经静脉移植人脐血间充质干细胞在鼠损伤脊髓的表达及神经功能修复

目的:采用Brdu免疫组化标记技术观察经静脉移植人脐血间充质干细胞进入损伤脊髓组织的表达情况,探讨其促进损伤脊髓神经功能恢复的作用。方法:实验于2003-10/2005-03在苏州大学生物技术研究所干细胞实验室完成。①选取健康成年Wistar大鼠60只,随机数字表法分为假手术组、模型对照组、干细胞移植组,20只/组。脐血标本来自苏州大学附属第一医院产科,产妇及其家属均签署知情同意书。②自脐带抽取新鲜脐带血50～60mL,分离培养人脐血间充质干细胞,调整细胞浓度为5×109L-1待用。在细胞移植前48h,体外进行Brdu标记。③模型对照组、干细胞移植组大鼠采用重物压迫法建立脊髓损伤模型。麻醉后取俯卧位,于T11节段处行背后方正中切口,剥离椎旁肌,咬除T11棘突及椎板,显露4mm×5mm硬脊膜,将55g重砝码放置于硬脊膜表面1min,然后逐层缝合伤口。假手术组仅显露硬脊膜,然后缝合伤口。④造模后5d,干细胞移植组大鼠自后肢大隐静脉缓缓注入人脐血间充质干细胞悬液0.2mL～0.3mL(1×106个)。模型对照组、假手术组给予等量生理盐水。⑤分别于细胞移植后1d、1,2,3周,采用BassoBeatlieBresnahan(BBB)评分法和斜板试验法测定各组神经功能情况。于细胞移植后1,3周制作冰冻切片,检测各组脊髓组织内脐血间充质干细胞的分布情况。结果:①神经功能检测结果:脊髓损伤细胞移植后3周内,模型对照组、干细胞移植组大鼠后肢运动功能均有所恢复,但干细胞移植组恢复较快,于术后1周BBB评分和斜板试验结果即明显优于模型对照组[(10.71±6.24),(5.13±3.36)分,t=2.39,P<0.05;(51.67±5.22),(46.63±3.72)度,t=3.39,P<0.01],并维持至术后3周[(17.29±4.03),(11.25±5.01)分,t=3.89,P<0.01;(65.77±8.06),(57.05±4.61)度,t=4.07,P<0.01]。②脊髓组织中人脐血干细胞的鉴定:假手术组、模型对照组脊髓组织中未见Brdu阳性表达区。干细胞移植组于移植后1周脊髓损伤区可见大量棕褐色Brdu阳性表达的人脐血间充质干细胞存在,并持续至移植后3周,而非损伤区则始终无阳性表达。结论:Brdu对脐血间充质干细胞具有良好的标记作用,经静脉移植的人脐血间充质干细胞能够进入脊髓损伤区,并可以促进损伤脊髓神经功能的修复。     

Assessment of quality of life,anxiety, socio‐economic factors and caries experience in Brazilian children with overweight and obesity

Purpose: This study evaluated the association between excess weight and quality of life (QoL), symptoms of anxiety, caries experience and socio‐economic factors in a representative sample of 8‐ to 10‐year‐old children from three public schools of Piracicaba (SP, Brazil). Materials and methods: The Autoquestionnaire Qualité de Vie Enfant Image was applied to explore family and social relations, activities, health, body functions and separation domains, and, by means of the Multidimensional Anxiety Scale for Children, symptoms of anxiety were screened. Clinical examination was performed using DMFT/dmft indexes to assess oral health and caries experience. Medical and nutritional history, parents’ schooling, monthly income and ownership of household goods and services were also evaluated. Results: Of the 313 subjects included, four subjects were underweight, 188 normal weight, 67 overweight and 54 presented obesity (38.7% with excess weight). Measures of QoL, anxiety scores and caries experience did not differ between groups. The regression model showed a significant association between excess weight and the ownership of household goods and services (OR = 5.4/CI = 1.6–18.3). Conclusions: High prevalence of excess weight was observed among prepubertal children, emphasizing the need for continued health programmes to limit risk factors for obesity. QoL, anxiety scores and caries experience did not differ between subjects with different body weights, although children from public schools with higher ownership of goods and services were more likely to present excess weight.     

