骨性关节炎与软骨细胞凋亡的关系

骨性关节炎 (ＯＡ)重要的病理学特征是关节软骨的降解。既往对ＯＡ的研究 ,大多着重于细胞外基质酶性降解和 /或合成新的基质受到抑制而导致软骨的破坏 ,很少注重软骨细胞生存或死亡在ＯＡ关节软骨降解中所起的作用。软骨细胞是成熟软骨中唯一的细胞类型 ,关节软骨与年龄有关的变化包括细胞数减少 ,空陷窝增加 ,异常基质钙化。细胞数量上的变化与软骨纤维化增加的频率一致[1,2 ] ,这提示细胞结构的减少成了基质降解及ＯＡ最终发生的因素。一个重要的现象是ＯＡ患者关节中正常软骨及非负重区软骨中的软骨细胞数少于正常人关节软骨中的软骨细…     

骨关节炎软骨及软骨下骨吡啶并林含量的变化

目的：测定骨关节炎（ＯＡ）软骨及软骨下骨中呢啶并林（Ｐｙｒ）含量的变化。判断Ｐｙｒ在ＯＡ诊断和现活跃程度评价方面的作用。方法：复制成年兔膝关节ＯＡ模型,取有内髁主要负重区关节软骨及软骨下骨,采用高效液相色谱法（ＨＰＬＣ）测定其Ｐｙｒ含量。结果：８周内,关节软骨中Ｐｙｒ含量逐渐下降;软骨下骨中Ｐｙｒ含量在模型术后早期下降,随后逐渐升高。结论：ＯＡ关节软骨及软骨下骨的Ｐｙｒ含量随病程发生变化,可能是造     

骨髓基质细胞修复兔关节软骨的实验研究

目的 研究骨髓基质细胞修复兔关节软骨的可行性。方法 取自体骨髓基质细胞体外培养扩增，聚乳酸吸附骨髓基质细胞植入兔膝关节软骨负重（内髁）和非负重区（外髁）缺损内，观察４、８、１２后软骨缺损的修复情况，并对组织切片评分结果 ８、１２周后，骨髓基质细胞在负重区缺损内可以形成透明软骨，组织评分接近正常软骨优于对照，非负重区内没有形成透明软骨。结论 骨髓基质细胞在负重区缺损内可以形成透明软骨，组织评分接近正     

选择性臀肌切断诱发骨关节炎实验模型

作者通过选择性切断豚鼠一侧臀大、中、小肌，满意地获得了髓关节骨关节炎（ＯＡ）动物模型。生物力学分析表明，术后实验髋负重及维持平衡能力障碍。术后１２周及２４周，通过组织学、ＳＤＨ组化技术和ＳＥＭ观察，ＯＡ呈渐进性改变，其病理特点是：关节软骨变性的同时伴有修复和增生。该模型的创立，为观察ＯＡ早期病理改变，以及为筛选治疗药物和选择术式提供可行性。     

膝关节退行性骨关节炎钙化层病理改变研究

[目的]对骨性关节炎软骨钙化层病理结构进行形态学分析,为临床诊治及预防相关疾病提供理论依据.[方法]标本均来源于临床诊断为膝关节退行性骨关节炎患者,共21例,其中,男1例,女20例.股骨髁负重区取材、修剪、固定后,常规制备石蜡切片,番红O/固绿染色,显微镜观察.[结果]本研究收集的标本平均年龄(65.57±7.43)岁;平均身高(155.38±5.32)cm;体均体重(59.95±8.99)kg;平均病程(13.04±9.66)年.番红O/固绿染色示钙化层病理改变主要为潮线复制、漂移,出现多条潮线结构,钙化层结构明显增厚,最厚处为900多微米;钙化层增厚伴血管长入;非钙化软骨及钙化层纤维样改变;潮线间隙增宽;钙化层及深层软骨缺损.[结论]膝关节退行性骨关节炎钙化层形态结构具有特异性的病理改变.     

