五倍子、蜈蚣对瘢痕疙瘩成纤维细胞增殖和胶原合成的影响

目的探讨五倍子、蜈蚣对瘢痕疙瘩成纤维细胞增殖和胶原合成的影响及意义.方法用MTT法和3H-脯氨酸掺入法检测不同药物浓度、作用时间的五倍子和蜈蚣对体外培养的瘢痕疙瘩成纤维细胞增殖及胶原蛋白合成的影响;用光镜和电镜观察五倍子、蜈蚣作用后瘢痕成纤维细胞的形态及细胞器超微结构变化.结果五倍子和蜈蚣能抑制瘢痕成纤维细胞的增殖及胶原蛋白的合成(P＜0.01),其抑制作用与剂量和时间有关.最佳浓度为10μg/ml,五倍子在作用后72h,蜈蚣在作用后48h,抑制作用最强,抑制率分别为89%和92%.五倍子、蜈蚣能明显影响成纤维细胞形态和超微结构(细胞核、线粒体、粗面内质网等).结论五倍子、蜈蚣能明显抑制瘢痕成纤维细胞增殖和胶原蛋白的合成.为临床应用中草药治疗增生性瘢痕提供了理论依据.     

抗转化生长因子β_1预防和治疗瘢痕疙瘩的研究

目的　探讨anti-TGF - β1在体外及动物模型实验中对瘢痕疙瘩成纤维细胞增殖和胶原合成的影响及意义。方法　用电镜观察anti-TGF - β1作用后体外培养及动物模型成纤维细胞的形态学变化 ,用MTT法和3 H -脯氨酸掺入等方法 ,检测anti-TGF - β1对体外培养的成纤维细胞的增殖和胶原蛋白合成的影响 ;用免疫组化技术观测anti-TGF - β1对动物模型中瘢痕疙瘩Ⅰ、Ⅲ型胶原蛋白的影响。结果　anti -TGF - β1能明显影响成纤维细胞的超微结构及抑制其增殖和胶原蛋白的合成 (P <0 .0 1)。抑制作用在 10 μg/ml时最大 ,抑制率达 72 %。对动物模型中瘢痕疙瘩Ⅰ、Ⅲ型胶原蛋白有明显的抑制作用 ,胶原高表达率实验组为 33.3% ,对照组为 88.9% (P <0 .0 1)。结论　在体外及动物模型实验中 ,anti-TGF - β1均能中和TGF - β1促进成纤维细胞增殖和胶原合成的作用 ,提示anti-TGF - β1将来可应用在临床预防治疗过度增生的瘢痕     

抗转化生长因子β1预防和治疗瘢痕疙瘩的研究

目的探讨anti-TGF-β1在体外及动物模型实验中对瘢痕疙瘩成纤维细胞增殖和胶原合成的影响及意义.方法用电镜观察anti-TGF-β1作用后体外培养及动物模型成纤维细胞的形态学变化,用MTT法和3H-脯氨酸掺入等方法,检测anti-TGF-β1对体外培养的成纤维细胞的增殖和胶原蛋白合成的影响;用免疫组化技术观测anti-TGF-β1对动物模型中瘢痕疙瘩Ⅰ、Ⅲ型胶原蛋白的影响.结果 anti-TGF-β1能明显影响成纤维细胞的超微结构及抑制其增殖和胶原蛋白的合成(P＜0.01).抑制作用在10 μg/ml时最大,抑制率达72%.对动物模型中瘢痕疙瘩Ⅰ、Ⅲ型胶原蛋白有明显的抑制作用,胶原高表达率实验组为33.3%,对照组为88.9%(P＜0.01).结论在体外及动物模型实验中,anti-TGF-β1均能中和TGF-β1促进成纤维细胞增殖和胶原合成的作用,提示anti-TGF-β1将来可应用在临床预防治疗过度增生的瘢痕.     

