骨组织工程研究的方法论检讨及其思路创新

目前骨组织工程的研究十分注重分析和实验的方法,走的主要是还原论的道路.系统科学的进展表明,生物体功能的行使远非简单的子系统叠加,单纯的还原论方法遇到了挑战.系统论更适合于骨组织工程研究的方法论指导.讨论整体论与还原论相结合的骨组织工程研究的创新思路,探讨建立体内灌注诱导成骨微环境系统这一创新性的近同构模型.     

从组织工程学看知识创新的主要特征

1　组织工程学体现了知识创新的创造性特征 ,创造性是知识创新的首要特性1985年Ｒｕｓｓｅｌ的一篇关于选择细胞移植的评论文章中大胆提出器官移植的新方法———即仅选择器官或组织的部分进行移植 ,他讨论了胰岛细胞的抑制和肝细胞的传递 ,但是这种把细胞悬浮在组织上是不能形成组织结构的 ,它因缺少固有的起始结构和引导组织再建的支架 ,而没有取得成功。 1984年Ｂｏｓｔｏｎ儿童医院进行了肝移植手术。但由于器官缺乏 ,在Ｖａｃａｎｔｉ领导下该院新建立的组织工程和移植实验室与麻省理工学院的Ｌａｎｇｅｒ教授指导的聚合物实验室的研究…     

生物工程领域的崭新前沿--组织工程

组织工程是在组织水平上操作的生物工程,主要致力于组织和器官的形成和再生,它是对外科领域中组织、器官缺损和功能障碍传统治疗方法和模式的一次革命。同时组织工程是一门多学科交叉的边缘学科,将是２１世纪具有巨大潜力的高技术产业,必将产生巨大的社会和经济效益。     

针对软骨组织工程研究发展的几点思考

简述软骨组织工程研究发展的新成果,软骨组织工程种子细胞的研究更加广泛深入,出现一些性能卓越的新型组织工程生物材料,更加优化的环境因素更有利于构建组织工程软骨.初步探讨了一些技术性问题,组织工程软骨还存在种子细胞的大规模扩增、软骨退化、软骨表型不稳定等一些技术性问题.探讨了软骨组织工程在临床应用方面的一些医学伦理学问题和对策,展望了我国软骨组织工程的发展前景.     

组织工程骨再生:细胞型,还是非细胞型——从技术方法的基本特征分析骨组织工程研究的两种技术路线

组织器官的丧失或功能障碍是人类健康所面临的主要危害之一 ,也是人类疾病和死亡的主要原因。病损组织、器官功能和结构的修复也是现代医学研究领域中的一个重大问题。随着现代医学的飞速发展 ,尤其是器官移植技术和人工器官的出现 ,使人类对组织器官缺损的治疗有了很大的进步。在矫形外科领域 ,自从 182 0年 ,德国医师ＰｈｉｌｉｐｓＶａｎＷａｌｔｅｒ将环锯取出的颅骨进行原位移植修复 ,开创了自体骨移植的先河。而后又发展出异体骨移植、异种骨移植直到建立完善的综合型骨库。骨不连、骨缺损的治疗水平达到了前所未有的高度 ,大量的患者…     

利用组织工程治疗骨缺损中的几点问题

骨缺损是临床上的常见病,也是骨科治疗的难题之一.近年来,骨组织工程发展迅速,利用骨组织工程治疗骨缺损成为研究的热点.组织工程应用的主要问题在于种子细胞的培养和细胞种植基质材料的优化.在此领域的发展过程中,渗透着丰富的哲学思想,理解和把握这些哲学思想对完善利用骨组织工程治疗骨缺损的工作将大有益处.     

