病人健康问卷抑郁量表(PHQ-9)在社区老年人群中的应用——信度与效度分析

目的检验病人健康问卷抑郁量表(PHQ-9)在老年人中的信度与效度。方法应用PHQ-9对社区622名老年人进行评定,进行同质性信度研究;1周后对随机抽取的61名老人进行再次评定,进行重测信度研究;从622名老人中抽取195名进行定式精神检查(SCID-Ⅰ)抑郁量表评定,进行PHQ-9的效度研究。结果PHQ-9内部一致性系数(Cronbach′α系数)为0.8325,条目间的相关系数为0.233～0.523,各条目与量表总分的相关系数为0.451-0.693。61名老人重测PHQ-9信度系数0.934,PHQ-9的灵敏度为88%,特异度为99%。结论PHQ-9在我国社区老年人群中也具有良好的信度与效度,并且条目简洁,操作方便,易于掌握和节省时间,值得在临床,尤其是基层社区卫生中心推广使用。     

Prediction of tumor recurrence by distinct immunoprofiles in liver transplant patients based on mass cytometry

Recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) is a marker of poor prognosis. However, the reliable biomarkers of post-LT HCC recurrence remain to be identified. In this study, serial peripheral blood samples from the LT recipients with and without HCC recurrence were collected at five time points. Single-cell mass cytomertry (CyTOF) was utilized for the in-depth analysis of peripheral blood monocellular cells (PBMCs). CyTOF analysis showed that at 3 weeks post-LT, the activated immune cell population was increased, while the fraction of immune cells with suppressive functions (myeloid-derived suppressive cells) was reduced. The post-LT immune composition in patients with LT for HCC was enormously different from that in patients with LT for causes other than HCC. Furthermore, at 3 weeks after LT, compared with patients without recurrence, the patients with HCC recurrences were high in two subsets of T cells: CD57⁺ HLA-DR⁺ CD8⁺ and CD28⁺γδ. The CD57⁺ HLA-DR⁺ CD8⁺ T cells presented high levels of perforin, granzyme B, and Ki-67 and displayed a highly cytotoxic and proliferative phenotype, while the CD28⁺γδ T cells had reduced levels of IFN-γ and, hence, were less activated compared to CD28^- cells. Based on these findings, we concluded that analyzing the PBMCs of LT recipients by CyTOF can predict the post-LT HCC recurrence. The distinct immune features can stratify patients with the risk of HCC recurrence at 3 weeks after LT, which will help clinician in further management plan and improve the prognosis of patients.     

免疫抑制小鼠内毒素血症时免疫细胞功能紊乱的实验观察

目的:本研究在建立免疫抑制小鼠内毒素血症模型的基础上,观察机体免疫紊乱状态。方法:选取Blbc/c小鼠,连续3d腹腔内注射甲基强的松龙30mg/kg,建立免疫抑制小鼠模型,3d后静脉注射10mg/kg剂量内毒素,于2,6h时点取血浆,分别采用化学比色法检测一氧化氮(NO)、TNF-α、INF-γ、IL-2、IL-4、IL-10、IL-18等细胞因子水平,以反映TH1、TH2以及巨噬细胞等免疫细胞的功能与状态。在此基础上,50只小鼠分为免疫抑制内毒素血症模型组(模型组)以及甲基强的松龙对照组(激素组)与空白对照组。此外,还观察其肺部病理学改变。结果:在激素组,与正常组小鼠比较,各时点的血浆NO变化不大,TNF-α有降低的趋势,而IL-18则明显降低;INF-γ、IL-2的水平降低明显,IL-4、IL-10的水平则处于正常水平,其中IL-10还稍有升高趋势。在内毒素组的各时点,与正常组比较,模型小鼠肺组织有出血、水肿和炎细胞浸润等急性肺损伤等病理改变,而且INF-γ、IL-2水平明显降低,IL-4水平有升高趋势,IL-10水平升高明显;此外,在注射LPS后2h时点,NO与TNF-α水平明显升高,在注射LPS后6h时点,而NO、TNF-α以及IL-18水平均显著升高。结论:免疫抑制内毒素血症模型小鼠的TH1细胞功能低下,而TH2细胞与巨噬细胞处于活化状态,机体炎症反应则类似MARS的特点。     

重肾双输尿管畸形活体供肾移植2例报告并文献复习

目的：探讨重肾双输尿管畸形供肾在亲属活体肾移植中的应用.方法：回顾性分析2005～2009年2例确诊为重肾双输尿管畸形供者行亲属活体肾移植的临床病例资料,总结治疗经验.结果：2供者术程顺利,无手术并发症,术后肾功能正常,2受者术后肾功能恢复良好,无手术并发症.结论：重肾双输尿管畸形供肾应列入边缘供体范畴,术前应充分评估,我们的处治方法是安全可行的.     

