颈椎前路椎体间微创融合器的生物力学实验研究

目的评价植入镍钛记忆合金微创融合器(NiTi-TFC/C)的颈椎节段的稳定性及压缩力学性能。方法采集24只羊颈椎标本随机分为4组,每组6份,四组处理分别为:单取髓核组、自体髂骨植骨组、微创融合器组和钛制融合器组(InterFix)。所有标本进行前路减压,并对后3组进行椎间融合术。分别对各组标本进行生物力学测试并进行比较。结果微创融合器组与钛制融合器组在强度、刚度及扭转力学等方面无显著性差异(P>0.05)。而微创融合器组与自体髂骨植骨组具有显著性差异(P<0.05)。最大承载力为12050N。结论该微创融合器强度大、刚度高、抗扭转能力强,具有良好的抗压能力,为颈椎融合提供新型的融合装置。     

Effects of Electroacupuncture of Different Intensities on Energy Metabolism of Mitochondria of Brain Cells in Rats with Cerebral Ischemia-Reperfusion Injury

Objective: To observe the effects of electroacupuncture (EA) of different intensities on lactate dehydrogernase (LDH), succinate dehydrogenase (SDH) and ATPase in brain tissue of rats with cerebral ischemia-reperfusion injury (CI/R). Methods: Forty male SD rats were uniformly randomized into sham operation group (group A), CI/R group (group B), CI/R+5 mA EA (group C), CI/R+3 mA EA (group D) and CI/R+1 mA EA (group E) groups with eight rats in each group. Transient general brain ischemia was induced by four-vessel occlusion and reperfusion. The rats in group C, group D and group E were punctured and stimulated at Baihui (GV20), Mingmen (GV4) and Zusanli (ST36) with the same intermittent and rarefaction-dense wave (30 to 50 Hz) and different electric current intensities: 5 mA , 3 mA and 1 mA for 20 min after CI/R. Then the activities of Na+-K+-ATPase, SDH and LDH in mitochondria of brain tissue were measured by spectrophotometry. The ischemic cerebral cortex tissue was taken for observing the ultrastructure changes of impaired nerve cells. Results: Compared with group A, the activities of LDH, SDH and Na+-K+-ATPase were lowerer in the group B (P<0.05 or P<0.01). However, the activities of LDH, SDH and Na+-K+-ATPase were higher in the group D than those in the group B (P<0.05 or P<0.01). In group A, the anatomical structure of the cerebral cortex cells was basically normal; in group B, the neuronal cellular structures were severely damaged, the neuronal mitochondria got swelling, the mitochondrial cristae were broken, the medullated nerve fibers were not integrated. In group C, group D and group E, the ultrastructure of impaired neuron were improved. Group D was the best among three groups above. Conclusion: EA of 3 mA intensity could strengthen aerobic metabolism by elevating the activities of SDH and LDH, meanwhile maintaining the ionic equilibrium in the exterior and interior brain cell and relieving the cellular edema by reinforcing the activities of Na+-K+-ATPase.     

经胸椎椎弓根-肋骨途径置钉固定中上位胸椎

目的探讨经椎弓根．肋骨途径置钉的安全性和牢靠性,找出较理想的进钉点。方法6具成人胸椎尸体随机分为3组,A组经椎弓根途径置钉,B、c2组以不同的进钉点经椎弓根一肋骨途径置钉。对3组螺钉的位置、钉道总长度及各组成部分的长度行影像学测量。结果B、C2组的误置率明显低于A组,B、c2组间的误置率相当。B、c2-N．$T道的总长度明显长于A组,B、c2组间的钉道总长度相当。B组钉道的非骨性部分长度占钉道总长的百分比明强低于C组。结论经椎弓根一肋骨途径置钉固定中上位胸椎的安全性和牢靠性有一定保障,横突中外1／3头侧是较为理想的进钉点。     

