Autologous stem cell transplantation in the treatment of refractory rheumatoid arthritis

The concept of using high-dose immunosuppressive treatment (HDIT) with autologous stem cell transplantation (ASCT) to treat patients with refractory rheumatoid arthritis has been provided by animal studies and anecdotal case reports. Over the past five years, an increasing number of patients with refractory rheumatoid arthritis have received HDIT with ASCT as an adjunct to intense immunosuppression. Here, we present a case of refractory rheumatoid arthritis in a 54-yr-old woman using HDIT with ASCT. Peripheral blood stem cells were mobilized with cyclophosphamide (4 g/m(2)) followed by G-CSF (5 microg/kg/day). Leukapheresis continued daily until the number of harvested progenitor cells reached 2 x 10(6) CD34+ cells/kg after CliniMax CD34+ positive selection. For HDIT, high-dose cyclophosphamide (total dose 200 mg/kg) and antithymocyte globulin (total dose 90 mg/kg) were administered and CD34+ cells were infused 24 hr after HDIT. The patient tolerated the treatment well but experienced an episode of neutropenic fever. She achieved an early dramatic improvement of joint symptoms during therapy. Fifty percent of improvement of rheumatoid arthritis by the American College of Rheumatology (ACR 50) preliminary definition was fulfilled during the 6 months following ASCT. Although further long-term follow-up is required, the patient's activity of arthritis has been stable since receiving HDIT with ASCT.     

人乳头瘤病毒18型L1-E6、L1-E7嵌合基因表达载体的构建及表达

目的 构建HPV 18 L1－E6，L1－E7嵌合基因的表达载体，并在CHO细胞中表达。方法 克隆HPV18 L1－E6和L1－E7基因，插入中介载体pGEMT-Easy中并测序鉴定。采用PCR定点突变法，突变L1－E6，L1－E7基因序列中与转化作用相关的位点，分别与L1基因连接后插入真核表达载体pVAX1，构建真核表达质粒pVAX-1L1 E6Mxx,L1E7Mxx。用磷酸钙沉淀法，转染CHO细胞，以抗HPV－18L1，抗E6和抗E7特异性单克隆抗体（mAb)做ELISA和免疫细胞化学法检测。结果 ELISA检测显示，转染各种pVAX1-LIE6Mxx-L1E7Mxx融合蛋白表达质粒的细胞提取物的P－N值均＞2．1；免疫细胞化学检测，在胞浆，胞核可见棕黄色颗粒。结论 我建的pVAX1-L1E6Mxx-E7Mxx融合蛋白质表达质粒，可在转当细胞内表达相应的L1－E6Mxx和L1－E7Mxx蛋白，为今后进行DNA疫苗的研究奠定了基础。     

重组人乳头瘤病毒6型病毒样颗粒的免疫原性分析

目的　研究重组人乳头瘤病毒 6型 (humanpapillomavirustype 6 ,HPV 6 )病毒样颗粒(virus likeparticle ,VLP)的免疫原性。方法　重组杆状病毒在昆虫细胞中表达制备的HPV 6L1VLP(L1 VLP)和HPV 6L1+L2VLP(L1+2 VLP)经鉴定后 ,用于免疫BALB/c小鼠 ,对诱导的体液免疫和细胞免疫反应进行了检测。结果　电镜观察显示L1 VLP和L1+2 VLP二者形态上无明显差异 ,为圆形颗粒 ,直径约 5 0nm ,SDS PAGE和Westernblot分析表明 ,L1+2 VLP中L1和L2蛋白摩尔比例为 4∶1。用ELISA法测定免疫小鼠血清抗体滴度 ,加佐剂L1 VLP免疫组和加佐剂L1+2 VLP免疫组血清针对HPV 6L1VLP的滴度在 1∶10 0 0 0以上 ,高于未加佐剂组免疫血清滴度 (1∶2 0 0 0 ) ,L1+2 VLP免疫诱导出了特异于L2抗原的抗体。血清抗体主要识别HPV 6构象依赖性抗原表位 ,与HPV 11抗原显示出一定的交叉反应 ,而与HPV 16无明显交叉反应。免疫小鼠脾淋巴细胞体外经HPV 6L1VLP再激活后出现了特异性增殖反应 ,3H TdR掺入值与未免疫组之间差异有显著性 (P <0 .0 1) ,L1 VLP和L1+2 VLP两组间差异无显著性 (P >0 .0 5 ) ,L1 VLP和L1+2 VLP免疫组刺激指数 (SI)分别为 6 .4和 6 .2 ,阴性对照组SI为 1.1。HPV 6L1VLP再刺激特异地诱导免疫组脾淋巴细胞IL 2和IL 10分     

