低温等离子体对血压计袖带的消毒效果实验研究

等离子体灭菌技术是消毒学领域继甲醛、环氧乙烷、戊二醛等低温灭菌技术之后又一新的低温灭菌技术,其特点是低温、快速灭菌、毒性残留低,而且对于耐湿热和不耐湿热的医疗器械均适用。由于血压计袖带在医院使用频繁,并且是反复使用,极易被病人体表携带的微生物所污染,故对血压计袖带的消毒已引起医院的重视。而目前医院内对血压计袖带多采用化学消毒液擦拭、紫外线照射或甲醛熏蒸等方法消毒。以上消毒方法有的有较多的毒性残留或有刺激性气味,有的需要较长的消毒时间,而低温等离子体灭菌方法可克服上述缺点。     

低温等离子体对血压计袖带的消毒效果实验研究

等离子体灭菌技术是消毒学领域继甲醛、环氧乙烷、戊二醛等低温灭菌技术之后又一新的低温灭菌技术,其特点是低温、快速灭菌、毒性残留低,而且对于耐湿热和不耐湿热的医疗器械均适用[1].由于血压计袖带在医院使用频繁,并且是反复使用,极易被病人体表携带的微生物所污染,故对血压计袖带的消毒已引起医院的重视[2].而目前医院内对血压计袖带多采用化学消毒液擦拭、紫外线照射或甲醛熏蒸等方法消毒.以上消毒方法有的有较多的毒性残留或有刺激性气味,有的需要较长的消毒时间,而低温等离子体灭菌方法可克服上述缺点.本实验研究采用高压电源为激发源.氩气为基础气体.介质阻挡放电(DBD)的方法产生大气压低温等离子体,对血压计袖带进行消毒,以观察其对血压计袖带表面自然菌的灭活效果.并与紫外线消毒血压计袖带进行比较.现报告如下.     

环氧乙烷用于口岸集装箱消毒效果的研究

目的研究环氧乙烷与二氧化碳混合气体杀菌效果。方法采用载体定量杀菌试验和模拟现场消毒试验方法,对环氧乙烷混合气体杀菌效果进行了实验室和模拟现场试验观察。结果在常温常湿条件下,用50 g/m3环氧乙烷混合气体熏蒸24 h,或用100 g/m3的该混合气体熏蒸5 h,对1 m3密闭玻璃柜内菌片上大肠杆菌和金黄色葡萄球菌杀灭率可达90%以上;对菌片上枯草杆菌黑色变种芽孢杀灭率仅达73%以上。在相同条件下,对集装箱模拟现场消毒效果与上述结果类似。结论环氧乙烷混合气体对集装箱内细菌繁殖体杀灭效果较好,但对细菌芽孢杀灭效果较差,需要改变消毒条件。     

环氧乙烷的正确使用

环氧乙烷在常温下是一种气体,沸点10.7℃,液化后为无色液体,早在1936年就用来杀菌消毒。它杀菌力强,对各种细菌、芽胞都有效;另外渗透性、扩散性好,可到达被消毒物的细小缝隙内,甚至对有渗透性包装物内的器件也可发挥杀菌力。因为在60℃左右的低温下即能消毒,故对耐温不高的医用高分子及     

过氧化氢等离子低温灭菌技术在手术室的应用

随着医疗技术和高科技的飞速发展,手术中使用的手术器械越来越多.有很多手术器械不能够耐受高温蒸汽灭菌,而低温灭菌技术又解决不了不耐热手术器械的灭菌问题,目前普遍使用的环氧乙烷灭菌和戊二醛浸泡消毒法,存在灭菌循环周期长、有毒、污染环境等缺点.     

