Molecular cloning of the gene for the allatostatin family of neuropeptides from the cockroach Diploptera punctata.

Allatostatins (ASTs) are insect neuropeptides that inhibit juvenile hormone biosynthesis by the corpora allata. We have isolated a cDNA from the cockroach Diploptera punctata that encodes a 41.5-kDa precursor polypeptide containing the AST family of peptides. Translation of the cDNA revealed a 370-amino acid pre-pro-peptide consisting of 13 AST-type peptides and appropriate processing sites for endoproteolytic cleavage and amidation. The 13 potential AST sequences are characterized by the C-terminal AST corestructure Phe-Gly-Leu-NH2, with only one exception. Separating the clustered ASTs in the precursor, three acidic spacer regions are found. Contained within the largest of these are two potentially related peptides that may also be processed. Southern blot analysis revealed the presence of a single copy of the AST gene per haploid genome, as well as the probability that the gene may be present in at least two allelic forms. In situ hybridization indicated the AST-encoding gene is expressed in neurosecretory cells of D. punctata brain.     

A randomized placebo-controlled trial of recombinant human interleukin- 11 in cancer patients with severe thrombocytopenia due to chemotherapy

Thrombocytopenia is a complication of cancer treatment that can limit dose intensity. Interleukin-11 (IL-11) is a growth factor that increases platelet production. We conducted a multicenter, randomized, placebo-controlled trial of recombinant human IL-11 (rhIL-11) in 93 patients with cancer who had already been transfused platelets for severe thrombocytopenia resulting from chemotherapy. The patients had received platelet transfusions for nadir platelet counts of < or = 20,000/microL during the chemotherapy cycle immediately preceding study entry. Chemotherapy was continued during the study without dose reduction. Patients were randomized to receive placebo or rhIL-11 at 50 or 25 micrograms/kg subcutaneously once daily for 14 to 21 days beginning 1 day after chemotherapy. Eight of 27 (30%) evaluable patients treated with rhIL-11 at a dose of 50 micrograms/kg did not require platelet transfusions versus 1 of 27 (4%) patients who received placebo (P < .05). Five of 23 (18%) patients treated with rhIL-11 at 25 micrograms/kg avoided platelet transfusions (P = .23). Side effects were fatigue and cardiovascular symptoms, including a low incidence of atrial arrhythmias and syncope. There were no differences among treatment groups in the incidence of neutropenic fever, days of hospitalization, or number of red blood cell transfusions. This study shows that rhIL-11 treatment of a dose of 50 micrograms/kg significantly increases the likelihood that patients who have already been transfused platelets for severe chemotherapy-induced thrombocytopenia will not require platelet transfusions during a subsequent chemotherapy cycle.     

Glucocorticoids and lymphocytes. III. Effects of glucocorticoid administration on lymphocyte glucocorticoid receptors

To determine the effects of glucocorticoid administration on the number of measured lymphocyte glucocorticoid receptor sites and the duration of such effects, seven normal volunteers were studied. Glucocorticoid receptor levels of the lymphocytes circulating in the blood of each volunteer were determined. Glucocorticoid was then administered in a regimen of a total of four doses of dexamethasone 4 mg p.o. every 6 hr. Determinations of the number of receptors were performed at 6 hr and at various subsequent times after the end of dexamethasone administration. When compared to baseline receptor numbers, six volunteers showed a decrease in receptor number after glucocorticoid administration (median maximum decrease 2,046 sites/cell). The fall in receptor number occurred rapidly, reaching a nadir within 30 hr from the end of glucocorticoid administration. The return of receptor number to baseline was more gradual, requiring from 3 to as long as 17 days in one subject. Our results suggest that in order to accurately interpret glucocorticoid receptor numbers in human lymphoid cells, glucocorticoid should not have been administered for 3 wk prior to determinations of receptor levels.     

Biliary and portal vein strictures following treatment of Hodgkin’s lymphoma

Treatment of abdominal lymphoma can be associated with bowel stricture or perforation. Rarely, the common bile duct or portal vein can be involved. This is the first case of stricture formation of both the portal vein and common bile duct in a patient following successful treatment of lymphoma. The development of extensive hilar varices rendered surgical management high risk. A staged approach to treatment was used. First, a percutaneous portal vein stent was placed, resulting in resolution of the hilar varices. This was followed by a surgical hepaticojejunostomy, performed without complication. Gastrointestinal complications are rare following treatment of lymphoma but may affect a variety of sites. The safe and effective treatment of this case highlights the benefit of a multidisciplinary approach to complex medical and surgical problems.     