软骨终板钙化与椎间盘退变关系的实验研究

目的　研究椎体软骨终板钙化与椎间盘退变的关系。　方法　通过切除２０ 只兔颈椎棘上、棘间韧带及分离颈椎后旁两侧肌肉造成颈椎力学上的失稳而诱导了颈椎间盘退变动物模型。在形态学上评定颈椎间盘退变程度,测定不同退变程度椎间盘软骨终板钙化层与非钙化层厚度。　结果　软骨终板钙化层厚度与椎间盘退变程度呈高度正相关性（ｒ＝ ０－９２） 。　结论　软骨终板的钙化可能是椎间盘退变的启动和促进因素     

大运动量跑步对大鼠膝关节软骨蛋白多糖的影响

目的 观察平板跑步运动对大鼠关节软骨蛋白多糖的影响.方法 将Wistar大鼠10只随机分为对照组和跑步组.对照组笼养,跑步组每天以20m/min速度,连续跑步1000m,每天1次.连续训练45d后,处死大鼠,切取双膝关节,固定,脱钙,包埋,沿矢状面整体切片,苏木素-伊红(HE)及番红O染色.观察股骨内侧髁负重区和胫骨内侧平台负重区软骨形态结构和基质染色差异,利用图像分析系统,测量胫骨平台软骨厚度,并对软骨各层染色深浅进行吸光度定量.结果 对照组软骨结构正常,跑步组软骨表面完整,胫骨内侧平台负重区非钙化层厚度较对照组显著下降(P<0.05);番红O染色,负重区软骨非钙化层平均吸光度较对照组明显下降(P<0.05),其中表层下降66%(P<0.01),中层下降56%(P<0.01),深层与对照组差异无统计学意义(P>0.05),而钙化层吸光度较对照组上升38%(P<0.05).结论 大鼠连续平板运动45d后,膝关节负重区软骨虽然结构完整,但已经出现退行性改变.

Abstract：

Objective To study the influences of the strenuous running training program on the knee joint articular cartilage. Methods At the age of 16 weeks, 5 male Wistar rats started running on a horizontal treadmill. Thereafter, the rats were trained for 45 days continuously. The rats ran 1 km/day at the speed of 20 m/min. Five matched male rats served as controls. Knees of the rats were studied by whole-mounted section, Hematoxylin and Eosin (HE) stain, safranin O stain. Results The cartilage surfaces were intact after the running exercise. The glycosaminoglycan concentration was decreased by an average of 66% in the superficial zone, 56% on the middle zone, but no difference was found in the deep zone. The glycosaminoglycan concentration was increased by 38% in the calcified cartilage. Conclusion Strenuous running induced marked decrease of proteoglycan in the uncalcified cartilage, but induced no osteoarthritis in this rat strenuous running model.     

自体骨软骨移植修复软骨缺损的研究

把非负重区正常软骨移植到负重区病损软骨部位，让其在受区发挥作用、改善关节功能、减轻患者痛苦是目前研究的热点。拟在关节镜监视下，取非负重区软骨自体移植替代负重区病变软骨．探讨自体骨软骨移植修复软骨缺损的可行性、效果及并发症。     

老年与青年股骨头内松质骨组织形态计量学比较研究

目的 研究老年部骨折患股骨头松质骨结构。方法 取股骨示本４９只,分成老年组２６例及青年组２３例。在股骨头致密区（负重区）和疏松区（非负重区）各截取软骨下３ｍｍ处７ｍｍ×５ｍｍ×５ｍｍ松质骨各一块作骨组织形态计量测定。结果 老年组致密区和稀疏区骨组织形态参数松质骨体积（ＴＢＶ）、平均骨小梁密度（ＭＴＰＤ）、平均骨小梁厚度（ＭＴＰＴ）、骨小梁间连接点数（Ｔｂ、ｎ）均明显低于青年组（Ｐ〈０．０５～０．     

