胰岛素样生长因子Ⅰ原位注射抑制骨骼肌失神经萎缩

目的 :研究胰岛素样生长因子Ⅰ (IGF Ⅰ )原位注射抑制骨骼肌失神经萎缩的可行性 ,为失神经肌萎缩的预防及治疗提供新的手段。方法 :2 4只成年SD大鼠 ,随机分成 2组 ,切断胫神经建立失神经支配的动物模型 ,A组于失神经支配的骨骼肌内注射rhIGF Ⅰ ,用量为 2 5 0ng/kg·2d ,B组注射生理盐水作为对照。 4周后观察比较骨骼肌湿重、骨骼肌细胞横截面积和超微结构。结果 :4周后 ,A组骨骼肌湿重为 (5 0 9.4± 92 .3 )mg、骨骼肌细胞横截面积为 (73 1.0 2±110 .64 ) μm2 ;B组骨骼肌湿重为 (4 61.8± 48.1)mg、骨骼肌细胞横截面积为 (5 77.2 2± 60 .64 ) μm2 。B组骨骼肌萎缩程度明显大于A组。超微结构也提示局部注射rhIGF Ⅰ对失神经支配的骨骼肌细胞的超微结构具有保护作用。结论 :失神经骨骼肌内局部注射rhIGF Ⅰ ,对其萎缩有一定的抑制作用。     

失神经支配骨骼肌退变形态学及酶组织化学研究

神经损伤后，骨骼肌萎缩的防治一直是周围神经外科的一大难题，为进一步明确失神经支配不同时期肌肉的形态结构、生理生化以及它们之间的内在规律，我们对大鼠失神经支配腓肠肌的组织形态学及酶组织化学变化进行研究，现报道如下。 材料与方法 一、实验动物与模型：ＳＤ大鼠４２只，随机分成７组，每组６只。硫喷妥钠溶液腹腔内注射麻醉后，在放大１０倍手术显微镜下，结扎切断肢神经后，两断端返转１８０°固定。分别于术后２、４、６、８、１２、１６及２０周取右小腿腓肠肌作实验观察，另取６只大鼠腓肠肌测定正常值作为对照。 二、实验…     

不同部位骨骼肌失神经支配后超微结构变化的实验研究

目的：探讨长期失神经支配后萎缩骨骼肌神经修复手术疗效欠佳的机制。方法：12例臂丛神经损伤后1、2、3、6、12和18个月患者，术中切取小指展肌和肱二头肌的失神经骨骼肌，以相同部位的正常骨骼肌作对照，观察失神经骨骼肌超微结构和计数肌卫星细胞数量变化。结果：失神经支配后2个月，骨骼肌细胞的超微结构基本正常，肌纤维周围无明显增生的胶原纤维，可见到运动终板，肌卫星细胞数量多；6个月，肌丝断裂，排列紊乱现象明显增多，细胞核体积变小，染色加深，细胞核固缩，肌纤维周边出现较多的成纤维细胞和脂肪细胞以及增生的胶原纤维；12个月后，未见类似运动终板的结构，肌卫星细胞体积缩小，数量减少，小指展肌较肱二头肌中肌卫星细胞含量下降速度快。结论：失神经经支配晚期骨骼肌纤维中运动终板消失和胶原增生以及肌卫星细胞含量的迅速下降可能是影响疗效的主要因素之一。     

大鼠失神经支配骨骼肌及其运动终板退变观察

神经损伤后骨骼肌萎缩防治一直是周围神经外科的一大难题。我们对大鼠失神经支配腓肠肌及其运动终板变化进行了连续,系统观察,以期为临床寻找检测肌肉萎缩程度方法和选定神经修复手术最佳时机提供理论依据。材料与方法一、实验动物与模型：ＳＤ大鼠４２只,随机分成７组...     

