牙周膜干细胞的研究进展★

背景：从牙周膜组织中分离出的牙周膜干细胞被认为是牙周组织工程的首选种子细胞，有自我更新能力，能分化形成牙周的3种组织：牙槽骨、牙周膜和牙骨质。 目的：就近年来牙周膜干细胞的分离、鉴定、相关细胞因子等方面进行简要综述。 方法：由第一作者检索Pubmed 数据库(http://www.ncbi.nlm.nih.gov/pubmed)、中国知网数据库(http://www. cnki.net/)2004-01/2010-09有关牙周膜干细胞分离、鉴定、相关细胞因子等方面的文献，英文检索词为“periodontal ligament stem cell”，中文检索词为“牙周膜，干细胞”。排除重复性研究，最终纳入35篇文献进行综述。 结果与结论：牙周膜干细胞是一种很有潜力的牙周组织工程种子细胞，能构建组织工程牙周膜，促进牙周缺损的修复。随着研究的深入，影响牙周膜干细胞生物性能的因素逐渐被发现，但其研究还有待进一步完善。     

肩锁关节脱位手术治疗中修复重建方式及修复材料的临床应用研究与进展

目的：目的：综合分析目前国内外肩锁关节脱位手术治疗中关于重建修复方式及修复材料的研究进展。 资料来源：检索人为第一作者,检索文献时限1996-01/2009-04,检索数据库包括CNKI 中国知网数据库 (http://dlib.cnki.net)、PubMed数据库 (http://www.ncbi.nlm.nih.gov/pubmed/)。英文检索词为“acromioclavicular joint, dislocation, operative treatment, literature review”;中文检索词为“肩锁关节,脱位,手术治疗,综述” 。检索文献类型包括基础研究、临床研究、综述及病例报告。 资料选择：纳入具有原创性、论点论据可靠的试验文章,观点明确、分析全面的文章及文献主题内容与课题联系紧密的文章。排除重复研究。 结局评价指标：选取与肩锁关节脱位手术治疗中关于重建修复方式及修复材料的相关文献,其中中文206篇,英文229篇。排除391篇内容陈旧或重复文献,纳入44篇符合标准的文献。 结果：肩锁关节脱位是临床上较为常见的脱位之一,由于肩锁关节是非刚性关节、微动关节,传统的坚强固定都只是非解剖固定方法,总体疗效欠佳。在探索治疗方法过程中,逐渐认识到喙锁韧带在肩锁关节稳定中的重要性,其重建修复方式及修复材料已是目前研究重点。 结论：目前肩锁关节脱位手术包括肩锁关节固定、喙锁间固定、喙锁韧带重建修复、动力性肌肉转移及锁骨远端切除等,各有优缺点。传统固定方法需要解决如何解剖复位固定肩锁关节的问题,重建修复喙锁韧带方法需要在修复材料选择、生物力学、长期临床随访方面进一步完善。 关键词：肩锁关节;脱位;手术治疗;综述     

激光扫描三维特征提取的临床应用及主要技术研究

背景：三维测量技术在逆向工程、质量检测、虚拟现实等各种领域的广泛应用，也逐渐进入到医学领域。选择安全、准确、快速、具有较高性价比的测量方法，可获得满足临床需求的测量数据，提供精确的手术模拟效果。 目的：综述激光扫描与三维特征提取技术在临床中的应用，并对应用中的主要技术进行分析。 方法：由第一作者检索2000/2009中国期刊全文数据库(http://ckrd.cnki.net)，万方数据库(http://www.wanfangdata.com.cn)及ScienceDirect数据库(http://www.sciencedirect.com)中已发表的关于利用激光扫描进行三维特征提取以及在临床中应用的文献，中文检索词为“激光扫描，三维重建，临床应用”，英文检索词为“laser scanning, three-dimensional reconstruction， clinical application”。 结果与结论：激光扫描进行三维特征提取完全能够满足临床要求，并已经广泛用于口腔正畸学、额面外科、整形设计、矫形设计、康复研究等领域，并且相比于CT，MRI等传统方法，具有快速、精确，对人体无伤害的优点；通过对利用激光扫描进行特征提取主要技术的研究，发现相关技术可以很好的满足临床要求，但是也存在一些问题，比如进行数据分块需要通过交互方式或迭代方式给出，不能自动分块；重构物体是由许多面片组成，这些面片对于造型处理起来也不直观；发展基于集成的逆向工程技术，包括测量技术、基于特征和集成的模型重建技术、基于网络的协同设计和数字化制造技术以及如何快速准确的提取特征等都是以后研究的主要内容。     

