肝癌特异性细胞毒T淋巴细胞的实施及临床研究

诱导肿瘤特异性细胞毒性Ｔ细胞，观察其体外、体内的抗肿瘤作用及其特异性；评价其扩上癌术后复发的临床应用价值。方法用细胞因子体外周期刺激方法提高肝癌细胞的免疫原性，再与肿瘤浸润Ｔ细胞共同培养，辅以ＣＤ２８产市民人刺激，诱导ＴＳ－ＣＴＬｓ，检测其体内外抗肝癌作用及其效应机制；大量扩增后回输患者，观察其免疫学指标的变化随访其术后复发情况。结果，体外研究表明，肝癌细胞经ＩＮＦ－γ、ＴＮＦ－α诱导后ＭＨＣＯＤ     

肝癌病人树突状细胞诱导高效而特异的抗肝癌免疫

目的 以肝癌病人树突状细胞（ＤＣ）体外诱导抗肝癌免疫。方法 自肝癌病人外周血中分离出单个核细胞（ＰＢＭＣ０;以人肝癌细胞系ＨｅｐＧ２肿瘤细胞的肿瘤相关抗原（ＴＡＡ）激活ＤＣ;以粒／巨噬细胞集落刺激因子（ＧＭ－ＣＳＦ）及白介素４（ＩＬ－４）联合刺激ＰＢＭＣ中ＤＣ;ＤＣ诱导自体Ｔ淋巴细胞增殖,分化为细胞毒性Ｔ细胞（ＣＴＬ）;检测ＣＴＬ及其上清液对ＨｅｐＧ２,ＢＥＬ－７４０２,ＬＯＶＯｅｙ ＨＯＳ－８６     

慢性呼吸性酸中毒对尿钙排泄的影响

慢性呼吸性酸中毒对尿钙排泄的影响何劲松，王伟铭，韩德萱ＥＦＦＥＣＴＯＦＣＨＲＯＮＩＣＲＥＳＰＩＲＡＴＯＲＹＡＣＩ－ＤＯＳＩＳＯＮＵＲＩＮＡＲＹＣＡＬＣＩＵＭＥＸＣＲＥＴＩＯＮＩＮ￥ＴＨＥＭＡＮＨｅＪｉｎｇｓｏｎｇ；ＷａｎｇＷｅｉｍｉｎｇ；ＨａｎＤｅｘ...     

骨肉瘤特异性细胞毒T淋巴细胞的诱导及其抗肿瘤特性的研究

目的 诱导崩肉瘤特异性细胞毒Ｔ淋巴细胞（ｏｓｔｏｓａｒｃｏｍａ ｓｐｅｃｉｆｉｃ ｃｙｔｏｔｏｘｉｃ Ｔｌｙｍｐｈｏｃｙｔｅ,ＯＳＳ－ＣＴＬ）观察其体内外的抗肿瘤特性。方法 通过生化方法从ＨＯＳ－８６０３细胞系中提取纯化骨肉瘤相关抗原（ｏｓｔｅｏｓａｒｃｏｍａ ａｓｓｏｃｉａｔｅｄ ａｎｔｉｇｅｎ,ＯＳＡＡ）,并与低剂量ＩＬ－２,ＣＤ３单体协同刺激骨肉瘤致敏的淋巴细胞诱导产生ＯＳＳ－ＣＴＬ。结果     

体外诱导骨肉瘤特异性细胞毒T淋巴细胞的实验研究

研究诱导骨肉瘤特异性细胞毒Ｔ淋巴细胞,及其体内外的抗肿瘤作用。方法：通过生化方法提取纯化骨肉瘤相关抗原,并与低剂量ＩＬ２、ＣＤ３ＭｃＡｂ协同刺激骨肉瘤致敏的淋巴细胞诱导产生ＯＳＳ－ＣＴＬ。结果：ＯＳＳ－ＣＴＬ表型特征为以ＣＤ３＋ＣＤ８＋ＣＴＬ为主的异质细胞群;对ＯＳＡＡ相关的肉瘤细胞显示高亲和杀伤活性。     

CTLA－4Ig的免疫抑制作用

ＣＴＬＡ－４Ｉｇ是一种通过基因重组产生的可溶性嵌合蛋白，和ＡＰＣｓ表面Ｂ７分子有高度亲合力．Ｂ７和Ｔ细胞表面的ＣＤ２８／ＣＴＬＡ－４结合能产生共刺激信号，使Ｔ细胞充分活化，从而产生对移植物的排斥反应，ＣＴＬＡ－４Ｉｇ能与ＣＤ２８竞争性地结合３７分子，阻断共刺激信号的发生，产生免疫抑制作用。ＣＴＬＡ－４Ｉｇ与目前常用免疫抑制剂的作用机理不同，有可能诱导供者抗原特异性免疫耐受。本文综述ＣＴＬＡ－４Ｉｇ的作用机理及其在移植免疫研究中的应用。     

