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Objective: To observe the clinical effect of Shengxue Mixture (SXM) in treating aplastic anemia and study the possible mechanism. Methods: Eighty-four patients in the treated group with Spleen-Kidney Yang deficiency syndrome and Spleen-Kidney Yin deficiency syndrome were treated with SXM-Ⅰ and SXM-Ⅱ respectively, and 30 patients in the control group were treated with Stanozolol. The clinical effect and several experimental parameters were also observed. Results: The basic cure was gained in 18 cases, remission in 23, markedly improved in 32, ineffective 11, total effective rate and cure remission rate of the treated group were 86.90% and 48.81% respectively, which were obviously better than those of the control group (P<0.05) with no obvious side-effect. While the patient's symptoms were alleviated, the peripheral blood cells increased, the ratio of T lymphocyte subsets tended to balance, the level of natural killer cell activity increased, interleukin-2 reduced, and reproduction of the bone marrow were markedly improved in most of the patients treated by SXM. Conclusions: SXM is an effective and safe drug for aplastic anemia. Its mechanism might be likely due to its regulating the immune function, which facilitates the recovery of the bone marrow hematopoiesis function.
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According to the TCM theories of Meridian and Pulse-Picture, the author probed in the treatment of idiopathic thrombocytopenic purpura (ITP) with auriculo-acupoint pressing (AAP) and obtained good result. The study was reported as follows.METHODS General Materials Forty-five patients with chronic refractory of ITP selected from the 269 ITP in-patients, hospitalized from January 1991 to January 1998, were observed. They were diagnosed according to the clinical manifestations, peripheral blood picture and bone marrow examination, as well as platelet antibody test in some of them, which were all in accordance with the unified diagnostic standard of ITP in China(1). All of the patients had course of disease over half a year and their disease treated with hormone for 2-3 months ineffectively, and had hemorrhagic symptoms, such as dermatorrhagia and rhinorrhagia, with no hepatosplenomegaly, and platelet count within 8-72×109/L. The hormone therapy was withdrawn or stopped gradually in the observation period.
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中药结合骨髓间充质干细胞移植治疗股骨头坏死的研究进展
股骨头坏死(osteonecmsis oflhe femoral head,ONFH)是骨科常见病、多发病,是一种进展性和致残性疾病,主要发生在30~50岁的中青年,约有半数患者累及双侧股骨头,是对髋关节具有特殊破坏性的退行性病变,终导致髋关节功能障碍,严重影响患者生活质量,造成沉莺的家庭和社会负担.
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供者特征对rhG-CSF动员的外周血和骨髓混合移植物中免疫细胞组成的影响
近,我们采用GIAC(即G,粒细胞集落刺激因子+I,强的免疫抑制+A,抗胸腺细胞球蛋白+C,外周血与骨髓联合)技术体系成功跨越了HLA不合屏障,从根本上解决了异基因造血干细胞移植(Allo-HSCT)供者来源缺乏的问题[1-2].大量资料显示,供者特征影响移植物的细胞组成,后者又与Allo-HSCT的预后密切相关[2-3].我们从供者的年龄、性别、体重等方面研究供者特征对粒细胞集落刺激因子(G-CSF)动员的外周血和骨髓混合移植物中免疫细胞组成的影响.
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从骨髓和脐血造血干细胞中诱导成骨样细胞
骨髓有2个重要的功能:造血和成骨.骨髓中存在造血干细胞(hematopoietic stem cells,HSCs)(CD34+细胞)和间充质干细胞(mesenchymal stem cells,MSCs).这2种干细胞共同存在于骨髓腔中,MSC对HSC不仅有空间位置的机械支持作用,还分泌多种造血因子支持其造血功能,有助于HSC未分化状态的维持.这2种干细胞之间是否存在着某种联系或交叉呢?我们分离了脐血CD34+细胞,并在体外培养扩增,探讨其中是否含有成骨细胞的前体细胞.
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乙醇诱导小鼠导致骨髓多能干细胞成脂分化
实验证明乙醇可引起股骨头内脂肪积聚,导致骨坏死[1],其作用机制尚不清楚.本研究旨在观察乙醇对骨髓多能干细胞(D1细胞)[2]的直接作用,进一步阐明乙醇性骨坏死的发病机制.
