供者提前使用粒细胞集落刺激因子动员的异基因骨髓移植对造血重建与移植物抗宿主疾病的影响

目的 :为观察使用 G- CSF提前动员供者的异基因骨髓移植方法对造血重建及 GVHD发生的影响。　方法 :用HL A相合 ,混合淋巴细胞培养阴性的供者 ,行异基因骨髓移植 ,在预处理方案 ,GVHD的预防及支持治疗方法相同 ,比较 A组5例病人供者接受 G- CSF2 5 0 μg/d连用 7d后采髓和 B组 4例病人常规采髓的异基因骨髓移植对造血重建和 GVHD发生的作用。　结果 :在类同采髓量中 ,A组所获单个核细胞、CD34 细胞数和 CFU- GM集落数明显多于 B组 (P<0 .0 1) ,A组白细胞大于 1.0× 10 9/L和血小板大于 2 0× 10 9/L的时间分别是 (13.0± 2 .0 ) d和 (14.0± 2 .1) ,比对照组快 8.8d和 10 .3d。 GVHDII～ III度发生率是 A组为 0 ,B组 2例 ,输入的 T淋巴细胞总数无明显改变 ,但 CD4细胞明显减少 ,CD8细胞增多 (P<0 .0 1)。结论 :HL A相合的异基因骨髓移植 ,提前使用 G- CSF动员供者 ,造血重建加快。供者使用 G- CSF可能降低 GVHD发生率 ,这一作用与骨髓内 T淋巴细胞亚群变化有关。     

不同细胞量异基因小鼠骨髓移植回巢规律的实验研究

目的 探讨不同细胞量骨髓移植的回巢规律,进一步提高移植效果。方法 采用异基因小鼠模型进行不同细胞量骨髓移植,观察了不同细胞量组及其在不同时间点的回巢情况。结果 回巢的阳性细胞比例;不同细胞量组之间的差别无统计学意义;不同时间点以第3天最高（P＜0．01）。从外周血、骨髓、脾的供体阳性细胞和回巢率的变化中可看到供体细胞在受体体内有回巢－出巢－再回巢的现象。回巢率：骨髓低细胞量组的回巢率高于高细胞量组（P＜0．01）,不同时间点和脾各组间回巢率差异无显著性,脾各时间点回巢率差异具有显著性（P＜0．05）。结论 在一定细胞量范围内低细胞量组的回巢率高于细胞量组,一次性大量移植可能是一种浪费。     

小鼠移植物抗宿主病模型的建立及其初步应用

建立小鼠GVHD模型 ,用以评价人CD4 0 Ig融合蛋白治疗的有效性。以雄性C5 7BL/ 6小鼠作为脾细胞供者 ,照射后的雌性BALB/c小鼠作为受者 ,分别将 2 5×10 7和 5 0× 10 7/L脾细胞在60 Co射线亚致死剂量照射后经尾静脉注入 30只受者小鼠体内 ,建立小鼠GVHD模型。然后 ,在GVHD诱导后第 0、2、4天分 3次经尾静脉注射CD4 0 Ig融合蛋白各 5 0、15 0、4 5 0 μg,观察CD4 0 Ig融合蛋白对GVHD小鼠的治疗效果。结果显示 :3注射脾细胞 4～5天后 ,小鼠开始出现GVHD典型体征 ,第 10天受体小鼠体内扩增出雄性供体小鼠Y染色体特异片段。CD4 0 Ig融合蛋白治疗可显著延长GVHD小鼠的平均存活时间。此结果表明 ,已成功地建立了小鼠GVHD模型 ,可用于评价抗GVHD的治疗效果。     

同基因骨髓混合半相合异基因骨髓移植抗白血病研究

为了诱发自体骨髓移植(ABMT)后的移植物抗白血病(GVL)效应,研究了同基因混合半相合异基因骨髓移植(MBMT)的GVL以及移植物抗宿主病(GVHD)的效应.结果表明受体小鼠接受亚致死量放射后行同基因BMT时,能够耐受1/6有核细胞量的H-2半同基因骨髓而不发生或发生轻度GVHD.比较观察混合1/6有核细胞H-2半同基因的同基因BMT的抗白血病效应,结果显示,单用同基因BMT者移植后2周皆死亡,混合组5周后仅2只死亡,预计生存率为0.66;单纯照射组及L615白血病细胞接种组者1周内全死亡,照射后未接种白血病细胞而行同基因BMT者5周后仅1只死亡,提示接受1/6量H-2半同基因骨髓细胞的同基因骨髓移植有显著的抗白血病效应(P<0.01),而不发生GVHD.     

