彩色超声对重型颅脑损伤术中急性脑膨出的诊断及治疗价值

目的 探讨彩色超声对重型颅脑损伤术中急性脑膨出的诊断及治疗价值.方法 回顾性分析2013-12至2018-12武警北京总队医院和武警四川总队医院收治的32例重型颅脑损伤术中发生急性脑膨出患者的临床资料,术中采取超声检查的方法,诊断脑膨出的病因及进一步指导手术治疗方案.观察记录术中超声诊断脑膨出的病因类别、部位特点(包括...     

超声引导脑电监测在脑动静脉畸形继发癫痫手术中的应用

目的 探讨超声引导联合皮层脑电图(ECoG)监测在脑动静脉畸形(cAVM)继发癫痫显微手术治疗中的作用和价值。 方法 回顾性分析显微手术治疗的18例cAVM继发癫痫患者的临床资料,术中均采用超声引导及ECoG监测的方法指导cAVM完全切除及致痫灶切除。 结果 术中超声能清晰显示cAVM血管团位置、边界及cAVM的供血动脉、引流静脉情况,指导cAVM血管团完整切除,也有效发现手术残余从而指导补充切除,最终达到cAVM血管团完全切除;术中ECoG可监测到cAVM周围及其远隔部位的痫性放电,有效指导致痫灶合理化处理以减少脑功能的损伤。本组病例术后随访≥2年,无神经功能障碍,癫痫无发作,按照Engel的疗效判断标准,均为EngleⅠ级。 结论 术中超声引导可准确定位cAVM且能判定其供血动脉及残余情况,指导完整切除;ECoG监测确定致痫灶,进一步指导切除范围。二者联合应用能够有效减少脑组织损伤、减少手术并发症,显著提高癫痫治疗效果。     

显微血管减压术治疗原发性三叉神经痛的疗效及技术改进

 目的 总结显微血管减压术治疗原发性三叉神经痛的疗效,并对手术进行部分改进。方法 选择2012-02至2015-12在武警北京总队医院采取显微血管减压术治疗三叉神经痛的76例,针对术中部分患者出现显露不良的情况,对手术探查入路及并发症的预防方法进行改良。结果 76例中,治愈65例,缓解11例。缓解的11例中,恢复性治疗1个月后,8例疼痛消失,3例无效。手术总有效率为96%。在所有患者术后随访中无神经功能缺失症状,未发生明显的并发症。结论 显微血管减压术是治疗原发性三叉神经痛的安全有效方法,通过手术方法的改进有利于提高手术治疗的有效率,并可以最大限度减少并发症发生。     

幕上胶质瘤伴癫痫临床治疗效果分析

目的比较肿瘤全切除术与次全切术对幕上胶质瘤伴癫痫的治疗效果。方法我院2010-06—2014-06收治的60例幕上胶质瘤伴癫痫患者为研究对象,根据不同术式将其分为全切组(n=40)与次全切组(n=20),术后随访3~12个月,比较2组癫痫预后控制效果,另外,比较术中致痫灶处理与否癫痫控制满意率。结果全切组癫痫控制有效率87.5%,高于次全切组的75.0%,但无显著差异(P0.05)。肿瘤全切、次全切术中致痫灶处理后癫痫控制满意率分别为87.0%、81.8%,显著低于致痫灶未处理的58.8%、33.3%,差异有统计学意义(P0.05)。结论肿瘤全切除术与次全切除术治疗母幕上胶质瘤伴癫痫疗效无显著差异,但术中致痫灶处理能明显提高癫痫控制满意率。     

