不同结构聚酯的体外生物降解

目的 :观察自行合成的聚己内脂 (PCL)、聚丙交酯 (PLA)及其不同比例的共聚物己内酯 /丙交酯共聚物a(PCLA2 /1)、己内酯 /丙交酯共聚物b(PCLA1/2 )在体外模拟的不同生物环境中的降解性质 ,探讨环境及材料结构与生物降解性质的关系 ,为在不同生物环境下选用适宜的生物降解材料提供实验依据。方法 :4种聚合物在血浆、胆汁、胰腺悬液中降解 1～ 7d ,观察材料的物理性状改变、测量质量损失和分子量变化。结果 :在不同生物降解液中 :PCL降解不明显、PLA降解最明显 ,PCLA2 /1和PCLA1/2在不同环境中降解规律不同。结论 :用不同比例单体共聚的方法获得了不同结构的生物材料 ,它们在不同环境中降解性质不同。     

类骨磷灰石涂覆改性聚(乙交酯/丙交酯)的细胞亲和性研究

目的 研究具有类骨磷灰石涂层的聚(乙交酯/丙交酯)[Poly(L-lactide-co-glycolide),PLGA]材料作为骨组织工程细胞支架材料的可行性.方法 采用氧等离子体预处理结合模拟体液1.5 SBF0孵育的方法对PLGA进行类骨磷灰石涂覆改性.用鼠OCT-1类成骨细胞作为种子细胞进行体外培养和扩增后分别种植于PLGA致密膜和多孔支架上,观察细胞在致密膜和多孔支架上的黏附率、黏附形态、增殖活力和生长形态.结果 经类骨磷灰石涂覆改性的PLGA,其表面OCT-1类成骨细胞的黏附率和增殖活力都得到了提高,细胞的黏附形态和生长形态良好;在多孔支架上培养的细胞能够迁移到支架的内部旺盛生长.结论 具有类骨磷灰石涂层的PLGA具有更高的细胞亲和性,可望成为一类新的骨组织工程细胞支架材料.     

丙交酯乙交酯共聚材料输尿管支架的动物实验研究

生物降解高分子材料是当前医用材料的一个重要分支。本研究在2005年制备出生物降解材料丙交酯乙交酯共聚物（PLGA）支架管，并进行输尿管原位植入动物实验研究，观察支架材料在体内的降解排泄规律及局部组织相容性情况，探讨新型可生物降解材料输尿管支架的可行性。     

组织工程中药物控制释放技术的应用研究

目的 研究应用药物控制释放技术,在组织工程中实现对生长因子的活性保护和控制释放。方法 应用药物控制释放技术,采用生物降解高分子对药物进行包埋或微包囊。结果 用脂肪族聚内酯为各类药物,包括生物活性物质的药物载体,通过调节脂肪族聚内酯的分子结构和控制释放方法,在采用聚丙交酯为神经导管和对生长因子实行包埋后,成功地实现了对大鼠坐骨神经5、10、15和20mm缺损的修复。结论 可利用脂肪族聚内酯作为药物载体,保护各类生长因子的生物活性,并实现对它们的持续释放。     

可降解高分子丙交酯-乙交酯共聚物(PLGA)三维支架的细胞相容性和鼻软骨组织工程

目的 探讨可生物降解丙交酯-乙交酯共聚物(PLGA)(80∶20)三维多孔支架生物相容性及用于构建组织工程鼻软骨可行性,为临床鼻软骨缺损的修复提供新来源.方法 体外分离培养新生兔关节软骨细胞,采用计算机形态分析和MTT法检测兔软骨细胞在PLGA膜和支架表面粘附、扩展和增殖情况.将培养扩增的兔软骨细胞,按6×106 cels/ml浓度接种于预加工的人鼻软骨外形PLGA多孔支架内,抗坏血酸体外诱导培养4周,形成软骨样组织,倒置显微镜、组织切片、扫描电镜观察人工软骨的组织形态结构.结果 培养开始阶段,软骨细胞在PLGA膜表面粘附较差,以后逐渐增高,24小时接近于对照组;MTT法结果显示,软骨细胞在PLGA支架内培养7天时细胞绝对数量明显增加,而相对增殖率逐渐下降.肉眼观察,培养物为人鼻软骨外形的透明软骨样组织,具有一定弹性和硬度,表面有大量软骨基质形成;倒置显微镜下可见人工软骨周围有大量软骨细胞聚集和细胞外基质形成.组织切片及扫描电镜分析,多孔支架材料的网孔不完整,孔内有大量软骨细胞和细胞外基质,可见典型软骨陷窝样结构.结论 可生物降解PLGA制备的三维多孔支架具有较好生物相容性和可塑性,可用于组织工程鼻软骨体外构建,具有潜在的临床应用价值.     

