第三脑室脑膜瘤(九例报告及文献回顾)

目的探讨第三脑室脑膜瘤的组织发生学、临床特点和外科治疗。方法报道9例经影像学、手术和病理学证实的第三脑室脑膜瘤，并回顾相关文献。结果第三脑室前部脑膜瘤5例，第三脑室后部脑膜瘤4例，平均发病年龄25．6岁，无明显性别差异；最常见的症状是梗阻性脑积水，缺乏硬脑膜附着为其影像学特征。肿瘤全切除6例。结论第三脑室脑膜瘤是一种罕见的脑室内脑膜瘤，起源于中间帆脉络组织或脉络丛，经半球间裂-胼胝体-穹隆间入路是合理的手术路径选择。     

中西医结合治疗小儿急性肾小球肾炎临床观察

急性肾小球肾炎为临床常见病，多发于少年儿童，男性多见。西医除对症处理外，无特效药物，中药治疗本病可明显缩短病程。笔者自2003年1月至2006年1月用清热利湿解毒汤治疗急性肾小球肾炎60例取得确切疗效，现报道如下。     

Effect of nuclear factor-κB p65 ASOND on I typ collagen expression and rat hepatic stellate cells proliferation

Objective Sstudy effect of nuclear factor-κB ASOND on I type collagen expression and rat hepatic stellate cells(HSC)proliferation.Methods Rat HSCs were separated by affusing and digestingof Ⅳ type collagenenzyme and density acentric method.Lipid-mediated NF-κB p65 ASOND(0.001,0.01,0.1,1μmol/L)Was transferred into rat HSCs.Toxicity of HSCs caused by NF-κB p65 ASOND and activity of LDH were determined by trypan blue staining.Proliferation affection of transferring NF-κB p65 ASOND into HSCs was determined by MTT.In different concentration NF-κB p65 ASOND.expression of Ⅰ type collagen stimulated by 1mg/L TNF-αwas determined by RT-PCR and ELISA.Results After transfection of NF-κB p65 ASODN,expression of NF-κB protein in HSCs was decreasing.Toxicity experiment indicated that NF-κB p65 ASOND of different concentration(0.001,0.01,0.1 and 1.0 μmol/L)had no effect on HSCs livability and LDH activity(P<0.05).Four different concentration NF-κ B p65 ASOND could restrain HSCs proliferation stimulated by 1 mg/L TNF-α.The expression of I type collagen and mRNA stimulated by 1mg/LTNF-αwas increased,and had a positive correlation with concentration(P>0.05).Conclusion NF-κB p65 ASOND may depress NF-κB activity to restrain HSCs proliferation and Ⅰ type collagen expression,and reduce extracellular matrix.     

AdEasy1／Cbfa1诱导间充质干细胞向成骨细胞分化的实验研究

目的：观察核心结合因子a1（Cbfa1）对兔骨髓间充质干细胞（MSCs）向成骨细胞分化的诱导作用。方法：体外分离培养兔骨髓MSCs，用AdEasy1／Cbfa1。转染MSCs，在转染后3d,1、2、3和4周时，组织化学和免疫组化等方法检测成骨标志碱性磷酸酶和骨钙素的表达。结果：AdEasy1／Cbfa1转染后的兔骨髓MSCs表现出与成骨细胞相似的形态，并且表达碱性磷酸酶和骨钙素。结论：Cbfa1可诱导兔骨髓MSCs向成骨细胞分化。     

血管移植搭桥治疗巨大动脉瘤

目的探讨中、高流量血管搭桥方法对颅内巨大颅内动脉瘤的治疗。方法8例巨大和颅底复杂动脉瘤患者,主要表现头痛发病者5例,视力减退者2例,面部麻木者1例。未破裂动脉瘤6例,2例患者发生动脉瘤破裂,Hunt-Hess分级分别为Ⅰ级和Ⅱ级。血管造影证实：动脉瘤体位于颈内动脉海绵窦段（C4段）4例、床突上段（C1段）2例、大脑中动脉M2～M1段者2例动脉瘤大小为2．5～6．0cm,平均直径3．7cm。其中6例动脉瘤为梭形,2例为宽颈动脉瘤。8例患者均采用额颞开颅,骨瓣要尽可能低到颅底,以缩短搭桥移植血管在颅外走行长度。通常用7-0显微缝线吻合移植血管与颈外动脉,用8-0缝线吻合移植血管与颅内段颈内动脉和大脑中动脉。4例患者利用大隐静脉移植搭桥,4例患者利用桡动脉移植搭桥。颅内、外搭桥完毕后将动脉瘤近心端和远端的供血动脉结扎和夹闭,阻断动脉瘤的全部血供。对3例有压迫脑神经或颅内占位引起颅压高的患者,将动脉瘤切除。结果5例术后头痛消失,1例视力减退者明显改善,1例动眼神经麻痹恢复。5例术后行脑血管造影检查,3例行CT血管造影检查,7例搭桥吻合血管全部畅通,动脉瘤消失。2例术后出现暂时性一侧肢体力弱,肌力在Ⅱ～Ⅲ级之间,术后1个月完全恢复。结论中、高流量颅内外血管搭桥可作为治疗颅内巨大动脉瘤的有效方法。     

