交感神经及其递质在椎动脉型颈椎病中的调控机制

目的:验证交感神经因素在椎动脉型颈椎病发病中对椎动脉供血不足的调控机制。方法:将40只家兔随机分为两组:模型组和对照组,每组各20只,在造模当日及造模后4周,分别检测每组的SPNs放电次数及NA的含量。结果:模型组胸髓侧角的SPNs放电次数57.45±7.89,56.60±7.44;对照组胸髓侧角的SPNs放电次数10.08±2.26,10.00±2.24。两组比较,P<0.001。模型组血浆中NA含量(5.48±0.46)pmol/ml,(5.36±0.43)pmol/ml;对照组血浆中NA含量(3.31±0.43)pmol/ml,(3.30±0.32)pmol/ml。两组比较,P<0.001。结论:交感神经因素在椎动脉型颈椎病发病中对椎动脉的供血不足起到重要的调控作用。     

椎动脉三维CT血管成像对椎动脉型颈椎病的诊断价值

目的:探讨椎动脉三维CT血管成像(CTA)在椎动脉型颈椎病(CSA)诊断中的应用价值。方法:2007年7月～2008年4月临床上诊断为CSA的患者共21例(CSA组),对其CTA上显示的椎动脉、横突孔及钩椎关节增生情况进行观测,并与21例非CSA患者(对照组)的CTA观测结果进行比较分析。结果:CSA组中椎动脉正常者4例,管腔变细者7例,走行异常者1例,椎动脉硬化者2例,管腔局限性狭窄者4例,血管走行迂曲者3例,无血管闭塞的患者。对照组中14例椎动脉表现正常,管腔变细者4例,走行迂曲者3例。两组中血管正常、局限性狭窄出现比率间均有显著性差异(P0.05,χ2分别为9.72、1.21)。CSA组中11例(52.4%)患者共有36个钩椎关节增生,以C4～C7增生(28个,77.8%)最为常见,32个(88.9%)为轻度增生,3个(8.3%)为中度增生,1个(2.8%)为重度增生。对照组中,6例(28.6%)患者共有19个钩椎关节增生,只有1个(5.3%)表现为中度增生,其余均为轻度增生。结论:CTA可以较好地显示椎动脉异常、局限性狭窄及钩椎关节的增生情况,在CSA中具有一定的诊断价值。     

MRA-MRI在椎动脉型颈椎病诊断与治疗中的指导作用

目的:探讨椎动脉磁共振造影(MRA)与磁共振成像(MRI)联合应用对椎动脉型颈椎病(CSA)诊断与治疗的指导意义。方法:回顾性分析2004年11月～2009年11月103例CSA患者的临床资料。患者均行MRA和MRI检测,对CSA进行诊断分型,并依据分型选择手术治疗方式或非手术治疗。根据Nagashima疗效评价标准随访临床疗效及MRA及MRI检查。结果:MRA-MRI可将CSA分为局部狭窄型、迂曲型、全程变细(闭塞)型和正常型。MRA局部狭窄型、迂曲型中MRI显示椎动脉狭窄部位存在外在压迫因素者行钩椎关节切除、横突孔切开,术后疗效优良率达86.7%;MRA-MRI判定颈椎不稳导致CSA者行椎体间融合,术后优良率达84.6%;MRA全程变细(闭塞)型和正常型采取非手术治疗,术后优良率77.0%。结论:MRA-MRI分型对CSA治疗方案选择可以提供有价值的参考。     

盐酸丁咯地尔联合穴位针刺治疗椎动脉型颈椎病效果观察

目的 探讨盐酸丁咯地尔静脉滴注联合穴位针刺治疗椎动脉型颈椎病（CSA）的疗效。方法 将80例CSA患者随机分为观察组和对照组各40例，对照组常规行颈部按摩，并行穴位针刺治疗，1次／d，疗程20d。观察组在此基础上行盐酸丁咯地尔静脉滴注。结果 观察组总有效率为95．0％，时照组为80．0％。两组比较，差异有显著性意义（P〈0．05）。结论 盐酸丁咯地尔静脉滴注联合穴位针剌治疗椎动脉型颈椎病疗效显著提高。指导患者正确进行颈部功能训练,做好健康指导可巩固疗效，避免复发。     

