In order to improve medical students' cognition of neurosurgery specialty and clinical practice,and cultivate students' self-learning ability,the model of flipping classroom combined with problem based learning was applied in clinical teaching in our department.The experimental group adopted flip classroom combined with PBL which penetrated the pre-class teaching design,classroom activity design,after-class summary and teaching feedback,while the control group adopted the traditional teaching method.The evaluation results showed that the students in the experimental group had significantly higher scores in-class knowledge and examination results than those in the control group.In addition,students had a high degree of recognition and satisfaction with the newly combined teaching model.The combination of flipped classroom and PBL teaching method could make up their deficiency,complement each other to achieve the best clinical teaching effect and improve students comprehensive ability.Meanwhile it puts forward new requirements for students and teachers,during which teachers need to be fully prepared and update teaching concepts for the sake of fulfilling the mutual promotion of teaching and learning.

Objective To evaluate the curative effect of different surgical forms on the pituitary adenomas, and their indications, merits and demerits. Methods The clinical data of 116 patients with pituitary adenomas, who underwent surgery from February, 2011 to October, 2017, were analyzed retrospectively. Of 116 patients with pituitary adenomas, 85 were treated by transnasal transphenoidal microsurgery, 24 by microsurgery via pterional approach, 4 microsurgery via right supercillary arche key hole approach and 3 by microsurgery via longtudinal approach. Results The pituitary adenomas were totally resected in 92 patients, subtotally in 20, in great part in 3 and partly in 1. Conclusions The surgical outcomes are good in these 116 patients. The pituitary adenomas confined to the sella and parasellar regions should be removed by microsurgery through transnasal transsphenoidal approach. But the invasive pituitary tumors should be by individualized microsurgery selected according to their characteristics on the images.

Objective To study the anatomic characteristics and clinical values of the internal auditory artery via the neuroendoscope and microscope.Methods We observed the related microdissection of the internal auditory artery of 15 cadavers through retrosigmoid approach by operative microscope and neuroendoscope,in which 3 cadavers were fresh.Results The internal auditory arteries were observed bilaterally in all specimens (100％).Among them,17 sides (56.7％,17/30) were isolated branch type,9 sides were dual trunk (30％,9/30),and 4 sides were three branches type (13.3％,4/30).The diameter of the vessel at its origin was 0.12～0.28 mm,the average caliber of IAA was 0.22±0.04 mm,the length of IAA ranged from 7.12 to 14.82 mm,and the Mean 10.18± 2.63 mm.The starting-point of IAA was quite variable,13.3％ (4/30) of the IAA origined from the inferior segment of the basilar artery,and 86.7 ％(26/30) of the IAA origined from ACIA.Among them,17 sides (65.4％,17/26) of the IAA origined from the ansa of the inferior cerebellar artery,9 sides (34.6％,9/26) of the IAA origined from the anterior inferior cerebellar artery involved in the inner ear canal.We observed that 73.3 ％(22/30) of the IAA branches were along the ventral side of the vestibulocochlear nerve;26.7 ％(8/30) of the IAA branches were above the nerves.It's easy to identify the IAA and its adjacent structures by various neuroendoscope through various anatomic fissures.Conclusion Most of internal auditory arterys were located anterior and posterior to the facial nerve,the microscope was impossible to see it directly.A thorough identification of the internal auditory artery requires theuse of both surgical microscopy and neuroendoscope.

目的 研究联合肠内、外营养支持加丙胺酰谷氨酰胺静脉注射对神经外科术后颅内感染患者营养及免疫能力调节作用.方法 术后颅内感染患者60例,随机分为实验组和对照组,均于感染后给予7 ～14天联合肠内+肠外营养支持治疗,实验组患者每天加用丙胺酰谷氨酰胺注射液0.4 g/kg.检测患者确诊感染后2天、7天、14天的胃肠道功能、三头肌皮皱褶厚度(tricepsskinfold thickness,TSF)及上臂肌围(arm muscle circumference,AMC),检测患者静脉血免疫球蛋白G(IgG)、C反应蛋白(CRP)、血清降钙素原(PCT)、T淋巴细胞亚群(CD4+、CD8+、CD4 +/CD8+)、统计营养支持干预期间的医疗费用和总住院时间,并进行比较分析.结果 实验组腹胀、腹泻、便秘的发生率低于对照组,差异有统计学意义(P＜0.05).TSF及AMC在干预前后组间比较,差异无统计学意义(JP＞0.05).两组患者的治疗初始IgG比较,差异无统计学意义(P＞0.05).在营养干预后第7天、14天,实验组的IgG及CD4+、CD4 +/CD8+明显高于对照组(P＜0.05).营养干预后第7天、14天,实验组CRP的水平明显低于对照组(P＜0.05).在营养干预后的第14天时,实验组PCT的水平明显低于对照组(P＜0.05).实验组营养治疗期间的平均医疗费用较低(P＜0.05).结论 术后颅内感染患者在充分常规营养治疗基础上加用丙胺酰谷氨酰胺注射液更能有效改善机体营养和免疫状况,减少治疗费用.

