慢性HBV感染者外周血CD4+CD25high调节性T细胞初步分析

目的 分析不同临床乙型肝炎病毒(HBV)慢性感染者外周血中CD4+CD25high调节性T细胞(Treg)的水平及其与各种临床指标的关系.方法 采集35例不同临床表现成年慢性HBV感染者(HBsAb+组5例、非活动肝炎组8例、活动肝炎组12例、免疫耐受期组10例)及12例健康成人外周血标本,流式细胞仪分析外周血中CD4+CD25high Treg含量,ELISA法检测HBsAg、HBsAb、HBeAg、HBeAb、HBcAb,RT-PCR法检测HBV DNA载量,同时进行肝脏生化功能检测,并进行统计学分析.结果 HBV慢性感染者[(12.35±6.48)个/μl;(1.82 4-0.87)%)]及健康成人外周血标本[(8.91±3.11)个/μl,(1.35±0.39)%]中CD4+CD25highTreg绝对计数和其占CD4+T细胞百分含量差异均无统计学意义(P＞0.05);分组分析发现,免疫耐受期组CD4+CD25highTreg占CD4T细胞百分含量高于HBsAb+组、活动肝炎组及健康对照组(P＜0.05);免疫耐受期组CD4+CD25highTreg绝对计数高于健康对照组(P＜0.05);余各组间差异无统计学意义(P＞0.05).分析CD4+CD25highTreg含量与临床指标间相关性发现,CD4+CD25highTreg占CD4+T细胞百分含量与丙氨酸氨基转移酶(ALT)水平呈负相关(r=-0.418,P=0.038),与CD4/CD8比值呈正相关(r=0.344,P=0.021),与HBV DNA水平无相关性(r=0.118,P＞0.05);CD4+CD25highTreg绝对计数与CD4/CD8比值呈正相关(r=0.360,P=0.015),与ALT水平及HBV DNA水平无相关性(r=-0.211,r=-0.060,P＞0.05).结论 CD4+CD25highTreg在HBV慢性感染的免疫发病机制中可能发挥一定作用.     

Comparative study of cardiac size by chest X-ray and echocardiography

Introduction: The study of cardiac size is important for the diagnosis of various types of cardiac diseases such as left ventricular enlargement due to aortic stenosis and right ventricular enlargement due to pulmonary stenosis. Although echocardiography is considered as gold standard for the diagnosis of cardiomegaly, it is costly and needs trained personnel for performing and interpreting the results of this diagnostic procedure. Chest X-ray is used as an alternative. Materials and methods: The present comparative study was carried on 35 males aged 25–60 years. On the basis of provisional clinical diagnosis, the patients were divided into three groups: (i) group A - 15 patients in whom clinical history did not suspect any cardiac enlargement; (ii) group B - 15 patients whose clinical history predisposed to left ventricular enlargement; and (iii) group C - 5 patients whose clinical history predisposed to right ventricular enlargement. All patients underwent chest X-ray (postero-anterior view) and 2D-echocardiography examinations. The findings of the two modalities were compared. Observations: The observations were very informative and showed that chest X-ray is useful for the diagnosis of cardiomegaly due to various types of cardiac diseases. On chest X-ray, the cardiothoracic ratio and transverse diameter showed a strong positive correlation with total ventricular dimension on echocardiography. Other parameters such as transverse diameter and transverse left diameter on chest X-ray also showed a positive correlation with right ventricular dimension on echocardiography. Conclusion: Chest X-ray is a reliable alternative for the diagnosis of cardiomegaly in the absence of echocardiography.     

Clinical role of interstitial pneumonia in patients with scrub typhus: a possible marker of disease severity

Interstitial pneumonia (IP) frequently occurs in patients with scrub typhus, but its clinical significance is not well known. This study was designed to evaluate interstitial pneumonia as a marker of severity of the disease for patients with scrub typhus. We investigated clinical parameters representing the severity of the disease, and the chest radiographic findings for 101 patients with scrub typhus. We then compared these clinical factors between patients with and without IP. We also studied the relationship between IP and other chest radiographic findings. The chest radiography showed IP (51.4%), pleural effusion (42.6%), cardiomegaly (14.9%), pulmonary alveolar edema (20.8%), hilar lymphadenopathy (13.8%) and focal atelectasis (11.8%), respectively. The patients with IP (n=52) had higher incidences in episode of hypoxia (p=0.030), hypotension (p=0.024), severe thrombocytopenia (p=0.036) and hypoalbuminemia (p=0.013) than the patients without IP (n=49). The patients with IP also had higher incidences of pleural effusion (p<0.001), focal atelectasis (p=0.019), cardiomegaly (p<0.001), pulmonary alveolar edema (p=0.011) and hilar lymphadenopathy (p<0.001) than the patients without IP. Our data suggest that IP frequently occurs for patients with scrub typhus and its presence is closely associated with the disease severity of scrub typhus.     