Efficacy of quadruple therapy for Helicobacter pylori eradication after failure of proton pump inhibitor‐based triple therapy in Singapore

BACKGROUND: Helicobacter pylori eradication is the mainstay in the treatment of H. pylori‐associated peptic ulcer disease. Current standard eradication therapy consists of 1 week of treatment with a proton pump inhibitor (PPI) and two antibiotics selected from amoxicillin, metronidazole and clarithromycin. In this study we aimed to assess the efficacy of quadruple therapy consisting of a PPI, bismuth, tetra‐cycline and metronidazole in patients for whom initial H. pylori eradication using a triple therapy regimen consisting of a PPI, amoxicillin and clarithromycin was unsuccessful. METHODS: Consecutive patients with H. pylori‐associated peptic ulcer disease, in whom H. pylori with triple therapy had been unsuccessful, were included in the study. These patients had been treated with a regimen that included a PPI (standard dose twice daily), amoxicillin (1 g twice daily) and clarithro­mycin (500 mg twice daily) for 1 week during 1997?2001. Diagnosis of peptic ulcer disease was made at esophagogastroduodenoscopy. Helicobacter pylori infection was considered to be present on the basis of either a positive rapid urease test, positive histo­logical identification of H. pylori or both. Failure of initial H. pylori eradication was established with either a rapid urease test, a ¹³C urea breath test or histology. Quadruple therapy consisted of a PPI (standard dose twice daily), metronidazole (400 mg three times daily), tetracycline (500 mg four times daily) and bismuth subcitrate (240 mg twice daily). Failure of quadruple therapy was diagnosed on the basis of a positive ¹³C urea breath test. RESULTS: Fifty‐three patients received quadruple therapy. The median age was 52 years (range 20?74) and the male to female ratio was 42 : 11. On an intent‐to‐treat basis, the eradication rate was 69.8%, whereas on a per‐protocol basis, the eradication rate was 82.2%. CONCLUSION: We conclude that a 1‐week quadruple therapy regime consisting of a PPI, bismuth, tetracycline and metronidazole was effective in 82.2% of patients who experienced an unsuccessful initial H. pylori eradication attempt with PPI, amoxicillin and clarithromycin.     

Co-morbidity, not age predicts adverse outcome in clostridium difficile colitis

AIM To examine whether age alone or comorbidity is a risk factor for death in older adults who developed Clostridium difficile (Cd)colitis during hospitalization.METHODS A retrospective, observational study design was performed in our Lady of Mercy Medical Center, a 650-bed, urban,community-based, university-affiliated teaching hospital. 121 patients with a positive diagnosis of Cd colitis (aged 23- 97 years) were studied, and data pertinent to demographic variables,medical history, co-morbidity, physical examination, and laboratory results were collected. Age was examined as a continuous variable and stratified into Age1 (＜80 vs 80 + );Age2 ( ＜ 60, 60 - 69, 70 - 79 and 80 + ); or Age3 (＜ 60, 60 - 69, 70 - 79, 80 - 89, 90 + ).RESULTS Cd colitis occurs more frequently with advancing age (55% of cases ＞80 years).However, age, per se, had no effect on mortality. A history of cardiac disease (P= 0.036), recurrent or refractory infection ＞4 weeks (P--0.007), Iow serum total protein (P=0.034), Iow serum albumin (P=0.001),antibiotic use ＞4 weeks (P＜0.010), use of over 4 antibiotics (P=0.026), and use of certain classes of antibiotics (P = 0.035 - 0.004) were predictive of death. Death was strongly predicted by the use of penicillin-like antibiotics plus clindamycin, in the presence of hypoalbuminemia, refractory sepsis, and cardiac disease ( P = 0.00005). CONCLUSION Cd colitis is common in the very old. However, unlike co-morbidity, age alone does not affect the clinical outcome (survival vs death).     

Acute promyelocytic leukemia: treatment results during a decade at Memorial Hospital

Fifty-seven adult patients with acute promyelocytic leukemia (APL) were treated between 1974 and 1984 with daunorubicin (DNR) or 4-(9- acridinylamino)methanesulfan-m-anisidide (AMSA) in combination with arabinosylcytosine (Ara-C) and 6-thioguanine (TG); they also received prophylactic heparin. Forty-one patients (72%) achieved complete remission (CR), including 11 of 12 patients who received the AMSA- containing regimen. The incidence of early fatal hemorrhage was 14%, lower than that of earlier studies or other published reports. Elevated WBC and serum lactate dehydrogenase levels at diagnosis were associated with an increased incidence of life-threatening hemorrhage and shorter remission duration. Advanced age was an unfavorable prognostic factor for male patients. Both DNR and AMSA in combination protocols are effective treatments for APL. The incidence of CR is similar to that achieved in other types of acute nonlymphoblastic leukemia (ANLL) with the same protocols, but the median duration of remission is significantly longer in APL (24 v 9 months) and the percentage of remissions longer than 60 months is also higher in APL (35% v 5%).     

CT planning for breast cancer

Radiotherapy to the affected breast or chest wall is well established as an integral part of postoperative management of breast cancer. However, it is known to be associated with increased cardiac and pulmonary morbidities and mortalities. Modern technologies, such as CT planning, have shown to improve treatment planning by accurately delivering optimal doses to the target volumes, while minimizing doses to sensitive structures, thus reducing potential treatment‐related adverse effects. The purpose of this study is to report on our experiences with CT planning of adjuvant radiotherapy for breast cancer.