目的 探讨脑卒中后抑郁大鼠海马区脑源性神经营养因子(BDNF)表达与神经行为的相关性.方法 60只大鼠随机均分为模型组与对照组,模型组建立了脑卒中后抑郁模型,对照组以假手术代替.记录大鼠的造模情况与神经行为状况,检测海马区BDNF表达水平并进行相关性分析.结果 对照组在实验过程中无死亡情况,模型组建模成功25例,成功率为83.3％;模型组大鼠造模后7d、28 d的神经功能缺损评分都高于对照组,对比差异均有统计学意义(P＜0.05);模型组大鼠造模后7d、28 d的体质量都显著低于对照组(P＜0.05),模型组大鼠造模后7d、28d的血清白介素(IL)-6与C-反应蛋白(CRP)值都显著高于对照组(P＜0.05),模型组大鼠造模后78 d的海马区BDNF相对表达水平显著低于对照组(P＜0.05);模型组大鼠海马区BDNF相对表达水平与神经功能缺损评分存在负相关性(r=-0.562,P=0.000).结论 脑卒中后抑郁大鼠海马区BDNF表达水平呈现下降的趋势,也伴随有炎症因子的大量释放,与大鼠的神经行为有显著相关性.

目的:探讨活血化痰胶囊对血管性痴呆大鼠海马区Bcl-2表达的影响.方法:建模成功的54只血管性痴呆大鼠随机分三组,模型组、西药组与中药组,各18只.西药组与中药组分别给予多奈哌齐、活血化痰胶囊0.77 mg/kg灌胃,模型组以等剂量的生理盐水代替,三组给药时间都为21 d,记录大鼠海马区Bcl-2表达情况.结果:中药组、西药组给药后7、14、21 d的逃避潜伏期都低于模型组,中药组也低于西药组,相比较组间差异均有统计学意义(P<0.05).中药组海马区域细胞排列比较紧密,仅见少数细胞变性、坏死,胞浆内尼氏体比较丰富.中药组、西药组给药后21 d的SOD活性高于模型组,MDA活性低于模型组,相比较组间差异均有统计学意义(P<0.05),中药组与西药组比较差异有统计学意义(P<0.05).中药组、西药组给药后21 d的Bax、Bcl-2蛋白相对表达水平高于模型组,中药组高于西药组,相比较组间差异均有统计学意义(P<0.05).结论:活血化痰胶囊在血管性痴呆大鼠中的应用能促进海马区Bcl-2表达,缓解氧化应激反应,促使大鼠具有更好的学习记忆能力.

目的 探讨下调GABA受体基因对癫痫模型大鼠海马神经细胞凋亡的影响及作用机制.方法 选择30只SD健康雄性大鼠,建立癫痫模型,建模成功后分为模型组 、上调组 、下调组各10只;进行细胞转染建立稳定转染的GABA上调组 、GABA下调组;检测3组大鼠海马神经细胞凋亡及PI3K、AKt、mTOR、Bax、Caspase-3蛋白表达水平.结果 上调组大鼠各时间点海马神经细胞凋亡率高于模型组(P<0.05);下调组大鼠各时间点海马神经细胞凋亡率低于模型组(P<0.05);下调组大鼠各时间点海马神经细胞凋亡率低于上调组(P<0.05).上调组大鼠各时间点海马神经细胞增殖率 、Bcl-2、p-PI3K、p-AKt、p-mTOR蛋白表达水平均低于模型组,而Bax、Caspase-3蛋白表达水平高于模型组(P<0.05);下调组大鼠各时间点海马神经细胞增殖率 、Bcl-2、p-PI3K、p-AKt、p-mTOR蛋白表达水平均高于模型组,而Bax、Caspase-3蛋白表达水平低于模型组(P<0.05);下调组大鼠各时间点海马神经细胞增值率 、Bcl-2、p-PI3K、p-AKt、p-mTOR蛋白表达水平均高于上调组,而Bax、Caspase-3蛋白表达水平低于上调组(P<0.05).结论 下调GABA受体基因可能是通过调节PI3K/AKt/mTOR来作用于下游凋亡靶基因,最终抑制癫痫模型大鼠海马神经细胞凋亡.

