HIV抗体阳性人免疫球蛋白的代谢和安全性分析

医疗卫生市场对静注免疫球蛋白(Intravenous Immunoglobulin,IVIg)的需求日渐增长,保障安全供血一直以来是一项严峻挑战。作为一种无法根治的血液传播病毒,人类免疫缺陷病毒(Human Immunodeficiency Virus,HIV)严重威胁着供血安全。HIV抗体是HIV既往感染的指标,然而HIV抗体并不具有感染性,含有HIV抗体的制品也不一定具有感染性。本文从抗体代谢、输入性HIV抗体代谢和不同来源HIV抗体的安全性等角度,综述了HIV抗体阳性的血液制品的安全性。     

18F-FDG PET/CT在多发性大动脉炎应用中的研究进展

多发性大动脉炎(TA)是一种累及主动脉及主动脉重要分支的慢性非特异度炎性疾病,主要依据患者的临床表现、实验室检查及相应的影像学检查进行诊断评估。近年来,¹⁸F-FDG PET/CT已逐渐应用于TA的临床工作中,并认为是评估该病活动性的相对金标准。就¹⁸F-FDG PET/CT在TA中的应用进行综述及展望,以期帮助临床医师更好地对TA进行诊断、治疗及评估。     

非新生儿破伤风诊疗规范

破伤风分为新生儿破伤风和非新生儿破伤风。我国已于2012年消除了新生儿破伤风,但非新生儿破伤风仍是一个严重的公共卫生问题。非新生儿破伤风重症患者在无医疗干预的情况下,病死率接近100%,即使经过积极的综合治疗,全球范围病死率仍为30%~50%,是一种极为严重的潜在致命性疾病。为规范我国非新生儿破伤风诊疗行为,提高医疗质量,保障医疗安全,特制定本规范。本规范包括了非新生儿破伤风的病原学、流行病学、发病机制、临床表现及实验室检查、诊断、鉴别诊断、分级、治疗等方面内容。     

TIM-3 配体galectin-9 诱导NK/T细胞淋巴瘤细胞的凋亡及其机制

目的：观察TIM-3 在NK/T细胞淋巴瘤（natural killer/T cell lymphoma, NK/TCL）细胞株中的表达及其配体galectin-9（GAL-9）诱导瘤细胞凋亡的作用及其部分机制。方法：Western blotting 测定NK/TCL细胞株SNK-1、SNK-6、SNT-8 和健康人外周血NK细胞中TIM-3 的表达;采用不同质量浓度重组人GAL-9（rhGAL-9）作用于NK/TCL细胞株24 h 后,通过CCK-8 法检测细胞增殖活性;流式细胞术Annexin-V/PI 双染法检测瘤细胞凋亡;Western blotting 检测caspase-3、PARP及其剪接体和MAPK信号通路蛋白磷酸化表达水平变化。结果：NK/TCL细胞株SNK-1、SNK-6 和SNT-8 的TIM-3 表达较健康人外周血NK细胞显著增高,其中SNK-1、SNK-6 细胞株与对照组相比差异具有统计学意义（P<0.05）;CCK-8 检测结果显示,rhGAL-9 对NK/TCL细胞增殖活力具有明显抑制作用,并有浓度依赖性;流式细胞术检测显示,rhGAL-9 可诱导3 种NK/TCL细胞株凋亡;Western blotting 结果显示,cleaved-caspase-3、cleaved-PARP蛋白表达量增高,MAPK通路中JNK蛋白磷酸化水平升高。结论：TIM-3 在NK/TCL细胞株中异常高表达,其配体GAL-9可诱导细胞凋亡,其机制可能与JNK磷酸化水平升高相关。     

17Beta-estradiol and progesterone improve in-vitro cytoplasmic maturation of oocytes from unstimulated prepubertal and adult rhesus monkeys