Radiation therapy induced modulation of wound healing at experimental vein graft anastomoses.

OBJECTIVES: The aim of this study was to investigate if radiation therapy (RT) favorably modulates wound healing at vein graft anastomoses. MATERIALS AND METHODS: Jugular vein grafts were sewn into carotid arteries in 32 rats which were randomly divided into two groups: RT (gamma source, 14 Gray, n=16) and control (C, sham irradiation, n=16). Grafts and adjacent arteries were analyzed at 2 (n=8) and 8 weeks (n=8) by histology, immunohistochemistry, and morphometry. RESULTS: Although, RT did not reduce the overall occurrence of intimal hyperplasia, the distribution differed. RT led to a reduction of intimal hyperplasia in arterial segments (median: C: 41.873 microm2; RT: 6.452 microm2, p < 0.0007). In contrast, RT augmented intimal hyperplasia in vein grafts (median: C: 30.287 microm2; RT: 90.455 microm2, p < 0.014). Vein graft diameters after RT were enlarged (median: C: 2.098 microm; RT: 3.381, p < 0.031). Over 80% of the cells were of mesenchymal origin in both groups. CONCLUSIONS: RT reduced intimal hyperplasia in arterial segments. However, RT led to graft dilatation and increased intimal hyperplasia in vein grafts. RT did not favorably modulate the vascular wound healing response in this model.     

发作性睡病与HLA—DQB1＊0602基因的相关性研究

目的 探讨发作性睡病与HLA—DQB1基因的相关性。方法 对30例发作性睡病患者的临床资料进行分析。用序列特异性引物-聚合酶链反应（PCR-SSP）分型技术测定HLA—DQB1等位基因，并与44例健康人检测的数据进行比较。结果 发作性睡病患者组DQB1＊0602基因频率为40％，与正常对照组9．09％相比较明显增高；未检出DQB1＊0401—0402基因，与正常对照组9．09％相比较，经统计学分析，差异有显著性（P〈0．05）。结论 HLA—DQB1＊0602基因为中国发作性睡病人群的易感基因；HLA-DQB1＊0401—0402基因为中国发作性睡病人群的保护基因。     

Lithium for irritability in Post-Traumatic stress disorder

Irritability is often a problem for patients with Post-Traumatic Stress Disorder (PTSD). We describe two cases that illustrate the use of lithium in the treatment of veterans with PTSD who complained of serious problems with irritability or angry outbursts. These cases are discussed in the context of evidence that lithium may be useful in other patients with disorders of impulse control. The evidence linking disorders of anger and impulse control to a dysregulation in neurotransmitter regulation, particularly in serotonergic pathways, supports a psychopharmacologic approach to treatment. These findings should lead to further study of the role of lithium in the treatment of this symptom complex in patients with PTSD.     

Renal and hemodynamic effects of dopamine in infants following cardiac surgery

The renal and hemodynamic effects of dopamine were measured during the immediate postoperative period in six infants following repair of congenital cardiac defects. Dopamine was infused at rates of 5, 10, and 15 micrograms/kg/min. Cardiac index (CI) increased significantly at a dopamine infusion rate of 15 micrograms/kg/min. The glomerular filtration rate (GFR) and urine output increased at dopamine infusion rates of 5 and 10 micrograms/kg/min and returned to baseline at 15 micrograms/kg/min. No significant changes occurred in right atrial pressure (RAP), left atrial pressure (LAP), systemic artery pressure, systemic vascular resistance (SVR), or pulmonary vascular resistance (PVR). Heart rate (HR) increased slightly at a dopamine infusion rate of 15 micrograms/kg/min. Pulmonary artery pressure (PAP) increased significantly in only one patient. These data demonstrate that infants require high doses of dopamine to produce the hemodynamic effects seen in adults and that these higher doses may be used without adverse renal effects.