新型宫颈癌治疗性疫苗肿瘤杀伤作用

目的研究新型治疗性疫苗NTV的体内外宫颈癌杀伤作用。方法采用51Cr释放法研究脾淋巴细胞对宫颈癌细胞TC-1的体外杀伤活性,将正常小鼠体内激活的免疫活性细胞输给荷瘤小鼠,采用过继性细胞毒性T淋巴细胞(CTL)转移实验研究CTL的体内抗肿瘤作用。结果 CTL杀伤实验设置的效应细胞与靶细胞数量比分别为3:1、10:1及30:1,51Cr释放分析结果显示,疫苗NTV能够显著诱导脾淋巴细胞的肿瘤特异性杀伤作用,杀伤作用呈剂量依赖性变化,杀伤效率最高可达到53.5%;疫苗NTV在过继性CTL转移实验中的肿瘤抑制率为64.7%,上述结果均与阴性对照组有统计学差异(P<0.05)。结论疫苗NTV在体内外对宫颈癌细胞均具有良好的杀伤作用。     

Oncol2012: 初始T细胞来源的效应细胞在荷B16黑色素瘤小鼠免疫治疗中的应用

背景：恶性肿瘤的过继性细胞移植免疫治疗已投入临床使用多年。如何提高效应细胞的杀伤能力,如肿瘤特异性细胞毒性T淋巴细胞(CTL),已经成为临床肿瘤免疫治疗的一个重要的努力方向。因此,我们探索了一种新的方法通过使用一定比例混合的CD4 、CD8 亚种群的初始T淋巴细胞来制备更有效的特异CTL并评价其肿瘤杀伤效率。 方法：实验使用荷B16恶性黑色素瘤的C57BL/6老鼠,并给予CTX腹腔注射进行预处理。分别评估CTX腹腔注射对肿瘤生长的影响情况及对肿瘤微环境的调节情况。应用磁珠分别阴性分选初始T细胞和总T细胞。在体外环境中检测并对比不同种T细胞的增殖能力以及细胞因子分泌水平。分别由初始T细胞（初始CD4 T：初始CD8 T=2:1）和总T细胞诱导分化得到肿瘤特异性细胞毒性T淋巴细胞。经CTX预处理的实验小鼠给予肿瘤特异性细胞毒性T淋巴细胞回输治疗,回输后检测效应细胞的归巢能力,检测肿瘤组织中IL-2、IFN-r、颗粒酶 B, 及穿孔素mRNA 水平,并测量肿瘤大小绘制生存曲线。 结果：CTX预处理组较对照组肿瘤生长情况无差异,但CTX预处理后较对照组可明显降低实验鼠脾脏中Treg细胞水平,以及血清中TGF-β1和IL-10 的水平（P＜0.05）。在体外初始T细胞较总T细胞表现出更强的增殖能力及细胞因子分泌能力（P＜0.05）。由初始T细胞诱导产生的效应细胞与由总T细胞诱导产生的效应细胞在归巢能力方面有显著差异（P＜0.05）,肿瘤组织中IL-2、IFN-r、颗粒酶 B 及穿孔素mRNA 水平存在显著差异（P＜0.05）。 结论：依据上述结果,我们认为由初始T细胞诱导产生的效应细胞拥有更强的增值能力、更强的归巢能力及细胞因子分泌水平,所以由初始T细胞诱导产生的效应细胞可以介导产生更强的抗肿瘤效应。     

肿瘤特异性过继T细胞免疫治疗技术进展

机体免疫功能在抗肿瘤中发挥重要作用。其中T细胞是抗肿瘤的主要效应细胞,细胞毒性T细胞可直接杀灭肿瘤细胞,辅助性T细胞具有免疫调节和辅助作用。肿瘤特异性过继T细胞免疫治疗技术是将患者的T细胞在体外进行扩增、激活或基因修饰后再回输,达到靶向性的杀灭体内肿瘤细胞的目的。其中,肿瘤浸润T细胞、树突状细胞介导T细胞及基因修饰T细胞是目前肿瘤过继细胞免疫治疗的主要技术,在肿瘤的治疗中取得了明显的效果,亦获得一定的研究进展。     

