Human neonatal thymectomy induces altered B‐cell responses and autoreactivity

An association between T‐cell lymphopenia and autoimmunity has long been proposed, but it remains to be elucidated whether T‐cell lymphopenia affects B‐cell responses to autoantigens. Human neonatal thymectomy (Tx) results in a decrease in T‐cell numbers and we used this model to study the development of autoreactivity. Two cohorts of neonatally thymectomized individuals were examined, a cohort of young (1–5 years post‐Tx, n = 10–27) and older children (>10 years, n = 26), and compared to healthy age‐matched controls. T‐cell and B‐cell subsets were assessed and autoantibody profiling performed. Early post‐Tx, a decrease in T‐cell numbers (2.75 × 10⁹/L vs. 0.71 × 10⁹/L) and an increased proportion of memory T cells (19.72 vs. 57.43%) were observed. The presence of autoantibodies was correlated with an increased proportion of memory T cells in thymectomized children. No differences were seen in percentages of different B‐cell subsets between the groups. The autoantigen microarray showed a skewed autoantibody response after Tx. In the cohort of older individuals, autoantibodies were present in 62% of the thymectomized children, while they were found in only 33% of the healthy controls. Overall, our data suggest that neonatal Tx skews the autoantibody profile. Preferential expansion and preservation of Treg (regulatory T) cell stability and function, may contribute to preventing autoimmune disease development after Tx.     

胸腔镜胸腺扩大切除术治疗重症肌无力的疗效观察及影响因素分析

目的对胸腔镜胸腺扩大切除术治疗重症肌无力(myasthenia gravis,MG)的疗效进行总结,分析影响MG手术疗效的因素。方法回顾性研究我院2000年6月～2009年10月47例MG接受胸腔镜手术的临床资料,采用单因素分析和logistic回归模型对患者性别、年龄、病程、MGFA分型、胸腺病理类型等可能影响因素进行分析。结果 45例完成随访,随访16～111个月,平均51个月。根据MGFA提出的治疗后状况分类:完全稳定缓解占64.4%(29/45),药物缓解占17.8%(8/45),微小症状表现占8.9%(4/45),恶化占2.2%(1/45),复发占4.4%(2/45),死亡占2.2%(1/45)。年龄(β=0.059,P=0.027,OR=1.060,95%CI为1.007～1.117)和胸腺病理类型(β=1.558,P=0.025,OR=4.750,95%CI为1.214～18.584)是影响手术疗效的因素。结论 MG行电视胸腔镜下胸腺扩大切除术疗效满意,年龄和胸腺病理类型是手术疗效的影响因素。     

电视胸腔镜下经胸径胸腺切除术与胸骨正中切开胸腺切除术治疗重症肌无力的临床随机对照研究

目的对比观察电视胸腔镜下经胸径胸腺切除术与胸骨正中切开胸腺切除术治疗重症肌无力的疗效。方法选择重症肌无力患者,随机分为给予电视胸腔镜下经胸径胸腺切除术治疗的观察组和胸骨正中切开胸腺切除术治疗的对照组,观察手术相关指标及应激状态指标。结果观察组的手术时间、术中出血量、术后机械通气时间、ICU监护时间、伤口引流量、重症肌无力危象发生例数、镇痛药物使用例数、术后卧床总时间、血糖水平、汉密尔顿焦虑自评量表(HAMA)评分、汉密尔顿抑郁自评量表(HAMD)评分、数字评估量表(NRS)评分均低于对照组,血胰岛素水平高于对照组(P0.05)。结论电视胸腔镜下经胸径胸腺切除术能减小手术创伤、促进术后恢复、缓解应激状态,具有积极的临床价值。     

