低级别胶质瘤继发癫痫的手术治疗

目的 探讨低级别胶质瘤继发癫痫的手术治疗方法.方法 采用视频脑电、脑磁图定位致痫灶、功能区,手术中联合应用立体定向引导、术中B超、术中皮质电刺激等技术治疗继发癫痫的低级别胶质瘤13例.结果 全部患者在手术切除、保护神经功能的同时,控制了癫痫发作,临床效果良好.结论 多种定位技术的联合应用,可在最大程度切除肿瘤、致痫灶的同时减少脑组织损伤,保留脑功能区皮质,控制癫痫发作,提高患者生活质量.

Abstract：

Objective To explore the methods of surgical treatment of low-grade glioma with secondary epilepsy.Method Video-EEG,magnetoeneephalography ( MEG) were performed to localizated the epileptogenic zone and domain in 13 patients,and stereotactic technology,ultrasound,electrocorticogram (EcoG) were performed intraoperative combinating to treat the low-grade gliomas that lead to epilepsy.Results The seizure was controlled while the tumor was resected and the neural function were protected in all patients.The clinical effect was significant.Conclusions The combination of multiple technology to localize the epileptogenic can resect the tumor or the epileptogenic zone maximum, reduce the injury of normal brain tissue,protect the cortex of brain domain,control the epileptic seizure and improve the patients' quality of life.     

局灶性皮质发育不良皮质中NMDA受体亚基表达情况

目的探讨N-甲基-D-天冬氨酸(N-methyl-D-aspartate,NMDA)受体亚基NR1、NR2A、NR2B在难治性癫病人局灶性皮质发育不良(focal cortical dysplasia,FCD)皮质中的表达及意义。方法选取20例难治性颞叶癫(术后病理证实为FCD)为FCD组及10例颞叶血管畸形病人为对照组,收集两组病人术中切除的颞叶皮质,利用免疫组化和Syber Green荧光定量PCR技术检测标本中NMDA受体亚基NR1、NR2A、NR2B蛋白和mRNA的表达情况。结果对照组NR1、NR2A和NR2B蛋白表达分别为3.5、3、3,FCD组分别为5、5、5。对照组NR1、NR2A和NR2B mRNA表达分别为1.109、1.079、1.157,FCD组分别为2.176、2.324、2.348。与对照组比较,FCD组NR1、NR2A、NR2B蛋白和mRNA表达显著增加(均P<0.01)。结论 FCD皮质中NMDA受体亚基蛋白及mRNA表达升高,可能是FCD致机制之一。     

伽玛刀治疗顽固性癫痫的初步报告

目的 探讨伽玛刀治疗顽固件癫痫的可行性、术前评估及疗效.方法 37例顽同性癫痫患者综合MRI、VEEG、MEG等资料确定癫痫灶部位,行伽玛刀治疗.周边剂最10～18 Gy/50%.结果 按国际癫痫学会外科手术疗效分类法,有效率83.8%.在心理状态、智商等方面也得到明显改善.结论 伽玛刀治疗顽同性癫痫安全、有效,可作为手术治疗顽固性癫痫的有益补充.     

伽玛刀治疗育龄妇女脑动静脉畸形的护理指导

2000年1月～2006年12月,我科对61例育龄妇女脑动静脉畸形（AVM）行伽玛刀治疗,由于治疗、宣传教育及指导到位．随访2年内AVM无再出血发生。现将护理指导经验报告如下：     

趋化因子配体20单克隆抗体对小鼠变应性鼻炎的抑制作用

目的 观察抗趋化因子配体(CCL)20抗体对小鼠变应性鼻炎的抑制作用.方法 选用BALB/c小鼠30只,随机分为变应性鼻炎(AR)组、CCL20单克隆抗体组和对照组,每组各10只.AR组及CCL20单克隆抗体组以卵清蛋白加入氢氧化铝佐剂行腹腔注射建立AR动物模型,CCL20单克隆抗体组再予CCL20单克隆抗体0.5 mg/kg腹腔注射,对照组则以0.9%氯化钠溶液腹腔注射.模型建立后第2天处死小鼠并取其鼻腔黏膜及胸腺组织,对各组动物进行AR症状评分,应用酶联免疫吸附法(ELISA)、逆转录聚合酶链反应(RT-PCR)分别测定鼻腔黏膜中CCL20的蛋白含量及基因表达情况,并应用流式细胞仪测定胸腺中CD4+及CD25+T细胞的比例.结果 ①AR症状评分:AR组、CCL20单克隆抗体组的症状评分分别为(6.0±0.8)、(4.1±1.1)分,两组问的差异有统计学意义(P＜0.05);且均显著高于对照组的(0.7±0.5)分.②小鼠鼻腔黏膜中CCL20 mRNA相对表达量:AR组、CCL20单克隆抗体组CCL20 mRNA相对表达量分别为13.49±0.65、13.21±0.53,均显著高于对照组的12.61±0.25(P值均＜0.05);AR组与CCL20单克隆抗体组间CCL20mRNA相对表达量的差异无统计学意义(P＞0.05).③胸腺中CD4+及CD4+CD25+T细胞计数:AR组、CCL20单克隆抗体组的胸腺CD4+T细胞比例分别为(92.3±1.2)%、(91.0±0.7)%,均显著高于对照组的(86.6±2.9)%(P值均＜0.05);但AR组与CCL20单克隆抗体组间的差异无统计学意义(P＞0.05).AR组、CCL20单克隆抗体组胸腺CD4+CD25+T细胞比例分别为(1.43±0.1 7)%、(2.38±0.43)%,均显著低于对照组的(4.05±0.68)%(P值均＜0.05);AR组与CCL20单克隆抗体组的差异有统计学意义(P＜0.05).结论 CCL20单克隆抗体可阻断CCL20/趋化因子受体6通路,能有效地抑制小鼠AR的症状.     

