白血病病人骨髓抑制期实施防感染措施时机的研究

目的 :研究白血病病人在化疗期间 ,不同时间实施预防感染护理的效果。方法 :对照组在化学疗法结束后给予预防感染的护理措施 ,实验组在化学疗法开始前 3～ 7d实施预防性护理措施。观察两组病人感染发生率。结果 :感染发生率实验组明显低于观察组。结论 :在化学疗法开始前实施预防性护理措施有助于降低感染发生率     

Disseminated tuberculosis following reduced-intensity cord blood transplantation for adult patients with hematological diseases

Allogeneic hematopoietic stem cell transplantation (allo-SCT) recipients are prone to infections. The incidences of mycobacterial infections after allo-SCT in several case series vary from less than 0.1-5.5%. However, no study has been published on tuberculosis following unrelated cord blood transplantation (UCBT). We retrospectively reviewed medical records of 113 adult patients with a median age of 54 years who underwent reduced-intensity UCBT (RI-UCBT) at Toranomon Hospital from March 2002 to May 2004. Mycobacterium tuberculosis infections were diagnosed in three patients (2.7%), of these two patients developed primary infection and one patient developed reactivation of latent tuberculosis. The interval between RI-UCBT and the diagnosis of tuberculosis was 34, 41 and 61 days. All the patients had disseminated disease at diagnosis. Histological examination showed the lack of granuloma in caseous necrosis. Combination antituberculous treatments showed limited efficacy, and two patients died immediately after diagnosis. M. tuberculosis caused life-threatening illness, rapidly progressing in RI-UCBT recipients. The lack of granuloma in caseous necrosis suggests the impaired T-cell function in early post transplant phase of RI-UCBT. We should consider M. tuberculosis in the differential diagnoses of fever of unknown source after RI-UCBT.     

Hospital-acquired conditions after bariatric surgery: we can predict,but can we prevent?

Background

Centers for Medicare and Medicaid Services initiated a non-payment policy for certain hospital-acquired conditions (HACs) in 2008. This study aimed to determine the rate of the three most common HACs (surgical site infection (SSI), urinary tract infection (UTI), and venous thromboembolism (VTE)) among bariatric surgery patients. Additionally, the association of HACs with patient factors and the effect of HACs on post-operative outcomes were investigated.

Methods

Patients over 18 years with a body mass index (BMI) ≥35 who underwent bariatric surgery were identified using the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database (2005–2012). Patients were grouped into two categories: HAC versus no HAC patients and baseline characteristics and outcomes, including 30-day mortality, reoperation, and mean length of stay (LOS) were compared. Multivariable logistic regression analysis was performed to identify the risk factors for developing a HAC.

Results

98,553 patients were identified, 2,809 (2.9 %) developed at least one HACs. SSI was the most common HAC (1.8 %), followed by UTI (0.7 %) and VTE (0.4 %). The rate of these HACs significantly decreased from 4.6 % in 2005–2006 to 2.5 % in 2012 (p < 0.001). Laparoscopic gastric banding was associated with the lowest rates of HAC (1.3 %) and open gastric bypass with the highest (8.0 %). HAC patients had significantly higher rates of in-hospital mortality (0.8 vs. 0.1 %, p < 0.001) and LOS (3.9 vs. 2.1 days, p < 0.001). On adjusted analysis, open GBP patients had 5.36-fold higher odds of developing a HAC. Interestingly, the presence of a resident surgeon 7–11 years post graduation was associated with significantly increased odds of HACs (1.86, 1.50–2.31, p < 0.001).

Conclusion

Our data demonstrate a strong correlation between these three HACs following bariatric surgery and factors intrinsic to the bariatric patient population. This calls into question the non-payment policy for inherent patient factors on which they cannot have impact. These findings are important to help inform health care policy decisions regarding access to care for bariatric surgery patients.     

