富于脂质的乳腺癌17例临床病理分析

目的 对富于脂质的17例乳腺癌患者的临床病理特征进行回顾性分析.方法 采用雌激素受体（ER）、雄激素受体（PR）、原癌基因人类表皮生长因子受体2（HER-2）、细胞角蛋白5/6（CK5/6）、细胞角蛋白14（CK14）和p63免疫组化套餐检测抗体在富于脂质的乳腺癌中的表达水平,同时采用荧光原位杂交法检测HER-2基因扩增水平;并用电镜观测富于脂质的乳腺癌的超微结构;生存分析采用Kaplan-Meier和Cox 回归法,同时对其临床病理参数进行ROC检验.结果 免疫组化ER、CK5/6、CK14和P63反应呈阴性;PR和HER-2反应呈阳性;超微结构显示：在乳腺癌胞质内存在大量的脂滴.生存分析结果显示：年龄、组织学分级、淋巴结转移和HER-2表达水平与富于脂质的乳腺癌患者预后具有显著统计学意义（均P＜0.05或0.01）.结论 富于脂质的乳腺癌患者为HER-2呈过表达亚型;富于脂质的乳腺癌患者的生存情况可能与年龄、组织学分级、淋巴结转移和HER-2表达水平有关;提示：HER-2表达可作为预测富于脂质的乳腺癌的预后标记物.     

Pregnancy outcome in recurrent aborters is not influenced by Chlamydia IgA and/or G

PROBLEM: It is unclear whether chlamydia infection influences the miscarriage rate and immunological factors in patients with recurrent miscarriage. METHOD OF STUDY: Chlamydia DNA, IgA and IgG to Chlamydia trachomatis, natural killer cell activity, complement 3 (C3), C4, hemolytic complement, antinuclear antibodies, antiphospholipid antibodies, prolactin, activated partial thromboplastin time, prothrombin time and fibrinogen were examined in 504 patients with a history of two or more consecutive first-trimester miscarriages. Subsequent pregnancy outcomes were compared between cases with and without antibodies to C. trachomatis. RESULTS: Totals of 10 of 30 and 48 of 201 patients receiving no medication miscarried subsequently with and without chlamydia infection. Chlamydia IgA and/or IgG were associated with a high level of C3 but not other immunological and coagulatory parameters. CONCLUSION: Antibodies to C. trachomatis do not influence subsequent pregnancy outcome in patients with a history of recurrent miscarriage.     

免疫球蛋白对脓毒症治疗效果的研究进展

本文介绍脓毒症与免疫机制的相关研究,主要从严重脓毒症和脓毒性休克的病生理机制及其自身免疫状态角度探讨补充免疫球蛋白可能的效应机制,分析通过免疫机制的干预影响难治性脓毒症预后的可能性及其机制,为预防及治疗重症脓毒症提供新的方法.     

The immune response induced by hepatitis B virus principal antigens

Hepatitis B virus （HBV） infection occurs primarily in hepatocytes in the liver with release of infectious virions and non-infectious empty surface antigen particles into the bloodstream. HBV replication is non-cytopathic. Transient infections run a course of several months, and chronic infections are often life-long. Chronic infections can lead to liver failure with cirrhosis and hepatocellniar carcinoma. It is generally accepted that neutralizing anti-HBs antibodies plays a key role in recovery from HBV infection by containing the spread of infection in the infected host and facilitating the removal and destruction of viral particles. However, the immune response initiated by the T-cell response to viral antigens is also important for viral clearance and disease pathogenesis in HBV infection. The three structural forms of the viral proteins, the HBsAg, the particulate HBcAg, and the nonparticulate HBeAg, may preferentially elicit different Th cell subsets. The different IgG subclass profiles of anti-HBs, anti-HBc, and anti-HBe in different HBV infection status were revealed. Moreover, the different IgG subclass profiles in chronic carriers did not change with different ALT and AST levels and may reflect the difference between stimulating antigens, immune response, and the stages of viral disease and provide the basis for the use of vaccines and prophylactic treatments for individuals at high risk of human HBV infection. This review elucidates the detailed understanding of the immune responses induced during transient and persistent infection, and the development of immunotherapy and immunodiagnosis in patients with HBV infection, and possible means of reducing the liver damage.     

