目的:探究老年高血压脑出血患者在合并卒中相关性肺炎(SAP)早期时,体内白细胞介素-6(IL-6)、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)及降钙素原(PCT)水平的动态变化及其临床意义.方法:选取老年高血压脑出血病患者90例,其中SAP感染组45例,未感染对照组45例.通过比较两组患者血清白介素-6(IL-6)、C-反应蛋白(CRP)、淀粉样蛋白A(SAA)及降钙素原(PCT)水平差异,分析血清感染指标单独检测以及联合检测对老年患者SAP早期诊断的敏感性和特异性.结果:SAP组血清感染指标水平显著高于对照组(P＜0.05),SAP组血清SAA、PCT与IL-6、CRP呈正相关(均P＜0.05),血清IL-6、CRP、SAA及PCT对老年患者SAP的早期诊断,曲线下面积分别为0.742、0.684、0.854、0.835,敏感度分别为68.9％、71.1％、73.3％、84.4％,特异度分别为77.8％、62.2％、86.7％、77.8％;血清IL-6、CRP、SAA及PCT联合检测对患者SAP的诊断,曲线下面积分别为0.925,敏感度为95.6％,特异度为75.6％.结论:血清IL-6、CRP、SAA及PCT水平对老年高血压脑出血患者合并SAP的诊断有临床意义,并且感染指标联合检测诊断更有意义.

Objective To explore the effect of minimally invasive aspiration and liquefaction drainage in the treatment of patients with cerebral hemorrhage and its influence on National Institutes of Health Stroke Scale（NIHSS） score. Methods Sixty patients with cerebral hemorrhage received in our hospital from January 2020 to February 2022 were selected as the research objects and divided into traditional group and minimally invasive group according to treatment methods, with 30cases in each group. The traditional group was treated with small bone window craniotomy hematoma removal, and the minimally invasive group was treated with minimally invasive aspiration and liquefaction drainage. The therapeutic effects of the two groups were compared. Results After treatment, the NIHSS score in the minimally invasive group was lower than that in the traditional group, the Scandinavian Stoke Scale（SSS） and Activity of Daily Living Scale（ADL） scores were higher than those in the traditional group（P＜0.05）. The total incidence of complications rate in the minimally invasive group was 3.33%, which was significantly lower than 23.33% in the traditional group（P＜0.05）. After treatment, the levels of interleukin-6（IL-6）, tumor necrosis factor-α（TNF-α） and hypersensitive C-reactive protein（hs-CRP） in the minimally invasive group were lower than those in the traditional group（P＜0.05）. The operation time in the minimally invasive group was shorter than that in the traditional group, and the intraoperative blood loss was less than that in the traditional group（P＜0.05）. After treatment, the scores of all dimensions of Generic Quality of Life Inventory-74（GQOLI-74） in the minimally invasive group were higher than those in the traditional group（P＜0.05）. Conclusion Minimally invasive aspiration and liquefaction drainage in the treatment of patients with cerebral hemorrhage has significant effects, it can reduce the total incidence of complications, regulate the levels of inflammatory factors, improve the scores of NIHSS, SSS, ADL and quality of life, which is worthy of clinical promotion and application.

社区获得性肺炎是呼吸内科临床治疗常见病与多发病,该病多发于老年群体,疾病的发生推测可能与细菌、病毒感染有关,患者发病后多具有咳嗽、咽喉疼痛、鼻塞等临床表现,部分患者可能表现出头昏、头痛、全身肌肉和关节酸痛等[1].社区获得性肺炎患者发病期间临床表现并不具有特异性,疾病症状与上呼吸道感染及其他呼吸道疾病极为相似,因此临床诊断中极易出现漏诊与误诊现象[2].既往研究认为,社区获得性肺炎患者发病期间其血清炎性指标可能伴随有较大程度改变,因此临床诊断多类血清炎性指标的检测均能为该病患者临床诊断提供数据支持[3];但长期研究发现,单项血清炎性指标提供的诊断数据并不充分,因此可考虑使用多项血清炎性指标数据对社区获得性肺炎进行联合诊断,最终提升诊断准确率,保证后续治疗方案的顺利且合理开展[4].本研究主要分析了降钙素原(PCT)、C反应蛋白(CRP)、白细胞检测在老年社区获得性肺炎临床诊断中的应用价值,现报告如下.

