RESUMO
Here, we took base construction of neurosurgery as example to discuss and analyze according to requirements and evaluation indexes of base construction in Xinqiao Hospital, and put forward the specific objectives, measures and implementations of base construction. Foremost, we summarized experiences and overcame shortcomings through interpreting and implementing scheme of our base construction, which would help to improve the construction of standardized residency training base in China.
RESUMO
The standardized training for surgical residents is the systematic and normalized training for residents in the base with national authentication, whose goal is to promote the clinical experience and skill for treatment of the patients. The base construction is an important step to apply the resident training system according to the national policies and regulations . This study analyzed the experience of the Neurosurgical Unit of Xinqiao Hospital in standardized training for surgical residents according to the base construction requirements and evaluation index. Based on the analysis, the study proposed the concrete aims, measures and applying steps for neurosurgery base construction, especially the regulations for diagnosis and treatment of neurosurgical disease , which as a whole is beneficial for promoting the quality of the standardized training of residents in future.
RESUMO
Objective To investigate the value of navigated transcranial magnetic stimulation (nTMS) in preoperative evaluation of epilepsy in functional zones.Methods Retrospective analysis was performed in 12 refractory epilepsy patients had functional cortical lesions and accepted surgery in our hospital from January 2016 to March 2017.The target surgery areas were considered in or near the functional areas by video electroencephalogram and stereotactic electroencephalography or Wada test,nTMS was used to identify the motor or language functional areas before surgery,and direct cortical stimulation (DCS) was performed during the surgery to identify the accuracy of nTMS.Treatment efficacies were evaluated 6-18 months after surgery.Results Hand motor areas were detected in all patients by nTMS,of which 72.7% patients (8/11,one severe hemispheric atrophy patient was excluded due to functional zone drift to the opposite) were coincided with intraoperative DCS (<0.5 cm),the deviation distance between 0.5 cm and 1 cm was noted in 27.3% patients (3/11);motor speech areas were detected in 11 patients with nTMS,72.7% patients (8/11) were coincided with intraoperative DCS (<0.5 cm),the deviation distance between 0.5 cm and 1 cm was noted in 27.3% patients (3/11),18.2% patients (2/11) were for adjacent relationship,and one was with large difference (>1.5 cm).And 8 patients had Engel grading Ⅰ outcome (seizure-free),2 had grading Ⅱ outcome (almost seizure-free),and one had grading Ⅲ outcome (worthwhile improvement).No persistent function deficits were noted.Conclusion The nTMS is an accurate,noninvasive and safe functional localization method,which can provide important information for epilepsy patients especially who are not suitable for invasive language evaluation in epilepsy surgery.
RESUMO
Objective To establish the new animal models of malformation of cortical development (MCD) induced by methylazoxymethanol acetate (MAM),and analyze the relationship between extent of histopathology and age,seizure susceptibility and effect of seizure on the histopathology.Methods Pregnant Sprague-Dawley rats were randomly divided into MAM group and control group;rats in the MAM group received twice intraperitoneal injection of MAM (15 mg/kg) to establish MCD models on embryonic day 15,while rats in the control group only given normal saline.Daily activities and EEG features of the next generation rats were observed;Thioine-Giemsa staining and immunofluorescence staining of NeuN were applied to observe the histological changes.Pilocarpine was administrated to investigate the effects of seizure susceptibility and epilepsy seizure on pathological morphology.Results The MAM rats were dull and curtail their activities,their seizure susceptibility elevated.The histopathological and immunofluorescence staining results revealed that the MAM rats' cerebral cortex decreased and the laminar organization was disrupted;there were heterotopic neuros,hypertrophic neurons and proliferation nodules in the hippocampal and cortex;the pathology changes exacerbated with age.The malformation of cortical development was more serious in the MAM rats which experienced seizure than the MAM rats.Conclusion The MCD rat models can be established by twice intraperitoneal injection of MAM,and their pathological features resemble the patient of MCD and their pathology exacerbate with age.Seizure can aggravate the pathology of MCD.Combining utilization MAM and pilocarine could be a good approach to establish animal models of epilepsy based on MCD.