Extraction of the Two-Dimensional Cardiothoracic Ratio from Digital PA Chest Radiographs: Correlation with Cardiac Function and the Traditional Cardiothoracic Ratio

The purpose of our study was to extract the two-dimensional (2D) cardiothoracic ratio from digital chest radiographs using image analysis software on a Magic View 300 system. We also wanted to investigate its correlation with cardiac function, as defined by left ventricular ejection fraction from MUGA scanning, and with the traditional one-dimensional cardiothoracic ratio. One hundred patients undergoing radionuclide ventriculography and concurrent digital PA chest radiography using a commercial selenium detector system were studied. The 2D cardiothoracic ratio was extracted by defining a region of interest around the cardiac and thoracic areas and calculating a ratio of the two pixel counts obtained. The one-dimensional cardiothoracic ratio was calculated in the traditional manner. Regression analysis was used to study the association between these ratios and the ejection fraction. The 2D ratio could be achieved on all radiographs after image manipulation. The traditional linear cardiothoracic ratio showed an inverse correlation with left ventricular ejection fraction (r = –0.45). The 2D cardiothoracic ratio showed an improved correlation (r = –0.52). Assuming that a left ventricular ejection fraction of 55% or more indicates normal cardiac function, the normal 2D cardiothoracic ratio is 0.23 or less and a ratio of 1:4 is suggested. The ratio of cardiac and thoracic area correlates better with cardiac function as assessed by left ventricular ejection fraction than the traditional linear cardiothoracic ratio. Two-dimensional cardiothoracic ratio is easily extracted and improves the data yield from digital PA chest radiographs on PACS systems.     

Comparison of four methods for assessing patient effective dose from radiological examinations

Three methods of indirect effective dose estimation were reviewed and compared to a direct effective dose determination method. An anthropomorphic phantom and thermoluminescence dosimetry were used to obtain dosimetric data associated with anterior-posterior (AP) abdominal radiography, posterior-anterior (PA) chest radiography, PA head radiography, and AP heart fluoroscopy. Effective dose was determined using: (i) organ specific dose values directly determined by thermoluminescence dosimeters, (ii) data published by National Radiological Protection Board (NRPB) and entrance surface dose (ESD), (iii) NRPB data and dose area product (DAP), (iv) energy imparted derived from DAP. The effective dose values estimated from the Rando phantom measurements were 161, 32.3, and 8.4 microSv/projection for the abdomen, chest, and head radiographs, respectively. Cardiac fluoroscopy yielded an effective dose value of 111 microSv/min. The effective dose values obtained indirectly using NRPB data and DAP were in good agreement with directly assessed values in all simulated exposures (difference <8%). The effective doses using NRPB data and ESD values differed from directly assessed values by less than 15% for the radiographic exposures and 60% for heart fluoroscopy. The energy imparted method yielded 136, 31, and 6.6 microSv/projection for the abdomen, chest, and head radiographs, respectively, and 111 microSv/min for heart fluoroscopy. Indirect patient effective dose determination using the NRPB dosimetric data and the measured value of incident radiation allows for reliable patient effective dose estimates. The use of DAP rather than ESD is recommended because it yields accurate results even for complex radiologic exposures involving fluoroscopy. The value of energy imparted may be used for the accurate determination of patient effective dose, especially when specific organ dose values are not of interest. The calculation of energy imparted with the use of EAP provides a reliable starting point for estimation of effective dose from radiologic examinations for which dosimetric data are not provided by NRPB.     

