一氧化氮供体改善血小板保存质量的初步研究

目的探讨一氧化氮(NO)供体S-亚硝基乙酰青霉胺(SNAP)对常温保存血小板过程中血小板质量的影响。方法离心法制备浓缩血小板共12人份,38~40 ml/份。将相同血型的2袋混合,加入复温后的冰冻血浆至约100 ml,混匀后均分、转移至2个血小板专用保存袋,分别为实验组:保存前加入终浓度10~5mol/L SNAP;对照组:加入等体积的无菌生理盐水。(22±2)℃振荡保存7 d,分别在d1、d3、d5、d7取样检测血小板计数、pH、血小板活化率及抗低渗性休克反应等指标。结果 2组血小板在保存过程中pH均保持在6.8以上;血小板活化率均不断升高,实验组从(5.93±1.43)%升高到(44.22±6.84)%,对照组从(8.22±1.33)%升高到(54.32±5.68)%,d1、d3、d5、d7 2组血小板之间活化率差异有统计学意义(P<0.05);d1、d5、d7实验组血小板抗低渗休克反应分别为(65.98±7.57%)、(53.1±8.44)%、(44.23±0.08)%,对照组为(50.92±4.48)%、(40.06±4.66)%、(35.28±0.04)%,d1、d5、d7实验组抗低渗休克反应能力高于对照组,差异具有统计学意义(P<0.05)。结论在血小板保存过程中加入NO供体SNAP一定程度上可以抑制血小板活化,改善血小板功能。     

中国部分地区无偿献血者梅毒感染情况比较分析

目的了解中国部分地区无偿献血者梅毒感染情况,以便采取相应有效的措施,阻断经血液传播梅毒。方法从文献数据库中收集哈尔滨、银川、宝鸡、枣庄、广州、南昌、益阳等城市及海南省2006~2008年无偿献血者梅毒感染情况的报道文献,汇同成都市血液中心同时段成都市无偿献血者梅毒感人情况的调查结果,采用统计软件spss17.0进行卡方检验,比较分析这些地方的献血者梅毒感染状况。结果 2006~2008年,9地每年无偿献血者梅毒抗体阳性检出率分别为0.21%~1.11%、0.20%~0.98%和0.06%~1.07%(P<0.05),9地每年合计梅毒抗体阳性检出率分别为0.59%(3 502/592 445)、0.56%(3 697/654 361)和0.57%(4 077/714 584);省会城市与其他地区,献血者每年的梅毒抗体阳性率分别为0.59%(2 890/488 593)vs0.59%(613/103 852),0.55%(2 966/535449)vs0.61%(731/118 912)(P<0.05),0.56%(3 246/580 973)vs0.62%(831/133 611)(P<0.05),3年合计献血者梅毒抗体阳性率二者分别为0.57%(9 102/1 605 015)vs0.61%(2 174/356 375)(P<0.05);3年间每年北方地区与南方地区献血者的梅毒抗体阳性率分别为0.78%(1 006/128 900)vs0.54%(2 496/463 545)(P<0.05),0.76%(1 158/152 144)vs0.51%(2 539/502 217)(P<0.01),0.81%(1 363/167 854)vs0.50%(2 714/546 730)(P<0.01)。结论本组资料显示中国各地区献血者梅毒感染阳性率不同,省会城市低于其他地区,北方地区高于南方地区。3年间各地献血者总的梅毒抗体阳性检出率略有降低,说明无偿献血中的梅毒疫情得到了一定控制,但梅毒抗体仍然是血液报废的原因之一。     

肝肾综合征诊疗进展

肝肾综合征(HRS)是慢性肝病进展性衰竭、晚期肝硬化门脉高压患者常见的并发症之一.其发病机制尚不明确.临床表现为功能性肾衰竭,并根据肾衰竭进展速度分为HRS I型和HRSⅡ型,国际腹水协会于2007年重新修订HRS诊断标准.治疗上,改善肾功能、延长生存期仍是目前治疗的重点.最有效的方法 是活体肝移植(OLT),但因费用昂贵及肝源有限,且HRS的生存时间短,因此需延缓患者生存时间为OLT治疗争取机会,而血管收缩药物联合静脉输注蛋、经颈静脉肝内门体分流术(TIPS)、分子吸附再循环系统(MARS)可作为HRS过渡至OLT治疗的桥梁治疗.     

