过氧化物酶阴性或低百分率的急性非淋巴细胞白血病

本文对45例急性白血病患者的形态学、细胞化学和免疫学表型进行了观察和分析,其中19例诊断为急性非淋巴细胞白血病。19例急非淋患者中,7例患者的原始细胞过氧化物酶染色阴性或低百分率,但经细胞化学染色和/或免疫学标记证实为髓系起源。文中对过氧化物酶阴性或低百分率急非淋的诊断、临床意义及原因进行了讨论。     

骨髓形态学在单核细胞白血病诊断中的作用

目的探讨骨髓形态学（包括细胞化学染色）在急性单核细胞白血病（AML-M5）和急性粒一单核细胞白血病（AML-M4）形态学、免疫学及细胞遗传学（MIC）分型中的作用。方法对47例初治AML的骨髓穿刺标本进行形态学、免疫表型和染色体检查，并对检查结果进行分析。结果47例形态学诊断为AML-M4和AML-M5的患者最终经MIC分型诊断为AML-M525例；AML-M419例（其中AML-M4Eo5例）；t（8；21）AML2例；T细胞性急性淋巴细胞白血病（T-ALL）1例。结论在AML-M4及AML-M5的MIC分型中，骨髓形态学仍具有重要的的诊断价值，免疫分型和染色体检查与形态学相互依存，有助于进一步提高诊断的准确率。     

TPA体外诱导分化在急性低分化白血病鉴别诊断中的应用

利用TPA体外诱导急性非淋巴细胞白血病(ANLL)和急性淋巴细胞白血病(ALL)出现的不同反应,建立了诊断急性未分化型白血病(AUL)的分型方法.以5～10×10~5/ml的AUL细胞经1.6×10~(-7)M/ml TPA处理后,出现细胞贴壁反应,非特异性酯酶阳性细胞增多,获得一定的吞噬乳胶粒的能力,形态上变为单核或巨噬系细胞,综合临床资料,可判断其为急性非淋巴细胞白血病.相反,细胞只出现凝集反应,则为急性淋巴细胞白血病.     

急性早幼粒细胞白血病的临床和实验室观察

总结了急性早幼粒细胞白血病发病时的临床特点：全血细胞减少，尤其是血小板减少，及多部位的出血表现；骨髓细胞以含粗大而丰富的嗜天青颗粒的早幼粒细胞为主要细胞成分，细胞化学反应过氧化酶强阳性和非特异性酯酶阳性又可被氟化钠抑制，而区别于急性单核细胞类型的白血病。     

急性白血病的诊断分型及预后判断

目的 采用形态学、免疫学、细胞遗传学和分子生物学分型体系对102例急性白血病进行综合分型。方法 按照FAB标准进行形态学分型；运用间接免疫荧光法标记活细胞膜表面分化抗原确定细胞属性；采用24h培养法或直接法制备染色体标本；用PCR方法检测融合基因。结果 形态学分型、免疫学分型与形态学、免疫学、细胞遗传学和分子生物学体系分型符合率分别为91．2％和98．0％；16／67型急性髓细胞白血病表达淋系抗原，预后好；6／26例急性淋巴细胞白血病表达髓系抗原，预后差。染色体异常（62／80例）检出率为77．5％；其中（44／62例）71．0％为特异性异常。融合基因的检查也具有特异性的分子标志。结论 形态学、免疫学、细胞遗传学和分子生物学体系分型可提高急性白血病的分型准确性，具有指导临床，提示预后的意义。     

重组腺病毒介导反义c-myc诱导HL-60细胞粒系分化的作用

目的：研究重组反义c-myc腺病毒（Ad-AS-c-myc）诱导人急性早幼粒HL-60细胞系粒系分化及作用分子机制。方法：采用重组腺病毒Lac-Z（Ad-LacZ）及Ad-As-c-myc联合硫酸鱼精蛋白转染HL-60细胞，X-gal染色判断转染效率。采用形态学、RT-PCR、流式细胞仪、四唑氮蓝（NBT）还原试验、非特异酯酶染色等方法进行研究。结果：Ad-AS-c-myc能抑制HL-60细胞C-myc基因在转录水平的表达。被转染HL-60细胞在形态上趋向成熟粒细胞，Ad-AS-c-myc使HL-60细胞周期G0／G1阻滞，过氧化物酶、非特异性酯酶活性增强。结论：Ad-AS-c-myc对HL-60细胞具有诱导粒系分化作用。其生物学作用与HL-60细胞c-myc的表达受抑、HL-60细胞出现一些成熟粒细胞的生理功能有关。     

急性白血病分类分型标准探讨

白血病是我国常见恶性肿瘤之一,在各种恶性肿瘤中占第六、七位;在儿童恶性肿瘤中居首位、约占半数左右.白血病患者的年龄、细胞类型等与治疗反应有着非常密切的关系.急性白血病的分型是制订治疗方案、评价疗效、判断预后、探索病因等十分重要的依据,故必须正确掌握.目前,血细胞的瑞氏染色形态学仍是急性白血病分型的主要依据,如配合细胞化学、超微结构、免疫学等检查则可使分型工作更精确、客观.     

