Amiodarone-induced experimental acute neuropathy in rats.

Amiodarone was injected endoneurially at increasing doses into the exposed tibial nerve of rats to study its electrophysiologic and pathologic effects on peripheral nerve fibers. Forty-five male Wistar rats were used, and each of the following concentrations was injected into 15 nerves: 25 micrograms/mL, 50 micrograms/mL, and 100 micrograms/mL. Microinjection of a 25 micrograms/mL concentration of amiodarone resulted in a subacute, incomplete conduction block evident at day 3 postinjection. This conduction block remained stable until day 10 and recovery was complete at day 35. Microinjection of a 50 micrograms/mL concentration of amiodarone produced a faster evolving conduction block, and significant axon degeneration (approximately 40% of fibers). Injection of a 100 micrograms/mL concentration resulted in severe acute motor axon degeneration followed by complete but delayed regeneration. Results of morphological studies closely correlated with electrophysiological findings. Amiodarone thus seems to have a direct toxic effect on axons at high concentrations in the peripheral nerve, and we suggest that different pathological changes described in human amiodarone neuropathy could be related to different concentrations of the drug in the nerve, perhaps due to variability of blood-nerve barrier efficacy.     

A computer and video display based system for training eccentric viewing in macular degeneration with an absolute central scotoma

A new approach designed to establish the most suitable area for eccentric viewing and to teach and train patients with severe age-related macular degeneration (AMD) to use the eccentric viewing technique is described. Using a computer and video display based system, as well as software written specifically for this purpose, we investigated and trained ten consecutive patients with AMD. The patients were 80.1 ± 5.6 years old, on average. All of them had an absolute central scotoma. Mean visual acuity was 0.035 ± 0.016. After 30 min of testing, instruction and reading on the screen, followed by 2.6 ± 0.69 one-hour training sessions, on average, with the low vision therapist, reading newspaper and book texts with the aid of hyperoculars or aplanatic systems and a very short reading distance, the patients achieved a reading speed of 58.9 ± 19.7 words/min, significantly (p<0.001) higher than the initial speed when reading on the screen, 11.5 ± 4.5 words/min.     

仿生髓核组织工程材料支架对体外培养髓核细胞合成代谢的影响

目的：观察自行设计构建的仿生髓核组织工程材料——CⅡ／HyA-CS（CHCS）支架对体外培养髓核细胞合成代谢的影响。方法：将体外培养的传1代髓核细胞接种于培养瓶内，置入CHCS支架，体外培养10d后，分别测定^3H-脯氨酸掺入量、培养液中糖胺聚糖（GAG）含量、髓核细胞可凝集蛋白多糖（Aggrecan）、核多糖（Decorin）、二聚糖（Biglycan）的mRNA表达及Aggrecan的蛋白表达等。结果：实验组与对照组的^3H-脯氨酸掺入量、培养液中GAG含量、髓核细胞Aggrecan、Decorin、Biglycan mRNA表达、Aggrecan蛋白表达等均无统计学差异。结论：CHCS支架对体外培养髓核细胞的合成代谢无明显抑制作用。     

Added value of OCT in evaluating the presence of leakage in patients with age-related macular degeneration treated with PDT

Background Evaluating the presence of leakage on fluorescein angiography (FA) in patients with age-related macular degeneration (AMD) retreated with photodynamic therapy (PDT) can be difficult. New diagnostic tools such as optical coherence tomography (OCT) might help to optimize PDT management.Methods Thirty AMD patients scheduled for regular follow-up FA in conjunction with PDT treatment were also scanned with OCT. Follow-up data at 9 months were retrieved from the patients’ medical records. Inter-observer agreement [kappa (κ) coefficient] for the presence of leakage on FA, for OCT parameters for leakage, and agreement between FA and OCT evaluations were calculated. The indication for retreatment was evaluated using the leakage analysis based on FA alone, OCT alone, and both examinations combined, and compared to the actual follow-up of the patients at 9 months.Results Agreement between the two observers for the presence of leakage on FA was moderate (κ=0.51). OCT agreement between the two observers for the presence of leakage was good (κ=0.85). Agreement between FA and OCT for the presence of leakage was poor (κ=0.16). Follow-up data at 9 months on all patients were analyzed. Seven out of 30 patients were not retreated at the time of examination, and four of these patients (57%) remained stable without further treatment. Twenty-three patients did receive a PDT treatment at the time of examination; and eight of these patients did not show leakage on OCT, and five of these patients (62%) remained stable without additional treatment. In contrast, only three out of 15 patients (20%) with leakage on both FA and OCT remained stable during this 9 month follow-up period.Conclusions Inter-observer agreement for the presence of leakage was moderate for FA and good for OCT. There was considerable disagreement between leakage as judged by OCT and by FA. OCT could be of help in the decision regarding PDT retreatment. Assuming that 57% of the patients without leakage either on FA or OCT would remain stable without retreatment, the rate of probable ineffective retreatment could be reduced from 35% to 20%.There was no financial support for this study. The authors have full access to the data and will allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review the data if requeste.d     

NO在卵巢切除鼠椎间盘中的表达及意义

目的: 研究一氧化氮(NO)在卵巢切除后鼠椎间盘组织中的含量, 并探讨其意义.方法:6月龄雌性SD大鼠64只,实验组32只,行双侧卵巢切除术;对照组32只,行假手术.术后3个月两组分别以Prodigy骨密度仪作大鼠腰椎骨密度值(BMD)测定;同时分别摘取子宫组织,进行病理学检查;分别取两组大鼠L4～L5椎间盘,取匀浆液测定NO和一氧化氮合酶(NOS)含量.结果:大鼠腰椎BMD两组之间有非常显著性差异(P<0.01);病理学检查实验组子宫明显萎缩;椎间盘NO含量实验组为(13.195±0.045)nmol/mg Pr,对照组为(10.399±0.036)nmol/mg Pr;术后3个月实验组大鼠椎间盘NOS含量实验组为(3.487±0.024)U/mg Pr,对照组为(2.766±0.021)U/mg Pr.两组之间均有非常显著性差异(P<0.01).结论:NO和NOS在卵巢切除鼠椎间盘的退变中起重要作用.     

