源性神经营养因子(BDNF)、神经元特异性烯醇化酶(NSE)和S100β表达.方法 前瞻性选取2017年6月至2019年6月邯郸市中心医院收治的缺血性脑血管病患者86例,依据随机数字表法将其分为观察组43例与对照组43例.2组患者入院后采取常规对症治疗.对照组给予脑蛋白水解物20 mL和250 mL 0.9％氯化钠溶液中,静脉滴注,每日1次;观察组在对照组基础上服用脑心通胶囊4粒/次,每日3次.2组疗程均为4周.比较2组疗效,治疗前、治疗4周后Barthel指数(BI)和神经功能缺损评分(NIHSS)、血浆BNDF、NSE和S100β表达影响.结果 观察组总有效率为93.02％,高于对照组的72.09％,差异有统计学意义(P<0.05).观察组治疗4周后BI评分为(69.42±6.25)分,高于对照组[(60.12±4.37)分],NIHSS评分为(10.29±2.64)分,低于对照组[(17.15±3.23)分],差异均有统计学意义(P<0.05).观察组治疗4周后血浆BNDF为(6.43±0.56)ng/mL,高于对照组[(5.37±0.39)ng/mL],NSE和S100β为(7.98±2.54)μg/L、(0.85±0.18)ng/L,均低于对照组[(14.23±4.12)μg/L和(1.63±0.32)ng/L],差异均有统计学意义(P<0.05).结论 脑蛋白水解物联合脑心通胶囊对缺血性脑血管病患者疗效良好,可上调BDNF表达及下调NSE和S100β表达.

目的 探究脑膜瘤组织中Grb2相关结合蛋白1(Gab1)的表达意义及经MAPK信号通路促进脑膜瘤细胞增殖和迁移的机制.方法 临床收集62例脑膜瘤患者的瘤组织和瘤旁组织,通过免疫组化染色检测Gab1.分别将人脑膜瘤细胞系SF3061分为对照组、Gab1组和sh-Gab1组.通过质粒转染过表达或沉默Gab1,分别检测转染后各组细胞活力、增殖、迁移和侵袭功能,以及丝裂原活化蛋白激酶(MAPK)通路相关蛋白ERK1/2、JNK、P38 MAPK蛋白水平.结果 脑膜瘤组织中的Gab1表达水平高于瘤旁正常组织(P<0.05).脑膜瘤分级越高,组织中Gab1表达水平越高(P<0.05).Gab1组蛋白和Gab1 mRNA水平显著下调(P<0.05),sh-Gab1组Gab1 mRNA和ERK1/2、JNK、P38 MAPK蛋白水平显著上调(P<0.05).CCK-8检测转染细胞活力、克隆形成数目、迁移和侵袭能力:Gab1组高于对照组(P<0.05),sh-Gab1组低于对照组(P<0.05).ERK1/2、JNK、P38 MAPK蛋白:Gab1组高于对照组(P<0.05),sh-Gab1组低于对照组(P<0.05).结论 Gab1在脑膜瘤中过表达,高Gab1水平与更高的脑膜瘤分级有关;Gab1通过调控MAPK通路上调ERK1/2、JNK、P38 MAPK蛋白促进脑膜瘤细胞的增殖、迁移和侵袭.

Objective To investigate the relationship between Notch signaling pathway and ep-ithelial mesenchymal transition in glioma cells.Methods Immunomagnetic bead was used to isolate brain glioma stem cells from human glioma tissue. The glioma stem cells were cultured in vitro. Immunofluorescence assay was used to identify the cells. RNA interference retroviral vector of Notch-1 gene(pSiRNA-Notch-1) was constructed. The experiment contained three groups: blank control group(non-transfected plasmid), negative control group(transfected with blank plasmid) and interference group(transfected with pSiRNA-Notch-1). The proliferation and differentiation of three groups were observed. The expression of mRNA and protein of Notch-1 and Hes-1 was detected by RT-PCR and Western blot.Results The cell proliferation and cell differentiation absorbance(OD) of interference group after 7d were(1.332±0.614) and(1.203±0.783) respectively, which were significantly lower than that of blank control group and negative control group(P<0.05). The relative expression of mRNA and protein of Notch-1 and Hes-1 in interference group after 3 d proliferation was(0.189±0.021) and (0.301±0.121),(0.422±0.022) and(0.091±0.032), which was significantly lower than that in blank control group and negative control group(P<0.05). The relative expression of mRNA and protein of Notch-1 and Hes-1 in interference group after 3 d differentiation was(0.253±0.071) and(0.192±0.043),(0.178±0.022) and (0.101±0.012), which was significantly lower than that in blank control group and negative control group(P<0.05). Conclusions Notch signaling pathway plays an important role in proliferation and differentiation of glioma cells. Notch-1 and Hes-1 may be involved in the regulation of proliferation and differentiation, which needs further study.

