• 【在免疫复合物介导的血管炎的鼠模型中,血管损伤的部位和CD18的相关性。】 复制标题 收藏 收藏
    DOI:10.1038/sj.jid.5700563 复制DOI
    作者列表:Sindrilaru A,Seeliger S,Ehrchen JM,Peters T,Roth J,Scharffetter-Kochanek K,Sunderkötter CH
    BACKGROUND & AIMS: :How neutrophils (polymorphonuclear neutrophils, PMNs) damage vessels in leukocytoclastic vasculitis (LcV) mediated by immune complexes (ICs) is unclear. If degradative enzymes and oxygen radicals are released from PMNs while adhering to the inner side of the vessel wall, they could be washed away by the blood stream or neutralized by serum protease inhibitors. We investigated if in LcV PMNs could damage vessels from the tissue side after transmigration. We used CD18-deficient (CD18-/-) mice because the absence of CD18 excludes transmigration of PMNs. When eliciting the Arthus reaction in ears of CD18-/- mice, deposition of ICs was not sufficient to recruit PMNs or to induce IC-mediated LcV. Injection of PMNs intradermally in CD18-/- mice allowed us to investigate if bypassing diapedesis and placing PMNs exclusively on the abluminal side leads to vascular destruction. We found that injected PMNs gathered around perivascular ICs, but did not cause vessel damage. Only intravenous injection of wild-type PMNs could re-establish the Arthus reaction in CD18-/- mice. Thus, PMNs cause vessel damage during diapedesis from the luminal side, but not from the perivascular space. We suggest that in order to shield the cytotoxic products from the blood stream, ICs induce particularly tight interactions between them, PMNs and endothelial cells.
    背景与目标: 尚不清楚:中性粒细胞(多形核中性粒细胞,PMNs)如何损害由免疫复合物(ICs)介导的白细胞碎裂性血管炎(LcV)中的血管。如果降解酶和氧自由基在粘附到血管壁内侧时从PMN中释放出来,它们可能会被血流冲洗掉或被血清蛋白酶抑制剂中和。我们调查了在LcV PMNs迁移后是否会从组织侧损害血管。我们使用CD18缺陷(CD18-/-)小鼠,因为CD18的缺失排除了PMN的迁移。当在CD18-/-小鼠的耳朵中引起Arthus反应时,IC的沉积不足以募集PMN或诱导IC介导的LcV。在CD18-/-小鼠中皮内注射PMN使我们能够研究是否绕过了隔尿管并将PMN专门置于房外侧导致血管破坏。我们发现注射的PMN聚集在血管周围IC周围,但并未引起血管损伤。只有静脉注射野生型PMN才能在CD18-/-小鼠中重建Arthus反应。因此,PMNs在进行尿管穿刺时会从腔侧引起血管损伤,但不会引起血管周间隙损伤。我们建议,为了从血液中屏蔽细胞毒性产物,IC诱导它们,PMN和内皮细胞之间的相互作用特别紧密。
  • 【肝细胞癌肝或外周血端粒酶表达的动态变化及其诊断意义。】 复制标题 收藏 收藏
    DOI:10.3748/wjg.v12.i31.4966 复制DOI
    作者列表:Yao DF,Wu W,Yao M,Qiu LW,Wu XH,Su XQ,Zou L,Yao DB,Meng XY
    BACKGROUND & AIMS: AIM:To investigate the dynamic alteration of telomerase expression during development of hepatocellular carcinoma (HCC) and its diagnostic implications in liver tissues or peripheral blood mononuclear cells for HCC. METHODS:Dynamic expressions of liver telomerase during malignant transformation of hepatocytes were observed in Sprague-Dawly (SD) rats fed with 0.05% of 2-fluoenyacetamide (2-FAA). Total RNA and telomerase were extracted from rat or human liver tissues. The telomerase activities in livers and in circulating blood were detected by a telomeric repeat amplification protocol-enzyme-linked immunosorbent assay (TRAP-ELISA), and its diagnostic value was investigated in patients with benign or malignant liver diseases. RESULTS:The hepatoma model displayed the dynamic expression of hepatic telomerase during HCC development. The telomerase activities were consistent with liver total RNA levels (r = 0.83, P<0.01) at the stages of degeneration, precancerosis, and cancerization of hepatocytes. In HCC patients, the telomerase levels in HCC tissues were significantly higher than in their adjacent non-cancerous tissues, but liver total RNA levels were lower in the former than in the latter. Although the circulating telomerase of HCC patients was abnormally expressed among patients with chronic liver diseases, the telomerase activity was a non-specific marker for HCC diagnosis, because the incidence was 15.7% in normal control, 25% in chronic hepatitis, 45.9% in liver cirrhosis, and 85.2% in HCC, respectively when absorbance value of telomerase activity was more than 0.2. If the value was over 0.6, the incidence was 60% in HCC group and 0% in any of the others (P<0.01) except in two cases with liver cirrhosis. However, the combination of circulating telomerase with serum alpha-fetoprotein level could increase the positive rate and the accuracy (92.6%, 125 of 135) of HCC diagnosis. CONCLUSION:The overexpression of telomerase is associated with HCC development, and its abnormality in liver tissues or in peripheral blood could be a useful marker for diagnosis and prognosis of HCC.
    背景与目标: 目的:研究肝细胞癌(HCC)发展过程中端粒酶表达的动态变化及其在肝组织或外周血单核细胞中的诊断意义。
    方法:在喂食0.05%2-氟乙酰胺(2-FAA)的Sprague-Dawly(SD)大鼠中观察肝细胞恶性转化过程中肝端粒酶的动态表达。从大鼠或人肝脏组织中提取总RNA和端粒酶。通过端粒重复扩增方案-酶联免疫吸附测定(TRAP-ELISA)检测肝脏和循环血液中的端粒酶活性,并对其在良性或恶性肝病患者中的诊断价值进行研究。
