自体干细胞移植治疗糖尿病足的干细胞动员和采集

背景：在自体干细胞移植治疗下肢缺血性疾病的干细胞动员期间,国内外大多数研究组均常规应用5~10 μg/(kg•d)的粒细胞集落刺激因子动员,5 d后采集干细胞进行移植,这是否为最佳的动员时间和采集时机未见相关报道。 目的：分析探讨自体干细胞移植最佳动员方案及采集时机,提高该方法的安全性。 方法：对备行干细胞移植的18例糖尿病足患者分别采用粒细胞集落刺激因子5,10 μg/(kg•d)进行造血干细胞动员,分析粒细胞集落刺激因子动员天数、剂量与外周血白细胞、单个核细胞、CD34+细胞数的关系,并检测干细胞动员前后、采集前后患者凝血指标、血小板计数的变化,观察患者动员及采集过程的不良反应。 结果与结论：随着动员天数的增加,白细胞和单个核细胞、CD34+细胞数也随之增加,干细胞获得的效率与粒细胞集落刺激因子的剂量、动员时间有关,外周血中CD34+总数与单个核细胞总数呈正相关。患者的凝血指标在动员和采集前后无显著变化。血小板计数在动员前后无变化,但在采集后有显著下降;18例患者中仅有1例在粒细胞集落刺激因子动员中发生轻度骨头酸痛,1例出现发热,其他患者均无不良反应发生。提示,糖尿病足患者干细胞采集的最佳时机不能单凭动员天数和外周血白细胞数决定,而是由外周血单个核细胞数和CD34+的数量来决定。且干细胞动员和采集对患者的不良反应小,安全性高。     

粒细胞集落刺激因子/粒-巨噬细胞集落刺激因子联合动员异基因造血干细胞移植

背景：目前FDA已批准应用于临床外周血造血干细胞移植的动员剂只有粒细胞集落刺激因子和粒-巨噬细胞集落刺激因子,其中粒细胞集落刺激因子单药应用是目前最主要的动员方案,但可引起供者骨骼肌肉酸痛、发热等不良反应。 目的：回顾性分析以粒细胞集落刺激因子/粒-巨噬细胞集落刺激因子联合应用为动员方案的异基因造血干细胞移植临床效果。 方法：选择2004-01/2009-10河南省人民医院血液科以粒细胞集落刺激因子与粒-巨噬细胞集落刺激因子联合应用为动员方案进行血缘全相合异基因造血干细胞移植51例,分析移植物成分、造血重建及移植物抗宿主病的发生率。 结果与结论：动员96 h后 CD34+细胞占单个核细胞的比例为(0.97±0.13)%,CD34+CD38-细胞占CD34+细胞的比例为(37.49±4.03)%;移植后的快速造血重建与 CD34+细胞、CD34+CD38-细胞输入量呈负相关。Ⅰ度、Ⅱ~Ⅳ度急性移植物抗宿主病的发生率分别为25.5%,15.7%;局限性、广泛性慢性移植物抗宿主病的发生率分别为39.2%,21.2%。提示在血缘全相合异基因造血干细胞移植中,粒细胞集落刺激因子/粒-巨噬细胞集落刺激因子联合可有效实现干细胞动员,所获CD34+细胞完全可以满足快速造血重建的需要;输入较多的CD34+细胞、CD34+CD38-细胞可能利于快速造血重建。     

养心通脉有效部位方与急性心肌梗死大鼠骨髓间充质干细胞的动员及定向归巢

背景：急性梗死心肌修复过程中,寻找可有效提高外周血骨髓间充质干细胞的数量、并动员其定向归巢于损伤心肌的骨髓间充质干细胞动员剂尤为关键。 目的：探讨养心通脉有效部位方对急性心肌梗死大鼠骨髓间充质干细胞动员入血及定向归巢于梗死心肌的影响。 方法：养心通脉有效部位方主要成分包括人参皂苷、丹参酮ⅡA、总生物碱、人参多糖等,由中南大学药学院依课题组稳定的制作工艺制作提供。SD大鼠70只,取8只大鼠作为正常对照组,剩余62只大鼠建立急性心肌梗死模型。取造模成功的32只大鼠,随机分为养心通脉有效部位方组、复方丹参注射液组、重组人粒细胞集落刺激因子组、模型对照组,各组均于造模3 h后给与对应药物,连续5 d。流式细胞仪检测外周血CD34+细胞数,免疫组化染色检测梗死心肌边缘区CD34+细胞数。 结果与结论：与模型对照组比较,重组人粒细胞集落刺激因子组、养心通脉有效部位方组外周血CD34+细胞数均明显增加(P < 0.01);心肌梗死边缘区胞浆CD34+细胞数均显著增加(P < 0.01)。与重组人粒细胞集落刺激因子组比较,养心通脉有效部位方组心肌梗死边缘区胞浆CD34+细胞数显著增加(P < 0.01)。养心通脉有效部位方能促进骨髓干细胞动员入血,并定向归巢于梗死心肌,其作用与重组人粒细胞集落刺激因子大体相当,在归巢CD34+细胞方面甚至强于重组人粒细胞集落刺激因子,是一种良好的骨髓间充质干细胞动员剂。     

