协同信号途径阻断和供体脾细胞输注诱导预存同种记忆性T淋巴细胞大鼠心脏移植物的耐受

Objective To induce the tolerance to cardiac allograft by combined blockade of OX40/OX40L and CD28/B7 co-stimulatory signaling and donor specific spleen cell transfusion in rat mod-els of pre-existent allogenic reactive memory T lymphocytes. Methods Lewis rats that underwent 3 days of adoptive transfer of donor specific CD8+ memory T cells, separated by immunomagnetic bead separation kit, received either separate or combined transfusion of AdCTLA4Ig, AdOX40Ig, donor spleen cells (DST) and transplantations of hearts of DA rats at the same time. Cardiac allografts were taken out 48 h after transplantation for histological analysis and cytokines expression ,and survival time of cardiac allografts with different treatments was observed. Results Compared with AdCTLA4Ig, AdOX40Ig and DST groups, AdCTLA4Ig + AdOX4OIg + DST group showed lower cardiac pathological grade with much lower expression level of IL-2 and IFN-γ,and much longer heart survival time. Conclusion Combined blockade of OX40/ OX40L and CD28/B7 and donor specific spleen cell transfusion could induce rat cardiac graft tolerance.     

协同信号途径阻断和供体脾细胞输注诱导预存同种记忆性T淋巴细胞大鼠心脏移植物的耐受

Objective To induce the tolerance to cardiac allograft by combined blockade of OX40/OX40L and CD28/B7 co-stimulatory signaling and donor specific spleen cell transfusion in rat mod-els of pre-existent allogenic reactive memory T lymphocytes. Methods Lewis rats that underwent 3 days of adoptive transfer of donor specific CD8+ memory T cells, separated by immunomagnetic bead separation kit, received either separate or combined transfusion of AdCTLA4Ig, AdOX40Ig, donor spleen cells (DST) and transplantations of hearts of DA rats at the same time. Cardiac allografts were taken out 48 h after transplantation for histological analysis and cytokines expression ,and survival time of cardiac allografts with different treatments was observed. Results Compared with AdCTLA4Ig, AdOX40Ig and DST groups, AdCTLA4Ig + AdOX4OIg + DST group showed lower cardiac pathological grade with much lower expression level of IL-2 and IFN-γ,and much longer heart survival time. Conclusion Combined blockade of OX40/ OX40L and CD28/B7 and donor specific spleen cell transfusion could induce rat cardiac graft tolerance.     

大面积急性坏死性筋膜炎1例报告

1病历摘要患者男，65岁。因“肛门左侧肿痛10天，阴囊胀痛5天”入院。10天前于肛门左侧发现一疖肿，疼痛伴寒战及发热，诊为“肛旁疖肿”行消炎治疗，后疼痛渐向阴囊扩展，5天前，阴囊胀痛剧烈，来本院就诊。既往无腹股沟斜疝史。体检：体温38．2℃，脉搏85次／分，血压18／12千帕，神志清，痛苦貌，左肩颈、胸腹壁、腰背部皮下有捻发音，以左下腹及腹股沟区为重，左侧阴囊肿胀发亮，表皮可见6厘米X4厘米发黑坏死区，触痛（＋），波动感明显。直肠指诊肛管左侧触痛（＋）。辅助检查：血白细胞18．6X109／升，中性粒细胞0．86，淋巴细胞0．1…     

后腹腔镜活体右侧供肾切取术的临床观察

腹腔镜活体供肾切取术是目前流行的取肾方法，出于对亲属供肾静脉长度的考虑，腹腔镜活体供肾切除术多倾向于取左肾，我院自2003年7月来开展后腹腔镜活体取肾术23例，其中有5例取右肾，效果满意，现报告如下。     

协同信号途径阻断和供体脾细胞输注诱导预存同种记忆性T淋巴细胞大鼠心脏移植物的耐受

Objective To induce the tolerance to cardiac allograft by combined blockade of OX40/OX40L and CD28/B7 co-stimulatory signaling and donor specific spleen cell transfusion in rat mod-els of pre-existent allogenic reactive memory T lymphocytes. Methods Lewis rats that underwent 3 days of adoptive transfer of donor specific CD8+ memory T cells, separated by immunomagnetic bead separation kit, received either separate or combined transfusion of AdCTLA4Ig, AdOX40Ig, donor spleen cells (DST) and transplantations of hearts of DA rats at the same time. Cardiac allografts were taken out 48 h after transplantation for histological analysis and cytokines expression ,and survival time of cardiac allografts with different treatments was observed. Results Compared with AdCTLA4Ig, AdOX40Ig and DST groups, AdCTLA4Ig + AdOX4OIg + DST group showed lower cardiac pathological grade with much lower expression level of IL-2 and IFN-γ,and much longer heart survival time. Conclusion Combined blockade of OX40/ OX40L and CD28/B7 and donor specific spleen cell transfusion could induce rat cardiac graft tolerance.     

