负载供肾抗原的受者DC2细胞可延长肾移植大鼠的存活时间

 【目的】观察负载供肾大鼠抗原的DC2（未成熟DC）在体内特异性抑制急性排斥反应及其对移植物的功能和存活时间的影响。【方法】健康成年BN大鼠65只和Lewis大鼠80只,以BN大鼠为供者,Lewis大鼠为受者。利用受者大鼠骨髓细胞在体外诱导分化为未成熟的淋巴系DC前体细胞（DC2）,并对其进行免疫表型分析。将所获得DC2负载供肾大鼠抗原,观察DC2在体外抑制混合淋巴细胞反应（MLR）,以及在大鼠同种异体肾移植模型中特异性抑制移植排斥反应发生的情况,Kaplan-Meier生存分析研究对移植大鼠的存活时间的影响。【结果】负载供肾抗原的受者DC2对MLR具有抑制作用（P<0.05）;输注负载供肾抗原的DC2实验组的大鼠肾移植术后中位生存时间是62±6天,输注负载无关大鼠抗原和不负载抗原移植的实验组,术后中位生存时间分别是30±4天和27±5天,各实验组与对照组的血清肌酐和细胞因子IFN-γ、IL-4和IL-10的mRNA表达之间的差异具有统计学意义(P<0.05)。【结论】大鼠同系受体来源的负载供肾抗原的DC2具有体外抑制MLR的作用,体内能够预防和抑制急性排斥反应的发生,延长生存时间,提高远期存活率。     

用负载供体抗原的致耐受性树突状细胞延长大鼠移植肾存活

目的 研究负载供体抗原的致耐受性受体树突状细胞(Dendritic cells,DC)对移植肾存活的影响。方法 以BN、Lewis大鼠为肾移植供、受体;受体骨髓源性DC负载供体淋巴细胞抗原并与共刺激阻断剂CTLA4Ig共孵育;将上述DC于肾移植前24 h经股静脉注入受体(治疗组),未注射DC的受体为对照组;观察各组移植肾存活时间,术后第20天,MTT法检测受体脾细胞对供体及无关抗原刺激的反应。结果移植肾存活时间:与对照组相比,治疗组移植肾存活时间显著延长[(54.6±9.5)d vs(8.3±0.8)d,P<0.01]。术后第20天,治疗组脾细胞对供体抗原刺激的反应明显低于正常对照[(0.17±0.04)vs(0.74±0.06),P<0.01],而受体对无关抗原刺激的反应与正常对照无显著差异[(0.72±0.04)vs(0.69±0.07),P>0.05]。结论 负载供体抗原的致耐受性受体DC可以特异性抑制受体对供体抗原的免疫反应、明显延长大鼠移植肾存活时间。     

口服MHC-CTB交联物对大鼠移植肾存活的影响

目的观察口服MHC-CTB交联物对大鼠肾移植术后的影响。方法用固相法合成MHC肽,对其相对分子质量和纯度进行检测后,口服MHC-CTB交联物灌胃2次/周,持续2个月;对照组口服灌胃生理盐水为对照,以BN(RT1n)大鼠为供体,Lewis(RT11)大鼠为受体,建立大鼠肾移植模型,观察两组术后外周血CD4+CD25+T细胞含量变化、两组生存时间、移植肾病理变化情况,并在体外试验中,通过混合淋巴细胞培养,进一步验证,MHC肽对T淋巴细胞有无抑制其增殖功能。结果通过固相法合成的MHC肽相对分子质量为1 389.81,纯度为98.1%,建立大鼠肾移植模型后,术后第1天外周血流式结果显示实验组CD4+CD25+T细胞较对照组明显升高(P<0.01),且实验组生存天数为(21.4±1.45)d,对照组生存天数为(8.2±2.15)d,二者间比较差异有统计学意义(P<0.01),移植肾病理切片显示对照组移植肾排斥变化早于实验组,体外混合淋巴细胞培养显示,实验组T淋巴细胞增殖弱于对照组(P<0.01),且添加MHC肽后,T淋巴细胞增殖抑制效果更明显(P<0.01)。结论口服MHC肽能有效诱导免疫耐受,抑制大鼠肾移植排斥,延长生存时间。     