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血管免疫母细胞性T细胞淋巴瘤骨髓/外周血瘤细胞免疫表型分析
血管免疫母细胞性T细胞淋巴瘤(AITL)是一类以异形T淋巴细胞增生伴显著血管增生,以及滤泡树突状细胞增生为主要表现,为一类来源于成熟T细胞的淋巴瘤[1].过去AITL瘤细胞形态学诊断缺乏特异性的鉴别特征,而近来AITL瘤细胞CD10[2]和CXCL13表达意义的发现为AITL的诊断提供了有力的支持,为了更深入了解AITL瘤细胞的免疫表型特征及发病机制,我们利用流式细胞术分析AITL患者骨髓及外周血有核细胞表面CD分子标志,期望获得更多信息.
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骨髓活检与涂片在非霍奇金淋巴瘤骨髓浸润诊断中价值的比较
非霍奇金淋巴瘤(NHL)通常发生于淋巴结,骨髓作为NHL的原发灶较少见,但却是NHL常见的浸润部位.探讨骨髓侵犯对指导恶性淋巴瘤的正确分期、治疗和预后有重要意义.目前除了骨髓穿刺和骨髓活检,检测骨髓侵犯的方法还包括MRI、流式细胞术、聚合酶链反应、骨髓三维结构重建等[1],但骨髓涂片和切片作为一种经典可靠且安全简便的方法,仍具有重要的应用价值.
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骨髓活检与骨髓穿刺在骨髓转移瘤诊断中的比较
虽然骨髓检查已经用来评价非血液系统肿瘤患者的分期~([1-4]),但采用大样本、随机化的骨髓检查来分析非血液系统肿瘤骨髓累及情况的报道并不多~[5].
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套细胞淋巴瘤同时累及肾脏和骨髓一例
患者男,73岁,因“纳差1年,双下肢水肿伴泡沫尿3天”主诉急诊入院。1年来患者无明显诱因开始出现胃纳减退,食后易打嗝、恶心、呕吐,予胃肠动力药及消化酶等对症治疗效果不佳。入院前 3天发现双下肢凹陷性水肿,伴尿中泡沫增多,无血尿。入院时患者体温36.7℃,血压140/88 mmHg (1 mmHg =0.133 kPa),全身浅表淋巴结无肿大,心脏闻及早搏3次/min,无明显杂音,腹平软,肝脾肋下未及,双下肢凹陷性水肿。化验结果:白细胞计数21.71×109 L -1,中性粒细胞百分比34.0%,淋巴细胞百分比61.0%。红细胞沉降率67mm/h。尿蛋白++,24 h 尿蛋白定量11.15 g。总蛋白49 g/L,白蛋白22 g/L,球蛋白27 g/L,白球比值0.8。尿素17.3 mmol/L,肌酐417μmol/L。肾活检病理结果:送检肾穿刺组织中找到肾小球结构21个,其中2个肾小球纤维化玻璃样变,部分肾小球毛细血管内可见到微血栓,部分肾小球系膜间质增生,特染结果示基底膜无明显增厚,肾小球内细胞数轻度增多,球囊壁上皮细胞不增生,肾小球轻度变性,个别肾小管内可见到细胞及蛋白管型,间质内散在少数淋巴细胞、浆细胞浸润,肾血管未见特殊病变。镜下肾组织中可见灶性分布以及散在分布小淋巴细胞。免疫组化显示:小淋巴细胞为 B 淋巴细胞,CyclinD1呈阳性反应,考虑套细胞淋巴瘤累及肾脏。骨髓象:骨髓增生活跃,淋巴细胞相对增多占59%,可见较多小淋巴细胞及少量幼淋巴细胞,提示淋巴系统增殖性疾病可能。免疫组化显示:小淋巴细胞为 B 淋巴细胞, CyclinD1呈阳性反应,符合套细胞淋巴瘤累及骨髓。结合患者的临床表现、实验室检查和病理检查结果,后诊断为套细胞淋巴瘤Ⅳ期 A 组,PS 2分,M-IPI 8分。治疗上考虑到患者病灶广泛累及,肿瘤预计对化疗不敏感;且已经存在肾脏功能不全,故对化疗耐受性有限,风险较大,在向患者家属说明清楚后,采用改善肾脏功能的对症治疗11 d 后患者主动要求出院。
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淋巴瘤侵犯骨髓患者初次血常规综合指标分析
恶性淋巴瘤晚期易侵犯骨髓或外周血,即恶性淋巴瘤的白血病期,该期疗效差、预后不良,严重影响患者健康[1,2].因此,本文研究收集2010-2012年我院淋巴瘤侵犯骨髓(lymphoma bone marrow involvement,LBMI)患者的初次血常规结果,分析白细胞(white blood cell,WBC)、血红蛋白(hemoglobin,Hb)、血小板(platelet,PLT)及淋巴细胞百分比(L%)的特点,以探讨综合分析上述指标对早发现、早诊断、早治疗LBMI患者的临床意义.
