The basic indices of cellular immunity in surgery for rheumatic heart defects]

Distinct changes of basic indicators of cellular immunity were diagnosed in 157 patients with rheumatic heart disease which needed surgical correction. A classification of disturbances of cellular immunity is proposed. A definite correlation between the degree of cellular immunity disturbances and basic clinical parameters of the rheumatic heart disease was followed as well as the influence of the immunological changes on the prognosis of operation results and the outcome of the disease.     

Disorders of immunity in infectious-toxic shock in patients with peritonitis

An analysis of results of the investigation of immunity in 46 patients with the infective-toxic shock (ITS) developed against the background of diffuse peritonitis is presented. The data obtained evidence substantial changes of the cell and humoral immunity in ITS which allows to speak about the development of the secondary immune deficient state in the patient. The degree of depression of immunity is dependent on severity of the process, it being more pronounced in hypodynamic ITS.     

Trained immunity and inflammation in rheumatic diseases

BackgroundRheumatic diseases include a variety of autoimmune and autoinflammatory conditions that are characterised by musculoskeletal involvement and systemic disease. Both innate and adaptive immunity can contribute to the complex inflammatory processes that take part in the pathogenesis of these debilitating disorders.FindingsOver the past decade, studies have led to a paradigm-shift around the concept of immune memory, generating the knowledge that cells of the innate immune system can develop a de facto memory mediated by epigenetic reprograming and metabolic changes (trained immunity).Here we provide an overview of current data that describe features of trained immunity in rheumatic diseases. We link evidence on inflammatory mediators and cytokine production, immunometabolism and epigenetic regulation of immunological programs, and outline the fact that trained immunity could play mechanistic roles in rheumatic diseases such as gout, rheumatoid arthritis, systemic lupus erythematosus or systemic sclerosis.ConclusionThis review describes recent findings in several important rheumatic disorders and emphasizes changes in the functional program of innate immune cells that are reminiscent of a trained immune phenotype. Further assessment of trained immunity in rheumatic disease can provide targetable mechanisms that could potentially alter the disease symptomatology and evolution.     

Delayed-type hypersensitivity skin reaction in the chronically uremic mouse: influence of severity and duration of uremia on the development of response

A technique of delayed-type hypersensitivity (DTH) skin reaction to a contact sensitizing agent, oxazolone, was used to assess the effects of uremia on cell-mediated immunity in chronically uremic mice and, for comparison, sham-operated and normal controls. The first objective was to establish that DTH responses are reduced in animals with renal failure. To do this, mice were made uremic by a combination of electrocoagulation of the entire surface of one kidney and subsequent contralateral nephrectomy; studies included biochemical and hematological evaluation using blood urea nitrogen level and hemoglobin concentration as routine indices to assess the degree and consequence of uremia, respectively. The second objective was to apply the technique to observe and compare changes during uremic states of varying severity and duration. A modest, although significant, decrease in both the induction and maintenance of DTH responses was observed in the mice with severe renal failure only (BUN above 100 mg/dl). This immunosuppressive effect was manifest early and persisted unchanged throughout the entire observation period (3-9 weeks). This study presents new evidence that severe uremia readily produces in the mouse sustained, albeit mild, changes in cell-mediated immunity. Furthermore the ability to elicit DTH skin reaction in the chronically uremic mouse offers a versatile system for studying changes in cell-mediated immunity occurring during uremia with a broad range of potential applicability.     

An analysis of the immunity indices of patients with indurative diseases of the head of the pancreas

Based on an analysis of dynamics of immunity indices the authors have revealed differences in the character of their changes in nontumoral and tumoral diseases and in relation to the stage of the malignant process. The optimal minimum of indices of the immunity status in indurative diseases of the pancreas head is proposed which is of significance for differential diagnosis and determination of resectability of the tumor.     

高强度聚焦超声对21例中晚期原发性肝癌病人免疫状态的影响

目的　探讨高强度聚焦超声 (highintensityfocusedultrasound ,HIFU)对原发性肝癌(hepatocellularcarcinoma,HCC)病人机体免疫状态的影响。 方法　采用重庆海扶技术有限公司研制的HIFU系统 ,治疗中晚期HCC病人 2 1例。分别在治疗前和治疗后 3、7、14、2 1d抽取病人外周静脉血 ,检测细胞免疫和体液免疫的相关指标。HIFU治疗后又行癌灶切除的病例 ,对标本进行光学显微镜、电子显微镜观察。结果　光学显微镜、电子显微镜观察结果显示 ,HIFU治疗区内癌组织发生了不可逆性损伤。CD4治疗前 (34± 13)后 (3、7、14及 2 1d分别为 4 0± 7,37± 7,39± 9,37± 7)差异无显著意义 (F =0 89,P >0 0 5 ) ;其他细胞免疫指标 (CD3 ,CD8,CD4/CD8,CD16)以及体液免疫指标(IgG ,IgA ,IgM ,C3 )治疗前后间的差异亦均无显著意义。结论　HIFU能有效地破坏HCC组织。HIFU治疗中晚期HCC病人难以明显改善机体的免疫状态 ,此时若配合免疫治疗等手段 ,有望使病人获得更好的预后。     

Criteria of immunotherapy application and its efficacy control in postoperative purulent-inflammatory complications

In 136 patients with surgical diseases the dynamics of the immunity indices and cytological changes of the wound discharge after the operation were studied up. Twenty practically healthy persons had constituted the control group. The most informative immunogram indices, which may be used for the postoperative complications occurrence prognosis, were determined. The results of investigations of the cytological changes in the wound are reflecting the immunoinflammatory reaction adequacy and serve as criterion for the immunotherapy administration substantiation in its efficacy control.     

