肝癌mRNA致敏的DC对SCID荷瘤鼠的抑瘤作用

目的通过重建人肝癌PBL-SCID嵌合模型来观察mRNA致敏的树突状细胞疫苗（mRNA DC）在体内的抑瘤效应并探讨机制。方法采用人外周血淋巴细胞腹腔注射法建立Hu-PBL-SCID鼠模型,尾静脉分别注射mRNA DC疫苗、抗CD4^＋、CD8^＋＋mRNA DC、未致敏的树突状细胞（DC）。每周1次,共两次,然后接种2×10^6HepG-2cells,观察鼠成瘤率、成瘤潜伏期、肿瘤体积以及测定特异性CTL活性。结果ELISA法可检测到鼠血清中人IgG水平,Hu-PBL-SCID嵌合模型重建成功,各组小鼠间成瘤率无明显差异,但mRNA DC组成瘤潜伏期延长,肿瘤生长缓慢,2周后肿瘤体积明显小于抗CD4^＋、CD8^＋＋mRNA DC组、DC组和PBS组,差异有统计学意义（P〈0.05）,实验组脾淋巴细胞对HepG-2细胞有特异性杀伤效应,而对胃癌SGC-7901细胞则无杀伤活性。结论mRNA致敏的树突状细胞疫苗体内能诱导产生明显的抑瘤作用。     

甲基强的松龙联合丙种球蛋白治疗重症手足口病的疗效分析

目的：探讨甲基强的松龙联合丙种球蛋白治疗重症手足口病的临床疗效。方法回顾性分析重症手足口病患儿214例的临床资料,根据治疗方法分为常规治疗组与联合治疗组。联合治疗组在常规治疗的基础上给予足量、早期甲基强的松龙联合丙种球蛋白治疗。比较两组临床疗效。结果联合治疗组的临床疗效显著优于常规治疗组（P＜0.05）。联合治疗组体温恢复正常时间、皮疹消退时间、神经症状和肺炎表现消失时间、白细胞、血糖降至正常时间显著短于常规治疗组（P＜0.01）。结论早期、足量甲基强的松龙联合丙种免疫球蛋白治疗重症手足口病能够显著提高临床疗效,值得临床推广。     

Evidence that appearance of thymulin in plasma follows lymphoid chimerism and precedes development of immunity in patients with lethal combined immunodeficiency transplanted with T cell-depleted haploidentical marrow

Thymulin, a peptide secreted by human thymic epithelial cells, circulates in peripheral blood. Levels of plasma thymulin (FTS-Zn) activity were analyzed in 21 patients with lethal combined immunodeficiency disorders who were treated with transplantation of HLA-haplotype-mismatched parental bone marrow depleted of T cells by differential agglutination with soybean agglutinin and E-rosetting (SBA-E-BMT). Among these 21 infants, 15 were patients with severe combined immunodeficiency (SCID) and 6 had combined immunodeficiency (CID) with Omenn's syndrome or CID with T cell predominance (CIDTP). In contrast to normal infants who possess high levels of plasma thymulin activity, 20 of the 21 patients demonstrated undetectable or low plasma thymulin levels for their age at admission prior to transplantation. Following SBA-E-BMT, however, thymulin became detectable in the plasma of 17 of 18 evaluable patients and reached normal or near-normal levels between 21 and 125 days posttransplant. In patients in whom the timing of engraftment could be established by emergence of donor lymphocytes, thymulin appeared in the plasma at approximately the same time as lymphoid chimerism was detected, and in all patients who were engrafted and immunologically reconstituted, the increment in thymulin levels preceded development of immune functions. These studies support the concept that normal marrow-derived cells in the graft can provide a stimulus necessary for induction of thymic epithelial secretory function in patients with thymic dysplasia. Further, immunologic reconstitution in these patients was not seen following SBA-E-BMT unless and until recovery of thymus function had been observed.     

