MuSK-mCherry融合荧光蛋白的构建及对重症肌无力患者MuSK抗体的检测

目的：构建肌肉特异性激酶（MuSK）与红色荧光蛋白（mCherry）的重组融合蛋白（MuSK-mCherry）,并作为抗原用于重症肌无力（ MG）患者血清中的MuSK抗体（ MuSKAb）的检测。方法：应用PCR技术,从含有mCherry 基因的载体pRSET-B扩增mCherry基因,经T载体（pGEM-T Easy Vector）克隆至含有MuSK细胞外区第22-452位氨基酸肽段基因的载体pMT/BiP/V5-His（ MuSK）上,构建MuSK-mCherry融合荧光蛋白基因。将重组载体转染果蝇S2细胞,表达产物以共聚焦显微镜检查。以MuSK-mCherry融合蛋白作为抗原,应用荧光免疫沉淀试验检测MG患者MuSKAb。结果：成功地构建了MuSK-mCherry融合蛋白基因,并得到了表达。经对已知MuSKAb阳性的MG患者血清中的MuSKAb的检测证实,构建的MuSK-mCherry融合蛋白在荧光免疫沉淀试验中可以检测到MuSKAb。结论：以MuSK细胞外肽段与mCherry构建的融合荧光蛋白作为抗原,可以用于MG患者血清中的MuSKAb的检测。     

唾液腺乳腺样分泌癌的研究进展

唾液腺乳腺样分泌癌(MASC)是一种近年来才被描述的唾液腺肿瘤新类型,因其存在与乳腺分泌性癌类似的特异性的E-二十六变异基因6-神经营养酪氨酸受体激酶3融合基因而得名.MASC在病理形态上非完全特异,与诸多唾液腺肿瘤有重叠,所以在病理诊断中经常将其诊断为腺泡细胞癌或黏液表皮样癌等.本文就MASC的临床表现、病理特点、分子生物学特征、鉴别诊断、预后和治疗等研究进展作一综述.     

肥胖和正常体质量腰椎融合患者并发症的比较

背景：肥胖可使脊柱尤其是腰椎退化,随着肥胖发病率的增加,肥胖患者发生腰椎外科的手术日益增多,有关的研究表明,肥胖可能增加腰椎融合的并发症,尤其是伤口感染。目的：分析肥胖是否改变接受腰椎融合患者并发症的概率。方法：纳入行腰椎单节段融合的患者（包括正常体质量和肥胖患者）268例为样本,将腰椎融合了分为两种类型：前路腰椎融合和后路腰椎融合,用切除自体的髂前上棘的松质骨行椎间植骨,美敦力枢法模的钛棒固定,探查硬膜前方无碎骨屑后移,切口放置引流,逐层关闭。腰椎融合后预防感染对症治疗,分别就患者的不同并发症方面的数据进行统计学分析。结果与结论：268例中104名为肥胖患者。肥胖患者的并发症包括有心脏、肾、肺、伤口并发症等,以伤口并发症和肺部并发症为主,与正常体质量患者比较,差异均有显著性意义（P〈0．05）,但前后路方式之间并发症发生率比较,差异无显著性意义（P〈0．05）。说明肥胖增加了腰椎融合手术并发症的风险,但在前后路腰椎不同融合方法中对患者的影响差别不大。     

腰椎小关节退变影像诊断技术的对照分析

目的：通过观察腰椎小关节退变的CT、常规MRI及脂肪抑制序列的影像表现,进一步提高临床对椎小关节退变的认识.方法：回顾性分析538例腰椎小关节退变的影像学资料,运用x2检验对其每项影像学征象的CT、常规MRI及脂肪抑制序列检查结果进行统计学分析.结果：脂肪抑制序列显示关节滑膜的炎性改变优于CT和常规MRI,MRI对关节面软骨的观察优于CT（P＜0.05）;而CT观察骨性关节面及关节下骨质退变、关节腔真空征和伴发征象有明显优势（P＜0.05）;但对于骨质增生引起的椎小关节改变三者无明显统计学差异（P＞0.05）.结论：对于早期或慢性期急性发作的椎小关节退变患者,应首选MRI检查并加扫脂肪抑制序列;对于慢性期或需要手术的患者,应首选CT检查.     

