间隙连接蛋白37在腰椎椎间盘突出症炎性反应中的意义

目的探索间隙连接蛋白37(CX37)在腰椎椎间盘突出症炎性反应中的意义。方法观察10例腰椎椎间盘突出症患者(观察组)及8例腰椎爆裂骨折患者(椎间盘部分损坏无明显退变,对照组)CT与MRI表现差异,采用Pfirrmann分级评估椎间盘退行性变程度。利用PCR方法检测患者椎间盘组织中CX37、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的表达,并分析CX37与IL-6、TNF-α表达的相关性。结果对照组影像学资料主要表现为不同程度的椎间盘损伤,观察组主要表现为椎间盘突出、髓核脱垂、髓核突出。对照组Pfirrmann分级Ⅰ级6例,Ⅱ级2例;观察组Ⅲ级3例,Ⅳ级3例,Ⅴ级4例。PCR结果显示观察组CX37、IL-6和TNF-α的m RNA表达水平均高于对照组,差异有统计学意义(P 0.05)。Pearson相关性分析显示,炎症因子IL-6,TNF-α的表达与CX37均呈正相关。结论腰椎椎间盘突出症患者髓核中CX37表达显著高于无椎间盘退行性变病例,且与炎症因子IL-6,TNF-α的表达均呈正相关,CX37可能通过调控炎症因子的表达参与椎间盘突出症的发生、发展。     

FasL在家兔退变髓核组织中的表达及其与白细胞介素-6和肿瘤坏死因子-α的相关性

目的 观察生理解剖学屏障与FasL的分子生物学效应之间的关系,探讨椎间盘退变的发病机制.方法 采用18规格的皮肤穿刺针穿刺家兔纤维环,在术后的3、6、10周收集正常及穿刺后的椎间盘组织,免疫组织化学染色观察FasL及白细胞介素(IL)-6和肿瘤坏死因子(TNF)-α等炎性因子的表达.结果 正常髓核组织中可见少许髓核细胞质中FasL呈弱阳性染色(8.7%),实验组髓核细胞质则呈强阳性染色(41.6%、48.8%、46.4%).FasL阳性细胞百分比在正常组与各实验组之间的两两比较,差异有统计学意义(P<0.01).实验组髓核细胞FasL阳性表达百分比与IL-6及TNF-α阳性表达百分比之间显著相关(r=0.424,P<0.05及r=0.527,P<0.01).结论 FasL与理解剖学屏障的共同作用,可能是使髓核组织产生免免效应的重要因素.当生理解剖学屏障受到损伤后(如穿刺纤维环),FasL、IL-6及TNF-α的表达程度增强,FasL所介导的免疫炎性反应是引起椎间盘退变的重要机制之一.     

脂肪细胞因子resistin诱导胰腺腺泡细胞促炎因子表达的研究

目的:探讨脂肪细胞因子resistin诱导胰腺腺泡细胞促炎因子表达的作用。方法:大鼠胰腺腺泡AR42J细胞中分别加入不同终浓度的resistin蛋白(1、10、100μg/L)作用24 h。碘比色法测定培养液上清淀粉酶含量,酶联免疫吸附分析法检测培养液上清TNF-α与IL-6含量,实时定量PCR方法检测细胞TNF-α与IL-6 mRNA表达,Western印迹法检测细胞核NF-κB P65蛋白。结果:细胞培养液上清淀粉酶含量随resistin浓度升高而逐步上升,与对照组比较有统计学意义(P<0.01;IL-6:(8.4±1.0)比(1.1±0.4),P<0.01)。结论:resistin可通过NF-κB途径诱导胰腺腺泡细胞促炎因子TNF-α与IL-6表达增加。     

椎间盘退变炎症因子表达水平与椎间盘退变程度相关性分析

目的探讨白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)以及神经生长因子(NGF)的表达水平与椎间盘退变程度相关性。方法采用酶联免疫吸附法测定154例腰椎病患的IVD样本中TNF-α,IL-6和NGF表达水平,评估椎间盘退变程度与IL-6、TNF-α、NGF表达水平的相关性。比较腰痛患者与腿痛患者IL-6、TNF-α、NGF表达水平。结果相关性分析结果显示,TNF-α表达水平与椎间盘变性程度呈正相关(r=0.411,P 0.05),IL-6水平与椎间盘变性程度呈正相关(r=0.392,P 0.05),NGF表达水平与椎间盘变性程度呈负相关(r=-0.164,P 0.05)。腰痛患者的TNF-α表达水平明显高于腿痛患者(P 0.05),但两者IL-6和NGF表达水平比较差异无统计学意义(P0.05)。结论 TNF-α、IL-6和NGF表达水平与椎间盘退变程度密切相关。腰痛患者的TNF-α表达水平较腿痛患者高,可能与腰痛症状的发生和进展有一定关系。     

