Acquired pMHC I Complexes Greatly Enhance CD4~+ Th Cell’s Stimulatory Effect on CD8~+ T Cell-Mediated Diabetes in Transgenic RIP-mOVA Mice

CD4+ helper T (Th) cells play pivotal roles in induction of CD8+ CTL immunity. However, the mechanism of CD4+ T cell help delivery to CD8+ T cells in vivo is still elusive. In this study, we used ovalbumin (OVA)-pulsed dendritic cells (DCOVA) to activate OT-II mouse CD4+ T cells, and then studied the help effect of these CD4+ T cells on CD8+ cytotoxic T lymphocyte (CTL) responses. We also examined CTL mediated islet β cell destruction which led to diabetes in wild-type C57BL/6 mice and transgenic rat insuli...     

Hemolytic-uremic syndrome following bone marrow transplantation in adults for hematologic malignancies

One hundred and sixty eight adult patients with B-cell non-Hodgkin's lymphoma (NHL) and other hematologic malignancies who underwent autologous or allogeneic bone marrow transplantation (BMT) were investigated for the subsequent development of hemolytic-uremic syndrome (HUS). All patients were conditioned with cyclophosphamide and total body irradiation. When examined at 3-month intervals for the first year post-BMT, all patients had uniform measurements of hematocrit (Hct) and serum creatinine. Sixteen patients who initially exhibited Hct and creatinine values that were normal range for the BMT populations developed a sudden decrease in Hct and increase in creatinine between 3 and 11 months post-BMT and fulfilled the clinical and laboratory criteria for HUS. None of these patients had known active cytomegalovirus infection, graft-versus-host disease, or cyclosporine administration. The degree of decrease in Hct and creatinine elevation ranged from solely laboratory abnormalities to a clinically significant syndrome. Twelve of the 16 patients developed acute clinical complications of congestive heart failure, hypertension (HTN), or peripheral edema. Twelve patients required red blood cell support, whereas only four patients required platelet transfusions. Both hemolytic anemia and thrombocytopenia have resolved in virtually all cases. At a mean follow up of 18 months postdiagnosis, creatinine elevations have persisted along with HTN. All patients have survived without life-threatening long-term sequelae. With the increasing use of BMT as a curative modality for patients with hematologic malignancies, it becomes important to prospectively monitor patients for the development of HUS and its potential long-term impact on renal function.     

Anthropometric characteristics and the burden of altered nutritional status among neuropsychiatric patients at Zomba Mental Hospital in Zomba,Malawi

Objective

To determine the prevalence of overnutrition and undernutrition among neuropsychiatric inpatients and outpatients at Zomba Mental Hospital in Zomba, Malawi.

Methods

In this analytical cross-sectional study (n = 239), data were collected from psychiatric patients who were either inpatients (n = 181) or outpatients (n = 58) at Zomba Mental Hospital, which is the largest mental health facility in Malawi. Information was collected about patient demographics, anthropometric data, dietary information, and tobacco and alcohol use, among other variables. Data were entered and analysed in SPSS 16.0 (SPSS Inc., Chicago, IL, USA). Means were generated and compared between male and female patients, and between inpatients and outpatients.

Results

The study recruited 158 male and 81 female patients, with mean ages of 31.24 ± 11.85 years and 33.08 ± 15.18 years (p = 0.328), respectively. Male patients were significantly taller (165.27 ± 7.25 cm) than female patients (155.30 ± 6.56 cm) (p < 0.001); were significantly heavier than females (60.02 ± 10.56 kg versus 55.64 ± 10.53 kg); and had a significantly lower mean body mass index (BMI) than females (21.87 ± 3.21 vs. 23.01 ± 3.78) (p = 0.016). Overweight and obese patients comprised 17.6% of the participants, and 8.8% were underweight. There were no significant differences in the prevalence of overweight, obesity, and underweight between male and female participants, or between inpatients and outpatients.