Perioperative synbiotic treatment to prevent infectious complications in patients after elective living donor liver transplantation: a prospective randomized study

Background

Although the effect of synbiotic therapy using prebiotics and probiotics has been reported in hepatobiliary surgery, there are no reports of the effect on elective living-donor liver transplantation (LDLT).

Methods

Fifty adult patients undergoing LDLT between September 2005 and June 2009 were randomized into a group receiving 2 days of preoperative and 2 weeks of postoperative synbiotic therapy (Bifidobacterium breve, Lactobacillus casei, and galactooligosaccharides [the BLO group]) and a group without synbiotic therapy (the control group). Postoperative infectious complications were recorded as well as fecal microflora before and after LDLT in each group.

Results

Only 1 systemic infection occurred in the BLO group (4%), whereas the control group showed 6 infectious complications (24%), with 3 cases of sepsis and 3 urinary tract infections with Enterococcus spp (P = .033 vs BLO group). No other type of complication showed any difference between the groups.

Conclusions

Infectious complications after elective LDLT significantly decreased with the perioperative administration of synbiotic therapy.     

Combination of donor splenocyte transfusion with blockade of γc signal synergizes to inhibit alloreactive T-cell proliferation and induces apoptosis

Background  The common γ chain (γc) plays a critical role in regulating proliferation, differentiation, and apoptosis of peripheral T-cells. It was previously confirmed that blocking the γc signal can successfully induce transplant tolerance in a murine model. Here we investigated the potential mechanism.

Methods  Splenocytes from C57BL/6 mice were transfused into T-cell deficient Balb/c nude mice that were reconstituted with syngeneic wild-type T-cells labeled with 5-carboxyfluorescein diacetate succinimidyl ester (CFSE). After 24 hours, recipients received i.p. injection of mixture of anti-γc mAbs, or with isotype control IgG2a. The labeled T-cells were harvested from recipient spleens after 12 and 48 hours. T-cell proliferation and apoptosis were detected by flow cytometry.

Results  T-cell proliferation was markedly inhibited and apoptotic T cells could be detected at 12 hours after the mAbs injection. Proliferation was inhibited at 48 hours, but the proportion of apoptotic T-cells was not more than at 12 hours. In the control group, however, T-cells actively proliferated and no significant apoptosis was detected at either time point.

Conclusions  The results suggested that blockade of γc signals can synergize with donor splenocyte transfusion and lead to inhibition of antigen-specific T-cell proliferation and induction of apoptotic T-cell death. This protocol may develop a novel approach to induce donor-specific tolerance.

     

广西巴马小型猪用于心脏移植的研究

目的：探讨广西巴马小型猪游离心脏保存与心脏移植的意义和价值。方法：广西巴马小型猪24头（25~30 kg）,按随机方法分为供体组（n=12）和受体组（n=12）。两组麻醉后行胸部前正中切口。供体组先行前腔静脉放血,阻断升主动脉灌注心脏停跳液（4℃改良Thomas液）,切取的心脏置入4℃生理盐水,用UW液冲洗至清亮,低温保存8 h。受体组常规建立体外循环,全身降温至30℃。心肺机的灌注量为70 mL/kg。阻断升主动脉。切除受体组的心脏,保留左心房后部。供体心脏按原位放入受体心包内,连续外翻缝合左心房全部—右心房大部分,肺动脉半周和主动脉的全部;开放主动脉阻断钳、心脏复跳后继续完成肺动脉、右心房其余部分的吻合。心肺复苏,并行循环2 h。进行血流动力学测定。结果：实验中未见呼吸抑制而死亡。12头巴马小型猪供体心脏植入受体后,心脏均可复跳,未发生漏血现象并可以脱离体外循环。结论：广西巴马小型猪用于心脏移植的研究是较理想的动物之一。