Lifespan of preserved red cells

Abstract. Forty-four long-term red cell survival studies were performed in 39 patients, the majority of whom had either traumatic injuries or carcinoma. With the aid of a computer, the lifespan and the rate of random destruction of preserved red cells were estimated in each recipient. The 24-hour survival was a satisfactory measurement of the percent of viable red cells in the transfusion. The mean red cell lifespan (97 days) was not affected by either the method of preservation (liquid or freeze preservation) or the length of storage at +4 or — 80°C. Accelerated linear removal of red cells was seen in severely injured patients; improved red cell survival was associated with improvement in the recipient's health. The correlation between the lifespan of transfused red cells and the recipient's general health suggests that the decreased long-term survival noted in these recipients was produced by some extracorpuscular ‘toxic’ factor.     

妊娠期肝内胆汁淤积症患者母胎混合淋巴细胞培养的研究

目的　通过观察母胎间混合淋巴细胞反应 ,探讨母胎组织相容性与妊娠期肝内胆汁淤积症 (ICP)发病的关系。方法　采用淋巴细胞转化法对 2 2例ICP患者 [ICP组 ,其中 5例合并妊娠高血压综合征 (妊高征 ) ]和 2 1例正常孕妇 (对照组 )进行母胎淋巴细胞混合培养 ,计算淋巴细胞转化率 ;比较两组间淋巴细胞转化率的差异。通过检测ICP组孕妇的血清甘胆酸盐水平 ,分析淋巴细胞转化率与血清甘胆酸盐水平的相关性。结果　ICP组淋巴细胞转化率为 ( 2 4± 5 ) % ,对照组为 ( 3 6± 9) % ,两组比较 ,差异有极显著性 (P <0 0 0 1)。ICP组合并与不合并妊高征者的淋巴细胞转化率无显著性差异 (P >0 0 5 )。ICP组淋巴细胞转化率与血清甘胆酸盐水平无显著相关性 [相关系数 (r) =0 40 3 ,P>0 0 5 ]。结论　ICP患者母胎混合淋巴细胞培养反应性降低 ,提示母胎间组织相容性增高、免疫识别与反应性降低。这一变化可能与ICP的发生有关     

Lack of Histocompatibility Leukocyte Antigen-G expression in early embryos is not related to germinal defects or impairment of interleukin-10 production by embryos

The expression of Histocompatibility Leukocyte Antigen (HLA)-G molecules is a mandatory prerequisite for the development of pregnancy but no hypotheses have yet been advanced regarding the lack of HLA-G modulation expression in a percentage of early embryos obtained by in vitro fertilization (IVF). One possible hypothetical model assumes that the absence of regulation of HLA-G or impaired interleukin (IL)-10 secretion could be related to germinal defects. We investigated the presence of soluble HLA-G antigens in supernatants of single embryo cultures from couples admitted to a second fertilization procedure; these couples showed a complete absence of HLA-G modulation in the first cycle's embryo supernatants (0/31). The results obtained in the second IVF cycle showed embryo supernatants positive for HLA-G (14/40), suggesting that the previous lack of antigen modulation is independent of germinal defects. Furthermore, since it has been reported that oocytes and early embryos can secrete IL-10, an anti-inflammatory cytokine produced by type 2 helper T cells that induces upregulation of HLA-G expression in monocytes and trophoblasts, we investigated the levels of IL-10 and soluble HLA-G in 40 embryo culture supernatants from 21 IVF cycles. No associations were observed between the presence of IL-10 and the production and concentrations of soluble HLA-G, or between IL-10 levels and pregnancy outcome. These results indicate that the lack of HLA-G production in early embryos is not related to germinal defects or to impairment in embryo IL-10 secretion but could be ascribed to possible uncorrected fertilization processes.     

Skeletal muscle major histocompatibility complex class I and II expression differences in adult and juvenile dermatomyositis

OBJECTIVE:

To analyze major histocompatibility complex expression in the muscle fibers of juvenile and adult dermatomyositis.

METHOD:

In total, 28 untreated adult dermatomyositis patients, 28 juvenile dermatomyositis patients (Bohan and Peter''s criteria) and a control group consisting of four dystrophic and five Pompe''s disease patients were analyzed. Routine histological and immunohistochemical (major histocompatibility complex I and II, StreptoABComplex/HRP, Dakopatts) analyses were performed on serial frozen muscle sections. Inflammatory cells, fiber damage, perifascicular atrophy and increased connective tissue were analyzed relative to the expression of major histocompatibility complexes I and II, which were assessed as negatively or positively stained fibers in 10 fields (200X).

RESULTS:

The mean ages at disease onset were 42.0±15.9 and 7.3±3.4 years in adult and juvenile dermatomyositis, respectively, and the symptom durations before muscle biopsy were similar in both groups. No significant differences were observed regarding gender, ethnicity and frequency of organ involvement, except for higher creatine kinase and lactate dehydrogenase levels in adult dermatomyositis (p<0.050). Moreover, a significantly higher frequency of major histocompatibility complex I (96.4% vs. 50.0%, p<0.001) compared with major histocompatibility complex II expression (14.3% vs. 53.6%, p = 0.004) was observed in juvenile dermatomyositis. Fiber damage (p = 0.006) and increased connective tissue (p<0.001) were significantly higher in adult dermatomyositis compared with the presence of perifascicular atrophy (p<0.001). The results of the histochemical and histological data did not correlate with the demographic data or with the clinical and laboratory features.

