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Âíóòðèâèäîâàÿ òðàíñïëàíòàöèÿ
Ìåíå 39 ëåò, ó ìåíÿ ñàõàðíûé äèàáåò 1 òèïà ñ ÷åòûðåõëåòíåãî
âîçðàñòà,(35 ëåò) îñëîæíåíèÿ íåçíà÷èòåëüíû. Äîçà 60 Åä, ïðè âåñå 82 êã, íà êîòîðîé ÿ ÷àñòî ãèïóþ. Ñ-ïåïòèä 0,32 íã/ìë (íîðìà 0,5-3,2).Ýòî çíà÷èò,÷òî äèàáåò ó ìåíÿ íå àóòîèììóííûé? È íå ñâÿçàí ñ íèçêîé ÷óâñòâèòåëüíîñòüþ êëåòîê ê ãîðìîíó? Íåäàâíî ïðèøåë ñ æåíîé â æåíñêóþ êîíñóëüòàöèþ,à òàì íà ìåäàáîðòû î÷åðåäü ÷åëîâåê òðèäöàòü,âîò ÿ è ïîäóìàë,à ÷òî åñëè çàïëàòèòü ãèíåêîëîãó,îíà óçíàåò ãðóïïû êðîâè íåóäàâøèõñÿ îòöà è ìàòåðè èõ ñîñòîÿíèå çäîðîâüÿ, ìàðêåðû ñàìîãî ýìáðèîíà,îòäàñò àáîðòíûé ìàòåðèàë ìíå. Ýòî æå ìîæíî âñå ñïëàíèðîâàòü,îíà íàçíà÷àåò äåíü,ÿ áåðó êîíòåéíåð è ïðèâîæó ìàòåðèàë,åãî ïîäãîòàâëèâàþò (èíêàïñóëèðóþò - ñîëè òèòàíà) è ââîäÿò ìíå â íàäëåæàùåå ìåñòî (ê ïðèìåðó, â ïàðåíõèìó ÿè÷êà-ãåìàòîòåñòèêóëÿðíûé áàðüåð). Ââîäÿò íå ñòâîëîâûå (÷òî áëåô),à ôåòàëüíûå èììóíîðåàêòèâíîñòü êîòîðûõ íèçêàÿ, äà îíè åùå è ïîäãîòîâëåíû è ïîäîáðàíû ïî ãèñòîñîâìåñòèìîñòè. Âåäü ïðè ïðàâèëüíîé ïîäãîòîâêå è ââåäåíèè (íàïðèìåð ïîä êàïñóëó ïî÷êè) äàæå êëåòêè êðîëèêà (ìåæâèäîâàÿ òðàíñïëàíòàöèÿ) ôóíêöèîíèðóþò äî 2-3 ëåò. À ôåòàëüíûå âíóòðèâèäîâûå íàâåðíî âîîáùå íå áóäóò îòòîðãàòüñÿ? Âåäü,â Ðîññèè äåëàåòñÿ ìíîæåñòâî àáîðòîâ. Ìàòåðèàë â õóäøåì ñëó÷àå ñîæãóò â áîëüíè÷íîì êðåìàòîðèè,â ëó÷øåì ïðîäàäóò,íàïðèìåð âî Ôðàíöèþ.Åñëè çàïðåòèòü ìåäàáîðòû,ìíîãèå æåíùèíû ïîéäóò íà êðèìèíàëüíûé àáîðò è ïîãèáíóò. È,åùå,ñêîëüêî ýòî ìîæåò ñòîèòü, âåäü çàäà÷à âðà÷à òîëüêî èíêóáàöèÿ,èíêàïñóëÿöèÿ è ââåäåíèå ïðîñòûì øïðèöîì, ÷òî ìîæíî ñäåëàòü â ëþáîé áîëüíèöå? Íà ñ÷åò çàêîíà è ýòè÷åñêèõ íîðì: âåäü íåëüçÿ æå çàïðåòèòü ââåñòè ìíå òî,÷åãî óæå íåò,äîïóñòèì ñëóùåííûé ýïèòåëèé äðóãîãî ÷åëîâåêà èëè ìåíñòðóàëüíóþ êðîâü (êàê ïðèìåð),êîãäà ýòî ïðèíåñåò ïîëüçó. "Óáèéñòâî ðåáåíêà" áóäåò ñäåëàíî íå ïî ìîåìó æåëàíèþ, à ïî æåëàíèþ åãî ðîäèòåëåé, ÷òî íå çàïðåùåíî çàêîíîì. Èõ ñåãîäíÿ ïî Ðîññèè óæå íàâåðíî òûñÿ÷è óáèëè. À îñêàë òåõ, êòî âåíèò â ýòîì ìåíÿ (åñòü òàêèå) ïðîñòî ãëóï. |
#2
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"Ìåíå 39 ëåò, ó ìåíÿ ñàõàðíûé äèàáåò 1 òèïà ñ ÷åòûðåõëåòíåãî
