牙周膜干细胞的研究进展★

背景：从牙周膜组织中分离出的牙周膜干细胞被认为是牙周组织工程的首选种子细胞，有自我更新能力，能分化形成牙周的3种组织：牙槽骨、牙周膜和牙骨质。 目的：就近年来牙周膜干细胞的分离、鉴定、相关细胞因子等方面进行简要综述。 方法：由第一作者检索Pubmed 数据库(http://www.ncbi.nlm.nih.gov/pubmed)、中国知网数据库(http://www. cnki.net/)2004-01/2010-09有关牙周膜干细胞分离、鉴定、相关细胞因子等方面的文献，英文检索词为“periodontal ligament stem cell”，中文检索词为“牙周膜，干细胞”。排除重复性研究，最终纳入35篇文献进行综述。 结果与结论：牙周膜干细胞是一种很有潜力的牙周组织工程种子细胞，能构建组织工程牙周膜，促进牙周缺损的修复。随着研究的深入，影响牙周膜干细胞生物性能的因素逐渐被发现，但其研究还有待进一步完善。     

50000/聚乙烯表面菌膜抑制及表征

目的：研究抗感染聚乙烯材料的抗菌效果和在菌液中对材料表面菌膜形成的抑制作用。 方法：材料制备：低密度聚乙烯（LDPE）与有机和无机两种抗菌剂混合后先挤出造粒，然后注塑成片。实验评估：①用活菌平板计数法测定材料的抗菌性能。②平板超声波法及扫描电镜判断材料表面菌膜的形成。 结果：①两种改性抗菌材料对大肠杆菌和金黄色葡萄球菌都有良好的抗菌效果，抗菌率达到99.9%。②细菌菌膜（菌膜）的形成主要包括粘附、繁殖和成熟3个阶段，添加有机抗菌剂的试样在菌膜形成前就可以显著抑制细菌在其表面生长，从而抑制菌膜形成，扫描电镜结果表明其表面未见菌膜形成。空白试样和无机抗菌试样表面均有大量细菌和细胞外基质粘附。 结论：有机抗菌聚乙烯对大肠杆菌和金黄色葡萄球菌有良好的抑菌作用，可抑制细菌在材料表面形成菌膜，为防治医用导管相关感染提供了新的途径。     

组织工程修复脊髓损伤

目的：就近年来组织工程修复脊髓损伤进展进行归纳总结。资料来源：检索人为第一作者,检索文献时限为1999-09/2009-09,检索数据库为PubMed数据库（http://www.ncbi.nlm.nih.gov/PubMed）及CNKI数据库（www.cnki.net/index.htm）。中文检索词为“脊髓损伤,组织工程”;英文检索词为“spinal cord injury,tissue engineering”。资料选择：纳入标准,①选取组织工程修复脊髓损伤相关的临床和实验研究论文;②组织工程修复脊髓损伤方面的相关研究进展。排除重复研究。结局评价指标：计算机初检到82篇文献,阅读标题和摘要进行初筛,排除研究目的与本文无关的文献31篇,内容重复性研究20篇,保留31篇文献进一步分析,包括综述、评述、论著及临床报道文章,对文献分析,总结研究内容。结果：组织工程修复脊髓损伤研究包括如下,组织工程种子细胞选择,组织工程脊髓对支架材料的要求,再生所需神经营养因子,再生所需特殊内环境构建。结论：选择最佳组织工程组分是修复脊髓损伤重要依据。     

低强度脉冲超声波对骨折愈合的影响

摘要 背景：随着人们寻求促进骨折愈合方法的同时,低强度脉冲超声波以其费用低廉、无创伤、无感染、治疗方便、无副作用等优点逐步受到人们的关注与重视。 目的：通过查阅大量相关资料并进行分析总结,从作用机制、动物实验和临床应用入手,对低强度脉冲超声波影响骨折愈合的研究现状进行综述,以期为促进骨折愈合提供新的思路和理论依据。 方法：由第一作者进行检索Pubmed数据库(http://www.ncbi.nlm.gov/Pubmed) 1989/2009、维普数据库(www.cqvip.com) 1981/2009和万方数据库(www.wanfangdata.com.cn) (1981-2009)的相关文章。英文检索词为“LIPUS,fracture”,中文检索词为“低强度脉冲超声波,骨折”。纳入与低强度脉冲超声波或超声波治疗骨折密切相关,同一领域选择近期发表或在权威杂志上发表的文章;排除重复性文献。文献类型包括综述、动物试验和临床试验等。计算机初检得到60篇文献,英文28篇,中文32篇。阅读标题和摘要进行初筛,排除因研究目的与此文无关的11篇,内容重复性的研究8篇,综述、述评类5篇,保留36篇文献做进一步分析,包括11篇中文,25篇英文文献;其中动物实验和体内、体外、细胞学实验28篇,临床研究8篇。 结果与结论：低强度脉冲超声波治疗骨折具有费用低廉、安全、环保、无创性、无感染、操作简便、适用范围广和并发症少等优点,动物实验和临床应用等证实低强度脉冲超声波是一种有效的促进骨折愈合的方法,目前公认的是要应用低频率、低强度。低强度脉冲超声波治疗骨折,不仅涉及物理学,而且涉及医学等多个学科,由于对超声波方面研究进展,以及机体的复杂性及伦理方面问题,其作用机制以及脉冲超声波参数值及各参数间该如何组合还有待进一步探索。 关键词：低强度脉冲超声波;骨折愈合;作用机制;临床应用;综述文献     

