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.     

Emergency treatment of craniocerebral firearm wounds

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经蝶入路显微外科切除颅咽管瘤

目的　为探求一种颅咽管瘤切除的手术径路可能性。　方法　回顾总结１８ 例颅咽管瘤的诊断方式,手术技巧和治疗结果,均经 Ｃ Ｔ 或 Ｍ Ｒ Ｉ扫描确诊。手术采取经唇下蝶窦入路或经鼻前庭鼻中隔蝶窦入路两种方式行肿瘤切除术。　结果　９ 例肿瘤获全切除,４ 例次全切除,余５ 例为部分切除,术后无死亡。１５ 例获长期随访（ 平均３１ 年） ,有１２ 例恢复良好。　结论　对位于鞍内的颅咽管瘤或肿瘤系囊性并向鞍上扩展者,采用经蝶入路显微手术切除是一种安全、有效的方法     

颅内海绵状血管瘤的诊断与治疗

目的 探讨颅内海绵状血管瘤的诊断和手术治疗方法。方法 回顾我院经手术证实的１６例病人的临床资料,对其临床特征、诊断和治疗经验进行总结。结果 按发生部位将肿瘤分为三种类型：大脑半球型,颅中窝型,小脑型。大脑半球型９型,主要表现癫痫发作;颅中窝型５例,主要表现为视力视野损害和眼球活动障碍;小脑型２例,表现为头痛和呕吐。肿瘤ＣＴ表现为圆形或类圆形的血供丰富的占位病变,但血管造影很少发现其血供。ＭＲ检查有     

大黄提取物治疗犬肢体枪弹伤后脑神经元c-fos基因表达变化

目的　探讨中药大黄治疗犬肢体高能量枪弹伤后脑神经元c fos基因表达的变化。方法　 18只杂种犬 ,以M 193、5 .5 6mm制式弹射击犬双后肢肌肉丰满处 ,随机分为对照组、大黄治疗组。对照组伤后应用无菌注射用水鼻饲 ,大黄治疗组应用中药大黄的乙醇及水提液鼻饲。采用免疫组化 ,对两组伤后 2、6、10小时远隔部位脑组织脑神经元中c fos基因的表达分别进行检测。结果　大黄治疗组脑神经元中c fos基因表达较对照组显著减少 (P <0 .0 1)。结论　中药大黄能够抑制犬肢体枪弹伤后脑神经元c fos基因的表达。     

超声实时导航下射频消融治疗巨大脑膜瘤

目的探讨超声实时导航下射频消融治疗在巨大脑膜瘤手术中的作用。方法回顾性分析2010年11月至2011年4月经开颅手术治疗的巨大脑膜瘤29例,术中行超声实时导航、造影,其中15例患者在肿瘤切除前应用射频消融治疗。观察指标包括临床症状变化以及并发症情况。结果超声实时导航可以从多种角度、各种切面清楚地观察到肿瘤的位置、形状、大小、边界及毗邻关系,可随时显示内部及周边大血管分布、走行情况。射频消融术后,肿瘤出现凝固性坏死,切除时瘤体出血明显减少。肿瘤全切25例(86.2%),大部分切除4例(13.8%)。大多数患者临床症状明显改善。术后病理诊断为脑膜瘤WHO I级27例,WHO II级2例。结论超声实时导航以及射频消融治疗对于提高巨大脑膜瘤的切除率,减少术中出血及术后并发症具有重要作用。     

中颅窝蛛网膜囊肿的临床特点及外科治疗

目的 探讨中颅窝蛛网膜囊肿的临床特点及不同术式对其治疗的临床疗效.方法 回顾性分析第四军医大学西京医院神经外科自2001年5月至2008年5月收治的352例中颅窝蛛网膜囊肿患者(占同期收住的颅内占位性病变患者的2.58%)的临床资料、手术方式及预后情况,其中男性发病率明显高于女性(男:女为4.1∶1),以左侧居多(左∶右为3.6∶1),324例行囊肿切除术,28例巨大囊肿行囊肿-腹腔分流术.结果 术后平均随访3个月～3年.头痛就诊患者中75例(58.59%)术后头痛完全消失,41例(32.03%)明显缓解.癫痫发作患者中8例术后发作频率明显减少或程度减轻.行为异常、注意力不集中或学习困难患者中11例术后改善明显.头围增大和颞部局限性隆起就诊者术后头围及局部隆起无明显变化.影像学复查显示囊肿完全消失者46例(13.07%),囊肿部分消失者257例(73.01%),囊肿无明显变化者49例(13.92%).结论 中颅窝蛛网膜囊肿的临床特点为男性、左侧多发,年龄愈小手术效果越好,手术仅部分切除壁层即可;囊肿巨大时行分流手术效果好,分流管以中低压为佳.

