单纯Ⅱ型胶原酶消化法分离、培养人退变椎间盘髓核细胞的形态学观察

目的:探讨单纯Ⅱ型胶原酶消化法体外培养扩增人退变椎间盘髓核细胞的可行性。方法:收集20例人退变椎间盘髓核,单纯Ⅱ型胶原酶消化分离出髓核细胞并连续培养传代,倒置相差显微镜和HE染色观察细胞形态学变化,甲苯胺蓝染色检测髓核细胞内聚集蛋白聚糖的表达,免疫细胞化学法行Ⅱ型胶原染色,观察髓核细胞的类软骨表型表达情况。结果:单纯Ⅱ型胶原酶消化法可较好的分离培养人退变椎间盘髓核细胞,20例人退变椎间盘髓核,培养成功16例;原代髓核细胞平均7d贴壁,呈类圆形或多角形,P1代髓核细胞平均12h贴壁,呈大梭形或多角形,两代细胞融合95%所需时间分别为30d和7d,差异有统计学意义(P0.01);聚集蛋白聚糖和Ⅱ型胶原主要表达于原代和P1代髓核细胞浆内,被甲苯胺蓝染成天蓝色,免疫细胞化学染色主要表现为黄褐色沉淀,两代间聚集蛋白聚糖和Ⅱ型胶原的表达无统计学差异(P0.05)。结论:单纯Ⅱ型胶原酶消化法可简化髓核细胞分离步骤,提高培养效率;传一代后髓核细胞增殖速率提高,但仍维持类软骨表型,表达聚集蛋白聚糖和Ⅱ型胶原。     

兔椎间盘髓核细胞体外生物学特性的实验研究

目的 对兔椎间盘髓核细胞进行体外培养,观察细胞的形态、表型及超微结构改变,研究其体外生物学特性.方法 取2周龄健康新西兰白兔椎间盘髓核组织,在含有15%灭活FBS的DMEM/F12培养液中培养,倒置相差显微镜下观察原代和传代细胞形态.分别在取材后、原代、第1代、第2代细胞培养期间,进行髓核细胞活力测定;爬片培养后进行甲苯胺蓝、HE、聚集蛋白聚糖番红O、Ⅰ型及Ⅱ型胶原免疫组织化学染色观察;MTT法绘制髓核细胞生长曲线,并行原代及第2代细胞透射电镜观察,对体外细胞的生物学特性进行研究.结果 倒置相差显微镜见原代髓核细胞呈类圆形,折光性较强;5 d开始有细胞贴壁,细胞呈多角形或短梭形;6～8 d细胞生长进入指数生长期;约17 d时,细胞长满瓶壁,可进行传代;随传代次数增加,细胞形态逐渐由多角形、短梭形向长梭形改变.髓核细胞活力测定在刚分离完成后细胞活力为95%～97%,原代培养期间为98%～100%,第1代培养期间仍能维持为100%,第2代细胞活力下降较为明显,为75%～80%.髓核细胞甲苯胺蓝染色呈强阳性:HE染色见细胞核、细胞质着色明显.第1代髓核细胞Ⅰ型胶原免疫组织化学染色呈阴性,Ⅱ型胶原免疫组织化学染色呈阳性,聚集蛋白聚糖番红O染色呈阳性;第2代细胞Ⅰ型胶原免疫组织化学染色呈阳性,Ⅱ型胶原免疫组织化学染色呈弱阳性,聚集蛋白多糖番红O染色着色较浅.MTT生长曲线与体外细胞培养时生长过程相符.透射电镜显示原代髓核细胞内线粒体少,胞质内有大量糖原颗粒,随传代次数增加,糖原颗粒减少,线粒体数量增多,细胞器开始肿胀.结论 明确了兔髓核细胞体外生物学特性变迁,为组织工程髓核的种子细胞研究提供了实验依据.     

低强度脉冲超声波对体外培养人退变腰椎间盘细胞的作用

目的 探讨低强度脉冲超声波(LIPUS)对体外培养人退变腰椎间盘细胞的作用.方法 体外培养人退变髓核细胞,台盼蓝染色法测定活细胞率.将每份髓核细胞样本分为对照组和LIPUS组.应用LIPUS每天作用20 min,作用后第0、2、4、8天,采用免疫组化法测定Ⅱ型胶原水平,采用酶联免疫吸附法检测聚集蛋白聚糖(aggrecan)水平.结果 体外培养人退变髓核细胞的活细胞率为90%～95%.LIPUS干预后第2、4、8天,LIPUS组Ⅱ型胶原的合成和aggrecan含量均较相应时间点对照组显著增加(P＜0.05).结论 LIPUS能够通过促进人退变髓核细胞合成Ⅱ型胶原和蛋白多糖防治椎间盘退变.     

