骨转换指标和骨密度预测骨折危险性的可行性

背景：骨密度虽然可以诊断骨质疏松,但不能及时反映受试者正在发生的骨代谢情况;骨转换指标虽然不能诊断骨质疏松,但它可以及时反映受试个体正在发生的骨转换速率。 目的：概述骨转换指标和骨密度预测骨质疏松症的骨折危险性,从理论上分析,骨折术后愈合与否的预测方法的可行性。 方法：以bone tunrnover,biochemical marker,osteoporosis为检索词,检索Pubmed数据库(1999-01/2009-01);以骨转换,骨代谢,生化标志物,骨密度,骨质疏松,骨折为检索词,检索CNKI数据库(1999-01/2009-01)。文献检索语种限制为英文和中文。纳入与骨转换指标和骨密度预测骨折危险性的研究紧密相关的文章;排除重复文献。 结果与结论：计算机初检得到631篇文献,根据纳入排除标准,对其中31篇文献进行分析。骨质疏松症是老年人发病及死亡的主要原因之一,早期预测骨质疏松症的骨折危险性意义重大。文章介绍了长期制动后的骨代谢机制、骨生化标志物种类、骨密度测量、多细胞基本单位和 OPG-RANKL-RANK 系统在骨重建中的作用;重点介绍了国内外学者运用骨转换指标和骨密度预测骨质疏松症和长期制动后的骨折危险性,从理论上分析骨折术后愈合与否的预测方法的可行性。     

步态运动学及动力学的研究方法

背景：运动学运用几何学的方法来研究物体的运动，通常不考虑力和质量等因素的影响；动力学主要研究人作用于物体的力与物体运动的关系。 目的：通过对运动学及动力学研究设备的介绍，引出运动学及动力学的研究现状，为以后人们对新设备的研究与新的步态研究实验提供依据。 方法：以gait, kinetics, kinematics为检索词，检索Pubmed数据库(1999-01/2009-06)。以步态，运动学，动力学为检索词，检索CNKI数据库(1999-01/2009-06)。文献检索语种限制为英文和中文。纳入有关步态的运动、动力学研究设备，排除其他运动学、动力学研究实验，排除较为陈旧，重复性研究。 结果与结论：计算机初检得到2367篇文献，根据纳入排除标准，对33篇文献进行分析。在步态分析方法上，国内外己经进行了多方面的研究，内容虽各有不同，但就对步态的测试方面，使用的仪器和方法几乎一致，即使用摄影或摄像记录和计算测量运动学参数，使用测力台记录动力学参数，也有少数使用足底压力分布器测量更精确的足-地压力分布规律，然后进行综合的统计分析等。动力学及运动学步态分析的应用不仅在康复医疗上，而且现正广泛运用到竞技体育和与之相关的鞋类制作，常用的方法是平面定点摄像及测力台分析。     

聚乳酸降解材料的绿色化学合成*★◆

摘要 背景：聚乳酸具有良好的生物相容性和生物降解性，广泛应用于药物缓释、手术缝合线、组织工程支架及骨修复材料等生物医用领域。但其常规合成方法需使用溶剂，生产效率较低且成本较高。 目的：对非溶剂的绿色化学方法-乳酸熔融缩聚/二异氰酸酯熔融扩链，合成聚乳酸降解材料的研究进展进行综述。 方法：应用计算机检索SCI-Expanded数据库(1995-01/2010-06)，以“Poly(lactic acid)，diisocyanate”为检索词；应用计算机检索中国期刊网络出版总库(1999-01/2010-06)，以“聚乳酸，异氰酸酯”为检索词。共收集130篇关于乳酸熔融缩聚/二异氰酸酯熔融扩链的文献，中文39篇，英文91篇。排除发表内容重复、实验结果较差的文献，共32篇文献符合标准被纳入。 结果与结论：采用非溶剂的绿色化学方法-乳酸熔融缩聚/二异氰酸酯熔融扩链，通过改变异氰酸酯和预聚物的种类和比例，就可以制备具有不同相对分子质量和性能的可降解聚乳酸基聚氨酯材料，有望在生物医用领域和日常生活中取得实际的应用。 关键词：熔融缩聚；熔融扩链；降解材料；聚乳酸；异氰酸酯 doi:10.3969/j.issn.1673-8225.2011.03.031     

