组织工程同种异体脱细胞真皮复合自体刃厚皮微粒皮移植

为观察组织工程同种异体脱细胞真皮复合自体刃厚皮、微粒皮移植的临床应用效果，选择2005-04/2008-06海南省农垦三亚医院烧伤整形科严重烧伤和瘢痕患者8例12个创面，采用脱细胞真皮复合自体刃厚皮片、脱细胞真皮复合自体微粒皮移植修复创面。12创面中，10个创面复合皮完全成活，1个创面出现散在点状坏死,经换药8 d愈合。1例植皮部分成活，经补充游离植皮后创面愈合。随访6~12个月，复合移植皮肤质地柔软，弹性良好，无瘢痕增生，类似全厚皮片。提示采用脱细胞真皮复合自体刃厚皮、微粒皮移植修复严重烧伤创面，疗效满意，没有排斥反应，是理想的治疗方法。     

异体表皮干细胞与猪脱细胞真皮构建复合皮移植6例

2005-01/2006-10在南昌大学第一附属医院烧伤科就诊的深度烧伤患者6例,均为四肢Ⅲ度烧伤创面。异种(猪)脱细胞真皮与异体表皮干细胞构建的复合皮由南昌大学第一附属医院烧伤中心提供。清创消毒后,6例患者均进行复合皮移植、自体刃厚皮移植,共移植复合皮12块,自体刃厚皮96块。复合皮移植是将复合皮剪成1.5 cm×1.5 cm,粗糙面向下、光滑面向上植于创面上;自体刃厚皮移植是将大片自体刃厚皮铺于矾土林纱布上,剪成1.5 cm×1.5 cm,植于复合皮的四周。移植后3 d揭去创面外层纱布,见复合皮及自体刃厚皮与创面粘连好、湿润,呈淡红色;7 d复合皮及自体刃厚皮大部分成活,随后成活的皮片向四周扩展,至14 d大部分皮片接近融合,21 d时创面已基本愈合。移植的复合皮、自体刃厚皮成活数量比较,差异无显著性意义(P > 0.05)。因复合皮扩展情况不如自体刃厚皮,所以复合皮移植后的创面愈合面积小于自体刃厚皮移植(P < 0.01)。在临床观察中6例患者暂未发生不良事件和副反应。提示表皮干细胞和(猪)脱细胞真皮构建的人工复合皮移植到受区,可建立血液循环,并保持一定的活力,达到覆盖创面、防止感染、防止体液流失的目的。     

异种脱细胞真皮基质组织补片修复口腔黏膜组织缺损71例

摘要 背景：近年来,同种异体脱细胞真皮基质组织补片已在口腔组织缺损修复中广泛应用,但有关异种脱细胞真皮基质组织补片修复口腔黏膜缺损的研究较少。 目的：评价异种脱细胞真皮基质在口腔黏膜组织缺损修复中的效果及生物安全性。 方法：选择口腔良、恶性肿瘤手术切除后遗留的黏膜及部分软组织缺损患者71例,男37例,女34例,年龄45(20~70)岁;其中良性肿瘤42例,恶性肿瘤29例。采用异种脱细胞真皮基质组织补片修复口腔软组织浅层缺损。观察生物膜成活情况,颜色、质地,比较组织补片修复无硬组织支撑部位(颊、舌、口底)和有硬组织支撑部位(牙龈、硬腭)的收缩率。 结果与结论：71例补片完全成活,未发生坏死、感染等并发症。植入后2周补片成活面积为(98.20±5.20)%,植入后3个月,补片颜色已与周围黏膜相近,大部分患者诉有不同程度的紧张感;植入后6个月补片植入区成功完成了细胞的爬行代替和血管化,生长稳定,无进一步收缩,弹性良好,患者感觉趋于正常。生物膜收缩发生在植入后2周~1个月,植入后3个月后基本稳定,术区组织形态与正常组织相比无明显差异。无硬组织支撑部位(颊、舌、口底)的收缩率较硬组织支撑部位(牙龈、硬腭)收缩率大。说明应用异种脱细胞真皮基质组织补片修复口腔黏膜具有组织相容性好、来源广泛、操作简单等优点,能够起到早期覆盖创面,促进创面愈合,减轻瘢痕生成的作用,可作为口腔黏膜缺损修复的理想材料。 关键词：口腔黏膜组织缺损;异种脱细胞真皮基质;组织移植;补片;牙周与口腔组织再生修复材料     

