颈椎前路椎间盘切除融合术后颈椎矢状位参数变化及其对临床疗效的影响

目的 探讨颈椎间盘突出症病人行颈椎前路椎间盘切除融合术（anterior cervical discectomy and fusion, ACDF）后颈椎矢状位参数变化及其对临床疗效的影响。方法 选取2014年1月至2016年1月在我院接受ACDF手术治疗的颈椎间盘突出症病人98例,对其临床资料进行回顾性分析。其中,男50例,女48例;年龄为（54.75±8.60）岁（40~78岁）。收集比较98例病人术前及随访时的C_2~7 Cobb角、T₁倾斜角、C_2~7矢状面轴向距离（cSVA）、颈倾角（NTA）、胸廓入口角（TIA）等矢状位参数,以及其手术前后的颈肩臂疼痛视觉模拟量表（visual analogue scale, VAS）评分、日本骨科学会（Japanese Orthopaedic Association, JOA）评估治疗分数、颈椎功能障碍指数（neck disability index, NDI）。98例病人根据T₁倾斜角是否大于30°分为高T₁倾斜角组和低T₁倾斜角组,比较两组病人的JOA评分改善率及后凸畸形发生率。结果 本研究所观察的矢状位参数中,术后T₁倾斜角、C_2~7 Cobb角较术前显著增大,NTA、cSVA较术前显著减小;功能相关指标中,VAS评分较术前显著下降,JOA评分显著上升,与术前比较,差异均有统计学意义（P均＜0.05）。高T₁倾斜角组和低T₁倾斜角组的JOA治疗改善率（56.06% vs. 53.12%）及后凸畸形发生率（12.50% vs. 16.67%）比较,差异均有统计学意义（χ²=12.538,P=0.001;χ²=10.895,P=0.003）。且高T₁倾斜角组病人中,单节段、双节段、多节段病人的后凸畸形发生率均显著低于低T1倾斜角组,差异均有统计学意义（P均＜0.05）。结论 ACDF治疗颈椎间盘突出症的短期临床疗效确切,T₁倾斜角＞30°病人的JOA治疗改善率较高,后凸畸形发生率较低。     

同种异体骨与聚醚醚酮椎间融合器应用于颈椎病的荟萃分析

目的 分析并比较同种异体骨与聚醚醚酮（PEEK）椎间融合器应用于颈椎前路椎间盘切除融合术（ACDF）治疗颈椎病的疗效与安全性。方法 通过PubMed、Cochrane Library、Web of Science、Medline、EMBASE、中国知网、万方数据和维普网数据库检索同种异体骨与PEEK椎间融合器应用于ACDF治疗颈椎病的相关文献,检索时间范围为建库至2021年7月1日。提取患者术后颈椎功能障碍指数（NDI）、疼痛视觉模拟量表（VAS）评分、颈椎曲度变化、融合率、置入物沉降率、假关节形成率、再手术率等资料,采用RevMan 5.3软件对研究结果进行荟萃分析。结果 共纳入8篇文献,包含6 950例患者,其中4 569例应用同种异体骨（同种异体骨组）,2 381例应用PEEK椎间融合器（PEEK组）。2组患者术后颈椎曲度、NDI和VAS评分差异均无统计学意义（P>0.05）;同种异体骨组融合率高于PEEK组[比值比（OR）=3.12,95%置信区间（CI）1.19 ~ 8.15,P<0.05],假关节形成率低于PEEK组（OR=0.25,95%CI 0.09 ~ 0.69,P<0.05）,再手术率低于PEEK组（OR=0.25,95%CI 0.12 ~ 0.52,P<0.05）,融合器沉降率与PEEK组相比差异无统计学意义（OR=0.71,95%CI 0.37 ~ 1.36,P>0.05）。结论 ACDF治疗颈椎病,应用同种异体骨和PEEK融合器临床疗效相当,融合器沉降率无明显差异;但应用同种异体骨具有较高的融合率、较低的假关节形成率和较低的再手术率。     

