如何促进人才培养、促进人才持续发展是当前医疗卫生行业和医疗教育行业的重点和难题,其中基层青年中医药人才的培养问题尤为突出.基于我国当前基层中医药人才发展和人才培养的现状,"鸿鹄青年"中医药人才培养计划从内在驱动力、外在支撑力2个角度切入,强调职业认同感、岗位胜任力和职业发展续航力的培养,以多方位的平台支持和长效人才培养机制激励基层青年中医药人才的发展,以期为中医药人才的培养探索出一条可行之路.

目的 通过对癫痫患儿手术前后行为学测评,探讨外科手术对癫痫患儿行为学的影响.方法 用儿童行为量表(CBCL)对2006至2010年手术治疗的92例癫痫患儿进行术前及术后1年、3年、5年以上的行为测评,分别用组平均值及个体水平进行分析.结果 无论组间均值还是个体水平,大部分患儿的社会能力及行为问题在术后得到明显改善.结论 外科手术对大部分癫痫患儿的社会能力和行为问题有明显的改善作用,对癫痫患儿的术前评估有一定的指导作用.

Objective: To investigate clinical characteristics of elderly patients with cerebral hemorrhage and perioperative nursing methods, in order to improve clinical efficacy. Methods:169 cases with cerebral hemorrhage were randomly selected and di-vided to elderly group (n=169, age of 80-98 years old) and control group (n=64, age of 50-70 years old). All patients were given conventional medical treatment and surgery. 128 cases in elderly group and 43 cases in control group were randomly selected and given a holistic nursing intervention ( as comprehensive nursing group) , while other 41 cases in elderly group and 21 cases in control group were given the conventional nursing intervention ( as conventional nursing group) . The clinical symptoms, clinical signs, CT or MRI findings, clinical concomitant diseases and clinical efficacy outcomes of all patients were retrospectively analyzed. Results:Theclinical symptoms, such as headache, dizziness, visual disorders, nausea, vomiting, speech disorders, psychiatric symptoms and epileptic convulsions, were often seen in the two groups, and the clinical signs were movement disorders, sensory disorders, pathological reflex, meaning disorders, meningeal irritation and abnormal pupil. Bleeding sites of imaging by CT or MRI showed occurred in the putamen, caudate nucleus, thalamus, cerebellum, brain stem, brain leaves and ventricle. There were no significantly differences in the clinical manifestations and bleeding sites in two groups (P>0. 05). The clinical concomitant diseases, such as hyperlipidemia, coronary heart disease, high blood pressure, chronic bronchitis, emphysema, diabetes and lung infections, were often seen in the two groups ( ordered by incidence rate from high to low) . There were significant differences in the incidence rates of hyperlipidemia, hypertension, chronic bronchitis and emphysema, and lung infections between the two groups (P<0. 05). The effective rates and mortality rates were 104 ca-ses (61. 5%) and 65 cases (38. 5%) for elderly group and 52 cases (81. 2%) and 12 cases (18. 8%) for control group, and there were significant differences in the clinical effective rate and mortality between the two groups (P<0. 05). The effective rate (68. 8%,&nbsp;93. 0%) and mortality rate (31. 2%, 7. 0%) of the patients with the holistic nursing intervention were better than those of (39. 0%, 57. 1 %) and (61. 0%, 42. 9%) of those with the conventional nursing intervention within the two groups (P<0. 05). Conclusions:The elderly patients with cerebral hemorrhage often suffer from hyperlipidemia, hypertension, chronic bronchitis, emphysema and lung infections. It is very important to carry out active medical treatment, intensive surgery and strength the perioperative systemic holistic nursing for improving the clinical efficacy of the elderly patients with cerebral hemorrhage.

目的：探讨癫痫患者长程视频脑电监测的护理方法。方法：对452例长程视频脑电监测的癫痫患者做好预见性护理，监测前对监测前患者进行健康教育，做好环境准备和制定监测护理方案；监测中护士陪伴，保证患者的安全和满足患者的生活需要，检查电极安装情况并给予调整，保证摄录效果；监测后对患者进行健康指导，做好皮肤护理和环境整理。结果：本组患者均顺利度过监测期，无一例意外发生。结论：长程视频脑电监测护理有效保证了患者的安全和监测质量。

基底动脉顶端动脉瘤血管内治疗已经成为首选治疗方法。随着血管内治疗技术的发展，各种并发症也随之增多。解放军总医院神经外科于2013年6月26日收治基底动脉顶端动脉瘤破裂致蛛网膜下腔出血患者1例，行支架辅助栓塞治疗后出现基底动脉尖综合征，结合文献分析如下。

