物理性刺激对骨膜软骨生成的影响

目的探讨物理性刺激对骨膜软骨生成方面的影响,以期培养出一种与正常关节软骨更相似的软骨组织。方法从新西兰大白兔胫骨近端内侧取下骨膜,将骨膜固定在支架上,然后将细胞支架悬吊在旋转瓶内,用水流产生的剪切应力去刺激骨膜。通过宏观观察、体积大小测量、组织切片染色与细胞外基质(ECM)成分的比较及生物力学测试分析软骨体外生长的最佳环境。结果宏观观察发现软骨生长的方向与水流的方向相同。组织切片染色可见有两层不同形态的软骨细胞和不同密度的ECM,免疫组织化学染色见在剪切应力的刺激下,软骨表面可分泌浅层蛋白质及润滑剂,且在不同大小的剪切应力刺激时,软骨表面还会产生不同厚度的表层。结论剪切应力刺激能使骨膜上的干细胞分化形成软骨,同时证明力学环境不仅影响细胞的分化与生长,而且影响细胞的形态与ECM的分泌。     

Extacorporeal shock wave therapy unsuccessful for chronic medial epicondylitis

Medial epicondylitis is a chronic noninflammatory condition resulting from mechanical injury. Despite many treatment options, including rest, medications, physiotherapy and operative interventions, the results are too often poor; thus new treatment options are sought. We treated 4 men with chronic epicondylitis (5 affected joints) with extracorporeal shock wave therapy after failed attempts of other treatments. The patients’ complaints were graded with the Nirschl scoring system prior to and six months after therapy. The treatment consisted of three sessions, at 20-day intervals, of 3000 pulses of ultrasonic shock waves from a Piezolith 3000 unit (energy dosage was gradually increased to reach step 10 equaling 0.9 mJ/mm²). At the 6-month follow-up, no patient was pain free. Three cases had slightly lower Nirschl scores than prior to the procedure but the patients rated this difference as insignificant; two cases were unchanged. No complications were observed but all patients rated the procedure as very unpleasant. The well recognized biologic effects of ultrasonographic waves (heat generation, oscillations, cavitation, etc.) that result in functional and structural changes of cellular membranes with sonochemical reactions (acceleration of normal metabolism, oxygenation and reduction in water solutions, polymer degradation, etc.), even if present in our cases, did not result in a noticeable decrease of symptoms, even though we used high energy and more impulses per session. Significant variations in methodology make inconclusive the results of numerous reports on the use of extracorporeal shock waves in epicondylar degenerative problems, although ineffectiveness of such therapy is the conclusion of a review by Haake and colleagues.     

单用体外震波碎石治疗尿路结石的体会

本文报道1988年6月～11月,单独应用上海交通大学电力工程系研制的JT—ESWL—Ⅱ型体外震波碎石机,治疗尿路结石506例,其中肾结石304例(双侧12例)输尿管结石199例(双侧5例),膀胱结石3例。冲击能量15～40焦耳,每次治疗冲击波次数为400～2800次。本组无开放手术、无肾脏丧失、无死亡。效果满意者96.44％。其并发症主要有血尿、结石串。作者认为单用ESWL治疗小于3Cm的尿路结石安全可靠、无严重并发症。文中对单用体外震波碎石(ESWL)治疗尿路结石病例选择,如何减少并发症,提高治疗效果进行了讨论。     

Pharmacokinetics and haemodynamic effects of ISDN following different dosage forms and routes of administration

The pharmacokinetics and haemodynamic effects of isosorbide dinitrate (ISDN) have been investigated following administration of single doses as a sublingual (SL) spray (2.5 mg), sublingual tablet (5 mg) and peroral tablet (10 mg) in a randomised, placebo-controlled double-blind cross-over trial in 16 healthy volunteers.After the sublingual spray C_max was higher (39.0 ng·ml^-1) and t_max was shorter (3.9 min) than after the sublingual (22.8 ng·ml^-1 and 13.8 min) and peroral (16.9 ng·ml^-1 and 25.6 min) tablets. The AUC of ISDN did not differ following any of the three formulations (1031; 879; 997 ng·ml^-1·min, for the spray, SL tablet and PO-tablet, respectively). Mononitrate metabolites of ISDN (IS-2-MN and IS-5-MN) and total nitrates in plasma increased in proportion to the administered dose. This indicates that the fraction of the dose absorbed was the same for all the formulations but that the extent of first-pass metabolism increased in the order sublingual spray < sublingual tablet < peroral tablet. Thus, compared to the spray, the relative bioavailability of ISDN was 48% and 28% from the sublingual and peroral tablets, respectively.The haemodynamic effects were quantified using the a/b ratio of the finger pulse wave and the systolic blood pressure and heart rate under orthostatic conditions. For the a/b ratio of the finger pulse, the maximal effect was higher (e_max=130%) and the time to e_max (t_emax) shorter (16.6 min) after the spray than the sublingual tablet (84.4% and 25.5 min) or peroral tablet (90.2 and 31.3 min). The onset of effect was within 3, 5 and 7.5 min after the spray, sublingual and peroral tablets, respectively. A larger change in the orthostatically-induced decrease in systolic blood pressure and increase in heart rate was obtained following peroral than sublingual administration despite the similar plasma concentrations of ISDN. This probably reflects the larger amount of pharmacodynamically active mononitrate metabolites formed after oral dosing. The integrated effect following administration of 2.5 mg ISDN as spray was similar to that of a sublingual tablet of 5 mg.     

