NBD多肽预处理的树突状细胞延长移植心存活时间的实验研究

目的 探讨NBD多肽预处理的供体源性树突状细胞(DC)在诱导心脏移植免疫耐受中的作用及可能机制.方法 体外培养供体源性BALB/c小鼠骨髓树突状细胞并以NBD多肽预处理(NBD多肽-DC,在小鼠心脏移植前7 d,将NBD多肽.DC输至受者C57BL/6小鼠体内.应用Cu-T建立小鼠颈部异位心脏移植模型,观察心脏移植物存活时间,病理分析检测排斥反应程度.混合淋巴细胞反应(MLR)测定受者脾脏T细胞对供者同种抗原的反应性,并用ELISA方法测定受者血清Thl型细胞因子(IFN-γ和IL-12)和Th2型细胞因子(IL-4和IL-10)水平的变化.结果 NBD多肽-DC可使移植心脏存活天数延长至(21.83±3.54)d,较PBS对照组的(6.66±1.21)d明显延长(P＜0.01),降低排斥反应病理分级(Stanford 1～2级),能诱导受者脾脏T细胞的抗原特异性低反应性,使受者小鼠血清INF-γ和IL-12水平显著降低(P＜0.01).而IL-4和IL-10水平明显升高(P＜0.01).结论 NBD多肽预处理的供体源性DC能够诱导针对移植供者产生的特异性免疫耐受现象,其机制可能与诱导受者T细胞的抗原特异性低反应性及Th1/Th2免疫偏移有关.     

雷帕霉素联合未成熟树突状细胞诱导小鼠皮肤移植免疫耐受

目的 研究雷帕霉素联合供者骨髓来源的未成熟树突状细胞在诱导小鼠同种异基因皮肤移植免疫耐受中的协同作用.方法 健康雄性C57BL/6小鼠和BALB/C小鼠分别为供者、受者,建立同种异基因皮肤移植模型.对照组术前术后未给予任何免疫干预措施;雷帕霉素组术后第0天至第6天给予雷帕霉素灌胃;未成熟树突状细胞组将供者骨髓来源的未成熟树突状细胞于术前第7天经尾静脉输注给受者;联合组将供者骨髓来源的未成熟树突状细胞于术前第7d经尾静脉输注给受者,并在术后第0天至第6天给予雷帕霉素灌胃.结果 对照组、雷帕霉素组、未成熟树突状细胞组、联合组的皮肤移植物存活时间分别为(6.9±1.9)、(12.3±3.0)、(17.0±3.4)、(20.8±3.6)d.方差分析提示组间差异有显著性意义(P<0.05);SNK检验提示各组之间的差异均有显著意义.结论 雷帕霉素能延长小鼠皮肤移植物的存活时间;联合供者骨髓来源的未成熟树突状细胞可延长免疫耐受的持续时间.     

N-乙酰半胱氨酸对负载主要组织相容性抗原的树突状细胞生物学特性的影响

目的研究N-乙酰半胱氨酸(NAC)对负载同种异基因MHC抗原的树突状细胞(DC)生物学特性的影响。方法用GM-CSF IL-4定向诱导BALB/c小鼠骨髓细胞分化为DC,观察在负载MHC抗原时加入NAC对DCI-Ad和CD86mRNA的表达和刺激T细胞增殖能力的影响,及其延长同种异基因小鼠皮肤移植物存活时间的效果。结果在NAC作用下,负载MHC抗原的DCI-Ad和CD86mRNA表达水平降低;经NAC处理后,负载MHC抗原的DC刺激T细胞增殖的能力降低;小鼠皮肤移植术前用经NAC处理的负载供者MHC抗原的DC注射到受者体内,可延长移植皮片存活时间。结论NAC可抑制同种异基因MHC抗原对DC的促成熟作用,有利于诱导小鼠皮肤移植免疫耐受。     