Objective To explore the preoperative evaluation of primary trigeminal neuralgia (TN) using 3T three-dimensional time-of-flight magnetic resonance angiography (3 D-TOF-MRA) and three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA).Methods 3D-TOF-MRA and 3D-FIESTA were performed on 52 patients with primary TN in our study.The relationship between vessels and trigeminal was compared on the symptomatic side and the asymptomatic side.The preoperative magnetic resonance imaging (MRI) findings and the surgical findings were compared.The sensitivity and specificity of preoperative MRI diagnosis were caculated.A 2-year follow-up was carried out after surgery and the relationship of preoperative MRI findings and clinical outcome was analyzed.Results The preoperative 3T MRI showed that the positive rate on the symptomatic side was 90.4％,and that on the asymptomatic side was just 25.0％.The sensitivity of preoperative MRI diagnosis was 89.8％ and the specificity was 100.0％.The preoperative MRI findings were in good accordance with the surgical findings.The patients with MRI positive findings had better outcome than the patients with MRI negative findings.Conclusion Preoperative 3T MRI combined with 3D-TOF-MRA and 3D-FIESTA has good sensitivity,specificity and predictive value in primary TN patients who are candidates for microvascular decompression.

鞍结节脑膜瘤多指起源于鞍结节的脑膜瘤，也包括起源于前床突、视交叉沟及鞍隔等部位的脑膜瘤，约占颅内脑膜瘤的5％～10％［1］。因肿瘤位于颅底中线部，位置深在，与视神经、视交叉、下丘脑、颈内动脉及海绵窦等重要结构毗邻，完全切除肿瘤及神经功能保护难度大［2］。2010年1月～2014年6月，我院采用翼点入路和显微神经外科技术切除鞍结节脑膜瘤46例，疗效满意，现报告如下。

Objective To investigate the gene expression of multidrug resistance associated protein (MRP1) and O6-methylguanine-DNA methytransferase (MGMT) in glioblastoma cell lines 8-MG-BA and H4 after incubation with phenytoin (PHT) in vitro.Methods We divided the cultured 8-MG-BA and H4 cells into drug group and control group.Reverse transcriptase-polymerase chain reaction (RT-PCR) and Western blotting were used respectively to observe the alteration of MRP1 and MGMT expression in 8-MG-BA cells after treatment with PHT at different time points (24, 48, and 96 h).Results (1) A specific MRP1 band of 257 bp and a specific MGMT band of 230 bp were visualized by RT-PCR analysis in 8-MG-BA cells, while the protein bands of MRP1 and MGMT also visualized by Western blotting in 8-MG-BA cells.(2) In 5 mg/L PHT group, the expression level of MRP1 mRNA in 8-MG-BA cells decreased in 24 h and 48 h (P ＜ 0.05), and that was raised to a normal level in 96 h (P＞0.05).In 10 and 20 mg/L PHT group, MRP1 mRNA level decreased remarkably in 24 and 48 h, and that had no significant change in 96 h (P ＜ 0.05).The expression level of MGMT mRNA had no significant change in 5 mg/L PHT group (P ＞ 0.05).In 10 and 20 mg/L PHT group, the MGMT mRNA expression was lowered remarkably (P ＜ 0.01).The down-regulation of MGMT mRNA had a PHT dose-dependent manner.(3) The expression of MRP1 and MGMT proteins in 8-MG-BA cells had similar tendency to mRNA after stimulation by PHT.Conclusion PHT can decrease the expression of MRP1 and MGMT genes.The down-regulations of MRP1 and MGMT have a dose-dependent manner.The time that MGMT down-regulated is later than that of MRP1.

