体外循环中S-100蛋白和神经元特异性烯醇化酶的变化及其与炎性细胞因子的关系

目的观察体外循环(CPB)手术期间S-100蛋白和神经元特异性烯醇化酶(NSE)的变化,探讨其与炎性细胞因子的关系.方法于CPB前、复温即刻、主动脉开放和CPB后6、24小时采集52例心脏病患者颈内静脉血,检测S-100蛋白和NSE的浓度,并将其与炎性细胞因子白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)和诱导型一氧化氮合成酶(iNOS)的浓度变化进行相关性分析.结果CPB开始后即有S-100和NSE升高(P<0.05),在术后6小时达到高峰(P＜0.05),术后24小时均恢复至术前水平(P＞0.05),二者变化趋势相同;S-100蛋白和NSE的变化与炎性细胞因子及iNOS浓度的变化有明显的相关性.结论CPB期间可出现S-100和NSE的一过性升高,此与炎症反应中释放的炎性细胞因子及iNOS的过度表达和产生有关,而患者多无明显的脑损害临床表现.     

Content change of neurofilament protein subunits in experimental brain diffuse axonal injury by lateral head rotation

Objective:To explore the content change of neurofilament (NF) protein subunits in the experimental brain diffuse axonal injury(DAI) by lateral head rotation.Methods:Twenty-four Sprague Dawley (SD) rats were equally divided into three injury groups (2h,12h,and 24h post injury) and one control group.The models of DAI were made in the injury groups by lateral head rotation.western blotting technique was used to measure the contene of NF68(a kind of NF protein subunit) in the brainstem tissues among all the injured and control rats.The NF68 immunohistochemical staining was used in another six SD rats in order to observe the morphological changes in DAI.Results:The NF68 content in the brainstem tended to decrease at 2h post injury,decreased significantly at 12h and continued its decrease at 24h.NF56 and NF52,as the breakdown products of NF68,had a tendency to increase at 2-12h after the injury,and amounted to a significantly higher level at 24h.Microscopically,there were a lot of swelling neuronal axons in the ventral part of the medullar oblongate at 2h after the injury.some axons were disconnected,and axonal retraction balls formed on their proximal end.Conclusions:There is and occurrence of phosphorolysis within the brainstem in DAI by lateral head rotation.These reactions cause the breakdown of NF68,which results in the decrease of NF68 in content.It suggests that the breakdown of neurofilament protein subunits is an important reason for structural destroy of neurofilaments in DAI.     

Nerve tissue protein S-100 and neurone-specific enolase concentrations in cerebrospinal fluid and blood during carotid endarterectomy

Nerve tissue protein S-100 and neurone-specific enolase levels in serum were studied in 10 patients before, during and for 2 days after elective carotid endarterectomy performed under general anaesthesia and using a Javid Shunt. In six patients, simultaneous cerebrospinal fluid samples were also obtained. Serum nerve tissue protein S-100 was normal throughout the operation, but in one patient with severe hypertension, levels increased to 1.38 microg. l-1 at 1 h postoperatively. Two patients showed an increase in cerebrospinal fluid nerve tissue protein S-100 during clamping: these patients also had neurological deficits at 6 months. Serum neurone-specific enolase increased from 5.8 to 9.3 microg.l-1 during shunting while cerebrospinal fluid neurone-specific enolase did not change. Uncomplicated carotid endarterectomy does not produce cerebral damage as measured by serum nerve tissue protein S-100; cerebrospinal fluid nerve tissue protein S-100 may be more sensitive for minor cerebral damage. Neurone-specific enolase appeared to be nonspecific. The lack of correlation between the neuroproteins may need to be explained before relying on these simple assays as diagnostic indicators of cerebral ischaemia.     

