PRP及前列地尔对兔缺血皮瓣的影响

【摘要】 目的 探讨富血小板血浆（PRP）、前列地尔注射液及其联合应用对兔缺血皮瓣的影响。 方法 选择 40 只健康新西兰兔随机分为20组，每组2 只，每只兔背部设计两块以中线对称的 10cm×2.5cm 大小超长宽比例任意皮瓣，形成每组 4 个兔背缺血皮瓣模型。每组随机分为对照瓣及实验瓣1、试验瓣2、试验瓣3。对照瓣：采用局部及静脉均注射生理盐水；实验瓣1：局部注射 PRP，静脉注射生理盐水；试验瓣2：局部注射生理盐水，静脉注射前列地尔注射液（0.8mL/kg)；试验瓣3：局部注射 PRP，静脉注射前列地尔注射液。术后 7d 在统一标准下拍照并取材。测量各瓣存活面积，计算皮瓣存活率；HE 染色后镜下观察各瓣组织结构层次、炎性细胞浸润情况及微血管口径变化；免疫组化检测 CD34 表达、测量微血管密度；酶联免疫吸附法（ELISA）检测血管内皮生长因子（VEGF）含量。结果 术后 7d，各瓣远端均发生不同程度坏死，经测量计算后得出：各瓣平均存活面积、存活率、微血管密度、VEGF 含量由大到小依次为：实验瓣3＞实验瓣1＞实验瓣2＞对照瓣，组间比较差异有统计学意义（均P＜0.05)。HE 染色后镜下观察可见：所有实验瓣较对照瓣组织水肿轻，新生毛细血管增多；实验瓣3较对照瓣及实验瓣1、实验瓣2结构、层次更清晰分明，新生毛细血管最多，大部分管腔扩大，炎性细胞浸润较少，组织水肿轻；实验瓣1较实验瓣2组织结构分明，新生毛细血管较多，炎性细胞浸润较少，但实验瓣2血管管腔直径更大。结论 富血小板血浆、前列地尔注射液单独应用时均能不同程度改善兔缺血皮瓣缺血坏死，提高皮瓣存活率，并且二者联合应用效果优于单独使用。     

Therapeutic plasma exchange in critically ill children: experience of the pediatric intensive care unit of two centers in Chile

IntroductionTherapeutic plasma exchange (TPE) is an extracorporeal blood purification technique used in a wide spectrum of diseases. We aim to review the indications, complications, and outcomes of critically ill children who received TPE and to compare a membrane versus centrifugal method in this cohort.MethodsA retrospective observational study in two pediatric intensive care units in Chile during eight years (2011–2019) Results: A total of 36 patients underwent 167 TPE sessions (20 centrifugation and 16 membrane-based). The more frequent indications for TPE were autoimmune neurological diseases in 14 cases, renal diseases (9), and rheumatological disorders (5). 58 % of children received other immunomodulatory therapy. According to ASFA, 45 % of cases were I-II category, 50 % to III, and 5% not classified. Response to treatment was complete in 64 % (23/36) and partial in 33 % (12/36). Complications occurred in 17.4 % of sessions, and the most frequent was transient hypotension during the procedure. Overall survival at discharge from the PICU was 92 %. Patients who received TPE as a single therapy (n = 26) survived 96 %. The clinical outcomes between the two apheresis methods were similar. Survivors had a significantly lower PELOD score on admission (14.5 vs. 6.5, p = 0.004).ConclusionsTPE is mainly indicated as a rescue treatment in neurological autoimmune diseases refractory to conventional immunomodulatory treatment.Complications in critically ill children are mild and low. The outcome in children requiring TPE as a single therapy is good, and no differences were observed with centrifugation or membrane method.     

