脐血CD_(34)~ CD_(19)~－细胞与体外培养集落的相关性分析

用两种单克隆抗体（单抗）标记脐血造血祖细胞表面抗原（ＨＰＣＡ，ＣＤ＿（３４））用流式细胞仪分析，并比较两种单抗标记的细胞与体外培养的粒单细胞集落形成单位（ＣＦＵ－ＧＭ），红系爆式集落形成单位（ＢＦＵ－Ｅ）和混合集落形成单位的相关性，结果表明脐血有核细胞中，抗ＨＰＣＡ－２－ＦＩＴＣ阳性的细胞占１．０５１０．７２％，Ｔｕｋ３（纯抗体）阳性细胞占２．０６±１．２５％，差别显著（Ｐ＜０．０５），每μｌ脐血两种单抗标记的细胞分别为９６．５６±５６．６４和２３１．４０±１６３．９３（Ｐ＜０．０５），变异系数依次为５８．４７％和６８．４３％。尽管抗ＨＰＣＡ－２－ＦＩＴＣ阳性细胞与阳性细胞数量呈显著正相关，但前者与ＣＦＵ－ＧＭ，ＢＦＵ－Ｅ，ＣＦＵ－Ｍｉｘ以及ＣＦＵｓ（ＣＦＵ－ＧＭ＋ＢＦＵ－Ｅ＋ＣＦＵ－Ｍｉｘ）均呈正相关，而后者仅与ＣＦＵ－ＧＭ，ＣＦＵｓ呈正相关。研究结果提示在检测造血祖细胞时，用抗ＨＰＣＡ－２－ＦＩＴＣ代替可降低假阳性，获得较好的细胞与ＣＦＵ间的线性关系。     

不同剂量紫外线照射对血液抗氧化作用的影响

实验用不同剂量短波紫外线（ＵＶ－Ｃ）照射家兔离体血液，采用化学发光法（ＣＬ）和分光光度法分别测定血浆超氧化物歧化酶（ＳＯＤ）活力和丙二醛（ＭＤＡ）含量。未照射血液血浆ＳＤＯ活力、ＭＤＡ含量分别为９４６．６７±５７．６５Ｕ／ｍｌ、１７．７６±３．３９ｎｍｏｌ／ｍｌ。小剂量（１５秒）照射后ＳＯＤ活力显著高于未照射血液（Ｐ＜０．０１），剂量增加后（３０秒）ＳＯＤ活力下降并接近未照射水平，照射１分钟后活力明显下降（Ｐ＜０．０５），并随短波ＵＶ－Ｃ剂量（３、６分钟）增大下降增多（Ｐ＜０．００１）。较小剂量ＵＶ－Ｃ（１５秒、３０秒、１分钟）照射后ＭＤＡ含量无明显变化，ＵＶ－Ｃ照射３分钟时ＭＤＡ含量开始出现明显升高（Ｐ＜０．０５），并随剂量加大（６分钟）进一步增高（Ｐ＜０．００１）。结果提示小剂量ＵＶ－Ｃ照射能够增强机体抗氧化能力，大剂量照射则使机体抗氧化能力下降，氧化损伤作用增强；并且说明ＵＶ－Ｃ照射所致机体脂质过氧化损伤与抗氧化能力下降，自由基生成增多、消除不足有关     

程控冻存对人单个核细胞产生白细胞介素1和白细胞介素2能力的影响

探讨冻存对人单个核细胞产生白细胞介素１（ＩＬ－１）和白细胞介素２（ＩＬ２－）能力的影响及相互关系。阐明冻存对细胞免疫功能影响的作用机制。用程控冻存技术和细胞因子活性测定方法，初步观察冻存对人外周血单个核细胞（ＭＮＣｓ）、贴附细胞（ＡＣｓ）和非贴附细胞（ＮＡＣｓ）产生ＩＬ－１和ＩＬ－２能力的影响。结果，经冻存后的ＭＮＣｓ和ＡＣｓ产生ＩＬ－１能力［分别为（１０９．７８±２５．７３）Ｕ／ｍｌ和（３８９．０４±１００．９０）Ｕ／ｍｌ］均较未冻存组［分别为（６０．７９±２２．０７）Ｕ／ｍｌ和（２２１．２４±６６．９９）Ｕ／ｍｌ］显著增强。冻存后ＭＮＣｓ和ＮＡＣｓ产生ＩＬ－２能力［分别为（２０．４４±９．８９）Ｕ／ｍｌ和（２６．５３±８．２１）Ｕ／ｍｌ］显著高于冻存前组［分别为（９．１０±４．６３）Ｕ／ｍｌ和（１１．９７±６．０６）Ｕ／ｍｌ］。冻存后细胞产生ＩＬ－２能力的增强与冻存对ＩＬ－１生成能力影响之间无显著相关性（相关系数ｒ＝０．２１），而与细胞失活可能有关。     