早期目标液体复苏对脑死亡血流动力学及氧代谢的影响

目的:探讨采用早期目标导向液体复苏治疗对脑死亡后的血流动力学和氧代谢的影响.方法:对32例首次判定脑死亡的患者采用早期3h内进行目标导向液体复苏治疗,分别于首次判断为脑死亡后开始液体复苏前(T0),液体复苏后3 h(T1),液体复苏后6 h(T2),首次判断为脑死亡12 h后(T3),通过桡动脉置管和Swan-Ganz...     

RESEARCH ON IMMUNOLOGIC DISORDER IN THE IMMUNITY IMMUNODEPRESSION AND ENDOTOXEMIA MICE

目的:本研究在建立免疫抑制小鼠内毒素血症模型的基础上,观察机体免疫紊乱状态.方法:选取Blbc/c小鼠,连续3 d腹腔内注射甲基强的松龙30 mg/kg,建立免疫抑制小鼠模型,3 d后静脉注射10 mg/kg剂量内毒素,于2,6 h时点取血浆,分别采用化学比色法检测一氧化氮(NO)、TNF-α、INF-γ、IL-2、IL-4、IL-10、IL-18等细胞因子水平,以反映TH1、TH2以及巨噬细胞等免疫细胞的功能与状态.在此基础上,50只小鼠分为免疫抑制内毒素血症模型组(模型组)以及甲基强的松龙对照组(激素组)与空白对照组.此外,还观察其肺部病理学改变.结果:在激素组,与正常组小鼠比较,各时点的血浆NO变化不大,TNF-α有降低的趋势,而IL-18则明显降低; INF-γ、IL-2的水平降低明显,IL-4、IL-10的水平则处于正常水平,其中IL-10还稍有升高趋势.在内毒素组的各时点,与正常组比较,模型小鼠肺组织有出血、水肿和炎细胞浸润等急性肺损伤等病理改变,而且INF-γ、IL-2水平明显降低,IL-4水平有升高趋势,IL-10水平升高明显;此外,在注射LPS后2 h时点,NO与TNF-α水平明显升高,在注射LPS后6 h时点,而NO、TNF-α 以及IL-18水平均显著升高.结论:免疫抑制内毒素血症模型小鼠的TH1细胞功能低下,而TH2细胞与巨噬细胞处于活化状态,机体炎症反应则类似MARS的特点.     

Molecular phenotypes reveal heterogeneous engraftments of patient-derived hepatocellular carcinoma xenografts

ObjectivePatient-derived xenograft (PDX) models provide a promising preclinical platform for hepatocellular carcinoma (HCC). However, the molecular features associated with successful engraftment of PDX models have not been revealed.MethodsHCC tumor samples from 76 patients were implanted in immunodeficient mice. The molecular expression was evaluated by immunohistochemistry. Patient and tumor characteristics as well as tumor molecular expressions were compared for PDX engraftment using the Chi-square test. The independent prediction parameters were identified by logistic regression analyses.ResultsThe engraftment rate for PDX models from patients with HCC was 39.47% (30/76). Tumors from younger patients and patients with elevated preoperative alpha-fetoprotein level had higher engraftment rates. Tumors with poor differentiation and vascular invasion were related to engraftment success. The positive expression of CK19, CD133, glypican-3 (GPC3), and Ki67 in tumor samples was associated with engraftment success. Logistic regression analyses indicated that GPC3 and Ki67 were two of the strongest predictors of PDX engraftment. Tumors with GPC3/Ki67 phenotypes showed heterogeneous engraftment rates, with 71.9% in GPC3⁺/Ki67⁺ tumors, 30.8% in GPC3⁻/Ki67⁺ tumors, 15.0% in GPC3⁺/Ki67⁻ tumors, and 0 in GPC3⁻/Ki67⁻ tumors. ConclusionsSuccessful engraftment of HCC PDXs was significantly related to molecular features. Tumors with the GPC3⁺/Ki67⁺ phenotype were the most likely to successfully establish HCC PDXs.