Gut-disc axis: A cause of intervertebral disc degeneration and low back pain?

Purpose

Low back pain (LBP), a widely prevalent and costly disease around the world, is mainly caused by intervertebral disc (IVD) degeneration (IDD). Although numerous factors may trigger this degenerative process, microbiome dysbiosis has recently been implicated as one of the likely causes. However, the exact relationship between the microbiome and IDD is not well understood. This review summarizes the potential mechanisms and discusses microbiome dysbiosis’s possible influence on IDD and LBP.

Methods

Prospective literature review.

Results

Alterations in microbiome composition and host responses to the microbiota causing pathological bone development and involution, led to the concept of gut-bone marrow axis and gut-bone axis. Moreover, the concept of the gut-disc axis was also proposed to explain the microbiome’s role in IDD and LBP. According to the existing evidence, the microbiome could be an important factor for inducing and aggravating IDD through changing or regulating the outside and inside microenvironment of the IVD. Three potential mechanisms by which the gut microbiota can induce IVD and cause LBP are: (1) translocation of the bacteria across the gut epithelial barrier and into the IVD, (2) regulation of the mucosal and systemic immune system, and (3) regulation of nutrient absorption and metabolites formation at the gut epithelium and its diffusion into the IVD. Furthermore, to investigate whether IVD is initiated by pathogenic bacteria and establish the correlation between the presence of certain microbial groups with the disease in question, microbiome diversity analysis based on16S rRNA data can be used to characterise stool/blood microbiota from IVD patients.

Conclusion

Future studies on microbiome, fungi and viruses in IDD is necessary to revolutionize our thinking about their possible role in the development of IVD diseases. Furthermore, we believe that inflammation inhibition and interruption of amplification of cascade reaction in IVD by targeting the gut and IVD microbiome is worthwhile for the treatment of IDD and LBP.

Level of Evidence I

Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

     

3D-SPACE序列结合3D-TOF MR血管成像在颅内动脉瘤支架辅助弹簧圈栓塞术后随访中的应用

目的探讨三维T1加权序列可变反转角度快速自旋回波序列(3D T1-SPACE)结合三维时间飞跃法MR血管成像(3D-TOF MRA)在颅内动脉瘤支架辅助弹簧圈栓塞术后患者随访中的应用价值。方法前瞻性收集2017年12月至2018年10月河南省人民医院收治的25例因颅内动脉瘤接受支架辅助弹簧圈栓塞术的患者,均为宽颈动脉瘤。术后6~10个月所有患者均行3D-TOF MRA、3D T1-SPACE序列MR扫描和DSA检查。分别使用3D-TOF MRA和DSA以Raymond分级法评价瘤腔栓塞情况,使用3D-TOF MRA和3D T1-SPACE序列以4分法评价载瘤动脉支架内管腔显示情况。采用配对设计的Wilcoxon秩和检验比较动脉瘤栓塞程度分级和支架内管腔显示情况。以DSA为金标准,计算3D-TOF MRA评估动脉瘤残留的特异度及准确率。结果术后6~10个月随访,对于动脉瘤闭塞情况,DSA造影显示Raymond 1级23例,2级1例,3级1例;3D-TOF MRA 1级21例,2级3例,3级1例;差异无统计学意义(Z=-0.557,P=0.577),其中有4例患者两种评估方法结果不一致。对于载瘤动脉支架内管腔情况的显示,3D-TOF MRA评分3分14例,2分8例,1分3例;3D T1-SPACE序列25例均为4分,3D T1-SPACE优于3D-TOF MRA(Z=-4.484,P<0.001)。以DSA为金标准,3D-TOF MRA结合原图像评估动脉瘤栓塞情况的特异度为86.9%(20/23),准确率为84.0%(21/25)。结论3.0 T MR 3D T1-SPACE序列可清晰显示支架内管腔,能准确判断支架内血管的通畅情况,3D-TOF MRA可充分评估动脉瘤瘤腔有无残留。将上述两种MRI血管成像技术相结合,可用于动脉瘤支架辅助栓塞术后的随访。     

非体外循环冠状动脉搭桥术后心肌损伤与炎症因子的关系

目的:探讨非体外循环冠状动脉搭桥术(OPCABG)后心肌损伤与炎症因子的关系。方法:根据患者术后24h肌钙蛋白(ITnI)水平分为2组,TnI<0.16μg/L者为A组,TnI≥0.16μg/L者为B组。集中通过液相芯片技术同期检测术前及术后1、4、24、72h细胞因子白细胞介素(IL)-6、IL-8和IL-10的表达水平。结果:2组患者术后1hIL-6、IL-8、IL-10水平达高峰,(IL-6 IL-8)/IL-10于术后24h达到高峰。2组组内(IL-6 IL-8)/IL-10水平各时间点比较差异有统计学意义(P<0.01),而组间比较差异无统计学意义(P>0.05),组内各时间点与处理分组的交互作用差异无统计学意义(P>0.05)。结论:OPCABG伴有炎症反应过程,可导致术后炎症因子水平的变化,(IL-6 IL-8)/IL-10水平与术后24h时心肌损伤状况无关。     