改良超滤联合常规超滤用于重症心脏瓣膜病患者瓣膜置换术的效果

目的 评价改良超滤联合常规超滤用于重症心脏瓣膜病患者瓣膜置换术的效果.方法 择期行瓣膜置换术的重症心脏瓣膜病患者108例,性别不限,年龄≥18岁,体重50～80kg,采用随机数字表法,将患者随机分为常规超滤绀(CUF组,n=56)和改良超滤联合常规超滤组(CMUF组,n=52).CMUF组于 CPB结束后行改良超滤,流世400 ml/min,超滤时间15～20 min.分别于诱导后(T1)、常规超滤开始(T2)、常规超滤结束(T3)、改良超滤开始(T4)、改良超滤结束(T5)、CPB结束后2 h(T6)、8h(T7)及24 h(T8)时采集动脉血样行血气分析,并测定血浆IL-6和IL-8浓度.计算T5-8时的氧合指数,并记录气道压.记录术中尿量、术后24 h尿量、胸腔引流量、术后呼吸机支持时间、术后血制品使用情况及ICU停留时间.结果 与CUF组比较,CMUF组T5,6时Hct升高,T7,8时氧合指数升高,术后呼吸机支持时间、术后24 h尿量、胸腔引流量和浓缩红细胞用量减少(P＜0.05)、血浆IL-6和IL-8浓度、气道压、术中尿量和ICU停留时间比较差异无统计学意义(P＞0.05).结论 改良超滤联合常规超滤可于重症心脏瓣膜病瓣膜置换术患者,改善术后脏器功能,减少异体输血.     

红光照射联合去腐生新膏治疗气虚血瘀型臁疮的临床效果

目的：观察应用红光照射治疗联合去腐生新膏外用治疗气虚血瘀型臁疮的临床疗效。方法：选取64例臁疮患者,中医证属气虚血瘀型,采用随机数字表法分为试验组和对照组,每组32例。两组入院后均行清创治疗,清创后两组均采用红光照射治疗,其中试验组配合外用去腐生新膏,对照组配合外用重组人碱性成纤维生长因子凝胶。比较治疗后两组患肢临床疗效(疼痛、肿胀、溃疡面积、溃疡深度、创面愈合率、愈合时间)、创面愈合相关因素[创面细菌阳性率、患肢经皮氧分压(tcpO₂)、皮肤不良反应率]、血清炎症及相关细胞因子[C反应蛋白(CRP)、白细胞介素(IL-6)、血管内皮生长因子(VEGF)]。结果：治疗后两组临床疗效指标(疼痛、肿胀、溃疡面积、溃疡深度、创面愈合率、愈合时间)及tcpO₂、CRP、IL-6、VEGF指标均较前改善。试验组治疗7 d后疼痛、肿胀缓解情况均优于对照组(P <0.05);治疗14 d后肿胀、CRP较对照组改善(P <0.05),溃疡面积、溃疡深度、tcpO₂、IL-6、VEGF较对照组明显改善(P <0.01)。...     

腹腔镜保守性手术联合药物治疗中重度子宫内膜异位症的临床疗效分析

目的探讨腹腔镜保守性手术联合药物治疗中重度子宫内膜异位症(EMs)的临床效果。方法回顾性分析2013年1月至2016年1月就诊于盛京医院妇科、行腹腔镜保守性手术治疗的中重度EMs患者420例的临床资料。根据术后用药不同分为GnRH-a组(A组,271例)和孕三烯酮组(B组,149例);其中EMs相关性不孕症患者共166例,按照术后用药分为两个亚组:A1组(使用GnRH-a,107例),B1组(使用孕三烯酮,59例)。术后随访2年,比较各组术后临床症状改善情况,及不孕症患者的妊娠结局。结果 (1)术后3个月临床疗效评估,A组治疗总有效率显著高于B组(89.2%vs.70.7%,P0.001),但随访期间A、B两组术后复发率(13.1%vs.12.9%)及药物不良反应发生率(10.4%vs.12.1%)比较均无显著性差异(P0.05)。(2)166例EMs相关不孕症患者中,A1组术后自然妊娠率显著高于B1组(44.9%vs.28.8%,P0.05),但两组间总妊娠率(67.3%vs.52.5%)无显著性差异(P0.05),两组间异位妊娠率、流产率、早产率、足月产率、剖宫产率、自然分娩率比较亦无显著性差异(均P0.05);统计不同时间段内妊娠例数,停药后6个月内A1组妊娠率显著高于B1组(43.9%vs.27.1%,P0.05)。(3)经Spearman秩相关分析,EMs相关不孕症患者术后妊娠率与生育指数评分(EFI)呈正相关(rs=0.714,P0.05)。结论中重度EMs患者行腹腔镜保守性手术后联合药物治疗可改善临床治疗效果,改善自然妊娠率,且GnRH-a的临床疗效优于孕三烯酮。     

