异体纤维环组织硬膜外腔植入对大鼠痛阈的影响

目的 观察硬膜外腔植入异体纤维环组织对大鼠痛阈的影响，以期为椎间盘源性疼痛提供理论依据。方法 18只雄性SD大鼠（体重260-280g）随机分为假手术组、异体脂肪对照组和异体纤维环组（每组n=6）。所有大鼠在水合氯醛腹腔麻醉下于L6-S1间隙手术暴露硬膜外腔，假手术组不植入任何物质，异体脂肪对照组和异体纤维环组分别植入异体大鼠腹膜外脂肪和尾椎纤维环。在手术前、术后第3天、术后第7天、术后第15天及术后第30天分别测定尾部对伤害性电刺激、温度刺激及机械刺激的反应。结果 术后假手术组和脂肪组大鼠对各种刺激的痛阈与术前相比没有显著差异（p〉0．05）；而纤维环组在硬膜外腔植入异体髓核后对电刺激、机械刺激和温度刺激均表现为痛觉过敏（P〈0．05）。结论 异体纤维环组织硬膜外腔植入可引起大鼠痛觉过敏，这可能是椎间盘突出引起根性神经痛的原因之一。     

Severe trauma caused by stabbing and firearms in metropolitan Sydney, New South Wales, Australia

BACKGROUND: Stabbing and firearm trauma causing severe injuries (injury severity score (ISS) >15) and death is uncommon in Australia. The present study describes the experience with stabbings and firearm trauma causing severe injuries at a major Australian urban trauma centre. METHODS: Data from a prospectively generated trauma registry regarding all patients presenting to Royal Prince Alfred Hospital (RPAH), Sydney, Australia with penetrating trauma causing severe injuries from July 1991 to June 2001 was retrospectively analysed. RESULTS: Of all patients presenting to RPAH with stabbing and firearms wounds over the 11 year study period, 28% received an ISS >15. One hundred and forty patients were identified. 94% were male. The mean age was 34 years (15-82 years). The number of cases/year has not shown an increasing trend. Thirty per cent of patients sustained firearm related injuries, with the remainder mainly caused by knives or machetes. Fifteen per cent of injuries were self inflicted. The most common location of injury was on a public street. Fifty-two per cent of patients were injured in more than one anatomical region, with the abdomen being the most common site of injury (53%). On hundred and seventy-four operations were performed - laparotomies (43%), thoracotomies (26%), craniotomies (5%) and orthopaedic, vascular, wound explorations and other procedures (26%). Twenty-eight per cent of patients suffered at least one complication during their admission, with coagulopathy being the most common complication (20%). Mean length of stay was 10.4 days (1-107 days). The total mortality rate for the severely injured patients was 21%, with gun-related injuries having a higher mortality rate than stabbing injury (36%vs 15%). Sixty per cent of deaths were related to exsanguination. CONCLUSIONS: Stabbings and firearm trauma are associated with significant morbidity, mortality and utilization of hospital resources in metropolitan Sydney. Overall mortality rates are similar to institutions with higher volumes of penetrating trauma.     

Smooth muscle in the annulus fibrosus of the tympanic membrane in bats, rodents, insectivores, and humans

The annulus fibrosus and its attachment to the bony tympanic ring were studied in a series of mammals. In the pallid bat, Antrozous pallidus, there is an extensive plexus of large interconnected blood sinuses in the part of the annulus that borders the tympanic bone. The spaces between the sinuses are packed with smooth muscle cells. Most of the cells have a predominately radial orientation; they extend from the bony tympanic sulcus to a dense collagenous matrix (apical zone) where radially oriented fibers of the pars tensa are confluent with the annulus. The muscles and vessels constitute a myovascular zone. A structurally similar myovascular zone is also present in the European hedgehog. In rodents, the annulus lacks the large interconnected blood sinuses but many small vessels are present. Smooth muscle is concentrated in the broad area of attachment of the annulus to the tympanic bone. In the gerbil, smooth muscle seems to be concentrated in the central part of the width of the annulus where it is attached to bone and radiates toward the tympanic membrane. In humans collections of radially oriented smooth muscle cells were found in several locations. The smooth muscle in all species studied appears to form a rim of contractile elements for the pars tensa. This arrangement suggests a role in controlling blood flow and/or creating and maintaining tension on the tympanic membrane.     

Adipokines as targets in musculoskeletal immune and inflammatory diseases

Adipokines are the principal mediators in adipose signaling. Nevertheless, besides their role in energy storage, these molecules can be produced by other cells, such as immune cells or chondrocytes. Given their pleiotropic effects, research over the past few years has also focused on musculoskeletal diseases, showing that these adipokines might have relevant roles in worsening the disease or improving the treatment response. In this review, we summarize recent advances in our understanding of adipokines and their role in the most prevalent musculoskeletal immune and inflammatory disorders.     

Pneumocephalus and Brown‐Sequard syndrome caused by a stab wound to the back

This report describes a case of Brown‐Sequard syndrome in a man who presented to the ED after a stabbing to the left scapula region. The incidental finding of pneumocephalus found on CT scan during workup lead to cervical MRI that revealed the spinal cord pathology associated with Brown‐Sequard syndrome.     

