去卵巢大鼠胫骨和椎骨松质骨微结构的显微CT分析

目的观察大鼠去卵巢后,椎骨和胫骨松质骨微结构变化。方法 50只7月龄SD大鼠随机分为基线组,去卵巢组和假手术组。基线组在试验开始时处死,去卵巢组和假手术组分别在去卵巢后3周、15周各处死。分离大鼠第五腰椎和左侧胫骨,用显微CT(microCT)对椎骨及胫骨骨骺端松质骨进行扫描,对其微结构定量分析。结果去卵巢第3周和第15周,OVX组胫骨骨体积分数(BV/TV)、骨小梁数量(Tb.N)和连接密度(Conn.D)均显著性小于SHAM组,骨小梁间隔(Tb.Sp)和结构模型指数(SMI)均明显大于SHAM组。去卵巢第3周,OVX组椎骨BV/TV显著性小于SHAM组,SMI明显大于SHAM组,至第15周,OVX、SHAM两组间椎骨的微结构差异与胫骨相同。纵向观察,OVX组胫骨随着时间变化出现BV/TV和Conn.D进行性减少,Tb.Sp进行性增加,面积骨密度(tBMD)和骨小梁厚度(Tb.Th)在第3到15周分别出现下降和增加。OVX组椎骨BV/TV在去卵巢3周内下降,Conn.D和Tb.Sp在3到15周内分别出现减少和增加。胫骨和椎骨的Tb.N随时间均进行性减少,SMI均在3周内增加。结论雌激素缺乏时大鼠松质骨微结构改变呈现出区域性,胫骨松质骨微结构丢失的发生比椎骨早,更为显著。     

PM2.5对去势后雌性SD大鼠骨微结构micro-CT的影响

目的探讨不同浓度的PM_(2.5)暴露对去势SD雌性大鼠骨微结构的影响。方法用不同浓度(35、70、150μg/m3)的PM_(2.5)对SD大鼠进行气道滴注,随机分为低剂量组、中剂量组和高剂量组,滴注后5个月末行去势手术;滴注后9个月末取股骨、胫骨、腰椎,运用显微计算机断层扫描术(micro-CT)分别检测三者骨微结构。结果与对照组相比,PM_(2.5)暴露组胫骨、股骨、腰椎的骨小梁骨密度(Tb.BMD)减小、骨体积分数(BV/TV)减小、结构模型指数(SMI)增大、骨小梁厚度(Tb.Th)减小、骨小梁数量(Tb.N)减少、骨小梁分离度(Tb.Sp)增加; PM_(2.5)暴露组中,胫骨骨小梁的BV/TV、Tb.Th、Tb.N、Tb.Sp指标改变与对照组比较差异有统计学意义(P0.05),股骨骨小梁的Tb.BMD、BV/TV、SMI、Tb.N、Tb.Sp指标改变与对照组比较差异有统计学意义(P0.05),腰椎骨小梁的SMI、Tb.Th、Tb.N、Tb.Sp指标改变与对照组比较差异有统计学意义(P0.05)。从micro-CT三维重建图结果看,与对照组比较,PM_(2.5)暴露组胫骨骨髓腔内明显空虚,骨小梁缺如;股骨Ward三角区骨小梁数量稀疏、间隙变大;腰椎骨小梁结构的完整性被破坏,杆状结构增多。结论表明PM_(2.5)暴露可使去势后雌性SD大鼠胫骨、股骨、腰椎骨小梁结构遭到破坏,数量减少,由片状结构转为杆状结构,由此可见PM_(2.5)暴露可加重绝经后骨量丢失。     

