CD105和MMP-9在骨巨细胞瘤中的表达及意义

目的研究骨巨细胞瘤组织中CD105和MMP-9的表达及与肿瘤生物学行为的关系。方法运用免疫组织化学S-P法,检测CD105和MMP-9在38例骨巨细胞瘤中的表达,分析其与肿瘤临床病理特征及复发的关系。结果1)CD105标记的肿瘤内MVD值为(9.70±2.34),MVD值随肿瘤组织学级别的升高而递增,但差异无显著性(P>0.05)。按X线表现分型,浸润型肿瘤的MVD值明显高于静止型,差异有显著性(P<0.05)。复发组的骨巨细胞瘤其MVD值高于未复发组,差异有显著性(P<0.01)。肿瘤内MVD值与放射学分型、肿瘤复发有关。2)MMP-9在骨巨细胞瘤中的阳性表达率为60.53%,MMP-9阳性表达率在不同组织学分级的病例中差异无显著性(P>0.05),按X线表现分型,MMP-9在活动型、浸润性两组的阳性率高于静止型组,差异有显著性(P<0.01)。MMP-9在复发组的表达率高于未复发组,差异有显著性(P<0.01),提示MMP-9过表达与肿瘤的复发有关。3)MMP-9阳性组的MVD值高于MMP-9阴性组,差异有显著性(P<0.01),Spearman相关分析提示MMP-9表达与MVD值呈正相关。结论CD105标记的MVD值和MMP-9过表达可作为预测骨巨细胞瘤复发的客观依据。MMP-9过表达与骨巨细胞瘤内新生血管的形成有关。     

Nogo-66受体在脂质筏中的定位

目的 探讨Nogo-66受体（NgR）存神经元胞膜脂质筏中的定位。方法 利用免疫荧光双标法检测NgR和脂质筏特异标志物穴蛋白（Cavcolin）在培养的小脑颗粒神经元上的表达．并用Wcstcrn blot法检测以去垢剂法提取的脂质筏中NgR的表达。结果 免疫荧光双标显示NgR和Cavcolin的表达部化．Western blot分析发现脂质筏中NgR的表达为阳性。结论 在小脑颗粒神经元胞膜脂质筏中有NgR的表达．提示脂质筏有可能促进NgR的信号转导。     

脑蛋白水解物注射液治疗弥漫性轴索损伤的临床观察

目的探讨脑蛋白水解物注射液对弥漫性轴索损伤的治疗效果。方法将128例弥漫性轴索损伤的病人随机分成脑蛋白水解物注射液治疗组(n=65)和对照组(n=63,)观察治疗早期病人的临床表现,治疗2wk格拉斯哥昏迷评分(GCS)和远期疗效。结果脑蛋白水解物注射液治疗组病人的呼吸、心率较快恢复稳定,呼吸异常(33.85%)、心率异常(40.00%)、入院两周神志清醒(36.92%)及伤后3个月恢复良好率(36.92%)显著高于对照组(P<0.05),植物生存及死亡率(20.00%)较对照组显著减少(P<0.01)。结论脑蛋白水解物注射液能有效减轻弥漫性轴索损伤病人的症状、缩短昏迷时间、改善患者预后、降低伤残及死亡率,提高生存质量。     

Arthroscopic Management of Giant Meniscal Cysts Among Young Patients: An Average Three‐Year MRI Follow‐Up

ObjectiveTo describe an arthroscopic technique for giant meniscal cyst excision with preservation of the functional meniscus, report the short‐ and medium‐term outcomes, and assess magnetic resonance imaging (MRI) for follow‐up imaging evaluations.MethodsA total of 54 consecutive patients with symptomatic meniscal cysts were admitted to the Second Xiangya Hospital of Central South University between 2014 and 2019. Nine patients with giant meniscus cysts (six females and three males) were included in this study. The age range of the patients was 6–34 years. All patients underwent a complete physical examination, X‐ray, Doppler ultrasound, and MRI of the knee preoperatively. After an arthroscopic diagnosis of a meniscal rupture with a giant meniscal cyst, partial meniscectomy, ablation of the cyst, and suturing of the retainable meniscus were performed. Lysholm and International Knee Documentation Committee (IKDC) scores were used preoperatively and at the most recent follow‐up. Clinical outcomes were classified into four categories: excellent, good, fair, and poor. During the last visit, all patients underwent MRI to assess the recurrence of the cyst and meniscal suture healing.ResultsPreoperative MRI and arthroscopic examination revealed giant meniscal cysts combined with meniscal tears and congenital discoid meniscus, and all giant meniscal cysts occurred in the lateral meniscus. The main types of meniscal tears were horizontal and complex tears. The cysts were unicystic in one case and multicystic in eight cases. The mean size of the cysts on the MRI was 5.86 cm × 2.24 cm × 2.48 cm. The mean follow‐up periods were 37.5 (19–60) months. Clinical outcomes were excellent in six patients and good in three patients. The postoperative scores were significantly improved compared to the preoperative scores (Lysholm: 90.78 ± 4.60 vs. 54.56 ± 7.25; IKDC: 96.2 ± 3.46 vs. 61.69 ± 3.36; p <0.01). No recurrence of the cyst was indicated on the MRI, and there was good healing of the torn meniscus.ConclusionsArthroscopic cystectomy combined with the meniscus suture technique was effective to eradicate residual cyst cavities, and traffic orifices be highly recommended.     

