全身照射对造血干细胞移植后造血系统重建的临床分析

目的 分析比较全身照射对自体和异体造血干细胞移植后造血重建状况的影响。方法 对70例自体和异体造血干细胞患者移植后造血系统重建状况进行动态观察及分析。结果 两组患者移植后,粒细胞、血小板的下降与回升有一定规律性,自体移植组和异体移植组中性粒细胞恢复时间分别为14和16 d,血小板恢复时间分别为23和27 d,两组比较差异均无统计学意义(P>0.05)。但是无论自体或异体移植组中,外周血移植均较骨髓移植的造血系统重建时间短,差异有统计学意义(P<0.05);吸收剂量≥10 Gy者血小板重建时间较<10 Gy者缓慢(P<0.05);中性粒细胞恢复时间与吸收剂量无关。结论 在全身照射剂量条件相同情况下,自体和异体造血干细胞移植后造血系统重建状况差异无统计学意义,但是外周血造血干细胞移植较骨髓移植造血重建迅速,血小板恢复时间与吸收剂量有关。     

X射线和γ射线预处理对小鼠异基因骨髓移植后造血免疫重建的影响

目的 研究X射线和γ射线两种预处理方式造成的损伤程度的差别,以及对造血、免疫重建的影响,确定适用于异基因造血干细胞移植的预处理照射方式.方法 对受鼠分别使用直线加速器X射线或60Coγ射线进行致死剂量(总剂量为7.0 Gy)全身照射后,给予相同数量供鼠骨髓细胞移植.观察受鼠移植后的生存时间、重要脏器(肝、小肠和肺)病理...     

低剂量全身照射在非清髓性干细胞移植中的临床研究

目的 观察非清髓性低剂量全身照射的临床效果和急性毒副作用。方法 2006年1月至2008年1月对27例异基因造血干细胞移植患者采用含有全身照射的非清髓预处理方案:全身照射(TBI)2 Gy,一次完成;受者原发病不同,受者机体状态、年龄、脏器功能以及供受者HAL相合情况等不同,使用的化疗方案也有不同,包括氟达拉宾、环磷酰胺、阿糖胞苷、马法兰等。预防移植物抗宿主病(GVHD)采用:环孢霉素、霉酚酸酯。结果 造血重建情况: 27例均于移植后第4~8天外周血WBC降至(0.05~0.9)×10⁹/L。中性粒细胞计数>0.5×10⁹/L为8~22 d(中位数为10.5 d),血小板计数>30×10⁹/L为11~28 d(中位数为14.5 d)。1、2年生存率为85.2%(23/27)、77.8%(21/27)。发热率65%,10例发生感染。无出血性膀胱炎和肝静脉闭塞症等并发症。急性GVHD 4例(15%), 慢性GVHD 5例(19%)。随访3~22个月21例(77.8%)仍存活。结论 采用低剂量全身照射的非清髓性造血干细胞移植预处理方案简便安全,并发症少,适应证广;全身照射总剂量2 Gy,1次完成的方案是安全有效的,可以达到免疫抑制效果。     

不同剂量率X射线辐照对小鼠免疫系统的影响

目的 检测经相同剂量不同剂量率X射线照射的BalB／C小鼠外周血淋巴细胞周期及胸腺和脾脏指数。方法 18只BalB／c小鼠随机分为对照组（controI），低剂量率照射组（20cGy／min）和高剂量率照射组（300cGy／min），每组6只。低剂量组和高剂量组采用剂量率分别为2．0cGy／min和300cGy／min的1GyX射线对小鼠进行全身照射，24h后取血及器官，用流式细胞仪检测外周血淋巴细胞的周期变化，用称量的方法得到胸腺和脾脏指数。结果 高剂量率辐射时，小鼠外周血淋巴细胞的损伤较低剂量时大，而且对雄性鼠的影响大于雌性；同时，胸腺和脾脏指数变化也随着剂量率的增大而减小。结论 低剂量率的照射对小鼠外周血淋巴细胞、胸腺和脾脏的影响较高剂量率辐射小；雌性鼠的辐射耐受能力较雄性强。     

造血生长因子在医源性急性放射病的临床应用

目的 探讨造血生长因子对使用全身照射(TBI)进行干细胞移植预处理患者造血重建的影响,进而起到模拟事故性急性放射病,了解细胞因子在急性放射病患者救治中的作用。方法对1990-2012年75例预处理含TBI的造血干细胞移植患者及其供者的造血生长因子应用、植入情况、不良反应发生等进行回顾性分析,了解细胞因子在造血功能重建、造血干细胞动员中的作用以及不良反应。结果 造血干细胞移植患者除1例因预处理不良反应死亡外,其他患者全部恢复造血功能重建。应用rhG-CSF组粒细胞植入的中位时间自体移植为10 d、异基因移植为12 d。自体移植患者应用rhIL-11组与未应用rhIL-11组血小板植入的时间分别为(11.67±1.53)、(13.70±6.27) d。所有TBI患者中口腔溃疡发生率为48%,腹泻发生率为44%。造血重建过程中细胞因子不良反应不明显,动员过程中半数出现轻度不良反应。结论 细胞因子在TBI后造血功能重建以及移植时的造血干细胞动员中起关键作用。     

