Evaluation of 3-Dimensional Exoscopes in Brain Tumor Surgery

ObjectiveThough the operating microscope (OM) has been the standard optical system in neurosurgery, a new technology called three-dimensional (3D) exoscope has emerged as an alternative. Herein, two types of 3D exoscopes for brain tumor surgery are presented. In addition, the advantages and limitations compared with the OM are discussed. MethodsIn the present study, 3D exoscope VOMS-100 or VITOM 3D was used in 11 patients with brain tumor who underwent surgical resection; the Kinevo 900 OM was used only in emergency. After completion of all surgeries, the participants were surveyed with a questionnaire regarding video image quality on the display monitor, handling of equipment, ergonomics, educational usefulness, 3D glasses, and expectation as a substitute for the OM. ResultsAmong 11 patients, nine patients underwent neurosurgical resection with only 3D exoscope; however, two patients required additional aid with the OM due to difficulty in hemostasis. Regarding video image quality, VITOM 3D was mostly equivalent to the OM, but VOMS-100 was not. However, both 3D exoscopes showed advantages in accessibility of instruments in the surgical field and occupied less space in the operating theater. Differences in ergonomics and educational usefulness between the exoscopes were not reported. Respondents did not experience discomfort in wearing 3D glasses and thought the exoscopes could be currently, and in the future, used as a substitute for the OM. ConclusionAlthough many neurosurgeons are not familiar with 3D exoscopes, they have advantages compared with the OM and similar image quality. Exoscopes could be a substitute for OM in the future if some limitations are overcome.     

Down-Regulated CK8 Expression in Human Intervertebral Disc Degeneration

As an intermediate filament protein, cytokeratin 8 (CK8) exerts multiple cellular functions. Moreover, it has been identified as a marker of notochord cells, which play essential roles in human nucleus pulposus (NP). However, the distribution of CK8 positive cells in human NP and their relationship with intervertebral disc degeneration (IDD) have not been clarified until now. Here, we found the percentage of CK8 positive cells in IDD (25.7±4.14%) was significantly lower than that in normal and scoliosis NP (51.9±9.73% and 47.8±5.51%, respectively, p<0.05). Western blotting and qRT-PCR results confirmed the down-regulation of CK8 expression in IDD on both of protein and mRNA levels. Furthermore, approximately 37.4% of cell clusters were CK8 positive in IDD. Taken together, this is the first study to show a down-regulated CK8 expression and the percentage of CK8 positive cell clusters in IDD based upon multiple lines of evidence. Consequently, CK8 positive cells might be considered as a potential option in the development of cellular treatment strategies for NP repair.     

日本血吸虫感染过程抗原定位的动态变化研究

本实验用ＩＦＡ方法，用日本血吸虫感染过程中的各期兔血清进行了成虫和虫卵的抗原定位研究，以观察抗原的定位随感染进程的动态变化。结果表明，用Ｒｏｓｓｍａｎ＇ｓ固定液固定的成虫石蜡切片的抗原定位及反应强弱依次为肠管壁、间质和皮层。雄性生殖系统，如睾丸可见荧光反应。雌性生殖系统未见荧光反应。雄虫的反应强度比雌虫强，尤其在间质部位最明显。成虫冰冻切片抗原定位反应最强的部位在皮层。间质较弱，肠管壁几乎阴性。对病鼠肝内虫卵抗原定位结果显示，石蜡切片抗原从感染后第４周起可见定位在虫卵内毛蚴的顶腺、侧腺及卵黄膜、卵间隙和卵壳上。顶腺和侧腺的阳性反应最强。第五周开始可见卵周有何博礼现象。冰冻切片的抗原也在第四周开始出现，定位在卵黄膜及卵壳上。     

