老龄活体供肾移植55例

目的:探讨老龄活体供肾移植的供受体围手术期并发症、近远期疗效及安全性.方法:中南大学湘雅三医院2004年4月至2009年4月共完成285例活体肾移植,其中供体年龄≥ 55岁55例(老龄组),供体年龄＜ 55岁230例(中青年组),比较两组供受体术后住院时间、手术并发症、肾功能恢复情况、急性排斥反应(AR)及肾功能延迟恢复(DGF)发生率、人/肾存活率之间的差异.结果:两组供体术后平均住院时间、术后1周平均血肌酐值(SCr)和肾小球滤过率(GFR)以及围手术期并发症发生率差异无显著性(P ＞ 0.05).老龄组受体术后SCr恢复时间、AR和DGF发生率分别为(3.77 ± 1.73)d、21.82%和3.63%,中青年组分别为(3.23 ± 1.97)d、26.64%和3.27%,两组比较差异均无统计学意义(P ＞ 0.05).老龄组受体术后1、2年SCr高于中青年组,但差异无统计学意义(P ＞ 0.05).两组受体术后1、2年人/肾存活率相似,差异无统计学意义(P ＞ 0.05).结论:术前严格控制老龄活体供体纳入标准、对供体进行全面系统的综合评估,老龄活体供肾移植与中青年活体供肾移植具有相似的近远期疗效,可作为缓解当前供体需求紧张的一种安全可行的途径.     

超声造影检测心肌梗死患者受损左室壁的价值

目的探讨超声造影在检测心肌梗死患者左室壁受损范围中的价值。方法对75名发生心肌梗死的患者进行实时心肌造影,分别于超声造影前后观察心内膜边界显示情况,评价和比较节段室壁运动情况。结果超声造影后左室心内膜边界的显示较造影前明显清晰,受损节段与未受损节段的对比增强。以冠状动脉造影结果为标准,造影检测的灵敏度、特异度和准确度均高于造影前（p〈0．05）。结论实时超声造影能有效增强左室心内膜边界显示和受损心肌边界显影,提高对左室壁受损范围检测的准确性。     

Early-life nutritional and environmental determinants of thymic size in infants born in rural Bangladesh

Aim:  The aim was to assess the impact of nutritional status and environmental exposures on infant thymic development in the rural Matlab region of Bangladesh.
Methods:  In a cohort of N_max 2094 infants born during a randomized study of combined interventions to improve maternal and infant health, thymic volume (thymic index, TI) was assessed by ultrasonography at birth and at 8, 24 and 52 weeks of age. Data on birth weight, infant anthropometry and feeding status were also collected.
Results:  At all ages, TI was positively associated with infant weight and strongly associated with the month of measurement. Longer duration of exclusive breastfeeding resulted in a larger TI at 52 weeks. TI at birth and at 8 weeks correlated positively with birth weight, but by 24 and 52 weeks and when adjusted for infant weight this effect was no longer present. Thymic size was not affected by pre-natal maternal supplementation or by socioeconomic status but was correlated to arsenic exposure during pregnancy.
Conclusion:  In this population of rural Bangladeshi infants, thymic development is influenced by both nutritional and environmental exposures early in life. The long-term functional implications of these findings warrant further investigation.     

Cartilage proteoglycan-specific T cells as vectors of immunomodulatory biologicals in chronic proteoglycan-induced arthritis

Systemic administration of agents that neutralize or antagonize Th1-mediated pro-inflammatory responses has been demonstrated to ameliorate inflammation in chronic autoimmune disease. However, systemic administration of such immunosuppressive biologicals causes serious side effects and has only limited success. To minimize these side effects, autoantigen-specific lymphocytes have been proposed as a carrier to deliver immunosuppressive agents to sites of inflammation. Here we studied the effects of primary cartilage proteoglycan-specific CD4+ T cells that were transduced using an efficient method of viral transduction with active genes encoding IL-1beta receptor antagonist, soluble TNF-alpha receptor-Ig, IL-4 or IL-10 in chronic proteoglycan-induced arthritis in mice. This is the first study describing such gene therapy using primary CD4+ T cells in a chronic arthritis. Moreover, the impact of proteoglycan-specific Th1, Th2 or na?ve T cells was studied. Although proteoglycan-TCR transgenic CD4+ T cells can transfer arthritis to lymphopenic recipients, none of the proteoglycan-TCR transgenic T cell phenotypes that were tested induced worsening of arthritis in wild type hosts. Proteoglycan-specific T cells ameliorated arthritis when expressing the transduced IL-10 gene, and not when expressing the other transgenes/phenotypes. Although all of the tested biologicals can suppress in a wide range of different inflammatory disorders, especially IL-10 would therefore serve as a promising candidate to be used in cellular gene therapy for chronic arthritis.     

