经阴道尿道中段耻骨弓下骨膜悬吊术治疗压力性尿失禁

目的:探讨简易、有效、费用低的治疗女性压力性尿失禁手术方法。方法:对有多年尿失禁症状、经常规检查提示主要为压力性尿失禁的18例妇女采用经阴道尿道中段耻骨弓下骨膜悬吊术加尿道后韧带折叠术进行治疗。结果:手术时间45～80min,平均(55±5)min;术中出血量100～300ml,平均(130±20)ml;无1例患者输血,未发生膀胱和直肠损伤等并发症。术后留置导尿24～72h,平均48h;术后住院5～10天,平均6天。18例中治愈12例(66%),改善4例(22%),总有效率为88%(16/18)。1例术后近期因排尿困难剪除悬吊尿道中段的缝线,另1例术前Ⅰ度尿失禁病人术后症状改善不明显。结论:经阴道尿道中段耻骨弓下骨膜悬吊术简单、有效、微创,不需使用特殊、昂贵的器械和材料,疗效好、并发症少,符合中国的国情,值得临床推广应用。     

反复整复对小儿骨折后骨外膜影响的解剖学观察

为观察骨折后复手法整复骨膜损作的情况，将６具尸体股骨干制成完全模断骨折。左侧为对照组，右国实验组，左侧直接测量骨摹员伤情况，右侧经反复（３次以上）手法整复后测量骨膜损伤情况，结果表明，长同骨折整复过程中反复手法复明显加重骨外膜损伤。     

Topographic superficial craniectomy for invasive scalp carcinoma

The management of non-melanoma skin cancer of the scalp that invades the deep structures can be challenging. An operative technique of topographic superficial craniectomy using a piezoelectric instrument (Piezosurgery (Mectron S.p.A., Carasco, Italy)) for tumours with periosteal invasion without diploic space invasion is presented here. The tumour was resected including the periosteum of the craniectomy area. A grid was carved through the outer table using the Piezosurgery device. The grid squares measured approximately 1.5 cm on each side. A bony strip was removed from one side of the grid to complete a deep cut while avoiding crossing the inner table. The squares were collected individually with a chisel and sent for pathological analysis. This technique was used to identify and localize any possible bone invasion. As this method allowed an accurate pathological diagnosis to be obtained from the Piezosurgery squares, it was possible to determine the appropriate adjuvant treatment, thereby reducing the risk of malignant cells spreading.     

Effect of estrogen on gene expression of fatty acid synthase in periosteum

Background Estrogen deficiency contributes to postmenopausal osteoporosis. Periosteum might be a potential target of estrogen, but the underlying mechanism at gene level is far from being elucidated. The objective of this study was to investigate the correlation between estrogen and fatty acid synthase （FAS） expression in periosteum. Methods Human periosteum cells were cultured in vitro. Expressed genes in the substrated cDNA library were verified using semi-quantitative PCR and real-time PCR. The expression of FAS in periosteum of ovarectomized （OVX） SD rats was investigated. Results FAS gene was most significantly expressed in the subtracted cDNA library of periosteal cells screened by semi-quantitative PCR. Low FAS expression was verified by real-time PCR in the estrogen exposed human periosteum rather than in the control. The estradiol levels were （20.81±12.62） pg/ml, （19.64±4.35） pg/ml and （13.47±1.84） pg/ml in the sham group, the control, and the OVX group, respectively. The estradiol levels in the OVX group was significantly lower （P=-0.0386）. The FAS gene expression in periosteum in the OVX group, sham group, and control group was 3.09±1.97, 1.33±0.47 and 1.51±1.32, respectively. The gene expression in the OVX group was significantly higher （P=0.0372）. Conclusion Estrogen modulates FAS gene expression in in vitro human perisoteum as well as in in vivo rat periosteum.     

