剔除CCR5基因供者小鼠细胞加重急性移植物抗宿主疾病

目的评价供者CCR5在经过强化预处理的骨髓移植动物模型受者体内的作用,为异基因造血干细胞移植的临床应用提供科学依据。方法经过致死剂量照射的BALB/C小鼠接受异基因C57BL/6小鼠骨髓移植。根据回输的细胞不同分为4组:1)B6 CCR5 KO组,受者接受C57BL/6 CCR5-/-小鼠骨髓和脾脏细胞;2)B6 WT组,受者接受野生型C57BL/6小鼠骨髓和脾脏细胞;3)B6 CCR5 KO BMC组,受者只接受C57BL/6 CCR5-/-小鼠骨髓细胞;4)B6 WT BMC组,受者只接受野生型C57BL/6小鼠骨髓细胞。结果与B6 WT组比较,B6 CCR5 KO组小鼠以更快的速度死于急性移植物抗宿主疾病(GVHD);其受者体内的CD8+T细胞大量增生;T细胞恢复后产生更多的干扰素-γ(INF-γ)和肿瘤坏死因子-α(TNF-α),T细胞有丝分裂原刀豆素水平处于较高水平,进一步促进T细胞增生。组织学检测提示移植剔除CCR5基因受者细胞的小鼠肾脏出现病理损伤,肝脏存在更为严重的病理变化。结论剔除CCR5基因的异基因骨髓移植使GVHD发病率增加,供者CD8+T细胞在受者体内增生加重肝肾损害。提示CCR5在异基因骨髓移植中起着重要作用。     

移植前选择性去除同种异体反应供者淋巴细胞预防移植物抗宿主病的实验研究

目的探讨在移植前选择性去除同种异体反应的供者淋巴细胞预防移植物抗宿主病(GVHD)的效果。方法以(BALB/c×C57BL/6)F1雌性小鼠(H-2d/b)为受鼠,于第0天接受亚致死量的60Coγ射线全身照射(TB I),总剂量为4 Gy,第1天接种P388D1白血病细胞,第2天输注由C57BL/6雄性小鼠(H-2b)为供鼠提供的不相匹配的供者脾淋巴细胞,第6天再次TB I 9 Gy,第7天输注由(BALB/c×C57BL/6)F1雄性小鼠(H-2d/b)提供的骨髓造血干细胞。结果以TB I选择性去除同种异体反应供者淋巴细胞组的小鼠无白血病和GVHD的发生,生存期超过了210 d。对照组的小鼠出现了明显的GVHD、白血病或因出血、感染导致的死亡,生存期短,为20~36 d(P<0.01)。结论在造血干细胞移植前输注不相匹配的供者淋巴细胞诱导移植物抗白血病(GVL)效应,然后再选择性去除同种异体反应的供者淋巴细胞来预防GVHD的发生是可行的。     

父方否决细胞对小鼠半相合干细胞移植模型移植物抗宿主病的预防作用

目的 探讨父方否决细胞对小鼠半相合干细胞移植模型移植物抗宿主病(GVHD)是否起预防作用.方法 以B6CF1(H-2 b/d)作为半相合干细胞移植的受鼠,给予9.0 Gy全身照射后4 h,单纯照射组经尾静脉注射0.3 ml D-Hank's 液,不进行细胞移植;对照组经尾静脉注射C57BL/6小鼠混合细胞悬液(4.5×106骨髓细胞 3.0×107脾细胞),但不进行其他治疗处理;实验组于移植4 d后经尾静脉注射BALB/c小鼠脾细胞悬液(数量分别为5.0×106、1.0×107),然后观察其造血恢复、植入及移植物抗宿主病(GVHD)的情况.结果 由于没有给予GVHD防治措施,对照组受鼠GVHD的发生率和死亡率分别为10/10和10/10;而1/6量否决细胞组小鼠GVHD的发生率为5/10,30 d生存率增加至5/10(P＜0.01),5只因GVHD死亡的受鼠中位生存期为20 d,较对照组(中位生存期14 d)有显著性差异(P＜0.05);1/3量否决细胞组小鼠GVHD的发生率为2/10,30 d生存率增加至8/10,中位生存期延长至30 d以上(P＜0.05).结论 半相合干细胞移植后输注父方否决细胞,可以诱导特异性免疫耐受,显著降低半相合干细胞移植GVHD的发生率.     

