自体游离骨膜移植修复儿童髋关节软骨大面积缺损：动物实验及临床应用

目的:通过自体游离骨膜移植修复儿童髋关节软骨大面积缺损的实验研究和临床应用,观察关节软骨缺损修复的组织形态学变化和临床应用疗效。方法:①动物实验:实验于2002-03/10在南京医科大学附属南京儿童医院儿科研究所完成。选用新西兰幼兔24只,将幼兔股骨头全层关节软骨用利刀切除其表面积的20%以上,制造髋关节软骨大面积缺损模型。按随机数字表法分为2组,每组12只,自体游离骨膜移植组取同侧股骨全层游离骨膜,将骨膜生发层朝向关节腔移植于软骨缺损区;对照组仅同法切除股骨头关节软骨。分别于术后第4,8,12,24周取其股骨头制成标本,对关节软骨缺损修复情况进行大体及组织形态学观察,并用Wston-blot法检测修复组织中Ⅱ型胶原蛋白的表达情况。②临床实验:选择2000-01/2005-06在南京医科大学附属南京儿童医院骨科手术治疗髋关节脱位时,采用自体游离骨膜移植修复髋关节软骨大面积缺损的患儿39例(48髋),监护人均知情同意。术后定期随访检查。髋关节脱位术后疗效根据临床功能及X射线检查结果进行评定:积分16-20分为优,11-15分为良,6-10分为可,<5分为差。结果:①动物实验:自体游离骨膜移植组术后第4周幼兔股骨头软骨缺损被光滑、不透明的类软骨组织替代;12周后软骨缺损由透明的软骨样组织修复;24周后则完全被近似正常的透明软骨修复。对照组术后24周股骨头软骨缺损仍由纤维样组织覆盖。自体游离骨膜移植组术后第4周起软骨缺损修复组织中Ⅱ型胶原蛋白呈持续高表达。②临床实验:39例患儿48髋均获随访,随访18-36个月18例22髋,37-54个月14例16髋,55-72个月7例10髋,平均32个月。髋关节脱位术后疗效优19例25髋(52.1%);良12例10髋(25.0%);可7例8髋(16.7%);差3例3髋(6.2%),优良率达77.1%。结论:动物实验结果显示幼兔自体游离骨膜移植3个月后基本完成了游离骨膜向关节软骨的分化,可为临床应用提供客观依据。临床实验证实,在手术治疗儿童髋关节脱位时,移植自体游离骨膜修复关节软骨大面积缺损,能够提高手术疗效。     

早期限饲对肉鸡脂质过氧化和抗氧化酶活性长期影响

目的：观察早期限饲（出雏后两周隔天饲喂）对肉鸡脂质过氧化作用和抗氧化酶活性产生的长期影响，并通过与后期限饲（屠宰前两周隔天饲喂）比较，观察不同阶段限饲对肉鸡血清、肝脏、胸肌、腓肠肌丙二醛浓度、超氧化物歧化酶和谷胱甘肽过氧化物酶活性的影响。方法：实验主要于2005—04／12在南京农业大学农业部动物生理生化重点开放实验室完成。实验分组：选取1日龄健康快三黄商品肉鸡100羽随机分为2组，对照组60羽，早期限饲组40羽。饲养至50日龄，从对照组随机选取20羽作为后期限饲组。实验处理：①早期限饲组，1-14日龄进行隔日限饲，以后自由采食。②后期限饲组，1～49日龄自由采食，50～63日龄进行隔日限饲。③对照组，全程自由采食。实验评估：记录每周体质量，检测14日龄对照组、早期限饲组，63日龄对照组、早期限饲组和后期限饲组血清、肝脏、胸肌、腓肠肌丙二醛浓度、超氧化物歧化酶和谷胱甘肽过氧化物酶活性。结果：100羽实验动物均进入结果分析。①14日龄早期限饲组肉鸡血清、肝脏、胸肌和腓肠肌丙二醛浓度、超氧化物歧化酶和谷胱甘肽过氧化物酶活性与对照组相比差异无显著性。②63日龄时早期限饲组血清丙二醛浓度和谷胱甘肽过氧化物酶活性均显著高于对照组（P〈0．05），肝脏超氧化物歧化酶活性显著低于对照组（P〈0．05）；后期限饲组血清丙二醛浓度以及超氧化物歧化酶和谷胱甘肽过氧化物酶活性均显著高于对照组（P〈0．05），而肝脏丙二醛浓度、胸肌超氧化物歧化酶活性显著低于对照组（P〈0．05），腓肠肌各项指标与对照组相比差异无显著性。后期限饲组血清谷胱甘肽过氧化物酶活性显著高于早期限饲组（P〈0．05）。后期限饲组肝脏丙二醛浓度显著低于早期限饲组，超氧化物歧化酶活性显著高于早期限饲组（P〈0．05）。结论：早期及后期限饲均能增强63日龄肉鸡体内整体水平脂质过氧化作用和抗氧化酶活性，早期限饲对肉鸡脂质过氧化作用和血清抗氧化酶活性的即时影响表现不明显，但其影响可以持续到后期。     

