Daily variation in circulating cytokines and acute-phase proteins correlates with clinical and laboratory indices in community-acquired pneumonia

Our objective was to investigate the initial levels of circulating proinflammatory cytokines, such as interleukin 1β (IL-1β), interleukin 6 (IL-6), and tumour necrosis factor alpha (TNF-α), of certain acute-phase proteins, such as C-reactive protein (CRP), fibrinogen (FBN) and albumin, and of the glycoprotein fibronectin at presentation and their daily variation during the clinical course of community-acquired pneumonia (CAP) in relation to clinical and laboratory indices of infection. Thirty otherwise healthy hospitalized patients aged 48 ± 3 years (mean ± SEM) and with bacteriologically confirmed CAP were studied prospectively. IL-1β and IL-6 were found to be 15-fold higher on admission (122 ± 9 pg mL^?1 and 60 ± 4 pg mL^?1 respectively), whereas TNF-α was three-fold higher (102 ± 5 pg mL^?1) than those of controls, all of them showing a decline towards normal. Initial CRP levels were increased 90-fold (416 ± 1 mg L^?1), whereas fibronectin levels were reduced (242 ± 9 mg dL^?1). The presence of parapneumonic effusion was associated with a higher TNF-α serum level (127 ± 7 vs. 86 ± 4 pg mL^?1, P = 0.0002), a more rapid daily decline in TNF-α (–7.2 ± 0.7 vs. ?3.8 ± 0.5 pg mL^?1 day^?1, P = 0.0005), a slower rate of decline in CRP (?42.8 ± 3.0 vs. ?54.6 ± 3.0 mg L^?1 day^?1, P = 0.02) and a slower rate of increase in FBN (5.9 ± 1.0 vs. 11.7 ± 1.0 mg dL^?1 day^?1), P = 0.001]. Furthermore, daily progression of serum levels of cytokines and acute-phase proteins correlated strongly with pyrexia, erythrocyte sedimentation rate (ESR), neutrophil count, alveolar–arterial oxygen difference and radiographic resolution, clinically manifested by improvement in the patients' condition.     

人HLA半相合混合脐血在SCID小鼠移植的实验研究

目的：探讨不同供者来源脐血混合移植的可行性和植入特性。方法：分别将两份人HLA半相合混合脐血或单份脐血输入经亚致量照射后的严重联合免疫缺陷（SCID）小鼠，观察两组脐血在SCID小鼠体内的植入状况及多系造血重建特性。结果：混合脐血和单份脐血移植均可在受鼠体内植入，形成供－受混合嵌合体，并能重建多系造血，存活率和植入率无统计学意义（P＞0．05）。用多聚酶链反应－序列特异性寡核苷酸（PCR－SSO）探针检测人HLA－DQB1基因发现，HLA半相合混合脐血移植可有1份或2份脐血植入，其中造血祖细胞含量和体外克隆形成能力高者，更易于植入，造血重建特性与单一脐血移植比较无统计学意义。结论：HLA半相合人混合脐血可同时在SCID小鼠体内植入，形成来自供－受三者的多嵌合状态，并能重建造血及免疫功能。     

Klippel-Feil anomaly combined with fetal alcohol syndrome

Summary Alcohol is the most frequent and most important teratogenic noxa for the embryo and fetus. It may lead to deformation of all cells and organs. A case of Klippel-Feil anomaly associated with fetal alcohol syndrome is described. The diagnosis of Klippel-Feil anomaly, even a late diagnosis made on the basis of rare deformities, is very important as the affected patients are at a high risk of alcoholism. The combination of Klippel-Feil anomaly with numerous other syndromes and deformities suggests a basic general disorder of skeletal maturation. Diverse cases of Klippel-Feil anomaly possibly originate., in reality, in an unrecognzied fetal alcohol syndrome.     

脐血来源的间充质干细胞生物学特性与向成骨细胞分化能力的研究

目的研究人脐血来源的间充质干细胞（UCBMSC）的免疫表型、生物学特性及其向成骨细胞分化的能力。方法分离脐血单个核细胞，以干细胞培养液培养间充质干细胞（MSC），观察其体外生长特性；用流式细胞术进行免疫表型测定和细胞周期分析；以含地塞米松、β-磷酸甘油和维生素C的诱导液定向诱导向成骨细胞分化；以碱性磷酸酶染色、矿化结节染色、骨桥蛋白mRNA的表达以及I型胶原表达鉴定MSC向成骨细胞分化的潜能。结果从脐血中可以培养出MSC，为成纤维细胞样的贴壁细胞。免疫表型分析显示CD45、CD34、CD11a、CD14、HLA．DR阳性细胞占1％～3％；CD166、CD44、CD106、CD29、CD105、CD49e、CD90、CD73表达率达91％～98％。细胞周期分析显示95％以上的细胞处于G0／G1期。定向成骨细胞诱导后，可以检测到碱性磷酸酶、I型胶原的表达，矿化结节的形成和骨桥蛋白mRNA的表达。结论UCBMSC是基质细胞的祖细胞，在合适的条件下可被诱导向成骨细胞分化，因此有可能作为有潜力的骨组织工程的种子细胞来源。     