炎性因子IL-1β、TNF-α与椎间盘退变关系的研究进展

IL-1β与TNF-α炎性因子作为椎间盘退变过程中的重要参与者日益受到国内外学者的关注。在椎间盘退变并最终导致下腰痛及神经根性症状全过程中,炎性因子从中起到重要的作用。在机械创伤、过度负荷、基因易感及感染等因素的作用下,纤维环及髓核细胞合成TNF-α、IL-1β。这些炎性因子在椎间盘退变过程中的作用大致可分为3个阶段。目前关于炎性因子在椎间盘退变病理生理过程中确切的调控机制仍需进一步研究,重点将在于阐述炎性因子在椎间盘退变中的调控机制、椎间盘退变的分子靶向治疗、细胞信号通路干预及寻找抗炎治疗的最佳时机上,为其将来的临床应用提供依据。     

前炎症因子在脊髓型颈椎病发病早期的表达

目的探讨前炎症因子在脊髓型颈椎病发病的早期变化,探讨前炎症因子与颈椎间盘早期退变的关系。方法收集从2004年5月~2005年1月之间我科收治的20例发病时间<1个月的早期脊髓型颈椎病患者术中取出的32个部分椎间盘髓核组织,与同时期取自死亡时间<24h的新鲜尸体中15个颈部椎间盘组织,分别作为实验组和对照组。采用免疫组化的方法检测其中TNF-α、IL-1β、IL-6的表达阳性例数,采用小鼠抗人TNF-α、IL-1β、IL-6单克隆抗体来检测早期脊髓型颈椎病患者椎间盘组织中的前炎症因子的含量。结果实验组32个颈部突出椎间盘组织中,TNF-α、IL-1β、IL-6表达阳性分别为27例、21例、18例,其中12例为4种细胞因子均表达阳性。对照组15个正常椎间盘组织中表达的阳性细胞较少。应用SPSS11.5统计学软件对实验数据进行统计学分析结果有差异性(P<0.05)。结论突出的颈椎间盘可产生TNF-α、IL-1β、IL-6,阳性细胞主要以成纤维细胞、软骨细胞及淋巴细胞为主,这些细胞因子可能在颈椎椎间盘早期退变中发挥作用。     

大鼠正常与退变性髓核突出导致神经根性疼痛的对比研究

目的探讨正常与退变髓核突出对大鼠疼痛阈值以及背根神经节中TNF-α表达的影响,研究椎间盘退变与神经根性疼痛之间的关系。方法72只大鼠随机分为4组:正常对照组(n=18)、假手术组(n=19)、正常髓核(N-NP)组(n=16)和退变髓核(P-NP)组(n=19)。对P-NP组大鼠利用尾椎椎间盘纤维环穿刺的方法建立椎间盘退变模型。分别取出N-NP组和P-NP组大鼠自体的正常髓核与退变髓核组织,置于手术显露后的腰5左侧神经根处,建立髓核突出致神经根性疼痛动物模型。采用行为学测试的方法分别观察各组大鼠术前1天,术后1、4、7、10、14、21天机械刺激阈值与热刺激阈值的变化;采用免疫组化方法分别检测术后第4、14天各组大鼠背根神经节中TNF-α的表达。结果行尾椎间盘纤维环穿刺后2周,组织学与MRI检查均证实椎间盘组织发生明显退变。对照组和假手术组动物未出现明显的痛觉过敏现象,N-NP组和P-NP组大鼠机械性刺激阈值均显著下降,该痛觉过敏现象持续至术后2周消失;与正常髓核组织相比,退变髓核所致机械性刺激阈值下降程度更为严重。各实验组均未发生热刺激阈值的规律性变化。术后第4、14天对照组和假手术组背根神经节中未见TNF-α明显表达,而正常及退变髓核组TNF-α表达量均显著升高。结论大鼠尾椎纤维环穿刺是建立大鼠椎间盘退变模型的一种有效方法。与正常髓核组织相比,发生退变的髓核组织可导致神经根性疼痛的加重,提示椎间盘退变过程中释放的炎症因子在疼痛的发生机制中可能起到了重要作用。     