Significance of serum neuron-specific enolase in patients with acute traumatic brain iniurv

Objective: To study the association between serum neuron-specific enolase ( NSE) and the extent of brain damage and the outcome after acute traumatic brain injury (TBI).Methods: The release patterns of serum NSE in 78 patients after acute TBI were analyzed by using the enzyme linked immunosobent assay. The levels of NSE were compared with Glasgow coma scale, the category of brain injury and the outcome after 6 months of injury.Results: There were different NSE values in patients with minor ( 12.96 μg/L ±2.39 μg/L ), moderate ( 23.44 μg/L ±5.33 μg/L ) and severe brain injury ( 42.68 μg/L ±4.57 μg/L ). After severe TBI, the concentration of NSE in patients with epidural hematomas was 13.38 μg/L±4.01 μg/L, 24.03 μg/L±2.85 μg/L in brain contusion without surgical intervention group, 55.20 μg/L ±6.35 μg/L in brain contusion with surgical intervention group, and 83.85 μg/L ± 15.82 μg/L in diffuse brain swelling group. There were close correlations between NSE values and Glasgow coma scale     

肾上腺原始神经外胚层肿瘤临床及病理分析

目的 分析肾上腺原始神经外胚层肿瘤(PNET)的临床及病理特点. 方法肾上腺PNET患者4例.男2例,女2例.平均年龄24(21、22、24、30)岁.常规实验室及内分泌检查无阳性发现.B超、CT检查示肾上腺区边界欠清的巨大囊实性软组织肿块,直径平均12(8～17)cm. 结果 1例穿刺活检确诊后拒绝治疗,6个月后死亡;1例手术探查后行减瘤术,术后8个月死亡;行肿瘤根治性切除治疗2例,术后1个月出现远处转移1例,肿瘤局部复发1例,4例病理学检查光镜下可见典型的Homer-Wright菊形团,免疫组织化学染色CD99阳性.病理诊断均为PNET. 结论 肾上腺PNET是一种罕见的原始神经外胚叶来源肿瘤,好发于青年,临床及影像学无特殊表现,确诊依据病理学检查.肿瘤恶性度高,进展迅速,预后极差.     

Significance of serum neuron-specific enolase in patients with acute traumatic brain injury

OBJECTIVE: To study the association between serum neuron-specific enolase (NSE) and the extent of brain damage and the outcome after acute traumatic brain injury (TBI). METHODS: The release patterns of serum NSE in 78 patients after acute TBI were analyzed by using the enzyme linked immunosorbent assay. The levels of NSE were compared with Glasgow coma scale, the category of brain injury and the outcome after 6 months of injury. RESULTS: There were different NSE values in patients with minor (12.96 microg/L+/-2.39 microg/L), moderate (23.44 microg/L+/-5.33 microg/L) and severe brain injury (42.68 microg/L+/-4.57 microg/L). After severe TBI, the concentration of NSE in patients with epidural hematomas was 13.38 microg/L+/-4.01 microg/L, 24.03 microg/L+/-2.85 microg/L in brain contusion without surgical intervention group, 55.20 microg/L+/-6.35 microg/L in brain contusion with surgical intervention group, and 83.85 microg/L+/-15.82 microg/L in diffuse brain swelling group. There were close correlations between NSE values and Glasgow coma scale (r=-0.608, P<0.01) and the extent of brain injury (r=0.75, P<0.01). Patients with poor outcome had significantly higher initial and peak NSE values than those with good outcome (66.40 microg/L+/-9.46 microg/L, 94.24 microg/L+/-13.75 microg/L vs 32.16 microg/L+/-4.21 microg/L, 34.08 microg/L+/-4.40 microg/L, P<0.01, respectively). Initial NSE values were negatively related to the outcome (r=-0.501, P<0.01). Most patients with poor outcomes had persisting or secondary elevated NSE values. CONCLUSIONS: Serum NSE is one of the valuable neurobiochemical markers for assessment of the severity of brain injury and outcome prediction.     