âîçðàñòà,(35 ëåò) îñëîæíåíèÿ íåçíà÷èòåëüíû. Äîçà 60 Åä, ïðè âåñå 82 êã, íà êîòîðîé ÿ ÷àñòî ãèïóþ. Ñ-ïåïòèä 0,32 íã/ìë (íîðìà 0,5-3,2).Ýòî çíà÷èò,÷òî äèàáåò ó ìåíÿ íå àóòîèììóííûé? È íå ñâÿçàí ñ íèçêîé ÷óâñòâèòåëüíîñòüþ êëåòîê ê ãîðìîíó?" - íåò, ó Âàñ Ñ- ïåïòèä ïîçèòèâíûé âàðèàíò 1 òèïà, ó åâðîïåîèäîâ íå ìîæåò áûòü íåèììóíîãåíîãî. Ïðîáëåìà ãèïîãëèêåìèè- ïðîáëåìà íåñîîòâåòñòâèÿ äîëû\ åäû\ óïðàæíåíèé.Ñëåäóåò ðàññìîòðåòü ñ âàð÷îè è äðóãèå ïðè÷èíû ãèîïãëèêåìèé( â ÷àñòíîñòè, ïîñìîòðåòü ÒÒà êðîâè) "Íåäàâíî ïðèøåë ñ æåíîé â æåíñêóþ êîíñóëüòàöèþ,à òàì íà ìåäàáîðòû î÷åðåäü ÷åëîâåê òðèäöàòü,âîò ÿ è ïîäóìàë,à ÷òî åñëè çàïëàòèòü ãèíåêîëîãó,îíà óçíàåò ãðóïïû êðîâè íåóäàâøèõñÿ îòöà è ìàòåðè èõ ñîñòîÿíèå çäîðîâüÿ, ìàðêåðû ñàìîãî ýìáðèîíà,îòäàñò àáîðòíûé ìàòåðèàë ìíå. Ýòî æå ìîæíî âñå ñïëàíèðîâàòü,îíà íàçíà÷àåò äåíü,ÿ áåðó êîíòåéíåð è ïðèâîæó ìàòåðèàë,åãî ïîäãîòàâëèâàþò (èíêàïñóëèðóþò - ñîëè òèòàíà) è ââîäÿò ìíå â íàäëåæàùåå ìåñòî (ê ïðèìåðó, â ïàðåíõèìó ÿè÷êà-ãåìàòîòåñòèêóëÿðíûé áàðüåð). Ââîäÿò íå ñòâîëîâûå (÷òî áëåô),à ôåòàëüíûå èììóíîðåàêòèâíîñòü êîòîðûõ íèçêàÿ"--------------- íåò, Âàì ïðèäåòñÿ äîãîâîðèòüñÿ îá óáèéñòâå ðåáåíêà íåçàäîëãî äî ðîæäåíèÿ, äëÿ îáåñïå÷åíèÿ äîñòàòî÷íîãî êîëè÷åñòâà çðåëûõ áåòà -êëåòîê, ïðè ýòîì ðåáåíîê äîëæåí áûòü ìàêñèìàëüíî ÄÀËÅÊ îò Âàñ ïî ãèñòîñîâìåñòèìîñòè ( èíà÷å àóòîèììóííûé ïðîöåññ óáüåò è íîâûå êëåòêè), åñèë èììóíîëîãè÷åñêè äîíîð áåòà êëåòêè ñõîäåò ñ ðåöèïèåíòîì ñ äèàáåòîì 1 òèïà, òî òîò æå èììóíîëãè÷åñêèé ïðîöåññ ñ êóäà áîëüøåé âåðîÿòíîñòüþ áóäåò óãðîæàòü è áåòà - êëåòêå äîíîðà. Ïðîäîëæåíèå ñëåäóåò .
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Ã.À. Ìåëüíè÷åíêî |
#3
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Íå íóæíî ÷òî áû êëåòêè áûëè çðåëûå, íóæíî ÷òî áû îíè áûëè ñïåöèàëèçèðîâàíû, à ñïåöèàëèçàöèÿ çàêàí÷èâàåòñÿ ê âîñüìîé íåäåëå áåðåìåííîñòè (2 ìåñÿöà).Ýòî çðåëûé ðåáåíîê?. Äîçðåþò Â-êëåòêè è ó ìåíÿ â òåñòèêóëàõ (òàì òåïëî è ñóõî). Åñòü ãåìî-òåñòèêóëÿðíûé áàðüåð, åñëè íå âåðèòå, âîçìèòå ó ìóæ÷èíû ñïåðìàòîçîèäû è ââåäèòå åìó ïîä êîæó, âîçíèêíåò Ãèïå÷óâñòâèòåëüíîñòü çàìåäëåííîãî òèïà. Ïî÷åìó æå îíà íå âîçíèêàåò â òåñòèêóëàõ? Ïîòîìó, ÷òî òóäà íå ïðîíèêàþò ëèìôîöèòû,çàòî òàì â äîñòàòêå ïèòàòåëüíûõ âåùåñòâ è èíñóëèíà, êîòîðûå ëåãêî ïðîõîäÿò è íóæíû äëÿ âûçðåâàíèÿ ñïåðìàòîçîèäîâ, ìîãó è äàëüøå ëåêöèþ ìèêðîáèîëîãèè âàì ÷èòàòü... Êòî æå óíè÷òîæèò ïîäñàæåííûå êëåòêè? Äà, òóäà ìîæíî ïîäñàäèòü è òðóïíûå, íî íå ñâîèì è íå ñåáå.
