脊柱侧凸顶椎区椎间盘纤维环中多聚蛋白多糖的表达及意义

目的：探讨脊柱侧凸患者顶椎区椎间盘纤维环中多聚蛋白多糖的表达及其意义。方法：采集2003年7月至2004年9月间行前路松解或矫形手术的40例脊柱侧凸患者侧凸顶椎区椎间盘组织。青少年特发性脊柱侧凸患者（adolescent idiopathic scoliosis，AIS）25例，胸椎椎间盘11例，腰椎椎间盘14例；先天性脊柱侧凸患者（congenital scoliosis，CS）15例，胸椎椎间盘6例，腰椎椎间盘9例。利用RT—PCR扩增多聚蛋白多糖（Aguecan），琼脂糖凝胶电泳，在UVP（紫外光测定法）成像系统进行扫描．GelWork图像分析系统中进行灰度测定半定量分析。分别计算AIS组和CS组凹侧、凸侧纤维环中Aggrecan含量，并对CS组和AIS组胸椎和腰椎以及椎间盘的凹侧和凸侧进行比较。结果：AIS组和CS组椎间盘凹侧纤维环中Aggrecan含量低于凸侧．差异有显著性（P〈0．01），胸椎椎间盘纤维环中Aggrecan的含量低于腰椎，但无统计学差异。AIS组Aggrecan的含量和CS组相应部位Aggrecan的含量无明显差别。结论：AIS椎间盘纤维环凹凸侧存在Aggrecan代谢差异．并且可能是脊柱侧凸所致的继发改变．但也可能是脊柱侧凸发生、发展中的重要因素。     

Ⅸ型胶原基因在特发性脊柱侧凸患者顶椎椎间盘内表达的初步研究

目的　研究Ⅸ型胶原基因在椎间盘内分布,探讨其在特发性脊柱侧凸发病中的作用。方法　收集特发性脊柱侧凸患者椎间盘标本14例,已知病因脊柱侧凸标本13例,采用3例突然死亡的正常青少年的6个椎间盘作为正常对照。采用免疫组化技术和RNA探针原位杂交技术研究Ⅸ型胶原基因mRNA在椎间盘内不同部位的分布,对其mRNA含量进行半定量分析,比较Ⅸ型胶原mRNA含量在不同部位的分布。结果　Ⅸ型胶原主要分布于内层纤维环、髓核及终板软骨内,以内层纤维环与软骨终板内较高。Ⅸ型胶原主要由小圆形类软骨细胞分泌,在肥大的软骨细胞内无表达。Ⅸ型胶原mRNA含量特发性脊柱侧凸顶椎凹侧与已知病因组及正常对照组间差异均有统计学意义(P<0. 05),已知病因组端椎两侧含量均低于正常对照组,其余各组间均无明显差异。结论　Ⅸ型胶原在特发性脊柱侧凸患者椎间盘内分布无异常。Ⅸ型胶原mRNA含量在特发性侧凸患者顶椎椎间盘凹侧内含量明显低于正常人,而已知病因的侧凸患者则无明显下降,提示Ⅸ型胶原可能与特发性侧凸发病有关。     

脊柱侧凸椎旁肌肌纤维群化现象的研究

目的对椎旁肌肌纤维群化现象与青少年特发性脊柱侧凸(adolescent id iopath ic scoliosis,AIS)的发生、发展之间的关系进行研究。方法本实验分三组,AIS组:20例,平均年龄15.3岁,平均Cobb角56.8°。顶椎位于T7~12。其中Cobb角>50°11例,Cobb角≤50°9例。先天性脊柱侧凸(congen ital scoliosis,CS)组:11例,平均年龄13.9岁,平均Cobb角66.7,°顶椎位于T7~12。对照组:取10例非脊柱侧凸病例作为对照。AIS和CS组取顶椎区两侧椎旁肌,对照组取非病变区两侧椎旁肌行病理分析。结果AIS和CS组均存在凸侧椎旁肌Ⅰ型肌纤维群化现象,对照组未观察到肌纤维群化现象。CS组的肌纤维群化程度显著高于AIS组(P<0.05),AIS组中Cobb角>50°的患者肌纤维群化程度显著高于Cobb角≤50°的患者(P<0.05)。结论脊柱侧凸凸侧椎旁肌Ⅰ型肌纤维群化现象系继发性改变,且与侧凸的严重性呈正相关。     

