思维导图对肝移植患者依从性的临床应用价值

目的:思维导图作为一种思维工具,被广泛应用于医学研究方面。本研究主要探讨思维导图对肝移植患者依从性的临床应用价值。方法:选择2010年6月至2012年9月在我院接受肝移植手术的患者100例,按手术时间进行编号,使用随机数字表将患者分为试验组和对照组,每组各50例,对照组应用常规健康教育模式,试验组应用思维导图方法宣教。采用调查问卷就肝移植患者依从性进行调查,比较两组患者问卷调查及质量评定的结果。结果:两组患者出院时依从性比较,服药、饮食、生活习惯、锻炼四个方面均没有统计学差异(P0.05),自我监测护理在出院时两组患者有统计学差异(P0.01)。患者术后六个月的依从性比较,除生活习惯和外,其余四个方面试验组的依从性明显要比对照组好(P0.05或P0.01)。两组患者术后第三日生活质量指数评分比较均没有统计学差异(P0.05)。患者术后六个月试验组生活质量较对照组高(P0.05)。结论:思维导图作为一种思维工具,应用于患者的健康宣教,取得了良好的效果。     

Human hair follicle pluripotent stem (hfPS) cells promote regeneration of peripheral‐nerve injury: An advantageous alternative to ES and iPS cells

The optimal source of stem cells for regenerative medicine is a major question. Embryonic stem (ES) cells have shown promise for pluripotency but have ethical issues and potential to form teratomas. Pluripotent stem cells have been produced from skin cells by either viral‐, plasmid‐ or transposon‐mediated gene transfer. These stem cells have been termed induced pluripotent stem cells or iPS cells. iPS cells may also have malignant potential and are inefficiently produced. Embryonic stem cells may not be suited for individualized therapy, since they can undergo immunologic rejection. To address these fundamental problems, our group is developing hair follicle pluripotent stem (hfPS) cells. Our previous studies have shown that mouse hfPS cells can differentiate to neurons, glial cells in vitro, and other cell types, and can promote nerve and spinal cord regeneration in vivo. hfPS cells are located above the hair follicle bulge in what we have termed the hfPS cell area (hfPSA) and are nestin positive and keratin 15 (K‐15) negative. Human hfPS cells can also differentiate into neurons, glia, keratinocytes, smooth muscle cells, and melanocytes in vitro. In the present study, human hfPS cells were transplanted in the severed sciatic nerve of the mouse where they differentiated into glial fibrillary‐acidic‐protein (GFAP)‐positive Schwann cells and promoted the recovery of pre‐existing axons, leading to nerve generation. The regenerated nerve recovered function and, upon electrical stimulation, contracted the gastrocnemius muscle. The hfPS cells can be readily isolated from the human scalp, thereby providing an accessible, autologous and safe source of stem cells for regenerative medicine that have important advantages over ES or iPS cells. J. Cell. Biochem. 107: 1016–1020, 2009. © 2009 Wiley‐Liss, Inc.     

香椿试管苗的生根与移栽

通过基内诱导生根、基外诱导生根及生根苗移栽等试验,研究了香椿试管苗的生根与移栽。结果表明,基内诱导生根的主要影响因子是生长素IBA,其次是培养基中无机盐浓度,适宜的生根配方是在不含无机盐的培养基中附加1.0mg/L IAB。用NAA、IAB短时间处理无根苗基部,可使部分苗生根,但生根率偏低。试管苗移栽的适宜时期为3月至7月初,以蛭石、河沙为基质效果较好。移载成活的关键是充分炼苗及良好的基质和适宜的时期,注意防虫并保温遮荫。     

Synaptic Contacts of Neurons of Fascia Dentata Transplants with Nonspecific Targets in Neocortex of Recipients

We carried out an electron microscopy study of possible synaptic contacts of the neurons of intracortical transplants of the rat brain fascia dentata with targets in the recipient somatosensory cortex. The axons of fascia dentata granular cell and their synaptic terminals could be easily identified in the neocortex due to their distinct morphological features (mossy fibers), although the fascia dentate cells normally do not interact with the neocortex. Thin nonmyelenized mossy fibers were found in both an intermediate zone between the transplant and brain and in the adjacent brain. Their presynaptic buds, like in situ, had large size and formed characteristic terminal, intraterminal, and en passant multiple synaptic contacts and desmosome-like junctions. The aberrant nerve fibers used perykaryons, dendrites of varying diameter, and dendrite spikes of the somatosensory cortex pyramidal neurons as postsynaptic targets in the neocortex. In addition to vacant spaces that appeared in the brain as a result of transplantation, the ingrowing axons induced the formation of additional contact sites: deep invaginations of the plasmalemma of perykaryons, somatic spikes, terminal branchings of dendrites, and dendritic outgrowths of complex branched shape. These aberrant contacts were characterized by the presence of polyribosomes, endoplasmic reticulum cisternae, and mitochondria in the postsynaptic loci. Osmiophility and extension of desmosome-like junctions were also enhanced in such synapses. Thus, it was shown that mossy fibers ingrowing in the recipient neocortex were capable of forming cell-to-cell contacts with signs of functional synapses to atypical cell targets.     

