固体硅胶隆鼻术后感染排异的原因与预防探讨

感染及排异是固体硅胶隆鼻术较为严重的并发症。其发生原因主要在于手术适应证掌握不当；硅胶假体的质量不过关，假体的修雕成形不佳，假体消毒处理不严；手术操作及术后处理欠妥等。提出了加强术前体检及适应证的掌握，选择质量过关的硅胶假体，努力提高术者的审美及专业技术水平，设计修雕成形出恰当的假体，并注意规范假体的消毒处理，这都可有效减少感染及排异并发症的发生。强调手术操作时尽量减少局部组织的损伤，勿剥破鼻部的皮肤及粘膜，并做好术后的处理及护理，这同样也是减少感染排异并发症的关键。     

Changes in pulmonary circulation during the early postoperative period following single lung transplantation

This study examines the pulmonary hemodynamics during reimplantation and rejection following unilateral lung transplantation in dogs. Nineteen mongrel dogs were divided into three groups according to the method of treatment used: group 1 (n = 6) underwent modified autotransplantation of the left lung; group 2 (n = 6), allotransplantation without immunosuppression; and group 3 (n = 7), allotransplantation with immunosuppression. The pulmonary arterial blood flow and ventilation scores, assessed by chest X-rays, were measured for 2 weeks postoperatively. Pulmonary blood flow to the transplanted lung decreased slightly in group 1, whereas in group 2, it decreased sharply from the 3rd postoperative day (POD) and was almost completely absent by the 14th POD. In group 3, it decreased by 28% on the 1st POD but recovered gradually to 37% by the 14th POD. Ventilation scores were the same among the three groups on the 1st POD but in group 2, they decreased rapidly from the 3rd POD. This change correlated well with that of the pulmonary arterial (PA) flow, although the ventilation score changed after the PA flow did. In conclusion, rejection was reflected earlier and more distinctly by the changes in PA flow than by chest X-rays.     

移植肾彩色多普勒血流超声与肾穿刺活检的对照研究

将彩色多普勒血流超声与移植肾活检结果相对照。评价无创性ＣＤＦＩ对移植肾排异反应的诊断价值。结果：不同病理状态下移植肾的阻力指数有所不同。急性排异和慢性排异反应组的ＲＩ值明显高于正常组。两次肾活检提示由急性排异转为慢性排异反应的同一患者，ＣＤＦＩ的动态观察显示，ＲＩ值明显增高。     

Mother and father involvement in day care centers serving infants and young toddlers

This study compared the involvement of 28 mothers and their spouses in day care centers serving infants and toddlers. The sample consisted of parents who work at varying distances from the center. Parents were interviewed ten times each to determine the amount of time they spend in the center, frequency of communication with care providers, mid-day visits to the center, playing with the child, and holding the child in the center. Factor analysis reduced these variables to one parental involvement factor. Mothers were significantly more involved than fathers in the center, after statistically controlling for distance to the workplace and occupational status.     

Attentional modulation of the cardiac defense response in humans

How cardiac components of the defense reaction are modulated by attentional factors related to sensory intake versus sensory rejection was examined. Forty-eight men participated in a test of the heart rate response to three presentations of an intense auditory stimulus while performing one of three attentional tasks during the 80 s following stimulus onset: (a) internal (rejection) task, (b) external (intake) task, and (c) no task. Results showed a potentiation of the defense response only under the external attention condition. We concluded that defensive reactions, far from provoking the rejection of the aversive stimulus, require allocation of attention to processing that stimulus in detail.     

小剂量多克隆抗体预防移植肾急性排斥反应

目的：探索能减少并发症，减轻病人经济负担，有效预防移植肾急性排斥反应的多克隆抗体的合理使用方案。方法：选择肾移植患者８０例，根据使用多克隆抗体的时间不同分３组，观察病人血ＣＤ３＋细胞数变化、急性排斥反应及并发症发生率，作前瞻性研究。结果：３组病人急性排斥反应率，术后５ｄ内ＣＤ３＋细胞数无统计学差异，而使用抗淋巴细胞免疫球蛋白（ＡＬＧ）时间较长者，术后６ｄ后ＣＤ３＋细胞数少于其他组，巨细胞病毒（ＣＭＶ）病及一般感染率明显高于其他组。结论：术后间歇使用小剂量ｔｉｅｎｔｓ′ＡＴＧ及术后连续３～６ｄ使用常规剂量ＡＬＧ是一种有效、安全、价廉的免疫抑制方案。     

