Prospective study of microchimerism in transplant recipients

BACKGROUND: We evaluated peripheral blood microchimerism in 48 consecutive organ transplant recipients (35 kidneys, ten livers, one kidney-liver, one kidney-pancreatic islet, one kidney pancreas) up to 12 months post-transplantation. Patients were categorized according to the presence or absence of rejection episodes, and the patterns of microchimerism in the two groups were then compared. METHODS: DNA was extracted from donor, pre-transplant, and post-transplant peripheral blood samples. Several polymerase chain reaction (PCR)-based assays were developed for the detection of microchimerism. Assay sensitivities ranged from 0.0001 to 3%. RESULTS: Microchimerism was detected only in sex-mismatched cases (male donors and female recipients) using nested PCR for a Y-chromosome marker. There were ten such cases (six kidneys, two livers, and two combined organ transplants). In patients without rejection (n = 7), there was a peak of donor-DNA at 1-3 wk post-transplantation followed by a second peak between 3 wk and 4 months. In patients with biopsy-proven rejection (n = 3), the peaks were absent and the levels of microchimerism were extremely low (< 0.001%). Microchimerism levels declined in all 10 patients and were barely detectable 1 yr post-transplantation. Microchimerism was not detected in the remaining 38 patients despite using a battery of sensitive PCR-based assays. CONCLUSIONS: In our study, microchimerism was detected using the Y-chromosome PCR assay only and the level of donor-DNA in a given patient varied over time. This study highlights the difficulties in establishing a correlation between microchimerism and transplant tolerance.     

多脏器微栓塞病细胞综合征动物实验模型──定义、判断标准、发生机制及其与临床的关系

利用健康杂交犬制作了多脏器微栓塞病细胞综合征（ＰＯＭＳ）模型,观察在不同时限、不同组织器官造成的病理生理改变。从中发现,钳夹腹主动脉阻断血流后,其供血器官都发生了ＲＯＭＳ,且不同器官的功能与结构损害有发生时间和程度的不同,但均有不同程度的微栓塞形成趋势,这有助对“多脏器衰竭”概念认识的深化。     

Interobserver variation in the assessment of pelvic organ prolapse

The aim of this study was to determine the interobserver agreement of two grading systems for pelvic organ prolapse: the vaginal profile and the International Continence Society (ICS) draft proposal. Forty-nine consecutive women referred for evaluation of urinary incontinence and/or pelvic organ prolapse were studied. Patients were first examined by a physician and a nurse clinician using the vaginal profile, followed by an examination according to the technique described in the ICS draft proposal for standardization of terminology (1994). statistic and Pearson's correlation coefficient were used to determine interobserver variability for the ICS system by overall stage, by stage-specific comparison, and by specific anatomic location. The vaginal profile was evaluated by obtaining a for overall degree of prolapse, stage-specific comparison and by anatomic area. The for the ICS stage was 0.79 (P<0.001), and the for the vaginal profile by area of greatest prolapse was 0.68 (P<0.001), indicating substantial interobserver agreement for both systems. The ICS system was noted to have substantial interobserver agreement by a stage-specific comparison. All anatomic locations of the ICS staging system were found to correlate significantly, and a high degree of interobserver precision was found. The vaginal profile also showed significant interobserver agreement by overall degree of prolapse, by specific degree of prolapse, and by anatomic area. It was concluded that both the proposed ICS staging system and the traditional vaginal profile show significant interobserver agreement both by overall stage, stage-specific analysis and specific location. The registered nurse examination correlated well with the physican examination, indicating that the most important factor in obtaining reproducible results may be definition and close attention to examination technique.EDITORIAL COMMENT: There has recently been a great deal of interest in the anatomy and physiology of the pelvic floor and the various investigative techniques to define its function. The lack of a standardized and reproducible system to describe pelvic organ prolapse through the hiatus of the pelvic floor has hampered research into its pathophysiology and treatment. The authors applied a validated statistic and Pearson's correlation coefficient to convincingly measure interobserver reliability for the ICS system and indicated an index of trend between points on the ICS scale as well.     