一起偶发性Eltor霍乱疫区的消毒及其效果

对一偶发性 Eltor 霍乱疫区的消毒处理表明,外环境用含氯消毒剂溶液或过氧乙酸溶液喷雾、擦拭;粪便与污水加以含有效氯消毒液处理;可燃性垃圾焚烧处理;室内环境与物品用2%戊二醛溶液处理;书籍、档案用环氧乙烷熏蒸等,可取得良好效果。     

钙磷骨水泥/复合脱蛋白骨关节移植修复兔股骨远端关节缺损

背景:研制有生物活性的人工关节是当前的重要课题,而载体+骨诱导因子+生长因子模式人工骨已被证实是理想的人工骨材料.目的:课题组创新性地采用钙磷骨水泥为载体,将其与骨形态发生蛋白及生长因子复合,并观察新型钙磷骨水泥/复合脱蛋白骨关节移植修复兔股骨远端关节缺损模型的成骨及血供重建能力.设计、时间及地点:随机对照动物实验,于2003-01/2006-06在重庆医科大学动物实验室完成.材料:取新鲜新西兰大白兔股骨远端(15 mm)制作脱蛋白骨关节,将人重组肿瘤坏死因子α、人重组骨形态发生蛋白2分别与钙磷骨水泥和脱蛋白骨关节复合,冷冻干燥,环氧乙烷消毒备用.方法:手术造成兔股骨远端15 mm关节缺损实验模型,将40只新西兰大白兔随机均分成两组:实验组将混合有人重组骨形态发生蛋白2、人重组肿瘤坏死因子α的钙磷骨水泥在异体脱蛋白骨关节表面涂层和髓腔内填塞后,置换一侧股骨远端;对照组进行单纯异体脱蛋白关节股骨远端移植.主要观察指标:植入后4,8,12,16周分别行X射线摄片以及组织学检查,观察骨缺损愈合情况、移植关节端成骨与成软骨情况;并于16周行血管造影,了解局部血供重建情况.结果:实验组在移植后第4周可观察到大量新生血管出现,网织状骨形成.至第12～16周时,复合脱蛋白骨关节完全存活,断端愈合.光镜下各时期的成骨面积实验组均大于对照组.股动脉血管造影示实验组移植部位周围血管数量明显多于对照组.结论:钙磷骨水泥/复合脱蛋白骨关节具有良好的成骨能力,在体内能促进股骨远端关节缺损的血供重建、愈合和替代.     

过氧化氢等离子低温灭菌对手术器械灭菌的效果

目的 探讨过氧化氢等离子低温灭菌器在手术器械消毒灭菌中的应用效果.方法 将手术室不耐高温器械分别采用过氧化氢等离子低温灭菌器灭菌和戊二醛熏蒸灭菌,比较两种灭菌方法的效果、器械损耗率、手术感染率和医护满意度.结果 两种灭菌方法的生物监测合格率方面均为100％.与熏蒸法比较,低温灭菌法的灭菌时间短（P＜0.05）,灭菌后有效时间较长（P＜0.05）,毒性反应的发生率较小（P＜0.05）,手术感染率低（P＜0.05）,器械损耗率较低（P＜0.05）.结论 过氧化氢等离子低温灭菌器灭菌均有快速、安全、质量好等特点,对器械损伤小,可作为不耐高温手术器械消毒的首选方法.     

不同消毒方法对采血车内空气消毒效果的比较

目的比较不同消毒方法对采血车内空气消毒效果。方法通过自然沉降法采样和细菌检测方法,对空气消毒机、紫外线灯和过氧乙酸熏蒸法等不同方法消毒采血车内空气的效果进行了检测。结果臭氧消毒机、紫外线灯和过氧乙酸熏蒸等3种空气消毒方法按照各自使用方法处理1 h(过氧乙酸熏蒸2 h)之后,采血车内空气中细菌总数均存在不同程度超标。动态空气消毒机运行1 h后,采血车内空气质量均符合Ⅲ环境要求,且在工作期间保持运行状态,仍可保持空气质量始终符合要求。结论所试验的4种空气消毒方法,只有动态空气消毒机可用于采血车空气消毒。     