供者NK细胞诱导小鼠MHC半相合骨髓移植的免疫耐受

目的：探讨纯化的供鼠NK细胞加入预处理方案与MHC半相合骨髓移植后免疫耐受的关系。 方法：制备（BALB/c^H-2d×C57BL／6^H-2b）CB6F₁^H-2d/b小鼠为受者,C57BL／6^H-2b的小鼠为供者。70只受者小鼠经致死剂量（9.0 Gy）照射后随机分为7组,每组10只。对照组：分别为单纯照射组、MHC半相合GVHD对照组、MHC半相合骨髓细胞移植组、同基因骨髓细胞移植组。实验组：CB6F₁^H-2d/b小鼠在完成照射后1 h内首先经静脉输注纯化后的MHC半相合供者NK细胞,分为1×106、5×105和2×105／只3个组,在照射后4 h移植MHC半相合骨髓细胞。以血像、体重、生存期和病理组织学等变化为观察指标并做组间比较。结果：①生存期：单纯照射对照组为(5.15±0.66)d,GVHD对照组为(15.80±1.93)d,其他组小鼠生存期均大于30 d。②病理学结果,MHC半相合GVHD对照组出现典型的GVHD病理表现,其他各组均无GVHD病理表现。 结论：在MHC半相合骨髓移植模型上证实,移植前将供鼠的纯化NK细胞加入移植预处理方案,能诱导免疫耐受。     

口服耐受后过继转输动物模型的建立方法

目的:探讨经口服受鼠脾淋巴细胞诱导耐受的供鼠淋巴细胞输注是否能减轻移植物抗宿主病(GVHD).方法:以雄性DBA-2小鼠(H-2d)为供者,分别用BALB/C鼠脾淋巴细胞、DBA-2鼠脾淋巴细胞、牛血清蛋白、普通饲料隔天喂养,单向混合淋巴细胞反应(MLR)评估诱导耐受状态.以雌性BALB/C小鼠(H-2d)为受者,给予6.0 Gy 60Coγ射线全身照射,尾静脉输注来自于DBA-2小鼠的2×107脾淋巴细胞.结果:耐受供鼠cpm值低于非耐受组,接受已耐受供鼠脾淋巴细胞输注的受鼠,发生GVHD较其他组轻.结论:经口服耐受的过继转输动物模型的实验方法有效可行.     

大小鼠之间造血干细胞嵌合体抗异种移植物抗宿主病

目的探讨克服异种骨髓移植间强烈的移植物抗宿主病(GVHD)的措施。方法(1)将12只SD大鼠经5.0 Gy亚致死剂量全身照射后,4 h内每只经尾静脉输入28只正常BALB/c小鼠骨髓细胞8×107个。2 d后从腹腔注射环磷酰胺(Cy)100 mg/kg·b.w.,诱导形成对BALB/c小鼠产生特异性免疫耐受的嵌合体大鼠10只。(2)24只BALB/c小鼠接受9.0 Gy致死剂量全身照射后随机均分为3组,照射后4 h内经尾静脉注射骨髓细胞进行移植。A组输注正常SD大鼠的骨髓细胞4×107个;B组输注正常SD大鼠的骨髓细胞4×107个和脾细胞2×107个;C组输注嵌合体SD大鼠的骨髓细胞4×107个和脾细胞2×107个;观察GVHD的发生情况。结果A组有2只小鼠死于感染和放射损伤,所有对象均未观察到明显GVHD表现。B组平均累积存活时间为10 d[95%可信区间为(8,12)],死前均出现不同程度的典型GVHD表现。而C组除2只小鼠分别于移植后18、31 d死亡外,其余的均存活超过150 d。三组间比较有统计差异(P<0.002)。结论对有受者嵌合体的供者进行异种骨髓移植,有助于克服异种移植物抗宿主病。     

B7反义肽预处理脾细胞诱导异基因嵌合体形成及延长移植物存活

目的　尝试以B7 CD2 8/CTLA4为靶点 ,用B7反义肽 (B7AP)预处理供者的脾细胞 ,免疫受者后结合输注供者骨髓细胞 ,诱导受体形成异基因嵌合体。方法　每只用 5× 10 6/ 10 0 μlB7AP预处理的供者小鼠 (C5 7BL/ 6 )脾细胞免疫受者小鼠 (BALB/c) ,诱导特异性同种低免疫应答反应 ;在此基础上每只受者小鼠输注供者骨髓细胞 2× 10 7/ 10 0 μl,诱导受者形成异基因嵌合体 ,以流式细胞术 (FACS)连续动态监测嵌合状态的维持情况并用小鼠心肌移植模型研究移植物存活的影响因素。结果　在受者体内成功诱导出了特异性同种低免疫应答反应 ,应答水平只有正常未免疫组的 4 3%(n =6 ,P <0 0 0 1) ;嵌合状态可以维持到 10 0d以上 (n =6 ) ,15 0d时嵌合率仍有 3.4 5 % ;嵌合小鼠进行同种异体小鼠心肌移植存活超过 10 0d(n =6 ) ,而对照组阿霉素组只能延长至 16d(n =6 )。结论　B7AP预处理小鼠脾细胞可诱导形成异基因嵌合体 ,并显著延长同种小鼠心肌移植存活的时间 ,为移植免疫的研究提供了一个简单易行的嵌合体平台技术 ,也为用B7AP在移植免疫中的应用进行了有益的尝试。     

