Objective: To investigate the inhibitory effect of polysaccharide from Phellinus Linteus on immune surveillance of glioma cells and its regulatory mechanism on the major histocompatibility complexⅠchain related gene B（MICB）/natural killer cell activated receptor 2D（NKG2D） signaling pathway. Methods: Total 60 C57BL/6 mice aged 6～8 weeks and GL261 cell line were se-lected. Fifty of them were randomly selected to establish brain glioma models, and the remaining 10 mice were recorded as control group. In addition, the model mice were randomly divided into groups. The elemene group was given 100 mg/kg elemene and 1 ml/100 g normal saline by gavage, and the different doses of polysaccharide from Phellinus Linteus groups were given 50, 100 and 200 mg/kg of polysaccharide from Phellinus Linteus dissolved in 1 ml/100 g normal saline by gavage, while the control group and model group were given the same amount of normal saline, all once a day for 4 weeks. After intervention, the mice were killed, and the tumor weight and tumor inhibition rates were compared among groups. Hematoxylin eosin（HE） staining was used to observe the pathological changes. NK cell infiltration was detected by CD57 antibody. Real time reverse transcription polymerase chain reaction（RT-q PCR） was used to detect the mRNA expression of major histocompatibility complexⅠchain related genes A（MICA）, MICB, UL16 binding protein 1（ULBP1）, UL16 binding protein 2（ULBP2）, UL16 binding protein 3（ULBP3）. The expressions of MICA, MICB, ULBP1, ULBP2 and ULBP3 were detected by Western blot. NK cells were separated by magnetic bead affinity cell sorting, and the activities of NKG2D on the surface of NK cells were detected by flow cytometry in the tissues of mice. Results:Compared with model group, the tumor weight of elemene group and the different doses of polysaccharide from Phellinus Linteus groups were decreased, the tumor inhi-bition rates were increased, the degeneration and necrosis of tumor cells were increased, the infiltration of NK cells was increased, the mRNA and protein expressions of MICA, ULBP2 and ULBP3 were decreased, the mRNA and protein expressions of MICB and ULBP1 were increased, and the NKG2D activities on the surface of NK cells were increased in elemene group and the three doses of polysaccharide from Phellinus Linteus groups, with statistically significant differences（P＜0.05）. There was no significant difference in all of the indexes between low-dose polysaccharide from Phellinus Linteus group and elemene group（P＞0.05）. Conclusion:Polysaccha-ride from Phellinus Linteus can inhibit the growth of glioma, promote the degeneration and necrosis of tumor cells, increase NK cell in-filtration, and it is suggested that it is related to regulating the signaling pathway of MICB/NKG2D, increasing the expression of MICB, ULBP1 and NKG2D activity on NK cells, decreasing the expressions of MICA, ULBP2 and ULBP3, and enhance immunosurveillance of glioma cells.

Background: Civilian gunshot wounds to the head refer to brain injury caused by projectiles such as gun projectiles and various fragments generated by explosives in a power launch or explosion. Gunshot wounds to the head are the deadliest of all gun injuries. According to literature statistics, the survival rate of patients with gunshot wounds to the head is only 9%. Due to the strict management of various types of firearms, they rarely occur, so the injury mechanism, injury and trauma analysis, clinical management, and surgical standards are almost entirely based on military experience, and there are few related reports, especially of the head, in which an individual suffered a fatal blow more than once in a short time. We report a case with a return to almost complete recovery despite the patient suffering two gunshot injuries to the head in a short period of time. Case Presentations: We present a case of a 53-year old man who suffered two gunshot injuries to the head under unknown circumstances. On initial presentation, the patient had a Glasgow Coma Scale score of 6, was unable to communicate, and had loss of consciousness. The first bullet penetrated the right frontal area and finally reached the right occipital lobe. When the patient reflexively shielded his head with his hand, the second bullet passed through the patient's right palm bone, entered the right frontotemporal area, and came to rest deep in the lateral sulcus. The patient had a cerebral hernia when he was admitted to the hospital and immediately entered the operating room for rescue after a computed tomography scan. After two foreign body removals and skull repair, the patient recovered completely. Conclusions: Gunshot wounds to the head have a high mortality rate and usually require aggressive management. Evaluation of most gunshot injuries requires extremely fast imaging examination upon arrival at the hospital, followed by proactive treatment against infection, seizure, and increased intracranial pressure. Surgical intervention is usually necessary, and its key points include the timing, method, and scope of the operation.

冠状动脉旁路移植术(coronary artery bypass grafting,CABG)在缺血性心脏病血管重建的治疗中起着重要作用.缺血性卒中是CABG术后的严重并发症之一,也是CABG术后死亡的主要原因之一.准确的术前评估和仔细选择血管重建策略是使缺血性卒中风险最小化的关键因素.本文通过对CABG术后缺血性卒中的发病机制、评估CABG术后缺血性卒中发生风险、牛津郡社区卒中项目(Oxfordshire Community Stroke Project,OCSP)不同亚型生存质量、防治原则的研究进展作一综述.

