长托宁对MECT治疗前后患者血压影响的临床分析

目的分析长托宁在无抽搐电休克治疗(MECT)前后对患者血压的影响。方法将64例接受MECT治疗的患者分为两组:对照组,32例,MECT前予以阿托品;研究组,32例,治疗前予以长托宁。分别于刺激前、刺激即时、刺激后5min、10min末比较两组的SBP、DBP及MAP。结果与对照组相比,研究组的刺激即时、刺激后5min、10min末的SBP、DBP及MAP均明显较低(P<0.05),而刺激前各血压值无差异(P>0.05)。研究组的刺激即时、刺激后5min、10min末的各血压值与刺激前无差异(P>0.05),而对照组的刺激即时、刺激后5min、10min末的各血压值显著高于刺激前(P<0.05)。结论长托宁在MECT治疗前后能有效稳定血压。     

不同强度低频经颅磁刺激对脑卒中后抑郁情绪的干预效应

目的观察不同强度低频经颅磁刺激对脑卒中后抑郁情绪的干预效应。方法选取48例脑卒中后抑郁病患,分为对照、假刺激与高、低强度磁刺激组,利用HAMD测量表分别测定、分析各组病患磁刺激治疗前后情绪变化情况。结果磁刺激能显著降低HAMD指数(P<0.01)、提高治疗有效率(P<0.05),并无不良反应出现。结论磁刺激能有效干预脑卒中后抑郁患者抑郁情绪,有望成为一种新的治疗手段而显著改善脑卒中后抑郁的预后。     

逆行胃电刺激后肥胖患者胃容受性、胃排空和胃肠激素变化

目的：探讨接受逆行胃电刺激后肥胖患者胃容受性、胃排空和胃肠激素变化。方法选择在我院进行治疗肥胖患者26例作为研究对象。给予逆行胃电刺激和假胃电刺激，分析不同刺激下胃容受性、胃排空和相关激素的变化。结果采用逆行胃电刺激后患者饱感时的进餐量和最大耐受程度进餐量均显著低于采用假胃电刺激后（P＜0.01）。采用逆行胃电刺激后和假胃电刺激后患者胃半排空时间、1h固体餐存留率、2 h固体餐存留率以及瘦素、生长激素释放肽、抵抗素、肽YY变化差异均无统计学意义（P＞0.05）。瘦素激素释放的变化与胃半排空时间变化呈正相关（r=0.577，P＜0.05）。结论急性逆行胃电刺激能够减少肥胖患者对液体的进餐量，但是对相关激素的释放影响不明显。     

地佐辛用于全麻术后躁动的临床观察

<正>术后躁动是指全麻手术患者术后不遵医嘱而自行行动导致的不同程度的不自主运动。术后躁动对患者的预后产生较不利的影响,严重时可导致患者发生意外伤害甚至死亡。目前,临床对于全麻术后躁动的发病机制尚不完全清楚,据文献报告显示,在引起术后躁动的各种不良刺激中,疼痛刺激占92.44%,气管导管的占65.77%,心理应激刺激占15.55%,导尿管刺激占11.11%,制动不当刺激占4.44%[1],本研究应用地佐辛防治全麻术后痛觉过敏反应,来探讨其减少术后躁动的发生情况。现将其报道如下。     

牙本质保护膜在全瓷冠牙体预备后的作用

目的 评价牙本质保护膜在全瓷冠修复的活髓牙备牙后牙本质面的保护作用.方法 选择63例行全瓷冠修复的患者,共82颗活髓牙,按就诊顺序随机分为A组和B组.A组32例(42颗牙),备牙后涂布牙本质保护膜;B组31例(40颗牙),备牙后涂布Gluma脱敏剂.采用可视分级评价法(VAS)评价探针刺激以及空气刺激预备牙的敏感程度.结果 A组:治疗前、后探针刺激以及空气刺激VAS值比较差异有统计学意义(P＜0.05).B组:治疗前、后探针刺激以及空气刺激VAS值比较差异有统计学意义(P＜0.05).A组和B组间,探针刺激以及空气刺激VAS值比较差异无统计学意义(P＞0.05).结论 牙本质保护膜能显著降低全瓷冠修复的活髓牙牙体预备后的牙本质敏感症状.     