异基因外周血造血干细胞移植治疗极重度骨髓型和肠型急性放射病的临床报告

目的 探讨异基因外周血造血干细胞移植在肠型和极重度骨髓型放射病救治中的作用和地位.方法 山东"10·21" 60Co 辐射事故中2例病人受到意外照射,病例A受照射剂量20～25Gy,诊断为"肠型放射病",病例B受照射剂量9～15Gy,诊断为"极重度骨髓型放射病".经联合环磷酰胺、抗淋巴细胞球蛋白和氟达拉滨预处理,2例分别行HLA半相合及全相合外周血造血干细胞移植.采用环孢霉素A和骁悉方案(病例A加用CD25单抗和供者间充质干细胞)预防移植物抗宿主病(GVHD).结果 2例均移植成功,供体完全存活,移植后9～11天白细胞开始恢复,2周后白细胞恢复正常、骨髓造血重建成功.2例均未发生移植排斥和GVHD.病例A照射后33天死于败血症和多器官功能衰竭.病例B照射后75天死于心衰为主的多器官功能衰竭.结论 HLA相合及半相合外周血造血干细胞移植救治极重度骨髓型和肠型急性放射病是完全可能和可行的,联合免疫抑制剂预处理对促进供体稳定植入是必要的,环孢霉素A、骁悉和CD25单抗及供者间充质干细胞对预防GVHD有重要作用.     

不同剂量γ射线照射后胎儿骨髓CD34+造血干细胞死亡规律

目的 探讨不同剂量γ射线照射后胎儿骨髓CD34^ 造血干细胞的死亡规律。方法 以流式细胞术PE－CD34^ ／FITC－AmnexinV/7AAD三色荧光法、多参数分析了受不同剂量γ射线照射后,不同时间点的胎儿骨髓CD34^ 造血干细胞凋亡、坏死和存活的时效和量效变化特点。结果 受大剂量率γ射线1次5Gy和8Gy照射后,和骨髓CD34^ 造血干细胞的死亡是在照射后为期1周的连续性死亡,既有凋亡又有坏死,但是以凋亡为主;受大剂量率γ射线1次10Gy和12Gy照射后,胎儿骨髓CD34^ 造血干细胞则在受照后当天即大量坏死,在持续1周内全部死亡。结论 受大剂量率γ射线1次照射后,造血干细胞在1周内发生了增殖期死亡而连续性空出所占据的龛位。     

山东济宁60Co辐射事故受照人员的临床救治

目的总结和探索肠型放射病和极重度骨髓型放射病临床诊治经验。方法中国山东济宁^60Co辐射事故中2例病人受到意外照射。综合估算，病例A受照剂量20～25Gy，诊断为“肠型放射病”；病例B受照剂量9～15Gy，诊断为“极重度骨髓型放射病”。经联合预处理，2例分别行单倍体和HLA相合外周血造血干细胞移植。结果2例患者均移植成功，供体完全植活，三系血细胞和骨髓造血重建成功，均无移植排斥和移植物抗宿主病。病例A于照后33d（d33）死于败血症和多脏器功能衰竭，病例B于d75死于心衰为主的多脏器功能衰竭。结论骨髓和外周血染色体及牙齿ESR检查等对超大剂量放射病诊断有重要价值。HLA相合及半相合外周造血干细胞移植救治急性放射病是完全可能和可行的。感染和多脏器功能衰竭仍然是病人的主要死亡原因。应加强对促进辐射损伤修复和多脏器功能衰竭的救治研究。     

不同剂量γ射线照射后胎儿骨髓CD34~ 造血干细胞死亡规律

目的　探讨不同剂量γ射线照射后胎儿骨髓CD34 造血干细胞的死亡规律。方法　以流式细胞术PE -CD34 FITC AnnexinV 7AAD三色荧光法 ,多参数分析了受不同剂量γ射线照射后 ,不同时间点的胎儿骨髓CD34 造血干细胞凋亡、坏死和存活的时效和量效变化特点。结果　受大剂量率γ射线 1次 5Gy和 8Gy照射后 ,胎儿骨髓CD34 造血干细胞的死亡是在照射后为期 1周的连续性死亡 ,既有凋亡又有坏死 ,但是以凋亡为主 ;受大剂量率γ射线 1次 10Gy和 12Gy照射后 ,胎儿骨髓CD34 造血干细胞则在受照后当天即大量坏死 ,在持续 1周内全部死亡。结论　受大剂量率γ射线 1次照射后 ,造血干细胞在 1周内发生了增殖期死亡而连续性空出所占据的龛位     

Toll样受体5激动剂CBLB502对7.0Gy60Coγ射线照射恒河猴的辐射防护作用观察

目的 观察Toll样受体5激动剂CBLB502对7.0Gy 60Coγ射线全身照射恒河猴的辐射防护作用.方法 30只健康成年恒河猴分为对症治疗组、WR-2721(辐射防护剂氨磷汀)组和CBLB502 2.5、10、40μg/kg组,每组6只.所有动物均用60C0 γ射线放射源一次全身双侧照射7.0Gy(剂量率13.00～13.52cGy/min).CBLB502给药剂量为2.5、10和40μg/kg,阳性对照药WR-2721剂量为30mg/kg,对症治疗组注射生理盐水0.3ml/kg,均为照射前0.5h一次肌肉注射.所有动物照射后在同一原则下给予对症治疗.观察各组动物一般体征、外周血象、造血祖细胞集落培养情况及组织病理学检查结果.结果 照射后40d时CBLB502 10、40μg/kg组动物存活率均为100％,而对症治疗组存活率仅为33％(2/6);WR-2721组各系造血恢复稍快于对症治疗组,但差异无统计学意义;与对症治疗组比较,CBLB502 40μg/kg组外周血白细胞和血小板最低值显著增高,血小板低值持续时间缩短,开始恢复时间提前,输血量明显减少(P＜0.05),骨髓、肠道等组织损伤明显减轻.结论 7.0Gy 60Coγ射线全身照射猴均发生了重度骨髓型急性放射病.照前30min一次性给予40μg/kg CBLB502对7.0Gy 60Coγ射线照射猴有明显的辐射防护作用,其效果优于目前常用的辐射防护剂WR-2721.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）