背景 :在 1932年之前,没有“腰椎间盘突出症”的概念,对于存在腰神经压迫并产生下肢神经症状的病例,被认为是发生于椎间隙的“骨软骨瘤”或“内生软骨瘤”。 1932年,Barr是美国波士顿Fenway医院的实习医生,就像5年前在齐鲁医院的我,每天早晨六点到病房抽血样,八点交班,八点半查房,九点之前进手术室…… Mixter是Barr的带教老师,同时也是麻省总医院的 神经外科 医生。 这一天,他们像往常一样进入手术室,为一名 “腰椎椎管内肿瘤”的患者实施了手术治疗,术后病理诊断为“内生软骨瘤”。但是,Barr不同于普通的实习医生,他提出将手术摘除的“内生软骨瘤”与正常椎间盘组织进行病理比较,Mixter同意了这一要求。 结果出乎他们的意料,病理结果显示两者结构完全相同。 他们继续对麻省总医院以往 20余类似病例所取病理组织进行了重新认定,结果发现当初所有被诊断为“内生软骨瘤”的病理组织其实均为椎间盘组织。 之后的事情应该是让所有医生都羡慕和向往的: 1934年,Mixter和Barr联合署名,在著名的医学杂志《新英格兰医学杂志》上发表题为《累及椎管的椎间盘破裂》的论文,以此为标志,开启了骨科的“椎间盘时代”。 又过了两年, Barr因其在“椎间盘突出症”的诊断上的突破性贡献,突格提升为副教授。 or Titf1) as a candidate suppressor of malignant progression. In this mouse model,Nkx2-1 negativity is pathognomonic of high-grade poorly differentiated tumours. Gain- and loss-of-function experiments in cells derived from metastatic and non-metastatic tumours demonstrated that Nkx2-1 controls tumour differentiation and limits metastatic potential in vivo. Interrogation of Nkx2-1-regulated genes,analysis of tumours at defined developmental stages, and functional complementation experiments indicate that Nkx2-1 constrains tumours in part by repressing the embryonically restricted chromatin regulator Hmga2. Whereas focal amplification of NKX2-1 in a fraction of human lung adenocarcinomas has focused attention on its oncogenic function,our data specifically link Nkx2-1 downregulation to loss of differentiation,enhanced tumour seeding ability and increased metastatic proclivity. Thus,the oncogenic and suppressive functions of Nkx2-1 in the same tumour type substantiate its role as a dual function lineage factor.neage factor.