A comparative study of SPECT/CT fusion imaging and CT in infiltrated mandible by gingival carcinoma

Objective： The aim of the study was to evaluate the clinical value of ^99mTc-methylene diphosphonic acid （MDP） SPECT/CT fusion imaging and CT scanning in diagnosis of infiltrated mandible by gingival carcinoma. Methods： 18 cases of gingival carcinoma were processed infiltrated mandible by ^99mTc-MDP SPECT/CT fusion image and CT, and their scanning results compared with pathology findings. Results： Eleven of 13 cases with well-differentiated squamous cell carcinoma showed positive images, one of 11 cases was false positive images by pathology findings, and 10 cases were exhibited infiltrated mandibles; 5 cases with moderately differentiated and poorly differentiated squamous call carcinoma showed positive images, pathology showed carcinoma call had infiltrated cavum ossis of mandible. Five of 18 cases were positive images by CT. Conclusion： ^99mTc-MDP SPECT/CT fusion imaging is a useful method in diagnosis of infiltrated mandible by gingival carcinoma.     

持续牵引下电针治疗腰椎间盘突出症疗效观察

目的:观察持续俯卧位牵引下电针治疗腰椎间盘突出症的临床疗效,为临床治疗该症寻求一种更好的方法.方法:将患者随机分为A组(42例)、B组(39例)和C组(38例).三组针刺方法相同,均取夹脊穴配委中、承山等穴,针刺后加电针,在此基础上,A组采用俯卧位持续牵引同时配合电针方法治疗,B组则先仰卧牵引再行电针治疗,C组单纯进行电针治疗,观察并比较临床疗效.结果:A组有效率为95.2%,优于B组的79.5%与C组的65.8%(P＜0.05,P＜0.01).结论:持续俯卧位牵引下电针为治疗腰椎间盘突出症的较佳方法.     

Halorubrum pleomorphic virus-6 Membrane Fusion Is Triggered by an S-Layer Component of Its Haloarchaeal Host

(1) Background: Haloarchaea comprise extremely halophilic organisms of the Archaea domain. They are single-cell organisms with distinctive membrane lipids and a protein-based cell wall or surface layer (S-layer) formed by a glycoprotein array. Pleolipoviruses, which infect haloarchaeal cells, have an envelope analogous to eukaryotic enveloped viruses. One such member, Halorubrum pleomorphic virus 6 (HRPV-6), has been shown to enter host cells through virus-cell membrane fusion. The HRPV-6 fusion activity was attributed to its VP4-like spike protein, but the physiological trigger required to induce membrane fusion remains yet unknown. (2) Methods: We used SDS-PAGE mass spectroscopy to characterize the S-layer extract, established a proteoliposome system, and used R18-fluorescence dequenching to measure membrane fusion. (3) Results: We show that the S-layer extraction by Mg²⁺ chelating from the HRPV-6 host, Halorubrum sp. SS7-4, abrogates HRPV-6 membrane fusion. When we in turn reconstituted the S-layer extract from Hrr. sp. SS7-4 onto liposomes in the presence of Mg²⁺, HRPV-6 membrane fusion with the proteoliposomes could be readily observed. This was not the case with liposomes alone or with proteoliposomes carrying the S-layer extract from other haloarchaea, such as Haloferax volcanii. (4) Conclusions: The S-layer extract from the host, Hrr. sp. SS7-4, corresponds to the physiological fusion trigger of HRPV-6.     

