脊髓栓系综合征诊疗体会

目的 探讨脊髓栓系综合征的治疗、预后.方法 脊髓栓系综合征患者198例,均采用气管插管全身麻醉并在显微镜下手术:脊髓脊膜膨出切除修部术 内外终丝切断松解术,藏毛窦切除 内外终丝切断松解术,或合并脂肪瘤切除术、神经松解或单纯外终丝切断松解术.结果 随访1～2年,131例有不同程度恢复,其中恢复良好者60 例(活动自如,肌力5级,无畸形,无感觉障碍)占43%;中等恢复71例(轻度畸形, 单足内翻,肌力4～5级,可自主活动,无感觉障碍)占53.4%;无明显恢复者8例肌力同术前,感觉同术前.1例术后1周死亡.结论 早期诊断,神经显微外科手术加功能锻炼效果显著.     

显微外科手术治疗脊髓栓系综合征临床研究

目的 探讨脊髓栓系综合征显微外科手术治疗及手术疗效观察.方法 本组22例,均经x-ray、CT、MRI检查,明确诊断,手术方法本组均在全麻及显微镜下操作,剥离粘连的脊髓、马尾和神经根,切断增粗的终丝,充分游离脊髓、马尾和神经根,脊柱侧弯者行Luque法固定.结果 本组22例,平均随访时间5年以上,按1992年ASIA修订的Frankel分级评分,总优良率达82%,无死亡率.结论 脊髓栓系综合征早期诊断,早期手术是减少终生残疾的关键,显微外科手术损伤小、能彻底地分离粘连,手术可以完全控制症状的继续加重.     

1例婴儿脊髓栓系综合征的围术期护理

<正>脊髓栓系综合征是由于脊柱、脊髓的先天畸形和椎管内外肿瘤及脊髓脊膜膨出所致的脊髓和圆锥受牵拉,脊髓圆锥缺血引发的综合征[1]。主要表现为大小便功能障碍,腰部或下肢疼痛,感觉减退和消失,进行性下肢运动障碍。MRI是诊断该病的金标准。手术越早效果越好,手术目的主要是松解马尾神经粘连、切除局部肿瘤、切断终丝、扩大硬膜囊,使受牵     

小儿脊髓栓系综合征根治的手术配合

脊髓栓系综合征（tethered cord syndrome TCS）是婴幼儿发育时脊髓圆椎在椎管内上升过程中出现的一种复杂病理改变，引起一系列神经功能障碍和畸形的一组征侯群。我院2002～2005年收治此类患者68例，经显微外科手术松解脊髓圆椎，终丝切除术后效果良好。现将手术配合报告如下：     

显微手术治疗脊髓栓系综合征

目的 研究显微外科手术治疗脊髓栓系综合征的疗效及手术特点。方法 回顾分析42例脊髓栓系综合征患者的临床资料,并结合文献进行论述。结果 本组病例中83％腰骶及下肢疾病得以改善,76％排便障碍得以改善,53％的鞍区、双下肢感官异常改善。结论 早期发现及诊断,并尽早行显微外科松解是治疗脊髓栓系综合症的有效方法。     

26例小儿脊髓栓系综合征围手术期护理

小儿脊髓栓系综合征(tethered cord syndrome,TCS)是在胚胎期脊髓发育异常、局部瘢痕粘连、终丝粗短,导致脊髓圆锥固定在正常椎骨节段以下,使脊髓、马尾神经及终丝受到牵拉,造成双下肢及大小便功能障碍的综合征。好该病确诊后,应尽早手术治疗。由于TCS的治疗有其自身特点,以及患儿不能主动配合治疗护理,故要求围手术期的护理必须认真负责。通过2009年3月至2012年9月住院26     

脊髓栓系综合征临床诊治分析

目的分析脊髓栓系综合征（TCS）的病因、诊断和治疗方法。方法对患者进行神经系统检查,腰骶部X线检查,MRI,行脊髓拴系松解术。结果随访6个月～4年,疼痛消失42例,明显减轻18例,鞍区感觉恢复6例,好转8例,没有患者出现术后症状加重。结论明确引起脊髓栓系的原因,作出正确诊断,为手术治疗提供依据,脊髓拴系松解术是治疗脊髓栓系的唯一有效的方法。     

