慢传输型便秘结肠肌间神经丛超微结构改变

目的　慢传输型便秘（ＳＴＣ） 病因不清、症状顽固、临床处理较困难． 进一步探讨其发生和发展的病理学基础．方法　应用电镜技术对１４ 例ＳＴＣ 患者和１１ 例非梗阻性直肠癌患者经手术切除的乙状结肠标本进行了对照研究．结果　与对照组相比，ＳＴＣ 患者结肠肌间神经丛的超微病理改变表现为：神经元及其突起有十分明显的退行性变，轴突及树突空化呈网格状结构，胞质内出现空泡及脂褐素等；轴突末端膨体及突触前区内突触小泡含量明显减少，大部分突触小泡出现空化．结论　ＳＴＣ 患者结肠肌间神经丛有明显的神经病理学改变，存在递质耗竭或递质合成、传输障碍等现象，它是ＳＴＣ 患者肠道传输减慢的超微病理基础． 这种改变可能与ＳＴＣ 患者长期滥用接触性泻剂有关．     

Ultrastructure of rat duodenal myenteric plexus revealed by quick-freezing and deep-etching method

A quick-freezing and deep-etching (QF-DE) method was employed with whole-mount strips of rat duodenal muscle walls to exhibit the cytoskeletons of the myenteric plexus. Nerve fibers in the myenteric plexus, which contained fewer neurofilaments than other types of neurons examined, had many varicosed contours, and were bundled by enteroglial cells. Cytoskeleton arrays were rarely observed in the varicosed regions, where synaptic vesicles were often seen, although other nerve regions contained many neurofilaments running almost in parallel with the nerve fiber bundle. Enteroglial cells had short cytoskeletons predominantly across the cytoplasm, becoming thinner the around varicosed regions of the nerve bundles. Such enteroglial extruded areas were often in close association with neighboring nerve fibers, indicating intercommunications between the nerve fibers. In distal parts of enteric nerve processes, there were numerous synaptic vesicles, but few neurofilaments. Smooth muscle cells were closely associated with the enteric nerve processes. Fine network structures, responsible for the extracellular matrix, were present between the smooth muscle cells and the enteric nerve processes. These specific structures of the myenteric plexus could be important for signalling or for the transportation of neurotransmitters involved in gut motility. (Received Feb. 25, 1998; accepted July 6, 1998)     

糖尿病大鼠胃肌间神经丛及平滑肌的形态学改变

目的　了解糖尿病 (DM )大鼠胃功能障碍有无形态学的异常并探讨其影响胃运动功能的机制。　方法　以链脲佐菌素 (STZ)制成DM大鼠 2 6只 ,分为 2组。DM A组 :用活血化瘀补肾中药“筋脉通” 3 .75g·kg- 1·d- 1灌胃 ;DM B组 :等量温水灌胃 ;对照组 :健康大鼠 10只。于 12周及 2 4周时处死大鼠 ,取胃组织固定、浸蜡、包埋、切片后分别进行HE染色及nNOS免疫组化染色 ,对其胃肌间神经丛及平滑肌等进行观察。　结果　 (1)DM A组及DM B组胃肌间神经丛数量分别为 (1.9± 0 .5)及 (1.4± 0 .4)个 /mm与对照组 (3 .1± 0 .4)个 /mm比较 ,其数量明显减少 (P <0 .0 5和P <0 0 1) ;神经丛中神经元细胞数在DM A组及DM B组分别为 (2 0 .3± 4.0 )个 /mm及 (11.4± 0 .4)个 /mm(P <0 .0 1) ,明显少于正常对照组 (3 7.0± 3 .8)个 /mm(P <0 .0 5和P <0 .0 1) ,非神经元细胞数量增加 ;(2 )DM大鼠环形肌及纵行肌变薄 ,以纵形肌厚度变薄为著 ,2组DM大鼠胃纵行肌厚度分别为(0 .0 6± 0 .0 2 )mm及 (0 .0 8± 0 .0 2 )mm与对照组 (0 .12± 0 .0 4)mm比较差异有显著意义 (P <0 .0 5) ;(3 ) 2组DM大鼠胃肌间神经丛中nNOS阳性细胞数量分别为 (2 8± 0 8)个 /mm及 (3 0± 0 8)个 /mm ,较对照组的 (5.3± 1.2 )个 /mm明显减少     

