OBJECTIVE: To sum up the clinical results of allogeneic humeral transplantation with vascular anastomosis, and evaluate the clinical significance. METHODS: From September to November 1979, 1 case with humeral shaft defect of 10 cm in length and 2 cases with tibia shaft defect of 12 cm in length were repaired by allogeneic humeral transplantation with vascular anastomosis. Azathiopurine and prednisone were applied for 3 months postoperatively. All cases were followed up for 20 years. RESULTS: Case 1 recovered well with good bone union and reconstruction after operation, and could work normally. In case 2, five chronic rejections were occurred during 3 years after operation, and recovered after treatment, the allograft bone was fractured after 2 years of operation, and unioned by autogeneous iliac bone transplantation. In case 3, the distal part of allograft bone was fractured after 46 months, and unioned by autogeneous iliac bone transplantation. The middle part of allograft bone was non-unioned after 20 years follow-up in case 3, but the patient could still work normally. CONCLUSION: The clinical results of allogeneic long bone transplantation can be improved by rational tissue matching test, application of effective immunosuppressive drugs in a certain period according to the principles of modern transplantation immunology.
Neoadjuvant chemoradiotherapy or chemotherapy combined with surgery for locally advanced esophageal cancer has become the standard treatment, and despite the survival benefit, most patients still experience postoperative recurrence and distant metastasis. Immune checkpoint inhibitors play an anti-tumor role by activating T cells, and immunotherapy has become one of the important strategies for first-line and second-line treatment of advanced esophageal cancer with the continuous evolution of immunotherapy models. Regarding neoadjuvant immunotherapy for esophageal cancer, a large number of studies are being carried out and explored, which are expected to inject new vitality into neoadjuvant therapy for esophageal cancer. This article reviews the current clinical studies on neoadjuvant immunotherapy for esophageal cancer.
【摘要】目的探讨肝肠联合移植的术式、免疫抑制治疗方案与效果。方法对一中年男性短肠综合征患者施行辅助性肝肠联合移植，术后患者免疫抑制治疗采用甲波尼龙（MP）、环孢素A（CsA）、环磷酰胺（CTX）与抗淋巴细胞球蛋白（ALG）处理。结果术后观察期内移植物存活良好。结论本例采用的免疫抑制治疗方案是成功的，且手术方法操作较为简便、易行。
Objective To assess the effects of different immunosuppressive drugs on proliferation and function of regulatory T cells (Tregs). Methods We searched MEDLINE (1966 to November 2009), EMbase (from inception to September 2009), and The Cochrane Library (Issue 4, 2009) for clinical and basic research about the effects of various immunosuppressive drugs on Tregs. Data were extracted and methodological quality was assessed by two independent reviewers. Outcome measures for clinical research included blood Tregs levels, acute rejection episodes, and graft function. Outcome measures for basic research included percentage of Tregs proliferation, function, Tregs phenotype, and evidence for possible mechanisms. We analyzed data qualitatively. Results Forty-two studies, including 19 clinical trials and 23 basic studies, were included. The immunosuppressive drugs studied were calcineurin inhibitors (CNIs), Rapa, anti-metabolism drugs, IL-2 receptor-blocking antibodies, T-cell depleting antibodies, and co-stimulation blockade antibodies. Most of the studies were on Rapa and CNIs. Eight basic studies on Rapa and CNIs showed that Rapa could promote the proliferation and function of Tregs, while CNIs could not. Five clinical trials involving a total of 158 patients showed that patients taking Rapa had higher blood concentration of Tregs than those taking CNIs, but no differences were found in graft function (6-42-month follow-up). Conclusion There is substantial evidence that Rapa favors Tregs survival and function. However, the larger number of the blood Tregs in the patients treated with Rapa does not show any correlation with better graft function. Large-sample and high-quality clinical studies with longer follow-up are needed to thoroughly assess the efficacy of immunosuppressive drugs on Tregs and to reveal whether a relationship exists between Tregs and graft function.