Conclusion

Our study—the first one of its kind in Malawi—characterised the anthropometry of neuropsychiatric patients at a major metal health facility in Malawi, and has shown a high proportion of overweight patients and a notable presence of underweight patients among them. Being overweight or obese is a risk factor for metabolic disorders. Being underweight may aggravate mental illness or disturb the effect of medication. There is need, therefore, to include nutrition screening and therapeutic or supplementary feeding as part of a comprehensive care and treatment plan for neuropsychiatric patients.     

Clinical and radiographic evaluation of biodegradable bone plates in the treatment of mandibular body fractures

Background:

Many different systems are available for the treatment of fractures ranging from the heavy compression plates for mandibular reconstruction to low profile plates for mid-facial fixation, and are made either from stainless steel, titanium or vitallium. Recently, biodegradable, self-reinforced polylactide plates and screws have been used for the internal fixation of fractures of the mandible with good results.

Aim of this study:

This study evaluated clinically the biodegradable bone plates for treatment of mandibular body fracture and to evaluate bone healing during the follow-up period using digital radiography.

Materials and Methods:

Eight patients had been suffered from mandibular body fractures were treated using Inion CPS^TM bioresorbable fixation system and the healing process were followed up using digitised panoramic radiography at first week and after 1, 3 and 6 months.

Results:

Clinical examination of fractured segments revealed stable fixation across the fracture sites while visual and quantitative assessment of radiograph showed healing process was comparable with results previously reported by titanium bone plates.

Conclusion:

Open reduction and internal fixation of mandibular fractures using bioresorbable fixation system with a brief period of inter-maxillary fixation have evolved to the point where the physical properties are sufficient to withstand the post-operative loads required for fracture repair of mandibular body fractures. The foreign body reaction is a major material-related problem which requires further studies.     

Frequency and outcomes of submandibular gland obstruction following resection of squamous cell carcinomas in the vicinity of the submandibular duct

IntroductionThe aim of this study was to report rates, associated factors and outcomes of submandibular gland obstruction following surgery for squamous cell carcinoma in the anterior floor of the mouth (FOM) or ventral tongue without a neck dissection where resection has involved (or has been in very close proximity to) the submandibular duct.MethodsA retrospective case note review was carried out for the period January 2007 to December 2011. Only patients who received primary local surgical resection for squamous cell carcinoma of the anterior FOM or ventral tongue were included.ResultsFifty-two patients were analysed. Fifteen (29%) developed submandibular gland symptoms following surgery. Symptoms resolved spontaneously for 14 (93%) and 1 patient required the submandibular duct to be repositioned. Comparatively, 2 patients (13%) developed symptoms when the duct was repositioned during primary surgery. No patients had their submandibular gland removed.ConclusionsResection of small tumours associated with the FOM and ventral tongue in proximity to the submandibular duct is associated with obstructive symptoms in about a quarter of patients; this is reduced by half when redirecting the duct. Symptoms are self-limiting and self-resolving. A prospective clinical trial comparing duct repositioning with subcapsular gland excision would help clarify potential benefits and best treatment modalities.     

Overexpression of the major vault transporter protein lung-resistance protein predicts treatment outcome in acute myeloid leukemia

The monoclonal antibody LRP56 recognizes a 110-kD major vault protein (lung-resistance protein [LRP]) overexpressed in several P-glycoprotein- negative (Pgp-), multidrug resistant tumor cell lines. To determine the frequency of LRP overexpression, its prognostic significance, and its relation to Pgp, we analyzed bone marrow specimens from 87 consecutive patients with acute leukemia. Diagnoses included de novo acute myeloid leukemia (AML; 21 patients), leukemia arising from an antecedent hematologic disorder or prior cytotoxic therapy (secondary AML; 27 patients), AML in relapse (29 patients), and blast phase of chronic myeloid leukemia (CML-BP; 10 patients). A granular cytoplasmic staining pattern was detected by immunocytochemistry in 32 (37%) cases, including 7 (33%) de novo AML, 13 (48%) secondary AML, 11 (38%) relapsed AML, and 1 of 10 CML-BP. Among 66 evaluable patients with AML, LRP overexpression was associated with an inferior response to induction chemotherapy (P = .0017). Remissions were achieved in 35% of LRP+ patients as compared with 68% of LRP- patients. Although Pgp adversely affected response in univariate analysis (P = .0414), only LRP had independent prognostic significance when compared in a logistic regression model (P = .0046). Differences in remission duration (P = .075) and overall survival (P = .058) approached significance only for LRP. Sequential specimens from remitting patients receiving treatment with the Pgp modulator cyclosporin-A showed emergence of the LRP phenotype despite a decrease or loss of Pgp at the time of treatment failure (P =.0304). Significant associations were observed between LRP and age greater than 55 years (P = .017), Pgp (P = .040), and prior treatment with mitoxantrone (P = .020) but not with CD34. These findings indicate that overexpression of the novel transporter protein LRP is an important predictor of treatment outcome in AML.     