组织工程皮肤移植过程中白细胞介素10和肿瘤坏死因子α的表达

背景：白细胞介素10和肿瘤坏死因子α在异体异种皮肤移植局部免疫与排斥反应中发挥了重要作用。但在组织工程人工皮肤移植过程中局部皮肤组织内白细胞介素10和肿瘤坏死因子α的表达情况目前尚不清楚。 目的：采用表皮干细胞联合脱细胞真皮构建人工皮肤并移植修复兔全层皮肤缺损创面,观察创面修复效果和局部皮肤组织白介素10与肿瘤坏死因子α的表达变化。 方法：将体外培养的人表皮干细胞或角质细胞接种到脱细胞真皮支架中,构建组织工程人工皮肤;取新西兰白兔常规制作背部全层皮肤缺损创面随机分为4组,表皮干细胞组、角质细胞组用含表皮干细胞或角质细胞的组织工程皮肤移植于皮肤缺损创面;脱细胞真皮组移植单纯脱细胞真皮;对照组创面空置。观察创面修复情况,局部炎症反应,创面愈合时间。各组分别于术后7d在部分创面取材观察组织形态和白细胞介素10与肿瘤坏死因子α表达。 结果与结论：含表皮干细胞的人工皮肤移植后创面愈合良好,局部炎症反应轻微,无出血、积脓、坏死,创面愈合时间较角质细胞组明显缩短。白细胞介素10在各组均有表达,其中表皮干细胞组表达最强,角质细胞组次之,脱细胞真皮组和对照组最弱。肿瘤坏死因子α在各组也均有表达,其中角质细胞组表达最强,表皮干细胞组次之,脱细胞真皮组和对照组较弱。说明以表皮干细胞作为种子细胞联合脱细胞真皮构建人工皮肤可用有效促进皮肤缺损创面的修复治疗,创面修复过程中局部皮肤组织内白细胞介素10和肿瘤坏死因子的表达变化可能是其取得较好效果的主要机制之一。     

人工真皮修复急性创伤后足背皮肤软组织缺损14例

背景：人工真皮具有硅胶膜和胶原海绵双层结构,是最早开发和应用于临床的组织工程化皮肤替代物,主要应用于皮肤软组织缺损修复。 目的：评价人工真皮在足背严重皮肤软组织缺损中的应用。 方法：选择北京积水潭医院烧伤科于2009-06/2010-12收治的14例急性外伤后足背严重皮肤软组织缺损患者,均有肌腱或骨外露。所有患者经清创后,以人工真皮移植,待人工真皮成活后以自体断层皮片移植,观察人工真皮和自体皮的成活情况。 结果与结论：所有植皮成活,创面愈合良好,供区未见明显瘢痕增生。提示人工真皮联合自体断层皮片移植可以有效修复足背严重皮肤缺损创面,减少供区损伤。     

即刻种植同期行软组织处理对种植体周围软组织形态的影响

背景：即刻牙种植关闭创口时，由于顶端附着龈的缺损，常用唇侧黏骨膜瓣滑行、自体游离龈组织移植、异种脱细胞真皮基质移植和二段式种植体一次手术法等对种植体周围软组织进行处理。但目前的研究仅限于临床病例报道，缺少相关动物实验的研究证据。 目的：建立即刻种植动物模型，分析唇侧黏骨膜瓣滑行、异种脱细胞真皮基质移植、自体游离龈组织移植和二段式种植体一次手术法对种植体周围软组织形态的影响。 方法：健康成年杂种犬全麻后拔除下颌双侧第二、四前磨牙，即刻植入BLB种植体。根据手术方式分为4组，唇侧黏骨膜瓣滑行组、自体游离龈瓣移植组、异种脱细胞真皮基质移植组和二段式种植体一次手术组。3个月后，唇侧黏骨膜瓣滑行组、自体游离龈瓣移植组、异种脱细胞真皮基质移植组行二期手术；2周后烤瓷冠修复，负荷1个月后处死动物，制作带牙周组织的硬组织磨片并进行组织形态学分析。手术前、后均测量各组的龈沟探诊深度、牙龈指数、附着龈宽度等指标进行统计学分析。 结果与结论：所有种植体周围软组织均愈合良好。种植体-软组织界面可以形成和天然牙周类似的结合上皮结构。唇侧黏骨膜瓣滑行组由于破坏了种植体周围软组织解剖结构，修复效果较差；自体游离龈瓣移植、异种脱细胞真皮基质移植和二段式种植体一次手术法可有效关闭软组织创口，不影响周围软组织形态；所有组龈沟探诊深度术前后无明显变化，所有组负荷1个月后的牙龈指数均高于术前(P < 0.05)，唇侧黏骨膜瓣滑行组负荷1月后附着龈宽度较术前明显降低(P < 0.001)。结果表明即刻种植同期进行适当的软组织处理方法可以取得较好的种植美学修复效果。     

