Ethanol changes Nestin-promoter induced neural stem cells to disturb newborn dendritic spine remodeling in the hippocampus of mice

Adolescent binge drinking leads to long-lasting disorders of the adult central nervous system,particularly aberrant hippocampal neurogenesis.In this study,we applied in vivo fluorescent tracing using NestinCreERT2::Rosa26-tdTomato mice and analyzed the endogenous neurogenesis lineage progression of neural stem cells(NSCs)and dendritic spine formation of newborn neurons in the subgranular zone of the dentate gyrus.We found abnormal orientation of tamoxifen-induced tdTomato+(tdTom^(+))NSCs in adult mice 2 months after treatment with EtOH(5.0 g/kg,i.p.)for 7 consecutive days.EtOH markedly inhibited tdTom^(+)NSCs activation and hippocampal neurogenesis in mouse dentate gyrus from adolescence to adulthood.EtOH(100 mM)also significantly inhibited the proliferation to 39.2%and differentiation of primary NSCs in vitro.Adult mice exposed to EtOH also exhibited marked inhibitions in dendritic spine growth and newborn neuron maturation in the dentate gyrus,which was partially reversed by voluntary running or inhibition of the mammalian target of rapamycinenhancer of zeste homolog 2 pathway.In vivo tracing revealed that EtOH induced abnormal orientation of tdTom+NSCs and spatial misposition defects of newborn neurons,thus causing the disturbance of hippocampal neurogenesis and dendritic spine remodeling in mice.

Perioperative visual loss after spine surgery

Perioperative visual loss(POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. According to the American Society of Anesthesiologists Postoperative Visual Loss Registry, the most common causes of POVL in spine procedures are the two different forms of ischemic optic neuropathy: anterior ischemic optic neuropathy and posterior ischemic optic neuropathy, accounting for 89% of the cases. Retinal ischemia, cortical blindness, and posterior reversible encephalopathy are also observed, but in a small minority of cases. A recent multicenter case control study has identified risk factors associated with ischemic optic neuropathy for patients undergoing prone spinal fusion surgery. These include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. These risk factors are thought to contribute to the elevation of venous pressure and interstitial edema, resulting in damage to the optic nerve by compression of the vessels that feed the optic nerve, venous infarction or direct mechanical compression. This review will expand on these findings as well as the recently updated American Society of Anesthesiologists practice advisory on POVL. There are no effectivetreatment options for POVL and the diagnosis is often irreversible, so efforts must focus on prevention and risk factor modification. The role of crystalloids versus colloids and the use of α-2 agonists to decrease intraocular pressure during prone spine surgery will also be discussed as a potential preventative strategy.

下颈椎后路侧块螺钉固定的“两点法”应用解剖研究

目的通过解剖学研究,获得安全的下颈椎侧块螺钉的置钉技术.方法取28具C3～7标本,年龄28～79岁.解剖确定安全的入、出针点--侧块背面中心内侧1 mm处为入针点、横突与侧块相交处后方为出针点,以克氏针代替螺钉置入,摄取标本侧位片和各椎体的横断面片,测量X线片上克氏针在矢状面和横断面成角.同时测量标本上克氏针在侧块内的长度(进针深度).结果以C3～7侧块背面中心内侧1 mm处为入针点,克氏针向头侧成角(头倾角)18～39°、向外侧成角(外倾角)为14～37°,针尖可自横突与侧块相交处后方穿出,该处与神经根和椎动脉均隔以横突后结节.C3～7侧块内进针深度为9.4～14.8 mm.结论颈椎侧块钢板螺钉在C3～7较安全的置钉技术是以侧块背面中心内侧1 m处为入钉点,外倾25～35°、头倾20～30°置入,深度为11～12 mm.

