Hemostasis and lipid metabolism in patients with non-insulin- dependent diabetes mellitus and angiopathy of the lower extremities

A study of hemostasis and lipid metabolism, a basal level of immunoreactive insulin, hemoglobin A1C was performed in 81 patients with non-insulin-dependent diabetes mellitus and associated angiopathy of the legs. Decompensated stage of the diabetes was characterized by hypercoagulation and hyperlipidemia. Treatment of diabetic angiopathy of the legs should be aimed both at compensation of diabetes and correction of abnormalities in hemostasis and lipid metabolism.     

干细胞移植治疗糖尿病

背景：干细胞移植可以从细胞和基因水平治疗糖尿病,从而达到临床治愈。目的：综述近年来国内外干细胞移植治疗糖尿病的相关研究进展。方法：应用计算机检索2000-01/2010-06PubMed数据库、中国期刊全文数据库相关文章,检索词为＂stemcells,diabetesmellitus,transplantation,insulin-secretingcell,treatment;干细胞,糖尿病,移植,胰岛素分泌细胞,治疗＂,共纳入27篇文章进行综述。结果与结论：糖尿病是一组由于胰岛素绝对或相对不足所引起的以慢性高血糖为特征的代谢性疾病,目前尚无根治的方法。干细胞具有极强的自我更新和多向分化潜能,可诱导分化为胰岛素分泌细胞,在体内和体外发挥调节血糖的作用,成为胰岛β细胞替代物的新资源。目前干细胞移植治疗糖尿病已在动物实验和小规模临床研究中取得了一定成果。     

Bone marrow transplantation for the treatment of genetic diseases

Consideration of a bone marrow transplant (BMT) for a child with a genetic disease depends upon many factors including the pathophysiology of the disorder, the natural history of the disease, whether an alternative therapy exists and whether a donor is available. Children with disorders such as severe combined immunodeficiency disease (SCID), in which life expectancy is minimal, are obviously candidates for a BMT, even with less than optimal donors, while those with disorders such as beta-thalassemia major, in which an alternative therapy exists, must be considered more carefully and only with an optimal donor. The risks of conditioning therapy, graft-versus-host disease (GVHD), and early death as well as the cost are critical to this decision and must be viewed in light of the potential outcome of a successful BMT and the life expectancy and quality of life with a BMT. For some genetic diseases with multisystem involvement (e.g., Hurler's mucopolysaccharidosis), the efficacy of a BMT has been reasonably demonstrated, providing significant brain damage has not occurred previously. For some other storage-related diseases, there is no place for BMT. Further studies are essential to increase our knowledge as to its potential role in other types of genetic-associated diseases.     

Islet cell transplantation for the treatment of diabetes mellitus

Diabetes mellitus is estimated to affect at least 16 million individuals in the United States and 135 million persons worldwide. It is a significant cause of morbidity and early mortality. The related expenses are astronomical with at least 15% of healthcare expenditures in the United States being used for the treatment of diabetes and its complications, a figure that approaches US$100 billion annually. The Diabetes Control and Complications Trial (DCCT) convincingly showed that intensive glucose management delays the onset and slows the progression of diabetic complications. Numerous studies have shown that pancreas transplantation not only delays the onset and progression of diabetic complications, but in some cases reverses some of the effects of diabetes. Human islet cell transplantation provides an alternative, less invasive alternative to whole organ transplantation. Human islet allotransplantation would only exacerbate the organ shortage, as recipients usually require islets from more than one pancreas. Xenotransplantation of porcine islets is a more attractive option; however, the recipient’s immune response to xenografted tissue would be a formidable obstacle. Microencapsulation of the islets is a method of immunoisolation that would prevent the need for immunosuppressive drugs and the risks associated with their long-term use and have the potential to make xenoislet transplantation a clinical reality.     

