视神经血管母细胞瘤的临床诊断及治疗

目的 研究视神经血管母细胞瘤的临床特点及治疗方法。方法 结合国内外文献报道的16例病例，分析华山医院神经外科手术切除的国内首例单发的颅内段视神经血管母细胞瘤。结果 视神经血管母细胞瘤可以发生在视神经的任何部位。首发症状为视力减退及视野缺损，术前与视神经胶质瘤、脑膜瘤的鉴别诊断困难。MRI是较有效的诊断手段。外生型视神经血管母细胞瘤可以完全切除且可以达到视神经及视力保护。结论 视神经血管母细胞瘤非常罕见．术前难确诊，绝大多数视神经血管母细胞瘤病人合并有Von Hippel Lindou病，手术切除是唯一治疗方法。     

Podoplanin在非小细胞肺癌中的表达

肺癌是发病率和死亡率增长最快、对人群健康和生命威胁最大的恶性肿瘤之一,据不完全统计,2015年我国肺癌确诊人数达73.3万,因肺癌导致死亡的患者有61万。目前,用于肺癌诊治的医疗费用成倍增长,给医疗资源的分配带来了严峻的挑战。WHO根据生物学行为、治疗以及预后等因素,将肺癌分为非小细胞肺癌（non-small cell lung cancer, NSCLC）和小细胞肺癌（small cell lung cancer, SCLC）,其中NSCLC占80%以上［1］。在NSCLC中,约65%的患者在首诊时已经发生了局部进展或者远处转移,转移性NSCLC患者的平均中位生存期只有1~2年［2］,而相对于 SCLC,NSCLC 对于传统治疗手段化疗和放疗都较不敏感,即使目前的靶向治疗药物如厄洛替尼或贝伐单抗等已在临床上广泛应用,但往往也只是初期疗效较为显著而已,几个月后多由于肿瘤细胞演化出不同的代谢旁路而逐渐耐药进而失去作用［3-4］。因此,提高转移性 NSCLC的疗效已刻不容缓,亟需新疗法来改善治疗效果、延长患者生存期。随着单克隆抗体尤其是肿瘤抗原特异性的单克隆抗体研究的发展,进一步推动了多种与肿瘤特异性抗体相结合的靶向疗法的基础与临床研究。 本研究通过大数据分析及临床资料阐明特异性肿瘤抗原podoplanin（PDPN）在非小细胞肺癌中的表达情况以及其与患者预后的关联,证实PDPN是一个新的、较为可靠的肺癌治疗靶点,从而为将来非小细胞肺癌中各类新型生物靶向疗法的开展提供了新的潜在特异性治疗靶位。     

三脑室海绵状血管瘤诊断及治疗

中枢神经系统的海绵状血管瘤(cavernous angioma)是中枢神经系统常见的一种血管畸形,可以发生在脑内任何部位。然而生长在第三脑室内的海绵状血管瘤极为罕见。本研究对复旦大学附属华山医院神经外科自2001年以来收治的4例三脑室海绵状血管瘤进行回顾性分析,并结合国内外文献,对三脑室海绵状血管瘤的临床特点及治疗进行探讨。     

铁在脑出血后脑水肿形成中的机制研究进展

脑出血(intracerebral hemorrhage,ICH)是常见的脑血管疾病,病死率及致残率都较高。国内的一项流行病学调查显示脑出血占中风的39.9%,脑出血的发病率高达85.4/10万,其病死率更高达41.3%,且脑出血患者的慢性伤残率达到39.1%[1]。而在美国,自发性脑出血所致的死亡人数占脑血管病总死亡数的15%,其中许多脑内血肿的病人因继发性脑水肿的形成而病情迅速恶化[2]。脑出血的病死率及致残率与出血后脑水肿的发生和发展密切相关。国内外研究表明,脑血肿降解产生的铁离子可以催化自由基反应产生以活性氧簇(reactive oxygen species,ROS)为主的大量自…     

脑出血后多聚二磷酸腺苷核糖聚合酶过度表达与脑水肿的相关性

Objective To explore the mechanism of brain edema formation caused by hemoglobin after intracerebral hemorrhage (ICH). Methods Hemoglobin was infused into the right basal ganglia of SD rats with stereotactic guidance. The animals were killed 24 h later for detection of brain water and ion contents. Western blotting and immunohistochemistry were applied to detect the expression of poly( ADP-ribose) polymerase (PARP). The effect of the iron chelator deferoxamine ( DFX) on PARP expression was also examined. Results Intracerebral infusion of hemoglobin caused an increase in brain water content [from (78.7 ±0.3)% to (82. 1 ±1.2)% in ipsilateral basal ganglia] at 24th h. At the same time,PARP expression was up-regulated after hemoglobin infusion. By the intraperitoneal injection of 500 mg/kg DFX, brain edema induced by hemoglobin was attenuated significantly [from (82. 1 ±1.2)% to (80.4 ±1.0)% in ipsilateral basal ganglia] , and PARP expression was also down-regulated. Conclusion PARP might play a potential role, at least in part, in delayed edema development after ICH, and reducding iron production by iron chelator and down-regulating PARP overexpression might be a useful target for therapeutic intervention to limit brain edema after ICH.     

