异基因供体骨髓细胞胸腺内注射对肠移植大鼠的影响

目的:观察异基因骨髓注射在大鼠小肠移植中的免疫耐受作用。方法:实验于2006-09/2007-03在平凉市第二人民医院及兰州大学第二医院完成。①将大鼠分为空白对照组(Wistar)、同基因移植组(FK344/N)、异基因移植组(Wistar)、骨髓胸腺内注射组(Wistar),空白对照组18只,其余每组18只受体大鼠,供体为18只FK344/N大鼠。除空白对照组外,各组选用供受体大鼠进行全小肠异位移植,骨髓胸腺内注射组在行异基因小肠移植前7d取供体骨髓细胞行受体胸腺内注入,同基因移植组、异基因移植组大鼠不注射异基因骨髓细胞,只进行全小肠移植。②每组大鼠分别于术后3,5,7d观察排斥反应,于各时间点每次处死6只,检测血清可溶性白细胞介素2受体表达,并取出移植肠进行苏木精-伊红染色后观察组织学变化。结果:纳入受体大鼠54只及空白对照组大鼠18只均进入结果分析。①排斥反应:异基因移植组大鼠异位全小肠移植术后3,5,7d可出现典型的轻、中、重度排斥反应,而同基因组和骨髓胸腺内注射组中未出现排斥反应。②可溶性白细胞介素2受体水平:术后3d,同基因移植组、骨髓胸腺内注射组可溶性白细胞介素2受体表达水平高于空白对照组(P<0.01),而第5,7天与空白对照组差异不显著(P>0.05),异基因移植组受体大鼠各时间点血清可溶性白细胞介素2受体表达均高于同基因移植组(P<0.01)。结论:移植术前7d异基因供体骨髓在受体胸腺内注射能显著减少小肠移植后急性排斥反应的发生。血清可溶性白细胞介素2受体的检测可能作为小肠移植急性排斥反应的早期诊断敏感的免疫指标。     

干细胞因子基因cDNA克隆及其在造血干细胞中的表达

目的:克隆人干细胞因子基因cDNA,构建真核表达载体并转导脐带血造血干细胞,观察干细胞因子在造血干细胞中的表达,从而为脐血造血干细胞扩增及移植奠定实验基础。方法:实验于2005-09/12在承德医学院基础医学研究所和湖南师范大学医学院寄生虫病研究室完成。①实验材料:健康胎儿脐带由承德医学院附属医院提供,产妇均签署知情同意书;pcDNA3.1.大肠杆菌E.coliDH5α由本室保存;pUCm-T vector (promega公司);BamHⅠ,XbaⅠ(New England BioLabs公司):②实验方法:无菌收集胎儿脐带,胶原酶 胰蛋白酶 乙二胺四乙酸联合消化,分离培养人脐带内皮细胞。从上述含脐带内皮细胞的培养液中分离提取干细胞因子mRNA,用反转录-聚合酶链反应扩增干细胞因子cDNA.纯化的PCR产物与载体pUCm-T加入连接反应体系,构建及克隆pUCm-T/SCF质粒,其与pcDNA3.1分别进行BamHⅠ、XbaⅠ双酶切反应,产物经琼脂糖凝胶电泳后回收干细胞因子cDNA和pcDNA3.1片段,构建真核表达型载体pcDNA3.1/SCF。以密度梯度法 免疫磁珠法分离收集人脐血CD34~ 造血干细胞.导入pcDNA3.1/SCF,设立未转导对照组。③实验评估:转导后1～7 d检测两组细胞上清液中干细胞因子水平的表达。结果:①人于细胞因子基因cDNA克隆:扩增的人干细胞因子基因cDNA理论上应为690 bp,实际PCR产物经琼脂糖凝胶电泳后,紫外线下可见-预期大小的条带,证明干细胞因子mRNA提取成功,反转录合成的cDNA完整。②分泌型真核表达质粒pcDNA3.1/SCF的构建:BamHⅠ和XbaⅠ双酶切后电泳可见690 bp的插入片段,与干细胞因子基因序列相同,表明分泌型真核表达质粒pcDNA3.1/SCF构建成功。③脐血造血干细胞培养上清中的干细胞因子水平:培养第1～7天.转导pcDNA3.1/SCF的脐血造血干细胞上清中的干细胞因子表达水平均明显高于未转导对照组(P<0.01)。结论:成功克隆人干细胞因子基因cDNA,并构建了重组质粒pcDNA3.1/SCF,该质粒转导脐血造血干细胞后.能在短期内有效表达。     

Current UK practice in emergency laparotomy

Introduction

Emergency laparotomy is a common procedure, with 30,000–50,000 performed annually in the UK. This large scale study reports the current spectrum of emergency laparotomies, and the influence of the surgical procedure, underlying pathology and subspecialty of the operating surgeon on mortality.