神经根型颈椎病患者术前颈椎矢状面参数对术后神经功能改善的影响

目的探讨神经根型颈椎病(CSR)患者术前颈椎矢状面参数对颈椎前路椎间盘切除融合术(ACDF)术后神经功能改善的影响。方法回顾性分析2016年1月-2020年1月接受ACDF治疗且随访时间 ≥ 6个月的171例单节段CSR患者资料。测量患者术前矢状面参数及责任节段椎间孔宽度,其中矢状面参数包括C_2~7 Cobb角、C_1~7矢状面轴向距离(SVA)、C_2~7 SVA、T₁倾斜角(T₁S)。采用颈椎功能障碍指数(NDI)评估患者术前及术后6个月的神经功能。根据患者术后6个月NDI将其分为症状缓解组(NDI < 15分,n=138)和症状缓解不良组(NDI ≥ 15分,n=33),比较2组术前颈椎矢状面参数、术前症状持续时间及椎间孔宽度的差异,利用多因素logistic回归模型分析术后神经症状缓解不良的危险因素。结果 2组术前C_2~7 Cobb角、C_1~7 SVA、C_2~7 SVA差异无统计学意义(P > 0.05);症状缓解不良组术前T₁S高于症状缓解组,椎间孔宽度低于症状缓解组,症状持续时间长于症状缓解组,差异均有统计学意义(P < 0.05)。多因素logistic回归分析结果显示,术前T₁S较高、椎间孔宽度过小及症状持续时间较长是术后6个月神经症状缓解不良的危险因素。结论对于单节段CSR患者,术后神经功能改善不良与术前T₁S较高、椎间孔宽度较小及症状持续时间较长有关。     

Hybrid手术与单纯颈椎前路椎间盘切除融合术治疗颈椎退行性疾病的疗效比较

目的 对比Hybrid手术［颈椎人工椎间盘置换术（CTDR）联合颈椎前路椎间盘切除融合术（ACDF）］与单纯ACDF治疗颈椎退行性疾病的临床疗效。方法 回顾性分析2010年8月—2019年8月收治的48例双节段及三节段颈椎退行性病变患者临床资料,其中采用Hybrid手术治疗8例（Hybrid组）,采用ACDF治疗40例（ACDF组）。应用倾向性评分匹配法（PSM）对Hybrid组和ACDF组患者进行匹配,共8对匹配成功。分别采用t检验、χ²检验及重复测量方差分析比较2组患者基本资料、手术前后颈椎功能障碍指数（NDI）、日本骨科学会（JOA）评分、疼痛视觉模拟量表（VAS）评分及C_2~7活动度（ROM）的变化。结果 匹配后2组术前NDI、JOA评分、VAS评分、C_2~7 ROM差异均无统计学意义（P > 0.05）。2组手术时间、术中出血量、住院时间差异均无统计学意义（P > 0.05）。2组患者术后NDI、JOA评分、VAS评分均较术前明显改善,差异有统计学意义（P < 0.05）;且Hybrid组NDI改善优于ACDF组,差异有统计学意义（P < 0.05）。2组患者术后C_2~7 ROM均较术前下降,差异有统计学意义（P < 0.05）;C_2~7 ROM随访中逐渐增加,且Hybrid组在各随访时间点均优于ACDF组,差异有统计学意义（P < 0.05）。结论 Hybrid手术与ACDF治疗颈椎退行性疾病具有相同的临床效果,Hybrid手术在改善颈部功能和保留颈椎ROM方面优于ACDF。     