重型颅脑损伤继发肺部感染患者血清胆碱酯酶和肿瘤坏死因子α水平的临床意义

目的探讨重型颅脑损伤继发肺部感染患者血清胆碱酯酶(ChE)、肿瘤坏死因子α(TNF-α)水平的临床意义。方法选取2012年3月至2019年4月武警北京市总队医院收治的重型颅脑损伤继发肺部感染患者80例作为疾病组,选取同期体检健康人80例作为健康组,检测两组血清ChE、TNF-α水平;根据临床肺部感染评分(CPIS)将疾病组分为两个亚组:轻度组(CPIS≤6分),重度组(CPIS>6分),比较两组患者血清ChE、TNF-α水平,分析两者与重型颅脑损伤继发肺部感染严重程度的相关性及诊断价值。结果疾病组血清ChE、TNF-α水平与健康组比较,差异有统计学意义(P<0.05)。重度组血清ChE水平低于轻度组,TNF-α水平和临床肺部感染评分(CPIS)高于轻度组。经Spearman相关分析,疾病组患者血清ChE水平与CPIS评分呈负相关(r=-0.438,P<0.001);TNF-α水平与CPIS评分呈正相关(r=0.216,P=0.028)。ROC曲线分析显示,血清ChE、TNF-α联合诊断重度颅脑损伤并发肺部感染严重程度的曲线下面积(AUC)为0.893高于单一指标。结论重型颅脑损伤继发肺部感染患者血清ChE、TNF-α水平异常变化;随着感染加重ChE水平有所降低,TNF-α水平升高,两者联合可帮助评估患者感染的严重程度。     

骨髓间充质干细胞体外对1型糖尿病大鼠淋巴细胞的免疫调节作用

目的 观察骨髓间充质干细胞(MSCs)体外对1型糖尿病(T1DM)大鼠淋巴细胞表型及增殖能力的影响,探讨其抑制淋巴细胞增殖的机制.方法 分离、培养和鉴定大鼠MSCs,噻唑蓝(MIT)比色法观察该细胞对淋巴细胞增殖能力的影响,应用流式细胞术分析MSCs对植物血凝素(PHA)作用下淋巴细胞凋亡,周期水平和CD4+CD25+调节性T细胞亚群(CD4+CD25+Tregs)比例的影响.结果 大鼠MSCs表型为CD29+、CD90+、CD106+、CD34-、CD45-,对PHA刺激的淋巴细胞增殖有抑制作用,以淋巴细胞:MSCs为1∶1时(C组)抑制作用最强;共培养体系中,大部分淋巴细胞处于G0/G1期;C组淋巴细胞凋亡水平(58.05±0.89)%显著高于对照组(43.35±0.86)%(P＜0.05);CD4+CD25+Tregs的比例C组(22.76±1.15)%显著高于对照组(5.80±0.68)%(P＜0.05).结论 MSCs体外可显著抑制PHA刺激的T1DM大鼠淋巴细胞的增殖,其机制与CD4+CD25+Tregs比例增高密切相关.

Abstract：

Objective To observe the effects of bone marrow mesenchymal stem cells (MSCs) on the lymphocytes of rats with type 1 diabetes mellitus (T1DM) in vitro, and investigate the inhibitory effect of MSCs on lymphocytes proliferation and the underlying mechanism. Methods MSCs were isolated from SD rats, cultured in vitro, purified and then identified by testing the phenotypes with flow cytometry (FCM). The third-generation MSCs were planted in 24-well plates. After treated with mitomycin C, MSCs were co-cultured for 72 h with the T1 DM rat's lymphocytes activated by phytohemagglutinin (PHA). The proliferation of lymphocyte was measured by methyl thiazol tetrazolium (MTT) method. FCM analysis was done to investigate the apoptosis, cell cycle and the proportion of CD4+ CD25+ regulatory T cells of the T1 DM rat's lymphocytes after co-cultivation. Results The phenotypes of MSCs from normal SD rats were CD29 + , CD90 +, CD106 + , CD34-, CD45 -. MSCs obviously inhibited the lymphocyte proliferation stimco-culture system, most of the lymphocytes were arrested at G0/G1 phase. The apoptosis rate of lymphocytes (58.05 ± 0. 89)% in group C was increased significantly as compared with the control group (43.35± 0.86 ) % ( P ＜ 0. 05 ) as well as the proportion of CD4 + CD25 + regulatory T cells (22.76 ± 1.15 ) % vs (5.80 ± 0. 68) %. Conclusion In vitro, MSCs can obviously inhibit the T1 DM rat' s lymphocytes proliferation stimulated with PHA via increasing the proportion of CD4 + CD25 + regulatory T cells.     

