精索静脉曲张手术后患者的管理策略

手术治疗精索静脉曲张在改善精液质量、提高配偶自然怀孕率和缓解局部疼痛症状中的作用已为多数医生所认同。随着手术方式的改进,越来越多的精索静脉曲张患者接受手术治疗,然而,临床对手术后患者的管理还重视不够。本文系统介绍了对精索静脉曲张手术后患者的疗效判断和后续治疗选择,包括观察随诊、非手术治疗方法和再手术。     

白细胞介素-6对椎间盘细胞中蛋白多糖代谢影响的实验研究

目的:研究白细胞介素-6(interleukin-6,IL-6)对椎间盘纤维环和髓核细胞中蛋白多糖代谢的影响。方法:自然流产的胎儿4例,4h内无菌取出椎间盘,分别进行纤维环和髓核细胞的体外培养。在纤维环细胞的培养液中分别加入IL-60(对照组)、400、800ng/ml,培养24h后,用Alcian法检测培养液中硫酸软骨素的含量。在培养中的髓核细胞中加入IL-60(对照组)、100、400、800ng/ml,培养24h,然后测量培养液中硫酸软骨素的含量。结果:在纤维环细胞中加入IL-6组较不加IL-6对照组培养液中硫酸软骨素的含量增加,在髓核细胞组中加入IL-6组和对照组的差别无显著性。结论:IL-6可以刺激椎间盘纤维环细胞中蛋白多糖的合成,但对髓核细胞中蛋白多糖的合成没有明显的作用。     

In vitro differentiation of human adipose-derived adult stromal cells into neuron-like cells in hippocampal astrocyte conditioned medium

BACKGROUND: At present, researches on differentiating from human adipose-derived adult stromal cells (hADASC) to neuron-like cells are focus on inducing by artificial-synthetic compound solution; however, hippocampal astrocyte conditioned medium (HCAM) can induce in vitro differentiation from hADASC to neuron-like cells is still unclear. OBJECTIVE: To observe whether HCAM can induce in vitro differentiation from hADASC to neuron-like cells. DESIGN: Randomized control study. SETTING: Department of Neurology, Taixing People's Hospital; Central Laboratory, North China Coal Medical College. MATERIALS: Donor of adipose tissue was donated by female volunteers suffering from caesarean section in the department of obstetrics & gynecology in our hospital and aged 20－35 years. Adipose tissue was collected from subcutaneous tissue of abdomen during the operation. In addition, 8 male newborn Wistar rats within 24 hours with average body mass of 20 g were provided by Animal Institute of Chinese Academy of Medical Sciences. Rabbit-anti-human Nestin polyclonal antibody, rabbit-anti-human glial fibriliary acidic protein (GFAP) polyclonal antibody, rabbit-anti-human neuro-specific enolase polyclonal antibody and mouse-anti-human microtubal associated protein 2 (MAP-2) polyclonal antibody were provided by Wuhan Boster Company. METHODS: The experiment was carried out in the Central Laboratory of North China Coal Medical College from October 2004 to June 2005. hADASC was cultured with HCAM and its growth and morphological changes were observed under inverted phase contrast microscope. Immunocytochemistry, immunofluorescence and Western blotting were used to evaluate the expressions of Nestin, which was a specific sign of nerve precursor, neuro-specific enolase and MAP-2, which was a specific sign of nerve cell, and GFAP, which was a specific sign of neuroglial cells. MAIN OUTCOME MEASURES: Nestin, which was a specific sign of nerve precursor, neuro-specific enolase and MAP-2, which was a specific sign of nerve cell, and GFAP, which was a specific sign of neuroglial cells. RESULTS: On the 3rd day of culture, partial hADASC started deformation from slender shuttle-shape cells to neuron-like cells. It suggested that cells stretched out apophysis, which were mainly double-pole or multiple-pole cells. Five days later, immunohistochemical detection suggested that expression of Nestin (10.5±0.037) was found out in cells; meanwhile, expressions of GFAP (38.4±0.052) and neuro-specific enolase (NSE) (15.7±0.023) were also found out in cells; however, expression of MAP-2 was not observed. Western blot indicated that, 5 days after effect of HCAM, Nestin was found out in hADASC; meanwhile, expressions of GFAP and neuro-specific enolase were also found out; however, expression of MAP-2 was not observed. CONCLUSION: HCAM can induce the differentiation from hADASC to neuron-like cells in vitro.     

溴脱氧尿苷免疫细胞化学方法显示鸡内耳毛细胞增殖活动

建立溴脱氧尿苷(bromodeoxyuridine,BrdU)免疫细胞化学方法显示增殖细咆.按100mg/kg剂量给鸡腹腔注射DNA合成的前体物质BrdU,6h后处死动物,取小肠组织制备石蜡切片,通过免疫细胞化学方法,成功地显示了小肠上皮细胞中的S期增殖细胞,将此法用于观察鸡内耳感觉上皮细胞的生理性再生状态,结果发现鸡前庭感觉上皮中存在着低水平的增殖活动。BrdU免疫细胞化学方法省时,无需特别防护,且定位准确,是显示增殖细胞的理想方法。     