少见部位骨巨细胞瘤的临床及影像学表现分析

目的:提高对少见部位骨巨细胞瘤影像学表现的认识能力,降低误诊率。方法:回顾性分析13例经手术病理证实的少见部位骨巨细胞瘤的临床及影像学资料。本组病例均是在拍摄X线正侧位片时首先发现病灶。10例行CT扫描。结果:X线检查诊断为骨巨细胞瘤2例,骨囊肿6例,跟骨结核1例,椎体结核2例,椎体血管瘤1例,椎体骨髓瘤1例。CT扫描检查诊断为骨巨细胞瘤5例,骨囊肿4例,椎体结核1例。13例中Ⅰ级者9例,Ⅱ级者3例,Ⅲ级者1例。结论:少见部位的骨巨细胞瘤影像学特征不典型,易与骨囊肿、骨结核、单发性骨髓瘤相混淆。对特殊部位的骨质膨胀性破坏,皮质变薄,并见有细小骨嵴者应考虑本病。     

颅内巨大动脉瘤的手术治疗

目的：颅内巨大动脉瘤虽然少见,但手术治疗困难,手术病死率和致废率仍较高。本对我院1980年以来手术治疗的30例颅内巨大动脉瘤作一回顾性分析。方法：动脉瘤瘤颈夹闭术13例,动脉瘤孤立后切除术11例;动脉瘤切除或孤立后载瘤动脉重建术2例;颈部颈内动脉结扎术2例;动脉瘤包裹术2例。结果 术后早期恢复良好为73．3％,中、重残为20％,死亡2例,病死率6．6％。动脉瘤瘤颈夹闭组的13例病人中、除1例术前Ⅳ级的前交通动脉瘤病人术后重残外,均恢复顺利。动脉瘤孤立或孤立后切除的11例病人中,4例术后早期出现不同程度的对侧肢体瘫痪,其中2例在术后3周内恢复正常,另2例分别在术后3个月和28个月恢复正常;1例大脑中动脉（MCA）动脉瘤术后因术野血肿再次手术清除血肿后,病人出院时能独立行走。单纯行颈部颈动脉结扎的2例病人出院时病情无明显变化。而仅行动脉瘤包裹术的2例病人均在术后因再出血死亡。结论 为消除巨大动脉瘤的占位效应和出血的潜在性,对颅内巨大动脉瘤提倡积极的直接手术治疗。动脉瘤瘤颈直接夹闭并保留载瘤动脉通畅是首选治疗,对必需行动瘤孤立且交叉循环不良的病例,应尽可能重建载瘤动脉。     

鼠神经生长因子在格林-巴利综合征治疗中促神经修复的作用

目的:探讨鼠神经生长因子在格林-巴利综合征治疗中促周围神经修复的作用。方法:格林-巴利综合征脱髓鞘组98例,分为脱髓鞘治疗组(A)50例及脱髓鞘对照组(B)48例;格林-巴利综合征混合型组88例,分为混合型治疗组(C)45例,混合型对照组(D)43例。格林-巴利综合征单纯轴索病变组39例,分为轴索型治疗组(E)21例,轴索型对照组(F)18例。A,C,E组常规应用静脉注射丙种球蛋白0．4 g·kg~(-1)·d~(-1),连用5 d等治疗并加用鼠神经生长因子,B,D,F组仅常规应用静脉注射丙种球蛋白0．4g·kg~(-1)·d~(-1),连用5 d等治疗,疗程结束后做神经功能评价及肌电图评价。结果:脱髓鞘组中A组的明显好转、痊愈率及神经传导速度恢复明显高于B组,P＜0．05;混合型组中C组在明显好转、痊愈率及神经传导速度与波幅恢复较D组明显提高,P＜0．05;轴索型组中E,F组在临床明显好转及痊愈率无显著差异,P＞0．05,但波幅恢复E较F组明显提高,P＜0．05。结论:鼠神经生长因子对格林-巴利综合征周围神经髓鞘的再生和轴索的恢复有显著疗效。     

