Cord blood banking in London: the first 1000 collections.

The London Cord Blood Bank was established with the aim of collecting, processing and storing 10000 unrelated stem cell donations for the significant number of children in the UK requiring transplantation, for whom a matched unrelated bone marrow donor cannot be found. Collection is performed at two hospitals by dedicated cord blood bank staff after delivery of the placenta. Mothers are interviewed regarding medical, ethnic and behavioural history by nurse counsellors and sign a detailed consent form. Donations are returned to the bank for processing. Volume reduction is undertaken by a simple, closed, semi-automated blood processing system, with excellent recovery of progenitor cells. Units are cryopreserved and stored in the vapour phase of liquid nitrogen. Blood samples from mothers and cord blood donations are tested for the UK mandatory red cell and microbiology markers for blood donors. Donations are typed for HLA-A, B and DR at medium resolution (antigen split) level using sequence-specific oligonucleotide probing and sequence-specific priming techniques. The selection of collection hospitals on the basis of ethnic mix has proven effective, with 41.5% of donations derived from non-European caucasoid donors. Bacterial contamination of collections has been dramatically reduced by implementation of improved umbilical cord decontamination protocols.     

Diet for cystic fibrosis. Nutritional requirements and prescriptions

Diet plays no direct role in neutralizing the effects of the basic defect in cystic fibrosis, but it can prevent some of the acquired damage caused by complications. Adequate caloric intake provides the energy needed for exercise and cell metabolism, a strong diaphragm, normal cellular immunity, and a positive psychological outlook. Clinical management is aimed at achieving good nutrition. Patient education about nutrition and use of dietary supplements should be started immediately upon diagnosis. Careful clinical examinations and regular follow-up are necessary to detect complications that will interfere with good nutrition. Complications must be treated aggressively. Psychological and social stresses need to be recognized, and psychological referral may be necessary. The clinician's best tools to achieve these goals are the patient's dietary and gastrointestinal history, the anthropometric measurements taken at each office visit, regular patient assessment, and constant attention to detail in monitoring and charting the course of disease. Extraordinary measures, such as nighttime feedings by nasogastric or gastrostomy tube and intravenous hyperalimentation, may be necessary. For best results, these measures must be started before pulmonary complications threaten survival.     

Feasibility and compliance studies of a home measurement monitoring program for cystic fibrosis

A home measurement monitoring system has been developed for assessing progress and planning changes in care for patients with cystic fibrosis. Daily diary recording of specified measurements, quantitative symptom data, and free text are to be used for early detection of deteriorating trends before serious complications develop. Daily measurements made at home are lung capacity, body weight, breathing rate, and pulse. The program has been in place for the past two years, and has maintained a 75-80% consistent diary response rate among the 111 patients initially committed to the program. Measurements are easy to perform, equipment design is simple and rugged, and data handling routines designed for the program using the INSIGHT clinical data base system perform satisfactorily. Checking for data entry errors and validity checks of home measurements are a regular part of the data handling activity. Patient acceptance and long-term compliance in this program agrees very favorably with reports of other diary programs in chronic disease. Diary compliance was significantly greater among younger patients and those who lived long distances from the hospital. This study has demonstrated that home monitoring is a feasible program for patients with cystic fibrosis. It presents the possibility of detecting adverse health trends earlier than is now practical, so that patients can be treated before serious complications develop, thereby preventing the large fluctuations in health status that often accompany CF.     

Postamputation neuromas and other symptomatic stump abnormalities: detection with CT

One of the potentially troublesome sequelae of limb amputations is the development of stump neuromas at the severed ends of major nerves. The ability to define them and to distinguish them from other causes of stump pain is of considerable clinical significance. Computed tomography was performed on ten lower limb amputees with stump pain. Five patients had neuromas that were manifest as focal or generalized alteration in the caliber, size, or contour of the nerve trunk in the affected stump. The remaining five patients each had an abnormality detected; these abnormalities included heterotopic bone formation, popliteal artery aneurysm, lipoma, scar tissue, and abscess in the contralateral limb.     

RENAL VENOUS WEDGE PRESSURE IN RENAL WRAP HYPERTENSION IN RABBITS

1. Renal cellophane wrapping to produce hypertension causes thickening of the capsule of the kidney. To determine whether this compresses the kidney, deep renal vein wedge pressure was measured as an estimate of tissue pressure in anaesthetized rabbits 1 month after cellophane wrapping (n= 5) or a sham operation (n= 3). 2. Renal vein wedge pressure was 18.3 ± 2.0 mmHg in hypertensive rabbits and 8.4 ± 1.1 mmHg in the sham-operated rabbits. 3. Arterial pressure was raised or lowered with angiotensin II or glyceryl trinitrate, respectively. Arterial and wedge pressures were approximately linearly related and, at any given arterial pressure, wedge pressure was approximately 8 mmHg higher in the cellophane-wrapped kidney than in the kidney of the sham-operated group. 4. These results, showing that renal wedge pressure is elevated in renal wrap rabbits, indicate that the kidneys are compressed, probably by the thickened renal capsule. This may explain the increased renal vascular resistance seen in this form of hypertension.     

