纳米相羟基磷灰石胶原复合材料与人骨髓基质干细胞体外相容性的研究

目的探讨纳米相羟基磷灰石胶原复合材料(nano-HAP／Collagen，NHAC)与人骨髓基质干细胞(hBMSC)相容性，为应用组织工程方法修复骨缺损提供依据。方法将人骨髓基质干细胞与纳米相羟基磷灰石胶原复合材料体外复合培养，进行形态学和功能测定。结果骨髓基质干细胞能在纳米相羟基磷灰石胶原复合材料上良好地粘附、增殖、生长。细胞的活性和碱性磷酸酶活性未受到纳米相羟基磷灰石胶原复合材料的影响。结论纳米相羟基磷灰石胶原复合材料具有良好的细胞相容性，可作为骨组织工程理想的骨载体材料。     

骨形成蛋白与肌瓣修复骨缺损的研究

采用羊胫骨缺损作为模型，分别植入肌瓣＋骨形成蛋白和肌瓣。植入后第１，２，３，４周分批将羊处死，并进行Ｘ线摄片和病理组织学检查。结果表明：植入肌瓣＋骨形成蛋白组术后第２周即在缺损边缘及中央出现大量新骨，于第４周基本由新骨充填；而单纯肌瓣植入组由缺损边缘少量新骨生长，术后第４周缺损由新骨部分充填。说明植入骨形成蛋白＋肌瓣能够较快地修复骨缺损。     

细胞复合型丝素支架材料修复兔桡骨骨缺损

目的 比较不同孔径的细胞复合型丝素支架材料体内成骨、修复兔桡骨骨缺损的治疗效果.方法 自新西兰大耳白兔股骨大结节和股骨髁处抽取骨髓,体外分离、培养、扩增兔骨髓问充质干细胞(rabbit bone marrow mesenchymal stem cells,RBMSCs),接种到3种不同孔径的丝素材料上,再移植于兔桡骨骨缺损处.根据丝素材料孔径设立实验A组[RBMSCs/SF(silk fibroin,SF)-Ⅰ]、实验B组(RBMSCs/SF-Ⅱ)、实验C组(RBMSCs/SF-Ⅲ).术后分别于2、4、8、12周大体观察、X线检查及组织形态学观察了解体内成骨、骨缺损修复及材料降解情况.另外设立二对照组,D组为缺损处仅植入丝素支架,E组为缺损处无植入物.结果 术后各组兔子均存活,无植入物毒性反应及排斥反应,材料体积不同程度降解减小,降解速度SF-Ⅰ＜SF-Ⅱ＜SF-Ⅲ.RBMSCs/SF-Ⅱ组比其他组在缺损种植处有更多的新骨形成,移植物的血管化任此B组也更好,缺损被较满意治愈.D、E二组修复骨缺损的效果明显差于细胞型丝素支架.结论 RBMSCs/SF-Ⅱ作为细胞复合型丝素支架材料表现最佳.细胞复合型丝素支架材料有望用于临床骨缺损的治疗.     

同种异体脱细胞骨的生物力学性质及其临床应用

目的　探讨人同种异体脱细胞骨的制备 ,生物力学特性及其临床应用效果。方法　取新鲜人尸体髂骨 ,用 2 0 %过氧化氢和 90 %的乙醚脱去其细胞成分 ,制成需要的骨块。以同等大小新鲜解冻骨块作对照 ,在通用力学实验机上行抗压性、应变程度、移位程度及弹性模量等测量。选择 37例先天性髋脱位 ,骨囊肿和内生软骨瘤的患儿行此脱细胞骨移植 ,随诊 3～ 12个月 ,观察骨诱导和骨缺损修复的效果。结果　组织学切片染色镜下观察见脱细胞骨保留较完整的骨小梁结构 ,无细胞残留。脱细胞骨的力学强度 ,抗压性与正常骨差别无显著性意义 ,但是弹性模量有所降低 (P <0 .0 1)。脱细胞骨在所有骨移植病例中显示良好的支撑效果和骨诱导成骨作用。结论　脱细胞骨是一种制备简单、效果可靠的骨移植材料 ,具有良好的硬度 ,相容性和诱导成骨功能 ,可以成为理想的骨组织工程支架材料     

