利奈唑胺联合利福平治疗C_5椎体次全切除钛网植骨融合内固定术后凝固酶阴性表皮葡萄球菌感染一例报告

正颈椎前路手术包括颈椎椎体次全切除钛网植骨融合术(anterior cervical corpectomy and fusion,ACCF)、颈椎前路椎间盘切除植骨融合术(anterior cervical discectomy and fusion,ACDF)等,在临床广泛开展,其术后感染发生率极低~([1])。回顾文献,既往报道多建议积极清创引流。笔者联合应用利奈唑胺及利福平治疗了1例颈椎前路C_5椎体次全切钛网植骨融合内固定术后发生凝固酶阴性表皮葡萄球菌感染的患者,经1年随访,疗效满意,报告如下。     

一期颈椎后前路联合手术结合自锁式颈椎融合器治疗脊髓型颈椎病的疗效

目的 分析一期颈椎后路单开门椎管成形、前路椎间减压、自锁式椎间融合器自体植骨椎间融合术治疗脊髓型颈椎病的疗效.方法 2006年9月-2009年4月,采用一期颈椎后路单开门椎管成形、前路椎间减压、自锁式椎问融合器自体植骨椎间融合术连续治疗脊髓型颈椎病102例;前路椎间减压单节段53例、双节段49例.记录患者术前及术后的JOA评分,在颈椎侧位X线片上测量椎间隙高度、椎问前凸角、颈椎前凸角的变化.结果 102例共随访12-40个月（平均18个月）.102例患者在术后2周内均感到神经症状明显好转;没有发生手术相关并发症.术后6个月随访时,所有患者主诉四肢感觉、肌力、活动均较前明显改善,颈椎X线及CT检查可见椎间已融合,椎间高度及生理曲度完好,无融合器移位、下沉、断裂发生.平均JOA评分由术前6.9±0.8分,提高到术后6个月13.5±0.9分,术后12个月13.6±0.8分;术后6个月随访时的JOA评分改善率：优43例,良49例,可10例,术后12个月时的JOA评分改善率与术后6个月无明显改变.结论 采用一期颈椎后路单开门椎管成形、前路椎问减压、自锁式椎间融合器自体植骨椎间融合术治疗脊髓型颈椎病能获得颈髓前后方的充分减压及满意的临床疗效,能获得满意的颈椎曲度、稳定性重建及椎间融合.     

颈椎前路钛板在颈椎前路手术中的应用

目的评价脊髓型颈椎病、颈椎骨折和颈椎椎体肿瘤前路减压后应用带锁钛板内固定的价值。方法对51例脊髓型颈椎病、46例颈椎骨折、5例颈椎椎体肿瘤患者采用前路减压、自体髂骨植骨和颈椎带锁钛板内固定术。结果随访86例,平均随访时间2.3年,术后3个月植骨块获得骨性融合,颈椎椎间高度和生理曲度维持满意,感觉、肌力明显恢复,钛板及螺钉无松动及断裂现象。结论颈椎前路减压术后应用带锁钛板内固定能促使植骨块融合,有效地维持椎间高度和颈椎生理曲度,有广泛的应用价值。     

一期后前联合入路治疗老年人脊髓型颈椎病的疗效观察

目的探讨一期后前联合入路治疗老年人脊髓型颈椎病的疗效。方法2008年1月至2011年1月,我科接受一期后前联合入路治疗脊髓型颈椎病的老年患者35例进行回顾性分析,采用日本矫形协会（JOA1评分及Nurcik分级对患者手术前后神经功能进行评价。后路手术均采用单开门椎管扩大成形术,前路手术采用椎间盘摘除Cage植骨融合术或椎体次全切钛笼植骨融合术。结果35例随访6～36个月,平均18个月。椎体次全切8例,单间隙椎间盘摘除Cage植骨融合术17例,2个间隙椎间盘摘除CAGE植骨融合术10例。手术历时180～300min,平均245min。出血100—1600ml,平均505ml。术前JOA评分（9．34±2．40）分,术后（13．11±1．90）分,平均改善率为47％,二者间差异有统计学意义（P〈0．05）。Nurcik分级,除1例术后仍为v级外,其余均有Ⅰ～Ⅲ级的提高。前路植骨均在术后4—9个月融合,未见假体移位、下沉;25例随访时进行了CT复查,未见后路再关门;30例术后进行了颈椎MRI检查,显示脊髓减压充分。术后发生吞咽时疼痛8例,一过性神经功能障碍3例,声音嘶哑1例,深静脉血栓1例,后路切口感染1例。结论脊髓型颈椎病的老年患者常合并较多的系统性疾病,术后并发症较多。一期后前联合入路是治疗老年人脊髓型颈椎病的有效术式。     