利用组织工程治疗骨缺损中的几点问题

骨缺损是临床上的常见病,也是骨科治疗的难题之一。近年来,骨组织工程发展迅速,利用骨组织工程治疗骨缺损成为研究的热点。组织工程应用的主要问题在于种子细胞的培养和细胞种植基质材料的优化。在此领域的发展过程中,渗透着丰富的哲学思想,理解和把握这些哲学思想对完善利用骨组织工程治疗骨缺损的工作将大有益处。     

组织工程学技术与医学科技伦理的相互关系——矛与盾还是剑与鞘

组织工程学技术为人类疾病治疗带来希望的同时,也提出了严峻的医学科技伦理问题.组织工程学产生和发展是必然的,与医学科技伦理的矛盾也是必然的,两者间如何找到平衡,是值得探索的.旨在阐明二者间矛盾的必然性,分析相互关系,是制约对立的矛与盾,还是和谐统一的剑与鞘,并提出如何实现双赢,找到平衡的若干设想.     

软组织生物力学与骨科临床

软组织的生物力学在骨科临床上的应用赋予骨科医生全新的理论思维,不仅纠正了传统治疗方法中的某些不足,更使新的治疗方法具有理论上的科学根据,从而提高临床疗效。临床骨科学是以人体运动系统(除骨骼外,尚包括肌肉、肌腱、韧带等软组织)为解剖学基础的,了解相关的软组织生物力学知识和基本概念,对于骨科医生在临床实践过程中的医疗行为是十分重要的。     

Towards a Richer Debate on Tissue Engineering: A Consideration on the Basis of NEST-Ethics

In their 2007 paper, Swierstra and Rip identify characteristic tropes and patterns of moral argumentation in the debate about the ethics of new and emerging science and technologies (or “NEST-ethics”). Taking their NEST-ethics structure as a starting point, we considered the debate about tissue engineering (TE), and argue what aspects we think ought to be a part of a rich and high-quality debate of TE. The debate surrounding TE seems to be predominantly a debate among experts. When considering the NEST-ethics arguments that deal directly with technology, we can generally conclude that consequentialist arguments are by far the most prominently featured in discussions of TE. In addition, many papers discuss principles, rights and duties relevant to aspects of TE, both in a positive and in a critical sense. Justice arguments are only sporadically made, some “good life” arguments are used, others less so (such as the explicit articulation of perceived limits, or the technology as a technological fix for a social problem). Missing topics in the discussion, at least from the perspective of NEST-ethics, are second “level” arguments—those referring to techno-moral change connected to tissue engineering. Currently, the discussion about tissue engineering mostly focuses on its so-called “hard impacts”—quantifiable risks and benefits of the technology. Its “soft impacts”—effects that cannot easily be quantified, such as changes to experience, habits and perceptions, should receive more attention.     

软组织生物力学与骨科临床

软组织的生物力学在骨科临床上的应用赋予骨科医生全新的理论思维,不仅纠正了传统治疗方法中的某些不足,更使新的治疗方法具有理论上的科学根据,从而提高临床疗效.临床骨科学是以人体运动系统(除骨骼外,尚包括肌肉、肌腱、韧带等软组织)为解剖学基础的,了解相关的软组织生物力学知识和基本概念,对于骨科医生在临床实践过程中的医疗行为是十分重要的.     

Kidney Transplants From Young Children and the Mentally Retarded

Kidney donation by young children and the mentally retarded has been supported by court decisions, arguments based on obligations inherent in family relationships, an array of contextual factors, and the principle of beneficence. These justifications for taking organs from people who cannot protect themselves are problematic and must be weighed against our obligation to protect the vulnerable. A compromise solution is presented that strongly protects young children and the mentally retarded but does not abdicate all responsibility to relieve suffering. Guidelines are proposed that prohibit the retrieval of kidneys from young children and the mentally retarded but permit one exception. They would allow retrieval of a kidney when the consequence to a first order relative with whom the donor has a meaningful and valuable relationship is otherwise imminent death. This would be done in accordance with additional guidelines that minimize harm to the donor. Since most patients with end stage renal disease can be maintained on dialysis the need for a kidney to prevent death should be an uncommon occurrence. This compromise is proposed as a solution to a dilemma that exists because two ethical principles are in conflict and one cannot be honored without violating the other.     