Gliomas are the most common primary malignant brain tumors and are highly aggressive. Invasion and migration are the main causes of poor prognosis and treatment resistance in gliomas. As migration and invasion occur, patient survival and prognosis decline dramatically. MicroRNAs (miRNAs) are small, non-coding 21–23 nucleotides involved in regulating the malignant phenotype of gliomas, including migration and invasion. Numerous studies have demonstrated the mechanism and function of some miRNAs in glioma migration and invasion. However, the biological and clinical significance (including diagnosis, prognosis, and targeted therapy) of glioma migration and invasion-related miRNAs have not been systematically discussed. This paper reviews the progress of miRNAs-mediated migration and invasion studies in glioma and discusses the clinical value of migration and invasion-related miRNAs as potential biomarkers or targeted therapies for glioma. In addition, these findings are expected to translate into future directions and challenges for clinical applications. Although many biomarkers and their biological roles in glioma invasion and migration have been identified, none have been specific so far, and further exploration of clinical treatment is still in progress; therefore, we aimed to further identify specific markers that may guide clinical treatment and improve the quality of patient survival.

目的 探讨思维导图教学法联合DOPS评价在住院医师规范化培训(住培)医师临床操作教学中的应用价值.方法 选取该院30名住培医师作为研究对象,随机分为两组.改良组运用思维导图教学法进行腰椎穿刺术教学,并在教学早期、中期及末期使用诊疗技能直接观察评估(DOPS)评价法对每位医师进行3次考评;传统组运用传统教学方法,在教学末期运用DOPS评价.对比两组医师的教学效果及其对教学方式的满意度.结果 改良组3次成绩逐渐上升,教学末期各项成绩均高于早期及中期,早期低于中期,差异均有统计学意义(P<0.05);中期"整体表现"项目成绩与末期比较,差异有统计学意义(P<0.05).教学末期,改良组成绩高于传统组,除"获取知情同意"项目外,其他项目比较,差异均有统计学意义(P<0.05).两组医师对教学方式的满意度比较,差异无统计学意义(P>0.05).结论 思维导图教学法联合DOPS评价有助于医师的临床操作,也能提高临床教学满意度.

食管癌是肿瘤科常见病与多发病,疾病的发生与多种维生素缺乏、不良生活习惯以及化学、生物性病因密切相关[1].患者发病初期通常无典型性临床表现,部分患者在吞咽过程中表现出不适感,疾病发生进展后吞咽困难症状逐渐加重,同时还具有消瘦、脱水、无力等体征表现.食管癌患者疾病的发生与进展均对其生活质量与生命安全具有严重威胁[2],因此及早制定合理治疗方案尤为重要.目前临床针对食管癌多采用手术治疗,部分患者治疗后临床症状显著改善,但后续恢复速度较慢,考虑到老年食管癌患者身体素质较差,后续康复治疗过程中极易出现营养不良症状,最终危害其预后结局[3].既往研究认为,针对食管癌手术患者进行白蛋白、转铁蛋白和视黄醇结合蛋白检测可较为准确的评估其术后营养状态,对后续治疗方案的制定与改善有重要价值[4].本研究主要分析了老年食管癌患者术后白蛋白、转铁蛋白和视黄醇结合蛋白水平变化以及3项指标对其营养状态的评估价值,现报告如下.