CTLA—4Ig的免疫抑制作用

ＣＴＬＡ－４Ｉｇ是一种通过基因重组产生的可溶性嵌合蛋白，和ＡＰｓ表面的Ｂ７分子有高度亲合力，Ｂ７和Ｔ细胞表面的ＣＤ２８／ＣＴＬＡ－４结合能产生共刺激信号，使Ｔ细胞充分活化，从而产生对移植物的排斥反应，ＣＴＬＡ－４Ｉｇ能与ＣＤ２８性地结合Ｂ７分子，阻断共刺激信号的发生，产生免疫抑制作用，ＣＴＬＡ－４Ｉｇ与目前常用免疫抑制剂的作用机理不同，有可能诱导供者抗原特异性免疫耐受。本文综述ＣＴＬＡ－４Ｉｇ的任     

巯甲丙脯酸与硝苯吡啶延缓慢性肾衰进展作用的比较

巯甲丙脯酸与硝苯吡啶延缓慢性肾衰进展作用的比较苏如松，李荣，赵爱国，曹风林ＣＯＭＰＡＲＩＳＯＮＯＦＬＯＮＧ－ＴＥＲＭＥＦＦＥＣＴＳＢＥ－ＴＷＥＥＮＣＡＰＴＯＰＲＩＬＡＮＤＮＩＦｅＤＩＰＩＮＥＯＮＰＲＯ－ＧＲＥＳＳＩＯＮＯＦＣＨＲＯＮＩＣＲＥＮＡＬＦＡ...     

恶性肿瘤病人蛋白尿的发生率,影响因素及临床意义

恶性肿瘤病人蛋白尿的发生率、影响因素及临床意义李玖顺，李丽鸣，李惠玲，张玉ＰＲＯＴＥＩＮＵＲＩＡＩＮＰＡＴＩＥＮＴＳＷＩＴＨＭＡＬＩ－ＧＮＡＮＴＴＵＭＯＲ：ＯＣＣＵＲＡＮＣＥ，ＩＮＦＬＵＥＮＣＥＦＡＣＴＯＲＳＡＮＤＣＬＩＮＩＣＡＬＳＩＧＮＩＦＩＣＡＮ...     

冬虫夏草对5／6肾切除大鼠肾脏病理改变的影响

冬虫夏草对５／６肾切除大鼠肾脏病理改变的影响程庆，于力方，师锁柱，陈香美ＥＦＦＥＣＴＯＦＣＯＲＤＹＣＥＰＳＳＩＮＥＮＳＩＳＯＮＲＥＮＡＬＨＩＳＴＯＬＯＧＩＣＡＬＣＨＡＮＧＦＳＩＮ５／６ＮＥＰＨＲＥＣＴＯＭＩＺＥＤＲＡＴ￥ＣｈｅｎｇＱｉｎｇｌｉ；ＹｕＬ...     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.     

Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: A randomised, double-blind, cross-over study with and without adrenaline

Background: Basic pharmacological research indicates that there are synergistic antinociceptive effects at the spinal cord level between adrenaline, fentanyl and bupivacaine. Our clinical experience with such a mixture in a thoracic epidural infusion after major surgery confirms this. The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief and side effects when removing adrenaline from this triple epidural mixture. Methods: A prospective, randomised, double-blind, cross-over study was carried out in 24 patients after major thoracic or abdominal surgery. Patients with only mild pain when coughing during a titrated thoracic epidural infusion of about 10 ml · h^?1 of bupivacaine 1 mg · ml^?1, fentanyl 2 μg · ml^?1, and adrenaline 2 μg · ml^?1 were included. On the 1^st and 2^nd postoperative days each patient was given a double-blind epidural infusion, at the same rate, with or without adrenaline. The effect was observed for 4 h or until pain when coughing became unacceptable in spite of a rescue analgesic procedure. Rescue analgesia consisted of up to two epidural bolus injections per hour and i.v. morphine if necessary. All patients received rectal paracetamol 1 g, every 8 h. Fentanyl serum concentrations were measured with a radioimmunoassay technique at the start and end of each study period. Main outcome measures were extent of sensory blockade and pain intensity at rest and when coughing, evaluated by a visual analogue scale, a verbal categorical rating scale, the Prince Henry Hospital pain score, and an overall quality of pain relief score. Results: The number of hypaesthetic dermatomal segments decreased (P <0.001) and pain intensity at rest and when coughing increased (P <0.001) when adrenaline was omitted from the triple epidural mixture. This change started within the first hour after removing adrenaline. After 3 h pain intensity when coughing had increased to unacceptable levels in spite of rescue analgesia (epidural bolus injections and i.v. morphine). Within 15–20 min after restarting the triple epidural mixture with adrenaline, pain intensity was again reduced to mild pain when coughing. Serum concentration of fentanyl doubled from 0.22 to 0.45 ng · ml^?1 (P <0.01), and there was more sedation during the period without adrenaline. Conclusions: Adrenaline increases sensory block and improves the pain-relieving effect of a mixture of bupivacaine and fentanyl infused epidurally at a thoracic level after major thoracic or abdominal surgery. Serum fentanyl concentrations doubled and sedation increased when adrenaline was removed from the epidural infusion, indicating more rapid vascular absorption and systemic effects of fentanyl.