豚鼠骨髓间充质干细胞的分离培养及成骨诱导

背景:利用骨髓间充质干细胞的取材灵活性及快捷性,对已掌握的培养技术及成骨诱导进一步探索性研究。目的:通过建立豚鼠骨髓间充质干细胞的体外分离培养法,探讨豚鼠骨髓间充质干细胞表型特征以及多项分化潜能。方法:利用贴壁培养法分离纯化豚鼠骨髓间充质干细胞,传代扩增,流式细胞分析检测细胞表面分子CD29、CD44、CD45的表达。分别采用成骨诱导培养液和成脂诱导培养液定向诱导骨髓间充质干细胞向脂肪细胞、成骨细胞分化。结果与结论:原代分离的骨髓间充质干细胞在接种后96h贴壁,细胞形态为椭圆形,多角形及短梭形,8d时细胞呈长梭形并达到90%单层融合。经传代扩增,细胞进一步纯化,细胞形态为均一的长梭形并呈漩涡状排列,而且生长速率加快。流式细胞检测CD29、CD44阳性率分别为95.7%和65.7%。不同诱导剂定向诱导后,经油红O、茜素红S、碱性磷酸酶染色、免疫组织化学Ι型胶原酶鉴定,P3代骨髓间充质干细胞分别向脂肪细胞及成骨细胞分化。结果表明,通过贴壁筛选方法,体外分离培养的豚鼠骨髓间充质干细胞具有很强的增殖能力,并保持稳定的表型特征及多向分化潜能。     

兔骨髓间充质干细胞的分离、培养及鉴定

目的探讨兔骨髓间充质干细胞分离、培养和鉴定的方法。方法全骨髓贴壁法提取兔骨髓中的间充质干细胞,流式细胞术检测细胞表面分子CD14、CD29、CD34、CD44、CD45和CD90等标志的表达以及不同代次兔BM-SCsDNA含量。通过定向分化检测兔BMSCs的多向分化潜能。结果兔骨髓间充质干细胞呈形态较为均一的小梭形、克隆样生长。流式细胞术检测结果显示,传代至第12代和20代的兔骨髓间充质干细胞检测对数生长期细胞的DNA含量结果显示细胞为正常二倍体细胞,无明显变异。细胞表面表达CD29（61.71%）、CD44（60.2%）,不表达CD14（0.4%）、CD34（0.34%）、CD45（0.64%）和CD90（0.04%）。兔BMSCs的定向分化结果显示其可向成骨细胞、脂肪细胞及成软骨细胞分化。结论成功获得具有多向分化潜能的兔骨髓间充质干细胞,其具有特定的细胞表面抗原,具有容易获取、增殖能力强等特点,是优良的组织工程种子细胞。     

贴壁和缩短胰酶消化时间培养大鼠骨髓间充质干细胞

背景：对于骨髓间充质干细胞的分离纯化、培养扩增目前已有几种方法,各自均有不同的优劣性。目的：观察贴壁法和缩短胰酶消化时间的方法体外分离和培养大鼠骨髓间充质干细胞的特点。方法：培养初期频繁换液,去除混杂细胞;传代后加入不同诱导剂定向诱导分化,使之分别向脂肪细胞,成骨细胞和软骨细胞方向分化。结果与结论：该分离培养方法在第3代可以得到纯化的骨髓间充质干细胞。分离培养的细胞纯度高,有良好的增殖和分化潜能。定向诱导培养的细胞能向成脂细胞、成骨细胞和成软骨细胞方向分化。     

贴壁和缩短胰酶消化时间培养大鼠骨髓间充质干细胞

背景:对于骨髓间充质干细胞的分离纯化、培养扩增目前已有几种方法,各自均有不同的优劣性。目的:观察贴壁法和缩短胰酶消化时间的方法体外分离和培养大鼠骨髓间充质干细胞的特点。方法:培养初期频繁换液,去除混杂细胞;传代后加入不同诱导剂定向诱导分化,使之分别向脂肪细胞,成骨细胞和软骨细胞方向分化。结果与结论:该分离培养方法在第3代可以得到纯化的骨髓间充质干细胞。分离培养的细胞纯度高,有良好的增殖和分化潜能。定向诱导培养的细胞能向成脂细胞、成骨细胞和成软骨细胞方向分化。     