枕叶癫痫临床表现复杂,其中视觉先兆为其特征性表现.在对枕叶癫痫进行术前评估时,影像学检查结果具有重要作用,但敏感性和特异性不同,需综合分析,皮层脑电图对病灶定位及个体化手术方案的设计具有重要作用.对具有外科治疗适应症的患者,应积极手术,尤其儿童尽早手术对于发育更有意义.病灶明确,行切除手术患者,术后完全缓解率较高,但术后有视野缺损的风险;对位于功能区的病灶,可采用切断传播途径的术式,可达一定的缓解率;毁损手术及神经电刺激对部分患者疗效较好,其应用价值及远期预后有待进一步研究.总体来说预后虽不及颞叶癫痫,但经完善评估,对于具有手术适应症的患者,外科治疗仍不乏为一种有效的治疗方式.

目的研究如何提高胶质瘤细胞的免疫原性,探讨胶质瘤免疫治疗的新途径.方法用重组腺病毒作载体,将共刺激分子B7-1基因和具有多重免疫功能的IL-2基因转入G422小鼠胶质母细胞瘤细胞中,取1×105个细胞(体积0.1 ml),在小鼠皮下接种,分野生型对照组、lacZ组、IL-2组、B7-1组和B7-1+IL-2组.接种后不同时间测量肿瘤大小.两周后检测荷瘤小鼠脾细胞的NK、LAK和CTL的活性及细胞因子的分泌.结果B7-1+IL-2组肿瘤生长明显受抑制(P＜0.05).B7-1组的NK、LAK、CTL的杀伤活性及脾细胞分泌细胞因子的水平都很低,与对照组相差不显著.IL-2组的CTL的杀伤活性较高,与对照组相差显著(P＜0.05),而NK和LAK活性及细胞因子水平与对照组相差不显著.B7-1+IL-2组的NK、LAK、CTL和脾细胞分泌细胞因子的活性与对照组相比,相差都非常显著(P＜0.01).结论单纯B7-1基因转染G422细胞不能增强其免疫原性;IL-2基因转染后,对机体的免疫反应有一定的增强作用,但效果不够理想;B7-1基因和IL-2基因联合转染G422细胞则可以明显增强其免疫原性,并有效激活荷瘤小鼠的特异性抗肿瘤免疫反应.

许多难治性癫痫病人可以通过迷走神经刺激(VNS)治疗.VNS通过神经化学物质变化产生抗惊厥作用.刺激信号传入孤束核,广泛投射到包括海马和杏仁核的许多区域.VNS增强神经活性,促进脑生理向好的方向发展.减少发作频率、时间和强度,改进病人认知状况、社会技能和生活质量,没有抗癫痫药的不良反应,儿童病例在攻击性、社会交往、和行动上都有进步,生活质量提高.不良反应是声音嘶哑,感觉异常,呼吸困难.总感染率为3%.VNS对于药物副作用大,不能承受手术风险,和不宜手术的病人来说,是一有益的辅助治疗方法.

我们用腺病毒作载体,将B7-1基因和IL-2基因联合转染脑胶质瘤细胞后小鼠皮下接种,观察了其对机体免疫功能的影响.

采用头皮针治疗脑损伤后运动性失语38例,在两侧言语区,用13.3 cm(4寸)毫针,行皮下穿刺,强刺激手法,留针12 h,10～15次为1个疗程,同时进行发声和言语训练辅以神经营养治疗,治疗中注意掌握适当刺激量,总有效率为90％(34/38).证明针刺方法简便,效果确实.

原发性脑干损伤伤情严重,致残、致死率高.1992～2000年,我院采用综合治疗方法收治此类伤172例,病死率34 3%,重残率33 1%.

Objective To explore the relationship between the c-fos immediate early gene expression in vascular smooth-muscle cells and cerebral vasospasm. Methods Thirty-six New Zealand rabbits were randomly divided into the experimental group, the neomycin group and the control group. Experimental group model was produced with modified two-hemorrhage method. The neomycin of 3mg·kg-1 was injected intravenously, twice a day, which was based on pre-experiment. The animals were sacrificed 12h, 2d, 7d after SAH, and then the brains were taken out for pathological examinations. The c-Fos protein was examined by immunohistochemistry in vascular smooth-muscle cells. Results The c-fos gene expressive rate was higher in the experimental group (75%) than in the neomycin (25%) and control (17%) group (P =0.032). The c-Fos expression increased sharply within 2 days after SAH and dropped 7days after SAH. Morphological changes in cerebral arteries were observed at 2 days after SAH ( P = 0. 005). Conclusion The c-fos gene expression is responsible for the pathological changes in the cerebral vasospasm after subarachnoid hemorrhage.

