Expanded polytetrafluoroethylene membrane for the prevention of peridural fibrosis after spinal surgery: a clinical study

Peridural fibrosis developing after laminectomy may cause pain that can necessitate reoperation. Many materials have been used as a barrier to invasion of fibrous tissue into the vertebral canal, but the ideal material has not been found. Various studies in animals have achieved favourable results with an expanded polytetrafluoroethylene (ePTFE) membrane. In a prospective, randomized study, we compared postoperative results in 33 patients who had an ePTFE membrane implanted to cover the defect caused by laminectomy during lumbar spine decompression with the results in 33 patients in whom no material was implanted. At operation, an ePTFE membrane was placed after the decompression procedure to cover the laminectomy defect completely. Systematic clinical and MRI follow-up evaluations of patients with and without the membrane were conducted 3, 6, 12, and 24 months postoperatively. The effect of ePTFE membrane implantation over laminectomy sites on postoperative peridural fibrosis, pain and neurological claudication was assessed. The ePTFE-membrane group had a significantly lower rate of epidural fibrosis on MRI (P < 0.0001) and of clinical manifestations of radiculalgia (P = 0.002) compared with the no-material group. Epidural fibrosis that occurred in the ePTFE group was generally less extensive than that in the no-material group. There was no significant difference in the rate of postoperative claudication in the two groups. Significantly more seromas occurred in the ePTFE group (P = 0.0002). There were no infections or other complications in either group. The results showed that placement of an ePTFE spinal membrane over the laminectomy defect produced by lumbar spine surgery provided a physical barrier to invasion of fibrous tissue into the vertebral canal, and patients with the membrane had less postoperative radicular pain. Received: 24 November 1997 Revised: 26 November 1998 Accepted: 2 December 1998     

Intracranial localization of arachnoid granulations in rats

BACKGROUND： This paper describes histomorphologic studies on arachnoid granulations in rats, which have not been investigated in China to our knowledge. OBJECTIVE： To observe the distribution of intracranial arachnoid granulations in rats. DESIGN, TIME AND SETTING： The observational experiment was performed in the Academy of Life Sciences of Shandong Taishan Medical College from May to August 2004. MATERIALS： Thirty healthy adult Wistar rats （3-4 months old） of SPF grade, equal numbers of each sex, were selected for this study. Methylene blue parenteral solution was provided by Jiangsu Jichuan Pharmaceutical Company （China）, and an optical microscope （Type： CH20; Olympus Co. Ltd., Japan） was used for observation of the histomorphology of the arachnoid granulations. METHOD： Injection of methylene blue parenteral solution into the cerebellomedullary cistern of rats. MAIN OUTCOME MEASURE： The blue stained parts of the lateral sinus were sectioned, stained by hematoxylin and eosin, and then observed under the microscope. RESULTS： The cavitas subarachnoidealis had extensive blue staining after methylene blue injection, while the arachnoid and dura were without dye accumulation. The blue dye indicated the location of the arachnoid granulations. The location of these granulations was fixed, mainly in the lateral sinus at both sides of confluence within 4 mm of the internal jugular vein. CONCLUSION： The arachnoid granulations of the rat were located mainly in the lateral sinuses of the dura mater.     

转化生长因子-β1对大鼠脑膜间皮细胞结缔组织因子表达的影响

目的 观察转化生长因子-β1（TGF-β1）对大鼠软脑膜间皮细胞（RLMCs）结缔组织生长因子（ CTCF）表达的影响.方法 体外培养RLMCs,并将其分为4组：（1）0组（正常对照组）：用无血清培养基（FSM）培养细胞;（2）1组：用含TGF-β11 ng/ml培养细胞;（3）2组：用含TGF-β1 2 ng/ml培养细胞;（4）3组：用含TGF-β14 ng/ml培养细胞;各组分别在TCF-β1刺激6、12及24 b后,采用逆转录-聚合酶链反应（RT-PCR）方法测定CTCF mRNA水平;蛋白免疫印迹（Westem blot）测定CTCF蛋白表达.数据以平均值±标准差（-χ±s）表示,各个浓度点组间比较采用单因素方差分析（One-way ANOVA）,两两比较采用最小显著法（LSD）检验,以P〈0.05有统计学意义.结果 在6、12及24 h分别以TCF-β1 1ng/mL、2 ng/mL、4 ng/mL处理,CTGF mRNA表达水平与对照组比较,差异有显著性（F6h=46.549、F12h= 287.098、F24h=109.202,P均〈0.001）,呈剂量依赖性,以TGF-β1处理12 h组CTGF mRNA表达差异明显.western blotting：正常对照组RLMCs细胞和不同浓度的TGF-β1刺激后均表达CTGF蛋白,在TGF-β1刺激6、12及24 h后,各组均随着浓度的增加而增加,差异有显著性（F6h= 52.988、F12h= 95.331、F24h=157.107,P均〈0.001）,呈剂量依赖性,以TGF-β1处理6h组CTGF蛋白表达差异明显.结论 TGF-β1能诱导RLMCs中CTGF通路激活.TGF-β1刺激RLMCs中CTGF mRNA和蛋白的表达,而且随浓度增加而显著.CTGF可能作为神经系统疾病中抑制脑膜纤维化的靶点而进一步研究.     