C7倾斜角与脊柱整体矢状面平衡的相关性

目的 探讨腰背痛患者C₇倾斜角（C₇S）与脊柱矢状面参数、脊柱矢状面平衡状态之间的关系。方法 对215例腰背痛患者进行回顾性研究,在术前、术后脊柱全长X线片上测量脊柱矢状面参数,并引入颈胸组合参数“颈椎前凸角（CL）/C₇S”。根据患者术前矢状面平衡状态（矢状面轴向距离,SVA）和胸椎代偿能力（胸椎后凸角,TK）将患者分为3类。类型A,脊柱矢状面平衡（SVA≤5 cm）;类型B,脊柱矢状面失平衡,胸椎具有代偿能力（SVA > 5 cm,TK≤40°）;类型C,脊柱矢状面失平衡,胸椎失代偿（SVA > 5 cm,TK > 40°）。分析C₇S与脊柱矢状面参数之间的相关性,比较3类患者脊柱矢状面参数的差异。结果 C₇S与T₁倾斜角（T₁S）、TK、CL、颈椎SVA（cSVA）、SVA及患者年龄之间均存在相关性（r = 0.305 ~ 0.802,P<0.05）。C₇S的变化与TK的变化有关（r = 0.494,P<0.05）,与SVA及CL的变化均无关。相比于类型A,类型B患者的SVA、CL和CL/C₇S 更大,TK更小,差异均有统计学意义（P<0.05）,cSVA、C₇S差异无统计学意义（P>0.05）;相比于类型A,类型C患者的cSVA、SVA、CL、TK、C₇S和CL/C₇S更大,差异均有统计学意义（P<0.05）;相比于类型B,类型C患者的cSVA、C₇S、CL和TK更大,差异均有统计学意义（P<0.05）,但CL/C₇S和SVA差异无统计学意义（P>0.05）。CL/C₇S评价脊柱矢状面平衡的临界值为0.618。结论 C₇S与脊柱矢状面参数之间存在较好相关性。当CL/C₇S > 0.618时,脊柱更多处于失平衡状态。     

不同术式对多节段脊髓型颈椎病患者颈椎矢状位形态的矫形效果

目的 通过对比颈椎前路椎间盘切除融合术（ACDF）、椎板切除融合术（LCF）和椎板成形术（LP）后颈椎矢状位形态改变情况,比较三者对多节段脊髓型颈椎病（MCSM）患者颈椎矢状位的矫形效果及对矫形效果的维持能力。方法 2016年1月—2019年12月,首都医科大学宣武医院收治MCSM患者188例,其中47例采用ACDF治疗（ACDF组）、72例采用LCF治疗（LCF组）,69例采用LP治疗（LP组）。根据术前颈椎前凸角（CL,C_2-7 Cobb角）将患者分为后凸型（CL < 0°）、平直型（0°≤CL < 10°）、前凸型（10°≤CL < 20°）和过度前凸型（CL≥20°）。根据术前和术后CL计算不同术式的前凸改变量（末次随访CL-术前CL）、前凸矫正量（术后1周CL-术前CL）和前凸丢失量（术后1周CL-末次随访CL）。采用日本骨科学会（JOA）评分和颈椎功能障碍指数（NDI）评估临床疗效。结果 3组临床疗效差异无统计学意义。ACDF组前凸改变量、前凸矫正量大于LCF组和LP组,差异均有统计学意义（P < 0.05）。ACDF可增加后凸型、平直型和前凸型患者的CL,随访中虽有部分丢失,但至末次随访时矫形效果维持良好;过度前凸型患者术后CL轻微增加,但随访时逐渐减小,过度前凸缓解。LCF可增加后凸型、平直型患者的CL,随访中前凸丢失量少于ACDF,但末次随访时矫形效果仍不如ACDF。LP术后各型患者CL均降低,但随访过程中前凸丢失量小于ACDF和LCF。结论 ACDF矫形能力较强,可用于治疗各种颈椎曲度类型MCSM患者,LCF适用于后凸型、平直型MCSM患者,LP可用于治疗CL > 10°的MCSM患者。MCSM手术方式的选择除常规考虑脊髓压迫位置、手术节段等,还应考虑患者颈椎矢状位形态特点。     

