目的 探讨胸腰段椎管内硬脊膜囊肿的手术方法及治疗效果.方法 回顾性分析2010年8月至2018年12月收治的有明确症状的11例胸腰段椎管内硬脊膜囊肿的临床资料.采取显微镜下囊肿交通口封闭术+囊肿切除术治疗.结果 腰背部疼痛10例,下肢进行性乏力9例,下肢疼痛5例,大小便无力4例;术前MRI检查证实胸腰段椎管内硬脊膜外囊性占位,平均累及(3.7±0.7)个节段.所有病例均完成囊肿交通口封闭,囊壁全切除4例,大部分切除5例,部分切除2例.术后无新发神经功能症状,腰背部及下肢疼痛症状均减轻.术后随访6个月～5年,平均2.5年;末次随访,所有病人McCormick分级提升一个等级以上,VAS评分[(2.54±1.81)分]较术前[(5.65±2.35)分]明显改善(P＜0.05),腰痛ODI评分[(10.72±3.44)分]较术前[(28.52±4.35)分]明显好转(P＜0.05),MRI检查证实囊肿均无复发,X线检查无脊柱失稳变形.结论 症状明显的胸腰段椎管内硬脊膜囊肿应行手术治疗,显微镜下确认并严密封闭囊肿交通口,复位椎板,治疗效果良好.

颅内表皮样囊肿生长缓慢、起病隐匿,临床主要表现多不典型,影像学技术在该疾病的鉴别诊断及围手术期病人病情评估中具有重要意义.治疗以显微手术切除病变为主,内镜辅助显微手术有助于全切除病变和保护神经功能.术后迟发性出血为最严重的并发症,其恶变也应引起重视.

Objective: With the continuing increase of the aged population, neurosurgeons face increasing numbers of chronic subdural haematoma (CSDH) patients using antithrombotic (AT) drugs, i.e., anticoagulants (ACs) and antiplatelets (APs). However, there are few case reports that address this cohort and their outcomes. Here, a retrospective analysis of CSDH patients on AT therapies was performed to investigate their clinical characteristics, surgical outcomes, and postoperative recurrence. Methods: We analysed 546 CSDH patients who underwent surgery at the Subei People's Hospital of Jiangsu province from January 2014 to December 2017. The patients were divided into groups based on their history of preceding AT treatments as well as recurrence. The clinical data, surgical outcomes, and recurrence were collected for further analysis. Results: A total of 124 patients (22.7%) were receiving AT therapy, including 43 patients (7.9%) taking ACs and 81 patients (14.8%) taking APs. AT cohorts exhibited significantly higher non-traumatic CSDH, more serious pre-illness status, and larger haematoma volume, compared with the control patients. The haematoma clearance rate, duration of YL-1 needle, complications, and functional outcomes did not differ after novel YL-1 needle drainage, whereas a higher recurrence, mortality, and prolonged length of stay were observed in the AT group. Multivariate regression of postoperative recurrence within 3 months revealed that preoperative consciousness disorders, AC therapy, haematoma volume, and operative complications were significant predictive factors of CSDH recurrence. However, AP therapy was not associated with recurrence. Conclusions: The use of ATs causes large haematoma volumes that aggravate the severity in CSDH patients and is more prevalent among non-traumatic patients. AC therapy was a risk factor for CSDH recurrence, whereas AP therapy was not.

