X线平片与三维CT重建对先天性脊柱侧凸患者半椎体畸形的诊断价值

目的评价术前X线平片、三维CT重建对于先天性脊柱侧凸患者半椎体周围解剖结构的分辨能力,以完善手术计划,提高手术治疗的目的性。方法对16例先天性脊柱侧凸患者实施后路(6例)或前路(5例)或前后路联合半椎体切除(2例)、软组织松解、器械矫形植骨内固定术,或单纯后路器械矫形植骨融合术(3例)。比较患者术前X线平片、三维CT重建与术中所见关于半椎体周围解剖结构描述的符合率。结果16例患者术前三维CT重建与术中所见关于半椎体畸形前或后面解剖结构特点的描述符合率为16/16。而术前X线平片半椎体前侧和后侧观察结果与术中所见的符合率分别为5/7和1/11。结论先天性脊柱侧凸患者术前X线平片仅能大致了解半椎体前侧的分节情况,而不能准确反映后侧结构的异常情况。三维CT重建可更准确显示半椎体畸形的位置与结构,为完善手术计划提供依据。     

Ⅰ型神经纤维瘤病成骨细胞生物学特性的研究

目的检测神经纤维瘤蛋白在Ⅰ型神经纤维瘤病(type1neurofibromatosis,NF1)脊柱侧凸患者成骨细胞中的表达,观察NF1脊柱侧凸患者成骨细胞的生物学特性。方法先天性脊柱侧凸患者10例,NF1脊柱侧凸患者8例,两组年龄和Cobb角相近。脊柱后路手术取髂骨松质骨,采用植块法进行成骨细胞培养。取第二代成骨细胞分别检测其增殖活性、碱性磷酸酶、Ⅰ型胶原和骨钙素等成骨细胞特异性分化指标,并采用免疫沉淀和Westernblot法检测神经纤维瘤蛋白在两组成骨细胞中的表达。结果NF1脊柱侧凸患者成骨细胞中神经纤维瘤蛋白表达水平明显低于先天性脊柱侧凸患者(灰度积分比值分别为1.05±0.06和2.59±1.40,P=0.002);碱性磷酸酶、Ⅰ型胶原和骨钙素水平均明显低于先天性脊柱侧凸患者(44.69IU/mg和51.38IU/mg,P=0.019;226.34ng/mg和249.93ng/mg,P=0.014;7.41ng/mg和8.87ng/mg,P=0.049)。NF1脊柱侧凸患者成骨细胞显示相对活跃的增殖活性(增殖倍数分别为3.34和2.70,P=0.049)。结论NF1脊柱侧凸患者成骨细胞神经纤维瘤蛋白表达降低的同时,其功能存在明显缺陷。成骨细胞功能缺陷可能是骨骼营养不良性改变和骨密度降低等各种骨骼异常共同的基础。     

神经纤维瘤蛋白在先天性脊柱侧凸患者成骨细胞和软骨细胞中的表达

目的：检测神经纤维瘤蛋白在先天性脊柱侧凸患者成骨细胞和软骨细胞中的表达。方法：6例先天性脊柱侧凸患者，在后路手术时取髂骨及髂骨生长板，分离、培养成骨细胞和软骨细胞，分别行碱性磷酸酶染色和甲苯胺蓝染色。逆转录-多聚酶链反应（RT—PCR）检测神经纤维瘤蛋白mRNA．间接免疫荧光和Westemblot检测神经纤维瘤蛋白在成骨细胞和软骨细胞中的表达。结果：先天性脊柱侧凸患者成骨细胞和软骨细胞中存在Ⅱ型神经纤维瘤蛋白表达，该蛋白主要分布在细胞浆，所表达蛋白为三磷酸鸟苷酶活化蛋白（GAP）活性较弱的Ⅱ型异构体。结论：先天性脊柱侧凸患者成骨细胞和软骨细胞中存在神经纤维瘤蛋白表达，但该蛋白是否通过对成骨细胞和软骨细胞的影响导致骨骼系统异常还有待于进一步研究。     

脊柱椎体旋转CT评估方法进展

脊柱侧凸是一种复杂的脊柱三维畸形,主要表现为脊柱侧方移位、椎体旋转及椎体楔形变。脊柱椎体轴向旋转是脊柱侧凸发生的首要因素。脊柱前后柱生长不平衡可影响躯干平衡进而导致脊柱旋转,后者是脊柱侧凸发生的始动因素之一。因此,在脊柱侧凸患者中评估椎体旋转程度显得极为重要。脊柱椎体旋转程度的常用评估方法为X线及电子计算机X射线断层扫描(CT)技术。自从1948年Cobb等提出X线片上评估椎体旋转程度的方法后,许多学者对X线片上评估椎体旋转的方法进行     

青少年特发性脊柱侧凸学校筛查的进展及意义

脊柱侧凸是指冠状位X线片（站立位）上Cobb角＞10°的脊柱畸形.特发性脊柱侧凸（idiopathic scoliosis,IS）是一种排他性临床诊断,需要排除继发于小儿麻痹症、脊柱肌肉萎缩、大脑性麻痹、马凡综合征、Ehlers-Danios综合征和软骨发育不全等疾病导致的侧凸畸形[1],尤其要排除先天性脊柱侧凸.先天性脊柱侧凸指脊柱在胚胎时期出现脊椎的分节不完全、侧椎体发育不完全或者混合有上述2种因素,造成脊柱两侧生长不对称,从而引起脊柱侧凸.     