Objective To explore the effects of several immunosuppressants on the cell numbers of cultured rat macrophages and Schwann’s cells. Methods The macrophages and Schwann’s cells were cultured from the newborn Wistar rats. Different concentrations of methylprednisolone(10-3, 10－4,10－6 and 10－8 mol/L), CsA(10－5, 10－6, 10－7 and 10－8 mol/L) and FK506(10-6, 10－7, 10－8 and 10－9 mol/L) were administrated to the cells, while control group was given no drugs. Twentyfour, 48 and 72 hours after administration, the cells from different concentrations were measured with MTT methods respectively. Theresults were compared and analyzed statistically. Results Only high concentration methylprednisolone (10-4 mol/L) and a certain range of concentrations of CsA (10-6，10-7 and 10-8 mol/L) and FK506 (10-7,10-8 and 10-9 mol/L) can provide protection to culturedrat macrophages. Under most concentrations, CsA and FK506 had no effects onthe cell number of cultured rat Schwann’s cell. Only with high concentration CsA (10-5 mol/L) and methylprednisolone (10-3 mol/L) could significantly decreased the cell number of Schwann’s cell. Long time (72 hours) and low dosage (10-8 mol/L) administration of methylprednisolone could significantlyprotect Schwann’s cell. Conclusion High concentration methylprednisolone and some certain concentration CsA and FK506 can protect cultured rat macrophages. But high concentration CsA and methylprednisolone prohibit the proliferation of Schwann’s cells. Only long time and low dosage methylprednisolonecan protect cultured rat Schwann’s cells.
自1989年巴西医生Raia开展人类首例活体肝移植（living donor liver transplantation, LDLT）以来，LDLT受体的优良预后及供体的安全性逐步得到了公认，加之“脑死亡”供肝的严重匮乏，LDLT技术迅速发展并被公认为是缓解供肝来源匮乏最有效的方法之一［1，2］。LDLT技术的发展大致经历了三个阶段： ①成人→儿童间活体肝移植（简称儿童活体肝移植，pediatric living donor liver transplantation, PLDLT）； ②成人→成人间活体肝移植(adulttoadult living donor liver transplantation, ALDLT)； ③急诊活体肝移植(emergency or highurgency living donor liver transplantation, ELDLT )。LDLT技术发展的每一阶段均是对前一阶段技术的总结和升华，技术难度和复杂性也逐步增加。
ObjectiveTo investigate the diagnosis, clinical features, treatment and outcome of pure red cell aplasia (PRCA) caused by human parvovirus B19 (HPV-B19) infection in kidney recipients. Method The clinical courses of six patients with PRCA caused by HPV-B19 infection after renal transplantation in West China Hospital between May 2018 and April 2019 were retrospectively investigated. Results The six patients showed obvious anemia symptoms, lacking rash, joint pain and other clinical symptoms of viral infection. The hemoglobin level of five patients got totally remission from a course of intravenous immunoglobulin (IVIG) treatment, and anemia symptoms like fatigue, weakness got notable improvement. One patient had no improvement after two courses of IVIG treatment, and his anemia was significantly improved after the third IVIG course combined with immunosuppressant conversion(from tacrolimus to cyclosporine), and one patient with recurrence accepted a repeated course of IVIG treatment and obtained remission of severe anemia again. The median time of reticulocyte firstly rose to above 0.084×1012/L from the day of IVIG treatment ended was 3.50 (1.25, 5.00) days, and the median time required for a 30 g/L increase in hemoglobin to the end of IVIG treatment was 16.00 (9.25, 31.25) days. No serious adverse reactions occurred and all patients had stable graft function. Conclusions The main clinical manifestations of PRCA caused by HPV-B19 infection after kidney transplantation are anemia symptoms, lacking other clinical symptoms of viral infection. HPV-B19 DNA detection combined with blood routine examination, reticulocyte count and bone marrow cytology (or none) can diagnose HPV-B19 infection. High dose of IVIG is effective and safe, and a repeated course is still effective when the infection recurs. For refractory PRCA that IVIG monotherapy fail, a combination with conversion from tacrolimus to cyclosporine can effectively improve the anemia without graft dysfunction.