    结果:肝癌模型在肝癌发生过程中表现出肝端粒酶的动态表达。在变性,癌前期和肝细胞癌化阶段,端粒酶活性与肝脏总RNA水平一致(r = 0.83,P <0.01)。在HCC患者中,HCC组织中的端粒酶水平显着高于其相邻的非癌组织,但前者的肝脏总RNA水平低于后者。尽管在慢性肝病患者中HCC患者的循环端粒酶异常表达,但端粒酶活性不是HCC诊断的非特异性标志物,因为正常对照组的发生率为15.7%,慢性肝炎为25%,肝为45.9%当端粒酶活性的吸光度值大于0.2时,肝硬化和HCC中的85.2%。如果该值超过0.6,则除两名肝硬化患者外,HCC组的发生率为60%,其他任何一组的发生率为0%(P <0.01)。但是,循环端粒酶与血清甲胎蛋白水平的结合可以提高HCC诊断的阳性率和准确率(92.6%,第125页)。
    结论:端粒酶的过表达与肝癌的发生有关,其在肝组织或外周血中的异常可能是诊断和预后的有用标志物。
  • 【非侵入性连续估计人pa骨的血流变化。】 复制标题 收藏 收藏
    DOI:10.1007/s11517-006-0070-0 复制DOI
    作者列表:Näslund J,Pettersson J,Lundeberg T,Linnarsson D,Lindberg LG
    BACKGROUND & AIMS: :A photoplethysmographic (PPG) technique to assess blood flow in bone tissue has been developed and tested. The signal detected by the PPG consists of a constant-level (DC) component-which is related to the relative vascularization of the tissue-and a pulsatile (AC) component-which is synchronous with the pumping action of the heart. The PPG probe was applied on the skin over the patella. The probe uses near-infrared (804 nm) and green (560 nm) light sources and the AC component of the PPG signals of the two wavelengths was used to monitor pulsatile blood flow in the patellar bone and the overlying skin, respectively. Twenty healthy subjects were studied and arterial occlusion resulted in elimination of PPG signals at both wavelengths, whereas occlusion of skin blood flow by local surface pressure eliminated only the PPG signal at 560 nm. In a parallel study on a physical model with a rigid tube we showed that the AC component of the PPG signal originates from pulsations of blood flow in a rigid structure and not necessarily from volume pulsations. We conclude that pulsatile blood flow in the patellar bone can be assessed with the present PPG technique.
    背景与目标: :已经开发并测试了用于评​​估骨组织中血流的光电容积描记(PPG)技术。 PPG检测到的信号由与组织的相对血管形成有关的恒定水平(DC)分量和与心脏的泵浦动作同步的脉动(AC)分量组成。将PPG探针施加到over骨上的皮肤上。该探头使用近红外(804 nm)和绿色(560 nm)光源,并且两个波长的PPG信号的AC分量分别用于监视the骨和周围皮肤中的脉动血流。对二十名健康受试者进行了研究,动脉闭塞导致两种波长的PPG信号均被消除,而局部表面压力对皮肤血流的闭塞仅消除了560 nm处的PPG信号。在具有刚性管的物理模型的并行研究中,我们显示了PPG信号的AC分量源自刚性结构中的血流脉动,而不一定源自体积脉动。我们得出的结论是,可以使用当前的PPG技术评估the骨中的搏动性血流。
  • 【使用源自人脐带血的干细胞的潜在临床应用。】 复制标题 收藏 收藏
    DOI:10.1016/s1472-6483(10)60646-3 复制DOI
    作者列表:Ghen MJ,Roshan R,Roshan RO,Blyweiss DJ,Corso N,Khalili B,Zenga WT
    BACKGROUND & AIMS: :There is an abundance of clinical applications using human umbilical cord blood (HUCB) as a source for stem cell populations. Other than haematopoietic progenitors, there are mesenchymal, endothelial stem cells and neuronal precursors, in varying quantities, that are found in human umbilical cord blood. These may be useful in diseases such as immune deficiency and autoimmune disorders. Considering issues of safety, availability, transplant methodology, rejection and side effects, it is contended that a therapeutic stem cell transplant, utilizing stem cells from HUCB, provides a reliable repository of early precursor cells that can be useful in a great number of diverse conditions. Drawbacks of relatively smaller quantities of mononucleated cells in one unit of cord blood can be mitigated by in-vitro expansion procedures, improved in-vivo signalling, and augmentation of the cellular milieu, while simultaneously choosing the appropriate transplantation site and technique for introduction of the stem cell graft.
    背景与目标: :有大量的临床应用使用人类脐带血(HUCB)作为干细胞群体的来源。除造血祖细胞外,人类脐带血中还存在不同数量的间充质,内皮干细胞和神经元前体。这些可能对诸如免疫缺陷和自身免疫性疾病等疾病有用。考虑到安全性,可用性,移植方法,排斥反应和副作用等问题,可以认为,利用HUCB干细胞进行的治疗性干细胞移植可提供可靠的早期前体细胞库,该库可在多种条件下使用。可以通过体外扩增程序,改进的体内信号传导和细胞环境增强来缓解一单位脐带血中相对较少数量的单核细胞的缺点,同时选择合适的移植部位和技术引入干细胞移植。
  • 【太空飞行期间对便携式临床血液分析仪的评估。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Smith SM,Davis-Street JE,Fontenot TB,Lane HW
    BACKGROUND & AIMS: This study was designed to validate the utility of a commercial portable clinical blood analyzer (PCBA) in ground-based studies and on the space shuttle. Ionized calcium, pH, electrolytes, glucose, and hematocrit were determined. Results agreed well with those from traditional laboratory methods, and the PCBA demonstrated good between-day precision for all analytes. In-flight analysis of control samples revealed differences in one analyte (sodium). There were few changes in crew members' results during flight, and these were expected. Potassium increased in flight compared with before flight, and potassium, pH, and hematocrit decreased after flight. Ionized calcium was decreased in flight and on landing day. Changes during flight were likely related to sample collection technique. Postflight changes likely reflected the fluid redistribution that occurs after exposure to weightlessness. These data confirm that the PCBA is a reliable instrument for most analytes, and can provide important medical data in remote locations, such as orbiting spacecraft.

