老化皮肤的胶原与弹性组织变化研究

目的：探讨光曝露情况及年龄因素对皮肤中弹性组织、Ⅰ/Ⅲ型胶原及基底膜Ⅳ型胶原的影响,进而探索皱纹形成的组织学原因。方法：对80例取自不同年龄志愿者的曝光部位（眶周/前额、面颊）及非曝光部位（腹部/臀部）的皮肤组织进行HE染色、Weigert染色、苦味酸天狼猩红染色及免疫组化处理,采用显微形态观察和半定量分析。结果：各部位皮肤基底膜内Ⅳ型胶原的含量无差异;随着曝光时间增加,前额/眶周皮肤中Ⅰ型胶原减少率最大,弹性变性物质增加率最大。结论：前额/眶周皮肤的胶原显著减少和弹性变性物质明显增生,是该部位皮肤皱纹早发的重要原因。     

Nocturnal hypoglycaemia in Type 1 diabetic patients,assessed with continuous glucose monitoring: frequency,duration and associations

Aims We quantified the occurrence and duration of nocturnal hypoglycaemia in individuals with Type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) or multiple‐injection therapy (MIT) using a continuous subcutaneous glucose sensor. Methods A microdialysis sensor was worn at home by 24 patients on CSII (mean HbA_1c 7.8 ± 0.9%) and 33 patients on MIT (HbA_1c 8.7 ± 1.3%) for 48 h. Occurrence and duration of nocturnal hypoglycaemia were assessed and using multivariate regression analysis, the association between HbA_1c, diabetes duration, treatment type (CSII vs. MIT), fasting and bedtime blood glucose values, total daily insulin dose and mean nocturnal glucose concentrations, and hypoglycaemia occurrence and duration was investigated. Results Nocturnal hypoglycaemia ≤ 3.9 mmol/l occurred in 33.3% of both the CSII‐ (8/24) and MIT‐treated patients (11/33). Mean (± sd ; median, interquartile range) duration of hypoglycaemia ≤ 3.9 mmol/l was 78 (± 76; 57, 23–120) min per night for the CSII‐ and 98 (± 80; 81, 32–158) min per night for the MIT‐treated group. Multivariate regression analysis showed that bedtime glucose value had the strongest association with the occurrence (P = 0.026) and duration (P = 0.032) of nocturnal hypoglycaemia. Conclusions Microdialysis continuous glucose monitoring has enabled more precise quantification of nocturnal hypoglycaemia occurrence and duration in Type 1 diabetic patients. Occurrence and duration of nocturnal hypoglycaemia were mainly associated with bedtime glucose value.     

Infected chronic hematoma mimicking soft tissue neoplasm

A rare case of an infected chronic hematoma in a patient with immunodeficiency syndrome mimicking a soft tissue neoplasm is presented. There are few reported cases of hematogenous infection of chronic hematomas, which be difficult to differentiate from soft tissue neoplasms.     

A Tissue-Engineered Artificial Bile Duct Grown to Resemble The Native Bile Duct

The aim of this study was to fabricate an artificial bile duct for the development of a new treatment for biliary diseases. Eighteen hybrid pigs were implanted with a bile duct organoid unit (BDOU) made of a bioabsorbable polymer. Twelve of the transplanted BDOUs had been seeded with autologous bone marrow cells (BMCs) in advance. Six animals, the controls, were grafted with the scaffold alone with no BMCs seeded. The common bile duct was cut, the hepatic cut end of the native common bile duct was anastomosed to the BDOU and the other end was anastomosed to the duodenum. The controls underwent a similar operation. The neo-bile duct was removed at pre-determined time points and investigated histologically. All 18 recipient pigs survived until their sacrifice at 6 weeks, 10 weeks or 6 months. Histological examination revealed incomplete epithelialization of the neo-bile duct at 6 weeks and 10 weeks after transplantation. At 6 months, the organoid exhibited a morphology almost identical to that of the native common bile duct. No differences were found between the controls and BMC-seeded pigs. These results show that the artificial bile duct thus fabricated can serve as a substitute for the native bile duct.     

成年男性舌下神经在舌根部的定位研究

目的:探讨成年男性舌根部舌下神经解剖走行特点,指导临床舌根部射频温控减容术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)时针形电极刺入舌根部的部位及深度,以避免损伤舌下神经。方法:选择10具成年男性的舌标本,定型后在冰冻状态下作冠状切面,通过计算机图像处理与测量系统行舌下神经定位测量,并进行相关的统计学分析。结果:(1)两侧舌下神经呈对称性分布。(2)成年男性舌下神经舌内部分的主干(本实验为舌盲孔前后15mm范围内)其垂直向解剖走行基本恒定,距舌表面(22.21±2.22)mm;水平向走行中,舌盲孔后一般位于舌中内(近中线侧)(28.61±2.66)％处,舌肓孔前为(21.89±1.93)％处。结论:本实验为舌根部射频温控减容术治疗OSAHS提供了一个相对安全的范围:在不超过(22.21±2.22)mm深度且舌盲孔后避开中内(近中线侧)(28.61±2.66)％区域、舌盲孔前避开中(内近中线侧)(21.89±1.93)％区域,基本不会损伤舌下神经。     

Sudden death due to arrhythmogenic right ventricular cardiomyopathy: Two case reports

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a kind of primary myocardial disease characterized by the regional or global replacement of right ventricular myocardium by fatty and fibrolipomatous tissues. The ARVC, usually presenting with different clinical manifestations and pathological changes, were mainly seen in young men and is one of the main causes of sudden death in the young. Here two autopsied cases of Chinese men aged 30 and 23 years old who appeared healthy but died suddenly while at work are reported respectively. One of the victims had extensive and severe pathological changes in his heart involving the left ventricular wall as well as the ventricular septum and the right atrium. Not only was there a global fatty and fibrolipomatous tissue replacement of the right ventricular myocardia, but also mild sarcoplasmic coagulation in the myocardium and focal lymphocytic infiltration in the myocardial interstitium of the right ventricular wall. In addition, slight atherosclerosis of the coronary artery and intimal thickening of the sino-atrial node were observed. It is believed that there are no marked differences in the pathological changes of ARVC between Chinese patients and patients from western countries. The etiology and pathogenesis of ARVC could not be explained by a single cause or factor and they are probably related to various congenital and acquired causes or factors.     