bFGF植入失神经骨骼肌对肌卫星细胞增殖与肌萎缩影响的实验研究

目的探讨bFGF植入失神经腓肠肌后填补神经营养因子丢失、促进肌卫星细胞增殖、延缓肌萎缩的作用。方法将28只健康雄性Wistar大鼠随机分成实验组和对照组,每组14只。切断大鼠左下肢坐骨神经,制备失神经支配动物模型。实验组于同侧腓肠肌内植入盛有0.1gbFGF的硅胶管,对照组植入盛有生理盐水的硅胶管。术后14d和30d取材行大体观察,电生理检测纤颤电位波幅变化,腓肠肌湿重测量,组织学观察,图像分析仪检测及透射电镜观察。结果术后14d和30d对照组腓肠肌萎缩程度及与周围结缔组织粘连程度均较实验组明显加重。术后14、30d,实验组腓肠肌纤颤电位波幅为(0.2206±0.3010)μm,对照组为(0.1552±0.0503)μm;实验组肌湿重为(2.4757±0.2546)g,对照组为(1.4591±0.6425)g;两组比较差异均有统计学意义(P<0.05)。术后14、30d实验组HE染色示腓肠肌内肌卫星细胞核较对照组增多;Mallory三色染色示对照组蓝色结缔组织略多于实验组;PCNA染色示实验组呈阳性反应,棕黄色细胞核略多于对照组;维生素C银染示实验组肌纤维间维生素C浓度和结缔组织增生均低于对照组。透射电镜观察术后30d,对照组肌丝排列紊乱或模糊不清等萎缩改变的肌纤维及肌纤维间的胶原纤维多于实验组。术后30d,实验组肌纤维直径和截面积分别为(66.3686±12.6727)μm和(2096.1129±311.5639)μm2,对照组分别为(55.5040±4.9450)μm和(1418.0680±264.9537)μm2;实验组PCNA阳性肌细胞核数量为(116.200±5.357)个,对照组为(53.000±3.937)个;两组比较差异均有统计学意义(P<0.05)。结论bFGF具有促进失神经腓肠肌的肌卫星细胞增殖、延缓肌纤维萎缩和抑制肌纤维向结缔组织增生的作用。     

神经束植入联合甲钴胺治疗失神经骨骼肌的实验研究

目的研究神经束植入治疗失神经支配骨骼肌．并比较靶肌肉局部用药与全身性用药的疗效,探讨神经营养药物应用的最佳给药方法。方法选用雄性大鼠60只随机等分5组．每组12只,制作左侧胫神经切断动物模型。A组：神经束植入组;B纽：神经束植入＋左侧腓肠肌注射甲钴胺;C组：神经束植入＋腹腔注射甲钴胺;D组：胫神经切断：E组：胫神经切断＋左侧腓肠肌注射生理盐水。术后当日开始,B组隔日左侧腓肠肌注射甲钴胺300μg／kg;C组隔日腹腔注射甲钴胺300μg／kg;E组隔日左侧腓肠肌注射等渗盐水0．02ml。分别于术后4周和8周测量左小腿腓肠肌电生理、肌纤维横截面积和肌细胞TUNEL染色。结果术后4周及8周,A,B,C三组腓肠肌电位波幅组间比较差异均有显著性（P〈0．05）;D组与E组腓肠肌纤颤电位波幅差异无显著性（P〉0．05）。术后4周及术后8周,肌纤维横截面积和肌细胞TUNEL阳性细胞数A,B,C组间差异均有显著性（P〈0,05）,D,E组间差异无显著性（P〉0．05）,A,B,C组与D,E组差异有显著性（P〈0．05）。B组明显优于其他组。结论神经柬植入能有效防治失神经骨骼肌萎缩,靶肌肉给药效果优于全身用药。     