体外循环膜氧合支持下全肺灌洗治疗肺泡蛋白沉积症一例并文献复习

目的提高对肺泡蛋白沉积症(PAP)患者肺灌洗治疗过程中低氧血症危险性的认识。方法介绍1例经病理证实的PAP患者体外循环膜氧合下的全肺灌洗治疗过程，并复习相关文献。结果57岁男性患者，因咳嗽和进行性呼吸困难12个月入院，动脉血氧分压(PaO2)为46mmHg(1mmHg=0．133kPa)，脉搏容积血氧饱和度(SpO2)85％～88％。胸部CT、经纤维支气管镜支气管肺泡灌洗和肺活检病理检查符合PAP。在手术室常规静脉全麻后，经口腔插入双腔管，分隔为通气肺和灌洗肺。两肺机械通气SpO2为80％～90％；当右侧单侧肺机械通气SpO2为68％～80％。于右股动脉和右股静脉插管，建立体外循环通道，开始静脉-动脉体外循环膜氧合(ECMO)支持，右侧单侧肺机械通气SpO2为89％～97％。左侧肺用总计20800ml生理盐水灌洗，灌洗期间SpO2为80％～94％；灌洗后，患者无呼吸困难。28d后未用ECMO完成右肺灌洗。1个月后复查CT示双肺浸润影基本消失。结论当PAP患者全肺灌洗操作前出现顽固的低氧血症，应考虑使用ECMO支持，以避免患者在全肺灌洗治疗中的危险低氧血症。     

苦参碱对兔耳增生性瘢痕成纤维细胞增生活性抑制作用

目的研究苦参碱(matrine,Mat)对兔耳增生性瘢痕成纤维细胞增殖活性的影响。方法利用兔耳腹侧面增生性瘢痕模型,采取免疫组织化学法观察增殖细胞核抗原的表达(proliferationcellnuclearantigen,PCNA)及嗜银核仁组织区染色法(AgNORs)统计NORs颗粒数,对比研究苦参碱在治疗兔耳增生性瘢痕过程中对成纤维细胞增殖活性的影响。结果局部注射苦参碱后,兔耳腹侧面增生性瘢痕中的成纤维细胞增生活性受到明显抑制,PCNA表达明显减弱,AgNORs记数明显减少。用药12周后对照组/苦参碱组PCNA标记指数和AgNORs分别为0.87/0.35,2.31/1.07(P<0.05)。结论苦参碱明显抑制兔耳增生性瘢痕成纤维细胞增生活性,对兔耳腹侧面增生性瘢痕有明显的治疗作用。     

移植骨髓间充质干细胞对兔退变椎间盘髓核细胞凋亡的影响

目的 观察骨髓间充质干细胞(MSCs)移植对兔退变椎间盘髓核细胞凋亡的影响.方法 以各兔L2/3、L3/4、L4/5、L5/6节段分为正常组、退变组、成纤维细胞(SFs)移植对照组、MSCs移植治疗组.MSCs和SFs分别经绿色荧光蛋白(GFP)转染后,注射植入退变椎间盘的髓核.通过透射电镜观察退变椎间盘凋亡髓核细胞形态;用实时定量聚合酶链反应(PCR)检测退变组织中髓核细胞凋亡相关基因bcl-2和box mRNA的表达;免疫荧光法标记髓核细胞凋亡相关蛋白Caspase-3,并通过TUNEL法标记凋亡髓核细胞,激光共聚焦显微镜检测髓核细胞凋亡蛋白表达率和细胞凋亡比率.结果 透射电镜下,退变椎间盘中凋亡髓核细胞呈现出核染色质边集,空泡形成,核膜断裂,凋亡小体形成等变化.MSCs移植治疗组bcl-2 mRNA的表达量高于退变组和SFs移植对照组(P<0.05),bax mRNA的表达量与退变组差异无统计学意义(P>0.05).MSCs移植治疗组细胞凋亡率和Caspase-3表达率均高于正常组[细胞凋亡率分别为(16.75±2.14)%和(6.86±1.08)%;Caspase-3表达率分别为[(20.34±1.03)%和(6.09±0.77)%](P<0.05),低于退变组和SFs移植对照组[细胞凋亡率分别为(31.87±4.16)%和(29.02±2.16)%;Caspase-3表达率分别为(31.50±3.78)%和(30.20±4.93)%](P<0.05).结论 髓核细胞凋亡在椎间盘退变过程中起重要作用.MSCs移植能有效抑制椎间盘髓核细胞凋亡,延缓椎间盘退变过程.     