小鼠胚胎胰腺移植治疗糖尿病(英文)

背景:胚胎胰腺组织具有来源广泛,β细胞增殖分化能力强,低免疫排斥性等优点。目的:探索小鼠胚胎胰腺组织的分离技术,观察其对糖尿病模型小鼠的血糖调节作用。方法:体视显微镜下分离E11.5~E16.5C57BL/6小鼠胰腺组织。链唑霉素诱导雄性C57BL/6小鼠建立糖尿病模型,随机分为2组:移植组模型小鼠肾被膜下移植5个E16.5胰腺组织,假手术组模型小鼠肾被膜下注入0.05mLRPMI1640培养液。移植组小鼠血糖水平≤11.2mmol/L后,利用IPGTT和IPITT方法检测移植后胚胎胰腺组织的内分泌功能,并摘除移植物观察血糖变化。结果与结论:体视显微镜下可分离出较完整的E11.5~E16.5小鼠胰腺组织,≤E12.5d小鼠胚胎胰腺组织的形态和颜色均难以与周围组织分辨,需根据其与毗邻脏器的关系仔细辨别;>E12.5d的小鼠胚胎胰腺已初具形态,颜色略发白。组织学和ELISA分别显示胚胎胰腺组织可表达并分泌胰岛素,其表达强度随发育时间逐渐增加。E16.5小鼠胰腺组织移植能有效地控制受体的血糖水平,使受体的体质量和糖耐量恢复正常;胚胎胰腺在受体的肾被膜下可生长发育,摘除的移植物胰岛素和胰高血糖素的表达均较移植前增强。说明胚胎胰腺组织可能成为治疗糖尿病的种子来源。     

小鼠胚胎胰腺移植治疗糖尿病

背景：胚胎胰腺组织具有来源广泛,β细胞增殖分化能力强,低免疫排斥性等优点。目的：探索小鼠胚胎胰腺组织的分离技术,观察其对糖尿病模型小鼠的血糖调节作用。方法：体视显微镜下分离E11.5~E16.5C57BL/6小鼠胰腺组织。链唑霉素诱导雄性C57BL/6小鼠建立糖尿病模型,随机分为2组：移植组模型小鼠肾被膜下移植5个E16.5胰腺组织,假手术组模型小鼠肾被膜下注入0.05mLRPMI1640培养液。移植组小鼠血糖水平≤11.2mmol/L后,利用IPGTT和IPITT方法检测移植后胚胎胰腺组织的内分泌功能,并摘除移植物观察血糖变化。结果与结论：体视显微镜下可分离出较完整的E11.5~E16.5小鼠胰腺组织,≤E12.5d小鼠胚胎胰腺组织的形态和颜色均难以与周围组织分辨,需根据其与毗邻脏器的关系仔细辨别;〉E12.5d的小鼠胚胎胰腺已初具形态,颜色略发白。组织学和ELISA分别显示胚胎胰腺组织可表达并分泌胰岛素,其表达强度随发育时间逐渐增加。E16.5小鼠胰腺组织移植能有效地控制受体的血糖水平,使受体的体质量和糖耐量恢复正常;胚胎胰腺在受体的肾被膜下可生长发育,摘除的移植物胰岛素和胰高血糖素的表达均较移植前增强。说明胚胎胰腺组织可能成为治疗糖尿病的种子来源。     

微胶珠化胰岛肌肉内移植治疗小鼠1型糖尿病

背景：前期实验证明海藻酸钡微胶珠具有免疫隔离作用,并且不会引起免疫排斥反应。目的：观察包裹胰岛海藻酸钡微胶珠对1型糖尿病小鼠的治疗作用。方法：分离纯化SD大鼠胰腺单个胰岛细胞团,并包裹于海藻酸钡微胶珠内。以腹腔注射链脲佐菌素诱导建立C57BL／6小鼠1型糖尿病模型,随机分组：实验组小鼠股二头肌内多点注射包裹胰岛的海藻酸钡微胶珠,对照组小鼠股二头肌内多点注射胰岛,糖尿病对照组及正常对照组小鼠股二头肌内多点注射生理盐水。术后观察小鼠血糖及胰岛微胶珠在肌肉内存在状况。结果与结论：分离纯化后获得高纯度胰岛,每只供体可获得（905．4：1：34．5）个,并具有良好生物活性。实验组小鼠血糖降为正常的时间约为6．3d,移植胰岛存活时间大于30d,对照组小鼠血糖一直未降至正常,移植胰岛存活时间约为4d。实验组降糖速率明显快于对照组和糖尿病对照组（P〈0．05）。表明包裹胰岛的海藻酸钡微胶珠镶嵌在肌肉组织中可良好存活,治疗小鼠1型糖尿病。     

