恶性淋巴瘤患者采用MAG方案进行干细胞动员的疗效观察

目的　观察恶性淋巴瘤患者进行自体外周血造血干细胞移植(APBSCT)前采用MAG方案动员干细胞的疗效.方法对进行APBSCT的12例恶性淋巴瘤患者,移植前动员均采用MAG方案,具体为阿糖胞苷(Ara-C)2g/m2每12h　1次,第1、2天；米托蒽醌(MTZ)　10　mg/m2,第2、3天.白细胞(WBC)计数＜1.0×109/L时开始使用重组人粒细胞集落刺激因子(rhG-CSF)　150μg/d,WBC　计数＜0.5×109/L时采用rhG-CSF　300μg/d,WBC计数开始回升时,每日检测血常规和观察外周血涂片,当外周血涂片中出现原始或幼稚细胞时给予rhG-CSF　300μg,每12h　1次,使用CS-3000血细胞分离机连续2d采集外周血干细胞并冻存备用.结果12例患者经MAG方案动员后,并发症主要为轻度感染.经两次采集,共采集到单个核细胞(MNC)(5.24±0.81)×108/kg,CD34+细胞(8.16±2.25)×　106/kg,均达到采集要求.结论恶性淋巴瘤患者采用MAG方案进行干细胞动员、采集,结果稳定可靠,安全性好.     

自体外周血造血干细胞移植对难治性淋巴瘤患者细胞免疫功能及预后的影响

目的 观察自体外周血造血干细胞移植(APBSCT)方法对难治性淋巴瘤患者细胞免疫功能及预后的影响.方法 选取本院98例难治性淋巴瘤患者,均行APBSCT治疗,观察其移植后细胞免疫功能恢复情况,予以3年时间的随访,记录患者生存情况,分析其预后影响因素.结果 所有病例成功重建造血;CD4+/CD8+恢复正常率为:治疗12个...     

脐带血来源的调节性T细胞对SLE病人淋巴细胞的作用初探

目的 通过分析脐带血调节性T细胞(CD4+CD25+细胞)的基本特性以及对系统性红斑狼疮(Systemic Lupus Erythematosus,SLE)患者淋巴细胞的抑制功能,为治疗SLE等疾病提供新的思路.方法 收集脐带血3例、SLE患者外周血6例和健康人外周血3例,肝素抗凝;检测CD4+CD25+及Foxp3+细胞比例;磁珠分选法分离各样本中CD4+CD25+细胞和CD4+CD25-细胞,分析各亚群细胞的纯度并进行体外扩增试验及体外抑制功能试验.结果 脐带血中CD4+CD25+细胞和CD4+ Foxp3+细胞比例最高,SLE患者外周血中最少;脐带血中CD4+CD25+细胞体外扩增能力比健康成人和SLE患者的CD4+CD25+细胞强.扩增后的脐带血CD4+CD25+细胞的体外抑制功能较扩增前及其它两者扩增后均增强,差异有统计学意义(P＜0.05).结论 脐带血中调节性T细胞比例多,生物活性强,输注脐带血来源的调节性T细胞可以成为治疗系统性红斑狼疮等自身免疫性疾病的理想途径.     

CD4~+CD25~+调节性T细胞对狼疮样小鼠的干预性研究

目的分析CD4+CD25+调节性T细胞(regulatory T cells,Tregs)对狼疮样小鼠的干预效应,为系统性红斑狼疮(systemic lupus erythematosus,SLE)的免疫干预提供新的思路。方法采用磁活性标记的细胞分选方法(magnetic activated cell sorting,MACS)分选BALB/c小鼠CD4+CD25+T细胞,应用流式细胞术(flow cytometry,FCM)检测分选细胞纯度。将6~8w♀CB6F1小鼠随机分为3组,包括正常对照组、狼疮鼠模型组(亲代淋巴细胞免疫)、狼疮鼠干预组(亲代淋巴细胞免疫后2w,输入5×106Tregs/鼠)。分别于诱导后2、4、8、12w,采用ELISA法检测ANA和抗-dsD-NA抗体,并观察肾标本的病理学改变。结果BALB/c小鼠脾脏单个核细胞经MACS分选后,CD4+CD25+T细胞纯度达98.5%。经亲代淋巴细胞输注后,CB6F1小鼠出现体重降低、皮肤干涩;ANA和抗ds-DNA抗体上升;以及狼疮肾炎的病理学改变。而输入Tregs对已出现自身抗体的狼疮鼠有明显的逆转效应,CB6F1小鼠于输注后抗-dsDNA即...     