The Fetal Patient: Coordinated Care for Families

Complete and accurate knowledge is critical to parent decision making for families with complex and/or life-threatening fetal conditions. Comprehensive fetal centers are available to provide multidisciplinary specialized assessment, evaluation, diagnosis, and nondirectional counseling. Interventional option may include fetoscopic procedures, open fetal surgery, and ex utero intrapartum treatment. The nurse coordinator serves as the family and health care provider liaison for arrangement of services and communication of the plan of care.     

链置换式扩增检测羊水中巨细胞病毒DNA

目的：介绍一种简便快速准确检测羊水中ＣＭＶ－ＤＮＡ的改良ＰＣＲ－链置换式扩增用于诊断胎儿先天感染ＣＭＶ。方法，将组成套式ＰＣＲ的外内两对引物按照一定比例（外：内＝１：５０－１００）加在同一试管中一次扩增羊水和胎儿组织中ＣＭＶ－ＤＮＡ。结果：９０例异常孕产史的孕妇羊水检测ＣＭＶ－ＤＮＡ，阳性率为３８．９％（３５／９０），其中合并染色数目异常２例（４７，ＸＹＹ和４７，ＸＸ，＋２１）（已引产）核型及染色     

胎儿宫内窘迫对新生儿神经行为的影响

目的：测定宫内窘迫的新生儿神经行为，以探讨宫内窘迫与新生儿神经行为表现、预后的关系。方法：用ＮＢＮＡ神经行为２０项指标进行测定。结果：宫内窘迫新生儿６０例与正常新生儿６０例比较，测定总分之间差异有显著性（Ｐ＜０．０１）。窘迫组中４１例无窒息者与正常对照差异有显著性（Ｐ＜０．０１），窘迫组中１９例有窒息者与正常对照组差异更为显著，急性窘迫３８例与慢性窘迫２２例之间也有显著差异（Ｐ＜０．００１）。结论：胎儿宫内窘迫影响新生儿的神经行为能力。     

1519例胎儿心电图的临床价值和相关因素分析

目的对1519例胎儿全部实行常规胎儿心电图(FECG)监测工作,探讨胎儿心电图应用情况,并对异常FECG结合临床,进行临床原因分析.方法采用随机湘样方法,应用杭州产FECG-D型胎儿心电图分析仪进行监测.结果发现采用横导联方式进行监测检出率为53.5%:在孕22w进行监测检出率为45.8%;异常FECG检出率为7.64%.结论对1519例FECG的监测发现采用横导联方式并在孕22w～26w期间进行监测检出率最高、波形效果好.并对监测发现的导致FECG异常改变的临床原因与胎儿宫内窘迫的关系进行浅要分析.     

Ontogeny of intrinsic innervation in the human kidney

We aimed to define, for the first time, the ontogeny of intrarenal innervation and to assess the distribution and nature of parenchymal nerves in the human fetal kidney. Our material consisted of routinely-processed renal tissue sections from 17 human fetuses, six of 20–24 gestational weeks (gw) and 11 of 25–40 gw, and three adults. We used immunohistochemistry with antibodies to the pan-neural markers neuron-specific enolase (NSE), neurofilaments (NF), PGP9.5, S100, and the adrenergic marker tyrosine hydroxylase (TH). NSE-, NF-, S100-, and PGP9.5-positive nerves, associated with arterial and venous vasculature, were identified in the renal cortex from 20 gw onwards, and their density appeared to increase with gestation, reaching adult levels at 28 gw. Most of the intrarenal nerves were TH-positive. Nerve fibers extended from the corticomedullary region to the outer cortex, reaching the renal capsule in the 3rd trimester. In detail, NSE-, NF-, S100-, PGP9.5-, and TH-immunoreactive fibers were observed in close apposition to the renal artery and its branches, occasionally reaching the afferent and efferent arteriole (3rd trimester). Nerve fibers were detected in close apposition to the juxtaglomerular apparatus in the 2nd and 3rd trimesters. In the renal medulla, NSE-, PGP9.5-, S100-, and TH-positive nerve fibers were detected close to tubular cells as early as 20 gw. However, their density gradually decreased during the 3rd trimester, and they were not observed in the medulla of the adult kidney. In conclusion, the human fetal kidney appears richly innervated during the 2nd and 3rd trimesters. There is a progressive increase in the density of parenchymal nerve fibers towards term from the corticomedullary region to the cortex. Most intrarenal nerves are adrenergic and have a predominant perivascular distribution, implying that renal innervation plays an important functional role during intrauterine life.