可吸收性多聚糖止血材料PerClot®对颅骨愈合的影响

背景：PerClot®是一种来源于纯化的植物淀粉、经特殊工艺制成的可吸收性多聚糖止血颗粒,可使血液成分(纤维蛋白和血小板)聚集,有利于原始骨痂的形成。 目的：观察来源于变性淀粉的可吸收性多聚糖止血材料PerClot®对颅骨愈合的影响。 方法：12只健康成年新西兰兔,每只顶骨钻2个圆形缺损孔洞,共24个。按照填充材料的不同随机分别为对照组、Perclot®组和骨蜡组,8个/组。Perclot®组和骨蜡组缺损处覆盖淀粉型可吸收多聚糖止血粉和骨蜡,对照组不使用任何材料。术后6周处死动物,取原缺损边缘扩展至少1.5 cm范围的颅骨,大体观察骨质愈合情况进行愈合评分。应用图像分析软件测量骨小梁和骨缺如面积。 结果与结论：缺损处愈合评分,评分越小,愈合越好,结果显示Perclot®组明显低于对照组(P < 0.05),骨蜡组与对照组比较无差异(P > 0.05);与对照组比较,Perclot®组骨小梁面积明显增高(P < 0.05),缺如面积明显降低(P < 0.05)。可见,Perclot®可吸收多聚糖止血粉有促兔颅骨愈合作用。     

高分子化合物及药物薄膜屏障在预防肌腱损伤中的应用

目的：探讨几丁搪、可吸收性防粘连膜、透明质酸3种高分子生物屏障材料对肌腱损伤导致的肌腱粘连的预防机制和作用原理。 方法：以肌腱粘连,高分子生物屏障,几丁搪,可吸收性防粘连膜,透明质酸为检索词,检索中国期刊全文数据库(1999-01/2009-06),以tendon adhesion, high polymer biology barrier, several Ding keeps out, absorbability antiseize continually membrane, hyaluric acid为检索词,检索Pubmed数据库(1999-01/2009-06),文献检索语种限制为中文和英文。以肌腱愈合质量和肌腱周围的炎性反应为评价指标,纳入几丁搪、可吸收性防粘连膜、透明质酸3种高分子生物屏障材料对肌腱损伤导致的肌腱粘连的预防机制和作用原理的研究,排除其他生物材料的研究。 结果：计算机初检得到223篇文献,根据纳入排除标准,对几丁搪、可吸收性防粘连膜、透明质酸3种高分子生物屏障材料对肌腱损伤导致的肌腱粘连的预防机制、作用原理进行分析。肌腱粘连是肌腱损伤后常见的并发症,其防治一直是医学界普遍关注的问题。肌腱愈合有内源性和外源性两种途径,而周围组织的粘连和肌腱瘢痕的形成与外源性愈合又有不可分割的关系,因此如果能促进内源性愈合,尽量避免外源性愈合,就可以较好地解决这个问题。目前国内外学者倍加推崇的是高分子化合物及药物薄膜屏障在防止肌腱粘连中的应用。 结论：高分子生物屏障材料一方面通过薄膜的屏障作用防止或减轻粘连,另一方面通过药物的药理作用影响肌腱愈合的内源性和外源性机制(主要加速内源性愈合),达到减轻粘连的目的。 关键词：肌腱粘连;高分子生物屏障;几丁搪;可吸收性防粘连膜;透明质酸     

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     

可降解高分子生物材料在整形外科术后防粘连中的应用

目的：探讨可降解高分子生物材料的性能特点及其在整形外科术后防粘连中的应用。 方法：由第一作者应用万方数据库(http://www.wanfangdata.com.cn/)检索1999-01/2009-12时限内与可降解高分子生物材料在整形外科术后防粘连的应用有关的文献，关键词为“透明质酸钠及其衍生物；纤维素衍生物；医用几丁糖；聚乳酸及其共聚物；整形外科；防粘连；生物材料”。排除重复研究、综述或Meta分析类文章。 结果：依据纳入排除标准共保留文献21篇。可降解高分子生物材料均具有较好的生物相容性、可降解性及可吸收性。透明质酸钠可抑制出血并具有抗炎特性。明质酸钠衍生物可弥补透明质酸钠在组织中易被降解和扩散、体内存留时间较短等缺点。羧甲基纤维素热稳定性、组织黏附性高，易于操作。氧化再生纤维素黏附性强，不需缝合；但用易受血液干扰。医用几丁糖具有一定止血功能，免疫抗原性小、无毒性。聚乳酸及其共聚物机械性能、化学稳定性优良，是最有发展前途的可生物降解的高分子材料。从应用研究的结果来看，透明质酸钠及其衍生物、纤维素衍生物、医用几丁糖和聚乳酸及其共聚物均能有效防止整形外科中术后粘连，具备广阔的发展前景。 结论：可降解高分子生物材料性能优越，能有效防止整形外科中的术后粘连，具有临床应用的可能性与可行性。     

