目的 观察皮下注射尼古丁对大鼠椎间盘退变程度的影响,分析椎间盘组织中水通道蛋白1(AQP1)和水通道蛋白3(AQP3)的表达变化,以探讨其影响的机制.方法 取健康雄性Wistar大鼠30只,随机分为实验1组、实验2组及对照组各10只.实验1组和实验2组皮下注射尼古丁稀释液1.5 mL/(kg·d),对照组皮下注射等量生理盐水,连续5周.实验1组和对照组于实验5周后、实验2组于实验10周后处死,取L4/L5椎间盘组织,采用HE染色法观察椎间盘退变程度,免疫组化染色法检测椎间盘组织AQP1、AQP3表达.结果 与对照组比较,实验1组和实验2组椎间盘组织结构模糊紊乱,严重炎性水肿、黏液样变性、层次不清,退变严重;与实验1组比较,实验2组的椎间盘各组织结构同样模糊紊乱,层次不清,但椎间盘纤维环有不同程度的基质填充.实验1组、实验2组AQP1、AQP3表达水平均较对照组降低(P均<0.05),实验2组AQP1、AQP3表达水平较实验1组升高(P均<0.05).结论 尼古丁可加速椎间盘退变,其机制可能与抑制AQP1、AQP3表达有关.

Study Design. To evaluate the effect of p38 pathway on spinal cord injury (SCI), a rat model of SCI was performed. Objective. We determined the effect of p38 on SCI and SCI related inflammation, apoptosis, and autophagy. Summary of Background Data. SCI is a severe clinical problem worldwide. It is difficult to prevent cell necroptosis and promote the survival of residual neurons after SCI. p38, a class of mitogen-activated protein kinases, its effect on SCI and SCI related inflammation, apoptosis, and autophagy have not been studied very well. Methods. The rats were randomly divided into the following four groups: the sham-operated (sham) group, the SCI group, the SCI + vehicle group, and the SCI + SB203580 (10 mg/kg) group. The p38 inhibitor SB203580 was administered by oral (10 mg/kg/d) gavage once per day for 14 days. Neurological recovery was assessed using the Basso, Beattie, and Bresnahan locomotion rating scale. Apoptosis, autophagy, and inflammation related proteins were measured by enzyme-linked immunosorbent assay kits or western blotting. Results. Our results showed that p38 was upregulated after SCI from day 3, which was paralleled with the levels of its proteins ATF-2, suggesting an increase in p38 activity. Our results showed administration of SB203580 attenuated histopathology and promoted locomotion recovery in rats after SCI. SB203580 administration significantly inhibited inflammatory cytokines levels as well as the inflammation signaling pathway. SB203580 administration also modulated the apoptosis and autophagy signaling pathway. Conclusion. Our findings suggest that p38 inhibitor SB203580 treatment alleviates secondary SCI by inhibiting inflammation and apoptosis, thereby promoting neurological and locomoter functional recovery, thus suggest the important role of p38 in neuronal protection after SCI. Level of Evidence: N/A

Dacron heart patch has been used in decompressive craniectomy, performing the function of septa, mainly to prevent extra adhesion of temporal muscle and decompressive meningeal adhesion in the second-stage cranioplasty, so as to make the operation easier. Then, we made the following modification technology: (1) We used artificial suturing-free dura participate directly in the duraplasty. (2) Dacron patch is not in need of trimming the side holes and can directly cover the decompression window. From March 2012 to October 2013, we applied the technology of artificial dura with Dacron heart patch in 23 patients; after operation, we found that the initial depressive craniectomy cost less time, due to the tension-reduced suture which was not needed, and in the second-stage cranioplasty, the temporal was easy to remove and had no adhesion with the Dacron patch, so as to reach temporal muscle anatomy preservation, and with no obvious postoperative complication.