Abstract：

Objective o investigate the clinical characteristics of middle cranial fossa arachnoid cyst (MCFAC) and its therapeutic effects with different surgical methods. Methods Three hundred and fifty-two patients with MCFAC (about 2.58% of patients with intracranial space occupying lesion),admitted to our hospital from May 2001 to May 2008, were chosen in out study; their clinical data,surgical approach and prognosis were analyzed retrospectively. The gender ratio of patient with MCFAC adopted resection of arachnoid cyst and arachnoid cyst-peritoneal shunt was performed in 28 patients.Results Follow-up was performed for 3 months to 3 years. The headache completely disappeared in 75 patients (58.59%) and partial remission in 41 (32.03%) after the operation. The frequency and degree of seizures obviously decreased in 8 of the patients with MCFIAC. Eleven patients with dystropy,attention-deficit disorder or difficulty of learning got improvement. The head circumference and local skull eminentia was stable. The cyst disappeared completely in 46 patients (13.07%), partially in 257 (73.01%) and no changes in 49 (13.92%). Conclusion The clinical features of MCFAC is that it mainly occur in the left side of male. The younger the patient with MCFAC is, the better the treatment effect in the surgical intervention is. good outcome can be achieved by resection of the parietal layer of arachnoid cysts. The indication of shunt with meso-low pressure shunt system is for larger arachnoid cyst.     

脂肪干细胞诱导神经干细胞分化的体外实验研究

目的研究脂肪干细胞（ADSCs）体外诱导神经干细胞（NSCs）分化的作用。方法从新生BALB／c小鼠中分别分离获得ADSCs及NSCs,进行体外培养和传代。构建ADSCs与NSCs共培养体系,以单纯NSCs组为对照,进行ADSCs诱导分化研究。共培养4、8、12d后行神经元特异性神经丝200免疫组化鉴定,统计NSCs分化为神经元的百分率。结果共培养后8—12d,可见大量成熟神经元,大多为多极神经元,少部分为双极神经元或假单极神经元,带有较长的轴突。共培养组NSCs分化为神经元的百分率大约为21％,而单纯NSCs培养组约为4％。共培养组神经元的转化率与单纯NSCs培养组神经元的转化率之间有显著性差异（P〈0．05）。结论ADSCs在体外能够促进NSCs向神经元转化。     

创伤性脑水肿甘露醇脱水治疗电阻抗断层成像实时监测的研究

目的探讨甘露醇对脑组织脱水过程中脑部电阻抗的变化规律,研究电阻抗断层成像监护技术对甘露醇脱水功效的监护作用。方法使用电阻抗断层成像技术,实时监测12例保守治疗的颅脑损伤伤员甘露醇脱水过程中相应的电阻抗一维指标与二维图像变化,每人选取干扰较少的4次脱水过程进行分析,并记录相应的排尿量和液体摄入量,分析在甘露醇的脱水过程中电阻抗指标变化。结果48次甘露醇脱水过程中,颅内液体量变化时相应组织的电阻抗一维指标也发生变化,当液体量减少时阻抗值升高,液体量回升时阻抗值降低,对应的EIT二维图像也发生相应的变化。结论连续实时EIT动态图像监护即可动态监护脑水含量改变,判别甘露醇的效果和指导拟定治疗方案,也有可能成为一种颅内病变脑含水量改变监测的有效方法。     

脑肿瘤相关性癫痫发生的影响因素分析及对症处理

目的探讨脑肿瘤相关性癫痫发生的影响因素及对症处理。方法选择2008年1月至2012年5月住院治疗存活的脑肿瘤患者共300例,伴随有相关性癫痫40例,对所有患者的临床资料进行回顾性分析。结果单因素分析结果表明,癫痫病家族史、病变复发、手术入路、肿瘤位置、肿瘤程度、年龄等因素在癫痫发作和未发作患者之间差异有统计学意义(P<0.05)。多因素分析显示,癫痫史、病变复发、手术入路、肿瘤程度4个因素对癫痫的影响差异有统计学意义(P<0.05)。所有患者对症处理后都痊愈出院,随访无复发与死亡。结论脑肿瘤相关性癫痫发生的影响因素主要为癫痫史、病变复发、手术入路和肿瘤程度,积极针对病因治疗,及时控制癫痫,可收到较好的效果。