动脉内重组人血管内皮抑制素联合化疗栓塞术治疗原发性肝癌的疗效及CT灌注参数变化

目的 探讨动脉内重组人血管内皮抑制素（恩度）联合化疗栓塞术（TACE）治疗原发性肝癌（PHC）前后CT灌注参数变化.方法 选取PHC患者40例,随机分为观察组及对照组各20例,对照组给予单纯TACE,观察组给予动脉内恩度联合TACE术,观察术前及术后1个月的CT灌注参数变化.结果 2组间客观缓解率（RR）及不良反应发生率无显著差异（P＞0.05）,但观察组临床受益率（CBR）显著高于对照组（P＜0.05）;术后,观察组患者血流量（BF）、肝动脉灌注值（ALP）、肝脏灌注指数（HPI）参数较术前显著下降（P＜0.05或P＜0.01）,且显著优于对照组（P＜0.05）.结论 动脉内恩度联合TACE术治疗PHC患者能显著提高CBR,不良反应未见显著增加,且CT灌注参数变化显著优于单纯TACE术.     

Clearance of hepatitis B virus from the liver of transgenic mice by short hairpin RNAs

Hepatitis B virus (HBV) causes acute and chronic hepatitis and hepatocellular carcinoma. Although a preventive vaccine is available, the therapeutic options for chronically infected patients are limited. It has been shown that RNA interference can prevent HBV gene expression and replication in vivo when HBV expression vectors are delivered simultaneously with small interfering RNA (siRNA) or siRNA expression constructs. However, the therapeutic potential of siRNAs to interrupt ongoing HBV replication in vivo has not been established. Here, we show that expression of HBV-specific siRNAs in the liver of HBV transgenic mice by recombinant adenoviruses can suppress preexisting HBV gene expression and replication to almost undetectable levels for at least 26 days. These results demonstrate that efficiently delivered siRNAs should be able to silence HBV in chronically infected patients.     

Dust mite-derived Enterobacterial fimbriae H protein enforces the allergen specific immunotherapy in asthma mice

BackgroundThe mite alimentary canal contains plenty of microbiota. It is accepted that some of the microbial products function as adjuvants to speed up immune responses.ObjectivesWe identified five bacterial proteins from dust mite, and Enterobacterial fimbriae H (FimH) was one of them. This study aims to test a hypothesis that the FimH protein enforces immunotherapy in asthmatic mice.MethodsAsthmatic mice were treated by allergen specific immunotherapy (ASIT) with rDer f1/f2 or rDer f1/f2 plus FimH. Changes in inflammatory cell infiltration, airway hyperreactivity, frequency of Tregs, splenic CD4⁺IFN-γ⁺ cells, and serum levels of TGF-β, IL-10, IL-13 and IL-17A of asthmatic mice were checked.ResultsASIT with rDer f1/f2 plus FimH reduced inflammatory cell infiltration, airway hyperreactivity (AHR), and levels of IgE and IgG1 compared to ASIT with rDer f1/f2 alone, but the levels of IgG2a increased. Asthmatic mice that underwent ASIT with rDer f1/f2 plus FimH showed increased frequency of Tregs, splenic CD4⁺IFN-γ⁺ cells, serum levels of TGF-β and IL-10; and deceased splenic CD4⁺IL-4⁺ cells, and serum levels of IL-13 and IL-17A. In vitro study showed FimH triggered IL-10 expression in a concentration dependent manner and facilitated the differentiation of Tregs.ConclusionUsed as an adjuvant, FimH enforces the effect of ASIT in asthmatic mice via augmenting Tregs.     