术前输注负载供者抗原的受者未成熟树突状细胞延长移植心存活时间的实验研究

目的:利用负载供者抗原的受者未成熟树突状细胞(imDC)干扰T细胞抗原间接识别途径,观察对同种异体移植心存活时间的影响。方法:用低剂量粒细胞-巨噬细胞集落刺激因子(GM-CSF)培养受者小鼠骨髓源性imDC,并在培养过程中加入供者可溶性抗原共同孵育,流式细胞术检测细胞表型,观察其在体外刺激自体T细胞增殖的能力,并于术前1周将约2.0×106个树突状细胞(DC)输入受者体内,观察其对同种异体移植心存活时间的影响。结果:受者DC可通过共同孵育的方式有效负载供者抗原,负载供者抗原的受者imDC在体外不能有效刺激自体T细胞活化增殖,将其于术前输入受者体内,移植心的存活时间由(7.2±1.7)天延长至(17.7±3.3)天。结论:术前输注负载供者抗原的受者imDC,可明显延长移植心的存活时间。     

转Fas配体基因的树突状细胞在诱导大鼠肝移植免疫耐受中的作用

目的:探讨受者体内注射转FasL基因的树突状细胞(DC)诱导大鼠肝移植免疫耐受的作用机制。方法:建立SD大鼠→Wistar大鼠肝移植模型,分别于术前5 d给受者腹腔注射转染多药耐药基因(mdrl)的DC细胞或转染FasL基因的DC细胞,并设空白对照组和环孢素A(CsA)对照组。术后3 d和7 d测定移植肝功能,同时以半定量逆转录聚合酶链反应(RT-PCR)检测移植肝组织中Fas、Fas配体(FasL)及白细胞介素12(IL-12),并观察受鼠的存活时间。结果:空白对照组的大鼠术后9～15 d全部死亡,CsA治疗组及转FasL基因治疗组的免疫排斥反应轻微,移植后大鼠的存活时间超过12周;空白对照组及转mdrl基因治疗组的丙氨酸转氨酶、天冬氨酸转氨酶、胆红素总量及直接胆红素显著高于CsA治疗组及转Fas[.基因治疗组;空白对照组及转mdrl基因治疗组的FasI。及IL-12表达增高,而CsA治疗组及转FasL基因治疗组的FasL及IL-2呈现不表达或低表达。结论:转染FasL基因的DC细胞能有效地诱导大鼠肝移植免疫耐受,其机理可能与诱导了肝脏内浸润淋巴细胞凋亡及抑制IL-12的表达有关。     

FasL基因修饰的树突状细胞的表型分析及其功能研究

目的研究FasL基因修饰后的树突状细胞（DC）的表型和功能的变化。方法以含小鼠FasL（mFasL）基因的重组真核表达载体转染小鼠骨髓来源的DC,FACS法检测DC表型的变化。将转染后DC与T细胞共同培养后,MTT法检测T细胞的增殖。Annexin V法检测T细胞凋亡。结果表型分析表明,FasL基因修饰的DC的CD80、CD86和MHCⅡ表达无变化。FasL基因修饰的DC能抑制T细胞的增殖,诱导T细胞发生凋亡。结论FasL基因转染的DC,其表型无明显变化,可抑制T细胞增殖,诱导T细胞凋亡。     

α-黑素细胞刺激素处理的树突状细胞对小鼠心脏移植物存活时间的影响

目的:观察α-黑素细胞刺激素(α-MSH)处理的小鼠骨髓来源的树突状细胞(DC)预防同种异基因小鼠心脏移植排斥反应的效果.方法:在供者BALB/c小鼠DC培养的过程中加入α-MSH,用流式细胞仪分析DC的表型变化,用ELISA方法检测培养上清中IL-12的分泌水平.在同种异基因心脏移植前,分别将α-MSH处理后7 d的 DC(α-MSH-DC)和正常培养7 d的 DC(Day7-DC)输至受者C57BL/6小鼠体内,并另设输入PBS的小鼠为对照组,通过颈部Cuff法小鼠异位心脏移植模型,观察心脏移植物存活时间,并用ELISA方法测定受者血清细胞因子水平的变化.结果:α-MSH-DC表面分子的表达明显低于Day7-DC.α-MSH-DC培养上清中分泌IL-12 [(95.2±6.3) pg/ml]的水平也明显低于Day7-DC[(197.1±10.2) pg/ml].与PBS组[(7.17±0.26) d]相比,Day7-DC组[(6.25±0.61) d]的心脏移植物存活时间缩短;而α-MSH-DC组[(15.08±1.32) d]的心脏移植物存活时间明显延长.与Day7-DC和PBS组相比,α-MSH-DC组移植后血清IL-2和IFN-γ细胞因子水平明显降低.结论:α-MSH可以抑制体外培养的DC表面分子的表达和IL-12的分泌;α-MSH处理的DC在体内能延长同种异基因心脏移植物的存活时间.     

