一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染

目的:探讨一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染的临床疗效及意义。方法:回顾性分析2011年3月~2015年1月我院收治并应用一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗的13例L5/S1椎间隙感染患者,其中男8例,女5例;年龄28~60岁(41.6±11.0岁);记录患者术中手术时间、出血量、术后并发症,记录术前、术后腰部疼痛视觉模拟评分(visual analogue scale,VAS)评估临床症状,术前术后腰骶角(lumbosacral angle,LSA)评估腰骶段前凸恢复情况。结果:所有手术均顺利完成,手术后1例出现逆行性射精,1例患者发生单侧下肢肌间静脉血栓,未出现严重并发症;前路手术时间为70~120min(90.0±27.5min),失血量为200~600ml(361.5±150.2ml);后路手术时间为50~70min(57.7±8.3min),失血量为50~200ml(106.9±56.9ml)。术后培养结果其中7例为金黄色葡萄球菌感染,3例为大肠杆菌,1例为铜绿假单胞菌,2例未见细菌生长,但病理检查结果提示感染性病变。病例均获随访,时间6~30个月(16.6±7.8个月)。末次随访时所有患者均达临床愈合,骨融合率100%,随访期内未见复发病例。VAS评分术前平均7.8±0.7分,术后6个月平均1.3±0.5分,与术前比较差异有统计学意义(P0.05);LSA术前4.4°±2.9°,末次随访时17.5°±2.8°,与术前比较有统计学意义(P0.05)。结论:一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染的手术创伤小、固定可靠、疗效确切,可以作为治疗L5/S1椎间隙感染的一种手术方法。     

经伤椎椎弓根复位植骨内固定术治疗胸腰椎陈旧性骨折

目的  探讨经伤椎椎弓根复位植骨结合后路内固定术治疗胸腰椎陈旧性骨折的临床疗效。方法  选择2013年1月-2014年6月河北省唐山市第二医院脊柱外科28例胸腰椎陈旧性骨折患者（伤后3～5周）。采用经伤椎椎弓根复位加椎体内植骨并后路椎弓根钉内固定治疗。观察术前、术后1周和术后3个月椎体高度压缩率、伤椎Cobb角、ODI评分及椎管侵占率等,并进行比较分析。结果  28例患者均成功实施手术并获随访,时间6～18（10.6±4.8）个月。伤椎高度矫正率约93%,椎体高度压缩率、伤椎Cobb角、ODI评分及椎管侵占率较术前均有明显改善。术前与术后1周及术后3个月比较差异有统计学意义（P <0.05）;除ODI评分外,术后1个周与术后3个月比较差异无统计学意义（P >0.05）。无内固定松动、断裂及神经损伤等并发症发生,植骨未吸收。结论  经伤椎椎弓根复位加椎体内植骨并后路椎弓根钉内固定对于治疗胸腰椎陈旧性骨折,可增加前柱支撑,减少椎体高度丢失,疗效满意。

     

几种灵芝rDNA基因间隔序列分析与鉴定

目的  基于基因间隔序列（ITS）序列对灵芝进行分类。方法  培养灵芝、提取DNA、优化聚合酶链反应（PCR）体系、纯化与克隆、测序、构建遗传进化树、进行遗传分析。结果  经过一系列的梯度实验得知优化的PCR体系为25μl反应混合物中含模板DNA 25 ng、Mg2+为2.0 mmol/L、dNTPs 200μmol/L、Taq 1.5 U、引物为20 pmol;最佳反应程序为93℃预变性4 min,93℃变性40 s,59℃退火40 s,72℃延伸1 min,共35个循环,72℃继续延伸7 min,4℃无限循环。所采用的HZ002、DZ003、NZ004和XC005在遗传进化树上面十分接近,说明其可以划分为同一菌属,同属于灵芝菌属。结论  基于ITS序列对灵芝进行分类,与其他的分子标记技术所取得的分类结果一致,证实依据ITS序列来对真菌菌属进行分类是十分合理的。

     

