重组合异种骨临床疗效观察

重组合异种骨（ＲＨＢ）骨形成蛋白（ＢＭＤ）与去除抗原特性后的异种松质骨的复合物，是近年来医学研究的一个新成果。既具有ＢＭＰ的高度诱导成骨作用，又具有松质骨的支架作用，十分便于临床使用、填充骨缺损。作者等应用ＲＨＢ治疗１６例骨缺损及骨不连，证实它是一种高效的成骨诱导物质，诱导生骨作用肯定，无明显副作用，临床使用方便，较自体骨移植愈合时间快，避免了取自体髂骨的痛苦。作者等认为，本生物制品颇值得大力推广应用。     

术前静脉造影对静脉管壁及其吻合效应的实验研究

以动物实验模拟行静脉造影后,肉眼观察,并以透射电镜和扫描电镜动态观察经灌注固定的局部静脉管壁和内皮细胞的改变,发现造影剂回流的静脉管壁在较长的时间内处于扩张状态,同时穿刺注射造影剂的部位出现较严重的淤血和血栓形成。内皮细胞连接有较广泛裂开、剥离及内皮下组织暴露。在受损严重的区域还可见有微血栓形成。造影1天后内皮细胞受损最为严重,至第3天基本恢复。血管吻合实验表明,术前3天静脉造影不影响直径为2.5mm静脉的吻合通畅率。     

Acute biliary-vascular fistula following needle aspiration of the liver

A patient with cavernous transformation of the portal vein and a suspected hepatic mass lesion underwent an ultrasound-guided aspiration of the liver with a skinny needle. Two days later he became acutely ill. Bilirubin level peaked at 1375 mumol/L (80.4 mg/dL), and alkaline phosphatase level was 2290 IU/mL. There was no evidence of biliary obstruction. A biliary-vascular fistula was diagnosed by endoscopic retrograde cholangiography, and nasobiliary drainage was placed, leading to resolution of the symptoms and jaundice. A pressure gradient between the biliary tree and a venous collateral probably led to flow of bile into a blood vessel. Nasobiliary drainage should be considered as a potential therapy for acute biliary-vascular fistula.     

The Influence of Intramammary Lipopolysaccharide Infusion on Serum Ca,P, Vitamin D,Cytokines and Cortisol Concentrations in Lactating Sows

Ten multiparous lactating sows were used to investigate whether intramammary infusion of lipopolysaccharides (LPS; Escherichia coli 0111:B4; 2.0 μg/kg of body weight) would affect the circulating concentrations of Ca, P, 25‐hydroxyvitamin D (25‐OHD), tumour necrosis factor‐α (TNF‐α), interleukin‐6 (IL‐6) and cortisol. The sows were randomly allotted to either control group (control) or LPS‐treated group with five individuals per group and were infused with either physiological saline solution or LPS solution. The rectal temperature and udder quarter appearance were recorded at 0 (just before infusion), 1, 3, 7, 12 or 24 h after infusion. Blood samples were taken at 0, 1, 3, 7, 12 or 24 h after infusion. Before infusion, the rectal temperatures of all sows were below 39.2°C. At 3 and 7 h after infusion, the sows in the LPS group had a rectal temperature over 39.4°C. At 24 h after infusion, the rectal temperatures returned to pre‐infusion levels. Serum Ca and P concentrations in the LPS group decreased (P < 0.05) after LPS infusion compared with the control group at 1 h after infusion. No significant differences (P > 0.05) in the concentrations of 25‐OHD were observed between groups control and LPS at any sampling time. Increased (P < 0.01) concentrations of serum TNF‐α, IL‐6 and cortisol were observed in the LPS group compared with the control group at 3 and 7 h after infusion respectively. In conclusion, the elevation of serum concentrations of TNF‐α, IL‐6 and cortisol and the alterations of circulating concentrations of Ca and P following LPS infusion indicate that the immune system has been activated and immune activation may affect macromineral homeostatic regulation, which might have important implications for metabolic health of lactating sows. Lowered serum Ca and P following immune activation also shows a causative mechanism whereby immune activation increases the risk of secondary disorders such as mastitis‐metritis‐agalactia syndrome. However, immune activation did not affect circulating concentrations of vitamin D metabolites.     

钻颅碎吸治疗急性期高血压性脑出血疗效观察

目的总结钻颅碎吸治疗高血压性脑出血的疗效。方法利用配对方法与保守治疗病人进行对比。碎吸组反复穿刺血肿,调整血压。对照组采取降颅压,营养脑细胞等内科治疗。结果碎吸组病死率15.6%,对照组病死率27%,两组相比P<0.05,CT观察发现,碎吸治疗可加速血肿的吸收。半年后随访结果表明,碎吸治疗可降低致残率。结论钻颅碎吸术可作为治疗部分高血压性脑出血病人的理想选择。     

