葡聚糖包裹的超顺磁性Fe3O4纳米颗粒用于MRI造影剂的研究

目的探讨葡聚糖包裹的超顺磁性Fe3O4纳米颗粒（dextran-coated superparamagnetic iron oxides nanoparticles,dextran／SPIONP）作为间质注射的MRI造影剂的可行性。方法应用界面共沉淀法,制备dex—tran／SPIONP,用透射电镜、能谱分析、X射线衍射、红外光谱测试、热重分析等方法对dextran／SPIONP的大小、磁性能等进行表征,并研究葡聚糖对SHONP的影响。然后,将dextran／SPIONP稀释成不同剂量,兔舌粘膜下间质注射后的不同时间段,切取前哨淋巴结,行核磁共振波谱分析,确定dextrart／SPIONP的最适剂量和最佳检测时间。结果dextran／SPIONP的平均直径为6～9nm,其表征与经典的共沉淀法制备的颗粒一致,具有超顺磁性,葡聚糖是影响SPIONP饱和磁化强度的主要因素。dextran／SPIONP用于间质注射的最适剂量为含铁量20μmol,最佳检测时间为注射后2Ah。结论用界面共沉淀法制备的dextran／SPIONP是一种适用于间质注射的MRI造影剂。     

An effective inducer of dopaminergic neuron-like differentiation

Rat bone marrow-derived mesenchymal stem cells were cultured and passaged in vitro. After induction with basic fibroblast growth factor for 24 hours, passage 3 bone marrow-derived mesenchymal stem cells were additionally induced into dopaminergic neurons using three different combinations with basic fibroblast growth factor as follows: 20% Xiangdan injection; all-trans retinoic acid + glial-derived neurotrophic factor; or sonic hedgehog + fibroblast growth factor 8. Results suggest that the bone marrow-derived mesenchymal stem cells showed typical neuronal morphological characteristics after induction. In particular, after treatment with sonic hedgehog + fibroblast growth factor 8, the expressions of nestin, neuron-specific enolase, microtubule- associated protein 2, tyrosine hydroxylase and vesicular monoamine transporter-2 in cells were significantly increased. Moreover, the levels of catecholamines in the culture supernatant were significantly increased. These findings indicate that Xiangdan injection, all-trans retinoic acid + glial-derived neurotrophic factor, and sonic hedgehog + fibroblast growth factor 8 can all induce dopaminergic neuronal differentiation from bone marrow-derived mesenchymal stem cells. In particular, the efficiency of sonic hedgehog + fibroblast growth factor 8 was highest.     

In vivo response to dynamic hyaluronic acid hydrogels

Tissue-specific elasticity arises in part from developmental changes in extracellular matrix over time, e.g. ～10-fold myocardial stiffening in the chicken embryo. When this time-dependent stiffening has been mimicked in vitro with thiolated hyaluronic acid (HA-SH) hydrogels, improved cardiomyocyte maturation has been observed. However, host interactions, matrix polymerization, and the stiffening kinetics remain uncertain in vivo, and each plays a critical role in therapeutic applications using HA-SH. Hematological and histological analysis of subcutaneously injected HA-SH hydrogels showed minimal systemic immune response and host cell infiltration. Most importantly, subcutaneously injected HA-SH hydrogels exhibited time-dependent porosity and stiffness changes at a rate similar to hydrogels polymerized in vitro. When injected intramyocardially host cells begin to actively degrade HA-SH hydrogels within 1 week post-injection, continuing this process while producing matrix to nearly replace the hydrogel within 1 month post-injection. While non-thiolated HA did not degrade after injection into the myocardium, it also did not elicit an immune response, unlike HA-SH, where visible granulomas and macrophage infiltration were present 1 month post-injection, likely due to reactive thiol groups. Altogether these data suggest that the HA-SH hydrogel responds appropriately in a less vascularized niche and stiffens as had been demonstrated in vitro, but in more vascularized tissues, in vivo applicability appears limited.     

关节局部注射罗哌卡因结合静脉PCA泵对全膝关节置换术后的镇痛研究

目的研究全膝关节置换术后关节周围注射罗哌卡因结合PCA泵的镇痛效果。方法选取择期行全膝关节置换手术患者90例,随机分为3组,每组30例（n=30）,第一组（A组）术后包括膝关节后关节囊和前侧切口周围组织浸润注射罗哌卡因,结合静脉PCA泵镇痛;第二组（B组）术后仅在前侧切口周围组织浸润注射罗哌卡因,而不注射后关节囊,结合静脉PCA泵镇痛。第三组（C组）术后仅采用静脉PCA泵镇痛。分别在术后2、12、24、48、72小时,以视觉模拟量表（visual analogue scale,VAS）评估患者术后的疼痛水平。结果术后2、12、24、48、72小时A、B、C组评分分别为2．0,2．1,4．9;2．7,2．6,5．5;3．5,3．4,4．6;2．4,2．5,3．8;1．4,1．4,2．8。A组和B组评分差异无统计学意义（P〉0．05）,A组和B组评分较C组差异有统计学意义（P〈0．05）。结论全膝关节置换术后应用罗哌卡因和静脉PCA泵能够有效缓解疼痛,后关节囊可不注射,镇痛效果优于单用PCA泵。     