ADAM10对小鼠颅颌面膜内成骨的影响

目的探索解聚素样金属蛋白酶10(ADAM10)对小鼠颅颌面骨骼膜内成骨的影响。方法应用组织免疫荧光染色及蛋白免疫印迹研究ADAM10在小鼠颅颌面骨中的不同时间点、不同部位的表达水平。通过cre-loxp技术在胚胎小鼠颅颌面骨骼中特异性敲除ADAM10基因,应用体视显微镜观察基因敲除小鼠的颅颌面畸形,X线检查、von Kossa染色检测基因敲除小鼠骨钙化情况,双标免疫荧光观察基因敲除小鼠骨组织细胞增殖、分化、凋亡能力的改变。结果组织免疫荧光染色显示小鼠上、下颌骨成骨活跃区ADAM10表达明显,同时蛋白免疫印迹结果证实,ADAM10在小鼠出生前后表达高,成年后表达明显降低。大体观察基因敲除小鼠身体体型较小,颅颌面畸形表现为面中部发育不足,上下颌骨发育不足,颅顶塌陷。X线片检测及von Kosaa染色显示基因敲除小鼠全身骨骼密度减低,骨组织形成较弱。免疫荧光检测发现ADAM10基因敲除小鼠下颌骨细胞增殖、成骨分化能力减低、凋亡增加。结论 ADAM10广泛表达于小鼠膜内成骨区域,可能通过影响骨组织细胞增殖、分化及凋亡来调控小鼠颅面部膜内成骨过程。     

先天性脊柱形成障碍椎体后部形态结构分析

目的采用X线和CT三维重建观察先天性脊柱形成障碍患者的椎体后部形态,探讨先天性脊柱形成障碍的结构与分型。方法对89例先天性椎体形成障碍患者进行脊柱正侧位X线和CT三维重建检查,观察椎体、椎弓根、椎板、关节突、横突和棘突的形态结构。结果89例患者共有184个椎体形成障碍畸形,其中104个半椎体畸形表现为脊柱侧后凸畸形＋有单侧椎弓根、单侧关节突、单侧横突、单测或者双侧椎板．并且与临近椎板完全分节或者融合。47个楔形椎体表现为脊柱侧后凸畸形．有双侧不对称的椎弓根、关节突和完全分节的椎板。33个蝶形椎体表现为脊柱后凸畸形．有双侧对称的椎弓根、关节突和独立的椎板。结论先天性脊柱形成障碍畸形的分型和治疗应该同时考虑椎体后部形态结构。     

雷帕霉素延缓老年小鼠脊柱退变的实验研究

目的探讨雷帕霉素(Rap)对老年小鼠自发性脊柱退变的保护作用。方法将20只老年C57B6小鼠(27月龄)随机分为实验(30 m+Rap)和对照(30 m)两组,实验组小鼠每天灌胃1次西罗莫司(2 mg/(kg.d)),对照组灌等量生理盐水,均持续灌胃3个月后取材,通过μCT观察椎体结构和进行骨小梁分析,组织切片行HE和阿尔新蓝染色观察椎体和椎间盘情况,还进行TRAP染色检测破骨细胞数目和免疫组织检测二型胶原(COLⅡ)表达及分布。结果 Micro-CT检查测量,发现雷帕霉素能缓解脊柱椎体骨皮质变薄和骨小梁减少,主要表现在喂雷帕霉素后椎体的BV/TV及骨小梁数量增加,骨小梁分离度减少,但骨小梁厚度无明显改变。HE染色和阿尔新蓝染色显示雷帕霉素能缓解老年小鼠椎间盘退变,表现在30 m+Rap组小鼠椎体骨小梁较30 m组多,30 m+Rap组小鼠椎间隙较30 m组大,30 m组纤维环结构紊乱,向髓核内生长替代部分髓核组织,生长板和软骨终板软骨退变明显。TRAP染色检测,发现30 m+Rap组破骨细胞减少,免疫组化检测显示COLⅡ在30 m组小鼠的软骨终板和生长板表达明显较30 m+Rap组减少。结论雷帕霉素能通过m TORC1调控破骨细胞和软骨细胞,延缓老年小鼠脊柱退行性病变。     

17555名青少年脊柱侧凸普查分析

目的分析17555名青少年脊柱侧凸普查结果。方法应用脊柱侧凸两检法(体检、X线照片),对贵州省六盘水市中心城区9~16岁共计17555名学生普查,体检阳性者行脊柱全长正侧位X线片,采用Cobb法测量,Cobb角≥10°确诊为脊柱侧凸。结果Cobb角≥10°的有184人,阳性率为10.5‰~14.3‰,其中先天性半椎体、脊椎分节不良、脊椎裂8例占4.35%^,特发性脊柱侧凸占95.11%,男女患病比例为1∶1.45。结论在学校进行广泛普查、早期发现、及时治疗是减少手术病例、消灭严重脊柱侧凸畸形的有效方法。     

应用凸侧融合凹侧撑开方法治疗半椎体所致先天性脊柱侧凸

目的评价应用前后路凸侧融合及凹侧皮下撑开治疗下胸椎完全分节型半椎体所致先天性脊柱侧凸的远期疗效。方法6例半椎体所致先天性脊柱侧凸患儿,男5例,女1例;年龄为4个月～2.6岁,平均11个月;手术时年龄1.6～5.9岁,平均3.4岁。均行全脊柱正侧位X线检查,采用Cobb法测量手术前后及随访时脊柱后凸角及侧凸角,了解冠状面及矢状面畸形矫正情况。结果6例患儿,经7.7～11.9年(平均10年10个月)随访,冠状面侧凸畸形由术前的49°改善至29°,改善率为41%;矢状面畸形改善程度不尽相同,3例后凸畸形有所改善,1例无明显变化,2例加重。结论前后路凸侧融合及凹侧皮下撑开手术,是治疗T11或T12半椎体引起的先天性脊柱侧凸的有效方法。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.