BACKGROUND: Effects of 17beta-estradiol and progesterone on rhesus monkey oocyte maturation in vitro were evaluated by embryo development subsequent to IVF. METHODS AND RESULTS: In experiment 1, immature cumulus-oocyte complexes collected from unstimulated adult females during the non-breeding season were matured in modified medium CMRL-1066 containing various combinations of gonadotrophins (FSH + LH), estradiol and/or progesterone. Formation of morulae and blastocysts was greatest in oocytes matured in medium containing estradiol and/or progesterone, with or without gonadotrophins (morula 38-46%, blastocyst 14-20%) than in control oocytes matured without estradiol or progesterone (morula 14%, blastocyst 0%). In experiment 2, cumulus-oocyte complexes from unstimulated prepubertal female monkeys were matured in medium with gonadotrophins, estradiol or progesterone. The best development to the morula stage was obtained with oocytes matured with gonadotrophins and estradiol or gonadotrophins and progesterone (43 and 25 morulae, respectively), while control oocytes matured with gonadotrophins but without steroid hormones gave the poorest morula developmental response (12%). However, there was no difference in blastocyst development across all groups (0-3%). CONCLUSIONS: These results demonstrate that during rhesus monkey oocyte maturation in vitro: (i) estradiol or progesterone can improve oocyte developmental competence; (ii) immature oocytes from prepubertal versus adult females have differential responses to challenge with estradiol or progesterone.     

胃癌癌胚抗原的分布型式与组织类型及组织发生分型的关系

本文应用免疫组化技术对104例胃癌组织CEA分布进行了观察。发现胃癌组织CEA有三种分布型式:即Ⅰ型(浆型),Ⅱ型(膜型)和Ⅲ型(弱反应型)。粘液癌以Ⅰ型分布为主,分化性癌以Ⅱ型分布为主,差分化癌三种分布型式均有。按组织发生分型,肠型胃癌主要显示Ⅱ型分布,胃型和干细胞型胃癌主要显示夏型分布。提示癌组织CEA分布型式可能与肿瘤分化程度有关,而癌组织CEA含量可能与组织发生有一定关系。     

优化密码促进HPV 6b E7蛋白表达及DNA疫苗诱导的细胞免疫反应

目的：探讨优化密码对人乳头瘤病毒6b型（HPV 6b）基因表达及免疫原性的影响，为治疗性DNA疫苗的研究奠定基础。方法：设计合成含优化密码及pRB结合位点突变的HPV 6bE7(humE7）全长基因。测序验证无误后，定向克隆于pcDNA3的Kpn I和EcoR I位点，成功构建真核表达质粒pcDNA3-hu-mE7。体外转染COS－1细胞，免疫荧光检测其E7蛋白表达。C57BL／6小鼠胫前肌内接种裸DNA，观察其诱导的细胞免疫反应。结果：pcDNA3-hu-mE7在COS－1细胞获得明显表达，表达产物主要位于细胞核中。DNA免疫结果显示，与含有野生型E7基因的表达质粒pcDNA3-wtE7比较，pcDNA3-hu-mE7免疫小鼠脾细胞培养上清中IFN-γ产生明显升高，CD8^ 和CD4^ 淋巴细胞活性增强。结论：优化密码能促进HPV 6b E7蛋白表达及DNA疫苗诱导的细胞免疫反应。     

KEYNOTE-033: Randomized phase 3 study of pembrolizumab vs docetaxel in previously treated,PD-L1-positive,advanced NSCLC