C4神经转位修复臂丛神经撕脱伤后C4节段脊髓组织中ChAT表达变化的研究

[目的]观察臂丛神经撕脱伤模型C4转位修复治疗后C4节段脊髓组织中乙酰胆碱转移酶(ChAT)的变化.[方法]Wistar大鼠30只,随机分为A、B、C组,各10只.A、B组建立臂丛神经撕脱伤模型.建模后,A组为实验组,行C4转位修复治疗;B为对照组,于椎间孔处切断C4和C6神经根后,不予吻合;C组为正常组,不进行手术.观察治疗后三组动物患肢功能;于术后3个月时,A组取C4、C6吻合口处神经0.5 cm,B组取C6断端0.5 cm神经,C组取C6神经根0.5 cm,均行HE染色,观察各组神经纤维情况;同时取三组动物C4段脊髓组织,采用免疫组化ABC法行ChAT染色,计数脊髓前角ChAT阳性运动神经元.[结果]①治疗后A组动物右侧前肢屈曲活动基本正常,肱二头肌未见萎缩;B组动物右侧前肢屈曲不能,呈伸直畸形,肱二头肌肌腹萎缩;C组动物正常.②HE染色后,A组可见多处再生神经纤维及髓鞘,分布均匀、致密,外膜连续,神经纤维排列较整齐;B组可见散在稀少神经纤维,排列紊乱无序,并有多处异物体形成;C组神经纤维分布均匀、致密,排列整齐.③A、B、C组C4脊髓前角ChAT免疫阳性运动神经元数分别为(23.27±3.35)、(19.53±2.97)、(25.53±3.42)个,A、C组与B组比较,P均＜0.05,A组与C组相近(P＞0.05).[结论]臂丛神经根性撕脱伤模型C4转位修复治疗后C4节段脊髓组织中ChAT 表达上调,这可能是C4转位修复治疗臂丛神经根性撕脱伤疗效好的原因之一.     

脊髓型颈椎病的平衡功能定量检测

目的 研究脊髓型颈椎病（ cervical spondylotic myelopathy, CSM ）患者的静态平衡功能。方法 平衡检测仪对脊髓型颈椎病和正常人平衡进行检测，通过测定动摇径总长（LNG）、重心轨迹的包络面积（ENV．AREA）、摆动角度（DEG）、Romherg率和单位面积轨迹长（LNG／A）分析CSM平衡功能，比较CSM平衡功能与颈椎体位和Nurick分型的相关性。结果 CSM患者动摇径总长、重心轨迹的包络面积、摆动角度、Romberg率、单位面积轨迹长与正常人比较显著增加，平衡减退与Nurick分型呈正相关。结论 脊髓型颈椎病患者静态平衡功能比正常人明显减退．静态平衡检测可以客观反应患者的平衡功能。     

大鼠脊髓缺血再灌注后血清内皮抑素变化及其与脊髓损伤的关系

目的观察大鼠脊髓缺血再灌注后血清内皮抑素(SE)水平变化及其与脊髓损伤的关系。方法采用N aslund腹主动脉阻断法制作脊髓缺血再灌注模型。将56只大鼠分为假手术对照组(C组,n=8)和模型组(M组,n=48)。C组只解剖出腹主动脉但不阻断;M组按腹主动脉阻断时间分为M 1组(n=24)和M 2组(n=24),分别阻断30m in和90m in。各组均于再灌注后6~8h、2d、7d取血样和脊髓标本,分别进行SE检测(EL ISA法)和脊髓组织学检查。结果①脊髓病理检查:M 1组脊髓病理改变较轻,再灌注后7d可恢复正常;M 2组运动神经元损伤较重,多数呈不可逆性坏死表现。②SE水平:C组为(56±10)ng/m l;M 1组无显著变化;M 2组于再灌注后2d开始升高达(85±17)ng/m l,与C相比P=0.01;7d时达(92±16)ng/m l,与C相比P<0.01。结论脊髓缺血90m in导致不可逆性脊髓损伤,SE水平亦显著升高。     

Mirabegron causes vesical and urethral relaxation in rats with spinal cord injury