应用Pyramesh钛网融合器植骨加Orion钛板内固定治疗颈椎椎体肿瘤

目的：探讨经颈前路切除颈椎椎体肿瘤后，利用Pyramesh钛网融合器（简称钛网）植骨修复骨缺损，Orion钛板内固定的方法治疗颈椎肿瘤的临床价值。方法：对9例颈椎肿瘤患行经颈前路椎体肿瘤切除，骨缺损处置入钛网支撑、植骨融合，椎前Orion钛板内固定。结果：9例患经过6-24个月的随访，无内固定物断裂、松动、脱出，植骨融合满意，无严重颈肩痛及颈椎不稳，无因肿瘤复发造成继发的颈椎骨折及脊髓压迫等并发症。结论：钛网植骨加Orion钛板内固定治疗颈椎椎体肿瘤，可充分保证固定节段的稳定性，植骨融合好，并可防止因肿瘤复发造成继发的颈椎骨折及脊髓压迫。     

钩椎关节植骨在Zero-P固定融合术中的应用及效果观察

目的评价经前路颈椎间盘切除减压植骨融合术(anterior cervical discectomy and fusion,ACDF)使用Zero-P椎间融合器钩椎关节植骨治疗颈椎病术后的融合效果。方法回顾分析2014年2月至2015年10月,接受单节段ACDF使用Zero-P椎间融合器治疗颈椎病的患者38例。将颈椎椎间隙分为四个部分:两侧钩椎关节、终板间以及椎间融合器后方。通过CT三维重建评价术后手术节段椎间隙四个不同部位的融合率。采用日本骨科协会(Japanese orthopaedic association,JOA)评分、疼痛视觉模拟评分(visual analogue scale,VAS)和颈椎功能障碍指数(neck disable index,NDI)对患者临床疗效进行评价,并记录吞咽困难等并发症发生情况。结果 38例顺利完成手术,未出现伤口感染、脑脊液漏、血肿形成、气管食管瘘、声音嘶哑、神经根或脊髓损伤等并发症。患者术后3、6、12个月随访总融合率分别为15.8%、63.2%、97.4%。植骨侧钩椎关节处术后3、6、12个月随访融合率分别为10.5%、47.4%、86.8%,终板间人工骨植骨处术后3、6、12个月随访融合率分别为2.6%、23.7%、78.9%,未植骨侧钩椎关节处术后3、6、12个月随访融合率分别为2.6%、13.2%、34.2%,椎间融合器后方术后3、6、12个月随访融合率分别为2.6%、10.5%、28.9%。植骨侧钩椎关节早期融合率高于终板间植骨融合率,植骨侧钩椎关节融合率高于未植骨侧钩椎关节融合率。患者术前、术后1周以及术后3个月、6个月和12个月随访VAS评分分别为6.7±1.6、3.3±1.1、2.1±0.9、1.6±0.9和1.4±0.7;NDI评分分别为31.8±5.4、18.6±3.3、11.9±3.0、8.5±3.0和7.7±2.6;JOA评分分别为9.6±1.4、13.5±1.6、14.5±1.1、14.6±1.0和15.3±0.8;椎间隙高度分别为(5.2±1.5) mm、(6.0±1.1) mm、(5.9±1.0) mm、(5.8±1.0) mm和(5.8±1.0) mm;C_(2～7) Cobb’s角分别为(14.7±2.3)°、(17.8±2.1)°、(18.9±2.0)°、(19.6±1.7)°、(19.3±1.3)°。所有患者的颈椎曲度、椎间隙高度、JOA、VAS和NDI评分均较术前有明显改善,差异有统计学意义(P0.05)。结论 Zero-P椎间植骨融合术中进行钩椎关节植骨是一种安全有效的手术方式,可有效提高融合率。     

