髓核低温消融术治疗颈性眩晕(附48例分析)

目的评价髓核低温消融术对颈性眩晕的临床治疗效果。方法回顾性分析采用颈椎间盘髓核低温消融术治疗48例颈性眩晕病人的手术经验。消融间隙:C3,4 21例,C4,5 15例,C5,6 4例,C6,7 1例,C3,4、C4,5同时消融3例,C3,4、C5,6同时消融4例。消融过程在G臂X-线机下进行,套管针穿刺到目的间隙后,插入特殊等离子刀头对椎间盘髓核进行低温消融。术后采用抗生素、地塞米松静脉滴注2 d。戴颈围7 d。随访时间3～5年,采用视觉模拟评分(VAS)系统记录病人治疗前后以及随访时的症状情况。结果病人术后当天即可戴颈围下地。眩晕及头痛症状术后即刻消失29例,术后1～2周逐渐缓解18例,改善不明显1例;VAS术前(6.92±0.87)分,术后即刻(2.94±0.63)分,术后3个月(2.36±0.61)分,术后1年(3.43±0.80)分,术后3年(3.73±0.71)分。术后出现Horner综合征1例,2周后自行缓解。结论颈椎间盘髓核低温消融术治疗颈性眩晕具有较好的近期和远期疗效,对于保守治疗无效而又不适宜手术治疗的病人,是一个值得推荐的治疗选择。     

The dorsal tegmental nucleus: an axoplasmic transport study

The afferent and efferent connections of the dorsal tegmental nucleus (DTN) were studied in the rat using axoplasmic transport techniques. Horseradish peroxidase (HRP) and Fast Blue were injected stereotaxically into either pars centralis or pars ventromedialis of the DTN, two subdivisions of the nucleus with distinctive connected with the ipsilateral lateral mammillary and interpeduncular neclei; these projections constitute the major afferent and efferent systems of the DTN. Commissural fibers from the corresponding pars centralis and intrinsic fibers systems are massive and form a complex fiber meshwork within the subnucleus. The prepositus hypoglossi nuclei (bilateral) also project to the pars centralis. Smaller numbers of afferent fibers arise from the lateral habenular nucleus, the posterior hypothalamus and the brainstem reticular formation.The pars ventromedialis of the DTN receives diverse inputs which include the septal nuclei, diagonal band of Broca, preoptic area, anterior and lateral hypothalamus, lateral and medial habenular nuclei, medial mammillary nucleus and many nuclei of the brainstem reticular formation. Based on the differences of connections and cytoarchitecture between the pars and the pars ventromedialis, the pars ventromedialis may be an entity separate from the dorsal tegmental nucleus.     

The effect of carbon dioxide laser irradiation on cranial bone healing

An experimental study on the effects of carbon dioxide laser irradiation osteotomy of the calvarium of 4-week old rabbits was compared with that of an osteotomy performed with a high speed drill. Histological studies of calvarium cross sections were performed at 2, 4 and 6 weeks following the osteotomies. As early as 2 weeks following high speed drill osteotomy connective tissue bridged the bone edges. By 4 weeks this bridge was thickened and endowed with numerous vessels. At 6 weeks numerous osteoblasts lined the bone edge and connective tissue bridge. Following laser osteotomy the carbonized edges interrupted the connective tissue from bridging the bone edges at 2, 4 and 6 weeks. By 6 weeks following the laser osteotomy connective tissue had grown past the carbonized residue and the healing process proceeded with osteoblast proliferation from points beyond the carbonized residue. The significance of these findings in reference to the reossification process following osteotomies for craniosynostosis and craniofacial surgery, is discussed.     

