激光治疗瘢痕的特征

目的:介绍国内近20年来激光治疗瘢痕的临床研究概况,以期进一步了解激光治疗瘢痕的新进展。资料来源:应用计算机检索Pubmed和中国生物医学文献数据库1983/2006的相关文章,限定文章语言种类为英文和中文,检索词为“cicatrices(瘢痕),laser(激光)”。资料选择:对资料进行初审,选择临床试验研究文献查找全文。纳入标准:①有明确诊断标准。②随机对照实验或对照试验。有无随访,是否采用盲法不限制。③治疗组干预措施为激光或激光联合药物;对照组干预措施为曲安奈德、冷冻联合曲安奈德或不采用药物措施。排除标准:①非对照研究。②治疗组或对照组的干预措施不符合纳入标准。③机制研究。④重复研究。资料提炼:共收集到相关文献120篇,按上述标准纳入31篇,其余文献均被排除。资料综合:31篇文章中11篇为随机对照研究,10篇为对照研究,各研究的研究期为1～6个月。各研究所纳入的病例数量为10～50例。其中6个研究对比了激光与传统药物治疗瘢痕的疗效及安全性,2个研究进行了激光治疗瘢痕基础研究机制比较,10个研究观察了激光结合与单纯药物或单纯激光对瘢痕的疗效,4个研究比较了激光联合西药治疗瘢痕的疗效,2个研究观察了激光治疗瘢痕的副作用。7篇介绍国内或国外瘢痕治疗的研究情况。结论:激光治疗瘢痕的疗效可靠,具有副作用少,方法简单,安全性高,易被患者接受等优势。但由于激光治疗瘢痕还存在着一定的局限性,今后还需要在激光的穿透深度方面研究。     

Influence of genetic variations in TLR4 and TIRAP/Mal on the course of sepsis and pneumonia and cytokine release: an observational study in three cohorts

Introduction

Severe sepsis is a disease of the microcirculation, with endothelial dysfunction playing a key role in its pathogenesis and subsequent associated mortality. Angiogenesis in damaged small vessels may ameliorate this dysfunction. The aim of the study was to determine whether the angiogenic factors (vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), and angiopoietin-1 (Ang-1) and -2 (Ang-2)) are mortality indicators in Malawian children with severe bacterial infection.

Methods

In 293 children with severe bacterial infection, plasma VEGF, PDGF, FGF, and Ang-1 and Ang-2 were measured on admission; in 50 of the children with meningitis, VEGF, PDGF, and FGF were also measured in the CSF. Healthy controls comprised children from some of the villages of the index cases. Univariable and multivariable logistic regression analyses were performed to develop a prognostic model.

Results

The median age was 2.4 years, and the IQR, 0.7 to 6.0 years. There were 211 children with bacterial meningitis (72%) and 82 (28%) with pneumonia, and 154 (53%) children were HIV infected. Mean VEGF, PDGF, and FGF concentrations were higher in survivors than in nonsurvivors, but only PDGF remained significantly increased in multivariate analysis (P = 0.007). Mean Ang-1 was significantly increased, and Ang-2 was significantly decreased in survivors compared with nonsurvivors (6,000 versus 3,900 pg/ml, P = 0.03; and 7,700 versus 11,900 pg/ml, P = 0.02, respectively). With a logistic regression model and controlling for confounding factors, only female sex (OR, 3.95; 95% CI, 1.33 to 11.76) and low Ang-1 (OR, 0.23; 95% CI, 0.08 to 0.69) were significantly associated with mortality. In children with bacterial meningitis, mean CSF VEGF, PDGF, and FGF concentrations were higher than paired plasma concentrations, and mean CSF, VEGF, and FGF concentrations were higher in nonsurvivors than in survivors (P = 0.02 and 0.001, respectively).

Conclusions

Lower plasma VEGF, PDGF, FGF, and Ang-1 concentrations and higher Ang-2 concentrations are associated with an unfavorable outcome in children with severe bacterial infection. These angiogenic factors may be important in the endothelial dysregulation seen in severe bacterial infection, and they could be used as biomarkers for the early identification of patients at risk of a poor outcome.     

鼠尾静脉流体力学转染技术对绿色荧光蛋白表达质粒器官靶向分布的影响

目的:观察流体力学尾静脉注射对绿色荧光蛋白基因器官靶向性的影响,为今后质粒载体的基因治疗和功能研究寻找潜在的靶器官。方法:实验于2005-12/2006-04在江西省分子医学重点实验室完成。选用健康雄性昆明鼠40只,将32只小鼠按随机数字表法分为流体力学注射和常规注射两大组,每大组再分为转染组和对照组两个小组(n=8),并设正常对照组(n=8)。①流体力学转染组将100μg/只绿色荧光蛋白表达质粒溶液2mL在5s内快速注入尾静脉;对照组仅在5s内注入林格氏液2mL。②常规注射组则将2mL林格氏液或绿色荧光蛋白表达质粒溶液在30s左右注入尾静脉。注射结束后24h采集各组小鼠血清检测转氨酶,并采集肝、脾、心、肾、肺和脑组织进行冰冻切片,部分肝组织采用多聚甲醛固定后切片,荧光显微镜下观察。结果:40只小鼠全部进入结果分析,无脱失。①流体力学注射组和常规注射组小鼠血清转氨酶与正常对照组比较差异均无显著性意义(P>0.05)。②常规尾静脉注射引起少数肾小球细胞表达绿色荧光蛋白,而肝、脾、心、肺及脑等组织未见明显绿色荧光蛋白表达。③流体力学注射引起肝内绿色荧光蛋白高水平表达,肝细胞表达率接近45%,其他组织则无绿色荧光蛋白表达。结论:流体力学方法是肝靶向性的活体基因转染方法,绿色荧光蛋白可作为该方法进行目的基因研究的一个可靠和方便的示踪剂。     

