脊髓的发育与脊髓畸变及脊髓损伤

脊髓畸变和脊髓损伤是中枢系统常见病变,它们与脊髓的发生发育关系密切。本文试图对它们的关系进行探讨,为脊髓畸变和脊髓损伤的诊治提供依据。     

胚胎脊髓移植对损伤脊髓修复作用的病理组织学和超微结构观察

目的：观察胚胎脊髓在缓解损伤脊髓的病理反应及其发生发展中的作用，方法：将妊娠１４ｄ大鼠胚胎脊髓植入半切洞损伤的成鼠脊髓后１、３、５、７、１０、１５、３０、４５和６０ｄ时，取材做光镜和电镜观察，结果：单纯脊髓损伤后，发生了出血水肿，变性坏死以及囊腔成胶质细胞增生和神经纤维再生，胚胎脊髓植入后，明显减轻了神经元和神经纤维的坏死变性程度，并能对损伤元实施挽救，有效抑制了病理囊腔的形成，也可填补原发损伤造     

大鼠脊髓针刺损伤程度与脊髓功能变化的相关性研究

摘要：目的通过观察大鼠脊髓穿刺致不同损伤程度后病理生理、运动及电生理改变,寻找对脊髓损伤程度最小的方法,为进一
步研究局麻药脊髓毒性提供新的途径。方法健康SD大鼠144 只随机分为对照组和实验组,实验组又分为A组（29G）、B组
（25G）和C组（21G）。实验动物暴露L4~5节段间硬脊膜,直视下分别用21G、25G、29G刺伤L4-5节段脊髓,缝合切口。各组分别在
术前进行双后肢运动功能评分,术后各时点记录运动功能评分（BBB评分）、电生理检测及脊髓病理观察。结果对照组麻醉恢
复后能站立行走,脊髓结构正常。实验组29G组行为学评分最高,脊髓损伤区域无明显病理改变;21G组运动、脊髓电生理和组
织病理的改变明显,2周时明显恢复。结论应用29G穿刺针对脊髓进行针刺对大鼠脊髓功能影响小,具有穿刺损伤小、重复性
好的优点,可为研究局麻药脊髓毒性提供新途径。
     

大鼠脊髓针刺损伤程度与脊髓功能变化的相关性研究

目的通过观察大鼠脊髓穿刺致不同损伤程度后病理生理、运动及电生理改变,寻找对脊髓损伤程度最小的方法,为进一步研究局麻药脊髓毒性提供新的途径。方法健康SD大鼠144只随机分为对照组和实验组,实验组又分为A组(29G)、B组(25G)和C组(21G)。实验动物暴露L4-5节段间硬脊膜,直视下分别用21G、25G、29G刺伤L4-5节段脊髓,缝合切口。各组分别在术前进行双后肢运动功能评分,术后各时点记录运动功能评分(BBB评分)、电生理检测及脊髓病理观察。结果对照组麻醉恢复后能站立行走,脊髓结构正常。实验组29G组行为学评分最高,脊髓损伤区域无明显病理改变;21G组运动、脊髓电生理和组织病理的改变明显,2周时明显恢复。结论应用29G穿刺针对脊髓进行针刺对大鼠脊髓功能影响小,具有穿刺损伤小、重复性好的优点,可为研究局麻药脊髓毒性提供新途径。     

