椎弓根固定及椎间植骨融合治疗腰椎退行性椎管狭窄症

腰椎退变性椎管狭窄症多见于中老年患者,一旦出现明显的神经压迫或间歇跛行症状,多需要手术治疗。以往采用只减压不Ⅰ期融合的方法治疗,具有简单、有效、费用低廉等优点,是一种公认的技术。但随着相关研究的深入,经过较长时间的随访发现,部分患者效果不理想,随访5年以上的优良率为50·0%~70·8%,说明了恢复腰椎稳定性对腰椎手术远期疗效的重要性。2001年2月-2004年10月,采用腰椎管减压、椎间Cage植骨融合、椎弓根内固定术式治疗36例腰椎退变性椎管狭窄症患者取得了满意的疗效。1临床资料本组36例,男16例,女20例;年龄32~69岁,平均为50·3岁…     

On the Use of Paramagnetic Beads and Ferrofluids to Assess and Eliminate the Leukocytic Contribution to Oxygen Radical Generation by Human Sperm Suspensions

PROBLEM: To develop a methodology to determine a) the leukocytic contribution to reactive oxygen species generation by human sperm suspensions and b) the therapeutic value of removing these cellular contaminants. METHODS: Leukocytes were removed with paramagnetic beads or colloidal ferrofluids coated with anti-CD45 antibody. The sperm suspensions were monitored for oxidant generation by chemiluminescence, leukocyte contamination by immunocytochemistry, and fertilizing potential using zona-free hamster oocytes. RESULTS: Percoll®-prepared human sperm suspensions exhibited a competence for PMA-induced reactive oxygen species generation which was significantly correlated with leukocyte contamination. However, the purified spermatozoa remaining after paramagnetic bead treatment, also demonstrated an intrinsic capacity for PMA-responsive reactive oxygen species generation and, freed from the oxidative stress created by the leukocytes, exhibited a significantly enhanced capacity for sperm-oocyte fusion. CONCLUSIONS: Although human spermatozoa can generate reactive oxygen species, sperm function is inhibited by the additional oxidative stress created by contaminating leukocytes. Removal of these cells with paramagnetic beads enhances fertilizing potential.     

Contrast on T2-weighted images of the lumbar spine using fast spin-echo and gated conventional spin-echo sequences

A prospective study in 31 patients was designed to compare contrast quantitatively using axial conventional, gated spin-echo T2-weighted (T2W) (SE) (asymmetrical echo TE 30 and 80 ms) and axial dual-echo fast spin-echo (FSE) sequences (TE_eff20 and 120 ms) to image lumbar discs, nerve roots, and cerebrospinal fluid CSF. We used two quantitative measures, percent (%) contrast and contrast-to-noise ratio (CNR), to compare the sequences. The FSE sequence had greater % contrast and CNR on the first and second echo images for both disc and nerve root detection using these scan parameters. An axial FSE sequence, therefore, provided contrast characteristics similar to those of gated axial T2W SE sequence in the lumbar spine, with a 60% saving in acquisition time. The FSE sequence is now our standard axial T2W study for the lumbar spine.     

核医学影像设备的发展与临床应用

γ相机和SPECT只能进行常规单光子显像，PET和双探头SPECT符合显像系统既能进行单光子显像，又能进行正电子符合显像，PET／CT系统的出现不仅提供高质量的衰减校正图像，保证了正电子显像校正数据的可靠性，而且能进行同机图像融合，提高了影像定位诊断的准确性。本文简要介绍了核医学影像设备发展历程，PET和PET／CT的原理以及在临床的应用。     

Three antidepressants (amitriptyline,dothiepin, fluoxetine), with and without alcohol,compared with placebo on tests of psychomotor ability related to car driving

Eight female volunteers received acute doses of amitriptyline 50 mg (AMI), dothiepin 50 mg (DOT), fluoxetine 40 mg (FLU) or placebo both with and without a ‘social’ dose of alcohol (ALC) equivalent to 0·5 g/kg body weight absolute alcohol. Performance on a variety of tests of psychomotor ability and cognitive function (critical flicker fusion, choice reaction time, tracking, Maddox Wing and simulated car steering) were performed at 1·5 and 4 hours following treatment. AMI and DOT both with and without ALC impaired performance on a range of tests at either or both 1·5 and 4 hours, although the effects of AMI and AMI + ALC were more widespread and severe than those found with either DOT or DOT + ALC. FLU and FLU + ALC showed no evidence of impairment on any test at either the 1·5 or the 4 hours assessments. The results suggest that there are differences between the experimental substances, at the doses used, in their intrinsic potential for impairing aspects of psychomotor performance and cognitive function.     

