供、受者细胞因子基因多态性预测肾移植效果的意义

目的 评价供受者细胞因子基因多态性预测移植肾急性排斥反应的意义。方法 采用序列特异引物聚合酶链反应(PCR-SSP)方法,对144例肾移植受者和65例供者进行细胞因子INF-α,IL-10,IL-6,TGF-β及IFN-γ基因型检测。结果 受者TNF-α或IL-10为高分泌型时移植肾急性排斥反应发生率与受者为低分泌型者相比有极显著性差异(P<0.01)。供者TNF-α或IL-1O为高分泌型时移植肾急性排斥反应发生率与供者为低分泌型者相比无显著性差异(P>0.05))。受者高分泌/供者高分泌TNF-α基因型组合的受者急性排斥反应发生率比所有其它基因型组合者高(P<0.01),而受者低分泌/供者低分泌TNF-α基因型组合的受者急性排斥反应发生率比所有其它基因型组合者低(P<0.01)。结论 同时检测供受者TNF-α基因型能为我们更加合理地选择肾移植供受者提供一种有效手段。     

受者细胞因子基因多态性预测肾移植术后效果的意义

目的 探讨受者细胞因子基因多态性预测移植肾急性排斥反应的意义。方法 采用序列特异引物聚合酶链反应（PCR－SSCP）方法，检测144例肾移植受者细胞因子基因型。结果 TNF－α或IL－10高分泌基因型组急性排斥反应发生率高于中低分泌组，差异有极显著性意义（P＜0．001）。TNF－α、IL－10高分泌基因型组急性排斥反应发生率比其它基因型组合组高，差异有显著性意义（P＜0．05）。结论 受者TNF－α和IL－10基因型是移植肾急性排斥反应的决定性因素之一。     

细胞因子及受体基因多态性与移植肾急性排斥反应的关系

目的 采用细胞因子基因芯片技术，检测肾移植受者5种细胞因子及其受体的21个等位基因位点的基因多态性，并探讨其与移植肾急性排斥反应的关系。方法 取144例肾移植受者的外周血，通过细胞中白细胞介素4（IL-4）、白细胞介素6（IL-6）、白细胞介素10（IL-10）、肿瘤坏死因子α（TNF-α）和转化生长因子β1（TGF-β1）及其受体启动区21个基因多态性位点，设计寡核苷酸探针58条，进行多重聚合酶链反应（PCR）扩增、标记、杂交和结果判断。将受者分成急性排斥反应组和无排斥反应组，比较两组受者5种细胞因子及其受体的21个位点的基因型和等位基因分布情况。结 果在肾移植受者中，与移植肾急性排斥反应相关的基因型为：TNF-α（-308A／A、A／6、G／G）、IL-10（-597A／A、C／C、A／C；-824T／T、C／C、C／T；-1087A／A、A／G）、TGF-β1（＋869C／C、C／T、T／T）；与移植肾急性排斥反应相关的等位基因为：TNF-α（-308A／G）、IL-10（-597A／C;-824T／C；-1087A／G）、TGF-β1（＋869C／T）。结论 Th1类细胞因子TNF-α能够促进移植肾排斥反应的发生；Th2类细胞因子IL-10和Th3类细胞因子TGF-β1对移植肾急性排斥反应起保护作用。     

细胞因子基因多态性指导肾移植术后免疫抑制剂应用的意义

目的：探讨细胞因子基因多态性在指导肾移植术后免疫抑制个体化用药中的意义。方法：用序列特异引物聚合酶链反应（PCR－SSP）方法，对126例肾移植受者进行细胞因子基因型检测，根据细胞因子基因型与免疫抑制剂的不同使用剂量进行分组，比较各组急性排斥反应的发生率，结果：肿瘤坏死因子（TNF－α）高分泌基因型的患者，使用中，低剂量CsA，急性排斥反应的发生率显著高于其它组合（P＜0．01），TNF－α低分泌基因型者使用高剂量CsA，急性排斥反应的发生率与使用中剂量CsA者的差异无显著性（P＜0．05，IL－10高＋中分泌基因型者使用中，低剂量CsA，急性排斥反应的发生率显著高于其组合（P＜0．01），IL－10低分泌基因型者使用高剂量CsA，急性排斥反应的发生率与使用中剂量CsA者的差异无显著性（P＞0．05），结论：常规检测细胞因子基因型对于肾移植术后制定免疫抑制治疗的个体化用药方案具有重要意义。ααα     

