腰椎终板、椎间盘退变及椎间盘造影疼痛激发试验的相关性研究

目的探讨下腰痛患者腰椎终板Modic退变、椎间盘退变及CT引导下腰椎间盘造影疼痛激发试验的相关性.方法对45例下腰痛患者常规行腰椎X线和MR检查,分别按Modic终板退变标准（0～3级）与Pearce椎间盘退变标准（Ⅰ～Ⅴ级）对终板和椎间盘进行评估.在CT引导下对45例患者中的40例（120个椎间盘）进行造影和疼痛激发试验,并按Dallas椎间盘造影分级系统（DDD）测评椎间盘退变程度.采用SPSS 11.5统计学软件分析腰椎终板Modic退变、椎间盘退变与腰椎间盘造影疼痛激发试验之间的相关性.结果40例下腰痛患者的腰椎终板Modic分级与椎间盘退变Pearce分级存在较强的相关性（Pearson x^2=43.326,P=0.000）,与椎间盘造影疼痛激发试验有显著相关性（Pearson x^2=27.858,P=0.000）;椎间盘退变Pearce分级与CT椎间盘造影椎间盘退变Dallas分级也呈较强的相关性.结论腰椎终板Modic退变分级与椎间盘退变Pearce分级密切相关,而与椎间盘疼痛激发试验有显著相关性,提示终板Modic退变可能是下腰痛的原因之一.     

项韧带骨化相关因素及其组织学变化

目的：探讨脊髓型颈椎病患者项韧带骨化的相关因素及其组织学改变特点.方法：将45例脊髓型颈椎病患者根据项韧带有无骨化分为两组,观察并统计两组患者的年龄、性别组成、颈椎椎间退变和颈椎稳定性情况,对各指标与项韧带骨化的关系进行相关性分析,同时观察项韧带骨化的组织学改变.结果：统计分析表明,项韧带骨化和颈椎椎间退行性改变及颈椎不稳定之间具有相关性（P＜0.05）;同时还与患者年龄、性别组成有相关性（P＜0.05）.项韧带骨化的组织学改变以软骨内化骨为主.结论：项韧带骨化与颈椎退行性改变及颈椎椎间关节不稳定具有相关性,组织学改变以软骨内化骨为主.     

过量氟化物导致大鼠腰椎黄韧带退变与骨化

[目的]研究氟化物在黄韧带骨化中可能的作用机理。[方法]36只雄性SD大鼠，实验组饮用含NaF（质量分数为1014）蒸馏水，分别于3个月及6个月时，检测骨密度，血清、骨组织标本中Ca、P^3＋、Mg、Zn、Cu、Fe、F^-含量和血清碱性磷酸酶（ALP）活性；行大鼠腰段标本X线检查后组织病理观察。[结果]3个月实验组10只大鼠中6只出现氟斑牙：6个月实验组均出现氟斑牙，且大鼠中轴骨骨密度显著增加（P〈0．05）。X线检查，6个月实验组中有4只可见黄韧带嵴状骨化影。病理观察，3个月实验组大鼠黄韧带呈退行性改变；6个月实验组部分黄韧带骨化，骨化类型以膜内骨化为主。[结论]过量氟化物可造成SD大鼠腰椎黄韧带的退变、骨化，在黄韧带的骨化中可能起重要作用。     

Freezing of gait in postmortem-confirmed atypical parkinsonism.

The frequency and pathophysiology of freezing of gait (FoG) in atypical parkinsonism is unknown. We analysed the frequency of FoG in postmortem-confirmed atypical parkinsonian disorders (APD) comprising corticobasal degeneration (CBD), dementia with Lewy bodies (DLB), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP). Sixty-six patients with pathologically confirmed APD (CBD, n = 13; DLB, n = 14; MSA, n = 15; PSP, n = 24) formed the basis for a multicenter clinicopathological study. Clinical features at first and last clinical visit were abstracted from patient records on standardized forms following strict instructions. At the first visit (median 36 months after symptom onset), 24% of APD had FoG (CBD, 8%; DLB, 21%; PSP, 25%; MSA, 40%). Logistic regression analysis showed a significant association of FoG and urinary incontinence (P = 0.04) at first visit. At last visit, 47% of APD had FoG (CBD, 25%; PSP, 53%; DLB, 54%; MSA, 54%). Clinicopathological correlation based on routine postmortem examination failed to identify a consistent neuropathological substrate of FoG. This study demonstrates that (1) FoG is common in APD, and (2) urinary incontinence is significantly associated with FoG in these disorders. Whether FoG and urinary incontinence share similar neuropathological substrates remains to be determined by future studies.     

