重睑术后粘连畸形及其治疗

目的 提出重睑术后粘连畸形的概念及其治疗原则，总结各种治疗方法的临床效果。方法 将本组30例重睑术后粘连畸形者的临床表现进行了分度，根据其形成特点，采用抽除缝线、眶隔脂肪瓣移位、眶隔部眼轮匝肌下移、睑板前齿轮匝肌瓣移转、自体脂肪组织游离移植和缩短上睑提肌肌健的方法治疗。结果 术后进行3个月至2年的随访，除隔部眼轮匝肌下移、睑板前眼轮匝肌瓣多转治疗效果欠佳外，其它方法均获得满意效果。结论 治疗重睑要后连畸形应在彻底松解局部粘连的基础上，根据局部条件采用隔断粘连区的方法，可以获得满意的长期效果，     

NDST-1 modulates BMPR and PTHrP signaling during endochondral bone formation in a gene knockout model

GlcNAc N-deacetylase/N-sulfotransferase-1 (NDST-1), a member of the enzyme family catalyzing the first modification step in the biosynthesis of heparan sulfate (HS), was knocked out in mice to investigate its role in embryonic development. NDST-1 null mice exhibited delayed endochondral bone formation including shortened calcified zones in limbs, delayed chondrocyte and osteogenetic differentiation, and increased chondrocyte proliferation. In situ HS binding assay revealed that the binding ability of bone morphogenetic protein (BMP) -2, -4, and -6 to endogenous HS was decreased in mutant phalanges, while that of fibroblast growth factor-1 (FGF-1) was not affected. Up-regulation of BMPR-IA, Phospho-Smad1 (P-Smad1) and parathyroid-hormone related protein (PTHrP), but not the Indian hedgehog, Gli1, Gli3, Patched, and FGFR-3, was observed. Furthermore, block of BMPR signaling with noggin rescued the delayed chondrocyte hypertrophic differentiation in NDST-1 (−/−) mice and recovered the expression of both P-Smad1 and PTHrP proteins. These results suggested that NDST-1-dependent heparan sulfate might negatively modulate BMP and its downstream PTHrP signaling, and thus affect endochondral bone development.     

Influence of Rifampin on Capsule Formation Around Silicone Implants in a Rat Model

This study investigated the effect of rifampin on the thickness of capsules around silicone implants by bactericidal activity against Stapylococcus epidermidis. Silicone blocks (1 × 1 cm) were placed into pockets created for each of the 40 rats included in the study. In group 1, the operation was performed under aseptic conditions. In group 2, standard S. epidermidis was inoculated into the pocket, whereas rifampin and S. epidermidis were applied in group 3. In group 4, only rifampin was applied topically on implants. After 12 weeks, the peri-implant capsules were removed and examined under a photomicroscope and a scanning electron microscope. The mean thickness of the capsules was 63.307 μm in group 1, 111.538 μm in group 2, 43.076 μm in group 3, and 30.384 μm in group 4. The differences between groups 2 and 3 and groups 2 and 4 were found to be statistically significant (p < 0.001). Rifampin appears to be an agent for preventing peri-implant capsule formation.     

腹部大手术后早期肠内营养的免疫学研究

目的：研究早期肠内营养支持对腹部大手术患者对机体免疫的影响。方法：37例腹部大手术患者,术后第1天即由鼻肠管进行肠内营养支持（EN组）,同时取另外37例行肠外营养（PN）组的腹部大手术患者,对营养指标和体液免疫指标进行检测。结果：EN组患者均能良好耐受早期肠内营养支持,肠内营养开始后第15天的血红蛋白、清蛋白、转铁蛋白均比PN组升高（P〈0.05）,第15天IgG较PN组升高（P〈0.05）,第3天IgA较PN组下降（P〈0.05）,第15天IgA下降更明显（P〈0.05）,第15天IgM变化与PN组差异无统计学意义（P〉0.05）。结论：手术后早期肠内营养的施行能够明显改善患者腹部大手术后的营养状况,不损害机体的体液免疫机制,安全有效,是较理想的营养支持措施之一。     

