急性髓细胞白血病骨髓有核细胞的TGF－β mRNA，TNF－αmRNA表达

急性髓细胞白血病骨髓有核细胞的ＴＧＦ－β　ｍＲＮＡ，ＴＮＦ－αｍＲＮＡ表达吴克复，宋玉华，马小彤，郑国光，孔祥银，李牧，邱录贵，孟庆祥近年来研究表明：β－转化生长因子（ＴＧＦ－β）是造血前体细胞的重要生理性负调节因子￣［１］。它不仅以旁分泌（Ｐａｒａ...     

白血病细胞系来源的树突状细胞诱导及其抗肿瘤免疫功能研究

树突状细胞（DC）在抗肿瘤免疫反应中起关键作用，但大多数白血病病病人有DC功能缺陷，在外体扩增DC并增强其抗肿瘤免疫功能及以DC为基础的肿瘤疫苗是对白血病有效的免疫治疗方法，为了探讨由不同的髓性白血病细胞诱生DC的条件及其抗白血病反应，选用HL－60，K562和THP－1细胞与不同的细胞因子组合诱生DC，以光学和电子显微镜术观察形态特征，用流式细胞术和单克隆抗体检测细胞表型，以同种混合淋巴细胞反应观察刺激淋巴细胞增殖，用^51Cr释放法检测诱生细胞的细胞术和单克隆抗体检测细胞表型，以同种混合淋巴细胞反应观察刺激淋巴细胞增殖，用^51Cr释放法检测诱生细胞的细胞毒作用，用ELISA法测定DC培养及DC＋血单个核细胞培养的血清中IL－12及INF－γ的量，结果表明，由K562，HL－60和THP－1细胞诱生的DC具有村突状细胞的形太学特征，细胞表达DC的表面分化抗原，其中GM－CSF＋IL－4＋TNF-γ刺激HL－60－DC和THP－DC和GMCSF＋IL－4＋IL－12刺激的K562－DC中有抗原表达。3种细胞诱生的DC对混合淋巴细胞反应CTL反应有强刺激细胞因子能诱导髓性白细胞产生DC，不同细胞需要不同的细胞因子和培养条件，这些DC表达抗原呈递细胞的表型具有刺激T淋巴细胞增殖和诱导CTL反应以及分泌IL－2和促进T细胞分泌INF－γ的作用。     

双歧杆菌对裸鼠腹腔巨噬细胞产生细胞毒性效应分子的影响

目的 了解青春型双歧杆菌刺激裸鼠腹腔巨噬细胞后产生的IL－6、IL－12及TNF－α的水平。方法 以青春型双歧杆菌注射于裸鼠腹腔，体外获取腹腔巨噬细胞，分别滴加兔抗鼠IL－6、IL－12及TNF-α单抗，然后以FITC标羊抗兔IgG孵育，最后用激光共聚焦显微镜测定巨噬细胞发出的荧光强度。结果 双歧杆菌注射组裸鼠腹腔巨噬细胞产生的IL－6、IL－12及TNF－α水平均显高于对照组（P＜0．01）。结论 青春型双歧杆菌能激活巨噬细胞，使之分泌多量的IL－6、IL－12及TNF－α。     

以柏-查综合征为首发症状的急性淋巴细胞白血病一例

以柏－查综合征为首发症状的急性淋巴细胞白血病一例叶宝国游慧萍赖亚栋柏－查（Ｂｕｄｄ－Ｃｈｉａｒｉ）综合征又称肝静脉阻塞综合征，多为血栓形成所致。以柏－查综合征为首发症状的急性淋巴细胞白血病（ＡＬＬ）较罕见。患者，男，１８岁。以右上腹痛、巩膜发黄３周，...     

血管细胞粘附分子—1与骨髓基质细胞

血管细胞粘附分子－1（vascular cell adhesion molecule1,VCAM-1）是一种重要的细胞粘附分子，VCAM－1与VLA－4结合后导致构型改变，都成为高亲和力的粘附分子，处于活化状态，能使造血干细胞的迁移、归巢、定居和分化等功能。在病理条件或受辐射的VCAM－1无论是表达还是功能都有很大的变化。     

霍奇金病R—S细胞分型诊断意义的探讨

目的 探讨Ｒ－Ｓ细胞谱系对霍奇金病（ＨＤ）的诊断意义。方法 观察并分析了７１例ＨＤ的Ｒ－Ｓ细胞分类。结果 未见单一类型Ｒ－Ｓ细胞出现，其中出现２种类型为７．１％，３种１８。３％，４种３５．２％，５种３３．８％，６种５．６％。以单核型Ｒ－Ｓ细胞最为多见（９３．０％），其次为多形型（８６．０％）。结论 以诊断型Ｒ－Ｓ细胞为代表系列Ｒ－Ｓ细胞的出现是ＨＤ诊断要点。     

用CTLL—2细胞测定白细胞介素—2的实验观察

我们探讨了CTLL－2细胞的增殖特性，倍增周期，传代时间以及各种来 源IL－2饲养CTLL－2的条件，在此基础上进一步探讨了^H-TdR参入，^125I-UdR参入和MTT酶显色反应等方法在测定CTLL－2细胞对IL－2的增殖反应中的优缺点，同时建立了CTLL－2细胞冻存方法和其它IL－2反应细胞测定IL－2的方法以弥补CTLL－2细胞饲养中的困难，对IL－2活性测定中的单位计算方法进行了探讨。     

以柏—查二氏综合征为首发症状的急性淋巴细胞白血病1例

以柏－查二氏综合征为首发症状的急性淋巴细胞白血病１例叶宝国游慧萍赖亚栋作者单位：３６３０００漳州市医院柏－查（Ｂｕｄｄ－Ｃｈｉａｒｉ）二氏综合征又称肝静脉阻塞综合征，多为血栓形成所引起，临床罕见，以柏－查二氏综合征为首发症状的急性淋巴细胞白血病更罕见...     

人GM-CSF基因转染小鼠肝癌细胞及其致瘤性研究

为建立以腺病毒为载体的GM－CSF基因转染瘤苗，并研究其体内抗肿瘤作用，应用携带有人GM－CSF基因的重组腺病毒（R－Ad5）载体转染BALB／c小鼠肝癌细胞株（H22），体外应用酶联免疫吸附试验（ELISA法）．检测GM－CSF表达水平，以GM—CSF基因转染的H22细胞进行致癌性研究。结果：（1）重组腺病毒载体能成功地介导GM－CSF基因转染H22细胞并能持续有效表达26～31天，瘤苗的辐照处理并不明显影响GM－CSF表达水平。（2）GM－CSF基因转染瘤苗体内致癌性显著降低。该结果揭示了应用GM－CSF基因转来瘤苗进行肿瘤基因治疗的可行性，为进一步研究肿瘤的GM－CSF基因治疗提供了依据．     

皮肤肿瘤中凋亡细胞与增殖细胞的检测

本文以末端标记法检测调亡细胞，以Ki-67及bcl－2、P53免疫组化法，对105例外科切除皮肤肿瘤标本进行观察，并计算其凋亡指数及增殖指数，分析其与不同类型皮肤肿瘤（基底细胞癌、鳞癌与Meck-el氏癌）的关系。皮肤肿瘤中凋亡细胞与增殖细胞的检测     

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.