神经元核内包涵体病是一种神经系统退行性疾病,具有临床异质性,国内罕见报道,我们报道1例散发性成人型神经元核内包涵体病的临床、影像和病理资料,以期提高临床医师对该病的认识。

目的 探讨僵蚕天南星方对大鼠急性缺血性脑水肿基质金属蛋白酶2(MMP-2)表达的影响及其作用机制.方法 将SD雄性大鼠随机分为假手术组、模型组、僵蚕天南星方组,除假手术组外,其他2组采用线栓法制备大脑中动脉缺血再灌注模型,采用免疫组织化学法、RT-PCR法观察各组大鼠缺血2h再灌注24 h、48 h、72 h、96 h大脑皮质中MMP-2的表达情况.结果 模型组及僵蚕天南星方组再灌注各时间点MMP-2阳性细胞数明显多于假手术组(P均＜0.05),僵蚕天南星方组再灌注各时间点MMP-2阳性细胞数明显少于模型组(P均＜0.05);模型组再灌注各时间点MMP-2mRNA表达量均明显高于假手术组(P均＜0.05),僵蚕天南星方组再灌注各时间点MMP-2mRNA表达量明显低于模型组(P均＜0.05).结论 僵蚕天南星方可能通过抑制MMP-2的表达而减轻脑水肿,改善大鼠缺血性脑损伤.

目的 观察脐血间充质干细胞(UCBMSCs)对脑梗死大鼠脑内NGF、BDNF表达及神经功能的影响.方法 实验分假手术组、对照组、移植组,采用颈内动脉线栓法制作脑梗死大鼠模型,移植组于成模后1d、4d经尾静脉移植2×106 UCBMSCs,假手术组和对照组尾静脉注射等量PBS,移植后7d、14d进行神经功能评分,3d、7d、14d免疫组织化学法分别计数梗死灶周边区域NGF、BDNF表达阳性细胞数.结果 移植后3d对照组、移植组脑内NGF、BDNF表达阳性细胞数明显高于假手术组,移植组明显高于对照组,7d、14d逐渐下降,14 d时两组比较无明显差别,大鼠神经功能较对照组改善不明显.结论 脑梗死后早期移植UCBMSCs促进脑内神经营养因子的表达,但神经功能修复作用有限.

目的 探讨颅内微小破裂动脉瘤血管内治疗的技术可行性和临床疗效.方法 回顾性分析我院2007年10月～2012年3月共收治的10例颅内微小动脉瘤性急性蛛网膜下腔出血患者行血管内治疗病例,其中颈内动脉床突上段动脉瘤1例,后交通动脉瘤4例,前交通动脉瘤2例,大脑中动脉瘤1例,椎动脉瘤1例,小脑后下动脉瘤1例；行单纯可脱性微弹簧圈动脉瘤囊内栓塞8例,对其中的宽颈动脉瘤辅以血管支架、球囊辅助的瘤颈成形技术完成治疗2例.结果 9例行可脱性微弹簧圈动脉瘤囊内栓塞病例,达完全致密栓塞8例,1例患者瘤颈有很小的部分残留为95％栓塞,在随访期间保持稳定；其中1例置入支架的颈内动脉床突上段动脉瘤,术后半年复查,未发现支架移位；本组病例无1例死亡.结论 血管内治疗颅内破裂微小动脉瘤是可行和有效的,是外科颅内动脉瘤夹闭术的一种有效替代方法.

