尿毒症患者T细胞亚群共刺激分子CD28和CD152的表达分析

目的探讨尿毒症患者T细胞亚群表面共刺激分子CD28和CD152(CTLA4)的表达与细胞免疫功能紊乱的关系。方法采用流式细胞术测定尿毒症患者外周血T淋巴细胞上共刺激分子对CD28和CD152(CTLA4)的表达。结果尿毒症患者与健康对照组相比,CD4+T细胞相对计数和CD4/CD8比值均明显增加,共刺激分子CD28和CD152(CTLA4)在CD4+和CD8+T细胞上表达均明显增加,P值均<0.05。尿毒症患者CD4+T细胞表达的CD28明显高于CD8+T细胞,两组间T细胞亚群上共刺激分子CD28表达率差值间比较有显著性差异,P<0.05;患者的CD152分子在CD4+T细胞上的表达较CD8+T细胞上明显减少(P=0.027)。结论尿毒症患者的细胞免疫功能紊乱,T细胞亚群比例失衡,共刺激分子对CD28、CD152(CTLA4)在CD4+和CD8+T细胞上表达均增加,提示可能存在T细胞活化或抑制信号调节失衡。     

FK506对肝移植受者外周血T细胞亚群及共刺激分子表达调节的研究

目的通过观察他克莫司(FK506)对肝移植患者T细胞亚群及T细胞表面CD28、CD152和可诱导共刺激分子(ICOS)表达的影响,探讨FK506对细胞信号传导通路的作用。方法流式细胞技术测定健康对照组、终末期肝脏疾病患者组及使用FK506治疗的肝移植患者组T细胞亚群及各亚群细胞表面CD28、CD152和ICOS的表达。结果CD3 T细胞总数在3组间差异无显著性;与疾病对照组比较,治疗组CD4 T细胞数明显下降,CD8 T细胞数明显增加;CD4 T细胞和CD8 T细胞上CD28和ICOS的表达均显著降低,而CD152分子则均显著升高。结论FK506对治疗组患者T细胞亚群平衡紊乱的迅速纠正有重要作用。通过抑制正性共刺激分子并同时促进负性共刺激分子表达,FK506可在T细胞免疫信号传导通路的上游阻断T细胞活化信号的传导,发挥了免疫调节功能。     

免疫抑制治疗对系统性红斑狼疮患者外周血单个核细胞CD28/CD80分子表达的影响

目的 探讨共刺激分子CD28/CD80在系统性红斑狼疮(SLE)患者中的表达及免疫抑制治疗的作用机制.方法 采用流式细胞分析方法 检测26例SLE患者免疫抑制治疗前、后外周血单个核细胞(PBMC)CD28/CD80分子表达.结果 初发活跃期SLE患者PBMC表达CD80 >细胞数(6.42±5.62)%,较正常对照组(3.11±1.81)%明显增多(P<0.05).经环磷酰胺和糖皮质激素治疗4周后,初发活跃期SLE患者PBMC表达CD80 >细胞数(4.60±3.94)%较治疗前明显下降(P<0.05).结论 SLE患者体内存在T、B细胞间或T细胞和抗原递呈细胞(APC)间CD28/CD80共刺激信号传导异常,这种异常的信号传导可能在SLE发病机制中起着重要的作用.环磷酰胺或/和糖皮质激素可能通过抑制共刺激分子间异常的信号传导而发挥治疗作用.     

胃肠道癌患者外周血CD8+T细胞功能相关标志物的检测及意义

目的探讨胃肠道癌患者外周血T细胞亚群和CD8+T细胞CD28共刺激分子等功能相关性标志物的表达及意义.方法用三色或四色荧光标记流式细胞术检测27例胃肠道癌患者及16例正常对照的外周血淋巴细胞.结果与正常对照组相比,肿瘤患者外周血T细胞标志如CD3+、CD4+、CD8+表达水平及CD4+/CD8+比值差异无显著性;CD8+CD28-T细胞显著增加(P<0.01),而CD8+CD28+T细胞显著降低(P<0.05).表达HLA-DR的活化CD8+T细胞显著增加(P<0.01),分泌IFN-γ的CD8+T细胞(Tc1)明显增多(P<0.01),而分泌IL-4的CD8+T细胞(Tc2)则正常人和肿瘤患者均很低.患者CD8+T细胞CD28及IFN-γ的表达变化与肿瘤分期无关.结论胃肠道癌患者中CD8+T细胞存在系统性活化的表现,其机制可能与CD28/B7以外的信号传递有关.胃肠道癌患者体内Tc1细胞的增加与肿瘤的分期缺乏明确关系.     