目的:探讨抗癫痫药物导致的中毒性表皮坏死松解症的临床表现、诊断及治疗方法.方法:对1例丙戊酸钠所致的中毒性表皮坏死松解症样重症药物反应的临床表现、治疗过程进行分析,并对相关文献进行复习.结果:本例患者女性,52岁,以右侧颞顶脑膜瘤入院,完善辅助检查,行开颅手术治疗,手术顺利,术后颅内情况恢复良好.术后给予丙戊酸钠抗癫痫治疗,在术后17天出现发热,并随之出现全身皮疹,水疱、瘀斑,随后部分疱壁破裂,超过30％的皮肤发生脱落,伴不完全性肠梗阻、口腔及外生殖器溃疡、结膜炎等黏膜病变,肝功能异常,低蛋白血症,凝血功能异常,转入重症医学科后,给予甲强龙、丙种球蛋白等对症、支持治疗,经积极治疗,效果欠佳,出现全身多器官功能衰竭,死亡.结论:使用丙戊酸钠后可能并发中毒性表皮坏死松解症,虽其发病率低,但死亡率及致残率均较高.

1 病例资料 17岁女性,足月顺产分娩一健康婴儿后9d突发左侧肢体无力,伴麻木,进行性加重,随后出现肢体抽搐,约2 min后自行缓解,期间间断发作.入院头颅CT示左侧顶叶低密度影并脑沟混杂高密度影,矢状窦高密度影.体格检查:神志浅昏迷,GCS评分11分;双侧瞳孔直径约3.0 mm,对光反射灵敏;左上肢肌力0级,其余肢体肌力正常;病理征阴性.血小板计数示287×109/L,纤维蛋白原为3.927 g/L,D-二聚体为5.7 mg/l.头颅CTV示上矢状窦后部腔内充盈缺损影,呈"空三角征",考虑上矢状窦栓塞.急诊介入溶栓治疗,予尿激酶40万U,溶栓后造影见上矢状窦通畅.术后予以普通肝素全身肝素化,维持活化部分凝血活酶时间在60～70 s;持续尿激酶溶栓治疗(25万U,1次/6 h).溶栓治疗5d、抗凝治疗15 d,病人意识清醒.出院随访3个月,四肢肢体肌力正常,病人正常生活.

脑膜瘤是神经外科常见的颅内肿瘤之一,居第二位.而中央回区的脑膜瘤位于重要的脑功能区,静脉密集,毗邻矢壮窦,且静脉分布变异性大,解剖复杂,手术难度大,全切率低,术后易复发.该区的静脉一旦损伤,常会引起严重的并发症,严重影响患者生活质量.所以本文就查阅相关该区静脉保护相关策略的文章进行综述.

1 病例资料 55岁女性,因间断性头痛1年入院.入院神经系统体格检查示右侧指鼻试验阳性、右侧跟膝胫试验阳性.头颅MRI平扫+增强示右侧小脑半球类圆形占位性病变,对周围脑组织造成推挤,呈T1等-低信号、T2等-低信号,均一强化,内部信号欠均一(图1A、1B).经右侧枕下乙状窦后入路手术.术中见肿瘤基底位于右侧横窦下硬脑膜,包膜完整、边界清楚、质地略韧、血供一般,肿瘤侵蚀硬膜及颅骨.先瘤内分块切除肿瘤,然后切除瘤壁及受浸润的硬膜,予以Simpson分级Ⅰ级切除.术后病理示脑膜瘤(脑膜皮细胞及砂粒体混合型;WHO分Ⅰ级).术后1d复查头颅CT示术区出血、第四脑室受压.术后4d出现缄默,神志清楚,能听懂他人言语,能遵嘱活动肢体,但不能发音,不对答.再次复查头颅CT示右侧小脑半球出血量同前,但第四脑室显影不清,侧脑室及第三脑室较前明显扩大(图1C、1D).急诊予以左侧侧脑室穿刺外引流术,每日引流脑脊液约300 ml,6d后复查头颅CT示脑室系统较前减小(图1E、1F).脑室外引流术后8d言语功能恢复正常,理解力及表达能力正常.脑室外引流术后10d复查头颅CT示脑室系统较前相似,第四脑室开始显影(图1G、1H).脑室外引流术后2周康复出院.术后随访6个月,恢复好.