严重烧伤早期大鼠心脏交感神经电生理活动的变化

目的 研究严重烧伤早期大鼠心脏交感神经电生理活动的变化规律及其机制,探讨心脏交感神经活动的变化与严重烧伤后心脏损伤的关系。方法 SD大鼠随机分为正常组（6只）、假伤组（18只）和烧伤组（20只）,在烧伤组大鼠背部制成30％TBSA的Ⅲ度烫伤。应用神经电生理方法记录心脏交感神经的放电活动,同时观察心电图和心肌力学指标的变化。结果 严重烧伤后大鼠心脏交感神经传出活动即刻增强,而传入活动经一潜伏期（约90s)后也显增强,且传入活动增强后传出活动进一步增强。交感神经传出、传入活动增强约持续3h左右,而后显降低,传入活动的变化早于传出活动的变化。部分大鼠在烧伤后1h左右,心脏交感神经放电活动除平均值增加外,波动性增大,呈间歇性“爆发”现象,其中4只大鼠在放电爆发性增加的同时频发室性早搏。烧伤后左心室收缩压峰值和左室内压最大上升／下降速率显降低。结论 严重烧伤后早期心脏交感神经传入和传出活动均增强,且传入活动的变化对传出活动的变化有一定的影响。心脏交感神经电生理活动增强可能是严重烧伤后早期心脏损伤的原因之一。     

改良硬化剂注射法大鼠椎动脉颈椎病模型建立的实验研究

目的：对硬化剂注射法制作法制作椎动脉颈椎病（cervical spondylosis of vertebral artery type,CSA）大鼠模型进行改良,评价改良硬化剂造模法制作大鼠CSA模型的有效性。方法：健康SPF级SD大鼠40只,雌雄各半,随机分为空白组20只,模型组20只。模型组采用改良硬化剂造模法造模,造模4周后观察大鼠的一般情况,经颅多普勒超声（transcranial Doppler,TCD）检测大鼠椎动脉血流速度、搏动指数、阻力指数,旷场试验检测大鼠精神紧张度。结果：造模后1～2 d,模型组大鼠均出现不同程度蜷缩喜卧、颤抖、眯眼、眼分泌物增多等情况,实验过程中未出现大鼠脱落及死亡情况。模型组的平均血流速度比空白组低（P<0.05）,模型组的搏动指数、阻力指数比空白组高（P<0.05）,模型组大鼠精神紧张度较空白组明显增高,组间差异具有统计学意义。结论：改良硬化剂造模法可成功制备CSA大鼠模型,具有成功率高、稳定性高、死亡率低、操作简单等优势。     

经颅多普勒超声转颈试验在椎动脉型颈椎病临床诊断中的价值和应用

目的 探讨经颅多普勒超声(TCD)转颈试验在椎动脉型颈椎病(CSA)临床诊断中的价值,为TCD诊断CSA提供一种更为准确和实用的方法.方法 采用自身对照研究方法,对60例常规头部中立位TCD检测正常的CSA患者和30例正常对照者进行TCD转颈试验.结果 CSA组TCD转颈试验阳性率为93.33%,而正常对照组的阳性率仅为16.67%,两者比较差异有显著性(P＜0.01).转颈时,CSA组的椎动脉和基底动脉的收缩期峰值血流速度和平均血流速度均较转颈前显著减慢(P＜0.01～0.001).结论 TCD转颈试验能够为常规TCD检测正常的CSA患者进一步提供血流动力学方面的重要依据,并提示常规TCD检测正常者不能排除临床CSA的诊断;TCD转颈试验可以作为临床诊断CSA的一种重要的辅助检查方法.     

椎动脉型颈椎病发病机制研究进展

椎动脉型颈椎病(CSA)自1926年首次提出相关症状后，对其发病机制的研究一直是脊柱外科争论的焦点，主要有椎动脉压迫、颈交感神经受刺激、颈椎节段不稳等几种学说，但是近年来随着研究的不断深入，又有学者提出应力应变、椎基底动脉环代偿功能、体液因子、血管闭塞、栓塞四种新的观点。阐述CSA发病机制可使人们对CSA有更全面的认识，并选择有效的治疗方法以提高临床疗效。     

家兔颈椎两侧肌肉平衡失调对椎动脉血流的影响

目的 探讨颈椎两侧肌肉平衡失调对椎动脉血流的影响。方法 通过外载荷力的作用，制作家兔椎动脉型颈椎病的动物模型，测定颈椎两侧肌肉张力，并记录各组动物椎动脉血流量的变化。结果 模型组受牵拉侧斜方肌、提肩胛肌、横突间肌等肌肉的肌张力明显高于对侧及正常组，模型组受牵拉侧椎动脉血流量明显低于对侧及正常组。结论 颈椎两侧肌肉平衡状态失调可使受牵拉侧颈部肌肉痉挛，椎动脉血流量明显下降，成功建立了椎动脉颈椎病模型。     