五倍子对裸鼠瘢痕疙瘩动物模型的作用

目的：探讨中草药五倍子对裸鼠瘢痕疙瘩成纤维细胞的影响及意义。方法：用Ⅰ、Ⅲ型前胶原cDNA探针原位杂交技术观察五倍子对裸鼠瘢痕疙瘩组织中成纤维细胞Ⅰ、Ⅲ型前胶原表达的影响;应用免疫组织化学染色方法检测增生性瘢痕组织中增殖细胞核抗原（PCNA）表达、原位末端标记法（TUNEL）观察细胞凋亡;电镜观察成纤维细胞超微结构变化。结果：五倍子治疗后瘢痕疙瘩组织中成纤维细胞Ⅰ、Ⅲ型前胶原mRNA的表达明显较对照组减弱;成纤维细胞PCNA阳性表达降低,TUNEL阳性细胞增加;明显影响成纤维细胞（细胞核、线粒体、粗面内质网等）超微结构。结论：中草药五倍子能抑制瘢痕疙瘩组织成纤维细胞Ⅰ、Ⅲ型前胶原mRNA的表达和细胞增殖,并且加快了细胞的凋亡,从而抑制瘢痕增生,为临床预防治疗瘢痕提供理论依据。     

积雪草甙对烧伤增生性瘢痕作用的实验研究

目的 研究积雪草甙对体外培养的成纤维细胞的胶原蛋白合成的影响,以及对裸鼠增生性瘢痕动物模型的作用,以探讨积雪草甙治疗增生性瘢痕的机制。方法采用光镜、电镜研究用药前后成纤维细胞的形态学的变化,以^3H脯氨酸掺入等方法检测成纤维细胞胶原蛋白的合成,通过建立裸鼠增生性瘢痕动物模型,观察积雪草甙在体局部注射对增生性瘢痕的作用。结果 积雪草甙能明显影响成纤维细胞的超微结构,抑制胶原蛋白的合成,并呈量效关系;在裸鼠体内局部注射积雪草甙可抑制瘢痕增生,而且大剂量使用未发现药物毒性作用。结论 积雪草甙治疗瘢痕增生的机理与其抑制成纤维细胞增殖和胶原蛋白合成有关。     

赛来昔布对瘢痕疙瘩成纤维细胞增殖及β-catenin和C-myc表达的影响

目的 探讨赛来昔布对体外培养的瘢痕疙瘩成纤维细胞增殖及β-catenin和C-myc表达的影响.方法 用不同浓度(0、25、50、100、125μmol/L)及不同作用时间(24、48、72h)的赛来昔布作用于人瘢痕疙瘩成纤维细胞,CCK-8(Cell Counting Kit-8)法检测人瘢痕疙瘩成纤维细胞的增殖活性,QRT-PCR、Western-blot检测体外培养的人正常皮肤及瘢痕疙瘩成纤维细胞中β-catenin和C-myc 的mRNA及蛋白表达.结果 CCK-8法显示,赛来昔布可显著抑制体外培养的人瘢痕疙瘩成纤维细胞增殖(P ＜0.05),呈剂量和时间依赖性;QRT-PCR和Western-blot显示:①与体外培养的人正常皮肤成纤维细胞相比,体外培养的人瘢痕疙瘩成纤维细胞中,C-myc 及β-catenin蛋白的表达明显上调(P ＜0.05),而β-catenin mRNA表达未见明显增加;②不同浓度(0、25、50、100、125μmol/L)赛来昔布作用的体外培养的人瘢痕疙瘩成纤维细胞中,随着赛来昔布浓度增高,β-catenin和C-myc的表达逐渐降低,各组之间差别明显(P ＜0.05).结论 人瘢痕疙瘩的发生与Wnt信号通路异常密切相关;赛来昔布能通过Wnt信号通路抑制瘢痕疙瘩成纤维细胞增殖,有望用于瘢痕疙瘩的临床治疗.     