生长因子在脱钙骨基质上附着方法及存在的问题

背景：脱钙骨基质作为一种生物衍生骨组织工程支架材料,以其优良成骨性能受到越来越多的关注,然而脱钙骨固有的诱导蛋白较少,骨诱导活性有限。与生长因子复合后诱导骨组织生长的作用明显增强,有利于骨损伤及骨缺损患者的康复。目的：综述生长因子在脱钙骨基质上的附着方法、研究进展及存在的主要问题。方法：由第一作者检索PubMed数据库和万方数据库,英文关键词为＂Demineralized bone＂,＂Growth factor＂,＂Combination＂。中文关键词为＂脱钙骨＂,＂生长因子＂,＂附着＂。纳入脱钙骨、生长因子在医学上应用研究的相关文献以及生长因子与脱钙骨附着方法方面的相关文献。结果与结论：脱钙骨具有良好的生物相容性、生物活性以及生物降解性,并且易于与周围骨融合,支持新骨组织的生长。将生长因子固定于脱钙骨上,能使生长因子准确、均匀到达骨缺损处,促进骨组织生长,更有利于骨移植和骨缺损患者的康复。目前脱钙骨基质与生长因子的复合方法仍存在结合不牢固,生长因子释放不稳定等问题,因此还需进一步加强对生长因子与脱钙骨基质复合方法的研究和探索。     

骨搬移、骨延长术治疗长骨慢性骨髓炎和感染性骨不连体会

目的探索分析IIizarov骨搬移、骨延长术治疗长骨感染和肢体短缩,以及感染所致骨折不愈合的临床疗效。方法回顾性分析2011年6月-2013年10月,用骨感染病灶清除、IIizarov外固定支架固定及骨干骺端截骨骨搬移和骨延长术治疗13例长骨感染、缺损的股骨、胫骨和腓骨慢性骨髓炎和感染性骨不连患者,其中股骨和胫骨慢性骨髓炎8例（伴股骨病理性骨折1例）,感染性骨不连4例;腓骨慢性骨髓炎1例。结果13例患者感染均得到一期治愈,窦道愈合,骨搬移结合处正常愈合。其中2例出院后自行搬移过程中出现钉道感染（1例经再次清创后治愈,1例经清创后感染复发截肢）,1例在骨愈合后发生再骨折,经髓内钉固定后骨折愈合。13例患者骨搬移长度5～13cm,平均7．5cm;13例患者中有11例骨搬移后双下肢等长,2例患侧下肢较健侧下肢短缩。所有患者未出现神经损伤。结论IIizarov骨搬移和骨延长技术是治疗长骨感染及感染性骨不连的一种有效办法,手术可祛除感染,治愈窦道,恢复肢体长度,从而解决患者痛苦,提高其生活质量。     

原发性或转移性骨肿瘤易误诊为原发性骨质疏松症

目的探讨原发性骨肿瘤及转移性骨肿瘤与原发性骨质疏松症的临床特点,以减少误诊误治。方法回顾分析我科2010年9~10月收治5例原发性骨肿瘤及转移性骨肿瘤误诊为原发性骨质疏松症的临床资料。结果本组5例均有不同程度的疼痛、乏力、食欲减退、体重减轻。1例伴腰椎压缩性骨折,1例在1年内先后左腕、右踝及左胫骨骨折。均在外院首诊为骨质疏松症,入我院后经完善医技检查最终确诊为肺腺癌骨转移3例,多发性骨髓瘤、前列腺癌骨转移各1例。结论恶性肿瘤和骨质疏松症均是中老年人常见疾病,两者鉴别困难。故在诊断原发性骨质疏松症前,应注重病史采集和体格检查,建立比较完整的排除诊断项目,以降低原发性骨肿瘤及转移性骨肿瘤的误诊率。     