脐血有核细胞移植治疗脑卒中的动物实验

目的:脐血有核细胞中富含多系前体细胞,具备改善受损神经系统功能的潜能。为此建立阻塞性脑卒中动物模型,探讨脐血有核细胞移植对其治疗的可行性。方法:实验于2004-09/2005-05在深圳市宝安区人民医院动物实验室完成。①实验材料:脐带血取自足月新生儿,由深圳宝安血站研究室提供,产妇及其家属均签署知情同意书。SD清洁级成年大鼠80只,随机取20只作为正常对照组,另60只以电凝法建立阻塞性脑卒中模型。剔除运动功能障碍不典型鼠后,随机取5只作为模型观察,余鼠按1∶1随机分为细胞移植组和模型对照组,当出现单只为尾数时,将其分配在细胞移植组。②实验方法:无菌抽取脐血20mL,加入乙二胺四乙酸抗凝,Ficoll法分离脐血有核细胞。造模后第10天,细胞移植组大鼠将头部固定,按前囟尾侧3.0mm,中线旁1.5mm,深度1.2mm注入1011L-1脐血有核细胞悬液5μL,1μL/min。模型对照组注射等量无细胞脐血清,正常对照组不给予任何干预。③实验评估:造模后4周,5只模型观察大鼠制作脑切片,行苏木精-伊红染色镜检。各组分别于细胞移植前、细胞移植后2,6周进行横木行走实验和触觉刺激试验,检测其运动和触觉功能的恢复。处死各组大鼠制作病理切片,免疫荧光检测脐血有核细胞在脑内生存和分化情况。结果:正常对照组、细胞移植组、模型对照组各20只、24只、24只进入结果分析。①阻塞性脑卒中模型大鼠病理特征:造模大鼠出现行为障碍,缺血部位出现中风囊,病理切片可见缺血坏死区等阻塞性脑卒中所致脑组织病理损伤。②运动和触觉功能测试:细胞移植前,细胞移植组与模型对照组大鼠的横木行走能力、撕胶纸能力均基本相似(P=0.05),且明显低于正常对照组(P<0.01)。移植后第2周,细胞移植组大鼠两项能力均明显强于模型对照组(P<0.05),但仍低于正常对照组(P<0.01)。移植后第6周,细胞移植组大鼠的横木行走能力明显改善,与正常对照组基本相似(P>0.05);撕胶纸能力仍低于正常对照组(P<0.01)。③阳性细胞免疫荧光检测:细胞移植组进针注射部位存在大量抗人RNP/CD45双阳性完整细胞,并向大脑中线、皮层梗死部位迁移。所植入的细胞约2.95%表达胶质纤维酸性蛋白,3.41%表达神经特异性烯醇化酶。结论:移植人脐血有核细胞能有效改善阻塞性脑卒中大鼠的运动和触觉功能缺陷。     

