转染绿色荧光蛋白的神经干细胞移植于半横断脊髓损伤处的体内外分化研究

目的 观察转染绿色荧光蛋白(GFP)的大鼠脊髓神经干细胞移植于半横断脊髓损伤处的体内外分化情况.方法 将表达GFP的慢病毒载体转染胎鼠脊髓神经干细胞,体外用10%胎牛血清诱导分化.转染后的神经干细胞与PLGA支架移植于大鼠半横断脊髓损伤处,术后1个月和3个月取材,行GFAP、NF和CNP免疫荧光染色.结果 转染GFP的神经干细胞球表达强烈的绿色荧光,体外分化可见GFAP/GFP、NF/GFP和CNP/GFP双阳性细胞,GFAP/GFP双阳性细胞明显多于其他两种.移植后3个月,GFP阳性细胞在脊髓内明显减少,可见少数GFAP/GFP和CNP/GFP舣阳性细胞,未见NF/GFP双阳性细胞.结论 转染GFP的神经干细胞可在体外增殖和分化,但大部分分化成胶质细胞.移植于急性期脊髓损伤处的神经干细胞不被诱导分化成神经元样细胞,可被诱导分化成神经胶质细胞.     

绿色荧光蛋白标记的大鼠神经干细胞移植于损伤脊髓后的迁移和存活

目的观察神经干细胞在体内的迁移和存活。方法体外培养胎鼠脊髓神经干细胞,用表达绿色荧光蛋白(GFP)的慢病毒载体进行转染,以乙交酯-丙交酯共聚物(PLGA)为支架移植入大鼠T9半横断脊髓损伤处。移植后1个月在荧光显微镜下观察神经干细胞在脊髓内的迁移,并计算其存活率。结果神经干细胞表达强烈的绿色荧光。细胞移植后1个月,在损伤脊髓的头端和尾端都可见GFP阳性细胞,计算出的存活率为(1.4911±0.0313)%。结论GFP标记的神经干细胞移植入大鼠损伤脊髓后向脊髓组织内迁移并有少数存活。     

神经干细胞移植治疗研究进展

神经系统起源于胚胎神经管多能干细胞,而成人中枢神经系统内干细胞样前体细胞的发现为应用神经干细胞(NSCs)治疗各种神经系统疾病提供了前提条件。通过内源性NSCs增殖与迁移治疗各种神经元缺失疾病能力有限,而应用NSCs移植或有特定分化潜能的神经前体细胞移植治疗中枢神经系统损伤以及各种神经退行性疾病则可以促进患者神经功能恢复。目前,NSCs疗法所面临的主要问题是如何使NSCs定向分化替代特定功能的神经元,而NSCs疗法研究的热点是如何在分子水平调控NSCs的分化以及损伤区域NSCs的命运。     

脑膜瘤的易感基因研究进展

脑膜瘤是颅内常见的良性肿瘤,研究发现脑膜瘤的发生与很多因素相关。脑膜瘤的研究应从多基因水平考虑,单核苷酸多态性作为一种新的研究肿瘤基因改变的方法,在脑膜瘤的研究中有重要作用。研究显示一些基因的遗传多态与脑膜瘤发生有一定联系。本文就有关DNA损伤修复基因、叶酸代谢基因、药物代谢基因、细胞凋亡基因等基因多态性与脑膜瘤易感性关系研究进展综述如下。     

