蝶窦和蝶鞍区的解剖观察及临床意义

①目的观察蝶窦和蝶鞍区的解剖结构，探讨其毗邻关系和临床意义。②方法用３０例尸头，３５例、７５侧干燥颅骨标本，观察蝶窦和蝶鞍区结构，测量并计算自能鼻棘至有关结构的长度和角度。③结果自前鼻棘至后床突的长为８１．６±７．２ｍｍ，矢状角为３４．６°±３．４°，侧偏角为５．９°±０．７°；至颈动脉管的长为６７．７±６．２ｍｍ，矢状角为３２．３°±４．１°，侧偏角为６．８°±０．５°；至视神经管颅口的长为６８．９±６．５ｍｍ，矢状角为３６．６°±６．３°，侧偏角为５．３°±０．４°．④结论蝶窦和双恻蝶窦口间部为蝶窦和蝶鞍区手术的最佳入路。     

雷帕霉素对大鼠心脏移植的免疫抑制效果

为了探讨雷帕霉素对ＳＤ、Ｗｉｓｔａｒ大鼠心脏移植的免疫抑制效果，将大鼠分为３组，实验组给ＲＰＭ，对照且包括未治疗组及环孢素组。结果显示ＲＰＭ为一强效免疫抑制剂，治疗优于ＣｓＡ。ＲＰＭ具有强大的免疫抑制效果，可显著延长心脏移植物的存活时间。     

Thrombolytic therapy of ultraselective intra一arterial urokinasc infusion for acutecerebral vascular o

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活化自体淋巴细胞过继性免疫治疗在原发性肝细胞癌中的疗效观察

目的：评价活化自体淋巴细胞过继性免疫治疗（adoptive immunotherapy,AIT）是否有助于改善原发性肝细胞癌的临床疗效。方法：选取2016年8月至2018年12月在中国人民解放军总医院第五医学中心确诊的64例原发性肝细胞癌患者,通过分层随机法分为免疫治疗组（n=29）和对照组（n=35）。免疫治疗组患者取60 ml外周血分离制备单个核细胞并在含OKT-3和IL-2的培养基中活化培养,回输前进行质控检测。免疫治疗组中的Ⅰ~Ⅲ期患者（n=14）于一线治疗后接受自体淋巴细胞输注（3个月内输注6次）,Ⅳ期患者（n=15）仅接受自体淋巴细胞输注;对照组患者接受肝细胞癌相关的其他治疗。疗效评估的主要终点是2 年无复发生存（relapse-free survival,RFS）率,次要终点为无进展生存期（progression-free survival,PFS）和总生存期（overall survival,OS）。结果：入组患者中位随访时间为2.8年（0.2~4.2年）。免疫治疗组29名患者共接受了167次（计划174次,完成率96%）预定淋巴细胞输注（平均每人次回输9.30×109个细胞,其中CD3+HLA-DR细胞约占63%）,治疗期间未观察到3级或4级不良反应发生。与对照组相比,免疫治疗组患者2年RFS率显著升高（62.1% vs 22.9%,OR=0.181,95%CI：0.06~0.54,P=0.002）,中位PFS（28 vs 8个月,P=0.004）和中位OS（38 vs 34个月,P=0.915）均显著延长。在Ⅰ~Ⅲ期患者中,免疫治疗组（n=14）2年RFS率较对照组（n=18）显著升高（92.9% vs 33.3%,OR=0.38,95%CI：0.004~0.368,P=0.005）,中位PFS明显延长（38 vs 14.5个月,P=0.005）,而两组OS间无显著差异;Ⅳ期患者两组间PFS（P=0.077）及OS（P=0.994）均未见显著差异。结论：活化自体淋巴细胞AIT为安全可行的肝细胞癌辅助性治疗方法,可提高Ⅰ~Ⅲ期肝细胞癌一线治疗后RFS率、延长患者RFS时间,而对进展期肝细胞癌患者的PFS和OS无明显影响。     

