国内六大行政区域六城市中老年人群膝关节骨性关节炎患病危险因素比较

目的：了解中国不同地区间中老年人群膝关节骨性关节炎患病危险因素。方法：调查时间为2005—07／08。①从中国六大行政区（西北，华北，华东。中南，东北，西南）选出六城市（西安，石家庄，上海。广州，哈尔滨市，成都），用分层多阶段整群抽样方法，抽取6218名40岁及以上具有正式户口常住男女人群进行膝关节骨性关节炎的流行病学问卷调查（包括一般情况、现病史、既往史、体格检查、X射线片检查情况和疾病诊断6个方面，共计94个问题141个变量指标），并对其中4808名有症状者进行X射线平片膝正侧位投照。②膝关节骨性关节炎诊断标准为临床症状阳性加X射线Kellgren ＆ Lawrence分级二级及以上者。③计算患病率，并采用Epilnf06．0和SPSS 10．0软件对其中83个变量进行多因素非条件Logistfc回归分析，表示疾病与暴露因素之间联系强度的指标用比值比（OR），若OR〉1，说明疾病发生危险性增加，与暴露因素呈正关联；若OR〈1，说明疾病发生危险性减少，与暴露因素呈负关联。 结果：①六城市膝关节骨性关节炎总患病率为15．6％，其中西安7．7％，石家庄11．2％，上海9．8％。广州30．5％，哈尔滨16．9％，成都17．5％，各城市患病率比较差异显著（P〈0．01）。②Logistic回归分析膝关节骨性关节炎在大部分城市有共同的危险因素如年龄大（OR=1．032—1．181），使用蹲坑排便年限长（OR=1．021-1．077），体质量高（OR=1．048—1．073），和开始饮酒年龄大（OR=1．008～1．028）；而从事专职体育运动（OR=1．651，西安），骨质疏松病史（OR=3．311，石家庄），吸烟（OR=2．654，石家庄），类风湿关节炎病史（OR=4．964，上海），文化程度高（OR=2．593，上海），女性（OR=2．510，广州），姐妹骨关节炎史（OR=13．251，哈尔滨），母亲骨关节炎史（OR=5．683，成都）等危险因素分别在不同地区出现． 结论：年龄大、使用蹲坑排便年限长、体质量高和开始饮酒年龄大是中国六地区膝关节骨性关节炎患病的共同危险因素，同时，不同地区主要危险因素又有一定差异。     

软骨修复组织蛋白多糖代谢与一氧化氮合酶抑制剂的影响

目的:应用一氧化氮合酶抑制剂可改善骨性关节炎和风湿性关节炎软骨的代谢,作者前期的实验也证明一氧化氮合酶抑制剂能提高软骨修复组织的质量。实验进一步观察一氧化氮合酶抑制剂对软骨修复组织蛋白多糖代谢的影响。方法:实验于1999-06/2002-02在南方医科大学完成。①实验分组:取雄性新西兰兔24只,8月龄,体质量(2.5±0.2)kg。随机抽签法分为对照组、骨形态发生蛋白组和S-甲基异硫脲组,每组8只。②实验方法:将大白兔双侧股骨髁间关节面造成全层软骨缺损,对照组:软骨缺损不充填任何物质;骨形态发生蛋白组:缺损用骨形态发生蛋白纤维蛋白凝胶复合物充填;S-甲基异硫脲组:缺损应用胶原复合骨形态发生蛋白充填,术后按5mg/(kg·12h)皮下注射S-甲基异硫脲。术后1年麻醉后处死动物。③实验评估:应用组织切片番红O-快绿染色和图像分析技术,按照染色百分率、平均灰度(平均染色程度)和染色厚度(软骨厚度)指标来检测糖胺聚糖含量;应用Na235SO4掺入法检测软骨修复组织蛋白多糖合成。结果:纳入新西兰兔24只,均进入结果分析。①术后1年,对照组几乎无红色染色区域;骨形态发生蛋白组可见到少量的不均匀红色区域;S-甲基异硫脲组可见到较多均匀一致的红色染色区域。②S-甲基异硫脲组软骨修复组织番红O染色百分率为89.28%,明显高于骨形态发生蛋白组36.54%和对照组13.4%,S-甲基异硫脲组修复组织番红O-快绿染色平均灰度值134.5,分别为骨形态发生蛋白组平均灰度值56.8的2.5倍,为对照组26.4的7倍。软骨平均厚度S-甲基异硫脲组1.75cm分别为骨形态发生蛋白组0.76cm和对照组0.25cm的2倍和6倍。③Na235SO4掺入法结果显示,S-甲基异硫脲组[35S]摄入量明显高于骨形态发生蛋白组和对照组(P<0.01)。结论:诱导型一氧化氮合酶抑制剂S-甲基异硫脲的应用能明显增加软骨修复组织糖胺聚糖含量和蛋白多糖合成,对于软骨修复质量的提高有积极意义。     

Contamination of mesenchymal stem-cells with fibroblasts accelerates neurodegeneration in an experimental model of Parkinson's disease