Serum markers of apoptosis in the early period of heart transplantation

Context and objective: To assess the relationship between levels of serum markers of apoptosis and rejection grades in heart transplant (HTx).

Materials and methods: A prospective study was conducted in 91 HTx. We correlated apoptosis markers and biopsy samples. The apoptosis markers were: TRAIL, TRAIL-R1, TRAIL-R2, TRAIL-R3, TRAIL-R4, sFas, sTNF-R1 and sTNF-R2.

Results: The only significant correlation with rejection grade was sFas (r?=?0.329; p?=?0.005). Cyclosporine showed a proapoptotic effect (sTNF-R1 0.02 and sTNF-R2 0.02) and everolimus an antiapoptotic effect (sTNF-R1 r?=??0.523; p?=?0.0001 and sTNF-R2 r?=??0.405; p?=?0.0001).

Conclusions: The utility of specific apoptosis markers in peripheral blood for diagnosis of acute cellular rejection is low. Everolimus may have an anti-apoptotic effect.     

Lowering the alemtuzumab dose in reduced intensity conditioning allogeneic hematopoietic cell transplantation is associated with a favorable early intense natural killer cell recovery

Background aimsThe anti-CD52 monoclonal antibody alemtuzumab is employed in allogeneic hematopoietic cell transplantation (alloHCT) for the prevention of graft-versus-host disease (GVHD). However, its optimal dosing in this setting has not been determined yet. We compared three different alemtuzumab dose levels in reduced intensity conditioning (RIC) alloHCT with respect to lymphocyte recovery and outcome.MethodsIn 127 consecutive patients with predominantly advanced stage hematologic malignancies, a first alloHCT after RIC was performed, applying a fludarabine-based protocol (in 93% FBM: fludarabine, bis-chloroethyl-nitrosourea [BCNU], and melphalan). For GVHD prophylaxis, cyclosporine and alemtuzumab at three different dose levels (40 mg, 20 mg, 10 mg) were administered. Recovery of the peripheral blood (PB) lymphocyte sub-populations and clinical outcome were determined with regard to the alemtuzumab dose.ResultsNatural killer (NK) cell concentrations in PB around day +30 correlated inversely with the alemtuzumab dose, whereas other PB lymphocyte subtypes remained essentially unaffected by dosing of alemtuzumab. Lower alemtuzumab doses were associated with a tendency toward improved overall survival mainly during the early post-transplantation months. With regard to the PB NK cell concentration around day +30, “early intense NK cell reconstituters” tended to show an overall survival benefit.ConclusionsAn alemtuzumab dose reduction to only 10–20 mg provides sufficient GVHD prophylaxis and supports improved NK cell regeneration early after alloHCT in PB (“NK cell saving effect”), which may have a positive effect on overall survival.     

Mapping differentiation pathways from hematopoietic stem cells using Flk2/Flt3 lineage tracing

Genetic fate-mapping approaches provide a unique opportunity to assess differentiation pathways under physiological conditions. We have recently employed a lineage tracing approach to define hematopoietic differentiation pathways in relation to expression of the tyrosine kinase receptor Flk2.¹ Based on our examination of reporter activity across all stem, progenitor and mature populations in our Flk2-Cre lineage model, we concluded that all mature blood lineages are derived through a Flk2⁺ intermediate, both at steady-state and under stress conditions. Here, we re-examine in depth our initial conclusions and perform additional experiments to test alternative options of lineage specification. Our data unequivocally support the conclusion that onset of Flk2 expression results in loss of self-renewal but preservation of multilineage differentiation potential. We discuss the implications of these data for defining stem cell identity and lineage potential among hematopoietic populations.     

Adaptive inflammatory microenvironment for cell-based regeneration in ischemic cardiovascular disease

Cell-based therapy has emerged to be a promising strategy for alleviating the heavy burden of ischemic cardiovascular disease for nearly two decades, despite a variety of pending questions about its availability and efficacy. One question is whether and how the cells behave for regeneration in vivo, which could be limited or potentiated by the inflammatory microenvironment following myocardial infarction or critical limb ischemia. To this end, we hypothesize that the “adaptive inflammatory microenvironment” is pertinent to the cell-based regeneration, and make a brief comment on it based upon recent evidence.