成骨诱导人脐带间充质干细胞与纳米羟基磷灰石/聚酰胺66支架材料的生物相容性

背景:纳米羟基磷灰石/聚酰胺66材料有利于成骨细胞的长入和新生骨的形成、且抗弯强度、抗压强度等各项参数与正常骨组织的力学性能相接近,能满足实验动物硬组织修复的要求.目的:分析成骨诱导后人脐带间充质干细胞与纳米羟基磷灰石/聚酰胺66复合支架的生物相容性.方法:体外培养人脐带间充质干细胞,纯化增殖,成骨诱导.取成骨诱导后的第3代人脐带间充质干细胞接种于纳米羟基磷灰石/聚酰胺66支架材料上,观察细胞的生长、增殖情况及材料细胞毒性.结果与结论:成骨诱导后人脐带间充质干细胞在复合支架上生长分化良好,增殖活性不受材料影响.成骨诱导14 d内,可见碱性磷酸酶活性随着培养时间延长而逐渐增高.MTT法检测细胞无毒性.扫描电镜观察,1 d后可见细胞在支架表面附着生长;7 d后可见细胞在材料上生长良好,材料空隙有大量充填.说明纳米羟基磷灰石/聚酰胺66支架可作为骨组织工程中人脐带间充质干细胞的细胞载体,具有良好的生物相容性,能满足骨组织工程的需要.     

多孔碳酸钙陶瓷与干细胞源性成骨细胞的相容性

背景：国内外的研究证实普通碳酸钙陶瓷作为骨替代材料时具有细胞支架作用。目的：观察多孔碳酸钙陶瓷与成骨细胞的相容性,及作为骨组织工程支架的可能性。方法：SD大鼠骨髓基质干细胞经矿化诱导培养、扩增并检测证实其已具成骨细胞表型后,分别与多孔碳酸钙陶瓷支架、普通羟基磷灰石陶瓷支架体外复合培养。结果与结论：骨髓基质干细胞经体外诱导形成成骨细胞,钙结节、Ⅰ型胶原和碱性磷酸酶免疫染色结果阳性。多孔碳酸钙陶瓷支架材料与羟基磷灰石陶瓷材料皆有细胞附着生长,但多孔碳酸钙陶瓷支架材料细胞的黏附能力、增殖活力及成骨活性均强于羟基磷灰石陶瓷材料。提示多孔碳酸钙陶瓷支架材料与SD大鼠骨髓基质干细胞源性成骨细胞有良好相容性。     

兔纤维环干细胞与猪脱细胞纤维环基质的生物相容性

背景：脱细胞纤维环基质和纤维环干细胞均来源于纤维环组织,二者复合构建的组织工程复合物可能具有更好的生物相容性。
　　目的：将兔的纤维环干细胞和猪的脱细胞纤维环基质进行体外共培养,观察细胞在脱细胞基质支架上的生长状态。
　　方法：制备猪脱细胞纤维环基质,通过扫描电镜和 DAPI 染色观察材料制备效果,傅里叶红外光谱仪鉴定基质的成分;分离和培养兔纤维环干细胞,将第1代纤维环干细胞种植于脱细胞纤维环基质表面,行细胞骨架染色,倒置免疫荧光显微镜和扫描电镜下观察细胞形态,并绘制细胞生长曲线。
　　结果与结论：制备成的猪脱细胞纤维环基质呈白色半透明状,扫描电镜下为纤维网状结构,DAPI染色显示无细胞残留,红外光谱分析显示脱细胞纤维环基质主要成分是胶原蛋白。细胞在支架材料上生长第1,3,7天的细胞骨架染色显示细胞很好的黏附于支架表面,生长状态良好,表明脱细胞纤维环基质有着良好的生物相容性,纤维环干细胞在其表面生长良好。     