适应新形势下医院临床教学的需要,抓好临床教学各环节质量控制是保证临床医学教学任务顺利完成及保证教学质量的基本条件。环节质量控制内容为:健立健全教学组织与教学管理制度;高素质的师资队伍;良好的教学环境;多种形式的教学方法;注重教学改革和信息反馈。

目的观察脐血间充质干细胞(UCBMSCs)对脑梗死大鼠神经功能及神经细胞凋亡的影响。方法实验分假手术组、对照组、移植组,采用颈内动脉线栓法制作脑梗死大鼠模型,移植组于成模后1 d、4 d经尾静脉移植2×106UCBM-SCs,假手术组和对照组尾静脉注射等量PBS,移植后7 d、14 d进行神经功能评分,TUNEL法测定脑组织凋亡细胞数。结果 UCBMSCs移植后7 d、14 d脑梗死大鼠神经功能较梗死组改善不明显,但神经细胞凋亡数减少。结论脑梗死后早期移植UCBMSCs促进神经功能恢复作用有限。

目的 探讨血清C反应蛋白与脑梗死病情严重性及预后的关系,进而了解辛伐他汀对脑梗死患者血清CRP水平及预后的影响.方法 采用随机、双盲对照的方法进行研究,将96例脑梗死患者分为对照组及辛伐他汀组.治疗前后检测血清CRP.结果 治疗后他汀组CRP水平下降,治疗前后的差值与对照组相比,差异有显著性(P<0.01).结论 脑梗死患者血清CRP水平与病情的严重性及预后相关,短期应用他汀类药物可以降低脑梗死患者血清CRP水平.

【Objective】 To explore clinical curative effect and security of urokinase in the early thrombolysis treatment of acute cerebral infarction. 【Methods】96 patients with acute cerebral infarction were randomly divided into two groups: in experimental group, 50 patients received early thrombolysis of urokinase, in control group, 46 pa-tients received conventional therapy for 14 days.The mean gap scores between pre-and posttherapic neurologic im-pairment degree score(NDS), basic cure rate, total effective rate, average stay and blood clotting functional parame-ters and so on were comparatively analyzed. 【Results】NDS rapidly decreased in experimental group and gradually decreased in control group (P 0.01). The basic cure rate and total effective rate in experimental group surpassed those in control group (P 0.05). The average stay in experimental group was shorter than that in control group (P 0.01). The blood clotting functional parameters showed a slight deterioration (P 0.05) but no severe hemorrhagic complication occurred in experimental group,and no significant changes occurred in control group (P 0.05). 【Con-clusion】Large dose of urokinase in the early thrombolysis treatment of acute cerebral infarction is effective and rel-atively safe.

Objective To explore the clinical curative effect of the management in stroke unit (SU) on the patients with cerebral infarction. Methods 370 inpatients with cerebra1 infarction,who were hospitalized in our hospital from June 2004 to December 2007,were randomly divided into stroke unit (SU) group and non-stroke unit group (general ward group) for the management respectively. The kev indexes recorded included hospital mortality,total effective rate,average stay,National Institutes of Health Stroke Scale (NIHSS),Barthel Index (BI),Oxford Handicap Scale (0HS). Results Hospital mortality in SU group and non-SU group was 5.94% and 14.29% and total effective rate was 88.61% and 79.76%,respectively. There was significant difference between the two groups on the two indexes above-mentioned (P 0.01). The average stay in the two groups was (17.50±7.35) d and (16.89±7.20)d,respectively. No significant difference existed between the two groups (P 0.05). There was significant difference in mean gap scores between the day of admission and discharge in NIHSS,BI and OHS (P 0.05). It was approved that SU group surpassed non-SU group in the indexes. Conclusion SU management mode excels general ward management mode in the treatment of cerebra1 infarction inpatients.

目的 评价依达拉奉对急性脑梗死的临床疗效并探讨其机制.方法 急性脑梗死患者随机分为两组:对照组30例,采用常规治疗及奥扎格雷80 mg静滴,1次/d,共14 d;依达拉奉(EDA)组30例,在对照组基础上加用EDA 30 mg+生理盐水100 ml静滴,2次/d,共14 d.测定治疗前、治疗后7、14 d血浆一氧化氮(NO)、丙二醛(MDA)含量,治疗前、治疗后7、14、21 d分别进行NIHSS、BI评分.结果 EDA组第7天、14天血浆NO、MDA浓度与对照组比较明显下降(P＜0.05),第14、21天 NIHSS、BI评分亦高于对照组(P＜0.05),梗死体积明显减小(P＜0.05).结论 早期使用EDA可以显著改善急性脑梗死患者神经功能.