Alfacalcidol treatment increases bone mass from anticatabolic and anabolic effects on cancellous and cortical bone in intact female rats

It has been reported that alfacalcidol had an anticatabolic and anabolic effect on bone in ovariectomized and aged male rat models, but this has not been tested on intact female rats. The current study was to determine the effects of alfacalcidol on cancellous and cortical bone in intact female rats with or without exercise. Seventy-four, 8.5-month-old, intact female rats were orally treated with 0, 0.005, 0.025, 0.05, or 0.1 microg/kg alfacalcidol alone or in combination with raised cage (RC) exercise for 3 months. In vivo peripheral quantitative computerized tomography (pQCT) of the proximal tibial metaphyses (PTM) and ex vivo histomorphometric analyses of the PTM and tibial shaft (TX) were performed. Only the 0.1 microg alfacalcidol/kg dose proved to be anabolic. pQCT analysis showed that this dose increased total and cortical bone mineral content and density and trabecular bone mineral density. Histomorphometrically, it induced an anabolic response by increased trabecular mass and microarchitecture from stimulated cancellous bone and bone bouton formations, and suppressed bone resorption more than bone formation on the trabecular and endocortical surfaces, to produce a positive bone balance. A positive correlation between trabecular connectivity and bone bouton numbers occurred. These findings suggest alfacalcidol treatment augments bone mass by increased cancellous bone mass and improved trabecular architecture through its anticatabolic and anabolic properties in the intact adult female rat. Last, raised cage exercise alone or the combination of raised cage and alfacalcidol was no more effective than alfacalcidol alone.     

三种颗粒细胞剥除方式对卵母细胞受精率及胚胎发育的影响

目的对三种颗粒细胞剥除方式在常规体外受精(IVF)中对卵母细胞受精率及胚胎发育影响进行前瞻性研究。方法2004年1～12月,因输卵管因素不育在我院生殖中心行常规体外受精-胚胎移植(IVF-ET)的患者54例,患者年龄均小于35岁。采用随机表法随机分为三组,每组18例,共818个卵母细胞。对三组卵母细胞在IVF后采取不同的颗粒细胞剥除方式:第一组在受精后4h完全剥除颗粒细胞;第二组在受精后4h部分剥除颗粒细胞,受精后16～18h再将颗粒细胞完全剥除;第三组在受精后16～18h完全剥除颗粒细胞(即传统的过夜培养方式)。对三组的受精率、优质胚胎率、囊胚形成率进行比较。结果第一组及第二组的优质胚胎率高于第三组,差异有统计学意义(P<0.05)。三组在受精率及囊胚形成率方面没有显著差别。结论第一组的颗粒细胞剥除方式最好,即缩短精-卵共培养时间可以提高胚胎质量,长时间的精-卵共培养对优质胚胎的形成有不利影响。较短时间(12～14h)的颗粒细胞与卵细胞的共培养可能对胚胎发育的质量无显著影响。     

Complications and Functional Results after Ileoanal Pouch Formation in Obese Patients

Objective Ileoanal pouch formation (IPAA) can be technically challenging in obese patients, and there is little data evaluating results after the procedure in these patients. We compare outcomes for patients with a body mass index (BMI) ≥30 undergoing IPAA when compared with those for patients with BMI <30. Methods Retrospective analysis of prospectively accrued data for patients with BMI ≥30 undergoing IPAA. Patient and disease-related characteristics, complications, long-term function, and quality of life (QOL) using the Cleveland Global Quality of Life scale (CGQL) were determined for this group of patients (group B) and compared with those for patients with BMI <30 (group A). Kruskal–Wallis and Wilcoxon rank sum tests were used to compare quantitative or ordinal data and chi-square or Fisher’s exact tests for categorical variables. Long-term mortality and complication rates were estimated using the Kaplan–Meier method with group comparisons performed using log rank tests. Results There were 345 patients (median BMI 32.7) in group B and 1,671 patients in group A. When the cumulative risk of complications over 15 years was compared, group B patients had a significantly higher chance of getting a complication (94.9% vs 88%, p = 0.006). The rates of pelvic sepsis (6.7% vs 5.3%, p = 0.3), pouchitis (58.1 vs 54.4%, p = 0.9), pouch failure (6% vs 4.5%, p = 0.9), and hemorrhage (5.6% vs 4.8%, p = 0.7) were similar for group B and group A. Group B patients, however, had a significantly higher risk of the development of wound infection (18.8% vs 8.1%, p < 0.001) and anastomotic separation (10.4% vs 5.4%, p < 0.001), whereas group A patients had a higher rate of development of obstruction over time (26.7% vs 22.3%, p = 0.02). Long-term outcome including QOL and function after 15 years was comparable between groups. Conclusions Although technically demanding, IPAA can be undertaken in obese patients with acceptable morbidity. Good long-term functional results and QOL that is comparable to nonobese patients may be anticipated.     

