Regeneration of spinal cord with cell and gene therapy

Objective: Transplantation of fetal spinal cord cells (FSCC) can promote regeneration of injured spinal cord, while Schwann cells (SC) and some growth factors have a similar effect. However, the synergistic effects and optimal combination of these modalities have not yet been evaluated. In the current study, the efficiency of cell therapy of FSCC and/or SC, with/without growth factors (nerve growth factor [NGF] and brain‐derived neurotrophic factor [BDNF]) was examined, with the aim of establishing an optimized protocol for spinal cord injury. Methods: One hundred and twenty adult rats were randomly divided into six groups with 20 rats in each group. One week after the thoracic spinal cord injury model had been created, the rats were treated with different therapeutic modalities: Dulbecco's modified Eagles medium (DMEM) in Group I, FSCC in Group II, FSCC plus SC in Group III, FSCC plus SC over‐expressing NGF in Group IV, FSCC plus SC over‐expressing BDNF in Group V, and FSCC plus SC over‐expressing both NGF and BDNF in Group VI. Subsequently, the rats were subjected to behavioral tests once a week after injury, while histology, immunohistochemistry and electron microscopy were performed at one and three month post‐operation. Results: Both SC and FSCC promoted regeneration of spinal cord injury when used separately, while a combination of the two types of cell resulted in better recovery than either alone. Both growth factors (NGF and BDNF) enhanced the outcomes of cell therapy, while synergistic effects meant that a combination of each individual component (group VI) achieved the best results according to locomotion scale, histology and immunoreactivity in the injured cords. Conclusion: SC, NGF and BDNF can enhance the outcome of FSCC therapy, while the combination of FSC with SC, NGF and BDNF is possibly the optimal protocol for clinical treatment of acute spinal cord injury.     

An unusual case of Dantrolene sodium-induced urinary retention in post-traumatic minimally responsive state

Introduction: An unusual case of urinary retention is reported occurring during the inpatient rehabilitation of minimally responsive state (MRS) following severe traumatic brain injury (TBI). Clinical picture: Urodynamic evaluation showed detrusor acontractility and subsequent management involved intermittent bladder catheterization and treatment of a single urinary tract infection. Treatment: Factors contributing to her bladder paralysis included severe immobility, tetraplegia and treatment of diffuse spasticity with oral Dantrolene sodium 250 mg per day. Constipation, diabetes and spinal cord injury were absent. In addition, she received unilateral partial sciatic neurolysis with 50% alcohol for severe knee flexor spasticity and intra-muscular Botulinum toxin A to both spastic upper limbs. Outcome: Bladder acontractility resolved completely when Dantrolene was reduced with subsequent achievement of a catheter-free status and small post-void residual volumes. Repeat urodynamics showed spontaneous detrusor contractions. Conclusion: A discussion of possible aetiologic factors for detrusor acontracility following TBI is presented including a brief review of the literature.     

Arteriovenous fistula of the superior gluteal artery as a complication of posterior iliac crest bone graft harvesting: 3D-CT angiography and arterial embolization

Superior gluteal artery injuries are rare, but potentially serious complications that occur during posterior iliac crest bone graft harvesting. The authors reported an arteriovenous fistula of the superior gluteal artery, which occurred as a complication during posterior iliac crest bone graft harvesting and was diagnosed with 3D-CT angiography, then treated with arterial embolization.     

腺相关病毒载体介导结缔组织生长因子对体外转染恒河猴和人腰椎间盘细胞蛋白多糖和Ⅱ型胶原影响的比较

目的比较腺相关病毒载体介导结缔组织生长因子（connective tissue growth factor,CTGF）对体外培养的恒河猴和人腰椎间盘细胞转染后蛋白多糖含量和Ⅱ型胶原的影响。方法将恒河猴及成人腰椎间盘髓核细胞进行体外培养,应用rAAV2-CTGF体外转染细胞,分别通过^35S标记蛋白多糖的方法和Ⅱ型胶原的SP-ABC免疫组化法检测腺相关病毒载体介导生长因子对椎间盘细胞蛋白多糖合成和Ⅱ型胶原的影响。结果恒河猴椎间盘细胞能进行体外培养并传代,其形态学特性与培养的成人椎间盘细胞相似,rAAV2-CTGF与对照组相比可促进恒河猴和人椎间盘髓核细胞的蛋白多糖生物合成（P〈0．01）,恒河猴和成人相比生长因子对于蛋白多糖的促进作用无明显差异（P〉0．05）。结论成功培养恒河猴及成人椎间盘细胞,腺相关病毒载体介导CTGF能显著促进髓核细胞蛋白多糖的合成,生长因子对恒河猴和人椎间盘细胞蛋白多糖含量的影响具有很大的相似性。     

抗T淋巴细胞单克隆抗体治疗再生障碍性贫血的临床研究

用抗人Ｔ巴细胞单克隆抗体ＳＭＵ３（抗ＣＤ３）ＳＭＵ８（抗ＣＤ８）治疗３２例再生障碍性贫血，基本治愈６例，缓解７例，明显进步１１例，无效８例，有效率７５％（２４／３２）。治疗前Ｔ淋巴细胞亚群ＣＤ４／ＣＤ８比例倒置，淋巴细胞表面ＨＬＡ－ＤＲ抗原表达增高，治疗后ＣＤ４／ＣＤ８比例恢复正常，ＨＬＡ－ＤＲ表达降低，无血清病及血细胞减少等严重毒副作用。     