电针刺激对 Beagle 犬展神经损伤修复的研究

摘要： 目的 建立展神经损伤电针刺激的动物模型, 研究电针刺激对展神经损伤修复的疗效。方法 24 只 Bea⁃ gle 犬随机均分为单纯损伤组(对照组)及损伤后电针刺激组(实验组)。行展神经脑池段压榨损伤, 展神经刺激电极及外直肌记录电极植入。于术后 1～12 周, 测量 2 组瞳孔中心至外眦内侧缘距离。结果 所有 Beagle 犬均能耐受手术, 颅内刺激电极和外直肌记录电极成功植入; 术后 1～2 周, 2 组 Beagle 犬瞳孔中心至外眦内侧缘距离比较差异无统计学意义, 术后 4～12 周, 实验组 Beagle 犬瞳孔中心至外眦内侧缘距离小于对照组(P＜0.01)。结论 成功建立应用于展神经损伤电针刺激的动物模型, 电针刺激可以明显促进损伤的展神经恢复。     

电针刺激对缺血性卒中大鼠神经功能的影响分析

目的探讨电针刺激对缺血性卒中大鼠神经功能恢复的影响。方法选取2～3月龄,体重80～120g雄性SD大鼠85只,按双肾双夹法的方法复制高血压大鼠模型,成功建模后对大鼠进行分组包括梗死灶周围电刺激组(A组)、肢体电刺激组(B组)、对照组(C组)和假手术组(D组),针对不同分组进行不同的卒中模型制作和电针治疗并对上述不同分组大鼠进行在不同时期神经功能评并定采用SPSS12.0统计学软件进行统计学分析。结果神经功能评分上,D组无运动功能缺损,评分均为7分。A,B,C3组电刺激治疗后评分逐渐增高,4周后评分接近6分。A组神经功能改善最明显且改善最快,B组次之,二者的神经功能在第1周、第2周时有显著性差异;两周以后A、B两组的神经功能改善程度无显著性差异。在电刺激后2至4周内C组神经功能评分虽然较刺激前有改善,但较A组、B组均差(P<0.05)。结论电刺激促进脑缺血后大鼠的肢体功能康复,神经症状学评分有明显改善,梗死灶周围头皮的电刺激治疗较肢体电刺激治疗改善程度好。脑梗死后早期进行电刺激治疗尤其是梗死灶周围头皮的电刺激治疗具有一定的治疗价值。     

肌电图仪在周围神经损伤手术中的临床应用

目的探讨肌电图仪在周围神经损伤手术中应用电刺激促进神经再生的监测作用。方法对23例周围神经损伤实施松解手术的患者于术中进行超强电刺激,在肌电图仪的持续监测下分析相应神经在刺激前后的电学变化。结果①电刺激后臂丛神经损伤和尺神经损伤复合肌肉动作电位的潜伏期较刺激前明显缩短,变化有统计学意义(P<0.05)。②电刺激后臂丛神经损伤、正中神经损伤、桡神经损伤的复合肌肉动作电位波幅明显高于刺激前,变化有统计意义(P<0.05)。结论肌电图仪在术中监测到对连续性尚存的损伤神经施行超强电刺激,能有效促进周围神经再生及神经功能恢复。     

光刺激对视觉功能区的^18F-FDG再分布的影响

目的研究光刺激和时间延迟因素对脑的视觉功能区^18F-FDG代谢影响。方法应用PET/CT对21例正常人脑行^18F-FDG PET显像,注射后1h按有无光刺激分成二组,并于注射后2h后分别再次采集脑部图像,分析光刺激和时间延迟因素是否会引起^18F-FDG在脑内的再分布。结果在给予光刺激后,大脑的布劳德曼（Brodmann）17、18、19分区、中枕回、楔叶及舌回区域对称性代谢增高,而在丘脑、前连合、胼胝体、尾状核及海马部位则对称性降低。在未受光线视觉刺激研究组,早期相和延迟相未见视觉传导通路上脑区代谢变化。结论^18F-FDG在引入体内后,如果未有光线刺激,其视觉功能区的代谢分布尚可保持相对稳定;反之,光线刺激可引起^18F-FDG在脑内的再分布及视觉功能区的代谢变化。     

北京博爱医院采用经颅磁刺激治疗技术取得较好效果

本刊讯中国康复研究中心北京博爱医院神经康复中心开展经颅磁刺激治疗,在脑卒中后康复,治疗颅脑损伤后遗留的语言、认知、运动、情绪等方面的功能障碍治疗中均取得较好的效果。经颅磁刺激治疗是通过经颅磁刺激方式,对大脑皮层进行着一种无创无痛的安全刺激的治疗方法,是一种绿色治     

