生物补片在女性盆底重建应用中的生物相容性

摘要 背景：生物补片是重要的盆底组织替代物，能够替代薄弱受损的盆底筋膜组织，在盆底重建中的应用越来越广泛。但其疗效及生物相容性研究却少有报道。 目的：介绍生物补片在女性盆底重建中的临床应用进展，评价各种材料的补片与宿主的生物相容性。 方法：由第一作者用计算机检索中国期刊全文数据库(CNKI：1990/2010)和Medline database(1990/2010)，检索词分别为“补片，妇产科疾病，治疗”和“obstetrics，gynecology diseases，treatment”，语言分别设定为中文和英文。最终纳入26篇符合标准的文献，分别以补片在女性盆底重建中的临床应用进展以及补片植入后的生物相容性和并发症两方面进行总结。 结果与结论：补片植入主要用于治疗女性盆底功能障碍性疾病，包括全盆腔重建，阴道前、后壁修补和阴道穹窿骶骨悬吊等，疗效较好。在各种类型植入物中，自体组织、同种异体移植物、异种移植物植入后易感染，磨损，生物相容性较差，作为重建材料并不合适。合成的可吸收补片材料坚固，应用方便，但可能发生感染、排斥和侵蚀等并发症，生物相容性较差。合成的不可吸收补片和脱细胞补片感染发生率低，并发症少，生物相容性较好。补片植入时尽量将生物补片置于无张力状态，无菌操作，要避免任何永久性的缝线穿透阴道黏膜、严密止血，即可降低并发症发生率。 关键词：生物补片；妇产科疾病；盆底重建；生物相容性；并发症 doi:10.3969/j.issn.1673-8225.2010.34.037     

生物网片材料在女性盆底重建中的应用

背景：与传统的全子宫切除+阴道前后壁修补手术相比，应用网片材料进行盆底重建能更好修补缺陷，实现结构重建和组织替代。 目的：评价生物补片材料在女性盆底器官脱垂手术中的应用情况、临床效果、并发症和不同手术方法对避免术后并发症的作用。 方法：采用电子检索的方式在万方数据库中检索1999/2010有关生物补片用于盆底功能障碍性疾病手术治疗的研究，关键词为“生物补片，盆腔重建”。排除重复研究、普通综述或Meta分析类文章，筛选纳入30篇文献进行评价。 结果与结论：目前用于盆底重建的材料有聚丙烯网片和Prolift专用网片，植入盆底后可显著加强盆底筋膜结构，重建阴道膀胱筋膜、直肠阴道筋膜及悬吊阴道穹窿部，恢复盆底脏器的解剖结构；且手术时间短，可迅速缓解患者症状，围手术期及术后随访无严重并发症，效果良好。用于盆底重建的材料选择很多，植入方法有多种，在实际操作中，应根据患者实际情况采取相应的措施，以达到最满意的效果。     

聚丙烯网片在女性盆底重建过程中的应用

目的：分析近几年生物补片材料在盆底重建修复中的应用，探讨聚丙烯补片重建女性盆底应用价值。 方法：以“聚丙烯，生物补片，补片材料，盆底重建，修复”为中文关键词；以:“polypropylene; biological repain plate; patch;pelvic reconstructive”为英文关键词，采用计算机检索2005-01/2010-05相关文章。纳入与生物补片和聚丙烯补片在女性盆底重建中应用的文章；排除重复研究或Meta分析类文章。以30篇文献为主重点讨论了提高聚丙烯补片材料性能及在盆底修复过程中的重要性。 结果：随着对盆底解剖的深入研究，新理论的不断提出，以及手术器械、修补材料的随之改进，盆底重建逐渐发展。在各类型植入物中，如自体组织、同种异体移植物、异种移植物植入后易感染或磨损，作为重建材料并不合适。而合成的可吸收补片材料坚固、应用方便，但也可能发生感染、排斥和侵蚀等并发症。 结论：应用聚丙烯网片行盆底重建方法简单，患者耐受性好，是目前各种补片材料中复发率较低、与宿主相容性较好，而应用最为广泛的。但聚丙烯材料网片是否为最佳补片材料、远期疗效是否最好均有待于长期随访观察和大规模前瞻性病例对照研究加以验证。     