失神经骨骼肌萎缩机制的研究进展

目的对近年失神经骨骼肌萎缩机制的研究进展作一综述。方法广泛查阅近年有关失神经骨骼肌萎缩的国内外文献,并进行综述。结果失神经骨骼肌萎缩的机制非常复杂,目前主要从组织学、细胞学和分子学的改变来研究萎缩机制。失神经骨骼肌纤维变细,排列紊乱,并有凋亡小体出现。促凋亡相关基因表达上调,抑制凋亡相关基因下调。骨骼肌卫星细胞在失神经支配后增多,但不能分化为成熟肌纤维,以致最后减少甚至耗竭。失神经支配萎缩的骨骼肌细胞中线粒体结构改变和代谢相关酶基因下调导致肌细胞代谢紊乱。结论骨骼肌纤维组织学改变,肌卫星细胞数量及分化改变,线粒体结构改变,凋亡相关基因和代谢相关基因表达发生改变均参与了失神经骨骼肌萎缩的发生。     

低强度脉冲超声波对大鼠失神经骨骼肌萎缩的影响

[目的]探讨低强度脉冲超声波(LIPUS)对失神经骨骼肌萎缩的影响。[方法]50只健康雄性SD大鼠随机分为五组:假手术组、模型组、60 m W/cm2、110 m W/cm2、170 m W/cm2LIPUS治疗组(即A、B、C、D、E组),n=10。右股后外侧纵向切口暴露并切断坐骨神经造成失神经动物模型,A组不切断神经。术后1 d,C、D、E组术侧腓肠肌分别给予相应强度LIPUS治疗(A、B组不行任何治疗)。术后4周和8周,测定术侧腓肠肌湿重比和肌纤维直径、截面积,Western Blot检测Caspase-3、Caspase-8、Caspase-9表达,TUNEL法检测细胞凋亡,透射电镜观察腓肠肌超微结构。[结果]术侧腓肠肌湿重比和肌纤维直径、截面积,B组明显低于C、D、E组,差异有统计学意义(P0.05)。Caspase-3、Caspase-8、Caspase-9蛋白表达及细胞凋亡指数,C、D、E组明显低于B组(P0.05)。透射电镜显示,C、D、E组肌丝溶解、Z线断裂和线粒体肿胀、空泡化均轻于B组。[结论]LIPUS可延缓失神经骨骼肌萎缩进程,其机制可能与调控凋亡相关蛋白表达、减少细胞凋亡有关。     

失神经支配红白肌肉早期运动神经营养活性研究

目的了解失神经支配后红白肌肉内脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)早期含量变化及相应运动神经传导功能恢复情况,探讨靶器官对损伤运动神经再生修复的作用. 方法 Wistar大鼠40只,平均分为5组,其中1组为对照,其余4组剪断双下肢坐骨神经制作肌肉失神经支配模型,分别于神经损伤后1、3、7和14天采用免疫组织化学方法检测肌肉内BDNF含量.另取15只Wistar大鼠,钳夹双下肢坐骨神经制作失神经支配肌肉神经再生模型,于伤后7天和14天采用神经电生理方法测定神经传导速度及肌电图. 结果比目鱼肌(soleus,SOL)失神经支配后1、3和7天BDNF含量较对照组大幅度升高,差异有统计学意义(P＜0.01),但随时间推移呈下降趋势,14天BDNF含量与对照组接近(P＞0.05);腓肠肌(gastrocnemius,GAS)失神经支配后1、3、7和14天BDNF含量与对照组均接近(P＞0.05).失神经支配肌肉神经再生模型中,伤后7天失神经支配SOL和GAS均未测到动作电位;伤后14天支配GAS和SOL的运动神经传导速度分别恢复至正常值的(36.60±7.40)%和(42.50±3.50)%,二者差异无统计学意义(P＞0.05);GAS M波波幅恢复至正常值的(19.9±6.4)%,而SOL M波波幅恢复至正常值的(13.7±4.0)%,二者差异无统计学意义(P＞0.05). 结论失神经支配红、白肌肉内早期运动神经营养因子含量在不同时间内发生不同的变化,但支配两种靶器官的损伤运动神经功能恢复相近.失神经支配后靶器官的运动神经营养活性是其内部各种运动神经营养因子综合作用的结果.     