川芎嗪与自体骨膜联合运用预防椎板切除术后硬膜外粘连的实验研究

目的 观察椎板切除术后用川芎嗪的同时在椎板缺损处植入自体骨膜预防硬膜外粘连的效果.方法 48只SD大鼠随机分成4组(n=12),均制作L2椎板损伤模型,A组硬膜外涂布生理盐水,B组硬膜外涂布川芎嗪,C组硬膜外覆盖自体骨膜,D组硬膜外涂布川芎嗪的同时加自体骨膜覆盖.术后12周对4组椎板切除部位进行大体观察,对粘连度、胶原含量、组织学评分及骨转化生长因子定量分析进行比较.结果 B、C、D组的改良RydellBalazs粘连韧度评分、胶原含量、改良Nussvuaum组织学评分均优于A组,差异有统计学意义(P<0.05),D组优于B、C组,差异均有统计学意义(P<0.05);TGF-β灰度值C组与D组高于A组与B组,差异均有统计学意义(P<0.05).结论 联合运用川芎嗪和自体骨膜能有效预防硬膜外瘢痕粘连和形成,比单独应用川芎嗪和(或)自体骨膜预防效果好.     

硬脊膜完整性可影响脑脊液中细胞因子的水平

背景：脊髓损伤后的病理生理机制非常复杂,人们对此认识还很不全面、深入。 目的：观察脊髓损伤动物模型中硬脊膜完整性对脑脊液内细胞因子水平的影响。 方法：采用钳夹压迫法建立新西兰大白兔脊髓损伤模型,随机分为无硬脊膜缺损组、硬脊膜缺损组、硬脊膜缺损复合膜修复组、硬脊膜缺损自体筋膜修复组。术后30 min、1 h、3 h、6 h、12 h、36 h采用酶联免疫吸附实验方法检测各组脑脊液中细胞因子白细胞介素6、白细胞介素10、肿瘤坏死因子α的变化。 结果与结论：无硬脊膜缺损组、硬脊膜缺损复合膜修复组和硬脊膜缺损自体筋膜修复组术后6 h脑脊液中白细胞介素6、白细胞介素10、肿瘤坏死因子α水平均显著低于硬脊膜缺损组(P < 0.05)。其余时间点4组间各因子水平差异无显著性意义(P > 0.05)。说明维护脊髓损伤模型中硬脊膜的完整性可影响脑脊液中白细胞介素6、白细胞介素10、肿瘤坏死因子α水平,抑制炎症反应。     

