弥漫性轴索损伤行亚低温治疗的护理

弥漫性轴索损伤（diffuse axonal injury DAI）是外伤直接引起的脑白质广泛性轴索损伤，是闭合性颅脑损伤中最严重的原发性损伤之一，占重型颅脑损伤20％，占死亡病人的29％-43％。其临床特点为病情危重，昏迷时间长，并发症多，这就给临床治疗和护理提出了更高要求，早期行亚低温治疗并给予护理干预，将大大提高病人的生存率，降低死亡率，提高病人的生命生存质量。     

Changes in T .lymphocyte subsets after severe traumatic brain inJury

BACKGROUND： Besides local changes of cranial parenchymal cells, hemorrhage, etc., severe traumatic brain injuries also cause the changes of total body fluid and various functions, and the changes of lymphocytes and T lymphocyte subsets should be paid more attention to. OBJECTIVE： To reveal the changing laws of T lymphocyte subsets after severe traumatic brain injury, and compare with mild to moderate brain injury. DESIGN： A comparative observation. SETTINGS： Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City; Central Laboratory of Shenzhen Hospital of Prevention and Cure for Chronic Disease. PARTICIPANTS： All the subjects were selected from the Department of Neurosurgery, Longgang District Buji People＇s Hospital of Shenzhen City from August 2002 to August 2005. Thirty patients with severe brain injury, whose Glasgow coma score （GCS） was ≤ 8 points, were taken as the experimental group, including 21 males and 9 females, aging 16 - 62 years. Meanwhile, 30 patients with mild traumatic brain injury were taken as the control group （GCS ranged 14- 15 points）, including 18 males and 12 females, aging 15 -58 years. All the subjects were in admission at 6 hours after injury, without disease of major organs before injury Informed consents were obtained from all the patients or their relatives. METHODS： （1） The T lymphocytes and the subsets in peripheral blood were detected with immunofluorescent tricolor flow cytometry at l, 3, 7 and 14 days after injury in both groups. （2） The conditions of pulmonary infections were observed at 4 days after injury. The differences of measurement data were compared with the t test. MAIN OUTCOME MEASURES： Changes of T lymphocytes subsets at 1 - 14 days after severe and mild or moderate traumatic injury. RESULTS： Finally, 28 and 25 patients with mild to moderate traumatic brain injury, whereas 25 and 21 patients with severe traumatic brain injury were analyzed at 7 and 14 days respectively, and the missed ones died due to the development of disease. （1） Changes of T lymphocyte subsets： At 1 and 3 days after injury, CD3, CD4, CD8, CD4/CD8 began to decrease, whereas CD8 increased in the experimental group, which were very significantly different from those in the control group （t =2.77 - 3.26, P 〈 0.01）, and began to recover at 7 days, which were significantly different from those in the control group （t = 2.06 - 2.24, P 〈 0.05）, and generally recovered to the normal levels at 14 days （P 〉 0.05）. （2） Conditions of pulmonary infections： At 4 days after injury, the rate of pulmonary infection was significantly different between the experimental group and control group [73% （22/30）, 0, x2=37.29, P 〈 0.01]. CONCLUSION： Patients with severe traumatic brain injury suffer from damages of cellular immune function at early period （within 7 days）, and they are easily to be accompanied by pulmonary infections.     

人血管生长素的亚细胞定位

已有大量研究表明血管生成素（angiogenin，ANG）与肿瘤的快速生长和转移有密切的关系，肺癌、胰腺癌、乳腺癌等患者的外周血血清中，ANG的水平明显升高，血清ANG的水平与这些肿瘤的发展及转移呈显著正相关，因此，可以检测血清中ANG的水平来预测肿瘤的发生与发展情况。此外，ANG对于创伤、烧伤及血循环较差的股骨头、半月板等损伤的修复具有较大的临床应用价值。在本研究中我们构建了人ANG真核表达质粒，转染人脐静脉内皮细胞（HUVEC）进行表达，并作了初步的亚细胞定位。     

用MTT比色分析法检测淋巴细胞转化

淋巴细胞转化试验通常是用 PHA 刺激体外培养的 T 细胞使其转化为淋巴母细胞的一种试验。根据 T 细胞的转化程度可判断机体的细胞免疫功能。该试验是临床常用的细胞免疫检测指标之一。如何测定 PHA 刺激     

