子宫内膜异位症子宫内膜及输卵管细胞对鼠胚胎发育的影响

目的探讨子宫内膜异位症(内异症)子宫内膜及输卵管上皮细胞对小鼠胚胎体外发育的影响。方法小鼠2细胞期胚胎202个与卵巢巧克力囊肿患者术中切除的子宫内膜及输卵管上皮细胞共培养(实验组),314个与非卵巢巧克力囊肿患者子宫内膜及输卵管上皮细胞共培养作为对照。结果体外培养72~96h后,与对照组输卵管上皮细胞及子宫内膜共培养时有25.7%和26.2%的2细胞期胚胎发育到扩张期囊胚,与实验组输卵管上皮细胞共培养有25.9%发育到扩张期囊胚,二者无显著差异(P>0.05),而子宫内膜仅为11.1%,二者有显著差异(P<0.05)。结论内异症患者的输卵管上皮细胞对鼠早期胚胎体外发育无影响;子宫内膜对胚胎发育有明显的抑制作用,这可能与内异症的生育率降低有关。     

泌尿系子宫内膜异位3例

例 1　 31岁。因右腰部间歇性疼痛 8年于 1 999年 1 2月 7日入院。 8年前因右肾绞痛 ,经对症治疗而愈。腰痛多发生在月经前后及经期 ,无血尿。在当地医院行静脉尿路造影示右肾不显影。入院后大剂量静脉造影 ,未见阳性结石影 ,左肾输尿管显影正常 ,右肾区见团状造影剂 ,范围 5.0 cm× 3.5cm,肾盂膨大呈喇叭状 ,其延续隐约可见右输尿管中上段淡影 ,横径约 2 .0 cm。右侧逆行插管造影 :肾盂呈卵圆形约 5.5cm× 3.5cm大小 ,输尿管中上段呈梭形增粗 ,宽处达 2 .0 cm,下段近膀胱处有一鸟嘴样狭窄 ,长 1 .5cm。 B超 :右肾盂分离扩张 4.6cm,未见强…     

沙利度胺联合血府逐瘀胶囊治疗血管炎

目的:评价沙利度胺联合血府逐瘀胶囊治疗血管炎的效果。方法:选取血管炎患者54例,随机分成2组。观察组口服沙利度胺、血府逐瘀胶囊。对照组口服泼尼松、雷公藤多甙片。以14 d为1个疗程,共3个疗程。结果:两组均有良好的疗效,观察组临床有效率为96.6%,对照组为92.0%,,两组均明显缓解关节疼痛、改善炎症状态及减少尿蛋白排泄。与对照组相比,观察组肝功能异常的发生率减少(P0.05),失眠患者的睡眠情况改善明显。结论:沙利度胺联合血府逐瘀胶囊治疗血管炎疗效明显,副作用较传统疗法少。     

沙利度胺对大鼠慢性移植物血管病的保护作用

目的探讨沙利度胺对大鼠慢性移植物血管病的保护作用。方法实验分为4组：同种移植对照组,供、受者均为Lewis大鼠,无特殊处理;异种移植对照组,Lewis大鼠接受Brown-Norway（BN）大鼠腹主动脉移植（BN-Lewis）;沙利度胺小剂量组（50mg·kg-1·d-1,BN-Lewis）;沙利度胺大剂量组（100mg·kg-1·d-1,BN-Lewis）。于移植后60d取移植动脉,分别进行组织病理学观察、测量内膜厚度,免疫组织化学法和蛋白质印迹法检测TNF-α及上皮细胞增殖细胞核抗原（PCNA）在移植动脉中的表达。结果同种移植对照组移植动脉形态正常;异种移植对照组移植动脉呈移植物血管病表现,血管内膜增厚;沙利度胺小剂量及大剂量组移植动脉呈内膜炎改变,内膜厚度比异种移植对照组减小（P〈0．05）。与异种移植对照组相比,沙利度胺小剂量组和大剂量组移植动脉TNF-α及PCNA蛋白表达量降低（均P〈0．05）。结论沙利度胺能降低移植动脉TNF-α及PCNA蛋白的表达,缓解移植动脉的纤维化进程以及内膜增生,对慢性排斥反应所致的移植物血管病具有抑制作用。     

