腰椎间盘手术致脑脊液漏的防治

分析腰椎间盘手术中硬脊膜损伤的原因,探讨了后脑脊液漏的防治。方法回顾１９９０年至１９９８年间４３例腰椎间盘手术致硬脊膜损伤的临床资料。结果经切口放置引流管的１２例病人,有８例于拔术后生了切口脑脊液漏,经切口旁皮肤,椎旁肌置管的３１例病人,拔管后无一例发生切口脑脊液漏。     

The use of a novel perfusion-based cadaveric simulation model with cerebrospinal fluid reconstitution comparing dural repair techniques: a pilot study

Background Context

Watertight dural repair is crucial for both incidental durotomy and closure after intradural surgery.

用流化床干燥法改善颗粒酶的热稳定性

通过流化床干燥法制备稳定化颗粒酶，提高酶的耐热性。在制备过程中进风温度为40℃，酶活回收率达到90％以上。采用海藻酸钠（SA）作包被剂，随着SA质量浓度的提高，酶的耐干热性先增加后降低，在0.4g/dL最高，而其耐湿热性不断增强。水分活度提高，固态酶的耐热性就随之降低，在Aw≥0．3时流化床干燥酶样品的耐热性都明显高于原酶粉，且SA质量浓度越高，酶对水分的耐受能力越高。在流化床干燥酶制剂中添加硫酸铵、氯化钠、硫酸钠等盐类稳定剂，酶的耐干热性有的增强，有的减弱，而其耐湿热性都有所增强，其中硫酸铵的热稳定化效果最好。酶在高温下的失活速度遵循一级动力学，即它的失活是由酶蛋白变性引起的，流化床干燥样品的失活常数低于原酶粉的失活常数，而不同温度下酶的失活遵循阿累尼乌斯方程。     

Post-haemorrhagic subarachnoid fibrosis in dogs. Scanning electron microscopic observation and dye perfusion study

Summary Scanning electron microscopic observations of the subarachnoid space were made in dogs focussing upon the fibre components in both the normal subarachnoid space and in areas of post-haemorrhagic fibrosis. It was concluded that the fibrous tissue originates from the arachnoid membrane itself, while organized haematoma is considered to form a component of the fibrosis.Perfusion of the subarachnoid space of dogs with a solution of 0.1% Toluidine Blue was also done. This showed that cerebrospinal fluid (CSF) is carried from the subarachnoid space directly to the dural sinuses through a fine string-like structure, which is conceivably one of the collateral CSF absorptive pathways.     

膝骨关节炎患者关节滑液中骨桥蛋白和软骨寡聚基质蛋白水平与疾病严重程度相关性

目的:探讨膝骨关节炎（knee osteoarthritis,KOA）患者关节滑液中骨桥蛋白（osteopontin,OPN）和软骨寡聚基质蛋白（cartilage oligomeric matrix protein,COMP）水平与疾病严重程度的相关性。方法：选取2018年2月至2020年5月收治的59例KOA患者作为KOA组,其中男25例,女34例;年龄60~75（65.57±1.56）岁;体质量指数（body mass index,BMI）21.4~30.7（26.12±1.54） kg/m²。采用Kellgren-Lawrence（K-L）分级对X线结果进行评估,其中Ⅱ级（K-L2组）14例,Ⅲ级（K-L3组）27例,Ⅳ级（K-L4组）18例。另选取18例因韧带或半月板疾病进行关节镜检查且无软骨损伤患者作为对照组,男7例,女11例;年龄61~78（64.88±1.60）岁;BMI 22.8~29.9（25.89±1.49） kg/m²。治疗前采集研究对象关节滑液样本,采用酶联免疫吸附试验检测关节滑液OPN、COMP水平,比较KOA组与对照组关节滑液OPN、COMP水平。比较不同K-L分级KOA患者性别、年龄、BMI等临床资料,采用酶联免疫试验检测其关节滑液中白细胞介素-1β（interleukin -1β,IL-1β）,OPN,COMP,基质金属蛋白酶3（matrix metalloproteinase -3,MMP-3）水平,比较不同K-L分级KOA患者临床资料和生化指标,采用Logistic回归分析影响KOA患者K-L分级的因素,采用ROC曲线下面积（area under the curve,AUC）预测KOA疾病严重程度。结果：59例KOA患者获得随访,时间8~27（15.75±3.27）个月。KOA组关节滑液OPN、COMP水平高于对照组（P<0.001）。K-L2组、K-L3组、K-L4组IL-1β、OPN、COMP、MMP-3水平比较差异有统计学意义（P<0.001）;与K-L2组比较,K-L3、K-L4关节滑液关节滑液IL-1β、OPN、COMP、MMP-3 水平均升高（P<0.05）;与K-L3组比较,K-L4关节滑IL-1β、OPN、COMP、MMP-3水平均升高（P<0.05）。多因素Logistic回归分析结果显示：关节滑液OPN、COMP、MMP-3水平是影响KOA患者K-L分级的独立危险因素（OR=6.653, 4.229,1.579,P<0.001）。关节滑液OPN预测K-L4级KOA的AUC为0.720[95%CI（0.588-0.851）],灵敏度为94.4%,特异度为65.9%;关节滑液COMP预测K-L4级KOA的AUC为0.731[95%CI（0.592-0.870）],灵敏度为88.9%,特异度为63.4%;关节滑液OPN联合COMP预测K-L4级KOA的AUC为0.839[95%CI（0.724-0.953）],灵敏度为94.4%,特异度为51.2%;OPN联合COMP预测K-L4级KOA的AUC大于单独OPN、COMP的AUC（Z=4.037,3.540,P<0.05）。结论：KOA患者关节滑液OPN、COMP水平升高,并随着K-L分级增加而升高。关节滑液OPN、COMP是影响KOA患者K-L分级的独立危险因素,二者预测K-L4级KOA 的AUC、灵敏度、特异度高,可用于评估KOA疾病进展。     