兔骨关节炎滑膜组织血管内皮生长因子mRNA表达及透明质酸钠的影响

背景：骨关节炎的发病机制目前还未完全清楚,研究发现血管内皮生长因子参与骨关节炎的发生发展。 目的：观察血管内皮生长因子在滑膜组织表达的改变及透明质酸钠对滑膜血管内皮生长因子基因表达的影响。　 方法：24只大耳白兔随机正常对照组、生理盐水组和透明质酸钠组行单膝前交叉韧带切断术,4周后生理盐水组关节腔注射生理盐水0.3 mL,透明质酸钠组注射等量的高分子量10 g/L透明质酸钠,1次/周,连续5周。第10周处死动物,比较各组股骨内髁关节软骨的大体变化,采用实时定量聚合酶链反应方法检测滑膜VEGF mRNA 的表达水平。 结果与结论：大体评分显示生理盐水组软骨退变的程度明显重于正常对照组和透明质酸钠组(P < 0.05);生理盐水组滑膜血管内皮生长因子 mRNA表达较正常组显著下降(P < 0.05),透明质酸钠组滑膜血管内皮生长因子mRNA表达较生理盐水组有升高,但比正常对照组低(P < 0.05)。结果表明,滑膜组织血管内皮生长因子表达下降可能参与透明质酸钠的发生发展,关节腔注射透明质酸钠对透明质酸钠滑膜组织血管内皮生长因子表达有上调作用,有利于滑膜组织修复,可能是其治疗透明质酸钠机制之一。     

干扰素/聚乳酸-羟基乙酸共聚物及壳聚糖/聚乳酸-羟基乙酸共聚物复合膜防止椎板切除后的硬膜外瘢痕粘连

摘要 背景：应用硬膜外阻隔材料是预防椎板切除后硬膜外瘢痕粘连的一种方法,而制备既有机械阻隔能力,又有抑制成纤维细胞的能力的复合膜是其中一个重要的研究方向。 目的：制备壳聚糖/聚乳酸-羟基乙酸共聚物[poly(lactic-co-glycolic acid), PLGA]与干扰素/PLGA复合膜,观察其防止兔椎板切除后硬膜外瘢痕粘连的作用。 方法：大耳白兔120只行L2椎板切除,随机分为6组：对照组硬膜外不放任何物质;自体游离脂肪移植组取皮下脂肪贴于硬膜表面;透明质酸钠组将透明质酸钠1 mL 滴于硬膜外;PLGA膜组、壳聚糖/PLGA及干扰素/PLGA复合膜组,分别将各种膜修剪成合适大小植于硬膜外。术后2,4,6,8 周处死动物,观察L2术区的瘢痕形成及与硬膜粘连的情况并评分。术后4周,透射电镜下观察成纤维细胞的超微结构。 结果与结论：随着时间的延长,对照组形成较广泛的瘢痕。游离脂肪组和PLGA膜组的瘢痕量少于对照组。透明质酸组早期瘢痕形成量明显少于自体游离脂肪组和PLGA膜组,后期无显著性差异,但优于对照组。壳聚糖/PLGA膜组与干扰素/PLGA膜组硬膜外瘢痕的形成量最少,与硬膜无或轻微粘连,其作用明显优于其他各组,但两种复合膜组间差异不明显。术后4周,对照组、游离脂肪组和PLGA膜组的成纤维细胞的状态和功能明显好于壳聚糖/PLGA膜组与干扰素/ PLGA膜组。壳聚糖/PLGA复合膜与干扰素/ PLGA复合膜是预防椎板切除后硬膜外瘢痕粘连的有效材料。 关键词：聚乳酸-羟基乙酸共聚物;干扰素;壳聚糖;硬膜外瘢痕;椎板切除 doi:10.3969/j.issn.1673-8225.2010.47.043     

透明质酸钠复合重组人骨形态发生蛋白2凝胶对自体半腱肌重建兔前交叉韧带腱-骨愈合的生物力学分析

背景：在前交叉韧带重建的早期，腱-骨连接处是整个移植物-骨隧道复合体的薄弱环节，所以腱-骨愈合的情况是关系韧带移植重建成败的关键。 目的：观察透明质酸钠复合重组人骨形态发生蛋白2凝胶对自体半腱肌重建兔前交叉韧带后腱-骨愈合的影响。 设计、时间及地点：随机对照动物实验，于2007-09/2008-06在潍坊医学院动物实验中心实验室完成。 材料：将重组人骨形态发生蛋白2和透明质酸钠混合制成混悬凝胶注射剂。48只兔随机分成2组，每组24只48膝。 方法：实验组随机选取一侧于胫骨隧道入口处注入重组人骨形态发生蛋白2与透明质酸钠凝胶（透明质酸钠-重组人骨形态发生蛋白2亚组），另一侧仅做重建后骨道不予处理（未处理亚组）；对照组随机选取一侧于胫骨骨道入口处仅注入重组人骨形态发生蛋白2（重组人骨形态发生蛋白2亚组），另一侧仅注入透明质酸钠（透明质酸钠亚组）。 主要观察指标：术后2，4，8，12周大体观察肌腱移植物生长情况及在胫骨隧道内的愈合情况，生物力学拉伸试验测定其生物力学的性能。 结果：透明质酸钠-重组人骨形态发生蛋白2亚组在术后2周隧道内见稀疏软骨样组织，4~8周时隧道内见沿骨隧道排列的软骨样组织，双股肌腱之间形成稳定组织连接。l2周时出现部分骨样组织包裹肌腱。其他亚组术后2周时隧道内仅为瘢痕组织，到术后12周隧道内肌腱与骨道壁之间仍充满瘢痕组织，未见稳定组织连接形成。4，8和12周透明质酸钠-重组人骨形态发生蛋白2亚组和重组人骨形态发生蛋白2亚组肌腱移植物部分断裂和完全断裂平均载荷高于未处理亚组与透明质酸钠亚组(P < 0.05)，同时，透明质酸钠-重组人骨形态发生蛋白2亚组高于重组人骨形态发生蛋白2亚组 (P < 0.05)。 结论：注入透明质酸钠-重组人骨形态发生蛋白2的肌腱移植物有良好的生物力学特性，能促进肌腱移植物在骨隧道内的早期腱-骨愈合。     

