细胞因子诱导的杀伤细胞与肿瘤浸润淋巴细胞体外细胞毒活性比较

目的比较用多种细胞因子诱导的杀伤细胞(CIK)与癌性胸水中肿瘤浸润淋巴细胞(TIL)的细胞毒活性,为临床应用提供依据.方法用不同的细胞因子分别诱导培养CIK和癌性胸水TIL,按常规法计数细胞增殖量,采用四甲基偶氮唑盐(MTT)比色法检测其细胞毒活性.结果诱导培养14 d后,CIK细胞毒活性为(76.65±16.78)%,增殖倍数为520±102;TIL细胞毒活性为(55.31±11.02)%,增殖倍数为182±78.结论CIK细胞对K562细胞的细胞毒活性在14 d时达峰值,而TIL细胞在2l d时才达峰值,且CIK细胞毒活性明显高于TIL细胞,增殖细胞数量也比TIL细胞高.CIK可替代TIL细胞进行胸腔注射治疗癌性胸水.     

自体CIK过继免疫治疗恶性肿瘤的最佳输注时间

摘要：目的:研究恶性肿瘤患者自体细胞因子诱导的杀伤细胞(CIK)的免疫表型与细胞毒活性的变化规律,探讨肿瘤患者CIK过继免疫治疗输注的最佳时间。 方法:采集40例恶性肿瘤患者外周血单个核细胞(PBMC),由IFN-γ、rhIL-1α、rhIL-2等细胞因子和CD3单克隆抗体体外诱导培养成CIK。用流式细胞术动态监测免疫表型,MTT法分析细胞毒活性。 结果：随着诱导时间的延长,PBMC中CD3⁺、CD3⁺CD8⁺、CD3⁺CD56⁺表型细胞所占比例呈上升趋势。CD3⁺CD4⁺细胞在7 d达到峰值,随后缓慢下降。CD25⁺细胞在培养的早期(3～7 d)即达峰值,7～14 d缓慢下降,14～21 d快速下降。HLA-DR+细胞在0～14 d处于上升期,14 d达峰值后快速下降。成熟CIK细胞毒活性［(52.49±7.70)%］较未活化的PBMC［(7.02±2.00)%］显著增高(P<0.01)。 结论:14 d左右能诱导出典型的CIK,CD3⁺CD56⁺细胞处于对数生长期。确立自体CIK过继免疫治疗恶性肿瘤的最佳输注时间为第14天。     

ATP和COA活化癌性胸水TIL的增殖力与杀伤活性的研究

目的 探讨ATP与COA活化癌性胸水肿瘤浸润淋巴细胞（TIL）的增殖力与杀伤活性。 方法 应用ATP和COA作为癌性胸水TIL的培养液,在7天、14天、21天、28天分别计算其增殖力,测定其杀伤细胞活性。 结果 单一的完全培养液TIL增殖量仅为（51．37±18．56）×108／ml,加入ATP和COA的完全培养液在14天时TIL增殖量即可达（105．31±24．76）×108／ml,扩增能力增加一倍以上。加入ATP和COA所培养的TIL其杀伤细胞活性明显增强,在14天百分比达到58．12±12．35, 21天百分比时可达78．50±11．93。同时可提前一周达到临床治疗胸腔积液输注所需的TIL数量。 结论 培养液中加入ATP和COA可以活化癌性胸水ITL的增殖力与杀伤活性,有一定的临床实用价值。     

树突细胞联合细胞因子诱导的杀伤细胞对耐药K562细胞的体外杀伤作用

目的研究细胞因子诱导的杀伤(CIK)细胞与同源树突细胞(DC)共培养后CIK细胞的增殖活性及表型的变化,并观察其对K562、K562/ADM细胞毒作用的影响。方法采集健康供者外周血单个核细胞(MNC)用于诱导培养CIK细胞及成熟DC,将成熟DC和CIK细胞混合培养,用MTT法检测DCCIK共培养细胞杀伤K562细胞及其耐药株的活性。结果在2.5～20.0效靶比范围内,CIK细胞对K562和K562/ADM细胞的杀伤率分别为(20.0±1.2)%～(61.1±2.2)%和(17.5±2.1)%～(45.2±3.3)%;DCCIK共培养细胞对K562和K562/ADM细胞的杀伤率分别为(25.2±2.3)%～(70.9±4.1)%和(22.4±2.7)%～(62.3±5.0)%。CIK细胞对K562敏感株和耐药株杀伤率的差异无统计学意义,DCCIK细胞对敏感株和耐药株的杀伤作用差异亦无统计学意义;DCCIK细胞对K562和K562/ADM细胞的杀伤活性均高于单纯CIK细胞组,差异有统计学意义(P<0.05)。结论DC与CIK共培养细胞的增殖活性和细胞毒活性高于CIK细胞。     