不同气腹压力对子宫内膜异位症模型异位病灶超微结构的影响

目的观察不同气腹压力对大鼠子宫内膜异位症模型异位病灶超微结构的影响。方法SD大鼠子宫内膜腹膜自体移植制成子宫内膜异位症模型,造模成功后随机分为对照组、10mmHg气腹组和20mmHg气腹组（每组10只）,作用时间1h,手术结束后1周取子宫内膜异位灶行电镜检查,观察异位病灶腺上皮细胞凋亡和其他细胞器超微结构改变。结果对照组异位灶腺细胞结构良好,基质细胞排列整齐,微绒毛正常。10mmHg和20mmHg气腹组均有异位灶腺细胞染色质边集,线粒体嵴消失,线粒体肿胀明显;微绒毛减少或消失,细胞连接缝隙增宽断裂,基底层细胞排列紊乱。与10mmHg比较,20mmHg气腹组异位灶各细胞器受损程度相对严重。结论CO2气腹可导致子宫内膜异位灶细胞超微结构破坏,20mmHg气腹组对其损伤作用大于10mmHg组。     

异位子宫内膜细胞增殖及增殖动力学研究

目的　探讨异位内膜细胞的增殖特性及增殖动力学。　方法　对 1 0例异位内膜组织 (试验组 )及 1 0例正常内膜组织 (对照组 )进行原代培养 ,采用免疫细胞化学检测两组内膜 ki-67表达 ,采用流式细胞术检测两组细胞的细胞周期。　结果　 ( 1 )异位内膜腺上皮细胞的 ki-67积分 ( 4.2 0± 0 .55)与正常内膜腺上皮细胞 ( 3 .90± 0 .70 )相当 ( P>0 .0 5)。异位内膜间质细胞 ki-67积分 ( 2 .92± 0 .58)与正常内膜间质细胞 ( 2 .60± 0 .3 7)相当 ( P>0 .0 5)。( 2 )异位内膜 G0 / G1、G2 / M、S期的比例分别为 ( 78.1 4± 3 .51 ) %、( 1 1 .53±2 .1 8) %、( 1 0 .3 2± 1 .72 ) %与正常内膜 ( 79.2 7± 2 .49) %、( 1 1 .53± 1 .43 ) %、( 9.2 0±1 .66) %相似 ( P>0 .0 5)。　结论　 ( 1 )异位内膜细胞并非高度增殖 ;( 2 )本实验提示异位内膜细胞的细胞周期可能受到了正常的调控     

彩超诊断腹壁子宫内膜异位1例

患者女,27岁,3年前行剖宫产手术。1年前出现月经来潮时下腹部切口瘢痕处疼痛,经后疼痛缓解,近日经期及经后下腹部疼痛加重,并能触及一包块。超声所见：子宫前位,轮廓清,大小、形态正常,肌层回声均匀,内膜厚度0·6 cm,宫内见节育器回声。     

沙利度胺对原发性肝癌介入栓塞术后血管生长因子的影响

目的 本研究旨在评价沙利度胺对原发性肝癌介入栓塞术后血管生长因子的影响,探索以介入治疗为主的中晚期肝癌的综合治疗模式.方法 以肝动脉栓塞术前1周内及术后30天血管内皮生长因子水平为观察终点指标,并观察沙利度胺的不良反应.采用前瞻性随机对照研究,对2006年2月～2006年8月就诊我科的68例原发性肝癌患者随机分为治疗组和对照组,治疗组给予沙利度胺200 mg/d口服1～6个月联合TACE,对照组单纯行TACE.TACE用药选用吉西它滨0.4～1.6 g、奥沙利铂100～200 mg、氟脲嘧啶脱氧核苷 0.5～1.0 g, 栓塞剂选用碘化油、明胶海绵.以双抗夹心ELISA法检测血VEGF水平.结果 介入治疗后两组患者的VEGF水平均有升高,但联合沙利度胺组VEGF升高幅度明显低于单纯介入栓塞组,两组有显著性差异(P《0.05).结论 口服沙利度胺可降低原发性肝癌介入栓塞术后的血管内皮生长因子水平,提示沙利度胺联合TACE可能进一步提高原发性肝癌介入栓塞治疗的效果.     

卵巢子宫内膜异位囊肿破裂14例分析

卵巢子宫内膜异位发囊肿破裂,国内80年代开始相继有报道[1]。近年子宫内膜异位症的发病率明显增加[2],卵巢子宫内膜异位囊肿破裂已不是妇科罕见的急腹症。现将我院经腹腔镜或开腹手术证实为卵巢子宫内膜异位囊肿破裂的14例病例报告如下。1临床资料1.1一般情况:选取我院2000年9月～2005年9月收治的卵巢子宫内膜异位囊肿破裂病例,共14例。年龄27～47岁(平均33.8岁)。2例未婚,6例婚后3年不孕,3例有阴道分娩史,1例有剖宫产史,2例有人工流产史。均未放置宫内节育器。11例有痛经史,占78.6%。有2例曾被诊断为卵巢子宫内膜异位囊肿。1.2临床表现:发…     