自体混合HLA半相合异基因骨髓移植后的移植物抗宿主病

目的:为了观察自体骨髓混合HLA半相合异基因骨髓移植治疗恶性血液病后的GVHD发生情况.方法:观察16例混合移植GVHD的发生情况及其对疗效的影响.结果:16例中无1例发生急性GVHD(aGVHD),但在ABMT后1h输入异基因骨髓的8例皆有程度不同的慢性GVHD(cGVHD),主要表现在皮肤,粘膜炎、全血细胞减少、肝功异常、发热、体重减轻及易感冒等.中位随访8月无1例复发,除2例在移植后3和8月分别因爆发性肝炎和急性阑尾炎穿孔死亡外.余6例皆存活.最长1例已无病存活12月余.其中供受者性别不同的5例移植后性染色体观察4例形成嵌合体,3例已超过半年,最长者已1年余.而ABMT移植后6h输异基因骨髓的8例,则未观察到急慢性GVHD.结论:移植过程是安全的,部分可诱发cGVHD,形成嵌合体,白血病的复发较少.     

猴头菌多糖促进同基因骨髓移植小鼠免疫功能重建

同基因骨髓移植55d后,受体小鼠免疫功能严重缺损,脾细胞产生IL—2的能力等细胞免疫功能明显低下。经腹腔连续注射猴头菌多糖15d后,小鼠脾细胞产生IL—2的能力,对ConA刺激的增殖反应和混合淋巴细胞反应均显著增强;抗羊红细胞抗体(IgM)分泌细胞数明显增加。实验结果提示:猴头菌多糖能明显促进同基因骨髓移植小鼠免疫功能的早期恢复。     

H-2半相合CD34+和TK+T细胞移植建立急性移植物抗宿主病模型及丙氧鸟苷疗效观察

目的　探讨HSV TK/GCV对H 2半相合CD34 细胞和TK T细胞混合移植急性移植物抗宿主病 (GVHD)的疗效。方法　从亲代雄性供鼠骨髓分离CD34 细胞 ,同时取脾脏T细胞转染tk基因。4 8只受鼠随机分为 6组 ,第 1组输入CD34 细胞 (1× 10 5) ;第2、3组输入CD34 细胞和T细胞 (1× 10 7) ;第 4～ 6组输入CD34 细胞和TK T细胞 (1× 10 7)。第 1组不予任何处理 ;第 2、4组于d0～d14给予PBS 0 2ml/d;第 3、5、6组于d7、d0、d7开始给予丙氧鸟苷(GCV)治疗 ,剂量为 5 0mg/ (kg·d)× 7天腹腔注射。结果　第 1组受鼠全部长期存活 ,无急性GVHD发生。 2～ 6组均发生急性GVHD ,病理表现典型。 2～ 4组 3周内均死于急性GVHD ,第 5、6组生存时间分别为 2 6 6± 4 8天和 4 0 5± 8 4天 ,与 2～4组相比差异显著 (P <0 0 1) ,第 6组生存时间长于第 5组(P <0 0 5 )。结论　H 2半相合CD34 和TK T细胞移植能够建立急性GVHD模型 ;TK/GCV系统对急性GVHD有较好治疗作用 ;GCV给予时间不同则疗效有差异。     

异基因小鼠骨髓细胞程序移植后回巢的实验研究

目的探讨骨髓程序移植后移植次数与移植细胞数对回巢的影响.方法采用异基因小鼠骨髓移植模型及流式细胞术,观察不同次数异基因骨髓细胞程序移植后不同时间的回巢状况、不同细胞数异基因骨髓细胞程序移植与单次大剂量移植的回巢状况.结果不同次数移植后各组不同时间阳性回巢细胞数与回巢率均以第3次移植的检测值最高,在共同时间点第4天时均以2次移植组最高(P＜0.05),提示移植后每天都会有回巢发生,但不同移植次数可能在时间上有不同的回巢高峰阶段.不同细胞数异基因骨髓细胞程序移植后,移植细胞数低的移植组与单次大细胞数组比较,回巢细胞数无明显差异,回巢率却远远高于后者(P＜0.01).结果显示在一定剂量范围内多次小剂量移植的回巢效果可能等于或好于单次大剂量移植,且总剂量可能降低至105.结论单次大剂量移植会造成移植干细胞的浪费,在一定细胞量范围内改变移植次数有利于改善移植效果.     

猴头菌多糖和胸腺素对骨髓移植小鼠免疫功能重建的促进作用

同基因骨髓移植55d后,受体小鼠免疫功能严重缺损,脾细胞产生IL—2的能力等细胞免疫功能明显低下。经连续腹腔注射猴头菌多糖和胸腺肽15d后,小鼠脾细胞产生IL—2的能力,对ConA刺激的增殖反应和混合淋巴细胞培养反应均显著增强:抗羊红细胞抗体(IgM)分泌细胞数明显增加。实验结果提示:猴头菌多糖和胸腺素合并使用能明显促进同基因骨髓移植小鼠免疫功能的早期恢复,且优于单独使用猴头菌多糖或胸腺素。     

CB6F1小鼠急性粒单核细胞白血病M4(AML-M4)模型的建立及鉴定

目的 建立CB6F1小鼠急性粒单核细胞白血病M4(AML-M4)模型并进行鉴定.方法 取CB6F1小鼠,经静脉注射小鼠粒单核细胞白血病WEHI-3细胞,观察不同数量(1×106、2×106、5×106、1×107个)细胞接种与小鼠生存时间的相关性.取接种1×106个细胞的小鼠为研究对象,动态观察其发病情况并在接种后每周...     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.