血必净注射液对异基因骨髓移植小鼠造血重建的影响

目的为了探讨血必净注射液对异基因骨髓移植（allo-BMT）小鼠造血重建的影响及其机制。方法取128只SPF级BALB／c小鼠,随机分为正常组（不做任何处理）,生理盐水对照组和血必净治疗组。生理盐水组在BMT后腹腔注射生理盐水0．4mL／只,每日1次,血必净组腹腔注射血必净注射液和生理盐水各0．2mL／只,每日1次。BMT后第7、14、21、28d统计小鼠存活率,计数外周血细胞、骨髓单个核细胞,采用流式细胞术分析骨髓单个核细胞VLA-4表达水平,采用免疫组化法分析骨髓基质中VCAM-1表达水平。第14d时分别计数脾集落形成单位（CPU-S）和粒-单系集落形成单位（CFU-GM）。结果血必净组BMT后第7、14、21、28d小鼠存活率,外周血细胞,骨髓单个核细胞,骨髓组织中VLA-4和VCAM-1表达水平,第14dCFU-S和CFU-GM均显著高于生理盐水组（P〈0．01或P〈0．05）。结论血必净注射液能促进异基因骨髓移植小鼠造血重建的恢复,该作用可能是通过提高造血细胞和基质细胞粘附分子的表达实现的。     

交锁髓内钉加同种异体骨移植治疗胫骨骨纤维结构不良21例

[目的]探讨交锁髓内钉内固定加同种异体骨移植治疗胫骨骨纤维结构不良的疗效。[方法]1997年－2000年对21例患者进行了病灶清除,交锁髓内钉内固定加同种异体骨移植术。[结果]术后随访1－3年,1例骨不连,1例复发,其余19例病灶区骨质生长良好,膝、踝关节活动及肢体负重良好。[结论]该手术方法使固定节段具有高度的内在稳定性,可早期进行功能锻炼,防止影响膝、踝关节的负重功能或防止创伤关节炎、适合于成人单发型局限性胫骨干纤维结构不良的治疗。     

同种异体组织工程预定形态软骨的研究

目的研究以聚羟基乙酸(Polyglycolicacid,PGA)为细胞支架同种异体预定形态组织工程化软骨在有免疫力的动物体内构建的可行性。方法取1周龄乳兔肋软骨和关节软骨,收集体外培养第3～4代的软骨细胞,接种于塑为管状和片状经多聚赖氨酸处理的PGA材料上。分别于6、12周取材,行大体和组织学观察评价。结果软骨细胞-PGA复合物体外培养1周有基质产生。种植6周后,管状和片状复合物生成软骨,结缔组织内可见炎细胞;12周时软骨细胞成熟。结论同种异体软骨细胞与PGA所形成的复合物在有免疫力的动物体内可构建出预定形态软骨。     

Rare case of Auto immune haemolytic anaemia in an infant with auto “f & kidd antibodies”

Background"f" antigen is a compound antigen in Rh blood group system. Anti f has haemolytic potential as described in literature. Its occurrence in an infant as autoantibody with another blood group system ie Jka is very rare.Case reportWe report a case of 10-month-old infant diagnosed with AIHA with autoantibodies directed towards "f" and Jka antigen. Antibody identification was done and antigen negative blood units were crossmatched & transfused with demonstrable haemoglobin rise and subsequent decrease in DAT grading.ResultAuto anti f + Jka was identified in a 10 months old infant. Autoantibodies were identified by identification 3 & 11 cell panel and select cell panel. Results were later confirmed by allogenic adsorption & elution. Patient was transfused antigen negative blood unit which lead to haemoglobin rise & gradual decrease in direct coombs test gradingConclusionTo our knowledge, this is the first case report of auto anti f + Jka having haemolytic potential in an infant which shows the importance of extensive immmunohaematology workup in providing compatible blood unit in patients with autoantibody.     

Combination of DNA-hypomethylating agent and hematopoietic stem cell transplantation in treatment of juvenile myelomonocytic leukemia: A case report