Effects of transforming growth factor beta-1 and all-trans-retinoic acid on androgen-induced development of neonatal mouse bulbourethral glands in vitro

Effects of transforming growth factor beta-1 (TGF-beta1) and all-trans-retinoic acid (All-trans-RA) on development of bulbourethral glands (BUGs) of neonatal mice were investigated in vitro. BUGs from 0-day-old male mice were cultured for 6 days in serum-free, chemically defined medium containing transferrin and bovine serum albumin, supplemented with 5alpha-dihydrotestosterone (DHT; 10-8 M) and insulin (10 microg/mL) alone or in combination. Prior to culture, BUGs from 0-day-old mice consisted of a simple epithelial rudiment encapsulated by mesenchyme. Epithelial growth and ductal branching occurred in BUGs cultured in medium containing DHT and insulin or DHT alone, but epithelial branching did not occur in BUGs cultured in the presence of insulin alone. Addition of TGF-beta1 at concentrations of > 5 ng/mL (0.2 x 10-9 M) to medium containing both insulin and DHT, inhibited the expected increase in overall size of BUGs, epithelial area and ductal branching in a dose-dependent manner. TGF-beta1 also decreased [3H]-thymidine labelling indices of both epithelium and mesenchyme. TGF-beta1 at 10 ng/mL elicited these inhibitory effects on BUGs cultured in medium containing DHT alone. Addition of All-trans-RA (10-8 to 10-6 M) to the medium containing DHT plus insulin, or DHT alone did not exert significant effects on either overall size of BUGs or epithelial growth and ductal branching. All-trans-RA at 10-6 M decreased the [3H]-thymidine labelling index of mesenchyme of BUGs cultured in medium with DHT plus insulin or DHT alone, but did not decrease the [3H]-thymidine labelling index of epithelium. The present results indicate that TGF-beta1 inhibits androgen-induced epithelial and mesenchymal growth as well as epithelial morphogenesis of BUGs from neonatal mice. Such an inhibitory effect of TGF-beta1 is not mimicked by All-trans-RA at physiological concentrations.     

危重病患儿应激性高血糖的临床研究

对探讨应激性高血糖对危重病患儿的影响，我院ＩＣＵ１９９５年１月－１９９５年１２月对２５５例急性病患儿进行了血糖监测，结果血糖〉６．６７ｍｍｏｌ／Ｌ１０７例；高血糖与器官功能障碍关系密切，一个和三个顺官功能衰竭时血糖分别为８．８９±３．０３ｍｍｏｌ／Ｌ和１３．２０±４．４５ｍｍｏｌ／Ｌ。两个和 器官功能衰竭时血糖分别为１０．６３±４．８２ｍｍｏｌ／Ｌ和１６．８０±１０．４６ｍｍｏｌ／Ｌ：，血虎高期     

儿科加强医疗病房全身炎症反应综合征和多器官功能不全综合征的临床分析

目的应用新概念———全身炎症反应综合征（ＳＩＲＳ）和多器官功能不全综合征（ＭＯＤＳ）认识多器官功能衰竭（ＭＯＦ）。方法回顾性总结分析１９９５年１月～１９９７年１２月我院儿科加强监护病房收治的危重患儿，根据Ｈａｙｄｅｎ修订的ＳＩＲＳ诊断标准和全国小儿急诊学组拟定的ＭＯＦ诊断标准进行临床分析。结果全组３０４例患儿，符合ＳＩＲＳ标准２５２例，占８２．９％．原发病有感染性疾病和非感染性疾病。在ＳＩＲＳ和ＭＯＤＳ病程发展过程中部分患儿出现一过性肝、肾、胃肠道和脑等器官功能受损的表现，最终进展为ＭＯＤＳ共６５例，占２５．８％。ＭＯＤＳ的病死率为４３．１％（２８／６５）。发生ＭＯＤＳ的高危因素为入院危重评分＜７５分，明显高代谢反应和合并Ｃ反应蛋白，而与年龄无明显关系。结论ＳＩＲＳ和ＭＯＤＳ是小儿加强医疗病房中常见病症，病死率较高。ＳＩＲＳ和急诊学组制定的ＭＯＦ诊断标准简单实用，但应根据美国胸科协会和危重病医学会倡议将ＭＯＦ更名为ＭＯＤＳ。ＳＩＲＳ和ＭＯＤＳ进展至器官功能衰竭前存在器官功能受损的表现，应予高度重视并早期干预。     