Objective To explore the clinical effect of hyperbaric oxygen assisted large decompressive craniectomy in the treatment of craniocerebral injury. Methods A total of 84 patients with craniocerebral injury admitted in our hospital from January to December 2021 were selected as the research objects, and the patients were divided into control group and observation group according to different treatment schemes, with 42 cases in each group. Both groups were given dehydration to reduce intracranial pressure, anti-infection, regulate water-electrolyte balance and hemostatic treatment, the control group was given large decompressive craniectomy on this basis, and the observation group was given hyperbaric oxygen therapy on the basis of the control group. The clinical treatment effect, prognosis, intracranial pressure, Glasgow Coma Scale（GCS）, Barthel Index（BI） scores and inflammatory factors levels were compared between the two groups.Results The total effective rate of treatment in the observation group was higher than that in the control group, and the difference was statistically significant（P＜0.05）. The good prognosis rate in the observation group was higher than that in the control group, and the difference was statistically significant（P＜0.05）. At 1, 3, 5 d after treatment, the intracranial pressure of the two groups decreased, that of the observation group was lower than the control group, and the difference was statistically significant（P＜0.05）. After treatment, the GCS and BI scores in the observation group were higher than those in the control group, and the differences were statistically significant（P＜0.05）. After treatment, the interleukin-2（IL-2） and tumor necrosis factor-α（TNF-α） of the two groups decreased, the interleukin-4（IL-4） increased, those of the observation group were better than the control group, and the differences were statistically significant（P＜0.05）. Conclusion Hyperbaric oxygen assisted large decompressive craniectomy in the treatment of patients with craniocerebral injury has a good effect, it can decrease the intracranial pressure, reduce inflammatory reaction and improve the prognosis, which is worthy of clinical promotion.

[目的]探讨肺炎支原体(MP)合并EB病毒感染患儿血清白细胞介素-2(IL-2)、白细胞介素-12(IL-12)水平及其与患儿预后的相关性.[方法]选取2019年5月至2020年5月陕西省人民医院收治的103例MP合并EB病毒感染的患儿(合并组)、103例单纯MP感染的患儿(MP组),选取同期进行体检的103例健康儿童(对照组).根据合并组患儿预后情况将其分为不良预后组(n=32)和非不良预后组(n=71).采用酶联免疫吸附(ELISA)法检测各组血清IL-2、IL-12水平,采用Logistic回归分析影响MP合并EB病毒感染患儿发生不良预后的因素,采用受试者工作特征(ROC)曲线分析血清IL-2、IL-12对MP合并EB病毒感染患儿不良预后的评估价值.[结果]合并组患儿血清IL-2、C反应蛋白(CRP)水平高于MP组、对照组,且MP组高于对照组(P＜0.05);合并组患儿血清IL-12水平低于MP组、对照组,且 MP组低于对照组(P＜0.05).不良预后组血清CRP、IL-2水平及发热时间均大于非不良预后组,血清IL-12水平低于非不良预后组(P＜0.05).Logistic回归分析结果显示:血清IL-2高表达是影响MP合并EB病毒感染患儿发生不良预后的独立危险因素,IL-12高表达是影响MP合并EB病毒感染患儿发生不良预后的保护因素(P＜0.05).ROC曲线分析显示:血清IL-2、IL-12及两者联合评估 MP合并EB病毒感染患儿不良预后的曲线下面积分别为 0.746、0.866、0.901,敏感度分别为 64.5％、93.5％、83.9％,特异度为 88.9％、79.2％、81.9％.[结论]MP合并EB病毒感染患儿血清IL-2水平升高、血清IL-12水平降低,且与预后密切相关,对患儿不良预后具有一定的预测价值,且二者联合预测价值更高.

目的:探讨胞质分裂原蛋白调节因子-1(protein regulator of cytokinesis-1,PRC1)对胶质母细胞瘤的作用及其可能的机制.方法:RT-PCR和Western blot检测胶质母细胞瘤组织和正常脑组织中PRC1的表达;人胶质母细胞瘤细胞株U251转染siRNA-NC和siRNA-PRC1序列,RT-PCR检测细胞中PRC1 mRNA表达;Western blot检测细胞中PRC1、Wnt1、β-catenin和CyclinD1蛋白表达;CCK-8检测细胞增殖能力;流式细胞术检测细胞周期分布;Transwell实验检测细胞迁移和侵袭;血管生成实验检测血管生成.结果:与正常组织相比,癌组织中PRC1 mRNA和蛋白表达升高(P＜0.001);与siRNA-NC组相比,siRNA-PRC1组细胞在24 h、48 h及72 h的细胞增殖能力降低(P＜0.01),G0/G1 期细胞含量升高(P＜0.05),S和G2/M期细胞含量降低(P＜0.05),细胞迁移数和侵袭数降低(P＜0.01),内皮细胞管道形成数降低(P＜0.001),Wnt1、β-catenin和CyclinD1蛋白表达降低(P＜0.01).结论:PRC1在胶质母细胞瘤组织中表达上调,PRC1可能通过促进Wnt/β-catenin途径活化,促进胶质母细胞瘤细胞增殖、细胞周期进程、迁移、侵袭和血管生成.

