未成熟树突状细胞诱导协调性异种胰岛移植耐受的研究

目的　研究未成熟树突状细胞 (DC)在协调性异种胰岛移植中的免疫耐受诱导作用。方法　分别应用 2 0 μg/L粒细胞集落刺激因子 (GM CSF)和 5 0 0 μg/LGM CSF 2 0 0 μg/L白细胞介素4 (IL 4) ,从BALB/c受鼠骨髓培养未成熟DC及成熟DC ,然后负载Wistar大鼠的主要组织相容性复合物 (MHC)抗原。将两种DC回输至糖尿病小鼠体内 ,7d后分别将Wistar大鼠和SD大鼠胰岛移植于糖尿病小鼠左肾包膜下 ,监测移植物存活情况 ,检测T细胞增殖反应 ,并进行病理切片检查。结果　负载MHC抗原成熟DC预处理的BALB/c小鼠体内胰岛迅速被排斥 ,负载MHC抗原未成熟DC预处理的BALB/c小鼠胰岛存活时间明显延长 (P <0 .0 1 ) ,但以SD大鼠作为供者的胰岛移植物迅速被排斥。耐受鼠的脾细胞对Wistar大鼠脾细胞的增殖反应微弱 ,而排斥鼠脾细胞则出现明显增殖反应。结论　未成熟DC预处理受者可诱导T细胞无能 ,并有效延长异种胰岛移植后的存活时间。     

Impact of medical and surgical intervention on survival in patients with cholangiocarcinoma

AIM:To examine surgical and medical outcomes for patients with cholangiocarcinoma using a populationbased cancer registry.METHODS:Using the California Cancer Registry’s Cancer Surveillance Program,patients with intrahepatic cholangiocarcinoma treated in Los Angeles County from 1988 to 2006 were identified and evaluated for clinical and pathologic factors and therapies received(surgery,radiation,and chemotherapy).The surgical cohort was further categorized into three treatment groups:patients who received adjuvant chemotherapy,adjuvant chemoradiation,or underwent surgery alone(no chemotherapy or radiation administered).Survival was assessed by Kaplan-Meier method;and Cox proportional hazard modeling was used in multivariate analysis.RESULTS:Of 825 patients,60.2% received no treatment.Of the remaining 328 patients,18.5% chemotherapy only,7.4% chemoradiation,and 13.8% underwent surgery.More male patients underwent surgical resection(P = 0.004).Surgical patients were younger than the patients receiving chemotherapy or chemoradiation(P < 0.001).Of the surgical cohort(n = 114),60.5% underwent surgery alone while 39.5% underwent surgery plus adjuvant therapy(chemotherapy n = 20;chemoradiation,n = 21)(P < 0.001).Median survival for all patients in the study was 6.6 mo.Median survival was highest for patients who underwent surgery(23 mo),whereas both chemotherapy(9 mo) and chemoradiation(8 mo) alone were each less effective(P < 0.001).By multivariate analysis,extent of disease,receipt of surgery,and administration of chemotherapy(with/without surgery) were independent predictors of overall survival.CONCLUSION:This study demonstrates that surgery is a critical treatment modality.Multimodality treatment has yet to be standardized,but play a role in optimal therapy for cholangiocarcinoma.     

腹腔镜下输卵管分级在输卵管性不育中的应用

目的　探讨腹腔镜对输卵管性不育的诊断与治疗意义。　方法　回顾性分析 2 0 0 1年 5月至 2 0 0 2年 12月应用腹腔镜手术治疗的 178例输卵管性不育患者临床资料。在腹腔镜下按输卵管病变外周粘连情况 ,有无其他合并症等不同程度分 4级 ,比较不育年限与输卵管分级的关系 ,随访不同级患者手术结果。　结果　输卵管分级随不育年限增加而逐渐增加的趋势。术后宫内妊娠率与输卵管分级明显相关 ,输卵管分级I、II、III、IV级的宫内妊娠率分别为 5 6 .2 %、19.8%、10 .3%及 0 ;IV级者体外受精 胚胎移植后的宫外孕发生率较高 ,但经输卵管近端结扎后再行体外受精 胚胎移植可明显减少宫外孕的发生。　结论　腹腔镜下输卵管分级可评价输卵管损害的严重程度和整形术的预后。     

