不同细胞因子组合对脐血巨核细胞的体外扩增效应

目的　探讨在体外液体培养条件下不同细胞因子组合促进脐血单个核细胞向巨核系增殖分化的效应。方法　将TPO(thrombopoietin)、SCF(stemcellfactor)、SCGF(stemcellgrowthfactor)、IL- 3、EPO(erythropoietin)等细胞因子组合成不同的实验组,在无血清液体培养体系中,体外扩增脐血单个核细胞 (CBMC)14d。扩增后于不同时间点用流式细胞仪检测CD61 细胞的比例,同时计数活细胞数,从而求得较好的细胞因子组合组。结果　经 14d培养后,SCF TPO组扩增效果最好,活细胞总数和CD61 细胞数量分别增加了 3. 14±0. 62倍和 48. 40±5. 71倍,显著高于单用TPO组的 1. 81±0. 36倍和 18. 72±3. 73倍。TPO IL 3组使CD61 细胞数量增加了 25. 82±3. 88倍,但扩增后CD61 细胞比例仅为 9. 34% ±1. 92%,低于TPO组的12. 21%±2. 27%;TPO SCGF组和TPO EPO组的扩增效果与单用TPO组相比无统计学差异 (P>0. 05)。结论　SCF能协同TPO增强巨核系造血,增加培养体系中巨核细胞的纯度和数量。     

无血清脐血巨核系祖细胞体外扩增的研究

脐血造血干细胞移植后血小板恢复延迟是一大难题,目前认为这主要与脐血中巨核系祖细胞数量不足及脐血巨核细胞分化成熟延迟有关,而将部分脐血进行巨核系祖细胞体外扩增后输注受者体内是有望解决这一难题的重要途径。但适用于临床应用的扩增条件至今仍未确立。本课题采用人脐血单个核细胞(MNC)在无血清培养体系中使用TPO,IL-3,SCF,IL-6等细胞因子进行不同的组合,在培养的0,6,10,14天进行MNC、CD41^ 细胞及CFU-MK数的检测。以寻找最佳的细胞因子组合及最佳的收获时机。结果表明：无血清条件下TPO与IL-3,SCF,IL-6等细胞因子联用可实现脐血巨核系祖细胞有效的体外扩增,各因子组中以TPO IL-3 SCF IL-6组扩增效果为最佳。其CFU-MK数于第10天最多,扩增达6．8倍,CD41^ 细胞扩增达8．8倍。结论：在人脐血MNC无血清培养条件下。TPO IL-3 SCF IL-6组为巨核系祖细胞体外扩增较佳的因子组合。由于TPO IL-3 SCF IL-6组的CFU-MK数于第10天最多,CD41^ 细胞数亦为同期最高,故培养后收获时间宜控制在其体外培养的第10天。     

人脐血巨核系祖细胞体外扩增的实验研究

本研究旨在探讨各种细胞因子对人脐血CD34 细胞体外扩增生成巨核细胞的作用,以建立人脐血巨核系祖细胞体外扩增的最佳体系。采用Ficoll分离液分离脐血单个核细胞,免疫磁珠法分离纯化CD34 细胞,进行体外半固体集落培养和液体培养,观察各种细胞因子组合对CD41 细胞和巨核细胞集落形成单位(CFU-MK)的影响。结果显示:TPO IL-6 IL3 FLT-3L4因子组合体外培养14天效果最好,在第7、14天CD41 细胞分别扩增了154.67±32.21倍、193.23±25.24倍。结论:本实验建立的巨核系祖细胞体外扩增体系,为促进脐血移植后血小板恢复奠定了实验基础。     