脱细胞猪皮为覆盖物的微粒皮移植修复大面积深度烧伤创面

背景：目前用作微粒皮的覆盖物除异体皮外包括猪皮、羊皮、自体焦痂、凡士林油纱布等,由于猪皮皮肤结构与人体相近似,价廉易得,是目前使用较为广泛的微粒皮覆盖物。 目的：观察脱细胞猪皮为覆盖物的微粒皮移植术运用于大面积深度烧伤治疗中的临床效果。 方法：对15例大面积深度烧伤患者采用早期切(削)痂术或肉芽创面清创后,行自体微粒皮移植、以脱细胞猪皮为覆盖物,移植后观察覆盖物脱落以及创面修复情况进行回顾性分析。 结果与结论：术后脱细胞猪皮与创面粘贴良好,术后5~7 d首次换药见脱细胞猪皮呈黄褐色或紫黑色,脱水干燥,猪皮下偶有少量积液,开窗引流后猪皮未溶解脱落;三至四周脱细胞猪皮干燥坏死、与创面逐步分离,猪皮脱落后创面完全愈合,鲜有创面裸露,创面愈合后瘢痕较轻,外观及弹性可。提示,脱细胞猪皮可替代大张异体皮成为微粒皮移植术的理想覆盖物,可使大面积深度烧伤创面修复达到较为理想的效果。     

丝素蛋白作为真皮替代物移植后的组织学变化

背景：目前国外研究者已研发出多种真皮替代物,取得了一定临床效果,但价格非常昂贵,因此研制和开发经济实用的高质量真皮替代物具有重要意义。 目的：了解以柞蚕丝素蛋白材料为支架构建组织工程真皮替代物移植后的组织学变化,并与聚乙烯醇海绵相比较。 方法：取清洁级雄性SD大鼠,背部制作一大小为20 mm×20 mm 的全层皮肤缺损创面,切下皮肤反取成刃厚皮待用,然后随机分为2组,海绵组：创面埋植聚乙烯醇海绵并覆盖自体表皮。丝素组：创面埋植交联柞蚕丝素多孔材料并覆盖自体表皮。分别于术后5,10,15,25 d取材,观察移植物及其周围组织大体标本和组织形态学变化,免疫组织化学染色增殖细胞核抗原和转化生长因子β1的相对定量分析。 结果与结论：移植术后丝素组复合皮片生长良好、全部存活;海绵组移植皮片大部分变黑、结痂,并有脱落。免疫组织化学结果显示丝素组在术后5~25 d 转化生长因子β1和增殖细胞核抗原的表达均显著大于海绵组。结果提示,以丝素蛋白为支架构建的组织工程真皮替代物具有良好的生物相容性,血管化过程快,并能促进皮肤创面的愈合。     

人工真皮修复骨外露创面23例效果评价

摘要 背景：近年来有应用人工真皮修复骨外露创面的报道,但其治疗效果尚不明确。 目的：评价应用人工真皮修复23例骨外露创面的治疗效果。 方法：选取北京积水潭医院烧伤科23例骨外露患者,男18例,女5例。骨外露创面清创后,进行人工真皮移植,待其成活后,进行自体薄断层皮片移植,观察人工真皮及自体断层皮片的成活情况和供皮区瘢痕增生情况。 结果与结论：所有骨外露患者中除1例女性颅骨外露部分修复外,其余患者人工真皮及自体皮片成活良好,骨外露创面均完全修复,供皮区未见瘢痕。结果提示,人工真皮修复骨外露创面效果较好。 关键词：人工真皮;自体皮片;修复;骨外露;组织构建 doi:10.3969/j.issn.1673-8225.2011.03.028     

异种脱细胞真皮替代睑板材料重建眼睑的可行性*☆

摘要 背景：眼睑后层重建是眼睑重建的重点和难点，其中睑板替代物更是研究的焦点。异种脱细胞真皮作为一种新型的组织工程材料，在国内外烧伤整形领域，正得到广泛的研究和应用。 目的：观察异种(猪)脱细胞真皮植入兔眼睑后的组织相容性极其组织病理学变化。 方法：剥取健康小白猪全层皮肤20 cm×20 cm，制备异种(猪)脱细胞真皮基质。同时制备兔睑板全层缺损模型并植入脱细胞真皮基质，观察大体情况，并分别于第1，2，3周取移植交界处眼睑组织光镜下观察组织学的改变。 结果与结论：大体观察未见明显排斥反应及眼睑的变形；光镜下1周时可见局部炎症细胞浸润，2周时炎症细胞减少，3周时正常纤维组织长入，逐渐分割代替植入的胶原纤维，炎症反应消失。提示异种脱细胞真皮免疫原性低，并可引导新生胶原的生长，是一种良好的睑板替代物。 关键词：异种脱细胞真皮；眼睑重建；组织工程；材料；相容性 doi:10.3969/j.issn.1673-8225.2011.03.004     

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.     

