Bile duct obstruction: radiologic evaluation of level, cause, and tumor resectability

In a prospective study of 65 patients with bile duct obstruction, various radiologic modalities were compared for their capability to demonstrate the level and cause of obstruction and to indicate accurately tumor resectability. Ultrasound (US) was performed in 65 patients, computed tomography (CT) in 51, direct cholangiography (DC) in 57, and angiography in 35. The level of obstruction was correctly indicated by US in 95% of patients and by CT in 90%, and the cause was correctly indicated by US in 88%, by CT in 63%, and by DC in 89%. In predicting tumor resectability, US was correct in 71% of patients, compared with 42% for CT, 58% for DC, and 25% for angiography. US therefore appears to be the single most useful modality in the evaluation bile duct obstruction.     

Aetiological Rôle Of Cerebral Blood-Flow Alterations In Development And Extension Of Peri-Intraventricular Haemorrhage

The aetiology and extension of peri-intraventricular haemorrhage (PIVH) are thought to be related to cerebral blood-flow alterations, and especially to increased cerebral blood-flow and fluctuating velocity of blood-flow. Using transcutaneous Doppler technique, the authors investigated cerebral blood-flow in 60 infants with gestations of less than 34 weeks. Pulsatility index (PI) and area under the velocity curve (AUVC) of the anterior cerebral arteries (ACA) were used as qualitative measures of cerebral blood-flow, and the coefficient of variation of PI and AUVC as indicators of fluctuations in blood-flow velocity. A reasonable correlation was found between PI and AUVC and their coefficients of variation in the ACA. First onset of PIVH was related to fluctuating blood-flow velocity, and extension of PIVH with both increased velocity (indicating increased blood-flow) and fluctuating velocity. Increased cerebral blood-flow and its fluctuating pattern were positively correlated with arterial carbon dioxide tension.     

Ultraviolet-B irradiation of platelets: a preliminary trial of efficacy

Prior studies established that ultraviolet-B light (UVB) irradiation of platelet concentrates (PCs) at appropriate doses can eliminate the mixed lymphocyte culture-stimulating and -responding capacity of lymphocytes in the PCs without adversely affecting in vitro platelet function. The in vivo recovery and survival and in vitro characteristics of UVB-irradiated platelets were investigated in paired studies. PCs were stored for 1 day and then exposed to UVB. Platelet recovery, survival, and function were comparable to those of nonirradiated platelets. Recovery and survival of platelets stored for 5 days before UVB exposure were decreased relative to controls, although they were considered clinically acceptable. Paired transfusion studies were also performed in seven thrombocytopenic patients by using platelets obtained by apheresis. Comparable posttransfusion platelet increments and bleeding time corrections were obtained with both irradiated and control (nonirradiated) platelets. It can be concluded that platelets survive and function relatively normally in vivo after UVB irradiation sufficient to abolish lymphocyte reactivity in mixed lymphocyte culture. Long-term studies of UVB-irradiated PCs are needed to assess their potential in reducing recipient alloimmunization.     

佐剂性关节炎大鼠细胞因子和淋巴细胞亚群变化与可铁宁的影响

目的:观察吸烟者体内尼古丁代替主要产物可铁宁在佐剂性关节炎动物模型抗炎和调节免疫方面的作用。方法:实验于2005-10/2006-09在南方医科大学南方医院检验科及实验动物中心完成。实验动物:SD大鼠50只。实验分组和给药:随机选取SD大鼠40只注射完全弗氏佐剂,致炎建立佐剂性关节炎模型,剩余的10只SD大鼠为正常组。将40只佐剂性关节炎大鼠随机分为炎症组10只,可铁宁低、中、高剂量组各10只,可铁宁各组于佐剂注射后1周开始灌胃给药,分别给0.5,1.5,4.5g/kg体质量剂量药物,连续7d。实验评估:致炎后28d开始进行运用ELISA及流式细胞术,检测用药后对白细胞介素1β、白细胞介素2,T细胞增殖等指标(CD4 ,CD8 ,CD4 /CD8 )的影响。结果:50只大鼠全部进入结果分析。①各组大鼠血清中白细胞介素1β、白细胞介素2含量:与炎症组相比,可铁宁高、中、低剂量各组白细胞介素1β含量明显下降[(101.4±11.24),(53.40±8.23),(60.34±5.97),(72.31±8.06)ng/L,P<0.05],白细胞介素2含量明显升高[(121.3±21.2),(195.9±51.6),(174.3±40.3),(169.7±53.2)ng/L,P<0.05],且作用有一定的剂量依赖性。②各组大鼠淋巴细胞亚群CD4 ,CD8 ,CD4 /CD8 变化:造模第28天,与正常组相比,炎症组的CD4 增加,CD8 明显降低(P<0.05),CD4 与CD8 的比值显著增加(P<0.05);与炎症组相比较,可铁宁高剂量组的CD4 显著降低(P<0.05);可铁宁各组的CD8 明显增加(P<0.05),CD4 与CD8 比值显著下降,呈剂量依赖性。结论:可铁宁可调节大鼠血清中异常的白细胞介素1及白细胞介素2含量,可铁宁在试验动物水平有抗炎和免疫调节的作用。     

