破裂大脑中动脉动脉瘤的显微手术治疗

目的探讨破裂大脑中动脉动脉瘤的诊断、显微手术治疗及其疗效。方法回顾性分析显微手术治疗的70例破裂大脑中动脉动脉瘤患者的临床资料。64例患者术前进行了头颅3D-CTA或/和DSA检查,6例仅行头颅CT检查。结果 70例患者中,67例行动脉瘤夹闭术,3例行动脉瘤包裹术。术后随访3月～2年,按GOS评分,5分57例,4分5例,3分5例,2分1例,1分2例;60例患者行3D-CTA或/和DSA复查,未见动脉瘤复发,其中1例行包裹术的患者动脉瘤无明显增大。结论破裂大脑中动脉动脉瘤应尽早采取显微手术治疗,以有效改善预后;术中多普勒超声的使用能为手术提供帮助。     

医学研究生临床SCI论文撰写及发表教学初探

SCI论文发表的数量和质量已成为体现研究生综合培养素质与能力的重要标志之一。本文从论文选题、论文类型及写作要点、期刊选择、返修及回复审稿人等方面探讨了如何指导研究生撰写及发表临床SCI论文。     

去铁敏对大鼠脑室出血后慢性脑积水与脑组织Wnt1、Wnt3a表达的影响

目的 观察去铁敏对大鼠脑室出血(IVH)后脑积水的干预效果及脑组织Wnt1、Wnt3a的表达影响.方法 雄性SD大鼠130只随机分为正常组、假性IVH组、IVH组及IVH加去铁敏组.采用脑室出血后慢性脑积水大鼠模型,于术后1 d、7 d及28 d处死大鼠,观察脑积水的发生率和脑组织中Wnt基因及蛋白表达情况.结果 正常组、假性IVH组未见脑积水发生,IVH组28 d脑积水发生率80%(12/15),显著高于IVH加去铁敏组28 d脑积水发生率20%(3/15).IVH后Wnt1、Wnt3amRNA及蛋白表达在7 d及28 d均显著高于假性IVH组,而去铁敏治疗组Wnt1、Wnt3a mRNA及蛋白表达在28 d较IVH组均显著降低.结论 去铁敏治疗可降低大鼠IVH后慢性脑积水发生率,Wnt信号通路参与了IVH后脑积水发生及去铁敏干预机制.

Abstract：

Objective To observe the effect of deferoxamine on chronic hydrocephalus after intraventricular hemorrhage (IVH) and the role of Wnt (Wnt1 and Wnt3a). Methods A total of 130Sprague Dawley male rats were randomly assigned into 4 groups: normal control group, sham - IVH group,IVH group and deferoxamine - treated group. The rats of subgroups except normal control group received an injection of autologous blood or saline into right lateral cerebral ventricles. Deferoxamine or vehicle was administered 3 hours after IVH and then every 12 hours up to 7 days in IVH group and deferoxaminetreated group. Rats were euthanized at 1, 7, 28 days for measurement, and the transverse diameter of the lateral ventricles were observed for evaluation of hydrocephalus. The expression of Wnt1 and Wnt3a were measured by RT -PCR and Western Blot. Results At 28 days, there was no hydrocephalus in the normal control group and sham - IVH group. 80 %(12/15) of the rats in IVH group developed hydrocephalus. The rate was only 20 % ( 3/15 ) in deferoxamine - treated group, which was much lower than that in IVH group. The expression of Wnt1 mRNA was normal in normal control group and shame - IVH group, and upregulated in IVH group. The peak expression was detected at 28 days. The expression was significantly higher than that in shame - IVH group at 7 days and 28 days, after deferoxamine treatment, downregulation of Wnt1 mRNA were observed and were significantly lower than that in IVH group. The Wnt3a mRNA had similar trends, while the expressed level was normal in normal control group and shame - IVH group, and upregulated following IVH. The peak expression was detected at 28 days, and was significantly higher than that in shame - IVH group at 7 days and 28 days. After deferoxamine treatment, the downregulation of Wnt3a mRNA was observed and was significantly lower than that in IVH group. Accordingly, Wnt1 protein expression was normal in normal control group and shame - IVH group, and increased after IVH. At 7 days and 28 days, the Wnt1 protein expression of IVH group was markedly higher than shame - IVH group. After deferoxamine treatment, the expression of Wnt1 protein was reduced and significantly lower than that of IVH group. The expression of Wnt3a protein was also normal in normal control group and shame - IVH group. The up-regulation of the protein expression was observed following IVH at 28 days, while down - regulation was observed after deferoxamine treatment at 28 days. Conclusions Deferoxamine could reduce hydrocephalus after IVH, and Wnt pathway may play an important role in the development of IVH and therapeutic effect of deferoxamine.     

