Ultrasonic study of venous patterns in the right hypochondrium: An anatomical approach to differential diagnosis of obstructive jaundice

Through real time ultrasonography, it is possible to display the splenic vein, the superior mesenteric vein, the vena porta, and the intrahepatic portal and systemic veins. In jaundice, it is of the utmost importance to carefully identify the vena porta before making a diagnosis of common bile duct enlargement. It is also necessary, when confronted with a pattern of apparently enlarged intrahepatic ducts, to conduct a thorough study of possible confluences of the ducts with the vena porta or vena cava to be certain that the ducts are not part of the portal or systemic venous network. Without such differentiation, portal enlargement caused portal hypertension, systemic venous enlargement caused cardiac insufficiency, or even nonpathological wide veins may lead to an erroneous diagnosis of obstructive jaundice.     

哮喘病人外周血CD4+ T淋巴细胞自噬现象的观察

摘要：目的观察分离培养的哮喘病人外周血CD4^＋T淋巴细胞的自噬现象。方法密度梯度离心法、尼龙棉柱法及磁分离法分离哮喘病人外周血CD4^＋T淋巴细胞，分空白组及地塞米松（DXM）组，培养72h后用流式细胞仪检测自噬细胞比例变化。结果DXM组与空白组72h自噬细胞发生率有显著性差异。结论DXM可诱导哮喘病人外周血CD4^＋T淋巴细胞自噬。     

哮喘患儿淋巴细胞胞浆游离钙离子浓度变化及其与呼吸爆发功能的关系

目的：研究哮喘患儿淋巴细胞胞浆游离钙离子浓度变化及其与呼吸爆发功能的关系。方法：采用Ｑｕｉｎ２荧光技术直接测定淋巴细胞胞浆游离钙离子〔Ｃａ２＋〕ｉ和细胞色素Ｃ还原法测定淋巴细胞呼吸爆发Ｏ÷２释放量。结果：淋巴细胞胞浆〔Ｃａ２＋〕ｉ哮喘发作期明显高于稳定期（Ｐ＜０．０１），稳定期与正常儿童相近（Ｐ＞０．０５），内、外源型哮喘间无显著性差异；淋巴细胞呼吸爆发释放Ｏ÷２量哮喘发作期明显高于稳定期（Ｐ＜０．０１），稳定期仍高于正常儿童（Ｐ＜０．０５），内、外源型哮喘间无显著性差异；相关分析显示哮喘患儿淋巴细胞胞浆〔Ｃａ２＋〕ｉ与其呼吸爆发Ｏ÷２释放量呈正相关关系（ｒ＝０．４１，Ｐ＜０．０５）。结论：哮喘患儿淋巴细胞呼吸爆发功能增强，其Ｏ÷２释放量的增加在哮喘气道炎症中起重要作用，淋巴细胞胞浆〔Ｃａ２＋〕ｉ的增高与其活化有一定关系，但钙拮抗剂不宜作为哮喘治疗的主要药物。     

Cross-presentation of glycoprotein 96-associated antigens on major histocompatibility complex class I molecules requires receptor-mediated endocytosis

Heat shock proteins (HSPs) like glycoprotein (gp)96 (glucose-regulated protein 94 [grp94]) are able to induce specific cytotoxic T lymphocyte (CTL) responses against cells from which they originate. Here, we demonstrate that for CTL activation by gp96-chaperoned peptides, specific receptor-mediated uptake of gp96 by antigen-presenting cells (APCs) is required. Moreover, we show that in both humans and mice, only professional APCs like dendritic cells (DCs), macrophages, and B cells, but not T cells, are able to bind gp96. The binding is saturable and can be inhibited using unlabeled gp96 molecules. Receptor binding by APCs leads to a rapid internalization of gp96, which colocalizes with endocytosed major histocompatibility complex (MHC) class I and class II molecules in endosomal compartments. Incubation of gp96 molecules isolated from cells expressing an adenovirus type 5 E1B epitope with the DC line D1 results in the activation of E1B-specific CTLs. This CTL activation can be specifically inhibited by the addition of irrelevant gp96 molecules not associated with E1B peptides. Our results demonstrate that only receptor-mediated endocytosis of gp96 molecules leads to MHC class I-restricted re-presentation of gp96-associated peptides and CTL activation; non-receptor-mediated, nonspecific endocytosis is not able to do so. Thus, we provide evidence on the mechanisms by which gp96 is participating in the cross-presentation of antigens from cellular origin.     