ICOS胞外区基因修饰的树突状细胞对移植肾存活的影响

目的:探讨诱导共刺激分子(Inducible costimulator,ICOS)胞外区基因修饰的树突状细胞(Dendritic ceUs,DC)对移植肾存活的影响.方法:以BN、Lewis大鼠为肾移植供、受体;用ICOS胞外区基因重组腺病毒转染供体骨髓源性DC使之表达ICOS胞外区;将供体DC于肾移植前24 h经股静脉注入受体为实验组,未注射DC的受体为对照组;观察两组移植肾存活时间.术后第20 d,MTT法检测受体脾细胞对供体及无关抗原刺激的反应.结果:与对照组相比,实验组移植.肾存活时间显著延长[(23.2±3.08)d与(8.5±1.4)d],P<0.01).术后第20 d,实验组脾细胞对供体抗原刺激的反应明显低于正常对照(0.37±0.06)与(0.84±0.12),P<0.01,而对无关抗原刺激的反应与正常对照差异无显著性(0.76±0.11)与(0.69 4-0.09),P>0.05.结论:I-COS胞外区基因修饰的供体DC可以明显延长大鼠移植肾存活时间.     

树突状细胞对大鼠牙移植后组织学及Th1/Th2细胞因子影响的研究

目的研究不同来源树突状细胞(dendritic cell,DC)对大鼠同种异体牙移植后免疫排斥反应的抑制效果。方法用BN大鼠60只、Lewis大鼠80只分别作为供、受体建立牙移植模型,将动物完全随机分为4组,每组各20只:A组为同基因牙移植组,将Lewis大鼠牙移植到Lewis大鼠;B、C、D组为同种异体牙移植组,将BN大鼠牙移植到Lewis大鼠;A、B组于术前7 d通过尾静脉输注PBS 0.5 ml于受体大鼠体内,C组于术前7 d通过尾静脉输注1×106/只的供体致耐受DC于受体大鼠体内,D组于术前7 d通过尾静脉输注1×106/只的受体致耐受DC于受体大鼠体内。各组于术后第1、2、4、8周随机处死5只大鼠,行移植牙病理学检查和ELISA检测外周血清IL-2、IFN-γ、IL-4、IL-10浓度。结果 C、D组IL-2、IFN-γ在各时间点均高于A组低于B组,IL-4、IL-10在各时间点均高于A、B组(P<0.05)。C组IL-2在第1周时低于D组,到第8周时则高于D组(P<0.05)。C组IL-4、IL-10在第1、2周时高于D组,到第8周时则低于D组(P<0.05)。C、D组牙根吸收较B组有所减少但仍高于A组(P<0.05),C、D组牙根吸收在2、4周时没有差异,在8周时D组低于C组(P<0.05)。C、D组炎性细胞浸润较B组均明显减轻但重于A组。结论供、受体致耐受DC均可抑制大鼠同种异体移植牙的排斥反应,减轻排斥反应程度。供体致耐受性DC对早期急性排斥反应抑制更明显,受体致耐受性DC对晚期慢性排斥反应抑制更明显。     

骨化三醇抑制大鼠肾移植排斥反应的实验研究

目的探讨骨化三醇对预防大鼠肾移植排斥反应的作用。方法行BN大鼠→Lewis大鼠的肾移植模型,再分别给予Lewis大鼠安慰剂、骨化三醇和环孢素A,观察应用不同药物后Lewis大鼠的存活时间、血肌酐(Cr)变化以及移植肾病理改变。结果对照组Lewis大鼠全部死亡,其存活时间为(6.2±1.0)d,移植后Cr迅速持续升高,移植肾均发生明显排斥反应;而骨化三醇组和环孢素组Lewis大鼠则未发生因排斥反应导致的死亡,移植前后Cr改变无统计学意义,移植肾病理检查仅骨化三醇组1只发现轻微排斥反应。结论在大鼠肾移植中骨化三醇可以达到与环孢素A相似的免疫抑制效果,对于预防排斥反应、延长移植大鼠的存活有较好的效果。     

CD154胞外区基因局部修饰对大鼠移植肾存活的影响

目的观察CD154胞外区基因局部修饰大鼠供肾对延长移植肾存活的效能.方法以CD154基因重组腺病毒为载体,将CD154胞外区基因转入BN大鼠供肾,以Lewis大鼠为受体,行同种肾移植为转染组,并以未转染BN供肾移植给Lewis受体为对照组;观察移植肾存活时间和术后肾功能变化.结果转染组移植肾存活(28±7.3) d,较对照组移植肾存活时间(8.6±1.2)d明显延长;移植组术后血清肌酐较同期对照组明显为低.结论 CD154基因局部转染可明显延长移植肾存活时间.     