Âàøà àãðåññèÿ êî ìíå íå ïîíÿòíà, õîòÿ ìîÿ ê ýíäîêðèíîëîãàì ëåãêî îáüÿñíèìà. Ðàçâå âû ëå÷èòå äèàáåò? Íåò, åãî ëå÷àò ôàðìàêîëîãè! Îòñóòñòâèå îñëîæíåíèé ñâÿçàííî ñ Ñ-ïåïòèäîì, êîòîðûé îò íèõ ïðåäîõðàíÿåò. Òàê ïî÷åìó íåëüçÿ âûïóñêàòü åãî ñìåñü ñ èíñóëèíîì â êàòðèäæàõ? È ïî÷åìó îá ýòîì ìîë÷àò? Âû ïîëó÷èëè çâàíèå. Çà ÷òî? Êàêîå õðîíè÷åñêîå çàáîëåâàíèå âû âûëå÷èëè? |
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"ÿ áåðó êîíòåéíåð è ïðèâîæó ìàòåðèàë" ---- ïðàâèëà ïåðåâîçêè òðóïà äëÿ äàííîãî ñëó÷àÿ íå ðàçðàáîòàíû, âðåìÿ- íå èçâåñòíî. Ïðèäåòñÿ ïðîâåçòè ðÿä èññëåäîâàíèé ïî óòî÷íåíèþ ñðîêîâ ïðîòåîëèçà ïîäæåëóäî÷íîé æåëåçû ïëîäà.
"åãî ïîäãîòàâëèâàþò (èíêàïñóëèðóþò - ñîëè òèòàíà) è ââîäÿò ìíå â íàäëåæàùåå ìåñòî (ê ïðèìåðó, â ïàðåíõèìó ÿè÷êà-ãåìàòîòåñòèêóëÿðíûé áàðüåð)" âíà÷àëå íàäî áóäåò çàêóïèòü çà ðóáåæîì è ïåîðåâåçòè çà ãðàíèöó îáîðóäîâíàèå äëÿ ñåïàðàòöè ñîáñòâåííî áåòà - êëåòîê èç ïîäæåëóäî÷íîé æåëåçû è ñîîòâåñòâóþùèå ðàñòâîðû, êðîìå òîãî, íóæåí îáó÷åííûé ïåðñîíàë äëÿ âûïîëíåíèÿ ýòîé ìàíèïóëÿöèè è ëàáîðàòîðíîãî êîíòðîëÿ êà÷åñòâà ïîëó÷åííûõ êëåòîê. Âïðî÷åì, ñîæíî çàðàíåå ïîñëàòü íàìå÷åííîãî äëÿ ýòèõ öåëåé ãèíåêîëîãà + 1-2 âðà÷åé -ëàþáîðàíòîâ è îáó÷èòü èõ. Ñëîæèâ çàòðàòû íà ïîêóïêó ýòîãî àãðåãàòà( òåõíè÷åñêè åãî èäåÿ ñðàâíèòåëüíî ïðîñòà. íî òåõíîëîãèÿ è ìàòåðèàëû + ïàòåíòíàÿ çàùèòà ïîòÿíóò ìèëëèàðäà íà 2-3 äîëëàðîâ) + îáó÷åíèå è ïðîæèâàíèå ïåðñîíàëà + ðàñòàìîæêà.. Äóìàþ. ìèëëèàðäîâ íà 10 ïîòÿíåò... " Âåäü ïðè ïðàâèëüíîé ïîäãîòîâêå è ââåäåíèè (íàïðèìåð ïîä êàïñóëó ïî÷êè) äàæå êëåòêè êðîëèêà (ìåæâèäîâàÿ òðàíñïëàíòàöèÿ) ôóíêöèîíèðóþò äî 2-3 ëåò" - âîò òîëüêî ïðî êðëèêà - íå íàäî. Ýòî îòå÷åñòâåííîå äîñòèæåíèå êðîëèêîðâîäñòâà ñëóæèò âåðîé è ïðàâäîé êðîëèêîâîäàì, íî íå ïàöèåíòàì. " À ôåòàëüíûå âíóòðèâèäîâûå íàâåðíî âîîáùå íå áóäóò îòòîðãàòüñÿ?" - äà, ïðè óñëîâèè ïîæèçíåííîãî ïðèåìà ñïåöèàëüíûõ ïðåïðàòàîâ ( ñåé÷àñ íîâàÿ ãåíåðàöèÿ èììóíîñóïðåññîðîâ, ïðîáëåìà â òîì, ÷òî ñòàðûå ñàìè ïî ñåáå âûçûâàëè äèàáåò). "È,åùå,ñêîëüêî ýòî ìîæåò ñòîèòü, âåäü çàäà÷à âðà÷à òîëüêî èíêóáàöèÿ,èíêàïñóëÿöèÿ è ââåäåíèå ïðîñòûì øïðèöîì, ÷òî ìîæíî ñäåëàòü â ëþáîé áîëüíèöå?" -ïîñîêëüêó çàäà÷à âðà÷à êóäà ñëîæíåå, íà âñêèäêó ( íó. êðîìå äåíåã, ïîòðà÷åííûõ íà àäâîêàòîâ çà óìåíüøåíèå ñðîêà ïðåáûâàíèÿ â òþðüìå çà óáèéñòâî) â 20-30 ìèëëèàðäîâ äîëëàðîâ îáîéäåòñÿ... "Íà ñ÷åò çàêîíà è ýòè÷åñêèõ íîðì: âåäü íåëüçÿ æå çàïðåòèòü ââåñòè ìíå òî,÷åãî óæå íåò,äîïóñòèì ñëóùåííûé ýïèòåëèé äðóãîãî ÷åëîâåêà èëè ìåíñòðóàëüíóþ êðîâü (êàê ïðèìåð),êîãäà ýòî ïðèíåñåò ïîëüçó" - ðàçðàáîòêà ïîêàçàíèé è ïðîòèâîïîêàçíèé ê ââåäåíèþ ìóæ÷èíå â òèòàíîâîì ïàêåòå îòòîðãøåãîñÿ ýíäîìåòðèÿ- çà Âàìè..