浆细胞性乳腺炎患者外周血Th17细胞的变化

目的观察浆细胞性乳腺炎(PCM)患者外周血Th17细胞数量的变化。方法采用流式细胞术检测慢性期PCM(CPCM)患者、亚急性期PCM(SPCM)患者、急性期PCM(APCM)患者和健康对照者(HC)的外周血中Th17细胞百分率;采用ELISA检测上述四组受检者的血浆IL-17和IL-23水平。结果 CPCM、SPCM和APCM三组患者的外周血Th17细胞数量、IL-17和IL-23水平依次增高,且均高于HC组,各组间比较差异均有统计学意义(P<0.05)。结论 PCM患者的外周血Th17细胞数量有所增多且功能增强。     

The soluble receptor ST2 is positively associated with occupational exposure to radiation

Purpose Radiation exposure, besides the risk of cancer, may also increase the risk of non-cancer diseases, including cardiovascular disease (CVD). This study investigates whether the soluble form of the ST2 receptor (sST2), an emerging prognostic marker in patients with CVD, can be used to monitor the CVD risk in individuals occupationally exposed to radiation.

Materials and methods sST2 in blood plasma from 69 individuals, 45 workers from the nuclear industry and 24 controls, was analyzed using enzyme-linked assay (ELISA). Total antioxidant status (TAS) of blood plasma and levels of reactive oxygen species (ROS) in lymphocytes were determined by colorimetric and fluorescence assays.

Results The data suggest a 5-fold increase in the number of subjects with sST2 levels above the clinical threshold and a 10-fold increase in the number of subjects with TAS levels outside the reference range in the exposed group when compared to the group of non-exposed individuals. The strongest up-regulation of TAS was measured in the group of younger workers with cumulative doses not exceeding 50 mSv.

Conclusion The present study may represent an initial step towards the establishment of sST2 as a biomarker for CVD risk estimation in the context of radiation exposure.     

Hemorrhagic Skin Nodules and Plaques: A Diagnostic Clue to Underlying Primary Plasma Cell Leukemia

Plasma cell leukemia (PCL) is a rare lymphoproliferative disorder characterized by a malignant proliferation of plasma cells (PC) in blood and marrow. Cutaneous involvement is very rare in PCL. We present the case of a 45-year-old lady who presented with multiple hemorrhagic nodules and plaques in the skin. Her total leucocyte count was 2,00,200/cmm with 85% abnormal plasmacytoid cells in peripheral smear. Biopsy of the skin lesions revealed diffuse infiltration by plasma cells with ‘choked’ blood vessels. A diagnosis of plasma cell leukemia with cutaneous involvement was made. On the second day of admission, the patient expired probably because of intracranial bleed due to thrombocytopenia. Post-mortem bone marrow and liver biopsy also showed diffuse infiltration by plasma cells. Monoclonality of the cells was proven by demonstrating the production of only kappa light chains.     

Therapeutic plasma exchange in the management of sepsis and multiple organ dysfunction syndrome: A report of three cases

Sepsis with multi organ dysfunction syndrome (MODS) is the most common cause of death in patients in noncoronary intensive care units. Currently, there are no specific treatments that reduce mortality in patients with sepsis and MODS. We report three patients who received therapeutic plasma exchange (TPE) for sepsis with MODS who completely recovered. The first patient, a 3‐year‐old male presented with Methicillin‐resistant Staphylococcus aureus‐associated respiratory, renal, coagulation, hepatic, and neurologic dysfunction. After 5 TPEs, the patient fully recovered. The second patient was a 36‐year‐old pregnant female who developed MODS at 22 weeks of gestation. She had developed respiratory, hepatic, renal, cardiovascular, neurologic, and coagulation dysfunction following pneumonia and concurrent urinary tract infection resulting in an intrauterine fetal demise. After 8 TPEs, the patient was discharged home with only mild residual hepatic dysfunction. The third patient, a 50‐year‐old female with a history of seizure disorder, was found unresponsive in over 100°F heat and diagnosed with Staphylococcus aureus‐associated MODS. Her respiratory, coagulation, neurologic, renal, and hepatic systems were affected. The patient underwent 6 TPEs after which she had marked improvement. In conclusion, TPE may be an effective adjunct therapy in MODS by possibly removing toxic mediators and replacing deficient factors using donor plasma. J. Clin. Apheresis 29:127–131, 2014. © 2013 Wiley Periodicals, Inc.