Ⅱ型胶原、转化生长因子β1和碱性成纤维细胞生长因子在脊柱侧凸患者关节突软骨中分布及表达的实验研究

目的研究青少年特发性脊柱侧凸（AIS）和先天性脊柱侧凸（CS）畸形最严重部位一顶椎凸、凹侧下关节突软骨中Ⅱ型胶原、转化生长因子β1（TGF—β1）和碱性成纤维细胞生长因子（bFGF）的表达特点。方法22例AIS患者,18例CS患者作为研究对象。取两组患者的顶椎和端椎凸、凹侧的下关节突,采用苏木素-伊红（HE）染色、免疫组化和原位杂交方法观察关节突的病理改变和Ⅱ型胶原、TGF-β1及bFGF在关节突中分布的特点。将所得的免疫组化和原位杂交图像输入图像分析系统,进行半定量分析,并作统计学分析。结果Ⅱ型胶原、TGF-β1、bFGF在AIS和CS中的有基本相似的表达特点,免疫组化和原位杂交方法均显示顶椎凹侧的表达高于凸侧,差异有统计学意义（P〈0．05）;上下端椎的凸凹侧之间及凸凹侧的上下端椎之间的表达差异无统计学意义,顶椎、上下端椎各对应部位在AIS与CS之间的表达差异无统计学意义;Ⅱ型胶原在凸侧与凹侧顶椎的表达高于同侧上、下端椎,差异有统计学意义（P〈0．05）。结论AIS和CS顶椎关节突软骨呈现退变及发育不全等征象,凹侧较凸侧明显。AIS和CS中Ⅱ型胶原、TGF—β1及bFGF在顶椎凹侧表达的增高可能为脊柱畸形后异常的生物力学引起了关节突细胞间基质重建而进行代偿的结果。压应力可引起TGF—β1及bFGF的表达增高;压应力和张应力均可以引起Ⅱ型胶原的表达增高,但顶椎凹侧压应力比凸侧张应力的影响更大。     

脊髓空洞源性脊柱侧凸椎旁肌肌纤维分型及群化的对比研究

目的分析脊髓空洞源性脊柱侧凸患者椎旁肌肌纤维分型及群化的特征,探讨其与脊柱侧凸发病的关系.方法病例分为三组：脊髓空洞源性脊柱侧凸（SS）组20例,青少年特发性脊柱侧凸（AIS）组16例,非脊柱侧凸（NS）组10例.术中切取两侧椎旁肌组织,统计三组的椎旁肌肌纤维分型及群化,并进行对比.结果SS组凸侧Ⅰ型肌纤维比例和横截面积均小于凹侧,差异无统计学意义;AIS组凸侧Ⅰ型肌纤维比例和横截面积均显著高于凹侧;NS组左、右侧之间差异无统计学意义.各组间比较显示：（1）凸侧Ⅰ型肌纤维所占比例,SS组和AIS组均高于NS组;凹侧Ⅰ型肌纤维所占比例,SS组高于AIS组和NS组.（2）凸侧Ⅰ型肌纤维横截面积,SS组低于AIS组;凹侧Ⅰ型肌纤维横截面积,AIS组低于NS组.（3）凸侧Ⅱ型肌纤维横截面积,SS组＜AIS组＜NS组;凹侧Ⅱ型肌纤维横截面积,SS组和AIS组均低于NS组.SS组中11例观察到椎旁肌Ⅰ型肌纤维群化,凹侧群化程度大于凸侧,但差异无统计学意义.AIS组中8例观察到凸侧Ⅰ型肌纤维群化,无凹侧肌纤维群化和Ⅱ型肌纤维群化.NS组左、右两侧均未见肌纤维群化.结论SS组患者椎旁肌肌纤维分型及群化的特征与AIS组明显不同,提示椎旁肌存在原发性失神经支配,可能与脊柱侧凸的发生、发展有一定相关性.     

