Platelet transfusion from donors mismatched for crossreactive HLA antigens

Increments in platelet counts following the transfusion of platelets mismatched for crossreactive antigens were evaluated in 67 patients with broad alloimmunization to HLA antigens. The corrected increments following 100 HLA, A-matched and B1U- or B2U-matched transfusions were compared with the increments following 307 B1X- or B2X-matched transfusions. HLA-A3 platelets were tolerated poorly by A1 and A11 recipients, as were A1 and A11 by A3 recipients, B17 and BW21 by recipients in the B7 crossreactive group, B5 by B15 and B17 recipients, and B27 by recipients in the B5 crossreactive group. B12 and BW21, and B8 and B14 platelets were not tolerated bidirectionally. Antigens associated with good increments included A28 in A2 recipients, B18 and BW16 (C match) in recipients in the B5 crossreactive group, B5 in B18 recipients, BW22 and B7 in recipients in the B7 crossreactive group. A1 and A11 were transfused successfully bidirectionally. These observations suggest that some private antigens within crossreactive groups are more immunogenic than others and support the observation of others than B17 and BW21 are not in the B5 crossreactive group.     

Hypergammaglobulinemia can be associated with a positive direct antiglobulin test, a nonreactive eluate, and no evidence of hemolysis

To determine the cause of a positive direct antiglobulin test (DAT), blood banks routinely perform serologic tests on eluates prepared from DAT-positive red cells. Negative eluates traditionally have been suspected to be associated with drug reactions. This report confirms that the most frequent cause of a positive DAT and a nonreactive eluate is hypergammaglobulinemia. The results of 74 patient samples with positive DATs were analyzed retrospectively. Eluates prepared from the red cells of 54 patients (72.9%) reacted; eluates from 20 patients (27.1%) did not react. This latter group had identical serologic and clinical findings, suggesting that they made up a homogeneous group. In particular, the patients had a positive DAT, a negative indirect antiglobulin test, and a negative eluate; an increased serum concentration of IgG; and no evidence of hemolysis. In a subsequent study, DATs were performed prospectively on red cells from 44 consecutive patients with elevated serum IgG levels. The serum IgG concentration was highest in the three patients whose red cells had a positive DAT. The DAT also became positive in two patients treated with high-dose intravenous gammaglobulin (IV IgG). These studies indicate that a negative eluate from red cells with a positive DAT, a common serologic finding, is often caused by hypergammaglobulinemia. The authors postulate that IgG binds nonspecifically to the red cells because of the hypergammaglobulinemia.     

聚乙二醇在猪组织工程瓣膜制备中的应用

目的:观察聚乙二醇法在组织工程瓣膜准备中的应用价值,比较聚乙二醇去细胞前后组织工程瓣膜的物理特性。方法:实验于2005-10/2006-03在华中科技大学同济医学院基础医学院生物化学系实验室完成。①实验分组:取猪10只,由于猪主动脉瓣为三叶瓣结构,共取得瓣叶组织30个,麻醉后宰杀取其心脏动脉瓣膜,分为去细胞组和对照组,每组各15个。②实验方法:去细胞组用聚乙二醇和DNase I处理;瓣叶组织放入1kg/L聚乙二醇,室温下浸泡30～45min,振荡器加以振荡;含抗生素磷酸盐缓冲液浸泡24h,反复3次洗脱;以5×104U/L DNase I液浸泡处理1h;对照组仅以含抗生素磷酸盐缓冲液浸泡24h,反复3次洗脱。③实验评估:苏木精-伊红染色、扫描电镜观察去细胞情况,吸光度(A)值,计算去细胞率(%)=(对照组A值-去细胞组A值)/对照组A值×100%。猪去细胞瓣膜条置于力学测试仪测定最大负荷、最大应力、最大应变和弹性模量。结果:纳入猪10只,均进入结果分析。①去细胞组织形态学观察:去细胞组猪瓣膜组织中看不到细胞成分,且细胞外基质结构保存完整,胶原纤维排列整齐,无明显断裂,仍呈波浪状平行排列,结构紧凑,弹性纤维结构清晰,组织无明显水肿。②DNA含量分析:聚乙二醇处理后去细胞百分率为95.32%。③生物力学检测:与对照组比较,去细胞组瓣膜组织最大负荷[(12.586±1.693),(10.242±1.435)N,P>0.05]、最大应力[(2.346±0.342),(1.877±0.572)N/mm,P>0.05]、弹性模量(15.152±1.579,14.549±0.678,P>0.05)、最大应变[(31.685±7.533),(28.118±6.045)mm/N,>0.05]等均无显著差异。P结论:聚乙二醇法去除细胞完全,细胞外基质保存完整,对组织机械性能无明显影响,适于构建组织工程瓣膜。     

The Hong Kong Society of Rheumatology consensus recommendations for the management of gout

Clinical Rheumatology - Gout is one of the most common noncommunicable diseases in Hong Kong. Although effective treatment options are readily available, the management of gout in Hong Kong remains...     

克泻灵片中苦参碱类生物碱的HPLC分析

目的:对克泻灵片中主要有效生物碱定性、定量。完善产品的质量控制及评价手段。方法:采用HPLC,紫外测定波长:220nm。结果:片剂中有有效生物碱以苦参碱类生物碱为主,其中苦参碱和槐定碱含量高,分别占总生物碱的14.2％～31.6％和22.6％～62.7％,其次为槐颗碱和槐胺碱,氧化苦参碱的含量很低。结论:建立了HPLC测定克泻灵片中主要生物碱,方法简便快捷,精密度好,回收率高,可用于制剂及原料的质量控制。     

Complementary medicine: use and attitudes among GPs

BACKGROUND: Information about use and attitudes of GPs towards complementary medicine is required in order to inform the debate about its place within mainstream medicine. There is evidence that public use of complementary medicine is particularly high in the South-West of England. OBJECTIVE: This study aimed to determine the use of, and attitudes towards, complementary medicine among GPs. METHODS: A questionnaire survey was performed of all primary care physicians working in the health service in Devon and Cornwall. RESULTS: Replies were received from 461 GPs, a response rate of 47%. A total of 314 GPs (68%, range 32-85%) had been involved in complementary medicine in some way during the previous week. One or other form of complementary medicine was practised by 74 of the respondents (16%), the two most common being homoeopathy (5.9%) and acupuncture (4.3%). In addition, 115 of the respondents (25%) had referred at least one patient to a complementary therapist in the previous week, and 253 (55%) had endorsed or recommended treatment with complementary medicine. Chiropractic, acupuncture and osteopathy were rated as the three most effective therapies, and the majority of respondents believed that these three therapies should be funded by the health service. A total of 176 (38%) of respondents reported adverse effects, most commonly after manipulation. CONCLUSION: Over two-thirds of the GPs in Devon and Cornwall who responded to the survey had been involved with complementary medicine in some way during the previous week. This figure is higher than the national average. The majority of respondents believed that acupuncture, chiropractic and osteopathy were effective and should be funded by the NHS.