生物免疫诱导治疗对肾移植患者机体免疫状态的影响

背景:目前生物制剂参与的免疫诱导治疗逐渐成为肾移植免疫抑制治疗方案的重要组成部分,既能有效预防急性排斥反应的发生,又能避免并发症的发生。目的:探讨不同生物制剂在肾移植免疫诱导治疗中对机体免疫状态及移植肾功能状态的影响。方法:回顾分析110例肾移植受者临床资料,根据应用生物免疫诱导治疗情况分组,单克隆抗体组(n=35)肾移植受者接受巴昔利单克隆抗体治疗,多克隆抗体组(n=43)肾移植受者接受兔抗人胸腺细胞免疫球蛋白治疗,对照组(n=32)肾移植受者未接受生物制剂免疫诱导治疗。对比分析3组受者在肾移植后1,4,12周的淋巴细胞绝对值、外周血CD4+T淋巴细胞亚群数量,并评价移植后12周内移植肾功能状态和感染并发症发生情况。结果与结论:单克隆抗体组、多克隆抗体组急性排斥反应发生率低于对照组(P0.05),多克隆抗体组感染并发症发生率高于单克隆抗体组、对照组(P0.05)。单克隆抗体组、多克隆抗体组移植后1,4,12周淋巴细胞绝对值均低于对照组(P0.05)。多克隆抗体组移植后1,4,12周外周血CD4+T淋巴细胞亚群数量低于单克隆抗体组、对照组(P0.05)。表明生物制剂参与的肾移植免疫诱导治疗方案可有效抑制移植受者活化T淋巴细胞功能状态,降低移植肾早期急性排斥反应的发生,但应用兔抗人胸腺细胞免疫球蛋白的感染并发症发生率较高。     

慢性移植物肾病患者免疫抑制剂的调整

目的 探讨调整免疫抑制剂的使用方案能否改善肾移植后慢性移植物肾病患者的肾功能。方法 对病理诊断为慢性移植物肾病早期肾功能不全的38例(A组)患者在1～2周内将其神经钙蛋白阻滞剂(环孢素A或FK-506)减少至原剂量的1／3或完全停用，同时适当增加硫唑嘌呤或骁悉的用量，与同期内环孢素A或他克莫司未作大幅度减量、仅适当增加硫唑嘌呤或骁悉用量的27例(B组)慢性移植物肾病患者进行对比，随访比较两组的移植肾功能，观察急性排斥反应的发生情况。结果 2年后A组有26例(68．4％)患者移植肾功能得以好转或不再继续恶化，而B组除4例(14．8％)移植肾功能维持在原有水平外，其他患者肾功能均进行性恶化。两组急性排斥反应发生率无显著差异。结论 快速减少甚至停用神经钙蛋白阻滞剂可使部分肾移植后慢性移植物肾病患者的肾功能得以改善或者防止其进行性恶化。这种药物调整不会增加排斥反应等并发症。     

临床活体肝部分移植受体的免疫抑制治疗

目的 报道１例临床活体肝部分移植受体的免疫抑制治疗情况。方法 １９９７年６月３０日,我科成功地施行了１例活体肝部分移植术,术后采用皮质激素、硫唑嘌呤、环孢素Ａ三联免疫抑制治疗,并监测环孢素Ａ的血药浓度。术后第１０天,发生急性移植排斥反应,经皮质激素冲击治疗及增加环孢素Ａ的用量后,排斥反应被逆转。在恢复期,采用小剂量的环孢素Ａ和骁悉维持治疗。结果 目前患者一般情况良好,已健康生存２年９个月。结论 活     