    背景与目标: 这项研究旨在验证商用便携式临床血液分析仪(PCBA)在地面研究和航天飞机上的实用性。测定了电离的钙,pH,电解质,葡萄糖和血细胞比容。结果与传统实验室方法的结果非常吻合,PCBA证明所有分析物的日间精度都很高。对照样品的飞行中分析揭示了一种分析物(钠)的差异。机组人员在飞行过程中的结果变化不大,这是可以预期的。与飞行前相比,飞行中钾增加,而飞行后钾,pH和血细胞比容下降。电离钙在飞行中和降落当天减少。飞行过程中的变化可能与样本采集技术有关。飞行后的变化很可能反映了失重后流体的重新分布。这些数据证实,PCBA是用于大多数分析物的可靠仪器,并且可以在诸如轨道飞行器之类的偏远地区提供重要的医学数据。

  • 【艾滋病患者的更昔洛韦耐药性巨细胞病毒(CMV)视网膜炎一例:CMV病毒载量和血室中病毒突变的纵向分子分析。】 复制标题 收藏 收藏
    影响因子 :
    发表时间:1997-06-01
    来源期刊:AIDS
    DOI:10.1097/00002030-199707000-00005 复制DOI
    作者列表:Boivin G,Gilbert C,Morissette M,Handfield J,Goyette N,Bergeron MG
    BACKGROUND & AIMS: OBJECTIVE:To study the temporal relationships between cytomegalovirus (CMV) viral load and specific UL97 mutations in polymorphonuclear leukocytes (PMNL) and plasma samples from a patient with AIDS who developed ganciclovir-resistant CMV retinitis.

    METHODS:Sequential PMNL and plasma samples were analysed for determination of the CMV viral load using non-molecular methods and a quantitative polymerase chain reaction (PCR) assay. Screening of the same samples for the most common mutations conferring ganciclovir resistance was performed using nested PCR and restriction enzyme analysis.

    RESULTS:At the time of progression of CMV retinitis (after 6 months of ganciclovir), a rapid increase in the CMV DNA load was found in both PMNL and plasma samples. This increase paralleled the emergence of a specific mutation (V594) in the same samples and recovery of ganciclovir-resistant blood isolates. In this patient, however, the only tests that substantially predicted the progression of CMV disease were the quantitative PCR assay using PMNL and to a lesser extent the pp65 antigenemia assay.

    CONCLUSIONS:Quantitative evaluation of the CMV viral load in PMNL using sensitive assays such as PCR appears to be a promising approach for monitoring antiviral therapy in subjects with AIDS. In addition, common mutations conferring ganciclovir resistance can be detected directly in PMNL and plasma samples.

    背景与目标: 目的:研究巨细胞病毒耐药性巨细胞病毒性视网膜炎的艾滋病患者的巨细胞病毒(CMV)病毒载量与多形核白细胞(PMNL)和血浆样品中特定UL97突变之间的时间关系。

    方法:使用非分子方法和定量聚合酶链反应(PCR)分析了连续的PMNL和血浆样品,以测定CMV病毒载量。使用巢式PCR和限制性内切酶分析对相同样品中最引起更昔洛韦耐药的突变进行筛查。

    结果:在CMV视网膜炎进展时(6个月后) (更昔洛韦)的检测,在PMNL和血浆样品中均发现CMV DNA载量迅速增加。这种增加与相同样品中特异突变(V594)的出现和更昔洛韦耐药血分离株的回收率平行。然而,在该患者中,唯一可以预测CMV疾病进展的检测方法是使用PMNL进行定量PCR检测,并在较小程度上使用pp65抗原血症检测。使用敏感的检测方法(如PCR)评估PMNL中CMV病毒载量似乎是监测艾滋病患者抗病毒治疗的一种有前途的方法。此外,可以在PMNL和血浆样品中直接检测到更昔洛韦耐药的常见突变。

  • 【在阿尔茨海默氏病中,MRI指导的SPECT测量颞叶内侧血流。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Julin P,Lindqvist J,Svensson L,Slomka P,Wahlund LO
    BACKGROUND & AIMS: UNLABELLED:In this study, we assessed the accuracy and reliability of MRI-guided SPECT measurements of medial temporal lobe blood flow in Alzheimer's disease (AD).

