透明质酸钠对大鼠成肌细胞增殖和分化的影响

目的 研究透明质酸钠对成肌细胞增殖和分化的影响。方法 采用酶消化法将新生SD大鼠骨骼肌组织分离、纯化、原代培养及传代培养；取第3代成肌细胞，分别加入浓度为0．05%、0．1％及0．2％的透明质酸钠溶液作为生长培养基行体外培养为实验A、B及C组，加入常规生长培养基为对照D组，观察各组成肌细胞增殖情况，并采用细胞计数及MTT法绘制生长曲线。另选择0．1%透明质酸钠融合培养基行体外成肌细胞培养，常规融合培养基作对照，观察透明质酸钠对成肌细胞分化功能的影响。结果A、B及C组成肌细胞增殖表现相似，2d时进入对数生长期，4d时均达顶峰；D组成肌细胞于3d时进入对数生长期，5d时细胞数倍增，6d时达顶峰。MTT法所测吸光度（A）值的变化反映成肌细胞的增殖情况，与细胞计数的结果一致，以B组细胞增殖作用最明显，B组A值在2～8d时均高于C、D组（P〈0．05），8d时高于A组（P〈0．05）。0．1％透明质酸钠融合培养基中的成肌细胞融合率较低且上升缓慢，7d时融合率最高，为11．7％；常规融合培养基成肌细胞融合率于6d时达到峰值，约为35．0%。结论 透明质酸钠与成肌细胞的细胞相容性较好，可以作为良好的成肌细胞培养基。     

Survivin在食管癌中的表达及其与bcl-2表达关系的相关研究

目的探讨Survivin在食管癌组织中的表达及其与bcl-2蛋白表达的相关性。方法应用免疫组织化学SP法,检测Survivin、bcl-2蛋白在68例食管癌组织和20例正常食管组织中的表达。结果Survivin蛋白在正常食管组织中低表达或不表达,68例食管癌组织中,49例表达阳性,占72.1%。Survivin蛋白表达与分化程度、淋巴结转移密切相关(P<0.05)。食管癌组织bcl-2蛋白表达阳性、阴性组中,Survivin蛋白阳性表达率分别为94.7%(36/38)和43.3%(13/30),两者比较,差异有统计学意义(P<0.05)。Survivin蛋白表达与bcl-2蛋白表达密切相关。结论Survivin在食管癌组织中表达上调,通过抑制细胞凋亡,在食管癌的发生中起到重要作用;凋亡相关基因bcl-2的上调与Survivin的表达可能在食管癌变中起协同作用。     

CT定位下经皮穿刺射频消融治疗肺肿瘤疗效分析

目的探讨CT引导下集束电极射频治疗肺恶性肿瘤的疗效。方法对1999年以来在cT定位引导下。采用WE7568集束电极射频肿瘤消融仪。用集束电极经皮穿刺到肺内肿瘤进行射频消融治疗，每针次温度75～95℃左右维持10min或15min．结果78例病人经CT引导行射频消融80例次，绝大多数病灶（77．4％）复查CT均有不同程度缩小或CT值下降30～37，疼痛等症状明显缓解。无严重并发症，无围手术期死亡。结论CT定位下经皮集束电极射频消融对肺恶性肿瘤的近期疗效明显，对晚期肺癌、多发性肺转移瘤及不能耐受手术者，可作为综合治疗的方法之一。     

Evaluating systems of care: Missing links in children's mental health research

Systems of care (SOCs) have been developed throughout the country to meet the needs of children with severe emotional disturbances (SED) and their families. In these SOCs, multiple agencies and disciplines are expected to work together with informal community supports to address families' needs (Stroul & Friedman, 1986a). A review of the literature on the impact of SOCs suggests: (a) communities' service delivery systems change; and (b) children experience modest improvements in symptomatology and functioning. At the same time, little is known about (a) which components of the SOC approach, at what levels, are necessary to impact child and family outcomes; (b) the degree to which SOCs affect other family members, beyond the target child; and (c) the impact of community contexts and supports in SOCs. Future research should improve measurement of key SOC constructs, examine the relation between specific levels of implementation and outcomes for the entire family, and investigate the impact of broader community systems and supports on families within SOCs. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 655–674, 2004.     

Free flap monitoring with continuous tissue oxygen tension measurement

Intraoperative and postoperative free flap monitoring by means of oxygen tension measurement was carried out in 11 patients. We used an invasive flexible microcatheter that allowed for measurement of oxygen tension in all types of free flaps. Two cases of the measured flaps were buried free flaps which do not allow monitoring by clinical assessment. All flaps monitored in this study survived. One case of displacement of the microcatheter occurred. In one patient, the tissue pO₂ monitor successfully detected early vascular thrombosis with subsequent reoperation and salvage of the free flap.     