Hepatitis B virus immunization with an adjuvant containing vaccine after liver transplantation for hepatitis B-related disease: failure of humoral and cellular immune response

Long-term hepatitis B reinfection prophylaxis after liver transplantation with hepatitis B immunoglobulin (HBIG) and nucleoside analogues is expensive and inconvenient. Studies evaluating humoral immune responses to hepatitis B virus (HBV) vaccines showed conflicting results. Best results were achieved under continuous HBIG administration with an adjuvant-containing HBsAg vaccine. In the present study, 8 patients who had been HBsAg positive and HBV DNA negative prior to liver transplantation were immunized with HBsAg-vaccine containing the adjuvant 3-deacylated monophosphoryl-lipid-A. Vaccination was started after discontinuation of HBIG. Six vaccinations were administered at weeks 0, 2, 4, 12, 16 and 24. Humoral (anti-HBs titres) and cellular (enzyme-linked immunospot assay and fluorescence-activated cell sorting analysis) immune responses were studied. Only one of eight patients responded with a humoral immune response (maximum anti-HBs titre 561 U/l). In this patient, decrease of anti-HBs titre before vaccination was significantly slower than in the other seven patients and anti-HBs did not become negative before first vaccination. A T-cell response to HBsAg could not be detected in any of the patients. The responder was the only patient who showed a T-cell response to HBcAg. In conclusion, the adjuvant-containing vaccine did not induce a humoral or a detectable cellular immune response in most patients. Patient-related preconditions and concomitant HBIG administration should be further investigated as possible predictors for response.     

异维A酸联合复方多黏菌素B软膏治疗中重度痤疮的疗效观察

目的：探讨异维A酸联合复方多黏菌素B软膏治疗中重度痤疮的临床效果。方法选择中重度痤疮患者60例为研究对象,随机分为研究组和对照组各30例,研究组联合异维A酸和复方多黏菌素B软膏治疗,对照组单用异维A酸治疗,比较两组患者的临床治疗效果。结果研究组总效率显著高于对照组（P＜0.01）,平均起效时间短于对照组（P＜0.01）。结论异维A酸联合复方多粘菌素B软膏治疗中重度痤疮具有较好的临床疗效,并且起效快,不良反应少,值得临床推广。     

Sudden death due to disease flare with luteinizing hormone-releasing hormone agonist therapy for carcinoma of the prostate

Luteinizing hormone-releasing hormone agonist therapy for prostate cancer is a new method of management for metastatic disease. During the initial 1 to 2-week period of administration an increase in serum testosterone concentration can lead to an exacerbation of clinical symptoms (flare phenomenon). Two patients are summarized who received luteinizing hormone-releasing hormone agonist therapy without flare blockade and died suddenly during month 1 of therapy. A review of 765 patients in 9 series found 10.9% who suffered disease flare and 15 who died during disease flare. Of these 17 patients 12 were similar to our 2. These data suggest that any patient placed on luteinizing hormone-releasing hormone agonist therapy for prostate cancer merits some form of flare blockade during the initial 1 or 2 months of therapy.     

第1 跖趾关节融合术治疗中重度足拇外翻合并第1 跖趾关节炎

目的 探讨第1 跖趾关节融合术治疗中重度足拇外翻合并第1 跖趾关节炎的临床疗效.方法 2016 年6 月至2018 年9 月北京中医药大学第三附属医院采用第 1 跖趾关节融合术治疗中重度足拇外翻合并第 1 跖趾关节炎患者26 例.手术前后于足负重位X线片上测量足拇外翻角(HVA)和第1 、2 跖骨间角(IMA),采用疼...     

