脂肪干细胞/Ⅰ型胶原凝胶/聚乳酸聚乙醇酸-β-磷酸三钙骨组织工程复合体的构建及其异位成骨研究

目的 构建基于脂肪干细胞、Ⅰ型胶原凝胶以及聚乳酸聚乙醇酸-β-磷酸三钙支架(PLGA-β-TCP)的骨组织工程复合体并对其异位成骨进行研究.方法 设计构建脂肪干细胞-Ⅰ型胶原凝胶/PLGA-β-TCP复合体(A组),同时设立单纯细胞/PLGA-β-TCP材料复合体(B组)、单纯Ⅰ型胶原凝胶/PLGA-β-TCP复合体(C组)以及单纯PLGA-β-TCP支架材料(D组)作为对照.扫描电镜、相差显微镜观察细胞材料复合情况并对脂肪干细胞增殖以及成骨分化进行分析.体外成骨诱导培养2周后移植于自体股部肌袋,8周后取出,依次行放射学、组织学定性及半定量分析.结果 (1)体外成骨诱导2周,A组细胞增殖率慢于B组(P<0.05,n=4),但其细胞总数远高于后者(P<0.01,n=4).A组碱性磷酸酶(ALPase)活性、细胞外基质矿化程度均显著高于B组(P<0.01,n=4).A组细胞悬浮于Ⅰ型胶原凝胶并均匀分布于材料孔隙中而B组细胞仅见黏附于材料表面.(2)移植8周,X线片示A组高密度钙化影形成,B、C、D组未见有阳性结果.A组材料孔隙中均匀充满新生骨组织,可观察到骨小梁样结构.B组仅在少数孔隙中有类骨组织形成,同时伴有结缔组织长入.A组新生骨面积百分比显著高于B组(P<0.01,n=4).结论 通过应用Ⅰ型胶原凝胶来实现脂肪干细胞与PLGA-β-TCP多孔支架材料的均匀复合,能够有效促进脂肪干细胞在材料孔隙中的成骨分化及均质骨组织形成.     

Ⅰ型胶原凝胶包埋脂肪干细胞复合PLGA-β-TCP支架修复兔自体桡骨缺损

目的 采用Ⅰ型胶原凝胶悬浮包埋兔脂肪干细胞并复合PLGA-β-TCP支架修复自体桡骨缺损。方法 使用Ⅰ型胶原凝胶悬浮兔脂肪干细胞并与PLGA-β-TCP复合构建脂肪干细胞-Ⅰ型胶原凝胶/PLGA-β-TCP复合体(ASCs-COL/PLGA-β-TCP)(A组),同时设立单纯细胞/PLGA-β-TCP材料复合体(ASCs/PLGA-β-TCP)(B组)、单纯Ⅰ型胶原凝胶/PLGA-β-TCP复合体(COL/PLGA-β-TCP)(C组)、单纯PLGA-β-TCP支架材料(D组)以及空白缺损(E组)作为对照,体外成骨诱导培养2周后植入桡骨1.5cm缺损部位。30只兔(60侧)采用两因素随机区组设计每只兔两侧骨缺损植入组别。分别于术后8、16、24周处死兔,取材,进行相关分析。结果 术后8周,大体观察、放射学、组织学检测示A组桡骨断端连续性基本恢复。术后16周,A组骨断端连续性完全恢复,髓腔未通。术后24周,A组髓腔再通,改建塑形趋于完成,材料基本降解。自术后16～24周,A组残存材料比例低于其他3组(P＜0.05,n=4);与A组比较,在整个观察周期内,B、C、D组均无明显成骨现象,E组保持骨缺损状态(P ＜0.05,n=4)。结论 通过应用Ⅰ型胶原凝胶悬浮包埋脂肪干细胞进而与PLGA-3-TCP多孔支架材料复合构建新型仿生骨组织工程复合体,可修复兔桡骨1.5 cm缺损。     