神经元特异性烯醇化酶和C反应蛋白对急性脑梗死病情及预后的评价

目的 探讨急性脑梗死患者血清神经元特异性烯醇化酶（NSE）和C反应蛋白（cRP）对其病情和预后的评估价值。方法测定92例急性脑梗死患者（观察组）和45例健康对照者（对照组）血清NSE和CRP水平,并分析观察组NSE和CRP水平与神经功能损害程度及梗死部位的关系。结果观察组血清NSE和CRP水平明显高于对照组（P〈0．01）。观察组采用美国国立卫生院卒中量表（NIHSS）评分,重型者NSE和CRP水平[（35．63±7．12）μg／L、（13．82±3．57）mg／L]显著高于轻、中型者[分别为（17．24±5．32）μg／L、（5．61±2．35）mg／L和（26．08±5．91）μg／L、（9．07±2．14）mg／L]（P〈0．01）。不同梗死部位患者血清NSE、CRP水平比较差异无统计学意义。结论NSE和CRP是反映脑内神经元损伤或坏死的客观指标,可作为脑梗死早期判断病情和预后的指标。     

CO2气腹对正常大鼠脑组织S-100、NSE mRNA和蛋白水平的影响

目的研究在不同CO2气腹压及不同时段下大鼠血和脑脊液S-100蛋白(S-100)、神经元特异性烯醇化酶(NSE)水平的变化对中枢神经系统的影响。方法Wistar大鼠建立气腹模型,光镜和电镜观察大鼠脑组织胶质细胞和神经元细胞组织学变化;抗体夹心法检测血液和脑脊液中S-100、NSE水平变化,RT-PCR技术和免疫组织化学的方法观察脑组织中S-100、NSEmRNA和蛋白水平表达的变化。结果CO2气腹后,A5-1组与对照组比较,海马区胶质细胞和神经元细胞均无明显变化,A10-2组胶质细胞和神经元细胞在光镜下呈轻度水样变,电镜下线粒体轻度肿胀;血液和脑脊液中S-100、NSE在CO2气腹压力后逐渐增加,但差异无统计学意义(P>0.05),S-100和NSE在血液和脑脊液中水平变化分别呈正相关(P<0.05);S-100、NSEmRNA在CO2气腹后逐渐增加,但与对照组比较差异无统计学意(P>0.05);脑组织S-100、NSE表达阳性面积随气腹时间及压力增加而逐渐增加,在A5-1组和A10-2组与对照组比较差异无统计学意义(P>0.05)。结论在10mmHg2h范围,CO2气腹对正常大鼠中枢神经系统无损害,CO2气腹在这一范围内应用对中枢神经系统是安全的。     

CO2气腹对正常大鼠脑组织S-100、NSE mRNA和蛋白水平的影响

目的研究在不同CO2气腹压及不同时段下大鼠血和脑脊液S-100蛋白（S-100）、神经元特异性烯醇化酶（NSE）水平的变化对中枢神经系统的影响。方法Wistar大鼠建立气腹模型，光镜和电镜观察大鼠脑组织胶质细胞和神经元细胞组织学变化；抗体夹心法检测血液和脑脊液中S-100、NSE水平变化，RT—PCR技术和免疫组织化学的方法观察脑组织中S-100、NSE mRNA和蛋白水平表达的变化。结果CO2气腹后，A5-1组与对照组比较，海马区胶质细胞和神经元细胞均无明显变化，A10-2组胶质细胞和神经元细胞在光镜下呈轻度水样变，电镜下线粒体轻度肿胀；血液和脑脊液中S-100、NSE在CO2气腹压力后逐渐增加，但差异无统计学意义（P〉0．05），S-100和NSE在血液和脑脊液中水平变化分别呈正相关（P〈0．05）；S-100、NSE mRNA在CO2气腹后逐渐增加，但与对照组比较差异无统计学意（P〉0．05）；脑组织S-100、NSE表达阳性面积随气腹时间及压力增加而逐渐增加，在A5-1组和A10-2组与对照组比较差异无统计学意义（P〉0．05）。结论在10mm Hg 2 h范围，CO2气腹对正常大鼠中枢神经系统无损害，CO2气腹在这一范围内应用对中枢神经系统是安全的。     