SDF-1/CXCR4轴在骨髓间充质干细胞移植促进胰岛再生中的作用

目的 观察同种异体骨髓间充质干细胞(MSCs)移植入受体后,基质细胞衍生因子(SDF)-1/CXCR4轴在促进残存胰岛及其周围新生血管增殖中的作用.方法 对大鼠MSCs进行体外培养、鉴定.链脲佐菌素(STZ)诱导的糖尿病大鼠随机分为A组(MSCs移植组)、B组(MSCs移植+SDF-I/CXCR4轴阻断剂AMD组)和C组(糖尿病对照组),另设D组(正常大鼠对照组).移植MSCs后第30天取出各组大鼠胰腺和血清,胰腺组织采用苏木素-伊红(HE)染色和免疫组织化学法观察CD31、增殖细胞核抗原(PCNA)、胰腺干细胞标志物(PDX)-1在胰腺组织的表达水平.血糖仪检测血糖水平、放免法检测胰岛素水平、酶联免疫吸附试验(ELISA)检测SDF-1水平.结果 (1)A组残存胰岛周围可见新生血管,CD31、PCNA、PDX-1染色阳性率分别为(71.2±5.3)%、(76.5±4.5)%、(69.8±6.7)%;B组残存胰岛周围基本未见新生血管,CD31、PCNA、PDX-1染色阳性率分别为(7.4±2.1)%、(5.5±3.7)%、(8.8±2.9)%,两组比较差异有统计学意义(P＜0.05).(2)移植后第25天,A组血糖浓度基本正常,低于B组和C组,而胰岛素水平明显高于B组和C组(P＜0.05).(3)A组与B组血清SDF-1水平差异无统计学意义(P＞0.05),但都明显高于C组(P＜0.05).结论 MSCs促进胰岛再生和新生血管形成,AMD3100能抑制MSCs的作用,进而提示SDF-1/CXCR4轴在胰岛再生和血管形成中具有重要作用.

Abstract：

Objective To investigate the role of stromal cell derived factor-1 (SDF-1)/CXCR4axis in recipients' remnant islets regeneration and neovascularization after the transplantation of allogeneic bone marrow mesenchymal stem cells (MSCs). Methods MSCs were isolated from SD rats, cultured in vitro and identified by testing the phenotypes with flow cytometry ( FCM ). The diabetic rats induced by streptozotozin were randomly divided into group A ( MSCs transplant group), group B ( MSCs transplant +AMD group) and group C ( DM control group). Group D serve as the normal control. The pancreata were removed and blood serum was retrieved from each group simultaneously at the 13th day after MSCs transplant. The expression of CD31, proliferating cell nuclear antigen (PCNA) and PDX-1 in each group of pancreas tissue was detected by using immunohistochemistry, and the morphological changes in the isletswere observed by Hematoxylin and Eosin (HE) staining. Serum glucose and insulin levels were determined by blood glucose monitor, radioimmunoscintigraphy, and SDF-1 in serum was by enzyme linked immunosorbent assay (ELISA). Results Neovascularization was observed in the remnant islets of the recipient pancreatic tissue and CD31 -positive cells (71.2 ± 5.3 ) %, PCNA-positive cells ( 76. 5 ± 4. 5 ) %, PDX-1-positive cells (69. 8 ±6. 7)% were highly expressed in group A. As compared with group A, seldom-positive cells[CD31 (7.4±2. 1)%, PCNA (5.5 ±3.7)% and PDX-1 (8.8 ±2.9)%]and rarely neovascularization were observed in group B (P ＜0. 05 ). Serum glucose level in group A was lower than that in group B and group C, but serum insulin level in group A was significantly higher than that in group B and group C (P ＜ 0. 05 ). There was no significant difference between group A and group B in serum SDF-1level ( P ＞ 0. 05 ), but that was higher in groups A and B than in group C ( P ＜ 0. 05 ). Conclusion Obviously, MSCs promote recipient neovascularization surrounding the islets, which enhances the proliferation and regeneration of remnant islets. AMD 3100 has the function of intervening SDF-1/CXCR4 axis,which inhibits the effect of MSCs on promoting islets regeneration. It is suggested that SDF-1/CXCR4 axis may play an important role in vascularization and islets regeneration.     

调节性T淋巴细胞与1型糖尿病的关系

在1型糖尿病患者和健康者体内均能发现胰岛β细胞特异性自身反应性T淋巴细胞,通常被包括调节性T淋巴细胞在内的免疫调节系统所控制。一旦针对胰岛抗原的自身免疫耐受平衡被打破,