温阳消饮法对CHF模型大鼠肾脏水通道蛋白2表达的影响

目的探讨温阳消饮法消除水饮的部分作用机制。方法 Wistar大鼠随机分为空白组和A组,A组动物采用阿霉素(Adr)腹腔注射制备慢性心力衰竭(CHF)模型。造模结束后将A组大鼠再随机分为:模型组、温阳消饮组、去桂消饮组。1温阳消饮组:按12 g/(kg·d)等效剂量灌胃给予温阳消饮方药液,每日1次,连续4周;2去桂消饮组:按10 g/(kg·d)等效剂量灌胃给予去桂消饮方药液,每日1次,连续4周;3模型组、空白组:同等条件饲养,不实施任何给药方案。结果与空白组相比,模型组血清脑钠素(BNP)含量明显升高,肾脏组织中水通道蛋白2(AQP2)蛋白表达降低,差异有显著性(P0.05或P0.01);与模型组相比,温阳消饮组、去桂消饮组血清BNP含量明显降低,肾脏中AQP2蛋白表达增加,差异有显著性(P0.05或P0.01)。结论温阳消饮法可显著降低CHF模型大鼠血清BNP含量,上调CHF模型大鼠肾组织AQP2的表达。     

129例不同孕期正常羊水γ－GT活性测定及临床应用

测定了１２９例正常妊娠不同孕期羊水和７例畸胎羊水γ－谷氨酰转肽酶（γ－ＧＴ，ＥＣ２．３．２．１）活性。正常羊水γ－ＧＴ在孕１４～１５周时活性最高，平均为６６８，１ｕ／Ｌ随孕周增加其活性逐渐降低。在孕２２周时，羊水γ－ＧＴ活性仅为１４周时的１４．４％。７例畸胎羊水中，无脑儿（２例）、脑积水（２例）和胸腔积液（１例）畸胎羊水γ－ＧＴ活性明显降低，且在正常羊水相应孕周组均值±２ｓ范围以下。死胎羊水γ－ＧＴ活性不降低，其中１例活性升高。     

正畸远移尖牙方式与龈沟液RANKL／OPG表达比值的相关性研究

目的探讨不同加力方式对牙齿移动速度的影响以及与龈沟液核因子κB受体活化子配体／骨保护素表达比值（RANKL／OPG）的相关性。方法选取双侧对称拔除4颗第一双尖牙的恒牙列患者,随机分为螺旋弹簧施力组和弹力橡皮链施力组,实施尖牙远中移动,分别于加力前,加力2、4、8、12、16、20周测量尖牙移动量和龈沟液RANKL／OPG值。结果加力4周后,螺旋弹簧组每个时间点的尖牙移动量均大于橡皮链组。两组各加力时间点的RANKL／OPG值均有显著差异。尖牙移动到位后和稳定3个月后的定位根尖片均无牙根吸收现象。结论螺旋弹簧组的骨改建作用强于橡皮链组,龈沟液RANKL／OPG值与骨改建过程具有相关性。     

Gas chromatography-mass spectrometry analysis on compounds in volatile oils extracted from Yuan Zhi（Radix Polygalae） and Shi Chang Pu（Acorus Tatarinowii） by supercritical CO2

OBJECTIVE:To analyze the constituents of volatile oils extracted from Yuan Zhi(Radix Polygalae),Shi Chang Pu(Acorus Tatarinowii),and a mixture of the two herbs.METHODS:The volatile oils were extracted using supercritical fluid extraction(SFE) with CO 2,and the constituents of the volatile oil extracts were analyzed by gas chromatography-mass spectrometry(GC-MS).The relative content of each component was calculated using peak area normalization.RESULTS:The optimized SFE conditions were 45 MPa at 35℃ for 2 h.Twenty-four compounds were identified in the extract from the Yuan Zhi(Radix Polygalae) and Shi Chang Pu(Acorus Tatarinowii) mixture,and six of these had relative contents >1.These compounds were 1,2-dimethoxy-4-(2-propenyl)-benzene;1,2,3-trimethoxy-5-(2-propenyl)-benzene;β-asarone;(Z,Z) 9,12-octadecadienoic acid;(Z) 6-octadecenoic acid;and ethyl oleate.Combination of the herbs increased the number of pharmacologically active substances in the extract and decreased the number of compounds with one benzene ring compared with the extracts from the individual herbs.CONCLUSION:These results indicate there is a synergistic relationship among the compounds in these herbs.     

自发性蛛网膜下腔出血患者血清及脑脊液中单胺类递质的变化

目的 探讨自发性蛛网膜下腔出血(SAH)患者血清和脑脊液中单胺类递质水平与SAH发病的关系.方法 30例自发蛛网膜下腔出血患者与30例健康对照组分别采集血清和脑脊液,运用反相高效液相色谱荧光法,检测去甲肾上腺素(NE)、多巴胺(DA)和5-羟色胺(5-HT)含量.结果 SAH患者血清中DA含量较对照组显著升高(P＜0.05),而NE和5-HT含量与对照组比较差异无统计学意义(P＞0.05).两组脑脊液中NE、DA比较差异无统计学意义(P＞0.05),SAH组5-HT含量低于对照组(P＜0.05).结论 血清DA升高和脑脊液中5-HT下降可能与SAH密切相关,其机制需进一步探讨.