重组人粒细胞集落刺激因子动员急性心肌缺血大鼠自体骨髓干细胞归巢

背景：骨髓中存在多潜能干细胞,利用其多向分化和归巢的能力,已成为近年来多种疾病治疗的研究方向。 目的：观察重组人粒细胞集落刺激因子动员急性心肌梗死大鼠骨髓干细胞归巢于缺血心肌的高度选择性,并评价其短期安全性。 设计、时间及地点：随机对照动物实验,于2006-09/2007-04在吉林大学基础医学院病理生理实验室完成。 材料：选取清洁级SD大鼠82只,雌雄各半,体质量250~300 g, 62只大鼠结扎冠状动脉前降支制成急性心肌梗死模型,20只作为假手术组。 方法：造模成功41只,分为模型组(n=20)和动员组(n =21)。模型组：皮下注射生理盐水2 mL/d,连续7 d;动员组：皮下注射生理盐水稀释至浓度2.5 mg/L重组人粒细胞集落刺激因子15 μg/(kg•d),连续7 d。假手术组：在相应冠状动脉结扎部位穿线,不结扎,其余操作步骤相同,皮下注射生理盐水2 mL/d,连续7 d。 主要观察指标：1周后计数3组大鼠外周血白细胞及单个核细胞百分比,4周后比较3组大鼠在体心功能。并取大鼠心脏、肺脏、肝脏、骨骼肌组织制切片行苏木精-伊红染色及CD34免疫组织化学染色观察心脏组织病理改变,毛细血管密度和CD34+细胞归巢情况。 结果：①造模1周后动员组大鼠的外周血白细胞及单个核细胞百分比较动员前明显增加(P < 0.05),且动员组大鼠的外周血白细胞计数及微核细胞率明显高于模型组(P < 0.05)。②造模1周时,动员组较模型组大鼠心肌梗死区可见较多CD34+细胞(P < 0.05);4周时,动员组和模型组均未见CD34+细胞。各组大鼠肝脏、肺脏及骨骼肌各个时段则均无明显差异。造模后4周,动员组心功能各项指标均优于模型组(P < 0.05),梗死面积明显小于模型组(P < 0.05),毛细血管密度明显高于模型组(P < 0.05)。 结论：重组人粒细胞集落刺激因子动员心肌梗死后大鼠自体骨髓干细胞到外周血循环并归巢于梗死心肌,并可分化成心肌样细胞及毛细血管内皮细胞,减少心肌梗死范围,改善心功能。短期观察重组人粒细胞集落刺激因子对肺脏、肝脏、骨骼肌无明显组织学影响。     

粒细胞集落刺激因子动员对大鼠内皮祖细胞体外扩增的影响

背景：内皮祖细胞在缺血性疾病治疗应用中存在数量低的问题，许多细胞因子影响其动员效果和功能。 目的：观察粒细胞集落刺激因子动员对体外扩增骨髓源性内皮祖细胞数量及功能的影响。 设计、时间及地点：细胞学体外观察，于2007-08/2008-03在北京大学人民医院肝病研究所完成。 材料：SPF级健康成年SD雄性大鼠16只，随机分为动员组和对照组，8只/组。重组人粒细胞集落刺激因子为麒麟鲲鹏生物药业有限公司产品。 方法：实验前动员组大鼠皮下注射经生理盐水稀释的重组人粒细胞集落刺激因子10μg/kg，2次/d，共5 d。采用密度梯度离心法分别从两组大鼠骨髓获取单个核细胞，洗涤后按2×107/孔接种在包被大鼠纤连蛋白的6孔板上，采用贴壁法纯化得到内皮祖细胞。 主要观察指标：骨髓单个核细胞集落数及细胞表型，骨髓源性内皮祖细胞贴壁情况及细胞表型，通过DiI-acLDL摄取、体外血管生成进行内皮祖细胞功能学鉴定，透射电镜观察细胞超微结构。 结果：与对照组比较，动员组骨髓单个核细胞集落增多，CD45+/CD34+、CD133+和Flk-1+阳性率均明显升高（F=5.655~61.892，P < 0.05）。培养第7，9天与对照组比较，动员组骨髓源性内皮祖细胞贴壁数、CD45+/CD34+、CD133+和Flk-1+阳性率均明显升高（F=5.694~38.879，P < 0.05）。贴壁细胞F1TC-UEA-1/Dil-acLDL双荧光染色阳性率为90%，接种于Matrigel包被的培养板24 h后形成毛细血管索样结构，胞质内有Weibel-Palade小体存在。 结论：粒细胞集落刺激因子动员能增加骨髓源性内皮祖细胞的数量，并促进其分化、增殖功能。     