姜黄素对瘢痕疙瘩成纤维细胞增殖和胶原合成的影响

目的:观察姜黄素对体外培养的人瘢痕疙瘩成纤维细胞增殖及胶原合成的作用,以寻找治疗人瘢痕疙瘩的有效药物。方法:体外培养人瘢痕疙瘩成纤维细胞,分别应用MTT比色法和羟脯氨酸比色法检测姜黄素作用后细胞增殖及胶原合成的变化。结果:和对照组相比,姜黄素能够显著抑制瘢痕疙瘩成纤维细胞的增殖及胶原合成(P<0.01)。结论:姜黄素具有体外抗瘢痕疙瘩的作用,可能成为治疗瘢痕疙瘩的有效药物。     

雷帕霉素对瘢痕疙瘩成纤维细胞增殖、迁移及凋亡的影响

目的通过体外细胞培养实验,观察雷帕霉素对瘢痕疙瘩及正常皮肤成纤维细胞增殖、迁移和凋亡的影响,探讨雷帕霉素用于治疗瘢痕疙瘩的可能性及有效性。方法在无菌条件下切取人瘢痕疙瘩和正常皮肤组织,分离培养其成纤维细胞;实验分为不同浓度雷帕霉素(2.5、5.0、7.5、10.0μmol/L)处理组和DMSO溶剂对照组。分别采用MTS法、划痕法和Annexin V-PI染色检测不同浓度雷帕霉素对两种成纤维细胞增殖、迁移和凋亡的影响。结果雷帕霉素能够抑制两种成纤维细胞的增殖,且对正常皮肤成纤维细胞增殖的抑制作用更强,其浓度越高抑制效率越高;能够显著抑制两种成纤维细胞的迁移,并明显诱导正常皮肤成纤维细胞的凋亡,且高浓度(10.0μmol/L)雷帕霉素处理组的凋亡率最高,但对瘢痕疙瘩成纤维细胞的凋亡作用不明显。结论雷帕霉素可以抑制两种成纤维细胞的增殖和迁移,诱导成纤维细胞的凋亡;雷帕霉素对成纤维细胞的影响,可能成为预防瘢痕疙瘩等纤维化疾病的有效药物。     

实时荧光定量聚合酶链式反应检测瘢痕疙瘩中核心蛋白多糖的表达

目的 探讨瘢痕疙瘩成纤维细胞中核心蛋白多糖的表达、含量,及其在瘢痕疙瘩形成中的作用和机制.方法对瘢痕疙瘩、正常瘢痕以及正常皮肤成纤维细胞进行体外培养,采用光镜、透射电镜观察成纤维细胞形态、活性及凋亡;应用实时荧光定量聚合酶链式反应(FQ-PCR)对核心蛋白多糖以及β1转化生长因子(TGF-β1)的mRNA表达进行检测、分析.结果 瘢痕疙瘩成纤维细胞形态不规则、排列紊乱,线粒体增多,粗面内质网扩张呈囊,细胞核常染色质丰富,表明其合成蛋白的功能活跃;瘢痕疙瘩成纤维细胞中核心蛋白多糖mRNA含量较正常瘢痕或正常皮肤成纤维细胞降低,而TGF-β1 mRNA表达则较正常皮肤及瘢痕组织成纤维细胞升高.结论 核心蛋白多糖在瘢痕疙瘩成纤维细胞内含量较正常皮肤明显减少,提示其对成纤维细胞增殖、合成的抑制作用随之减弱,同时使TGF-β1表达上调,导致成纤维细胞的大量增生、迁移,合成过量胶原.表明核心蛋白多糖是抑制瘢痕疙瘩形成的重要因子.     

