同种异体大鼠胰腺移植膀胱引流术式模型的建立及分析

大鼠胰腺移植模型可用于解决临床移植中常见问题的初步探索性研究．采用目前临床胰腺移植常用的膀胱引流术式,建立大鼠的同种异体胰腺移植模型30例,其中12例存活超过5d,存活超过2周者6例,超过3个月者4例。尸检及病理结果表明,手术过程中血管吻合技术的熟练程度、吻合时间过长及移植胰腺冷缺血期间保存温度超过4℃而使之活力下降是移植后动物死亡的主要原因。     

Delayed transient neurologic toxicity due to tacrolimus: CT and MRI

We report a case of transient neurologic toxicity secondary to tacrolimus. The clinical and imaging findings are reported and their subsequent regression after interruption of therapy in the patient following a bone-marrow transplant is also described. The etiology of the neurotoxicity and its analogy with other immunosuppressant agents are discussed. Received: 18 June 1999/Accepted: 14 December 1999     

三氧化二砷抑制肝癌细胞增殖的体内实验研究

目的：探讨As2O3对小鼠H22肝癌细胞增殖的抑制作用。方法：建立小鼠H22肝癌实体型移植瘤模型，腹腔应用As2O3治疗后，通过PCNA及CyclinD1免疫组化检测指标反映细胞增殖改变。结果：As2O3能够下调PCNA及CyclinD1蛋白的表达。结论：As2O3对小鼠肝癌细胞的增殖具有明显的抑制作用，具有治疗肝癌潜在价值。     

Development of rotary blood pump technology: past, present, and future

Even though clinical acceptance of a nonpulsatile blood flow was demonstrated almost 45 years ago, the development of a nonpulsatile blood pump was completely ignored until 20 years ago. In 1979, the first author's group demonstrated that completely pulseless animals did not exhibit any abnormal physiology if 20% higher blood flows were provided to them. However, during the next 10 years (1979-1988), minimum efforts were provided for the development of a nonpulsatile, permanently implantable cardiac prosthesis. In 1989, the first author and his team at Baylor College of Medicine initiated a developmental strategy of various types of nonpulsatile rotary blood pumps, including a 2-day rotary blood pump for cardiopulmonary bypass application, a 2 week pump for ECMO and short-term circulatory assistance, a 2 year pump as a bridge to transplantation, and a permanently implantable cardiac prosthesis. Following the design and developmental strategy established in 1989, successful development of a 2-day pump (the Nikkiso-Fairway cardiopulmonary bypass pump) in 4 years (1989-1993), a 2 week pump (Kyocera gyro G1E3 pump) in 6 years (1992-1998), and a bridge to transplant pump (DeBakey LVAD-an axial flow blood pump) in 10 years (1988-1998) was made. Currently, a permanently implantable centrifugal blood pump development program is successfully completing its initial Phase 1 program of 5 years (1995-2000). Implantation exceeded 9 months without any negative findings. An additional 5 year Phase II program (2000-2005) is expected to complete such a device that will be clinically available.     

Pharmacokinetic interaction between ondansetron and cyclophosphamide during high-dose chemotherapy for breast cancer

Purpose: Both ondansetron and cyclophosphamide are thought to be metabolized by hepatic microsomal processes. The purpose of this study was to evaluate the potential pharmacokinetic interactions between ondansetron and high-dose alkylating agent chemotherapy. Methods: A total of 54 breast cancer patients receiving high-dose cyclophosphamide, cisplatin and carmustine were treated prospectively in four sequential cohorts. Cohorts I and II received continuous infusions of both ondansetron and prochlorperazine, and cohorts III and IV received a continuous infusion of ondansetron alone at the same doses. All patients received lorazepam every 4 h. A group of 75 matched historical controls had received a continuous infusion of prochlorperazine with lorazepam. Pharmacokinetic monitoring of each drug used in the high-dose chemotherapy regimen was conducted. Results: Median AUCs of cyclophosphamide in patients receiving ondansetron (73.6 mg/ml · min) were lower than those of the control patients (88.3 mg/ml · min, n = 75, P = 0.0004), but the median cisplatin AUC was approximately 10% higher and no difference in the disposition of carmustine was demonstrated. Patients treated with ondansetron displayed a higher frequency of headaches than the controls. The frequency of achieving complete emetic control was greater in the ondansetron + prochlorperazine groups compared to the ondansetron alone groups and was greater in both these groups than in the prochlorperazine alone group on the first day of therapy only. Conclusion: Ondansetron altered the systemic exposure to cyclophosphamide when these agents were administered concomitantly. Ondansetron did not substantially improve overall emetic control when used alone but may improve control in combination with prochlorperazine. Future randomized studies are needed to delineate the effect of ondansetron on the disposition of the active cyclophosphamide metabolites so that clinical implications can be addressed. Received: 28 October 1997 / Accepted: 9 March 1998     

