冷冻同种异体骨软骨移植修复大面积关节软骨缺损的可行性研究

目的观察冷冻同种异体骨软骨移植修复大面积关节软骨缺损的可行性，为临床应用提供实验依据。方法共选取36只新西兰兔，随机数字表法分成供体组、实验组和对照组，每组12只。供体组制备冷冻同种异体胫骨内侧髁骨软骨移植物后处死；实验组将经程序深低温冷冻保存的同种异体胫骨内侧髁移植；对照组将取下的胫骨内侧髁原位植入。所有实验动物在术后12周处死。应用苏木精-伊红染色观察关节软骨组织的病理学变化，软骨缺损的组织学评分以半定量的改良Wakitani score法评估，内容包括：细胞种类、髓质染色、表面完整性、软骨的厚度、移植软骨在受体周围组织的完整性5个方面，采用0、1、2、3、4评分，最高总分14分。观察两组动物的大体标本、X线片、组织学检查、Waki-tani score评分及免疫组织化学检查结果。结果①移植软骨的大体观察：两组动物关节活动度正常，关节腔无粘连、无积液，实验组移植软骨颜色及高度与周围关节软骨大致相同，关节面较平整，基底部界限模糊。对照组关节软骨面平整、无塌陷，厚度不变。②两组动物关节X线片均见骨折线已模糊，对位、对线良好。③组织学检查：两组动物关节软骨均已被透明软骨覆盖，细胞排列有序，软骨基质大量分泌，未见淋巴细胞和浆细胞浸润。④两组动物关节软骨Wakitani score评分结果无显著性差异，总评分相近（P〉0.05）。⑤两组修复软骨Ⅱ型胶原免疫组织化学染色强阳性。结论冻存同种异体骨软骨移植后可完全修复大面积关节软骨缺损，并与自体骨软骨块修复兔的关节软骨缺损在组织学上相近，未见免疫排斥反应。     

异体软骨移植及其兔疫原性研究近交系小鼠动物模型的建立

选用两组主要组织相容性复合体不相同的近交系小鼠Ｃ５７ＢＬ／６和ＤＢＡ／２做为本实验的动物模型，分别将异体软骨和同基因软骨移植于Ｃ５７ＢＬ／６小鼠股部肌肉中。通过检测抗体－补体介导的细胞杀伤反应和细胞介导的细胞杀伤反应，观察移植软骨的免疫原性。实验结果显示，异体软骨移植后产生强烈的特异性免疫排斥反应，而同基因软骨移植后不产生免疫排斥反应，与阴性对照组无显著性差异。故认为Ｃ５７ＢＬ／６和ＤＢＡ／２可以作为异体软骨移棺及其免疫原性研究的动物模型。     

天然支架在软骨组织工程中应用的研究现状

由于软骨内无血管，缺乏血液供应，细胞代谢缓慢，临床上常见的由创伤和各种疾病（如骨关节炎，剥脱性骨软骨炎、骨坏死等）引起的关节软骨缺损难以自行修复。修复关节软骨缺损的传统的方法（关节灌洗清理术、微骨折、软骨下钻孔、骨膜和软骨膜移植）都存在一些技术上的局限性，均不能实现长期的软骨修复。自体软骨移植在临床上技术较成熟，但也存在供区缺损、来源有限等不足，异体软骨移植因免疫排斥反应而受到限制。组织工程化软骨的出现为软骨缺损修复提出了新的途径。1977年Green将分离、培养的软骨细胞与脱钙骨支架联合培养，开始尝试软骨组织工程的研究，并认识到细胞培养支架的重要性。目前，软骨组织工程中支架分为天然和人工合成支架。     

骨软骨移植修复关节软骨缺损的研究进展

关节软骨的完整性是关节行使正常功能的基础。而创伤等所致的关节软骨缺损可引起疼痛、滑膜炎和关节变性等，最终导致关节功能丧失。对于关节软骨缺损的治疗有促进软骨自身内源性修复和通过移植手段重塑关节(如：软骨移植、骨膜／软骨膜移植、软骨细胞／间充质细胞移植、软骨组织工程及骨软骨移植等)两种方法。近年来，国内外在骨软骨移植的基础与临床应用方面取得了一定进展，现综述如下。     

新鲜胎儿软骨游离移植治疗股骨头无菌性坏死：附16例报告

新鲜胎儿软骨游离移植治疗股骨头无菌性坏死（附１６例报告）山东黄河医院（２５００３２）宋洪庆，郭永红，孙洪毅，窦维福，张永宜，王文娟我院１９８９年以来，采用同种异体新鲜胎儿软骨移植，治疗中青年股骨头无菌性坏死１６例，临床应用效果满意，报告如下：一、临床...     

