胎兔、孕兔、成年兔伤口愈合中肿瘤坏死因子和表皮生长因子含量分析

目的：探索胎兔伤口无瘢痕愈合的可能机理及条件。方法：采用孕22－23d的母兔及所孕胎兔皮肤伤口无瘢痕愈合的动物模型及成年兔皮肤伤口愈合模型，以放射免疫法测定其表皮生长因子（EGF）和肿瘤坏死因子（TNF）含量。结果：胎儿伤口中的EGF和TNF术后3d明显升高（P＜0．05），并维持至术后7d；孕兔及成年兔仅在术后3d升高（P＜0．05），术后7d降到接近正常水平。结论：胎兔皮肤伤口中特有的细胞因子水平是胎儿伤口无瘢痕愈合的重要因素。     

胎兔皮肤伤口中糖胺多糖及透明质酸含量分析

目的探讨胎兔皮肤伤口无瘢痕愈合机理。方法 取胎兔,孕兔,成年兔切口及其周围组织,用阿利新蓝比色法,醋酸纤维素膜电脉分离法测定糖胺多糖（GAG）和透明质酸（HA）含量。结果 （1）胎兔正常皮肤（GAG及HA的含量均明显高于孕兔及成年兔（P＜0．01）,手术区,胎兔,孕兔,成年兔在术后3天时GAG及HA均升高（P＜0．05）。但术后第7天,胎兔GAG含量仍维持在高水平,而孕兔及成年兔其含量下降到接近正常水平,。结论 高浓度的HA在胎兔伤口间质的持续存在对胎兔伤口无瘢痕愈合起很重要的作用。     

胚胎兔和成年兔伤口愈合中肌成纤维细胞的表达

胚胎动物与成年动物的创伤愈合存在差别 ,表现在炎症反应轻、创面不收缩和无瘢痕形成[1,2 ] 。本实验在光镜和电镜下观察胚胎兔和成年兔伤口愈合过程中肌成纤维细胞(ｍｙｏｆｉｂｒｏｂｌａｓｔ,ＭＦＢ)的表达 ,以期探讨胎兔伤口不收缩的原因以及胎兔无瘢痕愈合的机制。材　料　和　方　法1.动物模型及分组 :选择怀孕 2 3ｄ的日本大耳白兔 6只 ,随机分为两组 ,每组 3只 ,每只孕兔取两只胎兔做创伤 ,分别于创伤后 3、6ｄ行剖宫产手术取出创伤胎兔 ,在取出创伤胎兔的同时 ,每只孕兔还剖取两只正常胎兔作对照。另取普通成年日本大耳白兔 12只 ,…     

透明质酸刺激因子对成纤维细胞活性功能和胶原合成的影响

目的 研究透明质酸刺激因子（HASF）对正常皮肤及瘢痕成纤维细胞活性和胶原合成的影响。方法 层析法从兔羊水及胎兔血清中提取HASF并做活性鉴定;用嗜银蛋白（AgNORs)染色法、^3H-脯氨酸掺入法和羟脯氨酸（HYP）测定法观察不同浓度的HASF对细胞增殖活性和胶原蛋白合成的影响。结果 HASF使两类细胞的AgNORs含量减少;两类细胞实验组脯氨酸掺入率与HYP含量均较对照组低,两种胶原测定法相关性好。结论 HASF对正常皮肤及瘢痕成纤维细胞的活性功能及胶原合成有抑制作用,可能影响伤口愈合中瘢痕的形成。     

无瘢痕愈合过程中胶原代谢演变的实验研究

目的与成年鼠伤口愈合过程进行对照,观察胎鼠无瘢痕伤口愈合过程中胶原代谢情况。方法建立无瘢痕伤口愈合模型,于术后不同时间点对胎鼠和成年鼠伤口组织行胶原蛋白V.G.染色,Ⅰ、Ⅲ型胶原免疫组化,Ⅰ、Ⅲ型胶原原位杂交。结果胎鼠伤口愈合快,组织结构再生完全,没有瘢痕形成,胶原呈网状正常排列,Ⅰ、Ⅲ型胶原蛋白及表达均增多,同时伴细胞数增多,Ⅲ型胶原首先形成网状排列;成年伤口胶原纤维沉积慢,平行排列的胶原逐渐呈束状填塞伤口以致瘢痕形成,伤口内Ⅰ、Ⅲ型前胶原mRNA表达均增多,细胞数目增多不明显。结论在胎儿伤口愈合过程中,Ⅰ、Ⅲ型胶原蛋白表达调控主要通过细胞数目增多来完成,胶原纤维始终呈网状正常排列;成年伤口愈合Ⅰ、Ⅲ型胶原蛋白表达调控则通过其mRNA水平增高来实现,胶原纤维呈束状排列,形成瘢痕组织。     

胎兔皮肤无瘢痕愈合相关蛋白的筛选与初步分析

目的：筛选胎兔皮肤组织无瘢痕愈合相关蛋白，并初步分析其在无瘢痕愈合过程中的作用。方法：建立胎兔背部切割伤模型，运用蛋白质组双向电泳技术筛选胎兔皮肤伤后差异表达的蛋白质，并进行质谱和数据库检索分析。结果：筛选出20个在伤后胎兔皮肤组织中特异高表达的蛋白质点，经过质谱和数据库检索分析后确定：伴侣素或线粒体蛋白P1前体、弹性蛋白（Vimentin，Vim）、微管蛋白β多肽、核不均一核糖核蛋白H（异质性胞核核糖核蛋白H）、α-烯醇酶（α-磷酸丙酮酸水合酶）等无瘢痕愈合相关蛋白在胎兔皮肤伤后表达增加。结论：上述无瘢痕愈合相关蛋白可能通过对基因转录和翻译的调控，促进胶原蛋白等的合成和正确的折叠、装配，以及促进细胞的增殖、分化和发育等，促进胎兔皮肤创伤的修复，参与其无瘢痕愈合过程。     