彩色多普勒在心脏起搏器综合征诊断中的应用价值

目的 :探讨运用彩色多普勒血流显像 (CDFI)并结合心电图 (ECG)诊断起搏器综合征 (PMS)的临床价值。方法 :对具有详实临床及ECG资料的心室按需 (VVI)起搏器安置患者 6 0例及对照组 4 8例进行CDEI检查 ,观察起搏组与对照组的三尖瓣返流 (TR)的发生率、返流程度 ,并分析二者之间的相关性。结果 :起搏组出现逆传P波 (即PMS阳性 )者 15例 ,CDFI检测出现TR者 2 0例 ,明显高于对照组 ,且PMS阳性者TR发生率明显高于PMS阴性者 ,表明安置VVI起搏器后出现逆传P波与TR的发生相关性良好。结论 :CDFI对PMS的诊断具有重要意义 ,尤其将ECG与CDFI结合应用有助于诊断率的提高。     

胫骨前肌疲劳时比目鱼肌诱发肌电图H波的变化及其机制探讨

为了解主动肌疲劳时拮抗肌脊髓运动神经元兴奋性变化的规律 ,本研究采用踝关节背屈运动形式 ,对胫骨前肌 (主动肌 )疲劳状态下的比目鱼肌 (拮抗肌 )诱发肌电图H波成分进行了观察。并以压迫阻断胫骨前肌Ⅰa类神经纤维传导的方法 ,对比目鱼肌H波变化机制进行了分析探讨。结果发现 :(1)胫骨前肌疲劳后 ,比目鱼肌H波明显受到抑制 ,与安静时比较呈非常显著性差异 ;(2 )胫骨前肌Ⅰa类神经纤维传导被阻断后 ,比目鱼肌H波的抑制现象没有解除。表明 ,胫骨前肌疲劳时比目鱼肌H波被抑制的原因 ,可能是由于主动肌内的代谢产物激活了Ⅲ·Ⅳ类神经纤维的感受器 ,Ⅲ·Ⅳ类神经纤维的传入冲动增加 ,使Ⅰa抑制性中间神经元被激活 ,导致拮抗肌脊髓运动神经元的兴奋性受到了抑制     

Seasonal covariation of the circadian phases of rectal temperature and slow wave sleep onset

There is a scarcity of well-controlled studies of the seasonal variation in circadian rhythmicity. In the present study, the circadian phase of rectal temperature and the onset of slow wave sleep were studied in a series of twelve 24-h experiments, one each month of the year, for six healthy subjects under controlled conditions in a climatic chamber. In winter, as compared with summer, the average circadian rhythm of rectal temperature was phase delayed by 45 min, and the average onset of slow wave sleep was phase delayed by 40 min. The temporal relationship between the circadian phase of rectal temperature and the timing of slow wave sleep was maintained throughout the year. Habitual rising and retiring times covaried as well. Furthermore, the circadian rhythm of rectal temperature followed the timing of the photoperiod across the year, but had a much smaller range of seasonal variation. Apparently, the seasonal variation in the photoperiodic zeitgeber is largely compensated for by the stabilizing influence of secondary zeitgebers. However, in healthy subjects some effect of photoperiodic variation can still be observed.     

Randomized, placebo-controlled, double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracoporeal shockwave therapy (ESWT) device: a North American confirmatory study.

Despite numerous publications and clinical trials, the results of treatment of recalcitrant chronic plantar fasciitis with extracorporeal shockwave therapy (ESWT) still remain equivocal as to whether or not this treatment provides relief from the pain associated with this condition. The objective of this study was to determine whether extracorporeal shock wave therapy can safely and effectively relieve the pain associated with chronic plantar fasciitis compared to placebo treatment, as demonstrated by pain with walking in the morning. This was set in a multicenter, randomized, placebo-controlled, double-blind, confirmatory clinical study undertaken in four outpatient orthopedic clinics. The patients, 114 adult subjects with chronic plantar fasciitis, recalcitrant to conservative therapies for at least 6 months, were randomized to two groups. Treatment consisted of approximately 3,800 total shock waves (+/-10) reaching an approximated total energy delivery of 1,300 mJ/mm(2) (ED+) in a single session versus placebo treatment. This study demonstrated a statistically significant difference between treatment groups in the change from baseline to 3 months in the primary efficacy outcome of pain during the first few minutes of walking measured by a visual analog scale. There was also a statistically significant difference between treatments in the number of participants whose changes in Visual Analog Scale scores met the study definition of success at both 6 weeks and 3 months posttreatment; and between treatment groups in the change from baseline to 3 months posttreatment in the Roles and Maudsley Score. The results of this study confirm that ESWT administered with the Dornier Epos Ultra is a safe and effective treatment for recalcitrant plantar fasciitis.