共刺激阻断剂CTLA-4Ig基因修饰的树突状细胞对移植肾存活的影响

目的探讨共刺激信号阻断剂CTLA-4Ig基因修饰的树突状细胞(dendriticcells,DC)对移植肾存活的影响。方法以BN、Lewis大鼠为肾移植供、受体;用CTLA-4Ig基因重组腺病毒转染供、受体骨髓源性DC使之表达CTLA-4Ig;将供、受体DC于肾移植前24h经股静脉分别注入受体(设为组1、组2),供、受体DC混合后注入受体(组3),未注射DC的受体为对照组;观察各组移植肾存活时间,术后第20天,MTT法检测受体脾细胞对供体及无关抗原刺激的反应。结果与对照组相比,组1移植肾存活时间显著延长[(54.1!11.6)dvs(8.4!0.7)d,P<0.01),组3移植肾存活时间延长更为明显(77.5!15.7)d,P<0.001],组2移植肾存活时间无延长(8.1!0.7)d,P>0.05。术后第20天,组1、组3脾细胞对供体抗原刺激的反应均明显低于正常对照(0.27!0.07)and(0.23!0.06)vs(0.74!0.06),P<0.01,而对无关抗原刺激的反应与正常对照差异无显著性(0.68!0.04)and(0.71!0.05)vs(0.69!0.05),P>0.05。结论CTLA-4Ig基因修饰的供体DC可以明显延长大鼠移植肾存活时间,而受体DC则无此作用,但两种DC联合应用可以使移植肾获得更长的存活时间。     

霉酚酸对致耐受性树突状细胞延长移植肾存活效应的影响

目的探讨霉酚酸(mycophenolic acid,MPA)对致耐受性树突状细胞(dendritic cells,DC)延长移植肾存活效应的影响。方法以BN、Lewis大鼠为肾移植供、受体;在供体DC培养过程中加入3种浓度MPA,以CTLA-4Ig基因转染DC使之成为表达CTLA-4Ig的致耐受DC;观察DC形态变化并检测受体脾细胞对上述DC的刺激反应。将未处理的致耐受DC以及0.05μmol/L MPA处理DC于肾移植前72h分别注入受体(组1、组2),注入供体DC的受体为组3,未注入DC的受体为对照(组4),观察受体血肌酐变化和移植肾存活时间。结果MPA组DC形态老化延缓,脾细胞对3种浓度MPA处理的DC刺激反应均显著低于对未经MPA处理致耐受DC的刺激反应;与对照相比,组1、组2移植肾存活时间显著延长,差异有统计学意义(P<0.01),其中组2延长更为明显〔(81.1±14.6)d vs(8.9±0.8)d,P<0.001〕,组3存活时间显著缩短(5.3±0.6d,P<0.05)。术后45d后组2血肌酐水平明显低于组1。结论MPA预处理可降低致耐受DC的抗原提呈能力,提高其延长移植肾存活的效能。     

云南眼镜蛇毒因子用于预致敏大鼠同种心脏移植的实验研究

目的观察纯化的云南眼镜蛇毒因子(Y-CVF)对预致敏大鼠同种心脏移植急性体液排斥反应的作用。方法BN大鼠到Lewis大鼠连续3次皮肤移植预致敏后行颈部异位心脏移植。将15对大鼠用随机数字法分成2组,实验组(n=8)于心脏移植前24h静脉给予Y-CVF80μg/kg;对照组(n=7)不用Y-CVF。观察移植心的生存时间,移植心停跳后病理学检查排斥类型,免疫组织化学染色观察移植心IgG和补体C3的沉积。结果Lewis大鼠预致敏后抗BN大鼠抗体滴度由0升高至1∶1028~1∶2056。对照组移植心存活时间为12·71h±13·94h,实验组移植心存活时间为99·50h±38·72h,与对照组比较差异有统计学意义(t=5·599,P<0·01)。病理检查结果证实,实验组均未发生急性体液排斥,仅见以大量单核淋巴细胞浸润为特征的急性细胞排斥反应。对照组则见以小血管内血栓形成为特征的急性体液排斥反应。免疫组织化学IgG染色实验组和对照组均为阳性,C3染色对照组为阳性,而实验组为阴性。结论使用Y-CVF可克服预致敏大鼠同种心脏移植急性体液排斥反应的发生。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.