亚低温治疗重型颅脑损伤病人的临床观察及护理

目的探讨如何降低重型颅脑损伤病人的致残率和病死率。方法2004年10月至2006年9月，我科采用北京康联医用设备研究所生产的ICE—I系列医用控温毯，对高热病人实施亚低温（32-34℃）治疗58例。亚低温治疗期间密切观察意识、瞳孔、生命体征、颅内压的变化及上消化道出血征象，发现异常及时处理；并加强基础护理、严格无菌操作、定时翻身按摩、预防褥疮及冻疮、防止感染。结果治愈30例．轻残12例，中、重残4例，死亡12例。较2004年10月以前同类病人的病死率同比下降了14％。结论低温治疗可使机体处于休眠和低温状态，从而降低组织代谢，特别是降低脑代谢，减少耗氧量，因而可防止或减轻脑水肿，降低颅内压力，改善脑的缺氧状态，有利于受伤脑细胞的恢复，从而使病死率降低。     

低剂量辐射对丝裂霉素C损伤小鼠胸腺和脾细胞的影响

目前低剂量辐射兴奋效应的发生和存在机制的研究已取得了一定的成果。低剂量辐射与低浓度化学因子之间的交叉适应性反应有助于阐明低剂量辐射兴奋效应的机制，低刺量辐射与低浓度化学因子之间存在明显的遗传学交叉适应性反应已有报道。但是，从免疫学角度探讨低剂量电离辐射诱导丝裂毒素C（MMC）损伤的适应性反应未见报道。因此，笔者利用小鼠胸腺细胞自发增殖和脾淋巴细胞转化，观察低剂量γ射线能否诱导抗MMC损伤的免疫学适应性反应。     

过敏性鼻炎-哮喘综合征新概念

随着医学的进展，已经认识到过敏性鼻炎和哮喘病往往同时存在。临床上有些患者以过敏性鼻炎为主而哮喘未确诊或处于亚临床状态，而更多的病人则可两种疾病同时存在。因此近年来提出了过敏性鼻炎-哮喘综合征（combined allergic rhinitis and asthmasyndrome）这个新的医学术语。     

四种物理因子对家兔淋巴细胞特异性免疫功能影响的实验观察

本文就直流电钙离子导入,紫外线照射,超短波及激光治疗,分别对家兔接种炎症下进行了淋巴细胞特异免疫机能的观察分析,结果前两种因子对淋巴结副皮质区及生发中心的特异机能产生了良好的效应,这给科研及治疗应用提供了科学依据。而后两种因子对淋巴结细胞为什么没产生反应,值得进一步探讨.     

Multi-parameter prediction of HLA class Ⅰ restricted cytotoxic T lymphocyte epitopes for human proliferating cell nuclear antigen

Objective To predict the HLA class Ⅰ restricted cytotoxic T lymphocyte epitopes for human proliferating cell nuclear antigen (PCNA). Methods By using 3 epitope prediction databases which including MHC binder ( BIMAS and SYFPEITHI databases) and proteasome cutting site ( PAProC databases), the epitopes of PCNA were predicted by analyzing several parameters and methods. Results After comprehensive analysis,we have obtained two possible HLA-A0201 restricted CTL epitopes SMSAD-VPLV (228-236, score 447 633. 595 ) and LINEACWDI ( 22-28, score 127 966.779);two HLA-A24 re-stricted CTL epitopos DYEMKLMDL ( 113-121, score 563 994.9 ) and EFARICRDL ( 143-151, score 40 540.7);two HLA-A1101 restricted CTL epitopes LTSMSKILK (72-80, score 1334. 2680 ) and DVPLV-VEYK (232-240,score 736.9236). Conclusion The multi-parameter epitope prediction method is feasi-ble for cytotoxic T lymphocyte epitope prediction.     

急性缺血性卒中的亚低温治疗研究进展

脑缺血神经细胞损伤的保护措施一直是临床和基础研究的重点。但迄今为止,仍然缺少令人满意的措施。缺血性脑血管病的发病机制复杂,亚低温作为一种脑保护疗法,可干预脑缺血的多个病理生理学环节,对脑缺血及再灌注损伤起到保护作用。目前国际医学界将低温划分为轻度低温(33~35℃)