FK506对肝移植受者外周血T细胞亚群及共刺激分子表达调节的研究

目的 通过观察他克莫司（FK506）对肝移植患者T细胞亚群及T细胞表面CD28、CD152和可诱导共刺激分子（ICOS）表达的影响，探讨FK506对细胞信号传导通路的作用。方法 流式细胞技术测定健康对照组、终末期肝脏疾病患者组及使用FK506治疗的肝移植患者组T细胞亚群及各亚群细胞表面CD28、CD152和ICOS的表达。结果 CD3^＋T细胞总数在3组间差异无显著性；与疾病对照组比较，治疗组CD4’T细胞数明显下降，CD8^＋T细胞数明显增加；CD4^＋T细胞和CD8^＋T细胞上CD28和ICOS的表达均显著降低，而CD152分子则均显著升高。结论 FK506对治疗组患者T细胞亚群平衡紊乱的迅速纠正有重要作用。通过抑制正性共刺激分子并同时促进负性共刺激分子表达，FK506可在T细胞免疫信号传导通路的上游阻断T细胞活化信号的传导，发挥了免疫调节功能。     

胃癌患者B7-CD28共刺激通路的研究

目的　探讨胃癌患者外周血中CD28 T细胞数量和患者胃癌原代细胞表面B7的表达水平,以探讨胃癌患者共刺激通路是否异常。方法　采用流式细胞术检测胃癌患者外周血中CD28 T细胞与胃癌患者原代细胞B7分子的表达,并与胃良性疾病作比较。结果　胃癌患者CD28 T细胞数低于对照组(P<0. 01)。胃癌患者原代细胞表面B7 -1(CD80)、B7- 2(CD86)表达水平低于对照组(P<0. 01)。结论　胃癌患者外周血T细胞低表达CD28分子,胃癌细胞低表达B7分子,从而影响B7- CD28共刺激通路,使T细胞不能有效地清除肿瘤。     

系统性红斑狼疮和类风湿性关节炎T细胞异常调节与免疫功能紊乱的研究

目的分析系统性红斑狼疮(SLE)和类风湿性关节炎(RA)外周血T细胞亚群表面共刺激信号分子表达,探讨人类SLE和RA中T细胞免疫紊乱状态。方法采用流式细胞技术检测SLE、RA患者外周血T细胞亚群表面CD28、CD152、诱导性共刺激因子(ICOS)、CD154、CD30和CD95分子表达。结果与健康对照组比较,SLE和RA患者组分别为CD3 CD8 T细胞和CD3 CD4 T细胞增加(P<0.05);SLE患者CD4 T细胞和CD8 T细胞上CD28和CD152分子表达率均增加,ICOS分子表达减少(P均<0.05),CD154和CD30分子表达率均下降;RA患者2类T细胞亚群上CD28分子表达均降低,CD152分子表达率均增加(P均<0.05),ICOS分子表达率无明显变化,CD154和CD30分子表达率分别增加或减少;SLE和RA患者CD4 T细胞和CD8 T细胞上CD95分子表达率均明显增加。结论SLE和RA有不同的外周T细胞亚群平衡失控;T细胞的异常活化受复杂的细胞共刺激信号网络分子调控。     