脊髓栓系综合征合并末端脊髓空洞症发病机制探讨

目的探讨脊髓栓系综合征合并末端脊髓空洞症的发病机制。方法选取我院2008年9月至2014年9月收治的38例脊髓栓系综合征合并末端脊髓空洞症患儿为试验组,同期收治的18例单纯脊髓栓系综合征患儿为对照组。试验组根据末端脊髓空洞大小分别采取不同的手术方式,对照组仅行脊髓栓系松解术,2组患儿术前及术后均应用磁共振成像(MRI)相位对比电影法测定椎管内脑脊液流速,观察脑脊液动力学改变,并随访临床症状的改善程度。结果试验组患儿术前MRI相位对比电影法显示空洞部位蛛网膜下腔脑脊液循环梗阻,脑脊液流速较慢,术中均发现空洞部位蛛网膜增厚,蛛网膜下腔粘连,术后空洞大部分明显缩小,MRI相位对比电影法显示脑脊液循环通畅,脑脊液流速增快,手术前后流速比较差异有统计学意义(P<0.05);对照组患儿术前、术后MRI相位对比电影法显示脑脊液流速无明显变化(P>0.05),术中未发现蛛网膜增厚、粘连;术前试验组与对照组脑脊液流速比较差异有统计学意义(P<0.05)。2组患儿术后临床症状大部分明显改善。结论脊髓栓系综合征合并末端脊髓空洞症的发病机制与脊髓蛛网膜下腔梗阻导致脑脊液动力学改变密切相关,根据MRI显示空洞/脊髓大小选择不同的手术方式可取得良好的治疗效果。     

脊髓栓系松解术治疗儿童和成人脊髓栓系综合征的疗效

目的 观察脊髓栓系松解术治疗儿童和成人脊髓栓系综合征的疗效。方法 127例脊髓栓系综合征患者,根据年龄分为A组(<14岁,70例)和B组(≥14岁,57例),比较两组临床症状和体征、手术情况及术后疗效。结果 B组大便功能异常、疼痛或麻木比例高于A组,而A组中无症状比例高于B组(P<0.05)。A组术中出血量少于B组(P<0.05)。A组大便功能异常、小便功能异常和肌无力治疗有效率高于B组,A组麻木治疗有效率低于B组(P<0.05)。结论 脊髓栓系松解术治疗儿童和成年脊髓栓系综合征患者均安全、有效。对于无症状的儿童患者,也应积极地进行手术治疗,以防止出现难以扭转的神经缺陷。     

脊髓栓系综合征的影像学评价

目的 探讨脊髓栓系综合征的CT、MRI表现以及在该病诊断中的价值.方法 分析经手术病理证实的45例脊髓栓系综合征患者的CT、MRI资料,再与手术病理对照.结果 45例脊髓栓系综合征中,CT诊断脊髓低位39例,漏诊6例.脊柱裂41例,椎体畸形脊柱侧弯7例,脊髓纵裂3例,其中骨性分隔1例,诊断准确率100%.MRI诊断脊髓低位45例,脊柱裂39例,漏诊6例,椎体畸形脊柱侧弯7例,脊髓纵裂3例,对1例骨性分隔显示不清.结论 脊髓栓系综合征伴发复杂骨骼畸形的患者,MRI结合CT诊断,对患者一次性手术能提供更加详细的信息,提高诊断准确性,减少漏诊.     

pH-responsive thiolated chitosan nanoparticles for oral low-molecular weight heparin delivery: in vitro and in vivo evaluation

The aim of present study was to investigate a pH-responsive and mucoadhesive nanoparticle system for oral bioavailability enhancement of low-molecular weight heparin (LMWH). The thioglycolic acid (TGA) was first covalently attached to chitosan (CS) with 396.97?±?54.54?μmol thiol groups per gram of polymer and then the nanoparticles were prepared with thiolated chitosan (TCS) and pH-sensitive polymer hydroxypropyl methylcellulose phthalate (HPMCP) by ionic cross-linking method. The obtained nanoparticles were characterized for the shape, particle size, zeta potential, drug entrapment efficiency and loading capacity. In vitro results revealed the acid stability of pH-responsive nanoparticles, which had a significant control over LMWH release and could effectively protect entrapped drugs in simulated gastric conditions. By the attachment of the thiol ligand, an improvement of permeation-enhancing effect on freshly excised carp intestine (1.86-fold improvement) could be found. The mucoadhesive properties were evaluated using fluorescently labeled TCS or CS nanoparticles. As compared with the controls, a significant improvement of mucoadhesion on rat intestinal mucosa was observed in TCS/HPMCP nanoparticles via confocal laser scanning microscopy. The activated partial thromboplastin time (APTT) was significantly prolonged and an increase in the oral bioavailability of LMWH was turned out to be pronounced after oral delivered LMWH-loaded TCS/HPMCP nanoparticles in rats, which suggested enhanced anticoagulant effects and improved absorption of LMWH. In conclusion, pH-responsive TCS/HPMCP nanoparticles hold promise for oral delivery of LMWH.     

