sIL-2R在急性移植物抗宿主病中的临床研究

目的探讨细胞因子sIL-2R在异基因造血干细胞移植（allo-HSCT）后急性移植物抗宿主病（aGVHD）发病机理中的作用。方法观察20例Allo-HSCT患者aGVHD的发病情况，移植前后定期采集20例患者的外周血，采用双夹心酶联免疫吸附法（ELISA）检测其细胞因子sIL-2R的浓度。结果①异基因造血干细胞移植后20例患者全部获得造血功能重建，中性粒细胞恢复到0．5×10^9／L及血小板恢复到20×10^9／L的中位时间分别为移植后13．5d及18d；②发生aGVHD的患者，sIL-2R浓度较移植前明显升高，sIL-2R浓度在aGVHD阳性组明显高于aGVHD阴性组（P〈0．01）。结论①细胞因子sIL-2R在aGVHD的发病中起重要的正向调节作用，检测异基因造血干细胞移植后患者血清的sIL-2R水平有助于预测aGVHD的发生；②sIL-2R与感染无相关性。     

促卵泡激素和血管内皮生长因子在大鼠卵巢组织冷冻自体异位移植中的保护作用

目的：探讨促卵泡激素(FSH)和血管内皮生长因子(VEGF)在大鼠卵巢组织冷冻自体异位移植后对卵泡内分泌功能的影响。方法 Wistar 大鼠30只随机分为 A、B、C 组,每组10只,A 组为新鲜卵巢组织移植,B 组和 C 组卵巢组织均直接覆盖玻璃化冷冻保存2周复苏后移植,但 C 组在移植前2 d 肌内注射 FSH 和 VEGF,连续用药5 d。移植6周后计算卵泡密度;检测大鼠血清中雌二醇(E2)水平;卵巢组织增殖细胞核抗原(PCNA)的表达情况,并测定子宫重量。结果 A、B、C 组移植后卵巢组织存活率比较差异无统计学意义(P >0．05)。 A、C 组卵泡密度、血清 E2水平、PCNA 阳性率和子宫重量均高于 B 组(P <0．05),A 组和 C 组比较差异无统计学意义(P >0．05)。结论大鼠卵巢组织冷冻复苏自体异位移植前注射 FSH 和 VEGF 可以有效提高卵泡存活率,有利于恢复卵巢内分泌功能。     

Extensor digitorum brevis and extensor hallusis brevis transplantation for treatment of long-standing facial pa-ralysis

Objective: To evaluate the efficacy of free transplan-tation of denervated muscles and vessels in the treatment of long-standing facial paralysis.Methods: A total of 26 patients with facial paralysis (10 males and 16 females, aged 16-65 years, mean: 47 years) were enrolled in this study to receive transplantation of denervated extensor digitorum brevis (EDB) and extensor hallusis brevis (EHB). The muscle tendon was slung to the ala nasi, the middle point of the nasolabial sulcus, the angu-lus otis and the chin to correct the nasal and oral deformity. The muscle belly was buried around the nerves that inner-vated the masseter muscle. Microsurgery was applied to anastomosing the tarsus lateral vessels to the superficial temporalis vessels.Results: After operation, all the patients immediately obtained satisfied static appearance. The movement of the paralyzed comer of the mouth could be obtained one month later and the smile of the paralyzed side could be restored after 3 months of training. And 88% patients achieved per-fect results, 8% obtained satisfactory results, and 4% got improvement 6 months after operation according to Stennert's paresis scoring system.Conclusions: Free transplantation of denervated muscles and vessels for the treatment of long-standing fa-cial paralysis, which seldom causes atrophy or liquefaction of the transferred muscles, can maintain muscle viability and induce reliable nerve regeneration. Therefore, it is a safe and efficient treatment method for the patients suffer-ing from facial paralysis.     