Refining the Reference Values of Diers 4D Formetric System and Introducing a Qualitative Spine Profile Based on Percentile Ranking

Background: In order to detect possible abnormalities of the spine posture of an individual patient, it is mandatory to dispose of adequate reference values based on measurements in a normal, symptom-free population. The Diers formetric?system allows for non-invasive and accurate assessment of the vertebral column based on the registration of external aspect of the back surface using the Moiré principle. Objective: To create a qualitative spine profile based on the percentile ranking of measurements obtained by the Diers formetric system taking into account possible confounding factors. Materials and Methods: Statistical analysis of formetric recordings in 216 symptom-free volunteers. Results: Maximal kyphotic angle, maximal scoliotic angle, sagittal imbalance, flèche cervicale, and pelvic inclination are significantly influenced by gender and by body mass index (BMI). A synoptic chart was created presenting the percentile ranking taking into account gender and BMI. The percentile ranking was summarized in both a table with colour code and depicted in a histogram of the individual’s Qualitative Spine Profile (QSP). Clinical Significance: Percentile ranking and the Quantitative Spine Profile taking into account gender and BMI should permit a more precise and reliable assessment of possible posture deviations related to the patient’s complaints, and may assist the therapist in selecting the best mode of treatment.

The Role of Orthotic Service in Modern Rehabilitation of Patients with Charcot-Marie-Tooth Disease

Charcot-Marie-Tooth (CMT) disease, which encompasses several hereditary motor and sensory neuropathies, is one of the most common neuro-muscular disorders. 80% of patients having CMT disease are diagnosed with per cavus deformity. Orthosis is widespread and varies widely in forms. The paper arises the necessity of habilitation at the earliest possible stage as only a few patients use it. The meta-analysis of 412 scientific papers concerning this problem demonstrates the getting better gate, balance and the stopping CMT progression which is scientifically proven. It is also shown that patients with CMT use low prevalence of orthotics, and demonstrate low compliance of patients (for various reasons), high expectations from this habilitation technique.

上下颈椎序列的关系及其临床意义

目的 对上下颈椎序列进行测量,探讨并分析其相互关系。方法 CR机上Pacscout软件测量颈椎曲线深度、Oc-C1角、C1-C2 角、C2 -C7角及C1-C7角。颈椎曲线深度<7mm定为颈椎曲度异常,排除颈椎创伤、畸形,共10 9例;≥7mm为颈椎曲度正常,曲度正常组排除颈椎创伤、畸形及颈椎病症状,共4 1例。采用SAS6 .12软件统计包分别行两样本均数差异的t检验,及各角度之间的Person相关和回归分析。结果 C2 -C7角、C1-C7角组间差异均有统计学意义(P <0 .0 1) ,C1-C2 角、Oc -C1角组间差异均无统计学意义(P >0 .0 5 ) ;颈椎曲度异常组C1-C2 角与C2 -C7角呈负相关,其直线回归关系为Y =2 7.2 0 0 6 4 5 - 0 .2 2 5 5 6 2X(r =- 0 .32 348,P =0 .0 391)。结论 颈椎序列主要是通过C2 -C7角的变化而变化,颈椎曲度异常时C1-C2 与C2 -C7角度呈负相关,寰枢椎固定融合手术时应注意寰枢椎角度的变化情况.

股骨颈骨折人工股骨头置换术后下肢不等长的预防处理(附6例报告)

目的探讨股骨颈骨折人工股骨头置换术后下肢不等长的预防方法.方法选择6例单纯股骨颈骨折人工股骨头转换作为研究对象.通过术前术中双侧髂前上棘及髌骨上缘反复测量验证,骨盆标准X线正位片股骨头模板运用确定股骨颈截骨平面及股骨距保留长度.术中软组织松解及假体试模反复运用验证,有效保持术后双下肢基本等长,避免下肢不等长引起跛行.结果术前6全患肢短缩2.0～4.7cm不等.术后测量4例双下肢等长,1例患肢短缩0.3cm,1例患肢延长0.2cm,无跛行.结论通过术前测量评估骨盆X线正位片上模板运用设定股骨颈截骨平有及股骨距保留长度,术中适当软组织松解及假体试模运用,双下肢髂前上棘与髌骨上缘长度再次测量印证,可有效保持术后双下肢基本等长,避免不等长引起跛行.