72例合并鼻中隔偏曲变应性鼻炎的外科治疗体会

目的探讨合并鼻中隔偏曲的变应性鼻炎(AR)患者鼻内镜下行下鼻甲成形术加鼻中隔成形术的治疗效果。方法对确诊为持续性AR且愿意行手术治疗的72例患者常规行鼻内镜检查及鼻窦冠状位CT扫描,鼻内镜下同期行下鼻甲成形术加鼻中隔成形术,术后定时随访判定疗效。结果合并鼻中隔偏曲的变应性鼻炎患者手术后6个月有效率为93.1%(67/72),1年有效率为80.6%(58/72),2年有效率为66.7%(48/72)。结论对经过常规药物或免疫治疗效果不理想,合并鼻中隔偏曲的变应性鼻炎的患者,通过鼻内镜下鼻甲成形术加鼻中隔成形术,可获得良好的临床效果。     

异位妊娠的发病原因探讨

目的探讨异位妊娠的发病原因,以便更好预防,减少发病率.方法总结2000年1月～2005年1 2月在我科住院确诊为异位妊娠患者人数,并与同时期住院分娩人数相比.分析2005年在我科异位妊娠手术患者临床资料,探讨其发病原因.结果异位妊娠发病率逐年上升;乡村人员占77.27%,无业人员(包括无固定职业)占94%;有人工流产史者占47%,无妊娠史者占14.39%,宫内放置节育环者占6.1%,已行输卵管结扎术者占12.12%;手术史者占9.8%,慢性盆腔炎者占29.55%.结论异位妊娠发病率逐年上升;患者大多数为乡村人员,无业者占大多数;人工流产是异位妊娠发病的主要原因;人工流产后发生异位妊娠发病率比慢性盆腔炎患者患异位妊娠发病率高.     

The biological activities of trichosanthin after coupling to dextran

• 1.1. The major biological and pharmacological activities of trichosanthin (TCS) were retained after its covalent coupling to dextran T40. The potency and toxicity was generally reduced.
• 2.2. A dose of TCS as low as 0.02 mg/25 g induced 100% mid-term abortion whereas 20 times as much dextran-trichosanthin (DX-TCS) is required to produce the same effect.
• 3.3. A third of the mice died at a TCS dose of 0.1 mg/25 g but 4 times as much DX-TCS did not cause any death.
• 4.4. DX-TCS suppressed Con A or PHA induced lymphocyte transformation in a dose dependent manner. The potency was decreased as compared to TCS.
• 5.5. Both TCS and DX-TCS exhibited a cytostatic effect on cultured tumour cells (PU5 and hepatoma), the former being more potent.

     

Cytotoxicity and inhibitory effects of low-concentration triclosan on adipogenic differentiation of human mesenchymal stem cells

Humans at all ages are continually exposed to triclosan (TCS), a widely used antimicrobial agent that can be found in many daily hygiene products, such as toothpastes and shampoos; however, the toxicological and biological effects of TCS in the human body after long-term and low-concentration exposure are far from being well understood. In the current study, we investigated the effects of TCS on the differentiation of human mesenchymal stem cells (hMSCs) by measuring the cytotoxicity, morphological changes, lipid accumulation, and the expression of adipocyte differentiation biomarkers during 21-day adipogenesis. Significant cytotoxicity was observed in un-induced hMSCs treated with high-concentration TCS (≥ 5.0 μM TCS), but not with low-concentration treatments (≤ 2.5 μM TCS). TCS inhibited adipocyte differentiation of hMSCs in a concentration-dependent manner in the 0.156 to 2.5 μM range as indicated by morphological changes with Oil Red O staining, which is an index of lipid accumulation. The inhibitory effect was confirmed by a decrease in gene expression of specific adipocyte differentiation biomarkers including adipocyte protein 2, lipoprotein lipase, and adiponectin. Our study demonstrates that TCS inhibits adipocyte differentiation of hMSCs under concentrations that are not cytotoxic and in the range observed in human blood.     

Differential gene expression patterns during embryonic development of sea urchin exposed to triclosan

Triclosan (TCS; 2,4,4′‐trichloro‐2′‐hydroxydiphenyl ether) is a broad‐spectrum antibacterial agent used in common industrial, personal care and household products which are eventually rinsed down the drain and discharged with wastewater effluent. It is therefore commonly found in the aquatic environment, leading to the continual exposure of aquatic organisms to TCS and the accumulation of the antimicrobial and its harmful degradation products in their bodies. Toxic effects of TCS on reproductive and developmental progression of some aquatic organisms have been suggested but the underlying molecular mechanisms have not been defined. We investigated the expression patterns of genes involved in the early development of TCS‐treated sea urchin Strongylocentrotus nudus using cDNA microarrays. We observed that the predominant consequence of TCS treatment in this model system was the widespread repression of TCS‐modulated genes. In particular, empty spiracles homeobox 1 (EMX‐1), bone morphogenic protein, and chromosomal binding protein genes showed a significant decrease in expression in response to TCS. These results suggest that TCS can induce abnormal development of sea urchin embryos through the concomitant suppression of a number of genes that are necessary for embryonic differentiation in the blastula stage. Our data provide new insight into the crucial role of genes associated with embryonic development in response to TCS. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 426–433, 2017.     

