去除外膜的外周神经移植对大鼠脊髓损伤的影响

目的检测大鼠脊髓损伤经显微外科技术处理的自体外周神经移植后神经纤维的再通及后肢功能恢复情况。方法利用改良Allen撞击方法建立脊髓打击损伤模型，12周后，将大鼠分为2组，实验组切取后肢腓肠神经，利用显微外科技术去除神经外膜，将其修剪成小段，游离移植于脊髓损伤处，对照组仅显露脊髓损伤段，不作神经移植。分三个时相点（1、2、3个月）进行辣根过氧化物酶（HRP）逆行示踪，并观察损伤移植处的形态学变化及大鼠后肢运动功能恢复情况。结果损伤移植处脊髓的形态学明显好转；损伤移植处上段脊髓中，移植1个月组有HRP阳性标记物，以后逐渐增多；移植组大鼠后肢运动功能明显恢复。结论经显微外科技术预处理外周神经组织移植后可促进大鼠脊髓结构和功能的恢复。     

FK506缓释膜应用于同种异体神经移植的实验研究

目的研究普乐可复(prograf,FK506)缓释膜在同种异体神经移植中的作用。方法应用异体神经桥接大鼠坐骨神经缺损,术中局部应用FK506缓释膜,分别于术后4、8、12周对移植物行大体和光镜观察,及轴突图像分析、移植神经电镜检查、小腿三头肌肌湿重比较、患肢坐骨神经电生理检查。结果C组(应用FK506缓释膜)的神经生长最好,基本与D组(自体神经移植)相同,B组(经预处理异体神经移植)次之,A组(新鲜异体神经移植)最差。经过对肌电图、轴突计数、肌湿重的统计学分析,C、B、A组的差异有统计学意义(P<0.05),C、D组之间差异无统计学意义。结论应用FK506缓释膜有助于减轻同种异体神经的免疫排斥反应,为神经再生创造良好条件;在同种异体神经移植中应用FK506缓释膜有助于促进神经再生。     

RGD多肽接枝聚复合导管桥接神经缺损的实验研究

Objective To investigate the effect of RGD peptide conjugated poly[ LA-(Glc-Lys) ]/βTCP/PLA nerve conduit for bridging peripheral nerve regeneration defect. Methods Forty-five male Wister rots were randomly divided into 3 groups, with 15 rats each. A 10 mm defect was created in the right sciatic nerve. In group A the gap was bridged by PLA tube. In group B RGD peptide conjugated poly[ LA-(Glc-Lys) ]/β-TCP/PLA nerve conduit was used to repair the defect. Autologous nerve graft was done in group C which served as control. Twelve weeks postoperatively nerve regeneration was evaluated by gross observation,electrophysiology, muscle weight and muscle morphometry of triceps surae, and ultrastructure of the regenerating nerve. Results Twelve weeks after the operation, nerve conduction velocity and muscle weight recovery of group B were better than those of group A. The differences were statistically significant( P < 0.05). There was no significant difference between group B and group C ( P > 0. 05). The results of histology and ultrastructure showed that nerve regeneration in group B and group C was significantly superior to that in group A.Conclusion RGD peptide conjugated poly[LA-(Glc-Lys)]/β-TCP/PLA conduit can achieve similar results in repairing sciatic nerve defect to that of autogentic nerve graft. It may be an ideal material to repair nerve defect.     

神经干细胞移植防治骨骼肌失神经肌萎缩的电生理研究

目的探讨采用神经干细胞移植的方法防治骨骼肌失神经萎缩的可行性。方法采用机械分离的方法从孕14～16 d的SD孕鼠中获取神经干细胞,并于神经元限定性培养基中进行传代培养,制备神经干细胞单细胞悬液。采用切断右侧胫神经的方法建立腓肠肌失神经支配的动物(SD大鼠)模型。将108只SD大鼠按注射药物的不同随机分为3组,每组36只大鼠。实验组:将神经干细胞悬液注射到切断的胫神经远端。损伤组:注射等量的生理盐水。对照组:注射等量的细胞培养液。术后8、12周采用HRP逆行示踪技术检测失神经骨骼肌重获神经再支配的情况,并应用肌肉电生理方法对重获神经再支配的骨骼肌进行功能评价。结果术后8、12周实验组用电刺激细胞移植部位的腓肠肌,均可引出肌肉收缩活动;且随着时间的延长,单次收缩的波幅、速度,和强直收缩的时间和强直收缩波幅的恢复率均进一步得到改善。对照组和损伤组均未能引出肌肉活动。结论神经干细胞移植能够实现失神经骨骼肌的神经再支配,并且能够与骨骼肌建立起功能性突触连接,有效预防骨骼肌的萎缩。     