幼兔桡骨临界性骨缺损动物模型的建立

目的建立幼兔桡骨不同尺寸骨缺损模型,确定幼兔桡骨临界性骨缺损长度。方法选取健康3月龄雄性新西兰兔20只(2.2~2.5 kg),采用左右侧配对设计的方法在双侧桡骨中段分别制作15 mm及20 mm桡骨骨缺损模型,按骨缺损长度分为A组(15 mm)及B组(20 mm),每组各20侧。分别于术后第1天,术后第4、8、12周行CT检查,应用CT-Hedberg评分评估骨愈合情况。于术后12周处死所有实验兔,取出尺桡骨标本,通过大体观察及HE染色组织学观察分析缺损区骨愈合情况。结果术后实验兔均存活,术后第12周大体观察:A组19例(95%)桡骨断端有连续性骨痂生成,新生骨表面光滑,塑形良好;B组缺损断端髓腔封闭,缺损区由纤维组织填充。术后第12周CT图像可见A组皮质骨塑性完全,B组断端及缺损尺侧均有新骨生成,髓腔封闭。术后各时间点CT-Hedberg评分:A组(3.0±0.6,3.9±0.3,4.0±0.2)与B组(1.6±0.5,2.7±0.6,2.9±0.6)间差异有统计学意义(P0.05)。组织学结果:A组缺损已修复完全,新生骨组织内可见血管再生,B组缺损区由纤维组织填充。结论在进行幼龄兔骨缺损研究时,可选择3月龄雄性新西兰兔桡骨干构建20 mm长骨缺损。     

RGD修饰的仿生骨膜及纳米化诱导骨促进兔脊柱融合的实验研究

目的 分析联用RGD修饰的仿生骨膜及纳米化诱导骨促进兔脊柱融合的可行性,探讨其应用潜力.方法 成骨诱导化培养兔脂肪基质细胞、制备释放rhBMP-2的壳聚糖/胶原蛋白/β磷酸三钙膜材及生物衍生型复合基质,联合生物凝胶+动态种植,构建RGD修饰的仿生骨膜与纳米化诱导骨;建立兔腰5～6横突间融合模型,移植5组: A组RGD修饰的仿生骨膜及纳米化诱导骨; B组纳米化诱导骨; C组RGD修饰的仿生骨膜、D组空白支架(nCs-PCL-β-TCP),E组自体髂骨行组织学、免疫组织化学、双能X线吸收法、手动触检及生物力学检查.结果 A组骨性融合能力最强,骨矿物含量(BMC)、骨密度值(BMD)、融合率及力学指标均高于其他组,差异具有统计学意义(P＜0.05);E、C组次之,B组融合相对延缓.D组未融合.结论 RGD修饰的仿生骨膜及纳米化诱导骨能强化骨再生,通过协同诱导、引导、传导效应,促进脊柱融合.     

采用不同腓骨移植术修复青少年肿瘤或肿瘤样变切除后的骨缺损

目的：探索青少年不同部位骨肿瘤或肿瘤样变切除后骨缺损的修复方法。方法；37例骨肿瘤或肿瘤样变，在作病灶彻底切除同时，分别采用吻合血管的腓骨长段充填植入，一侧嵌入式植入，节段性腓骨植入。结果：术后随访6个月至8年，所有病例未见复发、他处转移，用以修复骨缺损的腓骨愈合良好，其功能、外形恢复满意。结果：青少年为骨肿瘤与骨病变好发期，同时也是骨与关节生长、发育的未定型期，因此，对其骨肿瘤或骨病变切除，既要考虑彻底切除病变，同时应依据病变切除后不同骨缺损，选择更适合 的骨移植术予重建。     