Objective To find a gild standard dorsal approach by comparing several fixation methods .Meth-ods Six fresh human cervical spine specimens (C3 ~T1) were tested by applying pure moments to the C 3 vertebral body in increments of 0.5 Nm from 0 Nm to 2.0 Nm.Each specimen was tested in the following 8 conditions:①intact;②after destabilization via injury to the C5~6 facet;③with bilateral C5~6 lateral mass screws and rods;④after further destabilization by creating a right unilateral lateral mass fracture of C 5;⑤with unilateral left C5~6 lateral mass screws and rod;⑥with unilateral C5~6 lateral mass screws and rod supplemented with an interspinous cable;⑦with a bilateral multilevel dorsal construct C4~6;and⑧after a C5~6 anterior cervical discectomy and fusion (ACDF) procedure with a polyetheretherketone graft and plate .Results Relative to the normal,the range of C5~6 motion in each construct was:33.3%in the bilateral C5~6 lateral mass construct,113.6%in the unilateral C5~6 lateral mass construct,90.3%in the unilateral lateral mass construct supplemented by an interspinous cable ,44.2% in the bilateral C4~6 lateral mass construct,and 66.9%in the C5~6 ACDF construct.Conclusion A dorsal approach is used and the unilateral con-struct with a cable should only be considered in selected instances .

Caspase-3是凋亡过程中主要的酶切效应因子,对凋亡的完成起着至关重要的作用.本文就Caspase-3在卵巢上皮性肿瘤、子宫内膜癌、子宫颈癌及绒癌中的研究进展作一综述.

目的 研究PCNA和Caspase-3在妊娠滋养细胞疾病中的表达变化及意义,为妊娠滋养细胞疾病早期诊断、预后判断提供理论依据.方法 收集滋养细胞疾病标本50例,其中葡萄胎10例(均为完全性葡萄胎),侵蚀性葡萄胎20例,绒毛膜癌20例.正常早孕绒毛标本10例为对照组.应用免疫组织化学技术检测PCNA和Caspase-3在早孕绒毛、葡萄胎、侵蚀性葡萄胎、绒毛膜癌组织中的表达情况.结果 PCNA在正常早孕绒毛、葡萄胎、侵蚀性葡萄胎和绒癌中的表达分别为10.24%、20.70%、50.92%、53.65%,各组差异有统计学意义(P＜0.05).Caspase-3在正常早孕绒毛、葡萄胎、侵蚀性葡萄胎和绒癌中的表达先升高又降低,分别为1.25%、2.60%、6.40%、1.90%,各组差异有统计学意义(P＜0.05).结论 PCNA及Caspase-3表达异常,增殖/凋亡失衡是引起GTT的重要因素.

目的为细胞因子治疗椎间盘退变提供理论支持。方法采用Lindblom折尾加压法建立鼠尾椎椎间盘退变模型,将制模成功后大鼠随机分为A、B、C、D组各15只,A、B、C组用微量泵分别注入外源性胰岛素样生长因子-1（IGF-1）、成骨蛋白-1（OP-1）及生理盐水,注射速度为5μl/min,注射完毕于进针处涂红霉素软膏,1周后于相同节段椎间盘不同的进针部位进行第2次注射,方法同第1次。D组不予任何处理。4周后取材,光镜下观察椎间盘形态、厚度,软骨陷窝中细胞密度,分析AB-PAS染色标本髓核中蛋白多糖的平均光密度（MOD）值。免疫组织化学SP法检测鼠尾椎椎间盘软骨板内细胞PCNA表达情况,计算阳性表达率。结果与C、D组比较,A、B组内层纤维环胶原明显增粗,排列整齐,陷窝中细胞密度明显增高;髓核完整性较好,无明显缺失;椎间盘厚度、髓核的MOD值均明显增加,B组软骨细胞PCNA阳性表达率均明显高于A、C、D组。结论鼠尾椎椎间盘内注射IGF-1、OP-1可刺激细胞增殖、增加胶原和蛋白多糖释放,促进退变椎间盘的修复;且OP-1效果优于IGF-1。

