脂肪干细胞与骨髓间充质干细胞心肌样分化特性的比较

目的：骨髓间充质干细胞与脂肪干细胞均具有分化为心肌细胞的潜能。观察脂肪干细胞体外诱导分化为心肌细胞的特性及相关基因表达，比较骨髓间充质干细胞与脂肪干细胞心肌分化能力的差异。方法：实验于2006—08／2007—04在吉林省耳鼻咽喉研究所和教育部吉林大学人兽共患病重点实验室完成。①实验材料：脂肪组织标本来源于本院手术患者，所有患者知情同意，术中收集多余的皮下脂肪。（爹实验方法：分离培养人脂肪干细胞，用5-氮胞苷诱导传4～6代的脂肪干细胞分化，平行培养第5代骨髓间充质干细胞，诱导条件相同，对照组培养液不添加任何诱导因子。③实验评估：采用免疫荧光技术观察脂肪干细胞和骨髓间充质干细胞表达结蛋白Desmin和肌钙蛋白TroponinT的阳性细胞率。通过即时RT．PCR的方法检测诱导过程中细胞内GATA-4和NKX2．5的mRNA水平。结果：脂肪干细胞经5-氮胞苷诱导后3周，肌性基因标志结蛋白desmin和肌钙蛋白Troponin—T阳性细胞明显增加。与骨髓间充质干细胞组比较，脂肪干细胞表达心肌特异蛋白的阳性细胞率在诱导后第14天明显升高，而在第21天时，两组细胞的阳性表达率均达到60％左右，无明显的统计学差别，未加任何诱导条件的脂肪干细胞对照组培养14d时有2．5％和1．6％的细胞表达Desmin，Troponin．T，在骨髓问充质干细胞对照组未见心肌标记蛋白的阳性表达。即时PCR检测结果发现，诱导组与未经诱导组的脂肪干细胞均表达GATA-4和NKX2．5，骨髓间充质干细胞组在诱导后第7天出现GATA-4和NKX25的转录活性。结论：体外培养的脂肪干细胞能够被5-氮胞苷诱导分化为心肌样细胞，并且具有自发分化的能力，与骨髓间充质干细胞相比，脂肪干细胞的早期分化特性更有利于心肌干细胞移植治疗。     

Serum cardiac troponin T levels as an indicator of myocardial injury in ischemic and hemorrhagic stroke patients

Many studies in the literature have clearly shown the increase in creatine kinase-myocardial subfraction (CK-MB) levels and changes in electrocardiography (ECG) after stroke. However, the studies on cardiac troponin T (cTnT) which is more sensitive and specific to myocardium after stroke are relatively scarce. Moreover, its associations with volume of stroke lesions and type of stroke have not been investigated thoroughly. Thus, the aims of this study were to investigate a predictive value of cTnT in assessing myocardial injury and cardiac dysfunction in different types of stroke (hemorrhagic or ischemic stroke) and its relationship with stroke size and volume. This study included 62 patients (30 males and 32 females) with acute stroke confirmed by computed tomography (CT). Blood samples were obtained within 24 hours of stroke onset to measure the serum levels of creatin kinase (CK), CK-MB, lactate dehydrogenate (LDH), and cTnT. ECG and echocardiography were performed to assess myocardial function and left ventricular ejection fraction (LVEF). Of all patients included in the study, 20 patients (32%) demonstrated elevations in cTnT, while 28 patients (45%) had increased CK-MB levels. Serum levels of cTnT were positively correlated with stroke volume (r = 0.65, p < 0.0001), while inversely correlated with LVEF (r = -0.53, p < 0001). Serum levels of both CK-MB and cTnT were higher in patients with hemorrhagic stroke than those with ischemic stroke but this difference was not significant (p > 0.05). As a conclusion, cTnT has a higher specificity and sensitivity in detecting myocardial injury after stroke of both ischemic and hemorrhagic origins. Measurement of the serum levels of cTnT is of clinical importance in evaluating myocardial injury and provides a useful aid in estimating the volume of stroke lesions.     

