自体外周血干细胞移植物中单个核细胞计数与CD34+细胞的相关性

目的探讨自体外周血干细胞移植物中的单个核细胞(MNC)计数和CD34+细胞计数之间的关系. 方法行自体外周血干细胞移植(APBSCT)的患者16例,采用化疗联合粒细胞集落刺激因子(G-CSF)或粒单细胞集落刺激因子(GM-CSF)动员,用血细胞分离机进行外周血MNC分离,对每份采集物计数MNC和流式细胞仪计数CD34+细胞,进行直线相关分析. 结果 16例患者的MNC为0.10×108～2.62×108/kg,CD34+细胞为0.50×106～35.25×106/kg,移植物中的MNC计数和CD34+细胞计数呈正相关(r=0.694,P<0.001). 结论 MNC计数和CD34+细胞计数均能可靠预测自体外周血干细胞移植后的造血重建.     

儿童外周血造血干细胞采集方法与效果评价

目的:探讨儿童外周血造血干细胞(PBSC)的采集方法,并对采集效果进行评价。方法:患者采用化疗和G-CSF或GM-CSF动员,异体供者用G-CSF动员,待WBC数回升至>5.0×109/L,应用CS-3000 Plus、COM TEC和COBE Spectra 3种血细胞分离机进行PBSC采集,设定循环血量为总血容量(TBV)的2～3倍,对于体重<20 kg,红细胞压积(HCT)<24%或者TBV≤1 100～1 650 ml的小儿,须采用经25 Gyγ射线照射的同型少白细胞红细胞预注管路和低流速分离(全血流速一般为10～30 ml/min)。用流式细胞仪检测所采集干细胞的CD34+细胞数,并计数单个核细胞(MNC)数。分析采集细胞中CD34+细胞数与采前MNC数量及采集循环血量的关系。结果:使用CS-3000 Plus血细胞分离机成功采集10例,COBE Spectra血细胞分离机成功采集18例,COMTEC血细胞分离机成功采集3例。采集次数为1～5次,平均1.5次,获得CD34+细胞数(7.9±2.9)×106/kg,MNC数(7.4±3.1)×108/kg。相关性分析显示,所采集到的CD34+数量和采集前MNC数、采集的循环血量呈正相关(r2=0.6229,P<0.0001;r2=0.1905,P=0.0141)。结论:根据儿童患者/供者的体重、TBV、动员情况和循环血量等因素选择合适采集方法,经过1～2次单采都可以安全地采集到高浓度的、能满足临床需要的PBSC。     

健康供者外周血造血干细胞动员的临床研究

目的:探讨造血生长因子(HGFs)对健康供者外周血干细胞(PBSC)的动员作用,并比较粒细胞集落刺激因子(G-CSF)单用及G-CSF联合粒-巨噬细胞集落刺激因子(GM-CSF)的动员效果.方法:52例健康供者分成G-CSF单用组(34例)及与GM-CSF合用组(18例),分别采用G-CSF(5 μg·kg-1·d-1)及G-CSF(3 μg·kg-1·d-1)+GM-CSF(2 μg·kg-1·d-1),连续皮下注射5～6 d动员,采集PBSC.动员前后动态检测外周血及采集物MNC、CD34+细胞、CFU-GM计数.52例血液病患者接受上述供体动员之PBSC并行异基因PBSC移植(Allo-PBSCT).结果:动员后CD34+细胞及CFU-GM分别较动员前增加10.83及8.7倍,并在第5～6天达到高峰;G-CSF单用及与GM-CSF合用均可有效动员CD34+细胞和CFU-GM,但合用较单用更有效(P<0.05);所有患者接受Allo-PBSCT后均满意获得造血重建;随访观察至今应用HGFs对健康供者无明显不良反应.结论:采用中小剂量G-CSF单用和与GM-CSF合用均能安全、有效动员健康供者PBSC,但以合用更为有效.     