聚丙交酯-猪衍生异种骨复合材料的体外细胞亲和性研究

目的研究聚丙交酯（poly—L—lactide，PLI。A）-猪衍生异种骨（porcine—derived xenogeneic bone，PDXB）复合材料作为骨组织工程细胞支架材料的可行性。方法采用溶液浇铸法制备PLLA—PDXB复合膜，溶液浇铸一致孔剂溶出法制备PLLA—PDXB复合支架。对PLLA—PDXB复合膜和支架的表面进行水解处理，扫描电镜观察形貌特征，并测量复合膜的吸水率。用鼠OCT-1类成骨细胞作为种子细胞进行体外培养和扩增，并种植于复合膜和支架上，观察OCT-1类成骨细胞在复合膜上的黏附率、黏附形态、增殖活力和生长形态。结果PDXB粉末粒径均匀分布在50μm左右，物相结构与羟基磷灰石相似，但钙磷比降低。PLLA—PDXB复合材料经表面碱水解处理，PDXB粉末得以暴露。复合材料的亲水性和粗糙度明显增加。复合材料的细胞黏附率及细胞增殖活力均优于纯PLLA材料；细胞倾向于生长在有PDXB粉末暴露的表面上；在复合支架上培养的细胞能够迁移至支架内部旺盛生长。结论PLLA—PDXB复合材料具有优良的细胞亲和性，可望成为一类新的骨组织工程细胞支架材料。     

尿道注射聚(乳酸-羟基乙酸)共聚物微球治疗压力性尿失禁

目的 观察聚(乳酸-羟基乙酸)(PLGA)共聚物微球在大鼠尿道的组织相容性以及对实验大鼠尿失禁模型的治疗作用.方法 双相乳化法制备PLGA微球,电子显微镜及计算机图像分析仪分析其表征;将40只成年雌性SD大鼠随机均分为2组(实验组和对照组),并接受尿道松解术形成压力性尿失禁模型.实验组接受微球尿道注射,对照组仅接受等量生理盐水注射.在注射前1周和注射后2、4和8周,所有大鼠接受腹部漏点压(ALPP)的检测.此外,术后第2、4和8周,每组动物每个时间点处死3只,应用苏木素.伊红(HE)染色方法检测微球在尿道组织的形态学演变,此外应用免疫组织化学方法检测巨噬细胞特异性的炎症标志物CD68在注射部位尿道组织的表达,以评价微球与尿道肌层的组织相容性.结果 PLGA微球可成功地注射于大鼠尿道的肌层,并诱导局部炎症反应;CD68免疫染色证实浸润细胞以单核细胞和巨噬细胞为主.以微球和增生细胞为主的混杂组织位于黏膜下肌层内,发挥尿道填充作用.在术后2周,炎症反应最为明显,以后随着时间逐渐减退.全程未见变性、坏死等破坏性病理改变;实验组ALPP在微球注射后较注射前和对照组明显改善,并可维持到注射后8周.结论 PLGA微球在尿道组织是安全的,可起到尿道填充作用增加尿道阻力,发挥治疗压力性尿失禁的作用.PLGA微球作为可注射的细胞支架可用于尿失禁的组织工程.     

新型生物降解材料输尿管支架的生物相容性研究

目的探讨新型生物降解材料输尿管支架己内酯丙交酯乙交酯三元共聚物（PCLGA20：60：20）的生物相容性。方法通过肌肉埋植实验，初步评价材料生物相容性；通过PCLGA支架输尿管植入实验，观察支架管在输尿管局部组织相容性情况。结果测试材料肌肉埋植引发的局部组织反应为非细菌性炎症反应，材料周围纤维包裹层厚度小于30μm；输尿管植入实验中，PCLGA支架在12周内完全降解，输尿管腔内无材料碎片残留，支架植入术后的输尿管炎症反应随材料降解而逐渐消退。结论PCLGA材料具有良好的生物相容性，是加工生物降解输尿管支架的理想材料。     