国产与进口粒细胞集落刺激因子动员外周血造血干细胞的效果对照

为评估国产重组人粒细胞集落刺激因子在动员外周造血干细胞的效果,选择2001/2005收治的20例自体外周血造血干细胞移植患者,男11例,女9例,其中急性髓细胞白血病11例,急性淋巴细胞白血病5例,恶性淋巴瘤3例,多发性骨髓瘤1例。根据患者对药价承受能力分为2组：国产重组人粒细胞集落刺激因子动员组、进口重组人粒细胞集落刺激因子动员组,每组各10例,除急性髓细胞白血病采用大剂量阿糖胞苷动员外,其他均应用大剂量环磷酰胺动员,当白细胞降至低谷开始回升时加国产与进口重组人粒细胞集落刺激因子,白细胞升至5×109 L-1以上开始采集外周血造血干细胞。所有患者均移植成功,两者在给药剂量、用药天数,采集干细胞质量、造血功能重建及药物毒副反应等方面差异均无显著性意义。     

人重组粒细胞集落刺激因子对大鼠脑出血周围区新生血管的影响

背景：研究表明人重组粒细胞集落刺激因子可动员内皮前体细胞，增加脑缺血区域新生血管生成。 目的：观察人重组粒细胞集落刺激因子对大鼠脑出血周围区新生血管的影响。 设计、时间及地点：随机分组设计的动物对照实验，于2006-03/11在泸州医学院中心实验室完成。 材料：健康雄性SD大鼠72只，人重组粒细胞集落刺激因子。 方法：72只大鼠按随机数字表法分为3组，假手术组、脑出血组、治疗组，每组24只。断尾取自体血通过鼠脑立体定向仪注入鼠脑内制备脑出血模型，假手术组用生理盐水代替自体血。治疗组于制模后1 h腹腔注射人重组粒细胞集落刺激因子60 μg/kg。假手术组、脑出血组不做任何处理。 主要观察指标：于6，12，24，48，72 h，7 d 6个时间点检测血肿周围区CD34+血管的表达，每个时间点检测4只。利用内皮细胞的标志性抗原CD34变化了解微血管的生成情况，CD34抗原也越多，新生血管越多。 结果：脑出血组CD34＋血管数明显高于假手术组（P < 0.05）；治疗组CD34＋血管数明显高于脑出血组（P < 0.05），且在72 h增多明显，与7 d比较差异无显著性意义（P > 0.05），但与6，12，24，48 h比较差异有显著性意义（P < 0.05）。 结论：人重组粒细胞集落刺激因子能够促进脑出血后血肿周围新生血管生成。     

外周血CD34+细胞形貌在系统性红斑狼疮患者与健康人的差异比较

背景：系统性红斑狼疮患者CD34+细胞是否存在异常目前仍有争议。 目的：以健康人为对照，应用原子力显微镜观察比较二者外周血CD34+细胞形貌特征。 设计：病例-对照分析。 对象：6例系统性红斑狼疮患者，男3例，女3例，平均年龄26.3岁，平均病程19.0个月，均符合1982年美国风湿病学会制定的诊断标准。3例健康志愿者为对照。两组对象基线资料具有可比性。 方法：系统性红斑狼疮患者均静脉注射环磷酰胺4 g/m2，白细胞<1.0×109 L-1时给予粒细胞集落刺激因子5 μg/kg，待白细胞> 5.58×109 L-1及CD34+>2%时采集外周血干细胞。3例健康志愿者采取单用粒细胞集落刺激因子为动员方案。向外周血干细胞中加入CD34 MicroBeads FcR和FcR Blocking Reagent制备细胞悬液，离心弃上清，重悬后过滤，应用免疫磁珠细胞分选技术纯化CD34+细胞。 主要观察指标：原子力显微镜观察细胞表面形貌，每例患者随机测20个细胞，每个细胞不同部位做2 μm×2 μm图像5幅，将5幅图像的直径、平均粗糙度、均方根粗糙度、平均高度的均值作为该细胞的参数。 结果：成像范围在12 μm×12 μm时，可将细胞整体模拟成像。成像范围在2 μm×2 μm时，两组细胞表面均可见大小、深浅不一的凹陷及椭圆形球状突起，粗糙不平。与健康志愿者比较，系统性红斑狼疮患者外周血CD34+细胞的直径、平均粗糙度、均方根粗糙度、平均高度等参数经单向方差分析差异无显著性意义（F=0.203~4.553，P均> 0.05）。 结论：应用原子力显微镜选择成像范围在2 μm×2 μm时可清晰观测外周血CD34+细胞的表面结构，且系统性红斑狼疮患者和健康人的外周血CD34+细胞形貌基本相似。     