犬自体肺组织瓣修补食管壁部分缺损的可行性

目的:分析犬自体肺组织瓣修补食管壁部分缺损的可行性。方法:实验于2003-01/2004-11在中国医科大学附属第二医院动物实验室完成。选用健康成年杂种犬20只,按随机数字表法分为2组,即支架组和无支架组,每组10只。20只实验犬经右胸第5肋间进胸,于胸内中段食管处胸内食管侧壁制成长4cm,环1/2~2/3周径全层缺损。于相应部位选择适当的肺组织,制成带蒂类舌状肺组织瓣。两组均将肺组织瓣覆盖并缝合固定于食管缺损处,支架组于食管缺损内衬自扩性记忆合金支架(管腔直径2.0cm、长6.0cm)并固定。术后抗炎及营养支持治疗。观察实验犬术后情况,并于术后2,4,6,8,10和12周定期处死实验犬行组织学观察。结果:无支架组实验犬存活7只,其中1只犬存活>24个月;支架组存活6只。①实验犬术后一般情况:存活犬于术后均能正常经口进食,早期有进食后呕吐,再吃下呕吐食物的现象,以支架组明显。②组织学观察结果:术后2周,无支架组均可见替代物表面有胶原及炎性渗出物,边缘见1~2层鳞状上皮细胞;支架组除有无支架组基本表现外,可见支架固定良好,光镜下见网架压迫处有较多中性粒细胞浸润。4~6周,两组均可见替代物表面有新生的3~5层复层鳞状上皮细胞;支架组见支架已基本陷入黏膜层内。8~10周,两组均可见管腔表面有6~8层新生复层鳞状上皮细胞;支架组网架边缘瘢痕组织增生,支架完全被包裹,炎症较重的局部有细胞爬行中断现象或新生细胞层数较薄,多为一两层。结论:应用自体肺组织瓣修补食管壁部分缺损是可行的,但支架组支架对食管修补处组织刺激大,炎性反应重,瘢痕重,因此如何选择合适的支撑物是今后替代节段性食管缺损面临的重要问题。     

骨髓间质干细胞移植治疗大鼠急性心肌梗死的病理学观察

目的:观察急性心肌梗死大鼠行骨髓间质干细胞移植后受损心肌组织的病理形态学变化。方法:实验于2004-01/2005-06在上海胸科医院完成。选取健康成年雌性SD大鼠40只,随机数字表法分为骨髓间质干细胞注射组、模型对照组,20只/组。①两组大鼠均建立心肌梗死模型。造模0.5h后,骨髓间质干细胞注射组于结扎点下方缺血区域组织注射Dill标记的骨髓间质干细胞3×106个,模型对照组心肌缺血区域注射100μL生理盐水。②造模后4～6周处死两组大鼠,取出心脏,剪除双侧心房及右心室,沿左心室长轴由心尖到底部做3mm厚切片,镜下观察心肌梗死区域病理组织学表现。③选择心肌梗死表现明显的蜡块切片,行酸性复红染色,用LeicaQWin多媒体彩色病理图文分析软件进行图像分析,自动测量出切片中心肌梗死组织占总面积的百分比。免疫组化检测梗死心肌血管内皮生长因子和FactorⅧ蛋白因子的表达情况。结果:40只大鼠均进入结果分析。①梗死心肌的病理形态学观察:光镜下两组均可见大小不等的心肌梗死灶,梗死心肌区域细胞肿胀坏死,严重缺血坏死区出现心肌溶解。但骨髓间质干细胞注射组上述改变明显弱于模型对照组,其心肌梗死中层可见条索状的梗死灶及纤维瘢痕灶,并且有残存的心肌呈岛状散在分布,纤维瘢痕区域心肌细胞、微血管和毛细血管数量均明显增加,侧支循环丰富。另外,骨髓间质干细胞移植组于造模初期4只大鼠心内膜面有灶性软骨生成,向心室腔突起。②梗死心肌面积百分率的检测:骨髓间质干细胞注射组梗死心肌面积百分率明显低于模型对照组[(3.69±0.48)%,(19.20±1.77)%,t=7.621～10.820,P=0.001]。③梗死心肌血管内皮生长因子和FactorⅧ免疫组化检测:骨髓间质干细胞注射组血管内皮生长因子、FactorⅧ呈阳性表达,模型对照组未检测到血管内皮生长因子和FactorⅧ。结论:骨髓间质干细胞在大鼠心脏内可以转化为血管内皮细胞或分泌血管内皮生长因子,是治疗缺血性心血管疾病理想的细胞来源。心内膜面有灶性软骨生成可能是由于注射细胞时进针太深,警示注意骨髓间质干细胞移植的副反应。