LenkeⅡ型青少年特发性脊柱侧凸患者内固定冠状面失衡的相关因素分析

目的:探讨Lenke II型青少年特发性脊柱侧凸患者内固定冠状面失衡相关因素分析。方法:选取我院骨科已确诊为Lenke II青少年特发性脊柱侧凸患者60例,根据术前脊柱柔韧度、risser分级水平、支具支持治疗、椎体融合数、内固定系统选择等多方面影响因素对内固定后冠状面失平衡情况发生率进行分析评估,其数据结果应用统计学软件SPSS 17.0处理。结果:对术后患者评估比较,多种因素均可影响内固定后冠状面失平衡情况发生,表现为:脊柱柔韧度低、risser分级高、长时间支具佩戴、延长融合椎体范围、先进钉棒系统方案选择均可明显提高术后疗效,降低内固定后冠状面失平衡情况发生率(P0.05),其结果均有统计学意义。结论:临床上通过对患者脊柱柔韧度、risser分级情况评估来判断脊柱成熟度,并在术后积极支具辅助治疗,选用钉棒固定系统并延长融合椎体节段,可明显降低内固定后冠状面失平衡情况发生,提高远期随访疗效。     

3D打印技术在脊柱侧凸矫形术中的应用研究

目的:通过3D打印技术建立患者脊柱的立体实物模型,并探讨其在脊柱侧凸矫形手术中的临床应用价值。方法:2013年9月～2017年8月的15例脊柱侧凸畸形患者,采集患者的薄层CT扫描数据,利用3D打印技术建立实物模型,术前模拟置钉、模拟截骨,完善术前规划,并按照术前计划进行手术。结果:所有患者均按照根据术前3D打印模型制定的手术方案完成手术,术中置钉顺利,置钉准确率为93.6%。所有患者术中、术后无神经、血管、内脏损伤等并发症。结论:3D打印技术为术者提供了更加直观、立体、即时的影像资料,能够完善术前规划,提高置钉准确率,降低手术风险,在脊柱矫形手术中应用前景广泛。     

重度脊柱侧凸后路一期小切口矫形对肺功能的影响

目的:探讨采用脊柱后路分期矫形策略治疗重度脊柱侧后凸,一期小切口矫形术对患者肺功能的影响。方法:自2007年05月-2010年12月采用脊柱后路分期矫形策略中一期小切口矫形术治疗重度脊柱侧凸患者32例,其中男12例,女20例,年龄5～25(13.5±6.12)岁。一期小切口矫形术前侧凸主弯冠状面Cobb’s角为108°～150°(128.75°±13.51°),胸腰段矢状位后凸角60°～140°(97.78°±27.88°)。测量一期矫形术前及术后2周、3月、6月肺功能,包括肺活量(VC)、用力肺活量(FVC)、第一秒时间肺活量(FEV1)、最大呼气中段流速(MMEF)、最大通气量(MVV),计算其占预计值的百分比[VC%、FVC%、FEV1%、MMEF%、MVV%]。观察患者术前与术后不同时期肺功能的变化。结果:术后3月时肺功能较术前有明显提高(P<0.05),术后6月较术后3个月无显著提高(P>0.05)。结论:对于严重的脊柱侧凸患者,后路一期小切口矫形术后3月肺功能即可获得明显改善,可行二期手术治疗。     

根据退行性脊柱侧凸患者症状选择不同手术方案的临床研究

目的:探究根据退行性脊柱侧凸患者症状选择不同手术方案的治疗效果。方法:随机选取我院2007年9月到2015年10月收治的退行性脊柱侧凸患者124例,根据症状不同分A组和B组。A组62例患者腰背痛,接受长节段矫形内固定术;B组62例患者下肢症状明显,接受责任节段减压内固术。治疗期间记录两组手术时间、术中出血量、固定节段数及腰前凸角度,于治疗前、治疗后1个月以及末次随访时腰椎侧凸处的Cobb角,并采用视觉模拟评分法(VAS)和Oswestry功能障碍指数(ODI)评价患者疗效。结果:A组手术时间、出血量、固定节段数及腰前凸角度显著高于B组(P0.05);治疗后和末次随访两组患者VAS评分、ODI指数及Cobb角均有明显好转(P0.05),两组治疗后和末次随访之间的差异无统计学意义(P0.05)。结论:退行性脊柱侧凸在治疗时需根据患者具体症状选择不同的手术方案,长节段矫形内固定术耗时长、术中出血量多,在治疗时应谨慎,预防相关并发症的发生。     