论养法是《内经》“春夏养阳,秋冬养阴”理论精髓

《内经》提出了通过"春夏养阳,秋冬养阴"可以达到"养生、却病、延年"目的的论断,后世医家面对这个论题,提出了如何来"春夏养阳,秋冬养阴"的科学问题?即是通过什么方法来"养阳养阴"的问题?面对各种学说,其中不乏有相反甚至相矛盾的观点,使后学者不能领略其全貌,只有通过如何"养"这种途径才能统领临床的实际情况以及各医家的不同学术观点,显然如何"养"是整个理论的精髓所在。     

Skeletal Cell Fate Decisions Within Periosteum and Bone Marrow During Bone Regeneration

Bone repair requires the mobilization of adult skeletal stem cells/progenitors to allow deposition of cartilage and bone at the injury site. These stem cells/progenitors are believed to come from multiple sources including the bone marrow and the periosteum. The goal of this study was to establish the cellular contributions of bone marrow and periosteum to bone healing in vivo and to assess the effect of the tissue environment on cell differentiation within bone marrow and periosteum. Results show that periosteal injuries heal by endochondral ossification, whereas bone marrow injuries heal by intramembranous ossification, indicating that distinct cellular responses occur within these tissues during repair. Next, lineage analyses were used to track the fate of cells derived from periosteum, bone marrow, and endosteum, a subcompartment of the bone marrow. Skeletal progenitor cells were found to be recruited locally and concurrently from periosteum and/or bone marrow/endosteum during bone repair. Periosteum and bone marrow/endosteum both gave rise to osteoblasts, whereas the periosteum was the major source of chondrocytes. Finally, results show that intrinsic and environmental signals modulate cell fate decisions within these tissues. In conclusion, this study sheds light into the origins of skeletal stem cells/progenitors during bone regeneration and indicates that periosteum, endosteum, and bone marrow contain pools of stem cells/progenitors with distinct osteogenic and chondrogenic potentials that vary with the tissue environment.     

Current insights on the regenerative potential of the periosteum: Molecular,cellular, and endogenous engineering approaches

While century old clinical reports document the periosteum's remarkable regenerative capacity, only in the past decade have scientists undertaken mechanistic investigations of its regenerative potential. At a Workshop at the 2012 Annual Meeting of Orthopaedic Research Society, we reviewed the molecular, cellular, and tissue scale approaches to elucidate the mechanisms underlying the periosteum's regenerative potential as well as translational therapies engineering solutions inspired by its remarkable regenerative capacity. The entire population of osteoblasts within periosteum, and at endosteal and trabecular bone surfaces within the bone marrow, derives from the embryonic perichondrium. Periosteal cells contribute more to cartilage and bone formation within the callus during fracture healing than do cells of the bone marrow or endosteum, which do not migrate out of the marrow compartment. Furthermore, a current healing paradigm regards the activation, expansion, and differentiation of periosteal stem/progenitor cells as an essential step in building a template for subsequent neovascularization, bone formation, and remodeling. The periosteum comprises a complex, composite structure, providing a niche for pluripotent cells and a repository for molecular factors that modulate cell behavior. The periosteum's advanced, “smart” material properties change depending on the mechanical, chemical, and biological state of the tissue. Understanding periosteum development, progenitor cell‐driven initiation of periosteum's endogenous tissue building capacity, and the complex structure–function relationships of periosteum as an advanced material are important for harnessing and engineering ersatz materials to mimic the periosteum's remarkable regenerative capacity. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:1869–1878, 2012     

动态力学信号对人骨髓基质细胞、骨膜细胞生长和成骨表达的作用

目的 探讨动态力学信号对体外分离培养的人骨髓基质细胞、骨膜细胞生长与分化特征的生物学效应。方法 使用Flexcell应力系统，将频率为1Hz、振幅为5％变形、正弦波状力学信号作用于体外分离培养的正常人骨髓基质细胞和骨膜细胞，在不同时间段检测其对细胞DNA、总蛋白合成、碱性磷酸酶（ALP）表达和骨钙素分泌量的影响。结果 动态力学刺激对人骨髓基质细胞、骨膜细胞蛋白与DNA合成无明显作用。接受力学刺激信号后骨膜细胞受维生素D3刺激后分泌骨钙素显著增加，而骨髓基质细胞则显著下降。结论 动态力学信号能够促进人骨膜细胞向成骨细胞分化，这可能是其对骨的生物学作用的机制之一。