流动优化骨髓间充质干细胞的分化状况

背景：间充质干细胞在成体动物骨髓中含量极低。目的：观察成年大鼠骨髓间充质干细胞经生理范围流动切应力作用后,其体外生长规律、增殖及定向分化为成骨细胞及脂肪细胞的能力。方法：在体外取得SD大鼠骨髓原代间充质干细胞,利用平板流室系统加载1Pa切应力,对其进行培养及扩增,并分别向成骨细胞及脂肪细胞定向诱导。结果与结论：原代间充质干细胞为长梭形或多角形,集落样生长;经流动加载并传代后细胞生长速度加快,不以集落方式生长,而是均匀分布。细胞体积明显增大,多数为长梭形或多角形;生长曲线显示各代细胞有类似的生长规律;激光共聚焦显微镜显示CD44和CD90阳性,CD31及CD45阴性;向成骨细胞及脂肪细胞诱导14d后,VonKossa染色及油红O染色均为阳性,流动优化后骨髓间充质干细胞保持了体外大量增殖及多向分化潜能。     

流动优化骨髓间充质干细胞的分化状况

背景:间充质干细胞在成体动物骨髓中含量极低。目的:观察成年大鼠骨髓间充质干细胞经生理范围流动切应力作用后,其体外生长规律、增殖及定向分化为成骨细胞及脂肪细胞的能力。方法:在体外取得SD大鼠骨髓原代间充质干细胞,利用平板流室系统加载1Pa切应力,对其进行培养及扩增,并分别向成骨细胞及脂肪细胞定向诱导。结果与结论:原代间充质干细胞为长梭形或多角形,集落样生长;经流动加载并传代后细胞生长速度加快,不以集落方式生长,而是均匀分布。细胞体积明显增大,多数为长梭形或多角形;生长曲线显示各代细胞有类似的生长规律;激光共聚焦显微镜显示CD44和CD90阳性,CD31及CD45阴性;向成骨细胞及脂肪细胞诱导14d后,VonKossa染色及油红O染色均为阳性,流动优化后骨髓间充质干细胞保持了体外大量增殖及多向分化潜能。     

兔骨髓间充质干细胞分离培养及体外诱导分化为成骨细胞

【目的】建立兔骨髓间充质干细胞（MSCs）的分离、纯化及鉴定方法,观察体外成骨潜能。【方法】应用密度梯度离心联合贴壁筛选的方法,体外分离培养兔骨髓来源的M SCs ,培养过程中倒置显微镜下观察其生物学特性,流式细胞仪检测细胞表型,所得的细胞进行成骨诱导分化后进行碱性磷酸酶（alkaline phos‐phatase ,ALP）染色及茜素红染色鉴定,并对成骨分化指标进行检测。【结果】原代分离培养的贴壁细胞呈长梭形,漩涡状排列。传代后增殖迅速,细胞为单一的梭形,排列更加有序。培养的细胞CD44呈阳性表达,而CD34呈阴性表达。成骨诱导后ALP染色和茜素红染色均呈阳性。诱导组成骨分化后成骨标志物含量较对照组明显要高。【结论】密度梯度离心结合贴壁的方法可以获得高纯度MSCs ,增殖旺盛,体外具有成骨潜能。     

大鼠骨髓间充质干细胞的培养与鉴定

背景:骨髓间充质干细胞在骨髓中含量极低,体外培养难度较大.体外分离培养纯度高、活力强、生物特性均一的间充质干细胞,对组织工程及细胞的体内、体外实验显得至关重要.目的:建立大鼠骨髓间充质干细胞的分离、培养、纯化方法,并进行细胞形态学观察、表面标志物鉴定及多向分化能力检测.方法:通过全骨髓贴壁法体外分离、培养、纯化大鼠骨髓间充质干细胞,进行形态学观察,绘制生长曲线,细胞周期分析,流式细胞仪检测细胞表面标记物,分别向成骨、成脂方向诱导分化.结果与结论:大鼠骨髓间充质干细胞生长以梭形细胞为主,呈放射状排列的细胞集落,细胞生长旺盛,可连续稳定传代10代以上.生长曲线及细胞周期显示骨髓间充质干细胞符合正常细胞生长特征且生长活跃.第3代骨髓间充质干细胞CD44,CD90,CD105均呈阳性表达,而CD34,CD45呈阴性表达.成脂、成骨诱导后,油红O染色、碱性磷酸酶染色、von Kossa法染色和茜素红染色均呈阳性.全骨髓贴壁培养法操作简单,可大量分离、纯化、扩增骨髓间充质干细胞,所获细胞具有间充质干细胞的一般生物学特性,经诱导培养后具有多向分化潜能.实验所用的全骨髓贴壁法法为组织工程提供充足的种子细胞来源具有重要的现实意义.     