烟酰胺对兔髓核细胞增殖及凋亡的调节作用

背景：研究表明，烟酰胺能够对白细胞介素1β或肿瘤坏死因子α致椎间盘退变起到保护作用，但烟酰胺对椎间盘细胞凋亡与增殖的保护机制尚不很清楚。 目的：观察烟酰胺对兔髓核细胞增殖及凋亡的调控作用及其机制。 设计、时间及地点：随机对照分组设计，于2007-04/10在华中科技大学同济医学院附属协和医院骨科实验室及协和医院干细胞中心完成。 材料：2~3月龄日本大白兔10只，体质量1.5~2.0 kg，取L1~L6节段椎间盘内髓核细胞，体外培养髓核细胞凋亡模型。 方法：实验分为6组，正常对照组：不加任何药物；烟酰胺组：加入0.5 g/L 烟酰胺；白细胞介素1β组：加入10 μg/L 白细胞介素1β；白细胞介素1β＋Caspase抑制剂组：加入10 μg/L 白细胞介素1β及非特异性Caspase抑制剂Z-VAD-FM；白细胞介素1β＋小剂量烟酰胺组：加入10 μg/L 白细胞介素1β及0.05 g/L 烟酰胺组；白细胞介素1β＋大剂量烟酰胺组：10 μg/L 白细胞介素1β及0.5 g/L 烟酰胺。3 d 后对各组细胞行Annexin V-PI染色，Caspase-3、Caspase-8、Caspase-9功能染色检测及MTT检测。 主要观察指标：各组细胞凋亡率、caspase-3、8、9功能染色阳性细胞率及各组细胞的吸光度。 结果：①白细胞介素1β＋Caspase抑制剂组和白细胞介素1β＋大剂量烟酰胺组较白细胞介素1β组细胞凋亡率明显下降（P < 0.01）。②白细胞介素1β＋Caspase抑制剂组、白细胞介素1β＋大、小剂量烟酰胺组Caspase-3、Caspase-8、Caspase-9功能染色阳性细胞率较白细胞介素1β组明显下降（P < 0.01或P < 0.05）。③与白细胞介素1β组相比，白细胞介素1β＋Caspase抑制剂组和白细胞介素1β＋大剂量烟酰胺组吸光度升高（P < 0.01）。 结论：烟酰胺可以促进髓核细胞的增殖并抑制白细胞介素1β诱导的髓核细胞凋亡，对凋亡的抑制作用主要通过抑制凋亡的线粒体途径实现。     

Neurodegenerative effect of electrocauterization on spinal nerve root: an experimental study

We investigated the number of degenerated neurons in spinal roots of rabbits after spinal surgery to test if electrocauterization causes neuronal loss. The number of degenerated neurons was higher in study group than in control group, and the number of live neurons was higher in control group than in study group. These results suggest that electrocauterization applied during spinal surgery is hazardous to spinal neurons and should not be applied unless required.     

人工髓核假体的研究进展及其发展方向

背景：人工髓核置换是治疗腰椎间盘疾病以及重建椎间稳定和微动功能的最佳方法之一,理想的人工髓核材料的研究是当前研究的热点和难点。目的：简要回顾国内外治疗腰椎间盘突出症尝试的不同方法以及取得的成绩,重点分析人工髓核材料的发展历史及现状,并对预制型和原位聚合型两种人工髓核基本特性进行综述。方法：由第一作者检索1995/2010 PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)、万方数据库(http://www. wanfangdata.com.cn)、书籍《腰椎间盘突出症》有关腰椎间盘退变治疗方法、髓核置换材料选择及置入方法等方面的文献。英文检索词为“nucleus replacement,biocompatibility,disc degenerative”,中文检索词为“髓核置换,生物相容性,间盘退变”。检索文献量总计90篇,排除重复性研究,共保留其中的36篇归纳总结。结果与结论：目前髓核置换假体可以分为两种：预制型和原位聚合型。预制型假体与生理髓核组织的生物力学更相近,但是报道有不同并发症。原位聚合材料由不同的单体在置入后聚合、硬化形成弹性体,这就使手术创伤降到最小,减少内植物移位的风险,但是这些材料仍在初步评估节段。提示作为治疗腰椎间盘突出症的新方法之一,不同材料的人工髓核目前正处于不同研制阶段中,并且取得了一些有意义的早期研究成果,人工髓核置换作为常规手术的补充和改进,是一种具有潜力的治疗方式。     

Diagnosis of 3-level lumbar nucleus pulposus prolapse]

Clinical investigations and plain film of the spine are not sufficient for diagnosis of three-level lumbar nucleus pulposus prolapse. Contrast investigations, especially radiculography with television monitoring, are particularly suitable for demonstration of multiple prolapses. In a material of 730 cases two-level prolapse was found in about 12% of cases and three-level prolapse in about 0.5% of cases and this suggests that radiculography should be carried out routinely before each operation for lumbar nucleus pulposus prolapse.     

The colchicine experimental epileptic focus: an intracellular study

A new experimental epileptic focus is described in which colchicine is topically applied to neocortex. Stable epileptiform discharges developed, with bursts of action potentials, coincident with the surface epileptiform events. There were depolarizing and hyperpolarizing neuronal potentials and glial depolarizations concomitantly with the surface epileptic spikes.     