树突细胞与细胞因子诱导的杀伤细胞共培养增强其体内外抗肿瘤活性

目的探讨与树突细胞(DC)共培养能否增强正常人细胞因子诱导的杀伤细胞(CIK)的体内外抗瘤活性.方法分别按照常规方法从正常人外周血单个核细胞诱导DC和CIK细胞,将NB4白血病细胞冻融物(LCL)冲击或未冲击的DC与CIK细胞共培养(LCL-DC+CIK、DC+CIK),以CIK细胞单独培养作为对照.用流式细胞术分析细胞表型,酶联免疫斑点法(ELISPOT)测定分泌IFN-γ的细胞数,51Cr释放实验测定体外细胞毒活性,同时用NB4细胞系建立荷瘤裸鼠模型研究其体内抗肿瘤活性和归巢情况.结果在培养第15天, LCL-DC+CIK与CIK细胞单独培养相比,增殖速率明显提高 [(18.2±2.1)倍vs(11.6±2.3)倍, P<0.05],CD3+CD56+ 表达水平也明显提高 [(51.05±2.63)% vs(30.18±1.45)%, P<0.05],分泌IFN-γ的细胞数量明显增高 [(86.33±5.51)/104细胞 vs(44.61±3.05)/104细胞, P<0.05],同时LCL-DC+CIK对NB4、K562、KG1a的体外细胞毒活性增强.体内实验显示与单独培养CIK细胞相比,LCL-DC+CIK细胞共培养后,可明显抑制接种瘤细胞裸鼠的成瘤率,提高裸鼠的长期无瘤存活率(100% vs 66.7%, P<0.05),以DiI标记的LCL-DC+CIK细胞在接种后7 d内可在脾脏、淋巴结及肿瘤局部被检测到.LCL-DC+CIK与DC+CIK细胞在抗瘤效应上没有明显差异.结论与DC共培养可使CIK细胞获得更高的增殖速率和更强的体内外抗肿瘤活性,可以作为一种临床有效的抗白血病免疫治疗策略.     

ATP和COA活化癌性胸水TIL的增殖力与杀伤活性的研究

目的探讨ATP与COA活化癌性胸水肿瘤浸润淋巴细胞(TIL)的增殖力与杀伤活性.方法应用ATP和COA作为癌性胸水TIL的培养液,在7天、14天、21天、28天分别计算其增殖力,测定其杀伤细胞活性.结果单一的完全培养液TIL增殖量仅为(51.37±18.56)×108/ml,加入ATP和COA的完全培养液在14天时TIL增殖量即可达(105.31±24.76)×108/ml,扩增能力增加一倍以上.加入ATP和COA所培养的TIL其杀伤细胞活性明显增强,在14天百分比达到58.12±12.35,21天百分比时可达78.50±11.93.同时可提前一周达到临床治疗胸腔积液输注所需的TIL数量.结论培养液中加入ATP和COA可以活化癌性胸水ITL的增殖力与杀伤活性,有一定的临床实用价值.     