Methods

Anonymised data on consecutive patients undergoing an emergency laparotomy were submitted for a three-month period. The primary outcome measure was unadjusted 30-day mortality. Appendicectomy and cholecystectomy were among the procedures excluded.

Results

Data from 1,708 patients from 35 National Health Service hospitals were analysed. The overall 30-day mortality rate was 14.8%. ‘True’ emergency laparotomies (ie those classified by the National Confidential Enquiry into Patient Outcome and Death as immediate or urgent) comprised 86.5% of cases. The mortality rate rose from 8.0% among expedited cases to 14.3% among urgent cases and to 25.7% among laparotomies termed immediate. Among the most common index procedures, small bowel resection exhibited the highest 30-day mortality rate of 21.1%. The presence of abdominal sepsis was associated with raised 30-day mortality (17.5% in the presence of sepsis vs 12.6%, p=0.027). Colorectal procedures comprised 44.3% and within this group, data suggest that mortality from laparotomy may be influenced by surgical subspecialisation.

Conclusions

This report of a large number of patients undergoing emergency laparotomy in the UK confirms a remarkably high mortality by modern standards across the range. Very few pathologies or procedures can be considered anything other than high risk. The need for routine consultant involvement and critical care is evident, and the case distribution helps define the surgical skill set needed for a modern emergency laparotomy service. Preliminary data relating outcomes from emergency colonic surgery to surgical subspecialty require urgent further study.     

Cardiopulmonary exercise testing as a predictor of complications in oesophagogastric cancer surgery

Introduction

An anaerobic threshold (AT) of <11ml/min/kg can identify patients at high risk of cardiopulmonary complications after major surgery. The aim of this study was to assess the value of cardiopulmonary exercise testing (CPET) in predicting cardiopulmonary complications in high risk patients undergoing oesophagogastric cancer resection.

Methods

Between March 2008 and October 2010, 108 patients (83 men, 25 women) with a median age of 66 years (range: 38–84 years) underwent CPET before potentially curative resections for oesophagogastric cancers. Measured CPET variables included AT and maximum oxygen uptake at peak exercise (VO₂ peak). Outcome measures were length of high dependency unit stay, length of hospital stay, unplanned intensive care unit (ICU) admission, and postoperative morbidity and mortality.

Results

The mean AT and VO₂ peak were 10.8ml/min/kg (standard deviation [SD]: 2.8ml/min/kg, range: 4.6–19.3ml/min/kg) and 15.2ml/min/kg (SD: 5.3ml/min/kg, range: 5.4–33.3ml/min/kg) respectively; 57 patients (55%) had an AT of <11ml/min/ kg and 26 (12%) had an AT of <9ml/min/kg. Postoperative complications occurred in 57 patients (29 cardiopulmonary [28%] and 28 non-cardiopulmonary [27%]). Four patients (4%) died in hospital and 21 (20%) required an unplanned ICU admission. Cardiopulmonary complications occurred in 42% of patients with an AT of <9ml/min/kg compared with 29% of patients with an AT of ≥9ml/min/kg but <11ml/min/kg and 20% of patients with an AT of ≥11ml/min/kg (p=0.04). There was a trend that those with an AT of <11ml/min/kg and a low VO₂ peak had a higher rate of unplanned ICU admission.

Conclusions

This study has shown a correlation between AT and the development of cardiopulmonary complications although the discriminatory ability was low.     