Secondary manifestation of medulloblastoma: Metastases and local recurrences in 66 patients

Summary Although primary treatment of medulloblastoma is now successful in a high percentage of patients, its secondary manifestations still bear a poor prognosis. Thorough studies of secondary manifestations are therefore pivotal to plan therapeutic approaches for the long-term management of medulloblastoma. Here we describe the incidence of secondary tumour manifestations in 66 patients of a single centre who underwent surgery for medulloblastoma between 1975 and 1990. No patient was excluded due to a poor postoperative course. Thirty-five patients showed evidence of secondary tumour growth. Of these, 17 suffered from local recurrence, and 27 developed metastastatic disease. The median latencies for secondary manifestations were 25 months for local recurrence (n = 17), 11 months for spinal metastases (n = 10), 15 months for supratentorial metastases (n = 8), 8 months for subleptomeningeal dissemination (n = 6), and 23 months for systemic metastases (n = 8). Two patients developed primary metastatic spread to the posterior fossa. Of 8 patients with supratentorial metastases, 6 developed fronto-basal lesions. In our patients, 89% of secondary lesions occurred within less than 3 years after primary diagnosis. 85% of patients with extra-axial tumour spread had been treated with a permanent shunt. Radical tumour resection and radiotherapy with 30 Gy to the neuraxis and 20 Gy boost to the posterior fossa was an important prognostic factor in this series. Patients with additional chemotherapy did not benefit significantly from this treatment. We conclude that optimal management of the primary lesions should aim at (i) total resection, (ii) avoid permanent shunting, and (iii) completion of the radiotherapy with inclusion of the medial frontobasal cisterns in the radiotherapeutic regimen. Our analysis suggests that adequate postoperative screening programmes should consist of 3-monthly scans of the neuraxis in the first three postoperative years and 6-monthly scans thereafter.     

脑胶质瘤中p16蛋白、nm23蛋白及c-erbB-2蛋白的表达及其意义

目的 探讨p16蛋白、nm23蛋白及c-erbB-2蛋白在脑胶质瘤发生、发展中的作用。方法 应用免疫组织化学技术检测60例脑胶质瘤中p16蛋白、nm23蛋白及c-erbB-2蛋白的表达。结果 p16蛋白、nm23蛋白及c-erbB-2蛋白在脑胶质瘤和正常脑组织中的阳性表达率分别为43.3％和90％（P＜0.05）；36.7%和80％（P＜0.05）；41.7%和0（P＜0.05）。脑胶质瘤中p16蛋白及nm23蛋白缺失率在死亡组和生存组分别为73.7%和31.8%（P＜0.05）；84.2%和36.3%（P＜0.05）；c-erbB－2蛋白过度表达率在死亡组和生存组为68.4%和27.2%（P＜0.05）。结论 p16蛋白、nm23蛋白及c-erbB-2蛋白过度表达与脑胶质瘤发生、发展密切相关。     

Inappropriate secretion of antidiuretic hormone as a postoperative complication in a child with a medulloblastoma

We report the case of a child with a medulloblastoma who developed inappropriate secretion of antidiuretic hormone postoperatively. The etiology of this condition and the related literature are discussed.     

Treatment of medulloblastoma in children: Long-term results following surgery,radiotherapy and chemotherapy