迟发性运动障碍患者血清尿酸、催乳素水平相关性的研究

目的通过对迟发性运动障碍(TD)患者血清尿酸(UA)、催乳素(PRL)水平相关性的分析,探讨尿酸对TD保护作用的可能机制。方法测定伴TD的精神分裂症患者(TD组30例)血清尿酸、催乳素水平,并与不伴TD的精神分裂症患者(非TD组30例)进行对照;以异常不自主运动量表(AIMS)对TD临床症状进行评定。结果 TD组UA[(273±36)μmmol/L]较非TD组[(297±50)μmmol/L]显著降低(t=2.129,P=0.037);PRL[(28±7)ng/ml]较非TD组[(24±7)ng/ml]显著增高(t=-2.195,P=0.032)。TD组PRL水平与AIMS总分正相关(r=0.366,P=0.044);与血清UA水平负相关(r=-0.403,P=0.027)。结论 TD患者血清尿酸水平偏低、并与PRL水平负相关,尿酸对DA神经元可能有一定的保护作用。     

A computerized method for automated identification of erect posteroanterior and supine anteroposterior chest radiographs

A computerized scheme was developed for automated identification of erect posteroanterior (PA) and supine anteroposterior (AP) chest radiographs. The method was based on three features, the tilt angle of the scapula superior border, the tilt angle of the clavicle and the extent of radiolucence in lung fields, to identify the view of a chest radiograph. The three indices A(scapula), A(clavicle) and C(lung) were determined from a chest image for the three features. Linear discriminant analysis was used to classify PA and AP chest images based on the three indices. The performance of the method was evaluated by receiver operating characteristic analysis. The proposed method was evaluated using a database of 600 PA and 600 AP chest radiographs. The discriminant performances Az of A(scapula), A(clavicle) and C(lung) were 0.878 ± 0.010, 0.683 ± 0.015 and 0.962 ± 0.006, respectively. The combination of the three indices obtained an Az value of 0.979 ± 0.004. The results indicate that the combination of the three indices could yield high discriminant performance. The proposed method could provide radiologists with information about the view of chest radiographs for interpretation or could be used as a preprocessing step for analyzing chest images.     

生物型硬脑膜补片在兔睑板重建中的应用

探讨兔睑板重建中生物型硬脑膜补片植入替代睑板的组织相容性,观察其组织转归。方法 20只新西兰大白兔,随机数字表法分为生物型硬脑膜补片组和异体巩膜组,每组10只。去除兔左下睑8 mm×6 mm全层睑板后,分别植入生物型硬脑膜补片与异体巩膜。术后观察2组实验兔手术部位大体外观和对应结膜面的改变,术后2、4、6、8、12周行植片组织HE染色观察组织学改变;术后4、8周植片组织行CD4+、CD8+免疫组化检查。结果 生物型硬脑膜补片植入后未见明显排斥反应。免疫组化显示,术后4周、8周生物型硬脑膜补片组植片组织CD4+、CD8+细胞计数均少于异体巩膜组[术后4周:CD4+:(9±4)个/视野比(30±5)个/视野,CD8+:(8±3)个/视野比(66±10)个/视野;术后8周:CD4+:(9±-4)个/视野比(61±10)个/视野;CD8+:(7±2)个/视野比(27±7)个/视野,均P＜0.01]。组织学检查显示生物型硬脑膜补片引起的炎性反应轻微,植入初期机体新生纤维组织开始从周边融人植片,随后周边纤维组织转化成胶原纤维,外周新生血管长入,最终其纤维走行类似正常睑板纤维束。结论 生物型硬脑膜补片在植入兔眼睑后有较好的组织相容性,可以作为生物支架引导新生血管和胶原纤维长入,起到替代睑板的作用。     

CD3+/Tregs ratio in donor grafts is linked to acute graft-versus-host disease and immunologic recovery after allogeneic peripheral blood stem cell transplantation