外源性肿瘤坏死因子-α诱发兔椎间盘退变中β-catenin蛋白的表达及意义

目的 通过外源性肿瘤坏死因子(TNF)-α注射构建兔椎间盘退变动物模型,探讨该模型中β-catenin蛋白的表达及意义和炎性细胞因子在促进腰椎间盘退变过程中Wnt/β-catenin信号通路的作用.方法 选取12只健康成年日本白兔,雌雄随机,体质量2.5～3.0kg.手术暴露L2～5 3个间隙共36个椎间盘.随机分为4组,分别注入生理盐水、TNF-α 5 ng、TNF-α 10ng、TNF-α 20 ng,于术后第8周统一处死,取椎间盘髓核组织作苏木素-伊红(HE)-番红O染色病理切片进行形态学观察;各组分别随机选取4个椎间盘髓核组织标本,采用蛋白印迹法(Western blot)测定β-catenin蛋白含量并比较各组间差异.结果 HE-番红O染色病理切片显示,在5、10、20 ng组椎间盘组织中髓核细胞数量减少,正常网状结构破坏,细胞形态发生改变,出现肥大空泡样软骨细胞,组织基质蛋白聚糖含量明显降低,番红O淡染,生理盐水对照组椎间盘形态基本正常,无退变发生.蛋白印迹结果显示β-catenin蛋白含量在注射TNF-α组明显增加,各组吸光度比值分别为:0.142±0.036、0.351±0.041、0.472±0.052和0.710±0.063,组间差异有统计学意义(P＜0.05)且与TNF-α浓度相关.结论 通过外源性TNF-α盘内注射能够成功构建兔椎间盘退变动物模型,且退变程度与TNF-α呈浓度依赖性;在退变模型髓核组织中β-catenin蛋白含量增高且与TNF-α浓度正相关,提示炎症细胞因子触发了Wnt/β-catenin信号通路,在椎间盘退变过程中可能发挥了重要作用.     

肾综合征出血热患者多种免疫促炎因子及抗炎因子变化及其作用

目的探讨肾综合征出血热（HFRS）患者急性期（包括发热期、低血压休克期、少尿期）与恢复期促炎因子和抗炎因子的变化及其作用。 方法检测2016年4月至2017年6月哈尔滨医科大学第四附属医院和黑龙江省农垦红兴隆管理局中心医院收治的30例确诊为HFRS急性期和恢复期患者血清中肿瘤坏死因子-α（TNF-α）、干扰素-γ（IFN-γ）、白细胞介素-6（IL-6）和抗炎因子转化生长因子-β1（TGF-β1）、白细胞介素-10（IL-10）的水平,同期检测患者的胱抑素C（Cys-C）、肌酐（Cr）、乳酸脱氢酶（LDH）以及部分凝血活酶时间（APTT）等指标。另选同期13名健康志愿者作对照组,检测TNF-α、IFN-γ、IL-6、TGF-β1和IL-10水平。应用SAS 9.3国际标准统计学编程软件对结果进行分析。 结果HFRS患者急性期IFN-γ（χ²= 4.273、P= 0.0336）、TNF-α（χ²= 16.3562、P < 0.0001）、IL-6（χ²= 9.752、P = 0.0018）和IL-10（χ²= 6.3352、P= 0.0118）水平均显著高于对照组,差异均有统计学意义。HFRS患者急性期TGF-β1水平显著低于对照组,差异有统计学意义（χ²= 7.822、P= 0.0056）。HFRS患者恢复期TGF-β1水平与对照组接近或略低,差异无统计学意义（χ²= 3.000、P = 0.0833）。HFRS患者发病不同时期Cys-C、Cr、LDH和APTT等指标均于急性期升高,于恢复期下降,与IFN-γ、TNF-α、IL-6和IL-10变化趋势一致。 结论HFRS急性期时IFN-γ、TNF-α和IL-6等促炎因子分泌增加,主要因CD4⁺CD25⁺FoxP3 Treg细胞（调节性T细胞）产生的抗炎因子TGF-β1分泌不足,细胞因子失衡是导致机体免疫病理损伤的重要机制。     

炎性因子与椎间盘退变

椎间盘退行性变是腰腿痛的重要原因之一,其特征性改变是髓核中蛋白多糖特别是聚合体含量下降、胶原类型的改变及伴随的水分的丢失。目前,椎间盘退变的原因尚不完全清楚,白介素(IL)、肿瘤坏死因子-α(TNF -α)等炎性细胞因子(简称炎性因子)具有促进椎间盘蛋白多糖降解和抑制其合成,参与椎间盘炎症反应等作用,极可能在椎间盘退变及其继发性疾病发病机制中起重要的作用。1　椎间盘中的炎性因子及其来源和影响因素体内检测到的众多炎性因子中,IL - 1、IL - 6、IL - 8、IL - 10、TNF -α、干扰素-γ(IFN -γ)及集落刺激因子(GM -CSF)等…     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。