人工髓核假体置入治疗腰椎间盘突出症的疗效分析

目的：观察已在临床初步开展起来的人工髓核置换术治疗腰椎间盘突出症的中、远期临床疗效及并发症,分析其对策。 方法：纳入2002-02/2004-08南方医科大学附属南方医院脊柱骨病外科采用单枚人工髓核假体置换术治疗单节段腰椎间盘突出症患者98例,获得24～48个月随访患者75例,按平均随访时间达24,36,48个月,分为24个月组（n=30）,36个月组（n=23）,48个月组（n=22）。选同期采用单纯椎间盘髓核摘除术患者30例作为对照组,评估各组术后临床疗效,主观症状采用Oswestry功能障碍指数问卷表（0%表示正常,越接近100%则功能障碍越严重）和Prolo功能评分表（小于或等于5分为差,6～7分为中等,8～10为优）评价,分析术后影像学检查并测量手术节段活动度和椎间隙高度变化情况,同时观察假体位置情况,腰椎MRI观察假体位置和软骨终板的信号变化情况。腰椎活动度=（腰椎中立角度-前屈角度）＋（后伸角度-腰椎中立角度）=后伸角度-前屈角度;为消除X射线放大率的影响,椎间隙高度变化情况采用病变椎间隙后缘高度与上位椎体中部矢状径的比值表示。 结果：75例获得24～48个月随访者,全部进入结果分析。①48个月组2例、36个月组1例发生假体脱出,二次手术取出。其余患者术后临床症状均明显缓解,疼痛消失。②24,36,48个月组及对照组术后末次Oswestry功能障碍指数均较术前降低,差异有显著性意义（14.2%,52.1%;15.5%,55.2%;15.1%,53.6%;15.5%,51.5%;P〈0.05）。③24,36,48个月组及对照组术后末次Prolo能评分均较术前升高,差异有显著性意义（8.5,4.6分;8.6,4.5分;8.7,4.3分;8.4,4.2分;P〈0.05）。④24,36,48个月组同期手术节段腰椎活动度均高于对照组,差异有显著意义（P〈0.05）。⑤24个月组手术节段椎间高度较术前降低约4%、36个月组降低约12%、48个月组降低约18%、对照组较术前降低约25%,各组术前和术后椎间隙高度比值比较,差异具有显著性意义（P〈0.05）。⑥主要并发症：早期出现术后一过性腰痛24例,假体脱出3例。中、远期发现假体下沉32例,软骨终板损伤39例。 结论：单枚人工髓核假体置换治疗腰椎间盘突出症中、远期随访临床疗效肯定,但存在较严重并发症,应慎重开展此项手术。     

The prevalence of immunization to Duffy antigens in a population of known racial distribution

A retrospective study at our hospital determined the race or ethnicity of patients seen in an 8-year period who had formed antibodies to Duffy antigens. During that time, 9876 serologic investigations had been performed as a result of a positive direct or indirect antiglobulin test. Among these samples, sera from 45 previously transfused or pregnant patients contained anti-Fya and two contained anti-Fy3. Twenty-nine of the sera that contained anti-Fya (62%) were from blacks, 12 (25%) were from whites, and 6 (13%) were from Hispanics. Both examples of anti-Fy3 were made by black patients. Red cells (RBCs) from 21 of the black patients were Fy(a-b-), those from 7 were Fy(a-b+), and those from 1 could not be phenotyped. RBCs from 17 of the non-black patients were Fy(a-b+) and those from 1 could not be phenotyped. The population of transfused patients evaluated in this study was 47 percent black, 29 percent white, and 24 percent Hispanic. Calculations based on an expected Fy(a-) frequency of 88 percent in blacks, 33 percent in whites, and 20 percent in Hispanics predict that the racial makeup of the Fy(a-) population at our hospital would be 73 percent black, 18 percent white, and 9 percent Hispanic, which is not significantly different (p = 0.25) from the racial makeup of the patients forming anti-Fya and -Fy3. These data indicate that blacks make antibodies to Duffy antigens as frequently as non-blacks.     

人参皂甙Rb_1和Rg_1对小鼠中枢神经递质受体和脑内蛋白质合成的影响

应用放射配基结合法测定了人参皂甙Rb_1和Rg_1对α_1,α_2,β肾上腺素能受体、M胆碱能受体、5-羟色胺、多巴胺及GABA等七种受体的作用。结果均不能证明它们对这七种受体有亲和力。但给动物ip药物连续5天,Rb_1和Rg_1均能使中枢M胆碱受体密度显著增高。Rb_1及Rg_1还能显著增加脑内蛋白质的含量。上述实验结果对解释人参的中枢作用提供了重要证据。     

柯萨奇-腺病毒受体在肾癌组织中的表达及意义

目的:研究柯萨奇-腺病毒受体(CAR)在肾癌组织中的表达及意义.方法:应用免疫组化SP法检测12例癌旁正常肾组织和48例肾细胞癌组织中CAR的表达.结果:12例正常肾组织全部表达CAR,48例肾细胞癌组织中31例无CAR表达.不同分级CAR表达率分别为Ⅰ级54.5%(12/22)、Ⅱ级23.5%(4/17)、Ⅲ级11.1%(1/9);不同分期CAR表达率分别为Ⅰ期57.9%(11/19)、Ⅱ期30.8%(4/13)、Ⅲ期18.2%(2/11)、Ⅳ期0(0/5).结论:在多数肾细胞癌组织中CAR基因表达丧失;CAR表达变化与肾癌的分级、分期相关,可以作为肾癌分化、转移的重要生物学指标.     