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.     

Clobazam for Treatment of Intractable Epilepsy: A Critical Assessment

Summary: Clobazam (CLB), a 1,5-benzodiazepine, is a remarkably effective add-on drug for individual patients with refractory partial epilepsy. CLB has an excellent safety record. As with all benzodiazepines used for treating epilepsy, sedation and withdrawal effects, together with the development of tolerance, limit its usefulness. Recent efforts to prevent or reverse tolerance with intermittent administration of CLB or periodic injection of a benzodiazepine antagonist, flumazenil, are encouraging and justify further investigations.     

La passion de Torquemada et le terrorisme islamique : quelques points de comparaison

This original research compares the doctrinal, psychopathological and operational standpoints of the 15th century Spanish Inquisition (Torquemada) with those of radical Islamism from 1988 to 2005 (Al-Qaeda). The following are reviewed: (a) the main texts codifying the procedure for conducting the criminal investigation of a Holy Office trial (Directorium inquisitorum); (b) the life and work of the grand inquisitor Tomás de Torquemada (1420–1498); (c) the psychopathological relations between passion (passionate psychoses, passionate idealism, paranoid personality) and fanaticism; (d) “the madmen, the enlightened and the criminals” of Islamic terrorism; (e) the cognitive and emotional motives for engagement in the jihadist radicalization of young people; (f) the common principles of monotheistic fanaticism (Inquisition, Al-Qaeda) and the particular dogmas of Islamic terrorism in our time; (g) the operating modes of the Inquisition and the Jihadist holy war. The author concludes that the rigour and seriousness of the inquisitorial judicial procedure, which was precise, individual and personalized, contrasts with the revolutionary pamphlets of Al-Qaeda, which only provide broad guidelines for the modus operandi of the fight against infidels, who are usually random victims.     

Claustration et collectionnisme : réflexions à propos d’un cas de syndrome de Diogène avec vols kleptomaniaques et vengeurs

Social withdrawal is a pathognomonic behaviour that is consistently associated with mental illnesses. Compulsive hoarding can also be interpreted as a pathological behaviour, even when it does not involve kleptomania. Diogenes syndrome (DS) was first described in 1975, and is characterized by both behaviours - social withdrawal and compulsive hoarding. Even though it is often the manifestation of a psychiatric condition, its aetiology is diverse. The most frequent ones are however: dementia, schizophrenia and mental retardation. In this study, we describe an atypical case presenting with DS. Il consists of a young man, seen in a forensic setting, who had been diagnosed with kleptomania in the past, presents with compulsive hoarding, and whose recent thefts were fuelled by revenge. Finally, to our knowledge, the way social withdrawal is viewed is seldom taken into account. We analyse its implication on social withdrawal.     

Neurological soft signs and schizophrenia: a review of current knowledge

Schizophrenia is a frequent and disabling disorder emerging during adolescence or early adulthood. The identification of underlying processes has been hampered by the complex clinical expression and the probable etiological heterogeneity. The frequency of neurological soft signs (NSS) in patients with schizophrenia and their presence early in life (during the first two years) in high risk subjects support the hypothesis that schizophrenia is a "brain disease" reflecting pre- or perinatal insults during development. The growing interest for NSS has lead to multiple studies that are often difficult to compare. The objective of this review is to summarize the current knowledge on NSS, methodological issues and the future perspectives.     

Lacan, lecteur de Minkowski : l'approche structurale

The notion of structure occupies a predominant place in the theory of Lacan. He indicates that was developed from the work of Minkowski. In fact, through his phenomeno-structural approach, Minkowski does not limit himself to purely observable phenomena, but attempts to determine the underlying structure. He refers to the comprehensive phenomenology and psychopathology, and this method provides him with clinical finesse and another means of determining a diagnosis. Thus Lacan has used this as a basis for his approach to structure to develop a theory regarding the individual. This implies that the structure of the individual is based on his relation to language. From this concept, he then develops the clinical structures of neurosis, psychosis, and perversion. These structural landmarks also have an effect on the course of treatment.