羧甲基纤维素钠新型敷料的降解性和生物相容性

目的通过动物体内埋置实验，观察羧甲基纤维素钠新型敷料的可降解性和生物相容性。方法将羧甲基纤维素钠新型敷料埋植入小鼠皮下，分别在1、2、3、4周进行大体观察和取材，冰冻切片HE染色光镜观察。结果羧甲基纤维素钠新型敷料在体内3周已基本降解。体内植入大体观察及组织形态学检查显示其具有良好的可降解性和生物相容性。结论羧甲基纤维素钠新型敷料可被降解吸收，生物相容性好。     

新型高孔隙率聚乳酸支架复合物在体内形成新生软骨的实验观察

目的观察软骨细胞-新型高孔隙率聚乳酸(PLA)支架复合物在体内形成新生软骨的能力.方法体外培养兔耳廓弹性软骨细胞,取第2代软骨细胞与新型高孔隙率聚乳酸支架形成复合物,体外培养1周后移植于兔颈部气管旁带状肌间隙,以未种软骨细胞的聚乳酸支架作为对照.结果移植于兔体内1个月后,接种了软骨细胞的新型高孔隙率PLA支架有新生的软骨形成,2个月后新生软骨逐渐成熟并形成明显的软骨陷窝,而对照组无软骨形成.结论这种新型聚乳酸支架种植软骨细胞后在体内具有成软骨能力,可用作软骨组织工程的支架材料.     

PLGA/甲壳胺无纺布三维生物支架的安全性及组织相容性观察

目的：观察新型三维生物支架聚丙交酯-乙交酯共聚物[poly（dl-lactide-co-glycolide）,PLGA]/甲壳胺无纺布的生物安全性及组织相容性.方法：将PLGA/甲壳胺无纺布三维生物支架植入兔皮下,分别于术后2、4、8、12周进行血常规、肝功能、肾功能检测,观察切口局部情况及心、肝、肾组织学变化,植入支架局部取材进行组织学检查.结果：术后不同时间血常规、肝功能、肾功能检测与术前比较无明显差异（P＞0.05）,心、肝、肾组织学检查观察均未见病理性改变.体内植入大体观察及组织形态学检查显示其具有良好组织相容性.结论：PLGA/甲壳胺无纺布新型三维生物支架具有良好的生物安全性及组织相容性.     

新型骨支架材料20%β-TCP/PDLLA亲水性、组织相容性和生物安全性观察

目的观察新型骨支架材料20%β-TCP/PDLLA支架亲水性、组织相容性和生物安全性。方法体外滴水法观察比较支架材料20%β-TCP/PDLLA及PDLLA亲水性;体内研究,将材料植入大鼠体内,2,4,8,12周进行血常规、肝功能、肾功能,Ca2+、P、ALP检测;观察伤口局部情况及心肝肾组织学变化,植入材料局部取材进行组织学检查。结果β-TCP/PDLLA支架亲水性明显高于PDLLA支架,血常规、肝功能、肾功能,Ca、P、ALP检测两种材料无明显差异,心肝肾组织学检查观察均未见病理性改变。植入体内β-TCP/PDLLA支架组织学检查巨噬细胞2周时最高且多于PDLLA支架组,而后逐渐下降,12周时两组相当,均基本消失。结论新型骨支架材料具有良好的亲水性、生物相容性和生物安全性。     

复合材料气管内可降解支架的降解性能*☆

背景：经过对目前国内外可降解材料支架研究的充分调研,以及在镍钛记忆合金支架设计、制作、实验和临床应用的经验基础上,提出一种新型自膨式左旋聚乳酸可降解覆膜气管内支架的研究。目的：自行制作左旋聚乳酸复合羟基磷灰石生物可降解材料气管内支架,测试其机械力学、生物相容性及降解性能。方法：利用计算机辅助设计支架模型,应用相对分子质量150000的左旋聚乳酸和羟基磷灰石按一定比例混合后研制直径分别为20,21,22,23,24,25,26 mm的可降解气管内支架,采用万能实验机检测其力学性能。将研制的可降解气管内支架以合适的尺寸置入杂种犬气管狭窄模型,置入后4,8,12,16周观察支架黏均分子质量及质量变化,同时检测可降解气管内支架体外降解黏均分子质量及质量的变化。结果与结论：复合材料可降解气管内支架的平均径向支撑力为7.8 kPa,支架表面覆盖率小于20%,支架扩张率≥4%,支架纵向缩短率≤9%,已达到气管内可降解支架的力学要求。支架置入后4-16周组织病理学观察未见明显炎症反应。支架体内降解解组不同时间点的黏均分质量下降程度及质量损失率高于体外降解组(P均<0.05)。表明左旋聚乳酸/羟基磷灰石复合材料支架具有良好力学性能、生物相容性及可降解性。     

新型骨支架材料20％β—TCP／PDLLA亲水性、组织相容性和生物安全性观察

目的：观察新型骨支架材料20％β－TCP／PDLLA支架亲水性、组织相容性和生物安全性。方法：体外滴水法观察比较支架材料20％β－TCP／PDLLA及PDLLA亲水性；体内研究，将材料植入大鼠体内，2，4，8，12周进行血常规、肝功能、肾功能，Ca^2 、P、ALP检测。观察伤口局部情况及心肝肾组织学变化，植入材料局部取材进行组织学检查。结果：β－TCP／PDLLA支架亲水性明显高于PDLLA支架，血常规、肝功能、肾功能，Ca、P、ALP检测两种材料无明显差异，心肝肾组织学检查观察均未见病理性改变。植入体内β－TCP／PDLLA支架组织学检查巨噬细胞2周时最高且多于PDLLA支架组，而后逐渐下降，12周时两组相当，均基本消失。结论：新型骨支架材料具有良好的亲水性、生物相容性和生物安全性。     