Graft-versus-host disease (GVHD), mediated by mature T cells present in the donor graft, remains a major complication after allogeneic peripheral blood stem cell transplantation (PBSCT). Regulatory T cells (Tregs) (CD4(+)CD25(high)Foxp3(+)) are believed to maintain tolerance and to inhibit GVHD after allogeneic PBSCT (allo-PBSCT). In this study, we analyzed the graft CD3(+)/Tregs ratio (gCD3/Tregs R) and evaluated its impact on acute GVHD (aGVHD) and immunologic recovery after myeloablative allo-PBSCT. We analyzed 65 consecutive patients who underwent transplantation with unmanipulated peripheral blood stem cells from an HLA-identical related donor (n = 45) or an HLA-identical unrelated donor (n = 20). The median CD3(+) and Tregs doses administered were 256 × 10(6)/kg of body weight (range, 67-550 × 10(6)/kg) and 12 × 10(6)/kg (range, 2-21 × 10(6)/kg), respectively; the median gCD3/Tregs R value was 18 (range, 8-250). Patients were subdivided into a high gCD3/Tregs R (≥36) group (HR; n = 26) and a low gCD3/Tregs R (<36) group (LR; n = 39). The incidence of aGVHD (grade II-IV) was lower in the LR group compared with the HR group (8/39 [20%] versus 22/26 [84%]; P < .001). Median cytomegalovirus-specific CD8(+) T lymphocytes were significantly higher in the LR group than in the HR group at 1 month (2 cells/μL versus 0 cells/μL; P < .001), 2 months (6?cells/μL versus 1 cell/μL; P < .001), and 3 months (15 cells/μL versus 3 cells/μL; P < .001) months. Moreover, cytomegalovirus infection/disease was observed in 15% of patients in the LR group versus 69% of patients in the HR group (P < .001). At multivariate logistic regression, gCD3/Tregs R was correlated both with aGVHD (odds ratio, 2.50; 95% confidence interval, 1.30-4.50; P = .05) and with cytomegalovirus infection/disease (odds ratio, 2.35; 95% confidence interval, 0.9-5.00; P = .05). Taken together, our data may suggest that the balance in favor of graft Tregs content is able to mediate protective effects against aGVHD and to maintain an optimal microenviroment for the reconstitution of functional immunity.     

Evaluation of an asymptomatic COVID-19 patient post-surgery with chest radiography: A surgeon’s dilemma

Routine chest radiography is not a requirement in post-surgery cardiac bypass patients. However, the safety of abandoning routine chest radiographs in critically ill patients remains uncertain. Surgery in an asymptomatic coronavirus disease 2019 (COVID-19) patient presents additional challenges in postoperative management. Chest radiography remains a valuable tool for assessment of all patients, even a stable one. Management of surgical patients as an emergency in an asymptomatic COVID-19 case remains a surgeon’s dilemma.     

Imaging strategies used in emergency departments for the diagnostic workup of COVID-19 patients during the first wave of the pandemic: a cost-effectiveness analysis

ObjectivesEmergency departments (EDs) were on the front line for the diagnostic workup of patients with COVID-19–like symptoms during the first wave. Chest imaging was the key to rapidly identifying COVID-19 before administering RT-PCR, which was time-consuming. The objective of our study was to compare the costs and organizational benefits of triage strategies in ED during the first wave of the COVID-19 pandemic.MethodsWe conducted a retrospective study in five EDs in France, involving 3712 consecutive patients consulting with COVID-like symptoms between 9 March 2020 and 8 April 2020, to assess the cost effectiveness of imaging strategies (chest radiography, chest computed tomography (CT) scan in the presence of respiratory symptoms, systematic ultra–low-dose (ULD) chest CT, and no systematic imaging) on ED length of stay (LOS) in the ED and on hospital costs. The incremental cost-effectiveness ratio was calculated as the difference in costs divided by the difference in LOS.ResultsCompared with chest radiography, workup with systematic ULD chest CT was the more cost-effective strategy (average LOS of 6.89 hours; average cost of €3646), allowing for an almost 4-hour decrease in LOS in the ED at a cost increase of €98 per patient. Chest radiography (extendedly dominated) and RT-PCR with no systematic imaging were the least effective strategies, with an average LOS of 10.8 hours. The strategy of chest CT in the presence of respiratory symptoms was more effective than the systematic ULD chest CT strategy, with the former providing a gain of 37 minutes at an extra cost of €718.DiscussionSystematic ULD chest CT for patients with COVID-like symptoms in the ED is a cost-effective strategy and should be considered to improve the management of patients in the ED during the pandemic, given the need to triage patients.     