莱菔硫烷对小鼠脊髓损伤后后肢功能的作用

目的 观察莱菔硫烷(sulforaphane,SFN)对小鼠脊髓损伤后炎症反应、胶质瘢痕、轴突再生的干预作用,探讨其在脊髓损伤中的作用机制.方法 雌性ICR小鼠66只,按随机数字表法分为4组:假手术组(n=12)、单纯损伤组(n=18)、莱菔硫烷组[5 mg/(kg·d)SFN,ip,n=18]、溶剂对照组(等体积玉米油腹腔注射,n=18).假手术组仅咬除椎板,余各组行脊髓夹伤术,制备脊髓夹伤模型.建模后1、7、14、21、28 d进行小鼠后肢运动功能评分(BMS评分);Western blot检测建模后7d各损伤组小鼠脊髓GFAP、CSPG、P65表达情况,28 d后各损伤组GAP-43表达情况;ELISA检测建模后7d各组小鼠脊髓TNF-α、IL-1β表达情况;免疫荧光染色观察建模后7d各损伤组小鼠脊髓GFAP、CSPG、P65表达情况.结果 假手术组BMS评分9分,各脊髓损伤组术后后肢运动功能均有不同程度恢复,术后28 d时单纯损伤组评分为(2.17±0.41)分,溶剂对照组(2.33±0.52)分,莱菔硫烷组(3.33±0.52)分,后者与前二者比较差异有统计学意义(P＜0.05).术后7d行免疫荧光染色可见各脊髓损伤组星形胶质细胞活化,GFAP、CSPG、P65表达增加,单纯损伤组与溶剂对照组较莱菔硫烷组更明显.术后7d莱菔硫烷组GFAP、CSPG、P65蛋白相对表达量均较单纯损伤组与溶剂对照组低(P＜0.05),术后28 d莱菔硫烷组GAP-43蛋白相对表达量较单纯损伤组与溶剂对照组明显增加(P＜0.05).建模后7d,莱菔硫烷组小鼠脊髓TNF-α、IL-1β表达较其余损伤组明显降低(P＜0.05).结论 莱菔硫烷可减轻小鼠脊髓损伤后炎症反应,抑制胶质瘢痕形成,促进轴突再生,改善后肢运动功能.     

神经内镜控制下经鼻-经蝶手术入路切除垂体腺瘤

目的 探讨神经内镜控制下单鼻孔经蝶手术入路切除垂体瘤的适应证、手术方法、手术技巧及其优点。方法 经内镜控制下单鼻孔经蝶手术入路手术治疗垂体瘤患者9例。结果 肿瘤全切7例，次全切2例。手术效果良好。并发症2例;脑脊液漏及颅内感染1例，尿崩、高热、意识障碍1例。无死亡。结论 神经内镜控制下单鼻孔经蝶手术入路切除垂体瘤较传统手术方法具有微创、照明良好、视野开阔、并发症较少等优点，是垂体瘤手术治疗的发展方向。     