海藻酸钙纳米羟基磷灰石胶原复合材料与兔骨髓基质干细胞的体外细胞相容性

背景：采用仿生学原理，利用海藻酸钙、纳米羟基磷灰石及胶原按一定比例复合，制成一种可注射、可任意塑形且具有良好骨传导、骨诱导性的组织工程骨，其应用在微创外科技术中，具有组织损伤小、不破坏修复区血供、操作简便易行等优点。目的：验证海藻酸钙纳米羟基磷灰石胶原复合材料与兔骨髓基质干细胞的相容性。设计、时间及地点：对比观察实验，于2008-02／05在南方医科大学珠江医院中心实验室完成。材料：2周龄健康新西兰大白兔用于骨髓基质干细胞的分离培养。海藻酸钙纳米羟基磷灰石胶原复合材料由清华大学材料系研制提供，孔隙率90％，孔径50～200μm。方法：选取生长良好的第5代兔骨髓基质干细胞与海藻酸钙纳米羟基磷灰石胶原复合材料体外复合培养。主要观察指标：共培养5d后倒置显微镜下观察细胞在材料表面、孔隙内的生长情况，扫描电镜下观察细胞在材料上附着情况。细胞和支架共培养后CCK-8法测定细胞活性。结果：骨髓基质干细胞能在海藻酸钙纳米羟基磷灰石胶原复合材料上良好地黏附、增殖、生长，细胞活性未受到海藻酸钙纳米羟基磷灰石胶原复合材料的影响。结论：海藻酸钙纳米羟基磷灰石胶原复合材料与兔骨髓基质干细胞有良好的细胞相容性。     

兔骨髓基质干细胞成骨诱导及复合培养的生长状况

目的：研究体外培养的兔骨髓基质干细胞的成骨诱导及复合培养生长状况。方法：体外培养兔骨髓基质干细胞，向成骨细胞方向诱导分化，并接种于三维多孔羟基磷灰石材料上，观察其体外生长状况。结果：体外培养条件下，骨髓基质干细胞容易存活，可向成骨细胞转化，并能在支架材料上贴附生长。结论：骨髓基质干细胞可在体外培养条件下大量增殖，向成骨细胞转化，并能在三维多孔羟基磷灰石材料上贴附生长。     

异体脱矿松质骨基质和纳米羟基磷灰石材料应用于牙周组织工程中的可行性探讨

目的 进行人牙周膜细胞（PDLCs)三维立体培养的体外实验研究，初步探讨两种支架材料应用于牙周组织工程的可行性，为进一步研究牙周组织生理病理及牙周组织工程奠定实验基础。方法 组织块法培养人PDLCs，传代扩增后，接种于脱矿松质骨基质（CBM）和纳米羟基磷灰石材料（nHAC)两种三维支架上，体外继续培养3d，进行细胞计数和扫描电镜观察。结果 人PDLCs在两种支架材料上均能形成良好贴附并增殖，扫描电镜可见两种支架材料均具有良好的多孔网状结构，细胞在支架材料上生长旺盛，伸展充分。结论 CBM和nHAC均有望成为牙周组织工程的支架材料。     

多孔碳酸钙陶瓷与干细胞源性成骨细胞的相容性

背景:国内外的研究证实普通碳酸钙陶瓷作为骨替代材料时具有细胞支架作用。目的:观察多孔碳酸钙陶瓷与成骨细胞的相容性,及作为骨组织工程支架的可能性。方法:SD大鼠骨髓基质干细胞经矿化诱导培养、扩增并检测证实其已具成骨细胞表型后,分别与多孔碳酸钙陶瓷支架、普通羟基磷灰石陶瓷支架体外复合培养。结果与结论:骨髓基质干细胞经体外诱导形成成骨细胞,钙结节、Ⅰ型胶原和碱性磷酸酶免疫染色结果阳性。多孔碳酸钙陶瓷支架材料与羟基磷灰石陶瓷材料皆有细胞附着生长,但多孔碳酸钙陶瓷支架材料细胞的黏附能力、增殖活力及成骨活性均强于羟基磷灰石陶瓷材料。提示多孔碳酸钙陶瓷支架材料与SD大鼠骨髓基质干细胞源性成骨细胞有良好相容性。     

纳米羟基磷灰石对人骨髓基质干细胞体外成骨活性的影响

目的：观察人骨髓基质干细胞在纳米羟基磷灰石材料上的生长、分化特点以及成骨细胞形态. 方法：实验于2004-03/2005-07在中南大学湘雅医院医学实验室完成.①实验方法：采用密度梯度离心的方法分离人骨髓基质干细胞,加入含体积分数为0.1的新生牛血清的低糖DMEM完全培养基中作原代培养,细胞长至90%汇合时传代,取培养第3代细胞接种于纳米羟基磷灰石（卫生部肝胆肠研究中心纳米课题组提供）表面,并加入含1 mmol/L地塞米松、50 mg/L维生素C、10 mmol/L β-甘油磷酸钠的培养基中诱导分化、培养.②观察指标：复合培养第2,4,6,8天后采用MTT法检测细胞增殖情况;复合培养7 d后行钙-钴法成骨细胞染色观察细胞分化情况;培养8 d后应用扫描电子显微镜观察细胞在材料上的生长情况. 结果：MTT法检测出的吸光值随着培养时间的增加而增大（P＜0.05）;经加入特定的成骨诱导体系培养7 d后,附着于材料的骨髓基质干细胞具有典型的成骨细胞形态,经钙-钴法染色后细胞胞浆中可见灰黑色颗粒或块状沉淀的阳性反应,细胞形态也多呈多角形或短矩形;培养8 d后扫描电镜可观察到材料孔隙内有细胞长入. 结论：人骨髓基质干细胞在纳米羟基磷灰石材料上生长良好,提示纳米羟基磷灰石适于骨髓基质干细胞的生长、分化,可作为骨组织工程的细胞外支架材料.     