Repeatability of parametric methods for [18F]florbetapir imaging in Alzheimer’s disease and healthy controls: A test–retest study

Accumulation of amyloid beta (Aβ) is one of the pathological hallmarks of Alzheimer’s disease (AD), which can be visualized using [¹⁸F]florbetapir positron emission tomography (PET). The aim of this study was to evaluate various parametric methods and to assess their test-retest (TRT) reliability. Two 90 min dynamic [¹⁸F]florbetapir PET scans, including arterial sampling, were acquired (n = 8 AD patient, n = 8 controls). The following parametric methods were used; (reference:cerebellum); Logan and spectral analysis (SA), receptor parametric mapping (RPM), simplified reference tissue model2 (SRTM2), reference Logan (rLogan) and standardized uptake value ratios (SUV_r(50–70)). BP_ND+1, DVR, V_T and SUVr were compared with corresponding estimates (V_T or DVR) from the plasma input reversible two tissue compartmental (2T4k_V_B) model with corresponding TRT values for 90-scan duration. RPM (r² = 0.92; slope = 0.91), Logan (r² = 0.95; slope = 0.84) and rLogan (r² = 0.94; slope = 0.88), and SRTM2 (r² = 0.91; slope = 0.83), SA (r² = 0.91; slope = 0.88), SUVr (r² = 0.84; slope = 1.16) correlated well with their 2T4k_V_B counterparts. RPM (controls: 1%, AD: 3%), rLogan (controls: 1%, AD: 3%) and SUV_r(50–70) (controls: 3%, AD: 8%) showed an excellent TRT reliability. In conclusion, most parametric methods showed excellent performance for [¹⁸F]florbetapir, but RPM and rLogan seem the methods of choice, combining the highest accuracy and best TRT reliability.     

Oxidative inactivation of plasmin and other serine proteases by copper and ascorbate

Fibrin thrombi form at sites of injury, where leukocytes release a variety of oxidants. To determine whether oxidants might affect proteins of the fibrinolytic system, we examined the effects of various oxidants on plasmin. Plasmin was not inhibited by micromolar concentrations of hypochlorous acid, chloramine T, or H2O2. Neither Fe nor Cu affected plasmin alone or in the presence of H2O2. However, incubation of plasmin with 5 mumol/L Cu(I or II) in the presence of the reducing agent ascorbic acid resulted in a loss of its hydrolytic activity towards proteins as well as towards small synthetic substrates. The addition of EDTA, but not mannitol, prevented its inactivation. Inactivation was prevented by the addition of catalase and accelerated by hydrogen peroxide. Preincubation of plasmin with the competitive inhibitor alpha-N-acetyl-L-lysine methyl ester prevented inactivation by Cu(II) and ascorbate. These results together suggest site-specific oxidation of plasmin's active site. Treatment of the plasminogen activators tissue plasminogen activator and two-chain urokinase-type plasminogen activator, as well as trypsin, neutrophil elastase, and thrombin with Cu(II) and ascorbate resulted in a loss of their amidolytic and proteolytic activity, indicating the general susceptibility of serine proteases to this type of oxidation. Oxidation of the zymogens Glu-plasminogen and single-chain urokinase-type plasminogen activator by Cu(II) and ascorbate resulted in the failure of these molecules to generate active enzymes when treated with plasminogen activators or plasmin, respectively. The active site His residue may be the target of oxidative inactivation, as evidenced by the partial protection afforded plasmin by the addition of Zn(II), histidine, or the platinum derivative, platinum(II) (2,2':6',2"- terpyridine) chloride. Because platelets contain micromolar concentrations of Cu and leukocytes are rich in ascorbate, Cu-dependent site-specific oxidation might play a role in modulating proteolytic events and the life span of thrombi formed at sites of tissue injury.     

Monoclonal antibody 7G3 recognizes the N-terminal domain of the human interleukin-3 (IL-3) receptor alpha-chain and functions as a specific IL-3 receptor antagonist