几丁糖对不同来源成纤维细胞生物学特性的影响

目的　探讨医用几丁糖 (以下简称几丁糖 )对病理性瘢痕成纤维细胞生物学活性的作用。方法　以瘢痕疙瘩及增生性瘢痕成纤维细胞为研究对象 ,正常皮肤成纤维细胞为对照 ,用组织块法进行不同标本成纤维细胞体外培养。分别观测不同浓度的几丁糖作用后 ,不同来源成纤维细胞吸光度A、形态结构、合成及分泌胶原的量以及细胞因子TGF β1 、b FGF、IL 8等的变化。结果　几丁糖对不同来源成纤维细胞增殖及胶原、TGF β1 、b FGF、等的分泌均呈剂量依赖性抑制 ,对IL 8则促进 ;且对各组的影响差异无显著性意义。结论　几丁糖可以抑制瘢痕疙瘩和增生性瘢痕成纤维细胞的生长、增殖、合成及分泌胶原功能 ,有望在病理性瘢痕的防治中发挥重要作用。     

Histochemical and contractile properties of striated muscles of urethra and levator ani of dogs and sheep

AIMS: To understand their possible importance in long- and short-term control of continence, some properties of the striated muscles of the urethra and pelvic floor (levator ani) of dogs and sheep were investigated, especially fiber types and contractile characteristics. MATERIALS AND METHODS: Striated muscles of urethra and levator ani of 29 male and 6 female dogs and 11 male and 6 female sheep were removed and cut into strips. Some strips were frozen and stained for ATPase at pH 9.4 and 4.3 for fiber typing; others were set up in an organ bath to study contractile responses to nerve stimulation. RESULTS: All muscles contained both type I (slow) and type II fibers, ranging from 97% type II in female greyhound urethra to 60% in female sheep levator ani. For each muscle, there were fewer type II muscles in sheep than in dog. The diameters of the urethral fibers were about 60% of the levator ani in dogs and 34% in sheep. Contraction of the urethral muscle was faster than for levator ani and declined to about 80% of the peak, 500 msec after the beginning of stimulation at 20 Hz. The levator ani contraction rose to a steady level as long as stimulation continued. CONCLUSIONS: Both the levator ani and urethral striated muscles contain slow and fast fiber types. The levator ani muscles are capable of sustained contraction with rapid onset which will produce long-term closure of the urethra. The circular urethral muscle contraction was faster but less well maintained.     

Incorporation and release of85Sr and14C-proline-hydroxyproline in mineral and collagen of bone and incisor teeth of growing rats

The extent to which exchange and reutilization processes of mineral tracers affect skeletal mineral accretion and resorption measurements was evaluated by comparing the rates of appearance and disappearance of⁸⁵Sr and¹⁴C-proline-hydroxyproline in bones and teeth in growing rats for 12 days following simultaneous parenteral injection of these tracers. Expressions for the relative rates of collagen synthesis and breakdown, which unlike mineral metabolism are considered not to be complicated by exchange phenomena, were based on¹⁴C-proline conversion to¹⁴C-hydroxyproline; the specific activity of the latter was determined. Both the mineral and the collagen specific activities reflected the rates and patterns of growth of the samples assayed; rapid growth and a short interval of time between formation and resorption of tissue in themetaphyseal bone which contains the cartilagineous growth plate, slow growth and an interval of time between formation and resorption of tissue indiaphyseal bone and incisor teeth which is longer than the 12 days of the experiment. However, in metaphyseal bone the specific activity collagen/mineral ratio dropped by one half during the 4–12 day interval in contrast to diaphyseal bone and incisor teeth in which no change in this ratio was observed during this period of time. The data indicate that collagen in the metaphyseal growth zone is removed by resorption before it has become fully mineralized, and that exchange is a relatively unimportant factor in the long term kinetics of bone mineral.

