衰老皮肤再生还童机理

古往今来, 衰老都是人类无法对抗的世界性难题, 其实质是人体内各个组织器官解剖结构的逐渐改变和生理功能的逐渐衰退, 最终结果是生命的终止, 这是大自然赋予人类的客观规律。 为了对抗这种自然规律, 生命科学领域曾多次试图通过改变人类基因、 制造新物种等方法延缓人类的衰老, 并在这些方面投入了大量精力、 付出了大量心血, 但最终都随着20世纪著名生命科学家、 基因学之父———沃森的“否定基因治疗” 的演讲而宣告失败。 这说明任何没有科学结果的试验都只属于科学探索, 不代表科学真理。 而人体再生复原科学则是以实实在在的科学结论为主导, 秉持顺应生命属性规律的原则, 研究人体自身存在细胞的再生潜能和所需的再生营养物质。 该技术利用人体再生潜能和外源性再生营养物质, 原位再生复原自身组织和器官的后天缺损、 提前衰老、 异变、 严重疾病、 提前凋亡, 从而保障人体组织和器官的正常生理结构和功能, 实现预防和治疗疾病、 预防和中止人体提前衰老、 原位再生复原提前衰老的组织和器官等。 这是目前世界上唯一可以做到中止人体组织器官衰老、 实现人体组织器官再生复原和还童的科学, 也是目前生命科学领域唯一一个获得科学结果验证的真实性科学体系。 正是在这个科学体系下, 完成了人体最大器官———皮肤组织器官的再生还童, 当然, 这只是该体系中的一项科学成果, 本讲座便是针对这项成果的再生还童机理进行的综述。     

Clinical Assessment Of Stereotactic IGRT: Spinal Radiosurgery

The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited because of the availability of effective target immobilization devices. Recent advances in stereotactic IGRT have allowed for spinal applications. Large clinical experience with spinal radiosurgery to properly assess clinical outcomes has previously been limited. At our institution, we have developed a successful multidisciplinary spinal radiosurgery program in which 542 spinal lesions (486 malignant and 56 benign lesions) were treated with a single-fraction radiosurgery technique. Patient ages ranged from 18 to 85 years (mean 56 years). Lesion location included 92 cervical, 234 thoracic, 130 lumbar, and 86 sacral. The most common metastatic tumors were renal cell (89 cases), breast (74 cases), and lung (71 cases). The most common benign tumors were neurofibroma (24 cases), schwannoma (13 cases), and meningioma (7 cases). Eighty-nine cervical lesions were treated using skull tracking. Thoracic, lumbar, and sacral tumors were tracked relative to either gold or stainless steel fiducial markers. The maximum intratumoral dose ranged from 12.5 to 30 Gy (mean 20 Gy). Tumor volume ranged from 0.16 to 298 mL (mean 47 mL). Three hundred thirty-seven lesions had received prior external beam irradiation with spinal cord doses precluding further conventional irradiation. The primary indication for radiosurgery was pain in 326 cases, as a primary treatment modality in 70 cases, for tumor radiographic tumor progression in 65 cases, for post-surgical treatment in 38 cases, for progressive neurological deficit in 35 cases, and as a radiation boost in 8 cases. Follow-up period was at least 3 to 49 months. Axial and/or radicular pain improved in 300 of 326 cases (92%). Long-term tumor control was demonstrated in 90% of lesions treated with radiosurgery as a primary treatment modality and in 88% of lesions treated for radiographic tumor progression. Thirty of 35 patients (85%) with progressive neurological deficits experienced at least some improvement after treatment. Spinal stereotactic radiosurgery is now a feasible, safe, and clinically effective technique for the treatment of a variety of spinal lesions. The potential benefits of radiosurgical ablation of spinal lesions are short treatment time in an outpatient setting with essentially no recovery time and excellent symptomatic response. This technique offers a new therapeutic modality for the primary treatment of a variety of spinal lesions, including the treatment of neoplasms in medically inoperable patients, previously irradiated sites, for lesions not amenable to open surgical techniques, and as an adjunct to surgery.     

Content-based medical image classification using a new hierarchical merging scheme

Automatic medical image classification is a technique for assigning a medical image to a class among a number of image categories. Due to computational complexity, it is an important task in the content-based image retrieval (CBIR). In this paper, we propose a hierarchical medical image classification method including two levels using a perfect set of various shape and texture features. Furthermore, a tessellation-based spectral feature as well as a directional histogram has been proposed. In each level of the hierarchical classifier, using a new merging scheme and multilayer perceptron (MLP) classifiers (merging-based classification), homogenous (semantic) classes are created from overlapping classes in the database. The proposed merging scheme employs three measures to detect the overlapping classes: accuracy, miss-classified ratio, and dissimilarity. The first two measures realize a supervised classification method and the last one realizes an unsupervised clustering technique. In each level, the merging-based classification is applied to a merged class of the previous level and splits it to several classes. This procedure is progressive to achieve more classes. The proposed algorithm is evaluated on a database consisting of 9100 medical X-ray images of 40 classes. It provides accuracy rate of 90.83% on 25 merged classes in the first level. If the correct class is considered within the best three matches, this value will increase to 97.9%.     

