Flt3和c-kit在脐血CD34+干/祖细胞中功能性表达及意义

为了解作用于早期造血的细胞因子受体Flt3和c-kit在脐血CD34~+造血干/祖细胞中的表达及功能,从蛋白和基因水平对其进行了研究。采用常规双色直接免疫荧光标记法,使用流式细胞术测定新鲜分离的和体外不同培养时间的脐血CD34~+造血干/祖细胞中Flt3和c-kit蛋白水平的表达,用RT-PCR法测定Flt3和c-kit的mRNA水平表达,并在体外对受体功能进行了探讨。研究结果显示,新鲜脐血CD34~+细胞中(68.8±15.4)％为Flt3~+,(50.6±12.7)％为c-kit~+,随着体外培养时间的延长,二者表达逐渐下降。结论:脐血CD34~+造血干/祖细胞在体外液体培养条件下Flt3和c-kit阳性表达可维持2-3周,其配体FL和SCF在培养的第1周内对细胞扩增效果最显著。     

2型重组腺相关病毒对人脐血CD34+造血干/祖细胞的转导效率研究

为探讨 2型重组腺相关病毒 (rAAV 2 )载体能否有效地转导脐血CD34+造血干 /祖细胞 ,采用rAAV 2 /GFP感染经免疫磁珠法分离的脐血CD34+造血干 /祖细胞 ,在荧光显微镜下观察GFP的表达。结果显示 ,转导 19小时后感染复数 (MOI)为 2× 10 5时 ,CD34+细胞GFP基因的表达率为 4 3%。结论 :rAAV 2能有效地转导脐血CD34+造血干 /祖细胞。     

人胎盘组织源造血干/祖细胞的初步研究

为了探讨足月胎盘组织源单个核细胞(human mature placenta tissue-derived mononuclear cells,hPTMNC)中CD34+细胞的体外增殖、分化能力,寻找新的造血干/祖细胞来源供临床应用,分别采用流式细胞术检测、造血干/祖细胞集落培养和体外无细胞因子长期培养的方法,测定胎盘组织源和脐血中的CD34+细胞及其亚群和集落形成单位的数量。结果表明:胎盘组织源CD34+细胞(2.74±0.61%)及其亚群CD34+/CD38-细胞(2.46±0.42%)、造血干/祖细胞集落CFU-GM(186.90±24.52)和BFU-E(101.40±13.35)水平都较脐血CD34+细胞(1.73±0·32%)、CD34+/CD38-细胞(0.80±0.25%)、CFU-GM(136.90±25.15)、BFU-E(49.20±8.13)高;前者在体外无细胞因子培养条件下存活时间长,且细胞数量增加约2倍。结论:胎盘是胎儿期的造血器官,胎盘细胞成分更幼稚,是一种造血干/祖细胞移植的新的种子细胞。     

FL与SCF、IL-3、GM-CSF及EPO协同调控脐血造血干/祖细胞的体外扩增

目的　探讨造血细胞因子的不同组合对脐血造血干 /祖细胞的扩增作用。方法　应用免疫磁珠法分离纯化脐血CD3 4+ 造血干 /祖细胞 ,在体外液体培养体系中经各种不同细胞因子组合扩增 1周 ,用流式细胞仪检测CD3 4+ 造血干 /祖细胞并进行甲基纤维素法半固体培养 2周 ,在倒置显微镜下计数集落产率。结果　在FL、SCF、IL 3、GM CSF、EPO造血细胞因子的不同组合下脐血造血干 /祖细胞得以扩增 ,以IL 3+SCF +FL +EPO组的扩增效率最高 ,其有核细胞数、CD3 4+ 细胞及CFU GM、BFU E集落分别扩增 46 2± 175、3.47± 1.6 4、2 6 4± 10 5和 12 8± 6 7倍。结论　FL对扩增CD+ 3 4细胞具有较强的协同作用 ,合理的细胞因子组合扩增的脐血造血干 /祖细胞可成为异基因造血干细胞移植的主要来源。     

