肩、肘关节外科新进展

肩关节（Shoulder） 旋转袖（Rotator Cuff） 基础研究（Basic Science） Zuckerman讨论了软骨诱导形态发生蛋白-2（cartilagederived morphogenetic protein-2，CDMP-2）的早期工作。在鼠肌腱修复中，4周时CDMP-2治疗组的修复强度高于未治疗组。Dines讨论了关于血小板衍生生长因子（platelet—derived growth factor，PDGF）和胰岛素样生长因子-1（insulin-like growth factor-1，IGF-1）最初的研究观察。     

7-甲氧基-4′-羟基-3′-二乙胺甲基异黄酮(MHDF)对大鼠血流动力学和主动脉的作用

本实验观察了MHDF对整体大鼠血流动力学和离体大鼠胸主动脉的作用。结果表明iv MHDF(3～12.8 mg/kg)能降低大鼠左心室±dp/dt_max,V_max,V_pm和LVSP,延长T-dp/dt_max,减慢心率。MHDF还能舒张大鼠胸主动脉,ED₅₀为6.5×10^-6mol/L;非竞争拮抗NA和CaCl₂致主脉收缩,pD₂′为3.11±0.21和3.73±0.07;抑制高K⁺致主动脉收缩,IC₅₀为1.76×10^-5mol/L。提示MHDF对血管的作用与α受体阻断剂不同,而可能与钙拮抗有关。     

Proprioceptive evoked potentials in man: cerebral responses to changing weight loads on the hand

The retrotrapezoid nucleus (RTN), a part of the rostral ventrolateral medulla, is involved in the control of breathing. The mechanisms by which the RTN modulate the activity of respiratory neurons during chemoreceptor stimulation are not fully understood. This electrophysiological study performed in the cat demonstrates that 18 out of 22 RTN neurons receive inputs from the commissural subnucleus of the solitary tract (cNTS), the peripheral chemoreceptor afferents projection site. Moreover, six RTN neurons are found to present interconnection between RTN and the ventrolateral subnucleus of the solitary tract, an area containing mainly bulbo-spinal respiratory neurons. The present data suggest that RTN play a key role by concomitantly integrating chemosensitive informations relayed by the cNTS and providing an influence on the respiratory network.     

成纤维细胞分泌胶原蛋白与5-氟尿嘧啶的时间抑制效应

目的:观察5-氟尿嘧啶干预体外培养病理性瘢痕成纤维细胞增殖和胶原合成的作用及其时效关系。方法:实验于2005-05/2006-06在安徽医科大学微生物教研室完成。①原代细胞培养成纤维细胞:手术取4例增生性瘢痕、4例瘢痕疙瘩、4例正常皮肤组织,按文献方法进行成纤维细胞原代培养,待细胞融合后传代。②取4～6代传代细胞接种于96孔板,利用四唑盐比色法测定25g/L浓度5-氟尿嘧啶干预不同时间(1,2,5,10,15,30min)后3种体外培养成纤维细胞的增殖能力,统计得出最佳时效。③利用3H-脯氨酸掺入法检测经5-氟尿嘧啶干预不同时间后成纤维细胞的胶原蛋白分泌能力。结果:①原代培养成纤维细胞全部成活,形态良好,经5-氟尿嘧啶干预后细胞形态未发生明显变化。②四甲基偶氮唑盐法测3种不同来源成纤维细胞未干预时增殖能力,瘢痕疙瘩成纤维细胞>正常皮肤成纤维细胞(t=3.542,P<0.01),增生性瘢痕成纤维细胞>正常皮肤成纤维细胞(t=3.257,P<0.01);5-氟尿嘧啶干预成纤维细胞10min与5min比较,其对成纤维细胞的抑制效果增高(正常皮肤、增生性瘢痕、瘢痕疙瘩3种成纤维细胞10minA值依次为0.389±0.027,0.418±0.051,0.554±0.021;5minA值依次为0.537±0.033,0.589±0.074,0.783±0.015,q=3.80～4.18,P<0.05),与30min比较,差异无显著性。③干预10min3H-脯氨酸掺入量与空白对照组比较明显下降,差异有显著性(q=3.82～3.96,P<0.05),与5min干预组比较,差异均有显著性(q=3.96～4.14,P<0.05),与30min比较,差异无统计学意义。结论:5-氟尿嘧啶可有效抑制病理性瘢痕及正常皮肤来源的成纤维细胞体外增殖和胶原合成,干预10min时效应最佳。     

