自体造血干细胞移植治疗白血病102例疗效分析

目的探讨三组自体造血于细胞移植疗效及影响疗效因素，与同期化疗组疗效比较。方法对未净化自体骨髓移植(ABMT)17例、净化自体骨髓移植(PABMT)30例、自体外周血干细胞移植(APBHSCT)55例、同期化疗组34例，进行临床资料分析。结果ABMT组、PABMT组、APBHSCT组3年无病生存(DFS)率及复发率分别为63.8％、70.4％；66.5％、35.2％；26.6％、29.5％。骨髓恢复增生活跃中位时间分别为60d、58d、34d。影响疗效因素AML疗效优于ALL疗效，CR1期移植优于CR2期移植，CR到移植期间>7个月者优于<7个月者。化疗组3年DFS为7.38％，复发率为76.4％。结论PABMT组疗效优于其它二组，APBHSCT组造血功能恢复较其它二组快，AML疗效优于ALL疗效，CR1期移植优于CR2期移植，3个移植组疗效优于化疗组。     

自体外周血造血干细胞移植

自体外周血造血于细胞移植（Autologouspe－ripheralbloodstemcelltransplantation，APBSCT）是通过血细胞分离机从患者外周静脉血中采集造血干／祖细胞进行移植的方法。近年来APBSCT发展极为迅速，大有代替自体骨髓移植（Autologousbonemarrowtransplantation，ABMT）的趋势。APBSCT与ABMT相比，主要具有以下优点：（1）移植后造血功能恢复迅速，减少了感染、出血等并发症的发生率，从而降低了移植相关死亡率，同时也缩短了治疗时间，节减了移植费用；（2）外周血中混人肿瘤细胞的机会较骨髓移植少；（3）采集造血干细胞方法简…     

急性粒细胞白血病初次缓解后进行强化治疗与自体骨髓移植的随机对照研究

目前预防急性粒细胞白血病（AML）初次缓解后复发的方法共有三种：有合适供体的患者可接受异基因造血干细胞移植，其他患者可以接受强化治疗或自体骨髓移植（ABMT），本实验旨在比较后两者的疗效。病人和方法1820例随机分为两组，在诱导期分别用DAT方案（柔红霉素加阿糖胞音加硫鸟源吟）或ADE方案（阿糖胞着加柔红霉素加依托泊甙）化疗，各两个疗程。另128例患者只接受一个疗程或其他化疗方案。其中未能CR的患者被除外并给予补救治疗，剩下的患者在第3个疗程接受MACE方案（安吖啶加阿糖胞苷加依托泊甙），然后采集骨髓标本（每公斤…     

自体造血干细胞移植治疗恶性淋巴瘤

自体造血干细胞移植（Auto－HSCT）包括外周血和骨髓移植，发展极为迅速，目前已成为治疗有预后不良因素的恶性淋巴瘤（ML）的主要方法。我院1997年8月至今为2名ML患者分别予以自体骨髓移植（ABMT）、自体外周血于细胞移植（APBSCT）＋激活骨髓（ABM）治疗，取得良好疗效。1对象和方法1．1病例介绍例1男，30岁，体重65kg，体表面积1．65m2。因颈部、腹股为淋巴结肿大，诊断为NHLⅢA。组织病理学为弥漫小裂细胞型B细胞性，先后经CHt）P＋Bel、COP、CHOP＋VP－16、HDMTX等轮替化疗7个疗程，并辅赛诺金（a－Zb；干扰素）、…     

单克隆抗体净化骨髓用于急性粒细胞白血病自身骨髓移植

大剂量化疗和/或放疗后进行骨髓移植,为在完全缓解(CR)期全部消除隐匿的白血病细胞带来了很大希望。但大多数急性粒细胞白血病(AML)患者由于无 HLA 相配的供体,或年龄过大(>45岁),致使同种骨髓移植无法进行,用自身骨髓移植(ABMT)可克服这些困难。为增加 ABMT 治疗作用,本文报道用单克隆抗体净化骨髓,对 AML 病人进行 ABMT治疗的结果。病人和方法 AML30例,年龄11～53岁。除1例由骨髓增生异常综合征转为 AML 外,其余29例开始     

自体造血干细胞移植+BEAC方案治疗预后不良非霍奇金淋巴瘤疗效观察

用自体外周血造血干细胞移植（APBSCT）＋大剂量BEAC方案治疗预后不良非霍奇金淋巴瘤（NHL）患者10例，均获快速造血功能重建，其中7例高危初治者完全缓解（CR），3例复发者中CR2例、PR1例；无移植相关死亡。提示APBSCT＋大剂量化疗对预后不良或复发NHL安全有效，能改善患者生存率。     