乙交酯-丙交酯共聚物支架-细胞复合体移植对大鼠损伤脊髓的修复作用

目的 观察神经干细胞、雪旺细胞和组织工程材料乙交酯-丙交酯共聚物共移植后对大鼠损伤脊髓形态和功能的修复作用.方法 36只Wistar大鼠,随机数字法分为乙交酯-丙交酯共聚物移植组、神经干细胞/乙交酯-丙交酯共聚物绀和神经干细胞+雪旺细胞/乙交酯-丙交酯共聚物组.体外培养、鉴定胚胎脊髓源神经干细胞和雪旺细胞,制备和构建乙交酯-丙交酯共聚物支架细胞复合体并移植到大鼠脊髓T9半横断损伤部位,应用BBB行为评分和电生理技术在术后4、12周评价大鼠脊髓功能的恢复情况;应用透射电镜、HE染色和免疫组织化学染色方法在形态结构上观察轴突和髓鞘再生情况,以及神经干细胞在脊髓内的存活、迁移和分化情况.结果术后4、12周,细胞移植组的BBB评分较对照组明显提高(P＜0.05);细胞移植组的体感诱发电位和运动诱发电位波幅较对照组都有所好转.术后12周移植材料正中横断面透射电镜可见新生的无髓及有髓神经纤维;脊髓标本免疫组织化学染色显示移植的神经十细胞呵以在宿主脊髓内存活、迁移并分化成神经元和少枝胶质细胞,未分化成星形胶质细胞.结论 神经干细胞、雪旺细胞和组织工程材料乙交酯-丙交酯共聚物共移植可以促进半横断损伤的大鼠脊髓轴突再生,改善肢体的运动功能.     

应用石墨烯改良PLCL/Gel纳米纱支架材料的可行性分析

目的探索应用石墨烯(Gr)改良聚-L-丙交酯-己内酯/明胶(PLCL/Gel)纳米纱支架材料的可行性。方法采用自制的静电纺丝装置分别制备PLCL-Gel和Gr-PLCL-Gel水纺纳米纱支架材料。使用体视显微镜、扫描电子显微镜观察支架材料形态结构;通过拉伸试验观察该材料机械强度;采用CCK-8实验评价支架生物相容性,并将支架植入大鼠皮下,观察细胞浸润情况。结果拉伸试验显示,加入石墨烯可明显提高支架的力学性能。两组支架都无明显细胞毒性,在体内外实验中均表现出良好的生物相容性,体内实验表明石墨烯在一定程度上减轻了炎症反应。结论应用石墨烯改良PLCL/Gel纳米纱支架材料,可以获得具有合适力学性能、亲水性、生物相容性的纳米纱支架材料,在组织工程皮肤等方面具有应用潜能。     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.     

Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: A randomised, double-blind, cross-over study with and without adrenaline

Background: Basic pharmacological research indicates that there are synergistic antinociceptive effects at the spinal cord level between adrenaline, fentanyl and bupivacaine. Our clinical experience with such a mixture in a thoracic epidural infusion after major surgery confirms this. The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief and side effects when removing adrenaline from this triple epidural mixture. Methods: A prospective, randomised, double-blind, cross-over study was carried out in 24 patients after major thoracic or abdominal surgery. Patients with only mild pain when coughing during a titrated thoracic epidural infusion of about 10 ml · h^?1 of bupivacaine 1 mg · ml^?1, fentanyl 2 μg · ml^?1, and adrenaline 2 μg · ml^?1 were included. On the 1^st and 2^nd postoperative days each patient was given a double-blind epidural infusion, at the same rate, with or without adrenaline. The effect was observed for 4 h or until pain when coughing became unacceptable in spite of a rescue analgesic procedure. Rescue analgesia consisted of up to two epidural bolus injections per hour and i.v. morphine if necessary. All patients received rectal paracetamol 1 g, every 8 h. Fentanyl serum concentrations were measured with a radioimmunoassay technique at the start and end of each study period. Main outcome measures were extent of sensory blockade and pain intensity at rest and when coughing, evaluated by a visual analogue scale, a verbal categorical rating scale, the Prince Henry Hospital pain score, and an overall quality of pain relief score. Results: The number of hypaesthetic dermatomal segments decreased (P <0.001) and pain intensity at rest and when coughing increased (P <0.001) when adrenaline was omitted from the triple epidural mixture. This change started within the first hour after removing adrenaline. After 3 h pain intensity when coughing had increased to unacceptable levels in spite of rescue analgesia (epidural bolus injections and i.v. morphine). Within 15–20 min after restarting the triple epidural mixture with adrenaline, pain intensity was again reduced to mild pain when coughing. Serum concentration of fentanyl doubled from 0.22 to 0.45 ng · ml^?1 (P <0.01), and there was more sedation during the period without adrenaline. Conclusions: Adrenaline increases sensory block and improves the pain-relieving effect of a mixture of bupivacaine and fentanyl infused epidurally at a thoracic level after major thoracic or abdominal surgery. Serum fentanyl concentrations doubled and sedation increased when adrenaline was removed from the epidural infusion, indicating more rapid vascular absorption and systemic effects of fentanyl.