牛心包补片应用于后巩膜加固术的早期安全性与生物相容性

目的评估牛心包补片用于人眼后巩膜加固术的安全性和生物相容性。方法回顾性系列病例研究。分析2006年1月至2014年10月在上海和平眼科医院行后巩膜加固术的进展性轴性近视连续病例377例（670眼）,其中应用牛心包生物补片组182例（330眼）,年龄3~64岁,等效球镜度-6.00~-30.00 D,应用同种异体硬脑膜组195例（340眼）,年龄3~61岁,等效球镜度-6.00~-33.00 D,随访时长为至少6个月。所有患者均行常规眼部检查,部分患者还行眼部高频B超检查。采用卡方检验对计数资料进行分析。结果牛心包补片组和硬脑膜组术后6个月最佳矫正视力提高的分别有105眼（31.8％）和119眼（35.0％）,不变的有209眼（63.3％）和205眼（60.3％）,下降的有16眼（4.8％）和16眼（4.7％）,组间差异均无统计学意义（χ²=0.765,P>0.05）。术后第1天2组发生球结膜水肿的分别有225眼（68.2％） 和258眼（75.9％）,组间差异有统计学意义（χ²=4.935,P<0.05）。2组病例在术后6个月内均未出现感染、视网膜脱离、眼内出血、斜视/斜视加重及复视等并发症。牛心包补片组有1例出现双眼排异反应,而硬脑膜组有1 例1眼出现排异反应,差异无统计学意义（发生率分别为0.61%和0.29%,P>0.05）。行眼部高频B超检查的硬脑膜组有术后至少6年患者10例19眼,均检测到加固条带,而且未见条带钙化;牛心包补片组有术后6~12个月患者15例28眼,均检测到加固条带,而且厚度正常,出现部分钙化的有3眼（P>0.05）。结论牛心包补片应用于人眼后巩膜加固术具有良好的安全性、生物相容性和耐降解性。     

Neurological manifestations and neuroradiological presentation of Erdheim-Chester disease: report of 6 cases and systematic review of the literature

Erdheim-Chester disease (ECD) is a rare, non-Langerhans form of histiocytosis of unknown etiology that affects multiple organs. We report 6 cases of ECD with neurological involvement and neuroradiological abnormalities on brain MRI. A literature review revealed 60 other cases of ECD with neurological involvement. We therefore analyzed 66 ECD patients with neurological involvement. Cerebellar and pyramidal syndromes were the most frequent clinical manifestations (41% and 45% of cases), but seizures, headaches, neuropsychiatric or cognitive troubles, sensory disturbances, cranial nerve paralysis or asymptomatic lesions were also reported. Neurological manifestations were always associated with other organ involvement, especially of bones (at least 86%) and diabetes insipidus (47%). Neurological involvement was responsible for severe functional handicaps in almost all patients and was responsible for the death of 6 of the 66 patients (9%). Neuroradiological findings could be separated into three patterns: the infiltrative pattern (44%), with widespread lesions, nodules or intracerebral masses, the meningeal pattern (37%), with either thickening of the dura mater or meningioma-like tumors, and the composite pattern (19%), with both infiltrative and meningeal lesions. Received in revised form: 21 October 2005     

冷冻异体硬脑膜引导骨组织再生的动物实验及在口腔种植中的临床应用研究

探索利用冷冻处理异体硬脑膜引导种植体周围骨组织再生的可能性。12只日本大耳白兔 ,在双侧下颌下缘造成骨缺损 ,右侧覆盖兔冷冻异体硬脑膜 ,左侧不覆膜 ;临床用于种植体周围骨缺损24例 ,采用人异体冷冻硬脑覆盖。结果实验动物伤口均I期愈合。组织学观察实验侧4周时骨表面有柱状骨突起 ,18周改建为成熟骨 ;对照侧明显慢于实验侧。临床患者骨修复良好 ,其中15例(16区)裂隙状骨缺损修复率达87.8 %。冷冻异体硬脑膜是一种较理想的引导骨组织再生膜材料     

偏头痛大鼠硬脑膜及三叉神经节上TRPV1的表达变化

目的:观察TRPV1在偏头痛大鼠硬脑膜及三叉神经节上的表达变化。方法:取健康成年雄性SD大鼠60只,按随机数字法分为对照组(control组)、实验复方致炎剂(inflammation soup,IS)1 d组(IS 1 d组)、实验IS 3 d组(IS 3 d组)和实验IS 6 d组(IS 6 d组)。在雄性SD大鼠硬脑膜上埋置PE-10管,实验组分别给予1 d、3 d、6 d IS 20μl/d及对照组给予6天等量生理盐水。采用WesternBlot、免疫荧光法和Real-Time PCR法检测TRPV1在硬脑膜及三叉神经节上的表达情况。结果:对照组和实验组大鼠硬脑膜及三叉神经节上均可见TRPV1表达;与对照组相比,实验组硬脑膜、三叉神经节上TRPV1蛋白表达量、阳性细胞数及mRNA明显升高,以实验IS 6 d组最高(P<0.05)。结论:TRPV1在偏头痛大鼠硬脑膜及三叉神经节上的表达增加。TRPV1表达上调可能是偏头痛外周敏化的重要机制之一。