N- cadherin, E- cadherin and β- catenin expressions in human brainstem gliomas

Objective To explore the expression and significance of N - cadherin, E - cadherin and β - catenin in human brainstem gliomas. Methods N - cadherin, E - cadherin and β - catenin proteins and mRNA were detected in 38 cases of brainstem gliomas using immunohistochemistry and RT - PCR Methods. Results There was no significant difference in the expression of N - cadherin between grades Ⅰ ～ Ⅱ and grade Ⅲ ～ Ⅳ ( P ＞ 0. 05) . The expression of N - cadherin mRNA in human brainstem gliomas of grade Ⅰ ～ Ⅱ was significantly lower than that in grade Ⅲ～ Ⅳ ( t = 2. 711, P ＜ 0. 05 ). There was no significant difference in the expression of E - cadherin and E - cadherin mRNA between grade Ⅰ ～ Ⅱ and grade Ⅲ～ Ⅳ ( P ＞ 0. 05 ). The expression of β - catenin in human brainstem gliomas of grade Ⅰ ～ Ⅱ was significantly lower than that in grade Ⅲ ～ Ⅳ ( P ＜ 0. 05 ). As regard to β -catenin mRNA, there was no significant difference between grade Ⅰ ～ Ⅱ and grade Ⅲ ～ Ⅳ ( P ＞ 0. 05 ). Conclusions The over -expressionof N - cadherin and β - catenin may play an important role in the invasion and malignant progression of human brainstem gliomas.     

延颈髓髓内室管膜瘤预后相关因素分析

目的 探讨手术治疗的延颈髓髓内室管膜瘤的预后相关因素.方法 对30例手术治疗的延颈髓髓内室管膜瘤病例进行研究并随访,采用KPS评分和改良McCormick分级对手术前后功能进行评价.结果 疼痛为最主要症状,手术可缓解大部分症状;延颈髓髓内室管膜瘤预后与病程显著相关,与年龄、术前KPS评分、肿瘤全切与否、肿瘤长度及放疗等差异无统计学意义;男性预后较差;病理Ⅱ级全切组与近全切加放疗组预后差异无统计学意义.结论 显微外科手术可有效治疗延颈髓髓内室管膜瘤;早期发现、诊断和手术是良好预后的重要因素,未全切者术后行放疗可改善预后.

Abstract：

Objective To analyze the factors affecting the operative prognosis of intramedullary ependymomas in medulla oblongata and cervical cord.Method Thirty patients harboring intramedullary ependymomas in medulla oblongata and cervical cord were operated.The preoperative and postoperative status was taken by follow - up and evaluated by Karnofsky Performance Scale (KPS) and Modified McCormick classification system.Results Pain was one of the most common symptoms which could be relieved by operation; there was no statistic significance of age, gender, preoperative status, radical resection and length of the tumor or radiotherapy, while interval was significantly associated with outcomes.The outcome of male was worse than female.There was no significant difference in postoperative status between patients of WHO Ⅱtreated by complete resection and those treated by incomplete resection and radiotherapy.Conclusions Microsurgery is an effective approach for treating intramedullary ependymomas in medulla oblongata and cervical cord.The early detection, diagnosis and radical resection are the key for good prognosis.Postoperative radiotherapy is a beneficial adjuvant treatment.     

蝶窦海绵窦脑膜瘤术后眼睑下垂相关因素及并发症分析

目的 分析蝶窦海绵窦脑膜瘤显微手术术后眼睑下垂相关因素及并发症.方法 回顾性研究首都医科大学附属北京天坛医院颅底脑干病房从1993年4月到2008年12月的49例蝶窦海绵窦脑膜瘤的治疗情况,对可能导致术后眼睑下垂的危险因素进行Logistic回归分析.结果 男41例,女38例;平均年龄52.4岁;病史平均20.9个月.最常见症状为脑神经损害,MRI发现肿瘤平均最大径为5.09 cm.30例患者采用额颞人路,14例采用额颞断颧弓人路,5例选用眶颧入路切除肿瘤.肿瘤近全切除率52%,死亡率2%.随访到39例患者,平均随访73.7个月,4例随访中死亡,生存的35例患者中,22例正常生活.多因素分析发现,术后眼睑下垂与海绵窦分级、术前KPS评分及既往手术史相关.结论 蝶窦海绵窦脑膜瘤全切困难,术后最常见并发症是动眼神经麻痹,术后眼睑下垂与海绵窦分级、术前KPS评分及既往手术史相关.术后随访发现肿瘤复发可辅助放疗.