普通教师与特殊教育教师职业倦怠和教学效能感的比较

目的:比较普通教育教师和特殊教育教师的职业倦怠与教学效能感特点,分析其影响因素。对象:①采用Maslach教师职业倦怠问卷和教师教学效能感量表于2006-06/09根据年龄、性别、教龄及是否担任班主任等对重庆市200名普通教育教师、100名特殊教育教师的职业倦怠和教学效能感的现状进行调查。Maslach教师职业倦怠问卷包括22个条目共3个维度:情绪衰竭、去人性化、低成就感。教师教学效能感量表共27个条目,包括一般教育效能感和个人教学效能感,各个维度总分相加形成总效能感。两个量表/问卷各题项均采用5点计分,分数越高,表示职业倦怠感越严重,教学效能感越强。②计量差异比较采用t检验和方差分析,并应用相关分析以及逐步回归分析统计学方法。结果:普通中小学共发放200份问卷,收回有效问卷176份,有效率占91.7%;特殊教育学校共发放100份问卷,收回有效问卷76份,有效率为80%。①职业倦怠和教学效能评分差异:普教与特教教师之间的职业倦怠感存在着显著的差异(t=2.837,P<0.01),普教教师与特教教师职业倦怠感的差异主要体现在情感衰竭维度上[普教:(3.16±0.71)分,特教:(2.63±0.65)分,t=5.535,P<0.01];去人性化和低成就感维度上无显著差异。普教教师的一般教育效能感得分显著低于特教教师[(3.40±0.66),(3.70±.57)分,t=-3.391,P<0.01]。②职业倦怠感和教学效能的人口学差异:除5年及以下教龄的教师外,普教与特教教师在性别、教龄及是否班主任等方面存在着情感衰竭方面的显著差异(P<0.05～0.01)。除6～10年教龄的教师之间外,普教与特教之间的一般教育效能感也存在明显差异(P<0.05～0.01),普教低于特教。同时,女教师之间的个人教学效能感存在着显著差异,普教女教师高于特教女教师。③相关性:普教与特教教师的教学效能感与职业倦怠都呈明显负相关(r=-0.515,-0.502,P<0.01),但特教在情感衰竭维度上的相关性不如普教强(r=-0.320,-0.240,P<0.01,0.05)。④逐步回归分析结果:一般教育效能感对普教的情感衰竭和去人性化程度、对特教教师的低成就感预测性较强(Beta=-0.321,-0.274,-0.404,P<0.01);个人教学效能感同时预测着普教和特教的去人性化和低成就感(普教:Beta=-0.286,-0.360,P<0.01;特教:Beta=-0.480,-0.585,P<0.01)。是否班主任因素对普教教师的情感衰竭和去人性化预测作用明显(Beta=-0.283,-0.179,P<0.01,0.05),而教龄对特教教师的去人性化和低成就感的预测作用明显(Beta=0.258,0.212,P<0.05)。结论:①普教与特教教师的职业倦怠感中的情感衰竭维度和教学效能感中的一般教育效能感有明显差别。②普教与特教教师的职业倦怠感和教学效能感存在性别、教龄及是否班主任的差别。③教学效能感在普教与特教教师中对职业倦怠各因素的预测作用不尽相同。是否班主任因素对普教教师的情感衰竭和去人性化预测作用明显,而教龄对特教教师的去人性化和低成就感的预测作用明显。     

重组人粒细胞-巨噬细胞集落刺激因子乳酸链球菌表达载体的构建

目的:构建重组人粒细胞-巨噬细胞集落刺激因子乳酸链球菌表达载体,为进一步研究人粒细胞-巨噬细胞集落刺激因子在乳链菌的表达及其治疗价值奠定基础。方法:实验于2005-04/2006-03在南方医科大学南方医院消化病研究所完成。①载体pNCSF的构建:将质粒集落刺激因子及含有P59启动子、USP45蛋白信号肽的pNBC1000质粒分别加入BamH Ⅰ和Pst Ⅰ进行双酶切,并用Apa Ⅰ、Sac Ⅰ进行双酶切鉴定,重组质粒命名为pNCSF。②SDGFP的TA克隆及载体pNCSFGFP的构建:将经过优化适合在乳链菌表达的人粒细胞-巨噬细胞集落刺激因子基因克隆于含有P59启动子、USP45蛋白信号肽的pNBC1000载体,得到重组质粒pNCSF;同时设计上下游引物经PCR扩增增强荧光表达蛋白(EGFP),TA克隆后经测序验证,再连接于pNCSF获得重组质粒pNCSFGFP。③载体pTRCSF、pTRCSFGFP的建立:将获得的pNCSF和pNCSFGFP进一步克隆于穿梭载体pTR1001c,以获得人粒细胞-巨噬细胞集落刺激因子乳链菌表达载体pTRCSF及pTRCSFGFP。结果:①载体pNCSF构建结果:酶切鉴定产物经1.0%的琼脂糖凝胶电泳后,发现有(含启动子P59、信号肽USP45、人粒细胞-巨噬细胞集落刺激因子)720bp的目的片段。②SDGFP的TA克隆及载体pNCSFEGFP的构建结果:SDGFP阳性克隆产物经EcoRⅠ酶切鉴定得到775bp目的片段。pNCSFEGFP酶切鉴定产物经1.0%的琼脂糖凝胶电泳后,发现有(含启动子P59、信号肽USP45、人粒细胞-巨噬细胞集落刺激因子、SDGFP)1495bp的目的片段。③穿梭质粒pTRCSF、pTRCSFGFP酶切鉴定结果:经Xba Ⅰ、Sac Ⅰ进行双酶切鉴定,分别得到约717bp、1492bp大小目的片段。结论:获得了人粒细胞-巨噬细胞集落刺激因子乳链菌表达载体pTRCSF及pTRCSFGFP,并经酶切鉴定和测序证实。