进行性假性类风湿性发育不良症并双侧股骨髁上骨折1例

正患者,女,12岁。5岁开始逐渐出现行走不稳,左右摇摆,未予重视。2013年出现双髋关节疼痛,逐渐加重,5个月前发展为无法行走,需要坐轮椅。曾被诊断为"脑炎"、"先天发育异常"、"幼年性类风湿"等疾病,均未确诊,症状无改善。1 d前不慎从轮椅上摔下,双膝着地,双膝关节上方处剧烈疼痛,活动不能,为进一步治疗来我院就诊。急诊X线片(图1a,1b)示股骨远端及胫骨近端骨骺及干骺端扩大,双侧股     

The imbalance between regulatory and IL-17-secreting CD4T cells in multiple-trauma rat

Background

It has been well recognised that a deficit of numbers and function of CD4⁺CD25⁺Foxp3⁺cells (Treg) is attributed to the development of auto-immune diseases, inflammatory diseases, tumour and rejection of transplanted tissue; however, there are controversial data regarding the suppressive effect of Treg cells on the T-cell response in auto-immune diseases. Additionally, interleukin-17 (IL-17)-producing cells (Th17) have a pro-inflammatory role. The balance between Th17 and Treg may be essential for maintaining immune homeostasis and has long been thought as one of the important factors in the development/prevention of auto-immune diseases, inflammatory diseases, tumour and rejection of transplanted tissue, but their role in multiple trauma remains unclear.

Objective

This study aims to investigate whether an imbalance of Treg and Th17 effector cells is characteristic of rats suffering from multiple trauma.

Methods and subjective

Sixty Sprague-Dawley (SD) rats were randomly divided into three groups. The control group (n = 20, group I) no received procedures (normal). The sham group (n = 20, group II) only received anaesthesia, cannulation and observation. The bilateral femoral shaft fractures with haemorrhagic shock groups (n = 20, group III). Rats in groups II and III were killed at the end of 4 h after models were established. Peripheral blood samples were collected for assessment of Treg cells, Th17 cells and cytokines (IL-17, IL-6, IL-2, transforming growth factor beta (TGF-β)) and intestine tissue was collected for intestine histological analysis.

Results

We observed decreased Treg/Th17 ratios in CD4⁺T cells in rats with multiple trauma and a strong inverse correlation with disease activity (intestinal histological scores).

Conclusion

We suggest a role for immune imbalance in the pathogenesis and development of multiple trauma. The alteration of the index of Treg/Th17 cells likely indicates the therapeutic response and progress in the clinic.     

退变性腰椎侧凸合并椎管狭窄的阶梯性治疗策略

目的退变性腰椎侧凸合并椎管狭窄多为中老年患者,治疗方法选择复杂。探讨退变性腰椎侧凸合并椎管狭窄的阶梯性治疗策略及疗效。方法 2005年1月-2009年12月,收治退变性腰椎侧凸合并椎管狭窄患者117例,根据患者意愿、内科合并症、腰腿痛症状、腰椎侧凸后凸旋转三维畸形、腰椎稳定性的情况(侧方滑移、退变性滑脱),以及脊柱整体平衡状态,阶梯性地选择保守治疗(43例)、后路单纯减压术(18例)、后路短节段融合术(1～2个节段,41例)、后路长节段融合畸形矫正(≥3个节段,15例)方法治疗。比较患者治疗前后腰痛及腿痛的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、腰椎前凸角、侧凸Cobb角的变化。结果术后获1年以上随访72例;无死亡及内固定失败。保守治疗19例平均随访19.3个月(1～5年),无症状加重,末次随访时腰痛及腿痛VAS评分、ODI较治疗前明显降低(P<0.05),腰椎前凸角减小、侧凸Cobb角增大,但与治疗前比较差异无统计学意义(P>0.05)。后路单纯减压术12例平均随访36个月(1～5年),末次随访时腿痛VAS评分、ODI较治疗前均明显降低(P<0.05),腰痛VAS评分较治疗前减小,但差异无统计学意义(P>0.05);腰椎前凸角减小、侧凸Cobb角增大,但进展缓慢,与治疗前比较差异无统计学意义(P>0.05)。后路短节段融合31例平均随访21.3个月(1～3年),术后发生血肿、切口愈合不良、脑脊液漏、浅表感染各1例,经对症处理后治愈;末次随访时腰痛及腿痛VAS评分、ODI较治疗前均明显降低(P<0.05),腰椎前凸角及侧凸Cobb角均明显改善(P<0.05)。后路长节段融合10例平均随访17.1个月(1～3年),术后症状加重1例,经理疗及药物治疗3个月后缓解;术后深部感染1例,经清创切口持续冲洗引流后治愈;末次随访时腰痛及腿痛VAS评分、ODI、腰椎前凸角及侧凸Cobb角均较治疗前明显改善(P<0.05)。结论退变性腰椎侧凸合并椎管狭窄的治疗应个体化、阶梯性地选择治疗方案。手术治疗以减压为主、矫形为辅,应准确判断症状责任节段、侧凸责任节段、后凸责任节段,防止手术扩大化,积极控制出血,提高手术安全性。     

颈脊髓损伤患者营养状况变化及其与死亡率的关系

目的研究颈脊髓损伤患者营养状况的动态变化,分析其对患者死亡率的影响。方法将128例颈脊髓损伤依治疗结果分为非死亡组和死亡组。记录两组一般信息和血清总蛋白、血清白蛋白和血清前白蛋白水平。比较两组血清蛋白水平动态变化,分析其与死亡的关系。结果入院早期,血清总蛋白水平在死亡组降低;3~5 d后,3种蛋白水平在死亡组均低于非死亡组(P<0.05),死亡组下降幅度较大;患者较低的血清蛋白水平是死亡的危险因素。结论颈脊髓损伤患者伤后低蛋白血症在死亡患者中更为明显;低蛋白血症是此类患者死亡的危险因素。     

Necroptosis 在中枢神经系统损伤修复中作用的研究进展

Necroptosis 是一种新发现的程序性细胞死亡方式,由死亡受体与其配体的结合所启动,通过特定的信号通路执行。Necroptosis已被证实参与了多种疾病的病理进程,包括肿瘤、免疫性疾病、脑外伤及脑部缺血再灌注损伤等。     

Resveratrol attenuates spinal cord injury-induced inflammatory damage in rat lungs

Spinal cord injury (SCI)-induced systemic inflammatory response affects multiple organs outside the spinal cord. Treatment options for such complications are lacking. We studied the potential protective effects of resveratrol on SCI-induced inflammatory damage in rat lungs. Sprague-Dawley rats were subjected to weight-drop impact at the T10 vertebral level with administration of resveratrol (100 mg/kg) or vehicle (via the intraperitoneal route) immediately after trauma. Lung injury was studied by measuring: vascular permeability-related pulmonary edema; histopathologic scores, neutrophil infiltration and concentrations of inflammatory cytokines in bronchoalveolar fluid; expression of inflammatory enzymes and sirtuin (SIRT) 1 as well as nuclear factor-kappa B (NF-κB) activity in pulmonary tissues. Resveratrol treatment significantly alleviated SCI-induced pulmonary edema as indicated by the ratio of the wet weight to dry weight of lung tissue and pulmonary permeability index. Resveratrol significantly reduced neutrophil infiltration and production of inflammatory mediators. Resveratrol treatment was accompanied by up-regulation of expression of SIRT1 and suppression of NF-κB activity in pulmonary tissues. These data suggest that resveratrol may protect the lungs from SCI-induced inflammatory damage, and could be used as a therapeutic option against pulmonary problems after SCI.