系统性红斑狼疮患者外周血淋巴细胞CD28/CTLA-4分子表达的研究

目的探讨系统性红斑狼疮(systemic lupus erythematosus,SLE)患者外周血淋巴细胞CD28/CTLA-4分子和CD28/CTLA-4mRNA的表达。方法研究对象为SLE患者49例(活跃期30例、缓解期19例)及对照组23例。外周血单个核细胞(peripheral blood mononuclear cell,PBMCs)经梯度密度离心法分离后分佛波醇乙酯(PMA)(10ng/ml)及伊屋诺霉素(500ng/ml)刺激组和不加刺激剂组两组培养。将PBMCs分别培养24、48、72及96小时。应用流式细胞计量术(flow cytometry,FCM)检测外周血淋巴细胞培养前后CD28及CTLA-4分子的表达。采用RT-PCR方法检测CD28mRNA和CTLA-4mRNA的表达。结果刺激前后SLE患者CD3+及CD8+T细胞上CD28分子表达量与对照组比较差异均无统计学意义(P>0.05)。刺激前活跃期SLE患者CD3+T细胞上CTLA-4分子表达量较对照组明显降低[(0.78±0.51)%vs(1.34±0.76)%,P<0.05]。刺激后72小时SLE患者CD3+T细胞及CD8+T细胞上CTLA-4分子表达量仍低于对照组,但差异无统计学意义(P>0.05)。刺激前后PBMCs中CD28mRNA及CTLA-4mRNA表达情况与刺激前后CD3+T细胞上CD28及CTLA-4分子变化情况相似。刺激前SLE患者CD3+T细胞上CTLA-4分子表达量与SLE活动指数(SLEDAI)呈显著的直线负相关关系(P<0.001)。结论 SLE患者T细胞CTLA-4分子存在表达及上调机制障碍,提示CD28分子及CTLA-4分子存在功能失衡,这种失衡可能通过一定的机制参与SLE的发病过程。     

哮喘患者外周血单个核细胞表面共刺激分子检测及意义

目的探讨共刺激分子在哮喘发病免疫学机制中的作用。方法选取28例哮喘患者和15名对照者,采用三色标记的流式细胞术检测哮喘患者外周血单个核细胞表面共刺激分子的表达水平。结果与对照组相比,哮喘患者T细胞各亚群所占比例及B细胞、单核细胞占外周血单个核细胞的比例差异未见显著性,但CD4/CD8明显高于对照组(P<0.05)。CD4和CD8阳性T细胞表达的CD28及CTLA-4分子在两组间差异无显著性。哮喘组单核细胞(CD14阳性)CD80表达水平低于对照组(P<0.05)。而B细胞(CD19阳性)表面表达的CD86低于对照组(P<0.05)。结论哮喘患者体内存在的T淋巴细胞功能紊乱可能与T淋巴细胞活化过程中共刺激信号的异常有关。     

氢离子通过mTOR通路抑制CD8tT细胞功能

摘要:目的探讨氢离子(H*)对 CD8*T细胞功能及哺乳动物雷帕霉素( Rapamyein )靶蛋白( mammalian target of rapamycin ,mTOR)信号通路的影响。方法通过磁珠分 选的方法从人外周血单个核细胞( PBMC)中分选出CD8*T细胞,流式细胞术检 测CD8*T细胞的百分比并验证其纯度。根据细胞培养基的不同pH值将培养基分为对照组(pH为7.2~7.4) 、pH 6.7组和pH6.5组。细胞计数法检测不同pH分组中CD8*T细胞的增殖能力。流式细胞术检测经PMA/离子霉素刺激后不同pH分组CD8*T细胞中细胞因子TNF-a和IFN-γ的表达水平,并进一步分析在Rapanycin作用下, CD8*T细胞中TNF-a、IFN-γ水平以及S6蛋白磷酸化水平。qRT-PCR 检测不同pH分组中CD8*T细胞TNF-a和IFN-y mRNA的表达水平。Western blot 检测不同pH分组CD8*T细胞中mTOR信号通路相关蛋白AKT和S6的磷酸化水平。结果pH6.7组和pH6.5组中CD8*T细胞的增殖能力显著低于对照组(P<0.05 ) ;CD8*T细胞内细胞因子TNF-a和IFN-Yy mRNA水平显著低于对照组(P<0.05),其蛋白质表达水平与对照组相比亦显著降低(P<0.05), mTOR信号通路相关蛋白AKT和S6的磷酸化水平显著低于对照组( P<0.05)。经Rapamyein作用后,pH 6.5+Rapamyein组中CD8*T细胞S6蛋白磷酸化水平以及细胞因子TNF-ax、IFN-γ的表达水平均显著低于对照+Rapamyein组(P<0.05)。结论H*可 抑制CD8*T细胞的功能,且与mTOR信号通路相关。     

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.     

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.     

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.     

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.