Botulinum injection for the management of myofascial pain in the masticatory muscles. A prospective outcome study

We prospectively analysed the outcome after botulinum injection in patients who did not recover after conservative measures to manage masticatory myofascial pain, and who were not willing to take low dose tricyclic antidepressants as a muscle relaxant. We prospectively 62 patients were assessed with visual analogue scores (VAS) for pain on the affected side before, and 6 weeks after botulinum injection(s) (50 units Dysport^® in up to 3 sites), and measured mouth opening in mm. Of those treated 49 (79%) showed at least some improvement (pain reduced by more than 25%). Patients reported more than a 90% reduction in the VAS for 25 (30%) of the 84 sides of the face treated. Only 22 of the 62 patients had more than one course of treatment to the same side. Interincisal distance improved by a mean/median of 0.9 mm (p < 0.03) after treatment. Side effects included 3 cases of temporary weakness of a facial muscle. Ranking the VAS pain scores using the Wilcoxon test before and after injection showed a significant reduction in pain (median change −29.5, interquartile range −53 to −16, p < 0.0001). The treatment significantly improved patients’ pain scores and the overall mean/median reduction in pain was 57%. Botulinum injection does not guarantee complete resolution of myofascial pain, but it usually has some beneficial effect in improving the symptoms, and should be considered as an alternate treatment for masticatory myofascial pain if conservative methods have failed.     

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目的观察STA麻醉仪对牙科畏惧症患者的临床治疗作用。方法回顾2011年1—12月中国医科大学口腔医学院综合急诊科门诊收治的牙科畏惧症患者100例,应用STA麻醉仪治疗患者（试验组）44例,手推注射麻醉患者（对照组）56例。记录麻药起效、失效时间,患者自行评估疼痛程度,同时计算麻醉有效率,对两组结果进行数据分析比较。结果试验组的麻药生效及失效时间均小于对照组（P〈0．05）;试验组疼痛明显轻于对照组（P〈0．05）;试验组的麻醉有效率明显高于对照组（P〈0．05）。结论STA麻醉仪能有效地降低牙科畏惧症患者治疗中的恐惧程度,值得推广使用。     

丹参注射液联合尿激酶治疗脑血栓的疗效研究

目的 探讨丹参注射液联合尿激酶治疗脑血栓的临床疗效.方法 将我院收治的脑血栓患者60例随机分为观察组和对照组各30例,观察组给予丹参注射液联合尿激酶治疗,对照组给予奥扎格雷钠治疗,比较两组患者的临床疗效.结果 观察组的总有效率为100%,对照组的总有效率为73.33%,观察组疗效明显优于对照组,两组比较,差异有统计学意义(P＜0.05).结论 丹参注射液联合尿激酶治疗脑血栓的效果显著,有利于改善患者的神经缺损程度,且安全可靠,不良反应少,值得临床推广应用.     

丹红注射液对糖尿病周围神经病变神经传导影响的临床研究

目的观察丹红注射液对糖尿病周围神经病变患者下肢神经传导速度的影响。方法将60例2型糖尿病下肢周围神经病变患者随机分为观察组和对照组,每组各30例。观察组给予丹红注射液和前列腺素E1联合治疗,对照组给予前列腺素E1治疗,疗程均为4周,观察并记录治疗前后患者症状体征和神经传导速度变化。结果观察组和对照组神经传导速度均得到改善,以观察组改善程度更明显,两组间差异有统计学意义(P<0.05)。结论建立于基础治疗之上的丹红注射液联合前列腺素E1的中西医结合方案治疗糖尿病下肢周围神经病可取得满意的效果,值得临床推广和应用。     

支架释放同时推注造影剂评价支架术后即刻贴壁不良

目的:通过支架释放同时推注造影剂(Simultaneous injection contrast,SIC),判断支架贴壁情况与光学相干断层成像(optical coherence tomography,OCT),测量支架小梁与血管内膜之间距离,对比评价SIC方法,判断术后即刻支架贴壁情况的实用性。方法:入选21例原位病变的冠心病患者,行支架植入术的同时通过释放支架,同时推注造影剂(SIC)方法判断支架大体的贴壁情况,同时记录支架的型号释放压力等,之后用光学相干断层成像(OCT)精确判断支架的贴壁情况,并对OCT图像每隔1 mm的横截面的支架小梁的贴壁情况进行记录和分析,通过两者的结果对比,评价SIC方法在支架贴壁情况中的实用性。结果:21例患者中共植入支架34枚,其中2个支架节段用SIC及OCT判断均存在贴壁不良,11个支架节段SIC判断贴壁良好,而经OCT检查发现存在>1%的支架小梁贴壁不良。SIC和OCT检查均为贴壁良好的支架节段有21个。结论:SIC方法是在临床实践中一种简便实用的判断支架贴壁情况的方法,虽然其准确性难以与OCT相媲美,但作为一种简便经济的方法,值得在临床推广使用。