单次大容量采集自体外周血干细胞行APBSCT治疗恶性淋巴瘤

目的:探讨恶性淋巴瘤患者自体外周血干细胞(PBSC)的单次大容量采集方法及其效果。方法:根据7 例恶性淋巴瘤患者动员后外周血的单个核细胞数(MNC)、分离采集过程中收集的干细胞混悬液的混浊程度及病人的状况,采用Cobe-Spectra血细胞分离仪按患者全血容量(TBV)的3个循环单次分离并采集外周血的干祖细胞,计数MNC及CD34+胞数,冻存10-14 d后行自体外周血干细胞移植(APBSCT)术,观察造血重建的情况。结果:7例患者单次大容量采集到的MNC及CD34+平均细胞数分别为7.25×108/kg和5.57×106/kg,采集过程中有1例患者出现较重的肢端及口唇麻木感,余6例均无其他明显不适,采集顺利。行APBSCT术后中性粒细胞≥0.5×109/L及血小板≥20×109/L的平均天数分别为+8.9 d和+8.7 d。结论:部分恶性淋巴瘤患者可单次大容量采集到足够量的干祖细胞,且采集过程是安全的,行APBSCT术后造血重建迅速。     

粒细胞集落刺激因子动员正常供者外周血造血干细胞研究

目的:探讨粒细胞集落刺激因子(G-CSF)动员正常供者外周血造血干细胞的效果、影响因素及不良反应。方法:对20例造血干细胞正常供者采用中位剂量G-CSF10.9μg/(kg·d)皮下注射3～5天后,使用COBESpectra血细胞分离机采集外周血干细胞。采用流式细胞仪检测采集物中CD34 细胞数。结果:第一次采集的单个核细胞(MNC,个)及CD34 细胞量(个)分别为(1.12～13.06,中位数3.10)×108/kg供者体重及(1.14～10.42,中位数3.8)×106/kg供者体重。MNC及CD34 细胞采集总量分别为(2.21～13.60,中位数5.80)×108/kg受者体重及(2.30～14.00,中位数6.40)×106/kg受者体重,均达到移植要求。男性CD34 细胞总量显著高于女性。不良反应较为轻微。供者年龄、体重、G-CSF剂量、采集前白细胞数等与采集所得MNC及CD34 细胞量无明显相关性。结论:G-CSF作为正常供者动员剂安全有效。     

低体重患者外周血干细胞的动员和采集

目的　探讨动员和采集低体重患者外周血干细胞的方法和经验。方法　对 10例体重小于 30kg患者在经化疗 +生长因子方案动员后使用CS 30 0 0Plus血细胞分离机 (Baxter公司 )、专用SVCH分离夹并选择儿童单个核细胞收集程序进行外周血干细胞采集。结果　所有病例均采集成功 ,采集次数 2～ 4次 ,平均 2 3次 ,单个核细胞数 (MNC) :5 4 (3 6～ 7 8)× 10 8/kg ,CD34+ 细胞为 6 1(3 1～ 18 5 )× 10 6/kg,CFU GM为 3 3(1 6～ 5 1)× 10 5/kg ,台盼蓝拒染率 :98 5 %(97%～ 10 0 %) ,副作用小。结论　由于低体重患者自身的特殊性 ,外周血干细胞采集较正常人不同 ,为确保采集成功应选用专用器械和程序 ,做好采集前准备、控制血液总量、抗凝剂比例并积极处理并发症     

造血干细胞移植供者应用粒细胞集落刺激因子的研究

目的:探讨外周血造血干细胞移植(peripheral b lood stem cell transp lantation,PBSCT)供者应用粒细胞集落刺激因子(granu locyte colony stimu lating factor,G-CSF)后细胞成分的变化和药物对供者身体状况的近期影响。方法:对18例健康PB-SCT供者给予G-CSF 5~10μg/(kg.d)4~5 d,采集外周血单个核细胞进行检测,临床观察用药后出现的毒副反应。结果:①外周血白细胞在动员后4~5 d达峰值,动员后比动员前高7~14倍(P<0.01)。②细胞采集在动员后第4~5 d开始,两者单个核细胞(MNC)和CD34+细胞值之间无明显差异。③本组供者不同性别和体重间,MNC值有显著差异性。④主要毒副反应为骨痛和肌痛、乏力等,采集细胞过程中出现口唇、四肢麻木。结论:对PBSCT供者应用G-CSF 5~10μg/(kg.d),4~5d可有效动员MNC和CD34+细胞。供者对此剂量的毒副反应能够耐受。     