Changes in glial fibrillary acidic protein mRNA expression after corticospinal axotomy in the adult hamster

We examined changes in the expression of glial fibrillary acidic protein (GFAP) mRNA during Wallerian degeneration in the corticospinal system of the adult Golden hamster following axotomy. GFAP is the product of a type III intermediate filament (IF) gene that is expressed specifically in mature astrocytes. A well-studied component of a complex response termed reactive astrogliosis that occurs after various types of CNS injury is the increased production of astrocytic processes filled with GFAP-containing IFs. While increased expression of GFAP during reactive astrogliosis has been well established at the protein level, little is known about whether or not changes in GFAP mRNA levels occur after CNS injury. In the present study we used in situ hybridization methods to examine this issue. A 35S-labeled mouse GFAP cDNA probe was used for in situ hybridizations of sections of the brain stem obtained 2, 7, and 14 days after unilateral transections of the corticospinal tract in the caudal medulla. Film as well as emulsion autoradiography showed a dramatic increase in GFAP mRNA labeling associated with the degenerating corticospinal tract. GFAP mRNA levels were already dramatically increased in the injured corticospinal tract by 2 days post axotomy and remained elevated at 14 days. Interestingly, in addition to the robust increase in GFAP mRNA levels specifically associated with the degenerating tract, a diffuse increase in GFAP mRNA labeling was observed throughout the grey matter of the brain stem at 2 days post-axotomy, but not after this time. Immunoblotting and immunocytochemical experiments verified that the increased GFAP mRNA levels in the degenerating corticospinal system were accompanied by an increased expression of the protein. These results demonstrate that an increase in GFAP mRNA levels occurs during Wallerian degeneration in the CNS and suggest that increased expression of the GFAP gene is a major contributor to CNS scarring that results after direct traumatic injury.     

非孕期子宫肌瘤红色变性40例分析

目的 了解非孕期子宫肌瘤红色变性的临床特征。方法 本组回顾分析了1993年1月～2001年2月间住院手术治疗40例非孕期子宫肌瘤红色变性的临床病理特征。结果 非孕期子宫肌瘤红色变性发生率为2.3%。生育年龄多见，绝经后也可发生。有典型表现者2例，占5%，非典型下腹隐痛而无发热者7例，占17.5%，肌瘤结节局部压痛者12例，占30%，无任何症状者30例，占75%，白细胞升高占10例，25%。90%的红色变性肌瘤直径在5cm以上，77.5%为壁间肌瘤。68.6%有典型牛肉样改变，54.8%旋涡状结构存在。65%为单纯红色变性，余35%可合并其他类型变性。结论 非孕期子宫肌瘤红色变性临床过程缓和，症状不典型，易漏诊，不作为手术指征，但因子宫肌瘤往往较大，多需手术治疗。     

肝豆状核变性的治疗进展

阐述肝豆状核变性（HLD）在药物、饮食、外科和分子生物学方面的治疗进展，介绍了HLD的药物治疗、外科治疗和分子生物学治疗中的新方法或新技术：以DMPS等为主的药物治疗仍是治疗HLD的主体方法，肝移植等是治疗HLD中的暴发性肝功能衰竭的首选方法，基因等治疗为HLD的彻底治疗提供了可能。     

力学刺激促进骨髓基质干细胞体外软骨分化

目的探讨离心力刺激对猪骨髓基质干细胞(BMSCs)体外成软骨分化的作用,以及对三维支架上构建组织工程化软骨的影响,明确力学刺激与细胞分化及组织形成的关系,为体外软骨构建提供适当参数。方法抽取8周龄猪髂嵴骨髓,应用贴壁法分选单个核细胞,体外培养扩增后获得第2代BMSCs,以5.0×107/cm3的细胞密度接种到聚羟基乙酸(PGA)制成的圆柱形三维支架上,7d后分成4组,在不同的力学条件及诱导条件下培养。8周后取材,行相关检测。结果力学诱导组形成的组织呈白色,细腻光泽,形状规则,体积无明显改变,有良好的弹性和硬度,并具有典型的软骨陷窝结构和大量软骨特异性细胞外基质,Ⅱ型胶原及丰富的聚合蛋白多糖(GAG)成分。GAG含量为(6.0±1.2)mg/g,抗压强度为(2.2±0.8)kPa,弹性模量为(7.4±1.6)kPa。各项指标均明显优于其他各组。结论力学刺激有利于促进BMSCs成软骨分化,并在三维支架材料上构建组织工程化软骨。     

支架及无支架条件下构建组织工程软骨的研究进展

支架材料的研究是组织工程的研究热点之一,软骨细胞复合培养给组织工程软骨的构建带来希望,单一的材料诸如胶原、透明质酸、壳聚糖、纤维蛋白凝胶等已经证明可以与软骨细胞复合培养,两种或者多种材料复合可以提高材料的性能,更好地用于组织工程软骨的构建,并满足软骨缺损修复的需要;同样,在无支架情况下应用软骨细胞聚集培养、沉淀培养的方法,可以构建组织工程软骨,并给软骨缺损的修复带来新希望,但目前的研究较少。两者是组织工程软骨构建的两个主要方向。     

自体骨膜游离移植的实验研究--不同龄动物大块关节软骨缺损修复的比较

目的研究比较自体骨膜移植软骨再生修复不同龄动物大块关节软骨缺损。方法用52只不同龄家兔自体骨膜游离移植修复大块关节软骨缺损,比较移植骨膜生发层朝向关节腔与松质骨时再生软骨的差别。结果经不同时期肉眼和组织学检查证实,幼年兔和成年兔的骨膜移植都能生成软骨,修复大块关节软骨缺损。在成年兔骨膜再生的软骨与成年兔本身周围正常软骨的厚度、组织结构一样。移植骨膜生发层朝向关节腔与松质骨二者间再生软骨结果无明显差别。结论骨膜具有再生软骨的能力,可用来移植修复关节软骨的缺损。骨膜移植生发层不同朝向对软骨再生无明显影响。成年后骨膜移植修复关节软骨缺损能够生成与自身相适应的软骨。