人多药耐药基因-1及二氢叶酸还原酶基因共转导小鼠造血细胞

耐药基因转导骨髓细胞对化疗病人造血系统的保护作用已受到人们的重视.本研究利用多药耐药基因-1(mdr-1)及二氢叶酸还原酶(dhfr)双基因转染小鼠骨髓细胞,观察造血细胞对两种耐药谱化疗药物的抵抗能力.结果表明,所用逆转录病毒载体转染率达到15%左右,转基因骨髓细胞CFU-GM对taxo1及MTX的耐药能力明显增强,说明外源基因在造血祖细胞中的正确表达;转基因骨髓细胞回输给同系小鼠7个月后,FCM技术仍可检测到外周血白细胞gp170的表达,且其基因组DNA中可检测到mdr-1及dhfr基因特异序列,表明两种基因可能已稳定整合至造血干/祖细胞中.上述结果为以骨髓细胞为靶体的耐药基因治疗提供了有用的实验室资料.     

原代骨髓基质细胞层对逆转录病毒载体介导的造血干/祖细胞基因转导的支持效应

为探讨建立原代骨髓基质细胞层的方法并观察基质接触对造血干／祖细胞(HSC／HPC)基因转移的影响，采用Ficoll—Hypaque分离成人骨髓单个核细胞(MNC)，用基质细胞培养液培养，传代4次以建立原代骨髓基质细胞层。将经细胞因子预刺激的造血干／祖细胞接种到经辐照处理的基质细胞层上，进行逆转录病毒介导的多药耐药基因(mdr1)转导，以半固体集落培养和聚合酶锭反应法(PCR)检测长春新碱(VCR)抗性集落数和mdr1基因扩增片段以测定转导效率。结果表明：原代骨髓基质细胞培养传代4—6周形成混合贴壁细胞层，主要由成纤维细胞组成。集落法和PCR法检测显示基质接触能提高骨髓造血干／祖细胞基因转导效率2.1—3.3倍，对逆转录病毒介导的造血干／祖细胞基因转导具有明显的支持效应。结论：基质细胞接触联合细胞因子作用可提高逆转录病毒介导的造血干／祖细胞基因转导效率。     

急性髓细胞白血病P_(170)和CD_(34)表达与多药耐药关系分析

多药耐药(MDR)是急性白病化疗失败的主要原因,其机制较复杂,而由多药耐药基因(mdr-1)编码的P_(170)的过度表达所介导的耐药是主要的途径。CD_(34)抗原是目前公认表达于干细胞或造血祖细胞的一种分化抗原,急性髓细胞白血病(AML)患者白血病细胞CD_(34)抗原表达明显增加,且与化疗效果负相关。为探讨P_(170)和CD_(34_)两种不同的膜蛋白在白血病临床耐药中的作用和相互联系,我们应用免疫细胞化学APAAP法检测了急性白血病P_(170)和CD_(34),结果分析如下。 1 材料和方法 1.1 检测对象:47例AML患者均为我所初治     

内部核糖体进入位点介导多药耐药基因1在人CD34^＋细胞中的表达

为了达到双耐药基因共转染以拓宽造血细胞耐药谱的目的,初步观察了内部核糖体进入位点(IRES)介导多药耐药基因1(MDR1)在人早期造血细胞中的表达效率.由脑心肌炎病毒IRES调控MDR1基因翻译的双耐药基因逆转录病毒载体pSF-DIM和相同启动子调控的MDR1单耐药基因逆转录病毒载体pSF-MDR1,包装后获得的双嗜性包装细胞PA317/pSF-DIM和PA317/pSF-MDR1病毒滴度分别为8×104和1.3×105cfu/ml.用其上清感染人脐血CD34+细胞,经FCM检测表明基因转导后单基因转导组和双基因转导组P-gp表达均有提高,分别为28.82%(荧光强度25.49)和10.92%(荧光强度9.48),但单基因转导组高于双基因转导组.因此,IRES成功地介导了MDR1基因在人早期造血细胞中的表达,为后续的试验奠定了一定的基础.但是,双基因转导组和单基因转导组MDR1表达差异的原因还需进一步研究.     

多聚甲醛固定对流式细胞术检测人外周血白细胞P-糖蛋白表达的影响

多药耐药(multidrug resistance ,MDR)是影响肿瘤患者化疗效果的关键因素[1 2 ] 。MDR1基因编码的分子量为170 0 0 0的P 糖蛋白(P gp) ,可促使药物排出细胞而导致MDR。因此,P gp表达水平对肿瘤化疗效果及预后判断具有重要的指导作用。目前较多采用流式细胞术测定P gP ,所用单克     