显微镜辅助下颈前路椎间盘切除植骨融合术治疗多节段脊髓型颈椎病

目的探讨显微镜辅助下颈前路椎间盘切除植骨融合术(anterior cervical discectomy with fusion,ACDF)治疗多节段脊髓型颈椎病的疗效。方法回顾性分析2011年1月~2012年8月本院行颈前路手术治疗的60例脊髓型颈椎病患者的临床资料,根据手术方式分为常规ACDF组(A组,30例)和显微镜辅助ACDF组(B组,30例)。比较2组的手术时间、术中出血量、住院天数及并发症,以日本骨科学会(Japanese Orthopaedic Association,JOA)评分(17分法)及其改善率评价术后神经功能改善情况。结果 A组手术时间为(132.5±8.9)min,B组为(137.0±9.1)min,差异无统计学意义(P0.05)。A组术中出血量为(113.6±8.0)m L,B组为(93.7±5.3)m L,差异有统计学意义(P0.01)。A组住院(7.37±1.73)d,B组(6.63±1.13)d,差异无统计学意义(P0.05)。A组术前JOA评分为6.60±1.21,术后12个月为13.83±0.91,改善率为(69.72±7.66)%;B组术前JOA评分为6.87±1.46,术后12个月为14.23±1.17,改善率为(72.51±11.26)%。A组和B组改善率差异有统计学意义(P0.05)。结论显微镜辅助ACDF和常规ACDF是治疗多节段脊髓型颈椎病有效的方法,但显微镜辅助ACDF可减少术中出血量,是治疗多节段脊髓型颈椎病优先选择的手术方案。     

神经病理痛模型大鼠前扣带皮层不同水平磷酸化细胞外信号调节激酶表达差异比较

目的探讨痛相关情绪模型大鼠前扣带皮层(ACC)磷酸化细胞外信号调节激酶(p-ERK)的分布特点。方法将12只雄性SD大鼠随机分为对照组和模型组。模型组大鼠进行右侧腰5脊神经结扎制做模型。采用右后足跖机械痛阈检测观察行为变化,旷场实验和高架O迷宫实验检测痛相关情绪变化,免疫荧光技术检测同侧前扣带皮层前囟前3.2、2.7及2.2mm 3个水平p-ERK表达。结果大鼠经神经病理痛模型制做成功后机械痛阈显著下降,焦虑样行为产生。前扣带皮层前囟前3.2、2.7及2.2mm水平p-ERK阳性细胞表达量分别为11.89±2.57、32±4.67和17.56±2.04。对照组相应的p-ERK阳性细胞表达量分别为12.44±2.16、10±0.87和10.11±1.36。除前囟前3.2mm水平对照组与模型组相比没有显著性差异(P0.05)之外,其他两个水平p-ERK阳性细胞表达量模型组显著高于对照组(P0.01)。结论神经病理性疼痛能诱发大鼠焦虑情绪的产生及ACC脑区pERK的表达增高,这种变化可能主要与ACC脑区前囟前2.7及2.2mm水平p-ERK的变化相关,而与前囟前3.2mm水平无关。     

巢蛋白及性别决定基因高迁移率组蛋白在SAMP8小鼠穹窿下器的表达及其意义

目的 观察巢蛋白（Nestin）与性别决定基因高迁移率组蛋白(SOX2)在快速老化小鼠SAMP8穹隆下器（SFO）中的表达。 方法 成年8月龄SAMP8小鼠设为实验组,采用免疫组织化学和免疫组织化学荧光染色的方法观察Nestin及SOX2在穹隆下器中的表达,同时设正常老化小鼠SAMR1对照。结果 Nestin免疫组织化学染色发现,对照组免疫阳性细胞呈突起分布,放射丝状表达;实验组免疫阳性细胞染色深,丝状结构粗大,在血管周围密集分布,阳性细胞百分比（49.17±7.60）%较对照组阳性细胞百分比（16.33±4.41）%明显增多,差异有统计学意义（P＜0.01）。SOX2免疫组织化学染色,对照组免疫阳性细胞散在分布,染色深浅不一;实验组大部分阳性细胞染色较深,在血管周围密集分布;阳性表达细胞百分比（62.17±20.27）%较对照组阳性表达细胞百分比（36.00±16.20）%明显增多,差异有统计学意义（P＜0.05）。荧光双标染色,对照组SOX2散在分布,其间可见Nestin阳性表达,室管膜下区可见少量SOX2/Nestin双表达细胞。实验组阳性表达强烈,SOX2/Nestin双表达细胞增多。结论 Nestin及SOX2在快速老化小鼠SAMP8穹隆下器的表达明显增强,表明阿尔茨海默病（AD）在一定时期可能引起穹隆下器神经干细胞/祖细胞的增殖或分化增强,进而可能影响穹隆下器的神经生发功能。     

