POEMS综合征20例临床分析

目的探讨POEMS综合片的临床特征,提高对POEMS综合征的诊疗认识。方法回顾性分析20例POEMS综合征患者的临床表现、辅助检查、治疗及预后。结果20例患者均有多发性神经病、水肿及皮肤色素沉着,淋巴结肿大者18例,内分泌改变者18例,异常球蛋白血症者16例。16例患者给予激素治疗,其中7例合用人血免疫球蛋白静滴。18例患者有不同程度的好转。结论POEMS综合征临床表现复杂多样,各主要症状出现顺序不一,涉及多系统,临床应注意鉴别诊断。     

QDs-SA和Cy3荧光标记阿尔茨海默病细胞模型β淀粉样蛋白的比较研究

目的：观察利用量子点（QDs）标记的链霉亲和素复合物（QDs—SA）和传统荧光染料Cy3分别标记的阿尔茨海默病（AD）转基因细胞模型β淀粉样蛋白（AD）在荧光强度和抗光漂白性能的差异。方法：将pcDNA3．1／APP质粒转染至HEK293细胞建立稳定表达株,Western blot法检测转染细胞APP蛋白的表达,细胞免疫荧光检测AD蛋白生成。建立AD转基因细胞模型,分别应用QDs—SA和Cy3细胞免疫荧光染色技术靶向标记转基因细胞模型的Aβ蛋白,激光共聚焦显微镜下对荧光强度和抗光漂白特性进行检测。结果：Western blot法在稳定转染pcDNA3．1／APP质粒的细胞中检测到APP目的蛋白谱带,而未转染的空载体转染组细胞未见APP蛋白表达。共聚焦荧光显微镜下观察到：①APP基因转染后能够生成大量Aβ蛋白;②QDs—SA特异标记的Aβ蛋白主要分布在细胞膜和胞质,显现出均匀分布的高密度橙红色强荧光;③Cy3特异标记AD蛋白荧光强度较QDs—SA标记弱,且细胞膜染色不均匀,部分细胞膜区域有染料少量团聚;④QDs—SA相较于传统Cy3荧光染料的平均荧光强度值更大（P〈0．05）,488nm激发光连续激发12min,QDs—SA荧光标记的Aβ蛋白仍发射较强的橙红色荧光,荧光强度下降了29．25％,而传统荧光染料Cy3荧光强度下降幅度达76．82％。结论：QDs—SA能有效识别AD转基因细胞模型中AD蛋白,且在光稳定性和荧光强度等方面均优于传统的Cy3荧光染料标记的免疫荧光成像。     

加强神经外科护理风险管理的研究

目的探讨针对神经外科护理工作中存在的或潜在的风险,加强护理风险管理的方法,为患者提供安全、有效、优质的护理。方法评估神经外科护理工作中已存在的、或可能存在的风险,建立护理风险管理小组,健全护理风险防范制度,完善风险应急程序,加强护士风险意识和防范能力的培训,落实护理风险防范措施,加强护理风险管理的监控。结果从2010年9月至2011年8月我科实行加强护理风险管理后,与2009年9月至2010年8月相比,护理缺陷发生率明显降低,两者差异有统计学意义(P<0.05);护士的风险防范意识和风险管理能力明显提高,护理质量得到明显提高,得到患者及家属的普遍满意。结论实行护理风险管理,提高了护理人员的风险防范意识,对预防护理缺陷的发生。提高护理质量起了重要作用。     

铅中毒性脑病一例报告

患男,40岁.因记忆力下降、反应迟钝4个月,加重10d,于2004年11月25日收入院.4个月前患家人发现其逐渐出现反应迟钝、性格改变等症状,但尚能正常工作.近10d症状明显加重,伴头晕、非喷射性呕吐、赘述、独自出差在外不知回家.     

G蛋白偶联内向整流钾通道亚基2 mRNA在颞叶癫疒间大鼠海马内的表达

目的探讨G蛋白偶联内向整流钾通道亚基2(GIRK 2)在颞叶癫癎大鼠海马内的表达变化.方法应用腹腔注射海人酸致癎大鼠,采用原位杂交法检测大鼠海马GIRK 2 mRNA的表达.结果 GIRK 2 mRNA在癫癎大鼠海马齿状回表达增加,与正常对照组相比差异有显著性( P<0.01).结论癫癎大鼠海马内GIRK2增高是机体对神经元网络过度兴奋的代偿反应.     