Applications of the pulsatile flow versatile ECLS: in vivo studies

INTRODUCTION: T-PLS (Twin-Pulse Life Support) is the first commercial pulsatile ECLS (Extra Corporeal Life Support) device (1). The dual sac structure of T-PLS can effectively reduce high membrane oxygenator inlet pressure and hemolysis. To verify both the use of T-PLS for ECLS and the advantages of T-PLS, we tested various models. METHOD AND RESULTS: In the partial CPB (cardio pulmonary bypass) model (swine), T-PLS (N = 6), and Biopump (N = 2), a single pulsatile pump (N = 2), were compared. In the case of single pulsatile flow, during pump systole, pressure increased to 700 - 800 mmHg at the inlet port of the membrane oxygenator. fHb, a hemolysis measurement value, was about 80 mg/dL at 3 hours. On the contrary, because of T-PLS's dual sac system, the pressure of T-PLS had a maximum value of about 250 mmHg and fHb was similar to that of the commercial centrifugal pumps. In the total CPB model (bovine, N = 6), the heart was stopped via cardioplegia (Kcl). T-PLS flow was maintained at 3.0-4.5 L/min. T-PLS functioned like a natural heart, having a pulse pressure of 26-43 mmHg and a pulse rate of 40-60 bpm (beats per minute). In the emergency case model (canine, N = 6), T-PLS was started 10 minutes after cardiac arrest from electronic shock. In spite of cardiac arrest for a period of 40 minutes, the heart was recovered after defibrillation. In the ARDS (Acute Respiratory Distress Syndrome) model (canine, N = 6), minimal ventilator parameters were set: tidal volume 130 ml, respiration rate = bpm, FiO2 = 10%. Three hours after starting T-PLS, PO2 of the carotid artery blood (after 2 hours: 195 +/- 89.4; after 3 hours: 258 +/- 99.3 mmHg) was above half the value of the femoral artery but was within normal range. CONCLUSION: It is suggested that a portable pulsatile ECLS like T-PLS may be used as a CPB device and as an alternative CPR (cardiopulmonary resuscitation) device in the case of cardiac arrest. Due to the pulsatile flow, oxygenated blood is delivered to the patient without overloading the ARDS patients heart.     

A rat model for radiation-induced proctitis

Radiation proctitis is a frequent acute complication encountered with pelvic irradiation. This study was aimed at establishing the optimal radiation dose for radiation-induced proctitis in rats. Female Wistar rats were used. The rectal specimens were examined morphologically at 5th and 10th day following 10-30 Gy irradiation in single fraction. With increasing dose, mucosal damage became worse, and there was a prominent reaction after > or =15 Gy. We selected 17.5 Gy as an optimal dose for radiation proctitis and examined specimens at day 1-14 and at week 4, 6, 8, and 12 after 17.5 Gy. The rectal mucosa revealed characteristic histological changes with time. An edema in lamina propria started as early as 1-2 days after irradiation and progressed into acute inflammation. On day 7 and 8, regeneration was observed with or without ulcer. Four weeks later, all regeneration processes have been completed with end result of either fibrosis or normal appearing mucosa. This study showed that the radiation injury of the rectum in rat develops in dose-dependent manner as it has reported in previous studies and suggested that 17.5 Gy in single fraction is the optimum dose to evaluate the protective effect of various medications for radiation proctitis in face of the clinical situation.     

Colorectal adenocarcinoma as a second malignant neoplasm following rhabdomyosarcoma of the urinary bladder: a case report

Following improvements in therapy for childhood malignancies, the striking increase in survival rate over the past 30 years has led to the increase risk of developing second malignant neoplasms (SMNs). We report a case of colorectal carcinoma as a SMN, following treatment for rhabdomyosarcoma. The patient was diagnosed with rhabdomyosarcoma of the urinary bladder at his age of three years, and developed adenocarcinoma in the colon 13 years later. Histologic examination of the surgical specimen revealed adenocarcinoma involving the rectosigmoid area with radiation colitis in its background. The tumor cells showed strong immunoreactivity for p53 protein, suggesting the role of irradiation and p53 mutation in carcinogenesis. This case emphasizes the need for dose observation in survivors of early childhood malignancies treated with radiation and multiagent chemotherapy.     

PD-1-Expressing SARS-CoV-2-Specific CD8+ T Cells Are Not Exhausted,but Functional in Patients with COVID-19

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A case of leukemia cutis.

We report a case of leukemia cutis with atypical skin manifestations, presented with generalized various sized dark brownish to erythematous patches with plaques on the whole body of a 42-year-old man. Skin lesions developed 6 months ago and had no signs of itching or tenderness. He complained of sustaining fevers with abdominal discomfort. Laboratory findings showed elevation of leukocyte count and peripheral blood smear revealed 86% of lymphocyte. Histologic examination showed diffuse infiltration of abnormal cells that appeared to be leukemic in nature.     

恶性疟原虫FCC1/HN株环子孢子蛋白的原核表达、纯化及其对肝细胞靶向作用的观察

目的从恶性疟原虫FCC1／HN株基因组中扩增得到环子孢子蛋白(circumsporozoite protein,CSP)的全长编码基因,克隆至原核表达载体pET-32c中进行表达纯化,观察重组环子孢子蛋白对肝细胞的结合能力,探讨其作为原发性肝癌基因治疗的靶向分子的可行性。方法根据恶性疟原虫3D7株环子孢子蛋白的编码序列设计一对引物,利用聚合酶链反应(PCR)技术从恶性疟原虫FCC1／HN株基因组中扩增出CSP的全长编码基因,将其克隆到载体pGEM-T中,通过基因测序加以证实;进一步亚克隆至原核表达载体pET-32c中,在大肠杆菌BL21中用IPTG诱导表达,表达产物用Ni2+螯合柱亲和纯化,采用免疫印迹技术(WB)对纯化的融合蛋白进行免疫反应性检测;采用免疫组化(IHC)技术观察重组环子孢子蛋白对不同组织细胞的结合能力。结果从恶性疟原虫FCC1／HN株基因组中成功扩增到1263 bp的全长CSP基因,该基因在原核系统中经诱导表达出一相对分子质量(Mr)约62×103大小的融合蛋白,表达产物以包涵体的形式存在;通过Ni2+亲和柱纯化获得重组CSP融合蛋白;WB表明,重组CSP融合蛋白能被疟原虫阳性血清特异性识别;免疫组化结果显示重组CSP融合蛋白能够与肝癌和正常肝细胞特异性地结合,与其他组织来源的细胞则未见反应。结论CSP是疟原虫子孢子表面主要的蛋白,重组环子孢子蛋白作为原发性肝癌基因治疗的靶向分子具有一定的潜在应用价值。