My Heart Made Me Do It: Children's Essentialist Beliefs About Heart Transplants

Psychological essentialism is a folk theory characterized by the belief that a causal internal essence or force gives rise to the common outward behaviors or attributes of a category's members. In two studies, we investigated whether 4‐ to 7‐year‐old children evidenced essentialist reasoning about heart transplants by asking them to predict whether trading hearts with an individual would cause them to take on the donor's attributes. Control conditions asked children to consider the effects of trading money with an individual. Results indicated that children reasoned according to essentialism, predicting more transfer of attributes in the transplant condition versus the non‐bodily money control. Children also endorsed essentialist transfer of attributes even when they did not believe that a transplant would change the recipient's category membership (e.g., endorsing the idea that a recipient of a pig's heart would act pig‐like, but denying that the recipient would become a pig). This finding runs counter to predictions from a strong interpretation of the “minimalist” position, an alternative to essentialism.     

Essentialist Beliefs About Bodily Transplants in the United States and India

Psychological essentialism is the belief that some internal, unseen essence or force determines the common outward appearances and behaviors of category members. We investigated whether reasoning about transplants of bodily elements showed evidence of essentialist thinking. Both Americans and Indians endorsed the possibility of transplants conferring donors' personality, behavior, and luck on recipients, consistent with essentialism. Respondents also endorsed essentialist effects even when denying that transplants would change a recipient's category membership (e.g., predicting that a recipient of a pig's heart would act more pig‐like but denying that the recipient would become a pig). This finding runs counter to predictions from the strongest version of the “minimalist” position (Strevens,2000), an alternative to essentialism. Finally, studies asking about a broader range of donor‐to‐recipient transfers indicated that Indians essentialized more types of transfers than Americans, but neither sample essentialized monetary transfer. This suggests that results from bodily transplant conditions reflect genuine essentialism rather than broader magical thinking.     

小儿气管支气管异物手术的麻醉决策

气管支气管异物是耳鼻喉科急症之一,具有较高的病死率,及时手术取出异物是唯一的解决方法,而麻醉方式及其深浅程度的控制是手术成功的关键.随着对气管支气管异物病理生理机制认识的加深,手术的麻醉方式也经历了无麻醉、基础麻醉以及全麻,不同的麻醉方式适用于不同的临床情况,正确抉择适当的麻醉方法则是确保手术顺利实施的基础,并可有效地降低病死率及手术的并发症,预防疾病所致的潜在心理创伤.     

转变理念规范治疗

学科带头人的理念、意识、能力对于学科的发展及功能的实现起着关键的作用,关系到学科的未来发展.本期"临床决策研究"栏目中,孙文兵等撰写的"论当代临床学科带头人的领导素质"深入分析了学科带头人提升领导能力必需的十个转变,指出学科带头人在服务理念上,要由经营思维向职业思维转变,树立"救人为本,经营为道"的发展理念,一切以患者的最大利益为着眼点,为患者提供有效、安全、便捷的医疗服务.     

Regulating Biopharming: The Prism of Farmer Knowledge

Farmers have local knowledge relevant to the prospective assessment of biopharming—the farming of transgenic plants and animals genetically modified to produce pharmaceutical substances for use in humans or animals. However, biopharming regulatory regimes are being constructed in ways that render farmers' knowledge irrelevant. The exclusion of farmer knowledge is traceable to what we call its politico-epistemic unworkability as regulatory knowledge in regulatory regimes characterised not only by a focus on risk but also by pre-commitments to market-driven innovation and individual freedom of choice. Such innovation requires predictability in the regulatory environment, which is supplied in part through regulatory authorities' adoption of risk-assessment methodologies that both assume predictability (of natural and social worlds) and generate predictable decision outcomes. These regulatory approaches are co-constituted with scientific knowledge of gene flow developed through studies that can demonstrate a reliable and readily modellable decline of undesirable effect across space or time and therefore make possible the setting of clear and workable parameters for risk management. The farmers' knowledge discussed here highlights the extent to which this is a process of co-production. Moreover, it suggests that the claimed economic advantages of outdoor biopharming, achieved through the substitution of agronomic practice for laboratory infrastructure, depend both on natural processes that always also threaten to undermine confinement and on the habitus of successful farmers, which may in fact be incompatible with the kind of risk management that biopharming requires.