梗阻性黄疸患者血清sCD40L水平的变化及其临床意义

目的 观察梗阻性黄疸(OJ)患者血清可溶性CD40配体(sCD40L)水平的变化,并探讨其临床意义.方法 选择2015年4~12月在我院消化二科住院治疗的OJ患者35例作为观察组,另选同期在我院进行健康检查的志愿者35例作为对照组,检测对照组在入院时及观察组治疗前、治疗后3 d的血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、结合胆红素(DBIL)、血清sCD40L、肿瘤坏死因子-α(TNF-α)和白细胞介素-8(IL-8)的水平,分析OJ患者的sCD40L与其他指标的相关性.结果 观察组患者治疗前的血清ALT、AST、TBIL、DBIL、sCD40L、TNF-α和IL-8水平分别为(55.34±10.35)IU/L、(62.19±11.25)IU/L、(35.43±5.22)μmol/L、(8.94±2.58)μmol/L、(3.25±0.27)μg/L、(58.24±10.38)ng/L、(60.23±10.37)ng/L,均高于对照组的(32.17±5.32)IU/L、(36.27±6.78)IU/L、(10.19±4.58)μmol/L、(4.39±1.37)μmol/L、(2.84±0.32)μg/L、(34.52±9.26)ng/L、(43.69±11.26)ng/L,差异均有统计学意义(P<0.05),且观察组治疗后上述指标分别为(43.27±9.89)IU/L、(47.25±10.14)IU/L、(13.32±4.19)μmol/L、(6.18±2.97)μmol/L、(2.92±0.25)μg/L、(42.37±8.79)ng/L、(50.14±11.32)ng/L,均明显低于治疗前,差异均有统计学意义(P<0.05).OJ患者的血清sCD40L与血清TNF-α、IL-8、ALT、AST、TBIL及DBIL之间均呈正相关(均P<0.05).结论 OJ患者血清sCD40L水平明显上升,且其与炎症反应及肝功能指标联系紧密,临床可通过监测血清sCD40L变化了解患者病情,评估预后.     

心脏性猝死病人心肌组织CX43和CX40的表达

目的观察心脏性猝死病人左、右心室肌及室间隔肌缝隙连接蛋白43(CX43)及缝隙连接蛋白40(CX40)的表达,探讨CX43、CX40表达与心脏性猝死的关系。方法应用免疫组化及Simple PCI图像分析系统,分析比较心脏性猝死与非心脏性猝死病人心室肌及室间隔肌CX43、CX40的表达,并用SPSS 13.0统计软件对数据进行统计分析。结果非心脏性猝死病人CX43、CX40主要表达于心肌细胞闰盘处,少数表达于细胞侧面连接及胞浆中。心脏性猝死病人CX43、CX40多数弥散于胞浆及细胞侧面连接处,表达于闰盘的数量减少。心脏性猝死病人CX43在左心室、室间隔及右心室的表达明显低于对照组(t=2.09~8.01,P均<0.05);心脏性猝死病人CX40在左心室、室间隔及右心室的表达也明显低于对照组(t=3.24~9.40,P均<0.05)。结论CX43、CX40表达部位的改变与表达数量的减少,可能与心脏性猝死有一定关系。     

Umbilical cord stem cell transplantation for primary immunodeficiencies

Primary immunodeficiencies (PIDs) are a rare but important cause of mortality and morbidity in childhood: the most severe – known as severe combined immunodeficiency (SCID) – are fatal within the first year of life; other PIDs are less immediately life-threatening, but have a poor long-term outlook. Haematopoietic stem cell transplantation (HSCT) is the best treatment for SCID and is increasingly offered for other PIDs. The best results are achieved with an HLA-matched family donor. Umbilical cord stem cells (UCSCs) are an alternative stem cell source. Results using UCSCs in the treatment of haematological disorders and malignancy are as good as those for which marrow is the stem cell source. Although PIDs make up a small proportion of disorders amenable to treatment by HSCT, UCSCs are an ideal source of haematopoietic stem cells for many of these patients. Of the 52 patients with SCID or other PIDs for whom detailed information on outcome is available, results of engraftment, immune reconstitution, incidence of graft-versus-host disease and survival are comparable with other stem cell sources. Small stem cell dose and prolonged time to viral immunity limit the patients for whom UCSCs can be used. Newer methods of achieving better engraftment, ex vivo expansion of stem cells and generation of antigen-specific cytotoxic T cells are being developed at present, and will widen the application of UCSCs as a viable source for more patients.     

Dendritic cell maturation in active immunotherapy strategies

Dendritic cells (DCs) loaded with tumour antigen have become the centrepiece of clinical trials testing active immunotherapy strategies. Important variables include the source of DCs, the choice of antigens, the method of antigen loading and the route and timing of administration. Recently, the requirement for and the method of, DC maturation have been receiving particular attention. This is due to observations from in vitro studies and animal models demonstrating that mature DCs induce more potent antigen-specific T-cells responses than immature DCs. Furthermore, preliminary observations in human studies suggest that immature DCs might actually downregulate antigen-specific T-cell responses but mature DCs may augment them. Current studies are addressing how to define DC maturation, whether the variety of methods for maturation result in DCs with similar T-cell stimulatory capacity, how to maintain the maturational status and whether maturation in vitro before immunisation, or in vivo, after immunisation, results in better DC function.     