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Ã.À. Ìåëüíè÷åíêî |
#5
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Çâàíèå ìíå äàëè çà êðàñèâûå ãëàçà, ýòî î÷åâèäíî êàæäîìó ïðîñòîìó ñîâåòñêîìó ÷åëîâåêó.
Ïîéäåì äàëüøå- îá àãðåññèè è Ñ - ïåïòèäå. Èäåè î òîì, ÷òî Ñ - ïåïòèä íóæåí, è íóæíî ñèíòåçèðîâàòü ÷åëîâå÷åñêèé Ñ- ïåïòèä è ââîäèòü åãî ñ èíñóëèíîì- ýòî èäåè êîíöà 70-õ ãîäîâ. Ôèðìà Ëèëëè ðàçðàáàòûâàëà òàêèå ïðåïàðàòû â íàäåæäå, ÷òî íà Ñ - ïåïòèäå ñòàíåò ìåíüøå ðåòèíîïàòèé. Óâû, íå ïîëó÷èëîñü. Ãåòåðîãåííûé Ñ- ïåïòèä èç êðóïíîãî ðîãàòîãî, ñâèíîãî è ïð. íå íóæåí èç-çà èìóíîãåíîñòè, ÷åëîâå÷åñêèé ñåáÿ íå îïðàâäàë â êëèèí÷åñêèõ èñïûòàíèÿõ. Òåïåðü î ëå÷åíèè, ñìåëûõ ìûñëÿõ. âðà÷àõ âðåäèòåëÿõ è ïð. Îñòûíüòå, ëàäíî? À ïîòîì ïîãîâîðèì î Âàøåé ðàöóõå è ÿ ðàññññêàæó îá Ýäìîíòîíîâñêîì ïðîòîêîëå. ß ñ áîëüøîé ñèìïàòèåé îòíîøóñü ê ëþáîìó ïàöèåíòó, òåì áîëåå - ñ óâàæåíèåì ê ìóæåñòâó ëþäåé ñ äèàáåòîì 1 òèïà, íî ìîå ê íèì óâàæåíèå-íå ïîâîä äëÿ ïîâåäåíèÿ à ëà îäèí î÷åíü èçâåñòíûé ãåðîé â êâàðòèðå îäíîãî íå ìåíåå èçâåñòíîãî ïðîôåññîðà. Îñåíèâøàÿ Âàñ èäåÿ, óâû. áîëåå ÷åì áåññìûñëåííà. À âîò àãðåññèÿ áîëüíîãî äèàáåòîì 1 òèïà ê ýíäîêðèíîëîãàì, äåéñòâèòåëüíî, âïîëíå îïðàâäàíà. Îòêðûëè, ìåðçàâöû, èíñóëèí. ëå÷àò, ïàðàçèòû, êîíòðîëèðóþò, åùå è óëó÷øàþò ÷òî-òî, íåãîäÿè. Íåò, ÷òîá ïî íàøåìâó. ïî ïðîñòîìó, ìåíñòðóàëüíóþ êðîâü â òåñòèêóë ââåñòè, áåòà - êëåòêó â ñóõîå ÿè÷êî øïðèöåì ïîäñàäèòü.. Äåëîâ -òî. áëèí.. Ñîâñåì îáëàæàëèñü. íè õðåíà äåëàòü íå óìåþò...
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Ã.À. Ìåëüíè÷åíêî |
#6
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Èçâèíåíèÿ
Äîêòîð, ïðîøó ïðîùåíèÿ åñëè îñêàðáèë Âàñ. Ýíöåôàëîïàòèÿ! Ïðî Ýäàìîíòîâñêèé ïðîòîêîë î ïåðåñàäêå êëåòîê äåâî÷êå ïîñëå ïàíêðåàýêòîìèè ÿ óæå ïðî÷èòàë, íî íå ïîíÿë ïðè÷åì çäåñü ãèñòîñîâìåñòèìîñòü. Åùå ðàç äîêòîð, ïðîøó ïðîøåíèÿ, ãèïîãëèêåìèè êàæäûé äåíü, à ýòî æå ãèïîêñèÿ ìîçãà...
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#7
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1.Ïåðåâîçèòü ÿ èõ áóäó íà ëüäó, êàê îòðåçàííîå óõî. Çà 20-40 ìèíóò. Çà ýòî âðåìÿ äàæå íåéðîöèòû íåêîòîðûõ íå ïîãèáíóò.