Mesenchymal Stem Cells for Bone Repair and Metabolic Bone Diseases

Human mesenchymal stem cells offer a potential alternative to embryonic stem cells in clinical applications. The ability of these cells to self-renew and differentiate into multiple tissues, including bone, cartilage, fat, and other tissues of mesenchymal origin, makes them an attractive candidate for clinical applications. Patients who experience fracture nonunion and metabolic bone diseases, such as osteogenesis imperfecta and hypophosphatasia, have benefited from human mesenchymal stem cell therapy. Because of their ability to modulate immune responses, allogeneic transplant of these cells may be feasible without a substantial risk of immune rejection. The field of regenerative medicine is still facing considerable challenges; however, with the progress achieved thus far, the promise of stem cell therapy as a viable option for fracture nonunion and metabolic bone diseases is closer to reality. In this review, we update the biology and clinical applicability of human mesenchymal stem cells for bone repair and metabolic bone diseases.BMMNC = bone marrow mononuclear cell; BMP = bone morphogenic protein; BMT = bone marrow transplant; ESC = embryonic stem cell; FCS = fetal calf serum; iPSC = induced pluripotent stem cell; MSC = mesenchymal stem cell; OI = osteogenesis imperfecta; TNSALP = tissue nonspecific alkaline phosphataseRecent advances in stem cell research have prompted development of cell-based therapies for bone repair and treatment of metabolic bone diseases. Stem cells are defined by their ability to self-renew and their totipotency or potential to form cells derived from all 3 germ layers. In contrast, cells with self-renewal capacity but more restricted potential are called progenitor cells or tissue stem cells (eg, hematopoietic stem cells or mesenchymal stem cells [MSCs]). Finding an ideal stem cell for clinical applications with high self-renewal capacity and multipotent potential has been a challenge. In recent years, substantial advances have been made in examining the potential of stem cells, especially human embryonic stem cells (ESCs), in regenerative medicine. The ability of human ESCs to self-renew for prolonged periods without differentiation and, most importantly, their ability to differentiate into a large variety of tissues from all 3 germ layers were first characterized by Thomson et al.¹ These unique properties of ESCs, specifically self-renewal and pluripotency, made human ESCs ideal candidates for regenerative medicine.Initial enthusiasm for human ESCs has been tempered and limited by a number of issues, some of which were predicted on the basis of studies with murine ESCs, which were developed more than a decade earlier. Therapeutic use of human ESCs is complicated by immunologic incompatibility and possible development of malignant neoplasms or teratomas from administered cells.^2,3 This complication is further hampered by the legal and ethical issues that surround derivation of ESCs from human embryos and their use in research. Thus, despite the ability of human ESCs to self-renew and to differentiate into many cell types, these controversies have restricted their use for therapeutic purposes and prompted scientists to seek other options, such as examining the potential of adult stem cells for regenerative medicine.For editorial comment, see page 859Adult stem cells are present in substantial numbers in many tissues throughout life; however, their frequency decreases with age. Tissues that harbor MSCs or MSC-like cells include blood,⁴ adipose tissue,⁵ skin,⁶ trabecular bone,⁷ and fetal blood, liver, and lung.^8,9 The mesenchymal stem-like cells have also been identified in umbilical cord blood¹⁰ and placenta.¹¹ Despite sharing similar characteristics, these MSCs from different sources differ in their differentiation potential and gene expression profile.¹² Among the different types of adult stem cells, stem cells harbored in the bone marrow are considered to have the highest multilineage potential¹³ and have been studied for therapeutic purposes. Bone marrow is known to be a rich environment for many cell types. Among these cells are phenotypically and functionally diverse types of cells, collectively referred to as stromal cells. The MSCs comprise a small fraction (<0.01%) of stromal cells. We review the current literature on the biology and specific characteristics of human MSCs (Figure). We also describe recent advances in the use of systemic human MSC therapy in clinical studies related to fracture nonunion and metabolic bone diseases. We reviewed the PubMed literature using the keyword stem cells. The inclusion criteria were use of MSCs in animal models of bone repair and for clinical applications, especially in fracture nonunion, osteogenesis imperfecta (OI), and hypophosphatasia, as well as embryonic and induced pluripotent stem cells (iPSCs) and their use in clinical applications. Additional articles were obtained by assessment of references in the published reviews.Open in a separate windowFIGURE.Developmental hierarchy of stem cells (SCs) and therapeutic potential of human mesenchymal stem cells (MSCs). On fertilization of an egg, a blastocyst forms. The inner cell mass of the blastocyst consists of the most primitive SC or totipotent SC. This totipotent SC can give rise to cells of embryonic and extraembryonic origin. Pluripotent SCs are multipotent SCs that can self-renew and differentiate into hematopoietic SCs, endothelial SCs, and MSCs. Hematopoietic SCs differentiate into blood cells, whereas endothelial progenitors give rise to mature endothelial cells. However, MSCs are characterized by their multilineage differentiation potential, including for bone, cartilage, and adipose tissue. Human MSCs have been tested in several clinical applications to repair bone in different types of bone disease, including fracture nonunion, osteogenesis imperfecta, and hypophosphatasia.     