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持续发热肝脾大骨髓幼稚细胞
病例摘要患者男,23岁.主因"持续发热、肝脾大、骨髓发现幼稚细胞4个月"于2008年5月收入院.患者2008年1月无明显诱因发热38~39℃,伴有头痛、头昏、偶有恶心、呕吐,无咳嗽咳痰、腹痛腹泻、节痛、尿频尿急等,予以抗感染治疗效果差.
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小鼠骨髓树突状细胞改良培养及体外生物学特性的比较
目的:探讨小鼠骨髓树突状细胞体外生物学特性及用自体腹膜培养基代替细胞因子刺激树突状细胞体外生长的可能性.方法:无菌取小鼠的骨髓分离、培养DC前体,分别以小鼠腹膜分泌液和重组细胞因子mGM-CSF,mIL-4刺激培养使DC前体转化为DC,再用混合淋巴细胞增生反应(MLR)、细胞免疫组织化学染色及光镜、扫描电镜观察二种DC生物特性及免疫活性的差异.结果:培养6-8 d,二种方法培养的骨髓DC(BM-DC)均有大量细胞从集落中释放,并呈成熟状态,重组mGM-CSF,mIL-4刺激培养的DC得率稍高(6×106)于腹膜培养组(3×106),但无显著性差异;培养7 d BM-DC的B7-2表达较高,呈强阳性,混合淋巴细胞反应(MLR)中均表现出有强烈刺激同种T细胞增生的能力;尤以重组mGM-CSF,mIL-4组明显高于腹膜培养组,未加任何处理的空白对照组中DC前体具有非成熟DC的形态及功能特征,且无刺激同种T细胞增生的能力.结论:实验结果提示用自体腹膜培养基代替细胞因子刺激树突状细胞体外生长可获得一定数量的树突状细胞并具有相应的生物学特性及功能,基本能满足实验研究的需要,为基层单位开展树突状细胞的研究提供了可能性.
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第3例:阵发性心慌-肝脾肿大-腹水
诊治难点:·患者有阵发心慌、面色潮红、血压下降、腹泻、肝脾肿大及腹水等症状.腹水常见病因为肝硬化、肿瘤、结核等,系统性肥大细胞增多症为造成腹水的少见疾病之一.·阵发心慌、面色潮红等常为释放生物活性物质或激素有关,注意与类癌的鉴别.启示:·临床症状较多时,诊断上尽量用一元论解释全貌.常见病、多发病不能解释时,应考虑到少见病和罕见病的可能.·临床医生应加强对肥大细胞增生症的认识,这种疾病可有多种临床表现.
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第2例:慢性持续性大量心包积液
病历摘要患者男性,77岁因“发现中、大量心包积液10年,憋气加重一个月”于2010年7月5日入院.患者10年前因心房颤动应用可达龙(盐酸胺碘酮)治疗(累计剂量18g),治疗前超声心动图未见心包积液,服可达龙2月后逐渐出现下肢轻度水肿,胸闷、憋气,超声心动图提示中量心包积液,同时合并少量胸腔积液、少量腹腔积液,甲状腺功能检查提示甲状腺功能减退,行甲状腺穿刺,病理结果为桥本氏甲状腺炎,予优甲乐(左旋甲状腺素钠片)替代治疗后水肿、胸闷、憋气等症状好转,甲状腺功能改善,胸腔积液和腹腔积液消失,但定期复查超声心动图始终存在中—大量心包积液,持续10年.
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T淋巴细胞与同种异基因骨髓移植后移植物抗宿主病
同种异基因骨髓移植(allogeneic bone marrow transplantat,allo-BMT)是当今根治白血病的有效治疗手段之一,但是白血病复发以及移植物抗宿主病(graft-versus-host disease,GVHO)是制约其临床治疗效果的主要因素,目前GVHD已经成为影响骨髓移植成功的首位原因,因此针对allo-BMT后GVHD的防治研究就显得尤为重要.