目的 观察IGF-1(胰岛素样生长因子-1)、OP-1(成骨蛋白-1)在大鼠尾椎椎间盘退变中的作用.方法 利用Lindblom折尾加压法建立鼠尾椎椎间盘退变模型,将外源性IGF-1,OP-1在不同时间、不同部位分两次向同一退变尾椎椎间盘髓核内注射.4周后取材,光镜下观察椎间盘形态、厚度,软骨陷窝中细胞密度,分析AB-PAS染色标本髓核中蛋白多糖的MOD值.免疫组织化学SP法检测鼠尾椎椎间盘软骨板内细胞PCNA表达情况,计算阳性表达率.结果 ①HE染色:与对照组比较,OP-1组内层纤维环胶原增粗,排列整齐,陷窝中细胞密度高.两实验组髓核完整性较好,无明显缺失.②AB-PAS染色:与对照组相比,IGF-1,OP-1组椎间盘厚度均增加,髓核的MOD值增加,两实验组比较无明显差异.③免疫组织化学染色:OP-1组软骨细胞PCNA阳性表达率高于IGF-1与对照组.结论 ①鼠尾椎椎间盘内注射生长因子可以刺激细胞增殖,增加胶原和蛋白多糖释放,从而促进退变椎间盘的修复;②在PGs合成方面,两生长因子效果无明显差异,OP-1促进细胞增殖、胶原合成、逆转退变过程的效果优于IGF-1.

Objective:To study the expression of PCNA and Caspase - 3 in gestational trophoblastic disease which provides a theoretical basis for early diagnosis and treatment.Methods:10 cases of hydatidiform mole,20 cases of invasive hydatidiform mole and 20 cases of choriocarcinomas were selected.10 cases of normal villi tissues were investigated as control group.Expression of PCNA, Caspase - 3 in normal chorion of early gestation,hydatidiform mole,invasive hydatidiform mole and choriocarcinoma were detetected with immunohistochemistry method and image analysis technique.Results:The expression level of PCNA in normal villi,hydatidiform mole,invasive hydatidiform mole and choriocarcinomas was 10.24,20.70,50.92 and 53.65 percent respectively with significant differences(P<0.05).The expression of Caspase - 3 in normal villi,hydatidiform mole,invasive hydatidiform mole and choriocarcinomas was 1.25,2.60,6.40 and 1.90 percent respectively with significant differences(P<0.05).From normal villi to hydatidiform mole,to invasive hydatidiform mole,the expression of Caspase - 3 show an ascending tendency.Then in choriocarcinomas the expression of Caspase - 3 was significant decreased(P<0.05).Conclusions:The overproliferation of trophoblastic cell resulted from the disbalance between proliferation and apoptosis is associated with the development of GTT.

Objective To study the expression of E-cadherin ( E-cad) and vascular endothelial growth factor ( VEGF) in gestational trophoblastic disease and provide theoretical basis for its early diagnosis and treatment.Methods Ten cases of hydatidiform mole,20 cases of invasive hydatidiform mole and 20 cases of choriocarcinomas were selected. Ten cases of normal villi tissues served as the control group.Expression of E-cad and VEGF in normal chorion of early gestation,hydatidiform mole,invasive hydatidiform mole and choriocarcinoma were detetected with immunohistochemistry method and image analysis technique.Results ①The expression of E-cad in normal villi,hydatidiform mole,invasive hydatidiform mole and choriocarcinomas was 3.521,3.1045 0.9655 0.7682,gradually declined with the progression of gestational trophoblastic disease (P 0.05).②The expression of VEGF in normal villi,hydatidiform mole,invasive hydatidiform mole and choriocarcinomas was 0.4219,0.7521,0.9611,1.1420,significantly elevated gradually with the progression of gestational trophoblastic disease ( P 0.05).Conclusions ①The lower expression of E-cad is related to the progression of gestational trophoblastic disease and helpful to distinguish choriocarcinomas from hydatidiform mole.The overexpression of VEGF is associated with the deterioration of GTT.②The expression changes of E-cad and VEGF may play an important role in the development of gestational trophoblastic tumor.