多普勒超声诊断移植肾排斥反应与病理检查及肾功能指标的对比分析

目的：以病理活检结果为金标准，评估多普勒超声检查对移植肾排斥反应的诊断价值。方法：选择2003—01/2006—12在中国医科大学附属第一医院器官移植科行肾移植并在术后行超声检查的患者176例，均知情同意。①实验分组：根据术后移植肾功能分为2组，移植肾功能不良组78例，其中30例次行病理活检；移植肾功能正常组98例。②实验方法及评估：对患者移植肾行多普勒超声检查，参数选择峰收缩期流速、平均舒张期流速、阻力指数及血管显示率。血管显示率的评估标准（0～5级）：0级为肾动脉及其远侧血管未显示；5级为肾各级血管均显示良好。以病理活检结果为金标准，分别选取阻力指数=0．7，0．75，0．8，0．85为诊断界值进行诊断试验。结果：169例患者进入结果分析，脱落7例。①峰收缩期流速、平均舒张期流速不呈正态分布，无法作为肾功能评价指标。30例次病理活检中共有28例次被确诊为排斥反应，急性排斥反应15例次，慢性排斥反应13例次。②肾功能正常组患者中血管显示率5级者占63．30％，4级者占36．73％。肾功能不良组患者中血管显示率4级者占41．03％，3级者占46．15％，2级者占10．30％，1级者占2．60％。③移植肾功能不良组患者阻力指数显著高于移植肾功能正常组（P〈0．01）。移植肾功能不良组患者移植肾功能恢复后阻力指数显著低于移植肾尚未恢复时（P〈0．01），其中99％以上的患者△（阻力指数）≥0.20。④界值阻力指数=0．75的诊断试验的敏感性、特异性和准确性最高，均达到100％。结论：当移植肾血管阻力指数升高至0．75以上，特别是同一患者自身对照升高超过0.2以上和或血管显示率低于4级，结合临床表现和生化结果，提示可能出现移植肾排斥反应。     

体外分离培养人脐静脉内皮及内皮下间充质干细胞

目的:建立人脐静脉内皮及内皮下间充质干细胞体外培养和扩增的方法,探讨其生物学特性,建立间充质干细胞体外培养扩增体系。方法:实验于2006-04/2006-09在辽宁医学院解剖学实验室完成。解剖细胞培养室为无菌百级培养间。正常健康产妇顺产或剖宫产的新生儿脐带由辽宁医学院附属第一医院提供,产妇及其家属均知情同意,并经医院伦理委员会批准。实验方法:①体外分离和培养贴壁细胞:无菌条件下取正常健康产妇分娩或剖宫产脐带,将其用预热PBS充分洗涤去血渍后,从脐静脉一端插入留置针,用预热PBS冲净静脉腔血后,用止血钳夹闭另一端,注入经预热至37℃的Ⅰ型胶原酶,置于37℃水浴箱中消化,30min后放出胶原酶,并用PBS冲洗血管腔,收集消化液和冲洗液,400r/min离心10min,吸弃上清液,重悬于M199培养基(含体积分数为0.15的胎牛血清,2mmol/L谷氨z酰胺,2μg/L碱性成纤维细胞生长因子,100U/mL青霉素,100U/mL链霉素)。以5×108L-1密度接种于6孔培养板中,置于37℃、体积分数为0.05的CO2饱和湿度培养箱中培养,48h后全量换液,以后每3d全量换液。待细胞80%融合时,0.25%胰酶消化,按1×108L-1传代培养。②间充质干细胞生长曲线的测定:取传代培养细胞,按2×107L-1密度接种于24孔培养板内,每天取3孔,将细胞消化计数,连测8d,绘制间充质干细胞生长曲线。③间充质干细胞表面抗原检测:在24孔塑料培养板内放置无菌的盖玻片,每孔中种植108L-1第2代细胞悬液1mL。采用免疫细胞化学方法进行细胞表面抗原检测。结果:①间充质干细胞的形态学观察:接种的细胞48h后细胞完全贴壁生长,其镜下形态有呈椭圆形、多角形的内皮细胞以及呈梭形的成纤维样细胞,有的形成漩涡状生长的集落。②间充质干细胞生长曲线的分析:传代培养的潜伏期约为24～36h,细胞倍增时间约为30～36h,对数增殖期约为二三天,对数增殖期后第5天进入平台期。③间充质干细胞表面抗原特性:免疫细胞化学分析结果显示,间充质干细胞表面抗原cd166、cd44阳性,而vWF阴性,说明分离获得的细胞具有间充质干细胞的特点。结论:所建立的分离和培养方法可获取人脐静脉黏附细胞中一组独特的细胞群,具有间充质干细胞的生物学特性。