Growth of human tumor xenografts in nude mice and mice with severe combined immunodeficiency (SCID)

Twenty-three fresh tumor specimens obtained at surgery and 5 serially transferable human tumor xenografts were implanted subcutaneously into nude mice and mice with severe combined immunodeficiency (SCID) to compare the take rates of the fresh surgical specimens and the growth rates of the transferable strains. The overall take rates were 65% for the SCID mice and 60% for the nude mice, without any significant difference, although colon carcinoma seemed to have higher acceptance in the SCID mice with a take rate of 6/8. All the serially transferable strains were successfully accepted in the SCID mice, their growth rates being essentially identical to those in the nude mice. These results indicate that the SCID mouse can be used as a human tumor xenograft-mouse system as well as the nude mouse.     

Establishment and characterization of human urothelial cancer xenografts in severe combined immunodeficient mice

AIM: To establish and characterize a murine xenograft model of human urothelial cancer in severe combined immunodeficient (SCID) mice for therapeutic simulation. METHODS: Pieces of 30 freshly resected urothelial tumors (24 obtained from bladder and 6 from ureter or pelvis) were implanted subcutaneously into SCID mice, and xenograft tumors were passed in tumorigenic cases. At each passage, histopathology, TP53 mutational status assessed by yeast p53 functional assay, and the Ki-67 labeling index (LI) were examined to evaluate the preservation of original features. A growth delay assay after single-dose irradiation was performed in four representative xenografts. RESULTS: Tumor growth was observed in 18 mice (60%, 18/30). Histologically, 15 of the 18 were epithelial carcinomas similar to the original tumors, whereas the other 3 were Epstein-Barr virus-associated lymphoproliferative disease, resulting in a 50% (15/30) take rate. No correlation was found between the tumor take rate and the clinicopathologic features, TP53 mutational status, or Ki-67 LI of the patients' tumors. Of these 15 xenografts, 11 xenografts were passed from 3 to 10 generations. TP53 mutational status remained stable during the passages, and the Ki-67 LI of eight xenografts was within a range of 50% of the LI of the original tumors, although the other three xenografts increased by over 50%. Specific growth delay after irradiation, independent of the original tumor growth speed and Ki-67 LI, was observed in four xenografts. CONCLUSIONS: SCID mice are useful recipients for investigations of human urothelial cancer with a wide biological range. This easy-to-handle xenograft system can help to develop a better in vivo preclinical evaluation system for therapeutic agents as well as the investigation of tumor pathophysiology.     

腹腔镜联合药物治疗中重度子宫内膜异位症合并不孕症的临床分析

目的:探讨腹腔镜联合药物治疗中重度子宫内膜异位症伴不孕的临床价值。方法:对78例Ⅲ~Ⅳ期子宫内膜异位症伴不孕症在腹腔镜下行卵巢子宫内膜异位囊肿剔除术,粘连分离术,异位病灶电凝术,输卵管造口术及输卵管通液术。术后随机分为三组,A组28例未用药物治疗,B组23例内美通治疗三月,C组27例诺雷德治疗三月。比较三组患者术后复发、妊娠结局及用药副作用情况。结果:本组患者术后均病理诊断证实为子宫内膜异位症。至随访时,A、B、C组术后妊娠率分别为17.86%、30.43%、44.44%,复发率分别为32.14%、17.39%、14.81%。B、C组比A组的妊娠率高,而复发率低(P<0.05)。B组患者的副反应以高雄激素症状为主,C组患者的副反应以低雌激素所至围绝经期征候为主,均于停药后恢复。结论:应用腹腔镜可诊断各期内膜异位症及其引起不孕症的盆腔因素;腹腔镜手术治疗可提高内膜异位症患者的妊娠率。在腹腔镜术后加用抑制卵巢功能药物对提高妊娠率、降低复发率有重要作用。     

Laparoscopic management of bowel endometriosis: predictors of severe disease and recurrence

Background and Objectives:

The identification of high-stage and recurrent cases of bowel endometriosis is critical, because these cases require careful surgical planning. We aim to describe the clinical characteristics of women with bowel endometriosis, our principles in laparoscopic management of this pathology, and to identify predictors of severe disease and recurrence.

Methods:

This was a retrospective study of 193 patients with pathologically confirmed bowel endometriosis.