颈内静脉原位导丝法换置中心静脉长期血液透析导管的临床应用

目的探讨经颈内静脉原位导丝法换置中心静脉长期血液透析导管在维持性血液透析(MHD)患者中的应用价值。方法选取近3年在颈内静脉留置的中心静脉长期血液透析导管因功能障碍后,并经颈内静脉原位导丝法换置长期导管,术后及每次透析后均改用尿激酶封管患者16例(原位换置组);选取同期首次经颈内静脉留置中心静脉长期血液透析导管,普通肝素封管患者20例作为对照组;分析两组患者围术期泵控血流量及随访期的反应及开存期率、次开存期率。结果围术期泵控血流量原位换置组高于对照组,有统计学差异(P<0.05);两组比较感染例次/1000导管日0.9%与1.0%,无统计学差异(P>0.05)。原位换置组围术期未发生中重度并发症,12个月开存期率81.2%、次开存期率93.8%;对照组开存期率为65%、次开存期率85%;两组比较无统计学差异(P>0.05)。结论颈内静脉原位导丝法换置中心静脉长期血液透析导管,在MHD患者中的使用是安全的、可行的。     

Adenosine A2A receptors and basal ganglia physiology

Adenosine A2A receptors are highly enriched in the basal ganglia system. They are predominantly expressed in enkephalin-expressing GABAergic striatopallidal neurons and therefore are highly relevant to the function of the indirect efferent pathway of the basal ganglia system. In these GABAergic enkephalinergic neurons, the A2A receptor tightly interacts structurally and functionally with the dopamine D2 receptor. Both by forming receptor heteromers and by targeting common intracellular signaling cascades, A2A and D2 receptors exhibit reciprocal antagonistic interactions that are central to the function of the indirect pathway and hence to basal ganglia control of movement, motor learning, motivation and reward. Consequently, this A2A/D2 receptors antagonistic interaction is also central to basal ganglia dysfunction in Parkinson's disease. However, recent evidence demonstrates that, in addition to this post-synaptic site of action, striatal A2A receptors are also expressed and have physiological relevance on pre-synaptic glutamatergic terminals of the cortico-limbic-striatal and thalamo-striatal pathways, where they form heteromeric receptor complexes with adenosine A1 receptors. Therefore, A2A receptors play an important fine-tuning role, boosting the efficiency of glutamatergic information flow in the indirect pathway by exerting control, either pre- and/or post-synaptically, over other key modulators of glutamatergic synapses, including D2 receptors, group I metabotropic mGlu5 glutamate receptors and cannabinoid CB1 receptors, and by triggering the cAMP-protein kinase A signaling cascade.     

Finite-Element Stress Analysis of a Multicomponent Model of Sheared and Focally-Adhered Endothelial Cells

Hemodynamic forces applied at the apical surface of vascular endothelial cells may be redistributed to and amplified at remote intracellular organelles and protein complexes where they are transduced to biochemical signals. In this study we sought to quantify the effects of cellular material inhomogeneities and discrete attachment points on intracellular stresses resulting from physiological fluid flow. Steady-state shear- and magnetic bead-induced stress, strain, and displacement distributions were determined from finite-element stress analysis of a cell-specific, multicomponent elastic continuum model developed from multimodal fluorescence images of confluent endothelial cell (EC) monolayers and their nuclei. Focal adhesion locations and areas were determined from quantitative total internal reflection fluorescence microscopy and verified using green fluorescence protein–focal adhesion kinase (GFP–FAK). The model predicts that shear stress induces small heterogeneous deformations of the endothelial cell cytoplasm on the order of <100 nm. However, strain and stress were amplified 10–100-fold over apical values in and around the high-modulus nucleus and near focal adhesions (FAs) and stress distributions depended on flow direction. The presence of a 0.4 μm glycocalyx was predicted to increase intracellular stresses by ∼2-fold. The model of magnetic bead twisting rheometry also predicted heterogeneous stress, strain, and displacement fields resulting from material heterogeneities and FAs. Thus, large differences in moduli between the nucleus and cytoplasm and the juxtaposition of constrained regions (e.g. FAs) and unattached regions provide two mechanisms of stress amplification in sheared endothelial cells. Such phenomena may play a role in subcellular localization of early mechanotransduction events.     

