Transplanting the Highly Sensitized Patient: The Emory Algorithm

Renal transplant patients sensitized to HLA antigens comprise nearly one-third of the UNOS wait-list and receive 14% of deceased donor (DD) transplants, a rate half that of unsensitized patients. Between 1999 and 2003, we performed 492 adult renal transplants from DD; 120 patients (approximately 25%) had a panel reactive antibody (PRA) of >30%, with nearly half (n = 58) having a PRA of >80%. Our approach is based upon high-resolution solid-phase HLA antibody analysis to identify class I/II antibodies and a 'virtual crossmatch' to predict compatible donor/recipient combinations. Recipients are excluded from the United Network for Organ Sharing match run if donors possess unacceptable antigens. Thus, when sensitized patients appear on the match run, they have a high probability of a negative final crossmatch. Here, we describe our 5-year experience with this approach. Five-year graft survival ranged from 66% to 70% among unsensitized (n = 272), moderately sensitized (PRA < 30%, n = 100) and highly sensitized (>30% PRA; n = 120) patients, equal to the average national graft survival (65.7%). The application of this approach (the Emory Algorithm) provides a logical and systematic approach to improve the access of sensitized patients to DD organs and promote more equitable allocation to a highly disadvantaged group of patients awaiting renal transplantation.     

老年脑梗死患者急性期血小板活化功能定量检测

目的 :探讨老年脑梗死患者外周血中血小板膜糖蛋白变化的临床意义。　方法 :应用流式细胞术检测了 6 8例急性期老年脑梗死患者外周血血小板活化分子标记物CD4 1、CD6 2p和CD6 3的含量水平 ,与 4 2例正常老年人对照 ;并对脑梗死组病灶大小、梗死部位、病情分级等与血小板活化分子表达的变化进行分析 ,应用统计学进行处理。　结果 :急性期脑梗死患者血小板粘附分子CD4 1、CD6 2 p和CD6 3的表达水平显著高于正常对照组 (P <0 .0 1) ,且与梗死灶大小及病情分级密切相关 ,与梗死部位无关。　结论 :老年脑梗死患者急性期外周血血小板活化功能明显增强 ,为早期应用抗血小板聚集药物的治疗提供了实验依据     

新型纳米根管充填材料对成骨细胞生长的影响

通过体外培养的成骨细胞,采用二甲基噻唑二苯基四唑溴盐比色法和流式细胞术对新型纳米根管充填材料(nHA-PA66)作用下的成骨细胞生长情况的变化进行研究,评价其对成骨细胞生长的影响。以该材料的细胞培养基浸提液作用于实验组细胞,对照组采用培养基本身。实验组和对照组成骨细胞的生长情况和细胞周期无显著性差异,表明该新型纳米材料对成骨细胞的生长和细胞周期无不良影响。提示新型纳米根管充填材料的成骨细胞相容性较好,具有用作根充材料的基础。     

不同组织来源临床肿瘤主要细胞周期素表达类型的研究

目的观察人类主要细胞周期素（Cyclin D1、E、A、B1）在临床肿瘤细胞中表达特征并进行分类，探讨其对临床肿瘤分类的可行性及潜在意义。方法用流式细胞术（FCM）双参数法半定量检测161例恶性肿瘤手术切除标本细胞中Cyclin D1、E、A、B1表达，根据不同Cyclin在细胞周期中的作用及其异常表达特征，将肿瘤细胞主要Cyclin表达分为不同类型。结果细胞周期外Cyclin（D1）及周期内Cyclins（E、A、B1）在临床肿瘤细胞中表达无组织差异性（P〉0．05）。其异常表达大致可归为5种类型：Ⅰ型Cyclin（D1、E、A、B1）均高表达；Ⅱ型Cyclin D1低表达，Cyclin（E、A、B1）不同形式高表达；Ⅲ型Cyclin D1不表达，Cyclin（E、A、B1）不同形式高表达；Ⅳ型Cyclin D1不表达，Cyclin（E、A、B1）不同形式低表达；V型Cyclin（D1、E、A、B1）均不表达；再根据各型中不同周期内Cyclin的优势表达分为相应不同的亚型。a亚型：Cyclin（E、B1）表达为主；b亚型：CyclinE表达为主；c亚型：Cyclin B1表达为主；d亚型：Cyclin（E、A、B1）表达为主。肿瘤细胞主要Cyclin表达类型及相应亚型分布无组织来源的差异性（P〉0．05）。结论主要Cyclins表达类型可以作为不同组织来源肿瘤分类的依据，可能是体现不同肿瘤细胞周期破坏共同特征较为客观分类方法。     

As_2O_3诱导人肝癌细胞凋亡及对Fas表达和钙含量的影响

化疗在原发性肝癌的综合治疗中占重要地位.为寻找肝癌治疗新的有效药物,我们观察了As2O3对人肝癌细胞株BEL7402的生物学效应,以期为As2O3临床治疗肝癌提供实验依据.     

