Urokinase is one of the main activators of plasminogen.It has been a hot topic in recent years.According to the role of urokinase in pathological and physiological processes,it has been applied in many clinical fields,such as cancer treatment,vascular recanalization,tissue repair and so on.Urokinase has been widely used in neurology,including thrombolysis and minimally invasive puncture of intracranial hematoma as liquefying agent of hematoma.This article reviews the research progress of urokinase in central nervous system.

自发性脑出血（sICH）,是指非外伤（Non-traumatic）引起的颅内动脉、静脉或毛细血管自发性破裂所致的脑出血[1-3]。自发性脑出血约占所有卒中患者的13%-30%,有很高的致残率和致死率[3-7]。血肿的扩大是自发性脑出血急性期发生神经功能恶化的一个主要因素,也是脑出血患者早期病情发生进展和预后不良的关键性因素[8]。既往理论认为:自发性脑出血的血肿形成是一短暂的过程[9]。近年来,随着影像技术（CT、MRI）的发展,这种观点被逐渐否定。本文对近年来关于ICH早期血肿扩大的

Objective To investigate whether the collaborative application of temozolomide (TMZ),all-trans retinoic acid (ATRA) and radiotherapy can induce the apoptosis of U251 glioma cells and the molecular mechanism.Methods We detected the cell apoptosis rate of control group (100 μl nutrient solution),radiotherapy group (radiation dosage of 8 Gy),medicine group (TMZ 200 μmol/L + ATRA 20 μmol/L) and combined group (radiation dosage of 8 Gy + TMZ 200 μmol/L + ATRA 20 μmol/L) by flow cytometry method.The protein expression of p38 mitogen-activated protein kinase (MAPK) and nuclear factor-κB (NF-κB) was detected by Western blotting.Results The apoptosis rate was (9.96 ± 3.78)％,(37.35 ±5.36)％,(59.89 ±7.15)％ and (69.35 ±8.25)％ in control group,radiotherapy group,medicine group and combined group respectively.The apoptosis rate in combined group was higher than that in other groupsThese differences were more obvious (x2=7 471.175,P=0.000;x2=2 057.235,P =0.000;x2 =195.717,P =0.000).Combined group can up-regulate the protein expression of p38MAPK in contrast to control guoup,radiation group and medicine group.These differences were more obvious (t =46.000,P=0.000;t=10.150,P=0.000;t =4.266,P=0.013).Combined group can down-regulate the protein expression of NF-κB in contrast to control guoup,radiation group and medicine group.These differences were more obvious (t =36.380,P =0.000;t =30.090,P =0.000;t =68.620,P =0.000).Conclusion The combined use of TMZ,ATRA and radiotherapy can induce the apoptosis of U251 glioma cells probably by the upregulation of p38MAPK and downregulation of NF-κB.

1病例报告患者:女,59岁,因自觉疲乏无力8个月伴左侧肢体活动不灵10天到吉林大学中日联谊医院神经外科就诊。入院后查体:意识清,双瞳等大同圆、对光反射灵敏,言语应答准确,左侧上、下肢肌力Ⅳ级,右侧上、下肢肌力Ⅴ级,无病理反射。患者头部CT图像见:右侧颞顶部脑室前角及近大脑镰处可见片状高密度影,侵袭至左侧脑室前角,肿物边界欠清楚,周

脑室出血是神经外科常见急重症,致残率及死亡率高,总体死亡率为42.6%～83.3% [1] 。目前针对脑室出血简单且行之有效的外科治疗方法是脑室外引流术。本研究旨在探讨单管、双管脑室外引流术在治疗脑室出血中并发症的差异。一、资料与方法1.一般资料:2013年10月至2015年10月吉林大学第一医院神经血管病外科采用脑室外引流术治疗的脑室出血患者56例。24例采取单侧脑室外引流术(单管组),32例采取双侧脑室外引流术(双管组)。其中,单管组:男12例,女12例;双管组:男21例,女11例。两组平均年龄分别为(56.6±7.8)岁

高血压丘脑出血是常见的出血性卒中,目前手术是治疗丘脑出血的方法之一,针对患者的不同情况,我们采用开颅血肿清除术和微创穿刺引流术治疗110例高血压丘脑出血患者,现报道如下. 一、材料与方法 1.一般资料:患者选自2012年1月至2016年12月在吉林大学第一医院神经血管病外科收治的高血压丘脑出血患者110例,分别行开颅血肿清除术50例(开颅组),立体定向软通道微创穿刺引流术60例(微创组).开颅组:男30例,女20例,年龄28~75岁.