Objective To observe the expression changes of microRNA181c (miR-181c) in glioblastoma (GBM) and its effects on invasion and migration of tumor cells.Methods real-time PCR was used to detect the miR-181c expression in 41 GBM tissues (GBM group) and 15 normal brain tissues (control group).GBM cell line T98G was divided into four groups:groups A, B, C and D.In the groups A, B and C, the T98G was transfected with miR-181c with overexpression, control miRNA and miR-181c, respectively, but the group D without any treatment.After transfection 48 h, the invasion and migration in each group was investigated.Results Compared with the control group, the miR-181c expression was down-regulated in the GBM group, P<0.05.After transfection 48 h, the invasive cells in the groups B, C and D were more than those of the group A, P<0.05.Moreover, cell relative migration distance in the groups B, C and D was also longer than that of the group A, P<0.05.Conclusion The miR-181c is lowly expressed in GBM tissues, and the low miR-181c expression is closely related with GBM cell invasion and migration.

目的 探讨微小RNA-490-3p(miR-490-3p)对胶质瘤细胞增殖和凋亡的影响,观察miR-490-3p对胶质瘤生物学行为的影响.方法 通过荧光实时定量PCR(qRT-PCR)检测16例胶质瘤样本、胶质瘤旁组织及4种胶质瘤细胞系中miR-490-3p的表达;利用人工合成miR-490-3p mimic瞬时转染脑胶质瘤细胞株,qRT-PCR检测细胞中miR-490-3p的表达水平;采用MTT比色法检测胶质瘤细胞增殖情况;流式细胞术检测胶质瘤细胞凋亡.结果 胶质瘤样本及胶质瘤细胞系中miR-490-3p的表达量较瘤旁与正常胶质细胞系显著降低,miR-490-3p mimic能够显著上调胶质瘤细胞株中miR-490-3p的表达水平,并显著抑制胶质瘤细胞株U251、U87细胞的增殖能力显著增加细胞凋亡数量;结论 miR-490-3p在胶质瘤样本及胶质瘤细胞系中呈现低表达,过表达miR-490-3p有效抑制了胶质瘤细胞株的增殖,增加凋亡,提示miR-490-3p可能成为胶质瘤治疗的新靶点.

Objective To investigate the mechanism of miR -181c inhibiting the invasion of glio‐blastoma cell line T98G .Methods Using RT -PCR and Western Blot to detect the expression of miR -181c and TGF-βrelated genes .The effect of miR -181c and TGF -βon the invasion of glioma cells was measured by Transwell .Using molecular cloning technology to design and clone the target gene 3'-UTR and its mutation region .Using luciferase assay to analyse the combination of miR -181c and target genes .Results mRNA and protein expression of miR -181c and TGF -βpathway associated genes TG‐FBR1 ,TGFBR2 and TGFBRAP1 decreased (P< 0 .05) .miR-181c could weaken the invasion of T98G cells by influencing TGF -βsignal and the 3'-UTR of TGFBR1 ,TGFBR2 and TGFBRAP1 were direct targets of miR-181c .Conclusions miR -181c can inhibit the invasive ability of glioma cell line T 98G by regulating the TGF -βsignaling pathway ,and it can be an important molecule for glioblastoma treatment .