目的研究卒中单元对脑出血住院患者的影响。方法自2004年1月到2005年4月我院住院的急性脑出血患者共118例,符合入选标准者随机进入卒中单元和普通病房。观察指标是病死率、住院费用、6个月总医疗费用、住院时间、社会功能评价﹙OHS﹚、生活能力评价﹙BI﹚、神经功能评价﹙NIHSS﹚,综合分析卒中单元的效果。结果卒中单元与普通病房相比病死率、复发率、6个月总医疗费用、住院时间降低,康复率增加,但日住院费用增加。结论卒中单元与普通病房相比能显著提高患者生活质量、改善愈后和减轻患者家庭负担。

目的 评价卒中单元模式对急性脑梗死患者早期疗效的影响.方法急性脑梗死患者共106例,随机进入卒中单元(n＝53)和普通病房(n＝53),治疗前后定期进行神经功能(NIHSS)、生活能力(BI)、社会功能(OHS)评分,观察住院期间病死率、并发症发生率、住院费用、住院时间及治疗措施,出院时由患者或亲属填写满意度(VAS)评分.结果与普通病房比较,卒中单元显著改善NIHSS、BI、OHS评分,降低病死率、并发症发生率,缩短住院时间,满意度明显提高.卒中单元组早期康复比例、康复强度高于普通病房.人均住院费用和日平均住院费用卒中单元显著高于普通病房,但费用效益分析表明,卒中单元优于普通病房.结论卒中单元显著提高急性脑梗死患者早期疗效。

Objective To explore the relationship between the intelligence condition and the content of γ-aminobutyric acid (GABA) in cerebrospinal fluid (CSF) in epileptic patients.Methods We measured the Intelligence Quotient (IQ) of 40 cases of epileptic patients by using the Wechsler Intellectual Scaled, and tested their CSF-GABA contents by using HPLC.At the same time, factors which might have influence on patient’s IQ were analysed.Results In the 40 cases of epileptic patients, there were 14 cases of patients with FIQ≤89, and occupied 35%.The intelligence condition of epileptic patients was positive relation with the contents of CSF-GABA, education background and patterns of seizure,but was negative relation with the patient's age. Among all factors, content of CSF-GABA was very significant relationship with VIQ, PIQ and FIQ (P0 01,P0 05). CSF-GABA content in the group of intelligence disturbance patients was significantly lower than that in the group of normal intelligence patients.Conclusion The content of CSF-GABA could reflect in some degree the intelligence condition of the epileptic patient,which may provide us with objective evidence for clinical judgement, treatment and prevention of intelligence disturbance in epileptic patients.

Objective To analyze the clinical determination and mechanism of poststroke dementia.Methods 186 consecutively hospitalized patients who at admission after stroke,completed clinical valuation of neural-functional defect and intelligence assessments,and head CT scan.Their intelligene performances were assessed again after three months .Results Frequency of poststroke dementia was 32 5% .Poststroke dementia was related to age,level of education,residential area,hypertension ,hyperlipidemia,the location and severity of stroke,history of coronary heart disease and diabetes.But it unrelated to sex,smoking,alcohol drinking and type of stroke.Conclusions Dementia is frequently occurred after stroke,and multiple risk factors contribute to its occurrence

Esculentoside A (EsA) is a kind of saponin isolated from Phytolacca esculenta Van Houtte. It was shown to significantly inhibit phagocytic activity, intracellular and extracellular production of interleukin-1 by thioglycollate primed murine peritoneal macrophages in vitro at the concentration 0.01-1.0 mumol.L-1. In vivo experiments showed that EsA 2.5-5 mg.kg-1 markedly decreased serum hemolysin concentration in sensitized mice challenged with sheep red blood cells. Inhibition of antibody production by B lymphocytes, phagocytosis and the production of inflammatory mediators by macrophages may partially explain the wide and strong anti-inflammatory effect of EsA.