同胞供者经G—CSF动员后外周血干细胞与幼稚粒细胞关系的研究

目的：研究供者经粒细胞集落刺激因子（G-CSF）动员后,采集的外周血干细胞（PBSC）移植物中的幼稚粒细胞与CD34^ 细胞及单个核细胞（MNC）之间的相关性。方法：10例异基因外周血干细胞移植（allo-PBSCT)供者用G-CSF（仅2例用G-CSF GM-CSF）7.25-10ug.kg^-1.d^-1进行动员,于动员前及动员后,对外周血及收集的外周血干细胞（PBSC）收集物中幼稚粒细胞及CD34^ 细胞进行检测计数。结果：（1）动员后白细胞主数及细胞计数及幼稚粒细胞逐渐增加,至5天达高峰;（2）外周血MNC中幼稚粒细胞增加与CD34^ 细胞增加有较好的相关性;（3）经2次单采后供者血小板约降低60%,但一周后基本恢复正常,结论：G-CSF7.25-01ug.kg^-1.d^-1分两次皮下注射能有效动员PBSC;allo-PBSCT供者经G-CSF动员后,外周血MNC中幼稚粒细胞数结合可做为allo-PB-SCT的剂量阈标准。     

小剂量G-CSF联合GM-CSF动员外周血CD34+细胞

目的 探讨小剂量粒单巨噬细胞集落刺激因子(GM-CSF)联合粒细胞集落刺激因子(G-CSF)动员外周血干细胞的效率。方法 20例成人恶性血液病按统计学配对方法等分为2组。非霍奇金氏淋巴瘤(NHL)患者化疗方案为环磷酰胺2.0 g/d,静脉滴注,第1~2天,足叶乙甙0.2 g/d,静脉滴注,第1~3天;急性非淋巴细胞白血病(ANLL)患者用阿糖胞苷2.0 g/d,静脉滴注,第1~3天,足叶乙甙用法同NHL。当白细胞低于1.0×10⁹/L时研究组10例应用GM-CSF 2.5 μg/d·kg·b.w.联合G-CSF 2.5 μg/d·kg·b.w.;对照组单用G-CSF 5 μg/d·kg·b.w.,全部皮下注射5~6 d。白细胞5.0×10⁹/L以上时应用CS-3000 pluse分离外周血单个核细胞,流式细胞术计数CD34⁺细胞。结果 产品细胞分类计数单个核细胞占95%~99%,在研究组CD34⁺细胞平均采集9.4(8.4~10.2)×10⁶/kg·b.w.,CFU-GM 42.4(21.9~72.8)×10⁴/kg·b.w.,对照组平均采集CD34⁺细胞4.8(4.1~8.3)×10⁶/kg·b.w.,CFU-GM 28.1(7.1~60.2)×10⁴/kg·b.w.,2组差异显著(P<0.05)。副作用2组相似。结论 恶性血液病患者化疗后应用G-CSF联合GM-CSF动员CD34⁺细胞的效果优于单用G-CSF。     

粒细胞集落刺激因子动员外周血细胞成分组成分析

目的观察应用粒细胞刺激因子(G-CSF)刺激动员外周血细胞成分组成及其意义。方法对自体外周血造血干细胞(PBSC)移植患者及异体外周血造血干细胞(PBSC)移植供者,应用G-CSF动员,然后通过血细胞分离器循环分离采集富集的单个核细胞(mononuclear cell MNC)成分,进行涂片(薄片),瑞氏染色,显微镜下(10×100倍数)进行分类,计数100个WBC,取各类细胞的平均值。结果采集的细胞悬液MNC平均数为90.53%。分类检查:①淋巴细胞占最大比例,平均数为64.4%,主要为小淋巴细胞,细胞胞体小,核染色质凝聚或墨块状,未见核仁,胞浆极少或不清,无颗粒或数颗嗜天青颗粒。②单核细胞平均数为17.47%;比例居第2位,细胞胞体约为小淋巴细胞2~3倍,细胞圆形或不规则形、肿胀状;核质疏松、肿胀,不规则形、扭曲、折叠,易见花瓣样核,未见核仁,胞浆中等量,浅蓝色,可见少许非特异性颗粒;③分类中出现原始细胞,细胞比例低,0~20.5%之间,平均数为7.95%,细胞圆形,胞体与正常原始淋巴细胞、正常原始粒细胞相似,核圆形,核质细粒状均匀分布,核仁2~3个,胞浆少,核浆界线清楚,少数细胞可见数颗嗜天青颗粒。此外还可见到少数的各阶段粒细胞以及有核红细胞。流式细胞术分析CD34+细胞占3.08%。结论粒细胞刺激因子动员外周血MNC中以淋巴细胞、单核细胞为主,有一定数量的原始细胞,CD34+细胞比例较高。     

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.