抗精浆免疫抑制物抗体的补体结合功能测定及临床意义

目的探讨抗精浆免疫抑制物抗体（ＳＰＩＭ－Ａｂ）的作用机理。方法用补体结合试验（ＣＦＡ）测定了不明原因不育症患者ＳＰＩＭ－Ａｂ的补体结合功能，并与血清Ｃ３、Ｃ４、ＣＨ５０之间的关系进行了比较。结果２９例血清ＳＰＩＭ－Ａｂ阳性患者ＣＦＡ值为６．４２±１．５５Ｕ／ｍｌ，明显低于７１例血清ＳＰＩＭ－Ａｂ阴性患者的８．１１±１．６２Ｕ／ｍｌ（Ｐ＜０．０１）和３０例对照组的８．６０±１．８０Ｕ／ｍｌ（Ｐ＜０．０１）。且血清ＳＰＩＭ－Ａｂ水平与血清Ｃ３、Ｃ４、Ｃ５０呈显著的负相关（Ｐ＜０．０５～０．０１）。结论ＳＰＩＭ－Ａｂ能够与ＳＰＩＭ形成免疫复合物，激活补体，并可能对精子和受精卵产生免疫损伤，干扰生育。     

低分子量硫酸葡聚糖对Beagle狗外周血造血细胞动员作用的研究

为研究可供人体应用的造血干细胞动员剂，将低分子量硫酸葡聚糖（ＤＳ）给Ｂｅａｇｌｅ狗静脉注射，观察其对造血干细胞的动员作用。结果显示，注射ＤＳ１５ｍｇ／ｋｇ后１小时，外周血中ＷＢＣ、单个核细胞（ＭＮＣ）和ＣＦＵ－ＧＭ计数开始升高，３小时达到峰值，每升血中的数量分别为给药前的１．６，２．１和４．５倍。外周血中ＷＢＣ、ＭＮＣ计数随ＤＳ剂量增加而增加，注射ＤＳ６０ｍｇ／ｋｇ时ＷＢＣ、ＭＮＣ数分别为给药前的２．１和４．０倍。以１５ｍｇ／ｋｇ或３０ｍｇ／ｋｇ组狗外周血中各系祖细胞升高幅度最大，每升血中ＣＦＵ－ＧＭ、ＣＦＵ－Ｍｅｇ、ＢＦＵ－Ｅ和ＣＦＵ－Ｍｉｘ计数分别为给药前的９．０，６．８，１０．３和１３．０倍。     

IL—6基因转染的骨髓基质细胞系对骨髓移植小鼠造血功能恢复？…

目的：探讨白细胞介素６（ＩＬ－６）基因转染的骨髓基质细胞系ＱＸＭＳＣ１ＩＬ－６对骨髓移植后造血功能的重建作用。方法：将骨髓造血细胞和骨髓基质细胞系一起经尾静脉注射给同系小鼠，建立骨髓移植（ＢＭＴ）模型。小鼠的造血功能用脾结节（ＣＦＵ－Ｓ）、粒－单系祖细胞（ＣＦＵ－ＧＭ）、红系祖细胞（ＣＦＵ－Ｅ、ＢＦＵ－Ｅ）测定及外周血各项血液学指标来确定。结果：ＷＸＭＳＣ１ＩＬ－６转基因骨髓基质细胞可明显增强ＢＭ     