膝关节骨性关节炎与类风湿性关节炎患者骨小梁的显微结构分析

[目的]通过显微计算机断层扫描(micro-computed tomography,Micro-CT)检测胫骨平台软骨下骨小梁显微结构,分析膝关节骨性关节炎(osteoarthritis,OA)与类风湿性关节炎(rheumatoid arthritis,RA)患者骨小梁的显微结构。[方法]收集人工全膝关节置换术(total knee arthroplasty,TKA)中截取的OA及RA患者胫骨平台,用Micro-CT扫描标本的内、外侧胫骨平台软骨下骨小梁,获得显微结构参数进行分析比较。[结果]膝关节骨性关节炎患者内侧胫骨平台软骨下骨小梁的骨体积分数(BV/TV)、骨小梁厚度(Tb.Th)、骨小梁数目(Tb.N)大于类风湿性关节炎内侧胫骨平台软骨下骨小梁,骨表面积体积比(BS/BV)、骨小梁间隔(Tb.Sp)、结构模型指数(SMI)、各项异性的程度(DA)则小于类风湿性关节炎内侧胫骨平台软骨下骨小梁;而外侧胫骨平台软骨下骨小梁,骨性关节炎的BS/BV、Tb.Th、Tb.N大于类风湿性关节炎,Tb.Sp和DA则相反。膝关节骨性关节炎内侧胫骨平台软骨下骨小梁的BV/TV、Tb.Th、Tb.N大于其外侧,BS/BV、Tb.Sp、SMI小于其外侧。而类风湿性关节炎内侧胫骨平台软骨下骨小梁的BV/TV、Tb.Th小于其外侧。BS/BV、SMI、DA与其他显微结构参数间存在着相关关系。[结论]膝关节骨性关节炎与类风湿性关节炎及两种疾病的内、外侧胫骨平台软骨下骨小梁显微结构存在差异,这对人工膝关节假体的力学环境分析有一定的指导作用。     

股骨头松质骨样本空间结构的三维分析

目的在股骨头坏死和骨质疏松股骨颈骨折的研究中,股骨头松质骨的空间结构的重要性越来越受到重视。本研究介绍一种对股骨头松质骨样本的骨小梁的空间结构进行三维重建和评价的方法。方法对8个犬股骨头的松质骨样本进行硝酸银染色和白色聚酯包埋后,逐层连续断面切除,利用数码CCD镜头连续采集断面图像,获取样本断面的二维图像,利用计算机软件二值化图像,并进行三维重建,得到松质骨小梁空间结构的计算机三维图形,对样本进行三维评测,指标包括骨体积分数(BoneVolumeFraction,BVF,BV/TV)、骨表面积体积比(Bonesurface/bonevolumeratio,BS/BV)、骨小梁厚度(Trabecularthickness,Tb.Th)、骨小梁数目(Trabecularnumber,Tb.N)、骨小梁间隙(Trabecularspacing,Tb.Sp)、结构模型指数(StructureModelIndex,SMI)。结果用本方法可以获得了清晰的骨小梁三维结构图,图像空间解析度10μm×10μm×10μm。分析结果表明,样本的上半部分与下半部分相比,骨小梁的BV/TV、BS/BV、Tb.Th、Tb.N和Tb.Sp、SMI之间存在差异(P<0.05),样本的上半部分结构致密,BV/TV较大,而Tb.Sp较小(P<0.05),小梁结构也表现为板状模型。结论距离股骨头上关节面的深度不同,股骨头的空间指标也随之出现不同的变化。     

Micro-CT评价新型低弹β钛合金对动物骨质疏松性骨折愈合的影响

目的micro-CT评价新型低弹β钛合金内植物对大鼠骨质疏松骨折愈合的作用及应力遮挡效应。方法SD雌性大鼠去势,建立骨质疏松动物模型,采用Utvag方法制备双股骨骨折模型,选用弹性模量分别为110GPa和30GPa的钛合金制成髓内针固定骨折,左侧为高弹组,右侧为低弹组,分别于术后2、4、6、12w行micro-CT测定,检测骨小梁的体积(BV)、样本体积(TV)、骨体积分数(BVF)、骨小梁间隙(Tb.Sp)、骨小梁厚度(Tb.Th)、骨小梁数(Tb.N)和结构模型指数(SMI)等指标,比较两种弹性模量钛合金植入物对骨折骨痂形成的影响,并进行统计学分析。结果骨质疏松大鼠股骨骨折后4w,兴趣区域1(ROI1)区,低弹组除TV、Tb.Sp高于高弹组外,BV、BVF、Tb.Th均低于高弹组;术后6w,ROI1区,低弹组TV值高于高弹组,其余差异无显著性;术后12w,ROI1区,低弹组TV、BV、Tb.N、Tb.Th、SMI均高于高弹组。ROI2区,低弹组BV、BVF、SMI均高于高弹组。结论新型低弹β钛合金内植物有利于大鼠骨质疏松骨折早期骨痂的形成,并提高骨折愈合的远期质量,减少了骨折固定节段的骨量丢失。     