上肢屈曲性旋转撕脱离断伤的形成及功能挽救

目的探讨上肢轴向屈曲性旋转撕脱离断伤的形成以及侧胸和背部组织在功能挽救中的应用方式和疗效。方法2000年7月～2003年9月共收治6例上肢轴向屈曲性旋转撕脱离断伤患者,所有病例行一期再植或寄养再植。术后肩关节外展90°、肘关节屈曲100°位石膏或支具固定,6周后去除固定行功能锻炼。结果6例患者再植均顺利成活,随访3个月～2年,术后肩关节外展50°～90°,前屈50°～70°,后伸20°～30°,内收20°～40°;肘关节屈曲100°～140°,伸-20°～0°;重建术后3个月时屈肘肌力达Ⅳ～Ⅴ级。结论充分利用侧胸和背部组织特点进行分期、分层手术,解决创面覆盖和功能重建互相干扰的矛盾,是挽救严重轴向屈曲性旋转撕脱离断伤上肢,恢复其外形和功能的可靠方法。     

慢性阻塞性肺部疾病大鼠支气管成纤维细胞体外培养条件下结缔组织生长因子水平检测及意义

目的:探讨慢性阻塞性肺部疾病(COPD)大鼠和正常大鼠支气管成纤维细胞体外培养下结缔组织生长因子(CTGF)的蛋白活性、转录水平以及胶原合成水平。方法:以正常大鼠(对照组)和COPD模型大鼠(实验组)为细胞来源,组织块法进行成支气管成纤维细胞原代培养,应用第5代细胞为研究对象。比色法进行培养液羟脯氨酸含量检测,免疫组织化学染色技术、RT-PCR、免疫印迹方法进行CTGF定位检测、蛋白活性及转录水平观察。结果:实验组羟脯氨酸含量显著高于对照组。对照组大鼠支气管成纤维细胞有一定水平的CTGF表达,实验组成纤维细胞CTGF阳性表达增强,免疫印记及RT-PCR结果显示CTGF蛋白活性增强、转录水平升高。结论:CTGF在成纤维细胞中的高表达是大鼠COPD发生发展的重要环节。     

以冻干骨为平台重建组织工程化关节软骨的研究

目的:探索在兔冻干异体骨关节平台上利用组织工程的方法再造人工关节软骨的可行性。方法:实验分成四组,运用组织工程方法将不同构成的同种异体兔软骨细胞-支架材料复合物种植于兔冻干异体骨关节平台上,植入实验兔体内,3月后取材观察体内成软骨情况。结果:仅种植兔软骨细胞的冻干骨关节支架上未见新生软骨形成。粘合有种植兔软骨细胞的PLGA膜片的冻干骨支架关节腔内见新生类软骨样物出现。自体软骨层孔洞缺损模型使用软骨细胞-PLGA膜片复合物可修复软骨缺损。结论:软骨细胞-PLGA膜片复合物实验动物关节内可形成软骨样物;但在冻干骨关节平台上尚不能形成有功能意义的关节软骨层。     

Efficacy of continuous subcutaneous insulin infusion in Type 1 diabetes: a 2-year perspective using the established criteria for funding from a National Health Service.

AIM: To determine the 2-year efficacy of continuous subcutaneous insulin infusion (CSII) following the current established criteria for funding of a National Health Service. METHODS: Longitudinal, prospective, observational unicentre study. Included in the study were 153 Type 1 diabetes (T1D) subjects, previously treated with multiple daily injections (MDI) of insulin, in whom CSII was started in accordance with the criteria for reimbursement of the Catalan National Health Service. At baseline, we recorded data on age, gender, duration of the disease, body mass index (BMI), insulin dose and indications for CSII. Glycated haemoglobin (HbA(1c)) and the frequency of hypoglycaemic events were used to assess glycaemic control. Quality of life was assessed using three different self-report questionnaires. After 24 months, these same items were remeasured in all subjects. Serious adverse events and injection-site complications were also recorded. RESULTS: In 96% of subjects, CSII indication included less than optimal glycaemic control using MDI. HbA(1c) fell from 7.9 +/- 1.3 to 7.3 +/- 1.1% (P < or = 0.001) after 24 months of CSII. Insulin requirements were significantly lower at the end of follow-up (0.55 +/- 0.21 U/kg body weight) in comparison with before use of CSII (0.70 +/- 0.20, P < or = 0.001). BMI increased from 24.0 +/- 3.1 to 24.4 +/- 3.2 kg/m(2) after 24 months (P < or = 0.025). The rate of episodes of diabetic ketoacidosis per year remained unchanged. Mild and severe hypoglycaemic episodes were significantly reduced. The scores in all subsets of the Diabetes Quality-of-Life (DQoL) questionnaire significantly improved after 24 months of CSII. CONCLUSIONS: CSII, commenced according to the criteria for a nationally funded clinical programme, improves glycaemic control and quality-of-life outcomes with fewer hypoglycaemic episodes in T1D subjects previously conventionally treated with MDI.