目的 总结垂体腺瘤伴Rathke囊肿的临床特征与治疗方法.方法 回顾性分析2例经手术病理证实伴有Rathke囊肿的垂体腺瘤病例资料.结合临床特征、影像学表现、手术治疗以及相关文献进行分析.结果 2例病人均经翼点入路行开颅手术,术后病理结果为垂体腺瘤合并Rathke囊肿.1例术后随访13个月复查MRI示未见肿瘤及囊肿复发,1例术后视力较术前好转.结论 伴有Rathke囊肿的垂体腺瘤临床罕见,鞍区MRI提示垂体腺瘤旁存在囊性信号应考虑合并Rathke囊肿.临床明确诊断依赖于组织病理学观察及免疫组化标记.对于压迫症状明显且伴有Rathke囊肿的垂体腺瘤可手术治疗.

目的 探讨原发性中枢神经系统淋巴瘤(PCNSL)的诊断与治疗方法.方法 2009年1月至2012年12月收治12例PCNSL患者,手术+放疗+化疗6例,手术+放疗1例,活检+放疗+化疗4例,活检+放疗1例.结果 本组仅2例术前诊断为PCNSL.病理学检查示弥漫性大B细胞型非霍奇金淋巴瘤10例,小细胞T细胞淋巴瘤2例.10例患者出院后随访10个月至5年,手术+放疗+化疗5例,生存2～40个月,平均12.4个月;活检+放疗+化疗4例,平均生存11.9个月;活检+放疗1例生存3个月.结论 PCNSL临床表现缺乏特异性,确诊依赖病理学检查;化疗结合放疗是主要治疗手段;部分病例可考虑个体化手术治疗.

Objective To investigate the effect of target-controlled propofol on serum level of S100B protein in patients with severe head injury.Methods Forty patients with severe head injury were randomly divided into routine treatment group and propofo group with twenty cases in each group.All patients had the emergency craniotomy operation.The routine treatment group was only given routine therapy before and after operation,including sedation,dehydration,hemostatic,inflammatory,neurotrophy and supportive therapy; the propofol group was given the basis treatment plus the target-controlled propofol for at least three days after operation.The serum S100B levels were measured before operation,the 1 d,3 d,5 d,7 d after operation.Results The S100B levels in propofo group were significantly decreased in 1 d [(3.19 ±0.25)μg/L],3 d[(2.48 ±0.23)μg/L],5 d [(2.22 ± 0.27) μg/L] and 7 d [(2.00 ± 0.21) μg/L] after operation compared with routine treatment group [(3.23 ±0.20) μg/L,(2.89 ±0.28)μg/L,(2.55 ± 0.26) μg/L,(2.30±0.20)μg/L] (all P＜0.05).Conclusions Propofol of target controlled can effectively reduce the serum S100B levels in severe craniocerebral injury patients after the operation and protect neurocytes.

Objective To study the mechanism of T cell activation mediated by complement regulatory factor CD46 which provides a co-stimulatory signal. Methods Purified CD4+T cells were cultured in the presence or absence of IL-2 under stimulation with CD3 / CD46 or CD3 / CD28. The levels of IL-10,IFN-γ and IL-4 in supernatants were measured with ELISA; proliferation rates were assayed by( 3H-TdR) thymidine incorporation. Results In the presence of IL-2,levels of IL-10 were higher than in absence of IL-2 under stimulation with CD3 / CD46 or CD3 / CD28. When stimulated with middle lever of CD3,the lever of IL-10 was higher under CD46 costimulation than under CD28 costimulation; the lever of IFN-γ was lower under CD46 costimulation and no IL-4 were tested under neither of situation. The proliferation rates were lower under CD46 costimulation. Conclusion CD46 as a new co-stimulatory signal can activate T cells and induce higher IL-10 secretion than traditional signal.