Indicators of humoral immunity in the surgical treatment of toxic goiter

Changes in the content of gammaglobulins, immunoglobulins of all classes, and circulating immune complexes were revealed in 70 patients with toxic goiter given thyrostatic therapy, which may be evidence of disturbed humoral immunity. These disorders were most manifest in unstable compensation of toxicosis and in patients with ophthalmopathy. In patients with developed postoperative toxic reactions no specific changes in the immune status were detected in the preoperative period and no regularities allowing the prognostication of the development of a toxic reaction were revealed. Essential changes in humoral immunity values did not occur on the eighth postoperative day.     

Natural host defense mechanisms.

Severe injury, whether the result of a major accident, a large burn, or a complicated surgical operation, often results in sepsis. Under such conditions both specific and nonspecific host defense systems are affected. The individual facets of major concern are chemotaxis, phagocytosis, intracellular killing, complement depletion, and depression of humoral and cellular mediated immunity. The most profound changes occur in cell-mediated immunity. Within a few hours o injury, the number of circulating T cells becomes depleted, concomitantly thoracic duct lymphocytes are markedly reduced. This change is not only quantitative but functional. The clinical impact of these deficient host defense mechanisms lies in the fact that low virulent organisms may become a lethal threat to the injured patient. Currently, investigators are attempting to reverse thse deficiencies through the use of immunotherapy.     

Changes in cellular immunity and nutritional status in mice after thermal injury

A 13 per cent body surface area (BSA), full skin thickness burn was inflicted on LACA male mice and the changes in cellular immunity and nutritional status were observed. The results showed that thymus, spleen and circulating lymphocytes were significantly involved. A diminished mitogen responsiveness of spleen cells and altered peritoneal macrophage function were confirmed. Ear swelling tests indicated that the cellular immunity of burned mice was most severely depressed in week 2 postburn. The present study also showed that the dramatic change in nutritional status occurred earlier than that in cellular immunity and suggested the importance of early nutritional support after thermal injury.     

Choice of methods of surgical treatment and postoperative period management in patients with duodenal ulcer complicated by hemorrhage during continuous influence of small radiation dosage]

Results of surgical treatment of duodenal ulcer, complicated by hemorrhage, in patients, who were exposed to the small doses of radiation influence, are unsatisfactory. General, local immunity were studied up, pH-metry of gastroduodenal zone was conducted, activity of Helicobacter pylori (HP) urease was determined in patients with duodenal ulcer, complicated by hemorrhage, who have been exposed for a long time to the small doses of radiation influence and who were not. In patients, who have been exposed to radiation influence, reduction of secretory immunoglobulin A (sIgA) in duodenal mucus was revealed. Conduction of the local immunity changes correction, performing organpreserving surgical intervention and using immunocorrecting therapy after the operation, are recommended for improvement of the surgical treatment results.     

Hemosorption in the complex therapy of severe forms of acute pneumonia and infectious destruction of the lungs

The article deals with the results of treatment of 60 patients with severe pneumonia and acute infectious destructions of the lungs. Hemosorption improved the results of treatment of patients with this pathological condition due to rapid recovery from the state of toxicosis, stimulation of immunity, and improvement of microcirculation. The dynamics of changes of the immunological values are discussed, the indications for conducting hemosorption in patients with severe pneumonia and infectious destructions of the lungs and the criteria of its efficacy are determined.     

Consequences of vasectomy: an immunological and histological study related to subsequent fertility

Studies of 2 groups of patients 2 years and 8 years following vasectomy failed to demonstrate evidence of cell mediated immunity to sperm. Histological examination of testicular tissue from 11 patients undergoing reversal of vasectomy showed significant abnormalities in each. However, subsequent fertility within 15 months occurred in 7 (63.6%) of these patients. The nature of the testicular changes and the possible aetiological factors are discussed.     

肝癌患者集束电极射频消融治疗前后T淋巴细胞及红细胞免疫功能的研究

目的　研究肝癌患者接受射频消融治疗前后机体T淋巴细胞及红细胞免疫功能的变化。方法　分析 12 0例肝细胞肝癌患者射频消融治疗前和治疗后 3d ,7d和 14d外周血淋巴细胞亚群(T 3 ,T 4,T 8,T4/T 8)和红细胞C 3b受体花环 (RBC C3bR )及免疫复合物花环 (RBC ICR )形成率。结果　所有肝癌患者在射频消融治疗后 7d和 14d ,T 3细胞 ,T 4细胞 ,T 4/T 8及RBC C 3bR ,RBC ICR形成率均明显高于治疗前 (P <0 .0 5 )。结论　采用射频消融治疗肝癌 ,可以改善患者的细胞免疫状态。     

The effect of intravenous hyperalimentation on cell mediated immunity

The effect of intravenous hyperalimentation (IVH) on cell mediated immunity was examined in 22 patients. Each patient received PHA and PPD skin tests before and after the performance of IVH. In this study both PHA and PPD skin reactivity showed significant increase after IVH, and serum albumin levels had positive correlation with the PPD skin reaction changes. Absence of the established delayed hypersensitivity in the surgical patient, especially those with malignant diseases, is probably secondary to generalized malnutrition, and established cell mediated immunity can be restored by proper nutritional repletion.     

