“蛋壳”技术在经皮球囊扩张后凸成形术治疗严重骨质疏松性椎体压缩骨折中的应用

目的 探讨蛋壳技术在经皮球囊扩张后凸成形术治疗老年严重骨质疏松性椎体压缩骨折的可行性和疗效.方法 分析从2009年6月-2013年12月,采用蛋壳技术在经皮球囊扩张后凸成形术治疗老年人严重胸腰椎骨质疏松性压缩骨折43例46个椎体.局麻/全麻下经后路单侧椎弓根穿刺置入病椎,球囊缓慢扩张椎体,小剂量(0.5～1.0 mL)骨水泥注入撑开的空腔,再次插入球囊并撑开椎体高度,使之形成一薄的骨水泥蛋壳,撤出球囊,再次注入骨水泥填充.观察患者的视觉疼痛模拟评分(VAS)、活动能力评分、椎体高度测量及Cobb's角测量.结果 所有手术都顺利完成,无严重手术并发症.VAS评分由术前的(7.9±0.8)分下降至术后的(3.5±0.8)分(P＜0.05),活动能力评分由术前的(3.5±0.6)分改善到术后的(1.3±0.4)分(P＜0.05),椎体高度由术前的(13.5±2.0) mm增加到术后的(31.2±1.5) mm(P＜0.05),Cobb's角由术前的(31.8°±6.9°)矫正到术后的(18.2°±5.8°)(P＜0.05),差异均有统计学意义.所有患者门诊随访1～5个月,平均3.8个月,未出现椎体压缩、新发和相邻节段的骨折,临床表现明显改善.结论 蛋壳技术在经皮球囊扩张椎体后凸成形术中的应用是治疗老年严重骨质疏松性椎体压缩骨折的一种快速有效方法,具有可行性.     

扩大“蛋壳”结合闭合-张开技术治疗胸腰椎角状后凸畸形

目的:总结扩大“蛋壳”结合闭合-张开技术治疗胸腰椎角状后凸畸形的手术疗效.方法:2009年12月～2012年2月采用扩大“蛋壳”结合闭合-张开技术治疗13例胸椎及胸腰段角状后凸畸形患者,男8例,女5例;年龄15～47岁,平均33.5岁;完全分节后方半脊椎畸形3例,陈旧性胸椎及腰椎骨折后凸畸形6例,陈旧性脊柱结核后凸畸形4例(其中1例为T3～T5畸形愈合).后凸顶椎部位:T3～T5 1例,T7/8 1例,T8/9 1例,T11/121例,T12 4例,L1 5例.10例病变节段位于T11～L1水平者均存在严重腰背部疼痛,VAS评分8～10分,平均8.7±1.1分;3例胸段后凸畸形者均合并神经功能障碍,Frankel C级2例,D级1例.术前局部后凸角度62.0°～75.0°,平均67.3°.采用扩大“蛋壳”结合闭合-张开技术矫正后凸畸形,观察术后症状改善及畸形矫正情况.结果:患者均顺利完成手术,手术时间400±60min,术中失血为960±120ml.术中无节段血管、神经损伤,无硬膜撕裂、胸膜破裂和/或血气胸等并发症.术后局部后凸角矫正至18.0°～24.5°,平均20.3°±2.5°,平均矫正率为68.7％.所有患者术后均获得随访,随访时间24～36个月,平均29.6个月,末次随访时后凸角为19.0°～24.2°,平均21.0°±3.3°,与术后比较无显著性差异(P＞0.05);无矢状面失平衡者.术前胸背部疼痛患者VAS评分改善至2.1±1.9分,与术前比较有显著性差异(P＜0.05).术前2例Frankel C级患者1例恢复至D级、1例恢复至E级,1例D级患者恢复至E级.随访期间无内固定器械松动、断裂等并发症,植骨均融合.结论:扩大“蛋壳”结合闭合-张开技术治疗胸腰椎角状后凸畸形手术相对安全,矫正率较高,疗效可靠.     