Systemic changes in haemostatic balance are not associated with increased levels of circulating microparticles in women with recurrent spontaneous abortion

PROBLEM: Placental fibrin deposits in patients wih recurrent spontaneous abortion (RSA) indicate an exaggerated haemostatic response. This 'hypercoagulability' may involve pro-coagulant factors such as circulating microparticles (MPs). We investigated the relationship between circulating pro-coagulant MPs and systemic coagulation in RSA patients. METHOD OF STUDY: Platelet- and endothelial cell-derived microparticles (PMPs, EMPs) were evaluated by flow cytometry in RSA patients (n = 51) and compared to controls (n = 24) using annexin V (total numbers of MP), and antibodies against CD61, CD63 and CD62P (PMP), as well as CD144 and CD62E (EMP). Prothrombin fragment 1 + 2 (F(1+2)) and thrombin generation were determined to assess the pro-coagulant potential of MP. RESULTS: Numbers of annexin V-binding MP were nearly similar in RSA patients and controls. However, a subgroup of ten RSA patients (10/51; 20%) presented with MP concentrations >10,000 x 10(6)/L, compared to only one women out of the control group (1/24; 4%; P = 0.038). Neither PMP and EMP nor F(1+2) and thrombin generation differed significantly within the study population. CONCLUSION: The present study shows that circulating MPs are not directly associated with the extent of systemic coagulation activation in RSA patients. We hypothesize that increased numbers of circulating MPs either are only indirectly associated with coagulation during pregnancy of RSA patients, or affect abortion via mechanisms independently from hypercoagulation.     

Limited value of chest radiography in predicting aetiology of lower respiratory tract infection in general practice.

BACKGROUND: In patients with lower respiratory tract infection (LRTI), changes on chest radiography are rare but poorly characterised, especially in general practice. AIM: To describe the range of findings on chest radiographs and the associations between these findings and the aetiology of LRTI. DESIGN OF STUDY: A prospective observational study. SETTING: General practices in the Leiden region, The Netherlands. METHOD: Adult patients with a defined LRTI were included. Standard medical history and physical examination were performed. Sputum, blood, and throat swabs were collected for diagnostic tests. Chest X-ray findings were assessed in relation to the aetiology. RESULTS: An abnormality on the chest X-ray was observed in 72 (55%) patients. Forty-five patients (35%) had changes due to infection, and 26 (20%) due to pneumonia. Pathogens were detected in 84 patients (33 single bacterial, 43 single viral, and 8 dual). Twelve (29%) patients with a bacterial infection (including dual infections) compared to four (9%) patients with viral infection had pneumonia on the chest X-ray (odds ratio [OR] = 4.0; 95% confidence interval [CI] = 1.2 to 13.8). Using the presence of pneumonia on chest X-ray as a test to predict a bacterial infection, the positive predictive value and the negative predictive value were 75% (CI = 48 to 93%) and 57% (CI = 45 to 69%), respectively. CONCLUSION: Pneumonia on the chest X-ray was found more frequently in patients with a bacterial infection than in patients with a viral infection. However, the sensitivity and the specificity are such that pneumonia on the chest X-ray is not a reliable test to discriminate between bacterial and non-bacterial LRTI in the general practice setting.     

Case of scleroderma with congestive heart failure in which myocardial injury was detected by scintigraphy]

A 38-year-old woman with systemic sclerosis was admitted to our hospital because of dyspnea and finger ulcer. Chest X-p showed cardiomegaly and pleural effusion. Echocardiogram revealed diffuse hypokinesis of the left ventricle (ejection fraction 32%). Thallium scintigraphy demonstrated patchy perfusion defects. She was diagnosed as having congestive heart failure due to myocardial fibrosis, and was treated successfully with diuretics, cardiotonics, and beta-blocker. Scintigraphy may be useful to detect an early cardiac involvement in patients with systemic sclerosis, and intense pharmacological treatment might be started even before the patient develops symptoms.     

Presence of FLT3 mutations does not impair stem cell mobilization and feasibility of autologous peripheral blood stem cell transplantation in acute myeloid leukemia.