白细胞介素12单独或联合白细胞介素2对人脐血单个核细胞抗肿？…

目的 探讨白细胞介素１２（ＩＬ－１２）单独或联合白细胞介素２（ＩＬ－２）对人脐血单个核细胞（ＣＲＭＣ）抗肿瘤作用的影响。方法 采用＾３Ｈ－ＴｄＲ释放法测定经ＩＬ－１２和（或）ＩＬ－２刺激的ＣＢＭＣ和人外周血单个核细胞（ＰＢＭＣ）的抗肿瘤活性,及在电镜下观察激活的ＣＢＭＣ所杀伤的Ｋ５６２细胞的形态特征。结果 ①ＩＵ／ｍｌＩＬ－１２激活的ＧＢＭＣ即产生较强的杀伤活性,对Ｋ５６２及Ｒａｊｉ细胞的杀伤率分     

紫外线波段B对脐血免疫活性和造血活性抑制的体外研究

目的：探讨紫外线波段Ｂ（ＵＶＢ）对脐血淋巴细胞和造血细胞的作用差别。方法：选择０，５，１０，２０，５０ｍＪ／ｃｍ２等不同剂量ＵＶＢ照射脐血单个核细胞（ＭＮＣ），分别进行活力检测，混合淋巴细胞培养（ＭＬＣ），粒－单系祖细胞集落（ＣＦＵ－ＧＭ）培养和ＣＤ３４＋细胞比率检测。结果：脐血细胞ＭＬＣ的免疫增殖反应活性、免疫激活能力及ＣＦＵ－ＧＭ数均呈照射剂量依赖性下降（Ｐ＜０．０１），但在１０ｍＪ／ｃｍ２照射范围内脐血免疫活性下降幅度显著高于ＣＦＵ－ＧＭ。在脐血ＭＮＣ悬液内加入２０％小牛血清后不仅使ＵＶＢ的作用减弱，还加大了ＵＶＢ对脐血淋巴细胞和造血细胞失活作用的差别。ＵＶＢ照射前后ＣＤ３４＋细胞比率无明显变化。结论：小剂量ＵＶＢ照射可选择性降低脐血淋巴细胞的增殖反应活性，而对造血细胞活性影响少，提示运用ＵＶＢ预防脐血移植引起的移植物抗宿主病是可能的。     

纤维连结蛋白,粘附抗原和造血祖细胞

纤维连结蛋白（ＦＮ）是广泛存在于多种细胞表面、基质及血浆中的一种糖蛋白，在细胞粘附、迁移、分化及成熟中的作用已有较多研究。但ＦＮ与髓系祖细胞分化成熟的关系研究尚少。除ＢＦＵ－Ｅ、ＣＦＵ－Ｅ和ＣＦＵ－ＧＭ皆能和ＦＮ分子中ＲＧＤ短肽相结合外，最近发现，原始造血祖细胞（ＬＴＢＭＣ－ＩＣ）多向造血祖细胞（ＣＦＵ－ＭＩＸ）、ＢＦＵ－Ｅ、ＣＦＵ－Ｅ及ＣＦＵ－ＧＭ还能和ＦＮ分子肝素结合片段中的“ＣＳ１”多肽结合     

基因重组干扰素γ体外对骨髓增生异常综合征患者造血祖细胞的作用

对基因重组干扰素γ（ＩＦＮ－γ）体外对３２例骨髓增生异常综合征（ＭＤＳ）患者造血祖细胞的作用进行了研究，结果如下：①ＭＤＳ患者ＣＦＵ－Ｅ和ＣＦＵ－ＧＭ明显低于对照组，ＣＦＵ－Ｅ减低者占３０／３２例，ＣＦＵ－ＧＭ减低者占３１／３２例。②ＩＦＮ－γ体外可促进ＣＦＵ－Ｅ和ＣＦＵ－ＧＭ数增加，其作用为剂量依赖型，在ＩＦＮ－γ浓度为１００Ｕ／ｍｌ时达最大值。③ＩＦＮ－γ对ＭＤＳ患者ＣＦＵ－Ｅ和ＣＦＵ－ＧＭ的促增殖作用与患者自身集落数有关，在自身集落数正常和稍减低者这种作用最明显，在明显减低者这种作用小甚至为０．④上海和日本二种干扰素作用相似，无显著差异。以上结果提示ＩＦＮ－γ对ＭＤＳ治疗可望产生良好效果。     

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.     

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.     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

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.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.