伽玛刀治疗大鼠脑胶质瘤前后VEGF、PCNA表达及细胞凋亡研究

目的:通过应用伽玛刀对C6大鼠脑胶质瘤的治疗,检测治疗前后反映血管生成情况的血管内皮生长因子(VEGF)、反映细胞增殖情况的增殖细胞核抗原(PCNA)等的动态变化规律以及它们与凋亡的关系,探讨这些治疗效应在放射外科中的意义。方法:应用免疫组化及细胞凋亡方法进行统计学分析。结果:治疗后VEGF和PCNA表达降低,凋亡率明显高于对照组。结论:伽玛刀对于大鼠脑胶质瘤有明显的治疗作用。     

医患矛盾处理中的“七个三”

将医疗纠纷的预防和处理经验概括为"七个三",即预防纠纷抓"三早",发生情况"三处理",医患谈话"三参加",极端情况"三联动",调解处理"三参与",坚持原则"三不赔",问题过后"三总结"。医患矛盾的发生率得到有效控制,遗留的医疗纠纷也逐步得到妥善解决,改善了医疗环境。     

缝隙连接、缝隙连接蛋白43与癫痫

<正>缝隙连接(Gap junction,GJ)为细胞膜上的一种特殊结构,构成相邻细胞间的通道,离子及小分子可经其进行细胞间转运,通过缝隙连接可以介导细胞间的通讯和电传导,是电突触的基本结构[1]。缝隙连接蛋白(Connexin,Cx)是缝隙连接的组成部分,缝隙连接蛋白43(Cx43)在哺乳动物的中枢神经系统中数量最多,表达活性最强,其主要在脑组织星形胶质细胞中表达,和细胞信息传导等多个方面关系密切。Cx43在中枢神经系统的同步化放电、信息传递及生长发育     

神经生长因子基因转染联合强化铁营养防治豚鼠爆震性聋的实验研究

Objective To study the protective effects of adenovirus-mediated human beta-nerve growth factor gene (hNGFβ) transfer combined with iron fortified nutrition on blast hearing damage in guinea pigs. Methods Deafness was induced by blast (172dB SPL) in 35 healthy guinea pigs. Seven days after noise exposure, 10 guinea pigs were inoculated with adenovirus-mediated hNGFβ (Ad-hNGFβ) into the perilymphatic space (the gene group), another 10 guinea pigs were given hNGFβ combined with iron fortified nutritional diet (the combination group), still another 10 guinea pigs were inoculated with artificial perilymphatic fluid (APF), and 5 guinea pigs served as control, given neither medicine nor noise exposure. Auditory brainstem response (ABR) threshold shifts were monitored in the guinea pigs before blast exposure and after gene transfer. Changes in cochlear morphology were examined with immunohistochemical and HE staining. Results One week after successful inoculation of hNGFβ, it was noted that Ad-hNGFβ protein was expressed in each turn of the cochlea, and its intensity was almost equal. After gene transfer in the combination group and the gene group, ABR threshold shifts at week 1 and 4 were significantly smaller than those of the APF group. HE staining showed that the number of the spiral ganglion cells in the combination group and the Ad-hNGFβ group was significantly higher than that of the control group after 4 weeks (P<0.01). Conclusions Ad-hNGFβ combined with iron fortified nutritional diet was effective in the prevention and treatment of blast hearing damage of cochlear hair cells.     

岩斜区病变的手术入路

近年来,随着计算机辅助影像及显微外科技术的发展,神经外科医师开始对位置深在,周围结构复杂的病变进行探索和研究,试图将原来不能切除或只能部分切除的病变完全切除,并尝试寻找距离最近,损伤最小而且安全简洁的手术入路.岩斜区位置特殊,毗邻关系复杂,在过去的相当长的一段时间被认为是神经外科手术的"禁区".即使是现在,能够熟练进行岩斜区病变手术的神经外科医师也被认为达到手术水平的颠峰.