CIK细胞治疗恶性肿瘤患者的护理体会

细胞因子诱导的杀伤细胞（cytokine induced killer,CIK）细胞治疗是将患者自体或异体的抗瘤细胞过继输入体内的一种疗法．患者自体的抗瘤细胞往往抗瘤能力差,需要在体外进行扩增和强化而达到一定的数量和一定的抗瘤活性,再回输到病人体内达到增强病人抵抗肿瘤转移和杀灭肿瘤细胞的目的．CIK细胞过继性免疫治疗方法能改善患者全身状况,抑制肿瘤细胞生长和病毒的繁殖,提高生活质量和延长生存时间,减轻患者痛苦,治疗上相关反应小,使用方便,患者易接受．昆明医科大学附属延安医院自2007年开展自体CIK细胞静脉回输治疗218例恶性肿瘤患者,取得良好效果,现将护理体会报告如下.     

CD4+与CD25+调节性T细胞对直肠癌过继免疫治疗效应细胞的影响

①目的 探讨CD4+与CD25+调节性T细胞(Treg)在直肠癌过继免疫治疗中对免疫杀伤细胞的负性调节作用.②方法 利用流式细胞仪分别检测15例直肠癌患者和健康志愿者外周血中CD4+与CD25+调节性T细胞的含量;同时观察各实验组CTL对肿瘤细胞的杀伤效应.③结果 直肠癌患者外周血中CD4+与CD25+调节性T细胞占CD4+T细胞总数的(11.12±0.57)%,显著高于健康对照组的(8.77±0.66)%(t=2.687,P=0.012);去除Tmg细胞后诱导产生的抗原特异性CTL对靶细胞的杀伤效率为(33.74±4.42)%,显著高于未去除Treg细胞的对照组CTL的杀伤效率(17.39±2.54)%(t=3.206,P=0.0034).④结论 直肠癌患者外周血中调节性T细胞含量明显增高,并且时肿瘤抗原诱导的CTL的免疫杀伤功能具有明显抑制作用.     

微波消融联合过继免疫治疗肝癌的临床研究

目的观察微波消融联合树突状细胞疫苗及效应细胞过继免疫治疗肝癌的安全性,研究联合治疗对患者外周血淋巴亚群百分比的影响。方法 10例肝癌(D≤5 cm,≤3个病灶)并乙肝后肝硬化患者接受微波消融联合多种免疫细胞过继治疗纳入联合组,24例符合相同纳入标准的单纯微波治疗患者纳入微波组。免疫治疗3个疗程,分别于微波治疗日、微波治疗11 d后和第100天时开始进行,从患者外周血分离培养树突状细胞(DC)和效应细胞并经表型检测证实。在超声造影引导下,将未成熟DC、细胞因子诱导的杀伤细胞(CIK)和细胞毒性T细胞(CTL)回输到肝内消融区与充血带交界区。在超声引导下,将肿瘤抗原致敏的成熟DC回输到腹股沟淋巴结内,将DC-CIK和CTL回输到右上腹腹腔内。CIK细胞经静脉回输。治疗前及治疗后进行外周血淋巴细胞亚群及细胞因子检测。结果联合组54次细胞回输未出现Ⅱ级以上严重不良反应,随访1年临床及生化指标观察未发现心肺肝肾神经系统毒性及自身免疫反应。联合治疗后1个月,患者外周血CD8+CD28+淋巴细胞亚群百分比较治疗前升高,且显著高于微波组;CD8+CD28-效应细胞亚群百分比较治疗前显著升高;CD4+CD25highTreg细胞百分比较治疗前显著降低并显著低于微波组;CD4+/CD8+比值较治疗前降低并显著低于微波组。联合治疗后6个月时各指标均有回落,仅CD8+CD28+百分比及CD4+/CD8+比值较治疗前及微波组仍有显著差异。讨论微波消融联合树突状细胞和效应细胞过继免疫治疗肝癌是安全的,改善了机体免疫状态,其对临床疗效的影响尚需大样本随机试验长时间随访观察。     

