骨质疏松性脊柱内固定技术进展

骨质疏松症是一种以骨量减少,骨强度下降而脆性增加,骨折风险增加为特征的骨骼疾病。随着人口老龄化日趋严重,骨质疏松症已成为我国面临的重要公共健康问题。这些患者往往并存多种疾病,其中椎体骨折最为突出,危害较大。由于此类患者的虚弱的体质和较低的骨密度,实施手术治疗十分困难。新型的手术方式的开发和内固定植入物的设计明显降低了内固定失败率,提升了内固定稳定性。这些技术综合考虑了生物材料学、生物学和生物力学等多方面,在临床应用上获得了较好的疗效。本综述旨在总结脊柱内固定失败的机制和现存的新型手术技术与内固定植入物设计,并对未来脊柱内固定手术的发展方向加以展望。     

Continuous ambulatory hand force monitoring during manual materials handling using instrumented force shoes and an inertial motion capture suit

Hand forces (HFs) are commonly measured during biomechanical assessment of manual materials handling; however, it is often a challenge to directly measure HFs in field studies. Therefore, in a previous study we proposed a HF estimation method based on ground reaction forces (GRFs) and body segment accelerations and tested it with laboratory equipment: GFRs were measured with force plates (FPs) and segment accelerations were measured using optical motion capture (OMC). In the current study, we evaluated the HF estimation method based on an ambulatory measurement system, consisting of inertial motion capture (IMC) and instrumented force shoes (FSs).Sixteen participants lifted and carried a 10-kg crate from ground level while 3D full-body kinematics were measured using OMC and IMC, and 3D GRFs were measured using FPs and FSs. We estimated 3D hand force vectors based on: (1) FP+OMC, (2) FP+IMC and (3) FS+IMC. We calculated the root-mean-square differences (RMSDs) between the estimated HFs to reference HFs calculated based on crate kinematics and the GRFs of a FP that the crate was lifted from.Averaged over subjects and across 3D force directions, the HF RMSD ranged between 10-15N when using the laboratory equipment (FP + OMC), 11-18N when using the IMC instead of OMC data (FP+IMC), and 17-21N when using the FSs in combination with IMC (FS + IMC). This error is regarded acceptable for the assessment of spinal loading during manual lifting, as it would results in less than 5% error in peak moment estimates.     

Pollen development in a submerged plant,Ottelia alismoides (L.) Pers. (Hydrocharitaceae)

Exine structure and its developmental program in a submerged plant,Ottella alismoides (L.) Per. were investigated with scanning and transmission electron microscopies. Verrucate protrusions initiate on microspore plasma membrane at early tetrad stage. The verrucate protrusions develop into spines during free microspore stage. A foot layer is formed by accumulation of lamellated structure. The pollen grains ofOttelia alismoides are inaperturate, not omniaperturate, because of the well-developed foot layer. The inaperturate pollen grains ofOttelia are characterized by the spinous protrusions and the granular foot layer.     

Vertebral morphology of Nacholapithecus kerioi based on KNM-BG 35250

This paper describes the morphology of the vertebral remains of the KNM-BG 35250 Nacholapithecus kerioi individual from the Middle Miocene of Kenya. Cervical vertebrae are generally large relative to presumed body mass, suggesting a heavy head with large jaws and well-developed neck muscles. The atlas retains the lateral and posterior bridges over the vertebral artery. The axis has a robust dens and a large angle formed by superior articular surfaces. The thoracic vertebral specimens include the diaphragmatic vertebra and one post-diaphragmatic vertebra. The thoracic vertebral bodies are much smaller that those of male Papio cynocephalus, whereas many of the dorsal elements are large and robust, exceeding those of male P. cynocephalus. Lumbar vertebral bodies are small relative to body mass, craniocaudally moderately long, and have a median ventral keel. The transverse process is craniocaudally long and arises from the widest part of the body cranially and the pedicle above the inferior vertebral notch caudally. Anapophyses are present in one of the preserved lumbar vertebrae. The postzygapophyses are thick dorsoventrally. These lumbar features are broadly shared with Proconsul. However, the base of the spinous process is longer and more caudally positioned in N. kerioi compared to Proconsul, and is more similar to the condition in Pongo. They are not dorsally (or moderately caudally) directed as is seen in P. nyanzae, Pan, and most other extant primates. A caudally directed spinous process does not permit a broad range of spinal dorsiflexion. The presumed stiff back in N. kerioi suggests a different locomotor repertoire than in Proconsul. Morotopithecus bishopi, although not possessing the same features, exhibits another morphological suite of characters for lumbar stiffness. Diverse functional adaptations of the lumbar spine were present in African hominoids during the Early to Middle Miocene.     