关节软骨下骨移植后对关节软骨影响的实验研究

目的：探讨关节软骨下大块骨缺损骨移植后,局部成骨活动的发生与演变、关节软骨的活性变化及术后关节面塌陷、关节软骨退变等并发症的原因。方法：在家兔胫骨上端内侧,模拟临床骨肿瘤刮除,建立关节软骨下大块骨缺损动物模型,采用新鲜自体骨与同种异体脱钙骨移植后,通过大体观察、组织学观察、放射自显影方法进行动态观察。结果：模型建立２周后,软骨下骨完全坏死,出现吸收腔;４周时吸收腔内出现新的毛细血管,新骨开始沉积;到１２周时,坏死软骨下骨中毛细血管完全恢复,有８２５％的死骨被新骨替代。结论：（１）关节软骨下骨移植时,大量刮除软骨下骨,会增高术后关节软骨退变的发生率。（２）在关节软骨下骨移植时,如果大量刮除软骨下骨,将引起软骨下骨的缺血坏死,坏死的软骨下骨将逐渐被新生骨爬行替代。（３）用新鲜自体骨与异体脱钙骨移植修复关节软骨下大块骨缺损相比较,均经历了被吸收、血管长入、新骨形成取代移植骨的过程,愈合及修复程度均无显著差异。     

自体软骨移植在单侧唇裂鼻畸形整复中的应用

目的 探讨自体软骨移植在单侧唇裂继发鼻畸形整复中的应用.方法 术前对患者鼻翼软骨、鼻中隔软骨等亚细结构的发育状况进行分析,在充分解剖复位的基础上,采用自体软骨植入等方法,重塑鼻部形态.结果 本组单侧唇裂术后鼻畸形患者14例,通过自体软骨移植矫正,随访6个月～1年,外鼻形态持久、满意,移植物无外露、感染等并发症.结论 采用自体软骨移植修复单侧唇裂继发鼻畸形,能够获得良好的鼻通气功能和稳定、满意的鼻部形态.     

人工骺板软骨对家兔骺板损伤的修复作用

目的：探讨人工骺板软骨移植修复骺板损伤。 方法：切除家兔左侧胫骨上端骺板软骨约1/3～1/2,制备人工骺板软骨构件移植入该骺板损伤处;右侧胫骨近端骺板损伤后不进行移植作为对照。连续观察家兔双下肢外观及运动状态,摄双侧下肢X线片,测量胫骨角进行比较。行HE染色、甲苯胺蓝染色及免疫组化进行组织形态学观察。结果：移植8周时双下肢胫骨角,对照组为(38.80±13.50)°,人工骺板软骨移植组为(9.01±4.2)°;移植24周时对照组为(54.25±18.33)°,人工骺板软骨移植组为 (11.27±5.1)°,对照组与人工骺板软骨移植组相比差异均有显著性（P<0.01）。术后2周,对照组胫骨近端骺板内侧缺损处有骨桥形成,无软骨修复组织;而实验组移植后2周时,骺板缺损区已由软骨修复充填,移植的骺板软骨细胞排列未见层次及柱状排列状态,与正常骺板软骨相邻处分界明显;移植4周以后的骺板软骨细胞开始出现柱状排列状态,层次较明显。移植的骺板软骨Ⅱ型胶原染色阳性。结论：人工骺板软骨应能够修复骺板软骨损伤,效果满意。     

自体软骨膜移植修复关节面软骨的实验及临床研究进展

<正> 近年来国外、国内开展了自体软骨膜移植的实验研究。Lester(1959)在为漏斗胸畸形复发的儿童动手术时发在肋软骨膜可以再生软骨。Skoog 等(1972)通过动物实验证明软骨膜确有再生软骨的能力Ohlsen、Sohn 等又进一步把软骨膜移植于动物自身皮下、肌间、肝实质等处均生成软骨。Eng-kvist(1975)用自体软骨膜移植再生软骨的方法修复关节软骨缺损。自体软骨移植已有许多实验研究和一些临床研究报道,本文从     

组织工程技术修复软骨缺损的进展

“软骨一旦破坏 ,即无法得到修复”,早在 1 743年 Hunter即提出了此观点。两个半世纪以来 ,人们一直在探索修复关节软骨缺损的最佳方法和途径。现在一般认为 ,软骨组织的修复再生能力极弱 ,直径超过 4mm的软骨缺损不能自行修复。关节内清理和灌洗术、关节削磨成形术、软骨下骨钻孔术、微骨折、截骨术等传统治疗方法 ,因修复组织以纤维软骨为主 ,缺少正常透明软骨的力学性能及耐用性 ,故难以得到满意效果。自体软骨移植 ,存在供体有限的缺点 ,异体软骨移植须考虑免疫排斥方面等问题。骨膜和软骨膜移植术能在缺损区产生新生软骨 ,但同样存在…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.