全膝关节置换治疗严重膝关节疾病

背景：膝关节畸形施行人工全膝关节置换难度大,涉及面多,包括手术入路、术中截骨、软组织松解顺序、方法及程度、软组织平衡等,专家学者各不相同,意见不统一,争议较多。 目的：探讨全膝关节置换治疗成人严重膝关节疾病的手术方法和临床疗效。 方法：纳入42例(48膝)严重膝关节疾病合并畸形患者,均采用后稳定型假体进行全膝关节置换,由髌骨内侧入路,正确截骨,选择性的软组织松解,恢复膝关节正常的力线和软组织平衡,获得膝关节稳定,置换后采取针对性的康复训练,定期随访检查膝关节活动度、最大屈曲度并进行HSS评分、WOMAC 评分。 结果与结论：所有患者均获得随访,随访时间为25-84个月,平均35.5个月。所有患者置换治疗后膝关节活动度、膝关节最大屈曲度、HSS评分、WOMAC评分较置换前比较,均显著提高,差异有显著性意义(P < 0.01)。置换后切口均Ⅰ期愈合,无膝关节僵硬、血管及神经损伤、髌骨骨折、髌骨低位、假体松动等并发症发生,下肢力线均恢复正常。说明成人严重膝关节畸形经全膝关节置换,置换后畸形均得到纠正,功能较前明显改善,临床效果满意。     

特殊使用级抗菌药物点评系统的开发与应用

目的:开发特殊使用级抗菌药物点评系统,提高特殊使用级抗菌药物的临床使用水平,降低细菌耐药率。方法:利用易语言和数据库技术,建立特殊使用级抗菌药物合理性评分表,特殊使用级抗菌药物点评系统。对2010年1-6月和2013年1-6月特殊使用级抗菌药物使用病历的越级使用情况、病原微生物送检情况、抗菌药物使用合理性(药物选择、用法用量、联合用药)、会诊单例数、平均使用金额和特殊使用级抗菌药物使用强度进行回顾性统计并分析。结果:系统实现了特殊使用级抗菌药物处方点评功能,系统应用后抗菌药物越级使用率从14.9%下降至2.3%(P=0.000);病原微生物送检率从47.3%提高至93.9%(P=0.000);抗菌药物选择合理率从88.1%上升至96.9%(P=0.000);会诊单申请率从40.2%提高至97.3%(P=0.000)。特殊使用级抗菌药物使用强度从164.3下降至84.2(P=0.042);平均使用金额从1 210.4元下降至964.1元(P=0.032)。结论:特殊使用级抗菌药物点评系统提高了特殊使用级抗菌药物管理水平,有效地降低了特殊使用级抗菌药物费用支出。     

免疫吸附技术的临床应用体会

目的　为了评价蛋白A免疫吸附和低密度脂蛋白免疫吸附对免疫球蛋白(主要为IgG)和低密度脂蛋白(LDL)的吸附作用及临床效果。方法　使用瑞典Excorim公司的Citem10吸附-洗脱环路系统,对7例自身免疫性疾病和3例高脂血症患者进行了16例次免疫吸附治疗,并将治疗前后血浆免疫球蛋白或血脂进行对比分析。结果　吸附治疗后血浆IgG、IgA、IgM均明显低于吸附前的水平(P<0.001),LDL、Lp(a)、甘油三脂、胆固醇分别下降了70.9%、53.3%、19.7%、53.0%,而高密度脂蛋白(HDL)较吸附前增高51.3%。结论　蛋白A免疫吸附和低密度脂蛋白免疫吸附可以选择性地、有效地清除血浆IgG及LDL,缓解临床症状,且未见明显副作用。     