2. Ñïðàâèòñÿ è ãèñòîëîã, "íàêîâûðÿåò 40-50 îñòðàâêîâ, õîòÿ ðàñòâîðû íóæíû. Íî âåäü ê ïðèìåðó â Íîâãîðîäå åñòü ëàáîðàòîðèÿ, çàíèìàþùàÿñÿ êëåòî÷íîé òðàíñïëàíòàöèåé, äà è ìíîãî åùå ãäå, â Ìîñêâå òîæå åñòü. 3. Ïðî òåñòèêóëû-ñïåðìàòîçîèäû ìû óæå ãîâîðèëè. 4. À ñðîê òî çà ÷òî, çà óáèéñòâî ìåíÿ ÷òî-ëè. 5. ×òî òàêîå ðàöóõ? 6. Ãðàíò Áàíòèê, Ôðåäåðèê Ã. áûë ôèçèîëîãîì, êàê è Äæîí Äæåéìñ Ðèêêàðä Ìàêëåîä. À ïðè ÷åì çäåñü ýíäîêðèíîëîãè? Âû õîòèòå ñàìè ïðîäåëàòü ýòîò ýêñïåðèìåíò, òîãäà ïðèäåòñÿ èäòè ïî ïóòè èç âàøåãî ñîîáùåíèÿ. Íî ëþäè òî ýòèì çàíèìàëèñü, ïóñòü ñ êëåòêàìè íåñ÷àñòíûõ êðîëèêîâ. À êàêàÿ ðàçíèöà, ÿ æå òîæå ìëåêîïèòàþùååñÿ. |
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Âîò ïðè÷èíó ãèïîãëèêåìèé ñëåäóåò ïîèñêàòü - çäåñü ÿ ïîëíîñòüþ ê Âàøèì óñëóãàì.
Åùå ðàç- ó âàñ ëè÷íî î÷åíü õîðîøèé âàðèàíò äèàáåòà 1 òèïà- ò.í. Ñ - ïåïòèäïîçèòèâíûé, ò.å åñòü íåêîå îñòàòî÷íîå êîëè÷åñòâî áåòà - êëåòîê, âûðàáàòûâàþùèõ íåêîå ìèíèìàëüíîå êîëè÷åñòâî Ñ- ïåïòèäà è ýêâèìîëÿðíîå- èíñóëèíà. Êàê ïðàâèëî, ýòè ïàöèåíòû, íåñìîòðÿ íà áîëüøîé ñòàæ äèàáåòà, èìåþò ìàëî ìèêðîàíãèîïàòèé. Òåïåðü î ïðîòîêîëå- ïàöèåíòû ñ äèàáåòîì 1 òèïà- ýòî ëþäè, áåòà - êëåòêè êîòîðûõ ðàçðóøàþòñÿ àóòîèìóííûìè ìåõàíèçìàìè( àíòèòåëà, ëèìôîöèòàðíàÿ èíôèëüòðàöèÿ). ×åì áëèæå ê àíòèãåííîé ñòðóêòóðå ðåöèïèåíòà êëåòêè äîíîðà, òåì áîëüøå âåðîÿòíîñòü ïîâòîðåíèÿ àãðåññèè. Ïîýòîìó ïî Ýäìîíòîíîâñêîìó ïðîòîêîëó íå ñòðåìÿòñÿ ê àíòèãåííîé áëèçîñòè. È îá ôåòàëüíûõ áåòà- êëåòêàõ. Âîîáùå â ïðèëè÷íîé ëèòåðàòóðå( ñïåöèàëüíîé ìåäèöèíñêîé ïðèëè÷íîãî óðîâíÿ), äóìàþ, íå ìåíüøå 7-8 òûñ. ðàáîò ïî òåì èëè èíûì âûðàùèâàíèÿì èç òåõ èëè èíûõ èñòî÷íèêîâ áåòà - êëåòîê äëÿ ïåðåñàäêè. Ïðîáëåì î÷åíü ìíîãî, è ãëàâíàÿ: áåòà - êëåòêà- ñëîæíåéøèé îðãàí, â îáÿçàíîñòè êîòðîãî âõîäèò ÷óâñòâîâàòü ãëþêîçíûé ( è íå òîëüêî ãëþêîçíûé ) ñèãíàë è â îòâåò íà íåãî âûäåëÿòü èíñóëèí â íóæíîì êîëè÷åñòâå ñ íóæíûì âðåìåííûì èíòåðâàëîì( çàìåòüòå, ýòî èíñóëèí êàê-òî íàäî åùå íàñèíòåçèðîâûàòü è õðàíèòü). Äà åùå íàäî è äåëèòüñÿ ñ òåì æå òåìïîì, ÷òî è ñîáñòâåííî ÷åëîâå÷åñêàÿ çäîðîâàÿ áåòà - êëåòêà ( à ÷èñëî äåëåíèé êðàéíå ìàëî, è ïðîæèòü íàäî äîñòàòî÷íî) òàê âîò,òîëüêî ïîñëå ðîäîâ áåòà- êëåòêà ïðèîáðåòàåò â ïîëíîé ìåðå ýòè íàâûêè. Ïîìåøàòü æå åé èõ ïðîèáðåñòè ìîæåò ìíîæåñòâî âíóòðèóòðîáíûõ ôàêòîðîâ, à âîò íàó÷èòü åå âñå ýòî äåëàòü â êóëüòóðå ( äà åùå ýòó êóëüòóðó âûðàñòèòü) ïîêà íå î÷åíü -òî óäàåòñÿ...Âû âåñüìà óïðîùåííî ïåðäñòàâëÿåòå ñåáå âûêîâûðèâàíèå áåòà - êëåòêè èç ïïîäæåëóäî÷íîé æåëåçû, óâû, âñå ñîâñåì íå òàê ïðîñòî. Äåëî â òîì, ÷òî âïðîöåññå ñîçðåâàíèÿ íà êëåòêó â íóæíî ïîñëåäîâàòåëüíîñòè äåéñòâóåò ìàññà ïðîñòîâûõ ôàêòîðîâ, è äàëåêî íå âñå èç íèõ íàì ìèçâåñòíû. è âîñïðîèçâåñòè ýòî âñå â êóëüòóðå ïîêà íå ñëèøêîì-òî óäàåòñÿ... À êëåòêè -ïðåäøåñòâåíèêè äîëæíû åùå íàó÷èòüñÿ ñòàòü áåòà- êëåòêîé... È â î÷åíü - î÷åíü ìíîãèõ ëàáîðàòîðèÿõ âðà÷è - èññëåäîâàòåëè, ôèçèîëîãè. ôàðìàêîëîãè è êëèíèöèñòû ( äà.äà, èìåííî êëèíèöèñòû ñòîÿò íà çàâåðøàþùåì- êëèíè÷åñêîì ýòàïå èçó÷åíèÿ òîãî èëè èíîãî ìåòîäà) çàíèìàþòñÿ óñîâåðøåíñòââîàâàíèåì ëå÷åíèÿ äèàáåòà. Ðàçóìååòñÿ. ýòî ïîâîä, ÷òîáû èõ íåíàâèäåòü- âåäü îíè åùå íå íàó÷èëèñü èçëå÷èâàòü äèàáåò. Ñëàáûì óòåøåíèåì ñòàíîâèòñÿ òî, ÷òî îíè äàþò âîçìîæíîñòü ïàöèåíòàì ñ äèàáåòîì æèòü è ñïîêîéíî íåíàâèäåòü âðà÷åé...