粗聚焦震波对大鼠骨质疏松性骨折愈合的影响及生物力学评估

目的 观察粗聚焦震波对大鼠骨质疏松性骨折愈合过程中的骨密度、骨微结构及愈合后生物力 学特性的影响。方法66只体重为200~250 g的3月龄雌性SD大鼠卵巢去势制造骨质疏松模型,造模成功后左腿胫骨制造开放性骨折并予克氏针内固定。术后分为对照组和治疗组,治疗组用震波能量 密度0. 26 mJ/mm2,频率60次/分,冲击量为2000次治疗一次。结果治疗后4周和8周行组织学观察显示治疗组与对照组比较骨性骨痂所占比例较大,8周时骨小梁改建基本完成;而Micro CT检验数据结果显示治疗组骨密度（BMD );骨小梁体积（BV )、组织体积（TV )、骨体积分数（BV/TV )、平均骨小梁厚 度（Th. Th)、平均骨小梁数目（Tb.N)均明显高于对照组（P<0. 05),其中治疗8周后的骨密度改变存在 显著差异（-3.6% vs 4. 9%,P<0. 05)。且治疗组最大压缩荷载在治疗后4周（48.1±5.6(治疗组)vs 21. 8±4. 8(对照组））、8周时亦明显高于对照组（57.5±6.1(治疗组）vs28.6 ±5.0(对照组））。结论 粗聚焦震波能够抑制骨折后的骨丢失,增加骨密度,促进骨折愈伤组织的生长,改善骨小梁三维结构及骨组织的力学性能,可用来促进骨质疏松性骨折的愈合并改善骨质量,预防再骨折。     

静止期牙周病大鼠牙齿移动后上下颌牙槽骨骨微结构的差异

目的:观察静止期牙周病大鼠牙齿移动后上下颌牙槽骨骨微结构的差异。方法:SD雄性大鼠48只随机分为对照组和实验组(各半),实验组建立静止期牙周病动物模型,近中移动上、下颌右侧第一磨牙。各组于加力0d、7d、14d、21d各处死6只动物,取材,行Micro-CT扫描。结果:加力0d、7d,实验组大鼠上颌牙槽骨骨密度(BMD)、骨体积分数(BV/TV)、骨小梁厚度(Tb·Th)低于下颌,骨小梁数量(Tb·N)高于下颌(P0.05);加力14d,上颌牙槽骨Tb·Th低于下颌,骨小梁分离距离(Tb·Sp)高于下颌(P0.05);加力21d,上颌牙槽骨BV/TV、Tb·Th低于下颌,Tb·N、Tb·Sp高于下颌(P0.05)。加力14d,实验组大鼠上、下颌牙槽骨BMD、BV/TV降至最低,Tb·Sp升至最高。上、下颌牙槽骨Tb·N分别在加力7d、14d升至最高,Tb·Th分别在加力14d、21d降至最低。结论:静止期牙周病大鼠牙齿移动后,上颌牙槽骨骨骼强度低于下颌,且骨小梁的退行性改变较下颌严重。上颌牙槽骨主要以骨小梁厚度和分离距离的改变为主,下颌牙槽骨主要以骨骼强度的改变为主,且下颌牙槽骨的骨吸收和骨形成较上颌牙槽骨快。     

