调配骨水泥经皮椎体成形术注入治疗老年骨质疏松性椎体压缩骨折的疗效及其生物相容性

目的：总结经皮椎体成形术治疗老年骨质疏松性椎体压缩骨折的临床效果,并观察骨水泥材料与宿主的生物相容性反应. 方法：①患者对象：阳江市中医医院2003-02/2005-12收治的骨质疏松症性椎体压缩性骨折患者26例（32个椎体）,在C形臂X射线机透视下,行经皮椎弓根途径椎体成形术治疗.其中65岁以下的8例患者（8椎体）在硬膜外麻醉下行体位及手法复位后再行经皮椎体成形术治疗.②骨水泥注入方法及途径：调配骨水泥为英国CORIN公司生产的低黏滞度聚甲基丙烯酸甲酯,在骨水泥中加入尹索显或欧乃派克,粉∶液∶造影剂比例为3∶2∶1.应用1 mL专用注射器（美国COOK公司产品）经穿刺针将处于黏稠阶段的骨水泥注入椎体,当骨水泥达椎体后壁即停止注射.如果单侧穿刺骨水泥分布未超过椎体中线,则同时行另一侧椎弓根穿刺.③效果评估：观察椎体高度的恢复,采用目测类比评分法评估疼痛缓解程度,并发症发生情况与材料及宿主的反应. 结果：26例均完成手术进入结果分析.①每椎体注射骨水泥3.5～8.0 mL,平均4.5 mL,24 h后即离床活动.②手法复位后行经皮椎体成形术者,椎体高度椎体高度恢复到正常的75%～90%,随访≥12个月无椎体高度丢失.③术前目测类比评分为8.1（5.6～9.5）分,术后为2.7（1.2～4.8）分.23例患者腰痛术后24 h内消失,3例陈旧性骨折患者腰痛术后部分缓解.④并发骨水泥椎旁渗漏4例4椎体,未发现特殊的材料和宿主反应;前引流静脉渗漏2例2椎体,无临床症状;穿剌针抽出脑脊液1例,改行另侧穿刺成功. 结论：①经皮椎体成术治疗老年骨质疏松性椎体压缩骨折具有微创、见效快、疗效肯定的优点.②体位及手法复位后行经皮椎体成术,能大部分恢复椎体高度,适合于年龄相对较轻,椎体楔形压缩较多的患者.③只要操作熟练,单侧椎弓根穿刺即能达到临床目的.④骨水泥材料与宿主之间呈现较好的生物相容性.     

Localization of 13-hydroxyoctadecadienoic acid and the vitronectin receptor in human endothelial cells and endothelial cell/platelet interactions in vitro

Blood/vessel wall cell interactions depend, in part, on the expression of adhesion receptors on cell surfaces, such as expression of the vitronectin receptor (VnR) on the apical surface of endothelial cells (ECs) for platelet/EC adhesion. However, it is unclear how receptor expression is regulated from within cells. In previous studies, we found that ECs metabolize linoleic acid into the lipoxygenase monohydroxide, 13-hydroxyoctadecadienoic acid (13-HODE), and that the intracellular level of 13-HODE correlates inversely with VnR expression and platelet adhesion to the EC apical surface. In this study, we determined the physical associations of 13-HODE and VnR in unstimulated and stimulated ECs, ie, at times when ECs were and were not adhesive for specific ligands and platelets, using double antibody immunofluorescent staining techniques and binding assays. 13-HODE and the VnR were colocalized within unstimulated ECs. When ECs were stimulated, 13-HODE was no longer detectable, either in or outside the ECs, and the VnR was detected on the apical surface of the ECs. These changes were paralleled by increased vitronectin binding and increased platelet adhesion to the ECs. We suggest that colocalization of 13-HODE with VnR reflects a 13-HODE/VnR interaction, confining the VnR in a nonadhesive form inside unstimulated ECs, and, as a result, the ECs are nonadhesive. When the ECs are stimulated, 13-HODE and VnR dissociate, allowing the VnR to relocate on the EC surface, where the VnR undergoes a conformational change resulting in increased EC adhesivity.     

Administration of recombinant human interleukin-7 to mice induces the exportation of myeloid progenitor cells from the bone marrow to peripheral sites

The administration of recombinant human interleukin-7 (rhIL-7) to mice twice a day for 7 days does not appreciably change bone marrow (BM) cellularity, but does result in a threefold to fivefold increase in the total number of leukocytes in the spleen, an eightfold to 10-fold increase in the total number of nonparenchymal cells (NPC) obtained from the liver, and up to a 20-fold increase in the total number of peripheral white blood cells (WBC). This regimen of rhIL-7 administration also causes a profound reduction in the total number of progenitors in the BM for both single-lineage colony-forming units- culture (CFU-c) (> 90%) and multilineage CFU-granulocyte, erythroid, monocyte, megakaryocyte (CFU-GEMM) (> 99%) colonies. In contrast, mice treated with rhIL-7 exhibited increases in both CFU-c (20- to 40-fold, 20-fold, and 15- to 40-fold) and CFU-GEMM (8- to 10-fold, 30-fold, and 6- to 10-fold) cultured from the peripheral blood, spleen, and NPC, respectively. The increase in CFU in the NPC was accompanied by a fivefold increase in the number of MAC-1+ cells and a ninefold increase in the number of 8C5bright+ cells. Splenectomy of mice before the administration of rhIL-7 further increased the total number of WBC, NPC, and myeloid progenitors as compared with the rhIL-7-treated nonsplenectomized mice. Finally, selective depletion of the BM by intraperitoneal administration of 89Sr (98% reduction in BM cellularity and > 99% reduction in BM myeloid progenitors) abrogated the rhIL-7- induced increases in cellularity and myeloid progenitor number in the peripheral blood, spleen, and NPC. These results show that the changes in myelopoiesis observed after in vivo administration of rhIL-7 to mice result largely from the emigration of myeloid progenitors from the BM through the blood to the spleen, liver, and, possibly, other peripheral organs.     

Hemodynamics of portal blood flow shown by CT portography. Work in progress

Computed tomography and arterial portography were combined in 12 patients for studies of the anatomy and hemodynamics of the portal venous system. This technique was found to be more sensitive than conventional venous-phase angiograms of the superior mesenteric and splenic arteries for evaluation of the anatomy of the portal venous system and extent of thrombosis in patients with cavernous transformation and also facilitated recognition of subtle evidence of hepatofugal flow and portosystemic shunts. CT portography can be employed when conventional angiograms fail to show the portal vein adequately.