腰椎后路椎体间植骨融合的疗效观察

目的探讨腰椎后路椎体间植骨融合的手术技术,观察疗效并评价其应用价值。方法对明确诊断下腰椎不稳的71例患者行后路双侧椎板间开窗减压,椎弓根螺钉固定,单侧切除椎间盘保留侧方及前方的纤维环,刮除终板的软骨层,植入足量的自体松质骨。术后不同随访时间观察症状改善及植骨融合情况。结果平均随访37．3个月（23～82个月）,原有的神经压迫症状消失,术后疼痛VAS评分和Oswestry功能障碍指数改善率分别为（83．52±2．41％和（72．66±4．1）％。术后6～9个月移植骨间隙轮廓不清,CT示椎体与植骨块交界处无透亮区。11例（15．5％）患者融合不良,植骨块吸收,但症状改善。结论腰椎后路椎体间植骨融合术结合椎弓根固定符合腰椎的自然生物力学特征,即椎体的压力支撑原则以及后结构的张力带原则,是腰椎稳定性重建的理想植骨方法。     

钢板骨水泥"人工椎体"在脊柱转移瘤手术中的重建

目的探讨钢筋骨水泥“人工椎体”在脊柱转移瘤切除后重建中的应用效果。方法对18例胸腰椎转移瘤患者行病椎切除、椎体重建术。术前ASIA神经功能分级：A级1例，C级7例，D级10例。胸椎11例均实施一期前路手术，其中7例行肿瘤椎体切除、钢板骨水泥椎体重建术，4例行肿瘤椎体切除、钢板骨水泥椎体重建及内固定术；腰椎7例一期后路内固定加前路肿瘤椎体切除、钢板骨水泥椎体重建术5例，一期后路椎管减压、内固定，二期前路肿瘤椎体切除、钢板骨水泥椎体重建2例。结果术中病灶清除较为彻底，术后影像学显示内固定确切，手术均成功并获得满意疗效。随访4～28个月，术后胸背痛完全消失，术后ASIA神经功能分级：A级1例，D级5例，E级12例。1例4个月因脑转移死亡，其他17例存活时间8个月以上。结论钢板骨水泥“人工椎体”在脊柱转移瘤切除后重建术，可使患者早期自立从而提高患者的生存质量。     

颈椎结核外科手术治疗的临床分析

目的探讨颈椎结核手术治疗的方法及疗效。方法本组10例,男4例,女6例,平均年龄44岁。一期行颈前路病灶清除,椎管减压,植骨融合内固定。应用AO颈前路钛板内固定4例,Depuy颈前路钛板3例,枢法模颈前路钛板3例。所有病例术后佩戴颈托4～6周。抗结核治疗12—18个月。结果术后颈椎后凸畸形得以矫正,颈椎生理弧度得以恢复。神经功能有所恢复。术后3～6个月植骨融合,内固定位置良好,结核无复发。结论在抗结核治疗的基础上,颈前路一期病灶清除植骨内固定治疗颈椎结核可以恢复脊柱稳定性,解除脊髓受压,有利于结核病灶的清除。     

前路病灶切除植骨内固定治疗脊柱结核

目的评价前路病灶切除植骨内固定治疗脊柱结核的临床效果。方法自1998年1月至2003年12月对88例脊柱结核患者行前路病灶切除植骨内固定治疗,男50例,女38例,年龄16～58岁,平均43.6岁。术前均有不同程度的结核全身症状并局部疼痛,叩压痛,活动受限。影像学显示单椎体破坏塌陷22例,双椎体破坏楔形塌陷66例,均有大小不等的冷脓肿和不同程度的后凸畸形;Cobb角17。～50。,平均35。。不全截瘫25例,血沉35～136mm/h,术前抗结核治疗2～4周。前路彻底切除病灶,撑开矫正后凸畸形,平均矫正20。,椎间自体大块髂骨嵌入植骨钢板螺钉内固定,置入抗结核药。术后规则抗结核药物治疗9个月。结果切口一期愈合86例,延期愈合2例,获随访76例,随访时间1.5～5年,平均2～8年。植骨块术后6～8个月完全融合,无移位、折断和吸收。25例截瘫术后6个月内完全恢复,50例矫正角度无丢失,26例矫正角度丢失4。～6。。血沉于术后2～3个月降至正常。随访期内病灶无复发。结论前路病灶切除髂骨植骨内固定治疗脊柱结核,既能彻底切除病灶防止复发,又能矫正畸形、重建脊柱稳定性,恢复脊柱支撑功能,防止晚发神经损害。     