Pre-clinical studies have supported the use of mesenchymal stem cells (MSC) to treat highly prevalent neurodegenerative diseases such as Parkinson’s disease (PD) but preliminary trials have reported controversial results. In a rat model of PD induced by MPTP neurotoxin, we first observed a significant bilateral preservation of dopaminergic neurons in the substantia nigra and prevention of motor deficits typically observed in PD such as hypokinesia, catalepsy, and bradykinesia, following intracerebral administration of human umbilical cord-derived MSC (UC-MSC) early after MPTP injury. However, surprisingly, administration of fibroblasts, mesenchymal cells without stem cell properties, as a xenotransplantation control was highly detrimental, causing significant neurodegeneration and motor dysfunction independently of MPTP. This observation prompted us to further investigate the consequences of transplanting a MSC preparation contaminated with fibroblasts, a plausible circumstance in cell therapy since both cell types display similar immunophenotype and can be manipulated in vitro under the same conditions. Here we show for the first time, using the same experimental model and protocol, that transplantation of UC-MSC induced potent neuroprotection in the brain resulting in clinical benefit. However, co-transplantation of UC-MSC with fibroblasts reverted therapeutic efficacy and caused opposite damaging effects, significantly exacerbating neurodegeneration and motor deficits in MPTP-exposed rats. Besides providing a rationale for testing UC-MSC transplantation in early phases of PD aiming at delaying disease progression, our pre-clinical study suggests that fibroblasts may be common cell contaminants affecting purity of MSC preparations and clinical outcome in stem cell therapy protocols, which might also explain discrepant clinical results.     

How are caseload and service utilisation of psychiatric services influenced by distance? A geographical approach to the study of community-based mental health services

Introduction  

The aim of this study was to assess how the caseload and the utilisation of community-based mental health services is influenced by distance and to socioeconomic characteristics.     

Principal components analysis based control of a multi-dof underactuated prosthetic hand

Background  

Functionality, controllability and cosmetics are the key issues to be addressed in order to accomplish a successful functional substitution of the human hand by means of a prosthesis. Not only the prosthesis should duplicate the human hand in shape, functionality, sensorization, perception and sense of body-belonging, but it should also be controlled as the natural one, in the most intuitive and undemanding way. At present, prosthetic hands are controlled by means of non-invasive interfaces based on electromyography (EMG). Driving a multi degrees of freedom (DoF) hand for achieving hand dexterity implies to selectively modulate many different EMG signals in order to make each joint move independently, and this could require significant cognitive effort to the user.     

Evaluating the effect of a television public service announcement about epilepsy

Public service announcements (PSAs) are non-commercial advertisements aiming to improve knowledge, attitudes and/or behavior. No evaluations of epilepsy PSAs exist. This study sought to evaluate a televised PSA showing first aid for a seizure. A multilevel regression analysis was used to determine the effect of the PSA on epilepsy knowledge and attitudes taking into account school-level clustering as well as individual-level variables, including socioeconomic status, gender, language and familiarity with epilepsy. Of the 803 randomly selected Grade 5 (9-11 years) students, 406 (51%) had seen the epilepsy PSA. Those who saw the PSA scored significantly higher on knowledge (P < 0.001) and had more positive attitudes (P < 0.001) about epilepsy. Those who saw the PSA had even greater knowledge about epilepsy 1 month later, even though the PSA was no longer being televised. Having viewed, the PSA continued to be associated with higher knowledge and more positive attitudes independent of the effects of a school-based epilepsy education program.     

Squamous cell carcinoma complicating epidermolysis bullosa in a 6-year-old girl

Recessive dystrophic epidermolysis bullosa (RDEB) is a rare form of epidermolysis bullosa (EB) that presents with generalized blistering since birth. Squamous cell carcinoma (SCC) is the most common cutaneous malignancy seen in RDEB, starting from second decade onwards. We report a case of SCC complicating RDEB in a 6-year-old girl.     

Silent Double Aortic Arch Coincidentally Found During Cardiac Catheterization in Elderly Man

We describe a case of an elderly man known for coronary artery disease (previous bypass surgery) hospitalized for ischemia in inferior wall. Since the operation, the patient underwent coronary angiographies. Due to the impossibility of selective engagement of left subclavian artery from femoral access, LIMA was always visualized through a right radial approach. Despite the suspicious of abnormal origin of left subclavian artery, aortic angiography was never performed. During the third angiography, the double aortic arch was coincidentally visualized by using a left Amplatz catheter. The diagnosis was confirmed by 64‐slice computed tomography scan.     

Surgical sperm retrieval and intracytoplasmic sperm injection as treatment of obstructive azoospermia

Male genital tract obstructions may result from infections, previous inguinal and scrotal surgery (vasectomy) and congenital bilateral absence of the vas deferens (CBAVD). Microsurgery can sometimes be successful in treating the obstruction. In other cases and in cases of failed surgical intervention, the patient can be treated by microsurgical or percutaneous epididymal sperm aspiration (MESA, PESA) or testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). We present the results of 39 ICSI procedures for obstructive azoospermia in 24 couples. The aetiology of the obstruction was failed microsurgery in 11 patients, CBAVD in nine and genital infections in four. Sperm retrieval was accomplished via MESA in four cases, PESA in 18 cases and via TESE in 11 cases. TESE was only applied when PESA failed to produce enough spermatozoa for simultaneous ICSI. In six patients, the ICSI procedure was performed with cryopreserved spermatozoa after an initial PESA procedure. Fertilization occurred in 47% of the metaphase II oocytes; embryo transfer was performed in 92% of procedures and resulted in a clinical pregnancy in 13/39 procedures. Ongoing pregnancy was achieved in 10/39 procedures. One pregnancy was terminated early after prenatal investigation showed a cytogenetic abnormality (47,XX+18, Edwards syndrome). The other nine pregnancies resulted in the live birth of 10 children, without any congenital abnormalities. Epididymal and testicular retrieved spermatozoa were successfully used for ICSI to treat obstructive azoospermia, and resulted in an ongoing pregnancy in 10 of 24 couples (41.6%) after 39 ICSI procedures, a success rate of 25.6% per treatment cycle and of 27.7% per embryo transfer.