酸感受离子通道激活/抑制对大鼠痫性发作的影响

目的 观察酸感受离子通道( ASICs)激活/抑制对氯化锂-匹罗卡品大鼠的癫痫皮层脑电图癫痫放电的影响.方法 制作匹罗卡品大鼠癫痫模型,分别腹腔注射磷酸盐缓冲液(PBS)、阿米洛利、左乙拉西坦或酸性液体,记录脑电图癫痫样发电次数、波幅、放电间期变化.结果 在注射后60 ～ 90 min,与正常对照组比较,ASICs抑制组癫痫样放电次数(0.69±0.08)、波幅(0.70±0.16)均明显下降(P＜0.05),放电间期(1.46±0.18)延长(P＜0.05);ASICs激活组在注射后30 min内,癫痫样放电次数增高(1.05±0.07)(P＜0.05).结论 阿米洛利能抑制锂-匹罗卡品诱导的癫痫发作,酸性液体可促进癫痫发作,其作用机制可能与抑制或激活ASICs通道有关.     

The changes in human spinal sympathetic preganglionic neurons after spinal cord injury

We have applied conventional histochemical, immunocytochemical and morphometric techniques to study the changes within the human spinal sympathetic preganglionic neurons (SPNs) after spinal cord injury. SPNs are localized within the intermediolateral nucleus (IML) of the lateral horn at the thoraco-lumbar level of the spinal cord and are the major contributors to central cardiovascular control. SPNs in different thoracic segments in the normal spinal cord were similar in soma size. SPNs in the IML were also identified using immunoreactivity to choline acetyltransferase. Soma area of SPNs was 400.7+15 microm2 and 409.9+/-22 microm2 at the upper thoracic (T3) and middle thoracic (T7) segments, respectively. In the spinal cord obtained from a person who survived for 2 weeks following a spinal cord injury at T5, we found a significant decrease in soma area of the SPNs in the segments below the site of injury: soma area of SPNs at T8 was 272.9+/-11 microm2. At T1 the soma area was 418+/-19 microm2. In the spinal cord obtained from a person who survived 23 years after cord injury at T3, the soma area of SPNs above (T1) and below (T7) the site of injury was similar (416.2+/-19 and 425.0+/-20 microm2 respectively). The findings demonstrate that the SPNs in spinal segments caudal to the level of the lesion undergo a significant decrease of their size 2 weeks after spinal cord injury resulting in complete transection of the spinal cord. The impaired cardiovascular control after spinal cord injury may be accounted for, in part, by the described changes of the SPNs. The SPNs in spinal segments caudal to the injury were of normal size in the case studied 23 years after the injury, suggesting that the atrophy observed at 2 weeks is transient. More studies are necessary to establish the precise time course of these morphological changes in the spinal preganglionic neurons.     

大鼠膀胱低位控制中枢的形态学研究

目的从形态学上研究膀胱交感中枢和副交感中枢之间的联系。方法通过神经追踪的方法，在SD大鼠的腹下神经和盆节给予银光金（FG），确定膀胱的交感和副交感低位控制中枢的部位，于膀胱交感控制中枢及骶副交感核（SPN）分别给予辣根过氧化物酶（HRP）和结合麦芽凝集素的辣根过氧化物酶（WGA-HRP），分别在腰6至骶1（L6-S1）和腰1至腰2（L1-L2）节段检测逆行标记细胞和顺行标记末梢，并且通过免疫组织化学的方法鉴别副交感节前神经元（乙酰胆碱转移酶阳性）和中间神经元。结果腹下神经和盆节给予FG。逆标交感节前神经元主要位于L1，L2节段的后联合核（DCN）及双侧中间侧细胞柱（IML）。副交感节前神经元位于L6，S1节段的骶副交感核（SPN）。于L1-L2节段IML区给予HRP，在SPN的背内侧发现有逆标胞体较小的非胆碱能性神经元。于SPN中电泳入WGA-HRP，在L1-L2节段的IML区发现有顺行标记的神经末梢。结论膀胱的低位交感中枢和副交感中枢之间存在有形态学上的联系，骶副交感核（SPN）背内侧组的中间神经元可能在两者之间起协调作用。     

