脐带间充质干细胞移植治疗遗传性痉挛性截瘫2例

背景：遗传性痉挛性截瘫是一种具有临床及遗传异质性的神经系统遗传病,目前临床治疗无明显效果。目的：观察脐带间充质干细胞移植治疗遗传性痉挛性截瘫的效果及安全性。方法：将细胞总数为（2～6）×107个人胎儿脐带间充质干细胞通过静脉输注和腰穿鞘内注射途径移植到自愿接受干细胞移植的2例遗传性痉挛性截瘫患者体内。移植后定期随访观察患者临床症状及各项指标的变化并进行综合分析。结果与结论：2例患者经脐带间充质干细胞移植治疗后临床症状均明显好转,双下肢肌张力明显降低,不需借助拐杖或他人帮助可独立行走,并且步态平稳,移植后各项生化指标正常,未出现严重的并发症和明显的不良反应。随访1年余2例患者的症状持续缓解无复发。说明脐带间充质干细胞移植治疗遗传性痉挛性截瘫近期疗效明显,可以改善患者的临床症状,延缓病情的进展。     

脐带间充质干细胞移植治疗遗传性痉挛性截瘫2例

背景:遗传性痉挛性截瘫是一种具有临床及遗传异质性的神经系统遗传病,目前临床治疗无明显效果.目的:观察脐带间充质干细胞移植治疗遗传性痉挛性截瘫的效果及安全性.方法:将细胞总数为(2～6)×107个人胎儿脐带间充质干细胞通过静脉输注和腰穿鞘内注射途径移植到自愿接受干细胞移植的2例遗传性痉挛性截瘫患者体内.移植后定期随访观察患者临床症状及各项指标的变化并进行综合分析.结果与结论:2例患者经脐带间充质干细胞移植治疗后临床症状均明显好转,双下肢肌张力明显降低,不需借助拐杖或他人帮助可独立行走,并且步态平稳,移植后各项生化指标正常,未出现严重的并发症和明显的不良反应.随访1年余2例患者的症状持续缓解无复发.说明脐带间充质干细胞移植治疗遗传性痉挛性截瘫近期疗效明显,可以改善患者的临床症状,延缓病情的进展.     

脐带间充质干细胞治疗帕金森病的应用简

背景：动物实验中已多次验证,脐带干细胞移植可有效改善帕金森大鼠的旋转行为,且免疫排斥反应低。目的：以帕金森病统一评分量表作为观察指标,评估人脐带间充质干细胞移植对帕金森病的治疗效果。方法：纳入帕金森病患者15例,男8例,女7例,年龄52-76岁,帕金森病H＆amp;Y分级3-5级。在产妇知情同意情况下,通过医院伦理委员会批准,获取足月妊娠产妇的脐带,无菌收集脐带,培养脐带间充质干细胞。所有患者均住院治疗,自第2周起应用人脐带间充质干细胞进行颈动脉穿刺移植治疗。移植前及移植后1个月采用帕金森病综合评分量表对患者移植前后神经功能进行评定,分值越高表示神经功能缺损越严重。结果与结论：15例患者均进入结果分析。与移植前相比,移植后1个月患者帕金森病综合评分量表分值均明显降低（P＜0.05）,主要集中在对震颤、强直的改善,而运动迟缓、姿势不稳等临床症状无明显改善。患者均未出现移植物抗宿主病。提示脐带间充质干细胞移植治疗帕金森病效果显著,可明显改善患者的神经功能。     

脐带间充质干细胞移植治疗终末期肝硬化的疗效及安全性

背景：骨髓间充质干细胞移植已应用于治疗终末期肝病并取得一定疗效。目的：观察脐带间充质干细胞治疗终末期肝硬化患者的疗效及安全性。方法：无菌条件下分离培养脐带间充质干细胞,选择60例肝硬化患者,在内科治疗基础上经肝动脉插管进行脐带间充质干细胞移植。结果与结论：移植2,4,8,12周后,患者血清白蛋白、前白蛋白水平逐渐升高（P〈0.05）,总胆红素、凝血酶原时间明显低于治疗前水平（P〈0.05）。移植后患者乏力、腹胀、纳差明显好转,未发生与移植相关的严重并发症。说明脐带间充质干细胞治疗终末期肝硬化安全有效,能改善患者的肝功能、凝血功能及临床症状。     

脐带间充质干细胞移植治疗终末期肝硬化的疗效及安全性

背景:骨髓间充质干细胞移植已应用于治疗终末期肝病并取得一定疗效。目的:观察脐带间充质干细胞治疗终末期肝硬化患者的疗效及安全性。方法:无菌条件下分离培养脐带间充质干细胞,选择60例肝硬化患者,在内科治疗基础上经肝动脉插管进行脐带间充质干细胞移植。结果与结论:移植2,4,8,12周后,患者血清白蛋白、前白蛋白水平逐渐升高(P<0.05),总胆红素、凝血酶原时间明显低于治疗前水平(P<0.05)。移植后患者乏力、腹胀、纳差明显好转,未发生与移植相关的严重并发症。说明脐带间充质干细胞治疗终末期肝硬化安全有效,能改善患者的肝功能、凝血功能及临床症状。     