大鼠小肝细胞移植对急性肝损伤的影响

目的 探讨小肝细胞(small heptocytes,SHCs)移植对四氯化碳(carbon tetrachloride,CCl4)+2/3肝切(partial hepatectomy,PH)所致急性肝损伤的影响.方法 选择健康SD大鼠20只,饲喂含二乙基亚硝胺(DEN)饲料建立SD大鼠SHCs增殖模型.分离、培养、鉴定(电镜、免疫细胞化学)原代SHCs.SHCs行PKH26膜荧光染色.将实验用同一近交系SD大鼠30只随机平均分成空白对照组(B)、损伤造模组(M)和SHCs移植组(T).B组腹腔注射生理盐水.M组、T组腹腔注射CCk.24 h后戊巴比妥腹腔麻醉,消毒开腹.M、T组行2/3肝切,B、M组门静脉注入生理盐水,T组门静脉注入经膜荧光标记SHCs悬液.4周后.采血测血清谷丙转氨酶(ALT)、谷草转氨酶(AST),并取病理标本做冰冻切片荧光显微镜下观察及HE染色普通光镜下观察.结果 电镜下观察可见SHCs表面少量短而小的微绒毛突起,核浆比例高.呈现未分化细胞的形态.免疫细胞化学观察SHCs胞质AFP、CK-19染色呈棕黄色阳性信号.SHCs移植可以显著降低CCl4+2/3PH致肝损伤血清ALT、AST水平,可以明显改善CCl4+2/3PH致肝损伤肝脏病理改变.T组冰冻切片荧光显微镜下可以观察到由SHCs分化的肝细胞形成的肝板结构.结论 SHCs移植对CCl4+2/3PH所致急性肝损伤有一定治疗作用.     

骨髓间充质干细胞和骨髓单个核干细胞移植治疗大鼠心肌梗死的对比研究

目的观察髓间充质干细胞（MSCs）和骨髓单个核干细胞（BMMNCs）移植对急性心肌梗死后大鼠左心功能的影响及存活情况,比较两种干细胞移植的优劣性。方法雌性Lewis大鼠45只按随机抽签法分3组：对照组、MSCs组、BMMNCs组。结扎前降支制备心肌梗死模型,MSCs组和BMMNCs组均注射等数量（2×10^6）雄性MSCs和BMMNCs,对照组注射等体积的培养基。4周后超声检测左心功能、左心室前壁厚度,免疫原位杂交检测雄性鉴别基因sry片段的表达。结果MSCs组和BMMNCs组与对照组相比：左心室射血分数分别增加22．57％、24．09％（P=0．000）,MSCs组和BMMNCs组之间比较,差异无统计学意义（P〉0．05）;左心室前壁厚度增加（2．6±0．5）mm和（2．5±0．3）mm对（1．8±0．4）mm（P=0．000）;免疫原位杂交显示MSCs组与BMMNCs组sry表达阳性,对照组阴性。阳性细胞的数量相比较,BMMNCs组高于MSCs组（66．50±6．59比46．67±4．64,P=0．000）。结论MSCs和BMMNCs移植均能改善大鼠急性心肌梗死后左心功能,减轻左心室重构;移植4周后在受体心肌内存活干细胞数量BMMNCs优于MSCs。     

老年腰椎间盘突出症患者单纯椎间植骨融合与金属椎间融合器植入的远期疗效比较

目的 比较金属椎间融合器（Cage）植入术与椎间植骨融合术在老年腰椎间盘突出症患者术后椎间稳定性的临床效果。方法 28例腰椎间盘突出老年患者在椎间盘摘除后,15例19个椎间隙采用Cage植入（A组）;13例17个椎间隙采用单纯椎间植骨融合术（B组）。随访比较术后1周、6个月、24个月各患者X线片及C T片,测量施术节段椎间高度变化,评估两种方法的椎间稳定性。结果 术后6个月A组在维持椎间隙高度方面强于B组;术后24个月A组较B组椎间隙高度低;B组2年后融合率（88．24％）大于A组（84．21％）;其差异均有统计学意义（ P ＜0．05）。结论 术后6个月之内Cage植入术对腰椎稳定性效果优于单纯椎间植骨融合术;但其的远期效果较差。     