健康供者外周血造血干细胞动员后采集的最佳时机*

背景：外周血干细胞移植的首要条件是造血干细胞有效动员和采集,并能较快持久地重建造血。近年国内外不少单位已开展了此项工作,但平均每例供者采集次数较多,且造血干细胞的产率高低差别较大。 目的：探讨健康供者外周血造血干细胞动员后采集的最佳时机。 方法：2003-01/2008-12海口市人民医院进行异基因外周血造血干细胞采集的健康捐赠者16例,随机分为2组,单纯动员组6例,皮下注射粒细胞集落刺激因子5.0~10.0 μg/(kg•d),共5 d;联合组10例,在单纯动员组基础上,静脉推注地塞米松10 mg。每例供者均采集2次外周血造血干细胞,单纯动员组与联合组又各分为2 h,4 h两个亚组,即若在第4天动员后2 h采集,则第5天在动员后4 h采集;若在第4天动员后4 h采集,则第5天在动员后2 h采集。16例供者采集量为4.0~5.0 mL,推赶量3.0~5.0 mL,总循环血量6.7~10.1 L。 结果与结论：单纯动员组、联合组采集的单个核细胞数均达到(4.0~8.0)×108 kg-1。与2 h亚组比较,两组4 h亚组采集物的单个核细胞数均明显增加(P < 0.05)。提示粒细胞集落刺激因子动员后第4,5天进行采集,4 h采集物的细胞浓度明显高于2 h;供者采集时循环血量是其自身循环血量的1.8~2.2倍时已能一次采集足够量的细胞数,有较合理的采集时间-价值-效益的关系。     

重组人粒细胞集落刺激因子对脑出血大鼠脑水肿及血管再生的影响

背景：研究表明重组人粒细胞集落刺激因子可以减轻脑缺血后的脑水肿，并且可动员内皮前体细胞增加脑缺血区域新生血管生成，促进患者神经功能恢复。 目的：探讨重组人粒细胞集落刺激因子对大鼠脑出血后脑水肿及新生血管的影响。 设计、时间及地点：随机对照动物实验，于2006-03/11在泸州医学院中心实验室完成。 材料：健康雄性SD大鼠144只，随机分为假手术组、脑出血组、治疗组，48只/组。重组人粒细胞集落刺激因子为深圳新鹏生物工程有限公司产品。 方法：脑出血组与治疗组大鼠采用断尾取自体血方式建立脑出血模型，假手术组仅经注射点注入生理盐水。造模1 h后，治疗组大鼠腹腔注射重组人粒细胞集落刺激因子60 μg/kg。分别于干预后6 h，12 h，24 h，48 h，72 h，7 d时间点，每组各取8只大鼠，采用干湿重法测定大鼠组织脑含水量，采用SP、DAB显色法免疫组化检测CD34+血管的表达。 主要观察指标：脑组织含水量动态变化，CD34+血管免疫组化结果。 结果：与假手术组比较，脑出血组大鼠脑组织含水量显著升高(t=4.49，P < 0.05)，在48 h，72 h最明显；各时间点治疗组脑组织含水量均明显低于脑出血组(t=6.74，P < 0.05)。与假手术组比较，脑出血组CD34+血管数明显增加(t=3.42，P < 0.05)；治疗组CD34+血管数明显多于脑出血组(t=6.07，P < 0.05)，且在72 h，7 d时差异尤为明显。 结论：重组人粒细胞集落刺激因子作用于脑出血大鼠后，可减轻脑水肿程度，促进血肿周围新生血管生成。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.