下颈椎椎弓根三维CT测量及个体化置钉术的实验研究

目的探讨三维CT测量下颈椎椎弓根并利用其测量数据辅助行下颈椎椎弓根个体化置钉,判断其准确性.方法成人颈椎标本6例行三维CT扫描重建,在三维图像上定出椎弓根的轴线,并画出沿皮质骨内外、上下侧缘与轴线的平行线在侧块上的投影,此投影区域即为置钉的进钉点范围.测量此区域与上位颈椎下关节突下缘和侧块外缘的距离,以及测量椎弓根轴线在横断面上与正中线的夹角及矢状面与终板的夹角.利用上述测量数据在标本C3～C7椎弓根进行置钉.将置钉后的标本再进行常规CT扫描,判断置钉的准确性.结果利用上述方法,57个椎弓根行置钉术,86%(49个)完全在椎弓根内,14%(8个)穿孔.其中6个穿破横突孔,2例向椎弓根上外侧穿出.置钉准确性高于以往实验研究的结果.结论利用三维CT测量的数据辅助行下颈椎椎弓根置钉是安全的,其准确性高于传统方法,但仍有一定的穿孔率,说明术中探针的手感仍非常重要.

Hologic和Norland骨密度仪的精确度比较和数据换算

目的应用Hologic椎体体模和欧洲体模对不同骨密度仪进行横向及纵向评估,并应用 Shewhart规则进行仪器质量控制,同时比较Hologic及Norland骨密度仪活体精确度差异,探讨两者的数据换算关系。方法 Norland XR-36和Hologic Delphi A骨密度仪分别用欧洲体模连续扫描10次,每次扫描均应重新放置体模,用Shewhart规则对两台机器每日校准值进行质控。另外分别采用两套系统对30名志愿者的脊椎骨和左股骨的骨密度进行了两次重定位测量,计算精确度误差,通过F-检验比较差异。两台骨密度仪分别用Hologic腰椎体模每天测5 次,连续8 d,建立两仪器之间的数据换算关系。结果①Norland XR-36和Hologic Delphi A 骨密度仪用Shewhart规则监控均符合,Norhand XR-36连续3 m变异系数百分比为0．38％～ 0．53％,Hologic Delphi A连续3 m变异系数百分比为0．37％～0．41％,Norland-XR-36所测欧洲体模高、中、低为1．355,0．944,0．582,与真值相差9．6％,5．6％,16．4％;Hologic Delphi A高、中、低均值为1．423,0．940,0．534,与真值相差5．1％,6％,6．8％。②Hologic Delphi A的活体精密度高于Norland XR-36骨密度仪。③两仪器间BMD,BMC,Brea绝对值差异明显,但可用线性回归方程进行数据换算:BMD Hologic=0．970 Norland+0．026(r= 0．980;P<0．01);BMC Hologic=1．005 Norland+0．128(r=0．989;P<0．01);Brea Hologic=1．056 Norland-0．592(r=0．978;P<0．01)。结论以欧洲体模评估Norland XR-36和 Hologic Delphi A骨密度仪均有良好的精确度,但两仪器之间的数据不能直接互用,可用回归方程进行数据校正。质量控制是确保骨密度仪理想的精确度的必要措施。

Stem cells for spine surgery

In the past few years, stem cells have become the focus of research by regenerative medicine professionals and tissue engineers. Embryonic stem cells, although capable of differentiating into cell lineages of all three germ layers, are limited in their utilization due to ethical issues. In contrast, the autologous harvest and subsequent transplantation of adult stem cells from bone marrow, adipose tissue or blood have been experimentally utilized in the treatment of a wide variety of diseases ranging from myocardial infarction to Alzheimer's disease. The physiologic consequences of stem cell transplantation and its impact on functional recovery have been studied in countless animal models and select clinical trials. Unfortunately, the bench to bedside translation of this research has been slow. Nonetheless, stem cell therapy has received the attention of spinal surgeons due to its potential benefits in the treatment of neural damage, muscle trauma, disk degeneration and its potential contribution to bone fusion.