Cytomorphometric analysis of vaginal cells during normal cycle, under oral contraceptive therapy or in-vitro fertilization stimulation protocol

A cytomorphometric analysis of superficial vaginal cells inwomen in three groups of different types of hormonal concentrationwas made. There were 15 women in each group. Group I was studiedduring a natural cycle, group II under oral contraceptive therapyand group III during an in-vitro fertilization (IVF) stimulationprotocol. Morphometric parameters were measured on an imageanalyser. The area, perimeter and several form factors weremeasured separately for nuclei and cytoplasm. The nucleus:cytoplasmicratio was also determined. The cytoplasmic area was significantlyreduced in group II and was associated with a statisticallysignificant reduction of the nuclear area. The nucleus:cytoplasmicratio appeared significantly increased in group II and reducedin group III. Low oestradiol impregnation obtained with an oralminidosed contraceptive interfered with vaginal cell maturation.High oestradiol concentrations obtained during IVF protocolsinduced marked nuclear pycnosis but did not induce supra-physiologicalcell enlargement. Maximal cell size is genetically regulatedaccording to Driesch's law of volume invariance and hormonalover-stimulation has no effect on cell size. The nucleus:cytoplasmicratio appears to be a powerful parameter reflecting the oppositeeffects of hormones on cell compartments.     

Surface activation markers of T lymphocytes: role in the detection of infection in neonates

Diagnosis of perinatal infection in the newborn is difficult; there may be few clinical signs and current tests are slow or non-specific. Detection of organisms, antigen or specific antibody to common pathogens often requires repeat samples and does not give immediate results. Haematological parameters, although relied upon frequently to diagnose infection in the neonate prior to a positive bacterial isolation, are unreliable and insensitive. Indicators such as an increase in neutrophil band cell counts are highly variable between morphologists. Infection induces the expression of a number of T lymphocyte surface markers, including CD45RA/CD45RO and CD45RO. The use of changed expression of surface markers as a laboratory test for detection of infection in neonates was evaluated. We used multiparameter flow cytometry to detect expression of early (CD45RA/CD45RO) and late (CD45RO) activation markers. In the respective groups of 50 full term (including 25 normal vaginal deliveries and 25 caesarean deliveries) and 30 premature, i.e. < 36 weeks gestation (born by either normal vaginal delivery or caesarean delivery) the CD45RA isoform was brightly expressed on newborn ‘naive’ CD4⁺ T cells, whereas the CD45RO isoform (including both ‘bright’ and ‘dim’ populations) was present on < 19% of CD4⁺ T cells from these newborn infants. In a group of 37 infants, tested to evaluate possible effects of non-infective parameters such as respiratory distress and iso-immunization, no significant changes in surface marker expression were found and specificity of the test was confirmed. In 14 neonates with documented sepsis, up-regulation of dual staining CD45RA/CD45RO isoforms on CD4⁺ T cells was detected early in the infection. In addition, we found that CD45RO expression persisted for several weeks after bacterial infection, and up to several months in viral infection. In conclusion, detection of T cell activation by flow cytometry for the early diagnosis of neonatal infection is an easy test to carry out on small volumes of blood, is inexpensive, and may be a specific indicator of infection.     

脐血CD34^＋细胞免疫表型的分析

应用免疫磁珠法分离脐血ＣＤ３４＾＋细胞，以比较ＣＤ３４＾＋细胞亚群及各系相关抗原的变化。经过分离，ＣＤ３４＾＋细胞由１．４７±０．７７％升至５７．３９±１６．１７％，分离后ＣＤ３４＾＋ＣＤ３８＾－细胞占ＣＤ３４＾＋细胞的比率为７．８２±４．７９％ＣＤ３４＾＋。细胞纯化同时可减少ＣＤ３＾＋细胞达１４．１２±９．１８倍，ＣＤ１５＾＋细胞减少１６．４２±２１．４７倍；Ｂ系（ＣＤ１９）、巨核系（ＣＤ４１）