农达对小鼠脾脏淋巴细胞亚群和氧化应激状态的影响

目的探讨农达(roundup,活性成分为草甘膦)对小鼠脾脏淋巴细胞亚群和氧化应激状态的影响。方法将48只成熟SPF级雄性Balb/c小鼠随机分为阴性对照(蒸馏水)组和20、200、2 000 mg/kg农达染毒组,每组12只,灌胃染毒0.02ml/g,每日1次,连续染毒30 d。计算脾脏系数,采用流式细胞仪分析小鼠脾脏CD3~+、CD4~+、CD8~+T细胞,CD45r~+B细胞,CD49b~+NK细胞比例并计算CD4~+T/CD8~+T比值;测定小鼠脾脏中丙二醛(MDA)含量和超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)活力。结果染毒30 d后,各农达染毒组小鼠脾脏重量呈下降趋势;与阴性对照组相比,200、2 000mg/kg农达染毒组小鼠脾脏CD3~+、CD4~+、CD8~+T细胞比例明显升高,CD45r~+B细胞比例明显下降,200 mg/kg农达染毒组CD4~+T/CD8~+T比值下降,差异有统计学意义(P0.01)。各染毒组小鼠脾脏中MDA含量均增加,GSH-Px活力均降低,差异有统计学意义(P0.01)。结论除草剂农达可能通过影响小鼠脾脏淋巴细胞亚群和氧化应激状态,抑制小鼠免疫功能。     

应用G-CSF对不同人群外周血CD+34细胞和T细胞亚群影响的动态变化

目的探讨重组人粒细胞集落刺激因子(G-CSF)对健康人及处于完全缓解的恶性血液病患者的外周血CD+34细胞和T细胞亚群的影响.方法对12例健康人和16例自体外周血干细胞移植患者,以G-CSF 150 μg/12 h,皮下注射,连用6 d.应用流式细胞仪测定外周血CD+34和T细胞亚群.结果 (1)应用G-CSF前,两者的外周血CD+34细胞分别为(0.39±0.27)%和(0.47±0.25)%,两者之间无明显差异(P>0.05).应用72 h后,CD+34细胞分别达(1.29±0.64)%和(1.47±0.95)%,较前均有明显增加(P<0.01),两者之间无明显差异(P>0.05).应用96 h后,CD+34细胞达高峰,分别为(1.41±0.73)%和(1.58±0.83)%,两者之间无明显差异(P>0.05),但较应用G-CSF前差异显著(P<0.01).(2)无论是否应用G-CSF,恶性血液病患者的T细胞亚群比例均处于倒置状态,而健康人T细胞亚群则比例正常.随两者应用G-CSF后CD+34细胞逐渐增加,T细胞亚群变化不明显.结论健康人及处于完全缓解的恶性血液病患者,在应用G-CSF后,外周血CD+34细胞比例逐渐增加并于96 h后达到高峰,T细胞亚群无明显变化.     