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小儿再生障碍性贫血的鉴别诊断
再生障碍性贫血(aplastic anemia,AA)是指由于骨髓造血细胞衰竭所致的外周血出现全血细胞减少的临床状态.临床上包括了遗传性骨髓衰竭性疾病(inherited bone marrow failure syndromes,IBMFS)和获得性AA( acquired AA).IBMFS较为罕见,多为常染色体隐性遗传疾病.获得性AA在欧美国家的年发病率大约是2/106,在东亚地区则要高出2~3倍[1].根据是否能找到明确的病因,获得性AA又分为继发性和特发性两类.国内临床工作中,医生更愿意将AA仅指获得性AA.但本资料AA还包括了IBMFS.关于AA的分类如下:
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The present study aims to evaluate the effect of bone marrow mesenchymal stem cells on cold stress induced neuronal changes in hippocampal CA1 region of Wistar rats. Bone marrow mes-enchymal stem cells were isolated from a 6-week-old Wistar rat. Bone marrow from adult femora and tibia was collected and mesenchymal stem cells were cultured in minimal essential medium containing 10% heat-inactivated fetal bovine serum and were sub-cultured. Passage 3 cells were analyzed by lfow cytometry for positive expression of CD44 and CD90 and negative expression of CD45. Once CD44 and CD90 positive expression was achieved, the cells were cultured again to 90% conlfuence for later experiments. Twenty-four rats aged 8 weeks old were randomly and evenly divided into normal control, cold water swim stress (cold stress), cold stress + PBS (intra-venous infusion), and cold stress + bone marrow mesenchymal stem cells (1 × 106; intravenous infusion) groups. The total period of study was 60 days which included 1 month stress period followed by 1 month treatment. Behavioral functional test was performed during the entire study period. After treatment, rats were sacriifced for histological studies. Treatment with bone marrow mesenchymal stem cells signiifcantly increased the number of neuronal cells in hippocampal CA1 region. Adult bone marrow mesenchymal stem cells injected by intravenous administration show potential therapeutic effects in cognitive decline associated with stress-related lesions.
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Glial cell line-derived neurotrophic factor recombinant adenovirus vector-transfected bone marrow mesenchymal stem cells were induced to differentiate into neuron-like cells using inductive medium containing retinoic acid and epidermal growth factor. Cell viability, micro-tubule-associated protein 2-positive cell ratio, and the expression levels of glial cell line-derived neurotrophic factor, nerve growth factor and growth-associated protein-43 protein in the su-pernatant were signiifcantly higher in glial cell line-derived neurotrophic factor/bone marrow mesenchymal stem cells compared with empty virus plasmid-transfected bone marrow mes-enchymal stem cells. Furthermore, microtubule-associated protein 2, glial cell line-derived neurotrophic factor, nerve growth factor and growth-associated protein-43 mRNA levels in cell pellets were statistically higher in glial cell line-derived neurotrophic factor/bone marrow mesen-chymal stem cells compared with empty virus plasmid-transfected bone marrow mesenchymal stem cells. These results suggest that glial cell line-derived neurotrophic factor/bone marrow mesenchymal stem cells have a higher rate of induction into neuron-like cells, and this enhanced differentiation into neuron-like cells may be associated with up-regulated expression of glial cell line-derived neurotrophic factor, nerve growth factor and growth-associated protein-43.
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In vitro experiments have demonstrated that neuronal-like cells derived from bone marrow mesenchymal stem cells can survive, migrate, integrate and help to restore the function and be-haviors of spinal cord injury models, and that they may serve as a suitable approach to treating spinal cord injury. However, it is very difficult to track transplanted cells in vivo. In this study, we in-jected superparamagnetic iron oxide-labeled neuronal-like cells into the subarachnoid space in a rabbit model of spinal cord injury. At 7 days after celltransplantation, a smal number of dot-shaped low signal intensity shadows were observed in the spinal cord injury region, and at 14 days, the number of these shadows increased on T2-weighted imaging. Perl’s Prussian blue staining de-tected dot-shaped low signal intensity shadows in the spinal cord injury region, indicative of superparamagnetic iron oxide nanoparticle-labeled cells. These findings suggest that transplanted neuronal-like cells derived from bone marrow mesenchymal stem cells can migrate to the spinal cord injury region and can be tracked by magnetic resonance in vivo. Magnetic resonance imaging represents an efficient noninvasive technique for visual y tracking transplanted cells in vivo.