Objective Todetecttheexpressionlevelsoftumornecrosisfactor-α(TNF-α)and interleukin-6(IL-6)inintracranialaneurysms.Methods Sixteenconsecutivepatients(aneurysm group)with intracranial aneurysm confirmed by digital subtraction angiography (DSA)and clipped by microneurosurgery were enrolled retrospectively. A total of 19 trauma patients without vascular disease confirmed by CT and magnetic resonance imaging (MRI)in the same period were used as a control group. Hematoxylin-eosin (HE)staining and immunohistochemical staining were used to detect the aneurysm wall tissue and the colored portions of TNF-α and IL-6 in normal vessel wall,the mean value of optical density after its expression was analyzed,and the intensity of staining was compared. Results (1)Each layer of artery walls of the control group had no obvious TNF-α and IL-6 expression. The inner,media and out membranes of the aneurysm wall tissue of the aneurysm group had positive expression of TNF-αand IL-6. (2)The mean optical densities of TNF-α and IL-6 in patients of the aneurysm group were 0. 182 ± 0. 069 and 0. 148 ± 0.062 respectively,and they were higher than 0. 144 ± 0. 031 and 0. 105 ± 0. 020 of the control group. The differences were statistically significant (all P<0. 05). (3)The mean optical densities of TNF-α expression of each layer of the inner,media and out membranes in the aneurysm walls were 0. 224 ± 0. 071,0. 134 ± 0. 040,and 0. 106 ± 0. 065,respectively. There were significant differences (P<0.01). (4)The mean optical density expressed by IL-6 in the out membrane of the aneurysm walls was lower than the media and inner membranes (0. 096 ± 0. 018 vs. 0. 145 ± 0. 050,and 0. 148 ± 0. 070). There were significant differences (P<0. 05). (5)The results of Spearman correlation analysis showed that the mean optical density of TNF-αof the aneurysm group was positively correlated with that of IL-6 (r=0. 452, P<0.05).Conclusion TheexpressionlevelsofTNF-αandIL-6intheaneurysmwalltissueare higher,and they may be involved in intracranial aneurysm formation and rupture.

To explore the efficacy of microscopic vs .neuroendoscopic single nostril transsphe-noidal approach surgical methods for the treatment of invasive pituitary adenomas .[Methods]Totally 60 pa-tients with invasive pituitary adenoma in our hospital from Jan .2013 to Sept .2013 were enrolled in the study . All patients were randomly divided into two groups .The observation group( n =30) underwent neuroendo-scopic single nostril transsphenoidal approach surgery ,while the control group( n=30) underwent microscop-ic single nostril transsphenoidal approach surgery .The efficacy was compared between two groups .[Results]The operation time ,intraoperative blood loss ,postoperative hospital stay and other indicators in observation group were obviously better than the control group ,and there was significant difference between two groups ( P <0 .05) ,but there was no significant difference in vision improvement and total tumor resection rate be-tween two groups( P >0 .05) .After operation ,nasal septum defect and sinus infection rate in control group were obviously higher than those in observation group .The incidence rate of total complications in control group was 73 .3 % (22/30) which was obviously higher than that in observation group(20% ,6/30) ,and there was significant difference( P <0 .05) .[Conclusion] Neuroendoscopic single nostril transsphenoidal approach surgery for the treatment of invasive pituitary adenoma has very significant efficacy with short operation time , less intraoperative blood loss ,and can shorten postoperative hospitalization time and reduce the incidence of postoperative complications ,and is helpful for the patients'recovery .

Status epilepticus (SE), leading to 27 percent mortality in adult patients, becomes refractory to firstline intravenous diazepam, with prolonged seizure duration. The mechanism could be attributed to the declined inhibitory action of GABA; therefore, alternative medications acting on other targets are necessary. The aim of the present study was to examine whether DEX, a highly specific central α2-adrenoreceptor agonist, could show the anticonvulsant effect on self-sustaining SE (SSSE), and to explore the involved mechanisms. Five minutes after SSSE, which was induced in adult Wistar rats by constant amygdala stimulation for 25 min, DEX was injected intraperitoneally at two dosages (50/100 μg/kg). The number and cumulative time of repeated seizures were recorded; the levels of Glu/GABA and glutathione/malondialdehyde (GSH/MDA) in hippocampus tissue were detected. The results showed that DEX effectively decreased the number and cumulative time of repeated seizures, alleviated the levels of Glu and GSH/MDA in hippocampus tissue, but no effect was detected on the level of GABA, suggesting that DEX could be a potential agent for the treatment of SSSE, the possible mechanisms were antioxidation and inhibition of the Glu release.