骨髓间充质干细胞向软骨细胞的分化

背景：以骨髓间充质干细胞构建组织工程气管尚缺乏理想的特异性表面标志物,对其鉴定主要依赖细胞形态学、细胞表型及诱导分化的功能进行分析。目的：体外分离培养、鉴定兔骨髓间充质干细胞,观察在特定条件下向气管软骨细胞分化的潜能。方法：无菌环境取兔骨髓,经全骨髓贴壁筛选法分离培养细胞至第2代,流式细胞术鉴定第1、第2代细胞表面抗原CD44、CD45的表达。无菌环境取气管,经酶消化法分离培养气管软骨细胞,甲苯胺蓝染色鉴定软骨细胞蛋白聚糖的合成。在使用转化生长因子B1的基础上,将骨髓间充质干细胞与气管软骨细胞通过Transwell小室非接触式共培养,倒置显微镜观察细胞形态,甲苯胺蓝染色鉴定蛋白聚糖的合成,荧光实时定量PCR鉴定Ⅱ型胶原和蛋白聚糖mRNA的表达。结果与结论：分离、培养的细胞呈长梭形、不规则形聚集生长,传代后细胞生长速度明显增快,呈鱼群状聚集生长。第1代有96．97％的细胞表达CD44、13.72％的细胞表达CD45,第2代有99．11％的细胞表达CD44、8．54％的细胞表达CD45。气管软骨细胞甲苯胺蓝染色阳性。在诱导后,骨髓间充质干细胞形态逐渐由长梭形变为三角形或不规则形,表达软骨细胞特异性Ⅱ型胶原和蛋白聚糖mRNA基因,甲苯胺蓝染色示阳性。结果表明全骨髓贴壁筛选法可成功分离培养骨髓间充质干细胞,第2代纯度较高,且在特定诱导条件下具有分化为气管软骨细胞的潜能。     

大鼠骨髓间充质干细胞的培养与鉴定

背景：骨髓间充质干细胞在骨髓中含量极低,体外培养难度较大。体外分离培养纯度高、活力强、生物特性均一的间充质干细胞,对组织工程及细胞的体内、体外实验显得至关重要。目的：建立大鼠骨髓间充质干细胞的分离、培养、纯化方法,并进行细胞形态学观察、表面标志物鉴定及多向分化能力检测。方法：通过全骨髓贴壁法体外分离、培养、纯化大鼠骨髓间充质干细胞,进行形态学观察,绘制生长曲线,细胞周期分析,流式细胞仪检测细胞表面标记物,分别向成骨、成脂方向诱导分化。结果与结论：大鼠骨髓间充质干细胞生长以梭形细胞为主,呈放射状排列的细胞集落,细胞生长旺盛,可连续稳定传代10代以上。生长曲线及细胞周期显示骨髓间充质干细胞符合正常细胞生长特征且生长活跃。第3代骨髓间充质干细胞CD44,CD90,CD105均呈阳性表达,而CD34,CD45呈阴性表达。成脂、成骨诱导后,油红O染色、碱性磷酸酶染色、von Kossa法染色和茜素红染色均呈阳性。全骨髓贴壁培养法操作简单,可大量分离、纯化、扩增骨髓间充质干细胞,所获细胞具有间充质干细胞的一般生物学特性,经诱导培养后具有多向分化潜能。实验所用的全骨髓贴壁法法为组织工程提供充足的种子细胞来源具有重要的现实意义。     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.