非特异性酯酶α－NAE活性及抑制试验对急性白血病分型诊断的评价研究

本研究分别采用０，１．５，３．０，４．０，５．０，６．０，７．０，８．０，９．０，１０．０ｍｇ／ｍｌ共１０个不同浓度的ＮａＦ对２０６０份血液标本进行活性及抑制试验。结果表明：α－ＮＡＥ可存在于多种血细胞中，并且不能被以上任何浓度的ＮａＦ完全抑制，仅呈轻度或中度不完全抑制。这一结果为重新评价非特异性酯酶α－ＮＡＥ在急性白血病分型诊断中的价值和意义提供了新的理论依据     

人脐血源基质细胞分离培养条件的优化

目的探索人脐血源基质细胞(hUCBOSCs)的分离扩增条件,并观察其生物学特性。方法取产科胎儿脐带血,比较不同的分离方法、首次换液时间及培养体系对人脐血源基质细胞原代培养的影响。倒置显微镜动态观察细胞生长情况,瑞氏染色观察细胞形态特征,并采用细胞化学和免疫细胞化学方法对获得的细胞进行鉴定。结果明胶沉淀法优于其他分离方法,首次换液时间为第4天、改良Dexter培养体系培养效果最好。原代培养9~14d(平均12.1d)时贴壁细胞开始形成集落,15~21d(平均19.4d)时集落数量最多,培养28d贴壁细胞铺满培养皿底,细胞类型以"成纤维样"细胞、"巨噬样"细胞、"小圆"类细胞为主。细胞化学染色显示非特异性酯酶(NSE)染色阳性率100%,糖原染色(PAS)阳性率为100%,碱性磷酸酶(ALP)染色阳性率26%,过氧化物酶(POX)染色阴性;免疫细胞化学染色显示CD31阳性率96%,CD68阳性率95%,Fn阳性率94%,CD45阴性。结论在体外可以成功培养人脐血源基质细胞,为进一步的基础及临床研究提供了基础。     

非亲缘非清髓造血干细胞移植成功治疗急性淋巴细胞白血病首例报告

为探讨非亲缘非清髓异基因造血干细胞移植（URD－NAPBSCT）在治疗急性白血病中（AL）的作用，1例HLA完全相合的急性淋巴细胞白血病病人接受了URD－NAPBSCT治疗。结果病人顺利度过造血抑制期并获得完全性植入，移植后发生了皮肤Ⅱ度GVHD和间质性肺炎，经治疗后痊愈。结果初步表明，URD－NAPBSCT较简便安全，可为急性白血病提供新的有效治疗手段。     

Glycogen determination using periodic acid-schiff: artifact of muscle preparation

PURPOSE: It is common practice for the staining of muscle glycogen with periodic acid-Schiff (PAS) to thaw and dry muscle sections before staining. The goal is to investigate whether this thawing step results in a systematic error that is independent of muscle fiber type and muscle physiological state. METHODS: Muscle samples from six fasted male subjects were obtained before or after 3 min of high-intensity cycling. Each sample was sectioned; some sections were assessed for muscle fiber composition, and others were either thawed for 20 min or kept frozen before being PAS-stained for glycogen. The response to a 20-min freeze-thaw cycle was also assessed using rested and exercised rats as our experimental model, and the changes in glycogen were measured enzymatically. RESULTS: The inclusion of a 20-min thawing step resulted in a significant reduction (P < 0.05) in the weighted average of the optical density of PAS (ODPAS) staining in both the nonexercised (15 +/- 1.4%) and exercised human muscles (15 +/- 1.3%), with the absolute extent being greater in the nonexercised muscle samples (P < 0.05). Moreover, the observed decrease in ODPAS was greatest in Type IIa fibers for both the nonexercised (P < 0.05) and exercised (P < 0.05) muscle samples. The findings in rats suggest that the muscle damage associated with freeze-thawing is responsible for this stimulation of glycogenolysis. CONCLUSION: For the quantitative histochemical measurement of glycogen content in skeletal muscle, the common practice of thawing unfixed muscle sections before PAS staining should be abandoned because this causes glycogen breakdown, the extent of which varies across muscle fiber types and prior exercise history.     