An Enzyme-Linked Immunosorbent Assay (ELISA) for Quantitation of Adducts of Granulocyte–Macrophage Colony Stimulating Factor (GM-CSF) and Human Serum Albumin (HSA) in Stressed Solution Mixtures

HPLC analyses of GM-CSF in solution mixtures containing both GM-CSF and HSA showed losses of GM-CSF which could not be accounted for using conventional electrophoretic and/or RP-HPLC techniques. Further investigation of these mixtures by immunoblotting and by immunoaffinity chromatography demonstrated the presence of high molecular weight (>67,000) GM-CSF related species. No such species was detectable in solutions of GM-CSF alone. This experiment pointed to the formation of an adduct between GM-CSF and HSA in the solution mixtures. To probe further the hypothesis of a GM-CSF/HSA adduct, an immunologically based test was conceived which could react only with this type of hybrid molecule. A sandwich enzyme-linked immunosorbent assay (ELISA) was developed using two antibodies, anti-GM-CSF (capture antibody) and anti-HSA (detection antibody), as part of the quantitation of GM-CSF/HSA adducts. After confirming its existence by ELISA, a GM-CSF/HSA adduct was isolated from the solution mixture containing both GM-CSF and HSA. This isolate served as a primary reference standard in the ELISA assay. The immunoassay has a subnanogram sensitivity and is highly specific for GM-CSF/HSA adducts in the presence of either free GM-CSF or free HSA. As a verification, conjugates of GM-CSF/HSA were synthesized using a cross-linking reagent. These covalent conjugates reacted positively in the ELISA and are employed as a convenient alternative reference standard.     

Characterization of Poly(glycolide-co-D,L-lactide)/Poly(D,L-lactide) Microspheres for Controlled Release of GM-CSF

Purpose. This study describes the preparation and characterization of a controlled release formulation of granulocyte-macrophage colony-stimulating factor (GM-CSF) encapsulated in poly(glycolide-co-D,L-lactide) (PLGA) and poly(D,L-lactide) (PLA) microspheres. Methods. GM-CSF was encapsulated in PLGA/PLA microspheres by a novel silicone oil based phase separation process. Several different blends of PLGA and low molecular weight PLA were used to prepare the microspheres. The microspheres and the encapsulated GM-CSF were extensively characterized both in vitroand in vivo. Results. Steady release of GM-CSF was achieved over a period of about one week without significant 'burst' of protein from the microspheres. Analysis of microsphere degradation kinetics by gel permeation chromatography (GPC) indicated that low molecular weight PLA enhanced the degradation of the PLGA and thereby affected release kinetics. GM-CSF released from the microspheres was found to be biologically active and physically intact by bioassay and chromato-graphic analysis. Analysis of serum from mice receiving huGM-CSF indicated that the GM-CSF was biologically active and that a concentration of greater than 10 ng/mL was maintained for a period lasting at least nine days. MuGM-CSF was not detected followingin vivo administration of muGM-CSF microspheres. The tissues of mice receiving muGM-CSF microspheres were characterized by infiltration of neutrophils, and macrophages which were in significant excess of those found in mice administered with placebo controls (i.e. microspheres without GM-CSF). Conclusions. This study demonstrates the influence of formulation parameters on the encapsulation of GM-CSF in PLGA/PLA microspheres and its controlled release in biologically active form. The intense local tissue reaction in mice to muGM-CSF microspheres demonstrates the importance of the mode of delivery on the pharmacologic activity of GM-CSF.     

环孢菌素A对三种淋巴因子生物活性及其基因表达的影响

环孢菌素A抑制了用ConA和PMA在体外诱导小鼠脾淋巴细胞分泌的白细胞介素2、白细胞介素3和粒细胞巨噬细胞集落刺激因子,这种抑制作用与这些淋巴因子的信使核糖核酸的基因表述受到抑制有关。     

Role of hematopoietic microenvironment in prolonged impairment of B cell regeneration in age-related stromal-cell-impaired SAMP1 mouse: effects of a single dose of 5-fluorouracil