脐血造血干/祖细胞部分归巢受体功能缺陷的研究

本研究旨在了解来源于脐血造血干细胞表面部分归巢受体(homing receptor)的功能缺陷并探讨体外干预的效果和可行性。用流式细胞术对来源于脐血的CD34+造血干/祖细胞表面的P、E选择蛋白配体活性基团表达、CD26的表达及活性进行检测,同时检测骨髓和外周血作为对照。采用岩藻糖基转移酶体外处理脐血CD34+造血干/祖细胞并检测其表面选择蛋白配体活性基团的表达水平。结果表明,CD26在脐血、骨髓及外周血的CD34+造血干/祖细胞表面的表达率分别为:(7.62±0.63)%,(6.35±0.89)%和(6.18±0.91)%(p0.05),其活性分别为:67.15U/1 000个细胞(1U=1pmol/min),26.85U/1 000个细胞和20.95U/1 000个细胞,脐血CD34+造血干/祖细胞表面CD26的活性明显高于其它两者(p0.001)。P选择蛋白配体活性基团在脐血、骨髓和外周血CD34+造血干/祖细胞表面的表达率分别为:(83.46±6.33)%,(15.65±0.89)%和(80.17±6.85)%;E选择蛋白配体活性基团的表达率为:(25.31±1.03)%,(26.34±0.89)%和(29.79±1.78)%(p0.05)。脐血CD34+细胞体外行岩藻糖基化工程后,E选择蛋白配体活性基团表达率由(25.31±1.03)%提高至(63.23±1.08)%。结论:3种不同来源CD34+造血干/祖细胞表面的CD26分子表达无明显差别,但其活性不一,脐血的CD34+造血干/祖细胞CD26活性最高,骨髓的次之,外周血的最低。P选择蛋白配体活性基团在脐血及外周血CD34+造血干/祖细胞表面的表达无明显差别,但在骨髓干细胞表面表达偏低。体外经岩藻糖基化工程处理的脐血CD34+造血干/祖细胞可明显上调其表面E选择蛋白配体活性基团的表达。     

脐血造血干/祖细胞研究进展

脐血和骨髓均富含造血干/祖细胞,但二者在造血干/祖细胞的含量上存在差别。脐血中各CD34~+细胞亚群有着独特的免疫表型。脐血造血干/祖细胞能在体外扩增,扩增后的CD34~+细胞能在SCID小鼠体内重建造血。由脐血CD34~+细胞可以生成淋巴细胞和内皮细胞。脐血造血干/祖细胞移植与骨髓造血干/祖细胞移植在患者的生存率、复发率及移植免疫排斥等方面均具有可比性,有着极大的潜在价值。     

转白血病抑制因子基因人胚肺成纤维细胞对脐血CD34+细胞体外扩增的影响

背景:单份脐血的造血细胞数量有限,难以满足成人的需要,如何有效地扩增脐血造血干/祖细胞是目前研究的热点.目的:构建人白血病抑制因子基因修饰的人胚肺成纤维细胞,观察转基因细胞对脐血CD34+造血干/祖细胞体外扩增的影响.方法:建立转人白血病抑制因子基因的饲养层细胞,用RT-PCR法和ELISA法鉴定目的基因的表达;采用免疫磁珠法分离脐血CD34+造血干/祖细胞,流式细胞术检测纯度;将CD34+造血干/祖细胞与饲养层细胞共培养,流式细胞术检测各组增殖效果;扩增后的造血干/祖细胞用跨膜迁移实验检测自发迁移率和基质细胞衍生因子1诱导迁移试验以鉴定体外扩增的造血干/祖细胞的归巢能力.结果与结论:成功建立转基因饲养层细胞,RT-PCR法和ELISA法证实有目的基因表达,与人白血病抑制因子转基因饲养层细胞共培养7 d后CD34+造血干/祖细胞可大量扩增,同时表面黏附分子的表达量仍较高.体外迁移实验显示与转基因饲养层细胞共培养的造血细胞的诱导迁移率明显高于对照组,可以较好地保持其归巢能力.因此转人白血病抑制因子基因的饲养层细胞可有效扩增脐血CD34+造血干/祖细胞,延缓其分化,并且体外扩增后仍保持较高的归巢能力.     

