非血缘异基因造血干细胞移植治疗白血病21例临床观察

目的观察非血缘异基因造血干细胞移植治疗白血病的临床疗效及并发症。方法回顾性分析21例非血缘异基因造血干细胞移植的恶性血液病患者临床资料,其中19例为外周血造血干细胞移植,1例为骨髓移植,1例为脐血移植。HLA全相合8例,HLA不全相合13例。回输单个核细胞(MNC)中位数9.078×108/kg,CD34+细胞中位数4.62×106/kg。10例患者采用BuCy方案预处理,9例采用改良的BuCy2方案预处理,1例采用非清髓的BuCy+氟达拉滨的方案,1例采用TBI+VP-16+CTX+meCCNU预处理。预防移植物抗宿主病方案,其中20例采用短程甲氨蝶呤+环孢素A+霉酚酸酯+抗胸腺细胞免疫球蛋白的四联方案,1例脐血移植患者采用短程甲氨蝶呤+环孢素A+抗胸腺细胞免疫球蛋白。术后观察受者的造血重建、并发症以及预后情况。采用低剂量肝素+前列腺素E1+丹参注射液预防肝静脉闭塞病(VOD)。结果除1例患者于空髓期死于颅内出血,其余20例患者均获造血重建。高剂量组MNC及CD34+细胞较低剂量组中位重建时间平均缩短1d。预处理中出现高热、寒战、胃肠道副反应、肝脏损伤及口腔黏膜炎等副反应,均给予对症处理后好转。HLA不合者较HLA全相合者移植后移植物抗宿主病(GVHD)发生率高,差异有统计学意义。9例患者出现aGVHD(Ⅰ度3例,Ⅱ度4例,Ⅲ度2例);9例出现cGVHD,表现为皮肤及肝脏受损,经有效治疗后好转。术后100d内18例受者出现细菌或真菌感染,以上呼吸道感染为主,7例发生巨细胞病毒感染,2例出现EB病毒血症,1例出现尿BK病毒感染。1例患者因VOD死亡,其余患者均未发生VOD。5例发生Ⅱ级至Ⅲ级出血性膀胱炎,经治疗后均好转。受者总的中位生存时间为24月(136d~9年),1年及3年总生存率分别为85.2%和63.9%,无病生存率分别为81.0%和23.8%,无复发生存率为71.4%和14.3%。结论非血缘异基因造血干细胞移植是治疗白血病的有效方法;BuCy及改良BuCy2的预处理方案均安全有效,毒性反应可逆、可耐受;高剂量MNC及CD34+细胞数组造血重建时间较低剂量组缩短;HLA不全相合者移植后GVHD发生率较HLA全相合者增高;低剂量肝素+前列腺素E1+丹参注射液可有效预防VOD。     

Modeling Coastal and Marine Environmental Risks in Belize: the Marine Integrated Decision Analysis System (MIDAS)

The livelihood of coastal communities is directly linked to the health of intertidal and marine ecosystems. Coastal zones and marine areas are rapidly changing and highly vulnerable to impacts from climate change, accelerating human development, and over-fishing. Quality of life and the benefits of coastal development can be greatly enhanced, and costs minimized, by projecting and comparing alternative policy outcomes before management decisions are made. This article describes the Marine Integrated Decision Analysis System (MIDAS), an interactive decision support tool designed to assist the users and managers of Belize's system of marine management areas (MMAs) in understanding the interactions among various ecological, socioeconomic, and governance conditions in a spatially explicit manner. MIDAS can simulate and visualize the likely effects of alternative management strategies and therefore provides an important tool for evaluating potential scenarios. We developed two MIDAS modules to address specific threats in Belize –spatial risk resulting from mangrove deforestation in coastal areas and the potential effect of an oil spill off the coast of Belize. Workshops conducted in Belize indicate that diverse user groups such as fishers, tourism operators, and public environmental agencies can successfully utilize MIDAS to understand MMA outcomes, and environmental risks.     

南海环礁岛礁建港条件分析

介绍了南海海域的自然条件、南海环礁岛礁地形地貌特点和地质特征等,分析了南海环礁岛礁建港条件,总结 了建设原则,并给出了方案实例。     

肯尼亚珊瑚礁灰岩地区钢管桩终锤标准

针对肯尼亚珊瑚礁灰岩地区某水工项目钢管桩原设计收锤标准与施工情况不符的问题,进行新收锤标准下沉桩规律的研究,采用海利公式理论计算、高应变试验及锚桩法静载荷试验方法,并结合项目1440根基桩的实际沉桩工作,得出钢管桩在珊瑚礁灰岩地区的推荐收锤标准:1)珊瑚礁灰岩地区钢管桩沉桩施工时收锤控制推荐采用贯入度控制为主、设计桩尖高程为辅的原则; 2)打入式开口钢管桩施工,采用锤芯质量20 t、锤芯跳高1. 2 m时,φ1 200 mm×12 mm、φ1 200 mm×18 mm、φ1 200 mm×24 mm钢管桩推荐收锤贯入度分别为12～18、7～10、4～8 mm/击。对肯尼亚珊瑚礁灰岩地区钢管桩沉桩施工具有指导作用。     