Remodeling dendritic spines for treatment of traumatic brain injury

Traumatic brain injury is an important global public health problem.Traumatic brain injury not only causes neural cell death,but also induces dendritic spine degeneration.Spared neurons from cell death in the injured brain may exhibit dendrite damage,dendritic spine degeneration,mature spine loss,synapse loss,and impairment of activity.Dendritic degeneration and synapse loss may significantly contribute to functional impairments and neurological disorders following traumatic brain injury.Normal function of the nervous system depends on maintenance of the functionally intact synaptic connections between the presynaptic and postsynaptic spines from neurons and their target cells.During synaptic plasticity,the numbers and shapes of dendritic spines undergo dynamic reorganization.Enlargement of spine heads and the formation and stabilization of new spines are associated with long-term potentiation,while spine shrinkage and retraction are associated with long-term depression.Consolidation of memory is associated with remodeling and growth of preexisting synapses and the formation of new synapses.To date,there is no effective treatment to prevent dendritic degeneration and synapse loss.This review outlines the current data related to treatments targeting dendritic spines that propose to enhance spine remodeling and improve functional recovery after traumatic brain injury.The mechanisms underlying proposed beneficial effects of therapy targeting dendritic spines remain elusive,possibly including blocking activation of Cofilin induced by beta amyloid,Ras activation,and inhibition of GSK-3 signaling pathway.Further understanding of the molecular and cellular mechanisms underlying synaptic degeneration/loss following traumatic brain injury will advance the understanding of the pathophysiology induced by traumatic brain injury and may lead to the development of novel treatments for traumatic brain injury.

脊柱孤立性浆细胞瘤的临床及影像学特点分析

目的:探讨脊柱孤立性浆细胞瘤的临床及影像学特点。方法:分析经手术病理检查证实的6例脊柱孤立性浆细胞瘤病例的临床特点及影像学特征。结果:病椎附近逐渐加重的疼痛是其共同首发临床表现。其X线片多表现为椎体的溶骨性破坏;ECT上表现不一;CT多为椎体骨质的虫嗜状破坏;MRI示病椎信号失均,T1WI低信号,T2WI等或稍高信号,增强扫描有不均匀强化。结论:CT及MRI可明确脊柱孤立性浆细胞瘤的形态特征及病灶范围,其确诊仍需借助骨髓活检或手术标本病理检查。但对颈背部疼痛的患者,早期行MRI检查有助于及时发现病变,避免严重脊柱脊髓损害的出现。

PCDH17 restricts dendritic spine morphogenesis by regulating ROCK2-dependent control of the actin cytoskeleton,modulating emotional behavior

Proper regulation of synapse formation and elimination is critical for establishing mature neuronal circuits and maintaining brain function.Synaptic abnormalities,such as defects in the density and morphology of postsynaptic dendritic spines,underlie the pathology of various neuropsychiatric disorders.Protocadherin 17(PCDH17)is associated with major mood disorders,including bipolar disorder and depression.However,the molecular mechanisms by which PCDH17 regulates spine number,morphology,and behavior remain elusive.In this study,we found that PCDH17 functions at postsynaptic sites,restricting the number and size of dendritic spines in excitatory neurons.Selective overexpression of PCDH17 in the ventral hippocampal CA1 results in spine loss and anxiety-and depression-like behaviors in mice.Mechanistically,PCDH17 interacts with actin-relevant proteins and regulates actin filament(F-actin)organization.Specifically,PCDH17 binds to ROCK2,increasing its expression and subsequently enhancing the activity of downstream targets such as LIMK1 and the phosphorylation of cofilin serine-3(Ser3).Inhibition of ROCK2 activity with belumosudil(KD025)ameliorates the defective F-actin organization and spine structure induced by PCDH17 overexpression,suggesting that ROCK2 mediates the effects of PCDH17 on F-actin content and spine development.Hence,these findings reveal a novel mechanism by which PCDH17 regulates synapse development and behavior,providing pathological insights into the neurobiological basis of mood disorders.