不同营养支持方式对肠外瘘患者人体组成改善作用之比较

目的观察不同营养支持方式对肠外瘘患者人体组成的改善作用。方法30例肠外瘘患者分成两组各15例,分别给予全肠外营养支持(TPN)或全肠内营养支持(TEN),观察10d前后患者人体组成及血清胰岛素样生长因子-1(IGF-1)的变化。结果10d后所有患者的体重指数(BMI)与体细胞群(BCM)显著改善,而TEN组患者10d前后BCM增加幅度更明显,分别为(27.5±0.8)kg和(29.0±0.6)kg,Day10与Day0相比,P<0.01。两组患者总体水(TBW)与细胞内水(ICW)均增加,尤其ICW,Day10与Day0相比,TEN组P<0.01;TPN组P<0.05。血清IGF-1在两组患者治疗后均有显著上升,TEN组增加幅度更明显,Day0为(175.0±32.9)ng/ml,Day10为(255.5±34.1)ng/ml,与Day0比较,P<0.01;与TPN组比较,P<0.05。IGF-1的变化与BCM的改善显著正相关(r2=0.16,P<0.05)。结论营养支持治疗能显著改善肠外瘘患者的体细胞群,纠正细胞内、外水的异常分布,而EN作用更明显。     

2010至2012年31省2120131名育龄妇女孕前营养指标趋势分析

目的 分析2010至2012年中国育龄妇女孕前营养状况的变化趋势.方法 研究人群为2010年1月1日至2012年12月31日参加“国家免费孕前优生健康检查项目”覆盖的31个省、市、自治区220个试点县的21～49岁育龄妇女,共2 120 131人.研究孕前营养指标主要包括体质量指数(BMI)、血红蛋白含量(HB)和空腹血糖(FBG).结果 2010至2012年总体上中国育龄妇女孕前平均HB含量持续升高,而孕前平均BM1和FBG水平呈逐年下降趋势.将3个孕前营养指标测定的结果均分为4类,各类构成人群均主要分布在25 ～34岁年龄组.孕前低BMI人群发生率逐年增加,从2010年10.4％(31 649/304307)增加到2012年14.14％(114 159/807 131);孕前超重人群及肥胖人群均在2012年发生率最低,分别为10.65％(85 984/807 131)和2.32％(18 735/807 131).孕前低血糖发生率由2010年5.45％(16 581/304307)降至2012年5.23％(42 199/807 131);孕前空腹血糖受损及糖尿病发生率逐年降低,分别从2010年3.17％ (9 652/304 307)和1.64％(4 982/304307)降至2012年2.71％(21 875/807 131)和1.05％(8 505/807 131).孕前轻度及中重度贫血的发生率在逐年下降,分别从2010年12.29％和0.95％降至2012年9.62％和0.78％;孕前高HB含量人群也呈现不断下降趋势.2010至2012年中国育龄妇女3个孕前营养指标的变化趋势在4个分类中均差异有统计学意义(P ＜0.001).结论 中国育龄妇女总体孕前营养状况良好,肥胖、贫血及糖尿病的发生率呈逐年下降趋势.     

成人朗格汉斯组织细胞增生症的影像学表现

目的分析成人朗格汉斯组织细胞增生症累及不同系统的的影像表现,提高对该病的诊断水平。方法回顾性分析经手术病理证实5例朗格汉斯组织细胞增生症的影像学表现及临床资料。结果 5例中2例单发,3例多发。累及骨质的病灶多表现为穿凿样、溶骨性及膨胀性骨质破坏,边缘清晰或模糊,部分伴有硬化边,部分可见骨膜反应,MRI上表现为T1WI等信号,T2WI稍高、高信号。发生于中枢神经系统的变病1例现为三脑室漏斗部结节,边缘清晰,MRI增强呈明显强化,另一例表现为神经垂体T1WI信号减低。发生于软组织的表现为软组织增厚,部分形成软组织肿块。结论成人朗格汉斯组织细胞增生症是一种较罕见的疾病,可累及全身各系统,可单发也可多发,病变表现各异,无特异性的影像学表现,因此影像表现结合临床、病理才能确诊。     

O—Z皮瓣修复体表小面积皮肤缺损

目的评价O-Z皮瓣修复体表小面积皮肤缺损的临床效果。方法自2003年以来应用O-Z皮瓣修复体表肿块切除后所留下的小面积皮肤缺损34例，缺损面积5mm×5mm～20mm×30mm。结果34例患者术后皮瓣均成活良好。但有3例皮瓣尖端小部分血运欠佳，发紫，后经拆除张力最大缝线后，血运恢复，伤口I期愈合。术后随访3～24个月，瘢痕不明显，皮瓣颜色与周围一致，形态满意。结论该皮瓣具有操作简单、血运可靠、转移后张力分布均匀、切口瘢痕少、通用性强等优点，适合于修复体表小面积皮肤缺损。     