脑出血后多聚二磷酸腺苷核糖聚合酶过度表达与脑水肿的相关性

目的 探讨血红蛋白导致脑出血(ICH)后脑水肿的机制.方法 将血红蛋白注入SD大鼠的右侧基底节区,24 h后将其处死取脑组织检测脑水含量及钠离子含量.同时,采用Western blot分析及免疫组织化学方法来检测多聚二磷酸腺苷核糖聚合酶(PARP)的表达,并观察铁螯合剂--去铁敏(DFX)对PARP表达的影响.结果 脑内注射血红蛋白后24 h发现注射侧脑水含量明显升高[基底节含水量由(78.7±0.3)%上升至(82.1±1.2)%],同时PARP表达上调;而在脑内注射血红蛋白同时腹腔注射500 mg/kg的去铁敏则能使PARP表达下调并且使脑水肿减轻[基底节含水量由(82.1±1.2)%降至(80.4±1.0)%].结论 在脑出血后血红蛋白诱导的迟发性脑水肿的形成过程中,PARP起到了潜在的重要作用;而螯合血红蛋白的降解产物铁并抑制PARP过度表达,有可能成为减轻脑出血后脑水肿的新的有效治疗方法.

Abstract：

Objective To explore the mechanism of brain edema formation caused by hemoglobin after intracerebral hemorrhage (ICH). Methods Hemoglobin was infused into the right basal ganglia of SD rats with stereotactic guidance. The animals were killed 24 h later for detection of brain water and ion contents. Western blotting and immunohistochemistry were applied to detect the expression of poly( ADP-ribose) polymerase (PARP). The effect of the iron chelator deferoxamine ( DFX) on PARP expression was also examined. Results Intracerebral infusion of hemoglobin caused an increase in brain water content [from (78.7 ±0.3)% to (82. 1 ±1.2)% in ipsilateral basal ganglia] at 24th h. At the same time,PARP expression was up-regulated after hemoglobin infusion. By the intraperitoneal injection of 500 mg/kg DFX, brain edema induced by hemoglobin was attenuated significantly [from (82. 1 ±1.2)% to (80.4 ±1.0)% in ipsilateral basal ganglia] , and PARP expression was also down-regulated. Conclusion PARP might play a potential role, at least in part, in delayed edema development after ICH, and reducding iron production by iron chelator and down-regulating PARP overexpression might be a useful target for therapeutic intervention to limit brain edema after ICH.     

运用TiMate数字化钛网成型系统实施定点精确固定颅骨成型手术的研究

目的 研究点对点固定技术在TiMate数字化钛网成型系统塑型后的钛网植入手术中的应用。方法 对21例需行颅骨整形手术的患者在骨窗缘的头皮上按一定的间隔贴定位标记，进行薄层CT扫描。数据经TiMate软件处理后形成带有定位点标记的数字化钛网。并经数控加工系统成型，术中先把头皮定位标记用克氏针在颅骨上标出．再一一对应将带标记钛网固定。结果 所有患者手术时间均缩短，其中18例患者行术中CT导航，结果证实钛网植人后与术前计划完全相符。结论 点对点固定技术结合TiMate数字化钛网成型系统能确保钛网在植人阶段精确定位。提高手术质量与效果．缩短手术时间。     

颅内恶性神经鞘膜瘤临床诊断及治疗

目的通过分析颅内恶性神经鞘膜肿瘤这一罕见肿瘤的临床资料，加深对这一疾病的认识．以期提高治疗效果。方法回顾性分析我院1994年1月-2006年11月手术切除并经病理证实的11例颅内恶性神经鞘膜肿瘤患者的临床资料。结果本组病例年龄为3～51岁，男女病例比例为7：4；多数有颅神经障碍，局部肿块以及原有症状再度出现是本组病人的主要临床表现；这些病变起源可分为：（1）直接起源于颅神经根的；（2）非明确神经根起源的；（3）复发并恶变的。肿瘤全切除5例．次全切除3例，部分切除3例。术后近期效果较好，3例辅以放疗。术后3例存活超过5年，存活最长的病例超过10年。结论颅内恶性神经鞘膜肿瘤多见于儿童及中年患者，多数病人病程较短．临床症状因部位不同表现相应神经功能障碍，术后近期效果较好，肿瘤全切除及放疗可提高5年生存率。     

脑出血后多聚二磷酸腺苷核糖聚合酶过度表达与脑水肿的相关性

Objective To explore the mechanism of brain edema formation caused by hemoglobin after intracerebral hemorrhage (ICH). Methods Hemoglobin was infused into the right basal ganglia of SD rats with stereotactic guidance. The animals were killed 24 h later for detection of brain water and ion contents. Western blotting and immunohistochemistry were applied to detect the expression of poly( ADP-ribose) polymerase (PARP). The effect of the iron chelator deferoxamine ( DFX) on PARP expression was also examined. Results Intracerebral infusion of hemoglobin caused an increase in brain water content [from (78.7 ±0.3)% to (82. 1 ±1.2)% in ipsilateral basal ganglia] at 24th h. At the same time,PARP expression was up-regulated after hemoglobin infusion. By the intraperitoneal injection of 500 mg/kg DFX, brain edema induced by hemoglobin was attenuated significantly [from (82. 1 ±1.2)% to (80.4 ±1.0)% in ipsilateral basal ganglia] , and PARP expression was also down-regulated. Conclusion PARP might play a potential role, at least in part, in delayed edema development after ICH, and reducding iron production by iron chelator and down-regulating PARP overexpression might be a useful target for therapeutic intervention to limit brain edema after ICH.