骨髓基质干细胞移植治疗帕金森病的研究与进展

目的:探讨骨髓基质干细胞分化为神经元样细胞的潜能和在治疗帕金森病方面的应用及其作用机制。资料来源:应用计算机检索PUBMED 1997-01/2006-03期间与骨髓基质干细胞和帕金森病有关的文章,检索词为“bone marrow stromal cells”,以及“neuron,Parkinson’s disease,transplantation,in brain”组合检索,并限定文章语言种类为“English”。同时计算机检索中国期刊全文数据库2003-01/2006-03相关的文章,检索词为“骨髓基质干细胞,神经元,帕金森病,移植,脑内”,并限定文章语言种类为中文。资料选择:对资料进行初审,并查看每篇文献后的引文。纳入标准:文章所述内容应与骨髓基质干细胞分化为神经元样细胞及其应用于治疗帕金森病等中枢神经系统疾病的研究相关;以近5年且发表在较权威杂志者优先。排除标准:重复研究或Meta分析类文章。资料提炼:共收集到330篇相关文献,排除277篇内容陈旧或重复的文献,53篇符合纳入标准,有33篇检索到全文,选用其中的30篇作为本文参考文献:16篇涉及骨髓基质干细胞多向分化潜能;8篇涉及骨髓基质干细胞移植治疗中枢神经系统疾病;6篇涉及骨髓基质干细胞应用于治疗帕金森病的基础研究。资料综合:骨髓基质干细胞具有多向分化潜能,在特定条件下可分化为具有神经元形态并表达神经元标记物的细胞,在脑内可与损伤的细胞融合,能分泌营养因子或者刺激损伤部位产生内源性因子,促进损伤组织的修复并减少细胞凋亡,已成为细胞移植治疗各种疾病的理想种子细胞。结论:在适宜的条件下,骨髓基质干细胞经过诱导在体内、外均可分化为神经元样细胞,将其注入帕金森病模型大鼠纹状体内能形成表达神经标志性蛋白的神经元样细胞或星形胶质细胞,产生的细胞可在受损部位周围存活甚至移行至全脑,并明显恢复运动功能。     

Bone marrow transplantation for nonmalignant diseases

Bone marrow transplantation (BMT) has emerged as a major therapeutic option for a number of nonmalignant disorders affecting the bone marrow and leading to clinical manifestations most likely affecting distant organs. Disorders such as autoimmune diseases, metabolic disorders, hemoglobinopathies, immunodeficiencies, and others have been the target of high-dose therapy and autologous or allogeneic bone marrow, stem cell, or cord blood transplantation. Successful results have been reported in a large number of these disorders. In most instances the goal of transplantation is to provide sufficient degree of marrow engraftment to allow long-term amelioration of disease phenotype. For many of these disorders, early diagnosis is crucial in achieving the desired results as transplantation becomes difficult when significant end-organ damage sets in. Major unsolved problems, including toxicity of conditioning regimens, graft-versus-host disease, and donor availability, need to be addressed. We attempt to provide a comprehensive review of BMT and discuss unique features of this modality for treatment of nonmalignant disorders.     

Bone marrow processing for transplantation.

As indications for BMT increase, so do variations in bone marrow processing and manipulation techniques. Many centers have their own unique methods of mononuclear cell purification, concentration and storage. This is particularly evident in the processing of bone marrow for autologous BMT to allow dose intensification as salvage therapy for malignant disease. Unique procedures have been developed to maximize yields, concentrate mononuclear cells necessary for engraftment, and reduce the likelihood of GVH disease. Graft rejection and disease relapse still remain a problem in some of these "manipulated" marrows. Newer procedures may allow titration of the optimum numbers of immune reconstituting cells; however, at this time, these techniques are not precise and the balance between preventing GVH disease at the expense of graft failure or relapse may still jeopardize disease-free survival. Innovative purging techniques that include pharmacologic and immunologic methods, continue to evolve, necessitating standards for bone marrow processing that are flexible yet practical. Quality control and viability assays are essential to verify the biologic proliferative potential of progenitor cells capable of marrow reconstitution. Although no standards are yet established, all centers should have criteria to monitor the quality of the processed marrow. Blood banks and transfusion services are well versed in regulations governing processing, labeling, storage, and quality control of blood components. Bone marrow is the ultimate blood component, and it stands to reason that methods outlined in this article be integrated into transfusion medicine.     