部分性脾动脉栓塞治疗脾功能亢进

目的探讨脾功能亢进行脾部分栓塞时对门脉压力及外周血液变化的影响。方法对36例脾功能亢进患者,采用Seldinger's法经皮脾动脉超选择性插管造影,计数直径>1mm的脾内动脉血管数。用明胶海绵碎屑(1mm×1mm×1mm)或PVA颗粒实行脾动脉栓塞,栓塞上述血管的60%～80%,并进行1～36个月(平均20个月)临床随访观察对比手术前后门脉压力、血液成分的变化。结果平均门脉压力由4.05kPa降至2.51kPa,外周血液红细胞由2.0×1012/L升至4.20×1012/L,白细胞从3.2×109/L升至5.0×109/L,血小板从40×109/L升至150×109/L。食管静脉曲张引发上消化道出血4例中,术后3例未再出血。结论栓塞程度以脾血管数为计数单位,控制在60%～80%时,可较好地改善脾功能亢进患者外周血象、门静脉压力,减轻食管静脉曲张程度。     

Percutaneous transluminal rotational atherectomy in the treatment of peripheral vascular disease using a transluminal endatherectomy catheter (TEC): Initial results and angiographic follow-up

Purpose To evaluate the clinical results of percutaneous transluminal rotational atherectomy in the treatment of peripheral vascular disease. Methods Rotational atherectomy was performed in 39 patients aged 39–87 years (mean 66.6 years). A total of 71 lesions (43 stenoses and 28 occlusions) were treated in 40 limbs. Additional balloon angioplasty was required in 54% of lesions. Fifteen patients (37.5%) presented in Fontaine stage II, 10 patients (25%) in Fontaine stage III and 15 patients (37.5%) in Fontaine stage IV. Rotational atherectomy at 750 rpm was carried out over a 0.014-inch guidewire with continuous aspiration into a vacuum, bottle. Follow-up angiography and color flow Doppler examinations were performed in 22 patients (23 limbs) after a mean period of 6 months (range 2–14 months) Results There was one primary technical failure. In 36 of 40 lesions there was a good angiographic result with residual stenoses in less than 30%. In 70 lesions treated by rotational atherectomy, however, 54% showed residual stenoses of 30%–50% and these cases required additional balloon angioplasty. The mean ankle-brachial index improved significantly (p<0.001), from 0.49 before the procedure to 1.01 after the procedure. A single distal embolus, related to primary recanalization, occurred and there were two large inguinal hematomas. Cumulative clinical patency after 6 months was 83.8% and cumulative angiographic patency after 6 months was 79.1%. Conclusion Percutaneous rotational atherectomy is a promising approach for the treatment of chronic peripheral vascular disease. Further prospective, randomized studies are necessary to compare percutaneous transluminal angioplasty with this new technical approach.     

Comparison of iodine-123 low-density lipoprotein (LDL) and indium-111 LDL binding to mononuclear cells of healthy normolipaemic controls and patients with heterozygous familial hypercholesterolaemia