骨髓源性多巴胺前体细胞移植治疗帕金森病模型鼠

目的 探讨骨髓基质干细胞(BMSCs)诱导分化为多巴胺(DA)能前体细胞后移植治疗帕金森病(PD)模型鼠的疗效及作用机制.方法 将纯化的BMSCs诱导为DA前体细胞,免疫荧光染色和流式细胞仪检测TH阳性细胞的表达及百分比.将PD大鼠模型随机分为3组,分别注入诱导、未诱导的BMSCs和生理盐水于模型鼠右侧纹状体区.干预后观察行为学的变化,免疫荧光鉴定以及高效液相色谱检测腑内DA含量的变化.结果 诱导后可见TH阳性细胞,且比例可达10.3%.移植治疗6周后诱导组旋转次数变化多于未诱导组(P<0.05)和生理盐水组(P<0.01);诱导组可见BrdU/TH、BrdU/NSE双标阳性的细胞,未诱导组只见BrdU/GFAP双标细胞;BMSCs诱导组DA脑内含量明显高于未诱导组和生理盐水组(P<0.05),而后两组差异无统计学意义(P>0.05).结论 BMSCs诱导为DA前体细胞移植治疗PD模型的疗效总体好于未诱导的BMSCs组和生理盐水组.     

中国手外科发展历程

中国手外科事业的开拓者和奠基人——王澍寰院士首先创建了手外科专业,他不断创新技术,并培养了一批手外科人才。之后,京、津、沪三地相继建立手外科专业。1978年以后的中国大地迎来了手外科医学的春天,出版了中国第一部手外科专业经典——《手外科学》。1984年,中华医学会骨科分会成立了手外科学组,1994年改名为中华医学会手外科学会。1985年,《手外科杂志》正式创刊,1993年升格为《中华手外科杂志》。同期的临床工作中,断肢(指)再植成活率不断提高。在断肢再植、足趾移植及皮瓣移植之后,又出现了前臂皮瓣(杨果凡)、手再造(于仲嘉)及健侧颈7移位(顾玉东)手术。1999年9月,南方医院裴国献教授成功地开展了2例异体肢体移植(世界第3、4例)。中国手外科的历史进程虽然不长,但成就斐然,相信中国手外科事业今后一定会有更快的发展,一定会取得更大的成就。     

Intensive care management of paediatric organ donors and its effect on post-transplant organ function

Objectives 1. To document the clinical course of paediatric beating heart organ donors. 2. To evaluate the effect of the ICU management of pediatric donors on the immediate function of transplanted organs. 3. To examine the validity of current donor selection criteria.Design Retrospective chart review and case series study.Setting Multidisciplinary ICU of tertiary referral paediatric hospital.Patients All patients who became solid organ donors between January 1980 and July 1990.Outcome Measures 1. Incidence of major physiological abnormalities of the cardiovascular, pulmonary, renal and metabolic systems. 2. Number of organs retrieved and transplanted, reasons for non-translantation of donated organs. 3. Immediate post-transplant function of transplanted organs.Results Seventy-seven organ donors were identified from whom 134 kidneys, 31 livers and 12 hearts were transplanted. Sixty (78%) patients developed diabetes insipidus. Sustained hypotension occurred in 41 (53.2%) and was commoner in patients treated with inotropic agents in the presence of a low central venous pressure and in patients with diabetes insipidus who did not receive anti-diuretic hormone replacement. Twenty-seven patients suffered at least one cardiac arrest. The data on post-transplant function were obtained for 129 kidneys (from 70 donors) 30 livers and 9 hearts. Fifty-two kidneys, 10 livers and 2 hearts were transplanted from donors who had suffered at least one cardiac arrest without apparent adverse effect on post-transplant organ function. Thirty-six kidneys from 31 donors suffered either acute tubular necrosis (ATN) or primary non-function. The donors of these organs spent longer in ICU (60.6±45.7 h versus 41.8±30.1 hp=0.045) and had a higher mean maximum serum sodium concentration (163.4±10.9 versus 158.5±9.5 mmol/lp=0.05) than those without these complications. The serum creatinine concentration and degree of inotropic support did not predict post-transplant function. Standard biochemical tests for hepatic function, the dose of inotropic agent received, time in ICU and incidence of hypotension did not predict post-transplant liver function.Conclusions Aggressive fluid resuscitation and management of diabetes insipidus may promote stability in paediatric organ donors. Donor cardiac arrest does not alter the ICU course or compromise post-transplant organ function. The current criteria used for donor selection failed to predict post-transplant organ function and their use may increase organ wastage.