间充质干细胞与肿瘤生长发展关系的研究现状

背景：间充质干细胞是具有多向分化潜能的一类组织干细胞,肿瘤可以诱导间充质干细胞迁移进入肿瘤组织。针对间充质干细胞对肿瘤生长发展的影响目前已经进行了大量的研究。 目的：综述间充质干细胞在肿瘤生长发展过程中的作用。 方法：应用计算机检索2000-01/2009-06 PubMed数据库(网址http://www.ncbi.nlm.nih.gov/PubMed)相关文章,检索词为“mesenchymal stem cell,myofibroblast,neoplasms”,并限定文章语言种类为English。共检索到文献8 372篇,37篇文献符合纳入标准。 结果与结论：间充质干细胞能够迁移进入肿瘤组织并且可以促进肿瘤的生长发展,这一过程可能与间充质干细胞促进肿瘤间质重构、促进肿瘤血管形成、抑制肿瘤局部机体免疫相关。但是也有一些研究结果表明间充质干细胞可以抑制肿瘤生长。因此进一步加深间充质干细胞与肿瘤关系的研究可能会增加人们对肿瘤发病机制的理解。     

透明质酸钠凝胶预防剖宫产后宫腔粘连的临床应用

摘要 背景：透明质酸钠具有预防盆、腹腔粘连的作用，但透明质酸钠宫腔停留时间短，难以达到预防宫腔粘连的作用。国外研究对透明质酸钠进行化学修饰形成自交联透明质酸钠凝胶，它对受损的宫内膜具有很强的黏附性，在宫腔内停留时间可达72 h。 目的：评价透明质酸钠凝胶在剖宫产后预防宫腔粘连的效果及安全性。 方法：由第一作者检索PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及维普数据库(http://www.cqvip.com/)有关透明质酸钠凝胶预防剖宫产后宫腔粘连的文献，检索时限为1990-01/2009-12，中文关键词为“透明质酸钠凝胶，剖宫产，粘连，宫腔粘连”，英文关键词为“sodium hyaluronate，cesarean section，adhesion，intrauterine adhesions”，排除重复研究或综述类文章。 结果与结论：共检索到相关文献150余篇，排除内容重复、综述类文章后筛选纳入16篇文献进行评价，其中中文12篇，英文4篇。结果显示，透明质酸钠凝胶是由N-乙酰葡萄糖醛酸反复交替而形成的一种高分子多糖体生物材料，具有高度的黏弹性、可塑性以及良好的生物相容性，在剖宫产后预防宫腔粘连效果明显，特别是能有效减少分离后再粘连的发生。但有一点十分重要，透明质酸钠凝胶是绝对不能用于血管内的，以免引起肺栓塞并发症。注射过程应缓慢，以免回流入静脉系统。 关键词：透明质酸钠凝胶；透明质酸钠；剖宫产；宫腔粘连；预防 doi:10.3969/j.issn.1673-8225.2011.12.031     

血液透析导管材料选择及感染的防治

背景：能够抑制生物被膜形成的高分子血液透析导管材料对预防高分子导管相关感染具有重要意义。 目的：综述血液透析导管材料的选择及其引发感染的相关因素及防治。 方法：应用计算机检索CNKI、PubMed数据库2005/2011与血液透析导管材料及其引发感染的防治相关的文献。 结果与结论：良好的血管通路是保证血液透析顺利进行和透析充分的首要条件,由导管引发的感染也十分常见,其中导管材料选择、操作是否无菌、感染原因、部位、感染后处理是关键因素,直接影响到是否可以深静脉留置导管成功且能否稳定可靠。目前倾向首选硅胶类或聚氨基甲酸乙酯导管,高分子材料透析导管中带涤纶套永久性双腔血液透析导管长期留置具有不影响血流动力学、不需要反复进行皮肤穿刺、良好的抗感染性能、留置取出简单等优点,是老年透析、严重心血管疾患及肾移植过渡期患者的最佳选择。     