臂丛神经损伤后不同部位失神经骨骼肌萎缩后细胞凋亡的研究

目的 从臂丛神经损伤患者为对象,研究不同部位失神经骨骼肌的萎缩规律,并探讨细胞凋亡在失神经萎缩骨骼肌中的作用。方法 对５０例住院手术的臂丛神经损伤患者,术中切取不同部位的失神经骨骼肌８０块,按肌肉部位分为Ａ、Ｂ组,两组又各分为伤后１、２、３、４、～５、６～１１和１２～２４个月共６个时间组。Ａ组：手内在肌（小指展肌）３４块。Ｂ组：大肌肉（肱二头肌）４６块。每块肌肉分别作ＨＥ染色、Ｍａｓｓｏｎ染色和凋亡细胞核的免疫组化染色。结果 （１）随损伤时间的延长,肌细胞萎缩愈加明显。各时间组相比,Ａ、Ｂ组之间差异无显著性意义（Ｐ〉０．０５）。（２）失神经骨骼肌中染成绿色的胶原终结增多,早期增生并不明显,失神经支配１年以上肌肉中的胶原纤维增生更为显著。不同时间组间胶原纤维与骨骼肌细胞面积比的差异,有显著性意义（Ｐ〈０．０５）。     

失神经靶肌肉的弥散张量成像与病理对比研究

目的探讨磁共振弥散张量成像（DTI）在评价兔失神经靶肌肉退变及再生的价值。方法将36只新西兰大白兔右后肢制作失神经支配骨骼肌退变及再生模型,分别于术前、术后1d、3d、1周、2周、3周、4周、6周、8周各时间点对靶肌肉进行DTI及病理检查,每时间点4只,观察失神经侧与对侧正常组腓肠肌及比目鱼肌的FA、ADC值,λ∥,λ⊥值及病理学变化特点。结果 36只兔全部造模成功,术后第1天,失神经侧靶肌肉λ∥值、λ⊥值及FA值均开始下降,以λ∥值最显著,与术前比较有统计学差异（P〈0.05）,病理上靶肌肉肌纤维间质出现水肿;3d～4周,λ∥值、λ⊥值及FA值均逐渐下降,2周时FA值下降至最低值,而λ∥值、λ⊥值分别在4周时下降至最低值,而病理上有血管扩张、充血淤血、渗出、肌纤维灶性萎缩、肌肉间隙增宽的出现;6～8周,三者均逐渐升高、缓慢恢复,相对应病理改变逐渐减轻。经LSD法进行组间对比：λ∥值、λ⊥值及FA值与正常组有统计学差异的分别为1d～6周,1～6周及1～6周（P〈0.05）,而ADC在各组观察期与损伤前均无明显变化。结论失神经靶肌肉的弥散参数λ∥值、λ⊥值及FA值与其病理变化的趋势相一致,DTI能早期、敏感、准确评价失神经靶肌肉退变及再生的情况。     

Correlating magnetic resonance imaging with the biochemical content of the normal human intervertebral disc.

Magnetic resonance imaging was used to determine the T2 relaxation times of prepared proteoglycan solutions and of normal human intervertebral disc tissue from the annulus fibrosus (AF) and nucleus pulposus (NP). The collagen, proteoglycan, and water contents of the disc tissue samples were determined by biochemical assays after they were scanned. Correlations among 1/T2, collagen, proteoglycan, and water contents of the tissue samples and among 1/T2, water, and proteoglycan contents of the proteoglycan solutions were calculated. A moderate negative correlation between 1/T2 and water content was noted for the tissue samples, and a very high negative correlation was found between 1/T2 and water content for the proteoglycan solutions. The very high positive correlation between 1/T2 and proteoglycan content of the proteoglycan solutions is probably due to this negative correlation between 1/T2 and water content. There was no significant correlation between 1/T2 and proteoglycan content of the tissues. The moderate positive correlation between 1/T2 and collagen content is probably due to the high negative correlation between collagen content and water content. No significant correlation was found between the collagen and proteoglycan contents of the tissues. Thus it appears that the data confirm previous reports in the literature that the collagen of the disc tissue functions to control its water content.     