CD4+CD25+调节性T细胞对狼疮样小鼠的干预性研究

目的分析CD4+CD25+调节性T细胞（regulatory T cells,Tregs）对狼疮样小鼠的干预效应,为系统性红斑狼疮（systemic lupus erythematosus,SLE）的免疫干预提供新的思路。方法采用磁活性标记的细胞分选方法（magnetic activated cell sorting,MACS）分选BALB/c小鼠CD4+CD25+T细胞,应用流式细胞术（flow cytometry,FCM）检测分选细胞纯度。将68w♀CB6F1小鼠随机分为3组,包括正常对照组、狼疮鼠模型组（亲代淋巴细胞免疫）、狼疮鼠干预组（亲代淋巴细胞免疫后2w,输入5×106Tregs/鼠）。分别于诱导后2、4、8、12w,采用ELISA法检测ANA和抗-dsD-NA抗体,并观察肾标本的病理学改变。结果BALB/c小鼠脾脏单个核细胞经MACS分选后,CD4+CD25+T细胞纯度达98.5%。经亲代淋巴细胞输注后,CB6F1小鼠出现体重降低、皮肤干涩;ANA和抗ds-DNA抗体上升;以及狼疮肾炎的病理学改变。而输入Tregs对已出现自身抗体的狼疮鼠有明显的逆转...     

自体外周血造血干细胞移植在小儿恶性血液肿瘤的应用研究

目的　对 2 6例自体外周血干细胞移植 (APBSCT)治疗的小儿恶性血液肿瘤患儿有关材料进行总结分析。方法　自1989-0 1～ 2 0 0 3 -0 62 6例恶性血液肿瘤患儿 (急性淋巴细胞白血病 11例、急性髓系白血病 3例、恶性淋巴瘤 7例、神经母细胞瘤 5例 ) ,男 17例 ,女 9例 ,年龄 3 5～ 12 (平均 7 4)岁 ,在其完全缓解 ( 2 4例 ) ,部分缓解 ( 2例 )后进行了APBSCT治疗。移植时病程中位时间 12月 ( 6-64 )。 18例用化疗加rhGM -CSF或rhG -CSF动员 ,8例采用常规化疗方案作为动员剂。预处理方案中 19例基本方案为全身放疗 (TBI)加环磷酰胺 (CTX)。 7例未用TBI ,仅以马法兰为主做为预处理方案 (马法兰 +卡铂 +足叶乙甙 4例 ,白消胺 +马法兰 3例 )。结果　移植后白细胞 >0 5× 10 9/L、>1 0× 10 9/L、血小板 >2 0× 10 9/L的中位时间分别为 12 ( 8～ 2 0 )d、17d( 10～ 2 8)、2 1( 7～ 78)d。中位随访时间 7 3年 ( 1月至 14年 )。至今无病生存 70 %( 18/2 6) ,死亡 3 0 %( 8/2 6) ,其中移植相关死亡 2例 ( 7 7%)。结论　化疗联合G -CSF是一高效、低毒的动员方案 ;APBSCT是治疗小儿血液系统肿瘤 ,改善其预后的重要手段之一。     

CIK细胞治疗放化疗后的肿瘤患者的临床观察

目的 观察放化疗后的肿瘤患者回输CIK细胞后生活质量及细胞免疫功能变化,探讨CIK细胞治疗对放化疗后的肿瘤患者的治疗作用.方法 收集放化疗治疗后肿瘤患者患者31例,分别抽取CIK细胞回输治疗后外周血作细胞免疫指标检测,正常人14例作对照,并比较CIK细胞回输治疗后生活质量改善情况.结果 放化疗后的肿瘤患者外周血CD3+、CD4+细胞百分率下降,CD8+细胞百分率上升;CD4+/CD8+比值下调,CD16+CD56+细胞减少,与正常人相比差异有统计学意义(P＜0.05),CIK治疗后上述指标较治疗前有改善(P＜0.05).CIK细胞回输治疗后患者治疗后生活质量评分均较治疗前明显改善(P＜0.05).结论 放化疗后的肿瘤患者免疫功能下降,而CIK细胞回输治疗安全可靠,可以改善放化疗后肿瘤患者近期免疫功能及生活质量,可作为放化疗后肿瘤患者维持治疗的一种选择.     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Qualitative research with people with intellectual disability

Qualitative research methods are gaining popularity in disability research, in particular as a way to explore the personal experience of disability. However, using these methods can be problematic with people traditionally regarded as vulnerable in the research relationship. People with intellectual disability are often so regarded. This paper discusses ethical concerns and issues of research credibility in qualitative research with this group of disabled people. An ethnographic study about the parenting experience of parents with intellectual disability is used to illustrate strategies to achieve credibility in qualitative studies in intellectual disability research.