脉冲电磁场影响骨折愈合的研究进展

背景：随着人们寻求促进骨折愈合方法的同时,脉冲电磁场以其无创伤、无感染、治疗方便、副作用小等优点日益受到人们的关注与重视。 目的：通过查阅大量相关资料并进行分析总结,从作用机制、动物实验和临床应用入手,对脉冲电磁场影响骨折愈合的研究现状进行综述,以期为促进骨折愈合提供新的思路和理论依据。 方法：由第一作者检索Pubmed数据库(http://www.ncbi.nlm.gov/Pubmed) 1989/2009及维普数据库(www.cqvip.com) 1981/2009的相关文章。英文检索词为“PEMF,fracture”,中文检索词为“脉冲电磁场,骨折”。纳入与脉冲电磁场或电磁场治疗骨折密切相关,同一领域选择近期发表或在权威杂志上发表的文章;排除重复性文献。文献类型包括综述、动物试验和临床试验等。计算机初检得到62篇文献,英文32篇,中文30篇。阅读标题和摘要进行初筛,排除因研究目的与此文无关的9篇,内容重复性的研究6篇,综述、述评类7篇,保留40篇文献做进一步分析,包括16篇中文,24篇英文文献;其中动物实验和体内、体外、细胞学实验31篇,临床研究9篇。 结果与结论：脉冲电磁场治疗骨折具有安全、环保、无创性、无感染、操作简便、适用范围广和并发症少等优点,动物实验和临床应用等证实脉冲电磁场是一种有效的促进骨折愈合的方法,目前公认的是要应用低频率、低强度。脉冲电磁场治疗骨折,不仅涉及物理学,而且涉及医学等多个学科,由于对电磁方面研究进展,以及机体的复杂性及伦理方面问题,其作用机制以及脉冲电磁场参数值及各参数间该如何组合还有待进一步探索。     

运用锁定加压接骨板内固定置入系统治疗骨折的临床新进展

目的：就近年来锁定加压接骨板在桡骨远端、肱骨近端、胫骨及其他部位的骨折治疗进展进行归纳总结。 资料来源：检索人为第一作者,检索文献时限为1992-06/2009-05,检索数据库为PubMed数据库(http://www. ncbi.nlm.nih.gov/PubMed)及CNKI数据库(www.cnki.net/index.htm)。中文检索词为锁定加压接骨板,骨折,治疗,综述;英文检索词为LCP,Fracture,Therapy,Review。 资料选择：纳入标准：①运用锁定加压接骨板内固定系统行骨折内固定手术病例。②运用锁定加压接骨板内固定系统行骨折内固定手术的临床研究进展。排除重复研究。 结局评价指标：计算机初检到127篇文献,阅读标题和摘要进行初筛,排除研究目的与本文无关的文献51篇,内容重复性研究35篇,保留41篇文献进一步分析,包括综述、评述、论著及临床报道文章。 结果：近几年锁定加压接骨板内固定系统已经关泛用于全身各处骨折内固定,并且治疗效果明显优于普通加压固定内固定系统,它依托微创接骨板固定技术,具有创伤小、操作简单、内固定牢靠,在某种程度上替代了外固定架,而且稳定性大于外固定架并兼顾了骨折解剖复位的特点。但对于下肢干部骨折,临床仍然首选髓内钉固定,目前这方面文献较少,希望以后加强这几方面的对比研究。 结论：锁定加压接骨板作为国际内固定协会理论下产生的新技术,由机械力学转向生物力学角度,提倡“弹性固定”,减少创伤,促进骨痂形成做出了令人鼓舞的贡献。     

生物补片在盆底修补和重建中的应用

背景：熟悉补片的分类、特性，以及宿主与补片之间的反应，对于修复外科手术材料的合理选择是十分必要的。 目的：对补片及修复材料的分类、性质及其在盆底修补和重建中的应用和并发症的处理进行归纳总结。 方法：应用计算机检索PubMed数据库（http://www.ncbi.nlm.nih.gov/PubMed）及CNKI数据库（www.cnki.net/index.htm），在标题和摘要中以“补片材料，聚丙烯，复合补片”或“reconstructive pelvic surgery，repair，replacement”为检索词进行检索。选择文章内容与补片类型、材料学特点、生物相容性及其应用效果相关，同一领域文献则选择近期发表或发表在权威杂志文章。根据纳入标准选择24篇文献用于进行综述。 结果和结论：聚丙烯补片的优点是编织的网，网孔较大，有利于纤维组织长入，提高了组织的强度和抗拉性，白细胞和巨噬细胞可自由进入网孔内，因此不易藏匿细菌，故具较好的抗感染能力，感染后多可不去除网片。而膨化聚四氟乙烯层则质地柔软、表面光滑，组织耐受性非常好，可防止与腹腔内组织粘连，而其亚微米水平的孔径防止了细菌的侵入，它所造成的炎症及异物反应是目前人工合成材料中最轻的。 关键词：补片材料；聚丙烯；聚四氟乙烯；复合补片；综述文献 doi:10.3969/j.issn.1673-8225.2010.03.036     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Clobazam for Treatment of Intractable Epilepsy: A Critical Assessment

