降低自体造血干细胞移植后肿瘤复发的策略

大剂量化疗联合自体造血干细胞移植(AHSCT)的临床应用日益增多,现已成为多种血液病及实体瘤的有效治疗措施。与异基因移植相比,行AHSCT治疗后疾病复发率较高,其主要原因有:(1)缺乏异基因移植的移植物抗肿瘤(GVT)效应;(2)自体移植物中污染的肿瘤细胞再植入,这已被基因示踪实验技     

自体造血干细胞移植物的免疫净化研究及进展

自体造血干细胞移植(autologous stem cell transplantation,ASCT)是保证大剂量化疗和放疗安全用于治疗恶性肿瘤的有效措施.但不论是自体骨髓移植还是自体外周血干细胞移植,移植物中残留肿瘤细胞对移植后复发和总体治疗疗效均有直接影响.因此如何清除移植物中污染的肿瘤细胞成为研究热点之一.目前应用的体外净化的方法较多,主要有物理学(高温、冷冻、微波、光等)、化学(各种化疗药物)、生物学(长期液体培养、反义技术、蛋白酪氨酸激酶抑制物)、免疫学等方法.本文就近年来免疫净化方法(immunologic purging)的研究作一简要综述.     

抗CD20单抗在致敏受者异基因造血干细胞移植中的应用

目的:探讨抗CD20单抗(美罗华)在致敏受者造血干细胞移植预处理中应用后的脱敏效果。方法:5例致敏患儿中3例在造血干细胞移植预处理前应用美罗华。对比观察脐血移植后造血重建、供受体DNA短串联重复序列多态性分析嵌合度及有无移植物抗宿主病(GVHD)发生。结果:5例患儿造血干细胞移植后造血完全重建,编号2(未用美罗华)造血重建时间(造血干细胞移植后65 d)明显晚于预处理前使用美罗华患儿(编号3、4、5);其中2例出现血小板植入延迟,编号1(未用美罗华)血小板植入时间较编号4(经美罗华处理患儿)明显延长;5例供受体稳定嵌合;编号1(未用美罗华)出现极重度a GVHD,造血干细胞移植前应用美罗华患儿未出现或仅出现轻至中度a GVHD,编号4出现轻度c GVHD,累及胃肠道,经FK506调整后已明显好转。目前随访中位时间7.5个月,病情稳定。结论:美罗华在致敏受者异基因造血干细胞移植前应用对降低敏感性有一定疗效。     

恶性淋巴瘤自体造血干细胞移植的预处理进展

自体造血干细胞移植(ASCT)是治疗恶性淋巴瘤(ML)的重要手段之一,近年来大剂量化疗联合ASCT治疗ML的临床研究报道越来越多[1].预处理是ASCT的重要环节,是指在造血干细胞回输之前对患者进行大剂量化疗和(或)放疗及免疫抑制治疗,进一步清除患者体内肿瘤细胞,为造血干细胞回输做准备.预处理在杀伤肿瘤细胞的同时会对机体正常细胞产生杀伤作用,也就是预处理相关毒性.     

自体造血干细胞移植患者并发症分析及护理

自体造血干细胞移植(autologous hematolpoietic stem celltransplantation,ASCT)是近10多年发展起来的、用于治疗血液恶性肿瘤和其他恶性肿瘤的一种新方法,其原理是应用超大剂量的化疗或(和)放疗(预处理),以最大限度地杀伤体内残留的肿瘤细胞,摧毁异常的免疫机制,然后移植已采集保存的自体造血干细胞,重建患者的造血和免疫功能。ASCT的预处理方案与常规化疗有许多不同之处,在整个治疗过程中患者将承受较大的生理变化和心理压力[1]。所以,治疗期间并发症的预防及全方位的护理对治疗成功起到很重要的作用。我院1996~2006年共进行ASCT 20…     

自体造血干细胞移植的免疫净化研究及进展

自体造血干细胞移植 (ａｕｔｏｌｏｇｏｕｓｓｔｅｍｃｅｌｌｔｒａｎｓｐｌａｎｔａ ｔｉｏｎ ,ＡＳＣＴ)是保证大剂量化疗和放疗安全用于治疗恶性肿瘤的有效措施。但不论是自体骨髓移植还是自体外周血干细胞移植 ,移植物中残留肿瘤细胞对移植后复发和总体治疗疗效均有直接影响。因此如何清除移植物中污染的肿瘤细胞成为研究热点之一。目前应用的体外净化的方法较多 ,主要有物理学 (高温、冷冻、微波、光等 )、化学 (各种化疗药物 )、生物学 (长期液体培养、反义技术、蛋白酪氨酸激酶抑制物 )、免疫学等方法。本文就近年来免疫净化方法 (ｉ…     