重组2型腺相关病毒-转化生长因子β3对实验性肝纤维化大鼠肝脏组织病理学和Ⅰ型胶原表达的影响

Objective To investgate the effects of TGF β 3 on rat hepatic fibrosis. Methods The TGF β 3 cDNA was cloned into rAAV2 vector. Rats were randomly divided into four groups: normal control group, model group, negative control group and TGF β 3 group. Hepatic fibrosis was induced by hypodermic injection of 40% CCI4. Recombinant AAV2-TGF β 3 viral particles were injected via the vena caudalis one week before CCh treatment. Rats were executed 8 weeks after CCI4 treatment, global histological change was observed after HE staining, the distribution of the collagen fibers was observed after masson staining, his-tochemistry was done to observe the expression of collagen Ⅰ; The positive area rate of the collagen fibers and the average optical rate of collagen Ⅰ were quantified. Results HE staining indicated that collagen fibers were reduced in the TGF β 3 group. Masson staining shown that the collagen fibers were distributed around the blood vessel, in the portal area and disse space. Compared to the model group (13.2%±2.2%) and negative control group (12.3%±1.5%), the collagen fibers in liver tissues of TGF β3 group (7.7% ± 1.5%) were significantly decreased (q = 9.456, P < 0.01; q = 8.217, P < 0.01). Histochemistry indicated that the collagen fibers of liver tissues of TGF 15 3 group (0.185±0.033) were significantly higher than those in the model group (0.252±0.042) and the negative control group (0.230±0.029), (q = 6.228, P < 0.01; q = 4.346, P < 0.01). Conclusion TGF β 3 alleviates the damage to hepatic cell and the level offibrosis in CCI4 treated rats and inhibits the expression of collagen Ⅰ.     

Application of glow curve analysis methods to improve TLD-100 dose reassessment performance.

This paper presents a method of improving the TLD-100 dose reassessment performance. This method consists of applying numerical analysis techniques for evaluating the TLD-100 phototransferred thermoluminescence (PTTL) glow curve. From this analysis, a simple procedure for estimating the ultraviolet background components usually present in phototransferred thermoluminescence (TL) signals has been established. This procedure has been implemented in a computer program which performs the automatic evaluation of the glow curves and extracts the dose information contained in the PTTL curves. The use of this computer-aided evaluational method has enabled the extension of the working range of estimated absorbed dose down to 0.2-0.5 mGy with very adequate operational quality for doses even below the conventionally admitted lower reestimation limit (approximately 2 mGy). Because TL readout is a destructive process, the ability to reestimate doses can be important in any kind of dosimetric activity, such as operational dosimetry programs. The other commonly used dosimeter, film, uses a nondestructive readout and, therefore, presents some advantages over TLD when dose reassessment is necessary. With the reported improvements in the TLD-100 dose reassessment performance, the full range of absorbed doses covered by film dosimetry can now be reliably reassessed using TLD-100 dosimeters.     

可控性丝线留置术治疗体表难治性海绵状静脉畸形的实验及临床研究

目的研究可控性丝线的致栓效果及其治疗体表难治性海绵状静脉畸形的初步疗效。方法将丝线一端留置于不同管腔大小的静脉内,另一端挂于血管壁埋于皮下,实现其可控性,用经过不同处置的丝线,分别留置于兔耳缘静脉、股静脉,观察其引起血管栓塞的效果。选择致栓效果较好的丝线组,用于临床治疗难治性体表海绵状静脉畸形的患者。结果几种经不同处置的丝线,均能不同程度地起到闭塞血管的作用,对于管腔稍大,血流较快的静脉(兔股静脉),浸泡丝裂霉素并打结的丝线组,致栓效果最好;临床初步应用证实,可控性丝线治疗体表难治性静脉畸形,安全有效。结论可控性丝线静脉内留置术,是一种安全、有效、损伤小、操作简便的治疗体表难治性海绵状静脉畸形的新方法。     

The effect of fraction time in intensity modulated radiotherapy: theoretical and experimental evaluation of an optimisation problem.

BACKGROUND AND PURPOSE: In intensity modulated radiotherapy (IMRT), the complexity and the number of treatment fields have expanded. This may imply that the delivery time for each fraction becomes prolonged. In a number of IMRT techniques used in the clinic, the delivery time per fraction is usually 10-15 min, sometimes more than 15 min. In studies on human skin, prolonged delivery time is shown to cause significant reduction of radiation effects compared with acute irradiation. In this paper the effect of changes in fraction delivery time was studied by in vitro irradiation of mammalian cells. MATERIAL AND METHODS: Chinese hamster fibroblasts (V79-379-A) were used for simulating clinical situations. Most experiments were performed with 2Gy/fraction with 4-h intervals in 40-60 replicates. Each fraction was divided into different subfractions, simulating the delivery of a complicated treatment. The effect of changing the delivery time for each fraction was studied. Parameters for the cell survival curve and repair kinetics were determined experimentally. The same methods were also used for large fraction sizes (8Gy). The validity of the most widely used models in the literature, all derived from linear-quadratic formalism, were tested against the experimental results. RESULTS: The effect of prolonging the fraction time for 2-Gy fractions was underestimated by the biological models. The experiments showed that 10-min prolonged delivery time gave a ratio between surviving fractions at 2Gy (S-ratio) of 1.054 with a 95% confidence interval (CI) 1.030-1.080, while the models predicted 1.007 and 1.009. Extending the fraction time to 20 min gave an S-ratio of 1.063 with CI of 1.045-1.080, while the models predicted 1.012 and 1.014. For 8-Gy fractions, there was a good agreement between predications and experimental results. The ratio between surviving fractions at 8Gy is 1.370 with CI of 1.300-1.440, while the models predicated 1.37 and 1.35. CONCLUSIONS: The effect of prolonging fraction time at conventional dose/fraction is underestimated by biological models. Prolonging the fraction time will spare tissues with a fast DNA repair. There is a risk for sparing tumours. This should be considered when IMRT technique is implemented in the clinic.