New and emerging radiosensitizers and radioprotectors

The combination of chemotherapy and radiation has led to clinical breakthroughs in several disease sites, and current work continues to define optimum combinations of proven chemotherapy as well as more recently available, noncytotoxic agents. Administration of systemic therapies allows modulation of radiation response to improve tumor control (radiosensitization) or to prevent normal tissue toxicity (radioprotection). Substantial progress has been made in identifying the targets of standard chemotherapeutic radiation sensitizers and protectors as well as in the introduction of a new generation of molecularly targeted therapies in combination with radiation. We have reviewed the most recent, predominantly early phase clinical trials combining systemic agents with radiation. Although the proof of an improved schedule ultimately needs to come from well-run Phase III trials, the search among schedules could be shortened by the use of surrogate endpoints such as presence of active drug metabolites in the tumor. This has been accomplished only in a few cases and needs to become a more standard part of radiation sensitizer and protector trials.     

Religiosity and Physical and Emotional Functioning Among African American and White Colorectal and Lung Cancer Patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

Fruit and vegetables and cancer risk

The possibility that fruit and vegetables may help to reduce the risk of cancer has been studied for over 30 years, but no protective effects have been firmly established. For cancers of the upper gastrointestinal tract, epidemiological studies have generally observed that people with a relatively high intake of fruit and vegetables have a moderately reduced risk, but these observations must be interpreted cautiously because of potential confounding by smoking and alcohol. For lung cancer, recent large prospective analyses with detailed adjustment for smoking have not shown a convincing association between fruit and vegetable intake and reduced risk. For other common cancers, including colorectal, breast and prostate cancer, epidemiological studies suggest little or no association between total fruit and vegetable consumption and risk. It is still possible that there are benefits to be identified: there could be benefits in populations with low average intakes of fruit and vegetables, such that those eating moderate amounts have a lower cancer risk than those eating very low amounts, and there could also be effects of particular nutrients in certain fruits and vegetables, as fruit and vegetables have very varied composition. Nutritional principles indicate that healthy diets should include at least moderate amounts of fruit and vegetables, but the available data suggest that general increases in fruit and vegetable intake would not have much effect on cancer rates, at least in well-nourished populations. Current advice in relation to diet and cancer should include the recommendation to consume adequate amounts of fruit and vegetables, but should put most emphasis on the well-established adverse effects of obesity and high alcohol intakes.     

VEGF及KDR在大肠腺瘤和腺癌中的表达及意义

目的：探讨VEGF和KDR在大肠腺瘤和大肠腺癌中的表达及临床病理特征的关系。方法：大肠腺瘤和大肠腺癌组织标本各100例,采用免疫组织化学染色法检测VEGF和KDR在标本中的表达情况。结果：VEGF和KDR在大肠腺癌组中的阳性表达明显高于大肠腺瘤组（P〈0.05）;在正常大肠黏膜均未见VEGF和KDR表达的阳性染色;VEGF阳性表达组中KDR的阳性表达率为70%,显著高于VEGF阴性表达组中KDR的阳性表达率16%,两组比较有统计学意义（P〈0.01）。结论：大肠腺癌组织中KDR的表达与肿瘤大小、转移情况、浸润深度密切相关;VEGF和KDR在大肠腺瘤中的表达与患者的年龄、性别及分型均无相关性,而与增生程度相关（P〈0.05）。在大肠腺癌患者中VEGF及KDR表达更高,二者具有协同效应。     

肾上腺素能β受体与肿瘤生长及转移

大量研究表明肿瘤细胞可表达β受体，而一些神经递质、药物和社会心理因素可能通过β受体影响肿瘤的生长和转移，β受体激动剂、β受体阻滞剂以及抑郁等社会心理因素可加强或削弱这种作用。这为表达β受体肿瘤的治疗开辟了新的道路，提供了新的治疗靶点。     