硬膜外腔吗啡和电针对术后病人T淋巴细胞亚群的影响

目的：观察吗啡和电针对术后病人免疫功能的影响。方法：研究共分４组：正常对照组１０例（Ａ组）；将１８例Ａ．Ｓ．ＡⅠ￣Ⅱ级择期行单纯胆囊切除秫后病人随机分为手术组（Ｂ组），吗啡组（Ｃ组）和吗啡伍用电针组（Ｄ组）。分别于术后第１、３、７ｄ观察吗啡和电针对Ｔ淋巴细胞亚群表达能力的变化。结果：Ｂ组在手术后第１ｄ，ＣＤ３＾＋和ＣＤ４＾＋的表达能力有显著抑制（Ｐ〈０．０５）；Ｃ组在硬膜外腔注射吗啡１ｍｇ后，ＣＤ     

抗Fas锤头状核酶阻抑小鼠急性粒-单核白血病细胞免疫逃逸的研究

为了研究抗Fas锤头状核酶对T细胞Fas表达及其凋亡的影响和探讨增强供者淋巴细胞输注时移植物抗白血病（GVL）效应的新策略，构建可有效切割Fas mRNA的锤头状核酶真核质粒，用电穿孔法将其导入小鼠CTL细胞株CTLL-2之后，借助RT—PCR和Western blot检测其Fas的表达，同时检测转染前后其胱冬酶-3（Caspase-3）活性和凋亡（Annexin V—FITC法）的改变，并用MTT法检测空白对照组、空载体转染组及pU6-RZ596转染组CTLL-2细胞的增殖情况和体外杀伤小鼠急性粒-单核白血病细胞（WEHI-3）的活性。结果表明：构建的U6嵌合型锤头状核酶RZ596在细胞内能有效切割Fas，明显降低小鼠活化CTLL-2的Fas水平，与高表达Fas配体的WEHI-3孵育后，其存活率和体外杀伤WEHI-3活性明显高于对照组。结论：抗Fas核酶能显著降低小鼠活化CTLL-2的Fas表达，使其免于WEHI-3的膜Fas配体经Fas途径所致的凋亡，并提高CTL对小鼠急性粒-单核白血病细胞的杀伤力，从而阻抑小鼠急性粒-单核白血病细胞的免疫逃逸。     

超声诊断脾动脉假性动脉瘤1例

患者男,51岁,因“反复上腹部疼痛不适3年,加重15天”就诊。无高血压、胰腺炎及外伤史。查体:腹软,无压痛及反跳痛,腹部未扪及异常肿块。超声检查:左上腹脾门区探及大小约10.0 cm×9.6 cm的中等回声肿块,形态不规则,边界不清晰,回声不均质,内见范围约6.1 cm×6.0 cm的囊性回声,透声不清晰(图1A),超微血流成像(superb microvascular imaging,SMI)技术囊性回声内可探及漩涡状血流信号(图1B),PW测得动脉血流频谱,CDFI显示血流与脾侧脾动脉关系紧密(图1C)。超声诊断:左上腹脾门区脾动脉假性动脉瘤(splenic artery pseudoaneurysm,SAPA)。增强CT:脾胃间隙见一团状高低混杂密度影,增强动脉期低密度区轻度强化,静脉期明显强化。CT诊断:脾胃间隙混杂密度占位,考虑血肿伴活动性出血。DSA:脾动脉远端造影,可见造影剂外渗入囊腔(图1D),诊断为SAPA。该患者行脾动脉栓塞术,术后超声复查示瘤腔闭塞、动脉破口无血流信号。     