透明质酸含量在兔正常皮肤及皮肤创伤愈合过程的变化

目的　分析透明质酸在创伤愈合过程中的含量变化以及胎儿型愈合和成人型愈合的机理。方法　通过胎兔创伤模型及皮肤均化的方法，提取游离及结合的透明质酸（ＨＡ） ，应用透明质酸结合蛋白（ ＨＡＢＰ） 技术，对胚胎兔、成年兔皮肤在正常及创伤愈合过程中用放射免疫法测定游离、结合及ＨＡ 的总量。结果　⑴不同孕期正常胎兔皮肤的游离ＨＡ 及ＨＡ 总量的差异均无显著意义，结合ＨＡ 有显著的波动，而且均比正常成兔增高（ Ｐ＜ ０ ．０１） ；⑵胎兔皮肤创伤后不同愈合时间的游离ＨＡ 及ＨＡ 总量的差异均无显著意义，结合ＨＡ 的组成亦有显著变化；⑶创伤胎兔与正常胎兔相比，各组分ＨＡ 均增高（ Ｐ＜ ０ ．０５） ；⑷创伤成年兔游离ＨＡ 及ＨＡ 总量均比正常成年兔显著增高（ Ｐ＜ ０ ．０１） ，而在创伤成年兔内部游离ＨＡ 及ＨＡ 总量呈“山峰型”变化；⑸胎兔、成年兔皮肤创伤后对应比较发现，ＨＡ 总量均为胎兔高（ Ｐ＜ ０ ．０１） ，而游离ＨＡ 则第２ 、３ 天差异无显著意义。结论　ＨＡ 的增高是胎儿型愈合不可缺少的内部机制，其中游离ＨＡ 起主导作用，但结合ＨＡ 随孕期的延长以及在创伤后不同愈合时间所发生的显著变化，对于临床控制瘢痕形成具有很重要的意义     

透明质酸刺激因子对成纤维细胞活性功能和胶原合成的影响

目的研究透明质酸刺激因子（ＨＡＳＦ）对正常皮肤及瘢痕成纤维细胞活性和胶原合成的影响。方法层析法从兔羊水及胎兔血清中提取ＨＡＳＦ并做活性鉴定;用嗜银蛋白（ＡｇＮＯＲｓ）染色法、３Ｈ脯氨酸掺入法和羟脯氨酸（ＨＹＰ）测定法观察不同浓度的ＨＡＳＦ对细胞增殖活性和胶原蛋白合成的影响。结果ＨＡＳＦ使两类细胞的ＡｇＮＯＲｓ含量减少;两类细胞实验组脯氨酸掺入率与ＨＹＰ含量均较对照组低,两种胶原测定法相关性好。结论ＨＡＳＦ对正常皮肤及瘢痕成纤维细胞的活性功能及胶原合成有抑制作用,可能影响伤口愈合中瘢痕的形成。     

透明质酸刺激因子对成纤维细胞活性功能和胶原合成的影响

目的研究透明质酸刺激因子(HASF)对正常皮肤及瘢痕成纤维细胞活性和胶原合成的影响。方法层析法从兔羊水及胎兔血清中提取 HASF 并做活性鉴定;用嗜银蛋白(AgNORs)染色法、~3H-脯氨酸掺入法和羟脯氨酸(HYP)测定法观察不同浓度的 HASF 对细胞增殖活性和胶原蛋白合成的影响。结果 HASF 使两类细胞的 AgNORs 含量减少;两类细胞实验组脯氨酸掺入率与HYP 含量均较对照组低,两种胶原测定法相关性好。结论 HASF 对正常皮肤及瘢痕成纤维细胞的活性功能及胶原合成有抑制作用,可能影响伤口愈合中瘢痕的形成。     

胚胎兔、成兔皮肤在正常发育及创伤愈合过程中IgG的表达

目的 分析胚胎兔，成兔胚皮肤在便伤愈合过程中IgG表达的差异，为胎儿型及成人型愈合机制的研究提供依据。方法 在建立胎兔皮肤创伤模型的基础上，采用皮肤均化的方法，提取正常及创伤组织中的免疫球蛋白IgG，用双抗体夹心ELISA法进行含量测定。结果 随正常胎兔（孕23－28天）孕期的延长，皮肤中IgG有合成增加的趋势，而正常成免皮肤的IgG含量显著高于胎兔（P＜0．01）；胎兔皮肤创伤后不同时间（1－6d)的IgG含量与对应的正常胎兔（孕23－28天）相比，只伤后第1，2天增高（P＜0．01），而不同孕期的创伤胎兔之间差异无显著意义。成兔皮肤创伤后从第2天起IgG合成量明显高于正常成兔（P＜0．01），并呈现明显的上升趋势，对胎，成兔皮肤创伤后IgG变化趋势的动态发现胎兔呈平坦线性，成兔呈上升线性。结论 在胚胎发育成熟的过程中，免疫系统日臻完善，虽然IgG在较低水平，但在创伤后仍表现出一定的免疫反应，而成兔在创伤后却表现出强烈的免疫反应，不仅含量高而且趋势显著，免疫反应的不同是胎儿愈合与成人型愈合的本质差别之一。     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。