Bone and joint infection

Older adults are at risk for the immune dysfunction associated with advanced age, which contribute to their increased risk of infection. Hematogenous osteomyelitis occurs not only in children, but also in older adults. Iatrogenic septic arthritis can be occured after the intraarticular injection for the osteoarthritis in aging society. Tuberculous spondylitis occurs in older adults and the differential diagnosis with pyogenic spondylitis and vertebral metastasis is important.     

Bone formation and inflammation

Role of BMP signaling is crucial in the osteoblast differentiation and bone formation. BMP induces expression of Runx2, a master gene for osteogenesis, and cooperates with Runx2 in mature osteoblast to express target genes. These functions are suppressed by TGF-beta-induced Smad7 together with Smurf1 by various mechanisms, including degradation of type I receptor, Smadl/5, and Runx2. Bone remodeling is achieved by "coupling" of osteoblasts and osteoclasts. Although excess maturation and activation of osteoclasts is well described during inflammation, effect of inflammation to the osteoblast function is still unclear. Further exploration in this area thus might lead to discovery of novel therapeutic targets of inflammatory bone diseases.     

Bone and mineral metabolism

Although bones are normally thought of as supporting structures that fracture when one falls, bone is actually a very active metabolic organ. It is vital in the regulation of calcium and phosphate metabolism, magnesium storage, and in buffering metabolic acido-sis. Bone and mineral metabolism and some of their disorders are presented in this article.     

2型糖尿病患者骨密度与骨钙素变化研究

目的 :研究 2型糖尿病患者骨密度的变化以及与骨钙素和胰岛功能的关系。方法 :使用定量超声骨量 (QUS)分析系统测定 71例 2型糖尿病踝中部骨超声指数 (OSI) ,根据其测定结果将 2型糖尿病患者分为骨量正常组、骨量减低组和骨质疏松组 ,并与同年龄的正常对照组相比较。同时测定 2型糖尿病患者的血清骨钙素 (BGP)、C肽、血糖、血钙、血磷及血浆硷性磷酸酶等进行组间比较。结果 :2型糖尿病患者OSI低于对照组 ,差异显著 (P <0 .0 1)。 2型糖尿病BGP和C肽值三组间相比较差异显著 (P <0 .0 1)。结论 :2型糖尿病患者骨质疏松的发生比例高于正常人。骨密度降低者BGP和C肽呈同步降低 ,说明2型糖尿病患者的骨质疏松可能与胰岛功能降低有关。血浆骨钙素测定可以作为骨质疏松的监测指标之一。早期诊断糖尿病并及时予以有效的治疗 ,必要时早期使用胰岛素将可能会防止糖尿病患者骨质疏松的发生