Spinal manipulation results in immediate H-reflex changes in patients with unilateral disc herniation

The aim of this clinical investigation was to determine whether the abnormal H-reflex complex present in patients with S 1 nerve root compression due to lumbosacral disc herniation is improved by single-session lumbar manipulation. Twenty-four patients with unilateral disc herniation at the L5-S1 level underwent spinal H-reflex electro-physiological evaluation. This was carried out before and after single-session lumbar manipulation in the side-lying position. Eligibility criteria for inclusion in the study were: predominant sciatica, no motor or sphincteric involvement, unilateral disc herniation at the L5-S1 level on CT or MR imaging, age between 20 and 50 years. H-reflex responses were recorded bilaterally from the gastrosoleous muscle following stimulation of tibial sensory fibers in the popliteal fossa. H-reflex amplitude in millivolts (HRA) and H-reflex latency in milliseconds (HR-L) were measured from the spinal reflex response. Pre- and post-manipulation measurements were compared between the affected side and the healthy side. Statistical evaluation was performed by the Wilcoxon matched-pairs test (SPSS). Thirteen patients displayed abnormal H-reflex parameters prior to lumbar manipulation, indicating an S1 nerve root lesion. The mean amplitude was found to be significantly lower on the side of disc herniation than on the normal, healthy side (P = 0.0037). Following manipulation, the abnormal HR-A increased significantly on the affected side while the normal HR-A on the healthy side remained unchanged (P = 0.0045). There was a significant difference between latencies on the affected side and those on the healthy side (P = 0.003). Following manipulation there was a trend toward decreased HR-L. However, this trend did not reach statistical significance (P = 0.3877). Eight patients displayed no H-reflex abnormalities before or after manipulation. Their respective HR-A and HR-L values did not change significantly following manipulation. Three additional patients were excluded due to technical difficulties in achieving manipulation or measuring spinal reflex. These observations may lend physiological support for the clinical effects of manipulative therapy in patients with degenerative disc disease.Presented in part at EURO SPINE, Zurich, 18 October 1996, the International Conference on Spinal Manipulation, Bournemouth, 19 October 1996, and the North American Spine Society Annual Meeting, Vancouver, 25 October 1996     

重组人血小板因子4的表达、纯化及活性鉴定

目的: 用基因工程手段去获取有活性的重组人血小板因子4(rhPF4),为下一步的基础理论研究和临床应用奠定基础.方法: 用PCR手段获得人PF4的编码序列,克隆入质粒pRSET,构建融合表达载体pRSET-PF4,转化大肠杆菌,以IPTG诱导表达融合的人PF4蛋白,经镍柱亲和层析纯化,用SDS-PAGE分析所表达的目的蛋白及纯化后蛋白,用鸡胚绒毛膜尿囊膜实验(CAM)验证rhPF4的活性.结果: 成功构建了表达载体pRSET-PF4,DNA序列测定结果与预期结果一致.IPTG诱导表达的rhPF4融合蛋白部分以可溶形式存在,占菌体总蛋白量的11%.亲和层析纯化后目的蛋白纯度为84%.CAM实验表明,经纯化获得的rhPF4对鸡胚血管形成具有抑制作用.结论: 成功地获得了具有高度生物学活性的rhPF4蛋白.     

自体骨髓、骨联合移植在脊柱融合中的应用

目的 探讨自体骨髓、骨联合移植在脊柱融合中的运用。方法 84例中2例半椎体畸形、8例胸椎及胸腰椎结核、10例椎体滑脱、4例下颈椎骨折、51例胸腰段骨折、6例腰椎骨折及3例退变节段不稳患者在处理原发病的同时行植骨融合术，二期再在X线监视下行经皮注射自体骨髓移植，其中74例合并应用内固定器。结果 78例获得随访，平均随访期30．06个月。75例融合成功。3例失败，其中2例二次取内固定术中才被发现，第3例术后8个月X线片有假关节形成表现，再次术中也证实有假关节形成。无神经系统症状加重的病例出现。结论 骨髓、骨联合移植在脊柱融合中运用失败率低(3．85％)，成骨性强、生物安全性好。     

Myoblast fusion in Drosophila melanogaster is mediated through a fusion-restricted myogenic-adhesive structure (FuRMAS).

During myogenesis in Drosophila embryos, a prominent adhesive structure is formed between precursor cells and fusion-competent myoblasts (fcms). Here, we show that Duf/Kirre and its interaction partners Rols7 (found in founder myoblasts and growing myotubes) and Sns (found in fcms) are organized in a ring-structure at the contact points of fcms with precursor cells, while cytoskeletal components like F-actin and Titin are centered in this ring in both cell types. The cytoplasmic protein Blow colocalizes with the actin plugs in fcms after cell adhesion. Furthermore, the requirement of additional as yet unidentified components was demonstrated by using mammalian C2C12 myoblasts. In this study, we propose that the fusion-restricted myogenic-adhesive structure (FuRMAS) is pivotal in linking cell adhesion as well as local F-actin assembly and dynamics to downstream events that ultimately lead to plasma membrane fusion. Moreover, we suggest that the FuRMAS may restrict the area of membrane breakdown.     

腰椎间盘术后椎间盘炎的诊治

目的：探讨腰椎间盘术后椎间盘炎的病因。早期诊断和治疗问题。方法：分析10例术后腰椎间盘炎的临床表现、血象、血流变化、血和病灶细菌培养、腰椎X线平片、CT、MRI所见在发病后的敏感程度，比较3例非手术与7例经前路腹膜后（2例联合后入路）病灶清除，一期椎间植骨融合本治疗的效果。结果：不同程度的发热、痉挛性腰痛、血流增快是本病的特点。MRI、CF、X线片三者的诊断敏感性存在时间差，分别约为发病后1、3、5周。仅2例血和病灶细菌培养均阳性。前路减压植骨融合术减少全身性抗生素和镇痛剂的使用量，明显缩短病程。结论：ESR、MRI对早期确诊、引导手术价值较高。高热、痉挛性腰痛、血沉增快三者具一持续2周得不到控制，可考虑及早手术。手术疗法近期效果更为确切。