RESUMO
At present, there are still problems in medical postgraduate education in our country such as backward concept, disconnected basic research and clinical transformation, as well as imper-fect cultivation system and evaluation system. Translational medicine conception has been generally accepted and practiced, and provides a new thinking for medical postgraduate education. As a result, medical postgraduate education should reform education model to resolve the disconnection between basic research and clinical application, build a multidisciplinary intersection translational medicine research guidance team, create a strong translational medicine research atmosphere, and the quantita-tive evaluation system and peer evaluation system of scientific research achievements, thus strengthen-ing medical graduate students' concept of translational medicine and their scientific research ability, to provide the necessary talent base to solve the major problems in medical science.
RESUMO
Tuberous sclerosis complex (TSC) is a rare autosomal dominant neurocutaneous disease.Epilepsy is the most common manifestation.Studies show that even with a variety of antiepileptic drugs, more than 50% of TSC related epilepsy are drug-resistant.Since cortical tubers are the main epileptogenic foci, resection surgery become an important treatment of intractable epilepsy in TSC.In recent years, with the development of electrophysiology and imaging technology, surgical treatment of epilepsy in TSC shows a great efficacy of controlling seizures and improving intelligence.Up to date, there are no standard procedures of surgical treatment for refractory epilepsy in TSC.This paper aimed to provide some instructions.
RESUMO
Objective To detect the expression of bone morphogenetic protein receptor Ⅱ ( BMPR Ⅱ ) in human focal cortical dysplasia ( FCD Ⅱ b). Methods Fourteen specimens of FCD Ⅱ b surgically removed and pathologically verified were collected from June 2008 to June 2010 and the expression of BMPR Ⅱ in the normal brain tissues and the pathological specimens was detected by means of immunohistochemistry and western blot. Results In the normal brain tissues, BMPR Ⅱ was widely expressed in the cortical neurons of the grey matter, with no positive immunostaining in the white matter. In the cortical lesion of FCD Ⅱ b, BMPR Ⅱ was strongly expressed in the misshapen cells including balloon cells (BCs) , dysmorphic neurons (DNs) and giant neurons (GNs). Positive BMPR Ⅱ expression was also observed in the reactive astroeytes and low level expression of BMPR Ⅱ was found in the normal-appearing (NA) neurons. Western-blot analysis showed that BMPR Ⅱ expression tended to be lowered in the FCD Ⅱ b specimens compared with the normal brain tissues ( P < 0. 05 ). Conclusion The expression of BMPR Ⅱ is altered and reduced in the FCD Ⅱ b, suggesting that BMP signal pathway may participate in the pathogenesis of FCD.
RESUMO
Objective To investigate the roles of endoscopic biopsy and third ventriculostomy in the diagnosis and treatment of pineal region tumors in children. Methods Endoscopic biopsy and third ventriculostomy were performed in 9 pediatric patients with pineal region tumors. Results Successful third ventriculostomy, confirmed by MRI, was performed in 9 cases of children with obstructive hydrocephalus. No complications were found in all patients. Conclusion Endoscopic biopsy and third ventriculostomy are effective neuroendoscopic procedures in minimally invasive preferential management of pineal region tumors.
RESUMO
Objective To study the pathologic changes of hippocampus during the model development and explore the mechanism of epileptogenesis by observing the morphologic changes of hippocampal formation in rat of kainate-induced chronic temporal lobe epilepsy (TLE). Methods Thirty Wistar rats were injected of Kainic acid at dose of 2 ?g/20 ?l into the lateral cerebral ventricle under the guidence of stereotactic technique to make a epileptic focus, and subgrouped under acute phase, silent period and chronic phase. Another 10 rats received normal saline as controls. The rats were killed at 1 day, 15 day and 6 months after epileptic model establishment, and the hippocampus was taken out for HE staining, TUNEL staining, Timm’s staining, NSE staining. Results By cell counting, the neuron loss mainly occurred in acute phase, worst in CA3 and CA4, moderate in CA1 and CA2, and no loss in the dentate gyrus. The cell apoptosis in hippocampal structure was detected by TUNEL staining. Timm’s staining showed that mossy fiber began sprouting in silent period and increased continuously. Conclusion The morphologic changes of hippocampal formation in rat of kainate-induced TLE is mainly the neuron loss and the glia hyperplasy.