骨结构的重建理念

背景：在骨折治疗原则上,主要体现在从生物学和机械力学两方面进行骨结构重建,把生物固定与机械固定,髓内固定与髓外固定相结合。 目的：介绍骨折治疗、骨结构重建理念的发展历程和研究进展。 方法：应用计算机检索中国期刊全文数据库(CNKI：2006-01/2011-05)、Pubmed数据库和Medline database(2006-01/2011-05)数据库有关骨结构的重建理念的文章,检索词分别为“骨结构,重建,理念”和“bone structure,rebuild,principle”,语言分别设定为中文和英文。 结果与结论：共收集30篇有关骨结构的重建理念的文章,排除重复或类似的同一研究,14篇符合综述要求。骨折的治疗理念已经由机械力学固定体系逐渐转向生物学固定体系。骨折治疗必须着重于寻求骨折稳固和软组织完整之间的一种平衡,植入物和器械设计明显改善。近年来,又出现了数字化虚拟人体技术、生物力学有限元理论、创伤控制论、骨质疏松的药理学研究、用组织工程学理论和技术修复创伤缺损等。总的来说,骨结构重建的理念就是患者为中心,在宏观与微观的层次上选择骨折治疗最合理的方法,引导和促进骨的愈合、功能恢复。     

神经生长因子对骨折修复的作用★

学术背景：近来研究发现，在正常骨组织和骨折骨痂中有神经生长因子及其受体的表达,局部给予外源性神经生长因子对骨折修复具有促进作用。 目的：对神经生长因子在骨折修复中的表达、作用及可能的作用机制进行总结分析。 检索策略：应用计算机检索PubMed 1951-01/2007-06期间的相关文章，检索词为“nerve growth factor，bone fracture，repair，osteogenesis”。同时应用计算机检索中文CNKI全文数据库1990-01/2007-06期间的相关文章，检索词“神经生长因子，骨折，修复”。对资料进行初审，纳入标准：①神经生长因子的生物学特性。②骨折修复的过程。③神经生长因子对骨折修复作用的实验或临床研究。排除标准：重复研究、Meta分析或综述类文章。 文献评价：共收集到59篇相关文献，28篇符合纳入标准，排除的31篇为内容陈旧或重复文章。符合纳入标准的28篇文章中，分别涉及神经生长因子的发现发展、生物学特性9篇，神经生长因子的作用5篇，骨折修复过程中参与的因子及各方面因素的影响4篇，神经生长因子对骨折的修复作用10篇。 资料综合：①正常骨组织和骨折骨痂中均有神经生长因子及其受体的表达。②神经生长因子主要由来源于神经嵴的神经元支配的靶组织产生,其被这些神经元轴突摄取后逆行运输至胞体,通过多种途径调节神经细胞的基因转录而发挥生物效应,维持神经元的存活、刺激轴突的生长，并对外周神经的发育、营养起重要的作用。神经生长因子主要是通过促进骨折部位神经的再生参与骨折修复。③骨折愈合的机制十分复杂，神经生长因子对骨组织的作用也是多方面、多层次和相互交叉的,其机制尚未完全探明。 结论：虽然神经生长因子促进骨折修复作用的研究已经取得一些进展，但仍处于初级阶段，其作用机制尚不清楚。     

膝关节损伤生物材料及其生物力学特点☆

目的：总结近年对膝关节韧带的生物力学与人工韧带的研究进展,强调膝关节的损伤类型,膝关节前后交叉韧带修复的主要方法及进展。 资料来源：以human knee cruciate ligament, biomechanics, xenogeneic ligamentous, reconstruction为检索词,检索PubMed数据库(2008-01/2009-07);以膝关节交叉韧带,生物力学,重建,人工韧带,康复为检索词,检索中国期刊全文数据库(2008-01/2009-07)。文献检索语种限制为英文和中文。 资料选择：纳入膝关节及人工韧带相关的内容。排除已被证实落后的研究及重复性研究。 结局评价指标：①膝关节的生物力学特征。②膝关节韧带损伤的情况。③膝关节韧带的修复与重建方法。 结果：计算机初检得到526篇文献,根据纳入排除标准,对膝关节损伤生物材料及其生物力学进行分析。常见的膝关节损伤主要是韧带损伤,为恢复其功能主要采用手术重建,其中利用自体中1/3骨-髌韧带-骨作为移植材料的挤压螺钉内固定重建术,已成为重建前交叉韧带的标准方法。羟基磷灰石是一类具有良好生物相容性的生物活性材料,羟基磷灰石生物活性陶瓷植入体内不仅安全、无毒,还能传导骨生长,即新骨可以从羟基磷灰石植入体与原骨结合处沿着植入体表面或内部贯通性孔隙攀附生长,能与组织在界面上形成化学键性结合。 结论：对膝关节及膝关节韧带进行生物力学分析是防止和治疗膝关节损伤及疾病的基础。具有表面羟基磷灰石涂层无螺纹的假体松动率最低,是最适宜的假体置换材料。 关键词：膝关节;损伤;生物材料;生物力学     