目的:探讨人脑膜瘤组织中RNA结合蛋白脆性X相关基因1(FXR1)表达情况及其对脑膜瘤细胞生长和血管生成的影响.方法:收集我院24例脑膜瘤患者的肿瘤组织及瘤旁组织标本,免疫组织化学染色检测FXR1表达.分离并培养人脑膜瘤细胞,将培养的细胞分为空白对照组、pcDNA3.1-NC组和pcDNA3.1-FXR1组,采用脂质体转染法将pcDNA3.1-FXR1质粒载体与pcDNA3.1空质粒载体转染至脑膜瘤细胞;实时荧光定量PCR和蛋白质印迹(Western blot)检测细胞中FXR1 mRNA和蛋白表达水平;CCK-8实验检测细胞增殖活性;细胞克隆形成实验检测细胞菌落形成能力;Western blot检测VEGF、EDN-1蛋白表达水平;流式细胞术检测血管内皮细胞的标记CD31与CD34的阳性细胞表达;体外小管生成试验检测HUVECs成管情况.结果:脑膜瘤组织中FXR1阳性表达较瘤旁组织显著增加(P<0.05).与空白对照组和pcDNA3.1-NC组比较,pcDNA3.1-FXR1组细胞中FXR1 mRNA和蛋白相对表达量均显著升高(P<0.05),转染48、72和96 h后细胞增殖活性显著升高(P<0.05),细胞克隆形成数目显著增加(P<0.05),VEGF、EDN-1蛋白表达水平显著增加(P<0.05),CD34和CD31标记的阳性细胞数显著增多(P<0.05)同时,管腔形成数目明显增多.结论:FXR1在人脑膜瘤组织中呈高表达,过表达FXR1可促进脑膜瘤细胞生长与血管生成.

目的:探讨调强适形放疗联合替莫唑胺对脑胶质瘤患者生命质量及血清表皮生长因子(EGF)、血管内皮生长因子(VEGF)水平的影响.方法:选取我院于2015年3月到2017年2月期间收治的脑胶质瘤患者86例,分为对照组(n=43,调强适形放疗治疗)和研究组(n=43,对照组的基础上联合替莫唑胺治疗),比较两组患者疗效、生命质量、生存率血清VEGF、EGF水平以及不良反应.结果:治疗6个疗程后,研究组的总有效率为69.77％(30/43),高于对照组的48.84％(21/43)(P＜0.05).治疗6个疗程后,两组血清VEGF、EGF水平均较治疗前降低,且研究组低于对照组(P＜0.05).两组不良反应发生率对比无差异(P＞0.05).治疗6个疗程后,两组生活质量量表(QOL)、卡劳夫斯基(KPS)评分升高,且研究组高于对照组(P＜0.05).研究组治疗后1年、2年、3年生存率均高于对照组(P＜0.05).结论:调强适形放疗联合替莫唑胺治疗胶质瘤患者疗效较好,可有效降低患者血清VEGF、EGF水平,且不增加不良反应发生率,同时还可有效改善患者生命质量.

目的 分析改良单孔引流术治疗老年慢性硬膜下血肿的疗效.方法 选取2013年1月至2016年1月我院收治的58例高龄老年慢性硬膜下血肿患者为研究对象,所有患者均采用改良单孔钻颅引流治疗,对患者的临床疗效进行观察.结果 治疗后,3例患者因严重并发症死亡痊愈出院患者55例,颅脑CT复查显示脑组织复张良好,随访中50例患者脑膨复良好,症状改善,有3例复发,再次手术治愈;2例口服阿托伐他汀治疗.结论 改良单孔引流术治疗高龄老年慢性硬膜下血肿,疗效确切,且操作安全、简便,并发症少,值得临床推广应用.