Results:

Predictors of higher-stage endometriosis include a history of previous laparoscopic surgery (P=.04) and a presenting complaint of abnormal uterine bleeding (P=.01). The higher the stage of endometriosis, the more likely there would be coexistent urinary tract endometriosis (P=.02), a need for enterolysis (P=.002), ovarian cystectomy (P<.001), and bowel resection (P=.01) performed during laparoscopy. Patients with higher body mass index (BMI) had significantly higher recurrence rates of endometriosis compared to those with lower BMI (P=.002). Within our cohort, 87% of our patients achieved amelioration of symptoms by the end of the first postoperative month.

Conclusions:

Our study confirms that laparoscopic management of bowel endometriosis is safe and effective. We found 2 statistically significant predictors of higher-stage disease that should prompt careful surgical planning. Obesity is associated with a higher rate of recurrence of endometriosis.     

反应停对人肝细胞癌生长侵袭的作用

目的 观察反应停对人肝细胞癌（HCC）血管生成和肿瘤生长侵袭的干预作用。方法 建立高转移潜能人肝癌裸鼠肝原位移植模型，随机分成4组。各组模型自建立次日起分别经腹腔注射0．5％羧甲基纤维素钠（CMC）、反应停（200mg／kg体重）、紫杉醇（13mg／kg体重）、反应停（200mg／kg体重）＋紫杉醇（13mg／d）。给药第30天处死裸小鼠，观察肿瘤生长、转移情况，分别用免疫组织化学和半定量逆转录．聚合酶链反应（RT—PCR）的方法检测癌组织CD34和血管内皮生长因子（VEGF）mRNA的表达并记录微血管密度（MVD）。结果 反应停组肿瘤重量、体积均与空白对照组差异无统计学意义（P〉0．05）。各药物处理组肺转移灶计数、MVD和VEGF均低于对照组，以联合用药组最为显著。结论 反应停对HCC生长无明显抑制作用，但能抑制肿瘤血管生成并降低肺转移。     

荷人膀胱癌严重联合免疫缺陷鼠自发性转移模型的建立

目的建立荷人膀胱癌SCID鼠模型并观察其自发性转移情况。方法体外侵袭筛选膀胱癌细胞株T24,完成三次筛选的子代细胞记作T24-3;选取24只雌性SCID鼠,随机分为膀胱原位模型组和皮下异位模型组各12只,原位模型组采用酸预处理膀胱黏膜经尿道灌注3×106个T24-3细胞,同样剂量细胞注射接种于异位模型组鼠右后肢内侧皮下。通过成瘤性试验及鼠外周血中细胞角蛋白20（CK20）mRNA RT-PCR检测判定肿瘤模型及自发转移的发生。结果膀胱原位组64%成瘤,皮下组100%成瘤,肿瘤组织病理类型为移行细胞癌;且至6周膀胱原位组部分鼠出现肉眼可见多处远隔转移灶;不同周次部分鼠外周血中表达人CK20mRNA,至6周分别为5/11例和4/12例阳性表达。结论用经过侵袭筛选的高转移亚群T24-3细胞,行原位或异位种植可以成功制备荷瘤SCID鼠模型,并实现自发性转移。     

Complex nature of the human antisperm antibody response in SCID mice

Human peripheral blood mononuclear (PBMs) cells were introduced into the peritoneal cavity of severely‐combined immunodeficient (SCID) mice in concentrations of 2.5–4.0 × 10⁷ cells per mouse. Whole mononuclear cell suspensions were used either unstimulated or following primary in vitro culture with human spermatozoa. In some experiments, immunodepletion of CD8⁺ cells was carried out prior to grafting. Lymphocytes were obtained from nonsensitized (to antigen) human subjects or from individuals who were primed in vivo (vasectomized individuals in case of sperm antigens). An enzyme‐linked immunosorbent assay was employed to assess total human immunoglobulin (G or M) levels as well as the specificity of the antibodies generated. We have been successful by generating primary and secondary immune responses with ‘naïve’ human lymphocytes, challenged with chlamydia or ovalbumin but without adjuvant or CD8⁺ immunodepletion; however, we were unable to induce specific antibodies to spermatozoa under this regime in SCID male mice. We then employed female SCID mice, treated with sperm antigen extracts (glycosylated or deglycosylated) encapsulated in liposomes and human lymphocytes obtained from ‘naïve’ or pre‐sensitized in vivo subjects. It was found that the most pronounced humoral response to sperm antigens was obtained with deglycosylated antigens and PBMs from vasectomized (in vivo pre‐primed to spermatozoa) individuals. A presented SCID mice model can be helpful at understanding of antisperm antibody development and the molecular nature of generated antibodies to modified sperm antigenic entities.     