IgG4-related Disease with a Cardiac Mass Causing Cerebral Infarction

Immunoglobulin G4-related disease (IgG4-RD) is a systemic inflammatory disease characterized by infiltration of extensive IgG4-positive plasma cells and lymphocytes. Although IgG4-RD has been observed in almost all organs, it rarely affects the myocardium. Cardiovascular lesions of IgG4-RD appear as aortic (aortic aneurysm and aortitis) and pericardial (constrictive pericarditis) lesions as well as pseudotumors around the coronary arteries. We herein report a case of IgG4-RD with a cardiac mass in the right atrium involving a sinus node. This condition caused arrhythmia and repeated strokes. We successfully treated the patient through resection of the cardiac mass, catheter ablation and immunosuppressive therapy.     

Aspergillus fumigatus specific IgE and IgG antibodies for diagnosis of Aspergillus-related lung diseases

IgE and IgG antibodies against Aspergillus fumigatus were detected by crossed radio immunoelectrophoresis (CRIE) on the sera of seven patients with aspergilloma, six patients with allergic broncho-pulmonary aspergillosis (ABPA) and 25 patients with extrinsic asthma with Aspergillus allergy. IgE-CRIE analysis indicated the presence of A. fumigatus-specific IgE in sera of patients with ABPA and Aspergillus asthma but not of aspergilloma patients. IgG-CRIE showed that both aspergilloma and ABPA patient sera contained high levels of circulating specific IgG antibodies in contrast to sera of Aspergillus asthma patients, which did not show detectable amounts of Aspergillus-specific IgG antibodies. Specific IgE binding could be demonstrated for the major allergens Ag-10 and AG-40 in all ABPA patients, in 80% of Aspergillus asthma patients but not in sera from aspergilloma patients. Specific IgG antibodies directed towards the major allergens could be detected in most of the aspergilloma patients, between 30-70% of the ABPA patients but not in sera from patients with Aspergillus asthma.     

Kupffer cell depletion in vivo results in preferential elimination of IgG aggregates and immune complexes via specific Fc receptors on rat liver endothelial cells.

In the present study we have investigated the clearance kinetics and tissue distribution of monomeric (m) IgG and soluble aggregates of IgG (AIgG) and immune complexes (IC) in normal and Kupffer cell (KC) depleted rats. In normal rats, clearance of mIgG occurred in a biphasic manner with a first half-life (T1/2) (T1) of 36.3 +/- 6.3 min and a second T1/2 (T2) of 168.4 +/- 4.7 min. AIgG composed of 20-27 IgG molecules per aggregate were cleared significantly faster than mIgG with a T1 of 2.5 +/- 0.1 min and a T2 of 32.5 +/- 5.6 min. KC depletion did not have a significant effect on the clearance rate of mIgG (T1: 33.4 +/- 8.9 min; T2; 159.5 +/- 12.5 min), while clearance of AIgG was delayed significantly with T1 4.8 +/- 0.7 min and T2 41.2 +/- 3.2 min. Eight minutes after injection, 77% of AIgG was found in the liver in normal rats while 62% was found in the liver of KC-depleted rats. Double immunofluorescence studies indicated that AIgG in the liver was associated with KC and endothelial cells (EC) in normal rats. In KC-depleted rats, AIgG was strongly associated with EC. A similar staining pattern was observed when IgG-immune IC were administered. The clearance of AIgG in KC-depleted rats was inhibited fully by pre-administration of high concentrations of IgG but not by pretreatment with IgA. asialofetuin (ASFe) or ovalbumin (OVA). Aggregated F(ab')2IgG was cleared with a comparable rate to mIgG from the circulation, again suggesting Fc gamma receptor-mediated elimination of AIgG by EC. There was a reduced degradation of AIgG in rats depleted of KC as compared with normal rats. These data suggest binding and degradation of AIgG by EC in vivo.