脊髓缺血性二次瘫痪与脊髓血流量

目的：观察脊髓缺血后二次瘫痪与脊髓血流量（ＳＣＢＦ）的关系。方法：以清醒兔肾下主动脉（ＩＲＡ）阻断致腰骶段脊髓缺血为实验模型，采用氢气清除法观测脊髓灰质和白质血流量（ｇＳＣＢＦ和ｗＳＣＢＦ）及Ｔａｒｌｏｖ六级分类法观测脊髓功能变化。结果：ＩＲＡ阻断平均３４ｓ双下肢运动功能完全消失，５５ｓ双下肢感觉功能消失；缺血２０ｍｉｎ再灌流后１～３ｈ内８７％动物的双下肢功能恢复，但再灌流１７～２６ｈ出现二次瘫痪。ＩＲＡ阻断后股动脉血压由１１．３～１６．６ｋＰａ降至２．６２ｋＰａ以下，Ｌ６的ｇＳＣＢＦ由（５１．９４±１３）ｍｌ１００ｇ－１ｍｉｎ－１降至（５．８６±６．０）ｍｌ１００ｇ－１ｍｉｎ－１，Ｌ６的ｗＳＣＢＦ由（３５．８０±７．０）ｍｌ１００ｇ－１ｍｉｎ－１降至（６．７±８．０）ｍｌ１００ｇ－１ｍｉｎ－１；缺血２０ｍｉｎ再灌流即刻（１５ｍｉｎ）股动脉血压和Ｌ６ＳＣＢＦ恢复正常，但再灌流１、３和２４ｈＬ６的ｇＳＣＢＦ和ｗＳＣＢＦ与缺血前相比显著下降，再灌流４８ｈＬ６ｗＳＣＢＦ仍显著下降；但Ｔ１０的ｇＳＣＢＦ和ｗＳＣＢＦ在缺血期和再灌流不同时间均无显著性变化。结论：提示兔脊髓缺血性二次瘫痪可能与继发性ＳＣＢＦ下降有关。     

126例磁共振椎管水成像分析

目的: 探讨磁共振椎管水成像( MRM) 对揭示椎管内梗阻部位及原因的价值及限度。方法: 采用三维快速自旋回波(FSE) 加脂肪抑制技术作冠状面重T2 加权椎管水成像126例, 包括小脑延髓池6 例、颈段18 例、胸段19 例、腰段83 例。所有图像均经三维最大信号强度投影后处理。结果: 90-5 % (114/126) 图像质量优良。MRM 阳性106 人次(101 例,占80-2 % ) , 其中硬膜外病变51 人次、硬膜下病变30 人次、髓内病变23 人次( 共104 人次?) 。66 例手术前后对比, 本组100 % 定位正确, 定性正确率91-3 % 。结论: 重T2 加权FSE 序列MR 椎管水成像是可靠的、非侵袭性的检查方法, 它可代替常规X 线脊髓造影和CT 脊髓造影, 还可解决上述检查无法解决的一些难题     

亚低温在脊髓损伤治疗中的研究现状

对于脊髓损伤,临床上的治疗方法大致包括外科手术、药物、物理治疗等。近些年来,在亚低温广泛应用于颅脑损伤的基础上,又开展了应用于脊髓损伤治疗的研究和亚低温预处理保护髓内切开手术的研究。现将亚低温在脊髓损伤治疗中的研究现状作一综述,以期为脊髓损伤的治疗提供更为可靠的方法。     

肌蒂脊髓移植术治疗脊髓外伤性截瘫的实验研究

<正> 目前对于脊髓损伤的治疗方法尚在探索之中。我们依据肌蒂在生理、生化等方面的特殊优点,首先创用肌蒂脊髓移植的治疗方法;从1985年12月开始动物实验研究及临床应用。现把近年来的动物实验结果一并报告如下。方法与结果第一阶段实验,其结果已作了初步报告。本报告为第二批实验,已取得明显的实验结果。方法为选用中国杂犬36只;年龄2～3岁,体重12～15kg,雄性,用3%速可眠30mg/kg静脉麻醉。实验中途死亡6只;余下30只分三组(每组10只)对比观察,即肌蒂脊髓移植     

62例椎管内肿瘤术后的脊髓功能恢复

６２例椎管内肿瘤术后的脊髓功能恢复徐培坤，王远兴，李汉杰，王斌我科１９９０年～１９９３年间收治椎管内肿瘤６２例，均行手术切除。本文就该组病例分析探讨脊髓慢性受压解除后的功能恢复情况。１一般资料１．１性别与年龄本组男４４例；女１８例。年龄６～７４岁，按...     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.