In this study, we examined the age-associated defect of stromal cells, which support B cell development, treated with 5-fluorouracil (5-FU) to induce severe perturbation of hematopoiesis, including B lymphocyte development, using SAMP1 mice exhibiting senescence-mimicking stromal-cell impairment after 30 weeks of age. Significant findings of this study are as follows: first, a marked and prolonged decrease in number of CFU-preB cells in non-SCI mice (58% of the steady-state level) associated with more markedly depressed number of CFU-preB cells in SCI mice (20% of the steady-state level), despite the absence of difference in the number of CFU-GMs during the period; second, in the non-SCI mice, a significant and prolonged up-regulation of GM-CSF and IL-6, positive regulators of myelopoiesis and suppressive factors of B lymphopoiesis, was observed. In SCI mice, greater and prolonged suppression of B lymphopoiesis was clearly demonstrated by the significant up-regulation of the negative regulator TNF-alpha associated with the concomitant marked down-regulation of the positive regulator SDF-1, although the increases of GM-CSF and IL-6 were limited. That is, 'negative complementation' makes preB recovery after 5-FU treatment impaired and prolonged. Principal component analysis clearly showed differences in the cytokine expression patterns in both early and later phases and the time course of the expression pattern of each cytokine between SCI and non-SCI mice without supervising information. An impaired regulation of the expressions of not only positive but also negative regulators after 5-FU treatment was, in part, the cause of the impaired regeneration of CFU-preB cells in SCI mice.     

用夹心酶联免疫法研究hGM-CSF在大鼠体内的药物代谢动力学

用灵敏的夹心酶联免疫法(ELISA)建立了检测重组人hGM-CSF药代动力学的方法。此方法hGM-CSF在12.5～0.39ngml^-1范围内,检测呈线性相关。最低检测灵敏度为0.4ngml^-1。本方法不受血清中潜在干扰因素的影响,检测具高度特异性。大鼠schGM-CSF50,100,200μgkg^-1后15min,血中即有较高浓度的hGM-CSF,1h左右达峰浓度,以后快速下降。皮下给药,尿中可检测到原型hGM-CSF,但累积排泄率较低。本研究为临床合理用药提供依据。     

粒细胞巨噬细胞刺激因子联合全肺灌洗对特发性肺泡蛋白沉积症的疗效和安全性

目的 观察粒细胞巨噬细胞刺激因子（GM-CSF）联合全肺灌洗治疗特发性肺泡蛋白沉积症（IPAP）的疗效和安全性。方法 选取2015年8月至2017年3月在第二军医大学附属长海医院就诊的2例IPAP患者,经全肺灌洗后,分别予皮下注射和雾化吸入GM-CSF治疗,观察其疗效和安全性。结果 2例患者经GM-CSF联合全肺灌洗治疗,病情缓解。结论 GM-CSF联合全肺灌洗治疗对IPAP患者治疗有效、用药安全。     

Meta-analysis: the adjuvant role of granulocyte macrophage-colony stimulating factor on immunological response to hepatitis B virus vaccine in end-stage renal disease

BACKGROUND: Chronic dialysis patients often fail to produce protective antibodies to hepatitis B virus surface antigen after vaccination towards hepatitis B virus (HBV). Several authors suggested a benefit for granulocyte macrophage-colony stimulating factor (GM-CSF) as an adjuvant to HBV vaccination in patients with end-stage renal disease (ESRD). However, consistent information is still lacking. AIMS: To evaluate efficacy and safety of GM-CSF as adjuvant to hepatitis B vaccine in patients with ESRD by performing a systematic review with a meta-analysis of prospective controlled clinical trials (CCTs). METHODS: Only trials comparing the seroresponse rate in study (GM-CSF plus HBV vaccine) versus control (HBV vaccine alone) patients were included. We used the random effects model of DerSimonian and Laird, with heterogeneity and sensitivity analyses. The end-point of interest was the rate of patients showing seroprotective anti-hepatitis B titers at completion of HBV vaccine schedule in study versus control groups. RESULTS: We identified seven studies involving 187 unique patients with ESRD. Only prospective CCTs were included. Pooling of study results showed a significant increase in response rates among study (GM-CSF plus HBV vaccine) versus control (HBV vaccine alone) patients (pooled Odds Ratio, 4.63 [95% Confidence Intervals, 1.42; 15.14]). The P-value was 0.02 for our test of study heterogeneity. CONCLUSIONS: Our meta-analysis showed improved seroprotection rates with HBV vaccine after GM-CSF administration.     