特发性脊柱侧凸患者椎旁肌中胶原的表达及意义

目的:通过比较特发性脊柱侧凸(idiopathic scoliosis,IS)、先天性脊柱侧凸(congenital scoliosis,CS)顶椎凹凸侧椎旁肌和无脊柱侧凸患者椎旁肌的组织形态学改变及胶原蛋白表达的变化,探讨椎旁肌在IS发展中的作用机制。方法:分别取IS患者(A组)、CS患者(B组)顶椎凹凸两侧及无脊柱侧凸患者(对照组,C组)的椎旁肌,光镜和电镜下观察其组织学形态学改变;应用Masson三色染色法显示胶原蛋白的表达,图像分析系统测量各组胶原的阳性表达面积百分比;对各组结果采用SPSS13.0软件进行统计学处理。应用免疫组织化学方法对Ⅰ型和Ⅲ型胶原染色,观察其在各组的表达情况。结果:光镜和电镜下均显示A、B组凹侧椎旁肌形态明显异常,胶原表达增强、分布紊乱;A、B组凸侧椎旁肌及C组未见明显异常。A、B组凹侧椎旁肌中阳性胶原面积的百分比分别为0.255±0.036和0.253±0.023,明显高于凸侧(A、B组分别为0.057±0.006和0.055±0.002)及C组(0.056±0.004),差异有显著性(P<0.05)。免疫组织化学染色示A、B两组凹侧椎旁肌中Ⅰ型、Ⅲ型胶原表达无明显差异,而在凸侧椎旁肌中以Ⅰ型胶原阳性者为主。结论:IS患者凹侧椎旁肌形态明显异常,胶原表达增强且分布紊乱,其变化可能为IS的继发性改变。     

青少年特发性脊柱侧凸软骨Sox9表达及意义

[目的]检测Sox9及软骨特异性标记物Ⅱ型胶原及Aggrecan在青少年特发性脊柱侧凸(adolescent idiopathic scoliosis, AIS)患者关节突软骨细胞中的表达,探讨其与AIS发生、发展的关系。[方法]收集我院行后路脊柱侧凸矫形术的15例AIS患者的关节突软骨标本,设为AIS组;取同年龄段无脊柱侧凸行脊柱融合术的10例患者正常软骨标本,设为对照组。分别分离软骨细胞体外培养,分别采用RT-PCR,免疫组化,免疫荧光染色和Westen-blotting等方法检测AIS组及对照组软骨Sox9及Ⅱ型胶原及Aggrecan的表达情况,进行两组间比较和AIS组凸侧与凹侧间比较。[结果] AIS组患者软骨细胞内的Sox9及软骨特异性标记物CollagenⅡ及Aggrecan的表达明显高于非AIS组患者。相比于凹侧,AIS患者顶椎凸侧原代软骨细胞中Sox9及软骨特异性标记物CollagenⅡ及Aggrecan表达明显升高。[结论] Sox9在AIS患者体内及原代软骨细胞中的表达异常是AIS患者体内软骨发育异常及脊柱不平衡生长的重要原因,可能是AIS发生、发展的原因之一。     

特发性脊柱侧凸患者两侧椎旁肌中肌梭与运动终板病理学变化的对比研究

目的：对青少年特发性脊柱侧凸（AIS）患者两侧椎旁肌中肌梭与运动终板的病理学变化进行对比研究，探讨其与脊柱侧凸病因学可能存在的关系。方法：选取手术治疗的脊柱病变患者共41例．分3组．其中AIS组20例，平均年龄15．3岁，平均Cobb角56．8^o，顶椎位于T7～T12；先天性脊柱侧凸（CS）组ll例。平均年龄13．9岁，平均Cobb角66．7^o，顶椎位于T7～T12；对照组10例，均为非脊柱侧凸病例，其中l例腰椎滑脱、l例腰椎管肿瘤、2例Scheuermann’s病、6例腰椎间盘突出症，平均年龄17．3岁。经患者知情同意，所有病例均于术中取材，AIS组和CS组取顶椎区两侧椎旁肌，对照组取非病变区两侧椎旁肌。标本分别行HE染色和非特异性酯酶（ANAE）染色，对3组病例两侧椎旁肌中肌梭的形态结构、梭内肌纤维数目、平均横截面积以及运动终板的类型进行比较。结果：AIS组患者两侧椎旁肌标本共发现19个肌梭，CS组患者两侧椎旁肌标本共发现13个肌梭，对照组两侧椎旁肌标本共发现5个肌梭。AIS和CS组患者凸侧椎旁肌肌梭内的肌纤维数目及平均横截面积显著大于凹侧椎旁肌（P〈0．05）。AIS和CS组凹侧椎旁肌哟型终板数目和病变终板数目均显著多于凸侧椎旁肌（Pl〈0．05）。对照组两侧椎旁肌哟型终板数目和病变终板数目无显著差异（P＞0．05）。结论：AIS患者两侧椎旁肌中肌梭的形态结构和运动终板的类型存在差异，这种差异可能是脊柱侧凸的继发性改变。     