人骨髓间充质干细胞与脐血CD34+细胞体外扩增

为了研究骨髓间充质干细胞(MSC)及细胞因子对脐血CD34 造血祖细胞体外扩增的作用,及其扩增作用 对细胞黏附分子的影响,用免疫磁珠富集脐血CD34 细胞,然后接种到含有或不含有MSC和细胞因子的24孔培 养板,体外培养1周,观察不同指标并进行组间比较。结果表明:①SDF-1α SCF TPO FL因子组合与SCF TPO FL因子组合对脐血CD34 细胞的扩增作用无显著性差异(无论有无MSC细胞层存在)(P>0.05);②MSC 与上述细胞因子共存的培养体系优于相应的单纯细胞因子培养体系(P<0.05);③扩增前与扩增后脐血造血祖 细胞黏附分子CD44的表达没有明显变化。结论:趋化因子SDF-1α对SCF TPO FL因子组合的扩增作用无显 著影响;MSC增加细胞因子的脐血细胞体外扩增的作用;体外扩增不影响跻血细胞黏附分子CD44的表达。     

不同细胞因子组合对人脐血单个核细胞体外扩增及CD49d和CXCR4表达的影响

为了探讨不同的细胞因子组合对脐血单个核细胞体外的扩增作用及扩增后CD49d和CXCR4的变化，将新鲜脐血标本分离的单个核细胞接种于含有不同细胞因子组合的无血清无基质培养体系中培养7天，在0天，7天检测有核细胞数，CD34^＋细胞数及CD34^＋CXCR4^＋，CD34^＋CD49d^＋的细胞数和集落形成单位（CFU）数．根据不同细胞因子组合实验分组为：对照组；SF组（SCF＋FL）；SFT组（SCF＋FL＋TPO）和SFT6组（SCF＋FL＋TP0＋IL-6）。结果表明，和对照组相比，SF组合仅能低水平支持脐血造血细胞扩增，加入TPO后即SCF／FL／TPO组合能有效的扩增脐血细胞，但SFT和SFT6两组之间差异却无明显发生（P〉0．05）；SF，SFT和SFT63组的细胞因子组合均可提高脐血CD34^＋细胞CD49d，CXCR4的表达，但3组之间差异无显著性（P〉0．05）。结论：SF组合可协同扩增人造血细胞，但协同作用较弱；TPO在脐血造血干／祖细胞体外扩增中起重要调节作用，而IL-6作用不显著；SCF／FL／TPO 3种因子组合不仅可促进脐血造血祖细胞的扩增，而且可上调脐血造血细胞CD49d，CXCR4表达。     

细胞因子体外诱导脐血CD34+细胞增殖并向巨核细胞/血小板分化的研究

本研究旨在观察几种不同细胞因子组合通过体外培养以诱导造血干/祖细胞增殖和向巨核细胞/血小板分化.应用无血清培养基(StemSpan SFEM)体外扩增脐血CD34+细胞并向巨核细胞/血小板定向分化,将不同细胞因子组合分为3个阶段培养,并比较其培养效果.结果表明,在第一阶段的第14天时,SCF + TPO + FL + ...     

体外扩增的脐血单个核细胞植入NOD/SCID小鼠的研究

为了探讨在无血清、无基质培养条件下SCF、FL和TPO 3种因子组合体外扩增的脐血单个核细胞(MNC)的最佳移植时机及植入潜能,将SCF,FL和TPO 3种因子组合体外扩增的脐血单个核细胞培养14天,在0、7、10和14天检测有核细胞数(TNC),CD34 细胞数,CD34 CXCR4 细胞数,CD34 CD49d 的细胞数及集落形成单位(CFU)数,并将SCF FL TPO 3种因子组合的无血清无基质条件下扩增培养7天前后的脐血单个核细胞移植给经亚致死量照射的NOD/SCID小鼠,6周后用流式细胞术,PCR法检测存活小鼠体内的人源性细胞.结果表明,经过14天的培养,脐血细胞得到了有效的扩增,TNC数,CD34 细胞数,CD34 CD49d 的细胞数于7天达高峰,其后开始下降,而CFU数,CD34 CXCR4 细胞数于第10天达高峰.在移植6周后,扩增脐血移植组的NOD/SCID小鼠的存活率和人源性CD45 细胞的检出率分别为56.25%和(1.39±0.63)%,高于新鲜脐血移植组31.25%和(0.73±0.16)%,亦高于生理盐水移植组(0和0),差异有显著性(p＜0.05),扩增脐血移植组有6只NOD/SCID小鼠骨髓细胞中可检测到人特异ALU序列的表达.结论体外培养7-10天可能是收获细胞的最佳时机;SCF FL TPO 3种因子组合扩增7天的脐血单个核细胞能够植入NOD/SCID小鼠,其植入水平优于未扩增的脐血;上调脐血造血细胞上CXCR4,CD49d的表达可能会增加脐血造血细胞的植入能力.     