The effects of solifenacin and mirabegron on vesical and urethral function were compared in rats with or without spinal cord injury (SCI). Isovolumetric cystometry and urethral pressure recording were initially performed in intact rats. Then, the bladder neck was ligated under urethane anesthesia, after which a catheter was inserted through the bladder dome for isovolumetric cystometry and another catheter was inserted into the urethra to measure urethral pressure. Solifenacin (0.03–3 mg/kg) or mirabegron (0.03–3 mg/kg) was injected intravenously, and bladder and urethral activity were recorded. To create rats with SCI, the spinal cord was transected at the lower thoracic level under isoflurane anesthesia. After 2 weeks, a catheter was inserted through the bladder dome for single cystometry and bladder activity was recorded without anesthesia following intravenous injection of solifenacin or mirabegron. Isovolumetric cystometry revealed a larger decrease in maximum bladder contraction pressure after injection of solifenacin, whereas prolongation of the interval between bladder contractions was greater with mirabegron. In SCI rats, single cystometry showed that solifenacin and mirabegron both increased bladder volume at the first non‐voiding bladder contraction and decreased the maximum bladder contraction pressure. Mirabegron also increased the voided volume and decreased the percentage residual volume without altering bladder capacity. Solifenacin and mirabegron both inhibited bladder contractility, and mirabegron possibly also induced urethral relaxation. Mirabegron may be suitable for patients with overactive bladder and residual urine.     

单侧开门外侧块螺钉固定植骨治疗颈脊髓压迫症

目的 探讨单侧开门外侧块螺钉固定植骨术治疗颈脊髓压迫症的临床疗效.方法 自2004-02～2008-06采用单侧开门外侧块螺钉固定植骨术治疗颈脊髓压迫症26例,男18例,女8例;年龄51～67岁,平均58岁.26例中有22例为多节段脊髓型颈椎病(3个或3个节段以上),其中10例合并发育性椎管狭窄症(6例合并动力性椎管狭窄症,3例合并后纵韧带骨化症,1例为外伤性);4例为颈椎管内肿瘤.随访9个月～2年2个月,平均1年8个月.结果 疗效评定标准参照日本整形外科协会(JOA)评分标准,优8例,良15例,可2例,差1例,优良率为88.5%.无一例出现血管损伤或内固定物断裂并发症,1例脊膜瘤因肿物过大术后出现脊髓再灌注损伤表现,经积极治疗好转,生活可自理.结论 该法适用于需要从后方入路进行减压的颈脊髓压迫症,疗效肯定.其优点是手术相对安全,在彻底减压的同时进行坚强的内固定,尤其适用于伴有节段性不稳的脊髓型颈椎病.     

颈椎病大鼠模型的建立

目的研究大鼠颈椎病动物模型的建立。方法80只SD大鼠随机分成4组,模型组2组行颈后肌切除术,另2组为对照假手术组。于术后3月、术后6月分别处死模型组和对照组动物各1组,对颈椎间盘进行组织学观察。结果大鼠椎间盘在增龄的过程中逐渐发生退变,椎间盘由外周规则排列的纤维环、中央大的髓核及较完整软骨终板逐渐转变成纤维环出现玻璃样变、断裂,髓核出现皱缩、变小或消失,软骨板变薄、缺损。而模型组退变发生更为严重。结论模型的产生符合颈椎病慢性进展性退变过程。     

大鼠消化道肌间神经丛中一氧化氮合酶的分布

目的了解大鼠消化道肌间神经丛中一氧化氮合酶（ＮＯＳ）阳性神经元的分布规律．方法采用ＮＡＤＰＨ黄递酶（ＮＤＰ）组化技术在整装铺片上观察了大鼠消化道肌间神经丛中ＮＯＳ阳性神经元的形态特征并对其分布进行定量研究．结果整个消化道肌间神经丛中均有ＮＯＳ阳性神经元分布，密度（个／ｍｍ２）分别为１８±２５（食管），３１４±４７（胃），２６４±３１（十二指肠），２９５±３９（空肠）。３３７±４４（回肠），６７±２３（盲肠），３８６±４１（升结肠），４８７±５３（降结肠）和３６２±３３（直肠）．神经纤维分布仍以降结肠最密集（＋＋＋＋），食管最稀疏（＋）．ＮＯＳ神经元形态基本类似，大小差异较大，绝大部分神经元位于神经节内，每个神经节中ＮＯＳ神经元２～８个．多数神经元之间有突起相互连接，形成网络．结论消化道中ＮＯＳ神经元的分布与该处的生理功能相吻合，并可能与许多胃肠疾病的发生及发展密切相关     

Response of the gastric mucosa to manipulation of gastric acid output in the cervical cord transected rat

The role played by gastric acid in stress ulceration following acute quadriplegic injury was examined in the C7 cord transected rat. Gastric acid output was manipulated by intraperitoneal administration of cimetidine (50 mg/kg), pentagastrin (5μg/kg) or saline in equal volumes. In comparison with control values (78 μEq/h per 200 g rat weight), cimetidine significantly decreased (16 μEq/h per 200 g) and pentagastrin increased (156 μEq/h per 200 g) the median gastric acid output. However, while cimetidine also significantly reduced the resultant ulceration, pentagastrin did not significantly enhance the ulceration compared with the control values. Furthermore, there was no correlation between gastric acid output and total ulcer length in any of the groups. It is concluded that while acid plays a permissive role in ulcerogenesis, factors other than acid define the quantity of gastric stress ulceration following acute spinal injury.     