表皮细胞生长因子治疗创面出现干细胞岛现象的方法学鉴别研究

为从方法学和不同染色角度进一步确证在再生表皮的棘细胞层出现的“干细胞岛”，采用也发现干细胞岛相似的组织学切片，用CD87染色和基底膜染色对“干细胞岛”进一步鉴别，结果发现，CD87染色在再生表皮的基底膜呈阳性，基底膜染色在正常和再生表皮基底膜可以着色,而在发现干细胞岛的部位基底膜染色呈阴性。本实验结果进一步从方法学排除了由于切片误差以及表皮基底层干细胞迁移所造成的假阳性。     

Utility of four-dimensional analysis of the acetabular labrum applying motion-gated multislice computed tomography: comparison with arthroscopy and harris hip score

To analyze the kinesis and morphology of the acetabular labrum (AL) noninvasively, we applied 4-dimensional arthrography with motion-gated multislice computed tomography and compared the results with arthroscopy and Harris hip score (HHS) in 49 symptomatic patients who performed reciprocating hip flexion-extension as we carried out mimic retrospective electrocardiogram-gating acquisition. The kinematics and morphology of AL were classified as stabilized, irregular, or eccentric motion patterns. Of the 9 subjects who had intact or frayed AL on arthroscopy, 7 had stabilized motion (average 50 HHS) and 2 had irregular (44 HHS) motion by CT arthroscopy. Of the 16 without adhesive AL on arthroscopy, 6 had irregular motion (48 HHS) and 4 had eccentric motion (58 HHS). We found that the 4-dimensional arthrography with motion-gated multislice computed tomography can reveal both kinetic and morphological changes of the AL, and facilitate further stratification in subjects with the American Academy of Orthopaedic Surgeons class 0, or 1 or without "detached" morphological findings by arthroscopy.     

Endoluminal irradiation of tracheobronchial tumors using a high dose rate iridium-192 afterloading device

We report about 50 patients with inoperable bronchus tumors treated since March 1986 in a prospective non randomized study with high dose rate iridium-192 afterloading (AL) irradiation in 140 applications. 26 patients were treated combined with external irradiation. 32 were treated before with laser therapy, one with chemotherapy (small cell carcinoma). The actuarial survival rate (Kaplan-Meier) was 26% after 36 weeks for all patients; 38% for combined endoluminal and external irradiation and 9% for patients treated with AL alone. Death was caused by the local tumor in 85%. In 41% lethal bleeding was seen.     

Comparison of four different intra-articular injection sites in the knee: a cadaver study

Although intra-articular knee injection is not a complicated procedure, it could be difficult to assess whether the tip of the needle lies free in the joint or is embedded in synovium or other intra-articular soft tissues. The purpose of this study was to evaluate the accuracy rate of intra-articular injection using anteromedial (AM), anterolateral (AL), lateral midpatellar (LMP), and medial midpatellar (MMP) portals in cadavers. In this study 156 knees of 78 fresh cadavers were included. Anterolateral and AM injection to both knees of 39 cadavers (78 knees) were performed. MMP and LMP injection to both knees of other 39 cadavers were also performed. Accuracy rate was the highest (85%) in the AL injection portal and lowest in the MMP portal (56%). In conclusion, the accuracy obtained with use of the MMP portal was significantly lower than that obtained with the use of either the AM (P < 0.05), AL (P < 0.0001), or LMP (P < 0.05) portal. Although AL injection site resulted in good intra-articular delivery with 85% accuracy rate and with a lower incidence of soft tissue infiltration, the results were not statistically significant when compared to AM and LMP portals. Therefore, any of these three portals might be preferred depending on the experience of the physician. On the other hand, 100% accuracy could not be obtained through any portals in the study, which should be kept in mind when treating knee problems with intra-articular medications.     