The Desire for Body Contouring Surgery after Bariatric Surgery

Background  Obesity has become far more prevalent over the last few decades. In parallel, bariatric surgery has been increasingly utilized as a method of treatment. This appears to be having an impact on the rate of body contouring surgery for hanging redundant skin after the massive weight loss that usually results from bariatric surgery. Little literature is available addressing how frequently patients who have undergone bariatric surgery receive or desire body contouring surgery or regarding how satisfied these patients are with the hanging skin in certain body areas. Methods  Seventy individuals (out of 250 who were mailed the questionnaire) who had undergone Roux-en-Y gastric bypass surgery 6–10 years previously completed a questionnaire, which obtained information regarding their experiences with as well as their desire for body contouring surgery and more general body area satisfaction. Results  Thirty three of the seventy patients reported having undergone a total of 38 body contouring procedures. The most common were abdominoplasties (24.3%), breast lifts (8.6%), and thigh lifts (7.1%). However, subjects were not uniformly satisfied with body areas that had undergone body contouring surgery; some found the areas unattractive. The majority of patients, at least to some extent, desired body contouring surgery, often in several areas, most notably the waist/abdomen, rear/buttock, upper arms, and chest/breast. Conclusion  Paralleling the increasing use of bariatric surgery is an increasing desire for body contouring surgery. Most patients desire body contouring surgery after bariatric surgery. However, third party payors usually do not reimburse for such procedures.     

Combination of Obesity with Hyperglycemia is a Risk Factor for the Presence of Vertebral Fractures in Type 2 Diabetic Men

Although patients with type 2 diabetes show no bone mineral density (BMD) reduction, fracture risks are known to increase. It is unclear why the patients have an increased risk of fracture despite sufficient BMD. We investigated the relationships of body mass index (BMI), HbA_1c, and urinary C-peptide (uC-peptide) versus BMD, bone metabolic markers, serum adiponectin, and prevalent vertebral fracture (VF). A total of 163 Japanese type 2 diabetic men were consecutively recruited, and radiographic and biochemical data were collected. BMI was positively correlated with BMD at the whole body, lumbar spine, and femoral neck (P < 0.05) and negatively correlated with osteocalcin and urinary N-terminal cross-linked telopeptide of type-I collagen (uNTX) (P < 0.01). HbA_1c was negatively correlated with osteocalcin (P < 0.01) but not BMD at any site. Subjects were classified into four groups based on BMI and HbA_1c (group LL BMI < 24 and HbA_1c < 9, group LH BMI < 24 and HbA_1c ≧ 9, group HL BMI ≧ 24 and HbA_1c < 9, group HH BMI ≧ 24 and HbA_1c ≧ 9). Serum adiponectin, osteocalcin, and uNTX were lower and the incidence of VF was higher despite sufficient BMD in the HH group. Multivariate logistic regression analysis adjusted for age, duration of diabetes, uC-peptide, and estimated glomerular filtration rate showed that the HH group was associated with the presence of a VF and multiple VFs (odds ratio [OR] = 3.056, 95% confidence interval [CI] 1.031–9.056, P = 0.0439, and OR = 5.415, 95% CI 1.126–26.040, P = 0.0350, respectively). Combination of obesity with hyperglycemia was a risk factor for VF despite sufficient BMD in diabetic men.     

Weight Loss and Body Composition During the First Postoperative Year of a Laparoscopic Roux-En-Y Gastric Bypass

Background Weight loss in patients undergoing gastric bypass should be primarily from fat mass (FM), minimizing the fat-free mass (FFM) loss. The aim of this study was to analyze changes in body weight and body composition during the first postoperative year in 50 morbidly obese patients undergoing a Laparoscopic Roux-en-Y gastric bypass (LRYGBP) at the Obesity Clinic of the ABC Medical Center. Methods Patient’s weight and body composition were obtained before surgery and 1 year later using bioelectrical impedance analysis (BIA). Weight, FM, FMM, and total body water (TBW) were measured before and 1 year after surgery. Changes in body composition were particularly analyzed. Results There were 29 females and 21 males with mean age of 41 ± 12 years. Mean BMI before surgery and 1 year after surgery was 44.4 ± 7.4 kg/m² and 28.3±4.3 kg/m², respectively. The percentage of excess body weight loss at the 1-year period was 86% for women and 79.6% for men. The percentage of FM before surgery was 47.7 ± 5.1, and 1 year later it was 28.8 ± 8. The percentage of FFM was 66.5 ± 16.5 before surgery and 58.3 ± 13 at 1 year. Conclusions There is a significant weight loss in patients undergoing LRYGBP. Weight loss mainly occurs as a consequence of reduction in the FM with less impact on the FFM.