现代研究表明，补阳还五汤对脑缺血患者具有神经保护作用，可有效改善其神经行为学功能、减少脑缺血面积、降低梗死率和缺血再灌注损伤〔1〕；并可以刺激神经增殖、调节血管内皮生长因子的表达〔2〕，促进神经细胞的生长和分化、并抑制神经细胞凋亡〔3〕。本文就近年来有关补阳还五汤改善脑缺血作用机制的研究进行综述。

Objective To evaluate the efficacy objectively and systematically between endoscopic and microscopic surgery for transsphenoidal pituitary adenoma by a Meta-analysis.Methods A systematic literature search of Medline,the Cochrane Library,the Web of Science and the Google Scholar were performed to recruit studies between January,1990 and May,2015 that compared endoscopic and microscopic approaches in the treatment of pituitary adenomas.A Meta-analysis(R-3.1.3) was conducted to estimate the effect of different operative procedures.Results A total of 22 studies including 3 randomized or quasi-randomized controlled trails and 19 case-control studies met the inclusion criteria.Among 1421 patients studied,733 of them were treated with endoscopic and 688 were treated with microscopic surgery.The rate of gross tumor removal was higher in patients who underwent endoscopic surgery (71％) than those who underwent microscopic surgery (56％)(P ＜ 0.05).The rate of remission of hypersecretion was also higher in patients who underwent endoscopic surgery(60％) than those who underwent microscopic surgery(54％),but the difference was not significantly(P ＞ 0.05).Conclusion The present study indicates that the endoscopic transsphenoidal approach is more effective than microscopic surgery in the treatment of pituitary adenomas.

Objective To objectively and systematically evaluate the prognostic significance of nestin in glioma patients with Meta-analysis.Methods A systematic literature search of PubMed/Medline,Web of Science,Cochrane Library and Google scholar was performed to recruit studies between January 1990 and May 2015 that evaluated the correlation of nestin with overall survival (OS) and progression-free survival (PFS) in glioma patients.A Meta-analysis (R-3.1.3) was conducted to analyze the prognostic significance of nestin in glioma patients.Results A total of 8 studies with the total number of 1313 patients met inclusion criteria.The analysis demonstrated negative associations between nestin high expression and both poor OS (hazard ratio [HR]=1.64,95％ confidence interval [CI] =1.27-2.12,P=0.0001) and PFS (HR=1.54,95％CI=1.04-2.28,P=0.0301).WHO grading was the main source of heterogeneity of OS data (P=0.0015),and the lower the WHO grade,the more significant the influence in OS.The sample capacity was the main source of heterogeneity of PSF data (P=0.008),and the larger the sample capacity,the more significant the influence in PFS.Conclusion The nestin expression can be used for accurately assessing the survival of glioma patients,thus,nestin could be recommended as a useful survival biomarker in clinical practice.

目的 用Meta分析来评价姜在预防术后恶心呕吐方面的临床效果.方法 通过检索Pubmed、Web of science、Google scholar等数据库,搜集有关用姜来预防术后恶心呕吐的随机对照实验研究,应用R统计软件(R-3.1.3)对数据进行分析.结果 经过评价和筛选,纳入8篇随机对照研究.Meta分析结果显示:与对照组相比,姜具有预防术后恶心呕吐的作用,并且与对照组相比有统计学意义.结论 就目前已有的文献来看,姜在预防术后恶心呕吐上安全有效.尚有待开展高质量的多中心、随机、盲法、对照的临床研究进一步证实.

目的 分析经额侧脑室联合翼点入路显微切除第三脑室的内颅咽管瘤的临床疗效及并发症防治策略.方法 选取我院自2012年10月至2014年10月收治的100例内颅咽管瘤患者作为研究对象,采取随机数字表法分为实验组和对照组,每组各50例,实验组先采取经额部皮质造瘘,侧脑室室间孔入路切除侧脑室和第三脑室内的肿瘤,然后联合翼点入路切除鞍上及鞍旁残留的肿瘤.对照组只采取经额部皮质造瘘,侧脑室室间孔入路切除侧脑室和第三脑室内的肿瘤.术后随访7个月,对比两组患者肿瘤全切率、次全切率、部分切除率以及并发症的发生情况.结果 实验组肿瘤全切率、次全切除率、部分切除率分别为82.00％、14.00％、4.00％;对照组肿瘤全切率、次全切除率、部分切除率分别为58.00％、18.00％、24.00％,组间相比具有显著差异(x2=5.32,P＜0.05;x2=5.27,P＜0.05;x2 =5.31,P＜0.05).实验组并发症的发生率为24.00％;对照组并发症的发生率为46.00％,组间相比具有显著差异(x2=5.65,P＜0.05).结论 对于第三脑室的内颅咽管瘤,经额侧脑室联合翼点入路进行显微切除的手术方式,可以清楚查看肿瘤的部位以及肿瘤周围组织结构的具体情况,提高肿瘤的全切率,减少并发症的发生,可以作为一种理想方法应用于临床工作中.

Glioblastoma multiforme (GBM) is the most frequent and most aggressive brain tumor in adults. The introduction of temozolomide (TMZ) has advanced chemotherapy for malignant gliomas. However, a considerable number of GBM cases are refractory to TMZ, the need for more effective therapeutic options is overwhelming. Mounting evidence shows that endogenous AKT (protein kinase B) activity can be activated in response to clinically relevant concentrations of TMZ. AKT activation correlated with the increased tumorigenicity, invasiveness and stemness and overexpression of an active form of AKT increases glioma cell resistance to TMZ. Previous studies also show that TMZ contributes to glioma cell apoptosis by inhibiting mTOR signaling. Thus, we hypothesized that the dual PI3K–mTOR inhibitor NVP-BEZ235 may act as antitumor agent against gliomas and potentiate the cytotoxicity of TMZ. In the present study, we found that NVP-BEZ235 treatment of glioma cell lines led to G1 cell cycle arrest, and induced apoptosis. Combination treatment with both TMZ and NVP-BEZ235 resulted in synergistically inhibited glioma cell growth and induced apoptosis (combination index CI<1) in a subset of glioma cell lines, as shown in the increased levels of Bax, and active Caspase-3, and decreased level of Bcl-2. Furthermore, NVP-BEZ235 treatment reversed p-AKT levels enhanced by TMZ. Inhibition of mTOR (p70S6K) signaling with the combination of TMZ and NVP-BEZ235 can be augmented beyond that achieved using each agent individually. In vivo xenograft models in mice, the combinatorial treatment with TMZ and NVP-BEZ235 significantly reduced tumor growth rates and prolonged median survival of tumor-bearing mice. These findings exhibit that TMZ in combination with NVP-BEZ235 act synergistically to inhibit proliferation of glioma cells by down–regulating of the PI3K–AKT–mTOR pathway, suggesting TMZ and NVP-BEZ235 combination therapy may be an option for GBM treatment.