应用经胸超声心动图评估快速左心耳起搏心房颤动模型心脏结构及功能的变化

目的:应用经胸超声心动图观察高频率左心耳起搏致猪慢性心房颤动模型心脏结构和功能的变化。方法:实验于2005-09/2006-08在南京医科大学第一附属医院江苏省实验动物中心完成。①12只苏钟种猪随机分为实验组及对照组各6只,所有动物均开胸,将起搏电极固定在左心耳根部,高频率脉冲发生器植入左侧胸部囊袋。实验组术后恢复1周后起搏器以500次/min的频率快速起搏左心耳8周;对照组始终不起搏。②术后心电图定期监测起搏、心房颤动的发生情况;于术前、起搏后1周、起搏后4,8周超声心动图观察实验动物左房内径、心室收缩及舒张末左房面积、左房和左室射血分数、左室舒张及收缩末内径、左心室短轴缩短率等变化。结果:①实验组5只完成了实验,术后2周复查心电图,1只动物发生房颤,起搏8周3只发生阵发性房颤,1只未发生房颤;对照组则未发生任何心律失常情况。②左心房相关指标:起搏后1周,实验组左房内径、收缩末期左心房面积和舒张末期左房容积均较起搏前增加[(2.70±0.12),(2.50±0.12)cm;(6.78±0.81),(6.21±0.93)cm2;(4.66±0.53),(3.78±0.57)mL;P均<0.05],左房射血分数较起搏前下降[(55.6±6.0)%,(63.8±4.0)%,P<0.01],至起搏4,8周,左房射血分数进一步降低,左房内径等指标则继续增大。③左心室相关指标:起搏后1周,实验组左室舒张、收缩末期内径较起搏前增加[(3.64±0.13),(3.46±0.15)cm;(2.48±0.08),(2.14±0.09)cm;P均<0.01],左心室短轴缩短率和左室射血分数较起搏前下降[(31.6±2.0)%,(37.8±3.0)%;(60.8±2.0)%,(69.2±4.0)%;P均<0.01];至起搏4,8周,左心室短轴缩短率和射血分数进一步降低,左室舒张、收缩末期内径则继续增大,与对照组比较也差异显著(P<0.05,0.001)。结论:①超声心动图是监测房颤模型建立过程中心房、心室结构和功能变化的有效手段。②高频起搏左心耳是建立猪心房颤动模型的有效方法,快速心房起搏可导致左心房左心室增大及心功能减退。     

Serologic evidence that Scianna null (Sc:-1,-2) red cells lack multiple high-frequency antigens

Sera from three unrelated persons whose red cells (RBC) had the common Scianna phenotype (Sc:1,-2) contained IgG alloantibodies directed against high-frequency RBC antigens. In each case, sera or eluates or both failed to react only with Scianna null (Sc:-1,-2) cells, although an eluate from one person was compatible with a sibling's Sc:1,-2 cells. Cross-testing cells with sera or eluates, or both, from the three persons revealed no mutual compatibility. These studies show the existence of three additional RBC antigens phenotypically related to the Scianna blood group system. Sc:-1,-2 cells lack these antigens, which indicates that Scianna null cells lack multiple high-frequency antigens.     

Column agglutination technology: the antiglobulin test

A new system for typing and screening blood, based on the sieving effect of glass bead microparticles, has been developed. The test is performed in a microcolumn in which the red cell agglutinates are trapped in the glass bead matrix during centrifugation, and unagglutinated cells form a pellet at the bottom of the column. Anti- human globulin reagents were incorporated in the diluent and the new test system, column agglutination technology, was compared to conventional tube tests and low-ionic-strength method. Sera and plasmas (228 samples) were screened for red cell antibodies with two anti-human globulin reagents: one containing only anti-IgG and the other containing both anti-IgG and anti-C3b, -C3d. After initial testing, there was 94-percent agreement between column agglutination technology and tube tests, and after repeat testing, there was 97-percent agreement. The column agglutination technology anti-human globulin test eliminates the need to wash red cells, which decreases the overall test time. The test is easy to perform, and the results are more objective than those with tube and microplate methods.     

The cell and molecular basis of leukocyte common antigen (CD45)- triggered, lymphocyte function-associated antigen-1-/intercellular adhesion molecule-1-dependent, leukocyte adhesion