Fas配体表达对同种胰岛移植的影响

目的探究睾丸细胞FasL表达能否对共移植的胰岛移植物提供免疫豁免作用以及胰岛细胞FasL基因转染对同种胰岛移植的影响。方法　将同种大鼠胰岛及睾丸细胞同时移植于糖尿病受体，重组腺病毒AdV-FasL感染胰岛细胞后移植，观察移植物存活情况、胰岛功能，并检测移植物内浸润淋巴细胞以及基因转染胰岛细胞凋亡情况。结果　单纯移植胰岛组平均存活期为(6.3±0.6)d。与胰岛细胞同时移植的睾丸细胞数增加至1×107时，存活期大于50d（P<0.05）。表达FasL的睾丸细胞在移植物内诱导浸润淋巴细胞凋亡。FasL基因转染组出现排斥加速，存活期缩短至(3.4±0.2)d。FasL转染的胰岛细胞在移植后24h见FasL表达，48h表达增强，移植后FasL转染胰岛细胞凋亡。结论　表达FasL的睾丸细胞与胰岛同时移植可诱导活化的淋巴细胞凋亡，使胰岛移植物获得免疫豁免、存活期延长，但通过FasL基因转染使胰岛细胞直接表达FasL引起胰岛细胞凋亡和粒细胞浸润，导致排斥加速。     

CCR7基因修饰未成熟树突状细胞诱导小鼠皮肤移植免疫耐受的研究

目的 研究CCR7基因重组腺病毒体外转染未成熟树突状细胞(imDCs)对小鼠同种异体皮肤移植免疫耐受的影响.方法 小鼠骨髓细胞经梯度离心及rmIL-4、rmGM-CSF诱导培养未成熟树突状细胞;CCR7重组腺病毒经增强离心法转染未成熟树突状细胞;体外观察转染细胞混合淋巴细胞反应;取CCR7修饰imDCs于皮肤移植前2d、移植后第5天,经腹部注入受体小鼠,观察皮肤移植物存活时间和病理变化.结果 CCR7基因成功转染入imDCs;腺病毒转染后imDCs刺激T细胞增殖的能力较imDCs组增强但弱于mDCs组,IL-10可以明显降低刺激能力;CCR7腺病毒转染组皮肤存活时间长于转染前,IL-10能显著延长皮肤存活时间.结论 CCR7重组腺病毒转染imDCs后,imDCs刺激T细胞增殖的能力部分增强,皮肤移植物存活时间明显延长.     

霉酚酸酯对树突状细胞抗原递呈功能的影响和诱导同种移植免疫耐受作用

目的观察霉酚酸酯对体外培养的树突状细胞(DC)前体(DCp)的成熟过程和同种免疫刺激活性的影响作用,评价预先用霉酚酸酯处理的供者DC在诱导同种移植物受者免疫耐受中的作用,并阐述可能的机制。方法(1)在骨髓来源的DCp培养过程中加入粒细胞巨噬细胞集落刺激因子(GM CSF)和霉酚酸酯,用流式细胞术方法进行免疫表型分析,ELISA方法检测其白细胞介素(IL)12的分泌,并作混合淋巴细胞反应以观察其对同种T细胞的刺激能力。(2)24只C57/BL6小鼠被随机分成3组,每组8只,A组C57/BL6受者接受BalB/c小鼠供者心脏进行异位移植,B组C57/BL6受者在移植前7d注射未经处理的BalB/c供者DCp后进行异位移植,C组C57/BL6受者在移植前7d注射经霉酚酸酯处理的BalB/c供者DCp后进行异位移植,观察受鼠移植心脏的存活时间以及血清中细胞因子的变化。结果霉酚酸酯显著抑制了外源刺激下DCp的成熟过程,抑制其表面共刺激分子(CD80、CD86)的表达,降低IL12的分泌并显著抑制其同种T细胞激活能力(P<0.01)。接受未成熟DCp回输的受者移植心脏组(组B、组C)存活期显著长于单纯移植组(组A),而以霉酚酸酯处理的未成熟DCp(组C)可使移植物的存活时间得到进一步的延长,并且显著抑制了TH1细胞因子的产生。结论霉酚酸酯对DCp的成熟和功能有着显著的抑制作用,并能     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.     

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.