肠内营养在腹部手术中的应用

目的　探讨肠内营养在腹部手术中的应用价值。方法　 30例接受腹部手术的患者 ,术后 2 4～ 2 8h开始实施肠内营养 ,观察营养指标和免疫功能的变化及与肠内营养的关系。结果　通过肠内营养 ,患者的体重、血红蛋白、血浆蛋白、前白蛋白、血清白蛋白均有不同程度的提高 ,其中血浆蛋白和前白蛋白上升最明显 (P <0 .0 5 ) ,营养前后免疫指标IgA ,IgG ,IgM ,淋巴细胞计数差异有显著意义 (P <0 .0 1) ,且无严重并发症的发生。结论　肠内营养能够显著改善腹部手术患者的营养状况 ,明显提高患者的免疫功能 ,有效保障肠粘膜屏障功能的稳定性 ,防止细菌移位 ,避免了因此而引起的严重并发症的发生     

The effect of intravenous hyperalimentation on cell mediated immunity.

The effect of intravenous hyperalimentation (IVH) on cell mediated immunity was examined in 22 patients. Each patient received PHA and PPD skin tests before and after the performance of IVH. In this study both PHA and PPD skin reactivity showed significant increase after IVH, and serum albumin levels had positive correlation with the PPD skin reaction changes. Absence of the established delayed hypersensitivity in the surgical patient, especially those with malignant diseases, is probably secondary to generalized malnutrition, and established cell mediated immunity can be restored by proper nutritional repletion.     

高强度聚焦超声治疗中晚期原发性肝癌对患者免疫状态的影响

目的 观察高强度聚焦超声（HIFU）治疗中晚期原发性肝癌对患者免疫状态的影响。方法 对2003年3月至2003年12月我院收治的40例原发性肝癌患者行HIFU治疗,对其治疗前后进行自身比较并与射频治疗组进行比较,观察分析原发性肝癌患者在接受HIFU治疗后的免疫指标（cD3、cD4、CD8、CD4／CD8、NK、IL-2、TNF）变化。结果 HIFU治疗组与射频治疗组3、6、9个月及1年生存率比较,差异无统计学意义;患者上述各项免疫指标于HIFU治疗前后相比较差异无统计学意义,与射频治疗组比较,差异亦无统计学意义。结论 HIFU治疗中晚期原发性肝癌对患者早期免疫状态的影响不明显。     

Ischemia–Reperfusion Injury Enhances Lymphatic Endothelial VEGFR3 and Rejection in Cardiac Allografts

Organ damage and innate immunity during heart transplantation may evoke adaptive immunity with serious consequences. Because lymphatic vessels bridge innate and adaptive immunity, they are critical in immune surveillance; however, their role in ischemia–reperfusion injury (IRI) in allotransplantation remains unknown. We investigated whether the lymphangiogenic VEGF‐C/VEGFR3 pathway during cardiac allograft IRI regulates organ damage and subsequent interplay between innate and adaptive immunity. We found that cardiac allograft IRI, within hours, increased graft VEGF‐C expression and lymphatic vessel activation in the form of increased lymphatic VEGFR3 and adhesion protein expression. Pharmacological VEGF‐C/VEGFR3 stimulation resulted in early lymphatic activation and later increase in allograft inflammation. In contrast, pharmacological VEGF‐C/VEGFR3 inhibition during cardiac allograft IRI decreased early lymphatic vessel activation with subsequent dampening of acute and chronic rejection. Genetic deletion of VEGFR3 specifically in the lymphatics of the transplanted heart recapitulated the survival effect achieved by pharmacological VEGF‐C/VEGFR3 inhibition. Our results suggest that tissue damage rapidly changes lymphatic vessel phenotype, which, in turn, may shape the interplay of innate and adaptive immunity. Importantly, VEGF‐C/VEGFR3 inhibition during solid organ transplant IRI could be used as lymphatic‐targeted immunomodulatory therapy to prevent acute and chronic rejection.     

Causes, prevention and treatment of postoperative hypothyroidism

Postoperative hypothyrosis was diagnozed in 76 (6.17%) out of 1231 patients operated upon for various diseases of the thyroid gland. Among causes of this complication the authors point to lymphoid infiltration of tissue and changes in autoimmune processes. Adequate operative methods, leaving sufficient quantity of the gland tissue with special reference to cellular and humoral immunity are considered as prophylactic measures. The treatment includes thyroid drugs used by a special scheme with addition of corticosteroids in autoimmune forms of thyroiditis.