Objective To detect the expressions of high mobility group box-1,nuclear factor-kB(NF-kB)in tumor tissues of glioma patients and analyze the correlation of HMGB1 and NF-kB expressions with tumor pathology. Methods A total of 76 patients who undertook glioma resection were selected as observation group,and 20 patients who undertook intracranial decompression were selected as control group during September 2013 to September 2017. The expressions of HMGB1 and NF-kB were detected by SP immunohistochemistry(SP)and analyzed by combining clinical factors and postoperative tumor pathology to investigate the relationship between the expression levels of HMGB1 and NF-kB and the pathology of glioma. Results The positive expression rates of HMGB1 and NF-kB in glioma tissues of the observation group were both higher than those of the control group(P<0.05). The expression levels of HMGB1 and NF-kB in glioma tissues were observed in the observation group. The pathological grade of the tumor was related(P<0.05). Expression levels of HMGB1 and NF-kB in glioma tissue of the trial group were related with pathological grade of glioma(P<0.05). In the observation group,HMGB1 expression level was positively correlated with NF-kB expression level(r=0.316,P<0.05). Conclusion HMGB1 and NF-kB are significantly higher in glioma tumor specimens than normal tissues,and the expression of HMGB1 and NF-kB is correlated with tumor pathological grade,suggests that may be closely related to the occurrence and pathology of glioma.

目的 探讨超声多普勒(Carotid artery Doppler ultrasound,CDU)在评价颈动脉血管重建术后再狭窄中的意义.方法 选取行颈动脉内膜剥脱术(Carotid endarterectomy,CEA)和颈动脉支架置入术(Carotid artery stenting,CAS)的患者75例共95支血管.于术后12个月行颈动脉多普勒超声和数字减影血管造影(Digital Subtrac-tion Angiography,DSA),以DSA诊断为金标准,观察不同狭窄程度患者CDU指标差异,评估CDU指标在判断不同狭窄程度血管中的ROC曲线下面积,比较CDU指标评价不同狭窄程度血管的诊断效能.结果 (1)术后12个月DSA检查显示,70支血管无明显狭窄或轻度狭窄(狭窄程度<50％),16支血管中度狭窄(狭窄程度50～79％),9支血管重度狭窄(狭窄程度≥80％);与狭窄程度<50％血管相比,狭窄程度50％～79％和≥80％血管的颈动脉内径(t=9.877,16.109,P=0.000,0.000)显著缩小,PSV(t=8.466,13.571,P=0.000,0.000)、EDV(t=8.136,20.914,P=0.000,0.000)、PSVICA/PSVCCA(P=5.801,12.602;P=0.000,0.000)显著升高;(2)预测再狭窄程度50％～79％的CDU各指标ROC曲线下面积分别为PSV(0.992)、EDV(0.899)、PSVICA/PSVCCA(0.892),PSV预测再狭窄50％～79％的ROC曲线下面积明显高于EDV和PSVICA/PSVCCA,PSV的最佳截点为210cm/s;预测再狭窄程度≥80％的CDU各指标ROC曲线下面积分别为PSV(0.984)、EDV(0.812)和PSVICA/PSVCCA(0.924),PSV预测再狭窄≥80％的ROC曲线下面积明显高于EDV和PSVICA/PSVCCA,PSV的最佳截点为285cm/s;(3)以ROC曲线得出的最佳截点为界值,PSV在评价再狭窄程度≥50％和≥80％时的诊断准确率、灵敏度和阳性预测值均明显高于EDV和PSVICA/PSVCCA.结论 超声多普勒能够有效评价CAS和CEA术后颈动脉再狭窄程度,其中PSV≥210cm/s和285cm/s可作为再狭窄≥50％和≥80％的参考指标.

