复方补益中药抗白血病的实验研究

应用益气养阴方和补气养血方治疗淋巴白血病小鼠 L_(7212),发现两方均可显著提高其生存期(P<0.01及 P<0.05),但生命延长率较低(11.21%及7.5%)。从不同角度探讨中药作用机理,发现一方面可通过增强机体的免疫功能,提高机体的抗病能力,降低恶性变的淋巴细胞膜流动性,调整膜结构及功能,促其恢复正常状态以及有抑制或杀伤白血病细胞的作用。另对骨髓有一定抑制作用。临床上若有选择地与化疗药物同用,可产生协同作用。     

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.     

活体肝移植的临床研究

目的 总结活体肝移植的临床应用.方法 回顾性临床分析75例活体肝移植的临床经验,对活体肝移植的外科技术改进、建立供体安全保障体系和受体预后等问题进行探讨.结果 适应证为良性终末期肝病72例,恶性肿瘤3例.75例供体术后顺利康复,均未出现严重并发症;65例(65/75)受体健在,手术死亡5例(5/75),5例死于远期并发症(5/75).供体右半肝(不包括肝中静脉)21例,扩大右半肝(包括肝中静脉)2例,扩大左半肝(包括肝中静脉)48例,左半肝或左外叶(不包括肝中静脉)4例.术后主要并发症以血管并发症、胆道并发症、细菌及病毒感染和肺部并发症为主.结论 活体肝移植具有供肝来源广泛的优点,适合我国国情,有广阔的临床应用前景.改进活体肝移植技术,建立供体安全保障体系是改善受体预后的关键.     

XMRV在我国部分人群中的初步调查

目的检测XMRV是否存在于我国健康献血者和肿瘤患者体内。方法采用巢式反转录-聚合酶链反应方法,检测243例健康献血者和36例肿瘤患者的血液样本中的XMRV RNA,分析XMRV的感染情况。结果在所检测的279例血液样本中,XMRV RNA均呈阴性,各标本对应的内参引物三磷酸甘油醛脱氢酶基因(hGAPDH)均呈阳性。结论在所检测的样本中,没有发现XMRV的感染,需要进一步扩大样本量,探讨XMRV在中国的感染状况。     

Hypochromic reticulocytes,hypochromic erythrocytes and p-transferrin receptors in diagnosing iron-deficient erythropoiesis

Background: The purpose of this study was to test the hypothesis that hypochromic reticulocytes, hypochromic erythrocytes and p-transferrin receptors are sensitive variables in detecting iron-deficient erythropoiesis in healthy subjects and hemodialysis patients. Methods: Study 1: Twenty-one blood donors donated 450?mL blood. During the following 2 weeks blood samples were analyzed for the variables mentioned above. Study 2: Twenty-eight blood donors received 10 000 U recombinant human erythropoietin (rHuEPO) twice in the first week or placebo, after they had donated 450?mL blood. During the following 3 weeks the blood samples were analyzed for the variables mentioned in Study 1. Study 3: Eighteen hemodialysis patients receiving rHuEPO and iron treatment had either iron treatment discontinued for 4 weeks, after which iron was resumed, or received unchanged treatment. During 8 weeks blood samples were analyzed for the variables mentioned in Study 1. Results: Study 1: Blood donation induced an increase in hypochromic reticulocytes of 178%, in hypochromic erythrocytes the increase was 267%, and in p-transferrin receptors 32%. Study 2: Treatment with rHuEPO induced a more pronounced increase than placebo in hypochromic reticulocytes (232% vs. 158%) and hypochromic erythrocytes (1240% vs. 300%), but not in p-transferrin receptors. Study 3: Discontinuation of iron treatment did not cause any significant differences in the variables mentioned above between the two groups, but caused a 25% decrease in p-ferritin. When iron treatment was resumed, p-ferritin increased by 19%. We found no significant changes in the control group. Conclusions: Hypochromic reticulocytes, hypochromic erythrocytes and p-transferrin receptors are sensitive variables in the early detection of iron-deficient erythropoiesis in healthy subjects, but in this study the iron withdrawal period was too short to show the value of these variables in the detection of iron-deficient erythropoiesis in hemodialysis patients.     