不同加力时间下静止期牙周病大鼠牙槽骨骨微结构的变化

目的建立静止期牙周病动物模型,观察不同加力时间下其牙槽骨骨微结构的变化。方法选取156只28周龄SD雄性大鼠,随机分为对照组(50只)和实验组(106只),实验组建立静止期牙周病动物模型,再随机分为牙周治疗组和牙周+正畸治疗组(各50只),对牙周+正畸治疗组动物模型上颌右侧第一磨牙加力,力值为50 g。各组于加力后0、7、14、21、28 d各处死10只动物,取材,行Micro-CT检察。结果①加力0、7、14、21、28 d,实验组动物模型右侧上颌第一磨牙牙槽骨骨密度(bone mineral density,BMD)、骨体积分数(BV/TV)、骨小梁厚度(Tb·Th)均较对照组降低,骨小梁数量(Tb·N)、骨小梁分离距离(Tb·Sp)均较对照组升高;②相较牙周治疗组,加力14 d时牙周+正畸治疗组动物模型右侧上颌第一磨牙牙槽骨BMD、BV/TV、Tb·Th降低,Tb·N、Tb·Sp升高;加力28 d时,BV/TV升高,Tb·N、Tb·Sp降低;③加力14 d,牙周+正畸治疗组动物模型右侧上颌第一磨牙牙槽骨BMD、BV/TV、Tb·Th降至最低,Tb·N、Tb·Sp升至最高,但至28 d时各项指标已恢复至未加力时状态。结论①静止期牙周病动物模型牙槽骨骨质疏松且对力学刺激的反应变缓慢;②突然受力后静止期牙周病动物模型牙槽骨以吸收为主,但随着加力装置力量的减弱和力值的稳定,牙槽骨可逐渐恢复到加力前的状况;③较小的力值刺激有利于静止期牙周病动物模型牙槽骨的修复。     

高能震波对骨质疏松骨的结构及力学性能影响

目的 探讨高能震波对骨质疏松骨的结构及力学性能影响.方法 40只雌性新西兰兔去势,建立骨质疏松动物模型.应用高能震波处理一侧股骨近端,能量密度0.26 mJ/mm2,频率60次/min,冲击量为2000次;另一侧作为对照.分别于术后4、8、12、24周,行micro-CT、骨计量学及生物力学检测.结果 micro-CT分析显示治疗组表观骨密度(Density of TV)、相对骨体积(BV/TV)、骨小梁厚度(Tb.Th)、骨小梁数目(Tb.N)均明显高于对照组,而骨表面积体积比(BS/BV)、骨小梁间隙(Tb.Sp)、骨小梁结构模型指数(SMI)较对照组少(P<0.01).骨组织形态计量学检测显示治疗组骨小梁体积和骨小梁厚度增加,骨小梁间距减少,骨矿化沉积率明显降低(P<0.05),骨小梁数目变化不明显(P>0.05).股骨粗隆最大压缩载荷治疗组为186.13±15.64,对照组为121.83±17.82,治疗组明显高于对照组(P<0.05).结论 高能震波能促进骨质疏松骨形成,改善骨小梁的三维结构,增加骨质密度,改善力学性能,可被用来局部治疗骨质疏松及骨质疏松性骨折,预防再次骨折发生.     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

Single center experience in single-incision laparoscopic surgery in children in Turkey

Purpose

Minimally invasive surgery has evolved into single-incision laparoscopic surgery (SILS) in the recent years. Few reports have addressed the practicality of SILS in children. Our current experience with regard to feasibility and effectiveness of SILS in children is presented.

Methods

A retrospective review of the operative database for patients operated on using SILS in our department from March 2009 to July 2010 was performed. Data regarding the type of the procedure, age, sex, operative performance, hospital stay, and complications were collected.

Main Results

Among 43 patients, cholecystectomy was performed in 11; appendectomy, in 10; unroofing for ovarian cysts, in 5; unroofing for splenic cysts, in 4; oophorectomy, in 6 (ovarian torsion, 2; teratoma, 4); ovary-preserving teratoma excision, in 1; splenectomy, in 1; gonadectomy, in 3; and varicocelectomy, in 2. There were no conversions to standard laparoscopic or open techniques. The only postoperative complication was a wound infection that occurred after an appendectomy.

Conclusion

Although currently more expensive, SILS can be performed in children in almost every pediatric surgical procedure that can be accomplished with conventional laparoscopic techniques. The most significant contribution of SILS procedure is cosmesis. Postoperative pain and length of hospital stay were not improved.     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.     

Changes in alkaline phosphatase activity in periosteal cells in healing fractures

The quantitative changes in alkaline phosphatase activity in the periosteal cells close to the fracture in rat metatarsal bones has been measured during the first 5 days postfracture. This study has been made possible by two technological advances, firstly the development of cryostat microtomy for cutting unfixed, undemineralised bone, and secondly the use of scanning and integrating microdensitometry for quantifying the activity in each periosteal cell. The results showed a loss of alkaline phosphatase activity close to the fracture site, with activity rising to normal values 0.8–1.0 mm from the site. No alkaline phosphatase activity was found in the cells which proliferated from the periosteum. It is suggested that reduced glutathione could cause such inhibition.