Receptor-mediated endocytosis of trichosanthin in choriocarcinoma cells

Trichosanthin (TCS) is a ribosome inactivating protein (RIP). It is generally believed that its many biological activities act through inhibition of ribosomes resulting in a decrease in protein synthesis. It has been hypothesized that the rate of entry of TCS into cells to reach ribosomes is an important factor in determining its biological activity. To prove this hypothesis, we have mapped out and compared the intracellular routing of TCS in two cell lines, namely the choriocarcinoma JAR cell line, which is known to be highly sensitive to the toxic effects of TCS, and the hepatoma H35 cell line, to which TCS shows minimal toxicity. Results from laser scanning confocal microscopy indicated that fluorescein isothiocyanate labeled TCS quickly accumulated inside JAR cells within 4 h of incubation while only a low level of fluorescent signals was detected in H35 cells during the same period of time. When TCS was conjugated with gold particles (Au) and its intracellular locations were traced with a transmission electron microscope, it was found that most of TCS were bound to coated pits on the JAR cell surface and were rapidly internalized within an hour. By 4 h, TCS reached almost every cytoplasmic region including ribosomes, and the JAR cell began to degenerate. In H35 cells, however, the binding of TCS to coated pits was not observed, but instead, a small amount of TCS was found to penetrate the cell non-specifically by direct diffusion across the cell membrane. Our observations suggest that most of TCS enter JAR cells via a specific receptor mediated pathway, which allows a swift transport of TCS across the membrane and a rapid accumulation of intracellular TCS, while in H35 cells, TCS takes a slow and non-specific route. The receptor-mediated uptake together with the specific intracellular routing of TCS may partly account for the differential vulnerability of the choriocarcinoma cell line towards the toxicity of TCS.     

Effects of chronic exposure to triclosan on reproductive and thyroid endpoints in the adult Wistar female rat

Triclosan (TCS), an antibacterial, has been shown to be an endocrine disruptor in the rat. Previously, subchronic TCS treatment to female rats was found to advance puberty and potentiate the effect of ethinyl estradiol (EE) on uterine growth when EE and TCS were co-administered prior to weaning. In the pubertal study, a decrease in serum thyroxine (T₄) concentrations with no significant change in serum thyroid-stimulating hormone (TSH) was also observed. The purpose of the present study was to further characterize the influence of TCS on the reproductive and thyroid axes of the female rat using a chronic exposure regimen. Female Wistar rats were exposed by oral gavage to vehicle control, EE (1 μg/kg), or TCS (2.35, 4.69, 9.375 or 37.5 mg/kg) for 8 months and estrous cyclicity monitored. Although a divergent pattern of reproductive senescence appeared to emerge from 5 to 11 months of age between controls and EE-treated females, no significant difference in cyclicity was noted between TCS-treated and control females. A higher % control females displayed persistent diestrus (PD) by the end of the study, whereas animals administered with positive control (EE) were predominately persistent estrus (PE). Thyroxine concentration was significantly decreased in TCS-administered 9.375 and 37.5 mg/kg groups, with no marked effects on TSH levels, thyroid tissue weight, or histology. Results demonstrate that a long-term exposure to TCS did not significantly alter estrous cyclicity or timing of reproductive senescence in females but suppressed T₄ levels at a lower dose than previously observed.     

三种精索静脉曲张手术方法治疗与疗效比较

目的对比评价经腹腔镜、经腹膜后开放手术及经显微镜下治疗精索静脉曲张的临床应用价值及疗效、术前术后生育能力等比较。方法随机选择我院2005至2013年因精索静脉曲张收治的85例患者,采取三种不同手术方法治疗。结果三种不同的手术方法术后都恢复较快。随访无复发和睾丸萎缩。77例患者术后精液质量有不同程度的改善。患者精子数及活动率明显增高,手术前后比较存在显著差异（P〈0．01）,术后妊娠率达25％。8例患者术后生精功能改善不明显,提示术前精子数〈10×10^6／ml者。结论不论精索静脉曲张程度如何,一旦发现精液质量不好,并可排除其它原因,应尽早手术。对于一侧精索静脉曲张患者采取三种手术方法无明显差异,双侧和复发的精索静脉曲张优先考虑腹腔镜手术。