肾移植后并发糖尿病的危险因素及治疗

背景：肾移植后并发糖尿病是肾移植治疗后常见的并发症之一。目的：探讨肾移植后并发糖尿病的危险因素以及临床治疗。方法：应用数据库文献检索的方法获取肾移植后并发糖尿病研究的文献，对符合研究标准的文献进行深入的数据分析，文章选取肾移植后并发糖尿病的危险因素进行深入分析，并总结国内外关于肾移植后并发糖尿病的治疗方法。结果与结论：肾移植后并发糖尿病是由多种因素作用而引起的糖代谢异常，肾移植后并发糖尿病与患者年龄、体质量指数、血脂水平、免疫抑制剂方案、急性排斥发生频率、糖皮质激素累积等因素相关。在肾移植后定期检测血糖变化，可以较早的发现糖尿病的发生，通过中西医药物降低血糖和调整免疫抑制剂等方法可以有效治疗。     

Bone marrow transplantation for diseases of childhood

Bone marrow transplantation in childhood is an established treatment modality for aplastic anemia, the acute and chronic leukemias, and severe combined immune deficiency. Recently, experience with this treatment has also been favorable with small numbers of children who have Wiskott-Aldrich syndrome, several types of inherited storage diseases, Fanconi's anemia, thalassemia, infantile malignant osteopetrosis, and selected cases of lymphoma and other solid tumors. The psychosocial impact and financial costs of bone marrow transplantation can be substantial. Multi-institutional, prospective, randomized trials that would compare transplantation and conventional therapy are necessary to establish the indications and precise timing for this procedure. Further development of monoclonal antibodies, a better understanding of the histocompatibility antigen systems, and improvement in pretransplantation conditioning regimens should increase the spectrum of effectiveness for bone marrow transplantation in the coming years.     

骨髓间充质干细胞移植治疗大鼠扩张型心肌病

背景：扩张型心肌病所致的心肌纤维化是心力衰竭的病理基础,目前药物治疗、介入治疗和外科手术均不能替代坏死心肌和彻底改善心脏功能。目的：观察异体骨髓间充质干细胞移植对大鼠扩张型心肌病心脏功能的作用和心肌纤维化的影响。方法：40只Wistar大鼠随机数字表法分为细胞移植组（n=15）、对照组（n=15）和空白组（n=10）,前2组建立大鼠扩张型心肌病模型。造模成功4周后细胞移植组注射骨髓间充质干细胞悬液150μL（含3×106个细胞）,对照组和空白组注射等量培养液。结果与结论：与空白组相比,细胞移植组和对照组移植前左室收缩末期内径增加,射血分数和缩短分数明显下降（P〈0.01）;移植后4周,细胞移植组超声心动图检查和移植前相比,左室收缩末期内径下降、射血分数和缩短分数明显升高（P〈0.01）。细胞移植组心脏胶原的表达低于对照组（P〈0.05）。与对照组相比,其他2组基质金属蛋白酶2及基质金属蛋白酶9表达明显下降（P〈0.05）。提示骨髓间充质干细胞移植后可改善心肌纤维化及扩张型心肌病鼠的心脏功能。     

Bone marrow transplantation in children.

Bone marrow transplantation is a new concept in the treatment of leukemia and aplastic anemia. The problems seen in the transplanted patient are abundant and often life-threatening. Caring for these patients offers one of the most exciting challenges of nursing. The nurse not only acquires skill in caring for a patient with leukemia and aplastic anemia, but also becomes knowledgeable in infectious diseases, immunology, fluid and electrolyte balance, and cardiac, respiratory, and renal diseases. The complexity of these patients allows the nurse more direct, comsistent contact with them. As she becomes involved, she is given excellent opportunities for supporting the patient and family through this stressful time. Althoug bone marrow transplantation is an experimental procedure with problems still to be solved, results indicate its value in the treatment of refractory leukemia and aplastic anemia.