Rapid changes in surface antigen expression by blood monocytes cultured in suspension or adherent to plastic

Cell surface antigens used as markers of in vivo differentiation may not be stable on monocytes maintained under different conditions of in vitro culture. Monocytes were isolated from blood by centrifugation over Percoll or by adherence to plastic dishes, and the cells cultured in suspension or as adherent monolayers. Initially, monocytes obtained by both methods were similar in size, morphology, and surface antigen expression detected with the antimonocyte monoclonal antibodies OKM1, FMC17, PHM2, and PHM3. After culture, cells maintained in suspension were predominantly small, whereas those adherent to plastic rapidly increased in size; however, cytochemical staining for nonspecific esterase and acid phosphatase showed increased enzymic activity by monocytes in both systems, possibly reflecting increased cell maturation. The most striking difference was a substantial loss of FMC17 antigen by most monocytes within four hours in suspension culture, as compared with a qualitative and quantitative increase in expression by plastic adherent cells within two hours. These changes occurred even if the cells were first reacted with lipopolysaccharide. Monocytes taken from suspension culture and allowed to adhere to plastic rapidly synthesized the antigen, a process inhibited by cycloheximide, and conversely, cells removed from plastic progressively displayed decreased FMC17 antigen expression when transferred to suspension culture. No functional role in adherence or phagocytosis has been found for the FMC17 antigen. The results suggest that antigen expression may depend as much on the physical state of the cells as on apparent activation or maturation events.     

Differentiation-dependent and subset-specific recruitment of T-helper cells into murine liver

It has been suggested that the liver traps and deletes activated and potentially harmful T cells, especially of the CD8(+) subset, providing mechanisms to limit systemic immune responses. It is unknown whether this also applies to CD4(+) T cells. In this study, we show that activated stages of CD4(+) T cells were trapped in the liver on intraportal injection. Intravital microscopy showed an immediate adhesion of activated CD4(+) T cells within periportal sinusoids after intraportal injection. Furthermore, we detected high frequencies of interferon gamma (IFN-gamma)-- (Th1) and interleukin 4 (IL-4)-- (Th2) synthesizing effector cells in the liver. Transfer experiments were performed to identify those phenotypes showing specific retention in the liver. Our data show that effector stages and activated cells in general are more efficiently recruited into the liver than resting CD4(+) T cells, similar to what has previously been shown for CD45RB(low) memory cells. In addition, we observed a certain preference for Th1-polarized cells to be trapped by the liver. However, the actual cytokine-producing cells did not specifically enrich among the total population. In conclusion, these data indicate that the liver acts as a filter for activated and memory/effector cells. Cells trapped in the liver might subsequently undergo modulatory influences exerted by the postulated specific microenvironment of the liver.     

Lymphadenopathy-associated virus antibodies and T cells in hemophiliacs treated with cryoprecipitate or concentrate

Evidence for exposure to lymphadenopathy-associated virus (LAV) was investigated in 48 patients with hemophilia, 15 of whom had been treated exclusively with single-donor cryoprecipitate. The prevalence of antibodies to LAV in all patients was 53% in 1983 and 63% in 1984, while in patients treated only with cryoprecipitate, the prevalence was 31% in 1983 and 40% in 1984. Patients treated with any concentrate had a seroprevalence of 65% in 1983 and 77% in 1984. Seropositive patients were more likely to have a significant reduction in the ratio of helper to suppressor T cells, absolute numbers of helper T cells, and T cell function in vitro. Seven of 18 patients who were seronegative in 1983 had seroconverted by 1984. The relative risk of seroconversion for patients using any concentrate since 1981 compared with those using cryoprecipitate only was 3.9 (P = .04). Nevertheless, the rate of conversion in the latter group was 18% per year.     

Cover Picture: Eur. J. Immunol. 9/11

This month's cover depicts, by virtue of the scales, the balance of experts' opinions that are provided in the featured Macrophage Viewpoint series. Superimposed on the scales are cartoon drawings of the different macrophage subtypes (classical, alternative and regulatory) discussed by Fleming and Mosser (pp. 2498–2502); the background is kindly provided by Joan Stein‐Streilein and is reprinted with permission from Faunce, D. E. et al., J. Immunol. 2001. 166: 313–321 (© 2001 The American Association of Immunologists, Inc.). The background shows migrating F4/80⁺ APCs (pink) forming clusters with NKT and B cells in the marginal zone of mouse spleen, in the ACAID model of peripheral tolerance. The F4/80 antigen is discussed in the Viewpoint by Siamon Gordon et al. (pp. 2472–2476), and the paper first describing the F4/80 antibody features as one of the EJI classics on the EJI homepage ( www.eji‐journal.eu ).