Objective To investigate the protective mechanism of vinpocetine in brain injury traumatic(TBI)of rats.Methods250 Wistar rats were randomly divided into 5 groups:sham operation group,model group(intraperitoneal injection of normal saline)and vinpocetine group (intraperitoneal injection of 10mg/kg,20mg/kg and 40mg/kg),50 for each. The rats in the sham operation group only cranial skin incision,model group and vinpocetine group rats with Feeney free fall impact equipment caused by traumatic brain injury model,the administration of third days, seventh days and fourteenth days,the 5 groups were detected in rat plasma MDA(malondialdehyde)content and the activity of SOD,GSHx,CAT. On the fourteenth day,Western Blot was used to detect the expression of apoptosis protein Bcl-2,Bax,Caspase 3 and brain water in the brain tissue of 5 groups of rats.ResultsCompared with the model group,vinpocetine group(20mg/kg and 40mg/kg)of brain water content was significantly reduced(P all<0.05),plasma MDA decreased significantly(P<0.05,P<0.01);SOD,GSHx,CAT activity increased significantly(P<0.05, P<0.01);Bcl-2 increased significantly(P<0.05,P<0.01);Bax was significantly decreased(P<0.05,P<0.01);Caspase3 was significantly decreased(P<0.05,P<0.01).ConclusionVinpocetine can protect the brain injury through enhancing the antioxidant capacity,inhibiting the apoptosis pathway and relieving cerebral edema.

目的评价微创穿刺血肿引流术与显微小骨窗开颅血肿清除术治疗中等量高血压脑出血的效果。方法选择65例中等量(30~70ml)高血压脑出血患者,随机分为微创穿刺血肿引流术(穿刺组,35例)和显微小骨窗开颅血肿清除术(开颅组,30例),评价两组患者术后3月神经功能缺损程度、日常生活活动能力(ADL)、住院期间的死亡率及并发症。结果患者住院期间的并发症发生率差异显著(P<0.05),穿刺组少于开颅组。治疗3个月后随访,ADL达自理水平的良好状态者,两组有显著性差异(P<0.01),穿刺组优于开颅组。两组的死亡率无显著性差异。结论微创血肿冲洗引流术有助于患者神经功能的恢复,提高患者日常生活能力,值得推广和借鉴。

目的探讨小骨窗开颅显微镜下治疗基底节区高血压脑出血的临床疗效。方法对38例基底节区高血压脑出血患者采用小骨窗开颅,显微镜下清除血肿。结果术后24小时内复查CT显示,26例血肿清除90%以上,8例血肿清除70%~80%以上。死亡4例,其中2例死于术后再出血所致的脑疝,1例死于肺部感染,1例死于多器官衰竭。术后生存34例,随访3~6个月。日常生活能力(ADL)分级:Ⅰ级7例,Ⅱ级13例,Ⅲ级9例,Ⅳ级4例,Ⅴ级1例。结论小骨窗开颅显微镜下手术,视野清晰、操作精细,止血确切,手术创伤较小,术后恢复良好,是治疗基底节区高血压脑出血的有效手术方式之一。

目的拟建立野百合碱诱导的肺动脉高压大鼠模型,并观察尾加压素Ⅱ(urotensin-Ⅱ,UⅡ)在野百合碱(monocrotaline,MCT)诱导的肺动脉高压(Sprague-Dawley,SD)大鼠中的表达。方法 30只大鼠随机分成正常对照组(NC)15只和野百合碱组(MCT)15只,MCT组一次性颈背部皮下注射MCT(60mg/kg),NC组皮下注射相同剂量的生理盐水,饲养3周后分别测定两组大鼠平均肺动脉压力(MPAP),之后处死大鼠,测定右心室游离壁(RV)和左心室加室间隔(LV+S)的重量比,同时用放免法测定大鼠血浆中UⅡ的含量,免疫组化法检测大鼠肺细小动脉UⅡ蛋白的表达。结果 MCT组大鼠MPAP、RV/LV+S显著高于NC组(P<0.01),MCT组大鼠血浆中UⅡ的含量显著高于NC组(P<0.01);免疫组化显示随着肺动脉分支下移,UⅡ的水平越来越高(P<0.05和P<0.01)。结论通过野百合碱诱导大鼠建立肺动脉高压模型是一种较为经济方便的方法 ,UⅡ在肺动脉高压中起着一定的作用。

Objective To study the disposal methods for syphilis Infections during the health check of entry-exit people.Method To analyze the status of test methods for syphilis in Laboratory,the status of the treatment procedures of syphilis for the health check of entry-exit people,and the results of corresponding research.Result At present,there was no high sensitivity and specificity shown in the laboratory results which can reflect the infectiousness of syphilis(especially after treatment) as the basis whether the health certificate may be issued to the syphilis infections,but the therapy efficacy of penicillin for syphilis was sure with the cure rate at almost 100%.Conclusion The basis of issuing health certificates to the syphilis infections should be whether having received regular antisyphilis treatment.