颈椎前路减压融合术联合钩椎关节部分切除在神经根型颈椎病治疗中的应用

目的 评价颈椎前路减压融合术（anterior cervical decompression and fusion, ACDF）联合钩椎关节部分切除术治疗神经根型颈椎病的临床疗效。方法 回顾性分析2013年9月至2017年7月我科收治并进行手术的神经根型颈椎病病人76例,平均年龄为47.2岁;其中男43例,女33例。行ACDF联合钩椎关节部分切除者49例,纳入联合组;行单纯ACDF手术者27例,纳入单纯ACDF组。对其手术时间、术中出血量及手术前后C₂~C₇ Cobb角、颈部及上肢疼痛视觉模拟量表（visual analogue scale, VAS）评分、颈椎功能障碍指数（neck disability index, NDI）、植骨融合情况等进行统计分析,评价并比较两种手术方式的疗效。结果 随访时间为12~24个月,平均18个月。联合组1例病人出现C5神经根麻痹,余均无明显的神经功能损害等严重并发症;1例术后伤口内血肿,予以再次手术清除血肿。联合组手术时间为（123.74±10.19） min,术中出血量为（343.93±72.29） ml;单纯ACDF组手术时间为（108.00±10.50） min,术中出血量为（299.40±49.31） ml。所有病人术后Cobb角较术前明显增大,末次随访时Cobb角未见明显丢失;所有病人术后、末次随访时的VAS评分、NDI均较术前明显改善;两组间术前、术后及末次随访时的VAS评分比较,差异均无统计学意义（P均＞0.05）,但联合组术后的VAS评分优于单纯ACDF组;而联合组术后NDI较单纯ACDF组改善更显著,差异有统计学意义（P＜0.001）。所有病人末次随访时均植骨融合。结论 ACDF联合钩椎关节部分切除术治疗伴有钩椎关节增生、神经根管狭窄的神经根型颈椎病,与单纯ACDF相比,可以更快地缓解病人疼痛,提高病人生活质量,是一种安全、有效的治疗方法。     

零切迹融合器在颈前路椎间盘切除融合术治疗多节段脊髓型颈椎病中的应用价值

【摘要】 目的：探讨零切迹融合器（Zero-P VA）在颈前路椎间盘切除融合（anterior cervical discectomy and fusion,ACDF）术治疗多节段脊髓型颈椎病（multilevel cervical spondylotic myelopathy,MCSM）中的应用价值。方法：回顾性分析2018年8月～2020年8月期间在我科行ACDF治疗的55例MCSM患者的临床资料,其中应用Zero-P VA治疗27例（Zero-P组）,应用传统融合器＋钛板固定治疗28例（钛板组）。观察两组患者的手术时间、术中出血量、融合节段椎间高度和颈椎Cobb角。采用颈部疼痛视觉模拟评分（VAS）、颈椎功能障碍指数（neck disability index,NDI）、日本骨科协会（Japanese Orthopaedic Association,JOA）评分、Bazaz吞咽困难评分及植骨融合率进行临床疗效对比分析。结果：55例患者均顺利完成手术并获得完整随访,随访时间14～35个月,平均23.17±4.75个月。与术前相比较,两组患者术后VAS评分、NDI指数和JOA评分均有明显的改善,差异均有统计学意义（P＜0.05）,但两组之间无统计学差异（P＞0.05）。Zero-P组手术时间3节段为95.47±5.24min,4节段为115.12±7.53min,较钛板组手术时间（3节段130.85±6.97min和4节段155.69±9.28min）显著缩短,差异有统计学意义（P＜0.05）;术中出血量两组差异无统计学意义（P＞0.05）。Zero-P组颈椎Cobb角在术后3个月时为16.71°±1.28°,末次随访时为15.69°±0.26°,均优于术前（10.53°±1.36°）,差异有统计学意义（P＜0.05）;钛板组颈椎Cobb角术后3个月时为16.95°±2.64°,末次随访时为16.01°±1.71°,优于术前（10.67°±0.41°）,差异有统计学意义（P＜0.05）;而两组之间各时间点颈椎Cobb角的差异均无统计学意义（P＞0.05）。Zero-P组术后1例（3.70%）发生椎前异物感,术后1个月完全消失,无吞咽困难发生,未见相邻节段退变加速。钛板组术后4例（14.29%）发生椎前异物感,于术后2～4个月逐渐消失;术后3例（10.71%）发生吞咽困难,其中轻度1例（3.57%）,中度2例（7.14%）,3例患者在术后3～6个月逐渐好转,1例（3.57%）出现声音嘶哑,于术后2年取出钛板,患者声音嘶哑无明显改善;2例（7.14%）患者出现相邻节段（C2/3）退变加速,均未出现临床症状,予以保守观察。两组的吞咽困难发生率及相邻节段退变发生率间存在显著性差异（P＜0.05）。术后3个月时,Zero-P组植骨融合率为88.89%,钛板组植骨融合率为92.86%,末次随访时两组患者均达到有效植骨融合,但两组间植骨融合率无明显差异（P＞0.05）。两组患者均无硬脊膜损伤、食管损伤、神经根损伤、椎前血肿、伤口感染、假关节形成等并发症。结论：在ACDF治疗多节段脊髓型颈椎病中,使用零切迹融合器能够达到与传统融合器+钛板固定一致的临床疗效,和重塑颈椎曲度并恢复颈椎间隙高度的作用,并且手术时间短,术后患者吞咽困难、相邻节段退变发生率低。     