两种培养基对细胞因子诱导杀伤细胞体外扩增的影响

目的:比较AIM V、OpTmizer两种培养基对培养细胞因子诱导的杀伤细胞(cytokine-induced killercells,CIK细胞)的增殖、表型及细胞毒功能的影响。方法:分离7位志愿者外周血单核细胞(peripheral bloodmononuclear cells,PBMC),分别应用AIM V、OpTmizer两种培养基体外常规诱导CIK细胞,于培养第3、7、10、12、14、17、21天时,计算CIK细胞扩增倍数;通过流式细胞仪分析CD3、CD8、CD56分子的表达;通过LDH释放实验比较两种培养的CIK细胞对K562的细胞毒作用。结果:培养的10、12、14、17、21 d,OpTmizer扩增倍数明显高于AIM V(P<0.05);平均CD56~+及CD3~+CD56~+细胞频数,两组均高于基线(P<0.05);平均CD3-CD56~+细胞频数,OpTmizer组高于基线(ρ<0.05);对K562细胞的细胞毒作用,两组比较差异没有显著性。结论:OpTmizer扩增CIK细胞效率明显高于AIMV,而扩增的细胞亚群及对K562细胞的杀伤作用两组基本相同,OpTmizer比AIM V更适合于体外诱导培养CIK细胞。     

DC与CIK共培养对肝癌细胞杀伤活性的研究

本研究的目的是观察细胞因子诱导的杀伤细胞（CIK）与同源树突状细胞（DC）共培养后DC-CIK细胞的增殖活性、表型的变化,及其对肝癌细胞细胞毒作用的影响.采集健康供者的外周血单个核细胞（MNC）,置于37℃,5%CO2培养箱培养2小时,收集非贴壁细胞用于诱导培养CIK细胞,贴壁细胞诱导分化出成熟DC,将成熟DC和CIK细胞按1：5的比例混合培养3天,用MTT法检测DC-CIK共培养细胞杀伤SMMC-7721肝癌细胞株的活性.结果显示：DC与CIK细胞共培养后,DC-CIK细胞群的增殖活性和杀伤活性较单纯的CIK细胞更高.结论：DC与CIK共培养细胞是一种增殖活性和细胞毒活性均高于CIK细胞的免疫活性细胞.     

抗原冲击致敏的树突状细胞介导的特异性体外抗慢性粒细胞白血病细胞作用

为研究慢性粒细胞白血病 (CML)细胞冻融抗原 (CLA)致敏的树突状细胞 (DC)对特异性抗白血病的作用 ,将CML患者外周血单个核细胞来源的DC在体外用CLA致敏 ,再与CML患者的经细胞因子诱导的杀伤细胞(CIK)共同培养。应用乳酸脱氢酶释放法观察其对自身CML细胞 ,K5 6 2细胞和Raji细胞的杀伤活性 (CIK +CLA DC组 ) ,与未致敏的DC +CIK(CIK +DC组 ) ,CIK组及CIK +CLA组进行比较。结果表明 ,效靶比为 2 5∶1时细胞杀伤活性最强 ,在该效靶比下 ,4组细胞对自身CML细胞的杀伤活性分别为 (6 8 8± 14 2 ) % ,(5 2 5± 9 4 ) % ,(2 0 7± 7 5 ) %和 (2 4 2± 8 7) %。CIK +CLA DC组杀伤活性最强 ,与其余 3组比较有显著性差异 (P <0 0 1) ;CIK +DC组比CIK组杀伤活性强 (P <0 0 1) ;CIK组与CIK +CLA组比较无显著性差异 (P >0 0 5 )。CIK +CLA DC组在效靶比为 2 5∶1时对自身CML细胞 ,K5 6 2细胞和Raji细胞的杀伤活性分别为 (6 8 8± 14 2 ) % ,(14 6± 6 2 ) %和 (12 7± 10 2 ) % ,与K5 6 2细胞和Raji细胞比较 ,具有显著性差异 (P <0 0 1)。结论 :CIK对CML患者自身细胞具有一定的杀伤活性 ;CIK与CML DC共培养组对自身CML细胞杀伤活性比CIK组强 ;CIK与CLA抗原致敏CML DC共培养组具有最强的杀伤活性。CLA抗原     

乳腺癌浸润淋巴细胞的细胞毒活性研究

目的 研究乳腺癌的肿瘤浸润淋巴细胞(TIL)细胞毒活性。方法 采用生物技术提取乳腺癌的肿瘤浸润淋巴细胞，经过一定时间诱导培养，在7天、14天、21天、28天和35天分别检测TIL对K562细胞的细胞毒活性。结果 TIL对K562细胞的细胞毒活性4～5周时细胞毒活性最强。结论 临床可在乳腺癌TIL诱导培养4～5周时进行临床应用，可取得最佳疗效。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.