Brain-derived neurotrophic factor regulates AMPA receptor trafficking to post-synaptic densities via IP3R and TRPC calcium signaling

The change in the number of post-synaptic alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA)-type glutamatergic receptors (AMPARs) by neuronal activity is recognized as a molecular basis of synaptic plasticity. Here, we show that Ca(2+) transients evoked by brain-derived neurotrophic factor (BDNF) induce translocation of a subunit of AMPAR, GluR1, but not NMDAR, to the post-synaptic membrane in cultured cortical pyramidal neurons. Among BDNF-induced Ca(2+) transients, that dependent on IP3R was fully required, while store-operated calcium influx through the non-selective cation channel TRPC (transient receptor potential canonical) was partially required for the GluR1 up-regulation, suggesting that spatial and temporal calcium signaling regulate translocation of GluR1 to the polarized membrane domain.     

Neuro at the Nanoscale: Diffraction-Unlimited Imaging with STED Nanoscopy

Recent breakthroughs in fluorescence microscopy have pushed spatial resolution well beyond the classical limit imposed by diffraction. As a result, the field of nanoscopy has emerged, and diffraction-unlimited resolution is becoming increasingly common in biomedical imaging applications. In this review, we recap the principles behind STED nanoscopy that allow imaging beyond the diffraction limit, and highlight both historical and recent advances made in the field of neuroscience as a result of this technology.     

ADP-ribosylation Factor 6 (ARF6) Bidirectionally Regulates Dendritic Spine Formation Depending on Neuronal Maturation and Activity

Recent studies have reported conflicting results regarding the role of ARF6 in dendritic spine development, but no clear answer for the controversy has been suggested. We found that ADP-ribosylation factor 6 (ARF6) either positively or negatively regulates dendritic spine formation depending on neuronal maturation and activity. ARF6 activation increased the spine formation in developing neurons, whereas it decreased spine density in mature neurons. Genome-wide microarray analysis revealed that ARF6 activation in each stage leads to opposite patterns of expression of a subset of genes that are involved in neuronal morphology. ARF6-mediated Rac1 activation via the phospholipase D pathway is the coincident factor in both stages, but the antagonistic RhoA pathway becomes involved in the mature stage. Furthermore, blocking neuronal activity in developing neurons using tetrodotoxin or enhancing the activity in mature neurons using picrotoxin or chemical long term potentiation reversed the effect of ARF6 on each stage. Thus, activity-dependent dynamic changes in ARF6-mediated spine structures may play a role in structural plasticity of mature neurons.     