Objective: To investigate and analyze the effects of LncRNA CASC2 targeting NF-kB p65 on the proliferation, apoptosis and invasion of glioma cells. Methods: We detected the expression of CASC2 in gliomas and healthy brain tissue. The U87 cells were cultivated and transfected with CASC2 mimics and CASC2-NC mimics, while the control group was not transfected. The mRNA expression levels of CASC2, NF-kB P65, as well as cell proliferation, apoptosis, and invasion in each group were detected, and the targeting relationship between CASC2 and NF-kB P65 was verified by dual luciferase assay. Results: The relative expression degree of CASC2 in malignant glioma tissue was significantly lower than that in normal brain tissue (P<0.05). The relative expression of CASC2 in the group of CASC2 mimics was apparently increased (P<0.05), while the relative mRNA expression of NF-kB p65 was significantly decreased (P<0.05). According to CCK-8 experimental data, the absorbance value of the CASC2 mimics group at 450 nm wavelength at 24 h, 48 h and 72 h respectively, were significantly lower than that in the CASC2-NC mimics group and the control group (P<0.05). The test results of flow cytometry showed that the apoptosis rate in the CASC2 mimics group was significantly increased compared to the CASC2-NC mimics group and the control group (P<0.05). In addition, the Transwell detection experiment showed that the amount of cell invasion and migration in the CASC2 mimics group decreased significantly compared to that in the CASC2-NC mimics group and the control group (P<0.05). Conclusion: CASC2 expression was abnormally decreased in glioma tissues, which can inhibit the proliferation and invasion of glioma cell line U87 by targeting the expression of NF-kB p65.

颅脑创伤是临床常见的多发病,高原地区具有高海拔、低氧、低气压、低温等特点,为了适应高原环境的低氧特点,长时间在高原地区生活,大脑在发育过程中需要在功能与结构上都进行改变,因此颅脑损伤后患者的病理生理也较之前发生改变.高原颅脑损伤模型的建立作为颅脑损伤研究的基础,是研究颅脑损伤的关键.文章旨在对高原环境下颅脑损伤模拟方法和各种颅脑损伤模型的建立方法及特点进行综述,以期为临床提供参考价值.

tumor stem cells (BTSCs), and BTSCs have been successfully isolated in many types of brain tumors and brain tumor cell lines (10,11,16,20,24). However, whether BTSCs are present in meningiomas is unclear. In this study, we investigated the expression of BTSC markers in meningiomas. █ MATERIAL and METHODS

AIM: To investigate the expression of cancer stem cell markers in meningiomas. MATERIAL and METHODS: CD133, Nestin and Sox2 expression levels in 35 paraffin-embedded meningioma tissue samples were assessed using immunohistochemistry. RESULTS: In this study, five cases were atypical (WHO Grade II), two were anaplastic (WHO Grade III), and 28 were benign (WHO Grade I). Among atypical and anaplastic meningiomas, all were positive for Nestin and CD133, and 4 were positive for Sox2. Of the 28 benign meningiomas, 23 were positive for Nestin, 11 were positive for CD133, and none were positive for Sox2. In addition, Nestin and CD133 were expressed at significantly higher levels in the non-benign group than in the benign group. CONCLUSION: Nestin, CD133 and Sox2 expression levels may be correlated with the WHO pathological grade. Specifically, more aggressive meningiomas are characterized by higher positivity rates and higher levels of Nestin, CD133 and Sox2 expression in positive cells.

脑肿瘤干细胞是脑肿瘤内存在的类似干细胞的细胞亚群,具有自我更新能力并能产生异质性肿瘤细胞.与非肿瘤干细胞来源的肿瘤细胞相比,脑肿瘤干细胞表面表达了与神经干细胞表面相同的分子标记物(如CD133、Nestin) ,导致细胞的免疫原性降低,并抑制T细胞等免疫细胞的功能,使机体的免疫系统无法正常发挥作用[1]. 另一方面,胶质瘤干细胞高表达多种耐药因子及DNA损伤修复因子、侵袭因子,促进肿瘤浸润生长并可以有效耐受放射治疗及化疗药物的治疗[2]. 肿瘤血管有支持脑肿瘤生长的功能,而这些肿瘤干细胞则可以直接分化为血管内皮细胞或通过调节血管内皮细胞生长因子的方式来帮助肿瘤血管的生成. 因此本文的研究对象将着重于肿瘤血管与脑肿瘤干细胞之间的关系.

重型颅脑损伤有很高的致死率和致残率,高原地区低压、低氧的生活环境,导致颅脑损伤后,病情的发展具有其特殊性和严重性,而丙二醛是脂质氧化的一种终产物,可间接反映体内氧化应激的发生和发展.血清丙二醛水平与高原地区重度颅脑损伤患者近期预后有没有相关性、有怎样的相关性.能否通过改变血清丙二醛的水平,对高原地区重度颅脑损伤患者进行高危分层以及改善近期预后,已经逐渐被研究人员重视.