褪黑素和褪黑素受体对下丘脑-垂体-肾上腺轴作用的研究进展

松果体于儿童中期可发育至最高峰,普遍在7岁之后开始呈逐渐萎缩,并在成年后逐渐有钙盐沉着.褪黑素主要是由松果体进行合成和分泌所形成,存在较好的昼夜节律性,且通常是通过下丘脑的视交叉上核进行控制,并与环境中的光-暗呈现的周期改变存在密切关联.此外,褪黑素具有极其广泛的生物学作用,且其发挥作用的首站便是与特异性褪黑素受体相关...     

特发性脊柱侧弯鼠类模型的研究现状

特发性脊柱侧弯是一种严重影响青少年身心健康的脊柱畸形,其病因和发病机制至今不明,部分原因是缺乏合适的建模系统,其中鼠类因其易感性且与人类基因高度相似,而被大量用于建立脊柱侧弯模型。本文讨论了多种建模方法,包括杂交形成脊柱侧弯大鼠、双足大鼠模型、增强瘦素活性诱导模型、雌激素诱导模型、降低体内褪黑素含量以诱导模型、基因修改和无创实验模型诱导脊柱侧凸。这些模型揭示了遗传因素、激素水平和生物力学因素在脊柱侧弯发展中的作用。尽管动物模型无法完全复制人体脊柱,存在局限性,但它们有助于研究脊柱侧弯的发病机制、进展并为未来治疗提供了重要工具,对早期诊断和干预策略的发展具有重要意义。在此,我们总结了鼠类脊柱侧弯模型的发展现状,讨论了其优缺点,并展望了其应用前景。     

褪黑素在哮喘防治中的作用

褪黑素是由松果体分泌的一种神经内分泌激素,具有节律调节、应激反应和清除自由基等生物学功能。近年研究发现,在哮喘患者体内存在褪黑素分泌及代谢功能紊乱,褪黑素干预研究显现其在哮喘的抗炎、免疫调节等方面具有一定的作用。     

自体髂骨移植用于后路椎弓根钉棒系统矫形内固定术治疗脊柱侧凸的临床效果及对预后的影响

目的:探讨自体髂骨移植用于后路椎弓根钉棒系统矫形内固定术治疗脊柱侧凸的临床效果及对患者预后的影响。方法:选取2014年4月至2017年4月90例在我院及山西医科大学进行手术治疗的退行性脊柱侧凸患者作为研究对象,按照随机法将患者分为两组,各组45例患者。对照组采用后路椎弓根钉棒系统矫形内固定术,观察组采用后路椎弓根钉棒系统矫形内固定结合自体髂骨移植术。比较两组患者围手术期情况,术前、术后7天及术后12个月腰椎后凸角度、Cobb角、JOA评分、ODI评分的变化及术后并发症发生情况。结果:两组患者手术时间、术中出血量、体温恢复时间、WBC恢复正常时间、引流管置管时间比较差异无统计学意义(P0.05)。两组患者术后腰椎前凸角度、Cobb角较手术前明显改善(P0.05);术后12个月,观察组患者腰椎前凸角度高于对照组,Cobb角显著低于对照组(P0.05)。两组患者术后JOA评分高于手术前,ODI评分低于手术前(P0.05);观察组患者术后12个月JOA评分高于对照组,ODI评分低于对照组(P0.05)。观察组患者并发症发生率显著低于对照组(P0.05)。结论:自体髂骨移植应用于后路椎弓根钉棒系统矫形内固定术治疗退行性脊柱侧弯效果较好,不仅可纠正脊柱侧弯,同时可减轻患者疼痛感及不适感,安全性较高。     

MiRNA在特发性肺纤维化中的作用

近年来研究发现微RNA（microRNA,miRNA）与机体人部分生理、病理过程均有密切关系,如：组织的发育和分化、组织再生、病毒防御以及细胞增殖与凋亡等。miRNA在特发性肺纤维化（IPF）中的作用也日渐为研究者所重视,在IPF中有些miRNA上调（如miR-155、miR-21）,有些下调（如let-7、miR-29、miR-200）。这一发现为寻找IPF治疗方法提供了一个新的突破口。本文对近年来miRNA在IPF中作用的研究进展进行了综述,并对miRNA-21、let-7d、miRNA-155、miRNA-29以及miRNA-200在肺纤维化中的作用分别进行了阐述,为研究miRNA征IPF中的作用及机制提供一定参考。     