Magnetic resonance imaging of osteoarthritis: correlation with gross pathology using an experimental model

Conventional radiography has several limitations in the study of osteoarthritis (OA): changes occur late, they are restricted to bone, and they do not correlate well with the patient's symptoms. Magnetic resonance imaging (MRI) can visualize with great detail the soft tissue changes in and around joints. We have obtained MR images of knees using an experimental model of OA in order to study the early changes of OA, to correlate the images with the gross pathology, and to compare MR images with radiographs. The changes on MRI correlated with the gross pathological changes as assessed by Kendall's rank correlation test as follows: meniscal changes, tau = 0.58 (p less than 0.01); osteophytes, tau = 0.59 (p less than 0.05); capsular fibrosis, tau = 0.55 (p less than 0.05); and overall, tau = 0.68 (p less than 0.001). Abnormalities were evident on MRI as early as 4 weeks after the onset of the disease, which is 8 weeks before they appear on radiographs. Thus, MRI can show changes in OA earlier than radiography can, and the images correlate with the gross pathology.     

Magnetic resonance imaging measurement of the anorectal striated muscle complex in normal children

Purpose

The aim of the study was to describe and establish a normal measurement of the striated muscle complex (SMC) in healthy children using body phased-array or head coil magnetic resonance imaging.

Methods

Imaging was performed in 20 boys and 20 girls (age range, from 3 months to 14 years; average age, 3.2 years) without anorectal disorders. The dimensions of the puborectalis muscle (PR) and external anal sphincter (EAS) were measured in different planes.

Results

There was a close positive correlation between absolute width and length of SMC and age (P < .05), whereas there was no correlation between the relative width and length of SMC and age (P > .05). Normal relative length of the PR and EAS were measured as 0.47 ± 0.04 and 0.41 ± 0.04, respectively, and the normal relative width of PR and posterior EAS were 0.50 ± 0.04 and 0.44 ± 0.04 in children younger than 14 years.

Conclusions

The width and length of PR and EAS increase progressively with age. The relative width and length of PR and EAS were not variable with age. A relative width and length of PR and EAS were chosen as objective criteria for normal SMC in children younger than 14 years.     

Magnetic resonance imaging in acute pyelonephritis

The diagnosis of acute pyelonephritis in children remains a clinical challenge. We assessed the feasibility of magnetic resonance imaging (MRI) detection of pyelonephritis in four pediatric patients and compared the results with renal cortical scintigraphy. MRI revealed areas of high signal intensity in the kidney that coincided with photon-deficient regions in the radionuclide scans in two children with acute pyelonephritis. These findings confirm work in experimental animals and indicate that MRI can accurately detect acute pyelonephritis in children. Received December 29, 1997; accepted February 18, 1998     

Magnetic resonance imaging in female stress incontinence

A new technique is described for determination of the anatomy of the urethrovesical junction using magnetic resonance imaging. Using this technique it is possible to precisely define the anatomical relationships of the urethra and bladder base within the pelvis. It is non-invasive and non-ionizing. This report demonstrates its usefulness in Urogynecology.     