新生儿窒息多脏器血流动力学研究

目的研究新生儿窒息多脏器损伤的机理，提供早期诊断方法。方法应用美国Ｕｌｔｒａｍａｒｋ－９型彩色超声诊断仪及丹麦ＡＢＬ－５００型血气分析仪等，对新生儿窒息全身性多脏器血流动力学变化进行有对照组的前瞻性研究。结果（１）窒息新生儿脑、肾上腺、肾、肝、脾、胃及肠道等各脏器血液灌流量均减少，尤以舒张期为甚；但各脏器减少的程度不一致。（２）肺动脉压力与阻力增高，严重者可致持续胎儿循环，是病情严重的标志。（３）心脏功能障碍是缺氧缺血性心肌损伤的结果，窒息性心功能障碍表现为舒张功能首先受累，而收缩功能障碍则右室重于左室。（４）低氧血症是新生儿窒息各脏器损伤的病理生理基础，且低氧血症的程度与各脏器血流速度减慢的程度呈高度正相关（ｒ＝０．９３～０．９８，Ｐ均＜０．０１），与左室射血分数降低的程度呈高度正相关（ｒ＝０．９１，Ｐ＜０．０１），与肺动脉压力增高的程度呈高度负相关（ｒ＝－０．９７，Ｐ＜０．０１）。ＱＴ离散度是评价新生儿缺氧缺血性心肌损伤特异而敏感的指标。结论血流动力学紊乱是新生儿窒息各脏器损伤的主要原因，肺动脉压升高是新生儿窒息的重要病理生理变化。超声检测各脏器血流动力学变化，可用于新生儿窒息多脏器损伤的早期诊断     

实验动物和脏器标本的摄影方法

文章结合实践介绍了实验动物和脏器标本的摄影方法及注意事项,为从事这方面工作的科技人员提供了技术支持。     

多器官保存液的研究进展(Ⅰ)

本文综述了30年来多器官保存液的基础研究和临床应用的状况及进展。论述了器官保存的关键点。对现有的多器官保存液,包括:组氨酸-色氨酸-α-酮戊二酸溶液、威斯康星大学溶液、高渗枸橼酸盐腺嘌呤溶液、自制长征-1号溶液、Celsior溶液、Euro-Collins溶液、Carolina rinse溶液、St.ThomasⅡ溶液、乳果糖-组氨酸-聚蔗糖溶液、上海多器官溶液及其他器官保存液的成分及其特点进行分析,评估了上述器官保存液对脏器的保存效果,简述了中药在器官保存液中的应用。     

腭器官培养在腭裂发病机制研究中的应用

唇腭裂是人类最常见的出生缺陷之一,其发病机理复杂.多学科的研究表明,唇腭裂的病因涉及众多因素,受到多个因素的调控.其中导致腭裂发生的原因之一是腭板未能融合,而对于腭板融合过程的研究,在体内受诸多因素的限制,因此可以采用体外腭器官培养的方法进行研究.长期实践证明,与体内实验相比,体外腭器官培养模型可以模拟体内腭裂形成的过程.本文就腭器官培养方法在腭裂发病机制研究中的作用作一综述.