Effects of a formulary change from granulocyte colony-stimulating factor to granulocyte-macrophage colony-stimulating factor on outcomes in patients treated with myelosuppressive chemotherapy

STUDY OBJECTIVE: To evaluate the effects on efficacy and safety of a formulary change from granulocyte colony-stimulating factor (G-CSF) to granulocyte-macrophage CSF (GM-CSF). DESIGN: Retrospective chart review. SETTING: Single-center academic institution. PATIENTS: Fifty-six patients aged 18 years or older with breast cancer, lung cancer, melanoma, Hodgkin's lymphoma, or non-Hodgkin's lymphoma who developed neutropenia within 4 weeks after treatment with myelosuppressive chemotherapy and who had been given five or more doses of CSF as primary or secondary prophylaxis from January 1995-March 2002. Twenty-nine patients treated before January 2000 were given G-CSF; after the formulary change in January 2000, 27 patients were primarily given GM-CSF. MEASUREMENTS AND MAIN RESULTS: The primary efficacy end point was time to an absolute neutrophil count of 1.5x10(3)/mm3 or greater after treatment with CSF. Second and third efficacy end points, respectively, were frequency of febrile neutropenia and effect of CSF treatment on schedule and dose intensity of subsequent chemotherapy cycles. Primary and secondary safety end points, respectively, were frequency of adverse events and use of resources used to manage these events. The time to neutrophil recovery was similar with G-CSF and GM-CSF. Febrile neutropenia was more common in the patients given GM-CSF. Chemotherapy dose delays also were more common in patients treated with GM-CSF, as was the frequency of fever. Use of resources (platelet and red blood cell transfusions, intravenous antibiotics, and hospitalizations) was greater in the patients treated with GM-CSF. CONCLUSION: The formulary change to GM-CSF was associated with a higher frequency of febrile neutropenia, resultant chemotherapy dose delays, more adverse events, and greater use of resources to manage the adverse events. These results suggest that G-CSF and GM-CSF are not therapeutically equivalent, with G-CSF having a superior safety and efficacy profile for the prevention of chemotherapy-induced neutropenic events.     

多抗甲素对脐血树突状细胞体外扩增、成熟的影响

目的观察多抗甲素(polyactin A,PA)对脐血树突状细胞(dendritic cell,DC)体外扩增、成熟的影响。方法分别用加有PA、GM-CSF+TNF-α+IL-4(GTI)及GTI+PA(GTIP)的RPMI-1640培养液体外诱导培养脐血单核细胞,培养d7,Elivision免疫组化方法检测各组细胞CD1a、CD83、HLA-DR、CD34抗原表达情况,透射电镜观察细胞形态。结果PA组、GTI组及GTIP组均有一定数量的典型DC,电镜观察该细胞表面有大量粗细不等的树枝状突起;PA组CD1a+、CD83+细胞比例分别达19·63%±3·61%、14·52%±5·79%,高于对照组(即单纯培养液组);GTIP组CD1a+细胞比例升高最明显,高于GTI组。结论PA不仅能促进脐血DC体外扩增、成熟,还能协同GM-CSF、TNF-α、IL-4促进DC生成,PA是一种实用的DC活化剂。     

Morphologic Evidence of Anti-Tumor Specificity of T Cells Activated by Denritic Cells Derived from Peripheral Blood Mononuclear Cells of Thyroid Cancer Patients

Recent studies suggest that immunization with autologous dendritic cells (DCs) results in protective immunity and rejection of established tumors in various human malignancies. The purpose of this study is to determine whether DCs are generated from peripheral blood mononuclear cells (PBMNs) by using cytokines such as F1t-3 ligand (FL), granulocyte macrophage-colony stimulating factor (GM-CSF), IL-4, and TNF-α, and whether cytotoxic T cells activated against the thyroid cancer tissues by the DCs. Peripheral blood was obtained from 2 patients with thyroid cancer. DCs were established from PBMNs by culturing in the presence of FL, GM-CSF, IL-4, and TNF-α for 14 days. At day 14, the differentiated DCs was analyzed morphologically. The immunophenotypic features of DCs such as CDla, CD83, and CD86 were analyzed by immunofluorelescence microscopy. At day 18, DCs and T cells were incubated with thyroid cancer tissues or normal thyroid tissues for additional 4 days, respectively. DCs generated from the PBMNs showed the typical morphology of DCs. Activated cytotoxic T lymphocytes (CTLs) were observed also. DCs and the CTLs were attached to the cancer tissues on scanning electron microscope. The DCs activated the CTLs, which able to specifically attack the thyroid cancer. This study provides morphologic evidence that the coculture of T cells/cancer tissues activated the T cells and differentiated CTLs. The CTLs tightly adhered to cancer tissues and lysed cancer tissues vigorously. Therefore DCs could be used as potential vaccines in the immunotherapy.