Hierarchical Structure of the Intervertebral Disc

Optical microscope techniques are used to characterize the hierarchical structure of the collagenous components of the human intervertebral disc. In the anterior annulus fibrosus, the thickness of lamellae increases abruptly 2 mm inward from the edge of the disc, dividing the annulus into peripheral and transitional regions. Lamellae in the lateral and posterior aspects of the disc have a broad distribution of lamellar thicknesses throughout the annulus. In alternating lamellae, fibers are inclined with respect to the vertical axis of the spine in a layup structure. From the edge of the disc inward to the nucleus, this interlamellar angle decreases from + 62 to + 45 degrees. Within lamellae, the collagen fibers exhibit a planar crimped morphology. The plane of the waveform is inclined with respect to the vertical axis by the interlamellar angle. From the edge of the disc inward, the crimp angle increases from 20 to 45 degrees and the crimp period decreases from 26 to 20 um. A hierarchical model of the intervertebral disc has been developed that incorporates these morphological gradients.     

Insights into the Hallmarks of Human Nucleus Pulposus Cells with Particular Reference to Cell Viability,Phagocytic Potential and Long Process Formation

Objective: As a main cellular component within the disc, nucleus pulposus (NP) cells play important roles in disc physiology. However, little is known on the biologic hallmarks of human NP cells. Therefore, the present study aimed to address the features of human NP cells.Methods: Human NP samples were collected from normal cadavers, patients with scoliosis and disc degeneration as normal, disease control and degenerative NP, respectively. The NP samples were studied using transmission electron microscopy and TUNEL assay. Pre-digested NP samples were studied using flow cytometry with PI/Annexin V staining.Results: Both control and degenerative human NP consisted of mainly viable cells with a variety of morphology. Both necrosis and apoptosis were noted in human NP as forms of cell death with increased apoptosis in degenerative NP, which was further confirmed by the TUNEL assay. Phagocytic NP cells had the hallmarks of both stationary macrophages with lysosomes and NP cells with the endoplasmic reticulum. Annulus fibrosus cells have similar morphologic characteristics with NP cells in terms of cell nest, phagocytosis and intracellular organs. Moreover, NP cells with long processes existed in degenerative and scoliotic NP rather than normal NP. When cultured in glucose-free medium, NP cells developed long and thin processes.Conclusion: Human degenerative NP consists of primarily viable cells. We present direct and in vivo evidence that both human annulus fibrosus and NP cells have phagocytic potential. Moreover, NP cells with long processes exist in both scoliotic and degenerative NP with lack of glucose as one of the possible underlying mechanisms.     

仿生可降解PCL-PLGA纤维支架负载人脐带间充质干细胞构建组织工程纤维环

摘要： 目的 以聚己内酯 （PCL） 和聚乳酸聚乙醇酸共聚物 （PLGA） 为原料构建仿生可降解纤维支架, 评估其作为组织工程纤维环支架的可行性。方法 以PCL、 PLGA混合物为原料, 通过熔融纺丝法制备PCL-PLGA混合支架作为实验组, 纯PCL支架作为对照组。采用扫描电子显微镜 （SEM） 观察成品支架微观结构 （纤维直径和孔径）, 测量孔隙率; 使用力学加载装置测量支架的弹性模量; 体外监测支架降解情况; 对支架接种人脐带沃顿胶间充质干细胞（HWJ-MSCs） 后采用CCK-8法和细胞Live/dead染色检测支架的生物相容性。结果 实验组和对照组支架的纤维直径、 孔径和孔隙率组间差异无统计学意义 （P＞0.05）; SEM镜下可见支架纤维取向性好, 纤维成角60°; 混合支架的压缩弹性模量为 （1.42±0.11） MPa, 拉伸弹性模量 （5.47±0.23） MPa; 纯PCL支架的压缩弹性模量为 （2.36±0.19） MPa, 拉伸弹性模量 （8.95±0.22） MPa; 体外降解检测结果表明混合支架的降解周期和纤维环自我修复过程相适应; CCK-8检测和细胞Live/dead染色结果显示HWJ-MSCs在支架上有良好的增殖能力和活性。结论 采用熔融纺丝法制备的 PCL-PLGA纤维支架能够模拟天然纤维环的微观结构, 具有生物可降解性、 良好的生物相容性和力学性能, 是构建组织工程椎间盘合适的支架载体。     

物理疗法治疗跟骨刺痛70例

目的比较电子治疗仪和频谱治疗仪两种物理疗法治疗跟骨刺痛的效果，找出较好的治疗方法。方法第一组用电子治疗仪加局部应用电极治疗跟骨刺痛患者４０例，第二组用频谱治疗仪治疗“跟骨刺痛”患者３０例做对照组。结果第一组治疗结果，显效１５例，占３７５％，好转２３例，占５７５％，无效２例，占５％，总有效率９５％。第二组治疗结果，显效３例，占１０％，好转１９例，占６３３％，无效８例，占２６３％，总有效率７３３％。经统计学处理，两组显效率比较，Ｐ＜０．０１，差异有非常显著性，两组总有效率比较，Ｐ＜０．０５，差异有显著性。结论显效率和总有效率，第一组明显高于第二组，说明电子治疗仪局部治疗跟骨刺痛患者，疗效较好。     

Episodic parieto-occipital idiopathic stabbing headache-like pain: a case report

We describe a patient with a variant of idiopathic stabbing headache (ISH). This case differs from ISH by its temporal profile (status-like), its region (extratrigeminal), its lack of association with other types of headache, and the episodic form of pain attacks. Received: 5 April 2001 / Accepted in revised form: 4 October 2001