猪活体肾移植模型中腹腔镜手术对移植肾缺血再灌注损伤的影响

目的观察猪活体肾移植手术中腹腔镜手术对移植肾缺血再灌注损伤的影响。方法用猪同种肾移植模型（白色小型猪CEMP-III黑色小型猪CEMP-I），分腹腔镜组和开放手术组活体取肾。移植后1、3d观察移植肾组织学分析了解缺血再灌注损伤的程度，实时荧光定量聚合酶链反应（PCR）检测TLR4（Toll-like receptor）mRNA的表达了解导致缺血再灌注损伤差异的机制。结果组织学分析发现移植后1d两组移植肾以肾小管浊肿为主，移植后3d腹腔镜组移植肾肾小管多见片状坏死，而开放手术组仅见肾小管浊肿和局灶性坏死；检测移植肾中11LR4mRNA表达，发现移植后第1天两组11LR4mRNA表达指数差异无统计学意义（11．934-3．66比12．464-2．60，P〉0．05），移植后第3天两组TLR4mRNA表达指数差异有统计学意义（30．164-6．19比61．534-9．47，P〈0．01）。结论腹腔镜活体取肾手术中C02气腹引起腹内压增加影响供肾血流，导致早期移植肾有加重缺血再灌注损伤的风险，11LR4表达增加可能发挥重要作用。     

400例肾移植后随访五年的临床分析

环孢素A的使用大大降低了急性排斥反应的发生率，使肾移植术后近期人、肾存活率显著提高，但中长期人、肾存活率并无显著改善。我们对400例肾移植受者的随访资料进行了回顾性分析，并着重分析不同免疫抑制方案对人、肾长期存活率的影响，现报告如下。     

卡介苗膀胱灌注防治上尿路移行细胞癌术后复发

目的 :观察卡介苗 (BCG)化学免疫预防上尿路移行细胞癌术后复发的疗效。方法 :对 50例肾盂及输尿管癌患者术后应用BCG 12 0mg与常温盐水 60mL膀胱灌注 ,每周 1次 ,共 6次 ;每 2周 1次共6次 ;每 4周 1次至 2年 ;每 3个月 1次维持 5年。结果 :随访 1～ 15年 ,平均 8年 ,1、3、5年生存率分别为 92 0 % ( 4 6/ 50 )、77 8% ( 31/ 4 0 )、59 4 % ( 19/ 32 ) ;1、3、5年局部复发率分别为 2 0 % ( 1/ 50 )、15 0 %( 6/ 4 0 )、2 5 0 % ( 8/ 32 )。结论 :BCG膀胱灌注可减少上尿路移行细胞癌局部复发 ,提高 5年生存率。     

肾移植术后直肠结核一例

患者,男,因慢性肾小球肾炎、尿毒症于 2000 年在我院接受同种肾移植术。术后应用环孢素 A(CsA)、硫唑嘌呤(Aza)及泼尼松(Pred)预防排斥反应。术后 20 d 出院。术后7 个月出现尿频、排尿不适感,会阴部坠胀伴发热,体温37.9℃~38.4℃,在外院诊断为慢性前列腺炎,予以抗生素治疗     

协同信号途径阻断和供体脾细胞输注诱导预存同种记忆性T淋巴细胞大鼠心脏移植物的耐受

Objective To induce the tolerance to cardiac allograft by combined blockade of OX40/OX40L and CD28/B7 co-stimulatory signaling and donor specific spleen cell transfusion in rat mod-els of pre-existent allogenic reactive memory T lymphocytes. Methods Lewis rats that underwent 3 days of adoptive transfer of donor specific CD8+ memory T cells, separated by immunomagnetic bead separation kit, received either separate or combined transfusion of AdCTLA4Ig, AdOX40Ig, donor spleen cells (DST) and transplantations of hearts of DA rats at the same time. Cardiac allografts were taken out 48 h after transplantation for histological analysis and cytokines expression ,and survival time of cardiac allografts with different treatments was observed. Results Compared with AdCTLA4Ig, AdOX40Ig and DST groups, AdCTLA4Ig + AdOX4OIg + DST group showed lower cardiac pathological grade with much lower expression level of IL-2 and IFN-γ,and much longer heart survival time. Conclusion Combined blockade of OX40/ OX40L and CD28/B7 and donor specific spleen cell transfusion could induce rat cardiac graft tolerance.