Introduction:Juvenile myelomonocytic leukemia (JMML) is a rare myeloproliferative neoplasm of early childhood characterized by excessive proliferation of myelomonocytic cells and an aggressive clinical course. Allogenic hematopoietic stem cell transplantation (HSCT) is a firmly established treatment, but patients without fully matched donors have poor prognoses. Disease recurrence is the main cause of treatment failure. Meanwhile, most cases with splenomegaly present with platelet transfusion refractoriness, but splenectomy remains controversial. DNA hypermethylation correlates with poor prognosis in JMML; however, hypomethylating therapy alone does not eradicate leukemic clones. Thus, a suitable treatment with a good success rate remains elusive.Patient concerns:Here, we report our experience with a patient who suffered from recurrent fever, pallor, abdominal distention, leukocytosis, and thrombocytopenia with a silent past history and family history of somatic KRAS mutation. The patient was treated with decitabine as a bridging therapy before haploidentical HSCT. Decitabine was also used prophylactically after transplantation.Diagnosis:We arrived at a JMML diagnosis after observing leukocytosis, less than 20% blast cells in the peripheral blood and bone marrow, increased monocyte counts, negativity for the BCR-ABL fusion gene, positivity for somatic KRAS mutation, and massive splenomegaly.Interventions:The patient accepted splenectomy before HSCT, and haploidentical HSCT was applied after treatment with a DNA-hypomethylating agent. The hypomethylating agent was administered for 1 year after HSCT to prevent disease recurrence.Outcomes:The patient presented with complete remission of the disease and mild graft versus host disease for 26 months after treatment with decitabine and HSCT.Lessons:Combining haploidentical HSCT and DNA-hypomethylating agents may improve the prognosis of JMML. Meanwhile, splenectomy could be an effective option in cases with massive splenomegaly and platelet transfusion refractoriness.     

异基因造血干细胞移植后巨细胞病毒感染的检测及临床意义

目的：建立快速、早期、敏感的诊断人巨细胞病毒（human cytomegalovirus,HCMV)感染的DNA检测方法,旨在了解异基因造血干细胞移植受的HCMV的感染情况及指导临床诊治。方法：利用ELISA和巢式PCR方法对30例异基因造血干细胞移植受进行检测。结果：检测异基因造血干细胞移植受30例,PCR和ELISA方法HCMV阳性分别为20例和18例;其阳性率分别为66.7%和60%。作为阴性对照的20名正常同时进行HCMV的检测,其结果均为阴性。结论：PCR具有早期、快速、简便的优点,适用于临床对HCMV的早期快速诊断和作为指导临床用药及愈后判断的主要手段。     

Delayed platelet recovery after allogeneic hematopoietic stem cell transplantation: Association with chronic graft‐versus‐host disease and survival outcome

Delayed platelet recovery (DPR) despite prompt neutrophil engraftment is frequently observed after allogeneic hematopoietic stem cell transplantation (HSCT). However, few studies have evaluated the risk factors and long‐term outcome. Therefore, we retrospectively analysed 219 adult patients who underwent their first allogenic HSCT with neutrophil engraftment. Of these 219 patients, 50 (22.8%) had DPR that was defined as relapse‐free survival at day 60 after HSCT without primary platelet recovery despite neutrophil engraftment. The results of a multivariate analysis showed that a high‐risk underlying disease (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.04‐5.48; P = .041) and human leukocyte antigen–mismatched HSCT (OR, 2.63; 95% CI, 1.28‐5.43; P = .009) were associated with an increased risk of DPR. In univariate analyses, the occurrence of DPR was significantly associated with inferior overall survival, high nonrelapse mortality, and a low incidence of chronic graft‐versus‐host disease (GVHD), despite a comparable relapse rate. In multivariate analyses, DPR was associated with inferior overall survival (hazard ratio [HR], 2.00; 95% CI, 1.23‐3.27; P = .005) and a low incidence of chronic GVHD (HR, 0.42; 95% CI, 0.22‐0.78; P = .002). In conclusion, DPR was a strong predictor of shorter survival but also less frequent chronic GVHD.     

干眼的再生疗法研究进展

干眼是一种与泪液和眼表组织病变相关的多诱因疾病。目前干眼的主要治疗是对症治疗,包括眼部润滑和消炎,但是有局限性。细胞凋亡在干眼发病机制中的作用逐渐被发现,生物学最新的研究方向是使病变组织再生,特别是间充质干细胞,其具有多重性、营养性和免疫调节性。本文对干眼再生疗法最新研究进展进行综述。     

胚胎来源的同种异体组织工程化软骨形成的研究

目的研究探讨同种异体组织工程化软骨在动物体内形成。方法取怀孕100d胚胎羊的关节软骨经体外制成细胞生物材料复合物，并注射到异体羊腹壁皮下，每隔2周取材，连续半年，对所取标本进行评价。结果在同种异体动物体内能形成软骨组织并与正常软骨组织有相似的组织学特性。第2、4周的软骨组织有一定程度的免疫排斥反应和炎症细胞浸润。第6周免疫反应减轻。结论应用组织工程技术可在同种异体动物体内再生软骨组织，再生的组织周围存在一定程度的免疫反应，随接种时间的延长而逐渐减弱。