Movement disorders after intervertebral disc surgery: Coincidence or causal relationship?

It is well known that brain injury or central traumatic lesions may result in the subsequent appearance of movement disorders such as dystonia or tremor. The concept that peripheral lesions to neural structures may be involved in the pathogenesis of movement disorders has been discussed controversely but has gained more widespread acceptance only recently. Here, we report on 6 patients who developed movement disorders after spinal disc surgery. The movement disorders became manifest with a delay of 1 day to 12 months after surgery. Of the six patients, 4 underwent cervical disc surgery, and 2 patients were operated on for lumbar disc herniation; 2 patients presented with paroxysmal kinesigenic segmental dystonia, 1 patient with focal dystonia, 2 with unilateral tremor, and 1 with bilateral tremor. The appearance of the movement disorder was associated with persistent dermatomal or segmental pain. In all patients, the anatomic distribution of the movement disorder was related to the nerve root or spinal segment of the corresponding disc level and the manifestation was in close temporal relation to the surgery. We conclude that spinal disc surgery may be another, thus far neglected, cause for movement disorders. The postoperative pain syndrome in all patients should be considered as an important factor of pathogenesis. Overall, movement disorders associated with disc surgery appear to be rare, yet they may cause significant discomfort to the affected individual.     

颈椎间盘突出症的髓核突出类型及其临床意义

目的对颈椎间盘突出症进行分型,并探讨其临床意义。方法手术治疗颈椎间盘突出症110例,根据MRI特点分为Ⅰ型,Ⅱ型和Ⅲ型,并就分型和临床的关系,选择手术方式。结果两节段以下的各型突出,含有Ⅱ型或Ⅲ型突出的多节段颈椎间盘突出,伴动力性颈椎不稳的各型突出,均应首选前路手术;三节段以上的Ⅰ型突出,发育性颈椎管狭窄合并Ⅱ型或Ⅲ型突出,应选择后路手术。结论颈椎间盘突出症的分型对手术入路选择有指导意义。     

经皮穿刺腰椎间盘切吸术治疗腰椎间盘突出症的远期疗效

目的 观察X线电视引导下经皮穿刺腰椎间盘切吸术治疗腰椎间盘突出症的远期疗效。方法 32例经CT扫描证实的腰椎间盘突出症患者，其中，膨出型29例，游离型2例，以及突出型1例，均经X线电视引导下经皮穿刺腰椎间盘切吸术治疗，术后均经随访0.5～11.0a。结果 术后1周～3个月，32例中的24例临床症状与体征得到有效控制或明显减轻，随访5～11a观察表明，症状完全消失和明显减轻者分别见于23例和6例，总有效率90.6%，预后极好和较好者均见于膨出型腰椎间盘突出症患者。结论 游离型和突出型腰椎间盘突出症的疗效均不理想，因此，术前认真选择适应证是获得理想疗效的关键性因素。     

退变腰椎间盘髓核细胞立体培养与单层培养的生物活性比较

目的：比较体外单层培养和旋转微载体立体培养人退变腰椎间盘髓核细胞的生物学活性指标,探讨更加有效的椎间盘髓核细胞体外培养方法.方法：对获取的腰椎间盘突出症患者的24个椎间盘按年龄分为A组（20～25 岁）、B组（26～30 岁）、C组（36～45 岁）及D组（＞45岁）,分别利用酶消化法进行单层细胞培养和旋转微载体立体培养系统进行立体培养,观察细胞生长形态,检测细胞生长曲线及速度、细胞生长活性、细胞分裂指数及胶原含量.结果：单层培养的髓核细胞贴壁后为多角形或梭形,伸出伪足;立体培养的细胞在微载体上呈梭形或不规则形,呈立体状生长.立体培养的细胞生长速度较快,1周内两种培养方法各时间点及各组间比较均具有统计学意义（P＜0.05）.立体培养的髓核细胞活性提高,随年龄增加细胞活性下降;指数生长期细胞分裂指数与单层培养相比有统计学意义（P＜0.05）;Ⅰ、Ⅱ型胶原含量与单层培养相比有统计学意义（P＜0.05）,A组分别与B组、C组及D组比较均有统计学意义（P＜0.05）.结论：旋转立体培养人退变椎间盘髓核细胞的活性保持良好,较单层培养能够大量、优质收集种子细胞,可用于椎间盘组织工程中种子细胞的研究.     

SOLIS在颈椎前路融合术中的应用

目的 探讨新型颈椎前路融合器(SOLIS)在颈椎前路融合术中的应用效果.方法 对18例脊髓型颈椎病、12例颈椎间盘突出症采用颈椎前路减压融合术,小切口入路(3～4 cm),椎间盘及部分椎体后缘切除后保留椎体终板,植人带自体松质骨的SOLIS.以手术前后X线片及JOA评分评价疗效.结果 30例随访6～18个月,平均12.5个月.置人的SOLIS位置良好,无移动及脱出迹象;病变椎间隙高度恢复正常,未见椎间高度丢失;所有节段均于术后3～8个月骨性融合.术前JOA评分平均10.4分,术后平均14.9分,两者有统计学意义(P＜0.01).结论 颈椎前路融合器SOLIS具有良好的生物相容性,手术创伤小,能有效地恢复颈椎高度,融合率高,融合后稳定性好,神经功能改善优良率高.