Objective To explore the differences of the drainage efficiency between unilateral external ventricular drainage and bilateral external ventricular drainage in surgical treatment of intraventricular hemorrhage.Methods The clinical data of 56 patients with intraventricular hemorrhage treated by unilateral and bilateral external ventricular drainage were retrospectively analyzed.24 cases were treated by unilateral external ventricular drainage (unilateral group),32 cases were treated by bilateral external ventricular drainage (bilateral group).The hematoma clearance rate,duration of catheter drainage,the average daily cerebrospinal fluid (CSF) drainage volume,the times of injecting the urokinase and the average hospital days in the intensive care unit (ICU) were recorded,and compared between two groups.Results In the group of unilateral drainage tube and group of bilateral drainage tube,the clearance rate of hematoma was (74.6 ± 8.7) ％ and (78.5 ± 12.5) ％,comparison between the two groups was not statistically significant (t =1.308,P =0.196);the daily CSF drainage volume was (124.6 ±40.2) ml and that was (139.6 ±41.7) ml,comparison between the two groups was not statistically significant(t =1.353,P =0.182);the times of injecting the urokinase was (4.42 ± 1.26) and (4.06 ± 1.39),comparison between the two groups was not statistically significant (t =0.998,P =0.323);the hospital stay in the ICU was (10.6 ± 3.6) days and (13.3 ±5.0) days respectively,there was a significant difference between the two groups (t =2.243,P =0.029).The duration of catheter drainage in group of unilateral drainage tube was (5.0 ± 1.7) days,and that was (6.6 ±2.2) days in group of bilateral drainage tube,and there was significant difference between the two groups (t =2.959,P =0.005).Conclusion The bilateral external drainage can not improve the hematoma clearance rate,reduce the times of injecting the urokinase and lower the hospitalization days in the ICU of the patients.

Objective To investigate and compare the curative effect of endoscopic management and craniotomic hematoma evacuation in hypertensive intracerebral hemorrhage (HICH).Methods Seventy cases of HICH were randomly divided into 2 groups:endoscopy group (30 cases) and craniotomy group (40 cases).In the patients with intracerebral hematoma volume of 30-40 ml,the therapeutic effect was compared between two groups:incision of scalp,bone window,cortical incision,blood loss,operating duration,rate of hematoma evacuation,rate of rehemorrhage,rate of intracranial infection,mortality and Barthel index.Results The length of scalp incision in endoscopy group and craniotomy group was (5.40 ± 0.97) cm and (24.50 ± 3.88) cm,comparison between the two groups was statistically significant (t =26.310,P=0.000).The area of bone window in endoscopy group and craniotomy group was (12.5 ±2.2) cm2 and (63.3 ± 12.3) cm2 respectively,comparison between the two groups was statistically significant (t =22.320,P =0.000).The length of cortical incision in endoscopy group and craniotomy group was (1.05 ± 0.45) cm and (2.40 ± 0.52) cm respectively,comparison between the two groups was statistically significant (t =11.385,P =0.000).The blood loss in endoscopy group and craniotomy group was (80.0 ± 18.3) ml and (339.0 ±90.3) ml respectively,comparison between the two groups was statistically significant (t =15.450,P =0.000).The time of operating duration in endoscopy group and craniotomy group was (0.96 ±0.31) h and (4.35 ±0.57) h respectively,comparison between the two groups was statistically significant (t =24.440,P =0.001).The rates of hematoma evacuation in endoscopy group and craniotomy group was (81.O0 ± 7.93) ％ and (92.40 ± 6.15) ％ respectively,comparison between the two groups was not statistically significant (x2 =6.777,P =0.138).Rates of rehemorrhage in endoscopy group and craniotomy group was 7.5％ and 6.7％ respectively,comparison between the two groups was not statistically significant (x2 =0.018,P =1.000).The rates of intracranial infection in endoscopy group and craniotomy group was 10％ and 15％,comparison between the two groups was not statistically significant (x2 =1.350,P =0.723).Death rates in endoscopy group and craniotomy group was 5％and 6％ respectively,comparison between the two groups was not statistically significant (x2 =0.088,P =1.000).Barthel index in endoscopy group (75.34 ±20.51) was higher compared with craniotomy group (55.30 ± 10.20).Comparison between the two groups was statistically significant (t =1.350,P =0.000).Conclusion For the patients with intracerebral hematoma volume 30-40 ml,endoscopic surgery has the advantages including minimally invasive、short operating duration and good prognosis,but it has lower hematoma evacuation than craniotomic hematoma evacuation.