    METHODS:Interactively aligned three-dimensional MP-RAGE MRI and 99mTc-HMPAO SPECT images were used for MRI-guided measurement of medial temporal lobe CBF in eight control subjects and eight patients with probable AD. Intraoperator reliability was assessed by repeated alignment and measurement by one experienced operator. Accuracy was assessed by examining two subjects with fiducial markers.

    RESULTS:The alignment error was less than 1 SPECT pixel size (3.5 mm) and the coefficient of variation in repeated measures of medial temporal-to-cerebellar CBF ratios was 3.2%. The difference in mean medial temporal-to-cerebellar CBF ratios between eight control subjects and eight AD patients was 12%. Also by using three-dimensional seed-grow defined healthy brain reference regions, there were significant differences between control subjects and AD patients in medial temporal blood flow. Furthermore, the volumes of the MRI-defined medial temporal ROIs were smaller in the AD patients. The best separation between AD patients and control subjects was achieved by combining MRI measurements of atrophy and SPECT measurements of CBF.

    CONCLUSION:These data show that the accuracy and reliability of MRI-guided SPECT measurements of medial temporal CBF clearly allow the detection of changes in AD. Also, a direct comparison of structural and functional changes is possible by this methodology, which might improve the early diagnosis of AD.

    背景与目标: UNLABELLED :在这项研究中,我们评估了MRI指导的SPECT测量中度颞叶血流在阿尔茨海默病(AD)中的准确性和可靠性。

    方法 strong>:交互式对准的三维MP-RAGE MRI和99mTc-HMPAO SPECT图像用于MRI指导的八名对照受试者和八名可能患有AD的患者的内侧颞叶CBF的测量。一位经验丰富的操作员通过反复对准和测量来评估操作员的可靠性。通过检查两个带有基准标记的受试者来评估准确性。

    结果:对准误差小于1个SPECT像素大小(3.5毫米),并且重复内侧测量的变异系数颞小脑CBF率为3.2%。八名对照受试者和八名AD患者之间的平均内侧颞小脑CBF比率的差异为12%。同样,通过使用定义的三维种子生长的健康大脑参考区域,对照受试者和AD患者之间的颞内侧血流存在显着差异。此外,在AD患者中,MRI定义的内侧颞部ROI的体积较小。通过将萎缩的MRI测量值和CBF的SPECT测量值相结合,可以使AD患者与对照组之间达到最佳分离。

    结论:这些数据表明,MRI指导的准确性和可靠性内侧颞CBF的SPECT测量清楚地允许检测AD的变化。同样,通过这种方法可以直接比较结构和功能的变化,这可能会改善AD的早期诊断。