膝关节原发性骨关节炎软骨和软骨下骨病理改变的定量研究

目的观察膝关节原发性骨关节炎(osteoarthritis,OA)胫骨平台软骨和软骨下骨病理改变特点,对比内、外侧平台软骨和软骨下骨结构参数,探讨钙化层和软骨下骨在OA发病机制中的作用。方法取2009年10月-2011年5月行人工全膝关节置换术治疗的30例30膝原发性OA患者自愿捐赠的新鲜胫骨平台标本进行实验。其中男11例,女19例;年龄55～78岁,平均65.1岁。病程10～25年,平均16.6年;患膝内翻畸形1～23°,平均9.3°。大体观察胫骨平台后在内、外侧中央负重区取材,常规制备脱钙石蜡切片,行HE和番红O/固绿染色,观察关节软骨退变特点,参照Mankin评分标准评分并分期;观察钙化层及软骨下骨病理改变。应用Image Pro Plus 6.0图像分析软件测量软骨和软骨下骨结构参数,包括软骨全层(total articular cartilage,TAC)厚度、钙化层(articular calcified cartilage,ACC)厚度、ACC/TAC比值、软骨下骨板(subchondral bone plate,SCP)厚度以及骨小梁体积分数(trabecular bone volume,BV/TV)。结果大体观察内侧平台软骨退变较外侧严重,内侧平台软骨Mankin评分为(12.4±1.1)分,显著高于外侧平台的(8.3±1.6)分(t=12.173,P=0.000)。根据Mankin评分结果在60个标本中,14个为OA早期,可见软骨浅表层裂隙、潮线复制和软骨下骨增厚;19个为OA中期,可见软骨深层裂隙、多发软骨下骨吸收陷窝和明显增厚的软骨下骨;27个为OA晚期,可见软骨全层缺失、软骨内化骨和"象牙化"软骨下骨。软骨和软骨下骨结构参数测定示:内侧平台TAC厚度显著低于外侧平台,ACC/TAC比值、BV/TV及SCP厚度显著高于外侧平台,差异均有统计学意义(P<0.05)。内、外侧平台ACC厚度比较,差异无统计学意义(P>0.05)。结论钙化层和软骨下骨可能在OA发生与进展中发挥了重要作用。     

食管癌外科治疗的现状与展望

食管癌是目前世界范围内常见的恶性肿瘤,外科手术仍为其主要治疗方式,其主要手术方式有：（1）胸、腹、颈三切口食管次全切除术;（2）经左胸食管癌切除、主动脉弓下或弓上食管胃吻合术;（3）经左胸食管次全切除、食管胃颈部吻合术;（4）Ivor-Lewis手术;（5）腹部和颈部两切口食管拔脱、食管胃颈部吻合术;（6）电视胸腔镜辅助食管癌切除术;（7）食管次全切除,空肠或结肠代食管手术等。我们对食管癌的手术方式、围手术期管理、新手术技术应用及食管癌外科治疗的未来,包括微创食管外科技术、淋巴结清扫的进一步规范、新辅助治疗的作用,术后生活质量和人工食管研究等的现状和进展进行综述,并对目前存在的问题予以讨论。     

生育与不育男性精浆总抗氧化能力分析

目的:分析生育与不育男性精浆中总抗氧化能力(TAC)及其在男性生育中意义。方法:225例男性不育患者分为6组,分别为:梗阻性无精子症组(n=10),非梗阻性无精子症组(n=42),少精子症组(n=20),弱精子症组(n=78),少弱精子症组(n=57),以及正常精子症组(n=18)。28例正常生育男性作为对照(生育组)。分别采用计算机辅助精液分析(CASA)系统进行精液参数分析,采用比色法检测精浆TAC水平。结果:生育组男性精浆TAC为(19.82±6.33)U,梗阻性无精子症组(1.71±1.33)U,非梗阻性无精子症组(12.73±9.44)U,少精子症组(10.85±6.64)U,弱精子症组(13.88±8.24)U,少弱精子症组(11.20±7.02)U,正常精子症组(18.07±8.73)U;与生育组精浆TAC[(19.82±6.33)U]相比,在各不育症组中,除正常精子症组精浆TAC与生育组差异无显著性外,其余各组均显著低于生育组(P<0.01)。精浆TAC与精子密度(r=0.182,P<0.05)和a级精子(r=0.150,P<0.05)呈显著正相关。结论:精浆中TAC水平与男性不育密切相关,精浆中过低的TAC水平可能是引起男性不育的病因之一。     

Multiple Choice Questions

1. Regarding the management of severe rhabdomyolysis:

1. (a) Acidificationof the urine is helpful.
2. (b) Diuretic therapy is of provenbenefit.
3. (c) Bicarbonate infusion may be useful.
4. (d) Compoundsodium lactate is the ideal resuscitation fluid.
5. (e) Largevolumes of fluid may be required.

2. The following metabolicderangements are observed in earlyrhabdomyolysis:

1. (a) Hyperphosphataemia.
2. (b) Hypocalcaemia.
3. (c) Metabolic alkalosis.
4. (d) Hyperuricaemia.
5. (e) Hypokalaemia.