KEYNOTE-033 (NCT02864394) was a multicountry, open-label, phase 3 study that compared pembrolizumab vs docetaxel in previously treated, programmed death-ligand 1 (PD-L1)-positive, advanced non-small cell lung cancer (NSCLC), with most patients enrolled in mainland China. Eligible patients were randomized (1:1) to pembrolizumab 2 mg/kg or docetaxel 75 mg/m² every 3 weeks. Primary endpoints were overall survival (OS) and progression-free survival and were evaluated sequentially using stratified log-rank tests, first in patients with PD-L1 tumor proportion score (TPS) ≥50% and then in patients with PD-L1 TPS ≥1% (significance threshold: P < .025, one-sided). A total of 425 patients were randomized to pembrolizumab (N = 213) or docetaxel (N = 212) between 8 September 2016 and 17 October 2018. In patients with a PD-L1 TPS ≥50% (n = 227), median OS was 12.3 months with pembrolizumab and 10.9 months with docetaxel; the hazard ratio (HR) was 0.83 (95% confidence interval [CI]: 0.61-1.14; P = .1276). Because the significance threshold was not met, sequential testing of OS and PFS was ceased. In patients with a PD-L1 TPS ≥1%, the HR for OS for pembrolizumab vs docetaxel was 0.75 (95% CI: 0.60-0.95). In patients from mainland China (n = 311) with a PD-L1 TPS ≥1%, HR for OS was 0.68 (95% CI: 0.51-0.89). Incidence of grade 3 to 5 treatment-related AEs was 11.3% with pembrolizumab vs 47.5% with docetaxel. In summary, pembrolizumab improved OS vs docetaxel in previously treated, PD-L1-positive NSCLC without unexpected safety signals; although the statistical significance threshold was not reached, the numerical improvement is consistent with that previously observed for pembrolizumab in previously treated, advanced NSCLC.     

保留肛窦微创置管冲洗引流治疗肛周脓肿的可行性研究

【摘要】 目的 探讨肛旁置管冲洗联合负压引流对肛周脓肿的疗效及可行性。方法 将80例肛周脓肿患者随机分为试验组和对照组,试验组采用微创置管冲洗联合负压引流术,对照组采用传统术式,观察两种手术方法在疗效、安全性、术后肛门疼痛、肛门功能、肛周脓肿复发率及肛瘘形成率、手术时间及愈合时间、住院费用方面的差异。结果 腔内置管冲洗加负压引流术（试验组）对术后肛门疼痛、肛门功能、愈合时间、住院时间及治疗费用等方面均有积极影响,相比于对照组,差异有统计学意义（P＜005）;两组疗效及安全性相当,术后脓肿复发率及肛瘘形成率亦无显著差异（P>005）。结论 腔内置管冲洗加负压引流手术在保证疗效及安全性的基础上,减少了手术创伤,缩短了住院时间,降低了患者痛苦及经济负担,更大限度地保护了肛门功能,可在临床推广应用。     

疏阳化痰方对焦虑女性痤疮(阳郁痰凝证)患者疗效及血清炎性因子的影响

[目的]观察疏阳化痰方治疗焦虑痤疮女性患者80例疗效及对血清炎性因子影响。[方法]纳入2017年1月-2018年1月期间治疗的焦虑女性痤疮患者80例,随机分为治疗组和对照组,每组各40例,对照组常规给予丹参酮胶囊口服,治疗组在对照组基础上给予疏阳化痰方治疗,连续治疗12周;观察治疗前后两组治疗有效率、焦虑评分量表（SAS）、皮肤病生活质量指数（DLQI）、血清炎性因子[白介素-1α（IL-1α）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）]、血清激素水平黄体激素水平（LH）与雌二醇（E₂）、中医证候量表不良反应。[结果]1）治疗后治疗组缓解率为92.5%,对照组缓解率为85.0%,两组在缓解率方面对比无统计学意义（P>0.05）;2）两组治疗后痤疮国际改良分级等级分级比较无统计学差异（P>0.05）;3）两组治疗后DLQI评分、中医证候量表评分、SAS评分对比具有统计学差异（P<0.05）;4）两组治疗前后血清炎性因子（IL-1α、IL-6、TNF-α）、血清激素水平LH与E₂水平变化比较具有统计学差异（P<0.05）;两组治疗前后均未出现不良反应。[结论]疏阳化痰方联合丹参酮胶囊治疗焦虑女性患者痤疮（阳郁痰凝证）效果显著,值得临床应用推广。