纳米银抗菌技术在临床医疗中的应用

摘要 背景：作为一种新型无机抗菌材料,纳米银不仅具备超强的抗菌效果,且对人体更为安全。 目的：就纳米银材料的结构特性和抗菌机制、生物安全性、在医疗卫生领域的应用以及未来发展方向作一概述,以期纳米银材料得到广泛和有效的应用。 方法：应用计算机检索PubMed数据库中1997-01/2010-03关于纳米银抗菌机制及生物安全性的文章,在标题和摘要中以“nanosilver;antibacteria;biofilm;bio-safty”为检索词进行检索,选择文章内容与纳米银抗菌机制、细菌生物膜、以及纳米银生物安全性相关,同一领域文献则选择近期发表或发表在权威杂志文章。初检共得到123篇文献,根据纳入标准选择42篇文章进行综述。 结果与结论：纳米银材料由于其量子效应、小尺寸效应和极大的比表面积特性,容易与病原微生物密切接触,从而发挥更大的生物效应,因此具有抗菌范围广、持续杀菌时间长等优点。其抗菌广谱抗菌作用机制的深入,将为研制安全有效的广谱抗菌的纳米抗菌药物和材料提供理论基础和实验依据,为人类细菌感染的广谱预防和治疗提供新的方法和策略。 关键词：纳米银;抗菌;生物膜;生物安全性;医疗应用 doi:10.3969/j.issn.1673-8225.2010.42.026     

甲壳素/壳聚糖生物抗菌敷料在皮肤组织工程中的应用

目的：探讨甲壳素/壳聚糖生物抗菌敷料的性能及其在皮肤组织工程中的应用。 方法：由作者应用计算机检索中国知网(CNKI)与万方医学网中与生物抗菌敷料特性及临床应用有关的文献,检索时限为1996/2010。检索关键词：生物抗菌敷料,甲壳素/壳聚糖,皮肤组织工程,安全性,性能特点。纳入标准: ①甲壳素/壳聚糖生物抗菌敷料的性能。②甲壳素/壳聚糖生物抗菌敷料在皮肤组织工程中的应用。③同一领域选择近期发表或在权威杂志上发表的文章。排除标准：排除重复研究和较陈旧文献。对资料进行初审,并查看每篇文献后的引文。 结果：根据纳入排除标准,共纳入20篇相关文献。甲壳素/壳聚糖安全性和可降解性良好,吸湿性、抑菌性强,并具有止血和止痛、抑制瘢痕形成、促进细胞生长、加速伤口创面愈合和促进机体非特异性免疫的功能。从其在皮肤组织工程中的应用研究来看,甲壳素/壳聚糖可有效促进烧伤创面的愈合和皮肤再生,且不增加创面感染的机率。 结论： 甲壳素/壳聚糖生物抗菌敷料性能良好,能有效促进烧伤创面愈合和增强皮肤再生,在皮肤组织工程及其他医学领域中具有广泛常规应用的可能性。     

不同聚合方法对热凝基托树脂力学性能的影响

【摘要】 目的：热凝基托树脂经过不同方法聚合,观察比较其力学性能的变化,为临床提供理论依据。方法：分实验对照两组,实验组为热凝基托树脂经过快速方法聚合,对照组为热凝基托树脂标准方法聚合,对两种方法聚合的基托树脂试样在材料试验机上对其冲击强度、弯曲强度、弹性模量和布氏硬度进行测定,并对断面进行电子显微分析。结果：快速聚合基托树脂和标准聚合基托树脂的冲击强度（KJ/mm3）分别为6.73±1.23 ,7.35±0.93 ,弯曲强度（Mpa）为89.93±12.92 ,90.19±6.88 MPa,弹性模量（Gpa）为 2.2±0.2 GPa ,2.4±0.1,,布氏硬度（kg/mm2)为20.70±2.89,19.57±1.05kg/mm2,其各项力学性能无显著性差异（P>0.05）;不同方法聚合的基托树脂断面的微观结构也比较相似。结论：采用快速与标准两种方法进行基托树脂的聚合,其各项力学性能及微观结构无明显差异。但该材料在实际工作中,对于全口义齿及复杂局部义齿等基托比较厚的情况是否与本实验相一致,是否会影响义齿的质量,还须在临床上具体应用,作进一步的长期观察。     