NK、T混合淋巴细胞与顺铂联合对乳腺癌MDA-MB-231细胞株体外杀伤研究

目的：探讨利用荧光染料CFSE标记法及MTT法,观察人NK、T混合淋巴细胞（NKTm）体外杀伤MDA-MB-231肿瘤株的效果。方法：应用CFSE/PI染色法及MTT法标记人乳腺癌MDA-MB-231肿瘤株,观察NKT细胞联合顺铂在各种时序下对乳腺癌MDA-MB-231肿瘤株的杀伤效果。结果：CFSE染色条件下,人NKTm细胞体外对MDA-MB-231细胞效靶比E/T=25：1时较E/T=12.5：1时杀伤率明显升高;E/T=12.5：1时杀伤率略低于顺铂;先加入NKTm各组随与顺铂间隔时间的延长而杀伤率升高（以上P均〈0.05）。结论：NKTm细胞对MDA-MB-231肿瘤细胞的直接杀伤作用强,同顺铂联用时要提高对肿瘤细胞的杀伤率应先给予NKTm细胞后应用顺铂。     

联合应用NK细胞及CTL对黑色素瘤B16细胞的影响

目的探讨联合应用自然杀伤(NK)细胞及细胞毒T细胞(CTL)对黑色素瘤B16细胞的作用。方法提取NK细胞及CTL,分别用白细胞介素-2(IL-2)(6 000、600IU/L)及植物血凝素(8μg/mL)活化,流式细胞仪检测细胞表面受体,将NK细胞及CTL互为靶细胞及效应细胞进行细胞毒性实验;以黑色素瘤B16细胞为靶细胞检测CTL的杀伤率。结果 NK细胞表面受体NK1.1+的百分比在87%以上,NKp46+在90%以上;CTL表面受体CD3+的百分比在99%以上,CD8+在98%以上。NK细胞与CTL相互无细胞毒性,联合应用NK细胞与CTL明显增加对黑色素瘤B16细胞的杀伤作用。结论联合应用NK细胞及CTL对黑色素瘤B16细胞有协同杀伤作用。     

DC-CIK细胞免疫治疗应用

目的:研究DC-CIK在肿瘤中的应用,为DC-CIK的制备及临床细胞治疗技术探索便捷、高效和经济可行的方案。结果:树突状细胞(dendritic cells,DC)和细胞因子诱导的杀伤细胞(Cytokine-induced killer cells,CIK)联合过继性免疫治疗因其具有高效的杀瘤活性,被认为是目前最有前途的肿瘤免疫治疗手段之一。DC与CIK共培养,构成了一个体外活化免疫体系,回输后能够有效地抵抗癌细胞对免疫细胞的抑制作用,发挥更持久的杀瘤活性,是主动特异性免疫治疗和过继免疫治疗相结合的典范。然而作为一个新的治疗手段,DC-CIK过继免疫治疗的方案和标准尚待进一步规范和统一。不良反应、应用时机、给药途径和方法等问题亦需要深入探讨。结论:DC-CIK已应用于多种恶性肿瘤的细胞免疫治疗中,众多研究表明在应用DC-CIK细胞免疫治疗后明显的延长了患者生存期、提高生存质量、并减少了肿瘤的复发和转移。随着DC-CIK过继性免疫治疗技术的不断改进和完善,DC-CIK必将成为新一代过继细胞免疫治疗的最佳方法之一。     

CD4+CD25+调节性T细胞对直肠癌过继免疫治疗效应细胞的影响和作用

目的 探讨CD4+CD25+调节性T细胞（Treg）在直肠癌过继免疫治疗中对免疫杀伤细胞的负性调节作用。方法 利用流式细胞仪分别检测15例直肠癌患者和健康志愿者外周血中CD4+CD25+调节性T细胞的含量;分离提取直肠癌患者外周血CD4+T细胞,免疫磁珠法去除 CD4+CD25+调节性T细胞,同灭活的LOVO直肠癌细胞珠共培养并扩增为肿瘤抗原特异性CTL,以LOVO细胞为靶细胞行肿瘤杀伤实验,观察各实验组CTL对肿瘤细胞的杀伤效应。结果 直肠癌患者外周血中CD4+CD25+调节性T细胞占CD4+T细胞总数的（11.12±0.57）%,显著高于健康对照组（8.77±0.66）%（t=2.687,P＝0.012）;去除Treg细胞后诱导产生的抗原特异性CTL对靶细胞的杀伤效率为（33.74±4.42）%,显著高于未去除Treg细胞的对照组CTL的杀伤效率[(17.39±2.54)%; t=3.206, P=0.0034]。结论　直肠癌患者外周血中调节性T细胞含量明显增高,并且对肿瘤抗原诱导的CTL的免疫杀伤功能具有明显抑制作用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.