Bone marrow blood supply in gadolinium-enhanced magnetic resonance imaging

A retrospective study was performed to determine whether bone blood supply can be assessed on gadolinium-enhanced magnetic resonance imaging. Lumbar spine magnetic resonance imaging (MRI) examinations of 49 patients attending for post-laminectomy examination were reviewed (30 male, 19 female, mean age 46.4 years, age range 23–84 years). Each study included sagittal T1-weighted spin echo sequences before and after gadolinium administration. Regions of interest were drawn within the L3 vertebral body from a parasagittal slice from each sequence. Signal intensity (SI) values were ascertained and the percentage increase in SI was calculated. For each patient, changes in receiver gain for pre and post-gadolinium images were corrected by an image scaling factor. In all cases, a measurable increase in SI was found (mean 15.3%, range 4.4–55.7) due to bone vascularity. The results give no indication of the quantity or timing of blood supply but provide a basis for further work.     

Wiltse手术入路和后正中入路经椎间孔腰椎椎体间融合术治疗退变性腰椎滑脱症

目的 比较后正中入路、Wiltse手术入路经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)治疗退变性腰椎滑脱的临床疗效.方法 2008年3月-2010年3月收治37例退变性腰椎滑脱患者,其中23例行后正中入路TLIF手术(后正中入路组),14例行Wiltse入路TLIF手术(Wiltse入路组),观察两组患者手术前后日本骨科学会(JOA)评分、疼痛视觉模拟评分(visual analogue scale,VAS)及融合情况,比较两组疗效.结果 术后随访6～26个月,平均15.7个月,两组患者腰腿痛等临床症状明显缓解,X线片显示滑脱复位无丢失、植骨融合良好、内固定器械无松动或断裂.术后末次随访时Wiltse入路组融合率为86％,后正中入路组融合率为87％.Wiltse入路组和后正中入路组手术时间分别为(117.8±25.6)min、(128.5±38.7)min(P＞0.05);术中出血量分别为(203.5±16.4)ml、(284.4±27.6)ml(P＜0.05).Wiltse入路组和后正中入路组治疗后JOA评分与治疗前比较均有明显降低(P＜0.05).术后1周腰痛VAS评分两组间比较差异有统计学意义(P＜0.05),腿痛VAS评分两组间比较差异无统计学意义(P＞0.05);末次随访腰痛及腿痛VAS评分两组间比较差异无统计学意义(P＞0.05).结论 后正中入路、Wiltse入路TLIF手术治疗退变性腰椎滑脱均可达到满意的椎间融合率和临床效果,Wiltse入路术中出血量相对较少,术后恢复相对较快.     

Treatment of pediatric atlantoaxial instability with traditional and modified Goel–Harms fusion constructs

There are several treatment options for rigid fixation at C1–C2 including Brooks and Gallie type wired fusions and C1–2 transarticular screws. The use of a Goel–Harms type fusion, a construct with C1 lateral mass screws and C2 pedicle screws, has not been extensively described in pediatric patients. Here, we describe its relatively safe and effective use for treating pediatric patients by retrospective chart review of patients treated by the senior author for atlantoaxial instability with a Goel–Harms-type constructs during a 3-year period (2005–2007). Six patients were treated using Goel–Harms-type constructs. Five patients were treated utilizing a construct containing C1 lateral mass screws and C2 pedicle screws; one patient was treated using construct containing C1 lateral mass screws and C2 trans-laminar screws. The patients ranged in age from 7 to 17 years old (mean 12.7). All patients had findings of an os odontoideum on CT scans and three of the six patients had T2 hyperintensity on MRI. Three of the six patients presented with transient neurologic deficits: quadraplegia in two patients and paresthesias in two patients. In each patient C1 lateral mass and C2 screws were placed and the subluxation was reduced to attain an anatomical alignment. No bone grafts were harvested from the iliac crest or rib. Local morsalized bone and sub-occipital skull graft was used. All patients tolerated the procedure well and were discharged home on post-operative day 3–4. The patients wore a hard cervical collar and no halo-vests were needed. All patients had solid fusion constructs and normal alignment on post-operative imaging studies performed on average 14 months post-operatively (range: 7–29). The results demonstrated that Goel–Harms fusions are a relatively safe and effective method of treating pediatric patients with atlantoaxial instability and are not dependent on vertebral anatomy or an intact ring of C1. Follow-up visits and studies in this limited series of patients demonstrated solid fusion constructs and anatomical alignment in all patients treated.