听神经瘤术中面神经电生理监测的问题与对策

Objective To explore the solutions to some problems of intraoperative facial nerve monitoring during operation for acoustic neuroma and evaluate the function of anatomically preserved facial nerve. Methods The tumors were resected with suboccipital retrosigmoid approaches under microscope in 25 cases. Intraoperative monitoring was used to protect facial nerve and evaluated its function. Results Total removal was achieved in 25 patients( 100% ). The facial nerve was preserved anatomically in 23 cases(92% ),H - B Grade Ⅰ～Ⅱ in 19 cases, Grade Ⅲ～Ⅳ in 5, Grade Ⅴ～Ⅵ in 1. Stimulative intensity at the end of tumor resection was related to the function of facial nerve, and the lower was the better. The function of facial nerve might be Ⅰ～Ⅱ grade when stimulative intensity was lower than 0. 5 mA, and facial electromyograph response amplitudes was greater than 100 μV. The function of facial nerve was not ideal when stimilative intensity was above 2 mA and response amplitude was not clear. Conclusions Skilled technique of intraoperative facial nerve electrophysiologic monitoring can obviously increase the rate of anatomical and functional preservation of facial nerve, and quantitative analysis of electromyogram may help to evaluate its postoperative function.     

131I-Anti-EGFRv Ⅲ的制备及对U87胶质瘤细胞的放射免疫效应

目的 研究放射性核素碘(131I)标记表皮生长因子受体Ⅲ型突变体单克隆抗体IgG(Anti-EGFRvⅢ)的方法及放射免疫活性,观察标记产物131I-Anti-EGFRvⅢ对U87胶质瘤细胞的生物学效应.方法 利用Iodogen法标记131I至Anti-EGFRvⅢ,测定放化纯度、标记率、比活度、稳定性.经体外细胞结合试验分析131I-Anti-EGFRvⅢ的免疫活性,通过MTT法检测放射免疫效应.结果 131I-Anti-EGFRvⅢ放射化学纯度>90%,24、48、72 h放射性化学纯度依次为91.25%、90.74%和89.88%.标记率为64.56%,比活度为0.56 MBq/μg.131I-Anti-EGFRvⅢ与U87细胞结合率为41.69%,1.110 MBq 131I-Anti-EGFRvⅢ即有最大抑制细胞生长效应,随着时间延长,抑制效应更加明显.结论 Iodogen法标记131I-Anti-EGFRvⅢ具有较好的放射免疫活性,体外能够有效抑制U87胶质瘤生长.     

疑似肾性血小板减少症(可能的新疾病)多例及脑及艾滋病研究——溶血性尿毒综合征、CPM文献重新分析及其它

目的为优化血小板减少的鉴别诊断,论证临床中肾性血小板减少症的存在;方法重新分析溶血性尿毒综合征(HUS)等文献病例的客观资料,寻找肾性血小板减少症存在的证据;结果从"HUS"文献中发现疑似肾性血小板减少症数例,另外5篇文献的总计91例尿毒症并发肾性贫血患者,经我们分析约半数疑似肾性血小板减少;结论肾性血小板减少症(以肾脏分泌血小板生成素减少为主要原因)理论上推测其存在,实践上有我们揭示的临床病例群支持,应该是存在的;但尚未见我们之外的文献提出。此外,(1)对感染后溶血性尿毒综合征患者加用"血必净"可能取得更好疗效;(2)艾滋病治疗可采用编辑造血干细胞CCR5基因后回输体内的方法;意识内容的物质载体可能是暗能量;丘脑可能是意识内容的整合中枢;腺苷及其受体可能是神经-内分泌网络的交汇点;纹状体有可能有促进震颤症状的功能;(3)加州大学脑桥中央髓鞘溶解症(CPM)文献及北京协和医院文献漏诊急性梗阻性化脓性胆管炎;武汉大学人民医院CPM文献漏诊Wernicke脑病。     

神经干细胞原代培养方法的优化

Objective To study the influence of digestion times of low concentration trypsin on the proliferation and apoptosis of neural stem cells (NSCs) in the hippocampus of neonate rats.Methods Hippocampus of neonatal rats (within 24 h) were taken out, and treated with trypsin at 1.25g/L concentration and 37 ℃ for 5, 10, 15, 20 and 25 minutes; unicellular suspension was then successfully got and primary culture and subculture were performed. Effects of trypsinization on cell viability and growth of NSCs were compared by observing the cell morphology and Trypan blue staining.The 5-bromodeoxyuridine labeling was performed to assess the self-renewing and proliferative activities of NSCs. Fluorescence immunocytochemistry was carried out to examine the expressions of BrdU and nestin. Apoptosis was measured by Annexin V-FITC/PI assay and flow cytometry. Results Primary and passage culture of NSCs enjoyed rapid proliferation and formation of neurospheres. The neurosphere cells expressed NSCs specific marker nestin by immunofluorescence; all the neurosphere cells could incorporate BrdU into the nucleus; of the neurospheres obtained from the 3rd, 5th and 7th d, those digested for 15 rain enjoyed the highest level of NSCs neurospheres, the highest BrdU labeled clone and the lowest cell apoptosis as compared with those digested for 5, 10, 20 and 25 min (P<0.05). Conclusion The NSCs isolated from the hippocampus of neonatal rats have the ability of proliferation in vitro. And 1.25 g/L concentration of trypsin with digestion times could positively change the proliferative and apoptosis capacity of NSCs: too short or long digestion times can inhibit the proliferation of NSCs and induce the apoptosis of NSCs; the longer the digestion time, the higher the apoptosis of NSCs.     