  • 【患有肺囊性纤维化的患者,在呼气压力为正值且振荡的呼气压力为正值的情况下,进行胸部物理治疗时,血气压力立即变化。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Lagerkvist AL,Sten GM,Redfors SB,Lindblad AG,Hjalmarson O
    BACKGROUND & AIMS: OBJECTIVE:To assess and compare immediate effects of chest physiotherapy with positive expiratory pressure (PEP) versus oscillating PEP on transcutaneously measured blood-gas tensions in patients with cystic fibrosis. METHODS:Fifteen patients (mean age 12.5 y, range 6.9-21.5 y) participated. The treatments were randomized and performed on 2 separate occasions, 8 weeks apart. Spirometry was conducted before and after each treatment. We transcutaneously measured oxygen tension (P(tO2). RESULTS:There were no changes in spirometry values. During PEP, different trends in blood-gas tension were seen, and there were no consistent changes. During oscillating PEP, P(tO2) increased and P(tCO2) decreased. During oscillating PEP, P(tCO2) was lower and the intra-individual change in P(tCO2) was more pronounced than during PEP. The results obtained immediately after oscillating PEP showed a higher P(tO2) and a lower P(tCO2) than with PEP. CONCLUSION:PEP and oscillating PEP can both cause transitory effects on blood gases in patients with cystic fibrosis. However, oscillating PEP alters blood-gas tensions more than does PEP, and hyperventilation during oscillating PEP may reduce treatment time.
    背景与目标: 目的:评估和比较呼气正压(PEP)和振荡PEP对胸部物理治疗对囊性纤维化患者经皮测量的血气张力的即时效果。
    方法:15例患者(平均年龄12.5岁,范围6.9-21.5岁)参加了研究。治疗是随机的,分别在两个不同的场合进行,相隔8周。在每次治疗之前和之后进行肺活量测定。我们经皮测量了氧气张力(P(tO2)。
    结果:肺活量测定值没有变化。在PEP期间,观察到了血气紧张的不同趋势,并且没有一致的变化。在振荡PEP期间,P(tO2)增加而P(tCO2)减少。在振荡PEP期间,P(tCO2)较低,并且P(tCO2)的内部个体变化比PEP期间更为明显。振荡PEP后立即获得的结果显示,与PEP相比,P(tO2)更高,P(tCO2)更低。
    结论:PEP和振荡PEP均可对囊性纤维化患者的血气产生短暂影响。但是,与PEP相比,振荡PEP对血气压力的改变更大,并且在振荡PEP期间过度换气可能会减少治疗时间。
  • 【通过微孔过滤测量的外周血中性粒细胞流变学很好地反映了贝塞特的疾病活动。】 复制标题 收藏 收藏
    DOI:10.1016/s0923-1811(97)00599-9 复制DOI
    作者列表:Iijima S,Otsuka F
    BACKGROUND & AIMS: Activated neutrophils take a long time to pass through a narrow lumen like a micropore, and are supposed to play a deteriorating effect on microcirculation. Although the activation of neutrophils has been demonstrated in Behçet's disease, nobody analyzes the clinical activity of the disease by means of the rheological measure of neutrophils activity. Using a micropore (pore diameter 5 microns) filtration technique, we measured the filtration time of peripheral blood neutrophils, as a rheological measure of their activity, in order to determine the clinical activity of Behçet's disease. Twenty-one patients with Behçet's disease and 14 healthy control individuals were enrolled in the study. Symptoms and signs exhibited in the patients led us to distinguish the Behçet's disease into inactive and active cases. The latter were further differentiated into cases with absent symptoms and with present symptoms. Neutrophil filtration times were 11.5 +/- 4.8 s in the active cases with present symptoms, which were significantly (P < 0.05) larger than those (7.4 +/- 1.9 s) in the active cases with absent symptoms. The latter filtration times were further significantly (P < 0.001) larger than values (3.7 +/- 1.3 s) in the inactive cases and also those (4.8 +/- 1.2 s) in control subjects. Furthermore, increases in the filtration time obtained immediately after the exposure of cells to the chemotactic peptide formyl-methionyl-leucyl-phenylalanine (FMLP10 nM) were significantly (P < 0.01) larger in the active cases with present symptoms than those in the active cases with absent symptoms. The latter were also larger, but not significantly, than those in the inactive cases, and were significantly (P < 0.01) larger than those in control subjects. The present results demonstrate that the micropore filtration method reflects well the rheological activity of neutrophils as well as the clinical status of Behçet's disease. This method is much better than the measurement of O2 production to differentiate between active cases with absent symptoms and inactive patients or even control individuals. Furthermore, it is more sensitive and useful than laboratory data like the CRP value or the number of peripheral blood neutrophils.

    背景与目标: 活化的嗜中性粒细胞需要很长时间才能通过像微孔一样的狭窄内腔,因此应该对微循环起恶化作用。尽管在白塞氏病中已证明嗜中性粒细胞的活化,但没有人通过流变学方法测量嗜中性粒细胞的活性来分析该疾病的临床活性。我们使用微孔(孔径为5微米)过滤技术,测量外周血中性粒细胞的过滤时间,作为其活性的流变学指标,以确定贝塞特氏病的临床活性。本研究招募了21名Behçet病患者和14名健康对照者。患者表现出的症状和体征使我们将Behçet病区分为非活跃和活跃病例。后者被进一步区分为无症状和有当前症状的病例。在有症状的活跃病例中,中性粒细胞过滤时间为11.5 /-4.8 s,比没有症状的活跃病例中的中性粒细胞过滤时间显着(P <0.05)大(P <0.05)。后者的过滤时间比不活动时的值(3.7 /-1.3 s)大得多(P <0.001),也比对照组的人(4.8 /-1.2 s)大。此外,在有症状的活动病例中,将细胞暴露于趋化肽甲酰基-甲硫酰基-亮氨酰-苯丙氨酸(FMLP10 nM)后立即获得的过滤时间增加明显大于活动病例(P <0.01)。没有症状。后者也比不活动者大,但不显着,并且比对照组大(P <0.01)。目前的结果表明,微孔过滤方法很好地反映了中性粒细胞的流变活性以及白塞氏病的临床状况。这种方法比测量氧气的产生要好得多,以区分没有症状的活动患者和无活动的患者,甚至是对照个体。此外,它比实验室数据(如CRP值或外周血中性粒细胞的数量)更为敏感和有用。

  • 【在全髋关节置换术中使用其他血液回输技术进行血液稀释。】 复制标题 收藏 收藏
    DOI:10.1097/00003086-199706000-00018 复制DOI
    作者列表:Oishi CS,D'Lima DD,Morris BA,Hardwick ME,Berkowitz SD,Colwell CW Jr
    BACKGROUND & AIMS: Acute normovolemic hemodilution has been reported to result in blood savings varying from 18% to 90%. Very few of these are randomized prospective studies. This study attempts to determine the blood transfusion savings if acute normovolemic hemodilution is used in combination with autologous predonated blood and cell saver. Thirty-three patients undergoing total hip arthroplasty were assigned randomly to one of two groups (control, n = 16; hemodilution, n = 17). Patients in both groups entered an autologous predonation program if cleared medically and were placed on Cell Saver intraoperatively and in the postanesthesia care unit. In addition, the hemodilution group underwent acute normovolemic hemodilution preoperatively. Only 41% of the patients in the hemodilution group required any autologous blood transfusion as compared with 75% of the control group. In addition, the hemodilution group required a mean lower quantity of autologous blood transfusion (41% of the estimated blood loss) as compared with the control group (71%). The net anesthesia time increased by an average of 11.4 minutes in the hemodilution group. Acute normovolemic hemodilution is a safe procedure even in an older patient population. Hemodilution resulted in fewer patients needing autologous predonated blood transfusions. The major benefit of hemodilution was seen when predonation was not possible.