3. Regarding the diagnosis of rhabdomyolysis:

1. (a)Myoglobin isalways detectable in the urine.
2. (b) Serum creatininekinaseis a sensitive marker of muscledamage.
3. (c) Routinedipsticktesting of urine reliably differentiatesbetween haematuriaand haemoglobinuria.
4. (d) Measuring serum myoglobin is useful.
5. (e) The initial clinical sign of rhabdomyolysis may be discolouration     

Characterization of cDNA clones for porcine α(l,3)galactosyl transferase: The enzyme generating the Galα(l,3)Gal epitope

Abstract: Galoα(l,3)Gal is a terminal carbohydrate found on many glycosylated cell surface molecules of species other than humans and Old World monkeys, and is produced by the α(l,3)galactosyl transferase enzyme's adding galactose to a substrate. We have previously shown, by the transfection of COS cells with the cloned mouse α(l,3)galactosyl transferase, that most human anti-pig antibodies react with Galα(l,3)Gal. Using cross-species hybridization with the mouse α(l,3)galactosyl transferase cDNA, bacteriophage λ, gt11 and λgt10 pig cDNA libraries were screened and overlapping clones isolated which encode the pig α(l,3)galactosyl transferase. Sequencing of the clones demonstrated a single open reading frame coding for a protein with high homology to murine (75% identity) and bovine (82% identity) α(l,3)galactosyl transferases. Southern blot analysis shows the porcine α(l,3)galactosyl transferase gene to be a single copy gene, and northern analysis demonstrated an mRNA of 3.9 kb. After splicing the clones to produce a single full length clone, transfection of Galα(l,3)Gal^- COS cells led to strong reactivity with human serum and with the IB4 lectin (which reacts only with Galα(l,3)Gal), indicating that the expression of the transferase led to the expression of Galα(l,3)Gal. The cloning of the cDNA gene for the pig α(l,3)galactosyl transferase is the first step in the production of a transgenic pig lacking the transferase and therefore the Galα(l,3)Gal epitope; such animals could serve as donors for human transplantation.     

Ets-1和VEGF在膀胱移行细胞癌中的表达及意义

目的:探讨血管内皮生长因子(VEGF)和E26转录因子(Ets-1)的表达与膀胱移行细胞癌生物学行为的关系。方法:应用免疫组织化学的方法对48例膀胱移行细胞癌以及正常膀胱组织中的VEGF和Ets-1进行检测。结果:Ets-1的阳性率在Ta~1和T2~4分别为32.1%和65.5%(P<0.05);Ⅰ级和Ⅲ级的表达率分别为31.3%和66.7%(P<0.05);在初发肿瘤和复发肿瘤中的表达分别为33.3%和66.7%(P<0.05)。VEGF的阳性表达率在Ta~1和T2~4分别为28.6%和85.0%(P<0.01);Ⅰ级和Ⅲ级的表达率分别为25.0%和77.8%(P<0.01);在初发肿瘤和复发肿瘤中的表达分别为36.7%和77.7%(P<0.01)。结论:Ets-1和VEGF可以作为了解膀胱移性细胞癌生物学行为的参考指标。     

舍尼通~和抗生素联合用药治疗慢性非细菌性前列腺炎临床研究

目的:评价舍尼通与抗生素联合用药治疗慢性非细菌性前列腺炎的有效性及耐受性。方法:采用双盲、平行对照、多中心临床试验研究方法,通过Stam ey试验、前列腺按摩液(EPS)常规及美国国立卫生院慢性前列腺炎症状评分(NIH-CPSI),筛选出160例慢性非细菌性前列腺炎患者,随机分为试验组(80例,脱落1例)和对照组(80例)。试验组前4周合用舍尼通和左氧氟沙星,后4周单用舍尼通,服用剂量为舍尼通2次/d,1片/次,左氧氟沙星2次/d,0.1 g/次;对照组方法同上,仅将舍尼通换为安慰剂。所有患者均行入组前、治疗第4周和第8周随访并行NIH-CPSI评分、EPS等检查及药物不良反应的评估。结果:治疗后4周和8周,试验组疼痛评分降低分别为3.34±2.45,4.33±3.13,排尿评分降低分别为2.22±1.79,2.77±2.04;对照组疼痛评分降低分别为2.28±2.42,3.30±3.29,排尿评分降低分别为1.24±1.67,1.83±2.25。两组治疗前后的自身对比均差异有显著性(P<0.01),生活质量影响评分差异也有显著性(P<0.05)。组间比较,试验组较对照组第4周和第8周疼痛和排尿评分差异均有显著性(P<0.01或P<0.05)。两组治疗前后白细胞、卵磷脂小体差异无显著性(P>0.05),对药物的耐受性差异无显著性(P>0.05),无严重不良反应事件发生。结论:舍尼通与抗生素联合用药方案能更有效地缓解慢性非细菌性前列腺炎患者的疼痛不适症状和排尿症状,耐受性好,值得在临床上推广应用。     

