骨组织工程研究进展

组织工程学是应用生命科学和工程学的原理及技术，构建、培育活组织，研制生物替代物，以修复或重建组织器官的结构，维持或改善功能的一门新兴学科。目前组织工程学研究的主要问题是：①种子细胞的体内、体外培养；②支架材料的研究与开发；③种子细胞与基质材料相互作用的调控等。骨创伤、肿瘤和炎症等导致的骨缺损是目前骨科临床的常见病和难治病，惟一的方法是通过骨移植进行修复。利用骨组织工程培养的人工骨不仅可修复大面积的骨缺损，而且可按需塑形及大量制备，是一种理想的创伤修复及功能重建的材料。     

Bisphosphonate-related Osteonecrosis of the Jaws: An Update on Clinical, Pathological and Management Aspects

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is mainly observed in patients with multiple myeloma and bone metastasis from solid tumors receiving iv bisphosphonate therapy. The reported incidence of BRONJ is significantly higher with the iv preparations zoledronic acid and pamidronate while the risk appears to be minimal for patients receiving oral bisphosphonates. Currently available published incidence data for BRONJ are based on retrospective studies and estimates of cumulative incidence range from 0.8 to 12%. The mandible is more commonly affected than the maxilla (2:1 ratio), and 60–70% of cases are preceded by a dental surgical procedure. The signs and symptoms that may occur before the appearance of clinical evident osteonecrosis include changes in the health of periodontal tissues, non-healing mucosal ulcers, loose teeth and unexplained soft-tissue infection. Although the definitive role of bisphosphonates remains to be elucidated, the inhibition of physiologic bone remodeling and angiogenesis by these potent drugs impairs the regenerative capacity of the bone causing the development of BRONJ. Tooth extraction as a precipitating event is a common observation. The significant benefits that bisphosphonates offer to patients clearly surpass the risk of potential side effects; however, any patient for whom prolonged bisphosphonate therapy is indicated, should be provided with preventive dental care in order to minimize the risk of developing this severe condition. This article provides an update review of current knowledge about clinical, pathological and management aspects of BRONJ.     

富血小板血浆与骨再生

急性臂丛神经炎是一种少见病,但人们往往认识不足,在早期,易被误诊为神经根型颈椎病或胸廓出口综合征。为了提高对本病的认识,降低误诊和漏诊率,本文就急性臂丛神经炎的诊断、鉴别诊断与治疗进行综述。1诊断名词与病因急性臂丛神经炎,病因尚未明了,但却有典型的临床特征。最初由Parsonage等[1]和Turner等[2]报道为肩胛带综合征和麻痹性臂丛神经炎,后被称之为:Parsonage-Turner综合征。其他诊断名词有:急性臂丛神经炎,神经源性肌萎缩,术后原发性臂丛神经炎等[3,4]。     

Optimising Hormone Therapy in Advanced Disease

Although most prostate cancer (PCa) patients nowadays are diagnosed at an early stage of disease, unfortunately still a significant number of patients will develop advanced PCa or will be diagnosed at an advanced (or metastatic) stage of disease. The group of patients showing the highest increase in incidence are those with rising prostate specific antigen (PSA) after radical therapy.In the last quarter of 2004, a Medline search has been performed targeting publications on patients diagnosed with advanced PCa, as well as with PSA relapse after previous radical therapy. This review aims at providing guidance to optimise hormone therapy in those selected groups of patients by addressing three pivotal questions; (i) who should receive hormonal treatment, (ii) what type of hormonal therapy should the patient be offered and (iii) what is the best timing of starting hormonal treatment.In patients relapsing after radical therapy, the PSA doubling time (PSA DT) has become a critical instrument to distinguish patients to have innocuous PSA evolution from patients at high risk for disease progression. A PSA DT of 3 months seems to be the cut-off point for identifying patients at risk. Therefore patients with a PSA DT of less than 3 months should be advised to initiate hormonal therapy. Antiandrogen monotherapy may be considered in this setting as it has been shown to delay progression; however, significant survival data are not yet available. Whether luteinising hormone releasing hormone (LHRH) agonists should be given continuously or intermittently (IHT) remains subject of debate.Surgical castration has been the standard of care in patients diagnosed with advanced PCa. Currently, LHRH agonists have become the preferred way of suppressing testosterone.Combination of an antiandrogen and a LHRH agonist (CAB) shows a modest benefit over LHRH agonist monotherapy. As CAB leads to increased side effects and costs, LHRH agonist monotherapy is preferred in the majority of patients.Conflicting data have been published concerning the optimal timing of LHRH agonist therapy. So it is not clear whether LHRH agonist therapy should be started immediately or deferred until appearance of symptoms. When initiating continuous hormone therapy, patients should be carefully monitored for the risk of long term androgen deprivation (anaemia, osteopenia and osteoporosis).     