    背景与目标: 据报道,急性降血常规血液稀释可节省18%至90%的血液。这些很少是随机的前瞻性研究。这项研究试图确定如果将急性等渗血液稀释与自体预先捐献的血液和细胞保护剂结合使用可节省的输血量。将接受全髋关节置换术的33例患者随机分为两组(对照组,n = 16;血液稀释,n = 17)。两组患者均在接受医学检查后进入了自体捐赠程序,并在术中和麻醉后监护病房接受了Cell Saver治疗。另外,血液稀释组术前进行了急性等渗血液稀释。血液稀释组中只有41%的患者需要自体输血,而对照组为75%。此外,血液稀释组与对照组(71%)相比平均需要较少量的自体输血(估计失血量的41%)。血液稀释组的净麻醉时间平均增加了11.4分钟。即使在年龄较大的患者中,急性降血常规血液稀释也是一种安全的方法。血液稀释导致更少的患者需要自体先验的输血。当无法进行预先捐赠时,可以看到血液稀释的主要好处。

  • 【正常成年大鼠的血脑屏障缺陷区域的免疫环境增强。】 复制标题 收藏 收藏
    DOI:10.1016/s0165-5728(97)00038-6 复制DOI
    作者列表:Pedersen EB,McNulty JA,Castro AJ,Fox LM,Zimmer J,Finsen B
    BACKGROUND & AIMS: The circumventricular organs (CVOs) in the brain are without a blood-brain barrier (BBB) and as such directly exposed to blood plasma constituents and blood-borne pathogens. In light of previous studies showing discrepancies regarding the immunocompetence of these organs, we initiated the present study to provide a comprehensive immunohistochemical analysis of the cellular expression of immune-associated antigens within the pineal gland, area postrema and the subfornical organ. In all CVOs, subpopulations of cells morphologically similar to complement receptor type 3 immunoreactive microglial/macrophage cells expressed major histocompatibility complex (MHC) class II antigen, leucocyte common antigen (LCA/CD45), as well as CD4 and ED1 antigen. Based on morphological criteria the MHC class II antigen expressing cells could be grouped into a major population of classical parenchymal and perivascular ramified microglial cells and a minor population presenting itself as scattered or small groups of rounded macrophage-like cells. CD4 and ED1 antigen were expressed by both cell types. CD45 was preferentially expressed by macrophage-like cells. MHC class I antigen was expressed by the vascular endothelium in both BBB-protected and BBB-deficient areas and was additionally present as a lattice-like network throughout the BBB-deficient parenchyma in all CVOs. The results suggest that the BBB-free areas of the brain besides being constantly surveyed by blood-borne macrophages, possess an intrinsic immune surveillance system based on resting and activated microglial cells, which may function as a non-endothelial, cellular barrier against blood-borne pathogens.

    背景与目标: 大脑中的室间隔器官(CVO)没有血脑屏障(BBB),因此直接暴露于血浆成分和血源性病原体。鉴于先前的研究表明这些器官的免疫能力存在差异,我们启动了本研究,以提供对松果体,视网膜后区域和分支下器官内免疫相关抗原的细胞表达的全面免疫组织化学分析。在所有CVO中,与补体受体3型免疫反应性小胶质细胞/巨噬细胞细胞形态相似的细胞亚群表达了主要的组织相容性复合物(MHC)II类抗原,白细胞常见抗原(LCA / CD45)以及CD4和ED1抗原。根据形态学标准,可以将表达MHC II类抗原的细胞分为经典的实质和血管周围分枝的小神经胶质细胞的主要群体,以及表现为散在的或成团的圆形巨噬细胞样细胞的少数群体。 CD4和ED1抗原通过两种细胞类型表达。 CD45优先由巨噬细胞样细胞表达。 MHC I类抗原在BBB保护区和BBB缺失区均由血管内皮表达,并在所有CVO中的整个BBB缺失实质中均呈格子状网络存在。结果表明,除了大脑中无血脑屏障的区域不断被血源性巨噬细胞检查外,还具有基于静止和活化的小胶质细胞的内在免疫监视系统,该系统可能起非内皮细胞屏障的作用。传播的病原体。