双耐药基因导入脐血干／祖细胞降低联合化疗骨髓毒性作用的临床前研究

目的　探讨转染醛脱氢酶基因 (ALDH3)和多药耐药基因 (mdr 1)的人脐血CD3 4 细胞能否同时增强对活性环磷酰胺 (4 HC)和mdr 1基因靶药的抗性。方法　构建含ALDH3和mdr 1双耐药基因的逆转录病毒表达质粒G1Na ALDH3 IRES MDR1,经LipofectAMINE介导转染包装细胞 ,采用含 4 HC和长春新碱 (VCR)的培养基克隆选择后收集重组病毒上清于单向型GP E86与双嗜型PA317包装细胞行乒乓交互感染 ,将含ALDH3和mdr 1双耐药基因重组病毒的上清在细胞生长因子刺激下重复感染经免疫磁珠分离系统 (MACS)纯化后的人脐血CD3 4 细胞 ,用PCR、RT PCR、Southernblot、Northernblot、FACS和MTT等方法检测外源ALDH3与mdr 1基因在CD3 4 细胞中的转移和表达。结果　MACS分离纯化后的人脐血CD3 4 细胞纯度平均达 91% ,回收率为 72 % ,含双耐药基因重组病毒的上清最高滴度为 6 .5× 10 5CFU/ml,应用集落计数、PCR和FACS方法测定基因转导效率分别为 18.0 %、2 0 .0 %和16 7% ,未检测到辅助病毒存在 ,有P170功能的细胞占 16 0 % ,经双耐药基因修饰的脐血CD3 4 细胞对 4 HC的IC50 较对照组提高 3.5倍 ,对VCR和柔红霉素的IC50 较未转染细胞分别高 6 .8和 5 .5倍。结论　逆转录病毒载体介导双耐药基因转导脐血造血干 /祖细胞获高效共表     

提高多药耐药基因导入人CD_(34)~ 细胞转导效率的探讨

目的　探讨逆转录病毒介导的多药耐药基因 (mdr1)导入人CD34 细胞的影响因素 ,以提高基因转导效率。方法　用流式细胞术 (FCM)检测不同组合细胞因子及人骨髓基质细胞 细胞因子支持的基因转导效率 ;用造血祖细胞集落培养观察耐药性 ;用FCM检测不同浓度紫杉醇素对基因转导细胞的作用。结果　细胞因子SCF Flt配体 (FL) IL 3组合支持的基因转导效率高于其它组合 (SCF IL 6 IL 3,SCF IL 6 IL 3 Tpo ,SCF IL 3)。骨髓基质细胞 细胞因子 (SCF FL IL 3)支持的基因转导效率 (2 0 .5 % )又高于单纯用该组细胞因子的转导效率 (15 .2 % ) ,并且前者形成的抗性集落形成细胞数多于后者。在 10ng ml紫杉醇作用下基因转导CD34 细胞的阳性率可达 38.5 %。结论　骨髓基质细胞 细胞因子 (SCF FL IL 3)对基因转导有较强的促进作用 ;一定浓度的紫杉醇具有富集基因转导细胞的作用     

肺腺癌多药耐药基因的检测及临床应用研究

肿瘤细胞产主耐药性是肿瘤化疗难以取得预期效果的重要因素之一。在非P—gp(p糖蛋白)介导的肿瘤耐药细胞中，发现有多药耐药基因(MRD—1)的过度表达，我们检测了32例肺腺癌病人的外周血中MDR—1基因和多药耐药蛋白(P—170)的表达水平与临床耐药的相关性，现将结果报告如下。     

糖蛋白P及其介导的多药耐药及逆转策略

多药耐药（MDR）是肿瘤细胞对多种化疗药物产生抗药性的同时，对其它结构不同、靶位不同、作用方式不同的抗肿瘤药物产生交叉耐药性，是最重要、最常见的肿瘤耐药现象，肿瘤细胞对抗癌药物产生耐受性成为肿瘤化学治疗最大障碍之一。近年来研究发现肿瘤的多药耐药主要与一种分子量为170KD的跨膜糖蛋白P（P-gp）有关，由多药耐药基因1（MDR1）编码，本文将讨论有关P-gP及由其介导的肿瘤多药耐药的逆转策略的研究进展。     

多药耐药基因转染人骨髓间充质干细胞及对其化疗保护作用的实验研究

目的探讨逆转录病毒介导多药耐药基因（mdr1）体外转染人骨髓间充质干细胞（MSCs）能否提高其对化疗药物的耐受性。方法采用percon密度梯度离心法自骨髓中分离MSC并进行纯化和扩增；脂质体转染法将携带有mdr1基因的逆转录病毒载体导入293T包装细胞，获得的病毒上清感染MSC，流式细胞术测定mdr1基因编码产物P-糖蛋白（P-g170）的表达水平；罗丹明（Rh123）排泌试验检测P-g170的功能活性；MTT法测定转染MSC对化疗药物耐受性。结果mdr1基因导入骨髓MSC后稳定表达P-g170的阳性细胞百分率为33．9％，对照组为0．7％；Rh123排泌试验证实P-g170具有功能活性；转染MSC对多种化疗药物的耐受性明显强于未转染MSC。结论mdr1基因体外转染人骨髓MSC可明显提高MSC对多种化疗药物的耐受性，为有效提高大剂量化疗在肿瘤治疗中的应用提供了有力依据。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.