组织工程修复脊髓损伤

目的：就近年来组织工程修复脊髓损伤进展进行归纳总结。资料来源：检索人为第一作者,检索文献时限为1999-09/2009-09,检索数据库为PubMed数据库（http://www.ncbi.nlm.nih.gov/PubMed）及CNKI数据库（www.cnki.net/index.htm）。中文检索词为“脊髓损伤,组织工程”;英文检索词为“spinal cord injury,tissue engineering”。资料选择：纳入标准,①选取组织工程修复脊髓损伤相关的临床和实验研究论文;②组织工程修复脊髓损伤方面的相关研究进展。排除重复研究。结局评价指标：计算机初检到82篇文献,阅读标题和摘要进行初筛,排除研究目的与本文无关的文献31篇,内容重复性研究20篇,保留31篇文献进一步分析,包括综述、评述、论著及临床报道文章,对文献分析,总结研究内容。结果：组织工程修复脊髓损伤研究包括如下,组织工程种子细胞选择,组织工程脊髓对支架材料的要求,再生所需神经营养因子,再生所需特殊内环境构建。结论：选择最佳组织工程组分是修复脊髓损伤重要依据。     

颈椎在体运动学研究方法的进展★

背景：颈椎在体运动学研究能够通过侵袭性或非侵袭性方法获取生理载荷下活体颈椎的活动特性，可为颈椎疾病的诊断和治疗提供指导和参考。 目的：对目前有关颈椎在体运动学的研究方法和各自特点进行归纳总结。 方法：应用计算机检索Pubmed数据库(http://www.ncbi.nlm.nih.gov/pubmed/)及万方数据库(http://www. wanfangdata.com.cn)，英文检索词为“Spine,cervical,in vivo motion”，中文检索词为“脊柱，颈椎，测量，活动度”。检索文献总计238篇，最终选取30篇作为综述文献。 结果与结论：颈椎在体运动学研究可获取活体颈椎各个关节6个自由度(6DOF)的量化数据，对提高生理载荷下颈椎运动状况的认识水平，进一步了解颈椎退变的运动学特点，以及优化临床颈椎疾患的诊疗方案有重要作用，同时可为人工椎间关节及内固定器尤其是非融合内固定物的研制提供不可或缺的参考数据。其主要通过X射线、CT、MRI、超声、电磁等方法实现，但目前仍缺乏颈椎各节段在体运动范围公认的数值，颈椎在体运动学研究仍需不断深入。     

计算机辅助诊断技术中图像纹理研究的主要方法及其应用*

目的：综合分析目前图像纹理研究的主要方法以及在医学图像分析中的应用。 资料来源：英文文献的检索时间为1983/2009;中文文献的检索时间为2004/2009。以“medical image,texture research,image analysis,application”检索英文文献;以“医学图像,纹理研究,图像分析,应用”检索中文文献。检索数据库包括PubMed数据库(http://www.ncbi.nlm.nih.gov/sites/entrez/)、ScienceDirecr数据库(http://www.sciencedirect.com/)及中国知网数据库(http://www.cnki.net/)。 资料选择：纳入具有原创性的研究论文,及观点明确、资料充分、结论可靠的综述文章,排除重复性研究及与课题相关性较弱的文献。 结局评价指标：初检得到104篇文献,包括中文10篇,英文94篇。阅读标题和摘要进行初筛,排除研究目的与课题相关性较弱的33篇,重复性研究18篇,保留53篇中英文文献进一步分析。 结果：常用的纹理分析方法包括结构法、统计法、基于模型和基于变换的方法。结构法从纹理的基元形态及其分布规则视角分析规则纹理;统计法主要针对平滑度和粗糙度的纹理特征分析;基于模型的方法以构建图像模型为基础,它不仅可被用于描述纹理,而且还能用于合成纹理;基于变换的方法利用变换域信号处理方法分析纹理的数字特征。纹理研究在医学图像分析中发挥着重要作用,受到广泛关注。 结论：由于医学图像及其纹理的特殊性和复杂性,不是所有的纹理测度都能用于医学图像分析。医学图像纹理研究的发展方向之一是如何整合和发挥不同方法的优势,充分提取纹理特征,更准确地表征医学图像纹理及其改变与病理状态的关系,使之成为计算机辅助诊断算法的重要组成部分。     

肝移植后肺部感染的因素及防治策略

背景：尽管肝移植已经取得了很大进展，但移植后感染仍是威胁生命的主要问题，其中肺部感染是肝移植患者最常见的感染性并发症，也是导致移植后患者死亡的主要原因之一。 目的：就近年来肝移植后肺部感染的临床研究做一综述，为肝移植后肺部感染的治疗提供临床参考意见。 方法：由第一作者检索1995/2009 SPRINGER数据库 (http://springer.lib.tsinghua.edu.cn/home/main.mpx)及中国期刊全文数据库(http://dlib.cnki.net/kns50/)有关肝移植后肺部感染的易感因素、常见病原体、预防及治疗措施的文献，英文检索词为“liver transplantation，pulmonary infection，treatment”，中文检索词为“肝移植，肺部感染，治疗”。排除重复性研究。 结果与结论：计算机初检得到217 篇文献，最终纳入29篇文献进一步分析。结果提示肝移植后肺部感染的合理预防、早期诊断和及时处理，对于提高肝移植效果至关重要。肝移植临床医生应根据本地区、本单位致病微生物流行病学特点及实际医疗条件结合每个患者的具体情况，及时修正诊断与治疗，制定合理的预防与治疗方案。     