组织蛋白酶D在星形细胞瘤中心区、周缘区和水肿区的表达情况

目的 探讨组织蛋白酶D(CathD)在人脑星形细胞瘤瘤体中心区、周缘区和瘤周水肿区的表达情况及临床意义.方法 选择核磁共振检查未见肿瘤坏死或囊变且瘤体区与水肿区有明显分界的41例星形细胞瘤患者,分为复发组13例、未复发组28例.术中对照磁共振FLAIR序列留取瘤体中心区、周缘区和水肿区后行CathD免疫组化染色,对其在不同区域表达水平进行分析.结果 CathD在正常脑组织无或弱表达,其在瘤体中心区、瘤周水肿区和周缘区呈阳性表达,且周缘区[(10.780±1.557)分]高于中心区[(2.610±0.945)分],差异有统计学意义(P<0.05).在瘤体周缘区复发组CathD表达[(11.539±1.127)分]强于未复发组[(10.429±1.620)分],差异有统计学意义(P<0.05),而在瘤体中心区复发组与未复发组CathD表达差异无统计学意义(P>0.05).结论 周缘区和水肿区CathD明显表达提示瘤周水肿区可能是瘤细胞易于发生浸润的区域:中心区CathD相对低表达说明该区细胞外基质已被降解殆尽,是肿瘤侵袭较早发生的区域;周缘区和水肿区CathD表达情况可作为一种判断肿瘤复发的指标.     

脉络丛肿瘤临床特点分析

目的总结脉络丛肿瘤（CPT）的临床特点和诊治经验。方法本组31例CPT中，28例为脉络丛乳头状瘤，3例为脉络丛癌．全部行显微手术治疗。结果肿瘤全切24例，次全切除6例，大部分切除1例，无手术死亡病例。术后9例患者复查CT示脑积水改善不明显。结论脑积水是CPT的突出表现，与肿瘤大小及性质不一致，手术缓解率不高。虽然脉络丛肿瘤大多为慢性起病．但仍有少数表现为急症。     

颅咽管瘤侵袭第三脑室的方式对手术切除的影响

Objective To assess the impact of the positional relationship between the large craniopharyngiomas and the third ventricle on the outcome of surgical resection of the tumors. Methods In 72 cases of craniopharyngiomas, the tumors were classified into two types according to the radiographic and surgical findings defining the relationship between the tumors and the third ventricle. For each type of tumors, 3 grades were classified based on the tumor size, texture, and infiltration pattern of the third ventricle. The extend of tumor removal was confirmed by both intraoperative evaluation and postoperative CT or magnetic resonance imaging. The correlation between the degree of hypothalamus invasion and the extend of tumor removal was analyzed in all the cases. Results The craniopharyngiomas were classified into two types, namely those residing in the third ventricle (7 cases) and those invading the third ventricle(65 cases). The degree of tumor resection was significantly different between the 3 grades: total tumor removal was achieved in 95.7% of grade Ⅰ cases, in 80.0% of grade Ⅱ cases, and in only 47.4% of grade Ⅲ I cases (P<0.05). conclusion Understanding of the anatomical relationship of the tumor to the third ventricular floor can be great value for improving the outcome of surgical resection of large craniopharyngiomas.     

端粒酶反义寡核苷酸聚氰基丙烯酸丁酯纳米粒抑制脑胶质瘤细胞SHG44的研究

目的 观察端粒酶反义寡核苷酸聚氰基丙烯酸丁酯纳米粒(hTERT ASODN-PBCA-NP)体外对脑胶质瘤SHG44细胞的抑制作用.方法 制备的hTERT ASODN-PBCA-NP体外转染SHG44细胞,观测对细胞生长的作用以及端粒酶蛋白、hTERT mRNA表达的影响.结果 转染后48 h,空白对照组、NP组、SODN-NP组、ASODN组hTERT mRNA表达的相对值分别为2.23±0.12、2.31±0.14、2.33±0.16、2.15±0.13,端粒酶蛋白表达阳性率分别为(94.6±1.3)%、(93.2±3.1)%、(93.7±2.6)%、(87.4±3.3)%;ASODN-NP组分别为1.45±0.11、(53.14-1.8)%,与对照各组比较,表达差异有统计学意义(P<0.01).结论 PBCA-NP为载体介导的hTERT-ASOND可以进入SHG44细胞内部,阻断hTERT mRNA的表达,抑制细胞生长.     

硬脊膜动静脉瘘误诊分析

目的 探讨如何避免误诊硬脊膜动静脉瘘。方法 回顾分析3例误诊的硬脊膜动静脉瘘的临床表现，误诊原因及治疗结果。结果 1例误诊为腰椎间盘突出，2例误诊为前列腺肥大，不仅延误了诊断，还因误治加重了神经功能损害或导致正常器官损害。结论 仔细询问病史和查体，适时行脊髓MRI检查是避免误诊的关键。