兔脂肪干细胞的分离培养鉴定及成骨诱导分化研究

[目的]探讨在成骨诱导条件下兔脂肪干细胞的体外诱导分化情况：[方法]取3个月龄日本大耳白兔颈背部皮下脂肪，用Ⅰ型胶原酶消化获得细胞。Stro-1免疫细胞化学染色鉴定细胞性质；加入成骨诱导液后依次进行形态学、Ⅰ型胶原、碱性磷酸酶及钙盐沉积相关检测。[结果]（1）原代所获细胞Stro—1表达阳性？（2）在诱导条件下，Ⅰ型胶原、碱性磷酸酶及钙盐沉积均呈阳性表达。[结论]脂肪干细胞来源广、易获取、对机体创伤小，与骨髓间充质干细胞类似，经体外诱导后可实现成骨分化，为骨组织工程提供了一种新的种子细胞：     

自体富血小板血浆诱导兔脂肪干细胞成软骨分化的实验研究

[目的]体外分离、培养、鉴定兔脂肪干细胞,探讨富血小板血浆体外诱导脂肪干细胞成软骨分化潜能。[方法]取Ⅰ型胶原酶消化兔脂肪后,贴壁法分离培养脂肪干细胞,取第3代细胞分别予以成脂、成骨诱导,证实其多向分化潜能;同时取第3代细胞予以富血小板血浆诱导,2周后倒置显微镜观察细胞形态,行Ⅱ型胶原免疫荧光细胞化学染色、甲苯胺蓝染色和实时荧光定量PCR检测Ⅱ型胶原和聚集蛋白聚糖的表达。[结果]可以从兔脂肪中培养出脂肪干细胞,成脂、成骨诱导证实其多向分化潜能。经自体富血小板血浆诱导的脂肪干细胞,其Ⅱ型胶原免疫荧光细胞化学染色、甲苯胺蓝染色均为阳性。实时荧光定量PCR检测发现经自体富血小板血浆诱导的兔脂肪干细胞Ⅱ型胶原α1链基因和聚集蛋白聚糖基因表达明显高于对照组未经诱导的兔脂肪干细胞(P<0.01)。[结论]自体富血小板血浆可以有效诱导兔脂肪干细胞表达II型胶原和蛋白聚糖,可以诱导兔脂肪干细胞向软骨细胞方向分化。     

兔脂肪干细胞体外成骨诱导培养及成骨活性鉴定的实验研究

目的体外分离培养兔脂肪干细胞（adipose-derived stem cells,ADSCs）,在成骨诱导条件下鉴定其成骨活性。方法取4月龄新西兰大白兔腹股沟区脂肪,Ⅰ型胶原酶消化,分离、培养及传代原细胞,将第3代ADSCs消化后,加入成骨培养液中诱导分化,分别行碱性磷酸酶染色、茜素红染色、VonKoss（a钙结节）染色,以鉴定分化结果。结果体外分离培养的细胞增殖活跃,成骨诱导后碱性磷酸酶染色、茜素红染色及Von Kossa染色均呈阳性表达。结论脂肪干细胞具有成骨分化能力,是一种理想的骨组织工程种子细胞。     

兔骨髓基质干细胞体外分离培养及生物学特性研究

目的：研究兔骨髓基质干细胞（bone marrow-derived mesenchymal stem cells,BMSC）体外分离、诱导培养及增殖特点,探讨其生物学特性。方法：抽取兔骨髓,密度梯度离心结合贴壁培养法分离BMSC,诱导培养液定向诱导传代细胞向成骨细胞分化。倒置显微镜下观察细胞生长及增殖情况,流式细胞仪检测细胞表面标志物的表达,免疫组织化学观察Ⅰ型胶原表达,并检测碱性磷酸酶活性及细胞矿化作用。结果：体外培养的兔BMSC贴壁生长,10～14天后形成克隆。细胞形态为均一的长梭形并呈漩涡状排列,流式细胞仪检测CD34,CD45阴性,CD44阳性。免疫组化可检测到Ⅰ型胶原表达,碱性磷酸酶活性明显增高,并且出现矿化结节。结论：密度梯度离心结合贴壁培养BMSC,操作简单,细胞易于成活,诱导条件下成骨能力肯定,适合作为骨组织工程的种子细胞。     