  • 【肝细胞癌患者中识别野生型p53衍生表位的CD8 T淋巴细胞频率增加与表位缺失肿瘤变体的存在相关。】 复制标题 收藏 收藏
    DOI:10.1002/ijc.22251 复制DOI
    作者列表:Cicinnati VR,Zhang X,Yu Z,Ferencik S,Schmitz KJ,Dworacki G,Kaczmarek E,Oldhafer K,Frilling A,Baba HA,Schmid KW,Grosse-Wilde H,Broelsch CE,DeLeo AB,Gerken G,Beckebaum S
    BACKGROUND & AIMS: :Wild-type (WT) sequence p53 peptides are attractive candidates for broadly applicable cancer vaccines. The aim of this study was to evaluate the potential of a WT p53-based immunotherapeutic approach for patients with hepatocellular carcinoma (HCC). Circulating CD8+ T cells specific for WT p53(149-157) and WT p53(264-272) HLA-A*0201 restricted epitopes were directly identified in the peripheral blood by the use of peptide/HLA-A2.1 tetramers in 24 HCC patients. Cytotoxic T lymphocyte (CTL) activity after WT p53 peptide-specific stimulation was assessed by analysis of granzyme B and interferon-gamma mRNA transcription, using a quantitative real-time polymerase chain reaction assay. Tumor immunophenotyping was performed to evaluate the p53 status, the expression of major histocompatibility complex (MHC) and costimulatory molecules in freshly isolated tumor cells. HCC patients exhibited significantly higher frequencies of WT p53-specific memory CD8+ T cells and stronger WT p53-specific CTL activity, when compared with healthy controls. Increased frequencies of p53-specific CD8+ T cells and their activity correlated with selective HLA-A2 allele loss and reduced costimulatory molecule expression of tumor cells. Moreover, augmented numbers of p53-specific T cells coincided with high MHC class II expression in tumor cells but were inversely related to the T status of the tumor node metastasis staging system. Our results indicate the existence of natural immunosurveillance and tumor immune evasion, involving a T cell response against WT p53 tumor antigen in patients with HCC. These findings may have important implications for the future development of cancer vaccines.
    背景与目标: :野生型(WT)序列p53肽是广泛应用的癌症疫苗的诱人候选物。这项研究的目的是评估肝细胞癌(HCC)患者基于WT p53的免疫治疗方法的潜力。通过在24 HCC中使用肽/HLA-A2.1四聚体直接在外周血中鉴定出对WT p53(149-157)和WT p53(264-272)HLA-A * 0201限制性表位具有特异性的循环CD8 T细胞耐心。 WT p53肽特异性刺激后的细胞毒性T淋巴细胞(CTL)活性通过使用实时定量聚合酶链反应测定的颗粒酶B和干扰素-γmRNA转录分析来评估。进行肿瘤免疫表型分析以评估新鲜分离的肿瘤细胞中p53的状态,主要组织相容性复合体(MHC)的表达和共刺激分子。与健康对照相比,HCC患者表现出明显更高的WT p53特异性记忆CD8 T细胞频率和更强的WT p53特异性CTL活性。 p53特异性CD8 T细胞的频率增加及其活性与选择性HLA-A2等位基因缺失和肿瘤细胞共刺激分子表达降低有关。此外,p53特异性T细胞数量的增加与肿瘤细胞中II类MHC的高表达相吻合,但与肿瘤淋巴结转移分期系统的T状态呈负相关。我们的结果表明,在肝癌患者中存在自然免疫监视和肿瘤免疫逃避,涉及针对WT p53肿瘤抗原的T细胞应答。这些发现可能对癌症疫苗的未来发展具有重要意义。
  • 【通过气管内施用编码人血小板生成素cDNA的腺病毒载体来提高血小板水平。】 复制标题 收藏 收藏
    DOI:10.1038/nbt0697-570 复制DOI
    作者列表:Cannizzo SJ,Frey BM,Raffi S,Moore MA,Eaton D,Suzuki M,Singh R,Mack CA,Crystal RG
    BACKGROUND & AIMS: :This study was designed to evaluate the hypothesis that administration of a replication-deficient, recombinant adenovirus vector to the epithelial surface of the respiratory tract can be used to deliver a recombinant protein to the systemic circulation in sufficient quantities to evoke a systemic response appropriate to the recombinant protein. We administered AdCMV.TPO-an adenovirus vector containing an expression cassette coding for the human thrombopoietin (TPO) cDNA-to the respiratory epithelium of immunocompetent Balb/c mice. Over the following week, serum human TPO levels were elevated, platelet levels increased more than sixfold, and megakaryocytosis was evident in bone marrow. This strategy may be a useful approach to the nonparenteral administration of a variety of therapeutic recombinant proteins, such as those relevant to clotting, endocrine function, and bone-marrow function.
    背景与目标: :这项研究旨在评估以下假设:向呼吸道上皮表面施用复制缺陷型重组腺病毒载体可将重组蛋白以足够的量递送至全身循环,以引起适当的全身反应。重组蛋白。我们将AdCMV.TPO-一种含有编码人血小板生成素(TPO)cDNA的表达盒的腺病毒载体施用于具有免疫功能的Balb / c小鼠的呼吸道上皮。在接下来的一周中,人的血清TPO水平升高,血小板水平升高了六倍以上,并且在骨髓中发现了巨核细胞增多。该策略可能是非胃肠道给药多种治疗性重组蛋白(例如与凝血,内分泌功能和骨髓功能相关的蛋白)的有用途径。
  • 【专门的儿科机构环境对潜在供体器官恢复的影响。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Donkin M,Kolovos N,Checchia PA