腰椎间盘髓核退变MRI表现与生化改变的对照分析

目的：分析退变腰椎间盘髓核的MRI信号表现与生化改变的相关性。 方法：36个腰椎间盘髓核样本取自2006-08/2007-01在山东省千佛山医院手术的33例腰椎间盘突出症的患者, 依据Minna tertti分类法Ⅱ、Ⅲ类各18个。术前测量髓核及脑脊液矢状面MRI T2WI平均信号强度，计算二者的比值；术后测量髓核的水、胶原和蛋白多糖含量。用Pearson相关检验评估T2WI信号值和水、蛋白多糖和胶原含量之间的相关性。 结果：经Pearson相关检验表明，Ⅱ、Ⅲ类腰椎间盘的髓核平均信号强度比值与蛋白多糖、水含量呈正相关，与蛋白多糖含量之间的相关系数分别为0.745，0.723，P < 0.001；与水含量之间的相关系数分别为0.732，0.714，P < 0.001；与胶原含量呈负相关，相关系数分别为-0.679，-0.681，P < 0.001。 结论：退变腰椎间盘髓核MRI信号表现与其生化改变是一致的，信号强度随水、蛋白多糖含量的减少和胶原含量的增加而降低。     

The effect of glycerol and intracarotid phenoxybenzamine after experimental subarachnoid hemorrhage an ultrastructural study

Summary Twenty-four hours and one week, respectively, after subarachnoid hemorrhage (SAH) had been experimentally induced in baboons, therapeutic dosages of glycerol and/or phenoxybenzamine hydrochloride were injected intravenously. Groups of three animals were studied at various time intervals after SAH: one animal served as a control, one animal per group received phenoxybenzamine hydrochloride (PBZ), and thefinal animal received both PBZ and a 10% glycerol (in saline) injection. The animals were prepared for electron microscopy by whole body perfusion with a glutaraldehyde/phosphate fixative.Few ultrastructural abnormalities were noted in cerebral tissue in each of the animals receiving glycerol, whereas the brain tissue from the untreated animals and those which had been treated with PBZ alone showed morphological changes compatible with cerebral edema.This study was supported in part by U.S. Public Health Service Grant NS 00287.     

Antinociceptive effect of Er:YAG laser irradiation in the orofacial formalin test

Low-power, soft, or low-level laser irradiation has been successfully used to provide analgesia in injured or diseased tissues. In this study, we tested the possible antinociceptive effect of laser irradiation when applied to a normal tissue before the onset of a painful stimulus. Male Wistar rats (350-380 g) were used. A 1.5% formalin solution (50 microL s.c., diluted in saline) was injected into the right upper lip of the test animals (n = 9) immediately after 10 min of low-power Er:YAG laser irradiation (wavelength: 2.94 microm; energy: 0.1 J/cm(2)/pulse at 10 Hz). Control animals (n = 9) were restrained for 10 min without laser application. The nociceptive response, i.e., the amount of time the rats spent rubbing the formalin injected area, was measured by an investigator blind to whether the animals had been laser irradiated or not. On laser irradiated rats, significantly less nociceptive behavior was observed only during the late phase (12-39 min) of the test. This result is similar to that reported for nonsteroid antiinflammatory drugs (NSAIDs) and other peripherally acting antiinflammatory agents. We conclude that low-power laser irradiation have a tonic antinociceptive effect on inflammatory pain even when applied before tissue injury.     

The other-race effect for face perception: an event-related potential study

Summary It is well known that a recognition bias can be observed whenever subjects have to decide whether they have seen a person before that belongs to a different ethical group. Although this “other-race effect” is well documented on a behavioural level, its underlying mechanisms remain unclear. One plausible explanation might be that cortical areas involved in face processing are not as effective for other-race faces due to a missing experience with individuals from other ethnical groups. This interpretation is strongly supported by a functional magnetic resonance imaging study showing decreased brain activity on other-race faces. Furthermore, two event-related potential studies revealed differences in brain activity in the first 250 ms after face presentation, but with inconsistent results. Therefore, we investigated 12 Caucasian subjects, showing them faces of Asian and Caucasian subjects in a perceptual priming paradigm and measured the event-related brain potentials. On a behavioural level we found slower reaction times to Asian faces compared to Caucasian faces in the unprimed condition, reflecting a deficit for Caucasian subjects to process other-race faces. In accordance with these behavioural data we see a significantly reduced late N250r amplitude in the unprimed condition to the Asian faces compared to the Caucasian faces. These results clearly indicate that the other-race effect was present in our sample and very specific only in the unprimed condition around 350–450 ms after stimulus onset.