推拿改善兔椎动脉型颈椎病血供时效性的实验研究

目的:通过建立椎动脉型颈椎病(CSA)家兔模型,观察推拿改善椎动脉血流量时效性的特点,以及基于NPY、ET-1探讨这种时效性的物质基础。方法:将50只6月龄体质量为(2.0±0.5)kg,雌雄各半的清洁级新西兰大耳白兔,采用随机数字表方法分为空白组、模型组、推拿10 min组、推拿20 min组和推拿30 min组,每组10只。除空白组外均行注射硬化剂法制备CSA家兔模型,推拿10、20、30 min组行相应时长的推拿治疗,每日1次,连续10 d;分别于治疗前和治疗后使用Peri Flux 5000激光多普勒仪检测各组家兔椎动脉血流量,采用ELISA法检测血清中NPY、ET-1含量。结果 :治疗前后椎动脉血流量变化方面比较:模型组(0.009±0.775)PU与推拿10 min组(5.117±0.712)PU比较差异无统计学意义,模型组与推拿20 min组(11.634±0.999)PU、30 min组(11.831±0.992)PU比较差异有统计学意义(P0.01),推拿10 min组与推拿20、30 min组比较差异有统计学意义(P0.01),推拿20 min组与推拿30 min组比较差异无统计学意义。治疗前后NPY含量变化方面比较模型组(-0.327±0.863)pg/ml与推拿10 min组(24.518±6.027)pg/ml比较差异有统计学意义(P0.05),模型组与推拿20 min组(46.141±8.196)pg/ml、推拿30 min组(47.091±10.699)pg/ml比较差异有统计学意义(P0.01),推拿10 min组与推拿20、30 min组比较差异有统计学意义(P0.01),而推拿20 min组与推拿30 min组比较差异无统计学意义。ET-1含量变化方面比较模型组(0.300±1.109)pg/ml与推拿10 min组(3.283±13.385)pg/ml比较差异无统计学意义,模型组与推拿20 min组(36.701±8.928)pg/ml、推拿30 min组(37.719±7.320)pg/ml比较差异有统计学意义(P0.01),推拿10 min组与推拿20、30 min组比较差异有统计学意义(P0.01),而推拿20 min组与推拿30 min组比较差异无统计学意义。结论:推拿治疗CSA家兔需要达到20 min时才可以显著改善椎动脉血流量,但是继续延长推拿时间则无明显效果,推拿这种时效性特点的物质基础与血清中NPY和ET-1水平的变化密切相关。     

The heart reinnervates after transplantation

Background. Whether cardiac reinnervation occurs after transplantation remains controversial. If reinnervation does occur, how sympathetic and parasympathetic efferent neurons do this remains unknown.

Methods. Power spectral analysis of heart rate variability was assessed for 1 year after cardiac autotransplantation in 9 dogs. After induction of anesthesia 13 months after transplantation, cardiac and intrinsic cardiac neuronal responses elicited by both electrical stimulation of parasympathetic or sympathetic efferent neurons and systemic or local coronary artery administration of nicotine (5 μg/kg), angiotensin II (0.75 μg/kg), and tyramine (1.2 μg/kg) were studied. The transmembrane electrical properties of intrinsic cardiac neurons were studied in vitro. Ventricular tissue catecholamine content, -tubulin expression, and β-adrenergic receptor density and affinity were studied. The presence of axons crossing suture lines was sought histologically.

Results. Nerves were identified crossing suture lines. Electrical or chemical (ie, nicotine or angiotensin II) activation of sympathetic efferent neurons enhanced cardiodynamics, as did tyramine. Stimulating vagal efferent preganglionic axons induced bradycardia in half of the dogs. Functional reinnervation did not correlate with specific power spectra derived from rate variability in the conscious state. Responding to nicotine and angiotensin II in situ, transplanted intrinsic cardiac neurons generated spontaneous activity. These neurons displayed nicotine-dependent synaptic inputs in vitro. Ventricular tissue had normal β-adrenergic receptor affinity and density but reduced catecholamine and -tubulin contents.

Conclusions. The intrinsic cardiac nervous system receives reduced input from extracardiac sympathetic efferent neurons after transplantation and inconsistent input from parasympathetic efferent preganglionic neurons. These heterogeneous neuronal inputs are not reflected in heart rate variability or ventricular β-adrenergic receptor function. Transplanted angiotensin II–sensitive intrinsic cardiac neurons exert greater cardiac control than do nicotine-sensitive ones. The intrinsic cardiac nervous system remodels itself after cardiac transplantation, and this indicates that direct assessment of extracardiac and intrinsic cardiac neuronal behavior is required to fully understand cardiac control after transplantation.     