Differential effects of ceramide species on exocytosis in rat PC12 cells

Increases in several ceramide species have been shown by non-targeted lipid profiling (lipidomics) of the rat hippocampus after kainate lesions (Guan et al. FASEB J 20:1152–1161, 2006). This study was carried out to examine possible effects of ceramide species on exocytosis. Significant increase in membrane capacitance in voltage-clamped rat pheochromocytoma (PC12) cells, an indication of exocytosis, was detected immediately after external application of C2, C6, and C18 ceramide. In contrast, no increase in capacitance was found after addition of C16 and C20 ceramide, or DMSO vehicle. The effect of ceramide on exocytosis was dependent on the integrity of lipid rafts. Treatment of cells with the cholesterol binding agent/disruptor of lipid rafts, methyl β cyclodextrin, prior to addition of C18 ceramide suppressed the increase in capacitance induced by this lipid species. The ability of C2, C6 and C18 ceramide to trigger exocytosis was confirmed using total internal reflection fluorescence microscopy (TIRFM) experiments. External application of these species caused an exponential decrease in the number of subplasmalemmal neuropeptide Y (NPY)-enhanced green fluorescence protein (EGFP) labeled vesicles, indicating exocytosis. Interestingly, C18 is also the ceramide species that showed the greatest increase in the rat hippocampus after kainate excitotoxicity. It is postulated that C18 ceramide might facilitate exocytosis of glutamate from damaged neurons, thus propagating neuronal injury.     

Visceral adipose tissue is more strongly associated with insulin resistance than subcutaneous adipose tissue in Chinese subjects with pre-diabetes

Aims: To investigate the value of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in a cohort of a community’s residents who were diagnosed as pre-diabetes, and to evaluate the association of VAT and SAT with insulin resistance.

Methods: This study was based on cross-sectional analysis of data from 107 adults. VAT and SAT were assessed by computed tomography. Insulin resistance was defined by homeostasis model assessment of insulin resistance >2.69. The relationship of VAT and SAT with insulin resistance were examined by linear regression. Logistic regression was used to analyze the association of VAT and SAT with insulin resistance.

Results: A total of 87 subjects had VAT ≥100?cm². Thirty-six out of 107 (33.6%) subjects were detected to have insulin resistance, 71 were normal (66.4%), and all had insulin resistance with VAT ≥100?cm². VAT (r?=?0.378, p?r?=?0.357, p?p?=?.003), but that of SAT was lost.

Conclusion: Pre-diabetic subjects with insulin resistance had elevated levels of VAT. VAT was more strongly associated with insulin resistance than SAT in Chinese subjects with pre-diabetes.     

Synthesis of obeticholic acid,a farnesoid X receptor agonist,and its major metabolites labeled with deuterium

Simple and facile methods for the synthesis of deuterium‐labeled obeticholic acid and its 2 metabolites, glycine and taurine conjugates of obeticholic acid, are described herein. The 3 deuterated compounds were applicable for use as internal standards in drug development.     

2种固位方式对上颌前牙区种植的修复效果比较

目的 比较上颌前牙区螺丝固位（SR）和粘接固位（CR）的种植修复效果。方法 选择2015年7月至2016年10月于安徽医科大学附属口腔医院种植科修复的74例上颌前牙区缺牙患者（90颗种植体）,根据临床固位方式的不同,将患者分为SR组（51颗）与CR组（39颗）。比较两组修复后第1天和3、6、12个月边缘骨吸收、软组织指标和牙龈位置。结果 与SR组相比,CR组骨吸收量显著减少（F_组间=14.644,P<0.05）;改良出血指数（mSBI）显著增加（F_组间=7.536,P<0.05）;角化龈宽度（wKM）显著增加（F_组间=11.489,P<0.05）;牙龈边缘位置（GL）效果较好（F_组间=6.407,P<0.05）;两组改良菌斑指数（MPI）记分的差异无统计学意义（F_组间=1.525,P>0.05）。CR组美观满意度较高（t=-3.35,P<0.05）;刷牙出血满意度较低（t=3.022,P>0.05）;总体满意度差异无统计学意义（t=0.971,P>0.05）。结论 在边缘骨吸收、wKM、GL和美观满意度方面,CR效果较好;在mSBI和刷牙出血满意度方面,SR效果较好。CR与SR在上颌前牙区的种植修复效果上各有优劣,需临床进一步研究。