影响供精人工授精临床结局多因素分析

目的:探讨多种因素对AID治疗结局的影响。方法:回顾2008年11月~2010年5月在生殖中心实施AID助孕治疗的418名妇女639个治疗周期的病例,综合分析不孕妇女的年龄、输卵管情况、治疗周期、促排卵用药及授精次数等因素对AID治疗妊娠结局的影响。结果:AID周期妊娠率为34.90%(223/639),例数妊娠率为53.34%(223/418)。临床妊娠率与女方年龄、是否合并输卵管因素、授精与排卵时间等有一定关系。排卵前后短时内单次授精的平均妊娠率反而高于排卵前后双次授精。639个AID周期中,随治疗周期的增加累计妊娠率随之增高,但周期妊娠率下降,第1~3周期临床妊娠率依次为37.08%、31.98%、21.95%。AID促排卵周期妊娠率与自然周期无差异(34.02%、35.63%)。结论:不孕妇女的年龄、输卵管情况及授精时机的掌握是影响供精人工授精成功率的重要因素。对超过3周期仍不孕者,可考虑改行供精体外授精-胚胎移植进行助孕。     

Survivin及其剪接变异体survivin-△Ex3,survivin-2B mRNA在乳腺癌中的表达和临床意义

目的观察乳腺癌组织中survivin及其剪接变异体survivin-△Ex3,survivin-2B mRNA表达情况,并探讨其与临床病理学指标的关系。方法以逆转录-聚合酶链反应(RT-PCR)法检测50例乳腺癌及癌旁5cm正常乳腺组织标本中的凋亡抑制因子survivin及其剪接变异体survivin-△Ex3、survivin-2B mRNA表达,半定量分析电泳结果。免疫组化法检测乳腺癌石蜡标本中的雌激素受体(ER)、孕激素受体(PR)和HER-2基因。结果50例乳腺癌标本中survivin及其剪接变异体survivin-△Ex3、survivin-2B mRNA均高表达,与癌旁正常乳腺组织中差异有统计学意义(P<0.01),survivin mRNA与survivin-△Ex3,survivin-2B mRNA在乳腺癌组织中的高表达呈正相关(P<0.05),survivin-△Ex3,survivin-2B mRNA的表达与淋巴结转移有关(P<0.05)。结论Survivin及其剪接变异体survivin-△Ex3、survivin-2B系重要的凋亡蛋白抑制因子,与其他预后指标联合检测可望对患者的治疗以及预后作出更准确的预测。     

重视供肝机械灌注研究,推动肝移植高质量发展

随着器官捐献数量不断增加和扩大标准供者(ECD)供肝定义不断拓展,供肝质量必然成为影响肝移植高质量发展的突出问题,也是相关领域的研究重点.最大限度解决器官短缺和推动器官移植高质量发展是我国器官捐献与移植事业发展的方向.近年来,利用机械灌注(MP)对供肝进行灌注、保存、评估及修复,已成为当前国际上提高肝移植质量的研究热点...     

健康供者外周血造血干细胞动员的临床研究

目的:探讨造血生长因子(HGFs)对健康供者外周血干细胞(PBSC)的动员作用,并比较粒细胞集落刺激因子(G-CSF)单用及G-CSF联合粒-巨噬细胞集落刺激因子(GM-CSF)的动员效果.方法:52例健康供者分成G-CSF单用组(34例)及与GM-CSF合用组(18例),分别采用G-CSF(5 μg·kg-1·d-1)及G-CSF(3 μg·kg-1·d-1)+GM-CSF(2 μg·kg-1·d-1),连续皮下注射5～6 d动员,采集PBSC.动员前后动态检测外周血及采集物MNC、CD34+细胞、CFU-GM计数.52例血液病患者接受上述供体动员之PBSC并行异基因PBSC移植(Allo-PBSCT).结果:动员后CD34+细胞及CFU-GM分别较动员前增加10.83及8.7倍,并在第5～6天达到高峰;G-CSF单用及与GM-CSF合用均可有效动员CD34+细胞和CFU-GM,但合用较单用更有效(P<0.05);所有患者接受Allo-PBSCT后均满意获得造血重建;随访观察至今应用HGFs对健康供者无明显不良反应.结论:采用中小剂量G-CSF单用和与GM-CSF合用均能安全、有效动员健康供者PBSC,但以合用更为有效.     

献血员、化验员乙型肝炎病毒感染的血清流行病学调查

本文采用SPRIA和ELISA法测定了128名献血员和49名化验员的五项血清学指标及SGPT。结果表明献血员中HBV感染率城市高于农村,男高于女,AB血型者高于其它血型(P<0.01)。化验员HBV感染率(51.02％)高于献血员(48.33％)(RR=1.05),HBV的感染随工龄增长而升高。     

The Effect of Sex-Mismatched Red Blood Cell Transfusion on Endothelial Cell Activation in Critically Ill Patients