Tyrosine hydroxylase-positive cells and dopaminergic neuronal function in human embryonic stem cells An electrophysiological validation

BACKGROUND: Induced differentiation strategies and cytochemical properties of human embryonic stem cells (hESCs) have been investigated. However, the electrophysiological functions of tyrosine hydroxylase (TH)-positive cells derived from hESCs remain unclear. OBJECTIVE: To investigate the differentiation efficiency of TH-positive cells from hESCs in vitro using modified four-step culture methods, including embryoid body formation, and to examine the functional characteristics of the differentiated TH-positive cells using electrophysiological techniques.DESIGN, TIME AND SETTING: Neuroelectrophysiology was performed at the Reproductive Medicine Center and Stem Cell Research Center, Peking University Third Hospital, and the Neuroscience Research Institute and Department of Neurobiology, Peking University, from September 2004 to August 2008.MATERIALS: The hESC line, PKU-1.1, a monoclonal cell line derived from a pre-implantation human blastocyst in the Reproductive Medical Center of Peking University Third Hospital. The patch clamp recording system was provided by the Neuroscience Research Institute and Department of Neurobiology, Peking University. METHODS: The hESC line was induced to differentiate into TH-positive cells in vitro using a modified four-step culture method, including the formation of embryoid body, as well as the presence of sonic hedgehog and fibroblast growth factor 8. The cell karyotype was assessed by G-banding karyotype analysis techniques and specific markers were detected immunocytochemically. Whole-cell configuration was obtained after obtaining a tight seal of over 1 GΩ. Ionic currents were detected by holding the cells at -70 mV and stepping to test voltages between 80 and 40 mV in 10-mV increments in voltage-clamp configuration. MAIN OUTCOME MEASURES: We measured the cell karyotype, specific cell markers, and the electrophysiological properties of the voltage-gated ion channels on the cell membrane of TH-positive dopaminergic cells differentiated from our hESCs line in vitro. RESULTS: The differentiated cells had a consistent appearance, and the majority of cells (> 90%) expressed TH and (3-tubulion, as well as the neural progenitor marker, nestin. Cell karyotype analysis demonstrated that all of the hESCs had a stable and normal karyotype (46, XX) after differentiation. In addition, patch clamp recording showed that the 10 recorded TH-positive cells exhibited a fast inward current when the test voltage depolarized to 30 mV, and a delayed outward current when the test voltage depolarized to -10 mV. The peak of inward current was obtained at voltage between -10 mV and 0 mV, while the peak of outward current was obtained at 40 mV. The average peak of inward current density was (-50.05 ± 15.50) pA/pF, and the average peak of outward current density was (41.98 ± 13.55) pA/pF.CONCLUSION: More than 90% of the differentiated hESC-derived cells induced by the modified four-step culture method exhibit dopaminergic neuronal properties, including general electrophysiological functional properties, such as functional potassium and sodium channels.     

Stem fracture of conserve hemiarthroplasty

Resurfacing hemiarthroplasty of the femoral head has been recommended as a bone-preserving alternative to total hip arthroplasty for the management of osteonecrosis of the femoral head in the young patient. This case report describes failure of a cemented resurfacing hemiarthroplasty resulting from a fracture through the stem of the implant.     

Can sequential administration minimise the cost of high dose chemotherapy? An economic assessment in inflammatory breast cancer

OBJECTIVE: To evaluate the potential cost savings of using sequential high dose chemotherapy (HDC), with granulocyte colony-stimulating factor (filgrastim) and stem cell support, rather than single course administration of HDC with bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT). PERSPECTIVE: French public hospital perspective. METHODS: Direct medical costs of sequential treatment, estimated on the basis of physical quantities of resources consumed by 95 patients with inflammatory breast cancer (IBC) included in a French pilot multicentric trial (PEGASE 02), were compared with those of historical control groups of patients treated with single course HDC, either with BMT (n = 27) or PBSCT (n = 14). Costs were evaluated in 1998 French francs (1 Euro = 6.55957 French francs). RESULTS: The total cost of sequential HDC was significantly lower than that for single course HDC both with BMT (-29%; 22,755 Euros vs 32,284 Euros; p < 0.001) or PBSCT (-16%; 22,755 Euros vs 27,209 Euros; p = 0.026). This was mainly due to a reduction in the length of hospitalisation in transplantation units. CONCLUSION: According to our results, economic arguments cannot be used against the widespread use of sequential HDC for patients with IBC. However, further economic evaluations based on overall and disease-free survivals alongside a randomised clinical trial are still needed to definitively establish the cost effectiveness of sequential administration of HDC.     