Occupational and environmental radiation and cancer

Epidemiologic evidence on the relation between occupational and environmental radiation and cancer is reviewed. Studies of pioneering radiation workers, underground miners, and radium dial painters revealed excess cancer deaths and contributed to the setting of radiation protection standards and to theories of carcinogenesis. Occupational exposures today are generally much lower than in the past, thus any associated increases in cancer will be difficult to detect. Pooling investigations of these more recently exposed workers, however, has the potential to validate current estimates of risk used in radiation protection. New information on the effects of chronic radiation exposure also may come from studies in the former Soviet Union of Chernobyl clean-up workers and of workers at the Mayak nuclear facilities. Studies of environmental radiation exposures, other than radon, are largely inconclusive, due mainly to the difficulties in detecting the low risks associated with low dose exposures. Thyroid cancer, however, has been linked to environmental radiation from the Chernobyl accident and from nuclear weapons tests. Low-level radiation released during normal operations at nuclear plants has not been found to increase cancer rates in surrounding populations. Radon, a human carcinogen, is the most ubiquitous exposure to human populations; remediating high residential-radon levels is recommended, recognizing that the exposure can never be removed completely because it occurs naturally.     

Cell and tissue interactions in carcinogenesis and metastasis and their clinical significance

This review describes a new vision for future directions in the study of metastatic cancer biology and pathology. It is based upon clinical and experimental observations on the constituent cell lineages within a neoplasm and on tumour-host interactions. The vision incorporates information from studies in population biology, developmental biology and experimental pathology as well as investigations upon human malignant disease. The assembled information reveals that invasion and metastasis are supra-cellular manifestations of "emergent behavior" among combinations of normal and malignant cell lineages in vivo. Emergent behavior is a combinatorial interactive process in which a population displays new traits which cannot be achieved by individuals acting separately and which subside when the specific population mix disaggregates. Disruption of such pathological interactions in the field of a developing primary or secondary tumour is, therefore, required to disable the malignant population and arrest progression without tissue destruction. These conclusions originate, in part, from principles which govern the sociobiology and group behavior of bees, ants, fish, birds and human societies. In all these social organisms, external factors can disrupt signaling mechanisms and induce expanding self-perpetuating rogue behavior, leading to social disintegration. These principles also apply to cellular societies composing higher animals, which likewise need intrinsic rules to maintain social order and avoid anarchy, and recognition of this is essential for advancing future research on the mechanisms involved in carcinogenesis and metastasis. Summarised evidence is presented here to support the conclusion that miscommunications between cells and tissues in the region of the developing tumour and its metastases are the main direct perpetrators of malignant disease. Genetic lesions (mutations, deletions, translocations, reduplications, etc.), commonly seen in cancers, can significantly disrupt important molecular pathways in the networks of communications needed to sustain orderly tissue/organ structure and function. However, genetic lesions can also, themselves, be induced by abnormal cell interactions initiated by extrinsic carcinogenic agents such as chemicals, viruses, hormones and radiation. The evidence shows that, irrespective of the initiating cause, it is this miscommunication in the region of a developing tumour and its metastases that is ultimately responsible for the emergence and progression of the disease. The article describes how this information collectively, provides a framework for designing specific novel therapeutic approaches targeting the cell and tissue interactions driving tumour metastasis and its manifold effects on the whole body.     

Vitamin D and melanoma and non-melanoma skin cancer risk and prognosis: A comprehensive review and meta-analysis

Vitamin D is formed mainly in the skin upon exposure to sunlight and can as well be taken orally with food or through supplements. While sun exposure is a known risk factor for skin cancer development, vitamin D exerts anti-proliferative and pro-apoptotic effects on melanocytes and keratinocytes in vitro. To clarify the role of vitamin D in skin carcinogenesis, we performed a review of the literature and meta-analysis to evaluate the association of vitamin D serum levels and dietary intake with cutaneous melanoma (CM) and non-melanoma skin cancer (NMSC) risk and melanoma prognostic factors. Twenty papers were included for an overall 1420 CM and 2317 NMSC. The summary relative risks (SRRs) from random effects models for the association of highest versus lowest vitamin D serum levels was 1.46 (95% confidence interval (CI) 0.60–3.53) and 1.64 (95% CI 1.02–2.65) for CM and NMSC, respectively. The SRR for the highest versus lowest quintile of vitamin D intake was 0.86 (95% CI 0.63–1.13) for CM and 1.03 (95% CI 0.95–1.13) for NMSC. Data were suggestive of an inverse association between vitamin D blood levels and CM thickness at diagnosis. Further research is needed to investigate the effect of vitamin D on skin cancer risk in populations with different exposure to sunlight and dietary habits, and to evaluate whether vitamin D supplementation is effective in improving CM survival.