梓醇促进局灶脑缺血大鼠皮质脊髓束芽生和重塑

目的观察梓醇对局灶脑缺血大鼠病灶对侧皮质脊髓束(corticospinal tract,CST)轴突芽生和重塑的影响。方法30只SD大鼠随机分为假手术组、模型组、生理盐水组、梓醇治疗组和胞磷胆碱对照组。开颅电凝右侧大脑中动脉,制备局灶永久性脑缺血模型,造模后24 h首次经腹腔注射梓醇(5 mg·kg-1)或胞磷胆碱(0.5 g·kg-1),每日1次,连续7d。采用黏贴物移除实验和足失误实验测试受累前肢(左前肢)功能状况;核磁共振(MRI)测量脑梗死体积;生物素化葡聚糖胺(biotinylated dextran amine,BDA)顺行示踪健侧CST,检测脊髓颈膨大区健侧CST越边至失神经支配侧的纤维数量,了解脊髓颈膨大区CST轴突重塑;免疫荧光双标脊髓颈膨大区BDA标记纤维与生长相关蛋白(growth-associatedprotein,GAP-43),检测BDA/GAP-43共定位信号,了解脊髓颈膨大区CST轴突芽生能力。结果造模后7、14、21和28d,梓醇组和胞磷胆碱组左前肢黏贴片移除时间均比模型组和生理盐水组明显缩短(P<0.05),左前肢失误率也较模型组和生理盐水组明显降低(P<0.05);其中,造模后28 d时,梓醇组左前肢感觉运动功能状况明显优于胞磷胆碱组(P<0.05)。造模后1和28 d,各组脑梗死体积差异无显著性(P>0.05)。造模后28 d,梓醇组脊髓颈膨大区健侧CST越边纤维占(8.5%±2.1%),较模型组(4.7%±1.3%)和胞磷胆碱组(5.5%±1.8%)明显增加(P<0.05);梓醇组脊髓颈膨大区BDA/GAP-43共定位信号明显强于模型组和胞磷胆碱组(P<0.05)。结论梓醇可增强缺血性脑卒中大鼠皮质脊髓束轴突芽生和重塑能力,有助于受累肢体感觉运动功能恢复。     

颈部巨淋巴结增生临床分析

目的 提高对颈部巨淋巴结增生(Castleman病)的诊断水平.方法 回顾性分析曾经误诊的10例巨淋巴结增生的临床资料,分析临床诊断和鉴别诊断的经验和教训.结果 10例颈部巨淋巴结增生患者,男3例,女7例;按Frizzera分类标准分为局灶性8例(其中透明血管型6例,混合型2例),多中心性2例(其中浆细胞型1例,混合型1例).临床以无痛性颈淋巴结肿大为特征,多中心性2例伴有全身症状和(或)多脏器受累等特征.10例患者均为误诊后接受淋巴结切除术后病理检查确诊.随访4～17年10例患者均健康生存,其中1例多中心性浆细胞型患者术后2年复发,再次接受淋巴结手术切除术和化疗后4年未再复发.结论 颈部巨淋巴结增生临床少见,易于误诊,应采用淋巴结切除活检术病理检查确定诊断,注意与颈淋巴结结核、颈淋巴结炎、结节病、肉芽肿等鉴别.如无系统功能严重受累,首选手术切除.     

Giant cervical polyp: a case report and review of a rare entity

BACKGROUND: If cervical polyps are a common pathology in the female adult population, giant cervical polyps with a size greater than 4 cm are rare and until now only several cases have been described in literature. The size and the clinical presentation can mimic a cervical neoplasia. The management is surgical and can be conservative regarding to the benign pathological feature of this entity. CASE REPORT: We report the case of a giant cervical polyp of 5.5 cm occurring in a multiparous 47-year-old woman who clinically presented vaginal bleeding. The lesion was resected by electrosurgery with no recurrence 7 months after surgery. CONCLUSION: The diagnosis, management and outcome of this rare entity had been reviewed according to the literature.