我院自1990年至2000年,共收治嗅神经母细胞瘤(ONB)6例,现对其诊断与治疗分析如下. 1临床资料 6例0NB中男4例,女2例,年龄13～62岁,中位年龄22岁.首发症状鼻出血者3例,鼻塞者2例,头痛者1例.经CT和MRI检查,证实有鼻腔、鼻窦、眶内、颅内占位,或相互勾通,形状不规则,界限清楚,质地较均匀,强化明显.术前活检或术后病理检查,确诊为0NB.

Objective To seek a new way of gene therapy for brain glioma by studying on IL-2 gene and B7-1 gene cotransfected G422 murine glioblastoma cells.Methods IL-2 gene and B7-1 gene were co-transfected into G422 murine glioblastoma cells mediated by recombinant adenovirus in vitro.The proliferation of G422 cells was tested by MTT method and the level of IL-2 secreted by gene modified G-422 cells was tested by MTT method of the proliferation of CTLL-2.The expression of B7-1 and ICAM-1 on gene transfected G422 cells were assayed by FACS.Their colon-forming ability was tested with bilayer agrose culture after gene transfection.Results 4h after IL-2 gene transfection,IL-2 could be detected in the supernatant of gene modified G422 cells,and the level of IL-2 reached the highest level from 24 to 72 hours,but decreased markedly one week later.B7-1 was highly expressed and the expression of ICAM-1 was enhanced.Conclusion IL-2 gene and B7-1 gene could be co-transfected into G422 cells and could be expressed effectively mediated by recombinat adenovirus,which results in enhanced expression of ICAM-1 of the cells,whereas the proliferation of gene modified G422 cells is not changed.

我院自1992年以来,对3例自发性桥脑血肿进行手术治疗,效果满意,现报告如下.1临床资料例1:男,20岁.因头晕、复视1个月,饮水呛咳1周入院.缘于1个月前无明显诱因患者自觉头晕,视物双影,近1周来出现饮水呛咳.检查:嗜睡状,复视,左视时偶见粗大水平眼震,咽反射减弱.头颅MRI示桥脑内偏左见一长T1长T2异常信号,范围2.0 cm×1.5 cm×2.0 cm,边界清楚,占位效应明显.诊断:桥脑血肿.全麻下行后正中开颅,切开下蚓部显露Ⅳ脑室底部,见左上方饱满,穿刺深入0.5cm即抽出1 mL陈旧性不凝血.以穿刺点为中心,镜下纵形切开1cm,放出陈旧性不凝血及血凝块5 mL,血肿腔塌陷,腔壁光滑呈灰色,用小号标本镊钳取部分腔壁送病理检查.术后恢复好,1个月后复查CT示病灶消失.病理结果为脑干内血管畸形,含铁血黄素沉着.

目的：了解 IL-2基因修饰的细胞毒 T淋巴细胞（ cytotoxic T lymphocytes,CTL）的增殖和杀伤活性，探索细胞因子基因疗法及被动免疫治疗脑胶质瘤的新途径。方法：用昆明种小鼠的脾细胞体外诱导 CTL，用腺病毒载体转染 IL-2基因，观察其体外增殖活性和杀伤活性，再用 G422小鼠胶质母细胞瘤细胞建立肺转移瘤模型， 36 h后经过继回输， 2周后计数肺的肿瘤结节，观察 IL-2基因转染的 CTL对实验性肺转移瘤的治疗作用。结果：重组腺病毒载体在 MOI(multiplicity of infection)为 100时，转染率达 96.8％， IL-2基因修饰的 CTL增殖活性、 IL-2的分泌（ 248 u）和体外杀伤活性 (36.4％ )明显增强，对实验性肺转移瘤的治疗作用都显著增强，肺转移结节数 (28)显著减少（ P<0.01）。结论： IL－ 2基因转染的 CTL过继回输，可直接杀伤和诱导激活机体特异性抗肿瘤免疫反应，使体内抗肿瘤效果显著增强，有效抑制实验性肺转移瘤的生长，为胶质瘤的过继免疫治疗提供了新的思路和实验依据。