胸腰段脊柱侧前方改良入路的临床应用

目的:探索胸腰段脊柱侧前方新型入路。方法:研究胸、腰段层次解剖的差别及复杂肌肉走行、毗邻和神经支配关系,汲取既往入路的各自优点,设计了独特的“┓”形切口、改良的“胸膜外 腹膜后”入路。新型入路由同一手术组医生操作,临床应用2 6例胸腰段疾患,均行减压、植骨及Z形钛钢板内固定。结果:手术时间75～180min ,平均135min ,输血量2 0 0～80 0ml,平均4 2 3ml。术中无一例胸膜破裂,术后摄片示矫形优良,矢状位指数(sagittalindex ,SI)术后平均矫正10 3°,内固定物植入无一错误,无胸腔积液、深部感染,无脊髓损伤加重,术后恢复快。2 6例患者中13例获随访8～34个月,未见腰背肌肉失神经表现,内植物无失败,脊髓损伤Frankel分级提高至少1级占83. 2 % (10 / 12 )。摄片或CT扫描示融合成功,无假关节形成。随访期间SI轻度丢失1°～5°,平均2 5°。结论:新型“┓”形切口改良入路适应证广(T11- L2 ) ,技术难度低,损伤小,出血少,暴露充分,利于操作,手术时间缩短,还能避免加重脊髓、神经根及胸膜损伤,值得推广。

The Relationship between Neck and Shoulder Pain and the Sagittal Alignment of the Spine in Standing in Younger Generation

Background: The relationship between chronic neck and shoulder pain and posture remains controversial. The purpose of this study was to investigate the relationship between chronic neck and shoulder pain and spinal sagittal alignment in standing posture in younger generation. Methods: Subjects included 57 females and 32 males (average age, 29.9 ± 5.7 years). All subjects were 20s or 30s. Spinal curvature was assessed using SpinalMouse. The subjects were also divided into a normal group (VAS zero group) and a pain group by VAS results. Statistical analysis was performed by Student’s t-test. Significance was defined as p < 0.05. Results: The normal group and pain group included 29 and 60 subjects, respectively. In terms of location of pain, thirty-one subjects felt neck pain, 50 felt pain above the scapula, and 17 felt pain between the thoracic spine and scapula. Thoracic kyphosis and lumbar lordosis in the pain group were significantly higher than those in the normal group (p = 0.013 and p = 0.020, respectively). Thoracic kyphosis in subjects with neck pain or pain above scapula was significantly higher than that in subjects without pain (p = 0.0075 and p = 0.025, respectively). Lumbar lordosis in subjects with pain above the scapula or interscapula was significantly higher than that in subjects without pain (p = 0.016).

非外伤性上颈椎不稳定的手术治疗

目的 探讨非外伤性上颈椎不稳定的手术治疗效果。 方法 1998年1月～2 0 0 3年3月治疗非外伤性上颈椎不稳定2 3例,其中C1 、C2 肿瘤破坏3例,寰枕融合畸形3例,先天性齿状突不融合2例,单纯寰枢关节半脱位15例。采用寰枢椎融合术10例,其中Apofix固定5例,钢丝Brookes法固定2例,Atlas钛缆固定3例;枕颈融合术13例,其中Cervifix固定8例,CD- Cervical固定3例,U形棒固定2例。寰枢椎Apofix或Atlas钛缆固定者,取棘突松质骨行C1 、C2 骨屑植骨,余15例取自体髂骨外板行燕尾状大块植骨。 结果 2 3例均获随访6个月～5年,平均2 .5年,全部达骨性融合,时间3～8个月。2 0例术前合并神经系统受损症状者,术后6个月16例症状明显改善,4例无改善。根据JOA评分标准,平均术后改善率为2 7.1%。