“蛋壳”技术单椎体截骨治疗陈旧性胸腰椎骨折后凸畸形的手术配合

目的探讨经椎弓根"蛋壳"技术单椎体截骨治疗陈旧性胸腰椎骨折手术配合护理方法。方法采用一期后路经椎弓根"蛋壳"技术单椎体楔形截骨治疗陈旧性胸腰椎骨折伴后凸畸形患者22例,并定期随访评定神经功能恢复情况。结果全部患者手术顺利,腰背部疼痛、外观及后凸畸形明显改善。术后脊柱后凸Cobb角平均矫正36°,矫正率达80%;术后矢状面平衡距离平均7.5cm。所有患者均得到随访,平均随访32个月。14例术前有神经系统症状,术后神经功能都恢复正常,随访2年以上的患者矫正无明显丢失。结论一期后路经椎弓根"蛋壳"技术单椎体截骨是治疗陈旧性胸腰椎骨折伴后凸畸形安全有效的手术方法。恰当的手术配合能够保证该项技术的顺利实施。     

高频超声对甲状腺病灶伴蛋壳样钙化的诊断价值

目的 探讨高频超声诊断甲状腺结节伴蛋壳样钙化的价值.方法 回顾性观察73例经手术病理证实的甲状腺结节伴蛋壳样钙化患者的超声表现,并进行分类:①根据钙化位置分为结节内与结节边缘;②根据钙化表面特征分为光滑钙化与粗糙钙化;③根据钙化形状分为半环形钙化与环形钙化.结果 73例中,恶性结节20例(20/73,27.40％),良性结节53例(53/73,72.60％).钙化位于结节内与结节边缘以及半环形钙化与环形钙化在甲状腺良恶性结节之间差异均无统计学意义,而光滑或粗糙钙化在良恶性结节之间差异有统计学意义.结论 高频超声对于鉴别甲状腺结节伴蛋壳样钙化的良恶性有一定价值,如蛋壳样钙化更多见于良性病灶,但总体作用有限,诊断仍需依靠超声引导下穿刺活检及临床随访.     

In ovo exposure quail assay for risk assessment of endocrine disrupting chemicals

Although there are in vivo assays using various organisms for the risk assessment of chemicals with endocrine disrupting properties, effective experimental methods for avian species are still under debate. We have developed an in ovo exposure assay using Japanese quail eggs, aimed at assessing disrupting effects on avian reproductive development and function. Hybrid eggs from Brazilian Brown male and White Egg female quails, which can be genetically sexed by their plumage color after hatching, were prepared, and test materials dissolved in olive oil were injected into the air-chamber on day 10 of incubation. After sexual maturation of hatched chicks, we observed egg production by females and the egg quality and male-typical reproductive behavior, and then examined reproductive system morphology and serum steroid concentrations in both sexes. Treatment with a synthetic estrogen, diethylstilbestrol (DES, 0.5–50 ng/g egg), dose-dependently reduced the eggshell thickness and strength of eggs. A few females treated with 5 ng/g DES per egg produced soft-shelled/unmarked eggs, and all laying females treated with 50 ng/g egg produced eggs completely lacking shells. DES also induced shortening of the left oviduct and abnormal development of the right oviduct in a dose-dependent manner, while testis weight was reduced symmetrically. In addition, 2,2′,4′,6′-tetrachlorobiphenyl-4-ol (10–1,000 ng/g egg), which previously showed relatively high estrogenic activity in vitro, caused dose-dependent shortening of the left oviduct and reduction in testis weight. The methods for evaluating endocrine disrupting effects and preparing experimental birds proposed in the present study are expected to facilitate assays for avian reproductive toxicology.     

Vitamin C and eggshell membrane facilitate orthodontic tooth movement and induce histological changes in the periodontal tissue

ObjectivesCollagen remodeling of the periodontal tissue is an important mechanism that involves several biologically active substances to accelerate orthodontic tooth movement. It is known that Vitamin C (VC) enhances collagen production and induces tooth movement. Moreover, the eggshell membrane (ESM) is an integral component of various formulations used to promote wound healing. The purpose of our study was to determine the effects of combined treatment with VC and ESM on periodontal tissues during tooth movement.MethodsNine-week-old male osteogenic disorder Shionogi rats were randomized into four groups: control, VC, ESM, and VC + ESM. The control group was given tap water, and the VC, ESM, and VC + ESM groups were orally administered 0.1% VC solution, 1 wt% ESM solution, and a combination of 0.1 wt% VC and 1 wt% ESM solutions, respectively. A force of 25 or 75 g was applied for 10 days to produce orthodontic tooth movement. Distances of tooth movement were measured on days 3, 7, and 10 of treatment. Histological examination of the periodontal ligament was performed to determine the increase in type I and III collagen levels in response to treatment.ResultsDistances of tooth movement were significantly greater in the VC + ESM group than in the control group. The compression area of the alveolar bone showed increased osteoclastic activity and higher levels of bone resorption in the VC + ESM group. Expression levels of type I and III collagen in the tension area of the alveolar bone were higher in the VC + ESM group than in the control group.ConclusionsThis study revealed that the combined administration of VC and ESM accelerated tooth movement by protecting the periodontal tissue during orthodontic treatment. The combined clinical application of VC and ESM could potentially shorten orthodontic treatment time.     