补片在妇产科疾病中的临床应用及其生物相容性

目的：介绍补片在妇产科疾病中的临床应用进展，评价各种材料的补片与宿主的生物相容性。 方法：由第一作者用计算机检索中国期刊全文数据库(CNKI：1989/2009)和Medline database(1989/2009)数据库，检索词分别为“补片，妇产科疾病，治疗”和“obstetrics, gynecology diseases，treatment”，语言分别设定为中文和英文。共检索到53篇文章，按纳入和排除标准对文献进行筛选，共纳入23篇文章。分别以补片在妇产科疾病的临床应用进展和各种补片植入后的生物相容性和并发症两方面进行总结。 结果：补片在女性盆底功能障碍性疾病中的应用较为广泛，主要应用于全盆腔重建，阴道前、后壁修补和阴道穹窿骶骨悬吊等，操作简便，疗效较好。目前的重建材料有自体组织、同种异体移植物、异种移植物、合成的不可吸收补片、合成的可吸收补片、脱细胞补片等，各有其优缺点。补片最常见的并发症是感染和侵蚀，尽量将生物补片置于无张力状态，可降低并发症的发生率。 结论：补片植入主要用于治疗女性盆底功能障碍性疾病，疗效较好。在各种类型补片中，合成的不可吸收补片和脱细胞补片感染发生率低，并发症少，生物相容性好于其他类型补片。补片植入操作时尽量将生物补片置于无张力状态，严格无菌操作，严密止血即可降低感染和侵蚀的发生率。 关键词： 补片；妇产科疾病；盆底重建；生物相容性；并发症     

盆底重建替代材料生物补片在妇产科临床中的应用特点

摘要 背景：近几年，随着大量生物技术替代材料的应用，盆底缺陷修复和重建有了较大进步，替代材料补片是重要的盆底组织替代物，能够替代薄弱受损的盆底筋膜组织，在盆底重建中的应用越来越广泛。 目的：探讨盆底重建生物材料补片在女性盆底重建中应用的可行性、有效性及临床应用价值。 方法：由第一作者检索1990/2008PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及万方数据库(http://www. wanfangdata.com.cn)有关盆底功能障碍、盆底重建以及补片植入物材料应用等方面的文献，英文检索词为“reconstruction of whole pelvic floor，mesh，synthetic mesh implants”，中文检索词为“补片，生物材料补片，替代材料，盆底重建”。排除重复性研究。计算机初检得到54篇文献，根据纳入标准保留17篇进一步归纳总结。 结果与结论：女性盆底障碍性疾病，表现最为突出的是盆腔器官膨出。盆腔脏器膨出是由于盆底支持结构缺陷、损伤及功能障碍所致。传统的手术解决不了根本问题。目前用于盆底修复及重建的替代材料，大致包括生物材料补片、人工合成材料补片两类，其中生物材料补片分为3种：自身替代材料，同种替代材料，异种替代材料。由于它们能替代薄弱受损的盆底筋膜组织，是重要的盆底组织替代材料，在盆底重建中的应用越来越广泛。应用补片进行盆底重建，真正完成解剖结构的恢复从而达到功能的恢复，方法简单，操作容易，不延长手术时间，不增加手术并发症，患者耐受性好，安全可靠，近期疗效明显，远期疗效有待大量的临床实验和进一步观察。对不同脱垂部位患者均行改良全盆底重建是值得推广的临床经验。 关键词：补片；生物材料；盆底重建；盆底功能障碍；人工合成材料；综述文献     

医用补片在女性盆底重建的可行性和有效性

背景：了解补片类型、生物学及材料学特点、应用过程中的可行性、有效性以及并发症，为此项工作的开展奠定理论基础。 目的：归纳总结补片类型、生物学及材料学特点，明确补片在盆底重建中应用的可行性，并掌握其在盆底修补和重建中的并发症。 方法：应用计算机检索PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及CNKI数据库(www.cnki.net/index.htm)，中文检索关键词：补片，盆底重建。英文检索关键词：biological Patch，reconstructive pelvic surgery。选择文章内容与补片类型、材料学特点及其应用效果相关，同一领域文献则选择近期发表或发表在权威杂志文章。根据纳入标准选择28篇文献用于总结归纳。 结果与结论：盆底修复及重建的材料作为盆底组织替代物能替代薄弱受损的盆底筋膜组织，目前大致包括生物材料、人工合成材料两类。各种修补材料各有优缺点。选择何种材料补片的争论一直不断。综合文献显示，国内不同医疗机构应用补片治疗阴道前、后壁膨出，盆底器官膨出，压力性尿失禁等不同程度盆底功能障碍性疾病，治疗例数1~80例不等，从手术时间、补片放置时间、出血量、住院时间、术后恢复情况、修补成功率、术后残余尿量等指标显示补片的应用可行并有效，降低了术后复发率，重建了盆底功能。最常见补片相关并发症为侵蚀和感染。选择适合患者的手术方式需要根据患者的具体综合考虑。但应用哪种补片材料更佳、手术的远期疗效等均有待于延长随访时间、大规模前瞻性病例对照研究加以验证。 关键词：补片材料；盆底重建；生物材料；人工合成材料；并发症 doi:10.3969/j.issn.1673-8225.2010.21.032     