单节段椎间盘切除联合ROI-C植入术后颈椎弧度改变对疗效的影响

目的 分析颈前路采用零切迹颈椎融合器（ROI-C）行单节段椎间盘切除减压融合术（anterior cervical discectomy and fusion, ACDF）术后颈椎整体弧度（global cervical alignment, GCA）改变对疗效的影响。方法 回顾性分析我院于2012年1月至2014年5月使用ROI-C行单节段ACDF治疗颈椎间盘退变性疾病病人82例,其中男48例,女34例,年龄为35~81岁,平均55.3岁。末次随访的颈椎侧位X线片与术前比较：①维持组,GCA手术前后均为前凸者;②矫正组,术前GCA后凸、术后矫正为前凸者;③后凸组,手术前后均后凸者。记录术前和末次随访的颈部、手臂疼痛视觉模拟量表（neck/arm pain visual anologue scales, NVAS/AVAS）评分和颈部功能障碍指数（neck disability index, NDI）。结果 2012年3月至2016年12月对病人进行术后随访,随访时间为21~39个月,平均25.6个月。维持组46例,矫正组17例,后凸组19例,三组病例年龄分布存在差异（F_组间=4.593,P=0.014）;三组病人性别和手术节段之间比较,差异均无统计学意义（均P＞0.05）。术后GCA后凸发生率为23.17%（19/82）。术前三组间NVAS、AVAS和NDI各指标单变量方差分析,差异均无统计学意义（均P＞0.05）。三组末次随访的NVAS、AVAS和NDI与各组术前比较,差异均具有统计学意义（均P＜0.05）。三组之间AVAS术后改善情况比较,差异没有统计学意义（F_组间=0.580,P=0.562）;而改善程度△NVAS和△NDI的比较,差异均有统计学意义（均P＜0.05）。使用Dunnett-t检验行两两比较显示,矫正组的改善程度△NVAS和△NDI优于维持组和后凸组,差异均有统计学意义（均P＜0.05）。结论 采用ROI-C行单节段ACDF治疗颈椎退变性疾病,颈椎弧度由术前后凸矫正为前凸可获更多的NVAS和NDI改善,说明恢复和维持生理性前凸的GCA是取得最优疗效的重要因素;但术前存在GCA后凸的部分病例术后仍有颈椎后凸的影像学表现,因此治疗伴有GCA后凸的病例时,术者应谨慎确定融合固定的方式。     

同种异体骨椎间融合器在颈椎前路手术中应用的临床效果

目的 评估同种异体骨椎间融合器（Cage）在颈椎前路椎间盘切除融合术（ACDF）中的临床疗效及安全性。方法 回顾性分析2015年6月至2018年3月使用同种异体骨Cage行ACDF手术者45例（48节段）,收集其术前、术后3个月、术后6个月及末次随访时的疼痛视觉模拟量表（VAS）、颈椎功能障碍指数（NDI）评分、日本骨科协会（JOA）脊髓型颈椎病评分、椎间隙高度。术后3、6个月摄颈椎正侧位X线片、行CT三维重建评估融合率。结果 随访时间为（16.18±6.78）个月（6~25个月）。与术前的数值比较,45例病人术后3个月、术后6个月及末次随访时的VAS评分、NDI及JOA评分均有不同程度的改善,椎间融合率分别为64.58%（31/48）、93.75%（45/48）、100%（48/48）;椎间隙高度分别为（9.25±0.50） mm、（8.85±0.46） mm、（8.25±0.48） mm,均较术前显著改善,差异均有统计学意义（P均＜0.05）。无神经压迫、受损症状,无Cage脱出、位移等情况发生。结论 同种异体骨椎间融合器用于ACDF手术可提供早期的稳定和较高的融合率,且安全性良好。     

The influence of dihydroxylated vitamin D metabolites on bone formation in the chick