Summary: Clobazam (CLB), a 1,5-benzodiazepine, is a remarkably effective add-on drug for individual patients with refractory partial epilepsy. CLB has an excellent safety record. As with all benzodiazepines used for treating epilepsy, sedation and withdrawal effects, together with the development of tolerance, limit its usefulness. Recent efforts to prevent or reverse tolerance with intermittent administration of CLB or periodic injection of a benzodiazepine antagonist, flumazenil, are encouraging and justify further investigations.     

La passion de Torquemada et le terrorisme islamique : quelques points de comparaison

This original research compares the doctrinal, psychopathological and operational standpoints of the 15th century Spanish Inquisition (Torquemada) with those of radical Islamism from 1988 to 2005 (Al-Qaeda). The following are reviewed: (a) the main texts codifying the procedure for conducting the criminal investigation of a Holy Office trial (Directorium inquisitorum); (b) the life and work of the grand inquisitor Tomás de Torquemada (1420–1498); (c) the psychopathological relations between passion (passionate psychoses, passionate idealism, paranoid personality) and fanaticism; (d) “the madmen, the enlightened and the criminals” of Islamic terrorism; (e) the cognitive and emotional motives for engagement in the jihadist radicalization of young people; (f) the common principles of monotheistic fanaticism (Inquisition, Al-Qaeda) and the particular dogmas of Islamic terrorism in our time; (g) the operating modes of the Inquisition and the Jihadist holy war. The author concludes that the rigour and seriousness of the inquisitorial judicial procedure, which was precise, individual and personalized, contrasts with the revolutionary pamphlets of Al-Qaeda, which only provide broad guidelines for the modus operandi of the fight against infidels, who are usually random victims.     

Claustration et collectionnisme : réflexions à propos d’un cas de syndrome de Diogène avec vols kleptomaniaques et vengeurs

Social withdrawal is a pathognomonic behaviour that is consistently associated with mental illnesses. Compulsive hoarding can also be interpreted as a pathological behaviour, even when it does not involve kleptomania. Diogenes syndrome (DS) was first described in 1975, and is characterized by both behaviours - social withdrawal and compulsive hoarding. Even though it is often the manifestation of a psychiatric condition, its aetiology is diverse. The most frequent ones are however: dementia, schizophrenia and mental retardation. In this study, we describe an atypical case presenting with DS. Il consists of a young man, seen in a forensic setting, who had been diagnosed with kleptomania in the past, presents with compulsive hoarding, and whose recent thefts were fuelled by revenge. Finally, to our knowledge, the way social withdrawal is viewed is seldom taken into account. We analyse its implication on social withdrawal.     

Neurological soft signs and schizophrenia: a review of current knowledge

Schizophrenia is a frequent and disabling disorder emerging during adolescence or early adulthood. The identification of underlying processes has been hampered by the complex clinical expression and the probable etiological heterogeneity. The frequency of neurological soft signs (NSS) in patients with schizophrenia and their presence early in life (during the first two years) in high risk subjects support the hypothesis that schizophrenia is a "brain disease" reflecting pre- or perinatal insults during development. The growing interest for NSS has lead to multiple studies that are often difficult to compare. The objective of this review is to summarize the current knowledge on NSS, methodological issues and the future perspectives.     

Lacan, lecteur de Minkowski : l'approche structurale

The notion of structure occupies a predominant place in the theory of Lacan. He indicates that was developed from the work of Minkowski. In fact, through his phenomeno-structural approach, Minkowski does not limit himself to purely observable phenomena, but attempts to determine the underlying structure. He refers to the comprehensive phenomenology and psychopathology, and this method provides him with clinical finesse and another means of determining a diagnosis. Thus Lacan has used this as a basis for his approach to structure to develop a theory regarding the individual. This implies that the structure of the individual is based on his relation to language. From this concept, he then develops the clinical structures of neurosis, psychosis, and perversion. These structural landmarks also have an effect on the course of treatment.