不同生物补片材料在盆底重建应用中的可行性

摘要 目的：探讨替代材料补片在盆底重建中的可行性和有效性及其临床价值。 方法：采用电子检索的方式，在维普数据库及PubMed中检索有关盆底功能障碍、盆底重建以及补片植入物材料的应用等方面的文献，中文检索关键词为“补片,盆底重建”。英文检索关键词为“biological Patch, reconstructive pelvic surgery”。选择文章内容与补片类型、材料学特点及其应用效果相关，同一领域文献则选择近期发表或发表在权威杂志文章。 排除重复研究、普通综述或Meta分析类文章，筛选纳入16篇文献进行评价。 结果：生物材料补片分为自体和同种异体及异种材料。同种及异种移植材料目前多为脱细胞组织基质，其优势是不含细胞表面受体的特异识别位点，不易引发受体的免疫排斥反应，增加了组织相容性，减少了感染概率，而且可能存在某些复合生长因子，能够诱导调节细胞的生长和分化。合成材料补片也已广泛应用于临床，但可能发生感染、排斥和侵蚀等并发症。 结论：生物材料补片的出现在很大程度上避免了侵蚀问题，但使用寿命、安全性及客观效果尚有争议。     

生物补片在盆底修补和重建中的应用

背景：熟悉补片的分类、特性，以及宿主与补片之间的反应，对于修复外科手术材料的合理选择是十分必要的。 目的：对补片及修复材料的分类、性质及其在盆底修补和重建中的应用和并发症的处理进行归纳总结。 方法：应用计算机检索PubMed数据库（http://www.ncbi.nlm.nih.gov/PubMed）及CNKI数据库（www.cnki.net/index.htm），在标题和摘要中以“补片材料，聚丙烯，复合补片”或“reconstructive pelvic surgery，repair，replacement”为检索词进行检索。选择文章内容与补片类型、材料学特点、生物相容性及其应用效果相关，同一领域文献则选择近期发表或发表在权威杂志文章。根据纳入标准选择24篇文献用于进行综述。 结果和结论：聚丙烯补片的优点是编织的网，网孔较大，有利于纤维组织长入，提高了组织的强度和抗拉性，白细胞和巨噬细胞可自由进入网孔内，因此不易藏匿细菌，故具较好的抗感染能力，感染后多可不去除网片。而膨化聚四氟乙烯层则质地柔软、表面光滑，组织耐受性非常好，可防止与腹腔内组织粘连，而其亚微米水平的孔径防止了细菌的侵入，它所造成的炎症及异物反应是目前人工合成材料中最轻的。 关键词：补片材料；聚丙烯；聚四氟乙烯；复合补片；综述文献 doi:10.3969/j.issn.1673-8225.2010.03.036     

生物补片材料修复重建盆底组织

盆腔脏器脱垂的传统手术方式为阴式子宫切除加阴道前后壁修补，此种手术方法复发率较高。为提高盆腔脏器脱垂的治疗效果，生物补片材料被广泛的应用于修复重建盆底组织。目前，盆底重建手术的目标不仅是修复受损的组织，而是在修复的基础上通过提供各种形式的支持物使组织替代和再生。文章通过检索中国期刊全文数据库和PubMed对生物补片材料的相关内容，介绍其种类、生物学特性以及在修复重建盆底组织中的作用。     

人工材料聚丙烯补片在修补腹壁切口疝中的应用

摘要 背景：如何修补腹壁巨大缺损是临床经常遇到的难题，曾有许多学者尝试各种材料进行修补，但临床效果不是很满意。 目的：检索文献综合分析人工聚丙烯补片在修补腹壁切口疝中的应用效果。 方法：应用计算机检索检索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的相关文献，在标题和摘要中以“补片，外科手术，腹壁切口疝”或“patch，surgery，incisional hernia”为检索词进行检索。选择与人工材料聚丙烯补片在修补腹壁切口疝中的应用相关，同一领域文献则选择近期发表或发表在权威杂志文章。最终纳入符合标准的文献28篇。 结果与结论：临床常需要借助合适的材料来修复巨大的腹壁缺损，以维持腹壁的肌张力和外形。聚丙烯补片具有良好的生物相容性，置入体内后不会导致创口感染、排异反应及其他并发症，具有较理想的预防游离腹直肌皮瓣术后切口疝发生的作用，同时也增强了腹壁强度。临床研究表明其组织相容性良好，无排异反应，具有一定抗感染能力，是理想的疝修补材料。提示应用人工合成材料进行疝修补，操作简便、损伤小、恢复快、复发率低，并发症少。但提高修补技术，选择并研制抗张力强度大、炎症反应轻、顺应性高的补片仍是该领域研究的重点。 关键词：切口疝；腹壁；无张力修补：聚丙烯补片；生物相容性 doi:10.3969/j.issn.1673-8225.2010.47.035     

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.