褪黑素受体与GABAA受体在褪黑素延长小鼠睡眠时间中的作用

目的：研究褪黑素受体和GABAA受体在褪黑素延长小鼠睡眠时间中的作用。方法：以翻正反射消失为睡眠开始的指标,至翻正反射恢复作为睡眠时间。观察不同受体激动剂或拮抗剂对褪黑素催眠作用的影响。结果：褪黑素3型受体拮抗剂盐酸哌唑嗪对褪黑素延长小鼠睡眠时间的作用无明显影响。GABA受体内源性激动剂GABA能明显增强褪黑素延长小鼠睡眠时间的作用,而GABAA受体上的印防己毒素结合位点的配基,即氯离子通道阻断剂印防己毒素能明显拮抗褪黑素的催眠作用,GABAA受体上的GABA结合位点的拮抗剂荷包牡丹碱则对褪黑素延长小鼠睡眠作用无明显影响。结论：褪黑素延长小鼠睡眠时间的作用与褪黑素3型受体无关,而与GABAA受体关系密切,其作用主要由印防己毒素结合位点介导。     

Three-Dimensional Vertebral Wedging in Mild and Moderate Adolescent Idiopathic Scoliosis

Background

Vertebral wedging is associated with spinal deformity progression in adolescent idiopathic scoliosis. Reporting frontal and sagittal wedging separately could be misleading since these are projected values of a single three-dimensional deformation of the vertebral body. The objectives of this study were to determine if three-dimensional vertebral body wedging is present in mild scoliosis and if there are a preferential vertebral level, position and plane of deformation with increasing scoliotic severity.

Methodology

Twenty-seven adolescent idiopathic scoliotic girls with mild to moderate Cobb angles (10° to 50°) participated in this study. All subjects had at least one set of bi-planar radiographs taken with the EOS® X-ray imaging system prior to any treatment. Subjects were divided into two groups, separating the mild (under 20°) from the moderate (20° and over) spinal scoliotic deformities. Wedging was calculated in three different geometric planes with respect to the smallest edge of the vertebral body.

Results

Factorial analyses of variance revealed a main effect for the scoliosis severity but no main effect of vertebral Levels (apex and each of the three vertebrae above and below it) (F = 1.78, p = 0.101). Main effects of vertebral Positions (apex and above or below it) (F = 4.20, p = 0.015) and wedging Planes (F = 34.36, p<0.001) were also noted. Post-hoc analysis demonstrated a greater wedging in the inferior group of vertebrae (3.6°) than the superior group (2.9°, p = 0.019) and a significantly greater wedging (p≤0.03) along the sagittal plane (4.3°).

Conclusions

Vertebral wedging was present in mild scoliosis and increased as the scoliosis progressed. The greater wedging of the inferior group of vertebrae could be important in estimating the most distal vertebral segment to be restrained by bracing or to be fused in surgery. Largest vertebral body wedging values obtained in the sagittal plane support the claim that scoliosis could be initiated through a hypokyphosis.     

Altered Topological Organization of Cortical Network in Adolescent Girls with Idiopathic Scoliosis

Adolescent idiopathic scoliosis (AIS) is a multifactorial disease affecting approximately 1–4% of teenagers especially girls at the age of 10–16, but its etiopathogenesis remains uncertain. Previous study has revealed that the cortical thickness in AIS patients is different from that in normal controls. Cortical thickness measurements are known to be strongly correlated between regions that are axonally connected. Hence, a hypothesis is proposed to study the possibility to demonstrate abnormal structural network revealed by cortical thickness in AIS patients. The aim of the study is to investigate abnormalities in the organization of the brain cortical network in AIS patients. This study included 42 girls with severe idiopathic scoliosis (14.7±1.3 years old) and 41 age-matched normal controls (NC, 14.6±1.4 years old). The brain cortex was partitioned into 154 cortical regions based on gyral and sulcal structure. The interregional connectivity was measured as the statistical correlations between the regional mean thicknesses across the subjects. We employed the graph theoretic analysis to examine the alteration in interregional correlation, small-world efficiency, hub distribution, and regional nodal characteristics in AIS patients. We demonstrated that the cortical network of AIS patients fully preserved the small-world architecture and organization, and further verified the hemispheric asymmetry of AIS brain. Our results indicated increased central role of temporal and occipital cortex and decreased central role of limbic cortex in AIS patients compared with controls. Furthermore, decreased structural connectivity between hemispheres and increased connectivity in several cortical regions were observed. The findings of the study reveal the pattern of structural network alteration in AIS brain, and would help in understanding the mechanism and etiopathogenesis of AIS.     

