人脐血CD34+ 细胞静脉移植对急性心肌梗死大鼠血流动力学指标和超声心动图指标的影响

目的:观察人脐带血CD34 细胞移植治疗急性心肌梗死大鼠的可行性及其对心功能的影响。方法:实验于2006-03/10在首都医科大学附属北京友谊医院完成。①选取11～13周龄雄性SD大鼠40只,随机数字表法分为假手术组10只、模型对照组15只、细胞移植组15只。脐血由北京市脐血干细胞库提供,采自无妊娠并发症、身体健康、新生儿足月分娩(37～40周)孕妇,均签署知情同意书,自愿捐献用于科学研究和临床治疗。②一次性血袋抽取孕妇脐带血80～120mL,按5∶1比例加入60g/L羟乙基淀粉,4℃420r/min离心8min;去除红细胞,留取上层含有核细胞的血浆层,4℃1180r/min离心10min,去除血浆,留取有核细胞,测CD34 含量为0.35%～0.42%。③模型对照组、细胞移植组大鼠建立急性心肌梗死模型,麻醉后切开第4、5肋间肌,暴露心脏,在动脉圆锥和左心耳间、距左心耳下1mm处(相当于左前降支近段)用Prolene线结扎。假手术组只挂线不结扎。根据左室前壁颜色变白、活动减弱和心电图ST段明显抬高作为急性心肌梗死模型成功标志。④术后3h内,细胞移植组经尾静脉注射0.5mL人脐血干细胞悬液(含干细胞2×1010L-1),模型对照组经尾静脉注射0.5mL生理盐水。饲养30d。⑤分别于术前、术后1d和术后30d进行超声心动图检测。并于术后30d进行血流动力学检测。结果:假手术组挂线过程中死亡1只,模型对照组造模及细胞移植过程死亡4只,细胞移植组造模及细胞移植过程死亡5只。①人脐血CD34 细胞移植30d后对大鼠血流动力学的影响:与假手术组比较,模型对照组左室收缩压、左室压力最大变化率均明显减小(t=2.16～5.14,P均<0.05),左室舒张末压、心率均明显增加(t=2.01～8.86,P<0.01或0.05);与模型对照组比较,细胞移植组左室收缩压、左室压力最大变化率均明显增加(t=2.72～2.35,P均<0.05),左室舒张末压明显减小(t=4.24,P<0.01),心率无明显变化(t=1.67,P>0.05)。②人脐血CD34 细胞移植前后超声心动图检查结果:与假手术组比较,术前模型对照组和细胞移植组各指标无明显变化;术后1,30d模型对照组和细胞移植组左室舒张末期内径、左室收缩末期内径、左室舒张末容积、左室收缩末容积均明显增加(t=2.14～9.98,P<0.05或0.01),左室前壁厚度、左室后壁厚度、左室射血分数、左室短轴缩短率均明显减小(t=2.52～14.23,P<0.05或0.01)。与模型对照组比较,术前和术后1d细胞移植组各指标无明显变化,但术后30d左室舒张末期内径、左室收缩末期内径、左室舒张末容积、左室收缩末容积均明显减小(t=2.07～7.04,P<0.05或0.01),左室前壁厚度、左室后壁厚度、左室射血分数、左室短轴缩短率均明显增加(t=3.22～9.85,P均<0.01)。结论:在未使用免疫抑制剂的情况下,人脐带血CD34 细胞静脉移植可明显改善急性心肌梗死大鼠各项心功能指标,未见明显不良反应。     

High prevalence of vitamin D deficiency in elderly patients with advanced osteoarthritis scheduled for total knee replacement associated with poorer preoperative functional state

Vitamin D deficiency has been reported previously in patients with osteoarthritis undergoing total hip arthroplasty. We found a high prevalence of vitamin D deficiency in elderly patients with advanced knee osteoarthritis scheduled for total knee replacement and also a significant association with a lower preoperative functional state. A review of the literature is given on vitamin D deficiency in patients with knee osteoarthritis and the association with lower outcome scores after arthroplasty is discussed.     

Can the Ottawa and Pittsburgh rules reduce requests for radiography in patients referred to acute knee clinics?