BMP-2对人退变椎间盘髓核细胞影响的实验研究

[目的]探讨BMP -2对人退变髓核细胞合成细胞外基质的影响.[方法]分离、培养人退变椎间盘髓核细胞,取第2代髓核细胞,随机将退变推间盘髓核细胞分为2组.A组:加入100 ng/ml BMP -2,B组:加入200 ng/mlBMP -2,C组:对照组,不加干扰因素.通过对试验组和对照组髓核细胞采用光镜、电镜等形态学方法进行大体形态和超微结构观察,细胞Ⅱ型胶原和糖胺多糖的mRNA表达.ELISA检测细胞培养上清中人Ⅱ型胶原含量,DMMB比色法检测细胞培养上清中糖胺多糖含量.[结果]髓核细胞中Ⅱ型胶原、糖胺多糖表达水平实验组均高于对照组.[结论] BMP-2蛋白可促进退变腰椎间盘细胞分泌蛋白多糖和Ⅱ型胶原,增加细胞活性,恢复椎间盘的功能和活性,因此运用BMP-2椎间盘内注射有望成为椎间盘退变疾病生物治疗的方法之一.     

退变腰椎间盘细胞经体外转基因培养生物学活性的实验研究

目的构建转化生长因子（transforming growth factor,TGF-β3的真核表达载体pEGFP-TGF-β3转染椎间盘髓核细胞,研究转基因TGF-β3对退变髓核细胞生物学特性的影响。方法通过手术方法制作椎间盘突变模型,从而获取原代退变椎间盘髓核细胞,通过脂质体将真核载体pEGFP-TGF-β3导入髓核细胞,然后对细胞的形态和增殖活性（MTT法）进行观察,应用Westen Blot检测TGF-β3在髓核细胞的表达含量,应用免疫细胞化学方法检测转染后髓核细胞的Ⅱ型胶原的表达。结果髓核细胞转染后,细胞活性增强,TGF-β3表达增加,并随着时间的延长而增加。Ⅱ型胶原表达增加。结论TGF-β3转染退变髓核细胞可起到维持髓核细胞表型,并在细胞传代后仍发挥调节作用。TGF-β3确实具有促进髓核细胞增殖和Ⅱ型胶原合成的能力,从而有可能延缓甚至逆转椎间盘退变。     

椎间盘退变目的基因研究

椎间盘退变基因治疗旨在经转基因方法维持正常椎间盘细胞种群表型和数量,增强细胞合成蛋白聚糖、Ⅱ型胶原能力,从而延缓和逆转椎间盘退变.许多研究表明目的基因通过载体转染退变椎间盘髓核、纤维环细胞,能恢复细胞的生理功能.椎间盘退变基因治疗涉及目的基因、载体、靶细胞、转染方法和基因表达调控,该文就椎间盘退变基因治疗的目的基因和基...     

成人退变性椎间盘髓核细胞体外培养及形态学观察

目的通过对成人退变椎间盘髓核细胞的体外培养和形态学观察,进一步研究细胞因素在椎间盘退变中的作用机制。方法取5例患椎间盘突出症并行椎间盘摘除手术的成人髓核,分离后在培养基中进行髓核细胞培养,细胞染色、逆转录聚合酶链式反应、免疫荧光检测细胞Ⅰ、Ⅱ型胶原的表达。结果椎间盘髓核细胞可在体外培养,30d后方可进行传代,最佳的培养条件为胎牛血清/培养基体积分数为10%～20%,pH值7.0。髓核细胞中出现Ⅰ型胶原,并具有较高的表达,Ⅱ型胶原表达微弱。结论成人退变髓核细胞体外培养时间较长,细胞增殖能力低下,特定培养条件的摸索是成功与否的关键。     

椎间盘退变目的基因研究

椎间盘退变基因治疗旨在经转基因方法维持正常椎间盘细胞种群表型和数量,增强细胞合成蛋白聚糖、Ⅱ型胶原能力,从而延缓和逆转椎间盘退变。许多研究表明目的基因通过载体转染退变椎间盘髓核、纤维环细胞,能恢复细胞的生理功能。椎间盘退变基因治疗涉及目的基因、载体、靶细胞、转染方法和基因表达调控,该文就椎间盘退变基因治疗的目的基因和基因载体研究进展作一简要综述。     