Evaluating the Role of Melatonin in the Long-Term Treatment of Delayed Sleep Phase Syndrome (DSPS)

Delayed sleep phase syndrome (DSPS) involves a mismatch between the usual daily schedule required by the individual's environment and his or her circadian sleep-wake pattern. Patients suffering from DSPS are treated with chronotherapy, light therapy, or melatonin administration. While chro-notherapy and light therapy are demanding and difficult treatments that usually lead to compliance problems, melatonin administration is a relatively simple and easy treatment option. Previous studies carried out on relatively small samples of DSPS patients have shown that melatonin has a sleep-promoting and entraining action when taken in the evening. The present study, which accompanied routine treatment in our sleep clinic, examined the efficiency of melatonin treatment in a relatively large population of DSPS subjects by means of subjective reports. The 61 subjects, 37 males and 24 females, were diagnosed with DSPS by means of clinical assessment and actigraphy at our sleep clinic. Their mean pretreatment falling asleep and waking times were 03: 09 (SD = 86.22 minutes) and 11: 31 (SD = 98.58 minutes), respectively. They were treated with a 6-week course of 5 mg of oral melatonin taken daily at 22: 00. A survey questionnaire was sent to the home of each subject 12–18 months after the end of the treatment; the survey investigated the efficiency of the melatonin treatment and its possible side effects. Of the patients, 96.7% reported that the melatonin treatment was helpful, with almost no side effects. Of these, 91.5% reported a relapse to their pretreatment sleeping patterns within 1 year of the end of treatment. Only 28.8% reported that the relapse occurred within 1 week. The pretreatment falling asleep and waking times of patients in whom the changes were retained for a relatively long period of time were significantly earlier than those of patients whose relapse was immediate (t = 2.18, p <. 05; t = 2.39, p <. 05, respectively), with no difference in sleep duration. The implications of these findings, as well as further research possibilities, are discussed.     

Melatonin Treatment Effects on Adolescent Students' Sleep Timing and Sleepiness in a Placebo-Controlled Crossover Study

During the last few decades, the incidence of sleep-onset insomnia, due to delay of circadian phase, has increased substantially among adolescents all over the world. We wanted to investigate whether a small dose of melatonin given daily, administered in the afternoon, could advance the sleep timing in teenagers. Twenty-one students, aged 14–19 yrs, with sleep-onset difficulties during school weeks were recruited. The study was a randomized, double blind, placebo (PL)-controlled crossover trial, lasting 5 wks. During the first 6 d in wks 2 and 4, the students received either PL or melatonin (1 mg) capsules between 16:30 and 18:00 h. During the first 6 d of wk 5, all students received melatonin. Wks 1 and 3 were capsule-free. In the last evening of each week and the following morning, the students produced saliva samples at home for later melatonin analysis. The samples were produced the same time each week, as late as possible in the evening and as early as possible in the morning. Both the student and one parent received automatic mobile text messages 15 min before saliva sampling times and capsule intake at agreed times. Diaries with registration of presumed sleep, subjective sleepiness during the day (Karolinska Sleepiness Scale, KSS) and times for capsule intake and saliva samplings were completed each day. Primary analysis over 5 wks gave significant results for melatonin, sleep and KSS. Post hoc analysis showed that reported sleep-onset times were advanced after melatonin school weeks compared with PL school weeks (p < .005) and that sleep length was longer (p < .05). After the last melatonin school week, the students fell asleep 68 min earlier and slept 62 min longer each night compared with the baseline week. Morning melatonin values in saliva diminished compared with PL (p < .001) and evening values increased (p < .001), indicating a possible sleep phase advance. Compared with PL school weeks, the students reported less wake up (p < .05), less school daytime sleepiness (p < .05) and increased evening sleepiness (p < .005) during melatonin weeks. We conclude that a small dose of melatonin given daily, administered in the afternoon, could advance the sleep timing and make the students more alert during school days even if they continued their often irregular sleep habits during weekends. (Author correspondence: arne.lowden@stress.su.se)     