A severe Whipple disease with an immune reconstitution inflammatory syndrome: An additional case of thalidomide efficiency

We report the case of a 38-year-old man who presented with severe diarrhea, weight loss of 10 kg, ankles paresthesia and severe motor weakness in the left fibular nerve territory after introduction of azathioprine and corticosteroid for proteinuria. Coloscopy and gastroscopy revealed a typical aspect of Whipple disease (WD), associated with both positive PAS staining and specific immunohistochemistry. T. whipplei PCR results were positive in blood, faeces, saliva and duodenal biopsy specimens. Diagnosis of WD with systemic manifestations was retained and doxycycline plus hydroxychloroquine therapy were started. This treatment improved joint pain, and skin and intestinal symptoms. One month later, our patient presented with fever and an important inflammatory syndrome (CRP 150 mg/dL and 16.8 10⁹/L leukocytes), while no infection was found despite a thorough review. We concluded it was an immune reconstitution inflammatory syndrome (IRIS). Manifestations persisted despite increasing corticosteroids and thalidomide (200 mg/day) was introduced with good efficacy on these symptoms. WD may be revealed by non-specific symptoms such as weight loss or arthralgia, but also by many other misleading signs. Our observation illustrates the highly polymorphic clinical presentation of WD, and the diagnostic difficulties that may arise. This is also a new report of thalidomide effectiveness in IRIS in WD.     

Rat hepatocyte engraftment in severe combined immunodeficient x beige mice using mouse-specific anti-fas antibody

BACKGROUND: Hepatocyte transplantation holds promise as a treatment for acute and chronic liver failure; however, robust model systems needed to study xenogeneic hepatocyte transfer are lacking. Severe combined immunodeficient x beige (SCID/bg) hybrid mice readily accept foreign tissue. Repopulation of C.B-17 SCID/bg mouse liver with rat hepatocytes was studied following induction of mouse hepatocyte apoptosis using an anti-mouse agonistic fas monoclonal antibody (Jo2 mAb) that does not engage xenogeneic fas. METHODS: SCID/bg mice were transplanted with 1 x 10(6) fresh adult rat hepatocytes intrasplenically and treated with various doses, routes and frequencies of Jo2 mAb. Rat cell repopulation was characterized by quantitative immunofluorescent antibody (q-IFA) staining specific for rat dipeptidyl peptidase type IV (DPP-IV) and leucine amino peptidase, amplification of rat genomic DNA using polymerase chain reaction and histopathological and serum biochemistry analyses. RESULTS: Analysis of liver sections from mice treated twice weekly for 12 weeks with 0.4 mg/kg Jo2 mAb intraperitoneally consistently demonstrated >50% rat hepatocytes in the parenchymal mass by q-IFA. Rat hepatocyte engraftment protected mice from Jo2 mAb-mediated liver hemorrhage and hepatocyte apoptosis. Serum liver enzyme levels did not increase in Jo2 mAb-treated mice that were highly engrafted with rat hepatocytes, in contrast to matched non-engrafted mice. At 12 weeks post-engraftment, minimal fibrosis and inflammation were apparent and liver architecture had returned to near normal. Jo2 mAb did not induce histopathological abnormalities in other tissues known to express fas antigen (i.e. heart, lung). CONCLUSIONS: This novel model represents a simple and robust system of xenogeneic hepatocyte transplantation that could be applied to studies of liver biology, regeneration and hepatocyte transplantation.     

腹腔镜术后联合米非司酮治疗子宫内膜异位症临床研究

目的：探讨腹腔镜术后联合低剂量米非司酮治疗子宫内膜异位症周期及临床疗效。方法选取我院收治的66例子宫内膜异位症患者作为研究对象,随机均分为A、B、C三组,A组采用腹腔镜术后米非司酮治疗,B组采用术后孕三烯酮胶囊治疗,C组术后不予以任何辅助药物治疗,比较三组1年内复发率、缓解率、妊娠率、月经恢复时间及排卵恢复时间。结果三组缓解率差异比较无统计学意义（P＞0.05）,复发率及妊娠率比较差异有统计学意义（P＜0.05）;A组复发率明显低于B组及C组,妊娠率高于B组及C组,差异有统计学意义（P＜0.05）;A组及C组月经恢复时间及排卵恢复时间明显短于B组,差异比较有统计学意义（P＜0.05）。结论采用腹腔镜术后联合低剂量米非司酮短期疗法治疗子宫内膜异位症有助于缩短月经及排卵恢复时间,提高受孕率,降低复发率,临床疗效显著,值得在临床上推广应用。