转白血病抑制因子基因人胚肺成纤维细胞对脐血CD34~＋细胞体外扩增的影响

背景：单份脐血的造血细胞数量有限,难以满足成人的需要,如何有效地扩增脐血造血干/祖细胞是目前研究的热点。目的：构建人白血病抑制因子基因修饰的人胚肺成纤维细胞,观察转基因细胞对脐血CD34＋造血干/祖细胞体外扩增的影响。方法：建立转人白血病抑制因子基因的饲养层细胞,用RT-PCR法和ELISA法鉴定目的基因的表达;采用免疫磁珠法分离脐血CD34＋造血干/祖细胞,流式细胞术检测纯度;将CD34＋造血干/祖细胞与饲养层细胞共培养,流式细胞术检测各组增殖效果;扩增后的造血干/祖细胞用跨膜迁移实验检测自发迁移率和基质细胞衍生因子1诱导迁移试验以鉴定体外扩增的造血干/祖细胞的归巢能力。结果与结论：成功建立转基因饲养层细胞,RT-PCR法和ELISA法证实有目的基因表达,与人白血病抑制因子转基因饲养层细胞共培养7d后CD34＋造血干/祖细胞可大量扩增,同时表面黏附分子的表达量仍较高。体外迁移实验显示与转基因饲养层细胞共培养的造血细胞的诱导迁移率明显高于对照组,可以较好地保持其归巢能力。因此转人白血病抑制因子基因的饲养层细胞可有效扩增脐血CD34＋造血干/祖细胞,延缓其分化,并且体外扩增后仍保持较高的归巢能力。     

人参总皂甙协同造血生长因子体外诱导CD34+造血干/祖细胞扩增与分化的作用

为探讨人参总皂甙(total saponins of panax ginseng,TSPG)协同造血生长因子体外诱导CD34+造血干/祖细胞(HSC/HPC)扩增与分化的作用,收集人脐血、骨髓细胞并采用StemsepTM干细胞分选系统分离纯化CD34+HSC/HPC,用不同剂量TSPG加入不同组合的造血生长因子进行培养,检测细胞总数、CD34+细胞和CD33+细胞比例及集落形成细胞总数(CFC)、粒系祖细胞(CFU-GM)数量变化.结果显示10-70μg/ml TSPG均可不同程度地提高脐血细胞总数、CFC数和CD34+细胞数,50μg/ml是最佳刺激浓度,可使细胞总数、CFC数和CD34+细胞数分别增至(2470.5±79.96)×103、(53.96±4.29)×100%和(21.86±3.09)×100%;20μg/ml是液体培养诱导骨髓CD34+细胞向粒系分化的最佳浓度,可使细胞总数、CFU-GM和CD33+细胞分别增至(133.2±9.03)×103、(26.78±1.91)×100%和(16.98±1.73)×100%;甲基纤维素半固体培养检测显示,TSPG(10-50μg/ml)均能提高CD34+细胞形成CFU-GM的集落产率,以TSPG 20μg/ml效果最为明显.结论合适剂量的TSPG能够促进CD34+造血干/祖细胞体外扩增与定向诱导分化.     

脐血造血干/祖细胞免疫表型的流式细胞术双标法分析及其意义

目的比较脐血和骨髓中造血干/祖细胞(HSPC)的免疫表型差异.方法使用流式细胞术(FCM)双标法对38份脐血及10份骨髓HSPC进行免疫表型分析.结果①脐血有核细胞中CD34+细胞所占比例与骨髓中相近,约为0.5%;②脐血CD34+细胞中CD34+CD38-[(17.C4±5.37)%]、CD34+HLA-DR-[(32.65±10.71)%]及CD34+H-CAM+(CD44+)[(77.84±7.69)%]亚群含量均高于骨髓[含量分别为(8.26±3.19)%、(14.05±1.67)%和(70.02±6.40)%],CD34+CD13+、CD34+CD19+亚群比例低于骨髓.结论脐血与骨髓CD34+细胞比例相近,但前者较原始的干细胞含量更高,故脐血是极具潜力的HSPC来源;而脐血CD34+细胞中髓系及淋系祖细胞含量低于骨髓,可能是脐血移植后造血及免疫重建缓慢的原因之一.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.