Reduction of disability after stroke is a more informative predictor of long-time survival than initial disability status

Purpose. Few studies have evaluated the roles of reducing disability after stroke in predicting survival. This study aimed to investigate the effects of improvement in the Barthel Index (BI) and other prognostic factors on survival in patients with first-time noncardioembolic ischemic stroke.

Method. BI effectiveness was defined as the improvement of BI between initial stroke (within 3 days) and 2 months after stroke. Cox regression analysis and Kaplan-Meier methods were used to evaluate the predictive roles of various prognostic factors.

Results. A total of 111 patients were enrolled. Mean age at the time of stroke was 68 (±11.2) years. Median follow-up time was 77.4 months. Mean initial BI was 36.1 (±28.5) and mean BI effectiveness was 46.9 ± 29.0. Overall, 55 deaths (49.5%) of the cohort were ascertained. The BI effectiveness had significant effects on long-time survival while initial BI was not a significant predictor. Higher BI effectiveness led to lower risk of mortality (hazard ratio = 0.44, 95% CI 0.24 – 0.80, p = 0.007). Elder age was correlated with poor survival (overall p = 0.006). Subjects in the eldest age group (≧70 years) showed a significant elevated risk for death (hazard ratio = 3.42, 95% CI 1.18 – 9.92). There was a trend indicating that the smaller the lesion size, the more favourable the prognosis (overall p = 0.057).

Conclusions. BI effectiveness in the first 2 months after first-time noncardioembolic stroke was more informative than initial disability status for predicting long-time mortality. It highlights the potential benefit in maximizing functional performance in patients with stroke.     

Multidetector CT in pre- and post-operative evaluation of living-related liver transplantation

Objective

To assess the role of multi-detector CT (MDCT) in the pre and post operative evaluation of both potential donors and recipients for living related liver transplantation (LRLT).

Material and Methods

This prospective study included 26 patients for LRLT and their corresponding donors. For preoperative assessment, all subjects were evaluated by triphasic CT abdomen. CT angiography (CTA) with 3D reconstruction and CT volumetry was additionally done for donors. CT findings were compared to surgical results as gold standard reference. In post-operative evaluation, CT abdomen was performed at least once after transplantation for all recipients and for indicated donors. CTA was done for indicated recipients when US findings were inconclusive.

Results

No statistically significant difference was found between CT volumetry and intraoperative findings. Compared to surgical findings, MDCT identified hepatic arterial and portal venous anatomy with 100% sensitivity and specificity, while for hepatic venous anatomy; it showed sensitivity and specificity of 85.7% and 84.2%. Biliary complications and fluid collections were the commonest in recipients and donors respectively.

Conclusion

MDCT is a single comprehensive non-invasive and accurate imaging modality for preoperative evaluation of liver parenchyma, hepatic vascular anatomy and graft volume and postoperative complications in donors and recipients of LRLT.     

术前门静脉血栓对活体肝移植预后的影响

目的 探讨术前门静脉血栓对活体肝移植的影响.方法 回顾性分析天津市第一中心医院2007至2011年完成的99例成人间活体肝移植患者,根据术前是否有门静脉血栓分为2组,血栓组26例,无血栓组73例.比较2组的术前危险因素及门静脉血栓对活体肝移植手术和术后患者预后的影响.结果 26例门静脉血栓患者Ⅰ级血栓23例,Ⅱ级血栓3例.肝移植术前的脾切除是发生门静脉血栓的独立危险因素(x2 =10.211,P=0.001).术前门静脉血栓会延长手术的无肝期(Z=-2.430,P=0.015),但2组患者术后并发症发生率(x2=0.326,P=0.568)及死亡率均无统计学差异,而且对患者的1年生存率和3年生存率均无影响(x2=0.505,P =0.477).结论 对于活体肝移植合并Ⅰ级或Ⅱ级门静脉血栓的患者,通过合理的术中处理及术后预防,门静脉血栓不会影响患者的预后.但门静脉血栓增加了一定的手术难度,需要详尽的术前评估和仔细的术中操作.