CONCLUSION:

The overexpression of major histocompatibility complex I was an important finding for the diagnosis of both groups, particularly for juvenile dermatomyositis, whereas there was lower levels of expression of major histocompatibility complex II than major histocompatibility complex I. This finding was particularly apparent in juvenile dermatomyositis.     

妊娠过程中凋亡级联的作用和调节

细胞凋亡是一种级联事件,在妊娠过程中发挥了重要的作用,主要体现在胎盘形成过程中滋养细胞层分化为合体细胞滋养层,滋养层入侵确保了胎盘锚固于母体血管系统以保证胎儿氧气及营养的供应。滋养层细胞的凋亡限制了子宫壁侵入,维持母体完整性,凋亡产生的多肽是胎儿特异性耐受建立的诱导物。整个级联过程受母体免疫系统的监控,妊娠妇女的免疫应答并没有显著降低,母体免疫系统能够识别胎儿移植物这个外源性抗原并作出应答。母胎界面特定的免疫耐受诱导机制使绒毛外滋养细胞（EVT）限制和容忍相互联系。细胞因子主要由自然杀伤细胞、T细胞分泌,白细胞通过细胞因子发挥其免疫调节作用。凋亡过程受到基因调控、激素及氧化应激等因素的影响。     

胶原海绵人工硬脑膜结合臭氧修复颅脑损伤

背景：硬膜的完整性对于颅脑损伤患者手术的预后十分重要。人工硬脑膜是目前常见的硬脑膜修补材料,寻找理想的人工硬脑膜是神经外科探索的方向。 目的：观察并分析胶原海绵人工硬脑膜和臭氧治疗颅脑损伤患者的临床资料,探讨并评价其使用价值。 方法：回顾性分析60例颅脑损伤患者应用胶原海绵人工硬脑膜修补和臭氧治疗后的疗效及并发症随访结果。 结果与结论：患者中2例死于重型颅脑损伤术后弥漫性脑肿胀,1例死于脑损伤合并多器官衰竭,2例因广泛脑挫裂伤合并脑疝术后植物生存,其余55例患者进入结果分析。术后2例出现切口局部皮下积液,予穿刺抽吸及弹性绷带加压包扎后好转;1例术后出现术侧少量硬膜下积液,未行特殊处理,动态复查头颅CT显示积液逐步吸收减少。头颅CT 检查未见与人工脑膜有关的异常反应和表现。28例患者3-6个月进行颅骨修补时发现人工硬脑膜与正常硬脑膜融合恢复较好,无粘连及炎症反应发生。表明胶原海绵人工硬脑膜和臭氧在颅脑损伤患者治疗中充分发挥减压作用,维持脑功能,缩短手术时间,并发症少,相容性好,能够较好的与正常硬脑膜融合,保护脑皮质,为后期颅骨修补创造有利条件。     

重组蜘蛛丝蛋白在腹股沟疝修补术中的应用前景

疝是普通外科的常见疾病。无张力疝修补术是一种以人工材料制成修补平片用以加强腹股沟管的后壁,此方法的优点在于克服了传统手术对组织解剖结构的破坏,且修补后的组织低张力或无张力,但是寻找一种完美的修补材料是多年以来疝外科医师一直追寻的目标。完美的补片应具有：没有生物学活性及抗原性;免疫原性低;稳定性高;力学性能良好;组织相容性良好;抗黏连,抗感染,减轻患者疼痛感等特点。当前蚕丝因特性优质、产量来源广泛,已经大量应用于各个行业,其中生物医学领域也多有涉及,如在运动损伤中的组织修、药物纤维的开发与应用等,而蜘蛛丝因其某些特性与蚕丝相似,但其功能又远超蚕丝,因此,本文主要介绍蜘蛛丝以及其在医学中的应用,尤其是作为疝修补材料的应用。     

The Assessment and Outcomes of Crossmatching in Lung Transplantation in Korean Patients

BackgroundIn lung transplantation, human leukocyte antigen (HLA) compatibility is not included in the lung allocation score system or considered when placing donor allografts. However, HLA matching may affect the outcomes of lung transplantation. This study evaluated the current assessment status, prevalence, and effects of HLA crossmatching in lung transplantation in Korean patients using nationwide multicenter registry data.MethodsTwo hundred and twenty patients who received lung transplantation at six tertiary hospitals in South Korea between March 2015 and December 2019 were retrospectively reviewed. Clinical data, including general demographic characteristics, primary diagnosis, and pretransplant status of the recipients and donors registered by the Korean Organ Transplant Registry, were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier method with log-rank tests.ResultsComplement-dependent cytotoxic crossmatch (CDC-XM) was performed in 208 patients (94.5%) and flow cytometric crossmatch (flow-XM) was performed in 125 patients (56.8%). Among them, nine patients (4.1%) showed T cell- and/or B cell-positive crossmatches. The incidences of postoperative complications, including primary graft dysfunction, acute rejection, and chronic allograft dysfunction in positively crossmatched patients, were not significant compared with those in patients without mismatches. Moreover, Kaplan-Meier analyses showed poorer 1-year survival in patients with positive crossmatch according to CDC-XM (P < 0.001) and T lymphocyte XM (P = 0.002) than in patients without mismatches.ConclusionPositive CDC and T lymphocyte crossmatching results should be considered in the allocation of donor lungs. If unavailable, the result should be considered for postoperative management in lung transplantation.