血小板凝胶在颅脑手术中的临床应用

目的 探讨可吸收材料血小板凝胶在颅脑手术中的应用效果。方法 选取2013年10月至2014年3月行颅脑手术的患者120例（凝血机制均无明显异常）,分为观察组和对照组,各60例;观察组术中应用血小板凝胶加明胶海绵用于手术创面止血,对照组单独用明胶海绵进行常规止血。结果 观察组术后24 h出血量[（35±10）ml]明显少于对照组[（110±12）ml]（P<0.05）。观察组瘤腔、血肿腔术后渗血量[（5±4）ml]也明显少于对照组[（20±15）ml]（>P<0.05）。>结论 可吸收材料血小板凝胶在颅脑手术中有良好的止血效果,并且具有很好的安全性,配合常规止血材料使用,方便易用。     

银离子敷料联合水凝胶对Ⅱ度烧伤创面愈合的作用

目的：了解银离子敷料联合水凝胶促进Ⅱ度烧伤创面愈合的作用。 方法：选择2007-05/2009-05南通市第一人民医院烧伤整形科住院烧伤患者104例作为观察对象。随机分为2组：治疗组应用银离子敷料联合水凝胶序贯换药;对照组采用1%磺胺嘧啶银冷霜抹在凡士林纱布上外敷,于伤后7,10,15,17,21 d进行创面分泌物细菌培养、观察记录创面愈合情况及速度、观察药物不良反应、换药时创面痛感、肉芽破坏情况。 结果：治疗组创面细菌检出率明显低于对照组(P < 0.05)。治疗组浅Ⅱ度创面愈合时间比对照组平均缩短三四天,治疗组深Ⅱ度创面愈合时间比对照组平均缩短五六天。治疗组创面愈合速度较对照组明显加快(P < 0.05)。两组均无药物不良反应,治疗组创面换药时无明显疼痛感,肉芽组织无明显破坏。 结论：银离子敷料联合水凝胶序贯治疗Ⅱ度烧伤创面具有显著抗菌及促进创面肉芽组织和上皮再生、促进创面愈合的作用,且无不良反应。 关键词：银离子敷料;水凝胶;Ⅱ度烧伤创面     

透明质酸对体外培养大骨节病软骨细胞Ⅱ型胶原和聚集蛋白聚糖mRNA表达的影响

背景：透明质酸关节腔注射治疗骨关节炎已经成为一种常规方法,但对大骨节病的治疗还正在推广,施加透明质酸后对大骨节病患者软骨细胞代谢的影响,目前尚为空白。 目的：课题创新性设计观察透明质酸对体外培养的大骨节病软骨细胞分泌Ⅱ型胶原和聚集蛋白聚糖的影响,以期能指导临床治疗。 设计、时间及地点：对比观察,实验于2006-09/2009-01在西安交通大学医学院生物医学研究实验中心和地方病实验室完成。 材料：大骨节关节病标本来源于6例大骨节关节病患者实施膝关节手术摘除的软骨及游离体,正常标本来自6例意外截肢或身亡的新鲜膝关节软骨。 方法：分离、体外培养两组关节软骨细胞。两组细胞分别给予100,500 mg/L不同剂量的透明质酸钠干预及阴性对照(未加干预),培养6 d。 主要观察指标：通过反转录-聚合酶链反应观察透明质酸对大骨节病和正常人软骨细胞Ⅱ型胶原和聚集蛋白聚糖mRNA表达的影响。 结果：大骨节病组软骨细胞Col Ⅱ 和aggrecan mRNA表达量均较正常对照降低(P < 0.05),采用透明质酸钠补充治疗后,透明质酸钠100 mg/L和500 mg/L对大骨节病和正常人软骨细胞Col Ⅱ 和aggrecan mRNA的表达均有促进作用,其中透明质酸钠500 mg/L的促进作用更显著些。 结论：补充透明质酸钠可以促进大骨节病软骨细胞Col Ⅱ 和aggrecan的合成,其中,透明质酸钠500 mg/L对大骨节病软骨细胞合成代谢的促进作用较透明质酸钠100 mg/L明显。     

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.     

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.     

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.     

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.     

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.