Risk factors for hospital death of patients with end-stage renal disease without previous diagnosis of severe chronic renal failure arriving in an emergency situation at the hospital

OBJECTIVES: Many end stage renal disease (ESRD) patients get their first nephrologic care under critical clinical conditions and without previous diagnosis of chronic renal failure (CRF), a situation even worse than the late referral of CRF patients for nephrologic treatment. Data on these "nonreferred" patients are scarce. The objectives of this study were to assess clinical and laboratory features, the reasons for coming to the hospital and the factors associated with death in nonreferred ESRD patients first seen by a nephrologist in an emergency situation. METHODS: Retrospective study (April 1996-March 2000) using the medical records of patients diagnosed with ESRD at the nephrologic emergency visit in a university tertiary hospital. Clinical and laboratory parameters were reviewed. Patients were divided into two groups according to hospital outcome: survivors or nonsurvivors. RESULTS: There were 414 patients (12% of all nephrologic emergency visits), aged 49 +/- 17 years, 266 males (64%) and 208 (55%) hypertensive. Mortality rate was 13.7% (54/393). When compared to nonsurvivors were older, used mechanical ventilation and vasoactive drugs more frequently, presented higher infection rate, and showed lower plasma creatinine. Multivariate logistic regression showed as factors independently associated with death: first nephrologic visit at intensive care unit, infection as cause for seeking medical care, and increasing age. Plasma creatinine above 10 mg/dL was a protective factor for death. CONCLUSIONS: ESRD patients reaching dialysis in a nephrologic emergency situation presented high hospital mortality, which was mostly associated with their poor clinical condition at admission.     

Separation of the immune response genes for LDH-B and MOPC-173. III. Evidence that the failure of B10.BASR1 to respond to LDH-B is due to an antigen-presenting cell defect

Analysis of the immune response of a panel of intra-I-region recombinant mouse strains to LDH-B and MOPC-173 demonstrated that B10.ASR7 (H-2as3) and B10.BASR1 (H-2as4) failed to mount T-cell-proliferative responses to MOPC-173 and LDH-B, respectively. To localize the level of the immune response defect in the B10.BASR1 strain, B10.BASR1 macrophages were shown to be incapable of presenting LDH-B to immune responder B10.ASR7 T cells. These results were confirmed using alloreactivity-depleted and (B10.ASR7 X B10.BASR1)F1 immune T cells. Failure of these strains to respond was shown not to be the result of T cell suppression, because cyclophosphamide and anti-Lyt-2.2-plus-complement treatments did not restore responsiveness. Furthermore, B10.BASR1 macrophages were incapable of educating naive responder T cells in vitro to LDH-B--however, naive nonresponder B10.BASR1 T cells could be educated by responder macrophages to LDH-B in vitro. These results suggest that the failure of B10.BASR1 to respond to LDH-B reflects a defect at the macrophage-T cell interaction level, perhaps related to expression of unique I-A molecules created by intra-I-region recombinatorial events.     

Intravenous iron without erythropoietin for the treatment of iron deficiency anemia in patients with moderate to severe congestive heart failure and chronic kidney insufficiency

OBJECTIVES: Iron deficiency anemia is a frequent finding in many patients with congestive heart failure (CHF). The purpose of this study was to assess the effect of intravenous (i.v.) iron on the anemia of CHF patients and on cardiac remodeling, New York Heart Association (NYHA) classification and renal function. METHODS: Thirty-two patients with well-treated CHF which was NYHA class III-IV, and with hemoglobin (Hb) persistently <11 g/dL, were treated with i.v. iron over 26 weeks. Echocardiographic, hematological and renal parameters were measured at the beginning and end of the study. RESULTS: Hb increased significantly from 10.7 +/- 0.4 g/dL to 13.7 +/- 0.4 g/dL and from 9.4 +/- 0.6 g/dL to 12.7+/- 0.8 g/dL in the NYHA III and IV groups respectively. Posterior wall thickness, septal thickness (ST), left ventricular (LV) end diastolic volume and diameter, LV end systolic volume and diameter, LV mass index and LV ejection fraction (LVEF) were all abnormal initially. All of these parameters improved significantly in the NYHA III patients, and all but ST and LVEF improved significantly in the NYHA IV patients. NYHA classification improved from III to II in 9 of 19 NYHA III patients (47.4%) (p<0.01) but did not improve in any of the 13 NYHA IV patients. CONCLUSION: Intravenous iron causes a marked increase in hemoglobin in anemic CHF patients, and this is frequently associated with an improvement in cardiac remodeling and NYHA classification.     