人脐带间充质干细胞诱导成骨及治疗骨缺损

背景:人脐带间充质干细胞在成骨及组织器官修复方面具有更强的扩增能力及低免疫原性,其成集落生长潜能及成骨时间早于骨髓等其他来源间充质干细胞.目的:观察脐带间充质干细胞诱导成骨及移植治疗骨缺损的临床效果.方法:应用组织块贴壁法提取人脐带间充质干细胞,体外行成骨诱导并通过光镜观察、茜素红染色、碱性磷酸酶染色、Ⅰ型胶原的表达等证实其体外成骨能力;对临床骨缺损病例行人脐带间充质干细胞移植,移植后定期复查骨缺损部骨痂生长状况. 结果与结论:体外诱导证实人脐带间充质干细胞具有明确的成骨作用.骨缺损患者在人脐带源间充质干细胞移植后2个月X射线见左股骨髁上骨折部位骨块间隙模糊,骨折外周形成明显的骨痂,骨折断端相连,断端骨折线依然存在;移植后3个月见骨痂间已经形成明显骨性连接.证实脐带间充质干细胞具有体外诱导成骨及体内移植修复骨缺损作用.     

人脐带间充质干细胞诱导成骨及治疗骨缺损

背景：人脐带间充质干细胞在成骨及组织器官修复方面具有更强的扩增能力及低免疫原性,其成集落生长潜能及成骨时间早于骨髓等其他来源间充质干细胞。目的：观察脐带间充质干细胞诱导成骨及移植治疗骨缺损的临床效果。方法：应用组织块贴壁法提取人脐带间充质干细胞,体外行成骨诱导并通过光镜观察、茜素红染色、碱性磷酸酶染色、Ⅰ型胶原的表达等证实其体外成骨能力;对临床骨缺损病例行人脐带间充质干细胞移植,移植后定期复查骨缺损部骨痂生长状况。结果与结论：体外诱导证实人脐带间充质干细胞具有明确的成骨作用。骨缺损患者在人脐带源间充质干细胞移植后2个月X射线见左股骨髁上骨折部位骨块间隙模糊,骨折外周形成明显的骨痂,骨折断端相连,断端骨折线依然存在;移植后3个月见骨痂间已经形成明显骨性连接。证实脐带间充质干细胞具有体外诱导成骨及体内移植修复骨缺损作用。     

脐带间充质干细胞移植治疗初发1型糖尿病

背景：研究证实,新诊断的1型糖尿病患者,接受自体造血干细胞治疗后,绝大多数患者胰岛β细胞功能增强,不依赖胰岛素的时间也延长。目的：观察人脐带间充质干细胞移植治疗初发1型糖尿病的临床疗效。方法：选择12例病程〈3个月的初发1型糖尿病患者,其中6例行人脐带间充质干细胞和胰岛素治疗,另外6例行单纯胰岛素治疗。移植前及移植9个月后分别监测空腹及餐后血糖、胰岛素用量、C肽、HbA1c的变化和记录不良反应。结果与结论：随访9个月,干细胞治疗组的空腹血糖,糖化血红蛋白及C肽水平都有明显的改善,而对照组C肽水平明显下降,其他指标变化不明显。提示,人脐带间充质干细胞治疗初发1型糖尿病疗效良好。     

脐带间充质干细胞移植并康复治疗脑出血后遗症1年随访

背景：人脐带间充质干细胞具有定向分化为神经细胞的潜能,并且已在体内外实验中得到证实。临床有关脐带间充质干细胞移植治疗脑出血的报道较少。目的：观察人脐带间充质干细胞移植联合综合康复治疗对脑出血后遗症的治疗效果。方法：脑出血患者45例按照入院单双日分为2组,治疗组22例,对照组23例。常规治疗10～18d后,存在不同程度的后遗症,治疗组通过介入途径行人脐带间充质干细胞移植及康复治疗,对照组仅给予康复治疗。结果与结论：所有病例均获12个月随访。两组治疗后1,3,6,12个月Fugl-Meyer评分及改良Barthel指数均显著高于治疗前（P〈0.05）,治疗后治疗组Fugl-Meyer评分及改良Barthel指数均显著高于对照组（P〈0.05）,肢体运动功能及日常生活活动能力均明显改善。治疗组治疗后3个月功能改善更为明显,配合综合康复治疗有协同并弥补其不足的优点,通过颅脑MRI检查及各项相关生化检查表明其有效性及安全性。提示来源于脐带中的间充质干细胞体外培养后移植治疗脑出血后遗症,无特殊不良反应,配合综合康复治疗可达到功能恢复的较好效果。     

脐带间充质干细胞治疗脊髓小脑性共济失调12例

背景：目前尚未见应用脐带间充质干细胞治疗脊髓小脑性共济失调的报道。目的：观察脐带间充质干细胞治疗脊髓小脑性共济失调的临床效果。方法：选择 2010-09/12 解放军 455 医院干细胞移植中心收治的 12 例脊髓小脑共济失调患者,给予脐带间充质干细胞鞘内注射, 每次 10 7 个细胞,1 次/周,4 次为 1 个疗程。结果与结论：患者治疗后 1 个月与治疗前比较国际合作共济失调评分量表评分及日常生活量表评分均明显降低（P 〈 0.05）,提示患者的神经功能显著改善,总有效率为 16.7%。说明脐带间充质干细胞鞘内注射治疗可以在一定程度上改善脊髓小脑性共济失调患者的临床症状,提高患者生活质量。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.