SOX9、L—SOX5、SOX6及Ⅱ型胶原在青少年特发性脊柱侧凸患者顶椎终板软骨的共表达及意义

目的：观测SOX9、L—SOX5、SOX6及Ⅱ型胶原在青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者顶椎终板软骨中的表达，探讨其与AIS发生、发展的关系。方法：12例AIS患者，每例在前路手术时截取顶椎终板软骨1份，每份标本均包含凸侧与凹侧。切片行HE染色观察其组织细胞形态；行免疫组织化学染色，应用病理图像分析系统观测凸侧与凹侧的SOX9、L—SOX5、SOX6及Ⅱ型胶原表达的阳性细胞数和累积光密度（IOD），并计算这4个因子表达的相关性。结果：HE染色显示终板软骨有类似四肢长骨骺板样软骨内成骨组织形态．与凹侧比较凸侧显示了更强的软骨细胞活性。凸侧SOX9、L—SOX5、SOX6及Ⅱ型胶原表达的阳性细胞数和前三者的IOD值均明显大于凹侧，差异均有显著性（P〈0．05），凸侧Ⅱ型胶原表达的IOD值与凹侧比较无显著性差异（P〉0．05），4个因子表达的阳性细胞数之间的相关系数为0．46-0.91（P〈0．05），IOD之间为0．64～0．98（P〈0．05），均呈正性相关。结论：AIS患者顶椎凸侧与凹侧终板软骨的组织形态学及SOX9、L—SOX5、SOX6和Ⅱ型胶原的表达均存在差异，其可能是脊柱不同部位间机械应力差异下的继发性变化：4个因子的共表达异常触发AIS的可能性小。     

脊柱侧凸椎旁肌肌纤维不对称性分布的研究

目的　对特发性脊柱侧凸两侧椎旁肌肌纤维分布进行比较 ,并探讨其与脊柱侧凸病因学可能存在的关系。方法　本实验分三组 ,特发性脊柱侧凸组 :2 0例 ,平均年龄 15 .3岁 ,平均Cobb角为 5 6 .8° ,顶椎位于T7～12 。其中Cobb角 >5 0° 11例 ,Cobb角≤ 5 0° 9例。先天性脊柱侧凸组 :11例 ,平均年龄 13.9岁 ,平均Cobb角为 6 6 .7° ,顶椎位于T7～12 。对照组 :取 10例非脊柱侧凸病例作为对照。特发性脊柱侧凸和先天性脊柱侧凸组取顶椎区两侧椎旁肌 ,对照组取非病变区两侧椎旁肌 ,进行病理分析。结果　特发性脊柱侧凸和先天性脊柱侧凸组凸侧椎旁肌Ⅰ型肌纤维含量和横截面积均显著大于凹侧 (P <0 .0 5 ) ,对照组两侧无显著差异 (P >0 .0 5 ) ,特发性脊柱侧凸组中Cobb角 >5 0°的病例凸侧Ⅰ型肌纤维含量显著高于Cobb角≤ 5 0°的病例 (P <0 .0 5 )。结论　脊柱侧凸两侧椎旁肌肌纤维分布不对称系继发性改变     

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。     

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.     

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。     

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.     

Surgical management of ductal carcinoma in situ in Australia in 1995

Background: In the present paper we describe the presentation and management of ductal carcinoma in situ (DCIS) of the breast in women in Australia in 1995. This representative, national data set provides a historical comparator for studies examining DCIS management that follow. Methods: Surgeons identified by population‐based cancer registries as having treated a new diagnosis of DCIS between 1 April and 30 September 1995 completed a questionnaire on the presentation and management of each case. Results: Two hundred and five surgeons supplied treatment details on 418 DCIS tumours in 415 women . Half of all tumours were detected at BreastScreen clinics and a further 25% were detected at other mammography centres. Twenty‐six percent of tumours were palpable at presentation, 33% were multifocal and 55% were high grade (including comedocarcinoma). Breast conserving therapy (BCT) rather than mastectomy was utilized in 260 (62%) of cases. Tumours that were of low grade, small in size and not multifocal were more likely to be treated by BCT. Surgeons seeing six or more DCIS cases in the 6‐month period were more likely to utilize BCT. Of the conservatively treated cases, 22% were referred for a radiation oncology consultation. The most common reasons for treating DCIS with mastectomy were that the tumour was too extensive or multifocal (63%), it extended to margins of the specimen (42%), or patient concerns about recurrence (34%). Conclusions: In 1995 the majority of DCIS was treated with breast conserving surgery alone. Surgeons treating more DCIS cases were more likely to perform conservative surgery than surgeons treating only one DCIS case in the study period.     

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.