无精子及严重少精子症的遗传学缺陷分析

目的 探讨遗传缺陷在无精子、严重少精子症中的检测意义。方法 采用细胞遗传学技术及多重聚合酶链反应(PCR)技术对65例无精子及严重少精子症患者进行染色体核型分析、Y染色体无精子因子(AZF)检测，同时行精索输精管诊察，阴性者行精液果糖定量实验。结果 染色体核型异常8例(12．3％)，AZF因子缺失7例(10．8％)，输精管缺如2例(3.1％)。结论 遗传学检测在男性无精子、严重少精子症有重要意义。     

A prospective comparison of warfarin to aspirin for thromboprophylaxis in total hip and total knee arthroplasty

Current orthopedic practice requires consideration of contradictory recommendations regarding pulmonary embolism (PE) prevention among patients undergoing total hip arthroplasty (THA) and knee joint arthroplasty (TKA). A total of 696 consecutive patients underwent elective THA or TKA. Two hundred eighty-one patients received PE risk stratification per American Academy of Orthopaedic Surgeons guidelines. Of these patients, 152 standard-risk patients received aspirin, and 129 elevated-risk patients received warfarin. The comparator group of 415 patients received American College of Chest Physicians-recommended warfarin without PE risk stratification. Primary study outcomes were symptomatic PE, deep venous thrombosis, major bleeding, and death. The rate of symptomatic PE and venous thromboembolism among standard-risk group patients receiving aspirin was greater than the comparator group (4.6% vs 0.7% and 7.9% vs 1.2%, respectively). Most events (16/18) occurred among patients undergoing TKA. Patients with total joint arthroplasty at standard risk for PE receiving aspirin had a higher rate of symptomatic PE and venous thromboembolism than did patients receiving anticoagulation.     

A Swedish consensus on the surgical treatment of concomitant atrial fibrillation

Atrial fibrillation (AF) is a common arrhythmia among patients scheduled for open heart surgery and is associated with increased morbidity and mortality. According to international guidelines, symptomatic and selected asymptomatic patients should be offered concomitant surgical AF ablation in conjunction with valvular or coronary surgery. The gold standard in AF surgery is the Cox Maze III ("cut-and-sew") procedure, with surgical incisions in both atria according to a specified pattern, in order to prevent AF reentry circuits from developing. Over 90% of patients treated with the Cox Maze III procedure are free of AF after 1 year. Recent developments in ablation technology have introduced several energy sources capable of creating nonconducting atrial wall lesions. In addition, simplified lesion patterns have been suggested, but results with these techniques have been unsatisfactory. There is a clear need for standardization in AF surgery. The Swedish Arrhythmia Surgery Group, represented by surgeons from all Swedish units for cardiothoracic surgery, has therefore reached a consensus on surgical treatment of concomitant AF. This consensus emphasizes adherence to the lesion pattern in the Cox Maze III procedure and the use of biatrial lesions in nonparoxysmal AF.     

Important risk factors and attributable risk of vertebral fractures in the population-based Tromsø study

ABSTRACT: BACKGROUND: Vertebral fractures, the most common type of osteoporotic fractures, are associated with increased risk of subsequent fracture, morbidity, and mortality. The aim of this study was to examine the contribution of important risk factors to the variability in vertebral fracture risk. METHODS: Vertebral fracture was ascertained by VFA method (DXA, GE Lunar Prodigy) in 2887 men and women, aged between 38 and 87 years, in the population-based Tromso Study 2007/2008. Bone mineral density (BMD; g/cm2) at the hip was measured by DXA. Lifestyle information was collected by questionnaires. Multivariable logistic regression model, with anthropometric and lifestyle factors included, was used to assess the association between each or combined risk factors and vertebral fracture risk. Population attributable risk was estimated for combined risk factors in the final multivariable model. RESULTS: In both sexes, age (odds ratio [OR] per 5 year increase: 1.32; 95% CI 1.19-1.45 in women and 1.21; 95% CI 1.10-1.33 in men) and BMD (OR per SD decrease: 1.60; 95% CI 1.34-1.90 in women and1.40; 95% CI 1.18-1.67 in men) were independent risk factors for vertebral fracture. At BMD levels higher than 0.85 g/cm2, men had a greater risk of fracture than women (OR 1.52; 95% CI 1.14-2.04), after adjusting for age. In women and men, respectively, approximately 46% and 33% of vertebral fracture risk was attributable to advancing age (more than 70 years) and low BMD (less than 0.85 g/cm2), with the latter having a greater effect than the former. CONCLUSIONS: These data confirm that age and BMD are major risk factors for vertebral fracture risk. However, in both sexes the two factors accounted for less than half of fracture risk. The identification of individuals with vertebral fracture is still a challenge.     