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Zusammenfassung Das Ausmaß, bis zu welchem Austausch- und Wiederverwendungsprozesse der mineralen Tracer die Messungen des mineralen Skelett-Auf- und Abbaues beeinflussen können, wurde ausgewertet; zu diesem Zweck wurde die Geschwindigkeit des Auftretens und Verschwindens von⁸⁵Sr und von¹⁴C-Prolin-Hydroxyprolin in Knochen und Zähnen von wachsenden Ratten während der 12 auf die simultane parenterale Injektion dieser Tracer folgenden Tage verglichen.Der Ausdruck für die relative Geschwindigkeit des Kollagen-Auf- und Abbaues, bei welchem im Gegensatz zum Mineralmetabolismus kein Mitwirken des Austauschphänomens vermutet wird, basiert auf der Umwandlung von¹⁴C-Prolin zu¹⁴C-Hydroxyprolin; die spezifische Aktivität des letzteren wurde bestimmt.Aus der spezifischen Aktivität des Minerals sowie jener des Kollagens konnten die Geschwindigkeit und die Art des Wachstums der untersuchten Proben ersehen werden, d.h.schnelles Wachstum und ein kurzes Zeitintervall zwischen Bildung und Resorption des Gewebes imKnochen der Metaphyse, die auch die knorpelige Wachstumsplatte enthält, und andererseitslangsames Wachstum und längeres Zeitintervall (länger als die 12 Tage des Experimentes) zwischen Bildung und Resorption des Gewebes imKnochen der Diaphyse und in den Schneidezähnen. Immerhin fiel die spezifische Aktivität des Kollagen/Mineral-Anteils im Knochen der Metaphyse während dem 4–12tägigen Zeitintervall auf die Hälfte, im Gegensatz zum Knochen der Diaphyse und der Schneidezähne, bei welchen während dieser Zeitspanne kein Unterschied in diesem Verhältnis beobachtet wurde.Diese Ergebnisse zeigen, daß Kollagen in der Wachstumszone der Metaphyse durch Resorption verschwindet, bevor es ganz mineralisiert ist, und daß der Austausch ein relativ unwichtiger Faktor in der Kinetik auf lange Sicht des Knochenminerals ist.

     

Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines

Background:

Controversy continues regarding the best treatment for compression and burst fractures. The axial distraction reduction utilizing the technique employing the long straight rod or curved short rod without derotation to reduce fracture are practised together with short segment posterolateral fusion (PLF). Effects of the early postoperative mobilization without posterolateral fusion on reduction maintenance and fracture consolidation were not evaluated so far. The present prospective study is designed to assess the effectiveness of i) reduction and restoration of sagittal alignment, ii) no posterolateral fusion on the reduced, fractured vertebral body and injured disc, iii) fracture consolidation and iv) the fate of the unfused cephalad and caudal injured motion segments of the fractured vertebra.

Materials and Methods:

The study includes 15 Denis burst and two Denis type D compression fractures between T₁₂ and L₃. The lordotic distraction technique was used for ligamentotaxis utilizing the contoured short rods and pedicle screw fixator. Three vertebrae including the fractured one were fixed. The patients after surgery were braced for ten weeks with activity restriction for 2-4 weeks. The patients were evaluated for change in vertebral body height, sagittal curve, reduction of retropulsion, improvement in neural deficit. The unfused motion segments, residual postoperative pain and bone and metal failure were also evaluated.

Results:

The preoperative and postreduction percentile vertebral heights at, zero (immediate postoperative), at three, six and 12 months followup were 62.4, 94.8, 94.6, 94.5 and 94.5%, respectively. The percentages of the intracanal fragment retropulsion at preoperative, and postoperative at zero, 3, 6 and 12 months followup were 59.0, 36.2,, 36.0, 32.3, and 13.6% respectively.The preoperative and postreduction percentile loss of the canal dimension and at zero, three, six and 12 months were 52.1, 45.0, 44.0, 41.0 and 29% respectively suggesting that the under-reduced fragment was being resorbed gradually by a remodeling process. The mean initial kyphosis of 33° became mean 2° immediately after reduction and mean 3° at the final followup. The fractured vertebral bodies consolidated in an average period of ten weeks (range 8-14 weeks). The restored disc heights were relatively well maintained throughout the observation period. All paraparetic patients recovered neurologically. There were no postoperative complications.

Conclusion:

Instrument-aided ligamentotaxis for compression and burst fractures utilizing the short contoured rod derotation technique and the instrumented stabilization of the fractured spine are found to be effective procedures which contribute to the fractured vertebral body consolidation without recollapse and maintain the motion segment function.     