急性肺栓塞时心肌血流灌注的变化

目的观察急性肺栓塞（APE）后冠状动脉血流量及心脏肌钙蛋白T（cTnT）与肌红蛋白（Mb）含量变化，探讨心肌血流灌注在急性肺栓塞继发心肌损伤机制中的作用。方法通过介入方法经导管注入自体血栓选择性栓塞肺动脉，建立不同栓塞面积的急性肺栓塞动物模型。监测栓前、栓后5、30min，1、2h冠状动脉血流量变化及栓后4h血清cTnT与Mb含量。结果急性肺栓塞后血清cTnT与Mb含量升高。急性肺栓塞导致冠状动脉血流量显著下降，肺血管栓塞后15～30min降至最低值，30min后趋于平稳。右冠血流量下降程度与肺栓塞面积有显著相关性。结论冠状动脉血流量减少及血清心肌结构蛋白含量升高为急性肺栓塞继发心肌缺血改变提供了直接证据。急性心肌缺血严重影响急性肺栓塞的预后。     

Validation of a simplified technique for using the POPQ pelvic organ prolapse classification system

Our objective was to determine the inter-examiner agreement of a simplified pelvic organ prolapse quantification (POPQ) exam and to assess its correlation with the standard POPQ exam. This study consists of two parts; both were preformed in a prospective, randomized, blinded fashion on women presenting with complaints attributed to pelvic organ support defects. The first study was done to determine the inter-examiner reliability of a simplified POPQ exam. The simplified POPQ exam is based on the POPQ with similar ordinal staging but with only four points measured instead of nine. Forty-eight women underwent exams by five different investigators. The order of exams was randomized and the examiners were blinded to the results of each other’s findings. The results of these two exams were compared using weighted kappa statistics. The second part of the study was done to determine the inter-system agreement between the simplified vs standard POPQ exam. A group of 49 women were examined by four different investigators: one using the simplified and the other using standard POPQ exams. The order of the exams was randomized and the examiners were blinded to the results of each other’s exam. Kendall’s tau-b statistics were used to determine the inter-system agreement. For the inter-examiner reliability of the POPQ exam, the average age was 60±13 years. The weighted kappa statistics for the inter-examiner reliability of the simplified prolapse classification system were 0.86 for the overall stage, 0.89 and 0.86 for the anterior and posterior vaginal walls, respectively, 0.82 for the apex/cuff, and 0.72 for the cervix. All demonstrate significant agreement. For the inter-system association between the simplified POPQ and standard POPQ, the average age was 61±15 year. The Kendall’s tau-b value for overall stage was 0.90, 0.83, and 0.87 for the anterior and posterior walls respectively, and 0.78 for the cuff/apex and 0.98 for the cervix. There is good inter-examiner agreement of a simplified POPQ classification system and it appears to have good inter-system association with the POPQ.IUGA Standardization of Terminology Committee members: Robert Freeman MD (chairman), Steven Swift, Eckhard Petri MD, Richard J. Scotti MD, and Peter Dwyer MD.     

From Innumeracy to Insight: The Uncertainty of Help versus Harm in Treatment of Asymptomatic Aortic Aneurysms

There is insufficient evidence that the surgical treatment of asymptomatic infrarenal aneurysms > 5.5 cm. is beneficial to patients. This is the result of serious complications of aneurysm surgery and the dearth of information from randomized trials. Based on evidence from the literature we defined scenarios and translated data into natural frequency trees to improve understanding of the uncertainty of help versus harm due to treatment of aneurysms. Our analysis shows that the majority of patients can expect little on longevity from surgery while they are at risk of dying from surgery or suffering from serious morbidity. We conclude that, as long as uncertainty persist, patients should be treated in hospitals that can show very low surgical mortality and major morbidity rates. To further resolve the problem of uncertainty randomized trials for larger aneurysms should be performed. Important issues to discuss are the lower and upper limits of the diameter of the aneurysms and the age and risk profiles of the patients to be included in such trials.     

Analysis of surgical management of calvarial tumours and first results of a newly designed robotic trepanation system.

This study was performed to evaluate the surgical strategy in patients with calvarial tumours, in order to design and modify a robot-assisted trepanation system. A total of 75 patients underwent craniectomy for the treatment of calvarial tumours during the 10-year period from 1993 to 2002. The patients' complaints, the size, location and histology of the tumour, and the various cranioplasty techniques used were analysed retrospectively. In a second procedure several craniectomies at typical locations according to the study's results were performed in a laboratory setting using a hexapod robotic tool, constructed at the Helmholtz-Institute, RWTH Aachen University, and plastic model heads. The workflow was documented and the reproducibility and the accuracy of the procedure were registered. A total of 83 surgical procedures were performed on 75 patients. The majority (87 %) of lesions treated surgically were located in the frontal, temporal and anterior parts of the parietal region. Histological examination revealed benign lesions in 66 % of the patients and dural involvement in 46 %. According to these results craniectomies were performed using the robotic system. Mean positioning accuracy of the robotic system while milling was 0.24 mm, with a standard deviation of 0.04 mm, and maximum error under 1 mm. Craniectomies leaving a 1-mm layer of the tabula interna intact to ensure a healthy dura were performed in several regions successfully. The majority of calvarial tumours, requiring surgical treatment in our patients, were located in cosmetically relevant areas in which drilling can be carried out with the robotic trepanation system. Consequently, the surgical approach had to be planned carefully in order to achieve a good cosmetic outcome.