Summary Forty-seven children with histologically confirmed medulloblastoma are considered. Forty-five cases were surgically treated by direct approach to the tumour, while two cases were treated only with a shunt. A shunt was inserted preoperatively in 14 cases, postoperatively in 4 cases. Surgical resection was total or subtotal in 52% of cases, partial in 35%, and limited to a biopsy in 13%. Radiation treatment to the entire neuraxis was done in 37 cases: 10 of these cases received additional chemotherapy—mostly with CCNU—as primary treatment for medulloblastoma.Ten patients died within 30 days after surgery. Twenty-two patients died months after treatment, mainly from tumour recurrence (19 cases). One patient was lost to follow-up. Thirteen patients are survivors from 10 months to 20 years after treatment. As a whole, the one year survival rate has been 67%, 3 year survival 43%, and 5 year survival 27%. Complications affecting prognosis have been presented by tumour recurrence and metastases. CSF shunting and lack of prophylactic irradiation to the cerebral hemispheres have been considered responsible for the high incidence of supratentorial metastases in our series.Factors influencing prognosis have been the extent of tumour resection and association of primary chemotherapy with radiotherapy. Within 3 years after surgery survival has been 52% in cases with total resection against 31% in cases with partial resection of tumour. As regards chemotherapy, 3 year survival has been 60% for patients with combined treatment (chemo- and radiotherapy) against 37% in patients with radiotherapy alone. It is concluded that the best results in children with medulloblastoma are achieved by a radical resection, associated with a combined primary treatment of radiotherapy and chemotherapy.     

Immunochemical, ultrastructural and electrophysiological investigations of bone-derived stem cells in the course of neuronal differentiation

Numerous reports have highlighted the use of mesenchymal stem cells (MSC) for tissue engineering because of the capacity of the cells to differentiate along the osteogenic, chondrogenic or adipogenic pathway. As MSC also display neuronal morphologies under appropriate culture conditions, the differentiation capacity of stem cells seems to be more complex than initially thought, but it requires careful characterization of the cells. This is especially the case because recently it has been suggested that neuronal differentiation of stem cells is only an artifact. Here, we investigate the sequence of ultrastructural changes of bone-derived stem cells during neuronal induction and compare these data with immunocytochemical and electrophysiological properties of the cells. For further comparative analyses, stem cells were incubated with non-neurologically inducing stressors. The stem cells were harvested from human osseous debris and were characterized morphologically, immunocytochemically and by using FACS. After 6 h of neuronal induction, the cells had assumed neuronal morphologies and expressed neuron-specific enolase, β-III-tubulin, neurofilament-H and HNK-1, while only a subpopulation expressed CD15 and synaptophysin. However, electrical signaling could not be detected, neither spontaneously nor after electrical stimulation. Nevertheless, transmission electron microscopy revealed cellular features of neuritogenesis and synaptogenesis in the course of neuronal induction and suggested that the cells have features similar to those observed in immature neurons. Based upon the results, it can be concluded that neuronal induction had initiated the early steps of neuronal differentiation, while exposure of the cells to non-neurological stressors had caused necrotic alterations.     

癌基因产物c-jun和c-fos在髓母细胞瘤中的表达及临床意义

目的　了解c jun和c fos在髓母细胞瘤中的表达情况及其与预后的关系。方法　通过免疫组化方法测定c jun和c fos蛋白在 70例髓母细胞瘤和 10例正常小脑组织中的表达情况 ,并结合临床资料 ,对病人生存时间与c jun和c fos表达阳性率之间的关系进行分析。 结果　 (1)正常小脑组织标本不表达c jun和c fos;而髓母细胞瘤中多为不同程度的阳性表达 ,且以高阳性率为主 ,并发现阳性染色主要位于肿瘤细胞核 ,部分胞浆也有染色。 (2 )c jun和c fos表达呈正相关 (r =0 4 93,P <0 0 1) ;二者协同性较强。 (3)生存时间与c jun、c fos表达阳性率呈负相关 (c jun :r =- 0 4 4 7,P <0 0 1;c fos:r =- 0 5 90 ,P <0 0 1) ;c jun、c fos表达强度愈高 ,病人的生存率就愈低 ,生存时间就越短。结论　c jun和c fos在髓母细胞瘤组织中呈高表达。c jun和c fos二者在髓母细胞瘤中表达具有协同性。c jun、c fos在肿瘤中的阳性表达率与髓母细胞瘤病人的预后呈显著负相关     

C反应蛋白激活原纤毛抑制颅骨成骨细胞的增殖和分化

目的 研究C反应蛋白(C-reactive protein,CRP)对原代培养SD大鼠乳鼠颅骨成骨细胞(rat calvarial osteoblasts,ROB)增殖及成骨分化的影响.方法 取SD乳鼠颅骨组织用胰蛋白酶和胶原蛋白酶Ⅰ消化得到原代ROB,随后将ROB用α-MEM培养基培养,传代3次后用于后续实验.在对照...     