Analysis of femoral artery intima-media thickness during the cardiac cycle

BackgroundVariations in the intima-media thickness (IMT) of the carotid artery during the cardiac cycle are well established. The change in femoral IMT during the cardiac cycle is largely unknown. This study focuses on the variation of femoral IMT, vessel diameter, and cross-sectional area (CSA) of the IMT during the cardiac cycle.MethodsVideo clips of the femoral artery were obtained using B-mode ultrasonography in 60 patients between the ages of 18 and 50. IMT and diameter measurements were made using automated software, and CSA was subsequently calculated. Triplicate measurements of each femoral artery were made at three points in the cardiac cycle: the R wave, the T wave, and at the point of maximal vessel diameter falling after the T wave and before the following P wave.ResultsFemoral IMT, diameter, and CSA did not show a statistically significant difference with measurement on the R versus the T wave (P > 0.36, P > 0.28, and P > 0.76, respectively). Interestingly, when comparing measurements on the R or T wave with measurements taken at the maximum vessel diameter, there was a statistically significant difference in vessel diameter (P < 0.001) and CSA (P < 0.005) but not in femoral IMT (P > 0.2).ConclusionsUnlike studies of the carotid artery, there were no statistically significant differences between measurements made at the R versus the T wave. There were, however, statistically significant differences noted in diameter and CSA when measurements were taken at a point later in the cardiac cycle. This has ramifications for future studies on vascular remodeling.     

Clinicopathological Analysis of β-catenin and Axin-1 in Solid Pseudopapillary Neoplasms of the Pancreas

Background

Solid pseudopapillary neoplasm (SPN) is a distinct pancreatic neoplasm and has characteristic, aberrant nuclear expression of β-catenin in most cases. However, alterations in components of the Wnt pathway, other than the β-catenin (CTNNB1) gene mutation, have not been identified. In this study, we investigated the status of Axin-1, the spectrum of mutations in the CTNNB1 gene, and the clinicopathological features of SPNs.

Materials and Methods

We collected 27 SPNs from 25 patients. A tissue microarray was constructed to perform immunohistochemistry for β-catenin, E-cadherin, and Axin-1. The CTNNB1 and AXIN1 gene mutations were analyzed by DNA sequencing. Finally, the clinicopathological features of SPNs were analyzed for association with the CTNNB1 mutations and the Axin-1 alterations.

Results

All 27 SPNs expressed nuclear immunoreactivity of β-catenin and exhibited a lack of membranous decoration of E-cadherin. All SPNs harbored CTNNB1 gene mutations. No alterations were present in the AXIN1 gene, and the immunohistochemical analysis revealed weak or absent reactivity of Axin-1 in the cytosol. All cases with a codon-37 CTNNB1 mutation had weak Axin-1 immunoreactivity in the cytoplasm (P = 0.018). No other significant correlation was found between clinicopathological parameters, CTNNB1 mutations, and Axin-1 alterations.

Conclusions

Nuclear β-catenin immunoexpression is characteristic for SPNs and corresponds to the CTNNB1 mutation. The Wnt pathway is involved in the tumorigenesis of SPNs, primarily through the alteration of β-catenin. Despite the absence of any identifiable genetic mutation, a low level of Axin-1 in the cytoplasm might contribute to the aberrant distribution of β-catenin in SPNs.

     

刺激兔颈交感神经节及椎动脉对血压影响的实验观察

了解颈椎及其周围的软组织与颈椎性血压异常的关系,探讨颈椎性血压异常的发病机理。方法以健康大耳白兔５０只,暴露双侧颈前及颈后交感神经节和椎动脉,直接给予牵拉、压迫、电刺激、并用电动记纹鼓记录刺激前、后股动脉的血压变化。结果压迫牵拉刺激使兔的动脉血压变化较大,电刺激使动脉血压变化较小;     

针刀干预对膝骨关节炎兔股直肌组织形态及超微结构的影响

目的:观察针刀干预对膝骨关节炎(knee osteoarthritis,KOA)兔股直肌组织形态及超微结构的影响,揭示针刀治疗KOA可能的疗效机制.方法:选取6月龄新西兰雄性兔24只,体质量(2.0±0.5)kg,采用随机数字表法分为空白组、模型组、针刀组,每组8只.改良Videman法左后肢伸直位石膏固定制动6周复制...