Objective To evaluat the application value of TRUST for diagnosing latent syphilis. Method 165 serums of TPPA positive were tested by using TRUST and TP-IgM anitibodies,and both the case history and therapy status were investigated.Follow-up was then carried out. Result TP-IgM anitibodies were all negative among the serums of the 64 personnel of which TPPA was positive and TRUST was negative.No clinical symptoms or signs were found among the 26 personnel who came to accept follow-up, the TRUST and the TP-IgM anitibodies were all negative as well;Only one of the TP-IgM anitibodies was positive among the serums of the 19 personnel of which TPPA was positive and TRUST was a borderline reaction.Four of the TRUST changed to negative and the TP-IgM anitibodies (including the one of which TP-IgM anitibody was originally positive) all were negative among the 11 personnel who came for a follow-up,No clinical symptoms or signs were found either;TP-IgM anitibodies few were positive when the TRUST titers were under 1:4 among the serums of the 82 personnel of which TPPA and TRUST were all positive.Though no clinical symptoms or signs were found,but only nine of the TRUST changed to either a borderline reaction or negative among the serums of the 43 personnel of which TPPA was positive and TRUST was positive after they had accepted standard treatment. Conclusion The negative results of TRUST are reliable;The positive results of TRUST(getting rid of the false positive of biology) are trustworthy before the patients with syphilis accepted treatment,But the positive results of TRUST cann’t reflect reality state of Syphilis after they have accepted standard treatment.

目的比较心肌肌钙蛋白I(CTnI)与心肌酶谱在急性心肌梗死(AMI)诊断中的价值。方法对56例AMI和50例非心肌梗死患者同时检测血清CTnI、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)及天冬氨酸脱氢酶(AST)等指标,进行统计学处理及分析比较。结果CTnI对AMI诊断的敏感性(100%)高于CK(83.9%)、CK-MB(73.2%)、LDH(80.4%)及AST(75.0%)(P<0.01);CTnI对AMI诊断的特异性(98.0%)与CK-MB(92.0%)相近(P>0.05),高于CK(82.0%)、LDH(66.0%)及AST(78.0%)(P<0.01)。结论CTnI对AMI的诊断敏感性和特异性高,具有较好的临床应用价值。

目的探讨重型颅脑复合伤的诊治方法。方法对38例重型颅脑复合伤病例作回顾性总结分析。结果治愈28例,肢体功能障碍5例,植物生存状态2例,死亡3例。结论对重型颅脑复合伤应尽早明确诊断,积极处理,预防并发症,可显著提高临床疗效,降低死亡率。

<正>硬膜外血肿一般采用静脉复合麻醉下开颅手术,对患者特别是年老体弱者损伤较大。我科于2003年12月至2005年12月,对36例硬膜外血肿患者采用YL-1型一次性颅内血肿穿刺针穿刺引流及注入尿激酶溶解血肿,效果满意,现报道如下。

脑血管痉挛是蛛网膜下腔出血后严重的并发症,半个世纪以来一直是研究热点[1].目前,脑血管痉挛发生的病理生理机制仍然很不明确,有关内皮素-1(Endothelin-1,ET-1)的研究较多[2].作者动态检测脑脊液中ET-1浓度以期进一步探讨血管痉挛的发生机制及ET-1的作用.