颈椎前路Hybrid手术治疗双或多节段颈椎病的临床疗效观察

目的 观察颈椎前路Hybrid手术治疗双或多节段颈椎病的中短期临床疗效。方法 回顾性分析该院自2017年1月至2021年12月收治的采用Hybrid手术方式治疗的13例颈椎病患者的临床资料。采用疼痛视觉模拟量表(VAS)评分、日本整形外科协会(JOA)评分评价临床疗效;采用颈椎X线片及CT扫描三维重建等资料评估置换手术节段活动度、颈椎整体活动度、颈椎间盘假体位置、内固定融合率、异位骨化等影像学指标。结果 13例患者均获随访,随访时间8～45个月,平均14.6个月。术后置换节段活动度(9.12±1.86)°与术前(9.21±1.76)°比较差异无统计学意义(P>0.05),颈椎整体活动度(39.67±5.57)°较术前(52.12±6.43)°显著减小(P<0.05)。术后1个月随访,VAS评分[(1.37±0.78)分]较术前[(4.85±1.25)分]显著改善(P<0.05)。术后3个月随访,JOA评分[(15.32±1.92)分]较术前[(11.36±2.11)分]显著改善(P<0.05)。术后6个月,所有患者固定节段全部融合,随访期间未见内置物松动和下沉,...     

"痉"证方治疗脊髓型颈椎病的临床研究

目的观察“痉”证方治疗“痉证型”脊髓型颈椎病的疗效。方法以“痉”证方治疗“痉证型”脊髓型颈椎病，并以西药为对照组，以脊髓型颈椎病功能状态评定为标准，比较两组治疗前后改善率，进行临床疗效评定。结果“痉”证方组总有效率为80．0％．对照组总有效率为57、14％。“痉”证方组疗效优于对照组（P〈0．05）。结论“痉”证方治疗“痉证型”脊髓型颈椎病疗效显著。     

Unilateral cervical spinal cord lesion in a term newborn,associated with ipsilateral diaphragmatic atrophy and pulmonary hypoplasia

Two major factors can interfere with normal development of the fetal lungs: mechanical constriction resulting in decreased intrathoracic space and reduced or absent fetal breathing movements. We report a unique case in which both factors contribute to the development of lethal pulmonary hypoplasia. This full-term neonate had an isolated unilateral lesion in the cervical spinal cord resulting in ipsilateral neurogenic atrophy of the diaphragm, bilateral pulmonary hypoplasia, and lung immaturity. Evenetration of the atrophied diaphragm decreased intrathoracic space, compromising fetal lung growth. This was compounded by impaired fetal respiration due to the diaphragmatic atrophy, further aggravating pulmonary hypoplasia on the affected side. The other lung was also hypoplastic, although to a lesser degree, suggesting that its growth was also affected by either or both of these factors. Pediatr Pulmonol. 1994; 18:53–57. © 1994 Wiley-Liss. Inc.     

Melatonin reduces stress-activated/mitogen-activated protein kinases in spinal cord injury

Abstract:  Permanent functional deficits following spinal cord injury (SCI) arise from both mechanical injury and from secondary tissue reactions involving inflammation. The mitogen-activated protein kinases (MAPKs) play a critical role in cell signaling and gene expression. MAPK family includes three major members: extracellular signal regulated kinase (ERK), p38, and c-Jun N-terminal kinase (JNK), representing three different signaling cascades. Moreover, various studies have clearly shown that high-mobility group box 1 (HMGB1) protein is implicated as a putative danger signal involved in the pathogenesis of a variety of inflammatory conditions including autoimmunity, cancer, trauma and hemorrhagic shock, and ischemia-reperfusion injury. Recently, we have reported that the pineal secretory product melatonin exerts important anti-inflammatory effects in an experimental model of SCI induced by the application of vascular clips (force of 24 g) to the dura after a four-level T5–T8 laminectomy. However, no reports are available on the effect of melatonin on MAPK signaling pathways and HMGB1 expression in SCI. The aim of the present study was to evaluate whether the melatonin protective effect observed in SCI is related to the regulation of MAPK signaling pathways and HMGB1 in mice. In this study we demonstrate the efficacy of treatment with the melatonin in SCI in mice in reducing (a) motor recovery, (b) activation of MAPKs p38, JNK and ERK1/2, (c) tumor necrosis factor-α expression, and (d) expression of HMGB1. We propose that melatonin's ability to reduce SCI in mice is also related to a reduction in MAPK signaling pathways and HMGB1 expression.     