Magnetic resonance imaging (MRI) and arthroscopy in the detection of meniscal degenerations: Correlation of arthroscopy and MRI with histology findings

In a prospective double-blind study, the capability of magnetic resonance imaging (MRI) and arthroscopy in the detection and grading of meniscal degenerations is evaluated by correlating MRI findings and arthroscopic diagnoses with a histologic grading model. In 82.8% of our results, grading based on MRI studies corresponded with the histologic grading classification. In 12 instances a meniscal degeneration verified at light microscopy was not detected at MRI, whereas in 15 cases tomography yielded a false-positive result. The overall accuracy was calculated to be 0.93 with a specificity of 0.79 and a sensitivity of 0.96. Concerning the evaluation of meniscal degenerations, MRI provides a positive predictive value of 0.95 and a negative predictive value of 0.82. Compared with the diagnostic specificity of the anterior and posterior zones, that of the intermediate segment of the meniscus is significantly reduced (p < 0.001). At arthroscopy, meniscal degenerations were diagnosed with an overall accuracy of 38.8%, a sensitivity of 27.5%, and a specificity of 75.5%. In 80 cases of grade 3 abnormalities, five false-negative diagnoses were made initially. These results suggest that MRI offers a valuable diagnostic potential providing reliable information about the internal consistency of the meniscus complementary to diagnostic arthroscopy.     

肝门部胆管癌的MRI诊断

肝门部胆管癌是指原发于胆囊管开口与左右二级肝管起始部之间的胆管癌,亦称Klatskin瘤.肝脏MRI及MRCP检查是目前重要的影像学诊断方法.本文回顾性分析2010年10月至2012年10月第二军医大学附属长海医院收治的42例和第二军医大学附属东方肝胆外科医院收治的18例同时进行过MRI及MRCP检查的肝门部胆管癌患者的临床资料,将胆管癌按其大体病理特点基本可分为管壁浸润型、肿块型及腔内生长型3个类型,根据其术前影像学表现和术中及术后病理检查结果按Bismuth-Corlette进行术前和术后分型.术前术后分型一致者35例,分型诊断符合率为89.7％ (35/39).同时术中及术后发现肝实质受侵犯19例(术前MRI检查发现16例),灵敏度为84.2％;血管受侵犯10例(术前MRI检查发现12例),灵敏度为83.3％;肝门部、腹膜后淋巴结转移6例(术前MRI检查发现4例),灵敏度为66.7％.MRI多技术多序列的联合应用,有利于肝门部胆管癌的诊断及鉴别诊断,对肿瘤的分期及治疗方案的制订具有重要的价值.     

Magnetic resonance imaging and management of a pineal region dermoid

We report the case of a 19-year-old man harboring a pineal region dermoid, of which only eight other cases have been reported. A diagnosis was made with magnetic resonance imaging (MRI), which showed a marked high signal intensity on both T-1 and T-2 weighted images that is consistent with the lipid character of the lesion. Residual tumor could be seen on postoperative MR images. MRI is an accurate, noninvasive modality for the diagnosis and follow-up evaluation of these tumors.     

肛周脓肿的磁共振成像研究

目的探讨磁共振成像（MRI）对肛周脓肿的诊断价值。方法回顾性分析2007年7月至2009年3月间复旦大学附属金山医院收治的50例肛周脓肿患者的临床和MRI影像学资料。按以下步骤进行MRI检查：横断面T1WI,横断面、冠状面和（或）矢状面T2WI抑脂序列平扫,横断面、冠状面和（或）矢状面增强扫描。分析脓肿的部位、大小、形态、信号和增强特征。结果50例患者通过MRI共检出51个脓肿病灶．脓肿在T1WI表现为等或略低信号,T2WI抑脂脓腔呈明显高信号。增强见脓肿壁明显强化。脓肿最大径（3．4±1．7）cm,脓腔最大径（2．7±1．7）cm。脓肿呈类圆形26个,长圆形18个,新月形7个：脓腔单房41个,多房10个。脓肿位于肛提肌下方、括约肌间沟上方23例．位于括约肌间沟下方3例．跨肛提肌及括约肌间沟1例,跨肛提肌7例,跨括约肌间沟16例,肛提肌上方1例。结论MRI能无创、方便、准确地诊断肛周脓肿,清晰显示脓肿与肛管结构的解剖关系。