目的 研究应用骨水泥增强椎弓根钉固定治疗Kümmell病的有效性和安全性.方法 对2017年1月至2019年6月北京大学人民医院25例应用骨水泥增强椎弓根钉固定治疗Kümmell病患者进行回顾性研究,记录患者的手术时间、术中出血量、骨水泥体积.随访过程中通过腰椎正侧位X线片和CT进一步评价病椎高度、Cobb角;采用腰痛视觉模拟评分(VAS)评定临床症状改善情况,采用Oswestry功能障碍指数(ODI)评分评定术后功能改善情况.结果 VAS评分、ODI评分、病椎高度和后凸Cobb角度显示,术前和术后1周、术前和末次随访之间比较,差异有统计学意义(P＜0.05),术后1周和末次随访的随访值之间仅VAS评分比较差异无统计学意义(P＞0.05),而ODI评分、病椎前缘高度和Cobb角的差异具有统计学意义(P＜0.05).结论 骨水泥增强椎弓根钉内固定治疗Kümmell病可以减少脊柱后凸畸形、恢复椎体高度、缓解疼痛.尽管可能存在椎体高度丢失相关远期问题,但远期患者功能依旧恢复较好且并发症率较低,是一种安全有效的治疗方式.

Objective:Traumatic heterotopic ossification is the formation of extra-skeletal bone within soft tissues or joints after trauma. Injury factors induce many types of precursor cells to participate in this process. Many cytokines such as bone morphogenetic proteins, hypoxia inducible factor 1-α, inflammation factors and fibrin, can influence this process. Formation of heterotopic ossification often leads to the limitation of limb function and pain. However, prevention and treatment of heterotopic ossification often lead to bone nonunion and high recurrence rate. To find a treatment that can inhibit the formation of heterotopic ossification without affecting fracture healing has become a concern of clinicians. It is necessary to explore the formation mechanism of heterotopic ossification and find effective and safe methods. The authors document the cellular and molecular mechanisms involved in formation of traumatic heterotopic ossification for better understanding the factors affecting the formation of heterotopic ossification so as to provide references for new treatment methods.

Kümmell's disease is often manifested as delayed progressive collapse of the vertebral body, and the imaging manifestation is the intravertebral vacuum cleft of the vertebral body. With the wider knowledge of the disease, more studies into the diagnosis and treatment are reported. Due to the lack of recognized diagnostic criteria, the current studies are limited by different inclusion criteria. At present, it is considered that the core symptom is progressive pain and typical imaging manifestations after trauma. In treatment of Kümmell's disease, the rate of vertebral collapse and bone cement leakage is high after vertebroplasty, but internal fixation has no advantage over vertebroplasty. The authors review the diagnosis, staging and treatment of Kümmell's disease in order to provide readers with further comprehensive understanding of the disease.

腰椎不稳是临床上一种常见的疾病,是慢性腰痛的常见原因之一.但是对于腰椎不稳,目前并没有统一的诊断标准.由于腰椎不稳的临床表现缺乏一定的特异性,因此其诊断标准尚存在一定分歧.目前临床中常用前屈后伸位(flexion/extension,F/E)X线片的椎体相对位移或成角作为腰椎不稳诊断依据,但是研究者对于应用多大的移位及成角作为诊断标准有不同意见:移位＞4mm,成角＞10 °[1];或移位＞3mm,成角＞9°[2];抑或移位＞5mm,成角＞10°[3]在文献中均有报道.

患者60岁,因卵巢浆液性乳头状囊腺癌行子宫全切除+双侧附件切除术,术后17年肿瘤复发伴下腔静脉瘤栓形成,行肿瘤细胞减灭术后1年疾病进展,化疗后带瘤生存至今已5年余.患者于1996年因卵巢囊肿蒂扭转开腹行右侧附件切除术,术中快速冰冻病理检查提示卵巢浆液性乳头状囊腺癌(G2),遂行子宫全切除+双侧附件切除术,术后给予腹腔内顺铂化疗1次,卡铂+多柔比星+环磷酰胺方案化疗6个疗程,随后规律随访,未见异常.2001年12月患者因血清CA125水平升至42 kU/L,行正电子发射体层摄影术(PET)-CT检查未见异常,予紫杉醇+顺铂方案化疗4个疗程,血清CA125水平降至正常.2010年行腹部CT检查提示腹主动脉旁多发增大淋巴结,未诊治.2013年出现双下肢水肿伴右侧肋下疼痛,血清肿瘤标志物正常,腹部CT检查显示腹膜后异常软组织肿物(图1),考虑为肿瘤复发.患者出现站立后及傍晚时的意识改变,考虑为下腔静脉瘤栓形成所致.因肿瘤复发的间隔时间长,对化疗反应好,经多学科讨论后于2013年1月25日行肿瘤细胞减灭术.术中探查未见腹水,盆腔未见异常,腹膜后肿物包裹腹部大血管,上至肾血管水平,下至左、右髂总血管分叉处,肿瘤侵及右侧输尿管,遂行腹部大血管及输尿管表面肿瘤剥除术;探查时触及下腔静脉内约6 cm瘤栓,遂阻断瘤栓上游的下腔静脉,切开下腔静脉取出瘤栓,放置下腔静脉滤器,有部分肿瘤残留,手术满意.术后病理检查提示低分化癌,下腔静脉内瘤栓形成.行腹腔内卡铂化疗1次,间断进行以铂类药物为主的静脉化疗,肿瘤抑制效果好.1年后出现病灶进展,予博来霉素+奈达铂+依托泊苷方案化疗后成功抑制肿瘤生长.化疗后定期复查血清CA125水平及PET-CT检查未见残留肿瘤进展,目前患者带瘤生存已63个月(2013年1月至2018年4月).