Differences in Sentinel Lymph Node Pathology Protocols Lead to Differences in Surgical Strategy in Breast Cancer Patients

Background Internationally, there is no consensus on the pathology protocol to be used to examine the sentinel lymph node (SN). At present, therefore, various hospitals use different SN pathology protocols of which the effect has not been fully elucidated. We hypothesized that differences between hospitals in SN pathology protocols affect subsequent surgical treatment strategies.Methods Patients from four hospitals (A–D) were prospectively registered when they underwent an SN biopsy. In hospitals A, B, and C, three levels of the SN were examined pathologically, whereas in hospital D, at least seven additional levels were examined. In the absence of apparent metastases with hematoxylin and eosin examination, immunohistochemical examination was performed in all four hospitals.Results In total, 541 eligible patients were included. In hospital D, more patients were diagnosed with a positive SN (P < .001) as compared with hospitals A, B, and C, mainly because of increased detection of isolated tumor cells. This led to more completion axillary lymph node dissections in hospital D (66.3% of patients (P < .0001), compared with 29.0% in hospitals A, B, and C combined). Positive non-SNs were detected in 13.9% of patients in hospital D, compared with 9.7% in hospitals A, B, and C (P = .70). That is, in 52.4% of patients in hospital D, a negative completion axillary lymph node dissection was performed, compared with 19.3% of patients in hospitals A, B, and C combined.Conclusions Differences in SN pathology protocols between hospitals do have a substantial effect on SN findings and subsequent surgical treatment strategies. Whether ultrastaging and, thus, additional surgery can offer better survival remains to be determined.     

Bowler-hat sign: a simple principle for differentiating polyps from diverticula

The bowler-hat sign has been described both with colonic polyps and with diverticula. The authors describe a simple principle for evaluating a bowler-hat sign in order to determine whether it is caused by a polyp or a diverticulum. If the bowler hat points toward the center of the long axis of the bowel, it represents an intraluminal structure (ie, a polyp). If, however, it points away from the center of the long axis of the bowel, it represents an extraluminal structure (ie, a diverticulum). Only if the bowler hat is located in the midline or is directly parallel to the long axis of the bowel is it impossible to classify the abnormality as a polyp or a diverticulum. The value of this principle was confirmed with both a radiographic model and a blinded review of radiographs from 37 cases demonstrating the bowler-hat sign. When a bowler hat is present on a double-contrast barium enema examination, use of this principle provides a simple and objective means of differentiating a polyp from a diverticulum.     

Skeletal metastases from hepatoma: frequency, distribution, and radiographic features

Over the past 6 years, the authors evaluated 300 patients with hepatoma as part of phase 1 and 2 treatment protocol trials. Analysis of the available clinical data and radiographic studies revealed 22 patients (7.3%) with skeletal metastases demonstrated by radiography, computed tomography (CT), and/or nuclear scintigraphy. The plain film appearance of skeletal metastases from hepatoma was osteolytic in all cases. CT scanning best demonstrated the expansile, destructive nature of these metastases, which were often associated with large, bulky soft-tissue masses. Skeletal metastases from hepatomas demonstrated increased radiotracer uptake on standard bone scans and were gallium avid, similar to the hepatoma itself. In addition, they could be targeted therapeutically with I-131 antiferritin immunoglobulin. The most frequent sites of skeletal metastases were the ribs, spine, femur, pelvis, and humerus. An initial symptom in ten patients was skeletal pain corresponding to the osseous metastases. In five patients, pathologic fractures of the proximal femur or humerus developed and required total hip replacement or open-reduction internal fixation. Patients with long-standing cirrhosis or known hepatocellular carcinoma who also have skeletal symptoms should be evaluated for possible osseous metastases.     

Biological Evaluation of Compounds with -NCS- Group or Derived from Thiazole and Imidazole. Activity on Prostaglandin Synthetase Complex

Abstract— The effects of compounds with activity against thyroid peroxidase were tested on the activity of hydroperoxidase and cyclo-oxygenase of the prostaglandin synthetase complex in-vitro. Active compounds were found to inhibit the peroxidase, and the cyclo-oxygenase function. These compounds were also found to have anti-inflammatory activity as demonstrated by the reduction of carrageenan-induced oedema of the hind paw of the rat. Indomethacin and non-steroidal anti-inflammatory drugs tested under the same conditions were shown to have activity towards the cyclo-oxygenase rather than the peroxidase function of the prostaglandin synthetase complex. A common feature of the active compounds was the presence of an -NCS- linkage or free -SH group.