目的 探讨炎症反应指数结合其他临床指标构建的Nomogram模型,对动脉瘤性蛛网膜下腔出血(aSAH)患者预后预测的价值.方法 分析2015年1月—2017年12月收治的178例aSAH患者的临床资料;以及炎症反应指数,包括血中性粒细胞/淋巴细胞比值(NLR)、间接中性粒细胞/淋巴细胞比值(dNLR)、血小板/淋巴细胞比值(PLR)、单核细胞/淋巴细胞比值(MLR)、预后营养指数(PNI)、全身炎症反应指数(SIRI).根据GOS评分将患者分为预后良好组与不良组.通过单因素、多因素分析筛选出影响预后的独立危险因素;应用Nomogram法对各个因素进行评分,构建预后模型.用ROC评判模型对aSAH患者预后预测的准确性.结果 本组患者中,131例患者(73.6％)为预后良好,47例患者(26.4％)为预后不良.单因素分析显示吸烟、高血压、Hunt-Hess分级、改良Fisher分级、脑血管痉挛、中性粒细胞、单核细胞、NLR、dNLR、MLR及SIRI与预后有显著关系(P<0.05-0.001).多因素Logistic回归分析显示,吸烟(P=0.006)、高血压(P<0.001)、Hunt-Hess分级(P=0.016)、改良Fisher分级(P=0.018)、脑血管痉挛(P=0.017)、SIRI(P=0.043)是影响预后的独立危险因素.将上述指标纳入Nomogram预后模型,经验证该模型的一致性指数良好(C-指数=0.782,P<0.01).ROC曲线显示,结合SIRI和其他指标的模型(AUC=0.836,95％CI:0.760～0.911,P<0.001),比没有SIRI的模型(AUC=0.798,95％CI:0.722～0.875,P<0.001)和仅有SIRI的模型(AUC=0.671,95％CI:0.579～0.763,P=0.001),对aSAH患者的预后预测更准确.结论 炎症反应指数与aSAH预后密切相关;其中SIRI对预后的预测价值更大,为其预后不良的一个独立危险因素.且结合SIRI构建的Nomogram模型对aSAH预后具有更佳的预测价值,有助于预判aSAH患者的预后.

胶质母细胞瘤(glioblastoma,GBM)是一种侵袭性、致命性疾病,常导致预后不良,对许多病人来说,复发是不可避免的结果,因标准治疗方案如手术、放疗和化疗已证明在长期生存获益方面是不够的.近年来,相关研究发现周细胞在GBM微环境中起着多方面的作用,有望作为治疗GBM的潜在靶点.本文对周细胞在GBM中的最新研究进展进行综述.

Apoptosis is a form of programmed cell death that occurs in multicellular organisms. Fibroblasts are the main cellular ingredients in keloid tissue, which has a relatively low apoptosis level. A natural metabolite of estradiol, 2-Methoxyestradiol (2ME2) exerts a pro-apoptotic effect on tumor cells. In this study, the expression levels of key factors in the apoptosis pathway and the expression level of the proliferating cell nuclear antigen (PCNA) were measured to assess the levels of apoptosis and proliferation in both normal skin fibroblasts and keloid fibroblasts. Twelve samples were obtained from 12 patients: 6 keloid patients and 6 non-keloid patients. All 12 of the patients were randomly selected from the Department of Plastic Surgery at Peking Union Medical College Hospital from June 2016 to December 2016. After cell culture, fibroblasts were divided into the following 6 groups: normal skin fibroblasts (S); keloid fibroblasts (K); keloid fibroblasts treated with 2ME2 (2ME2); keloid fibroblasts treated with DMSO (DMSO); keloid fibroblasts treated with the caspase inhibitor Ac-DEVD-CHO (IN); and keloid fibroblasts treated with both Ac-DEVD-CHO and 2ME2 (IN+2ME2). Fibroblasts at up to passage 3 were used for analysis. Cell activity was measured by the cell counting kit-8. TUNEL staining was used to observe the cell apoptotic morphology. The key apoptosis factors (caspase-3, caspase-8, caspase-9, Bcl-2, Bax, and cytochrome-c) and PCNA expression levels were detected by immunofluorescence analysis and Western blotting. A certain concentration of 2ME2 was also used in group S to evaluate the toxicity. Compared with that in the other groups, 2ME2 significantly inhibited cell activity and led to apoptotic appearance of fibroblasts. In protein analysis, 2ME2 remarkably increased the expression of apoptosis factors and decreased the PCNA expression. Apoptosis levels were reduced by both the caspase inhibitor and 2ME2; thus indicating that the pro-apoptosis effect of 2ME2 was achieved through a caspase-dependent mechanism in keloid fibroblasts. Toxicity assessment showed that 2ME2 had a very low influence on normal skin fibroblasts. 2ME2, considered to be a new promising type of chemotherapy drug, exerts a pro-apoptosis effect by regulating the caspase family and an anti-proliferation effect towards keloid fibroblasts, and it presents low toxicity towards normal fibroblasts in vitro.