Peripheral Neuropathies Due to Systemic Lupus Erythematosus in China

This article aims to analyze the frequency and clinical characteristics of peripheral neuropathy (PN) in patients with systemic lupus erythematosus (SLE).A total of 4924 SLE patients admitted to the Peking Union Medical College Hospital, Beijing, China, from January 1995 to September 2013 were included in this retrospective analysis. The individuals designated as control patients were selected from the pool of SLE patients without PN using the systematic sampling method of 1:2 during the same time.The prevalence of SLE-associated PN (SLE-PN) in SLE patients was 1.5% (73/4924). Seventy-nine cases of PN affected 73 patients and 6 of these patients (8.2%) presented with 2 types of PN. Among the 7 types of PN, polyneuropathy was the most frequent and was diagnosed in 47 cases (59.5%); the remaining patients suffered from mononeuropathy (13.9%), cranial neuropathy (12.7%), myasthenia gravis (10.1%), autonomic neuropathy (2.5%), or acute inflammatory demyelinating polyradiculoneuropathy (1.3%). Five patients developed PN before the onset of SLE (3 out of 5 patients had myasthenia gravis). The most common PN-related symptoms were myasthenia and numbness (50.6%), followed by pain in affected regions (35.9%). PN symptoms were relieved in a majority of the patients (76.7%) after treatment. Compared with non-SLE-PN patients, patients with SLE-PN had a higher frequency of fever (65.8% vs 45.9%, P < 0.01), mucocutaneous involvement (73.9% vs 36.3%, P < 0.01), arthritis (42.5% vs 28.1%, P < 0.05), myositis (17.8% vs 5.5%, P < 0.01), and central nervous system involvement (38.4% vs 21.9%, P < 0.05) as well as being positive for the anti-Sm antibody (31.4% vs 18.8%), immunoglobulin G (IgG) elevation (53.6% vs 37.1%, P < 0.01), and reduction in complement 3 (54.8% vs 36.9%, P < 0.05). A statistically significant difference was found between the Systemic Lupus Erythematosus Disease Activity Index scores in SLE-PN patients compared with the non-SLE-PN patients (P < 0.05). Multivariate logistic regression showed that the only risk factor for PN was IgG elevation (odds ratio = 2.553, 1.224–5.327, P = 0.012).The prevalence of PN in SLE occurs more frequently in patients with an active form of the disease. IgG elevation is a risk factor for SLE-PN and should be assessed in these patients. Young female patients with myasthenia gravis should be closely monitored for the development of SLE.     

Histopathological Diagnostic Value of the IgG4+/IgG+ Ratio of Plasmacytic Infiltration for IgG4-Related Diseases: A PRISMA-Compliant Systematic Review and Meta-Analysis

This article aims to perform a meta-analysis to evaluate the diagnostic value of the immunoglobulin G (IgG)4⁺/IgG⁺ ratio of plasmacytic infiltration for IgG4-related diseases.Four databases—EMBASE, ISI Web of Knowledge, PubMed, and the Cochrane Library—were systematically searched. Approximately 200 participants from several studies were included in this research. STATA 11.2 software (Stata Corporation, College Station, TX) and Meta-DiSc 1.4 (Unit of Clinical Biostatistics, Ramon y Cajal Hospital, Madrid, Spain) were used to perform the meta-analysis.Nine studies were included in the meta-analysis. The pooled diagnostic odds ratio was 18.94 [95% confidence interval (CI), 2.89–124.30]. The sensitivity was 58.80% (95% CI, 50.90–66.30) and the specificity was 90.20% (95% CI, 81.20–95.80). The positive and negative likelihood ratios were 3.12 (95% CI, 1.07–9.16) and 0.26 (95% CI, 0.09–0.70), respectively. The area under the curve of the summary receiver-operating characteristic was 0.88.To conclude, the IgG4⁺/IgG⁺ ratio of plasmacytic infiltration is modestly effective in diagnosing IgG-related disease.     

Evaluation of the Clinical Performance of a Novel Chemiluminescent Immunoassay for Detection of Anticardiolipin and Anti-Beta2-Glycoprotein 1 Antibodies in the Diagnosis of Antiphospholipid Syndrome