Two kinds of memory signals in neurons of the human hippocampus

Prior studies of the neural representation of episodic memory in the human hippocampus have identified generic memory signals representing the categorical status of test items (novel vs. repeated), whereas other studies have identified item specific memory signals representing individual test items. Here, we report that both kinds of memory signals can be detected in hippocampal neurons in the same experiment. We recorded single-unit activity from four brain regions (hippocampus, amygdala, anterior cingulate, and prefrontal cortex) of epilepsy patients as they completed a continuous recognition task. The generic signal was found in all four brain regions, whereas the item-specific memory signal was detected only in the hippocampus and reflected sparse coding. That is, for the item-specific signal, each hippocampal neuron responded strongly to a small fraction of repeated words, and each repeated word elicited strong responding in a small fraction of neurons. The neural code was sparse, pattern-separated, and limited to the hippocampus, consistent with longstanding computational models. We suggest that the item-specific episodic memory signal in the hippocampus is fundamental, whereas the more widespread generic memory signal is derivative and is likely used by different areas of the brain to perform memory-related functions that do not require item-specific information.

The hippocampus is essential for the formation of declarative (conscious) memory (1, 2), including both episodic memory (memory for events) and semantic memory (factual knowledge). Episodic memories represent the “what, when, and where” information about remembered events (3). Here, we focus on the neural representation of episodic memory for events, specifically words presented and later repeated in a continuous recognition memory format (4).Bilateral hippocampal lesions result in substantial anterograde amnesia for new events, whether memory is tested by recall or recognition (5). By contrast, bilateral lesions to a more anterior medial temporal lobe structure―the amygdala―have no such effect (6). One might therefore expect to find single-unit activity associated with episodic memory in the hippocampus but not in the amygdala. Yet, the earliest single-neuron studies failed to detect hippocampal neurons that fired differentially to recently presented test items vs. novel items. This was true in studies with humans (7, 8) and monkeys (9–11). One early study with monkeys identified a few such neurons in the hippocampus (12), and other studies found them in areas other than the hippocampus (e.g., inferomedial temporal cortex or inferotemporal temporal cortex) (9–11, 13, 14). Overall, this was not the pattern anticipated from lesion studies.Subsequent studies successfully detected some memory-related neural activity (15–17), observing that ∼10% of hippocampal neurons exhibited differential firing rates based on item status, with some firing more for repeated items and others firing more for novel items. Surprisingly, similar “memory-selective” neurons were also reliably detected in the amygdala at approximately the same frequency. Yet, these memory-selective neurons responded differentially to the generic, categorical status of test items (repeated vs. novel) and thus are not episodic memory signals (i.e., signals representing memory for specific events). According to neurocomputational models dating back to Marr (18), episodic memory representations in the hippocampus are supported by sparse neural codes (19–21). If memories for individual items are sparsely coded in largely nonoverlapping (pattern-separated) neural assemblies, it should be possible to find neurons that respond to particular repeated items, rather than to an item’s generic status. Two recent single-unit studies with humans detected such neurons in the hippocampus, but not in the amygdala (22, 23), apparently reflecting sparsely coded episodic memories. In the present study, we tested 1) whether the generic and the item-specific signals coexist in neural firing patterns recorded during the same memory task, and 2) whether the two kinds of signals are present exclusively in the hippocampus or are also evident in other brain regions.During a continuous recognition memory procedure, neurons were simultaneously recorded from four brain regions: hippocampus, amygdala, anterior cingulate cortex, and prefrontal cortex. Altogether, 55 continuous recognition memory sessions were completed by 34 epilepsy patients who had implanted clinical depth electrodes with microwires measuring single-unit activity (SUA) and multiunit activity bilaterally (24). We limited the present analyses to SUA. Words were presented consecutively and repeated once after varying lags; patients judged each word as either “novel” or “repeated.” Thus, repeated words differed from their earlier presentations as novel words only with respect to their combined “what, when, and where” episodic status (3).     

The formation and function of the neutrophil phagosome

Neutrophils are the most abundant circulating leukocyte and are crucial to the initial innate immune response to infection. One of their key pathogen-eliminating mechanisms is phagocytosis, the process of particle engulfment into a vacuole-like structure called the phagosome. The antimicrobial activity of the phagocytic process results from a collaboration of multiple systems and mechanisms within this organelle, where a complex interplay of ion fluxes, pH, reactive oxygen species, and antimicrobial proteins creates a dynamic antimicrobial environment. This complexity, combined with the difficulties of studying neutrophils ex vivo, has led to gaps in our knowledge of how the neutrophil phagosome optimizes pathogen killing. In particular, controversy has arisen regarding the relative contribution and integration of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase-derived antimicrobial agents and granule-delivered antimicrobial proteins. Clinical syndromes arising from dysfunction in these systems in humans allow useful insight into these mechanisms, but their redundancy and synergy add to the complexity. In this article, we review the current knowledge regarding the formation and function of the neutrophil phagosome, examine new insights into the phagosomal environment that have been permitted by technological advances in recent years, and discuss aspects of the phagocytic process that are still under debate.