Hypoxic–ischemic brain injury is an important cause of neonatal mortality and morbidity. Brain-derived neurotrophic factor (BDNF) has been reported to play a neuroprotective role in hypoxic–ischemic brain injury; however, the specific effects and mechanism of BDNF on hypoxic–hypoglycemic hippocampal neuron injury remains unknown. The current study investigated the action of BDNF in regulating cerebral hypoxic-ischemic injury by simulating hippocampal neuron ischemia and hypoxia. We found that BDNF, p-Trkb, and miR-134 expression levels decreased, and that exogenous BDNF increased survival and reduced apoptosis in hypoxic–hypoglycemic hippocampal neurons. The results also show that BDNF inhibits MiR-134 expression by activating the TrkB pathway. Transfection with TrkB siRNA and pre-miR-134 abrogated the neuroprotective role of BDNF in hypoxic–hypoglycemic hippocampal neurons. Our results suggest that exogenous BDNF alleviates hypoxic–ischemic brain injury through the Trkb/MiR-134 pathway. These findings may help to identify a potential therapeutic agent for the treatment of hypoxic–ischemic brain injury.

Objective:To explore the difference of therapeutic effect between tert-butylhydroquinone (tBHQ) and sulforaphane (SFN) in rats with traumatic brain injury.Methods:A total of 80 healthy adult male rats were randomly divided into 4 groups:sham group,TBI group,tBHQ treatment group and SFN treatment group,then the traumatic brain injury (TBI) model were prepared by eCCI.tBHQ treatment group rats were given intraperitoneal injection three times tBHQ (50 mg/kg) before injury 24 h,and SFN treatment group rats were given intraperitoneally injected SFN (5 mg/kg) after injury 15 min.Neurologic deficits was evaluated 24 h after TBI by mNSS method,brain edema was detected by the wet-dry ratio method.The expression levels of NOX2 protein and Nrf2 protein in the brain tissue were investigated using Western blot and ELISA analysised,respectively.Results:Compared with TBI group,there were significant difference on mNSS scores ((4.5± 0.71) vs (9.2± 0.79),(6.0± 0.82) vs (9.2± 0.79)),brain edema (79.4％ vs 85.6％,80.3％ vs 85.6％),the expression levels of NOX2 protein and Nrf2 protein (0.93 ng/mL vs 0.81 ng/mL,0.87 ng/mL vs 0.81 ng/mL) in tBHQ treatment group and SFN treatment group.In addition,there were also significant differences on mNSS scores (0.5± 0.71) vs (6.0± 0.82)),the expression levels of NOX2 protein and Nrf2 protein (0.93 ng/mL vs 0.87 ng/mL) between tBHQ treatment group and SFN treatment group.Conclusion:In the TBI model of rats,tBHQ and SFN could effectively attenuated cerebral oxidative stress and improved nerve function after TBI,but the curative effect of tBHQ was better than the SFN.

目的：评价复方丹参滴丸治疗脑血栓康复期的临床疗效与安全性。方法：以陕西省人民医院神经外科收治的脑血栓患者作为研究对象，观察组与对照组各纳入患者50例，均给予内科保守治疗、康复治疗，对照组给予安慰剂，观察组给予复方丹参滴丸，对比相关指标。结果：4周后，观察组与对照组 PLT 低于治疗前、观察组低于对照组，观察组与对照组 PU 、ICAex 高于治疗前、观察组高于对照组，观察组 HCT 高于治疗前、对照组，差异具有统计学意义。3个月后，观察组与对照组神经功能缺损评分低于治疗前、观察组低于对照组，差异具有统计学意义。两组均无不良反应。结论：在常规治疗基础上，口服复方丹参滴丸，有助于增强颅内灌注，减轻神经功能损伤，增强康复治疗效果。