胸神经联合前锯肌平面阻滞对保留胸肌乳腺癌根治术后患者早期康复质量的影响

目的 探索胸神经联合前锯肌平面阻滞对保留胸肌乳腺癌根治术后患者早期恢复质量的影响。方法 选取2020年9月～2021年3月在邯郸市中心医院诊断乳腺癌并拟行保留胸肌式乳腺癌根治术的117例患者。根据是否术前行胸神经联合阻滞,分为全麻组和全麻复合神经阻滞组。于术毕24、48 h记录患者恶心呕吐发生率,上肢感觉异常,腋窝疼痛评分以及镇痛补救药物的用量。术毕48 h,行40项恢复质量评分量表（QoR 40）评分。比较术前血常规与术后一天血常规中性粒细胞和淋巴细胞的比值。结果 全麻复合神经阻滞组在24、48 h的恶心呕吐发生率及镇痛补救药物用量均显著低于全麻组（P＜0.05）,术毕24 h的上肢感觉异常,腋窝疼痛评分全麻复合神经阻滞组均显著低于全麻组（P＜0.05）,术后QoR-40评分全麻复合神经阻滞组显著高于全麻组（P＜0.05）。术后中性粒细胞和淋巴细胞的比值全麻复合神经阻滞组较全麻组明显降低（P＜0.05）。结论 全麻复合胸神经阻滞可提高保留胸肌式乳腺癌根治术后患者的舒适度和满意度,有助于提高早期康复的质量。     

清热祛瘀颗粒对稳定性冠心病患者颈动脉易损斑块的影响

目的 观察清热祛瘀颗粒对冠心病伴颈动脉易损斑块患者的治疗作用。方法 82例稳定性劳力型心绞痛伴颈动脉易损斑块患者中医辨证属痰热血瘀型者,随机分为清热祛瘀颗粒加西医常规治疗的试验组（41例）和采用西医常规治疗加安慰剂治疗的对照组（41例）,共观察25周。采用高频超声检测颈动脉复杂斑块的数目、简单斑块的数目、斑块的Crouse积分及颈动脉内中膜的厚度,观察清热祛瘀颗粒对颈动脉斑块及血浆高敏C反应蛋白(hs-CRP)、CD40L变化及肝肾功能。结果 试验组治疗后颈动脉复杂斑块的数目、斑块的Crouse积分、颈动脉内中膜的厚度较治疗前为低,差异均有统计学意义（P<0.05）;颈动脉斑块的Crouse积分、颈动脉内中膜的厚度也较对照组治疗后为低,差异亦有统计学意义（P<0.05）, 试验组治疗后hs-CRP及CD40L与治疗前及对照组治疗后比较,差异均有统计学意义（P<0.05,P<0.01）。治疗过程中未见明显不良反应。结论 清热祛瘀颗粒对冠心病伴颈动脉易损斑块患者的颈动脉斑块具有一定的稳定作用。     

Mutations in the transcription factor FOXO1 mimic positive selection signals to promote germinal center B cell expansion and lymphomagenesis

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Echocardiographic criteria for aortic root dissection.

Echocardiographic findings from 10 patients without clinical indications of aortic root dissection or aortic valve disease from 1 patient with angiographic confirmation of aortic root dissection are reported and compared. Previously reported echocardiographic findings were confirmed in the patient with aortic root dissection. These include (1) a widened posterior or anterior aortic wall, or both; (2) parallel motion of the separated margins of the aortic walls; and (3) aortic root dilatation (42 mm or more at end-systole). However, all three findings were also noted in 5 of the 10 patients without clinical indications of aortic root dissection or aortic valve disease, and at least two of the three findings were noted in the remaining 5 patients. Echocardiographic detection of aortic root dissection appears to be most reliable when clinical indications of the anomaly are present.     

The use of dextran-40 during percutaneous transluminal coronary angioplasty: A report of three cases of anaphylactoid reactions—one near fatal

Successful percutaneous transluminal coronary angioplasty is achieved by fracture of the atheromatous plaque and perhaps dilatation of the arterial walls to increase the luminal diameter of the artery. Because this ?controlled”? injury stimulates platelet adhesion on the subendothelial matrix, the use of dextran-40 in addition to heparin has been advocated. The overall incidence of Dextran-induced anaphylactoid reactions at our institution was 0.6% and of severe life-threatening reactions, 0.2%. With the recent doubts cast on the efficacy of dextran-40, the question arises regarding its routine use in PTCA.     

Simian virus (SV) 40 like sequences in cell lines and tumour biopsies from Australian malignant mesotheliomas

Background : Simian virus (SV) 40 sequences have been found in some, but not all studies of mesotheliomas. This virus is known to cause tumours in rodents but its role in human oncogenesis remains controversial.
Aims : The aim of this study therefore was to determine whether SV40 is associated with the development of mesotheliomas in Australia. The absence of the virus or its gene products in tissue derived from mesotheliomas would detract from this possibility.
Methods : We used polymerase chain reaction from three pairs of primers to amplify different regions of the large T antigen from DNA from cell lines and cDNA from both cell lines and an independent set of tumour biopsies from patients with mesothelioma.
Results : We examined five human mesothelioma cell lines that were established in our laboratories. In addition, we examined several tumour biopsies from seven different patients. SV40 like sequences were present in all the cell lines and in at least one sample from each of the patients examined.
Conclusions : The large T antigen of SV40 or an SV40 like virus is expressed in Australian mesotheliomas and therefore could be aetiologically-associated with tumourigenesis. Alternatively, these sequences could be expressed subsequent to the development of the disease.