自体造血干细胞移植治疗急性白血病的临床观察

目的：评价自体造血干细胞移植治疗急性白血病的疗效;观察多疗程中大剂量阿糖胞苷（Ara-C）治疗后外周血干细胞采集效果。方法：17例急性白血病患者行自体造血干细胞移植,其中骨髓移植4例,外周血造血干细胞移植13例,在外周血造血干细胞移植的患者中有4例在诱导和巩固治疗中采用中大剂量Ara—C2疗程或2疗程以上,观察不同组患者造血干细胞采集情况及造血重建情况,并监测患者的疗效。结果：外周血干细胞移植的患者采集的中位MNC数和中位CD34^＋细胞数明显高于骨髓组,差异有统计学意义（均P〈0．05）;使用中大剂量Ar〉C2疗程或2疗程以上的患者采集的中位MNC和中位CD34^＋细胞数与未使用的患者比较差异无统计学意义（P〉0．05）;外周血干细胞移植患者中性粒细胞〉0．5&#215;10^9／L和血小板〉20&#215;10^9／L的时间较骨髓移植患者短,差异有统计学意义（P〈0．01）;4例患者在复发状态行自体造血干细胞移植,移植后中位生存期9．5个月,缓解期行自体造血干细胞移植的移植后中位生存期81个月,差异有统计学意义（P〈0．05）;17例患者中位生存期（OS）84个月,中位无白血病生存期（DFS）81个月,患者3年无白血病存活率为（68．25&#177;11．23）％。结论：自体外周血造血干细胞移植比自体骨髓移植造血重建快;2疗程或2疗程以上的中大剂量Ara-C治疗的患者仍能采集到足量的外周造血干细胞;缓解期行自体造血干细胞移植可获得较好的OS和DFS。     

自体外周血干细胞移植和自体骨髓移植的临床疗效比较

目的 :比较自体外周血干细胞移植 (APBSCT)与自体骨髓移植 (ABMT)的临床疗效。方法 :用ABMT治疗 2 1例 ,用 APBSc T治疗 2 0例。预处理方案包括全身照射 (TBI) 6 .6～ 8.8Gy加环磷酰胺 (CTX) 10 0～ 12 0 m g/ kg或 TBI 2 .0 Gy加全淋巴照射 (TL I) 4 .0 Gy加 CTX 10 0～ 12 0 m g/ kg加 Vp- 16 6 0 0～ 10 0 0 m g/ m2加环己亚硝脲 (CCNU ) 2 0 0 m g方案或卡氮芥 (BCNU ) 2 0 0 mg/ m2 加 CTX 12 0 mg/ kg加 VP- 16 80 0 m g/ m2 方案或 MAC方案 (马法兰 140 m g/ m2 加 Ara- C 2～ 4g/ m2 加 CTX 12 0 m g/ kg)。结果 :ABMT组造血重建 2 0例 ,移植相关死亡 2例 (9.5 % ) ,复发 4例 (2 0 % ) ,2年无病生存率 (DFS) 6 8.5 0 %± 10 .87% ;而 APBSCT组均获造血重建 ,无移植相关死亡 ,复发 5例 (2 5 % ) ,2年 DFS为 6 2 .34 %± 14.2 6 %。两组差异无显著性意义。结论 :APBSCT与ABMT的疗效相当。     

自体造血干细胞移植治疗恶性血液肿瘤的临床观察

我院自 1 993年 9月以来 ,采用自体造血干细胞移植 (AHSCT)治疗恶性血液肿瘤患者 1 6例 ,报告如下。1　资料与方法1 .1 　 临床资料1 6例患者均经临床、血象、骨髓或组织活检病理确诊。男 1 0例 ,女 6例 ;年龄 6～ 42 (平均 2 1 .5)岁。其中急性非淋巴细胞白血病 (ANLL ) 1 0例 (按FAB分型 :M11例 ,M2 a3例 ,M32例 ,M53例 ,M61例 ) ,移植时均完全缓解 (CR) ,CR16例 ,CR1后进行巩固强化 3～ 5疗程 ;CR2 4例 ,CR2 后进行巩固强化 3疗程。接受自体骨髓移植 (ABMT) 5例、自体外周血干细胞移植 (APBSCT) 5例。急性淋巴细胞白血病 …     

净化及非净化自体骨髓移植治疗白血病39例临床研究

报告自体骨髓移植治疗白血病３９例，其中非净化自体骨髓移植（ＡＢＭＴ）１４例，净化自体骨髓移植（ＰＡＢＭＴ）２５例。中位年龄２８岁（１０～４３岁）。ＡＭＬ２７例，ＡＬＬ１０例，ＣＭＬ２例。ＣＲ１３１例，ＣＲ２７例，ＮＲ１例。ＣＲ至移植时间中位数６．７个月（２～１９个月）。预处理方案：ＴＢＩ加Ａｒａ－ｃ、ＤＮＲ或ＶＰ１６。ＡＢＭＴ组及ＰＡＢＭＴ组３年无病生存（ＤＦＳ）率分别为６８．３２％及６７．５７％，复发率为３０．７６％及２６．８０％。但ＰＡＢＭＴ组ＡＭＬ患者３年ＤＦＳ率为８２．３５％及ＣＲ２期移７５％３年ＤＦＳ率为７５％，明显高于ＣＲ。期移植未净化者５０％。化疗组３年ＤＦＳ率为７．３８％及复发率７６．４％，两移植组疗效优于化疗组。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.