新型纳米银/聚氨酯胆道支架表面抗菌涂层的体外抑菌试验*

摘要 背景：胆管支架已广泛应用于胆管各种良恶性狭窄的姑息治疗,临床短期疗效显著,但长期疗效由于支架再狭窄而受到限制。 目的：研制新型纳米银/聚氨酯胆管内支架复合抗菌涂层并检测其体外抗菌性能。 方法：原位还原法用纳米银、聚氨酯制备纳米银/聚氨酯抗菌材料,采用抑菌环试验法分别测定实验组(纳米银/聚氨酯)、阳性对照(硝酸银纸片)和阴性对照(普通聚氨酯材料)3组对金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌、肺炎克雷伯杆菌和肠球菌的抑菌环直径并记录分析数据。 结果与结论：纳米银/聚氨酯在体外对金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌、肺炎克雷伯杆菌和肠球菌均有抑制效果,与硝酸银纸片相比,抑菌效果差异无显著性意义。结果显示纳米银/聚氨酯复合物具有良好的抗菌效果,且具有较好的稳定性。 关键词：纳米银;聚氨酯;复合材料;抑菌;应用 doi:10.3969/j.issn.1673-8225.2011.03.018     

纳米人造皮肤及其材料在烧伤创面的应用

目的：总结评价目前纳米人造皮肤及材料的种类、性能特点以及在烧伤创面的应用情况和发展前景。 方法：采用电子检索的方式,在万方数据库(http://www.wanfangdata.com.cn/)中检索1999-01/2009-12有关纳米人造皮肤及材料在烧伤创面应用的研究文章,关键词为“纳米技术,人工材料,烧伤创面”。排除重复研究、普通综述或Meta分析类文章,筛选纳入24篇文献进行评价。 结果：目前,用于皮肤修复的纳米敷料主要有载角质细胞生长因子、细菌纤维素、纳米银和几丁聚糖纳米微粒等。根据尺寸效应和表面效应的原理,将各种皮肤敷料纳米化,可使敷料更好地黏附,能有效防止创面出血和感染,减少疼痛,加快创面修复。其中纳米银的临床应用最多,发展最快。纳米银与其他材料的复合使用也在研究探索之中,并已取得一些成效。同时,纳米材料用于烧伤创面修复的安全性、稳定性、均匀性和生产率等问题也引起人们的重视,是当前该方向的热点研究问题之一。 结论：纳米敷料种类多样,功效良好,不良事件少,是比较理想的烧伤创面用药类型,值得进一步研究。 关键词：纳米技术;人工材料;烧伤皮肤;创面修复;安全性 doi:10.3969/j.issn.1673-8225.2010.29.023     

纯钛金属与聚甲基丙烯酸甲酯树脂材料基托全口义齿修复后的语音学评价

摘要 背景：有研究表明口腔中修复体的范围、厚度和形态直接影响患者的语音功能,而纯钛金属基托和树脂基托由于材料厚度的不同对语音功能的影响有所不同。 目的：通过分析配戴纯钛金属基托与聚甲基丙烯酸甲酯树脂基托全口义齿同一患者的计算机语音学参数,探讨上颌义齿基托对语音功能的影响。 方法：用计算机语音分析系统及语音分析软件PRAAT4.4.34对同一患者分别配戴纯钛金属基托义齿、聚甲基丙烯酸甲酯树脂基托义齿提取辅音/x,sh,r,zh,ch,j ,q/第一强频集中区频率值、辅音/g,k,zh,ch,j,q/嗓音起始时间值进行统计学分析,并对两组舌根塞音三维语谱图进行观察比较。 结果与结论：聚甲基丙烯酸甲酯树脂基托全口义齿由于基托厚度较大而在一定程度上不利于患者语音功能的恢复,选择纯钛金属基托义齿,减少舌腭区基托厚度更有利于患者语音功能的恢复。结果提示用计算机语音分析系统提取分析第一强频集中区频率值和嗓音起始时间等语音学参数对患者配戴全口义齿后语音清晰度分析具有客观性,上颌义齿舌腭区基托材料厚度越小,越有利于患者语音功能的恢复。 关键词：全口义齿;无牙颌;辅音;语音学;钛;聚甲基丙烯酸甲酯;生物材料     

几种常用载银抗菌材料改性方式的研究现状

摘要 背景：银系抗菌剂具有生物安全性高,抗菌谱广,不产生耐药性等特点,是口腔无机抗菌剂中研究的热点。 目的：围绕几种常用银系无机抗菌剂载体结构、载银原理及对其载银方式、载银环境等改性增强其抗菌效果和改善原材料缺陷的研究现状作以综述。 方法：应用计算机检索CNKI数据库、OVID数据库2000/2010有关银系抗菌剂及其载体的相关文章。 结果与结论：无论是传统的沸石、磷酸盐等载体,还是新型的纳米载银方式,人们都从材料本身特征及其载银特质方面不断改性,以期得到用量更少,抑菌性能更优及克服了变色等性能缺陷的优质载银抗菌剂。以后载银无机抗菌材料的开发,除了可以更进一步地利用纳米载银以外,还可以往复合抑菌,缓释抑菌以及将抑菌作为其他材料的添加辅助性能等方面发展。 关键词：银系抗菌剂;载体;改性;抗菌材料;口腔生物材料 doi:10.3969/j.issn.1673-8225.2011.12.038     