新型骨水泥椎弓根螺钉在治疗腰椎滑脱合并骨质疏松症的应用研究

目的:探讨评估聚甲基丙烯酸甲酯(polymethvlmethacnrlat, PMMA)增强的具有"渐变孔"结构的侧开孔中空椎弓根螺钉(Fenestrated pedicle screw, FPS)治疗腰椎滑脱症的安全性及疗效。方法:回顾性分析2013年1月～2017年12月收治32例合并有骨质疏松症的腰椎滑脱患者,均应用具有"渐变孔"结构的FPS融合手术治疗,记录手术时长、术中出血量,住院时长;测量椎间隙高度、椎体楔形变指数、滑脱距离、滑脱角、骨盆指数、腰椎前凸角;随访评估Oswestry功能障碍指数问卷表(Oswestry Disability Index Questionnaire, ODI)评分和视觉模拟评分法(Visual Analogue Score, VAS)评分,比较分析术前、术后及末次随访时的差异;结果:术中X线及术后三维CT检查发现3枚渗漏的骨水泥螺钉(2.2%),均为Yeom C型,术后无不适。随访7～61个月(平均34.9个月),滑脱复位良好,后凸畸形和矢状位失衡矫正良好,ODI评分和VAS评分均较术前有显著改善(p0.05)。随访期间,全部病例滑脱无复发,无椎弓根螺钉松动、断裂,无椎间隙塌陷,根据SUK标准融合成功率100%。结论:新型骨水泥螺钉能够提供良好的固定稳定性,并且能够避免骨水泥渗漏发生以及螺钉松动脱出,为骨质疏松脊柱手术提供一种新的选择。     

Dosimetric characterization of carbon fiber stabilization devices for post-operative particle therapy

PurposeThe aim of this study was to evaluate the dosimetric impact caused by recently introduced carbon fiber reinforced polyetheretherketone (CF/PEEK) stabilization devices, in comparison with conventional titanium (Ti) implants, for post-operative particle therapy (PT).MethodsAs a first step, protons and carbon ions Spread-Out Bragg Peaks (SOBPs) were delivered to CF/PEEK and Ti screws. Transversal dose profiles were acquired with EBT3 films to evaluate beam perturbation. Effects on image quality and reconstruction artifacts were then investigated. CT scans of CF/PEEK and Ti implants were acquired according to our clinical protocol and Hounsfield Unit (HU) mean values were evaluated in three regions of interest. Implants and artifacts were then contoured in the sample CT scans, together with a target volume to simulate a spine tumor. Dose calculation accuracy was assessed by comparing optimized dose distributions with Monte Carlo simulations. In the end, the treatment plans of nine real patients (seven with CF/PEEK and two with Ti stabilization devices) were retrospectively analyzed to evaluate the dosimetric impact potentially occurring if improper management of the spine implant was carried out.ResultsAs expected, CF/PEEK screw caused a very slight beam perturbation in comparison with Ti ones, leading to a lower degree of dose degradation in case of contouring and/or set-up uncertainties. Furthermore, CF/PEEK devices did not determine appreciable HU artifacts on CT images thus improving image quality and, as a final result, dose calculation accuracy.ConclusionsCF/PEEK spinal fixation devices resulted dosimetrically more suitable than commonly-used Ti implants for post-operative PT.     

Stem cells sources for intervertebral disc regeneration

Intervertebral disc regeneration field is rapidly growing since disc disorders represent a major health problem in industrialized countries with very few possible treatments.Indeed, current available therapies are symptomatic, and surgical procedures consist in disc removal and spinal fusion, which is not immune to regardable concerns about possible comorbidities, cost-effectiveness, secondary risks and long-lasting outcomes. This review paper aims to share recent advances in stem cell therapy for the treatment of intervertebral disc degeneration. In literature the potential use of different adult stem cells for intervertebral disc regeneration has already been reported. Bone marrow mesenchymal stromal/stem cells, adipose tissue derived stem cells, synovial stem cells, muscle-derived stem cells, olfactory neural stem cells, induced pluripotent stem cells, hematopoietic stem cells, disc stem cells, and embryonic stem cells have been studied for this purpose either in vitro or in vivo. Moreover, several engineered carriers(e.g., hydrogels), characterized by full biocompatibility and prompt biodegradation, have been designed and combined with different stem cell types in order to optimize the local and controlled delivery of cellular substrates in situ. The paper overviews the literature discussing the current status of our knowledge of the different stem cells types used as a cell-based therapy for disc regeneration.