肿瘤坏死因子基因型多态性与肾移植受者急性排斥反应的关系

目的：探讨肾移植受者外周血中肿瘤坏死因子（TNF-α）基因多态性与急性排斥反应的关系。方法：应用序列特异性引物聚合酶链反应（PCR—SSP）测定62例肾移植受者外周血中TNF-α的基因型,并结合供受者HLA配型情况,比较各基因型对急性排斥反应发生率的影响。结果：在HLA—DR错配的情况下,TNF—α等位基因为高分泌型者,其术后急性排斥反应发生率较低分泌型者高（P〈0．05）。结论：TNF-α基因型对肾移植排斥反应发生率有明显影响,可据此或可制定更为合理的个体化免疫抑制治疗方案。     

细胞因子基因型多态性与肾移植排斥反应的关系

目的：探讨细胞因子基因型多态性对肾脏移植后急性排斥反应发生率的影响。方法：采用序列特异引物聚合物酶链反应（PCR－SSP）法对115例肾移植受者和24名健康对照者的细胞因子肿瘤坏死因子（TNF）－α,转化生长因子（TGF）－β1,白细胞介素（IL）－6和IL－10基因型进行测定,探讨其细胞因子基因型对肾脏移植后急性排斥反应发生率的影响。结果：在115例肾移植受者及24名健康对照者中,TNF－α和IL－10低产生型基因型者分别为88.7%(102.115),87.5%(21/24)和80％(92/115),75%(18／24）,占明显优势。而TGF－β1和IL－6的硎 是以高产生型占明显优势,分别为79.1%(91/115),100%(115/115)和66.7%(16/24),100%(24/24)。115例肾移植受者中,在移植后6个月内共有26例发生了急性排斥。其中TNF－α高产生基因型和IL－10的中,高产基因型受者的急性排斥发生率分别为53．8％（7／13）和43．5％（10／23）,显著高于相应的低产生基因型受者的18．6％(19/102,x^2=8.17)和17．4％（16／92,x^2=7.16),差异有非常显著意义（P值均＜0＝0．01）。结论：肾移植受者和正常健康人群的TNF－α和IL－10基因型是以低产生型为主;TGF－β1和IL－6的基因型是以高产生型为主;TNF－β1和IL－10细胞因子基因型多态性对肾移植术后急性排斥反应的发生率有显著的影响。     

耐受性树突状细胞延长大鼠移植脾存活时间

目的 观察供者来源的耐受性树突状细胞（DC）在脾移植中的作用，并探讨其作用机理。方法 以Wista大鼠为供者，SD大鼠为受者，建立同种颈部异位脾脏移植模型。（1）分离供者的骨髓细胞，分别采用白细胞介素4（IL-4）和白细胞介素10（IL-10）诱导培养出成熟的DC和耐受性DC，并在光镜下观察两者的细胞形态学差别。采用流式细胞术检测两者对共刺激分子CD86表达的差异，采用混合淋巴细胞反应比较其在体外刺激同种异体T淋巴细胞增殖的反应能力。（2）将受者随机分成4组，每组10只。单纯移植组：受者不经任何预处理仅进行脾移植。IL-10DC组：在移植前7d经受者尾静脉注射2×10^6／ml的经IL-10诱导的DC 1 ml。IL-4 DC组：在移植前7d经受者尾静脉注射2×10^6／ml的经IL-4诱导的DC 1 ml。空白对照组：在移植前7d经受者尾静脉注射无细胞的培养液1ml。观察各组移植术后发生急性排斥反应的时间。结果 （1）经IL-10诱导的骨髓细胞表现为未成熟树突状细胞的形态和特性，细胞体积大，但少见树突状突起，细胞表面低表达CD86分子，不能有效刺激T淋巴细胞的增殖。而经IL-4诱导的骨髓细胞为典型的成熟树突状细胞，细胞胞体大，并有树突状突起，细胞表面高表达共刺激分子CD86，可显著刺激T细胞的增殖。（2）IL-10 DC组发生急性排斥反应的时间较其他3组明显延迟（P〈0．01）；IL-4 DC组发生急性排斥反应的时间较单纯移植组和空白对照组明显提前（P〈0．05）；而单纯移植组与空白对照组间则无明显差异（P〉0．05）。结论 应用供者来源的耐受性树突状细胞能够延缓大鼠移植脾急性排斥反应的发生时间。     