阵发性睡眠性血红蛋白尿症患者外周血淋巴细胞增殖、杀瘤活性及其对正常表型骨髓造血细胞的影响

阵发性睡眠性血红蛋白尿症 (PNH)克隆可能由于缺乏GPI锚连蛋白而逃脱免疫攻击 ,形成生长优势。本研究测定PNH患者淋巴细胞增殖反应及对K5 6 2细胞的杀伤作用 ,并与正常对照比较 ,观察其淋巴细胞功能。采用体外液体培养体系 ,应用免疫磁珠技术分选PNH患者骨髓CD34+ 及CD34- 细胞 ,分别向 2组细胞及对照细胞加入自身CD5 9+ 或CD5 9- 淋巴细胞及其培养上清液、外源性IFN γ及IL 2。培养 10天后 ,测定骨髓细胞中PNH细胞 (CD5 9- )百分数 ,观察淋巴细胞对骨髓中CD34+ 及CD34- 细胞中PNH细胞含量的影响。研究结果表明 ,对PHA的增殖反应 ,PNH患者未分选的淋巴细胞与健康对照比较、PNH患者自身CD5 9+ 与CD5 9- 淋巴细胞之间比较均无统计学差异 ,但对K5 6 2细胞的杀伤作用PNH患者未分选的淋巴细胞明显低于健康对照组 ,分别为 (5 0 .0 0± 2 8.6 7) %及 (76 .13± 10 .15 ) % (P <0 .0 5 ) ,而PNH患者CD5 9- 淋巴细胞与CD5 9+ 淋巴细胞之间无显著性差异。PNH患者骨髓细胞中加入自身CD5 9- 淋巴细胞或其培养上清液、CD5 9+ 淋巴细胞或其培养上清液、外源性IFN γ和IL 2培养后 ,CD5 9+ 细胞均有不同程度下降 ,除CD5 9+ 淋巴细胞组外 ,其他各组CD5 9+ 细胞下降与培养前比较有显著性差异 (P <0 .0 5 ) ,IFN γ及IL 2组     

Quantitative Doppler evaluation of the splenoportal venous system in various stages of cirrhosis: differences between right and left portal veins

PURPOSE: The purpose of our study was to evaluate the relationship between the splenoportal hemodynamics in patients with cirrhosis and the stage of the disease. METHODS: Patients with cirrhosis were grouped according to modified Child-Pugh scoring into stages A, B, and C of cirrhosis. A control group of healthy volunteers was included. After gastroenterologic clinical and laboratory examinations, all participants underwent a splenoportal Doppler sonographic evaluation in which the vessels' diameter, area, and blood flow velocity were measured and blood flow rate and the congestion index in the splenoportal venous system were calculated. RESULTS: Seventy-five patients with cirrhosis (25 women and 50 men) were enrolled; the control group consisted of 30 healthy volunteers (15 women and 15 men) with no liver disease. The mean age (+/- standard deviation) of the patients was 54.4 +/- 14.8 years (range, 13-80 years) and of the control subjects was 47.3 +/- 14.5 years (range, 18-72 years). No significant differences in vessel diameter, blood flow velocity, and blood flow rate were found in the main and left portal veins between the study group and the control group. In the right portal vein, we found decreases in the vessel diameter, blood flow velocity, and blood flow rate, and in the splenic vein, we found increases in vessel diameter and blood flow rate. The congestion index was increased in the main portal and splenic veins but was unchanged in the left portal vein. CONCLUSIONS: Although our data indicate that there is no difference in Doppler sonographic parameters of the main portal vein according to Child-Pugh scores, the hemodynamic differences between the left and right branches of the portal vein may be clinically useful in patients with cirrhosis.