Mercury-Induced Autoimmune Glomerulonephritis: Requirement for T-Cells

Mercury-induced autoimmunity in Brown–Norway rats hasbeen shown previously to be due to polyclonal activation ofB lymphocytes, requiring the presence of T lymphocytes. Autoimmunityin that strain is characterised by the appearance of an autoimmuneglomerulonephritis, by the production of a host of autoantibodies,and by an increase in total serum IgE. In the present study,T-cell deprived rats were tested to assess the role of T cellsin the appearance of autoimmune abnormalities in vivo. It willbe shown that both BN rnu/rnu and BN ‘B’ rats, whohave virtually no T cells, do not develop autoimmunity followingHgCl₂ injections. In contrast BN ‘B’ rats reconstitutedwith normal T cells, and BN rnu/+ rats, exhibit autoimmune manifestations,including autoimmune glomerulonephritis, quite similar to thoseobserved in Brown–Norway rats. These data demonstratethat T cells are essential for mercury-induced autoimmunityto occur in Brown–Norway rats.     

Lack of expression of the T-cell marker XTLA-1 in Xenopus tropicalis: exploitation in thymus restoration studies.

Flow cytometric studies employing the monoclonal antibody XT-1 reveal that, in contrast to other strains and species of Xenopus examined, thymocytes and splenocytes from X. tropicalis do not express the T lineage-specific antigen XTLA-1. Thymus dependence of XTLA-1 expression in splenocytes is confirmed in X. laevis by early thymectomy experiments. When X. tropicalis larval thymus is implanted to thymectomized X. borealis larvae, histological studies reveal extensive colonisation by host-derived (quinacrine-positive) cells following metamorphosis. Flow cytometry of propidium iodide-stained nuclei shows that within 3 months of xenothymus implantation, 90% of cells within the implant originate from the recipient; donor cells were undetectable in recipient spleens at this time. The emergence of near normal levels and distribution of XTLA-1 positive cells within xenogeneic thymus implants within 3 months of implantation is illustrated by flow cytometric observations and through immunofluorescence analysis of cryostat sections. These kinetic studies indicate that immigrant host cells require sojourn within the foreign thymus environment before they express the T-cell marker.     

电视胸腔镜治疗胸腺瘤和重症肌无力

目的　探讨电视胸腔镜治疗胸腺肿瘤和重症肌无力 (MG)的手术方法和可行性。方法　1996年 3月至 2 0 0 2年 12月 ,2 2例病人行胸腺瘤和 (或 )重症肌无力胸腔镜手术治疗。其中男 16例 ,女 6例 ;年龄 14～ 77岁 ,平均 44 1岁。行胸腺全切 12例 ,合并MG者行胸腺扩大切除 10例。结果　所有手术均在胸腔镜下完成 ,无中转开胸者。 3例MG病例术后需短暂呼吸机辅助通气 ( <2 4h) ,二次气管插管1例 ,余无严重并发症 ,无手术死亡。平均手术时间 10 8min ,平均胸腔引流 2d ,平均术后住院 4 5d。结论　胸腔镜治疗Ⅰ期胸腺瘤较开胸手术具有创伤小、恢复快等显著优势 ,且符合该类肿瘤的外科治疗原则 ;胸腔镜胸腺扩大切除治疗重症肌无力在技术上是可行的。     

重症肌无力症行胸腺切除术后危象的防治（附23例临床资料分析）

本文报告了重症肌无力症行胸腺切除术后危象２３例，占我科手术治疗１０７例重症肌无力病例的２１．５％，因危象死亡１例（４．３％）。通过对临床资料进行分析，作者认为，重症肌无力症行胸腺切除术后危象多数可以预测，发生危象与病人重症肌无力临床类型，术前服用抗胆碱酯酶药物剂量，是否合并胸腺瘤，术前曾发生危象以及肺通气功能障碍等因素有关。对于术前预测术后可能发生危象者，可于术毕行预防性气管切开，合理调整抗胆碱酯酶药物用药剂量，加强控制肺部感染等综合性防治措施。     