珊瑚礁灰岩地区超长钢管桩工程性状

针对珊瑚礁灰岩地质下超长钢管桩的工程性状的研究,结合东非某水工项目的桩基施工情况,剖析钢管桩在该地质情况下的沉桩规律。该桩基为1. 2 m直径钢管桩,采用锚桩法进行3根基桩静载荷试验,分别为12、18和24 mm壁厚,最大桩长为71. 2 m,基桩持力层为东非的珊瑚礁灰岩,进入持力层最大为31. 8 m。通过预先埋设在桩身上的低温敏光纤光栅传感器,结合沉桩规律总结和静载荷试验,揭示不同桩顶荷载作用下珊瑚礁灰岩的工程特性。为该地质条件下钢管桩设计及理论研究提供参考。     

Bcl-2、Bax、Fas、FasL、穿孔素和粒酶B在移植肾急性排斥中的共同表达和意义

目的 检测Bcl-2、Bax、Fas、FasL、穿孔素和粒酶B 在移植肾急性排斥时的表达水平,探讨其在急性排斥中的作用及可能的分子机制.方法 选取30例移植肾穿刺活检标本及18例正常供肾组织为研究对象,采用免疫组化方法检测Bcl-2、Bax、Fas、FasL、穿孔素和粒酶B 的表达情况.结果 ①根据Banff97病理诊断标准,急性排斥标本30例,其中ⅠA 12例,ⅠB 11例,ⅡA 5例,ⅡB 2例;②所有组织中均可发现细胞凋亡现象,急性排斥标本中更为明显;③Bcl-2在急性排斥标本中的表达水平低于正常组织(P＜0.05),与急性排斥的病理变化呈负相关(P＜0.05);Bax在两组的表达水平无差别(P＞0.05);Fas、FasL、穿孔素和粒酶B在急性排斥组中的表达水平均高于对照组,并与急性排斥的病理变化呈正相关,以FasL和粒酶B 最为明显(P＜0.01).结论 ①Bcl-2在肾小管上皮细胞的表达减少提示急性排斥反应的发生;②Bax对于预测急性排斥反应的意义不大;③Bcl-2、Fas、FasL、穿孔素和粒酶B的表达变化均与急性排斥反应密切相关,尤以FasL和粒酶B明显,可作为监测移植肾形态学变化、功能状态以及判断预后的重要指标.     

肝动脉桥式转流维持犬移植肝肝动脉血流的作用

目的介绍一种新的解决原位肝移植中肝动脉缺血(hepatic arterial ischemia,HAI)的方法:应用肝动脉桥式转流(hepatic arterial bridge bypass,HABB)维持动脉吻合时供肝肝动脉血流,并对其血流动力学参数变化进行初步观察。方法选择健康雄性西安地区杂交犬20只,制作犬简易自体原位肝移植模型,通过腹主动脉建立肝动脉桥式转流,测量转流前、转流15 min和转流结束1h肝动脉峰值流速(peak velocity,PV)和血流量(blood flow,BF),并统计腹主动脉插管时间和并发症。结果转流情况下肝动脉内血流峰值流速和血流量低于转流前(P<0.05),分别为转流前的83%和80%;在转流结束,开放肝动脉1h后,其血流动力学参数与转流前没有显著性差异。平均腹主动脉插管时间3 min,2例出现腹主动脉插管后荷包缝合处出血。结论肝动脉桥式转流是一种简便而有效的解决原位肝移植中肝动脉缺血的方法,但是这一方法仍然需要继续完善和改进。     

肝移植术后糖尿病危险因素的分析

目的探讨肝移植术后糖尿病(PTDM)发生及发展的危险因素。方法回顾我院2005年1月至2006年12月间收治的66例肝移植受者的临床资料,对可能导致肝移植术后糖尿病的相关因素进行分析,筛选出在临床出现的高危因素。结果本组PTDM发生率为36%(24/66),多因素Logistic回归分析显示:术中腹水量、术中激素剂量、术后葡萄糖补充量、免疫抑制剂血药浓度、术后30 d内感染是肝移植术后发生糖尿病的高危因素。结论移植术后糖尿病是肝移植常见并发症之一,针对以上危险因素及早采取有效、合理的防治措施是减少PTDM的关键。     

Toxicity to the normal hemocytes by ALA-PDT for the ex vivo purging of hematopoietic stem cell grafts

Objective To study the toxic effects of 5-amionlevulinic acid-based photodynamic therapy (ALA-PDT) on human peripheral blood mononuclear cells (PBMCs), cord blood mononuclear cells (CBMCs) and peripheral blood stem cells (PBSCs), and furthermore, to understand the possible causes of this response. Methods We used MTT assay to detect the survival rate of PBMCs, CBMCs and PBSCs after treated by ALA-PDT under the optimum experiment conditions with U937 as control;Annexin V-FITC/PI was used to detect the pattern of cell death induced by ALA-PDT. By using flow cytometry, we detected intracellular PpIX fluorescence intensity. Results After ALA-PDT treatment the survival rate of PBMCs had no significant change;however in PBSCs and CBMCs, the survival rate reduced to 70%, and the survival rate of leukemia cell U937 was the lowest, about 30%. After incubation with ALA,except for PBMCs, intraceUuiar PplX fluorescence intensity of the other two kinds of normal haemocytes and U937 increased obviously. These results combined with the flow cytometry suggested that the main pattern of cell death here was apoptosts. Conclusion Under the optimum experiment conditions, ALA-PDT has a slight effect on normal haemocytes but excellent depletions of leukemia cells. Therefore, it can effectively purify autologons bone marrow or stem cell grafts.