Oblique transcorporeal approach to anteriorly located lesions in the cervical spinal canal

Summary The technique of obliquely drilling out the postero-lateral part of the cervical vertebral bodies is described. It uses the antero-lateral (retro carotico-jugular) approach to control and displace the vertebral artery postero-laterally and to expose the lateral aspect of the vertebral bodies. It provides, through a wide field and with minimal retraction of the carotid artery and the internal jugular vein, an extensive view of the anterior aspect of the spinal cord. It has already been used to treat 15 anterior lesions compressing the spinal cord including neurinomas and osteophytes.     

Analgesic dose-response relation in cervical epidural block

The relationship between the age and the spread of analgesia from different epidural anesthetic doses was examined by studying analgesic dose responses in cervical epidural analgesia. Two different anesthetic doses (5ml or 10ml) of 2% mepivacaine were injected into the cervical epidural space at a constant pressure (80mmHg) using an intravenous apparatus, and the spread of analgesia to pinprick was assessed. The significant correlation was found between the patients age and the number of spinal segments blocked (5ml:r = 0.8498, P < 0.01, 10ml:r = 0.5988, P < 0.01). The inverse linear relationship was found between the patients age and the segmental dose requirement (5ml:r = –0.6754, P < 0.01, 10ml:r = –0.5784, P < 0.01). Patients under 39 years of age showed a direct relationship between the dose injected and the number of spinal segments blocked, enabling prediction of the number of segments blocked with a given dose of local anesthetic. Doubling the epidural dose approximately doubled the number of spinal segments blocked. The analgesic dose-response relation in patients over 60 years of age differed from that in patients under 39 years of age and doubling the epidural dose did not double the number of spinal segments blocked. Progressively more extensive analgesia was obtained from a given dose of local anesthetic with advancing age. It was difficult to limit the extent of analgesia by injecting a smaller dose of local anaesthetic in the elderly.(Hirabayashi Y, Matsuda I, Inoue S et al.: Analgesic dose-response relation in cervical epidural block. J Anesth 2: 22–27, 1988)     

颈痛患者手法治疗：最佳实践指南解读

颈痛在临床上常由颈椎退行性疾病引起,易对患者颈部功能及生活质量造成不良影响。为提供最佳、有效的诊断及治疗方案,2019年美国国家健康科学大学发表了《最佳实践建议：颈痛患者的整脊治疗管理》。课题组在充分研读最新版指南诊治内容的基础上,从诊断、治疗、注意事项3个方面进行解读,同时检索相关文献,纵向对比多个高质量颈痛相关指南,从生物力学及神经生物学方面分析手法治疗颈痛的科学性,并结合中国诊疗现状分析认为其推荐的手法治疗及诊疗流程在中国具有可行性,基于此认为将国内外现有的循证医学证据结合中国传统医学能指导临床实践。     

宫颈粘液过氧化物酶在月经周期中的变化规律

本文对29例月经周期正常妇女的宫颈粘液过氧化物酶进行了30个周期的研究。在月经周期不同时间测定宫颈粘液过氧化物酶(CMPx)活性及血清促黄体生成素(LH)、雌二醇(E_2)和孕酮(P)。结果表明:在排卵前三天酶活性明显下降,至排卵后一天开始上升。卵泡期,酶活性与E_2呈负相关(r=-0.67);黄体期,酶活性与P呈正相关(r=0.79)。本研究提示:1.CMPx在排卵周期具有特定的变化规律,其变化受体内激素水平影响,可作为预告排卵的指标。2.如简化测定方法,可为自然避孕提供新途径。     

Preservation and redirection of HPV16E7-specific T cell receptors for immunotherapy of cervical cancer

Human papilloma virus (HPV) type 16 infections of the genital tract are associated with the development of cervical cancer (CxCa) in women. HPV16-derived oncoproteins E6 and E7 are expressed constitutively in these lesions and might therefore be attractive candidates for T-cell-mediated adoptive immunotherapy. However, the low precursor frequency of HPV16E7-specific T cells in patients and healthy donors hampers routine isolation of these cells for adoptive transfer. To overcome this problem, we have isolated T cell receptor (TCR) genes from four different HPV16E7-specific healthy donor and patient-derived human cytotoxic T lymphocyte (CTL) clones. We examined whether genetic engineering of peripheral blood-derived CD8+ T cells in order to express HPV16E711-20-specific TCRs is feasible for adoptive transfer purposes. Reporter cells (Jurkat/MA) carrying a transgenic TCR were shown to bind relevant but not irrelevant tetramers. Moreover, these TCR-transgenic Jurkat/MA cells showed reactivity towards relevant target cells, indicating proper functional activity of the TCRs isolated from already available T cell clones. We next introduced an HPV16E711-20-specific TCR into blood-derived, CD8+ recipient T cells. Transgenic CTL clones stained positive for tetramers presenting the relevant HPV16E711-20 epitope and biological activity of the TCR in transduced CTL was confirmed by lytic activity and by interferon (IFN)-gamma secretion upon antigen-specific stimulation. Importantly, we show recognition of the endogenously processed and HLA-A2 presented HPV16E711-20 CTL epitope by A9-TCR-transgenic T cells. Collectively, our data indicate that HPV16E7 TCR gene transfer is feasible as an alternative strategy to generate human HPV16E7-specific T cells for the treatment of patients suffering from cervical cancer and other HPV16-induced malignancies.     