重组杜氏利什曼原虫39kD抗原的诊断价值

为了给内脏利什曼病（ＶＬ）患者提供较为准确的实验诊断方法。我们将表达杜氏利什曼原虫３９ｋＤ抗原的大肠杆菌制备物进行电泳并转移至硝酸纤维滤膜上，以１１例确诊ＶＬ病人的不同稀释度血清对其识别，当稀释度达１∶４００时，全部病人血清均能明显识别３９ｋＤ抗原带．而正常人血清和其他病人血清不识别３９ｋＤ抗原带，说明重组杜氏利什曼原虫３９ｋＤ抗原具有一定的诊断价值，用其检测病人血清中相应抗体可以诊断内脏利什曼病。     

恶性疟原虫重组质粒DNA接种诱导BALB/c小鼠的免疫应答

目的：观察重组质粒ＤＮＡ直接免疫接种诱导ＢＡＬＢ／ｃ小鼠的免疫应答水平，为恶性疟原虫ＤＮＡ疫苗在动物和人体的应用提供依据。方法：构建编码多价保护性抗原的重组质粒ｐｃＤＮＡ３－Ｐｆ８，ＰＣＲ法检测免疫鼠的肌肉、肝脏、肾脏、心脏、脾脏和肺组织中ｐｃＤＮＡ３－Ｐｆ８，ＥＬＩＳＡ、Ｔ淋巴细胞转化试验、体外抑制试验观察其诱导的体液免疫及细胞免疫水平。结果：用ＰＣＲ法从上述组织中均检测到ｐｃＤＮＡ３－Ｐｆ８，ＥＬＩＳＡ法测得免疫鼠血清的特异性抗体滴度达１２５６０，淋巴细胞转化试验显示恶性疟原虫可溶性抗原能特异性地剌激免疫鼠脾细胞增殖，免疫血清在体外还能抑制恶性疟红内期疟原虫的生长、发育。结论：编码恶性疟原虫多价保护性抗原的重组质粒ｐｃＤＮＡ３－Ｐｆ８直接免疫接种，能特异性地剌激ＢＡＬＢ／ｃ小鼠产生体液免疫和细胞免疫应答，其免疫血清在体外对疟原虫生长发育具有明显抑制作用。     

Surgical interventions in a cohort of patients with haemophilia A and inhibitors: an experiential retrospective chart review

Strategies for the management of perioperative bleeding in patients with haemophilia and inhibitors have evolved rapidly as a result of the development of the bypassing agents Factor Eight Inhibitor Bypassing Activity, Anti-inhibitor Coagulant Complex (FEIBA) and activated recombinant factor VII (rFVIIa). However, there are currently no established guidelines for perioperative use of bypassing agents, and few controlled clinical studies have been carried out. Thus, case reports, such as those presented here, provide useful anecdotal evidence to guide the treatment of inhibitor patients. The purpose of this report was to describe experiences in the use of bypassing agents in a small cohort of patients with haemophilia A and inhibitors undergoing surgical procedures. Cases from five treatment centres were reviewed. Twenty-two procedures using FEIBA, rFVIIa or a combination of both agents were compiled from seven inhibitor patients (six with an alloantibody inhibitor and one with an acquired autoantibody inhibitor). Eleven procedures used FEIBA monotherapy, two employed rFVIIa monotherapy and nine were performed using combination therapy. Supplemental therapies were required to manage bleeding in some cases. Haemostatic control was achieved in all cases, and treatment regimens were generally well tolerated. One thrombotic adverse event was reported: evidence of disseminated intravascular coagulation (DIC) was found after rFVIIa use in one case, although the direct cause of DIC was unknown. The experiences in this case review demonstrate that both major and minor surgical procedures can be safely performed in patients with haemophilia and high-titre inhibitors under the cover of bypassing agents, with a high expectation of success.     

siRNA沉默STAT3基因对人肝癌细胞的抑制及对相关生长调控基因的调节

目的: 探讨RNA干扰技术沉默STAT3基因表达对人肝癌细胞的抑制作用及对相关生长调控基因的调节.方法:构建pSilencer 3.0-H1-siRNA-STAT3重组质粒, 转染人肝癌细胞株SMMC 7721, 采用MTT法观察重组质粒对肝癌细胞的生长抑制, RT-PCR和Western blot及免疫组化法分别观察STAT3基因和蛋白水平的变化, 同时检测 survivin, c-myc, VEGF, p53, caspase3生长调控基因的mRNA, 并用流式细胞技术(FCM)及AO/EB染色方法观察细胞凋亡.结果: pSilencer 3.0-H1-siRNA-STAT3重组质粒对肝癌细胞的生长有抑制作用, 实验组48 h和72 h抑制率分别为59.32%, 76.49%, 与空白组及阴性组细胞相比有显著性差异(P<0.01);在重组质粒组, STAT3基因mRNA及蛋白水平表达降低, surviving, VEGF的mRNA表达下调, p53, caspase3的mRNA表达上调(P<0.01), c-myc的mRNA表达却无明显改变;重组质粒可诱导SMMC 7721细胞凋亡, 凋亡率达21.6%(P<0.01), 细胞周期分析显示细胞阻滞于G2期.结论:pSilencer 3.0-H1-STAT3-siRNA可能通过下调基因survivin和VEGF mRNA表达, 上调p53和caspase3 mRNA表达来抑制STAT3基因在人肝癌细胞中的表达.     