亲缘间外周血异基因移植后白血病复发的危险因素分析

目的 分析急慢性白血病患者行亲缘间、外周血异基因造血干细胞移植（Allo-HSCT）后复发的危险因素。方法 选取2016年1月至2020年10月期间行Allo-HSCT的62例白血病患者为研究对象,其中急性髓系白血病（AML）30例,急性淋巴细胞白血病（ALL）24例,慢性粒细胞白血病（CML）8例。造血干细胞来源均为亲缘供者外周血,给予改良BU/CY±ATG清髓性预处理方案,统计移植后疾病复发情况,分析复发的危险因素。结果 随访至2021年10月,中位随访时间为38(12～52)个月,共20例患者复发,总体复发率为32.3%(20/62),其中,AML复发率为33.3%(10/30),ALL复发率为37.5%(9/24),CML复发率为12.5%(1/8)。单因素分析显示,移植后复发的发生与患者性别、年龄、疾病类型、血型、人类白细胞抗原（HLA）配型、初诊时伴髓外病变、急性移植物抗宿主病（aGVHD）的发生、巨细胞病毒（CMV）感染无明显关系（P>0.05）;与移植前微小残留病（MRD）水平、慢性移植物抗宿主病（cGVHD）的发生有关,移植前MRD阳性、移植后未并发cGVHD患...     

口服供者脾细胞诱导成年大鼠皮肤移植物存活期延长

目的 :观测口服供者脾细胞后受者大鼠皮肤移植物的存活时间 ,并探讨口服耐受的形成机制 .方法 :以纯系SD大鼠为供者 ,纯系Wistar大鼠为受者 ,行异体皮肤移植 ,将 2 0只受者大鼠随机分成 2组 :A组为对照组 ,单纯作皮肤移植 ;B组为口服抗原组 ,本组于皮肤移植前 7d始每日接受供者脾细胞 5× 10 7个 ,导管灌胃 ,7d后观察体外混合淋巴细胞培养(MLC)、体内的迟发型超敏反应 (DTH) ,并行皮肤移植 ,观察移植皮肤的存活时间 .结果 :口服抗原后 ,体外混合淋巴细胞培养及体内的DTH反应均出现明显的抗原反应性降低 ,口服抗原组的移植皮肤存活时间达到 (15 8± 1 3 )d ,而对照组为(4 9± 0 1)d ,两组差异显著 (P <0 0 1,n =10 ) .结论 :口服抗原可以引起受者对异基因抗原的特异性免疫反应降低 ,能使受者的皮肤移植物存活期延长     

裸鼠移植瘤造模的注意事项

正答:1.实验要严格遵照无菌操作原则,所有手术器械和物品要在使用前严格消毒灭菌,且实验要在超净工作台内完成;2.皮下移植瘤、手术切除的肿瘤组织、培养的肿瘤细胞等移植物要快速进行处理及移植,尽可能在2h之内完成,为防止污染,可使用少许抗生素;3.肿瘤细胞株皮下接种时要取对数生长期细胞,活细胞数大于95%,用无血清的培养基、PBS或生理盐水调整细胞浓度,制备成所需的细胞悬液,每只小鼠接种体积通常为0.1-0.2 mL;4.肿瘤细胞株皮下移植的部位较多,可选择接种皮肤松弛、血供良好、肿瘤生长后圆整度好、且易于实     

局部应用肝细胞生长因子对静脉移植物内膜增生的影响

目的:探讨局部应用肝细胞生长因子静脉移植物内膜增生的影响。方法:取犬一侧颈外静脉,对半剪成两段后分别吻合在双侧股动脉上,其中一侧静脉移植物在移植前用肝细胞生长因子处理(实验组),另一侧为单纯的静脉移植(对照组)。术后2周、4周分别切除移植静脉,计算机图像分析系统测量和计算内膜厚度、内膜面积,进行扫描电镜检查,用免疫组织化学方法检测静脉移植物平滑肌细胞增殖细胞核抗(PCNA)的表达。结果:实验组静脉移植物术后2周、4周内膜厚度和内膜截面积明显低于对照组(P<0.01)。实验组静脉移植物术后2周、4周的PCNA指数也明显低于对照组(P<0.01;P<0.05)。扫描电镜检查显示实验组静脉移植物内皮层破坏程度轻于对照组。结论:局部应用肝细胞生长因子能抑制静脉移植物内膜的增生。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.