Our aim was to study the role of the Ottawa and Pittsburgh rules to reduce the unnecessary use of radiographs following knee injury. We prospectively reviewed 106 patients who were referred to our clinic over a 3-month period. The Ottawa and Pittsburgh rules were applied to individual patients to evaluate the need for radiography. One hundred and one patients (95%) had radiography of their knee. Five patients (5%) had a fracture of their knee and in all cases, the Ottawa and Pittsburgh knee rules were fulfilled. Using the Ottawa rules, 27 radiographs (25%) could have been avoided without missing a fracture. Using the Pittsburgh rules, 32 radiographs (30%) could have been avoided. The Ottawa and Pittsburgh rules have a high sensitivity for the detection of knee fractures. Their use can aid efficient clinical evaluation without adverse clinical outcome and may reduce healthcare costs.     

The interaction between C5a and both C5aR and C5L2 receptors is required for production of G‐CSF during acute inflammation

The complement activation product, C5a, is a key factor for regulation of inflammatory responses. C5a and C5a_desArg bind to their receptors, C5aR and C5L2, but the functional roles of C5L2 remain controversial. We screened the patterns of 23 inflammatory mediators in cultures of LPS‐activated mouse peritoneal elicited macrophages (PEMs) in the presence or absence of recombinant mouse C5a. Production of most mediators studied was suppressed by C5a, whereas G‐CSF production was enhanced. G‐CSF gene expression and secretion from PEMs was amplified two‐ to threefold by C5a in a dose‐ and time‐dependent fashion. The degradation product C5a_desArg promoted lower levels of G‐CSF. The effects of C5a on G‐CSF were associated with activation of PI3K/Akt and MEK1/2 signaling pathways. C5a did not enhance G‐CSF production in cultures of PEMs from either C5aR‐ or C5L2‐deficient mice, indicating that both C5a receptors are indispensable for mediating the effects of C5a in the production of G‐CSF. Finally, G‐CSF levels in plasma during polymicrobial sepsis after cecal ligation and puncture were substantially lower in C5aR‐ or C5L2‐deficient mice as compared with that in C57BL/6J WT mice. These findings elucidate the functional characteristics of the C5L2 receptor during the acute inflammatory response.     

Nonbronchial systemic collateral arteries: significance in percutaneous embolotherapy for hemoptysis

Twenty patients with massive or recurrent hemoptysis underwent percutaneous transcatheter embolotherapy between 1979 and 1986 for the following diseases: cavitary aspergillosis (n = 4); cystic fibrosis (n = 4); tuberculosis (n = 3); bronchogenic carcinoma (n = 3); bronchiectasis (n = 3); small cell lung carcinoma 6 years after irradiation (n = 1); congenital heart disease, after Glenn and Blalock anastomoses (n = 1); and unknown interstitial disease (n = 1). Bronchial arteries were embolized in all but one patient. In nine patients (45%) nonbronchial systemic collateral arteries contributed significantly to areas of pathologic pulmonary tissue and frequently were the major arterial supply. These nonbronchial systemic collaterals included branches of the subclavian and axillary arteries (n = 7), intercostal arteries (n = 5), and phrenic arteries (n = 3) and accounted for 59.5% of the total number of arteries embolized. Recognition and occlusion of nonbronchial systemic collaterals providing blood to hypervascular pulmonary lesions is essential for successful percutaneous embolotherapy of hemoptysis.     

Bifid origin of the left vertebral artery

Two patients demonstrating a bifid origin of the left vertebral artery are described. The embryologic origin of this anomaly is reviewed together with diagnostic and therapeutic implications, emphasizing the importance of knowledge and recognition of the anomaly. It is suggested that this anomaly is not as rare as previously thought.     

Percutaneous transluminal angioplasty following endarterectomy

Recurrent occlusive disease was found by noninvasive methods and confirmed arteriographically in 7 patients who had undergone endarterectomy for stenosis of one [5] or both iliac arteries [1] or the subclavian artery [1]. Three patients with iliac artery stenosis had percutaneous transluminal angioplasty (PTA) 1 to 5 years after endarterectomy. One patient with stenosis of the external iliac artery had PTA 4 years after endarterectomy, and dilatation was repeated 7 months later because of recurrence. One patient had 2 endarterectomies and 2 PTAs within 8 years for stenosis of the right common iliac artery. One patient had recanalization of the left common iliac artery 6 years after endarterectomy with low-dose streptokinase followed by PTA. Another patient underwent endarterectomy of the left subclavian artery 3 months after PTA and required further dilatation at 5 and 10 months because of recurrence. The authors conclude that endarterectomy does not preclude PTA (or vice versa) in patients with recurrent arterial occlusive disease.