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Ã.À. Ìåëüíè÷åíêî |
#9
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Pediatric Clinics of North America
Volume 52 • Number 6 • December 2005 - Âåñü íîìåð ïîñâÿùåí DM A Look to the Future: Prediction, Prevention, and Cure Including Islet Transplantation and Stem Cell Therapy Anna Casu, MD Massimo Trucco, MD Massimo Pietropaolo, MD PANCREAS AND ISLET TRANSPLANTATION A major goal of clinical investigation in T1DM is to restore a physiologic insulin secretion after engrafting the pancreas or the pancreatic islets into T1DM diabetic recipients. Although ectopancreatic transplantation of donor pancreas has proved fairly effective in normalizing blood glucose levels with partial to complete restoration of C-peptide production in selected groups of patients, islet transplantation gave less promising results [116]. It should be noted that pancreas and islet transplantation cannot be considered as life-saving procedures, and the benefit and risk of these procedures must be thoroughly weighed, particularly if one is dealing with pediatric patients that need long-lasting chronic immunosuppressant therapy to prevent allorejection of the graft. The improvement of new immunosuppressive regimens is an important objective to achieve before considering pancreas and islet transplantation as the standard of care for T1DM [117]. Over the past few years, Shapiro and coworkers [118] have been able to reverse T1DM following islet implantation and the success of the Edmonton protocol has again sparked interest for islet transplantation. Shapiro and coworkers [118] administered a steroid-free immunosuppression regimen along with a larger number of transplanted islets compared with previous islet transplantation protocols; sirolimus (0.2 mg/kg/d orally, followed by 0.1 mg/kg/d); low-dose tacrolimus (<2 mg/d orally); and daclizumab (1 mg/kg intravenously every 14 days), an anti interleukin-2 receptor antibody [118]. Side effects were those related to transhepatic puncture and intrahepatic infusion and those related to immunosuppression, such as ulceration of the buccal mucosa, nausea and vomiting, arthralgias, diarrhea, and anemia. Some of the patients had low white blood cell count and a rise in serum creatinine. After a median follow-up of 20 months, 11 transplanted patients were off insulin. According to the American Diabetes Association criteria for diagnosis of diabetes after oral glucose tolerance test, however, only two subjects met the criteria for normal glucose tolerance and the remainder had diabetes [119]. The Edmonton protocol has been widely adopted; however, data on long-term follow-up are not yet available. STEM CELL THERAPY, GENE THERAPY, AND OTHER THERAPIES With the initial success of the Edmonton protocol and increased interest for islet transplantation [118], a number of concerns have arisen, including the insufficient number of donors to yield a sufficient number of implantable islets and the need for a life-long immunosuppressive therapy to prevent both allograft rejection and autoimmunity recurrence. These major obstacles have shifted the interest to alternative approaches to create less immunoreactive and potentially endless alternative sources of islet cells, or to regenerate pancreatic β-cells (reviewed in [120]). The shortage of implantable islets could be overcome by a number of new approaches, including transformed insulin-producing cell lines, transfection of different cell types enabled to produce insulin, in vivo transdifferentiation of liver cells, and isolation of xenogeneic porcine islets [117], [120], [121]. It has been hypothesized that newly formed islets derive from the duct epithelium [122], or alternatively from the islet cells themselves [123] or from islet neogenesis, a precursor that may be able to compensate for islet loss. Islet neogenesis may be the end result of a dedifferentiation of pancreatic epithelial cells, or newly formed islets might originate from common endocrine, multipotent progenitors. These islet progenitors seem also to be present within the pancreatic islet microenvironment [124]. It might be easier to derive precursor cells from stem cells, adult or embryonic, and use them to regenerate the damaged endocrine pancreas. Embryonic stem cell lines might give rise to a potentially unlimited source of insulin-producing cells. Even if embryonic stem cells were soon made available for the scientific community, however, their differentiation toward insulin-producing cells would still remain very difficult to direct. In contrast, achieving transdifferentiation into β-cells from adult stem cells obtained from tissues that belong to other lineages might be a more feasible task. The latter could be an attractive approach to avoid the serious problems related to allorejection