供者淋巴细胞输注治疗小鼠H22肝癌的实验研究

目的:观察供者淋巴细胞输注(DLI)对小鼠H2 2肝癌的治疗作用。方法:荷瘤昆明小鼠分荷瘤对照组(A组)、5- 氟脲嘧啶(5 - FU)化疗组(B组)、DLI组(C组)及5 - FU加DLI组(D组) 4组。比较各组小鼠生存期、抑瘤率及瘤体病理检查结果,检测NK细胞及IL 2的活性。结果:B、C组生存时间长于A组(P <0 .0 1) ,D组长于C组(P <0 .0 1) ;B、C、D各组抑瘤率依次为61.3 %、3 4.7%、89.5 % ;C、D两组NK细胞及IL 2活性明显高于A、B组(P <0 .0 5 ) ;病理观察见C、D组大量炎性细胞浸润。结论:DLI对小鼠H2 2肝癌有治疗作用,是一种潜在可行的实体瘤细胞过继免疫治疗方法。     

供者淋巴细胞输注对H22肝癌荷瘤小鼠免疫功能及瘤体生长的影响

目的 探讨供者淋巴细胞输注（donor lymphocyte infusion，DLI）及其联合化疗（氟尿嘧啶，5-Fu）对H22肝癌荷瘤小鼠免疫功能及瘤体生长的影响。方法 荷瘤昆明（KM）小鼠随机分4组：荷瘤对照组（A组）、5-Fu组（B组）、DLI组（C组）、联合组（D组）。检测各组小鼠外周血T淋巴细胞亚群和IL-2水平的变化及NK细胞的活性，计算瘤体生长抑制率。结果 C、D两组小鼠外周血CD3^＋、CD4^＋、CD4^＋／CD8^＋、IL-2水平及NK细胞活性明显高于A、B两组（P〈0.05）。B、C、D各组抑瘤率分别为61．3％、34，7％、89．5％。结论 供者淋巴细胞输注与化疗联合使用可以抑制实体瘤的生长，提高H22肝癌荷瘤小鼠的免疫功能，诱导有效的移植物抗肿瘤效应，是一种潜在可行的实体瘤细胞过继免疫治疗方法。     

TJU103对小鼠同种异基因造血干细胞移植模型GVHD的预防作用

目的探讨TJU103对小鼠同种异基因造血干细胞移植模型移植物抗宿主病(GVHD)是否起预防作用。方法(1)用单向混合淋巴细胞培养方法检测TJU103对T淋巴细胞增殖的影响;(2)以BALB/c(H-2d)、CB6F1(H-2d/b)分别作为完全异基因移植和半相合基因移植的受鼠,给予9.0Gy全身照射后4h,单纯照射组经尾静脉注射0.3mlD-Hank's液,不进行细胞移植;对照组经尾静脉注射C57BL/6小鼠混合细胞悬液(4.5×106骨髓细胞 3.0×107脾细胞),但不进行其他治疗处理;实验组经尾静脉注射C57BL/6小鼠混合细胞悬液(4.5×106骨髓细胞 3.0×107脾细胞) TJU103(终浓度25μg/ml),此后腹腔注射TJU10350μg/d,共7d,然后观察其造血恢复、植入及GVHD的情况。结果(1)TJU103可以显著抑制T细胞活化增殖,其抑制作用呈剂量依赖性,在25μg/ml浓度时,可以抑制83%细胞增殖。(2)由于没有给予GVHD防治措施,对照组受鼠GVHD的发生率和死亡率分别为10/10和10/10;而完全异基因移植实验组小鼠GVHD发生率仅为2/10,30d生存率增加至8/10(P<0.01),中位生存期延长至30d以上(P<0.01);半相合基因移植实验组小鼠GVHD发生率为1/10,30d生存率增加至9/10(P<0.01),中位生存期延长至30d以上(P<0.01)。结论TJU103不仅可以显著抑制体外T淋巴细胞增殖效应,而且可显著降低小鼠同种异基因造血干细胞移植模型GVHD的发生率。     

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…