FLAG方案治疗难治复发急性白血病的临床应用研究

 目的 初步探讨大剂量阿糖胞苷(Ara-C)联合氟达拉滨(Flud)和粒细胞集落刺激因子(G-CSF)即FLAG方案治疗难治复发急性白血病(acute leukemia,AL)的疗效和不良反应.方法 32例AL均采用FLAG方案化疗,即Flud 50 mg/d,第1～5天;Ara-C 2 g/(m2·d),第1～5天;G-CSF 300 μg/d,化疗前1 d开始,完成1个疗程者进入疗效分析.结果 31例顺利完成化疗,有效率(CR+PR)为54.8%(17/31) ,CR为48.4%(15/31).9例复发AL的CR 率为66.7%,23例难治AL的CR率为 39.1%,其中AML CR率为58.3%,B-ALL 仅20%,2例T-ALL均CR.15例CR AL中3例进行异基因外周造血干细胞移植(allo-PBSCT).早期死亡4%.总中位生存时间14(3～43)个月.结论 包含大剂量阿糖胞苷的FLAG方案为难治复发AML的有效方案,耐受性好,而对B-ALL的敏感性差.     

后交叉韧带止点形态学测量及其重建骨道直径探讨

目的:在膝关节尸体标本上测量后交叉韧带(PCL)止点的形态大小,探讨重建PCL时骨道直径的选择。方法:解剖20具新鲜冷冻的膝关节尸体标本,标记PCL股骨和胫骨止点边界和前外束(AL)与后内束(PM)的分界。确定PCL、AL和PM纵轴并测量其长度,经过纵轴中点做其垂线,沿垂线测量其止点宽度,该宽度则为骨道最大直径。测量值用均数(第25百分位数~第75百分位数)表示。结果:PCL、AL和PM胫骨止点的纵轴宽度分别为10.64(9.52~11.51)mm,6.54(5.50~7.58)mm和5.85(5.37~6.56)mm。股骨止点纵轴宽度分别为11.01(10.27~12.04)mm,9.56(8.91~10.52)mm和9.47(8.85~10.28)mm。结论:根据解剖重建和胫骨、股骨骨道一致的原则,PCL单束重建的骨道直径可从9.5 mm到11.5 mm,均值10.5 mm;双束重建AL骨道直径可从6.5 mm到8.5 mm,均值7.5 mm;PL骨道直径可从6.0 mm到7.5 mm,均值6.5mm。     

Quantifying magnetic resonance imaging features to classify placenta accreta spectrum (PAS) in high-risk gravid patients

ObjectiveThis study aimed to quantify the magnetic resonance imaging (MRI) features of placenta accreta spectrum (PAS) and to use MRI-based scores to classify them in high-risk gravid patients.Materials and methodsThe clinical data and MRI features of 65 high-risk gravid patients diagnosed with PAS were retrospectively reviewed. The MRI features of PAS were analysed and compared using the chi-squared test, and the odds ratios (ORs) for significant risk factors for classification of PAS were identified via a multivariate logistic regression model. A receiver-operating characteristic (ROC) curve was used to calculate cut-off values and their corresponding sensitivity, specificity, and accuracy in classifying PAS.ResultsWe identified 3 significant risk features for classification of PAS, including placental heterogeneity (OR = 13.604), abnormal vascularization at the placental-maternal interface (OR = 9.528), and focal myometrial interruption (OR = 118.779). The significant risk features for classification of PAS were scored according to their OR values, as 3 points (OR ≥ 20), 2 points (10 ≤ OR < 20), or 1 point (OR < 10). Based on the scores of the 3 risk features, a cut-off score of 4.5 points achieved optimal sensitivity (94.3%), specificity (90%), and accuracy (92.3%) for classifying PAS in high-risk gravid patients.ConclusionQuantifying these MRI features including placental heterogeneity, abnormal vascularization at the placental-maternal interface, and focal myometrial interruption can make a classification of PAS in high-risk gravid patients.     

原浆型和纤维型星形胶质细胞调控神经干细胞定向分化的比较研究

目的探讨原浆型星形胶质细胞（protoplasmic astrocyte,PAS）和纤维型星形胶质细胞（fibrous astrocyte,FAS）对神经干细胞（neural stem cell,NSC）定向分化的调控作用。方法将4＇,6-二脒基-2-苯基吲哚（4’,6-Diamidino-2-phenyindole,dilactate,DAPI）标记的NSC分别与PAS、FAS共培养,10天后免疫组化法对分化神经元进行鉴定,显微镜下随机选取20个视野,每次计数100个细胞,计算NSC分化为神经元的比例。结果NSC与PAS共培养后分化成的神经元比例较高,与胶质细胞的比例约为61％：39％;FAS与NSC共培养后分化神经元数量相对较少,以胶质细胞居多,其比例约为41％：59％。结论PAS与FAS相比更能促进NSC向神经元分化。