Principles and Practice of Hemofiltration and Hemodiafiltration

There is growing interest in the convective dialysis therapies, hemofiltration (HF) and hemodiafiltration (HDF). Both require dialysis membranes which are highly permeable to solutes as well as fluid, and in both cases large volumes of ultrafiltration are the condition for convective transport. In HDF the convection is combined with diffusion, and as a consequence, maximum clearance over the entire molecular weight spectrum is achieved. Optimal forms of HDF provide urea clearance 10–15% higher than the corresponding diffusive mode. The larger the solute, the greater is the impact of convection, and β₂-microglobulin (β₂m) levels may be up to 70% reduced. Traditional postdilution HF provides high clearance of medium sized and large molecules. Satisfactory clearance of small solutes requires blood flows in excess of 500 ml/min. With access to practically unlimited volumes of substitution solution through on-line ultrafiltration, predilution HF can now be used. This increases the clearance of small solutes to an acceptable range. For HDF as well as HF, large patient populations consistently treated for longer periods of time are needed to make valid outcome comparisons with other therapies.     

Recognition and management of phaeochromocytoma and paraganglioma

Phaeochromocytomas and paragangliomas (PPGL) are catecholamine-secreting neuroendocrine tumours arising from the chromaffin cells in the adrenal medulla. These tumours may be identified incidentally, as part of a work-up for multiple endocrine neoplasia or following haemodynamic surges during unrelated procedures. Advances in perioperative management and improved management of intraoperative haemodynamic instability have significantly reduced surgical mortality from around 40% to less than 3%. Surgery is the definitive treatment in most cases and laparoscopic resection where possible is associated with improved outcomes. Anaesthetic management of PPGL cases represents a unique haemodynamic challenge both before and after tumour resection. In this article we describe the physiology of these tumours, their diagnosis, preoperative optimization methods, intraoperative anaesthetic management and management of postoperative complications.     

骨折不愈合与延迟愈合的成因与治疗

目的探讨骨折不愈合与延迟愈合的成因、报肯治疗的方法与设果。方法对1990年7月～2004年12月间收治的107例骨折不愈台、54例骨折延迟愈合2例先天性胫骨骨不连进行回顾性研究，分析原因，随访治疗结果。18例延迟愈合行保守治疗，本组其他145例行手术治疗，结果除2例先天性胫骨骨不连外，其余161例的成因中均有医源性因素。10例失去随访，153例平均随访17（6-28）个月，骨折均获骨性连接，愈合时间平均10（6-14）个月，肢体功能恢复良好，结论医源性技术缺陷是骨折不愈合与延迟愈合的主要原因，针对各种不同因素进行合理治疗可获得满意效果。     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist and nabilone, a synthetic cannabinoid.     

Physiology and pharmacology of nausea and vomiting

Nausea and vomiting are both very unpleasant experiences. The physiology is poorly understood; however, understanding what we do know is key to tailoring a preventative or therapeutic antiemetic regime. There are two key sites in the central nervous system implicated in the organization of the vomiting reflex: the vomiting centre and the chemoreceptor trigger zone. There are five key neurotransmitters involved in afferent feedback to these areas. These are histamine (H₁ receptors), dopamine (D₂), serotonin (5-HT₃), acetyl choline (muscarinic) and neurokinin (substance P). Postoperative nausea and vomiting will occur in around one-third of elective patients who have no prophylaxis. This can result in many detrimental effects including patient dissatisfaction, unplanned admission and prolonged recovery. It is therefore essential that clinicians understand how they can prevent and treat nausea and vomiting using either a single agent or a combination of antiemetics to target relevant receptors. Commonly used drugs include antihistamines, dopamine antagonists, serotonin antagonists and steroids. More novel agents are being developed such as aprepitant, a neurokinin receptor antagonist, palonosetron, a 5HT₃ receptor antagonist, and nabilone, a synthetic cannabinoid.