Analysis of BAC<Subscript>5</Subscript> mcAb-related epitope using random peptide library

Objective To identify epitope relating to BAC₅ mcAb, a kind of monoclonal antibody (mcAb) located on the surface of nasopharyngeal carcinoma (NPC) cells. Methods Using BAC₅ mcAb as a selected target, the 3 rounds of biopanning to a 12 mer random peptide library (RPL) presented by M13 phages were carried out. The positive M13 phage clones were chosen and confirmed with sandwich ELISA for antibody capture and competitive assay. The exogenous DNA fragments in the positive/negative M13 phages were sequenced to deduce and compare the order of the amino acids of exogenous peptides among the phage clones. Results 77% (35/45) of the phages eluted from the 3rd round of biopnning could be captured by BAC₅ mcAb. The 3 kinds of the peptides were displayed by M13 phages from the 8 positive clones identified with competitive assay. The same character of “-P-V-” structure existed near N-terminus of the 3 different peptides, i. e.-H-Q-S-H-Y-P-Y-P-V-V-S-L- (4/8)-Q-N-Q-A-W-F-S-Q-P-V-R-M-(3/8) and T-Q-A-Y-K-G-F-P-V-L-P-S- (1/8) in comparison with the peptide “-N-H-Q-S-T-F-W-Q-K-W-T-A-” displayed by M13 phages from the negative clones (6/6). Conclusion BAC₅ mcAb can recognize the 3 kinds of the peptides with-P-V-structure near N-terminus. These peptides mimic the structure of the epitope on the surface of NPC cells recognized by BAC₅ mcAb. This project was founded by Health Foundation of Guangdong Province (Grant No. A1999212)     

迅速发展型鼻咽癌——31例临床病理分析

作者报道一种病程短,很快发生远处转移并导致死亡的鼻咽癌,称为迅速发展型鼻咽癌。其临床病理特点是:(l)患者从自觉症状至死亡的时间平均仅11.7个月。(2)多数患者来诊时已有大块或累及锁骨上区的颈淋巴结转移(N_3病例占51.6％)。(3)角化性鳞癌和非角化性癌所占比例较高(43.3％)。(4)癌组织中淋巴细胞,树状突细胞以及单核/巨噬细胞的浸润较少。临床大夫如能及时识别这一特殊类型的鼻咽癌,并采取相应措施,将达到减少远处转移,提高疗效的目的。     

人源性抗EB病毒IgG/VCA抗体在SCID小鼠中的诱导

将人外周血淋巴细胞（ＰＢＬ）和腹腔淋巴结淋巴细胞（ＰＬＮＬ）移植入严重联合免疫缺陷疾病（ＳＣＩＤ）小鼠腹腔，２个月后，小鼠血清内产生人源性ＩｇＧ和抗ＥＢ病毒壳抗原ＩｇＧ抗体（ＩｇＧ／ＶＣＡ）。比较结果显示，用Ｂ９５－８细胞作为ＶＣＡ来源所诱导的实验组１０只小鼠，ＩｇＧ／ＶＣＡ阳性率为７０％（７／１０），对照组为１７％（２／１２）。ＩｇＧ／ＶＣＡ的几何平均滴度（ＧＭＴ）和血清ＩｇＧ浓度，在１４只ＳＣＩＤ－ＰＬＮＬ小鼠中为１∶１０８和（９６．２±５６．４）μｇ／Ｌ；在８只ＳＣＩＤ－ＰＢＬ小鼠为１∶７．８和（１３．８４±６．０）μｇ／Ｌ。该结果提示，ＳＣＩＤ－ＰＬＮＬ小鼠较ＳＣＩＤ－ＰＢＬ小鼠更适合用于人源性特异ＩｇＧ的诱导。     

Comparison of 3D T1-SPACE and DSA in evaluation of intracranial in-stent restenosis