because adult tissues can be obtained from an autologous living donor. Nevertheless, this approach is not likely to prevent the recurrence of autoimmunity if it is not combined with immunotherapy. A similar strategy is based on converting the patient's nonislet cells of different lineages into insulin-producing cells. This has been accomplished using gene-engineered hepatocytes that were able to produce insulin after transfecting them with pdx1 under the control of the rat insulin 1 promoter [125]. Although not yet confirmed, this observation suggests that engineered surrogate β-cells or insulin-producing cells obtained from cells of different lineages could be exploited to restore insulin secretion. Other alternative sources of insulin-producing cells include xenogeneic donor manipulated cells that could provide an indefinite supply of β-cells for transplantation. In an elegant set of experiments, the generation of a transgenic pig that was deficient for α(1,3)-galactosyltransferase resulted in the dissipation of the hyperacute xenograft rejection response. This was a major advance that might set the stage toward the attainment of the first clinical trial in humans using xenogeneic islet donors [126], [127], [128], [129]. Although many of these approaches seem to hold great promise as alternative strategies to cure T1DM, it is unlikely that the recurrence of islet autoimmunity can be prevented without an appropriate immunotherapeutic treatment. In T1DM patients, the autoimmune process not only damages the pancreatic β-cells, leading to the clinical onset of the disease, but also limits the regeneration of newly formed β-cells that will eventually replace those cells that are lost. The recurrence of autoimmunity in combination with allorejection is probably what differentiates transplanted patients with T1DM from patients who received islet autotransplantation and were able to maintain long-lasting glucose homeostasis [117], [130]. Strategies aimed at blocking this autoimmune process, or at manipulating potentially less immunoreactive transplanted cells, should yield more encouraging results. These strategies include patient's own cells of different lineages converted into insulin-producing cells; xenogeneic donor manipulated cells; and other manipulated insulin-producing cells, which are likely less immunoreactive. Furthermore, the autoimmune process is successfully averted by blocking the autoreactive T cells with an anti–T-cell antibody (antilymphocyte serum) and by inducing a mixed allogeneic chimerism by transplanting bone marrow from a diabetes-resistant donor [131]. Hematopoietic precursors do not directly participate in islet cell regeneration, although they might be necessary to promote an effective regenerative process, which is independent of the ability to block the autoimmune process [132]. A better understanding of the autoimmune process and the ability to restrain this process not only could prevent the disease, but also help restore residual islet function following islet transplantation or regeneration. |
#10
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"Ïðè ÷åì çäåñü ýíäîêðèíîëîãè"- ñêàæåòå ñâîåìó ëå÷àùåìó âðà÷ó, æåëàòåëüíî â ìàêñèìàëüíî ãðóáîé ôîðìå. Áóäåòå èìåòü óñïåõ.
Íàêîâûðÿòü îñòðîâêè- èäåÿ õîðîøàÿ. Òîëüêî òàê íå äåëàþò. Ðàçâå ÷òî êðîëè÷üè. Ðàöóõà- òåðìèí äëÿ îáîçíà÷åíèÿ ïðåäëîæåíèÿ ðàöèîíàëèçàòîðñêîãî, èñõîäÿùåãî îò ïðîñòîãî ðàáî÷åãî â ëó÷øèõ òðàäèöèÿõ íàðîäíîãî ìèôîòâîð÷åñòâà. Òèïà "ñòî èíæåíåðîâ íè÷åãî íå ìîãëè ïðèäóìàòü, à äÿäÿ Âàíÿ ñïüÿíó âàëåíêîì ñòóêíóë, âîò ðàêåòà è íà Ëóíå"..
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Ã.À. Ìåëüíè÷åíêî |
#11
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Ñïàñèáî,Àëîí, íî êàê áû ïðàâèëà ôîðóèà íå çàñòàâèëè íàñ âñå ýòî ïåðåâåñòè. òóò òàêàÿ òåíäåíöèÿ, ÷òî ïàöèåíòó íàäî âñå ãîâîðèòü ïî ðóññêè.. Ïîýòîìó ïîïðîøó ñíèñõîæäåíèÿ- ïàöèåíò îáðàòèëñÿ íå ñ êëèíè÷åñêèìè ïðîáëåìàìè, à ñ ðàöèîíàëüíûì ïðåäëîæåíèåì ïî ìàññîâîé óòèëèçàöèè àáîðòóñîâ Ðîññèè. Ìîæíî, ìû íå ñòàíåì ïåðåâîäèòü òåêñò, ëþáåçíî ïðåäîñòàâëåííûé Àëîíîì, òåì áîëåå, ÷òî ÷àñòü åãî ïîëîæåíèé ÿ óæå ïåðåñêàçàëà?
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Ã.À. Ìåëüíè÷åíêî |
#12
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Ýòî íå äëÿ ïàöèåíòà - ïðîñòî õîòåë îáðàòèòü âíèìàíèå çàèíòåðåñîâàííûõ ëèö íà ïîñëåäíèé íîìåð Pediatric Clinics of North America.
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#13
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1.ß âåäü õîòåë ïåðåñàäèòü íå â ìûøöû ëèöà, à â ïàðåíõèìó ÿè÷êà, ãäå íåò ëåéêîöèòîâ, à ãóìîðàëüíûé èììóíèòåò ó ìåíÿ íå ìîã âûðàáîòàòüñÿ íà ýòè êëåòêè, ÿ æå èõ íå ââîäèë. Êàêàÿ êëåòêå ðàçíèöà ðàçâèâàòüñÿ âî ìíå èëè èçíà÷àëüíîì òåëå, ãëàâíîå ÷òîáû åå íå àòàêîâàëè è ñîçäàëè óñëîâèÿ, õîòü â êàêîì òî ãèïîòåòè÷åñêîì èíêóáàòîðå, ïðîñòî ýôôåêò íàñòóïèò îòñðî÷åíî.