Summary The ability of 1,25(OH)₂D₃ and of 24,25(OH)₂D₃ to prevent or to heal rickets in chicks was evaluated by studies of plasma biochemistry, growth plate histology, bone morphometry and microradiography, and bone mineralization. 1,25(OH)₂D₃ at a dose of 100 ng/day produced fewest abnormalities compared with vitamin D₃-treated control chicks. Bone growth was slightly greater than vitamin D₃-treated controls in chicks given a lower dose of this metabolite; the reverse was observed in chicks given a higher dose. 24,25(OH)₂D₃ was less effective than 1,25(OH)₂D₃ in preventing rickets even at doses as high as 400 ng/day. Treatment of rachitic chicks with doses of 24,25(OH)₂D₃ up to 300 ng/day produced no healing effect on the bone lesions, in marked contrast to the beneficial effects observed with 1,25(OH)₂D₃.     

Analysis of oxygen transport to the brain when two or more parameters are affected simultaneously

We composed a model, combining oxygen transport system from blood to tissue with the oxygen consumption system at the tissue. The aim of this study is to apply it to the brain tissue under conditions when two or more oxygen transport parameters are affected simultaneously. The following values were assumed. Critical tissue P_{O 2} (Pcrit_{O 2}) 2mmHg; oxygen consumption above this level 3ml·min^–1·100g^–1; diffusion coefficient from blood vessel to tissue (Dvt) 0.2ml·min^–1·mmHg^–1·100g^–1; cerebral bloow flow (CBF) 50ml·min^–1·100g^–1; hemoglobin 15g·100ml^–1. The Hill equation was used for oxygen dissociation curve with n of 2.7 and P₅₀ of 27.0mmHg.The changes of oxygen consumption of the brain (V¨_{O 2}) were analyzed when 2 or more of 5 parameters, Pa_{O 2}, CBF, Dvt, P₅₀ and hemoglobin decreased simultaneously from their respective normal values.As the number of parameters affected increased, the level at which oxygen consumption begins to be affected became higher. With all five parameters combined, a reduction down to 78 per cent of normal resulted in tissue hypoxia. We conclude that the oxygen consumption of the brain is fairly resistant when only one parameter is affected, but it becomes increasingly vulnerable when several parameters are affected simultaneously. A clinically important finding is that the brain is particularly vulnerable to a combination of hypocapnia and a decreased level of 2,3DPG.(Suwa K: Analysis of oxygen transport to the brain when two or more parameters are affected simultaneously. J Anesth 6: 297–304, 1992)     

Comparison of the effects of 1,25-dihydroxycholecalciferol,prostaglandin E2, and osteoclast-activating factor with parathyroid hormone on the ultrastructure of osteoclasts in cultured long bones of fetal rats

Summary The effects of 1,25-dihydroxy vitamin D₃ [1,25(OH)₂D₃], prostaglandin (PGE₂), and osteoclast-activating factor (OAF) on the size of osteoclasts, nuclei, ruffled borders, and clear zones in cultured long bones of fetal rats were quantitated. In addition, the number of osteoclasts in the bones was counted and the release of calcium from the bone into the culture medium was determined. These data were compared with the corresponding effects of parathyroid hormone (PTH). All agents tested increased the size of the ruffled borders significantly after 3 h, the size of the clear zones after 12 h, and the size of the cells after 12–24 h. No important differences in sizes were noticed between the agents tested or between the agents and PTH. The number of osteoclasts was increased after 24 h of treatment with PTH, but not after the other agents. Calcium release was significantly increased for all agents between 12 and 24 h. It is concluded that bone resorption by 1,25(OH)₂D₃, OAF, and PGE₂ is mediated primarily by increased activity of existing osteoclasts similar to PTH activation.     

Paradoxical effect of 1.25 dihydroxycholecalciferol on osteoblastic and osteoclastic activity in the skeleton of the eelAnguilla anguilla L

Summary Female mature eels (300 to 500 g) received one intraperitoneal injection of 1.25 (OH)₂D₃ (10 μg). Their vertebral bone was compared, 8 h and 24 h after the injection, with vertebral bone of control mature female eels receiving solvent alone (ethanol). Sexual maturation in female eels induces a bone decalcification with hypercalcaemia and hyperphosphataemia. The control eels showed marked osteoclastic resorption and osteocytic osteolysis and the degree of mineralization of the intercellular substance decreased. Injection of 1.25 (OH)₂D₃ into these female mature eels provoked as early as 8 h : 1) an increase in hypercalcaemia and hyperphosphataemia ; 2) a major conversion of lining cells to osteoblasts and a stimulation of osteoblastic activity with new bone formation ; 3) diminished osteoclastic resorption without changing osteocytic osteolysis or bone matrix mineralization.     