小鼠肠移植术前输注表达吲哚胺2,3双加氧酶的供者树突细胞抑制排斥反应

目的观察干扰素γ(IFN-γ)诱导供者(C57BL/6小鼠)脾树突细胞(DC)表达吲哚胺2,3双加氧酶(IDO)的情况;研究受者(BalB/c小鼠)小肠移植术前输注高表达IDO的供者DC对排斥反应的抑制作用。方法用IFN-γ诱导供者DC表达IDO;半定量逆转录聚合酶链反应、免疫印迹法及毛细管电泳法检测IDO表达水平及活性,混合淋巴细胞培养(MLR)测定IDO刺激T细胞增殖的能力。利用小鼠异位小肠移植模型,设单纯移植组、DC输注移植组(术前输注供者脾DC 2×10~6个)及诱导DC输注移植组(术前输注经IFN-γ诱导的供者脾DC 2×10~6个),术后观察移植肠存活时间并行病理学检查。结果经IFN-γ诱导的脾DC IDO分子mRNA转录水平(相对量)、IDO蛋白表达水平(相对量)及培养液中犬尿氨酸浓度分别为(1.23±0.02)、(2.74±0.01)以及(76.52±0.44)μmol/L,未经IFN-γ诱导的脾DC分别为(1.05±0.05)、(1.40±0.17)及(43.31±0.48)μmol/L,前者显著增强(P<0.01)。脾DC对同种T细胞增殖的刺激作用在IFN-γ诱导后减弱,在加入IDO的特异性抑制剂后增强。输注诱导DC移植组移植肠中位存活时间(12 d)较单纯移植组(6 d)及输注DC移植组(7.5 d)显著延长(P<0.01),而移植肠病理分级显著性降低(P<0.05)。结论IFN-γ可诱导小鼠脾DC高表达活性的IDO,后者可减弱DC刺激T细胞增殖的能力。受者术前输注高表达IDO的供者DC能够诱导针对供者的特异性免疫耐受而减轻排斥反应。     

Experience with the Wujciak-Opelz allocation system in a single center: an increase in HLA-DR mismatching and in early occurring acute rejection episodes

The present single-center, retrospective study was undertaken to assess the impact of the Wujciak-Opelz allocation system (XCOMB), currently used within Eurotransplant for renal allografts, on the incidence of early occurring rejection episodes (RE). Implementation of the system resulted in an increase of HLA-DR mismatches (MM), while the incidence of HLA-A + B + DR MM remained unchanged. During the 1st post-transplant month, the total number of RE, expressed per patient-months, increased by 64 % (0.326 vs 0.199, P = 0.007); when considering only severe and irreversible RE, the increase was 76 % (0.158 vs 0.090, P = 0.011). In contrast, from the 2nd to the 12th post-transplant month, the incidence of RE, regardless of severity, was similar before and after implementation of XCOMB. As early occurring RE have detrimental effects on long-term graft outcome, these observations, if confirmed on a larger scale, would justify changes in the allocation algorithm. Received: 13 February 1998 Received after revision: 29 April 1998 Accepted: 20 May 1998     

Investigation of the anti-complement agents, FUT-175 and K76COOH, in discordant xenotransplantation

Abstract: We examined whether hyperacute rejection (HAR) of a discordant xenograft in a nonhuman primate model could be inhibited by the anticomplement agents, FUT-175 (FUT) and K76COOH (K76). The inhibitory effect of FUT and K76 on baboon sera was studied in vitro by i) complement-mediated hemolysis of sheep erythrocytes (by measuring serum CH50) and ii) cytotoxicity to cultured pig kidney (PK15) cells. The in vivo administration of FUT (at 0.2–25 mg/kg/h i.v. continuously) and K76 (50 mg/kg i.v. bolus) allowed evaluation of the serum levels of these drugs. Both FUT and K76 inhibited serum CH50 in a concentration-dependent manner. An enhanced effect was obtained by combining K76 with FUT therapy. High concentrations of FUT (>10^-4 M) and K76 (>10³ μxg/ml) were necessary to suppress serum CH50 to <5% of the normal level. However, PK15 cytotoxicity remained at >50% in the presence of i) 10^-4 M of FUT, ii) 10³ μg/ml of K76, and iii) 10^-6 M of FUT + 10³ μg/ml of K76. Pig heart transplantation (HTX) was performed in two baboons receiving FUT (1 mg/kg/h i.v. continuously) and K76 (at 200 mg/kg ×1 or 400 mg/kg + 200 mg/kg × 2 i.v, respectively). Cytotoxicity of the serum to PK15 cells at the time of HTX showed 39% and 1% cell death, respectively, in these two baboons, and the CH50 level was 1% (of control level) and 0%, respectively. Graft survival was 4.5 hours and 10 hours (with death of the baboon), respectively (compared with a mean of 29 minutes in control experiments). Both excised grafts showed typical features of hyperacute rejection. Immunopathological studies revealed deposition of C1q, C3d, C6, properdin, and Factor B, demonstrating that complement activation was not fully inhibited by FUT and K76. We conclude that i) FUT and K76 are indeed potent complement inhibitors, ii) the dosages of FUT and K76 necessary to suppress complement-mediated injury cannot be extrapolated from previously reported data obtained from serum CH50 levels, and iii) higher (possibly toxic) dosages will be required to inhibit complement activation completely. It seems unlikely that HAR will be prevented by these drugs alone, although they may be beneficial when combined with other forms of therapy.