Idiopathic scoliosis and concentrations of zinc,copper, and selenium in blood plasma

The concentration of zinc, copper, selenium, albumin, and ceruloplasmin in blood plasma and the activity of superoxide dismutase and glutathione peroxidase in erythrocytes were determined in a set of patients with idiopathic scoliosis (n=51). A significant decrease of selenium concentration (0.50±0.16 μmol/L) was found when compared with a control group (0.69±0.07 μmol/L) (p<0.01). The same levels of significance were found out for selenium levels corrected for albumin content. In a group of patients with a curvature over 45° indicated for a surgical correction, the average plasma concentrations of selenium were significantly lower (p<0.05) in comparison with a group of patients with a curvature below 45° treated conservatively. The GSH-Px activity in erythrocytes was the same in both sets. In comparison with the controls, no significant differences were revealed in all of the other parameters. The detection of the decreased blood plasma concentration of selenium has suggested possible disturbance of well-proportioned distribution and of general optimal availability of selenium in the organism of patients with idiopathic scoliosis with likely effects on the process of synthesis and maturation of collagen affecting the axial skeleton stability.     

Melatonin modulates the ERG circadian rhythm in crayfish

One of the most important functions modulated by melatonin is the synchronization of circadian rhythms. In crayfish (Procambarus clarkii), we have obtained evidence that the amplitude of the electrical response to light of the retinal photoreceptors the receptor potential, is modified by the action of melatonin and that the magnitude of this action depends on the circadian time of melatonin application. In contrast, the electroretinogram (ERG) circadian rhythm can be synchronized by either single or periodic melatonin application. In this work we hypothesized that, in crayfish, melatonin acts on effectors and on pacemaker of ERG circadian rhythm as a non-photic synchronizer. Melatonin could be a hormone that sends a signal of darkness to the ERG circadian system.     

Physiological Pineal Effects on Female Reproductive Function of Laboratory Rats: Prenatal Development of Pups,Litter Size and Estrous Cycle in Middle Age

The present study investigates whether and how the pineal or its hormone melatonin influences female reproductive functions, namely the litter size, prenatal development of offsprings, and estrous cyclicity, especially its age‐related cessation in a non‐seasonal breeder, the laboratory rat. Wistar rats were maintained under a 24 h light‐dark (12L∶12D) cycle. Female rats were divided into 3 groups: non‐operated (NO), sham‐operated (SX), and pinealectomized (PX). Surgeries were performed in 35–40 day‐old females. Starting at an age between 70 days and 7 months, female rats of all 3 groups were repeatedly mated with intact males. PX mothers more frequently delivered pups with malformations (e.g., taillessness, hydronephrosis, 7 out of 1263 pups) than control rats (0/1323; p<0.007). In the first delivery at 3 months of age, but not at later ages, PX mothers delivered more pups of lower body weight than control animals (p<0.001). Examination of vaginal smears showed that almost all female rats of the NO, SX, and PX groups had 4‐day estrous cyclicity when they were young–between 60 days and 5 months of age. At an age of 17 to 18 months, most female rats of the NO and SX groups showed irregular, continuously diestrous or pseudopregnancy‐like patterns, and 4‐day estrous cyclicity was found in only 10% of the NO or SX animals. In contrast, about 50% of the PX rats showed 4‐day estrous cyclicity at this older age (p< 0.001). Melatonin, when added to drinking water (0.4 mg/L) for 16 days during the dark phase increased the frequency of diestrous phase, except in continuously diestrous rats and very few others. This melatonin effect was strong in PX rats but relatively weak in SX rats. In conclusion, the pineal hormone appears to influence various reproductive functions and developmental processes, especially pregnancy and the timing of reproductive aging in rats. The effects of pinealectomy are more prominent at an age of 60 to 80 days (i.e., shortly after puberty) and at the beginning of the cessation of cycles in middle‐aged females.