胎儿毛乳头细胞的培养和鉴定及其体外诱导分化

目的探讨胎儿毛乳头细胞（dermal papilla cells，DPCs）生物学特性和体外诱导分化潜能，论证作为组织工程种子细胞的可行性。方法Ⅰ型胶原酶消化法分离毛乳头，Eagle动物细胞培养基（DMEM）／F12（3：1）中培养细胞，通过免疫荧光检测α平滑肌动蛋白（smooth muscle actin-α，SMA—α）、Ⅰ型胶原、Ⅱ型胶原、层粘连蛋白，对细胞的生物学特性进行鉴定。取第3、7代细胞以成脂诱导液、成骨诱导液体外定向诱导7～10d，油红染色和Von Kossa染色、骨桥蛋白免疫荧光检测鉴定细胞的成脂和成骨特性。结果体外培养的DPCs表达SMA—α、Ⅰ型胶原、Ⅳ型胶原和层粘连蛋白，成脂诱导10d后油红染色可见细胞胞浆内红色脂滴形成，成骨诱导7d后Von Kossa染色细胞间有黑色钙结节形成，细胞表达骨桥蛋白。结论体外培养DPCs具有干细胞特性，可作为皮肤组织工程和骨组织工程一种新的种子细胞。     

小鼠胎肝间充质干细胞的体外成骨诱导及复合陶瓷化骨的实验研究

目的探讨小鼠胚胎肝脏间充质干细胞的体外分离培养方法，并观察其成骨分化潜能及与陶瓷化骨支架材料的复合能力。方法将小鼠胎肝组织制成单细胞悬液行原代和传代培养，流式细胞仪检测其表面标志。用化学成骨诱导体系对纯化的胎肝间充质干细胞行成骨诱导，并进行成骨功能检测。将其与经过Ⅰ型胶原表面改性的陶瓷化骨复合培养，观察细胞在其上的黏附生长情况。结果原代培养的胎肝间充质干细胞，具有集落形成能力，为梭形或多角形。易于传代，传代细胞与原代细胞大小、形态相似。流式细胞仪检测表明，传代后的细胞CD29、CD44阳性，CD34、CD45阴性，表达间充质干细胞的特征标志。成骨诱导7d后碱性磷酸酶染色可见有较多阳性细胞，Ⅰ型胶原免疫组织化学染色呈强阳性；14d后，细胞碱性磷酸酶活性定量检测明显增高；28d后，矿化结节染色呈阳性。将细胞与经胶原表面改性后的煅烧陶瓷化骨复合培养。扫描电镜见载体上有大量细胞黏附于材料表面。结论小鼠胎肝间充质干细胞易于获取及传代；体外成骨诱导后可向成骨细胞方向分化；能在陶瓷化骨支架材料上黏附生长。     