大豆异黄酮对大鼠慢性移植肾肾病的防治作用

目的通过对肾移植大鼠的饮食营养干预，观察大豆异黄酮对慢性移植肾肾病的防治作用。方法选择近交系雄性Fisher（F344）大鼠作为供者，雄性Lewis（Lew）大鼠作为受者，采用显微外科技术制作肾移植模型。将受者随机分为三组，分别给予高异黄酮大豆蛋白饲料（HIS组）、低异黄酮大豆蛋白饲料（LIS组）或酪蛋白饲料（CAS组）。移植前和移植后第4、12和24周时检测血压，并收集受者的血和尿样，检测尿蛋白和血肌酐含量。24周时处死大鼠获取移植肾，行组织学和免疫组织化学检查。结果在移植后4周时，HIS组受者的尾动脉收缩压、24h尿蛋白含量和血肌酐浓度即低于LIS组和CAS组，但差异无统计学意义（P〉0．05）；移植后12周和24周时，HIS组的受者尾动脉收缩压、24h尿蛋白含量和血肌酐浓度均较LIS组和CAS组显著降低（P〈0．05）；移植后24周时，HIS组移植肾组织的间质纤维化和炎症、血管硬化、肾小球硬化和肾小管萎缩等慢性病变均较LIS组和CAS组为轻（P〈0．05）；HIS组移植肾组织中转化生长因子-β1（TGF-β1）的表达和分泌均较LIS组和CAS组为少（P〈0．05）。结论大豆异黄酮对移植肾功能和结构有保护作用，可作为一种防治慢性移植肾肾病的新方法。     

外周血淋巴细胞转化生长因子β1 mRNA表达与慢性移植物肾病的关系

目的研究转化生长因子β1（TGF-β1）在慢性移植物肾病（CAN）发生发展中的作用以及免疫抑制剂对TGF-β1的影响。方法采用实时荧光定量PCR检测15例CAN和22例非CAN患者外周血淋巴细胞TGF-β1 mRNA表达,分析CAN、免疫抑制剂和TGF-β1 mRNA表达3者之间的关系。结果CAN组TGF-β1 mRNA表达明显高于非CAN组,分别为0．1 55±0．027和0．123±0．028（P〈0．01）。服用环孢素（CsA）的患者TGF-β1 mRNA表达明显高于服用他克莫司（FK506）者,CAN组分别为0．170和0．137（P〈0．01）,非CAN组分别为0．135和0．106（P〈0．01）。TGF-β1 mRNA表达与肾移植受者血肌酐（r2=0．77,P〈0．01）和血尿素氮（r2=0．63,P〈0．01）呈良好线性关系。结论CsA能引起肾移植受者外周血淋巴细胞TGF-β1 mRNA高表达,后者可诱发和促进CAN的发生与发展。     

供者细胞因子基因多态性对肾移植受者急性排斥反应发生的影响

目的 研究供者的细胞因子和细胞因子受体基因多态性对肾移植受者急性排斥反应发生的影响.方法 (1)将126例肾移植受者分成急性排斥组和无排斥组,比较可能影响发生急性排斥反应的因素在两组中的分布情况;比较两组受者中供者的13种细胞因子及受体22个位点的基因型及部分细胞因子表达型的分布情况.(2)根据HLA-DR配型分成0～1个HLA-DR位点错配、HLA-DR完全错配两种情况,分别比较阳性基因多态性在急性排斥组和无排斥组中的分布情况.结果 (1)急性排斥组的HLA-DR错配数明显高于无排斥组;无排斥组供者的白细胞介素(IL)-1α889 C/C、IL-1Ra raspI 11100 T/T、IL-4Rd+1902 A/A、转化生长因子(TGF)-β1密码子10 C/C、IL-10-1082A/A、IL-10低表达型的频率明显较高,IL-12～1 188 A/A、IL-2-330 G/G、IL-10 GCC/ATA频率明显较低;(2)HLA-DR 0～1个位点错配时,两组供者中IL-1Rα msp I 11100 T/T、IL-4Rα+1902 A/A、TGF-β1密码子10 C/C、IL-2-330 G/G、IL-10低表达型频率明显不同,而在HLA-DR完全错配时,只有IL-12-1188 A/A表达频率明显不同.结论 供者的IL-1α-889 C/C、IL-1Rα msp I 11100 T/T、IL-4Rα+1902 A/A、TGF-β1,密码子10 C/C、IL-10-1082 A/A和IL-10低表达型是不发生肾移植急性排斥反应的遗传学指标,而IL-12-1188 A/A、IL-2-330 G/G则是发生急性排斥反应的遗传学危险因素.HLA-DR错配状况可干扰供者细胞因子基因多态性对急性排斥反应发生的影响.     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。