Objective:To clarify the improvement of pedicle screw fixation with an improved hollow pedicle screw and screw tunnel augmentation technique in spinal vertebrae with osteoporosis. Methods:Injecting bone cement into pedicle screw tunnel by self-designed pedicle screw with hollow lateral holes and hollow screw tunnel augmentation instruments in order to augment the screw tunnel. Sixteen vertebrae(L1 to L4)obtained from 4 spinal specimens aged.The mean bone mineral density was (0.715±0.13)g/cm2.And the thirty-two pedicle were devided into four groups.Four fixtion methods were applied.group Ⅰ:commen pedicle screws,group Ⅱ: commen pedicle screws + bone cement pefused in pedicle screw tunnel,group Ⅲ: pedicle screw with hollow lateral holes and bone cement pefused from screw.group Ⅳ:bone cement pefused by hollow screw tunnel augmentation instruments + commen pedicle screws.Measure the maximum axial pullout strength (Fmax) and draw load - time curve after the bone cement completely solidified.Results:The Fmax of four groups: groupⅠwas(458±81)N, groupⅡwas(596±107)N,group Ⅲ was(828±133)N,group Ⅳ was(857±155)N。The Fmax of group Ⅲ and group Ⅳ were significantly greater than those groupⅠand groupⅡ(P0.01). The Fmax of group Ⅱwere also significantly greater than those group Ⅰ (P 0.05).There was no statistical difference between group Ⅲ and group Ⅳ (P 0.05).Conclusion:The manipulation of self-designed pedicle screw with hollow lateral holes and hollow screw tunnel augmentation instruments with bone cement could enhance the fixation stability of the pedical screw significantly in osteoporotic vertebrae.

Objective To observe the diadynamic value of electromyography(EMG)for brachial plexus injuries.Methods The routining EMG examination,including nerve conduction velocity(NCV),sensory action potential(SNAP),somatosensory evoked potential(SEP),were performed to forty brachial plexus injuries patients.Results Among all the 40 cases,18 cases were total brachial plexus root injuries,including 16 pre-ganglion injuries,and 2 post-ganglion injuries.NCV abnormity occurred in 88 nerve examination(88/150);SNAP abnormity occurred in 32 eaamination(32/84);SEP abnormity occurred in 14 examination(14/26);Abnormal spontaneous electrical activity occurred in 243 muscles(243/420).Conclusion The EMG examination has an important role in the diagnosis and prognosis of brachial plexus nerve injuries.

Objective To evaluate the effect of gentamicin and saline in hand injury debridement.Methods The total of 102 hand-injury patients were randomly divided into two groups when debridement,45 cases were given gentamicin,and 57 cases were given saline.All operations were finished by one physician,according to the postoperative medical schedule.The wound information was recorded within the first twelve days.Results The infectious rates of gentamicin and saline were 17.78% and 22.81% respectively,the averagement was 20.9%.There were no significant differences between gentamicin and debridement(χ~2=0.39,P>0.05).Conclusions The postoperative infectious rates aren't decreased by using geomycine compared with saline when debriding.

目的探讨双头空心加压螺钉加克氏针内固定治疗股骨颈骨折的疗效。方法对76例应用双头空心加压螺钉加克氏针内固定治疗股骨颈骨折进行了观察分析,平均随访6年10个月。结果髋关节功能评价参照Merled-Aubigue评分标准,优28例(36.84%),良39例(51.32%),差9例(11.84%)。结论双头空心加压螺钉治疗股骨颈骨折具有操作简单、安全、创伤小,对骨折断端有加压作用,但抗旋转能力比较差,加用克氏针内固定可有效控制旋转移位,降低骨折不愈合和股骨头坏死率。

1 病例资料 患者,男,59岁.因左下肢放射性疼痛4个月,加重2个月入院.一般情况好,神志清.皮肤及黏膜无黄染,肝脏未触及,无明显叩击痛.L2～4左侧椎旁可触及12 cm×12 cm大小质韧肿物,局部压痛,活动度差,周围边界欠清.左大腿前外侧感觉减退,直腿抬高试验及加强试验均为阴性.双下肢肌力正常.腰椎MRI及CT均示:左椎旁神经源性肿瘤.肝功及凝血酶原时间均正常.初步诊断:椎旁肿瘤,性质待诊.行肿瘤切除术,术中见肿瘤边界不清,累及左侧横突及椎间孔,腰大肌及肾脏向前移位,出血多.术后标本行病理检查,结果为转移性肝细胞癌.血甲胎球蛋白(AFP)为28.68 μg/L(正常值为0～10.9 μg/L).肝脏CT检查,显示肝右叶低密度占位,考虑为恶性肿瘤,无腹水.腹膜后淋巴结无肿大.此时确诊为肝癌椎旁转移.行肝癌CT引导下穿刺,肿瘤内注射冰乙酸4 ml,进行肿瘤灭活治疗.肿瘤灭活7 d后,CT检查可见肿瘤明显液化坏死.患者住院17 d后出院,左下肢放射性疼痛消失,大腿外侧有局部麻木感.