脂肪源性干细胞体外成骨特性的研究

目的探讨兔脂肪源性干细胞体外成骨分化能力。方法取3个月龄新西兰白兔颈背部皮下脂肪组织,型胶原酶消化获得细胞。绘制细胞生长曲线,采用免疫细胞荧光法检测细胞表面抗原CD44、CD45;分别加入条件培养液对所获得细胞进行成骨成脂诱导,并分别进行形态学、碱性磷酸酶、钙盐沉积和油红O染色相关检测;将脂肪源性干细胞分为成骨诱导组和非成骨诱导组,分别于诱导后1、2、3、4周检测两组的碱性磷酸酶和钙离子浓度并作统计分析。结果 a）所获细胞CD44阳性表达,CD45阴性表达;所绘制的生长曲线成典型的＂S＂型。b）在诱导条件下,碱性磷酸酶及钙盐沉积均呈阳性表达,油红O染色为阳性。c）碱性磷酸酶浓度在诱导组与非诱导组之间存在组间差别,在各个时间点诱导组碱性磷酸酶浓度均高于非诱导组（P〈0.05,n=5）;诱导组碱性磷酸酶浓度在不同诱导时相其浓度变化趋势不同（P〈0.05,n=5）;钙离子浓度在诱导组与非诱导组之间存在组间差别,在各个时间点诱导组钙离子浓度高于非诱导组（P〈0.05,n=5）。诱导组钙离子浓度在不同诱导时相其浓度变化的趋势不同（P〈0.05,n=5）。结论脂肪干细胞的易分离培养、增殖快和良好的成骨诱导活性完全符合对种子细胞的要求,是一种理想的骨组织工程种子细胞。     

脂肪组织来源干细胞定向分化脂肪组织的体内外实验研究

目的 分离和培养脂肪组织来源干细胞（ASCs），鉴定其是否具有干细胞表面标志，研究携带GFP基因的ASCs向脂肪组织的体外定向诱导分化能力，同时判断种子细胞ASCs与Ⅰ型胶原支架混合培养后在体内构建组织工程化脂肪组织的可能性。方法 取GFP小鼠腹股沟部脂肪组织，使用酶消化法进行原代培养，流式细胞仪鉴定其表面干细胞标志，细胞传至第3代后使用脂肪分化培养基诱导2周，观察细胞形态及功能变化。将诱导分化后的细胞与支架材料混合培养后12h，将支架材料移植到裸鼠背部皮下，观察新生组织情况，并对新生组织使用HE及油红O染色进行鉴定。结果 原代培养的ASC形态类似于成纤维细胞，具有很强的增殖能力，能持续稳定表达表面干细胞标志。在脂肪分化培养基的作用下，胞浆内脂滴不断聚集，逐渐演变为成熟的脂肪细胞，油红O染色阳性。体内实验中在裸鼠皮下发现了0．5ml的新生组织块，常规病理及油红O染色均证实其为成熟脂肪组织块。结论 脂肪组织来源的干细胞ASC能在体外定向诱导分化为成熟脂肪细胞，且ASC能作用种子细胞与Ⅰ型胶原支架在体内成功构建脂肪组织。     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.     

Surgical management of ductal carcinoma in situ in Australia in 1995

Background: In the present paper we describe the presentation and management of ductal carcinoma in situ (DCIS) of the breast in women in Australia in 1995. This representative, national data set provides a historical comparator for studies examining DCIS management that follow. Methods: Surgeons identified by population‐based cancer registries as having treated a new diagnosis of DCIS between 1 April and 30 September 1995 completed a questionnaire on the presentation and management of each case. Results: Two hundred and five surgeons supplied treatment details on 418 DCIS tumours in 415 women . Half of all tumours were detected at BreastScreen clinics and a further 25% were detected at other mammography centres. Twenty‐six percent of tumours were palpable at presentation, 33% were multifocal and 55% were high grade (including comedocarcinoma). Breast conserving therapy (BCT) rather than mastectomy was utilized in 260 (62%) of cases. Tumours that were of low grade, small in size and not multifocal were more likely to be treated by BCT. Surgeons seeing six or more DCIS cases in the 6‐month period were more likely to utilize BCT. Of the conservatively treated cases, 22% were referred for a radiation oncology consultation. The most common reasons for treating DCIS with mastectomy were that the tumour was too extensive or multifocal (63%), it extended to margins of the specimen (42%), or patient concerns about recurrence (34%). Conclusions: In 1995 the majority of DCIS was treated with breast conserving surgery alone. Surgeons treating more DCIS cases were more likely to perform conservative surgery than surgeons treating only one DCIS case in the study period.     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.