Objective To detect the expression of matrix metalloproteinase-2 and 9(MMP-2 and MMP-9) in intracranial aneurysms.Methods 17 patients were diagnosed as intracranial aneurysms with DSA and clipped by microsurgery were enrolled in the study(aneurysm group).Each patients had one aneurysms,10 were small aneurysms,and 7 were large aneurysms;11 patients with Hunt-Hess grade Ⅰ to Ⅱ and 6 with Hunt-Hess grade Ⅲ.15 patients with cerebral trauma but without vascular diseases confirmed by CT and MRI as the control group.HE staining and immunohistochemical staining were used to detect the expression of MMP-2 and MMP-9 in the aneurysm wall and normal vessel wall tissue.The positive index(PI) was calculated.Results ①The positive expression of MMP-2 and MMP-9 in each layer of aneurysm walls in the control group was low.The intima,media,and adventitia of the aneurysm wall tissue had positive expression of MMP-2 and MMP-9 in the aneurysm group.②The positive expression rates of MMP-2 and MMP-9 in patients of the aneurysm group were 88.2% and 82.4% respectively.They were higher than 6.7% and 13.3% of the control group.The difference was statistically significant(P0.01).③The PI values of MMP-2 and MMP-9 of the small aneurysms were 5.1±2.2 and 5.1±4.2 respectively;the PI values of MMP-2 and MMP-9 of the large aneurysms were 4.6±2.4 and 4.1±2.3 respectively.The differences were not statistically significant(P0.05).④The PI values of MMP-2 and MMP-9 in patients with Hunt-Hess Ⅰ or Ⅱ were 4.5±1.6 and 4.2±3.7 respectively;the PI values of MMP-2 and MMP-9 in patients with Hunt-Hess ≥ III were 5.7±3.1 and 5.7±3.1 respectively.The differences were not statistically significant(P0.05).Spearman correlation analysis showed that the PI values of MMP-2 and MMP-9 in the aneurysm group were positively correlated(r=0.425;P0.05).Conclusion The expression of MMP-2 and MMP-9 is higher in the aneurysm wall tissue,and it may be involved in the formation and rupture of intracranial aneurysms.

Objective To investigate the expression of apuaporin 4 (AQP4) protein and mRNA in cerebral edema following fluid percussion injury in rats.Methods The experimental models were established in 64 rats according to Dixon's method.The water content of injured brain and the expression of AQP4 protein and mRNA were measured by using dry-wet measure,immunohistochemistry,Western blotting and reverse transcriptase-polymerase chain reaction (RT-PCR) at 1st h,6th h,12th h,24th h,3rd day and 7th day after operation respectively.Results As compared with control group,the water content was increased in model group from 6 h [(79.11 ± 1.28) ％],reached the peak at 24 h [(82.74 ±1.10)％],lasted to 3rd day [(82.04 ± 1.69)％],and then began to drop; the AQP4 expression was increased from 6 h (IA 471.40 ±45.19),reached the maximum at 24 h (IA 944.20 ± 101.84),lasted to 3rd day (IA 920.60 ± 194.22) and began to drop.Until 7th day,the AQP4 immunoreactive expression was still higher in model group than in control group.The linear regression analysis indicated that the expression of AQP4 protein and mRNA in edematous brain had a positive correlation with change of brain water content (rp,=0.981 ;rm =0.973,P ＜ 0.05).Conclusion The AQP4 expression upregulation plays an important role in cerebral edema following fluid percussion injury in rats and inhibition of AQP4 upregulation may become the new strategy for treatment of traumatic brain edema.