Aminobisphosphonates Cause Osteoblast Apoptosis and Inhibit Bone Nodule Formation In Vitro

Bisphosphonates are widely used for the treatment of bone diseases associated with increased osteoclastic bone resorption. Bisphosphonates are known to inhibit biochemical markers of bone formation in vivo, but it is unclear to what extent this is a consequence of osteoclast inhibition or a direct inhibitory effect on cells of the osteoblast lineage. In order to investigate this issue, we studied the effects of various bisphosphonates on osteoblast growth and differentiation in vitro. The aminobisphosphonates pamidronate and alendronate inhibited osteoblast growth, caused osteoblast apoptosis, and inhibited protein prenylation in osteoblasts in a dose-dependent manner over the concentration range 20-100 microM. Further studies showed that alendronate in a dose of 0.1 mg/kg inhibited protein prenylation in calvarial osteoblasts in vivo, indicating that alendronate can be taken up by osteoblasts in sufficient amounts to inhibit protein prenylation at clinically relevant doses. Pamidronate and alendronate inhibited bone nodule formation at concentrations 10-fold lower than those required to inhibit osteoblast growth. These effects were not observed with non-nitrogen-containing bisphosphonates or with other inhibitors of protein prenylation and were only partially reversed by cotreatment with a fourfold molar excess of ss-glycerol phosphate. We conclude that aminobisphosphonates cause osteoblast apoptosis in vitro at micromolar concentrations and inhibit osteoblast differentiation at nanomolar concentrations by mechanisms that are independent of effects on protein prenylation and may be due in part to inhibition of mineralization. While these results need to be interpreted with caution because of uncertainty about the concentrations of bisphosphonates that osteoblasts are exposed to in vivo, our studies clearly demonstrate that bisphosphonates exert strong inhibitory effects on cells of the osteoblast lineage at similar concentrations to those that cause osteoclast inhibition. This raises the possibility that inhibition of bone formation by bisphosphonates may be due in part to a direct inhibitory effect on cells of the osteoblast lineage.     

维拉帕米对胶原基因表达及大鼠腹膜粘连形成的影响

目的探讨维拉帕米(Verapamil)在胶原基因表达及大鼠腹膜粘连形成中的作用.方法通过造成腹壁和盲肠浆膜的均一缺损制成大鼠粘连模型;关腹前注入1ml生理盐水或维拉帕米(0.002 kg/L);术后7 d进行粘连评分;采用逆转录-聚合酶链反应(RT-PCR)方法测定各组织标本Ⅰ(α2)、Ⅲ(α1)型胶原基因mRNA的表达.结果与正常腹膜相比,模型组和生理盐水组粘连组织Ⅰ(α2)、Ⅲ(α1)型胶原基因mRNA表达显著增强(0.64±0.17至4.37±0.83、3.56±0.57,P＜0.01;0.06±0.02至0.39±0.12、0.47±0.21,P＜0.01);与模型组或生理盐水组相比,维拉帕米组大鼠粘连显著减轻,同时Ⅰ(α2)、Ⅲ(α1)型胶原基因mRNA表达显著减弱(0.77±0.21,0.09±0.03,P＜0.01).结论粘连形成过程中胶原基因表达增强,抑制胶原基因表达能减轻粘连程度.