Toll样受体信号转导通路在器官移植中的作用

器官移植已成为治疗终末期器官衰竭患者的主要手段,为避免术后排斥反应的发生和发展,患者术后需终生服用大量免疫抑制药物.尽管免疫抑制剂的应用有效地预防了急性排斥反应的发生,但其在实体器官移植患者中仍有引起潜在严重并发症的可能.此外,尽管长期服用免疫抑制药物,大多数移植患者仍会因急性或慢性移植物损伤引起移植器官功能障碍.虽然...     

Toll样受体信号通路在器官移植免疫耐受研究中的新进展

器官移植是治疗终末期器官衰竭的主要手段,但移植患者需终身服用免疫抑制剂,虽可有效抑制急慢性免疫排斥的发生,但仍存在严重并发症的可能。近年来研究发现,天然免疫系统在器官移植的排斥反应中发挥着重要作用。天然免疫识别由许多不同蛋白质家族的受体启动,其中最主要的是Toll样蛋白受体(TLRs)。TLRs是一组具有重要免疫活性的跨膜蛋白,其可诱导免疫耐受,也可激活特异性免疫系统,在器官移植的不同时期都可能发挥重要作用。     

热休克蛋白与器官移植

热休克蛋白(HSPs)是一组主要存在细胞内、结构高度保守的蛋白质分子家族,具有抗炎症、抗细胞凋亡和减轻过氧化作用,对移植器官保存和缺血再灌注损伤发挥自身保护作用。同时,在生理条件下,HSPs也存在于细胞间隙,调控炎症和排斥反应的过程。HSPs适当的表达可能会减轻炎性反应,从而抑制移植排斥;另一方面,HSPs也可激活天然免疫系统和获得性免疫系统,加重移植排斥反应。HSPs对器官移植排斥的确切作用仍需进一步探索。     

人活体小肠移植受体血清IL-8与排斥反应相关

目的 观察我国首例活体部分小肠移植受体围手术期趋化因子IL-8的变化及其与移植物缺血再灌注损伤和急性排斥反应的相关性。方法 双抗夹心ELISA法测定受体术前及术后1-140d血清IL-8动态水平。结果 受体血清IL-8水平夺术后1d显著升高（2.44ug.L^-1vs0.26ug.L^-1),且于次日迅速下降（1.70ug.L^-1),术后4d达术前水平,血清IL-8的第2个高峰出现于术后67d发生移植物急性排斥反应时（1.47ug.L^-1)。但高度较第1次低,恢复较第1次慢,在术后96d达术前水平。结论 在人活体部分小肠移植中,血清IL-8水平与移植物缺血再灌注损伤和急性排斥反应密切相应。可作为重要的小肠移植物急性排斥反应的信号之一。     

Toll样受体与器官移植

传统上人们认为移植物的识别和耐受发生在继发性免疫系统控制的范围内，而先天性免疫系统作为宿主防御的第一线，主要在抵抗微生物入侵上发挥作用。Toll样受体（Tolllike receptors，TLRs）是新近发现的先天性免疫系统中的细胞跨膜受体及病原模式识别受体之一。目前的证据表明，TLRs除了对病原体相关分子模式（PAMPs）或微生物产生应答以外，还能被内源性配体激活。参与缺血再灌注损伤的发生以及影响移植物的功能和存活。本文对TLRs在器官移植中的潜在影响做一综述。     

Toll样受体与病毒性肝炎相关性的研究进展

天然免疫系统发挥防御作用的关键是对病原体的识别,近年来的研究发现Toll样受体(Toll-likereceptors,TLRs)家族作为一种病原体模式识别受体(pattern recognition receptors,PRRs),在天然免疫中通过识别病原微生物及其特殊结构、代谢物等病原体相关分子模式(pathogen-associated molecular patterns,PAMPs),激活天然免疫系统,通过刺激信号的级联反应导致细胞因子的产生和协同刺激因子的表达,产生前炎症因子、抗微生物肽以抵御病原微生物所致损害;同时向抗原提呈细胞发出警报,最终激活获得性免疫,在天然免疫和获得性免疫中起到了桥梁的作用。研究显示,有些TLRs在病毒性肝炎的发生和发展中,通过影响肿瘤坏死因子(TNF)、干扰素(IFN)及调节Th1和Th2反应平衡而发挥重要作用。本文就近年来TLRs与病毒性肝炎的相关性研究作一综述。     

肾缺血再灌注损伤发生机制的研究进展

缺血再灌注损伤（IRI）是临床常见的病理生理变化,常见于急性失血、中毒性休克和器官移植手术等过程中,尤其在器官移植中几乎不可避免,其不仅能够导致移植物功能的延迟恢复,甚至可能触发急性排斥反应的发生,引起早期的移植物功能衰竭。肾缺血再灌注损伤是临床上导致急性肾小管坏死和肾移植失败的重要因素。急性肾缺血再灌注损伤的发病机制至今尚未完全阐明,目前的研究资料表明,急性肾缺血再灌注损伤与ATP的减少、大量氧自由基的生成、细胞内钙超载、炎性介质和粘附分子、细胞因子、内皮素（ET）、细胞凋亡等有关。     

CD4+CD25+调节性T细胞及其在肝移植后免疫耐受中的作用

当今,肝移植是许多肝病患者在终末期提高生活质量的最佳选择,而术后排斥反应直接关系到手术的成功与否.目前临床上主要使用免疫抑制药物来减轻或避免排斥反应.但长期应用免疫抑制剂会引起许多不良反应,包括引起感染、增加肿瘤发生率等,严重影响移植物及受者的存活.有效控制移植后排斥反应,诱发并维持宿主对移植物的免疫耐受,一直是器官移植领域研究的焦点及难题.     

脂质过氧化抑制剂对同基因大白鼠移植肾MHC基因表达调控的研究

同种肾移植术后，宿主T细胞对移植物主要组织相容性复合物（MHC）抗原的识别并对移植物排斥，为宿主抗移植物反应的关键环节。抑制宿主T细胞免疫活性或抑制移植物MHC表达，将减轻器官移植术后排斥反应发生的频率和强度。本研究以Wistar大白鼠间肾脏低温保存后移植为模型，选用细胞脂质过氧化抑制剂对供体和受体进行治疗，观察对移植肾MHC表达的影响，结果表明：脂质过氧化抑制剂能有效地抑制移植肾MHC的基因表达，同时对移植肾脏的功能起保护作用，这种对MHC表达的抑制以及对肾功能的保护与脂质过氧化抑制剂对肾脏低温保存期及移植术过程中缺血再灌注所致器官组织的细胞脂质过氧化反应的抑制有关。     

SIRT3基因在器官缺血-再灌注损伤中的作用

器官移植是挽救各器官终末期疾病的先进医学科学技术,缺血-再灌注(IR)损伤在器官移植过程中不可避免,缺血时细胞能量来源减少,再灌注时发生氧化应激,最终激活一系列通路,导致细胞死亡,影响供者器官的质量及术后移植肝功能的恢复。SIRT3是Sirtuin蛋白家族的成员,主要位于线粒体基质,在细胞能量代谢以及氧化应激过程中有着重要的调节作用。本文就SIRT3基因在器官IR损伤中的作用作一综述。     

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…     

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.     

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.     

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.     

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.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…