犬脊髓挫伤后胶质瘢痕形成模型的建立

目的：利用犬脊髓挫伤模型，结合磁共振成像、体感诱发电位、运动诱发电位分析犬脊髓损伤后胶质瘢痕的形成。 方法：实验于2002-05／2003—04在解放军第三军医大学新桥医院实验动物中心完成。选取成年健康杂种犬12只，随机分为正常对照组3只，脊髓损伤组9只。脊髓损伤组动物，俯卧固定，定位棘突后以Ts为中心作行椎板切除，骨窗10mm&;#215;15mm，暴露脊髓背侧硬膜，参考Allen’s法自行设计打击装置。用冲击棒至脊髓损伤，致伤能量为450g&;#183;cm，形成重度脊髓损伤模型。正常对照组除不致伤外，其余操作同脊髓损伤组。脊髓损伤组分别于伤后1d，2周，8周各取材3只。术后进行犬后肢功能观察评价，测定犬双后肢体感诱发电位和运动诱发电位的变化，观察脊髓结构的影像学及组织学变化。 结果：①犬脊髓损伤后运动功能的变化：脊髓损伤组动物在损伤后1d。2周，8周观察的时间范围内，后肢和尾巴均未见活动。②犬脊髓损伤前后的电生理变化：脊髓损伤组动物在损伤前体感诱发电位和运动诱发电位均正常，但伤后增加刺激强度均不能记录到体感诱发电位和运动诱发电位。⑧各组脊髓结构的影像学比较：脊髓损伤组动物伤后损伤部位表现为T1加权成像呈局部低信号，T2加权成像呈高信号，信号纵向为（10．0&;#177;0．13）mm，大约是砸伤长度的2倍，为椭圆形空洞形成，局部脊髓萎缩变细，蛛网膜下腔粘连、连续性中断。④犬脊髓损伤后脊髓组织学变化：伤后1d脊髓弥漫出血、渗出，脊髓中央管变形，神经元内氏体减少。伤后2周仍有出血、水肿，脊髓白质空泡样改变，脊髓中央灰质坏死、空洞形成。伤后8周空洞壁为大量胶质细胞形成的胶质瘢痕，并见炎细胞浸润。 结论：450g&;#183;cm致伤能量可导致犬脊髓严重损伤，从而形成典型的空洞及胶质瘢痕，提示该模型有利于慢性时期损伤修复的分析。     

高压氧治疗时机对家兔实验性局部脑缺血治疗效果的影响及微透析监测研究

目的 观察高压氧(HBO)治疗时机对家兔实验性局部脑缺血治疗效果的影响.方法 75只家兔按随机数字表法平均分为3组,每组25只,即大脑巾动脉闭塞(MCAO)组:右侧大脑中动脉阻断.不行HBO治疗;MCAo+HBO组:右侧大脑巾动脉阻断后即予HBO治疗;MCAO+DHBO组:右侧大脑巾动脉阻断7d后行HBO治疗.动物放入HBO舱(100%O2,250 kPa,1 h/d)行HBO治疗30 d.MCAO后第1天、第3天、第10天、第30天观察各组动物的行为学变化、脑梗死体积,并采用微透析技术分析家兔缺血脑组织细胞间液中的葡萄糖、乳酸、丙酮酸、乳酸/丙酮酸比值以及谷氨酸水平的变化.结果 缺血后MCAO+HBO组行为学评分较其他组低;第3天至第30天,MCAO+HBO组脑梗死体积低于其他两组,差异有统计学意义(P<0.05).微透析分析能量代谢指标中乳酸丙酮酸比值变化最为明显.其中缺血后1 d和3 d右侧脑组织间液中MCAO+HBO组较其他两组降低,差异有统计学意义(P<0.05).缺血后家兔脑组织间液中谷氨酸浓度升高,3d时逐渐下降,缺血后1 d和3d右侧腩组织间液中MCAO+HBO组较其他两组降低,差异有统计学意义(P<0.05).结论 HBO治疗能通过改善神经组织的能量代谢,减轻兴奋性氨基酸毒性作用,改善缺血缺氧对神经的损害;而HBO治疗脑梗死应尽早进行.     

先天性巨大蛛网膜囊肿并脑积水合并胸椎神经鞘膜瘤1例

1临床资料患者男性,32岁,汉族,因右下肢无力1年,加重4月,胸背痛10 d于2012年1月4日入院。患者缘于1年前无明显诱因出现右下肢乏力,无感觉异常,无大小便障碍,无头昏、头痛等,能正常行走及进行日常工作生活,未重视。4月前右下肢无力明显加重,仍无其他伴随症状,在外院行腰椎CT平扫,诊断为"腰椎间盘突出",对症治疗无效。2011年12月     

颅内肿瘤手术后继发远隔部位血肿的诊治

颅内肿瘤手术患者后继发颅内远隔部位血肿较少见.本研究报告我科10年来9例患者的情况,探讨其发生的机制,以及如何预防、如何及时发现和处理,减轻其对病员造成的危害.