    BACKGROUND & AIMS: BACKGROUND:The relationship between accessibility to the full range of subspecialty care available at freestanding pediatric hospitals and organ donor management and recovery rates has not been studied. OBJECTIVE:To examine current rates of recovery of organs from children for transplantation at free-standing pediatric hospitals versus all other hospitals. METHODS:Data from the hospitals served by Mid-America Transplant Services from January 2000 to July 2003 were reviewed. Organ recovery rates from freestanding children's hospitals were compared with the rates from other types of institutions. Patients were included if their organs were considered medically suitable at the time of referral for donation. RESULTS:Overall, 66% (210/318) of the potential organs were recovered. The type of institution in which the potential donor was managed did not influence the proportion of organs recovered: 67% (96/144) at freestanding children's hospitals versus 66% (114/174) at all other hospitals. A greater proportion of livers were recovered at other donor institutions than at children's hospitals (100% vs 85%, P< or =.01). CONCLUSION:The organ recovery rate from potential pediatric donors is low. In general, this rate does not appear to be affected by the type of managing pediatric institution except for liver recovery, which favors institutions that are not freestanding children's hospitals. The low rate of recovery suggests that although suitable donors are identified, appropriate referrals are made, and families provide consent for donation, major obstacles remain to the successful recovery of organs.
    背景与目标: 背景:尚未研究独立式儿科医院可提供的全面亚专业护理的可获得性与器官捐赠者的管理与康复率之间的关系。
    目的:研究在独立的儿科医院与所有其他医院中,儿童从器官移植的当前恢复率。
    方法:回顾了2000年1月至2003年7月由中美洲移植服务中心服务的医院的数据。将独立儿童医院的器官恢复率与其他类型机构的器官恢复率进行了比较。如果在转诊时认为其器官在医学上合适,则将患者包括在内。
    结果:总体上,回收了66%(210/318)的潜在器官。管理潜在捐赠者的机构类型不会影响器官康复的比例:独立儿童医院为67%(96/144),而其他所有医院为66%(114/174)。与儿童医院相比,其他捐赠机构的肝脏回收率更高(100%比85%,P <或= .01)。
    结论:潜在的小儿供体器官恢复率低。通常,该比率似乎不受受儿科机构管理的类型的影响,除了肝脏恢复外,这有利于非独立儿童医院的机构。较低的康复率表明,尽管确定了合适的捐献者,进行了适当的转介,并且家人同意捐献,但器官成功康复的主要障碍仍然存在。
  • 【使用MR数字减影血管造影评估儿童颅内病变的血液供应。】 复制标题 收藏 收藏
    DOI:10.1007/s00247-006-0268-1 复制DOI
    作者列表:Chooi WK,Connolly DJ,Coley SC,Griffiths PD
    BACKGROUND & AIMS: BACKGROUND:MR digital subtraction angiography (MR-DSA) is a contrast-enhanced MR angiographic sequence that enables time-resolved evaluation of the cerebral circulation. OBJECTIVE:We describe the feasibility and technical success of our attempts at MR-DSA for the assessment of intracranial pathology in children. MATERIALS AND METHODS:We performed MR-DSA in 15 children (age range 5 days to 16 years) referred for MR imaging because of known or suspected intracranial pathology that required a dynamic assessment of the cerebral vasculature. MR-DSA consisted of a thick (6-10 mm) slice-selective RF-spoiled fast gradient-echo sequence (RF-FAST) acquired before and during passage of an intravenously administered bolus of Gd-DTPA. The images were subtracted and viewed as a cine loop. RESULTS:MR-DSA was performed successfully in all patients. High-flow lesions were shown in four patients; these included vein of Galen aneurysmal malformation, dural fistula, and two partially treated arteriovenous malformations (AVMs). Low-flow lesions were seen in three patients, all of which were tumours. Normal flow was confirmed in eight patients including two with successfully treated AVMs, and in three patients with cavernomas. CONCLUSION:Our early experience suggests that MR-DSA is a realistic, non-invasive alternative to catheter angiography in certain clinical settings.
    背景与目标: 背景:MR数字减影血管造影(MR-DSA)是一种对比增强的MR血管造影序列,可对脑循环进行时间分辨评估。
    目的:我们描述了MR-DSA评估儿童颅内病理的尝试的可行性和技术成功。
    材料与方法:由于已知或怀疑颅内病理需要动态评估脑血管系统,我们对15例接受MR成像的儿童(年龄范围5天至16岁)进行了MR-DSA检查。 MR-DSA由厚的(6-10 mm)切片选择性RF破坏的快速梯度回波序列(RF-FAST)组成,在静脉内给予Gd-DTPA推注之前和期间均已获得。减去图像并将其视为电影循环。
    结果:所有患者均成功进行了MR-DSA检查。四名患者出现高流量病灶。其中包括Galen动脉瘤畸形静脉,硬脑膜瘘和两个经过部分治疗的动静脉畸形(AVM)。在三名患者中均发现了低流量病变,所有这些都是肿瘤。在八名患者中确认了正常血流,其中包括两名成功治疗过的AVM和三名患有海绵状瘤的患者。
    结论:我们的早期经验表明,在某些临床情况下,MR-DSA是导管血管造影术的一种现实的,非侵入性的替代方法。

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