颅脑损伤者常伴有各种不同程度的呼吸功能障碍,这是颅脑损伤后一系列病理生理改变的重要因素之一.一般临床常压吸氧难以纠正缺氧,同时呼吸道梗阻气管切开、深昏迷、病情危重的患者不适宜做高压氧舱.笔者采取氧合液静脉输入,纠正体内缺氧及脑缺氧,增加需氧含量,提高氧分压,在颅脑外伤早期,应用氧合液治疗的基础和临床研究鲜有报道.2004年9月至2005年6月,笔者采用双盲对照实验的方法治疗了50例急性颅脑损伤患者,取得较好疗效.现报告如下.

阵发性室上性心动过速(PSVT)为临床上常见的快速心律失常,90%由折返所致,多数可用药物终止,如未及时终止发作,可给患者造成痛苦,甚至危及患者生命.本组18例23例次PSVT发作患者,分别因三磷酸腺苷(ATP)、普罗帕酮静注无效,采用食管调搏超速抑制而使发作终止.

Objective:To investigate the effects of carvedilol and metoprolo l on left ventricular hypertrophy and microproteinuria in the treatment of essential hypertension(EH).Methods:One hundred and four outpaˉtients with EH1and2were randomized into two groups and treated with carvedilol(20～40mg/d,groups A)and metoprolol(50～100mg/d,group B)for24weeks respectively.The levels of interventricular septal thickˉness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular mass indexes(LVMI),α 1 -miˉcroglobulin(α 1 -MG)and microalbuminuria(Alb)were measured before and after the treatment.Thirty subjects with normal blood pressure were selected randomly to serve as control group.Results:Compared with the control group,all markers were elevated in group A and B before the treatment(P0.01).The blood pressure and heart rate significantly decreased in group A and B after the treatment(P0.01),and the heart rate decreased significantly in group B than that in group A(P0.05).There was no significant difference in IVST,LVPWT,LVMI,α 1 -MG and Alb between group A and control group after the treatment(P0.05),and all these markers were significantly higher in group B than that in control group(P0.05).LVPWT,LVMI ,α 1 -MG and Alb decreased in group A after the treatment(P0.01),and there was no significant change in IVST(P0.05).There was no significant change in all markers in group B after the treatment compared with that before the treatment(P0.05).Conclusion:Carvedilol and metoprolol may play a satisfactory role in the treatment of EH,but carvedilol has more advantages in protecting the damage of target organs compared with metoprolol in patients with EH.

随着交通、建筑等事业发展,颅脑损伤严重威胁着生命,影响其生活质量,特别是20～50岁青壮年.如果对重度颅脑损伤合并失血性休克延误诊治和抢救,造成病死率极高.我院于1998年6月～2003年6月共收治179例重型颅脑损伤,其中伴失血性休克32例,经积极抢救其病死率达46.9%,现将抢救治疗经验总结如下.

长期血压升高势必导致靶器官结构和功能损害,冠状动脉粥样硬化性心脏病(简称冠心病)、心功能不全、脑中风和肾功能不全是其主要的靶器官损害,严重威胁人民生命安全.为此,研究高血压靶器官损害,探讨其发病机制,为防治高血压所带来的危害均有一定临床意义.

各种颅脑疾病术后伴发颅内积气报道较多,逐步引起临床重视.闭合性颅脑损伤术后伴发颅内积气有其自己特点.我院近5年共行闭合性颅脑损伤手术253例,112例术后72小时内行CT扫描,39例35%颅内有积气,为对该并发症进一步认识,现总结如下.

目的:探讨硬膜下积液(SFC)演变为慢性硬膜下血肿(CSDH)的成因及治疗.方法:从临床、影像学、包膜光镜电镜等方面观察SFC转为CSDH的演变情况.治疗采用钻孔引流冲洗或骨瓣成形术.结果:SFC演变为CSDH的包膜与单纯CSDH包膜结构相同,手术方式相同.结论:SFC新生包膜毛细血管增生,纤溶系统激活,毛细血管反复出血可能为CSDH的形成机制.对该病及时治疗,效果佳.

1990～1999年本科采用急诊锥颅放血加大骨瓣减压血肿清除术与同期单纯大骨瓣减压血肿清除术相比,疗效显著.报道如下.