Detection of antiphospholipid antibodies represents the first-line approach for diagnosis of antiphospholipid syndrome (APS). In this study, we evaluated the clinical performance of a novel chemiluminescence assay (CIA) in detection of IgG/IgM/IgA anti-cardiolipin (aCL) and IgG/IgM/IgA anti-β2 glycoprotein 1 (aβ2GP1) antibodies and to compare it with commercial enzyme-linked immunosorbent assay (ELISA) kits from the same manufacturer.A total of 227 sera were tested in this study, including 84 samples from patients with APS, 104 samples from patients with non-APS diseases as disease controls, and 39 healthy controls. Serum IgG/IgM/IgA aCL and IgG/IgM/IgA aβ2GP1 were determined by both ELISA (QUANTA Lite™ ELISA) and CIA (QUANTA Flash®assays).Significant quantitative correlations were identified between ELISA and CIA in IgG/IgM/IgA aCL and IgG/IgM/IgA aβ2GP1 autoantibodies detection (P < 0.001), with the rho value ranging from 0.51 to 0.87. In addition, ELISA and CIA demonstrated good qualitative agreements in IgG/IgM/IgA aCL and IgM/IgA aβ2GP1 autoantibodies determination with kappa coefficient ranged from 0.52 to 0.77. In contrast, ELISA and CIA showed a moderate qualitative agreement in IgG aβ2GP1 detection with a kappa value of 0.2. Notably, significantly higher IgG aβ2GP1 positive sera were detected by CIA, compared to those detected by ELISA in both primary APS (52.9% vs. 8.8%) and APS associated to other diseases sera (70.0% vs. 8.0%). For diagnosis of APS, IgG aβ2GP1 detection by CIA (IgG aβ2GP1 CIA) demonstrated the highest sensitivity (63.1%), followed by IgG aCL CIA (48.8%). More importantly, IgG aβ2GP1 CIA demonstrated the highest ability to predict the thrombotic events in patients with APS, with an OR of 3 (95% CI: 1.1–7.9).Our data suggest that this novel CIA assay had good performance in detecting aCL and aβ2GP1 antibodies, especially in the detection of IgG aβ2GP1 antibodies. Our findings could shed insight on the application of CIA in the laboratory diagnosis of APS in China.     

Association of MCP-1-2518A/G polymorphism with susceptibility to autoimmune diseases: a meta-analysis

We performed a meta-analysis to estimate whether combined evidence shows the association between the MCP-1-2518A/G polymorphism and susceptibility to autoimmune diseases. Relevant articles dated to July 2014 were acquired from the PubMed, EMBASE, ISI, and CNKI databases. The number of the genotypes and/or alleles for the MCP-1-2518A/G in cases and control subjects was extracted, and statistical analysis was conducted using STATA 11.2 software. Summary odds ratios (ORs) with their 95 % confidence intervals (95 % CIs) were used to calculate the risk of autoimmune diseases with the MCP-1-2518A/G. Significant increased risk of autoimmune diseases could be found for A allele vs. G allele (OR?=?1.616, 95 % CI 1.027–2.542, P?=?0.038) and AA?+?AG vs. GG (OR?=?1.616, 95 % CI 1.027–2.542, P?=?0.038) in Asian patients with rheumatoid arthritis (RA), and for A allele vs. G allele (OR?=?1.383, 95 % CI 1.142–1.676, P?=?0.022) and AA vs. AG?+?GG (OR?=?1.575, 95 % CI 1.361–1.823, P?<?0.001) in European patients with Crohn’s disease (CD). In addition, when comparison of European patients with lupus nephritis (LN) and without LN, significant association between patients with LN and without LN also could be found for AA vs. AG?+?GG (OR?=?0.713, 95 % CI 0.545–0.933, P?=?0.014). This meta-analysis showed that the MCP-1-2518-A allele confers susceptibility to Asian patients with RA and European patients with CD.     

乔本氏病针吸细胞学免疫表型观察研究

目的 探讨乔本氏病针吸甲状腺内浸润淋巴细胞免疫表型活性及临床意义。方法利用流式细胞仪检验技术测定甲状腺内浸润淋巴细胞CD3、CD4、CD8、CD4／CD8、CD7、CD19、NK、CD44、CD95／Fas、Bcl-2免疫活性，同时利用放免检验技术，测定T3、FT3、T4、FT4、7T3、TSH、TGA、MCA8项指标。结果表明乔本氏病甲状腺内浸润淋巴细胞大部分为T淋巴细胞，少数为B淋巴细胞，并且CD3＋、CD7＋T淋巴细胞比值最高，CD4＋T淋巴细胞次之，但均明显高于CD8＋T淋巴细胞，CD4／CD8比值与正常外周血相似，CD19＋B淋巴细胞及NK细胞比正常外周血B淋巴细胞不同程度减低，诱导细胞凋亡基因CD95／Fas表达明显增高，而抑制凋亡基因Bcl-2减低最明显，CD44正常，显示该病良性免疫反应紊乱疾病。8项放免指标T3、FT3、T4、FT4、γT3各项指标仅有20％～22％增高，69％～79％均呈正常，2％-7％减低，TSH增高有20％，TGA、MCA增高有79．5％-79．9％，20．1％～20．5％在正常范围内。结论乔本氏病甲状腺内浸润淋巴细胞免疫活性及分布和功能异常，更有助于进一步探讨了解乔本氏病发病机制，为自身免疫性甲状腺疾病诊断、预防、治疗及预后观察提供理论依据，并认为小针头甲状腺疾病诊断最权威性诊断和鉴别诊断指标。