扬子鳄(Aligatorsinensis)卵壳的扫描电镜观察

为比较扬子鳄受精卵及未受精卵卵壳，用扫描电镜观察其超微结构。结果表明：其卵壳由外致密层、蜂窝层、乳突层、外壳膜和内壳膜５层组成。并就经孵化的卵壳外致密层表面出现的腐蚀坑和裂纹产生的原因及生理意义进行了讨论。     

Mechanisms of estrogen-induced effects in avian reproduction caused by transovarian application of a xenoestrogen,diethylstilbestrol

To clarify breeding failure in avian species caused by the estrogenicity of chemicals, alterations in the reproductive systems of Japanese quail exposed in ovo to a xenoestrogen were investigated. An injection of diethylstilbestrol (DES) into the yolk before incubation decreased, after sexual maturation, egg-laying performance of female quails, which accompanied inducing abnormal development of the oviducts. All females treated with 50 ng DES/g of egg did not lay eggs, while 0.5–5 ng DES/g reduced egg weight and eggshell strength and thickness. In the uterus (shell gland), the mRNAs for calcium regulating factors, osteopontin and calbindin D28 K, were reduced dose-dependently by DES. Scanning electron microscopy showed that shell thinning was pronounced in the mammillary and cuticular layers of the eggshell, regions where osteopontin proteins are reportedly located. These indicate that transovarian exposure to xenoestrogens causes malformation and dysfunction of the oviducts, where calcium regulating molecules could play key roles in eggshell thinning.     

Purification of Ovocalyxin-32, a Novel Chicken Eggshell Matrix Protein

The eggshell is a highly ordered structure resulting from the deposition of calcium carbonate and an organic matrix from the acellular uterine fluid. Characterization of the individual matrix components is necessary to determine their influence upon calcite crystal shape, size, and orientation during eggshell calcification. We have purified and sequenced a novel 32-kDa protein, ovocalyxin-32 (OCX-32), which is present at high levels in the uterine fluid during the terminal phase of eggshell formation, and is localized predominantly in the outer eggshell. Database searches identified expressed sequence tags (ESTs) whose alignment yielded the complete cDNA. OCX-32 protein possesses limited identity (32%) to two unrelated proteins: latexin, a carboxypeptidase inhibitor expressed in rat cerebral cortex and mast cells, and to a skin protein that is encoded by a retinoic acid receptor-responsive gene, TIG1. The timing of OCX-32 secretion into the uterine fluid suggests that it may play a role in the termination of mineral deposition.     

A New Histomorphometric Method to Assess Growth Plate Chondrodysplasia and Its Application to the Toothless (tl,Csf1null Osteopetrotic Rat

The proliferation and hypertrophy of growth plate chondrocytes set the pace and pattern for growth of endochondral bones. Complex signaling pathways regulating chondrocyte differentiation during development and growth have been discovered in recent years, but as yet little is known about how chondrocytes are able to orient themselves to align properly with respect to the direction of bone growth. Histomorphometric methods developed for analysis of growth plates rely to a significant extent on assessments of the relative heights of the zones of proliferating and hypertrophic chondrocytes. In a growing number of osteopetrotic mutations, however, it is becoming apparent that growth plates lack clearly demarcated zones of chondrocyte differentiation, and they show other notable histological abnormalities that cannot be measured with standard approaches. This is particularly true of mutations in which osteoclasts are altogether absent. We therefore developed a new approach that measures the salient features of this type of chondrodysplasia and have applied it to the toothless (tl) rat. The tl rat has a frameshift mutation in the Csf-1 gene that renders it null, resulting in severe osteopetrosis. An accompanying pathology is a severe, progressive growth plate chondrodysplasia. We measured cell orientation, cell area, and local columnar organization as functions of distance from the upper margin of the growth plate, in addition to growth plate thickness and cell density. All these parameters were markedly abnormal in the tl rats, thus implicating Csf-1 not only in its well-established role in regulating osteoclastic bone resorption, but also in endochondral ossification. This approach should prove useful in distinguishing among growth plate chondrodysplasias, most especially in the growing number of osteopetrotic mutations having growth plates that lack the normal zonal organization and in which the chondrocytes are mis-oriented. In turn, detailed assessments of chondrocyte misorientation may give insights into how they normally are able to arrange themselves with such precision.