锶在骨组织工程中的研究与应用☆

目的：总结锶元素在骨组织工程中的研究现状，分析存在的问题和进一步的应用前景。 资料来源：以strontium，bone为检索词，检索ScienceDirect数据库(1990-01/2009-03)；以锶，骨为检索词，检索CNKI数据库(1990-01/2009-03)，文献检索语种分别限制为英文和中文。 资料选择：纳入与锶和骨组织工程有关的试验研究和综述。排除关于放射性锶研究的相关文献和内容重复的文献。 结局评价指标：①破骨细胞的活性。②成骨细胞的增殖。③骨诱导能力。 结果：计算机初检得到216篇文献，根据纳入排除标准，对符合条件的41篇文献进行汇总分析。锶是人体内的一种微量元素，绝大多数锶都存于骨组织中。它可以调节骨组织的结构，改善骨的强度，促进骨细胞的生理活性。试验研究证实锶盐具有抗骨吸收和增加骨形成的作用，锶盐可以抑制破骨细胞的活性，促进成骨细胞的活性，促进骨盐的沉积；其与羟基磷灰石和磷酸三钙等复合后，其机械强度、溶解性及诱导成骨能力等特性明显得到改善；锶盐口服有治疗骨质疏松症的作用。 结论：锶对于骨细胞生长分化和骨基质吸收沉积都有不可替代的生理作用，应在骨组织工程的研发中给予必要的重视。 关键词：锶；骨组织工程；羟基磷灰石；磷酸三钙；雷诺酸锶     

富血小板血浆在骨愈合治疗中的作用

背景：富血小板血浆可明显促进各种组织的修复和愈合。临床上运用其治疗骨软骨以及软组织缺损等骨科疾病方面已取得了很多成果。 目的：简要综述近年来富血小板血浆相关研究,总结其在骨科基础研究与临床应用中的进展。 方法：以platelet-rich plasma, bone formation, tissue engineering为检索词,检索Pubmed数据库(1999-01/2011-01),以富血小板血浆,骨缺损,组织工程为检索词,检索中国期刊全文数据库(1999-01/2011-01)。纳入与干细胞以及干细胞在骨科应用方面的基础和临床研究,排除不相关及重复研究。计算机初检得到301 篇文献,根据纳入排除标准,最终纳入30篇。 结果与结论：尽管目前还存在争论,但富血小板血浆仍是一种非常有潜力的技术,尤其是作为细胞支架在组织工程中的应用如能被进一步研究证实有效,将对骨组织工程乃至其他各种组织工程研究产生重大的影响。因此除了规范研究在循证医学方面的要求之外,这应该是PRP今后研究的有一个重要方向。     

生物力学测量与传统测量的比较

质与应用。 目的：综述国内外关于生物力学测量的最新研究以及与传统测量的比较研究。 方法：应用计算机检索Science Direct 数据库、Ei数据库1960-01/2009-10期间的相关文章，检索词为“biomechanics measurement”，并限定文章语言种类为English。同时计算机检索中国期刊全文数据库、中国生物医学文献数据库等1994-01/2009-10期间的相关文章，检索词为“生物力学测量”，并限定文章语言种类为中文。此外还手工查阅相关专著数部。纳入生物力学测量、运动生物力学、生物力学的发展状况、运动生物力学测量方法的研究。 结果与结论：在对比生物力学测量方法与传统测量方法的基础上，各自分析了两者的突出特点，并进行了差异性的研究。生物力学测量技术具有主动性、实时性以及局限性等不同的特点。生物力学的测试过程很多与医学、生物学密切相关，并提出传统测量、测试有利因素为生物力学各个数据的测量工作提供了借鉴意义，为更好地进行生物力学的研究工作提供了理论指导。     

干细胞移植与运动性颅脑损伤的修复

背景：目前临床上针对颅脑损伤，尤其是运动性颅脑损伤的治疗方法是当前研究的热点问题之一。干细胞具有自我更新能力强、多向分化潜能等特点对运动性颅脑损伤的治疗提供了广阔的应用前景。 目的：通过分析运动性颅脑损伤的病理学变化及干细胞技术的应用，探讨干细胞技术应用于运动性颅脑损伤，促进其功能恢复的重要作用。 方法：应用计算机检索Medline数据库(1994-01/2010-03)、重庆维普数据库(1994-01/2010-06)、清华同方数据库(1994-01/2010-06)等以“Stem cell，spots brain injury，neural stem cells，mesenchymal stem cells”为英文检索词，以“干细胞；运动性颅脑损伤；神经干细胞；骨髓间充质干细胞”为中文检索词。以与运动性颅脑损伤和干细胞技术相关的文献为纳入标准，以重复性研究、陈旧性文献为排除标准。共检索到126篇相关文献，通过对重复性研究和陈旧性研究之后得到23篇符合标准的文献。 结果与结论：干细胞移植技术应用于颅脑损伤的研究虽已取得了很大的进步，但在治疗运动性颅脑损伤的领域尚处于探索阶段，有待进一步研究解决的问题很多，通过分析发现干细胞尤其是神经干细胞和骨髓间充质干细胞对于运动性颅脑损伤的治疗具有十分重要的作用，且其研究前景较为广阔。     

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.     

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.     

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.     

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.     

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.