七氟醚吸入麻醉与丙泊酚复合七氟醚麻醉对血糖的影响

目的 探讨七氟醚吸入麻醉对血糖水平的影响.方法 30例全麻患者随机分成七氟醚吸人麻醉组(A组)和丙泊酚复合七氟醚麻醉组(B组),每组15例.观察术前以及手术2h时的血糖浓度.结果 A、B两组手术2h的血糖均比术前明显升高[(6.23±1.45)mmol/L vs.(4.86±0.85)mmol/L和(6.66±1.48)mmol/L vs.(5.11±0.43)mmol/L](P<0.05);但组间差异无统计学意义.结论 七氟醚吸人麻醉与内泊酚复合七氟醚麻醉均不能抑制应激性血糖升高.     

血液稀释用于围术期血液保护

围术期血液稀释可以有效地维持术中循环功能稳定,优化血液流变状态,改善微循环灌注,提高患者对失血的耐受性,减少异体输血量,降低输血引起的输血反应及感染血源性传染病的概率。合理的血液稀释对凝血曲线和凝血功能影响小,不干扰组织氧代谢水平,对脏器功能无明显不良影响。这一血液保护技术疗效确切,效果好,费用合理,值得推广。     

咪哒唑仑对罗哌卡因致惊厥作用的影响

目的从致惊厥的行为学、安全性角度探讨咪哒唑仑对罗哌卡因致惊厥作用的影响。方法皮下注射咪哒唑仑20min后,腹腔注射罗哌卡因,观察小鼠惊厥潜伏期、持续时间、未惊厥率及其死亡率：并按序贯法分析咪哒唑仑对罗哌卡因致惊厥半数有效量（ED50）和半数致死量（LD50）的影响。结果0．5、1．0mg／kg咪哒唑仑可显著延长罗哌卡因致小鼠惊厥潜伏期（P〈0．05。P〈0．01）,显著缩短惊厥持续期（P〈0．01）,减少惊厥发生率和死亡率;且本试验剂量咪哒唑仑（0．2、1．0mg／mL与5．0、7．5mg／mL）可分别增大罗哌卡因致惊厥ED50和LD50。结论咪哒唑仑可缓解罗哌卡因的致惊厥作用,结果对临床联合用药有一定的参考意义。     

Enhanced sensitivity of hepatocellular carcinoma cells to chemotherapy with a Smac-armed oncolytic adenovirus

Aim： The aim of the present study was to further improve the therapeutic effects for human hepatocellular carcinoma （HCC） and reduce the damage in normal cells using a novel chemo-gene-virotherapeutic strategy. Methods： An oncolytic adenoviral vector （ZD55） similar to the typical oncolytic adenovirus ONYX-015, with a deletion of E1B-55K gene, was employed to express the second mitochon- dria-derived activator of caspases （Smac） protein by constructing a recombinant virus ZD55-Smac. The enhanced cytotoxicity of the combined treatment of ZD55- Smac with cisplatin or 5-fluorouracil （5-FU） was evaluated in several HCC cell lines. Moreover, the negative effects on normal cells have been tested in human normal liver cell lines L-02 and QSG-7701 cell lines by 3-（4,5-dimethylthiazol-2-yl）- 2,5-diphenyltetrazolium bromide assay and apoptotic cell staining. Results： According to our observation, ZD55-Smac is superior to ONYX-015 in sensitizing chemotherapy, ZD55-Smac used in conjunction with chemotherapy was found to exhibit obviously enhanced cytotoxicity in HCC cells, yet significantly abolished the negative toxicity in normal cells by utilizing the tumor selective replication vector and reducing the dosage. Conclusion： This chemo-gene-virotherapeutic （cisplatin or 5-FU＋ZD55-Smac） strategy is superior to the conventional chemo- gene or chemo-viro approach.