同时定性定量测定混合物的光谱多元分析法

本文采用逐步回归方法,并结合光谱多组分分析的品质因数理论,对已知可能存在物种的范围,而实际的物种及其含量需待分析确定的混合物体系,可进行光谱数据解析,同时解决定性定量测定问题。与目标转换因子分析方法不同,本法毋需获取组分浓渡不尽相同的一组混合物光谱,仅用一个试样的光谱矢量数据即能同时完成定性定量分析,用药物试样对本法进行校验,获得满意结果。     

动物组织膜L-维生素C电极的研究

本文以猪肝组织切片偶合氧电极制成了维生素C生物电极。测试了电极的响应特性,当Cu²⁺)离子存在下,在21.14～352.3μg/ml的维生素C浓度范围,电极的动力学响应与维生素C浓度的对数呈线性关系。研究了激活剂的浓度、缓冲介质、温度等因素对电极性能的影响。测得该条件下酶促反应的米氏常数8.0×10^-4mol/L。将电极用于药物中Vc含量分析,结果令人满意。     

表面活性剂用于黄酮药物的薄层色谱分离鉴定的研究

以表面活性剂的胶束溶液为流动相的胶束色谱技术已引人重视,并已成功地应用于药物的薄层色谱分离鉴定。黄酮类化合物是中草药中广泛存在的一类有效成分。本文以十余种表面活性剂的胶束溶液为流动相研究了槲皮素、桑色素和芦丁的胶束薄层色谱行为,拟出了以4％Zeph—乙酰丙酮—水(5:1.5:1.5)溶液为流动相,聚酰胺薄膜为固定相分离此三种黄酮的层析体系,并对槐花进行分离和鉴定,得到了良好效果。     

混合物体系的纯组分红外光谱辨析

用迭代目标转换因子分析法,对混合体系的红外光谱的纯组分光谱辨析进行了研究。三组分及二组分的氨基酸混合体系的纯组分红外光谱辨析结果表明,该法可获满意效果。     

Chronic daily headache- one disease or two? Diagnostic role of serum ionized magnesium

The entity of chronic daily headache (CDH) is well documented, but is not included in the current classification. We divided patients with CDH into groups with and without migrainous features. This division resulted in clearly distinguishable syndromes of daily migrainous headaches (DMH) and daily tension-type headaches (DTH). Family history of headaches was more common in patients with DMH. Patients in both groups had a high incidence of caffeine or drug overuse. The clinical division into DMH and DTH was supported by our finding of a higher incidence of disturbed magnesium (Mg) metabolism in patients with DMH. Of 26 patients with DMH, 8 (30.8%) had low serum ionized, but not total, Mg levels, and 16 (61.5%) had high ionized calcium/magnesium ratios. The corresponding numbers for the 22 patients with DTH were 1 (4.5%) and 8 (30.4%). These new laboratory measurements offer possible biological markers for the diagnosis of different headache syndromes.     

Risk factors for delirium after on-pump cardiac surgery: a systematic review

IntroductionAs evidence-based effective treatment protocols for delirium after cardiac surgery are lacking, efforts should be made to identify risk factors for preventive interventions. Moreover, knowledge of these risk factors could increase validity of etiological studies in which adjustments need to be made for confounding variables. This review aims to systematically identify risk factors for delirium after cardiac surgery and to grade the evidence supporting these associations.MethodA prior registered systematic review was performed using EMBASE, CINAHL, MEDLINE and Cochrane from 1990 till January 2015 (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007371). All studies evaluating patients for delirium after cardiac surgery with cardiopulmonary bypass (CPB) using either randomization or multivariable data analyses were included. Data was extracted and quality was scored in duplicate. Heterogeneity impaired pooling of the data; instead a semi-quantitative approach was used in which the strength of the evidence was graded based on the number of investigations, the quality of studies, and the consistency of the association reported across studies.ResultsIn total 1462 unique references were screened and 34 were included in this review, of which 16 (47 %) were graded as high quality. A strong level of evidence for an association with the occurrence of postoperative delirium was found for age, previous psychiatric conditions, cerebrovascular disease, pre-existent cognitive impairment, type of surgery, peri-operative blood product transfusion, administration of risperidone, postoperative atrial fibrillation and mechanical ventilation time. Postoperative oxygen saturation and renal insufficiency were supported by a moderate level of evidence, and there is no evidence that gender, education, CPB duration, pre-existent cardiac disease or heart failure are risk factors.ConclusionOf many potential risk factors for delirium after cardiac surgery, for only 11 there is a strong or moderate level of evidence. These risk factors should be taken in consideration when designing future delirium prevention strategies trials or when controlling for confounding in future etiological studies.

Electronic supplementary material

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