抗癌药物紫杉醇的发现,化学及构效关系

自从利用生物试验从植物提取物筛选新的抗癌化合物以来，已经发现了许多新的活性成分．但仅极少数化合物如长春碱、长春新碱、秋水仙碱、紫杉醇（Taxol）等，被最终研究开发成新的抗癌药物，而其中最令人们瞩目的则是近年来开发的紫杉醇．迄今发表。。有关紫杉醇及其类似物（taxoids）的研究资料颇为丰富，且有更加增多的趋势，已成为当今天然药物化学研究的“热点”．研究内容十分广泛，车要有植物化学（提取分离、结构测定）、分析、生理活性、化学修饰、合成、构效关系、生物技术、细胞生物学和分子生物学以及临床等。发表了许多综述、…     

Olympus AU5400生化分析仪的测定误差及对策

目的测定O lympus AU5400模块式生化分析仪各分析系统间的误差,探讨用酶校准品校正仪器以减少其系统误差的可行性。方法由同一单元内、外圈,不同单元的同圈比色杯组成相应系统测定新鲜混合血清8项生化指标的批内精密度并比较其差异;再分别用3种酶校准品对系统进行校正,比较校正前后5项酶活性测定结果的差异和实际K值与理论K值的差异。结果AU5400的内、外圈的批内精密度均较好,变异系数CV为0.47%～1.59%。不同单元同圈比色杯测定8个项目的相关系数(r)为0.992～1.000,6个项目测定结果的差异均有统计学意义(P<0.01)。经酶校准品校正后,肌酸激酶(CK)、γ-谷氨酰基转移酶(GGT)与碱性磷酸酶(ALP)测定结果差异无统计学意义(P>0.05)。乳酸脱氢酶(LDH)测定的比例误差由4.0%减小至0.7%;而丙氨酸氨基转移酶(ALT)比例误差和恒定误差均有所减小。同一单元内、外圈测定8个项目的结果高度相关(r=0.998～1.000);4个项目的结果差异有统计学意义(P<0.001)。经酶校准品校正后,ALT、GGT及LDH的结果差异均无统计学意义(P>0.05),而ALP的比例误差和恒定误差均有所减小,但差异仍有统计学意义(P<0.001)。不同酶校准品校正后的实际K值相差最大可达32.7%。结论AU5400的4个分析系统测定不同项目时,可产生较明显的比例误差和/或恒定误差;采用酶校准品进行校准后,大部分酶学项目的误差会显著减小,但少数项目的系统误差并不一定能完全消除。     

计算机在医学领域中的应用及展望

对计算机在医学文献检索、医学统计软件包的编制、疾病诊断、医院管理等医学领域中的应用作了简要的综述，并对未来的发展进行了预测。     

Open mesh versus non-mesh repair of groin hernia meta-analysis of randomized trials leased on individual patient data

Abstract Background. The EU Hernia Trialists Collaboration was established to provide reliable evaluation of newer methods of groin hernia repair. It involved 70 investigators in 20 countries. Materials and methods. Twenty eligible trials (5016 participants) of open mesh vs. non-mesh groin hernia repair were identified. Meta-analysis was performed using raw individual patient data where possible. Results. Fewer hernia recurrences were reported after mesh repair. There were no clear differences between mesh and non-mesh groups in complications. Overall, those in the mesh groups had a shorter hospital stay, quicker return to usual activities and less frequent persisting pain, but individual trial results varied. Conclusions. The review provides strong evidence that open mesh repair is associated with a reduction in the risk of recurrence of between 50% and 75%. There is also some evidence of quicker recovery and of lower rates of persisting pain following open mesh repair. Electronic Publication     

Intratympanic steroid therapy for inner ear diseases, a review of the literature

To evaluate the value of clinical trials on intratympanic steroid therapy in Ménière’s disease (MD), idiopathic sudden sensorineural hearing loss (ISSNHL) and rapidly progressive sensorineural hearing loss (RPSNHL). Medline and Pubmed databases from 1966 to present were searched for clinical studies on intra- or transtympanic (cortico)steroid therapy of MD, ISSNHL and RPSNHL. Results were cross-checked with additional databases to obtain a complete data set. Clinical trials were evaluated on the basis of comparability, internal and external validity. Articles were judged using the following questions: was a randomised double-blind controlled trial performed? Which criteria were used to confirm the diagnosis of MD, ISSNHL, RPSNHL? Which therapy was evaluated? How long was the follow-up? Which criteria were used to evaluate the results? Reliable evidence on the efficiency, optimum dosage and administration schedule of intratympanic steroid therapy in MD, ISSNHL and RPSNHL is lacking, therefore further investigation is required.     

Valproinsäure in der prophylaktischen Behandlung der Migräne

Zusammenfassung Im Jahr 1988 wurde erstmals von der m?glichen Wirksamkeit der Valproins?ure in der Migr?neprophylaxe berichtet. Seit 1992 sind insgesamt 359 Patienten in 5 Doppelblindstudien untersucht. In allen Studien ergab sich eine signifikant überlegene Wirksamkeit im Vergleich zu Placebo, eine Studie belegt einen gleichen Effekt wie Propranolol. Es fehlen noch Wirksamkeitsanalysen, die sich am Plasmaspiegel orientieren. Die Nebenwirkungen entsprechen denen aus der Epilepsietherapie, scheinen aber im Vergleich zu Propranolol etwas h?her zu liegen. International und nach den Empfehlungen der Deutschen Migr?ne- und Kopfschmerzgesellschaft gilt Valproins?ure mittlerweile als etabliertes Mittel der zweiten Wahl.