2.ß ÷èòàë ïðî ýòó ôîðìó äèàáåòà. Ïîìîåìó îíà íàçûâàåòñÿ Maltus(?). Ìîæåò ïîäñêàæèòå òèï íàñëåäîâàíèÿ ýòîé ôîðìû (âåäü Âû íå îäíà, ñ ïîìîùíèêîì). Íî âñå îñëîæíåíèÿ ÿ ñâÿçûâàþ ñ ãèïîãëèêåìèÿìè, ê ïðèìåðó, äèëÿòàöèÿ ñåðäöà (à ìîæåò îò òîãî, ÷òî ïèâî ëþáëþ?). 3.Î ìàëîé ÷àñòè ïîñëåäñòâèé ýòèõ ãèïîãëèêåìèé ÿ ñåãîäíÿ ïèñàë íà ôîðóìå:[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] â ñòàòüå "Äîèãðàåòåñü". 4.Íó ëàäíî, ïîéäó âûïüþ êðóæå÷êó ïèâà, çàâòðà íà ñóòêè. 5.ß ìåæäó ïðî÷èì, òîæå âðà÷îì ðàáîòàþ. Íà ÑÌÏ, óæå ìíîãî ëåò. È ÷òî çíà÷ÿò âàøè ñëîâà "òóò òàêàÿ òåíäåíöèÿ, ÷òî ïàöèåíòó íàäî âñå ãîâîðèòü ïî ðóññêè"? 6. Ïîîáùàåìñÿ â áóäóùåì, åñëè ÿ âàì íå ñèëüíî íàäîåë. |
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Òîò ôàêò, ÷òî âû âðà÷ è ëþáèòå ïèâî, ìåíÿ ðàäóåò åùå ìåíüøå, âïðî÷åì, êàêè Âàøå óïîðñòâî ïî ïîâîäó òàíòàëîâîé ïîäñàäêè àáîðòóñíûõ áåòà - êëåòîê â ìíîãîñòðàäàëüíóþ òêàíü ÿè÷êà.
Ïðî êàêóþ ïðî ýòó ôîðìó äèàáåòà è ÷òî âû ÷èòàëè,ÿ íå ïîéìó, íî âîò êîãî âû ñ÷èòàåò ìîèì ïîìîøíèêîì, ÿ ïîíèìàþ åùå ìåíüøå. Äîêòîð èç Èçðàèëÿ, òàê æå, êàê è âàøà ïîêîðíàÿ ñëóãà, â ïðèíöèïå, èìåþò ìíîãî ðàáîòû, ïîìèìî áåñåä ñ èçîáðåòàòåëÿìè. Ïðîáëåìà îáó÷åíèÿ ýìáðèîíàëüíîé êëåòêè- ïðåäøåñòâåííèêà áåòà- êëåòêè âûïîëíåíèþ âñåõ îáÿçàíîñòåé áåòà - êëåòêè, ðàâíî êàê è åå âûðàùèâàíèå, ñòàëêèâàþòñÿ ñî ìíîãèìè ñëîæíîñòÿìè. Íàèáîëåå óñïåøíî ïðîáëåìà ïåðñàäêè ðåøàåòñÿ ñ ïîïîøùüþ Ýäìîíòîíîâñêîãî ïðîòîêîëà, îäíàêî è çäåñü ìíîãî îãðàíè÷åíèé.Âûó÷èòü äðóãèå êëåòêè ñòàòü áåòà- êëåòêîé òîæå íå óäàåòñÿ â ïîëíîé ìåðå. Âàøè ïðåäñòàâëåíèÿ î òåõíè÷åñêèõ ïðèåìàõ ïîëó÷åíèÿ êóëüòóð è èõ âûðàùèâàíèÿ äàëåêè îò ñîâðåìåííûõ ïðèíöèïîâ, õîòÿ è áëèçêè ê èäåÿì äâàäöàòûõ ãîäîâ ïðîøëîãî âåêà. Ïðîáëåìû ïèâíîãî íàðóøåíèÿ áàëàíñà ãëþêîçû + ïðîáëåìû ìèîêàðäà äåéñòâèòåëüíî ñóùåñòâóþò. Åñëè âàì íóæíà ìåäèöèíñêàÿ ïîìîùü- áóäó îáÿçàíà åå îêàçàòü. Ñâåòñêàÿ áåñåäà ñ ïåðèîäè÷åñêèì íàðóøåíèåì ïðîòîêîëà âñ âàøåé ñòîðîíû íåñêîëüêî íàïðÿãàåò.
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Ã.À. Ìåëüíè÷åíêî |
#15
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Íó òîãäà íå áóäåì îáùàòüñÿ, ìíå òîæå âàø àïëîìá íå ïîíðàâèëñÿ, äà è îáÿçàííîñòè ìíå âàøè íè ê ÷åìó, áåç íèõ 35 ëåò æèë ñ÷àñòëèâî (è ñìîæåòå ëè âû ÷òî íè áóäü ñäåëàòü - íåò). Ïðîùàéòå.
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