用含活性细胞的胶原支架复合皮修复小鼠全层皮肤缺损的研究

目的构建具有活性细胞成分的复合皮，观察其在修复小鼠全层皮肤缺损中的作用。方法将异种成纤维细胞种植于脱软骨细胞胶原支架上培养3d，形成真皮替代物。再将其放置于培养的上皮细胞膜上共同培养10d，组成含活性细胞成分的复合皮。将复合皮移植于小鼠的全层皮肤缺损处，记录其生长情况并于术后定期活检，进行组织学观察。结果胶原支架中可见生长良好的成纤维细胞和复层表皮细胞。移植术后1周，复合皮与小鼠缺损创面粘连紧密，可见明显的血管化。术后6周，创面愈合良好，移植物与创缘融合，未见明显排斥反应。结论以脱软骨细胞胶原为支架构建的复合皮，可作为皮肤替代物修复全层皮肤组织缺损。     

成纤维细胞-无细胞真皮替代物的生物学活性及移植实验

目的 研究含成纤维细胞的无细胞真皮替代物的生物学活性及真皮支架作用。方法 将成纤维细胞种植于无细胞真皮表面培养,形成活性真皮替代物。采用ELISA法和RIA法测定培养上清中IL－6、IL－8、TGF－β1及细胞外基质层粘连蛋白、透明质酸的分泌。并将真皮替代物植入BALB／c-nu小鼠（裸鼠）全层皮肤缺损创面,观察血管化速度、创面收缩率。结果 成纤维细胞种植于无细胞真皮表面生长良好,可形成单层细胞膜片,并分泌多种细胞因子和细胞外基质成份。活性真皮替代物植入创面后,与单纯无细胞真皮移植相比,血管化速度加快,收缩率减小。结论 无细胞真皮上种植成纤维细胞后具有较强的生物学活性,可作为较好的真皮替代物。     

体外构建复合皮移植后对大鼠创面愈合的影响

目的：观察角质形成细胞和成纤维细胞与无细胞异种真皮基质构成的复合皮移植于全层皮肤缺损创面后的效果,寻找一种新的创面覆盖物。方法：54只SD大鼠作背部全层皮肤缺损创面后分为A、B、C三组,分别以A型复合皮（角质形成细胞＋成纤维细胞＋无细胞异种真皮基质）、B型复合皮（角质形成细胞＋无细胞异种真皮基质）和普通敷料进行移植,术后定期观察创面愈合情况并进行创面收缩率的计算,同时切取创面组织进行组织学检测。结果：三组中,A组的创面愈合及外观情况最好;A组创面收缩率明显低于B、C两组（P（0．05）;组织学检测提示A组复合皮上皮分化充分,胶原增生有序,表皮一真皮连接结构重建明显,未见明显的急性期免疫排斥反应。结论：角质形成细胞和成纤维细胞与无细胞异种真皮基质构成的复合皮移植后能改善创面愈合质量,是一种较理想的、可探索的皮肤替代物。     

自体组织工程化全层皮肤缺损修复实验研究

目的 为制成含表皮细胞与成纤维细胞的双层皮肤替代物，直接用于修复全层皮肤缺损。方法 选用长枫杂交仔猪10只，酶消化法获取皮肤表皮细胞与成纤维细胞，将原代培养处于对数生长期的表皮细胞、成纤维细胞分别与30％氧化异丙烯F－127混匀成细胞悬液后，种植聚羟基乙酸（polyglycolic acid,PGA)形成细胞－生物材料复合物，用于修复自体动物背部直径4cm全层皮肤缺损，以单纯生物材料（PGA＋氧化异丙烯）充填的创面作为对照组。修复术后1，2，4，8周取材，通过组织学和基底膜特殊染色等方法对新生组织进行评价。结果 第1周新生组织即出现表皮与真皮2层结构，特殊染色观察到连续的基底膜。第2周表皮与真皮均较前增厚。修复后第8周组织工程化皮肤的形态结构均与正常皮肤相似。对照组则无皮肤形成，仅见大量肉芽组织。结论 应用组织工程技术，以PGA 氧化层丙烯为表皮细胞、成纤维细胞载体构建的组织工程化皮肤可修复全层皮肤缺损。     

自体组织工程化皮肤修复全层皮肤缺损的实验研究

目的为制成含表皮细胞与成纤维细胞的双层皮肤替代物,直接用于修复全层皮肤缺损.方法选用长枫杂交仔猪10只,酶消化法获取皮肤表皮细胞与成纤维细胞,将原代培养处于对数生长期的表皮细胞、成纤维细胞分别与30%氧化异丙烯F-127 混匀成细胞悬液后,种植聚羟基乙酸(polyglycolic acid,PGA)形成细胞-生物材料复合物,用于修复自体动物背部直径4 cm全层皮肤缺损,以单纯生物材料(PGA+氧化异丙烯)充填的创面作为对照组.修复术后1,2,4,8周取材,通过组织学和基底膜特殊染色等方法对新生组织进行评价.结果第1周新生组织即出现表皮与真皮2层结构,特殊染色观察到连续的基底膜.第2周表皮与真皮均较前增厚.修复后第8周组织工程化皮肤的形态结构均与正常皮肤相似.对照组则无皮肤形成,仅见大量肉芽组织.结论应用组织工程技术,以PGA+氧化异丙烯为表皮细胞、成纤维细胞载体构建的组织工程化皮肤可修复全层皮肤缺损.     