BackgroundObservational studies suggest that sex-mismatched transfusion is associated with increased mortality. Mechanisms driving mortality are not known but may include endothelial activation. The aim of this study is to investigate the effects of sex-mismatched red blood cell (RBC) transfusions on endothelial cell activation markers in critically ill patients.Study Design and MethodsIn patients admitted to the intensive care unit who received a single RBC unit, blood samples were drawn before (T₀), 1 h after (T₁), and 24 h after transfusion (T₂₄) for analysis of soluble syndecan-1, soluble intercellular adhesion molecule-1, soluble thrombomodulin (sTM), von Willebrand factor antigen, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNFα). Changes in the levels of these factors were compared between sex-matched and sex-mismatched groups.ResultsOf 69 included patients, 32 patients were in the sex-matched and 37 patients were in the sex-mismatched group. Compared to baseline, sex-matched transfusion was associated with significant reduction in sTM level (p value = 0.03). Between-group comparison showed that levels of syndecan-1 and sTM were significantly higher in the sex-mismatched group compared to the sex-matched group at T₂₄ (p value = 0.04 and 0.01, respectively). Also, TNFα and IL-6 levels showed a statistically marginal significant increase compared to baseline in the sex-mismatched group at T₂₄ (p value = 0.06 and 0.05, respectively), but not in the sex-matched group.DiscussionTransfusion of a single sex-mismatched RBC unit was associated with higher syndecan-1 and sTM levels compared to transfusion of sex-matched RBC unit. These findings may suggest that sex-mismatched RBC transfusion is associated with endothelial activation.     

Donation after cardiac death liver transplantation is associated with increased risk of end‐stage renal disease

Limited organ supply has led to greater use of liver allografts with higher donor risk indices (DRI) and/or donated after cardiac death (DCD). DCD status is associated with acute kidney injury after liver transplantation; however, less is known about the association between donor quality and end‐stage renal disease (ESRD). Using SRTR data, we assembled a cohort of liver transplant recipients from 2/2002 to 12/2010. We fit multivariable Cox regression models for ESRD. Model 1 included total DRI; model 2 included components of DRI, including DCD, as separate variables. Forty thousand four hundred and sixty‐three liver transplant recipients were included. Median DRI was 1.40 (IQR 1.14, 1.72); 1822 (5%) received DCD livers. During median follow‐up of 3.93 years, ESRD occurred in 2008 (5%) and death in 11 075 (27%) subjects. There was a stepwise increase in ESRD risk with higher DRI (DRI ≥1.14 and <1.40: HR 1.17, P = 0.06; DRI ≥1.40 and <1.72: HR 1.29, P = 0.003; DRI ≥1.72: HR 1.39, P < 0.001, compared with DRI <1.14). Adjusting for DRI components separately, DCD status was most strongly associated with ESRD (HR 1.40, P = 0.008). Higher DRI is associated with ESRD after liver transplantation, driven in part by DCD status. Donor quality is an important predictor of long‐term renal outcomes in liver transplant recipients.     

Selective Hemi-Portocaval Shunt Based on Portal Vein Pressure for Small-for-Size Graft in Adult Living Donor Liver Transplantation

We developed an algorithm of graft selection in which left lobe donation is considered primarily if the graft-to-recipient weight ratio (GRWR) is estimated to be greater than 0.6% in preoperative volumetry with utilization of a hemi-portocaval shunt (HPCS) based on portal vein pressure (PVP) more than 20 mmHg at the time of laparotomy. A total of 11 consecutive adult living donor liver transplantations with small-for-size graft according to our graft selection algorithm were performed between December 2005 and August 2007. Ten patients required HPCS using a vein graft all survived without small-for-size syndrome (SFSS) and shunt complications with a median follow-up of 296 days. One patient without HPCS died of chronic vascular rejection. In all cases, PVP were regulated successfully under 20 mmHg by HPCS. Graft volume reached in mean 84.3% of standard liver volume in right lobe grafts and mean 95.4% in left lobe grafts at 3 months after liver transplantation. Actuarial rate of shunt patency at 1, 3, 6 months and 1 year were 80%, 55%, 26% and 20%, respectively. Selective HPCS based on PVP is an effective procedure and results in excellent patient and graft survival with avoidance of SFSS in grafts greater than 0.6% of GRWR.     

多层螺旋CT在活体肝移植供体术前评估中应用现状

影像学评估是活体肝移植供体术前综合评估的核心步骤.多层螺旋CT功能强大,基本可满足活体肝移植供体术前的"一站式"影像学检查.本文参考国内外文献,从外科医师的角度,综述多层螺旋CT在活体肝移植供体术前评估中的应用现状,为活体肝移植供体术前影像学检查方法的选择提供指导.     

Evaluation and treatment of marginal grafts with surgical diseases in kidney transplantation

Background  Marginal renal grafts may alleviate the shortage of suitable organs to meet an increasing demand of kidney transplantation, especially when live donors are currently limited to relatives of patients in China. The aim of this study was to investigate how to increase the available donors pool, evaluation, and treatment of marginal donors.

Methods  We had performed 121 kidney transplantation cases with living relative donors. Five out of these cases applied marginal grafts with surgical diseases, including one renal stone, one duplex kidney, one renal leiomyoma and two cases of simple renal cysts. In each case, particular surgical interventions were exerted on the graft prior to standard engrafting procedures.

Results  All recipients recovered with functioning transplants given that their serum creatinine levels declined to a normal range within one week after operation. These recipients were subsequently followed up for 10 months on average and their kidney functions remained stable.

Conclusions  Marginal renal grafts with surgical diseases, which can be treated surgically before engrafting, may provide satisfying transplantation outcomes. Positive and cautious consideration of these grafts may increase renal donor pool.