Effects produced by the administration of high doses of 1,25-dihydroxycholecalciferol to the chick embryo

Summary White Leghorn chick embryos were injected on the 15th day of incubation with 70 to 300 pmoles 1,25-(OH)₂D₃. All doses produced hypercalcemia; with the highest dose, the concentration of calcium in serum started to rise 4 h after the injection, reached a peak 20 h after, and was still high 48 h after. Twenty hours after the injection of the same dose, the concentration of inorganic phosphorus in the serum was significantly lower than in the corresponding controls.The tibias from 17-day-old chick embryos injected with 300 pmoles on day 15 were shorter, lighter, and had a lower ash content than those from controls. Histological signs of resorption appeared to be reduced with respect to controls, but no precise quantitation was conducted.The fact that hypercalcemia was not accompanied by hyperphosphatemia may suggest that the vitamin stimulates resorption of calcium from the shell, which is mainly formed by calcium carbonate rather than from the bone from which calcium and phosphate are usually resorbed together.     

Histological observations on the failure of rachitic rat bones to respond to 1,25/OH)2D3

Summary Rachitic rats, maintained on diets with low or normal P contents, were given daily intraperitoneal doses of 1,25(OH)₂D₃ or 25OHD₃ at levels of 100 or 200 ng. Plasma chemistry was measured and the ash content and histological appearance of the bones investigated. Using labeled material it was shown that the dosing levels of 1,25(OH)₂D₃ employed ensured a higher than normal plasma concentration of that metabolite over the period between doses. 1,25(OH)₂D₃ was not as effective as 25OHD₃ in raising bone ash or reducing the amount of osteoid. The difference between the effects of the metabolites was evident at both dietary P levels, but more marked at the higher P level. In contrast, the metabolites reduced the width of the epiphyseal plate to an approximately similar degree, and this is possibly the reason why there are discrepancies between previous reports of the effectiveness of 1,25(OH)₂D₃ compared with 25OHD₃ or vitamin D₃. Dosing with 1,25(OH)₂D₃ failed to maintain a constant plasma P_i value over the period between doses in animals fed the low P diet.     

The value of laser in the treatment of malignant disease of the larynx

The value of functional and reconstructive surgery to the larynx in the treatment of malignant tumours to preserve residual function as far as possible has been clearly demonstrated. A further step in the development of functional surgery is classical microsurgery of the larynx which facilitates diagnosis and endoscopic microsurgical treatment of benign tumours. However, recently following the introduction of the carbon dioxide (CO₂) laser it has been shown that it is possible to treat also malignant tumours of the larynx by endoscopic microsurgery.An incision made by the photo-thermal CO₂ laser scalpel is characterized by the relative absence of bleeding, lack of post-operative oedema, rapid epithelialization without associated infection or cicatrization and this results in optimal post-operative laryngeal function.This paper presents the results of treatment of selected cases of T1 and T2 carcinoma of the glottis treated by CO₂ laser excision under microlaryngoscopic control.In this series healing was rapid with minimal hospitalization and without a tracheostomy. Excellent functional results were achieved and the patient was able to return rapidly to his original occupation. It is our opinion that at present this treatment modality represents the optimal treatment for T1 and T2 carcinoma of the glottis.     

Vitamin D deficiency in the chick embryo: Effects on prehatching motility and on the growth and differentiation of bones,muscles, and parathyroid glands

Summary Vitamin D-deficient chicken embryos were obtained by feeding laying hens diets in which 3–7 μg calcitriol replaced the vitamin D₃ supplement. A large proportion of the D-deficient embryos failed to complete the prehatching positional changes required to start pulmonary respiration. For this reason most of them became cyanotic and had subcutaneous edema and hemorrhages in the head and neck and died without hatching. Total as well as leg-bone and muscle weights were significantly lower in the deficient embryos than in the controls and these changes probably explain the inability of the embryos to complete the movements required to place the beak in contact with the air chamber and start pulmonary respiration. The histological study of the tibiae showed decreased mineralization with narrower trabeculae and enlarged osteoid seams; bone resorption at the inner surface was also significantly decreased. The ultrastructural study of parathyroid glands showed increased functional activity reflected by increased number and size of cisternae of rough endoplasmic reticulum. Injection of 10 ng calcitriol, 1 μg 24, 25-(OH)₂D₃, or 2 μg 25OHD₃ to deficient embryos on the 14th day of incubation improved hatchability, bone and muscle weights, and both bone mineralization and resorption.     