血小板源性生长因子基因修饰的人工复合皮移植大鼠创面效果观察

目的观察血小板源性生长因子B(PDGFB)基因修饰的人工复合皮移植大鼠创面后的效果。方法构建PDGFB真核表达质粒,在脂质体介导下转染大鼠成纤维细胞。分别构建复合皮1(角质形成细胞 猪脱细胞真皮基质 PDGFB基因转染的成纤维细胞)和复合皮2(角质形成细胞 猪脱细胞真皮基质 未转染的成纤维细胞),移植于大鼠背部全层皮肤缺损创面,相应设为转染组、未转染组(各18只)。以不作皮肤移植的8只大鼠全层皮肤缺损创面为对照组。术后2周观察大鼠创面移植皮片存活情况。术后2、4、6周观察大鼠创面大体情况,计算创面收缩率,并取创面组织标本进行组织学观察。结果(1)术后2周,转染组大鼠中皮片完全存活者14只、部分存活者3只、未存活者1只;未转染组大鼠中皮片完全存活者10只、部分存活者4只、未存活者4只。(2)术后2周,对照组创面结痂。术后6周转染组移植皮片表面光滑,有弹性,抗磨擦性强,愈合效果优于其他两组。(3)术后2、4、6周,对照组大鼠创面收缩率均高于其他两组,转染组创面收缩率低于未转染组(P<0.05)。(4)术后2周转染组移植皮片内可见较多毛细血管分布;6周时表皮细胞分化达7～10层,纤维排列致密整齐,毛细血管分布均匀。结论用含PDGFB基因的人工复合皮移植修复创面,可明显提高创面愈合质量。     

脱细胞猪小肠黏膜下层与猪脱细胞真皮基质作为真皮支架的对比研究

目的：应用脱细胞猪小肠黏膜下层与猪脱细胞真皮基质作为真皮替代物与SD大鼠自体刃厚皮片进行复合移植,修复SD大鼠全层皮肤缺损,比较两者优劣性,为临床提供更理想的真皮替代物。方法：以36只SD大鼠为动物模型,随机区组法随机分为两组,每组18只,在其背部造成2.5 cm×2.5 cm的全层皮肤缺损,实验组应用脱细胞猪小肠黏膜下层+自体刃厚皮移植修复,对照组应用猪脱细胞真皮基质+自体刃厚皮移植修复,移植后2周对移植皮片成活率分析研究,移植后4周、8周、12周取材进行一般观察、组织学观察和收缩率的计算。结果：术后2周,实验组植皮存活率大于对照组,差异有统计学意义(P<0.05)。于术后4周、8周、12周动态观察,实验组植皮区收缩率较对照组低,但组间比较差异无统计学意义(P>0.05)。HE染色组织学观察,术后4周,两组植入材料与移植皮片融合度均很好,植入材料内及其周围均有大量的成纤维细胞和新生毛细血管长入,并有炎症细胞浸润;术后8周,两组植入材料内及其周围均有成纤维细胞和新生毛细血管长入,炎症细胞较术后4周时少,两组植入材料的原有胶原纤维结构尚清晰,出现疏松;术后12周,两组植入材料...     

人表皮细胞与无细胞异种真皮复合移植的实验研究

目的 观察人表皮细胞与无细胞异种真皮复合移植全层皮肤缺损创面后的效果,寻找一种新的创面覆盖物。方法 42只裸鼠作背部全层皮肤缺损创面,分别进行复合皮移植（复合皮组）和单纯表皮细胞膜片移植（对照组）,术后定期观察创面愈合情况并进行创面愈合率及创面收缩率的计算,同时留取创面组织进行组织学检查。结果 与对照组相比较,复合皮组的创面愈合及外观情况良好,两组创面愈合率及收缩率的差异有显性意义（P＜0．05）;组织学检测提示复合皮上皮分化充分,胶原增生有序,表皮－真皮连接结构重建明显,未见明显的急性期免疫排斥反应。结论 人表皮细胞与无细胞异种真皮复合移植能改善创面愈合质量,可作为一种新的皮肤代用品。     

表皮干细胞活性复合皮肤修复裸鼠全层皮肤缺损

目的用表皮干细胞和成纤维细胞作为种子细胞，研制一种增殖能力强具有表皮、真皮的组织工程化人工复合皮肤。方法从幼儿包皮中分离表皮干细胞，用胶原Ⅳ纯化、富集表皮干细胞，接种在3T3细胞滋养层上，将体外传代培养的表皮干细胞和真皮成纤维细胞分别接种在经冷冻干燥及戊二醛交联的I型胶原基质网架的两侧，在液面下培养2周后，改为气-液界面培养，构建复合皮肤，移植到裸鼠全层皮肤缺损处，以表皮细胞胶原海绵复合皮肤和无细胞接种的胶原海绵膜作为对照。术后进行大体观察，在第7、14、21天取材行组织学、免疫组织化学及电镜观察。结果用表皮干细胞构建的复合人工皮肤增殖能力强，新生的皮肤瘢痕轻，形态满意，创面愈合的速度和质量均优于对照组。结论在胶原海绵上用表皮干细胞构建的复合人工皮肤增殖能力强，较好地解决了种子细胞的老化问题，可望成为一种较为理想的皮肤替代物。     

人工真皮复合自体刃厚皮片修复全层皮肤缺损创面的临床研究

目的:探讨人工真皮复合自体刃厚皮片修复全层皮肤缺损创面的临床效果.方法:于2009年至2011年采用人工真皮复合自体刃厚皮片修复全层皮肤缺损创面20例(治疗组),并从同期采用单纯中厚皮片移植修复的全层皮肤缺损患者中,随机抽取2 0例作为对照组,对比评估供皮区愈合时间,治疗6个月后植皮区存活皮片色泽及质地.结果:治疗组移植皮片的色泽和质地明显优于对照组(P＜0.05),而供皮区愈合时间短.结论:人工真皮复合自体刃厚皮片移植是修复全层皮肤缺损创面的一种新的有效方法.     

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。