膀胱粘膜下层无细胞基质的研制

目的 探讨膀胱粘膜下层无细胞基质的制作与评价。方法 自膀胱解剖出膀胱粘膜下层，置于PBS、0．5％SDS、双蒸水中反复洗涤去除细胞，必要时加用胰蛋白酶消化。获得的细胞外基质采用HE、免疫组化、扫描电镜评价去细胞效果，细胞植入无细胞基质观察细胞能否粘附于该材料。结果 HE、免疫组化、扫描电镜均未见制备的材料中存在细胞及细胞碎片，体外细胞植入试验见细胞可粘附于材料并增殖。结论 采用本制备方法可以得到膀胱粘膜下层无细胞基质，有望为临床提供尿道下裂生物替代材料。     

猪心包塑形三瓣叶管道的制备及其体外评价

目的制备出猪心包塑形三瓣叶管道，在体外条件下检测其抗反流性、力学强度、抗酶降解能力、血液相容性和免疫原性，并与牛颈静脉三瓣管道相比较，以探讨其临床应用前景。方法以心包制备三瓣叶管道共计12根，并取与猪心包三瓣叶管道直径大致相同的带瓣牛颈静脉8根，通过 HE染色、Masson 三色染色和 Elastica-vall-Gienson 染色粗略了解管道的免疫原性；以蠕动泵模拟心脏搏动以评价管道的抗反流特性；计算最大拉伸强度和断裂伸长率来评价力学性能；以胶原蛋白酶降解管道来比较抗酶降解的能力；以体外溶血率比较管道的血液相容性。结果①牛颈静脉管道组（A 组）的溶解百分比为30．12％±2．37％，猪心包管道组（B 组）的溶解百分比为36．27％±4．62％；②蠕动泵转数为30 r／min 时，A 组反流比率为24．17％±10．53％，B 组为18．91％±13．48％，50 r／min 时，A 组反流比率为47．6％±9．8％，B 组为44．9％±9．64％，70 r／min 时，A 组反流率为57．2％±10．7％，B 组为53．3％±19.4％；③横轴血管片最大拉伸强度分别为 A 组（2．82±1．2）N ／mm2、B 组为（11．84±4．69）N ／mm2，断裂伸长率分别为 A 组78．43％±19．24％、B 组49．26％±11．27％，纵轴血管片最大拉伸强度 A 组（1.92±1．25）N ／mm2、B 组（13．29±5．08）N ／mm2，纵轴断裂延伸率分别为 A 组77．07％±18．74％、B组49.72％±15．85％；④A 组溶血率为0．14％±0．465％，B 组溶血率0．0975％±0．445％。结论自制的猪心包带瓣管道，大体和微观形态无明显改变，在抗反流性能上与牛颈静脉无明显差异，机械性能明显优于牛颈静脉，短期抗酶降解能力较牛颈静脉略有不足，免疫原性上优于牛颈静脉管道，具备良好的血液相容性。     

组织工程化骺板软骨修复兔部分骺板损伤的实验研究

目的 利用组织工程骺板软骨修复兔骺板缺损,防止肢体畸形发生.方法 取2周龄兔骺板软骨细胞,体外复合牛关节软骨细胞外基质后植入4周龄兔右侧股骨远端骺板缺损处,左侧仅造成缺损,无填充物,作为自身空白对照.于每周行X线检查,4、8、12、16周时行组织学和免疫组化检查.结果 X线显示移植侧股骨畸形明显比对侧轻,骺板缺损处未见明显骨桥生成,被结构紊乱的软骨组织填充,具有一定的生长能力.空白对照侧骨桥形成,骺板早闭.组织学显示移植侧骺板较窄,排列紊乱.免疫组化结果显示移植处染色阳性.结论 组织工程方法培养出骺板软骨不仅可以阻止骨桥产生,还具有一定的生长能力,有望成为治疗骺板早闭的一种合适的材料.     