LARS人工韧带重建与膝关节前、后交叉韧带运动损伤

摘要 目的：探讨LARS人工韧带在重建膝关节前、后交叉韧带的效果。 方法：由第一作者应用计算机检索维普数据库(http://www.cqvip.com/)与LARS人工韧带重建膝关节前、后交叉韧带有关的文献,检索时限为2000-01/2010-02。检索关键词：LARS人工韧带,交叉韧带,重建。对资料进行初审,并查看每篇文献后的引文。纳入标准：①LARS人工韧带重建膝关节前、后交叉韧带的优势与不足。②LARS人工韧带重建膝关节前、后交叉韧带的临床应用效果。排除标准：重复研究或较陈旧文献。依据纳入排除标准共保留相关文献31篇。 结果：LARS人工韧带重建膝关节前、后交叉韧带有关节镜下手术操作方便,手术时间短、创伤小,可早期从事运动,强度大,植入简单,固定可靠等优点;同时也存在医疗费用高,多数患者难以承受,影响临床广泛推广的不足。在临床应用效果来看,国内、外学者一致认为LARS人工韧带重建膝关节前、后交叉韧带应用效果非常好,远胜过其他重建方法。 结论：建议对多发韧带损伤、韧带重建翻修或需早期活动的患者,应首选LARS人工韧带。 关键词：LARS人工韧带;前交叉韧带;后交叉韧带;重建;生物材料     

人工肛门括约肌的材料学特征及其临床应用

背景：严重肛门失禁由多种原因造成,严重影响患者的生存能力和生活质量。为了有效控制失禁,恢复肛门的正常功能,多年来国内外学者作了多方面的尝试;特别是试图通过手术重建或肌肉移植代替肛门括约肌功能。虽然已不断改进各种重建方式,但肛门功能的恢复并不理想。 目的：探讨人工肛门括约肌的材料学特点及其临床应用情况。 方法：由第一作者检索Pubmed数据库(http://www. ncbi.nlm.nih.gov/pubmed/)及万方数据库(http://www.wanfangdata. com.cn)1991-01/2009-12有关人工肛门括约肌、人工肛门的材料学特征以及肛门失禁治疗后生活质量评定的文章,英文检索词为“Anal sphincter,fecal incontinence”,中文检索词为“肛门括约肌,人工肛门,肛门失禁”。排除较陈旧的文献及重复研究,共纳入22篇符合标准的文献。 结果与结论：理想的人工肛门括约肌应该采用具有良好生物相容性的生物材料,尽可能地减少肠组织的炎症反应。和动力性股薄肌移位术一样,人工肛门括约肌也是通过隧道将人工括约肌放置在原来的括约肌周围,这种装置持续维持一定的压力,患者需要排便时通过位于阴囊或阴唇的手动泵进行复原。人工肛门括约肌治疗严重肛门失禁的作用是可以肯定的。 关键词：人工肛门括约肌;人工肛门;生物材料;肛门失禁;并发症 doi:10.3969/j.issn.1673-8225.2010.29.027     

透明质酸钠凝胶预防剖宫产后宫腔粘连的临床应用

摘要 背景：透明质酸钠具有预防盆、腹腔粘连的作用，但透明质酸钠宫腔停留时间短，难以达到预防宫腔粘连的作用。国外研究对透明质酸钠进行化学修饰形成自交联透明质酸钠凝胶，它对受损的宫内膜具有很强的黏附性，在宫腔内停留时间可达72 h。 目的：评价透明质酸钠凝胶在剖宫产后预防宫腔粘连的效果及安全性。 方法：由第一作者检索PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及维普数据库(http://www.cqvip.com/)有关透明质酸钠凝胶预防剖宫产后宫腔粘连的文献，检索时限为1990-01/2009-12，中文关键词为“透明质酸钠凝胶，剖宫产，粘连，宫腔粘连”，英文关键词为“sodium hyaluronate，cesarean section，adhesion，intrauterine adhesions”，排除重复研究或综述类文章。 结果与结论：共检索到相关文献150余篇，排除内容重复、综述类文章后筛选纳入16篇文献进行评价，其中中文12篇，英文4篇。结果显示，透明质酸钠凝胶是由N-乙酰葡萄糖醛酸反复交替而形成的一种高分子多糖体生物材料，具有高度的黏弹性、可塑性以及良好的生物相容性，在剖宫产后预防宫腔粘连效果明显，特别是能有效减少分离后再粘连的发生。但有一点十分重要，透明质酸钠凝胶是绝对不能用于血管内的，以免引起肺栓塞并发症。注射过程应缓慢，以免回流入静脉系统。 关键词：透明质酸钠凝胶；透明质酸钠；剖宫产；宫腔粘连；预防 doi:10.3969/j.issn.1673-8225.2011.12.031     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.