Human leucocyte interferon-α in chronic hepatitis C resistant to recombinant or lymphoblastoid interferon-α: a randomized controlled trial

Patients with biopsy-proven chronic hepatitis C, who failed to respond to a previous course of either recombinant (rIFN-α) or lymphoblastoid (LyIFN-α) interferon-α, were randomized to receive either leucocyte (Le) IFN-α (patients) or a second course of the same IFN-α (controls), to compare the efficacy and safety of these treatment schedules. All patients received the same dose of IFN-α as was used during their previous treatment (3 million units (MU) or 6MU three times weekly) for 6 months. Patients with a normal alanine aminotransferase (ALT) value at month 6 were treated for a further 6 months. All patients were followed-up for 12 months after treatment. A total of 69 patients were enrolled, 44 in the LeIFN-α group and 25 in the control group. At the end of the treatment period, 13 of the 44 patients (29.5%) in the LeIFN-α group had a biochemical response (normal ALT) and six of 44 (13.6%) patients had undetectable serum hepatitis C virus (HCV) RNA. At the end of the follow-up period, 10 patients (22.7%) had normal ALT values and serum HCV RNA was undetectable in three (6.8%). None of the patients in the control group showed normal ALT values at any time. Genotype 1b tended to be more frequent among non-responders (61 vs 45%); basal γ-glutamyl transpeptidase (γ-GT) values were lower in responders than in non-responders (33.3±11.70 Ul^–1 vs 58.4±33.04; P =0.01). LeIFN-α was well tolerated by all patients. These results support the use of LeIFN-α in patients with chronic hepatitis C who are non-responders to a previous treatment with recombinant or lymphoblastoid IFN-α.     

不同溶栓药物和剂量治疗急性心肌梗塞239例对比分析

２３９例急性心肌梗塞（ＡＭＩ）患者接受溶栓治疗，其中采用日本尿激酶（ＵＫ）９６万Ｕ３５例，１５０万Ｕ５５例；国产ＵＫ９６万Ｕ１５例，１５０万Ｕ５３例；德国链激酶（ＳＫ）１５０万Ｕ６６例；国产重组链激酶（ｒＳＫ）１５０万Ｕ１５例。对不同剂量及不同溶栓剂的疗效与安全性进行对比分析发现：１９９２年前国产ＵＫ９６万Ｕ比日本进口ＵＫ９６万Ｕ血管再通率低（２０．０％ｖｓ５１．４％Ｐ＜０．０１）。１９９２年后国产ＵＫ剂量增至１５０万Ｕ，血管再通率显著提高（５６．６％ｖｓ２０．０％Ｐ＜０．０１），与进口ＵＫ１５０万Ｕ的疗效与安全性相近（Ｐ＞０．０５）；国产ｒＳＫ１５０万Ｕ与进口ＳＫ１５０万Ｕ的血管再通率相似（７３．３％ｖｓ６５．２％Ｐ＞０．０５）；且比国产ＵＫ１５０万Ｕ的血管再通率明显提高（７３．３％ｖｓ５６．６％Ｐ＜０．０５），虽然ｒＳＫ轻度出血高于ＵＫ（２６．７％ｖｓ９．４％Ｐ＜０．０１），偶有低血压发生，但不影响疗效。国产ｒＳＫ与ＵＫ比进口ＳＫ和ＵＫ价格低２～４倍。因此认为，国产ｒＳＫ和ＵＫ是较为有效、安全、价廉且适合我国国情的溶栓药物。