髓母细胞瘤周期蛋白基因D1、p16的表达及其与临床病理特点的关系

目的　通过检测髓母细胞瘤周期蛋白基因 (cyclin)D1和 p16的表达 ,探讨它们与传统临床病理特点之间以及cyclinD1和 p16之间的相互关系。 方法　应用免疫组织化学方法并用图像分析系统测定染色的积分吸光度 (IOD)检测cyclinD1和p16在髓母细胞瘤和正常小脑组织中的表达情况 ;应用统计学方法分析它们与临床病理特点的相互关系 ,以及cyclinD1和 p16之间的相互关系。结果　 (1)正常小脑组织cyclinD1表达较低 ,髓母细胞瘤表达较高 (IOD值分别为 0 .2 93 1、1.0 712 ) ;p16在正常小脑组织中则呈现高表达 ,而髓母细胞瘤出现降低 (IOD值分别为 1.6815、1.0 10 9) ;(2 )髓母细胞瘤cyclinD1和 p16表达情况与肿瘤年龄、部位、病理类型、是否伴坏死、分化程度及分化方向有关 ;(3 )在纤维增生型髓母细胞瘤中cyclinD1和p16呈正相关关系 (r =0 .5 3 4,P <0 .0 5 ) ,而在经典型髓母细胞瘤中呈负相关关系 (r =-0 .40 7,P <0 .0 1)。结论　髓母细胞瘤临床病理特点的不同更深层次的原因之一是肿瘤细胞cyclinD1和 p16发生了不同变化从而导致肿瘤细胞形成各自不同的细胞周期改变     

直肠腺癌术前分化程度与分级准确率的比较研究

目的 对直肠腺癌术前活检分化程度及分级的准确率进行比较,以指导临床工作.方法 收集上海长海医院2006年3月至2008年5月间收治的100例直肠腺癌病例资料进行回顾性研究,由一位病理科教授对术前活检组织切片和术后病理切片重新测片,将高、中分化归为低度恶性肿瘤,低和未分化归为高度恶性肿瘤,对直肠腺癌进行分级,确定术前活检分化程度的准确率.结果 本组患者术前分化程度的准确率为72%.术前活检分化偏高的病例占20%,偏低的病例占8%.术前直肠癌分级准确率为91%,术前分级偏低者占5%,偏高者占4%（P〈0.01）.结论 术前直肠腺癌活检分级准确率较高.     

Limitations of using aggrecan and type X collagen as markers of chondrogenesis in mesenchymal stem cell differentiation.

The study was initially designed to differentiate human bone marrow-derived mesenchymal stem cells (MSC) into chondrocyte-like cells, for use in tissue engineering. We cultured MSCs in defined chondrogenic medium as pellet cultures supplemented with transforming growth factor (TGF)-beta1 or -beta3 and dexamethazone, as they are commonly used to promote in vitro chondrogenesis. Markers of chondrogenesis used were type II collagen and aggrecan, with type X collagen being used as a marker of late-stage chondrocyte hypertrophy (associated with endochondral ossification). Our results show that aggrecan is constitutively expressed by MSCs and that type X collagen is expressed as an early event. Furthermore, we found that type X collagen was expressed before type II collagen in some cases. This is surprising because it is understood that stem cells have to be differentiated into chondrocytes before they can become hypertrophic. Thus, caution must be exercised when using aggrecan and type X collagen as markers for chondrogenesis and chondrocyte hypertrophy, respectively, in association with stem cell differentiation from this source.