Abstract：

Objective To study the surgical results and complications for sphenocavernous (SC)meningioma patients with special reference to postoperative ptosis.Method 49 consecutive cases of SC meningiomas operated between April 1993 and Dec 2008 in our department were reviewed.All the probable risk factors related to postoperative ptosis were studied with Logistic regression analysis.Results There were 38 female and 11 male patients ( mean age 52.4 years, range 31 ～ 74 years).The mean duration of symptoms was 20.9 months( ranging from 1 week to 108 months).Cranial nerves palsy was the most common presenting symptoms.The mean maximal diameter of tumor on MRI was 5.09 cm.Frontotemporal approach was performed in 30 cases,frontotemporal zygomatic approach in 14 cases and frontotemporal orbitozygomatic osteotomy approach in 5 cases.Subtotal resection was achieved in 52% patients.The surgical mortality was 2%.Follow -up data were available for 39 patients,with a mean follow- up of 73.7 months.Four patients died during follow - up period.Of the 35 living patients, 22 lived a normal life.Multi - factors that might influence ptosis after operation included the grading of cavernous extension, pre - operation KPS and the history of surgery for tumors.Conclusions Complete and safe resection of SC meningioma is difficult.Our experience suggests that the most common complication after SC meningioma surgery is ocular CN dysfunction.The factors relative to postoperative ptosis include the extension to cavernous sinus,pre - operation KPS and history of surgery for meningioma.Gamma knife radiosurgery could be considered as an adjuvant therapy only for recurrent tumors during follow - up period.     

脑脊液循环动力学的初步计算机建模分析

目的 应用磁共振相位对比法和计算流体力学软件对脑脊液循环系统进行数值模拟,分析脑脊液循环的动力学特性,并与临床实际相比较.方法 用磁共振相位对比法测定2例正常人的中脑导水管脑脊液流速,并利用临床磁共振扫描图像建市脑脊液循环系统的数值模型,用Matlab软件及Enguage软件提取脑脊液循环系统的轮廓并进行网格划分,然后应用COMSOL Muhiphysics软件进行脑脊液循环系统数值模拟及脑脊液动力学分析.结果 通过模拟软件能模拟脑脊液循环存在的与心动周期相关的有规律的双向流动,表现为心脏收缩期向足侧流动,舒张期向头侧流动,各时相期计算出的速度与我们用磁共振相位对比法测定的在体速度相一致.同时脑脊液循环系统的数值模型能够计算得到颅内压力梯度、脑和脊髓组织固体应力等.结论 脑脊液循环系统的计算机建模分析能无创性得到脑脊液循环的各项动力学量化指标,计算所得与临床实际相符合.本模型为进一步研究一些中枢系统疾病如交通性脑积水、Chiari畸形、脊髓空洞症等的脑脊液动力学机制奠定了基础.     

颅咽管瘤的治疗现状

颅咽管瘤是一种先天性肿瘤,约占颅内肿瘤总数的1.2%~4.6%。尽管颅咽管瘤在WHO肿瘤分级中为I级,但其生物学行为经常表现为侵袭性,且由于其位置深在,与下丘脑-垂体轴、视神经、视交叉等重要结构毗邻而使手术全切除十分困难,以至其临床治疗效果不佳,易复发。肿瘤切除程度,肿瘤大小,肿瘤钙化情况等诸多因素均与CP复发相关;目前对于复发颅咽管瘤的治疗措施包括再次手术,手术+放射治疗,放射治疗,化学治疗等方案。     

ChiariⅢ型畸形一例报告并文献复习

目的 报告1例ChiariⅢ型畸形病例成功治疗经验并复习文献.方法 通过神经系统检查和MRI检查确诊,行枕下后正中入路脑膨出修补术,延颈髓栓系松解术,第四脑室出口再造术.结果 患儿术前症状改善,术后1年随访恢复良好.结论 选择合适的手术时机,手术方法得当,Chiari Ⅲ型畸形可取得较好预后.