匹罗卡品致(癎)大鼠海马中表达生长抑素的中间神经元数目变化及其轴突出芽

Objective To investigate the roles of somatostatin(SS)positive intemeurons in the development and compensation of temporal lobe epilepsy.Methods Piloearpine-induced epilepsy rat model was established.Immunohistochemistry method was used to detect number changes and axonal sprouting of SS positive intemeurons in different domains of the hippocampus at difierent time points.Degeneration of SS positive interneurons and their neurophils were detected by the double immunofluorescence staining with SS and Fluoro-Jade B(FJB)at 7 and 60 days after status epilepticus (SE).Results In the exoerimental rat group,the number of SS positive neurons decreased in each hippocampal domain,and it reached the lowest at 7 days post-SE(There were 11.1±3.3 in hilus,2.8±0.9 in CA1region and 1.8±0.7 in CA1region,t=13.519,9.644 and 8.808,all P<0.01).In chronic phase,the number of SS neurons gradually recovered,and exceeded the control group in CA1 area at 60 days post-SE(12.8±1.5 vs 8.8±1.3,t=-4.506,P<0.01),however,the number of SS neurons in the hilus(25.5±4.6)and CA1 area(4.8±0.8)remained significantly less than normal levels(t value were 4.691 and 3.953.both P<0.01).Increased SS positive fibers were found in the lacunosum-molecular (1m)layer and outer molecular layer of dentate gyrus after 30 days post-SE,and numerous SS positive fibers were seen threnghout the layers of area CA1 at 60 days post-SE.Double immunofluuorescence revealed that a few SS positive interneurons and fibers were also labeled by FJB in area CA1 at 7 days post-SE and in CA domain/hilus at 60 days post-SE.Conclusions SS intemeurons loss plays an important role in the development of temporal lobe epilepsy.The loss is partially caIlsed by the degeneration and death of neurons;SS positive neurophils increase within area CA1 in chronic phase may play a significant role in the generation and compensation of temporal lobe epilepsy.     

匹罗卡品致(癎)大鼠海马中表达生长抑素的中间神经元数目变化及其轴突出芽

Objective To investigate the roles of somatostatin(SS)positive intemeurons in the development and compensation of temporal lobe epilepsy.Methods Piloearpine-induced epilepsy rat model was established.Immunohistochemistry method was used to detect number changes and axonal sprouting of SS positive intemeurons in different domains of the hippocampus at difierent time points.Degeneration of SS positive interneurons and their neurophils were detected by the double immunofluorescence staining with SS and Fluoro-Jade B(FJB)at 7 and 60 days after status epilepticus (SE).Results In the exoerimental rat group,the number of SS positive neurons decreased in each hippocampal domain,and it reached the lowest at 7 days post-SE(There were 11.1±3.3 in hilus,2.8±0.9 in CA1region and 1.8±0.7 in CA1region,t=13.519,9.644 and 8.808,all P<0.01).In chronic phase,the number of SS neurons gradually recovered,and exceeded the control group in CA1 area at 60 days post-SE(12.8±1.5 vs 8.8±1.3,t=-4.506,P<0.01),however,the number of SS neurons in the hilus(25.5±4.6)and CA1 area(4.8±0.8)remained significantly less than normal levels(t value were 4.691 and 3.953.both P<0.01).Increased SS positive fibers were found in the lacunosum-molecular (1m)layer and outer molecular layer of dentate gyrus after 30 days post-SE,and numerous SS positive fibers were seen threnghout the layers of area CA1 at 60 days post-SE.Double immunofluuorescence revealed that a few SS positive interneurons and fibers were also labeled by FJB in area CA1 at 7 days post-SE and in CA domain/hilus at 60 days post-SE.Conclusions SS intemeurons loss plays an important role in the development of temporal lobe epilepsy.The loss is partially caIlsed by the degeneration and death of neurons;SS positive neurophils increase within area CA1 in chronic phase may play a significant role in the generation and compensation of temporal lobe epilepsy.     

姜黄素对氯化锂-匹罗卡品诱导癫癎持续状态的预防作用

目的探讨姜黄素对氯化锂-匹罗卡品诱导大鼠癫持续状态(SE)的预防作用及其神经元保护作用。方法Spra-gue-Daw ley(SD)大鼠45只随机均分成3组:预防组(n=15)、非预防组(n=15)和对照组(n=15)。观察各组SE的发生情况;SE后24 h,用焦油紫尼氏染色检查海马CA3区的存活神经元,用DNA片段原位末端标记技术(TUNEL)检查CA3区细胞程序化死亡情况。结果预防组SE发生率为66.7%,明显低于非预防组(100%)(P<0.05);预防组SE潜伏期为(41.0±18.1)m in,明显长于非预防组的(21.5±8.2)m in(P<0.01)。SE后24 h,CA3区存活神经元数量和程序化死亡细胞数量在预防组和非预防组间差异无统计学意义(P>0.05)。结论预先给予姜黄素能抑制氯化锂-匹罗卡品诱导的SE,但无明显神经元保护作用,其机制和潜在的临床应用价值值得深入研究。     

优化神经病学课程体系的探索

总结了湘雅医院神经病学课程以知识点整合教学内容,以新进展更新教学内容,以临床问题带动医学专业知识与人文社科、基础医学知识的衔接与渗透,对课程体系进行整体优化和改革创新的经验,深入探讨在新教学模式下如何进一步优化神经病学课程体系。     

UPLC法测定翠云草中6种双黄酮类成分含量

目的:建立UPLC法同时测定翠云草中2,3,2″,3″-四氢穗花杉双黄酮、2,3-二氢穗花杉双黄酮、穗花杉双黄酮、2,3-二氢-4′-甲氧基穗花杉双黄酮、白果黄素、罗波斯塔双黄酮-4′-甲醚等6种双黄酮类成分的含量。方法:采用ACQUITY UPLC BEH Shield RP_(18)色谱柱(100 mm×2.1 mm,1.7μm);以乙腈-0.1%甲酸溶液为流动相,梯度洗脱;流速:0.2 mL/min;柱温:30℃;检测波长:270 nm。结果:6种成分在各自范围内线性关系良好(r≥0.9997),平均加样回收率为98.24%～100.67%,RSD均小于2.0%。聚类分析结果显示,15批翠云草药材按产地分为湖北宜昌、广西南宁、湖南吉首三大类。结论:建立的含量测定方法灵敏、准确,可对翠云草药材质量进行控制。