FK506-壳聚糖膜与体外培养雪旺细胞生物相容性的研究

目的 探讨FK506-壳聚糖膜片与培养的雪旺细胞生物相容性.方法 将生长状况和纯度较好的第3代雪旺细胞,分别传代接种于含有FK506-壳聚糖膜片、单纯壳聚糖膜片的培养皿中培养,以盖玻片作为对照组.计算3组雪旺细胞倍增时间、雪旺细胞纯度;用MTT法比较不同膜片上雪旺细胞的生长活力,绘制生长曲线;S-100免疫荧光染色.结果 雪旺细胞倍增时间对照组为5.9 d,单纯壳聚糖膜片及FK506-壳聚糖膜片组均为4.0 d;雪旺细胞纯度分别为80%、89%,93%;雪旺细胞增殖情况以FK506-壳聚糖组最佳,单纯壳聚糖组次之,对照组最差;各组雪旺细胞均呈S-100阳性,FK506-壳聚糖组与单纯壳聚糖组雪旺细胞排列呈典型的漩涡状或栅栏状.结论 FK506-壳聚糖膜片具有更显著的组织相容性与生物功能性,并保持了雪旺细胞的生物学特性.     

罗格列酮对多囊肾囊肿衬里上皮细胞p38促分裂原活化蛋白激酶信号通路的影响

Objective To investigate the effect of rosiglitazone on p38 mitogen-activated protein kinase (p38MAPK) pathway in polycystic kidney cyst-lining epithelial cells. Methods The cyst-lining epithelial cells (PKD cells) from human polycystic kidney were treated with rosiglitazone (10 μmol/L), peroxisome proliferator-activated receptor-γ (PPARγ) inhibitor GW9662 (10 μmol/L), rosiglitazone (10 μmol/L) +GW9662 (10 μmol/L), p38MAPK specific inhibitor SB203580 (10 μmol/L), SB203580 (10 μmol/L)+ rosiglitazone(10 μmol/L) for 2 hours followed by epidermal growth factor (EGF) stimulation. Protein expressions of p38, phuspho-p38 (p-p38) and proliferating cell nuclear antigen (PCNA) were detected by Western blot. p38 mRNA was examined by RT-PCR. Expression of c-fos and c-jun was observed by immunocytochemistry. Results (1) EGF markedly up-regulated the expressions of p38, p-p38, PCNA, c-fos anti c-jun compared with control group (P<0.01). (2) Compared with EGF treated group, rosiglitazone significantly reduced p38 activation and mRNA expression (P<0.01, respectively). Rosiglitazone, rosiglitazone+SB203580 could significantly down-regulated p-p38, PCNA, c-fos and c-jun expression (P<0.01, respectively) with no significant difference between these two groups. (3) GW9662 partially reversed the reduction effect of rosiglitazone. Conclusions Rosiglitazone can inhibit proliferation of autosomal dominant polycystic kidney disease cyst-lining epithelial cells partially through down-regulating p38 activation and reducing c-fos, c-jun and PCNA expression. The above effect of rosiglitazone is in part PPARγ-independcnt.     

Axonal remyelination by cord blood stem cells after spinal cord injury

Human umbilical cord blood stem cells (hUCB) hold great promise for therapeutic repair after spinal cord injury (SCI). Here, we present our preliminary investigations on axonal remyelination of injured spinal cord by transplanted hUCB. Adult male rats were subjected to moderate SCI using NYU Impactor, and hUCB were grafted into the site of injury one week after SCI. Immunohistochemical data provides evidence of differentiation of hUCB into several neural phenotypes including neurons, oligodendrocytes and astrocytes. Ultrastructural analysis of axons reveals that hUCB form morphologically normal appearing myelin sheaths around axons in the injured areas of spinal cord. Colocalization studies prove that oligodendrocytes derived from hUCB secrete neurotrophic hormones neurotrophin-3 (NT3) and brain-derived neurotrophic factor (BDNF). Cord blood stem cells aid in the synthesis of myelin basic protein (MBP) and proteolipid protein (PLP) of myelin in the injured areas, thereby facilitating the process of remyelination. Elevated levels of mRNA expression were observed for NT3, BDNF, MBP and PLP in hUCB-treated rats as revealed by fluorescent in situ hybridization (FISH) analysis. Recovery of hind limb locomotor function was also significantly enhanced in the hUCB-treated rats based on Basso-Beattie-Bresnahan (BBB) scores assessed 14 days after transplantation. These findings demonstrate that hUCB, when transplanted into the spinal cord 7 days after weight-drop injury, survive for at least 2 weeks, differentiate into oligodendrocytes and neurons, and enable improved locomotor function. Therefore, hUCB facilitate functional recovery after moderate SCI and may prove to be a useful therapeutic strategy to repair the injured spinal cord.     