3种不同术式治疗重症肌无力的比较

目的探讨不同时期不同手术方式治疗重症肌无力的疗效。方法回顾分析我院1991～2006年有随访资料的269例重症肌无力采用不同术式胸腺切除术治疗的临床资料,根据不同时期开展不同术式分为3组：胸骨劈开组（1991年1月～2002年5月,n=161）胸腔镜组（2002年2月～2005年7月,n=67）、胸腔镜联合颈部切口组（2005年2月～2006年11月,n=41）。结果胸骨劈开组手术时间（97.5±17.5）min显著短于胸腔镜组（130.3±31.5）min（q=12.991,P〈0.05）和胸腔镜联合颈部切口组手术时间（152.2±33.9）min（q=18.005,P〈0.05）。胸骨劈开组术后发生肌无力危象41例显著高于胸腔镜组4例和胸腔镜联合颈部切口组4例（χ^2=14.394,P=0.000）,但后2组肌无力危象发生率无统计学差异（χ^2=0.532,P=0.466）。胸骨劈开组术后第1年完全稳定缓解率26.7%（43/161）,与胸腔镜组25.4%（17/67）和胸腔镜联合颈切口组31.7%（13/41）差异无统计学意义（χ^2=0.554,P=0.758）。胸骨劈开组术后第2、3年的完全稳定缓解分别为31.7%（51/161）、35.4%（57/161）,与胸腔镜组无统计学差异31.3%（21/67）、43.3%（29/67）（χ^2=0.002,P=0.961;χ^2=1.251,P=0.263）。结论胸腔镜下胸腺切除术能取得胸骨正中劈开手术同样理想的中远期治疗效果,胸腔镜联合颈部切口胸腺切除术是否能够提高远期疗效,有待进一步随访观察。     

Sleep apnoea in well-controlled myasthenia gravis and the effect of thymectomy

We conducted overnight polysomnographic sleep studies of 16 patients (5 men and 11 women) with clinically well-controlled myasthenia gravis (MG). The subtypes of MG were IIA (3 patients), IIB (11 patients), IV (1 patient) and V (1 patient). Twelve patients were found on polysomnography to have obstructive and/or central types of the sleep apnoeas (SA). Their mean age was 42.4, SD 16.4 years, and the mean duration of MG was 7.4, SD 6.96 years. SA was not detected in 4 patients whose mean age was 30.8, SD 10.71 years and who had manifested MG for a mean duration of only 0.9, SD 0.65 years. Thus, patients with a longer duration of MG tended to have more SA. In 9 of the 12 SA patients, polysomnographic studies were repeated following thymectomy. SA had resolved in 6 patients, but persisted in 3. These findings suggest that SA is a possible clinical manifestiation of MG and that nocturnal dysfunction of both peripheral and central colinergic systems may be involved. Received: 10 April 1996 Received in revised form: 12 September 1997 Accpeted: 1 October 1997     

剑突下与侧胸入路胸腔镜手术治疗胸腺瘤效果的 Meta分析

目的 评价经剑突下入路胸腔镜(SPT)与侧胸入路胸腔镜(VAT)手术治疗胸腺瘤的临床效果.方法 计算机检索PubMed、Embase、The Cochrance Library、中国知网(CNKI)、万方(WANGFANG)等数据库,获得SPT与VAT手术治疗胸腺瘤的临床研究,检索时限均为建库至2019年12月,采用RevMan 5.3软件对符合纳入标准的研究进行Meta分析.结果 按照制定的纳入、排除标准,最终进入系统评价的文献共有17篇病例对照研究.包括SPT组623例,VAT组640例.Meta分析结果:与VAT手术治疗胸腺瘤病人相比,SPT组明显减少了手术时间(SMD=?1.67,95％CI:?2.78～?0.55,P=0.003)、术中出血量(SMD=?2.10,95％CI:?3.20～?1.01,P=0.0002)、术后引流量(SMD=?4.79,95％CI:?6.57～?3.01,P<0.00001)、引流管保留时间(SMD=?0.80,95％CI:?1.28～?0.31,P=0.001)、减轻术后疼痛(SMD=?1.44,95％CI:?1.72～?1.16,P<0.00001),缩短住院时间(SMD=?1.86,95％CI:?3.07～?0.64,P=0.003),差异有统计学意义.结论 现有临床资料显示,与VAT手术相比,SPT手术切除是治疗胸腺瘤的更好选择,可以作为治疗常规手术方式.