关节内侧间隙测量对髋关节脱位术后稳定性的预测

目的探讨关节内侧间隙测量对髋关节脱位术后稳定性的预测意义。方法分析2004～2007年本院10例髋关节再脱位患儿以及随机抽取的50例术后未发生再脱位患儿的影像学资料,对其术后1d、1周、1．5个月、3个月、4个月、5个月、6个月骨盆平片进行患侧髋关节内侧间隙值OA以及泪滴至髋臼外缘的距离OA的测量,并采用D值（D=OA／OA）进行标准化处理。结果无再脱位组D值基本小于0．8。其中30例采用髋关节外展支具,未出现再脱位,D值位于0．66～0．8之间;脱位组在石膏同定期间,D值基本小于0．7,此时股骨头位于髋臼内,未出现脱位;术后6周至3个月拆除石膏后,D值为0．66．0．8,未采取措施,相继出现脱位,此时D值基本大于0．8。结论测量关节内侧间隙对于评价髋关节脱位术后关节的稳定性以及预测早期再脱位有重要意义。D值小于0．66,关节稳定,不会出现再脱位;D值为0．66～0．8,关节稳定性受到影响,可能出现再脱位,需尽早采取干预措施;D值大于0．8,出现再脱位,简单保守治疗措旆失去作用．需再次手术蚕新复位。     

Tacrolimus: the good, the bad, and the ugly

The aim of this study was to evaluate the efficacy and side-effects of tacrolimus in pediatric transplant patients previously receiving cyclosporin A (CsA). This study was a retrospective chart review strengthened by a concomitant patient interview. Eleven pediatric cardiac or renal transplant patients, who had been converted from CsA to tacrolimus from October 1995 to January 1999 at The Cleveland Clinic Foundation, were included; there were six renal and five cardiac transplant patients. Each chart was reviewed to assess transplanted organ function pre- and post-conversion. For the six renal transplant patients, creatinine levels and biopsy findings were evaluated. For the five cardiac transplant patients, cardiac catheterization and routine biopsy data were analyzed likewise. Epstein Barr virus (EBV) status was also evaluated in each patient. In addition, each parent or patient was interviewed to ascertain dates of transplant, current medications, and side-effects. The patients' ages ranged from 6 to 20 yr (mean age 14.6 yr). All patients had been converted to tacrolimus. Eight patients were converted for treatment of refractory rejection, two were converted because of CsA-associated side-effects, and one patient was converted empirically for a history of multiple previous transplant rejections. Seven out of eight patients who received tacrolimus for rejection therapy improved. One patient had complete resolution of gingival hyperplasia. Another patient who previously developed hemolytic uremic syndrome on CsA had no further evidence of hemolysis. Four patients were weaned off steroid therapy. Despite conversion, two renal transplant patients progressed to chronic rejection. Five patients exhibited no side-effects. Side-effects experienced included transient hyperglycemia in conjunction with steroid use, headaches, and tremors that subsided rapidly. Four of 11 patients developed post-transplant lymphoproliferative disease (PTLD). Fortunately, reducing the dose of tacrolimus and/or surgical resection of the mass (if present), eradicated the disease. In conclusion, conversion therapy successfully provides an alternate treatment for acute rejection. It also enabled some patients to discontinue steroid therapy, maximizing growth potential. PTLD is a severe, potentially life-threatening complication that needs to be recognized and monitored closely. In conclusion, tacrolimus has been shown to be a very effective agent for the treatment of refractory organ rejection, but must be used cautiously.     