螺旋CT三维重建对颈椎狭窄症的术前评价

目的 探讨螺旋ＣＴ三维重建对颈椎狭窄症术前的诊断价值。方法 用螺旋ＣＴ对４５例拟行手术治疗的颈椎狭窄症患者行薄层容积扫描，采用合适的重建参数及阈值在工作站上进行三维重建，多角度、多层面拍片。结果 三维重建图像清晰显示颈椎椎管、横突孔及椎间孔的狭窄情况，４５例患者中，其ＣＴ表现有椎体骨质增生（ｎ＝３６），骨质增生合并后纵韧带肥厚骨化（ｎ＝６），椎间盘钙化（ｎ＝３），横突孔狭窄（ｎ＝９）以及椎间孔不规则狭窄（ｎ＝２４）。上述 ＣＴ诊断均经病理证实。结论 螺旋ＣＴ三维重建简化了观察者的思维过程，可直观地了解颈椎狭窄症的三孔立体空间的实际大小、形态、位置及周围组织的立体解剖显示，可为制订手术方案提供重要的信息。

青年非创伤性颈椎生理弧度异常的病因及机理探讨

目的:探讨青年出现非创伤性颈椎生理弧度异常的可能病因和机理。方法:收集门诊非创伤性颈椎生理弧度异常的青年患者123例,通过询问病史和体格检查,了解职业类别、工作生活环境、睡眠姿势和枕头高度、每天低头时间的长短和每次低头时间长短等情况。同时在颈椎侧位片上测量颈椎弓深,以评价颈椎生理弧度异常的严重程度。结果:青年颈椎弓深与每天低头时间、每次低头持续时间、工作生活环境、睡眠枕头高度等存在密切相关性。结论:青年非创伤性颈椎生理弧度异常与职业性质、工作环境、生活习惯等有关,颈椎动力性平衡系统失调是导致青年非创伤性颈椎生理弧度异常的主要机理之一。

原发性脊柱恶性淋巴瘤的X线平片、CT、MRI研究

目的探讨原发性脊柱恶性淋巴瘤的影像学表现,评价X线平片、CT、MRI诊断的作用。资料与方法12例原发性脊柱恶性淋巴瘤患者均经穿刺或手术病理证实,均有X线平片和MRI平扫加增强扫描。5例CT检查,其中3例有增强扫描。结果12例均为非霍奇金淋巴瘤。其中颈椎1例,胸椎7例,腰椎2例,胸腰椎受累2例,共有30个椎体受累。附件受累4例,软组织肿块10例,椎管内、硬膜外肿块6例,病理性骨折3例。X线平片表现为椎体骨质破坏、椎弓根影消失、椎体压缩性骨折。CT示椎体为溶骨性骨质破坏,平扫肿瘤为中等密度,增强扫描肿瘤轻至中度强化。MRT1WI上肿瘤呈略低及等信号,T2WI上呈低、等、高多种信号,增强扫描肿瘤呈轻至中度强化。结论(1)原发性脊柱恶性淋巴瘤绝大多数为非霍奇金淋巴瘤;(2)肿瘤可侵犯相邻多个椎体,软组织肿块常较大且极少坏死,增强扫描肿瘤轻至中度强化;(3)MRT2WI上肿瘤信号较低可能与肿瘤细胞密集和含较多纤维组织有关;(4)肿瘤较易侵入椎管内沿硬膜外向上、下呈袖套状生长;(5)X线平片对发现病变及定性诊断价值有限,MRI显示骨内病灶较CT更敏感。