胰肾联合移植后的免疫抑制治疗

背景：胰肾联合移植已经被公认为是糖尿病(包括1型和2型)合并终末期尿毒症的有效治疗手段,由于胰腺为高免疫原性器官,合理的免疫抑制治疗是保证胰腺移植成功的关键。 目的：探讨胰肾一期联合移植后免疫抑制药物的合理应用。 方法：纳入2005-01/2009-06在中山大学附属第一医院器官移植中心完成胰肾一期联合移植的患者9例,其中男5例,女4例,胰液引流均采用空肠引流方式。术后采用白细胞介素2单克隆抗体诱导的四联免疫抑制方案：白细胞介素2单克隆抗体+他克莫司+麦考酚酸+激素,并逐渐过渡至单用他克莫司维持治疗。回顾性分析以上9例患者围手术期及长期随访情况。 结果与结论：胰肾一期联合移植后,除1例早期死亡外,其余8例患者移植后1周内肌酐降至正常水平,移植后停用胰岛素时间为(11.5±3.5) d,空腹血糖恢复至正常时间为(15.4±6.3) d。8例患者随访4~50个月期间,共有4例发生移植肾急性排斥,其中1例在接受床边血液透析过程中并发心脑血管意外后家属放弃治疗,其余3例患者经抗胸腺细胞球蛋白或激素冲击治疗后移植肾功能均逆转恢复,随访过程中未发现移植胰腺排斥。说明胰肾联合移植是治疗糖尿病合并终末期糖尿病肾病的有效方法,术后早期采用白细胞介素2单克隆抗体诱导的四联免疫抑制方案并逐渐过渡至单用他克莫司维持治疗是安全的。     

环孢菌素A抑制小鼠同种心脏移植急性排斥反应中Lymphotactin表达的研究

目的：研究小鼠同种心脏移植急性排斥反应中淋巴细胞趋化因子（lptn）的表达情况及环孢菌素A（cyclosporine A, CsA）的抑制作用。 方法： 改良Banff评分系统判断同种小鼠移植心急性排斥反应程度，RT-PCR检测移植心组织内淋巴细胞趋化因子表达水平，ELISA方法检测心脏移植小鼠脾细胞活化T细胞核因子(NFAT)活性。 结果： C57BL/6-Balb/c急性排斥组小鼠移植术3 d后脾脏显著增大。术后第5、7 d移植心肌间淋巴细胞浸润程度评分分别为2.667±0.577和2.333±0.577。C57BL/6-Balb/c+CsA组小鼠移植术后脾脏肿大明显减轻，术后第5、7 d心肌间淋巴细胞浸润程度评分分别为1.000±0.000和1.333±0.577。急性排斥组和CsA处理组小鼠移植心脏在术后第5 d和第7 d都可检测到Lptn mRNA阳性表达，但CsA处理组Lptn mRNA的表达明显弱于急性排斥组。治疗剂量的CsA可以完全抑制NFATc1活性。 结论： Lptn在早期移植免疫事件中具有重要的作用，CsA仅能部分抑制Lptn mRNA的表达。活化T细胞Lptn的表达调控存在NFAT以外的途径。     

T淋巴细胞亚群检测在肾移植排斥反应与环孢霉素A中毒鉴别诊断中的应用

目的探讨外周血淋巴细胞亚群检测在人类同种异体肾移植术后急性排斥反应与免疫抑制剂环孢霉素A（cyclosporine A，CSA）中毒的诊断与鉴别诊断中的价值。方法采用四色流式细胞技术对26例肾移植术后肾功能正常、11例急性排斥反应、10例环孢霉素A中毒患者外周血淋巴细胞亚群中CD3^＋、CD3^＋CD4^＋、CD3^＋CD8^＋细胞的百分比进行检测。结果肾功能正常组、急性排斥反应组与环孢霉素A中毒组外周血淋巴细胞中CD3^＋细胞的百分比分别为71．83％±9．65％、73．29％±8．85％、72．06％±12．04％，3组比较差异无统计学意义；CD3^＋CD4^＋细胞的百分比分别为38．69％±9．21％、49．58％±8．41％、40．15％±9．98％，急性排斥反应组与正常组和CSA中毒组比较差异有显著统计学意义（P〈0．01）；CD3^＋CD8^＋细胞百分比分别为29.28％±9．02％、19．18％±5.35％、30．86％±9．19％，急性排斥反应组与正常组和CSA中毒组比较差异有显著统计学意义（P〈0．01）；CD3^＋CD4^＋／CD3^＋CD8^＋分别为1．76±0．97、2．92±0．71、1．81±0．92，急性排斥反应组与正常组和CSA中毒组比较差异有显著统计学意义（P〈0．01）。结论检测外周血淋巴细胞亚群的变化，对肾移植术后急性排斥反应和环孢霉素A中毒有鉴别诊断的价值。     