The incidence of stageⅡendometrial cancer accounts for about 12%of endometrial cancer. The combination of the dilationand curettage, hysteroscopy and the imaging technique is a good choice for diagnosis. At present, the surgical approach of stage Ⅱ endometrial cancer is controversial, different studies have come to different conclusions, to expand the resection range to reduce the recurrence rate also increased intraoperative and postoperative complications. We should carefully balance the benefits of prognosis and increasing risk of surgery in selecting the surgical range. More prospective experiments are needed. Postoperative radiotherapy can reduce the recurrence rate, but have no effect on the overall survival rate. And vaginal brachytherapy may be better than pelvic radiotherapy. Adjuvant chemotherapy is needed in high-risk stage Ⅱ endometrial cancer. The three year survival rate of stageⅡendometrial cancer is 79%-85%. The diagnosis, treatment and prognosis of stageⅡendometrial cancer, which is the endometrial cancer patients with cervical stromal involvement [new International Federation of Gynecology and Obstetrics (FIGO) stageⅡ] are reviewed.

A static biological leaching method was used to treat the 2,4-DNT-3-SA contaminated soil. The effects of oxygen conditions, soil to water ratio and temperature on the removal efficiency of 2,4-DNT-3-SA were evaluated. The result suggested that under the aerobic and 37oC conditions, the removal efficiency of 2,4-DNT-3-SA reached more than 98% when the ratio of soil to water was 10:5. High-throughput sequencing results indicated that the dominant bacteria in the soil were Genus Pseudomonas, Sphingobium and Sporolactobacillus.

Objective:To assess the tissue distribution of 3β-hydroxyandrost-5-ene-17-one succinate(A1998) intralipid after iv administration to rats.Methods:After single iv administration of A1998 intralipid 20 mg·kg~(-1),rats were euthanized at certain prescheduled timepoints to collect related rat tissues for the determination of the A1998 concentration-time curve by a pre-column derivation HPLC.Results:The A1998 was mainly distributed in rats'lung,spleen and liver.Compared with the concentration-time curve in the plasma,heart and kidney tissues,the lung,spleen and liver tissues of rats showed significantly higher A1998 concentrations after 15 minutes of iv administration,i.e.,(32.73±3.87),(23.47±8.04) and(14.87±1.63) (μg·g~(-1),) respectively,and longer sustenance of the A1998 concentration after 36 hours of the iv administration [(4.37±2.74),(4.69±2.37) and(8.30±5.96) μg·g~(-1),respectively].No A1998 concentrations were detected in rats'stomach,small intestinal,ovarian,uterine and body fat tissues.Conclusion:The A1998 was rapidly distributed into tissues from the plasma in terms of highly selective affinity to lung,live and spleen tissues.

目的:建立高效液相色谱柱前衍生法测定兔血浆中海星甾醇（A1998）浓度。方法:用2,4-二硝基苯肼（2,4-DNPH）将A1998 C-17位上的2个羰基衍生化,形成双腙,以提高检测灵敏度。选用A1998的同系物3β-羟基雄甾-5烯-17酮己二酸酯（C6）作为内标。色谱条件:采用Agilent Zorbax Exend C18反相色谱柱（4.6 mm×150 mm,5μm）,流动相为100%甲醇,流速2.0 mL·min-1,检测波长为360 nm。结果:血样中A1998浓度在0.05-10μg·mL-1范围内具有良好的线性关系（r=0.9998）,最低检测浓度为0.05μg·mL-1。回收率大于80%,日内及日间精密度RSD分别为3.2%-15%和6.7%-11%。结论:本方法灵敏、准确、实用,能够满足动物药物代谢动力学研究的要求。

To study the effect of immune damage in liver on cytochrome P450 metabolism enzymes (CYP450) and the possible mechanism. The immune hepatic injury model was established by intravenous injection of BCG(125 mg/kg) for 2 weeks, CYP450 total content in hepatic homogenate was determinated by spectrophotography, the hepatic tissues injury and iNOS protein expression were examinated by H-E histopathological staining and immunohistochemistry respectively. Both of granulomas caused by inflammatory cells soakage and iNOS protein positive brown stained conglomerations were observed in BCG-stimulated hepatic section. Compared with the control group [(1.93±0.26) μmol/g)], CYP450 enzyme content was significantly decreased by BCG-immune stimulation [(1.10±0.45) μmol/g], (P0.05) in mice. Administration of aminoguanidine (AG, 25～100 mg/kg), a selective iNOS inhibitor, not only reduced the granuloma formation, iNOS expression, but also enhanced the CYP450 content inhibited by BCG-stimulity in mice hepatic tissue. The results indicated that iNOS expression participated in the down-regulating CYP 450 mechanism induced by BCG-immune hepatic damage in mice.