珊瑚转化羟基磷灰石应用于牙周组织工程的细胞相容性和细胞毒性

背景:经处理后的珊瑚转化羟基磷灰石具有良好的生物相容性和可降解性,其三维相通的孔隙结构不仅可为种子细胞的黏附、增殖提供足够的内部空间和表面积,而且有利于营养成分的渗透和血管化形成。目的:对珊瑚转化羟基磷灰石进行细胞相容性和细胞毒性的研究,以初步探讨其应用于牙周组织工程的可行性。方法:将体外培养的人牙周膜细胞接种到珊瑚转化羟基磷灰石支架上体外三维复合培养,通过细胞计数方法和扫描电镜观察人牙周膜细胞在珊瑚转化羟基磷灰石支架上的附着、生长情况,并设立阴性对照组和阳性对照组,采用MTT测试法和碱性磷酸酶活性检测法评估稀释浓度分别为100%,50%,10%,1%的珊瑚转化羟基磷灰石浸提液对人牙周膜细胞增殖及功能表达的影响。结果与结论:珊瑚转化羟基磷灰石具有良好的多孔网状结构,人牙周膜细胞在珊瑚转化羟基磷灰石支架上生长旺盛,伸展充分,而不同浓度的材料浸提液对人牙周膜细胞的生长、增殖及碱性磷酸酶活性的影响差异均无显著性意义。提示珊瑚转化羟基磷灰石具有良好的三维空间结构和细胞相容性,且无细胞毒性,有望用作牙周组织工程的支架材料。     

纳米晶羟基磷灰石/胶原骨与骨髓间充质干细胞的相容性

背景：组织工程支架材料表面的微观和亚微观结构对细胞的黏附与生长有很重要的影响。利用纳米技术和三维造孔技术制备的纳米晶羟基磷灰石，胶原骨模仿了天然骨的成分与微结构特征。目的：观察体外培养的人骨髓间充质干细胞与纳米晶羟基磷灰石，胶原骨的细胞相容性。设计、时间及地点：单一样本观察，于2005-09／2006—12在江苏大学医学技术学院完成。材料；纳米晶羟基磷灰石，胶原骨由清华大学材料科学与工程系研制。人骨髓间充质干细胞由健康成年志愿者自愿捐献，受试者对实验内容知情同意。方法：全骨髓法体外培养骨髓间充质干细胞，应用成骨诱导剂（地塞米松、维生素C、β-磷酸甘油、碱性成纤维细胞生长因子）诱导向成骨细胞表型转化。将第3代骨髓间充质干细胞与纳米晶羟基磷灰石，胶原骨复合培养14d。主要观察指标：通过碱性磷酸酶组织化学染色、Von Kossa染色鉴定诱导培养的成骨细胞的细胞学特性。通过倒置显微镜、扫描电镜观察细胞生长及其在纳米晶羟基磷灰石，胶原骨上的生长情况。结果：原代培养的骨髓细胞增殖迅速，10～12d左右即可稳定传代，传代细胞7-9d即可传代。经诱导培养的细胞碱性磷酸酶组织化学染色阳性，Von Kossa染色阳性，可见钙化的基质沉积，呈现典型的成骨细胞形态和生物学特征。构建的骨髓间充质干细胞与纳米晶羟基磷灰石／胶原骨共培养模型中，细胞可在纳米晶羟基磷灰石，胶原骨表面良好贴壁。复合培养8d，分布于支架材料上的细胞大量增殖、分泌细胞外基质。复合培养14d，大量细胞在材料表面和孔隙中生长，细胞之间广泛存在突起连接。结论：纳米晶羟基磷灰石肢原骨适合种子细胞的贴附、生长和增殖，细胞相容性良好。     

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.