PCR直接扩增与套式扩增用于HLA－DR基因分型的研究

人类ＨＬＡ抗原分型在人类学、法医学、疾病易感性及器官组织移植等研究中有重要的意义。在骨髓移植中，进行供者、受者ＨＬＡ配型，选择相合的供体，减少ＧＶＨＤ发生，是移植成功的关键。目前国内主要采用血清学方法进行ＨＬＡ配型。由于方法上的缺点，常有约２０％左右的误差率，因此，基因分型技术的研究与应用势在必行。该研究通过设计合成ＨＬＡ基因序列特异性引物，建立了ＨＬＡ－ＤＲ基因分型的套式扩增和直接扩增ＰＣＲ－ＳＳＰ技术，并在骨髓移植配型中进行了应用。对两种分型技术进行了对比，两种方法各有特点，套式扩增在高度同源的ＤＮＡ序列扩增中有高度的特异性，并具有高度的灵敏性，很少量的ＤＮＡ即可满足ＰＣＲ扩增，但需两次扩增，非同源因素影响增大；直接扩增操作简便，一次扩增完成分型，但结构同源因素对特异性影响大。两种方法经周密设计均有高度的准确性，可常规用于临床骨髓移植配型     

溃疡性结肠炎的红细胞免疫与HLA相关性研究

从免疫，遗传学角度对３２例溃疡性结肠炎（ＵＣ）患者及１０１名无血缘关系的健康人进行ＨＬＡ－Ⅰ类（Ａ、Ｂ，Ｃ）、Ⅲ类（Ｃ４Ａ、Ｃ４Ｂ、ＢＦ）基因频率及红细胞免疫功能进行了测定，结果显示ＵＣ患者的ＨＬＡ－Ｂ５、Ｂ２７的基因频率显著增高，（Ｐ＜０．０５，０．０１：ＲＲ＝２．２９１，２６．３２）；而Ｃ４ＡＱо的基因频率则显著降低（Ｐ＜０．ＯＳ，ＲＲ＝０．１００８），其它基因（ＨＬＡ－Ａ、Ｂ、Ｃ、Ｃ４Ａ、Ｃ４Ｂ、ＢＦ）和ＵＣ无明显相关，提示ＨＬＡ－Ｂ５、Ｂ２７是我国ＵＣ的易感基因，Ｃ４ＡＱо是抗性基因。实验显示ＵＣ红细胞免疫功能低下，表明ＵＣ是一种遗传性免疫病。     

高糖餐后急性有氧运动对健康青年男性糖代谢的影响

目的:探讨高糖餐后进行急性有氧运动对健康青年男性血糖及胰岛素水平的影响。方法:11名健康青年男性进行平衡随机交叉自身对照实验,包括口服葡萄糖耐量试验(OGTT)(用OGTT表示)和在OGTT后即刻进行一次45分钟的中等强度有氧运动(用OGTT EX表示)。抽取空腹及服用葡萄糖后1、2、3和4小时的肘静脉血,测定血清血糖和胰岛素水平,并分别计算血糖和胰岛素曲线下面积。结果:OGTT EX和OGTT实验后1h的胰岛素水平有显著性差异(P<0.05),胰岛素曲线下面积也有显著性差异(P<0.05),但其血糖及血糖曲线下面积的差异无显著性(P值分别为0.9466和0.9556)。结果表明,高糖餐后进行急性有氧运动可抑制胰岛素水平升高。     

Sedating patients undergoing mechanical ventilation in the intensive care unit--winds of change?

The majority of mechanically ventilated patients in the intensivecare unit (ICU) require sedation to reduce anxiety, encouragesleep and to increase tolerance to tracheal tubes and the ventilator.Sedative and analgesic drugs are amongst the most commonly prescribedmedications in the ICU.¹ The choice of agent and the way inwhich they are used varies widely between and within ICUs. Ina survey of 164 ICUs in the US,² 18 different sedative agentswere used, the commonest of which were the opiates and benzodiazepines.A more recent study³ revealed substantial differences in theclinical use of drugs for sedation and analgesia in the westernEuropean countries surveyed.  These differences in clinical practice can have an importantimpact on patient outcome and cost of care: excessively deep     

产后盆底肌训练对盆底功能的恢复效果观察

目的观察产后盆底肌训练对提高盆底肌力、改善尿失禁及盆腔脏器脱垂的效果。方法选取94例产后盆底功能障碍性疾病患者,随机分为两组,各47人。观察组采用标准的盆底肌训练,每周进行2次,5周为1个疗程;对照组完成相关健康教育和练习产后操。两组患者治疗前后均进行盆底肌力测定以及评价压力性尿失禁和盆腔脏器脱垂的发生情况。结果观察组与对照组盆底肌力治疗有效率分别为66.0%和89.4%,压力性尿失禁治疗有效率分别为59.6%和78.7%,盆腔脏器脱垂治疗有效率分别为57.4%和74.5%,差异均有统计学意义(P<0.05)。结论产后盆底肌训练对提高盆底肌力、改善尿失禁及盆腔脏器脱垂效果较好,值得推广应用。