受体蛋白质酪氨酸激酶和血管内皮生长因子在人胚胎卵黄囊和胎肝中的表达

目的研究人胚胎发育不同时期卵黄囊和胎肝内受体酪氨酸激酶(KDR)、血管内皮生长因子(VEGF)和CD34的分布及表达,为胚胎造血分化提供理论依据。方法取15份不同胎龄的胎儿卵黄囊和胎肝,固定、切片,进行免疫组织化学SP法染色,观察KDR、VEGF和CD34的表达及分布。结果在卵黄囊和胎肝中均有KDR+、VEGF+和CD34+细胞。在中期胎肝组,KDR和VEGF的灰度值分别为103.8±6.1和96.4±6.3,表达强于晚期胎肝组(KDR和VEGF的灰度值分别为90.4±6.0和87.4±6.3)(P<0.05),KDR与VEGF的表达具有一定相关性(P<0.05)。结论KDR和CD34在胎肝和卵黄囊中广泛表达,提示在胎肝和卵黄囊中可能有成血管血液干细胞存在,KDR和VEGF相互作用,可能介导成血管血液干细胞的存活、扩增和分化。     

人参多糖对人白血病细胞株K562细胞信号转导的调控

目的：研究人参多糖（GPS）对人红白血病细胞株（K562）信号转导的调控.方法：采用细胞体外培养技术,免疫细胞化学、Western Blot检测GPS诱导后K562细胞蛋白酪氨酸激酶JAK2、核因子NF-κBp65和信号传导及转录激活因子5（STAT5）的表达,免疫沉淀法检测GPS对K562细胞JAK2磷酸化的影响,RT-PCR技术检测GPS诱导后K562细胞c-myc,p53表达的变化.结果：免疫细胞化学和WesternBlot检测GPS诱导后K562细胞,JAK2蛋白表达明显增强,随着剂量的加大、时间的延长更加明显[（12.33±2.05）vs（88.18±13.57）];NF-κBp65[（79.48±9.56）vs（6.98±1.45）]和STAT5[（71.56±16.28）vs（10.23±2.16）]蛋白表达明显减弱;GPS（40mg/L）作用K562细胞6d后,加入GM-CSF继续刺激5～10min,JAK2酪氨酸磷酸化增强,而刺激20min后JAK2酪氨酸磷酸化明显减弱.GPS（40mg/L）诱导K562细胞3,6d后,c-myc mRNA明显减弱[（196±12）vs（136±11）],而p53mRNA无明显变化[（202±16）vs（181±16）].结论：GPS激活了酪氨酸蛋白激酶JAK2,促进其磷酸化,同时抑制STAT5,NF-κB信号转导途径,下调原癌基因c-myc表达,促进K562细胞凋亡与分化.     

当归多糖对脐血造血细胞的抗冷冻损伤作用

目的：探讨当归多糖（APS）对脐血造血细胞的抗冷冻损伤作用.方法：采用细胞计数法比较羟乙基淀粉（HES）、明胶、淋巴细胞分离液（Ficoll）分离脐血单个核细胞（MNC）的回收率.应用细胞计数法、台盼蓝拒染法、集落形成实验和流式细胞术,检测冻存1,3,6mo脐血MNC的生物学活性,将脐血MNC与不同浓度APS共培养24h后冻存,1mo后复苏,观察APS对脐血MNC抗冷冻损伤的作用.结果：HES法、明胶法的MNC回收率均大于85%,显著高于Ficoll法（50.00±4.00）%（P〈0.05）;冻存1,3,6mo组MNC,CFU-Mix,CD34＋细胞回收率及台盼蓝拒染率差异均无显著性,且脐血MNC的损伤与冻存时间不相关.APS50,100,200,400mg/L不同浓度APS组MNC,CFU-Mix回收率和台盼蓝拒染率除APS400mg/L组下降外,其余各组明显上升（P〈0.05）;各组组间CD34＋细胞回收率差异无显著性.结论：APS可有效提高脐血造血细胞的抗冷冻损伤能力.