Objective: The suppressive cytokine interleukin-10(IL-10) plays a central role in allergic and autoimmune diseases.Complement regulatory factor CD46 is a newly found costimulatory molecule for T cell activation, and it can induce IL-10 production in CD4+T cells. The other researches showed CD4+CD25+regulatory T cells(CD4+CD25+Tregs) as an important immuno-suppressive cells can induce surrounding cells secreting IL-10 so as to enlarge the suppressive function. This study was to investigate IL-10 production by CD4+CD25-T cells co-cultured with CD4+CD25+Tregs under CD46 costimulation. Methods: Purified CD4+CD25+Tregs and CD4+CD25-T cells were cultured alone or cocultured at a ratio of 1:10 under stimulation with CD3/CD28 or CD3/CD46, undivided CD4+T cells were also cultured under the same condition for comparison. The levels of IL-10, in supernatants were assessed by enzyme-linked immunosorbent assay(ELISA). Proliferation rates were assayed by(3H-TdR)thymidine incorporation. Results: Levels of IL-10 in the supernatants were higher in cocultured CD4+CD25+Tregs/CD4+CD25-T cells and CD4+T cells than in CD4+CD25-T cells alone, either under CD46 or under CD28 costimulation. Under CD46 costimulation, Levels of IL-10 in CD4+CD25-T cells, cocultured cells and CD4+T cells were higher than under CD28 costimulation, the proliferation rates were lower than CD28. Conclusion: Under CD46 or CD28 stimulation,CD4+CD25+Tregs can induce IL-10 secreting in CD4+CD25-T cells, CD46 as a new co-stimulatory signal can activate higher IL-10 secretion than traditional signal. This study revealed the function of CD4+CD25+Tregs in inducing IL-10 production under CD46 costimulation, thus further researches about activation of immune cells under CD46 pathway are important to identified the relationship of the alterations of immune cells through this new pathway with pathogenesis of some disease.

Objective To investigate the concentration of carmustine and teniposidc in glioblastoma cell line 8-MG-BA and H4 after incubated in different concentrations of Phenytoin (PHT)in vitro.Methods After treatment with phenytoin on different concentrations,intracellular concentration of carmustine and teniposide in H4 and 8-MG-BA cell line was determined by high efficiency liquid chromatography method in 60 and 120 minutes.Verapamil was used in control group.We used external standard calibration curve method to make linear regression calculations and the instrument precision and recovery rate of the methods were determined.Results The intracellular concentration of of bis-chloroethyltrosourea (BCNU)and teniposide (VM-26)in H4 cells was significantly higher than that in 8-MG-BA cells in control group (P ＜0.01).After being treated with PHT 5 mg/L,10 mg/L and VRP5 mg/l,the intracellular concentration of BCNU and VM-26 in 8-MG-BA cells was significantly higher than that in control group (P ＜ 0.05).The intracellular concentration of of BCNU and VM-26 in cells treated with PHT 5 mg/L.was significantly lower than that in PHT 10 mg/L treatde group (P ＜ 0.05).When the drug mass concentration was 0.05 to 5 mg/L,there was a good linear relationship between drug concentration and peak area.The recovery of VM-26 was (96 ±5)％,(100±4)％,(99 ±2)％ respectively.The recovery of VM-26 was (100 ± 5)％,(99 ±4)％,(99 ±4)％ respectively.The intra and inter-day RSD were less than 5％ (n =5).Conclusion PHT can increase the intracellrlar concentration of BCNU and VM-26 in 8-MG-BA cells.

目的 研究不同浓度苯妥英钠及维拉帕米对化疗耐药胶质母细胞瘤细胞系( 8-MG-BA)化疗耐药逆转的影响.方法 用不同浓度苯妥英钠对8-MG-BA及H4细胞系处理后,以四甲基偶氮唑蓝(MTT)法检测其对上述两种细胞系化疗耐药逆转的影响,并与维拉帕米处理进行对照.结果 用苯妥英钠5μg/ml、10 μ g/ml和维拉帕米5μg/ml处理后,8-MG-BA细胞对卡莫司汀的逆转倍数分别为25.34、34.97和14.27,对替尼泊苷的逆转倍数分别为13.44、21.71和11.10.结论 苯妥英钠逆转作用大于维拉帕米,且呈现剂量依赖关系.

目的 探讨室间孔区病变的临床特征及显微外科治疗方法.方法 对我科收治经显微外科方法治疗的17例室间孔区病变进行回顾性分析.按病变累及的范围分为三类,结合具体病例采用经皮质-侧脑室入路、胼胝体前入路和经室间孔人路等手术方式进行治疗.结果 病变全切除13例,次全切除3例,部分切除1例:死亡2.例,其中1例死于深部静脉损伤,另1例死于再出血.11例合并有脑积水,2例因急性颅高压并发脑疝先行脑室外引流术;术后6例出现近期记忆障碍.结论 室间孔区病变术前容易合并脑积水,术后并发症多,其中记忆障碍较为明显.