动员人外周血巨核祖细胞体外扩增的研究

本研究探讨多种细胞因子(TPO、SCF、FL、IL-1、IL-3、IL-6)组合的几种培养体系对人外周血CD34+细胞体外诱导扩增生成巨核细胞的作用,研究人外周血来源的巨核细胞体外扩增的最佳细胞因子组合及培养时间。用Ficoll-Hapaque分离法分离动员的外周血(MPB)单个核细胞,免疫磁珠法分离纯化CD34+细胞,并将其在含胎牛血清的液体培养体系中、各组细胞因子诱导下培养15天。在不同时间点采用血细胞计数板进行细胞计数,采用流式细胞术检测培养体系中CD41+细胞的含量;同时采用甲基纤维素半固体培养法进行巨核细胞集落培养,测定巨核细胞集落形成单位(CFU-MK)的数量。结果表明经过15天的培养,在MPB来源的CD34+细胞体外诱导并扩增巨核祖细胞体系中,以TPO/FL/IL-6/IL-3组合的扩增效果最好,明显高于其它3组,CD41+细胞第5天、10天分别扩增了93.97±17.27倍、131.23±18.26倍。第15天CD41+细胞含量及CD41+细胞数迅速下降。CFU-MK产率(/1×103个细胞)第5天、10天分别为83.33±10.02个、120.67±13.01个,明显高于其余3组。结论以TPO/FL/IL-6/IL-3因子组合为体外诱导扩增巨核祖细胞的最佳组合,动员外周血的巨核祖细胞体外诱导扩增以培养第10天为宜。本实验建立了动员人外周血来源的巨核祖细胞体外扩增体系。     

GM-CSF对脐血CD34+巨核祖细胞体外扩增及分化的影响

本实验旨在研究GM-CSF对脐血CD34^＋细胞诱导分化为巨核细胞的影响.采用免疫磁珠法分选CD34^＋细胞,在含有TPO＋IL-3＋SCF并添加了不同浓度（5、20、100ng/ml）的GM-CSF的无血清培养基中进行培养.培养6、10、14天后计数单个核细胞（MNC）,检测CD41^＋细胞比例和CFU-MK.结果表明,培养14天后3种不同浓度GM-CSF对MNC均有明显的扩增作用,其中以20和100ng/ml GM-CSF的扩增效果较好.3种不同浓度的GM-CSF均使CD41^＋细胞比例增加,20和100ng/ml与5 ng/ml GM-CSF相比更能提高CD41^＋细胞的比例.5和20 ng/ml的GM-CSF能促进CFU-MK的形成,但100ng/ml的GM-CSF却抑制CFU-MK的形成.结论：在TPO＋IL-3＋SCF细胞因子组合中添加GM-CSF有利于促进脐血CD34^＋细胞诱导分化为巨核细胞.     

两步法脐血巨核细胞体外扩增的研究

目的探寻一种通过脐血单个核细胞体外培养获得大量巨核细胞的方法。方法首先将脐血单个核细胞在无血清培养液中加入TPO、SCF、IL-6、IL-3培养至14d行巨核祖细胞体外扩增,然后单纯加入TPO、IL-6再培养4d诱导巨核细胞成熟。结果单个核细胞数扩增了约4.8倍,CD41+细胞扩增了44倍,有核细胞形态学分析50%~74%为巨核细胞,巨核细胞中94%~96%为颗粒及产板型巨核细胞,绝大部分呈“核浆发育不平衡、胞核发育延迟”现象。结论使用这种两步培养法在体外可获取大量的脐血来源的巨核细胞以供研究使用。     

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.