胆道支撑管显影材料的制备及体外细胞毒性评价

目的 探讨新型显影胆道支撑管材料制备的可行性，对构建出的材料进行体外细胞毒性评价和筛选。方法 选择具有X线下显影特性的基础材料A、B、C，分别与硅橡胶生胶共混炼，模压后分别得到相应的显影复合材料甲、乙、丙，经一段和二段硫化过程完成加工。采用MTT法作为体外细胞毒性评价的方法，测定参比对照材料和新材料的50％浓度的浸提液对小鼠成纤维细胞的增殖率的影响，确定细胞毒性级别。结果 新材料甲、乙、丙在x线下影像清晰。甲、乙材料的细胞毒性级别为零，丙材料细胞毒性级别为2。结论 构建出在X线下显影的弹性体材料可行。材料甲、乙是制造新型胆道支撑管的初选材料，材料丙无应用的价值。     

早期培养学生临床思维能力的探讨

临床思维能力是临床能力的核心和基础,提高临床思维能力是医学教育的终极目标之一,学生应尽早得到临床思维能力的培养和训练。通过对常用诊疗技术课程教学进行相应的改革实践,即应用多媒体技术支持的病案教学与临床见习整合的方法,培养学生的临床思维能力,经实践观察,这些教改措施与提高学生的临床思维能力有正相关关系。     

Synthetic scaffold morphology controls human dermal connective tissue formation

Engineering tissues in bioreactors is often hampered by disproportionate tissue formation at the surface of scaffolds. This hinders nutrient flow and retards cell proliferation and tissue formation inside the scaffold. The objective of this study was to optimize scaffold morphology to prevent this from happening and to determine the optimal scaffold geometric values for connective tissue engineering. After comparing lyophilized crosslinked collagen, compression molded/salt leached PEGT/PBT copolymer and collagen-PEGT/PBT hybrid scaffolds, the PEGT/PBT scaffold was selected for optimization. Geometric parameters were determined using SEM, microcomputed tomography, and flow permeability measurements. Fibroblast were seeded and cultured under dynamic flow conditions for 2 weeks. Cell numbers were determined using CyQuant DNA assay, and tissue distribution was visualized in H&E- and Sirius Red-stained sections. Scaffolds 0.5 and 1.5 mm thick showed bridged connected tissue from top-to-bottom, whereas 4-mm-thick scaffolds only revealed tissue ingrowth until a maximum depth of 0.6-0.8 mm. Rapid prototyped scaffold were used to assess the maximal void space (pore size) that still could be filled with tissue. Tissue bridging between fibers was only found at fiber distances < or =401 +/- 60 microm, whereas filling of void spaces in 3D-deposited scaffolds only occurred at distances < or =273 +/- 55 microm. PEGT/PBT scaffolds having similar optimal porosities, but different average interconnected pore sizes of 142 +/- 50, 160 +/- 56 to 191 +/- 69 microm showed comparable seeding efficiencies at day 1, but after 2 weeks the total cell numbers were significantly higher in the scaffolds with intermediate and high interconnectivity. However, only scaffolds with an intermediate interconnectivity revealed homogenous tissue formation throughout the scaffold with complete filling of all pores. In conclusion, significant amount of connective tissue was formed within 14 days using a dynamic culture process that filled all void spaces of a PEGT/PBT scaffolds with the following geometric parameters: thickness 1.5-1.6 mm, pore size range 90-360 microm, and average interconnecting pore size of 160 +/- 56 microm.     

胸腰脊神经根鞘形态观测及其临床意义

目的：为了探讨腰腿疼痛等疾病与脊神经根鞘的关系。方法：用巨视解剖和游标卡尺测量法对１５具尸体的胸腰脊神经根鞘进行了解剖学观察与测量。结果：①左、右胸腰脊神经根鞘长度和横径基本对称；②Ｔ１根鞘长度和横径大于其它胸神经根鞘，接近Ｌ２水平，Ｌ３～Ｌ５根鞘长度和横径大于其它胸腰神经根鞘，尤其Ｌ５更为突出；③胸腰脊神经根鞘开口式，由上向下，由２～３孔逐渐减至１孔。结论：①Ｔ１、Ｌ２～Ｌ５脊神经根鞘既长又粗，与周围接触范围大，受损危险增大；②根鞘开口式孔数由上向下减少，发生在鞘内的炎症和肿瘤引起前、后根同时受累的机会增多。     

院外纳曲酮治疗酒精依赖的疗效观察

目的 :评估纳曲酮院外治疗酒依赖的临床疗效。方法 :采用随机对照的方法 ,分别对纳曲酮组和安慰剂组各 2 3例和 2 2例 ,作总疗程 12周的临床观察。结果 :纳曲酮显著降低病人对酒精的渴求程度 ,其疗后 4、 8、 12周的保持率分别为 91 3 %、 77 9%、 73 3 % ,明显高于安慰剂。纳曲酮的副作用与安慰剂相当 ,其主要副作用为轻度的恶心、厌食、头晕。结论 :纳曲酮是一种安全有效的治疗酒依赖的药物     

早期脑血管病的微循环表现

通过对血液微循环观测，分析微循环障碍与早期脑血管病发生率的相关性。方法：采用微循环显微镜观察人体甲襞微循环的微血管和微血流的动态变化。结果：微循环障碍患者，表现明显微血管痉挛性和淤滞性改变，由于微循环灌注减少，加重组织缺血缺氧，微血栓形成。结论：微血管及微血流的异常影响人体机能代谢的变化，导致微血管内皮损伤、血液的凝固性增强，而外周血流及血管的异常改变，同样可影响脑血流量及供血。提示微循环障碍与早期脑血管病密切相关。对早期预防、诊断具有重要参考价值。