丘脑是脑出血常见的出血部位之一,丘脑和下丘脑关系密切,下丘脑是神经内分泌的中心,丘脑出血后,下丘脑受刺激或者破坏,通过下丘脑-垂体-肾上腺皮质轴(hypothalamic-pituitary-adrenal axis,HPA轴)的调节,导致内分泌异常,特别是肾上腺皮质激素.肾上腺皮质激素对糖代谢、水盐代谢、应激反应等都有密切的关系,肾上腺皮质激素,无论是增高还是减低,都会对机体造成严重的影响,通过对丘脑出血肾上腺皮质激素变化的研究,分析机体的变化等,以指导临床.本次研究从丘脑出血后激素水平的变化,导致血糖水平、血钠水平、上消化道溃疡等方面变化进行总结.

Calcified chronic subdural hematoma (CCSDH) is a rare disease that accounts for approximately 0.3%–2.7% of all chronic subdural hematomas (CSDHs). The clinical features of CCSDH are very similar to those of noncalcified CSDH and include headache, decreased alertness, weakness, numbness, gait disturbance, seizures, memory impairment, confusion, and unconsciousness. All symptomatic CCSDH should be treated surgically. Majority of these patients recover well following surgery. In this report, we present the case of a patient with CCSDH who developed severe cerebral edema following its removal, necessitating decompressive craniectomy. Although there were no abnormal findings in laboratory blood tests, and no signs of brain herniation or epilepsy was found the following day after surgery, the patient's family refused all treatment and a postoperative brain computed tomography (CT) scan. The patient was discharged and died at home. Cerebral hematoma and normal perfusion pressure breakthrough (NPPB) may cause severe cerebral edema following the total removal of a CCSDH.

水通道蛋白4(AQP4)是一种与水的通透性有关的蛋白,主要存在于中枢神经系统,并广泛表达于中枢神经系统的星形胶质细胞、脉络丛上皮细胞、室管膜上皮细胞等支持细胞中,目前大量研究表明,AQP4不仅与脑水肿的发生发展密切相关,同时还参与多种神经系统疾病的病理过程,对临床神经系统疾病的诊断及治疗具有重要的意义,本文就AQP4与几种常见神经系统疾病的联系作一综述.

随着神经干细胞(Neural Stem Cells,NSCs)理论的提出,神经系统疾病的替代治疗有了广阔的应用前景.目前已经证实,许多组织中均存在干细胞,但是根据干细胞的组织来源不同,其向神经细胞分化的能力也有差异.本文就近几年来不同组织来源的干细胞向神经细胞分化的研究进展作一综述.

目的：探讨超早期C T引导下钻孔抽吸治疗高血压丘脑出血的方法和疗效。方法对合理选择的27例高血压丘脑出血患者，行超早期C T引导下钻孔抽吸治疗。结果血肿清除率62.5％～91.4％，平均（76.6±11.5）％。2例血肿量≥70 mL的患者，术后原血肿部位发生再出血，血肿量均＜10 mL。术后死亡1例。术后6个月，26例患者预后按ADL分级：Ⅱ级9例，Ⅲ级12例，Ⅳ级4例，Ⅴ级1例。结论超早期C T引导下钻孔抽吸治疗高血压丘脑出血，手术创伤小，血肿清除快，临床治疗效果满意。

目的：探讨小骨窗显微手术治疗基底节区高血压脑出血的临床疗效。方法选取2013年1月至2014年12月该院收治的基底节区高血压脑出血患者172例，依据手术方式分为小骨窗显微手术组和传统大骨瓣开颅手术组，每组86例，应用日常生活能力分级法（ ADL）评估预后，比较两组术后血肿清除率、血肿复发率、并发症发生率、住院时间等。结果两组血肿清除率、血肿复发率、住院时间、病死率比较无统计学差异（ P＞0．05）。术后并发症有肺部感染、消化道出血、切口感染、脑梗死。小骨窗显微组术后并发症发生率为8．1％，显著低于大骨瓣开颅组18．6％（ P＜0．05）。小骨窗显微组术后功能恢复良好率（ADL Ⅰ～Ⅲ级）显著高于大骨瓣开颅组（P＜0．05）。结论与传统大骨瓣开颅手术比较，小骨窗显微手术具有微创、血肿清除彻底、并发症发生率低、术后神经功能恢复好、住院时间短等优点，是治疗基底节区高血压脑出血的有效术式。

<正>颅脑创伤约占全身各系统创伤第2位,但是在交通事故中因颅脑创伤而死亡的人数却占首位[1]。颅脑外伤的患者伤情不同发生智能障碍程度亦不同。轻型颅脑损伤患者的头颅影像检查可能正常,但是患者在不同时期可表现出不相同的心理障碍特征[2],急性期以情绪不稳定为主,在稳定期又以情绪抑制为主。