更昔洛韦对原位肝移植术后巨细胞病毒感染的预防和治疗:19例临床资料回顾

目的:巨细胞病毒感染是器官移植后的一个严重并发症,回顾性分析肝移植术后患者巨细胞病毒感染的诊断和防治方法.方法:①回顾分析2005-05/2006-08解放军总医院第二附属医院全军器官移植中心收治的19例肝移植受者的临床资料,供者均为健康献肝者.供者、受者对治疗方案均知情同意,且得到医院伦理道德委员会批准.②术后1个月检测1次巨细胞病毒血清抗体,预防和治疗巨细胞病毒感染均采用静脉注射更昔洛韦.术后采用三联免疫抑制疗法,根据术后血药浓度及肝功能改变调整免疫抑制药物用量.③采用酶联免疫吸附法检测患者血中巨细胞病毒抗体巨细胞病毒IgG、巨细胞病毒IgM.结果:19例受者中6例发生巨细胞病毒感染,均无临床症状,并全部治愈.结论:更昔洛韦能够有效治疗肝移植术后巨细胞病毒感染.积极预防、早期治疗肝移植术后患者巨细胞病毒感染是治疗成功的关键.     

龈壁设计对应用嵌体修复后牙体组织应力改变的影响

目的:建立嵌体修复后牙体三维有限元模型,应用不同的龈壁设计,观察相关力学参数变化。方法:①下颌第一磨牙标本来源于佳木斯大学解剖学教研室,标本要求:磨耗少,其牙冠长、宽、高接近正常下颌第一磨牙的均值。②建立有限元模型:用蜡块将牙齿固定,使扫描尽可能与牙体长轴垂直,扫描至牙颈部。根据各层图上建立的平面坐标,设颊舌向为X轴,近远中向为Y轴,龈向为Z轴。按照有限元单元划分的原则和计算机分析软件的要求,对各个断层的解剖轮廓进行边界节点选择和单元网格划分。根据组织结构特点,进行节点调整。通过人机交互,输入每个节点的坐标和组成单元的节点,分层建立由六面体单元所构成的三维有限元模型。③计算:在后牙邻洞应用不同的龈壁设计,于面上施加一竖直向下的力,大小为170N,方向与Z轴相同,通过有限元分析计算获取应力分布图像和应力数据。结果:①龈壁高度的增加,使牙釉质应力减少(0.1～0.27MPa),对牙本质无明显影响。②龈壁宽度的增加,使牙釉质应力增加(0.1～0.27MPa)、牙本质应力亦增加(0.01～0.03MPa)。③龈壁角度的增加,牙釉质和牙本质应力无明显改变。结论:Ⅱ类洞嵌体设计时,龈壁高度增加,宽度尽量减小有利于减小修复后牙体的应力。龈壁角度的有无对牙体应力无影响。     

Prolonged-release melatonin versus placebo for benzodiazepine discontinuation in patients with schizophrenia or bipolar disorder: A randomised,placebo-controlled,blinded trial

Objectives. We assessed if prolonged-release melatonin can facilitate withdrawal of long-term benzodiazepine usage in patients with schizophrenia or bipolar disorder. Methods. Randomised, placebo-controlled, blinded, parallel superiority trial of 24 weeks duration. Participants were randomised to prolonged-release melatonin 2 mg daily versus matching placebo and were continuously guided to gradually reduce their usual benzodiazepine dosage. The primary outcome was mean benzodiazepine daily dosage at 24 weeks. Secondary outcomes included pattern of benzodiazepine dosage over time, benzodiazepine cessation proportion, and benzodiazepine withdrawal symptoms. Results. In total, 86 patients (21–74 years) were enrolled: 42 were randomised to melatonin versus 44 to placebo. We found no significant effect of melatonin on mean benzodiazepine dosage at 24 weeks (melatonin group 8.01 mg versus placebo group 5.72 mg diazepam equivalents; difference between means –2.29; 95% CI –5.78 to 1.21; P = 0.20). Benzodiazepine cessation proportion was 38.1% (16/42) in the melatonin group versus 47.7% (21/44) in the placebo group (OR 0.64; 95% CI 0.26 to 1.56; P = 0.32). Prolonged-release melatonin had no effect on benzodiazepine withdrawal symptoms. Conclusions. Benzodiazepine dosage was comparably low between the groups after 24 weeks of guided gradual dose reduction. In this context, prolonged-release melatonin did not seem to further facilitate benzodiazepine discontinuation.