Renal transplantation in elderly patients older than 70 years of age: results from the Scientific Registry of Transplant Recipients

BACKGROUND: Elderly patients (ages 70 yr and older) are among the fastest-growing group starting renal-replacement therapy in the United States. The outcomes of elderly patients who receive a kidney transplant have not been well studied compared with those of their peers on the waiting list. METHODS: Using the Scientific Registry of Transplant Recipients, we analyzed data from 5667 elderly renal transplant candidates who initially were wait-listed from January 1, 1990 to December 31, 2004. Of these candidates, 2078 received a deceased donor transplant, and 360 received a living donor transplant by 31 December 2005. Time-to-death was studied using Cox regression models with transplant as a time-dependent covariate. Mortality hazard ratios (RRs) of transplant versus waiting list were adjusted for recipient age, sex, race, ethnicity, blood type, panel reactive antibody, year of placement on the waiting list, dialysis modality, comorbidities, donation service area, and time from first dialysis to first placement on the waiting list. RESULTS: Elderly transplant recipients had a 41% lower overall risk of death compared with wait-listed candidates (RR=0.59; P<0.0001). Recipients of nonstandard, that is, expanded criteria donor, kidneys also had a significantly lower mortality risk (RR=0.75; P<0.0001). Elderly patients with diabetes and those with hypertension as a cause of end-stage renal disease also experienced a large benefit. CONCLUSIONS: Transplantation offers a significant reduction in mortality compared with dialysis in the wait-listed elderly population with end-stage renal disease.     

一种保留哺乳功能的乳头内陷矫正术研究

目的:探索一种保留育龄期孕前患者哺乳功能的乳头内陷矫正方法。方法:临床纳入乳头内陷程度为Ⅰ型、Ⅱ型的孕前育龄患者各60例,随机分为Ⅰ型手术组、Ⅰ型对照组、Ⅱ型手术组及Ⅱ型对照组各30例。手术组孕前进行手术,并佩戴矫正器6个月,对照组不予手术处理。同时以乳头发育正常的30例孕前育龄者作为正常组。纳入成功妊娠、生产并尝试哺乳患者,统计乳头高度,母乳喂养情况,乳头皲裂及乳腺炎的发生情况。结果:对于Ⅰ型和Ⅱ型患者,手术组术后即刻及孕晚期,其乳头高度相对术前及对照组均有显著性改善(P0.01),母乳喂养4个月成功率显著提高(P0.05),乳头皲裂和乳腺炎的发生率显著降低(P0.05),且除Ⅱ型患者的术后乳头高度外,与正常组比较差异无统计学意义(P0.05)。结论:对于Ⅰ型及Ⅱ型乳头内陷,佩戴乳头内陷矫正器除可增加乳头高度外,可在保留哺乳功能的同时,降低产后乳头皲裂和乳腺炎发生率。     

腹腔镜与开腹中低位直肠癌全直肠系膜切除保肛手术长期结果的meta分析

目的:通过meta分析比较腹腔镜与传统开腹全直肠系膜切除(total mesorectal excision,TME)保肛手术治疗中低位直肠癌长期结果的差异。方法:检索Pub Med、MEDLINE、Cochrane Library、中国生物医学文献服务系统(CBM)、万方数据库、中国知网数据库、维普等电子数据库。收集比较腹腔镜与开腹中低位直肠癌TME保肛手术的随机对照试验(randomized controlled trial,RCT)、非随机对照试验(non-randomized controlled trial,non-RCT)。统计分析使用Revman 5.2软件。结果:共将6篇文献纳入meta分析,1篇RCT,5篇non-RCT,共882例患者,其中腹腔镜组477例,开腹组405例。两组切缘阳性比值比(odds ratio,OR)=1.67,95%可信区间(confidence interval,CI)=(0.91,3.05)(P=0.10);吻合口瘘OR=1.03,95%CI=(0.57,1.87)(P=0.91);局部复发OR=0.71,95%CI=(0.16,3.15)(P=0.65);总生存率风险比(hazard ratio,HR)=0.98,95%CI=(0.90,1.07)(P=0.67);无病生存率HR=1.02,95%CI=(0.82,1.28)(P=0.85)。两组差异均无统计学意义。结论:腹腔镜中低位直肠癌TME保肛手术具有与传统开腹手术相似的长期结果。但目前仍需设计RCT评估患者术后长期肿瘤学结果及术后生活质量。     

股骨近端防旋髓内钉治疗Russell-TaylorⅡ型股骨转子下骨折

目的探讨股骨近端防旋髓内钉(PFNA)治疗Russell-TaylorⅡ型股骨转子下骨折的手术方法及疗效。方法对17例Russell-TaylorⅡ型股骨转子下骨折患者牵引复位后均行PFNA内固定治疗。结果手术时间60~90 min,术中出血量150~400 ml。17例均获随访,时间10~24个月。骨折均达骨性愈合。按Harris标准进行髋关节功能评价:优10例,良6例,可1例。结论 PFNA治疗Russell-TaylorⅡ型股骨转子下骨折操作简单,创伤小,疗效满意。     

C2,3椎弓根螺钉固定融合治疗不稳定型Hangman骨折

目的：探讨C2,3椎弓根螺钉固定融合术治疗不稳定型Hangman骨折的疗效。方法2006年4月～2013年3月,采用C2,3椎弓根螺钉固定融合术治疗不稳定型Hangman骨折患者8例。根据Levine分型标准Ⅱ型骨折6例,ⅡA型骨折2例。手术均采用OASYS内固定系统,并在C2,3椎板及关节突间植骨。为确保安全及准确,所有操作在C形臂X线机导航下完成。术后平均随访18个月,采用正侧位、动力位X线片及CT扫描评估固定融合节段的完整性和稳定性。结果8例患者颈椎骨折均获得满意复位,术中无一例发生脊髓及椎动脉损伤。术后1例切口愈合不良,经换药后愈合。末次随访时影像学检查显示患者均获得骨性愈合。随访期间所有患者无螺钉松动、断裂等并发症发生。结论 C2,3椎弓根螺钉固定融合术是治疗不稳定型Hangman骨折的有效方法,可以复位骨折并使之达到骨性愈合,并发症发生率低。