A simple post hoc transformation that improves the metric properties of the BBB scale for rats with moderate to severe spinal cord injury

The Basso, Beattie, Bresnahan (BBB) open field locomotor scale is a popular measure of functional recovery following spinal cord injury (SCI). To examine the metric properties of the scale, we performed detailed analyses of BBB scores from 643 rats with moderate and severe SCI (12.5, 25, or 50 mm MASCIS) from two different laboratories. The analyses revealed that the BBB scale is ordinal in the most frequently used portion of the scale. Higher scores (14 and greater) were not frequently assigned in the dataset as animals with mild injuries were not sampled, making the ordinal nature of the upper end of the scale difficult to assess. The rare scores assigned in this range disproportionately increased variance. Under these conditions collapsing scores above 14 into one category increased effect size. Analysis of the lower region of the scale revealed that some scores (2 and 3) were rarely assigned, implying a discontinuity in the scale. The discontinuous nature of the lower portion of the scale presents a problem for both parametric and nonparametric statistical analyses. Pooling scores 2/3/4 eliminated the gap, enhancing the metric properties of the scale. Under the injury conditions evaluated, the transformation helped assure that the data were continuous and ordered. Further, interval durations were comparable across the entire range of the transformed scale, allowing application of parametric statistical techniques. The transformation should be applied in a post hoc fashion to reduce variability and increase power in cases where few scores fall in upper portion of the scale.     

Surgical management of peripheral vascular disease in patients with severe coronary artery disease: importance of operative concept to reconstruct catheter insertion route for PTCA or CABG

We discussed the operative concept of revascularization of lower extremities in patients associated with severe, coronary artery disease (CAD). Those with symptomatic CAD may undergo coronary artery bypass (CABG) or percutaneous coronary angioplasty (PTCA) with or without intraaortic balloon pump (IABP). Special attention should be paid during operation in these patients in order to reconstruct the arterial catheter route, which gives us the best way to percutaneous transfemoral approach to the aorta or the coronary arteries. One should not choose arbitrarily extra-anatomical bypass, such as axillo-femoral or femorofemoral, in these cases. Also, artificial graft should not be applied in the common femoral arteries, which will make percutaneous approach difficult. Common femoral arteries, if needed, are best reconstructed by means of thromboendarterectomy. Attaining smooth, bilateral aorto-ilio-femoral continuity is the main goal of revascularization of lower extremities in patients with CAD.     

术中置入左心房导管用于合并中重度肺动脉高压患儿先天性心脏病修复术后管理的效果

目的 评价术中置入左心房导管用于合并中重度肺动脉高压患儿先天性心脏病修复术后管理的效果.方法 择期CPB下行心脏修复术的先天性心脏病合并中重度肺动脉高压患儿60例,性别不限,年龄9个月～14岁,ASA分级Ⅲ或Ⅳ级,采用随机数字表法,将其随机分为2组(n=30):中心静脉置管组(C组)和左心房置管组(L组).全麻诱导后2组置入三腔中心静脉导管.L组经右颈内静脉置入单腔中心静脉导管,术中由术者经房间隔或卵圆孔置入左心房用于术后左心房压力(LAP)监测及血管活性药给药,术后维持LAP 8～ 12 mm Hg.记录机械通气时间和ICU停留时间.记录术后48 h内多巴胺、多巴酚丁胺、硝普钠、米力农、前列地尔的用量.结果 与C组比较,L组术后多巴胺、多巴酚丁胺、米力农、硝普钠、前列地尔用量减少,机械通气时间和ICU停留时间缩短(P＜0.05).结论 左心房导管监测LAP不仅可指导合理用药,还可提高治疗效果,优化合并中重度肺动脉高压患儿先天性心脏病修复术后管理的效果.