Neuroimaging in the developmental disorders: the state of the science

The developmental disorders of childhood autistic, developmental language, reading (dyslexia), and attention deficit-hyperactivity disorders-manifest with deficits in the traditional behavioral domains of cognition, language, visual-spatial function, attention, and socialization. However, none of these disorders has been associated with characteristic discrete focal lesions or recognized encephaloclastic processes. Developmental cognitive neuroscientists must therefore begin with the spectrum of sometimes divergent behaviors occurring within these disorders and work backward in an attempt to identify the responsible anomalous neural systems. Since the advent of "brain imaging" two decades ago, much effort has focused on identifying brain-behavior correlates in these disorders. The results of these neuropathologic, structural, and functional neuroimaging studies are presented and the reasons for the often divergent findings are discussed. As we approach the end of the Decade of the Brain, current neuroimaging techniques give us the technology for the first time to apply a fundamental cognitive approach to brain-behavior relationships in the developmental disorders, to eliminate the conglomeration of "apples and camels" phenomenon. Researchers are working together to create comparable protocols and to adhere to methods that can be replicated across sites. The future prospects for a greater understanding of the developmental disorders are now much brighter with neuroimaging technology.     

抗癫(癎)药物对骨代谢的影响和防治研究进展

癫痫是神经科常见病，目前控制癫痫发作的主要手段是药物治疗。抗癫痫药物（anti—epileptic drugs，AEDs）对骨骼代谢的影响在上个世纪60年代末就有报道，近年来广大学者对此进行了深入的研究。现就国外关于AEDs对骨代谢的影响、监测和防治的研究作综述如下。     

Flaws in the assessment of the best interests of the newborn

We examined the literature on ethical decisions regarding neonates, to assess whether personal beliefs and prejudices influence end-of-life decisions taken by caregivers. Studies show that religion and familiarity with disability influence caregivers' decisions, whereas the influx of already being a parent, age, sex and professional experience is controverse. Caregivers' attitudes towards end-of-life decisions are also affected by personal concerns about litigation, prejudices and their view of disability. The concept of 'poor quality of life' is widely used as a reference in end-of-life decisions, but this can be interpreted differently, leaving room for a wide range of personal viewpoints. In most cases, parents' opinions are considered important and are sometimes the main determinant in decision making. However, it is unclear whether parents' decisions are based on their own wishes or on the best interests of the newborn.
Conclusion: In neonatal end-of-life decisions, patients may not receive cures based only on their best interests.     

Effect of the adaptation of the food of the hospitalized child on the cover of the nutritional needs]

AIMS: Denutrition remains a major concern in hospitalized children. Daily experience suggests that the meals proposed by hospital dietetic service, although well-balanced and in accordance with the recommendations, may be poorly accepted and consumed by children. The aims of this study were to assess the effect of modification of foods offer on energy intakes as well as nutriments and minerals and trace elements in hospitalized children. PATIENTS AND METHODS: During a 1-month period, 25 consecutive children (range 4-17 years; 13 girls), hospitalized in our pediatric department were included in the study (reasons for hospitalisation comprised: medical reasons [n=7], orthopedic problem [n=16] or surgery [n=2]). They had no restricted diet and received the usual pediatric hospital feeding according to the French recommended dietary allowances (RDA) (D1). They were compared to 21 children--matched for age, sex, nutritional status and pathology, hospitalized during the following 1-month period--who received a modified diet (D2), elaborated by dieticians according to the child's preference and excluded or limited food usually nonconsumed by the children. Food consumption was prospectively measured for 24h by analysis of the nonconsumed foods, as well as browsing and extra food brought by the family. Analysis of energy, carbohydrate, lipid, protein, iron and calcium intake was made using Bilnut 3 software (Nutrisoft, France). RESULTS: D2 covered 119+/-37% of the median energy needs versus 89+/-37% for D1 (p<0.05). The median energy needs were more often reached with D2 as compared to D1 (62% versus 32%, p<0.05). Protein intake was high in both groups, more importantly with D2 (266+/-111% of RDA versus 193+/-77% with D1, p<0.05). We observed no difference between the 2 diets in regards of fat/carbohydrate balance and iron intake. Calcium intake was increased with the adapted diet: 68+/-26% of RDA with D2 versus 49+/-26% with D1 (p<0.01). CONCLUSION: Adapting food offers to preference influences food and caloric intakes in hospitalized children. This could be an efficient strategy to prevent acute undernutrition in hospital.