The human interleukin-3 receptor (IL-3R) is expressed on myeloid, lymphoid, and vascular endothelial cells, where it transduces IL-3- dependent signals leading to cell activation. Although IL-3R activation may play a role in hematopoiesis and immunity, its aberrant expression or excessive stimulation may contribute to pathologic conditions such as leukemia, lymphoma, and allergic reactions. We describe here the generation and characterization of a monoclonal antibody (MoAb), 7G3, which specifically binds to the IL-3R alpha-chain and completely abolishes its function. MoAb 7G3 immunoprecipitated and recognized in Western blots the IL-3R alpha-chain expressed by transfected cells and bound to primary cells expressing IL-3R alpha. MoAb 7G3 bound the IL-3R alpha-chain with a kd of 900 pmol/L and inhibited 125I-IL-3 binding to high- and low-affinity receptors in a dose-dependent manner. Conversely, IL-3 but not granulocyte-macrophage colony-stimulating factor (GM-CSF) inhibited 125I-7G3 binding to high- and low-affinity IL- 3Rs, indicating that MoAb 7G3 and IL-3 bind to common or adjacent sites. In keeping with the inhibition of IL-3 binding, MoAb 7G3 antagonized IL-3 biologic activities, namely stimulation of TF-1 cell proliferation, basophil histamine release, and IL-6 and IL-8 secretion from human endothelial cells. Two other anti-IL-3R alpha-chain MoAbs failed to inhibit IL-3 binding or function. Epitope mapping experiments using truncated IL-3R alpha-chain mutants and IL-3R alpha/GM-CSFR alpha chimeras revealed that 31 amino acids in the N-terminus of IL-3R alpha were required for MoAb 7G3 binding. MoAb 7G3 may be of clinical significance for antagonizing IL-3 in pathologic conditions such as some myeloid leukemias, follicular B-cell lymphoma, and allergy. Furthermore, these results implicate the N-terminal domain of IL-3R alpha in IL-3 binding. Since this domain is unique to the IL-3/GM- CSF/IL-5 receptor subfamily, it may represent a novel and common binding feature in these receptors.     

Is the oral fungal pathogen Candida albicans a cariogen?

Pathobiology of dental caries is complex. Data from recent molecular microbiologic studies have further redefined the role of the oral microbiome in the etiology of dental caries. This new information challenges the conventional view on the hegemony of classic cariogenic prokaryotes such as Streptococcus mutans in caries etiology, and raises the intriguing possibility of the participation of the eukaryotic oral fungal pathogen Candida in the caries process. The virulence attributes of Candida species such as their acidogenicity and aciduric nature, the ability to develop profuse biofilms, ferment and assimilate dietary sugars, and produce collagenolytic proteinases are all indicative of their latent cariogenic potential. Based on the above, oral candidal counts have been used by some as a caries risk indicator. On the contrary, other studies suggest that Candida is merely a passenger extant in an acidic cariogenic milieu, and not a true pathogen. In this review, we critically examine the varying roles of Candida, and traditionally accepted cariogens such as the mutans group of streptococci in the pathobiology of dental caries. The weight of available data tends to imply that Candida may play a pivotal role as a secondary agent perpetuating the carious process, especially in dentinal caries.     

First update of the International Xenotransplantation Association consensus statement on conditions for undertaking clinical trials of porcine islet products in type 1 diabetes—Chapter 2a: source pigs—preventing xenozoonoses

Chapter 2 of the original consensus statement published in 2009 by IXA represents an excellent basis for the production of safe donor pigs and pig‐derived materials for porcine islet xenotransplantation. It was intended that the consensus statement was to be reviewed at interval to remain relevant. Indeed, many of the original salient points remain relevant today, especially when porcine islet xenotransplantation is performed in conjunction with immunosuppressants. However, progress in the field including demonstrated safe clinical porcine xenograft studies, increased understanding of risks including those posed by PERV, and advancement of diagnostic capabilities now allow for further consideration. Agents of known and unknown pathogenic significance continue to be identified and should be considered on a geographic, risk‐based, dynamic, and product‐specific basis, where appropriate using validated, advanced diagnostic techniques. PERV risk can be sufficiently reduced via multicomponent profiling including subtype expression levels in combination with infectivity assays. Barrier facilities built and operated against the AAALAC Ag Guide or suitable alternative criteria should be considered for source animal production as long as cGMPs and SOPs are followed. Bovine material‐free feed for source animals should be considered appropriate instead of mammalian free materials to sufficiently reduce TSE risks. Finally, the sponsor retention period for archival samples of donor materials was deemed sufficient until the death of the recipient if conclusively determined to be of unrelated and non‐infectious cause or for a reasonable period, that is, five to 10 yrs. In summary, the safe and economical production of suitable pigs and porcine islet xenograft materials, under appropriate guidance and regulatory control, is believed to be a viable means of addressing the unmet need for clinical islet replacement materials.