目的 探讨2-甲氧基雌二醇(2ME2)对瘢痕疙瘩成纤维细胞caspase-3、caspase-8以及细胞色素C(Cyt-c)表达水平的影响.方法 随机选取自2017年1-6月就诊的胸部瘢痕疙瘩患者6例,对其手术切除的瘢痕疙瘩组织进行成纤维细胞原代培养,选取第3代细胞,并将瘢痕疙瘩成纤维细胞分为普通对照组(K)、DMSO对照组(CTL)以及实验组(2ME2).K组采用10％ FBS-DMEM培养基培养;CTL组采用0.07％ DMSO及10％ FBS-DMEM培养基培养;2ME2组采用6.975 μmol/L 2ME2的10％ FBS-DMEM培养基培养.3组细胞培养时间均为24 h;培养结束后在光镜下观察瘢痕疙瘩成纤维细胞形态,并进行瘢痕疙瘩成纤维细胞caspase-3、caspase-8及Cyt-c的免疫荧光染色和Western blot蛋白定量分析.结果 细胞培养24 h后,2ME2组可见细胞凋亡形态,胞质含量较少,细胞核固缩.免疫荧光结果可见2ME2组瘢痕疙瘩成纤维细胞caspase-3、caspase-8及Cyt-c有显著着色;Western blot蛋白定量结果示,2ME2组的瘢痕疙瘩成纤维细胞caspase-3、caspase-8及Cyt-c的表达量较其他两组显著升高.结论 2ME2能够显著提高瘢痕疙瘩成纤维细胞caspase-3、caspase-8以及Cyt-c的表达水平,可能具有一定的瘢痕疙瘩细胞凋亡促进效应.

Keloids are raised, red, hard and irregular tumors that are prone to extend beyond the wound borders. Surgical excision is not sufficient to eradicate a keloid. Adjuvant therapy with radiation is a recommended treatment that reportedly achieves improved efficacy. However, radiation does not only kill cells in the keloid tissue but also stimulates their resistance, and intractable cases can display continuous recurrence. Quercetin was initially extracted from natural products and is used as a dietary supplement. The role of quercetin as an oxidant scavenger has been highlighted in many studies and has drawn interest to the application of ionizing radiation (IR) sensitization. In this study, we first demonstrate that keloid fibroblasts acquire resistance after IR treatment, and this can be relieved by treatment with quercetin. Further, we showed that hypoxia-inducible factor 1 (HIF-1), a prognostic marker used in clinical practice after radiation therapy, was associated with stronger radioresistance in keloid fibroblasts, which was downregulated after quercetin treatment. The inhibition of HIF-1 expression by quercetin was found to be dependent on the phosphatidylinositol-3-kinase (PI3K)/Akt pathway. Quercetin has been reported to reduce the phosphorylation of Akt. Taken together, we revealed one mechanism underlying the suppression of radioresistance by quercetin, which involved the regulation of HIF-1α by the PI3K/Akt pathway. Our study provides a molecular basis for the application of quercetin in radiation sensitization in the treatment of keloids.

目的 探究正常皮肤、浅表性瘢痕、瘢痕疙瘩组织中细胞凋亡关键因子Caspase-3、Caspase-8的表达水平,并通过增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)表达水平推测组织细胞增殖情况.方法 随机选取2017年1～6月就诊的胸部瘢痕患者共18例,按胸部瘢痕性质分为正常皮肤组(A组)、浅表性瘢痕组(B组)和瘢痕疙瘩组(C组),每组各6例.通过各组HE染色切片观察其组织形态,并通过免疫组织化学染色和Western blot技术对3组Caspase-3、Caspase-8以及PCNA的表达情况进行分析.结果 3组经HE染色后可见胶原含量依次增多,排列逐渐紧密,但C组中Caspase-3(1.03±0.21)、Caspase-8 (0.95±0.17)及PCNA(3.93±1.02)的表达水平较其他2组显著升高.结论 瘢痕疙瘩组织相对于正常皮肤和浅表性瘢痕可能具有较高的细胞凋亡水平和细胞增殖水平.