microRNA-134 (miR-134) has been reported to be a brain-specific miRNA and is differently expressed in brain tissues subjected to ischemic injury. However, the underlying mechanism of miR-134 in regulating cerebral ischemic injury remains poorly understood. The current study was designed to delineate the molecular basis of miR-134 in regulating cerebral ischemic injury. Using the oxygen-glucose deprivation (OGD) model of hippocampal neuron ischemia in vitro, we found that the overexpression of miR-134 mediated by recombinant adeno-associated virus (AAV) vector infection significantly promoted neuron death induced by OGD/reoxygenation, whereas the inhibition of miR-134 provided protective effects against OGD/reoxygenation-induced cell death. Moreover, cyclic AMP (cAMP) response element-binding protein (CREB) as a putative target of miR-134 was downregulated and upregulated by miR-134 overexpression or inhibition, respectively. The direct interaction between miR-134 and the 3′-untranslated region (UTR) of CREB mRNA was further confirmed by dual-luciferase reporter assay. Overexpression of miR-134 also inhibited the expression of the downstream gene of CREB, including brain-derived neurotrophic factor (BDNF) and the anti-apoptotic gene Bcl-2, whereas the inhibition of miR-134 upregulated the expression of BDNF and Bcl-2 in neurons after OGD/reoxygenation. Notably, the knockdown of CREB by CREB siRNA apparently abrogated the protective effect of anti-miR-134 on OGD/reoxygenation-induced cell death. Taken together, our study suggests that downregulation of miR-134 alleviates ischemic injury through enhancing CREB expression and downstream genes, providing a promising and potential therapeutic target for cerebral ischemic injury.

The hippocampus is vulnerable to damage under conditions of ischemia and hypoxia, causing multiple mental illnesses. cAMP response element-binding protein (CREB) plays a pivotal role in preventing the apoptosis of neurons and many other cells. Here, we found that AMP-activated protein kinase (AMPK) and CREB are oppositely regulated in mouse primary hippocampal neurons impaired by hypoxia-hypoglycemia. AMPK overexpression reduced the CREB level by upregulating SIRT1 and was negatively posttranscriptionally regulated by miR-134, suggesting a negative regulatory role of AMPK in the expression of CREB. Interestingly, the downstream genes of CREB, brain-derived neurotrophic factor (BDNF), and Bcl-2 remained unchanged when CREB was downregulated by AMPK expression. In addition, in AMPK−/− primary hippocampal neurons, comparisons between the effect of upregulation and silencing of miR-134 on the expression of CREB, BDNF, and Bcl-2 were made. The results reveal that AMPK is crucial for the activation of CREB via phosphorylation. Therefore, AMPK plays a dual role in the regulation of CREB in mouse primary hippocampal cells: a negative effect on total CREB expression by elevating SIRT1/miR-134 and a positive effect on activity via phosphorylation.

Objective To isolate,culture and identify adipose-derived stem cells(ADSCs) from SD rats so as to provide a theoretical basis for later experiments which are to select suitable seed cells.Methods Adipose tissues were isolated from the inguinal fat of SD rats.By combining zymogen digestion with differential velocity adherent method to obtain cells,the morphology and proliferation characteristics of the cells were observed under the inverted phase contrast microscope.Their growth curves were detected;freezing and resuscitation were performed.The third-generation cells differentiated into the osteogenic direction by osteogenesis-inducing liquid,and then underwent type Ⅰ collagen staining,alkaline phosphatase dyeing,and alizarin red staining.Adipogenic-inducing liquid was used to induce them into the adipogenic direction,and oil red O staining was conducted.Results ADSCs were successfully obtained and cultured from the rat adipose tissues.They presented fibroblast-like growth.After being cultured by osteogenesis-inducing liquid,they showed osteogenic characteristics.Type Ⅰ collagen staining,alkaline phosphatase dyeing and alizarin red staining were all positive.After being cultured by adipogenic-inducing liquid,they displayed adipogenic properties.After oil red O staining,fat droplets were visible within the cytoplasm.The ADSCs showed no significant decrease in their proliferation activity and capability of differentiating into diverse cell types after being cryopreserved in liquid nitrogen for two months.Conclusion Rat ADSCs were successfully isolated and cultured.The ADSCs obtained could grow and proliferate rapidly,capable of differentiating into diverse cell types.It provides a theoretical basis for later experiments which use tissue engineering to repair tissue damage.