受体淋巴细胞向小肠移植物相关淋巴组织迁移的实验研究

目的：动态分析移植小肠各淋巴组织内供、受体淋巴细胞的表型及免疫状态，以推断其在小肠移植排斥反应中的作用。 方法： 小鼠小肠移植后2、4、6 d，观测移植物排斥病理形态变化，流式细胞术分析移植物肠系膜淋巴结（MLN）、派氏结（PP）、粘膜上皮细胞间淋巴组织（IEL）与固有层淋巴组织（LPL）中淋巴细胞中供、受体淋巴细胞的比例及激活状态。 结果:在移植后6 d，组织学观测到移植物开始出现排斥征象；移植后2、4 d，移植肠MLN、PP内受体来源的淋巴细胞迅速取代供体细胞，而移植肠IEL与LPL内受体来源的淋巴细胞比例增加速度略慢，但在移植后6 d也基本取代供体细胞；在移植后4 d，受体来源的T细胞表达激活分子CD69与CD25的比例达到89.8%±3.4％和84.5%±10.2％，显著高于供体T细胞与受体自身肠道中的T细胞。 结论:移植小肠内的淋巴组织在移植后早期即被受体来源的淋巴细胞迅速取代并激活，抑制这一过程可应用于缓解排斥反应。     

移植物细胞因子表达与小肠移植排斥反应相关性的实验和临床病例研究

目的结合移植物细胞因子表达的实验和临床病例研究，探索早期诊断小肠移植急性排斥反应的细胞因子相关的敏感指标。方法①两例短肠综合症患者接受活体小肠移植术。定期或病情变化时随时行内镜组织学检查并测定受体大鼠移植物sIL-2R、IL-4、IL-6和IFN-γ表达水平。②BN-LEW大鼠部分小肠移植，A组：SBT（n=20）；B组：SBT＋FK506（2．5mg／kg，n=20），术后第1、4、7、14和30天测定受体大鼠移植物sIL-2R、IL-4、IL-6和IFN-γ水平同时取移植肠黏膜行病理组织学检查。结果首例术后67d发生排斥反应，第2例于术后20d和80d分别发生强烈排斥反应。发生排斥反应相应时相均发生IL-2Rα、IFN-γ表达的显著升高，排斥反应控制后IL-2Rα迅速恢复，但IFN-γ仍在较高水平维持较长时间。A组大鼠术后第1天始即显示IL-2Rα、IFN-γ和IL-6表达的显著升高，于术后7d达到最高，移植后14d仍在高水平。B组仅术后第1天出现IL-2Rα、IFN-γ和IL-6表达的迅速升高，第4天已恢复至基本正常。结论移植物IL-2Rα、IFN-γ表达的升高与小肠移植急性排斥反应密切相关，有望成为早期诊断小肠移植急性排斥反应的敏感指标。     

FTY720对小肠移植物中淋巴细胞及单核细胞浸润的影响

目的：研究FTY720对同种异体小鼠小肠移植排斥反应的作用及可能机制。方法：以C3H小鼠（H-2k）为供者，C57BL/6小鼠(H-2b）为受者，行异位小肠移植。分别建立FTY720治疗组、空白对照组及同系移植组，在移植后6 d与12 d进行组织学观测评定排斥分数，流式细胞术分析移植物肠系膜淋巴结（MLN）、派氏结（PP）、粘膜上皮细胞间淋巴组织（IEL）与固有层淋巴组织（LPL）中淋巴细胞中受者淋巴细胞及单核细胞浸润情况。结果：FTY720在移植后6 d可有效抑制排斥反应，但在移植后14 d，排斥反应仍可发生在空白对照组，移植后6 d移植物内受者淋巴细胞基本取代供者细胞；而在FTY720治疗组，受者淋巴细胞进入移植物的速度及数量明显减缓，包括CD4+与CD8+ T细胞，以及CD19+ B细胞。受者来源的γδT淋巴细胞也显著减少。FTY720对Gr1+CD11b+单核细胞系也有一定的抑制作用。结论：FTY720可通过减少受者淋巴细胞及单核细胞进入移植小肠，起到缓解排斥反应的作用。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.