纳米复合羟基磷灰石在口腔治疗中的应用

学术背景：纳米羟基磷灰石的应用研究是口腔医学领域中的一个非常重要的课题,已有将纳米复合羟基磷灰石应用于根管治疗的报道。 目的：介绍羟基磷灰石在口腔领域尤其在口腔颌面外科和口腔内科中的应用进展,综合分析纳米羟基磷灰石在根管充填研究动态,展望其在口腔材料领域的潜在发展。 检索策略：由第一、二作者应用计算机检索EBSCOhost数据库和NCBI数据库1992/2007相关文献,检索词为“Hydroxyapatite,Nanometer”,限定语言种类为“English”;同时检索CNKI全文数据库、维普全文数据库、万方数字化期刊1995/2007相关文献,检索词为“羟基磷灰石,纳米”,限定语言种类为中文。纳入标准：内容与羟基磷灰石的结构、改性研究、生物学特性以及在口腔医学领域有关。排除标准：较陈旧和重复研究。 文献评价：共收集到276篇相关文献,纳入30篇完全符合要求的文献,其中9篇介绍纳米羟基磷灰石在口腔颌面外科及口腔内科的临床应用;21篇关于纳米羟基磷灰石的基础研究,包括细胞毒性、生物相容性、骨诱导性、复合材料的制备和抗菌性及其在组织工程领域中的应用。 资料综合：纳米复合羟基磷灰石由于与天然骨无机结构相似生物相容性极好,有骨诱导性,对骨缺损的修复起到了关键作用,纳米特性减少了根管充填后的微渗漏,纳米羟基磷灰石和一些抑菌/抗菌制剂复合的新型纳米复合羟基磷灰石有良好的抑菌/抗菌性,对牙髓病和根尖周病的治疗起到了良好效果。 结论：新型纳米复合羟基磷灰石符合生物材料细胞毒性要求,按毒性剂量分级属无毒级,无致热原性、对皮肤无刺激作用,具有良好的生物相容性、骨诱导性、细胞黏附性和抑菌/抗菌性,有望在口腔基础研究和临床应用中发挥更大的作用。     

全口义齿疲劳强度与义齿材料学的关系

背景：全口义齿是口腔修复临床工作中常见的一种修复形式,然而全口义齿上基托中间断面的早期断裂是影响全口义齿使用寿命的一个重要因素。 目的：从力学方面分析全口义齿的早期失效问题。 方法：通过对基托的受力分析、结构分析、材料性能分析,找出上基托中间断面早期断裂的真正原因,从而提出解决上基托中间断面早期断裂的新方法,提高全口义齿的疲劳强度,延长修复体的使用寿命。 结果与结论：采用现有的优质高疲劳强度的塑料制造基托的全口义齿,与用合金钢丝或铸钢制成基托骨架的全口义齿比较：①它有延长使用寿命的作用(一般说也不会有永久寿命)。②价格要低一倍或更多。③质量轻带上舒适。 关键词：全口义齿;受力分析;疲劳强度;修复体;塑料 doi:10.3969/j.issn.1673-8225.2010.29.017     

纳米银诱导细胞凋亡的研究与进展****

目的：总结国内外纳米银诱导细胞凋亡的研究进展。 资料来源：应用计算机检索PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed,英文) 1972-08/2009-09 的相关文章,检索词“silver nanoparticles, apoptosis ,silver nanoparticles toxicity”,限定文章语言种类为English。同时计算机检索中国期刊全文数据中国知网(www.cnki.net/index.htm,中文)1972-08/2009-09 的相关文章,检索词“纳米银,凋亡,纳米银毒性”,限定文章语言种类为中文。 资料选择：纳入具有原创性的研究论文,其研究材料或方法具有代表性。排除重复性研究及与课题相关性较弱的文献。 结局评价指标：纳米银的毒性作用及纳米银诱导细胞凋亡的机制研究。 结果：目前较关注纳米银的临床运用,但是,有一些报道证实纳米银对细胞产生毒性,使细胞发生凋亡。纳米银颗粒可以通过多种途径引起细胞凋亡,而具体是哪种途径为主,则受到纳米银颗粒的粒径、粒径分布、形状、表面性质等众多因素的影响。 结论：目前人们还不了解纳米银诱导细胞凋亡的机制,对纳米银颗粒引起细胞凋亡机制的研究,有利于人们改进纳米银颗粒的制造工艺或表面结构,从而减小其对细胞的毒性。 关键词：纳米银;凋亡;纳米银毒性     

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.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

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.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

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.