羊膜移植联合重组干扰素aIb滴眼预防翼状胬肉术后复发的临床观察

目的观察重组干扰素aIb滴眼液对翼状胬肉切除羊膜移植术后预防复发的效果。方法将105例翼状胬肉切除羊膜移植术后患者,分成50例治疗组,用重组干扰素aIb滴眼液滴眼,55例对照组用0.1%氟米龙滴眼液滴眼,两组均4~6次/d,约12d拆线,继续滴眼药水4~6周。结果术后经12~24个月,平均15个月随访,治疗组50例,无1例复发;对照组55例,复发6例,复发率10.9%,两组比较差异有显著性(P<0.05)。结论重组干扰素aIb滴眼液能很好地抑制翼状胬肉成纤维细胞的增殖及新生血管生长,是翼状胬肉切除羊膜移植术后预防复发的理想辅助药物。     

A retrospective study of fluid therapy for 100 patients of liver transplantation

Objective: To review the evolution of fluid therapy (IOFT) during liver transplantation (LTX) based on clinical experience in our institute over 7 years. Methods: All patient records (n = 130) of LTX from 1996 to 2003 were examined. After excluding patients with co-morbidities 100 cases were found suitable for IOFT analysis. All patients had undergone LTX and follow-up under the same surgical team. Based on IOFT records we tried to identify distinct patterns of practice evolving over 7 years. Intraoperalive hemodynamics (IOHD) and long-term outcome records were examined. Results: Retrospectively, 3 types of IOFT were found. Group A (n= 18, period 1996-1997) received high amounts of crystalloids; group B (n= 24, period 1998-2000) received high amounts of plasma and albumin; and group C (n = 58, period 2001-2003) received lower amounts of albumin and plasma and recommended amounts of 6% hy-droxyethyl starch 200/0. 5 (HES) and high amounts of vasoprcssors. Intraoperatively, group A exhibited the highest levels of central venous and pulmonary artery pressures in the neo-hepatic stage (P<0. 05). Postoperatively, the patients in group C had the shortest time to extubation; the values for group A,B,C were (15.8±11), (17. 3±10. 2) and (7. 98±3. 2) h respectively( P<0. 05). At the end of one-year follow-up, the patients in group C had the lowest mortality (group A, B, C were 27. 78%, 29. 17% and 6. 25% respectively; P<0. 05). Conclusion: In our institute over the years the use of crystalloids, albumin and plasma during IOFT of LTX is gradually replaced to a large extent by HES. The improvements in IOHD and long term outcomes are likely to be related to improved surgical experience of our team. Nevertheless, the shift in IOFT practices might be associated with an beneficial effect on IOHD or long term outcome. Treatment with proper amount of liquid and vasoactive drugs may be a better method of fluid therapy.     

Suppressive effects of antigens on the activity of specific activated lymphocytes：A test to define the specificity of activated lymphocytes

Objective：With the regular mixed lymphocytes culture （MLC） to detect the allograft rejection, the reactivity of the activated lymphocytes （primed lymphocytes） of a recipient shows sometimes increase and sometimes decrease against the antigens from the donor, which is inconsistent with the clinical results. In order to establish a convenient method for testing the specificity of the activated lymphocytes in vitro, so as to know the rejection occurred or not by testing the existence of the specific activated lymphocytes against donor＇s HLA antigens in the recipient＇s peripheral blood. Methods： Anti-IL-2 neutralizing monoclonal antibody （anti-IL-2 N-mAb） and immunosuppressors were introduced in this test system in the presence of specific stimulators and activated lymphocytes. Results ： When the activated lymphocytes were chosen from the one-way MLC 4 d to undergo re-stimulation by specific stimulators, the activity of activated lymphocytes in the treatment group was suppressed significantly compared with that in the control group. The result of this test method is consistent with the biopsy in the clinical diagnosis of rejection. Conclusion：h suggests that the activated lymphocytes can be inactivated by specific antigens in certain conditions. This can be a useful tool to define the specificity of the activated lymphocytes.     

Living donor small bowel transplantation: Literature review 2003–2006

The experience with living donors for intestinal transplantation is limited. However, Intestinal Registry data suggest that the outcomes of the procedure are comparable with those obtained with intestinal transplant from deceased donors. In selected cases, this strategy may have a role in the treatment of patients with irreversible intestinal failure suffering life-threatening complications from total parenteral nutrition. The present review covers most of the published data on this topic between 2003 and 2006, with special reference to living donor intestinal transplantation of pediatric recipients.