椎间盘组织再生研究进展

退变性椎间盘病是导致各种脊柱退行性疾患的主要原因.椎间盘组织内髓核细胞功能降低、细胞外基质减少、微环境异常可导致椎间盘生物学功能减弱.目前有多种生物学方法可为椎间盘组织再生提供条件.转化生长因子-β1、胰岛素样生长因子-Ⅰ、骨形态发生蛋白-2等刺激髓核细胞活性,使其分泌细胞外基质的功能增强,进而改善髓核细胞微环境,维持椎间盘功能稳定.骨形态发生蛋白-2基因转染促进蛋白聚糖合成增加,稳定髓核细胞外基质;Sox9基因转染促进椎间盘细胞再生,并与多种细胞因子协同作用并促进椎间盘稳定.椎间盘源性细胞和非椎间盘源性细胞移植取代退变椎间盘细胞,可刺激退变细胞活性增加,产生大量蛋白聚糖、Ⅱ型胶原和其他基质蛋白.猪小肠粘膜下层支架、胶原支架、琼脂糖支架等均可为椎间盘组织再生提供生物学支架.生物学方法的不断发展,有望为退变性椎间盘病提供安全、可行的非手术疗法.     

PKH26标记结合活体荧光成像技术在椎间盘组织工程研究中的应用

目的体外评估PKH26标记对山羊髓核细胞生物学功能的影响,并结合活体荧光成像系统评价种子细胞在裸鼠体内的生物学行为。方法取1岁龄山羊椎间盘分离髓核组织,通过酶消化法获取原代细胞,倒置相差显微镜下观察,传代获取第1代髓核细胞,行PKH26荧光标记,荧光显微镜下观察标记后的细胞荧光强度,并行甲苯胺蓝和Ⅱ型胶原免疫细胞化学染色观察,锥虫蓝染色比较标记前后细胞活性,MTT法检测标记前后细胞增殖特性,实时荧光定量PCR检测细胞Ⅰ、Ⅱ型胶原及蛋白聚糖基因表达。将标记后的髓核细胞接种至一体化纤维化-髓核支架的髓核部分,纤维环部分作为阴性对照,体外培养3 d后植入5只6周龄雄性裸鼠体内,培养6周后活体成像技术检测髓核细胞-支架复合物在体内的荧光强度及范围。结果倒置相差显微镜观察示原代髓核细胞簇状生长,呈卵圆形,第1代髓核细胞呈类软骨样细胞形态;标记后的第1代髓核细胞甲苯胺蓝染色和Ⅱ型胶原免疫细胞化学染色均呈阳性;标记后荧光强度均匀,标记前后细胞活性均在95%以上;标记前后细胞生长曲线比较差异无统计学意义(P>0.05);实时荧光定量PCR检测示标记前后细胞Ⅰ、Ⅱ型胶原和蛋白聚糖基因相对表达量差异均无统计学意义(P>0.05)。活体成像技术显示体内髓核支架有强烈荧光,纤维环支架未见荧光。结论 PKH26标记对髓核细胞的活性、增殖及细胞表型的表达无明显影响,结合体内活体荧光成像系统可以追踪细胞在体内的生物学行为。     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.     

动静脉穿刺网络课件的开发及其应用

目的:确保护理教学效果,提高教学水平。方法:应用多项信息技术将动静脉穿刺技术制作成教学网络课件,并用于临床教学。结果:该课件在本校园网上运行半年余,2000余人次对其进行访问,受到师生好评。结论:该课件能及时反映动静脉穿刺的最新研究进展及具体操作步骤和使用方法,实现护理教学的直观性和交互性,对护理教学和临床带教指导有一定的借鉴作用。     

Physiology and pharmacology of nausea and vomiting

The physiology of nausea and vomiting is poorly understood. The initiation of vomiting varies and may be due to motion, pregnancy, chemotherapy, gastric irritation or postoperative causes. Once initiated, vomiting occurs in two stages, retching and expulsion. The muscles responsible for this sequence of events are controlled by either a vomiting centre or a central pattern generator, probably in the area postrema and the nearby nucleus tractus solitarius. Drugs which induce vomiting include ipecacuanha, a gastric irritant, and apomorphine, a dopamine-receptor agonist. Opioid drugs also induce vomiting, but opioid antagonists are not useful to treat nausea and vomiting. Anti-emetic drugs consist of a variety of neurotransmitter antagonists and may act in the periphery, the central nervous system or both sites. The most important drugs are antagonists at muscarinic, dopamine D₂, 5-HT₃, histamine H₁ and neurokinin NK₁ receptors. These drugs are discussed with particular attention to post-operative nausea and vomiting (PONV).