We recently reported that cross-linking the leukocyte common antigen (CD45) can rapidly induce aggregation of human peripheral blood mononuclear cells via lymphocyte function-associated antigen-1 (LFA-1) and intercellular adhesion molecule-1 (ICAM-1) interactions. Herein, we have examined both T-cell--monocyte cellular interactions and the molecular signaling that are involved in this phenomenon. Experiments using highly purified T lymphocytes showed that CD45-induced aggregation requires the presence of both T cells and monocytes. Cross- linking CD45 only on T lymphocytes, but not on monocytes, initiated cellular clustering after reconstituting to the respective untreated cell type. By several criteria, CD45-induced clustering of T cells to autologous monocytes was shown to be Fc-receptor--independent. When comparing intracellular signaling in leukocyte aggregation induced by CD45 cross-linking versus phorbol myristate-12-13-acetate (PMA) treatment, the former was found to be fivefold to 10-fold more sensitive to H-8, a reagent that effectively blocks cAMP- and cGMP- dependent protein kinases. On the other hand, reagents that increase intracellular cAMP levels (eg, dbcAMP, forskolin, and IBMX), protein kinase C (PKC) inhibitors (eg, staurosporine), and tyrosine kinase inhibitors (eg, herbimycin A and genistein) all readily inhibited PMA- induced, but not CD45 monoclonal antibody-induced, aggregation. We conclude that cross-linking the leukocyte common antigen on T cells induces LFA-1--/ICAM-1--dependent T-cell--monocyte aggregation through a unique signaling pathway independent of PKC, which involves instead cAMP-/cGMP-dependent protein kinases.     

游离足趾移植术中Ⅱ趾血供系统的特点

目的：游离足趾移植是拇指Ⅱ类以上缺损再造术的首选。分析与Ⅱ趾移植相关的足部供血系统的血管走行、分支情况及变异程度，并提出临床应用中为保证手术成功而采取的相应对策。方法：对1978—03/2007—06天津医院手、显微外科收治的91例Ⅱ趾移植再造拇（手）指患者进行回顾性分析，所有病例均为ⅡB-ⅢB类型拇指缺损，均为择期手术，对治疗方案知情同意。术中遇第一跖背动脉纤细型，采取足背动脉-足底深支-第一跖底动脉的第2套供血系统。当第一跖背动脉走行不定而误伤时，手术继续进行，完整切取Ⅱ趾后，进行第一跖背动脉吻合修复。注意第一跖背动脉至足趾的分支解剖特点，辨清与Ⅱ趾的关系，采取不同的手术对策。结果：91例拇指缺损患者获得了97．8％的成活率及优良的外形与功能恢复，移植术中Ⅱ趾的使用率是100％。Ⅱ趾的血供系统特点：①由足背动脉发出的第二跖背动脉很少见，足背动脉的弓状动脉分支也很少见。②第一跖背动脉起始、走行、口径虽不恒定，但是有章可循。③第一跖背动脉终末交通支及至Ⅱ趾的分支情况分为3型，各型对Ⅱ趾的血供也有其不同特点。结论：全面掌握与Ⅱ趾移植相关的足部供血系统的解剖特点，术中仔细游离并采取相应的处理方法，是保证手术成功的关键。     

自主研制镍钛记忆合金左心耳封堵器封闭左心耳对实验动物左心功能的影响

目的:应用经胸彩色多普勒超声技术评价自主研制的镍钛记忆合金左心耳封堵器封闭左心耳对实验动物猪左心房、左心室功能的影响。方法:实验于2005-09/2006-08在南京医科大学第一附属医院江苏省实验动物中心完成。①实验分组:选用苏钟小型种猪17只,随机分为实验组12只和对照组5只。②实验干预:实验组12只苏钟小型种猪使用自主研制的左心耳封堵器(发明专利号码:200610037789.3,公开号CN1799521,由镍钛合金骨架、多聚四氟乙烯膜和传送连接部分等构成。其外观呈单盘状,封堵器的左心房面呈圆盘状,直接连接放入心耳内的圆柱体结构)行左心耳封堵,对照组5只手术步骤相同而不采用封堵器行左心耳封堵。③实验评估:两组动物分别于术前、术后1周、2周、4周采用经胸超声心动图检查观察心功能的改变,测量左心房内径、最大及最小容积、左房射血分数、左心房搏出量、血流分数等左房功能参数以及左室射血分数、左室短轴缩短率、Tei指数、E/A比值等指标。结果:①实验动物数量分析:在施行左心耳封堵后,1头猪于术中出血过多并出现室颤后死亡,1头猪因封堵器脱入左房,卡在二尖瓣口导致死亡。其余动物封堵效果良好。②两组动物术后1,2,4周左房功能指标各参数与术前比较无明显变化(P>0.05);与术前相比,实验组术后1周、2周左室射血分数、左心室短轴缩短率、E/A比值分别由术前的0.70±0.04、0.39±0.03、1.33±0.28降低至术后1周的0.59±0.05、0.31±0.03、0.95±0.11(P<均0.01)及术后2周的0.62±0.05、0.33±0.05、0.90±0.05(P<均0.01);Tei指数由术前的0.48±0.02增加至术后1周的0.59±0.03(P<0.01)及术后2周的0.58±0.04(P<0.01)。对照组手术前后左室功能指标差异无显著性。结论:自主研制左心耳封堵器可以有效的封堵左心耳;左心耳封堵后短期内对实验动物左房功能无明显影响;封堵后短期内对左心室功能具有短期的减弱,更长期的安全性有待于进一步研究。