Safe laparoscopic cholecystectomy:Adoption of universal culture of safety in cholecystectomy

The incidence of biliary injury after laparoscopic cholecystectomy(LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Various aspects of safe cholecystectomy include:(1) thorough knowledge of relevant anatomy, various anatomical landmarks, and anatomical variations;(2) an understanding of the mechanisms involved in biliary/vascular injury, the most important being the misidentification injury;(3) identification of various preoperative and intraoperative predictors of difficult cholecystectomy;(4) proper gallbladder retraction;(5) safe use of various energy devices;(6) understanding the critical view of safety, including its doublet view and documentation;(7) awareness of various error traps(e.g., fundus first technique);(8) use of various bailout strategies(e.g., subtotal cholecystectomy) in difficult gallbladder cases;(9) use of intraoperative imaging techniques(e.g., intraoperative cholangiogram) to ascertain correct anatomy; and(10) understanding the concept of time-out.Surgeons should be facile with these aspects of this culture of safety in cholecystectomy in an attempt to reduce the incidence of biliary/vascular injury during LC.     

臂丛神经根支配功能的电生理研究

１５例患者行健侧颈７神经根移位术时，对其正常臂丛神经根进行了肌电生理检测（刺激各神经根，在上肢１２组肌肉内记录最大波幅值）。结果证实臂丛神经根的肌肉机能支配如下：颈５主要组成腋神经支配三角肌。颈６主要组成肌皮神经支配肱二头肌。两者共同支配肩肘的功能。支配的肌群有密切的相关性，只是支配肌群的次序有所不同。颈７主要组成桡神经支配肱三头肌。参与肩、肘、腕及手部功能的支配。颈８主要组成正中神经支配屈指肌群。胸１主要组成尺神经支配手内部肌。两者以共同支配手部的肌群为主。支配的肌群有密切的相关性，只是支配肌群的次序不同而已。作者认为颈７神经根的支配特殊性，为临床上行健侧颈７神经根移位提供了解剖学依据。也为今后开展其他颈神经根的移位，提供了解剖学依据。     

单侧成角度股骨转子间骨折外固定器的设计和临床应用

作者从１９９２年１１月～１９９５年５月利用自行研制的单侧成角度外固定器治疗股骨转子间骨折４５例，平均１８个月随访，效果良好。骨折临床愈合时间４０～５５天。全部病人无髋内翻及深部感染和死亡发生。同保守牵引及手术切开内固定治疗比较，本外固定器优点在于：（１）手术创伤小、时间短、固定可靠，患者可早期功能活动。（２）近端固定针之间呈一定角度，充分防止了固定针的松动脱出及穿入髋臼。（３）通过固定器及万向节调整，减小了骨折部位的内翻剪力，使生理应力增加，有利于骨折愈合。     

Pig-to-human xenotransplantation: The expression of Galα(l–3)Gal epitopes on pig islet cells

Abstract: Previous histological studies of porcine tissues using the Galα(l–3)Gal specific lectin, IB4-biotin, and an immunoperoxidase technique demonstrated the widespread distribution of Galα(l–3)Gal in pigs—particularly in the endothelium of all vessels and in the parenchyma of liver and kidney. An exception was the endocrine (islets) and exocrine tissue of the pig pancreas—adult islets did not express Galα(l–3)Gal and apart from ducts, and the exocrine pancreas was also nonreactive. Because of the potential use of islet xenotransplantation for the treatment of diabetes, a more extensive study was undertaken of fetal pancreas and of cultured islet cell clusters. Like the adult pancreas, islets from fetuses at term or earlier, essentially did not express Galα(l–3)Gal; however, during culture, under a variety of conditions, they became strongly reactive with IB4 and expressed large amounts of Galα(l–3)Gal. Staining for pancreatic hormones (insulin, glucagon, and somatostatin) demonstrated that true islets were being examined, although double staining for insulin and Galα(l,3)Gal indicated that cells secreting insulin were not Galα(l–3)Gal positive. The origin of the Galα(l–3)Gal⁺ cells is not apparent, nor is whether they are precursors of hormone secreting cells. It was of interest that, after transplantation to nude mice and allowing for maturation, the islets resembled the adult phenotype and were Galα(l–3)Gal negative. The implications of the findings are not clear but indicate that some cells in the cultured fetal islet (other than insulin secreting cells) could be the target of antibody mediated destruction.