Modulation by epidermal growth factor of the basal 1,25(OH)2D3 receptor level and the heterologous up-regulation of the 1,25(OH)2D3 receptor in clonal osteoblast-like cells

Summary The effects of epidermal growth factor (EGF) on basal 1,25-dihydroxyvitamin D₃ (1,25-(OH)₂D₃) receptor level and on parathyroid hormone (PTH)-induced 1,25-(OH)₂D₃ (OH)₂D₃ receptor up-regulation were studied in the phenotypically osteoblastic cell line UMR 106. EGF in concentrations exceeding 0.1 ng/ml reduced the number of 1,25(OH)₂D₃ binding sites without changing the binding affinity. Maximal reduction was 30% at about 1 ng/ml. This reduction was independent of a change in cAMP content. EGF dose-dependently attenuated both PTH-induced 1,25(OH)₂D₃ receptor up-regulation and PTH-stimulated cAMP production without and effect on the ED₅₀ of the PTH effects. For both PTH responses the IC₅₀ and the maximal effective dose were similar, 0.1 ng/ml an 1 ng/ml EGF, respectively. Reduction was first seen at 0.01 ng/ml EGF. At this concentration. EGF reduced PTH-stimulated 1,25-(OH)₂D₃ receptor binding without an inhibition of the cAMP response. Time-course studies with 1 ng/ml EGF revealed that at 2 h preincubation EGF reduced the heterologous up regulation by PTH, and maximal inhibition was seen after 4 h. In contrast, PTH-stimulated cAMP production was just significantly inhibited only after 6 h, with 60% inhibition after 24 h preincubation. The effects of prostaglandin E₂ and forskolin on both 1,25(OH)₂D₃ binding and cAMP production were inhibited in a similar fashion. On the other hand, dibutyryl cAMP- and 3-isobutyl-1-methylxanthinestimulated 1,25(OH)₂D₃ binding were not affected by EGF. Taken together, our results demonstrate that EGF reduces both the basal number of 1,25(OH)₂D₃ binding sites and the heterologous up-regulation of the 1,25(OH)₂D₃ receptor. The current data suggest that EGF reduces heterologous upregulation of the 1,25(OH)₂D₃ receptor independent of as well as dependent on the cAMP messenger system. The EGF effect is not primarily located at the PTH receptor, at cAMP phosphodiesterase, or at protein kinase A level.     

Separate functions of α2β1 and α2β1 integrins in the metastatic process of human gastric carcinomaintegrins in the metastatic process of human gastric carcinoma

The expression of α₂β₁ and α₃β₁ integrins was studied immunohistochemically in 110 resected human gastric carcinomas. Formalin-fixed and paraffin-embedded samples were serially sectioned and stained with monoclonal antibodies specifically against the α₂ and α₃ subunits of β₁ integrins. Approximately 27% of the tumors expressed α₃β₁ integrin, and 20% expressed α₃β₁ integrin. The expression of α₃β₁ integrin was associated with lymph node and liver metastases (P<0.05 andP<0.05, respectively), and the expression of α₃β₁ integrin was associated with liver and peritoneal metastases (P<0.005 andP<0.0005, respectively). A multivariate analysis by the logistic regression model revealed that the expression of α₃β₁ and/or α₃β₁ integrins was an independent factor related to liver metastasis, and that the expression of α₃β₁ integrin was as strong an influence on the formation of peritoneal metastases as the depth of invasion. The expression of α₃β₁ integrin also correlated with increased invasiveness of the tumor; however, there was no correlation between α₂β₁ integrin expression and the invasiveness. These results suggest that α₂β₁ and α₃β₁ integrins have separate influences on the metastatic properties of cancer cells.