树突状细胞C型凝集素在自然流产中的表达研究

目的通过检测早期自然流产患者子宫蜕膜组织中树突状细胞C型凝集素（DC-SIGN）的表达,探讨其在自然流产发生中的可能机制。方法采用免疫荧光染色法及实时荧光定量PCR（RT-PCR）技术检测DC-SIGN在蜕膜组织中的表达,比较两组间表达情况及分布差异。结果 1.通过免疫荧光染色技术检测显示：妊娠期子宫蜕膜组织均表达DC-SIGN,主要分布于细胞膜上,自然流产组中DC-SIGN＋DC表达明显低于对照组（46.20±2.40 vs 78.21±0.28,P〈0.01）。2.RT-PCR结果显示：自然流产组明显低于对照组,患者蜕膜组织中DC-SIGN mRNA相对表达量（0.0032370±0.00124 vs0.0076412±0.0040,P〈0.05）。结论树突状细胞（DC）在母胎免疫耐受机制中起着重要的作用,蜕膜组织DC-SIGN的表达量降低可能导致早期自然流产的发生。     

人牙釉质酸蚀过程中三维形貌的原子力显微镜观察

目的 比较不同酸蚀时间处理后牙釉质表面的三维形貌并分析粗糙度的改变,探讨酸蚀对牙釉质微观形貌的影响.方法 将15颗新鲜前磨牙包埋、切割、打磨后得到光滑牙釉质切片,按单纯随机法分为5组,用37％磷酸凝胶分别酸蚀0(对照组)、5、10、20和30s,原子力显微镜观察釉质表面形貌,分析轮廓改变,计算图像的算术平均粗糙度(Ra)、均方根粗糙度(Rq)、十点高度平均差(Rz)值及表面积、容积并对5组的结果数据进行单因素方差分析,用Turkey's法进行组间两两比较,以P＜0.05为差异有统计学意义.结果 镜下形貌观察显示,0～20 s内釉质的釉柱结构逐渐明显,釉质表面由较光滑逐渐变为典型鱼鳞状;20 s后表面形态变化不明显.表面轮廓观察显示,随着酸蚀时间由0s增加至30 s,釉柱间隙首先被溶解,酸蚀深度逐渐增加到2.8μm,30 s后釉柱顶部宽度减小至1.8μm,且高度略降低.从0s到30 s,Ra值由(19.69±3.42) nm增加到(359.51±75.79)nm,Rq值由(22.02±5.57) nm增加到(431.02±83.09) nm,Rz值由(0.24±0.08) μm增加到(2.38±0.26) μm;组间比较显示,Ra和Rq值的20s组与30 s组和Rz值的10、20和30 s组差异无统计学意义(P＞0.05),其余各组间差异均有统计学意义(P＜0.05).同时釉质表面积由(406.77±3.88) μm2 (0 s)增大到(546.69±84.02) μm2 (30 s),容积由(65.73±14.46) μm3 (0 s)增大到(474.63±52.50)μm3(30 s).结论 随着酸蚀时间的增加,釉质表面酸蚀深度不断增大,表面粗糙度增加,表面积及容积增大,酸蚀会造成釉质微观形貌的明显改变.     

线粒体脑病:一例报告并文献复习

目的探讨线粒体脑病临床、影像学及病理学特点。方法与结果女性患者,52岁。因发作性肢体抽搐、麻木共3次入院,临床表现为局灶性癫发作、智能障碍,双侧锥体束征阳性。影像学检查均考虑为缺血性卒中及脑萎缩,脑电图显示中至重度异常波形。脑脊液红细胞计数1.04×106/L,中性粒细胞比例、蛋白定量和免疫球蛋白IgG水平升高,氯化物水平降低;血清超敏C反应蛋白和红细胞沉降率升高。组织病理学显示皮质内部分神经元肿胀,星形胶质细胞反应性增生及毛细血管数目增加;肿胀及形态正常的神经元胞质内均有Mito染色阳性颗粒物质存在,反应性星形胶质细胞胶质纤维酸性蛋白表达阳性。电子显微镜观察,神经元胞质内大量异常线粒体堆积,形态、大小不一,线粒体嵴变平或延长并旋绕成同心圆状,线粒体内出现嗜锇小体和类结晶样包涵体。结论线粒体脑病临床少见,易误诊为缺血性卒中,对线粒体病的诊断需进行临床表现、血清酶学、生化指标、肌肉组织活检及分子生物学等多项检查。