The binding of radiolabelled lipoproteins, iodine-123-labelled low-density. lipoprotein (LDL) and indium-111-labelled LDL, to peripheral blood mononuclear cells (MNCs) was compared in normolipaemic subjects and in patients with heterozygous familial hypercholesterolaemia (FH). ¹²³I-LDL and ¹¹¹In-LDL binding to MNCs exhibited high-affinity, highly specific, time- and temperature-dependent binding reaching saturation at concentrations above 50 nM. The number of LDL binding sites (B_max) was significantly (P<0.01) lower in FH patients (P<0.001; ¹²³I-LDL: B_max 279±44 ng protein/10⁸MNCs; ¹¹¹In-LDL: B_max 309±43 ng protein/10⁸MNCs) as compared with controls (¹²³I-LDL: B_max 2874±246 ng protein/10⁸ MNCs; ¹¹¹In-LDL: B_max 3145±339 ng protein/10⁸ MNCs). The corresponding dissociation constants (K _d) were 16±8 nM for ¹²³I-LDL and 12±6 nM for ¹²³In-LDL in healthy volunteers (¹²³In-LDL vs ¹¹¹In-LDL, P<0.05). In FH patients, the K _d values were 20±8 nM for ¹²³I-LDL and 16±6 nM for ¹²³In-LDL (P<0.05 vs controls for both ¹²³I-LDL and ¹¹¹In-LDL). ¹¹¹In-LDL binding to MNCs was inhibited (IC₅₀) by 30±8 nM in healthy controls and 38±12 nM in FH patients (P<0.05). ¹²³In-LDL binding to MNCs was inhibited (IC₅₀) by 34±8 nM in healthy controls and 46±10 nM in FH patients (P<0.05). Taken together, these results suggest a reduced number of LDL receptors expressed on MNCs from FH patients. We conclude that ¹¹¹In-LDL and ¹²³I-LDL are equally well suited as a probe of receptor-mediated binding and uptake of LDL.     

Thoracoscopic wedge resection

Summary Thoracoscopic surgery is decidedly expanded by the ability to perform pulmonary wedge resections of the lung by using the Endo-GIA-stapler. In addition to thoracoscopic biopsies, since July 1991 we have carried out wedge resections in 12 patients suffering from spontaneous pneumothorax (nine) or peripheral bronchial carcinoma (three). Postoperatively one air fistula persisted over 9 days. The chest tube was removed within 48 h in all other patients. There was no other major complication. The postoperative hospitalization period lasted 4.6 days (1–9 days). Operating time was 44 min (30–70 min). The benefit for the patient consists in the little-impaired breathing mechanics, the short hospital stay, and the favorable cosmetic result.     

复方红芪减方对周围神经再生影响的实验研究

目的　研究复方红芪提取液进行减方后对周围神经再生的作用。方法　建立钳夹损伤大鼠双侧坐骨神经的动物模型。按术后每日灌服药物的不同将 40只SD雄性大鼠随机均分为 4组。对照组 :灌服生理盐水 ;复方红芪组 :灌服复方红芪提取液 2ml ;减方组 :灌服复方红芪减方后提取液 2ml;补阳还五汤组 :灌服补阳还五汤 2ml。术后 2周及 4周 ,观察坐骨神经功能指数、运动神经传导速度及单位视野有髓神经纤维计数。结果　坐骨神经功能指数 :红芪组和减方组与对照组、红芪组与减方组的差异均有显著意义 (P >0 .0 5 ) ,且减方组优于红芪组 (P >0 .0 5 )。有髓神经纤维计数 :复方红芪组优于对照组 (P<0 0 1) ,减方组明显优于对照组 (P <0 .0 1) ,而红芪组与减方组间无显著差异。运动神经传导速度 :红芪组、减方组、补阳还五汤组与对照组相比 ,均优于对照组 (P <0 .0 5 ) ,但前 3组间无明显差异。结论　复方红芪减方提取液早期可以促进周围神经再生 ,药效更为专一 ,且优于传统方剂补阳还五汤。     

A statistically significant sex difference in the number of colony-forming cells from human peripheral blood

 The number of colony-forming cells (CFC) in the peripheral blood (PB) of 43 volunteers was examined using a semisolid clonogenic culture assay. In all, 22 male (age 21–39 years) and 21 female individuals (age 21–39 years) were tested, ten of each group twice to examine the intraindividual variability of colony-forming cells in PB. A statistically significant sex difference in the number of CFC, erythroblastic colonies (BFU-E), and granulocyte/macrophage colonies (CFU-GM) in PB was detected in favor of male individuals. No significant difference between female and male PB was found for the number of CFU-GEMM. The intraindividual variability of CFC and BFU-E was significantly higher in female donors. These results support previous reports by others on a potential influence of sex steroids on hematopoiesis. Received: 8 November 1996 / Accepted: 4 April 1997