目的 探讨应用球囊或支架辅助栓塞技术治疗颅内宽颈动脉瘤的效果.方法 颅内宽颈动脉瘤患者24例,介入治疗术前经影像学检查或术中数字减影血管造影明确诊断.采用全身麻醉,经股动脉穿刺入路,在数字减影血管造影下,根据动脉瘤的形状、大小,采用相应辅助技术,选用合适的弹簧圈,逐步将瘤腔满意填塞.结果 24例患者共计24个瘤体,使用球囊辅助弹簧圈技术栓塞8个,使用支架辅助栓塞技术16个,其中100％栓塞21例,95％栓塞2例,死亡1例.23例患者电话随访1个月后恢复良好,无再出血发生.结论 联合使用支架和微弹簧圈治疗颅内宽颈动脉瘤安全、有效.

目的:探讨脑胶质瘤术后间质内放化疗的疗效。方法:88例脑恶性胶质瘤患者分为两组,手术切除+术后间质内放疗(A组),手术切除+术后外放疗(B组),A组手术切除恶性脑胶质瘤后放置Ommaya化疗囊,术后1周开始间质化疗,间质化疗的第二周同步联合放疗,观察两组治疗的近期疗效和生存率。结果:A组的有效率为81.82%,显著高于B组(22.73%);A组1、2、3年生存率分别为84.09%、63.64%和45.45%,显著高于B组患者的生存率。结论:手术切除结合术后间质内放化疗治疗脑恶性胶质瘤疗效确切。

Objective To investigate the correlation between the expression of VEGF and the lymph node metastasis of colorectal carcinoma.Methods VEGF was detected by immunohistochemistry in 24 cases of colorectal carcinoma with lymph node metastasis and 16 case of colorectal carcinoma without lymph node metastasis.CD34 was used as a marker to evaluate the MVD.All the data were analyzed using 10.1 statistical package.The comparison was performed by x2 test and Spearman rank correlation analysis.The level of significance is α =0.05.Results in the 40 cases of colorectal carcinoma,24 cases encountered lymph node metastasis with an MVD (40.65 ± 11.80) and 21 cases were VEGF positive (87.5％).In the 16 cases without metastasis,the MVD was (25.02 ± 11.52) and 4 cases were VEGF positive (25.0％).MVD and VEGF were significantly different between thecases with lymph node metastasis and those without (t =-4.138,x2 =16.00,P ＜0.01 ).In the 40 cases,there were 25 cases with positive VEGF with an MVD (41.33 ± 11.61 ) and 15 cases with negative VEGF with and MVD (22.84 ±8.88).The difference between the cases with positive VEGF and those with negative VEGF (t =5.301,P ＜0.05 ).VEGF level was positive correlated with MVD in the colon cancer ( rs =0.539,P ＜ 0.05 ).Conclusion VEGF may play a role in promoting the lymph node metastasis of colorectal carcinoma

锁孔神经外科已成为现代微创神经外科重要方向之一.桥脑小脑角区位置深,操作空间小,解剖结构复杂,该部位手术历来是神经外科医师面临的巨大挑战.本文通过探讨乙状窦后入路相关解剖和临床应用研究,进一步理解锁孔理念及其发展前景.乙状窦后锁孔入路处理桥小脑角区多种病变具有明显的优势,且与其他入路互补性强.内镜辅助进一步扩大了乙状窦后锁孔入路的多用途性.

目的 探索大肠癌组织中血管生成素-2(Angiopoetin-2)与大肠癌淋巴转移的关系.方法 采用免疫组化方法检测40例大肠癌组织中血管生成素-2的表达,采用CD34标记计数肿瘤组织微血管密度(MVD),分析血管生成素-2和大肠癌淋巴转移病理因素关系,采用X2检验和Spearman等级相差分析对相应资料进行分析,显著性标准α=0.05.结果 在大肠癌合并淋巴结转移癌中,血管生成素-2阳性表达明显高于无淋巴结转移的大肠癌.结论 血管生成素-2可能促进大肠癌的血管生成,进而促进大肠癌的转移.