脱钙骨/聚乳酸重组人工骨的体内生物学特性

背景:前期实验证实脱钙骨/聚乳酸重组人工骨不仅孔隙率、孔径、机械强度等性能符合人工骨材料的要求,并且结合了两种材料的优势,具有明显的促进细胞贴附、增殖作用.目的:进一步探讨脱钙骨/聚乳酸重组人工骨在体内的生物相容性、降解情况及成骨特点,评价其性能.方法:将脱钙骨/聚乳酸重组人工骨随机植入成年新西兰白兔1.5 cm的桡骨缺损及一侧臀肌内,并设立不植入任何材料的空白对照组.观察脱钙骨/聚乳酸重组人工骨植入后动物局部反应,检测血钙值;植入后6,8,12,16周取骨缺损处标本作X射线、骨矿含量、大体标本及组织形态学观察,臀肌处标本仅作组织形态学观察,分析不同时期组织反应、骨缺损修复及材料降解情况.结果与结论:脱钙骨/聚乳酸重组人工骨植入后无明显的局部不良反应,血钙值无明显变化;骨缺损内骨矿含量在植入6～16周内升高幅度明显高于空白对照组;X射线、大体标本及组织形态学观察显示,脱钙骨/聚乳酸重组人工骨的成骨方式主要是骨传导成骨,至植入后16周时骨缺损基本修复,而空白对照骨缺损断端仅有少量骨修复,形成骨不连;脱钙骨/聚乳酸重组人工骨植入后即开始其降解过程,12周以后材料周围出现较多吞噬有材料颗粒的巨噬细胞和多核巨细胞,16周时仍有部分材料未降解吸收.结果证实脱钙骨/聚乳酸重组人工骨具备良好的生物相容性和骨传导成骨能力,可以在体内逐渐发生生物降解.     

生物可降解冠状动脉支架涂层材料聚乙二醇- 聚乳酸-聚谷氨酸共聚物的生物相容性研究

目的 对聚乙二醇-聚乳酸-聚谷氨酸共聚物材料进行体内生物相容性研究，为该材料作为冠状动脉内支架涂层材料的临床应用提供实验依据。方法 通过急性全身毒性试验、皮内刺激试验、溶血试验、细胞毒性试验、热源试验、过敏试验、体内植入试验综合评价聚乙二醇-聚乳酸-聚谷氨酸共聚物的生物相容性。结果 聚乙二醇-聚乳酸-聚谷氨酸共聚物浸提液无溶血反应和急性全身毒性反应，无热源反应，材料中不存在致敏性物质。复合材料体内植入在初期有轻度的炎症反应，12周后炎症反应基本消失，未见巨噬细胞积聚现象，材料在16周基本完全降解。结论 聚乙二醇-聚乳酸-聚谷氨酸共聚物具有良好的生物相容性，其作为冠状动脉内支架涂层材料或载体应用于临床具有可行性和安全性。     

多孔丝素材料组织相容性的初步研究

背景:丝素蛋白支架材料被植入生物体内后会发生降解且无法完全与宿主组织分离,这类材料生物相容性的研究大多为体外实验,其体内的组织相容性和降解过程的研究结果仍不充分。目的:初步观察多孔丝素材料的体内组织相容性。方法:将多孔丝素支架埋藏于SD大鼠背部皮下,术后2,4,6,8周分别取材,对伤口局部及材料情况大体观察,然后材料切片苏木精-伊红染色行组织学观察。结果与结论:动物伤口愈合良好,多孔丝素表面形成极薄的纤维包裹,周围组织反应轻微。组织切片见炎细胞浸润,以巨噬细胞为主,支架材料边缘孔隙内有成纤维细胞和毛细血管长入。8周时材料边缘部分可见支架结构崩解现象,而材料内部变化不大。结果显示组织细胞可以沿多孔丝素支架表面贴附生长,提示支架材料具有较好的组织相容性。     

多孔丝素材料组织相容性的初步研究

背景：丝素蛋白支架材料被植入生物体内后会发生降解且无法完全与宿主组织分离,这类材料生物相容性的研究大多为体外实验,其体内的组织相容性和降解过程的研究结果仍不充分。目的：初步观察多孔丝素材料的体内组织相容性。方法：将多孔丝素支架埋藏于SD大鼠背部皮下,术后2,4,6,8周分别取材,对伤口局部及材料情况大体观察,然后材料切片苏木精-伊红染色行组织学观察。结果与结论：动物伤口愈合良好,多孔丝素表面形成极薄的纤维包裹,周围组织反应轻微。组织切片见炎细胞浸润,以巨噬细胞为主,支架材料边缘孔隙内有成纤维细胞和毛细血管长入。8周时材料边缘部分可见支架结构崩解现象,而材料内部变化不大。结果显示组织细胞可以沿多孔丝素支架表面贴附生长,提示支架材料具有较好的组织相容性。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.