大鼠脊髓半切损伤后外源性NEP1-40对神经中丝NF200表达的影响

目的探讨外源性Nogo受体拮抗剂（NEP1-40）在脊髓损伤修复过程中的作用及机制。方法将60只雌性Wistar大鼠随机分为假手术组、模型组和治疗组各20只。后两组均建立大鼠T10脊髓右侧半横断损伤模型,治疗组通过损伤处置管从术后第1天开始每天予NEP1-4015μg溶于PBS缓冲液25μl,连续7d;模型组予等量的PBS缓冲液;假手术组仅去除椎板,不做脊髓半横断,术后不埋管,不用药。分别于术后7、14、21、28d采用Basso-Beattie-Bresnahan运动（BBB）评分法行大鼠行为学表现评分,免疫组化染色法检测受损节段脊髓中NF200的表达。结果治疗组各个时间点的BBB评分均高于模型组,NF200阳性细胞的数目均高于模型组（P均〈0.05）。BBB评分与NF200阳性细胞数量呈明显正相关（r=0.937,P〈0.01）。结论脊髓损伤后注射NEP1-40可增加NF200阳性神经元数目,促进轴突再生及运动功能恢复。     

Bryan人工颈椎间盘置换术在无骨折脱位脊髓损伤患者中的应用价值

目的探讨Bryan人工颈椎间盘置换术在无骨折脱位脊髓损伤患者中应用价值。方法采用Bryan人工颈椎间盘置换术治疗50例无骨折脱位脊髓损伤患者（存在创伤诱因5例）,比较有、无创伤诱因患者的临床效果。结果创伤与无外伤组在术前及末次随访置换节段活动度上比较均无统计学差异;创伤组术前及末次随访置换节段均无不稳定;创伤组JOA术前值及末次随访值均较无创伤组低,两组在JOA改善率上无统计学差异。结论对于无骨折脱位脊髓损伤患者,当压迫节段局限、无病变节段不稳定,颈椎人工间盘置换术也是一种有效的治疗策略。     

刺激外周神经对幼鼠脊髓、海马c-fos蛋白表达的影响

目的 探讨电刺激坐骨神经后不同时间幼鼠脊髓、海马神经元c-fos蛋白的表达及意义.方法 将30只SD雄性幼鼠随机分成3组:空白对照组,单个电刺激组,强直电刺激组.强直电刺激组包括:强直刺激后1h组、2h组和3h组.首先对单个电刺激组施加单个电刺激,对强直刺激组施加强直电刺激,而后再对强直电刺激组施加同样参数的单个电刺激.实验完毕后取各组动物脊髓和海马神经元做免疫组织化学染色,观察各组动物脊髓和海马神经元内c-fos表达的变化.结果 单个电刺激组、强直电刺激组海马、脊髓神经元内c-fos蛋白强表达,与空白对照组的弱表达比较差异均有统计学意义(P＜0.05);强直刺激后,海马、脊髓不同时间神经元内的c-fos表达不同,以强直刺激后2h为表达量最高.结论 电刺激坐骨神经可使幼鼠海马、脊髓神经元内c-fos蛋白表达增加,推测电刺激后海马、脊髓神经元内c-fos表达量的增加与学习记忆联系密切.     

Long-term outcome of spinal cord electrical stimulation in patients with refractory chest pain

Background and hypothesis: Treatment of patients with refractory chest pain remains a challenge. In this study, the long-term clinical effects of spinal cord electrical stimulation were evaluated in 10 consecutive male patients (mean age 53.7 years) with chronic chest pain in a prospective observational study. Methods: After placement of the electrode in an epidural position and before implantation of the device, patients were subjected to clinical evaluation, including atrial pacing, in order to document significant antianginal effects. Results: Spinal cord electrical stimulation abolished or improved pacing time to angina by more than 50% in seven of the patients who subsequently had the device implanted. In three of these patients, the system was ineffective after a period of 3-9 months despite paresthesia in the area of anginal pain with electrical stimulation. The effects of treatment remained satisfactory in the remaining patients (40%) after a mean follow-up of 60 (45-72) months. Thus, a long-lasting clinical response was able to be predicted in 57% of the patients. Conclusion: Spinal cord electrical stimulation is one of the few therapeutic options in inoperable patients with refractory chest pain.