骨髓源干细胞与特发性肺纤维化的治疗

目的:综合目前国际上研究骨髓源干细胞对抗肺纤维化的研究进展,介绍目前对其机制的假定,为干细胞在肺纤维化治疗上的应用提供思路。资料来源:应用计算机检索Pubmed数据库2000-01/2006-12相关文献,检索词"stem cells,lung fibrosis",限定文章语言种类为"English"。同时查阅中文期刊数据库2000-01/2006-12干细胞与肺损伤相关文章,检索词"干细胞,肺损伤",限定文章语言种类为中文。资料选择:对资料进行初审。纳入移植的异体骨髓源干细胞在肺损伤受体内行为的基础与临床相关研究,以及特发性肺纤维化进程中因子环境的相关文章。排除综述文献、重复研究。资料提炼:共收集到文献207篇,按上述标准引用其中31篇。资料综合:由于肺部结构的复杂性,干细胞的应用研究进展落后于其他器官。目前主要的研究还集中于动物模型阶段,临床上的研究多效果有限。动物模型研究多采用在模型鼠体内植入干细胞观察治疗效果的方法,主要通过性别不匹配或携带标记鼠的骨髓细胞或骨髓细胞亚群移植等手段。关于移植干细胞减缓炎症、对抗纤维化的机制,目前的研究结论还有待统一。一种假定是植入的干细胞替代II型肺泡上皮,另一假定是外来的干细胞改变受损部位微环境。结论:骨髓来源干细胞在治疗及预防肺纤维化方面可能存在巨大潜力,其具体治疗方案与治疗机制还有待进一步研究。     

具有防坠床功能的智能护理床的研制

目的:设计一种护理床,以预防缺乏自控能力的老年人和智障人员发生坠床危险。方法:利用重心测定原理,计算患者在床上的位置,并辅以红外探测报警,实现自动报警防坠床的主要功能。结果:该护理床在Labview环境下编制监控程序,建立自动监控报警系统;以相应比例的砝码代替患者进行实验测试。结论:测试结果表明:①该装置监控到报警响应时间短,能够及时发现隐患,减少患者意外发生。②护理床采用全自动监控报警,可减轻护理人员的负担。     

逆转手法按摩和系列石膏固定治疗小婴儿先天性马蹄内翻足

目的:观察应用逆转手法按摩和系列石膏固定治疗先天性马蹄内翻足的疗效。方法:选择2004-01/2006-02郑州市儿童医院门诊就诊的先天性马蹄内翻足患儿29例41足,柔软型20例27足,僵硬型9例14足;平均年龄46d。于石膏室应用逆转手法按摩后行系列石膏固定治疗,矫正后应用矫形支具维持治疗。矫正标准:足部外展40°、外翻20°、背伸20°,提起患儿,其足部能在桌面上踏平。结果:24例34足通过手法按摩、系列石膏固定矫正,占83%(24/29),平均治疗时间6.3周;5例7足(均为僵硬型)畸形减轻,3例3足行经皮跟腱延长术,2例4足行肌平衡术。全部病例均获随访,随访6￣30个月,平均17个月。其中3例6足畸形复发,5足行经皮跟腱延长术,1足行肌平衡术。结论:应用逆转手法按摩、系列石膏固定治疗先天性马蹄内翻足效果显著。     

Should endometrial polyps be removed in patients with postmenopausal bleeding?—an assessment of study designs and report of a failed randomised controlled trial (ISRCTN73825127)

We describe the design of a randomised controlled trial to evaluate the efficacy of endometrial polyp removal in women with postmenopausal bleeding. We designed a trial in which patients with postmenopausal bleeding and endometrial thickness >4 mm undergo hysteroscopy. If during hysteroscopy an endometrial polyp was diagnosed, patients were asked to participate in this trial and after informed consent allocated to immediate removal of the polyp or expectant management. This trial suffered from lack of recruitment related both to doctors seeking for informed consent as well as to patients' unwillingness to participate in this trial. However, a randomised controlled trial on this subject is still necessary to evaluate the efficacy of uterine cavity evaluation in the diagnostic work-up of women with postmenopausal bleeding, focussing on benign pathology. Therefore, we propose an alternative design, which might be more feasible.