Objective:In-stent restenosis (ISR) after stenting for intracranial stenosis is a significant issue. This study aimed to evaluate the usefulness of the 3D T1-SPACE technique in the follow-up of patients after stent implantation.Methods:Fifteen patients with intracranial arterial stenosis were prospectively enrolled 6–8 months after stenting. Digital subtraction angiography (DSA) and 3D T1-SPACE imaging were performed to evaluate the degree of stenosis and the enhancement of the vessel wall. Bland–Altman plots were used to assess the agreement between the two imaging methods, and the Pearson correlation coefficient was calculated as a measure of the linear correlation.Results:Eight Enterprise stents and seven Wingspan stents were used in 15 patients. The follow-up DSA after 6–8 months showed that the degree of stenosis was 40% (range, 30–72%), and ISR occurred in 4 of 15 (26.7%) lesions. The degree of stenosis assessed using the 3D T1-SPACE imaging technique was 35% (range, 30–75%). All four patients with ISR demonstrated significant enhancement. The Pearson correlation coefficient between the two methods was 0.959 (p < 0.05), and the Bland–Altman plot showed that all data points were within the consistency limits ( x- ± 1.96 s).Conclusion:As a non-invasive imaging modality, 3D T1-SPACE showed great consistency with DSA in measuring the degree of stenosis after intracranial stenting. It may be used as an optional method for detecting ISR.Advances in knowledge:This study evaluated the usefulness of 3D T1-SPACE technique in the follow-up of patients after stent implantation, which could be used as an optional and non-invasive method in detection of in-stent restenosis.     

非血管化游离骨移植中细胞活力的实验研究

目的 :探讨非血管化游离骨块中细胞存活能力及数量与离体时间的关系。方法 :取狗非血管化游离髂骨块 ,在离体 2 5～ 15 0min的不同时间点 ,消化骨块获得细胞 ,进行活细胞计数。对消化获得细胞体外培养2 4h后 ,再进行活细胞计数 ,分析细胞存活与离体时间的关系。结果 :在离体 2 5～ 15 0min时间内 ,骨块细胞的存活率从 91.96%降至 9.5 2 %。统计学检验 ,2 5min组与 70min以前组之间没有统计上的差别 ,P >0 .0 5 ;2 5min组与 70min及其以后组之间有明显差别 ,P <0 .0 1。培养 2 4h后 ,以上各时间点的细胞存活率则从88.73 %到 3 .88% ,组间差别与刚离体时相同 ,但 70min后的各组活细胞率明显下降。结论 :非血管化狗游离髂骨块的离体时间对其中的细胞存活有明显影响 ,离体 70min可能是其关键点 ;在非血管化游离骨移植中 ,尽量缩短骨块的离体时间 ,有利于保存更多的活细胞     

重症急性胰腺炎119例治疗分析

目的　探索一种减少重症急性胰腺炎（ｓｅｖｅｒｅ ａｃｕｔｅ ｐａｎｃｒｅａｔｉｔｉｓ,ＳＡＰ） 并发症,降低其病死率的新途径。 方法　将我院普外科１９８０ 年１ 月至１９９８ 年１０ 月治疗的ＳＡＰ１１９ 例按不同的治疗阶段分为三组。Ａ组：１９８０ 年１ 月至１９９３ 年１０ 月的手术治疗为主的手术组;Ｂ 组：１９９３ 年１０ 月至１９９５ 年１０ 月以周围静脉给药为主的非手术组;Ｃ组：１９９５ 年１０ 月至１９９８ 年１０ 月采用以区域性动脉灌注（ｌｏｃａｌａｒｔｅｒｉａｌｉｎｆｕｓｓｉｏｎ,ＬＡＩ） 给药为主的介入治疗组。结果　Ａ组６８ 例,死亡１４ 例,病死率２０％ （１４／６８）,Ｂ组２０ 例,死亡２ 例,病死率１０％ （２／２０）,Ｃ组３１ 例,无死亡。 结论　ＳＡＰ以区域性动脉灌注给药为主的治疗方法优于周围静脉给药组和手术组     

前哨淋巴结阳性乳腺癌非前哨淋巴结转移的情况分析

目的探讨前哨淋巴结（SLN）阳性乳腺癌患者的临床病理特征与非前哨淋巴结（NSLN）转移的关系。 方法回顾性分析2010年1月至2016年1月中山大学附属第一医院500例行前哨淋巴结活检（SLNB）的临床分期为T_1-2N₀M₀期乳腺癌患者资料,其中病理检查确诊SLN阳性、随后行腋窝淋巴结清扫（ALND）的乳腺癌患者共89例,总结其临床、病理因素的特征及其对腋窝NSLN转移的影响因素进行单因素及多因素Logistic分析。 结果SLN阳性率为17.8%（89/500）,49.4%（44/89）出现NSLN转移。单因素分析显示,NSLN转移与原发肿瘤分期、脉管浸润、SLN阳性数、SLN阳性率相关（χ²=4.062、36.084、7.003、10.889,P=0.044、<0.001、0.030、0.004）。进一步多因素Logistic回归分析显示,脉管浸润、SLN阳性率是NSLN转移的独立预测因子（OR=46.142,95%CI：11.821~258.472,P<0.000 1;OR=10.482,95%CI：2.564~51.312,P=0.002）。 结论SLN阳性的乳腺癌患者,其原发肿瘤分期、肿瘤是否多发、脉管浸润、SLN阳性数、SLN转移率与腋窝NSLN转移相关。其中,脉管浸润及SLN阳性率≥0.5是SLN阳性乳腺癌患者腋窝NSLN转移的独立预测因子。