Association of Muscle Weakness With Post‐Fracture Mortality in Older Men and Women: A 25‐Year Prospective Study

Osteoporotic fracture increases the risk of premature mortality. Muscle weakness is associated with both increased fracture risk and low bone mineral density (BMD). However, the role of muscle strength in post‐fracture mortality is not well understood. This study examines the change of muscle strength measured at quadriceps (QS) before and after fracture and defines the relationship between muscle strength and post‐fracture mortality. The study involved 889 women and 295 men (who were participating in the Dubbo Osteoporosis Study) who had at least one low‐trauma fracture (ascertained from X‐ray reports) after the age of 50 years. Median follow‐up time was 11 years (range 1 to 24). To determine the change in muscle strength before and after a fracture, we selected a subset of 344 women and 99 men who had had at least two muscle strength measurements before the fracture event and a subset of 407 women and 105 men who had had at least two measurements after the fracture. During the follow‐up period, 366 (41.2%) women and 150 (50.9%) men died. The annual rate of decrease in height‐adjusted muscle strength before fracture was 0.27 kg/m (1.85%) in women and 0.40 kg/m (1.79%) in men. Strength loss after fracture was not significantly different from that before fracture. In women, after adjusting for baseline age and BMD, each SD (5 kg/m) lower height‐adjusted pre‐ and post‐fracture quadriceps strength was associated with a 27% (hazard ratio [HR] = 1.27; 95% confidence interval [CI] 1.07, 1.50) and 18% (HR = 1.18; 95% CI 1.01, 1.38) increase in post‐fracture mortality risk, respectively. Similarly, in men, each SD (5 kg/m) lower height‐adjusted pre‐ and post‐fracture QS was associated with increased mortality before fracture (HR = 1.33; 95% CI 1.09, 1.63) and after fracture (HR = 1.43; 95% CI 1.16, 1.78). Muscle weakness accounted for 15% (95% CI 0.05, 0.24) of premature deaths after fracture in women and 23% (95% CI 0.11, 0.35) in men. These results indicate that in the older individuals, lower muscle strength is an independent risk factor for post‐fracture mortality. © 2017 American Society for Bone and Mineral Research.     

坚持化学烧伤研究特色立足临床技术创新

北京军区解放军第二五一医院是一家开展床位1300张的三级甲等医院,拥有1个国家医院运行机制研究基地、3个全军专科中心,其中全军烧伤中心为医院首家成立者.     

环孢素A及FK506对人肝癌细胞株增殖的影响

目的:探讨免疫抑制剂环孢素(CsA)及他克莫司(FK506)对肝癌细胞增殖的影响及可能机制。方法:采用噻唑蓝(MTT)比色法观察CsA及FK506对QGY鄄7701、QGY鄄7703、SMMC鄄7721和BEL鄄7402等4株肝癌细胞增殖的影响。还应用Hoechst33258荧光染料涂片,在荧光显微镜下观察用药组细胞的形态学改变。结果:随着作用时间延长,10μM的CsA对4株肝癌细胞均呈现明显的生长抑制效应(P<0.01),而0.5μM的FK506与对照组相比,其生长抑制作用不明显(P>0.05)。荧光显微镜下CsA用药组肝癌细胞呈现凋亡改变;而FK506用药组与对照组无显著差异。结论:免疫抑制剂CsA非但未促进体外肝癌细胞生长,相反呈明显的抑制效应。FK506尽管未呈现对肝癌细胞增殖的抑制效应,也未显示有生长促进作用。CsA对肝癌细胞的增殖抑制作用与诱导癌细胞发生凋亡有关。