子宫颈鳞癌组织中T、B、NK淋巴细胞浸润与肿瘤免疫

目的对子宫颈鳞癌(Cervical squamous cell carcinoma,CSCC)组织中T、B、NK淋巴细胞的浸润与肿瘤免疫状况进行研究,探讨免疫细胞的变化规律,阐明局部免疫状态对CSCC发展的影响,为CSCC的免疫治疗及预后提供理论依据和参考指标.方法用免疫组织化学(S-P)法,以CD4、CD8标记T细胞、CD20标记B细胞、CD57标记NK细胞,经计数分析和SPSS11.0统计软件处理.结果在早期CSCC组织中浸润淋巴细胞种类与数量依次为CD8+、CD20+、CD57+和CD4+,差别显著(P＜0.05).在进展期CSCC组织中浸润淋巴细胞类型与数量依次为CD8+、CD20+、CD4+和CD57+,差别显著(P＜0.05).4种淋巴细胞在进展期高分化CSCC中的数量,无显著差异(P＞0.05);但在进展期中、低分化CSCC中的数量,均存在着显著差异(P＜0.05).T淋巴细胞浸润的数量伴随分化程度的降低而增高,尤其CD8+T淋巴细胞增加更明显;CD4+/CD8+T淋巴细胞＜1,且CD4+与CD8+T淋巴细胞的比例逐渐降低.结论在CSCC组织中浸润的淋巴细胞中以T细胞为主,其次为B细胞,NK细胞浸润最少,说明CSCC局部以细胞免疫为主,体液免疫也不容忽视.CD8+T细胞比例增加是细胞免疫受抑制的表现.CSCC组织中T细胞抗肿瘤免疫受到抑制,需要免疫调节,增强抗肿瘤免疫力.     

宫颈病变程度与人类乳头瘤病毒(16、18型)负荷的关系

目的探讨宫颈病变程度与人类乳头状瘤病毒(HPV)16、18型负荷的关系。方法采用实时荧光定量聚合酶链反应(FQ-PCR)方法,检测宫颈不同病变活检组织及石蜡包埋标本中HPV16、18型感染状况。结果正常宫颈上皮感染HPV16、18型阳性率为3%,CINⅠ、Ⅱ、Ⅲ级和宫颈癌感染HPV16、18阳性率分别为45.7%,69.5%,72.2%和74.6%。正常宫颈与CIN,宫颈癌HPV16、18阳性率差异有极显著性(P<0.0001)。宫颈糜烂(Ⅰ°、Ⅱ°、Ⅲ°),CIN(Ⅰ、Ⅱ、Ⅲ级)及鳞癌HPV16、18阳性标本平均拷贝数分别为:3.58×103、1.80×105、1.19×107,随着病变程度加重而逐渐增加,差异有极显著性(P<0.0001)。结论宫颈病变程度与HPV16、18型负荷呈正相关。对宫颈病变组织标本行HPV16、18型检测,对判断宫颈病变发展趋势,积极处理癌前病变,阻断病程、预防宫颈癌的发生将起到重要作用。     

Cathepsin-D expression in cervical carcinoma and its prognostic significance

An immunohistochemical study was made of cathepsin-D protein expression in each of the three main types of uterine cervical carcinoma (squamous carcinoma, adenosquamous carcinoma and adenocarcinoma) with particular reference to lymph node status and prognosis. Of the 61 cases, 54.1% showed cytoplasmic staining in more than 2.5% of tumour cells counted. Cathepsin-D expression was significantly higher in adenocarcinoma (mean -3.128) than in squamous carcinoma and adenosquamous carcinoma (mean –3.709,P=0.047 using logit transformation). Cathepsin-D had no prognostic value in any of the three tumour types. No relationship was found between cathepsin-D staining and lymph node status and there was no advantage in adding cathepsin-D values to lymph node status. These results suggest that immunostaining for cathepsin-D protein expression is unlikely to be of use as a prognostic marker.     

Ras homolog gene family H (RhoH) deficiency induces psoriasis-like chronic dermatitis by promoting TH17 cell polarization

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颈椎前路椎体间微创融合器的生物力学实验研究

目的评价植入镍钛记忆合金微创融合器(NiTi-TFC/C)的颈椎节段的稳定性及压缩力学性能。方法采集24只羊颈椎标本随机分为4组,每组6份,四组处理分别为:单取髓核组、自体髂骨植骨组、微创融合器组和钛制融合器组(InterFix)。所有标本进行前路减压,并对后3组进行椎间融合术。分别对各组标本进行生物力学测试并进行比较。结果微创融合器组与钛制融合器组在强度、刚度及扭转力学等方面无显著性差异(P>0.05)。而微创融合器组与自体髂骨植骨组具有显著性差异(P<0.05)。最大承载力为12050N。结论该微创融合器强度大、刚度高、抗扭转能力强,具有良好的抗压能力,为颈椎融合提供新型的融合装置。