Fetal liver tyrosine kinase 3 (FLT3) mutations represent a powerful prognostic indicator in acute myeloid leukemia (AML). Further, interaction between FLT3 and its ligand plays a role in normal hematopoiesis. Accordingly, FLT3 mutations may affect mobilization of peripheral blood stem cells (PBSCs) and feasibility of autologous stem cell transplantation (ASCT) in AML. We analyzed the effect of FLT3 mutations on mobilization of CD34(+) cells and on PBASCT feasibility from 111 patients with AML, with a median age of 58 years and normal karyotype. Overall, 23 patients (21%) had FLT3 mutations. The complete remission rate was 74% and was not influenced by FLT3 mutations (73% for patients with FLT3(-) and 78% for those with FLT3(+); P= .78). The successful mobilization rate was 79% and was comparable for patients with FLT3(-) and with FLT3(+) (P = .42). Median numbers of CD34(+) cells collected were 7.6 x 10(6)/kg and 7.1 x 10(6)/kg for patients with FLT3(-) and those with FLT3(+), respectively (P = .64). Among 73 patients evaluated for mobilization, feasibility of ASCT was 71%, and there was no difference between patients with FLT3(-) (74%) and those with FLT3(+) (61%), P = .43. We conclude that the FLT3 mutations have no influence on mobilization of CD34(+) cells or on feasibility of PBASCT in patients with AML and normal karyotype.     

A reversed CD4/CD8 ratio of tumor-infiltrating lymphocytes and a high percentage of CD4(+)FOXP3(+) regulatory T cells are significantly associated with clinical outcome in squamous cell carcinoma of the cervix

In this study, 40 biopsy samples collected from cervical cancer patients at the First Affiliated Hospital of Xi'an Jiaotong University, China, were retrospectively assessed using immunohistochemistry for CD4(+) and CD8(+) tumor-infiltrating lymphocytes (TILs) and were analyzed for the expression of FOXP3, OX40, granzyme B (GrB) and perforin (Prf). The proliferating index of the TILs was determined by assessing Ki67 expression. We determined the prognostic value of low and high numbers of TILs on survival by performing Kaplan-Meier analysis using median values as the cut-off points. Except for the number of CD4(+)FOXP3(+) regulatory T cells (Tregs) and the CD4/CD8 ratio, none of the CD4(+), CD8(+), OX40(+), GrB(+) or Prf(+) TILs were associated with the overall 5-year survival rate. The 5-year survival rate was significantly lower in patients who had a high percentage of Tregs as compared with the those who had a lower percentage (35.3% versus 88.9%, P=0.001), while the 5-year survival rate was significantly higher in patients with a high CD4/CD8 ratio as compared with patients who had a low CD4/CD8 ratio (82.4% versus 44.4%, P=0.029). When we considered the deaths and surviving cases as separate groups, we found that both the number of CD4(+) T cells and the CD4/CD8 ratio were significantly lower in patients who died as compared with those who survived (26.33±11.80 versus 47.79±38.18, P=0.023 and 0.60±0.25 versus 1.17±1.02, P=0.019, respectively). In conclusion, decreased proportions of tumor-infiltrating CD4(+) T cells with high percentages of Tregs and reversed CD4/CD8 ratios were significantly associated with the clinical outcome of patients with cervical carcinoma.     

The autoreactivity of B cells in hereditary angioedema due to C1 inhibitor deficiency

Patients with hereditary angioedema (HAE) tend to produce autoantibodies and have a propensity to develop immunoregulatory disorders. We characterize the profile of autoantibodies in a group of HAE patients and investigate their memory B cells' phenotype and activation status. We studied the activity status phenotype, Toll-like receptor (TLR)-9 expression and total phosphotyrosine in B cells isolated from HAE patients. Additionally, the following autoantibodies were assessed in the serum of 61 HAE patients: anti-nuclear, rheumatoid factor, anti-cardiolipin, anti-tissue transglutaminase, anti-endomysial, anti-Saccharomyces cerevisiae, anti-thyroid and anti-neutrophil cytoplasmic antibodies. In 47·5% of HAE patients we detected at least one of the tested autoantibodies. Expression of CD69, CD5 and CD21 was found to be significantly higher on memory B cells from HAE patients compared to healthy controls (4·59 ± 4·41 versus 2·06 ± 1·81, P = 0·04, 8·22 ± 7·17 versus 3·65 ± 3·78, P = 0·05, 2·43 ± 0·54 versus 1·92 ± 0·41, P = 0·01, respectively). Total phosphotyrosine in B cells from HAE patients was significantly higher compared to healthy controls (4·8 ± 1·1 versus 2·7 ± 1·3, P = 0·0003). Memory B cells isolated from the HAE group contained higher amounts of TLR-9 compared to healthy controls (8·17 ± 4·1 versus 4·56 ± 1·6, P = 0·0027). Furthermore, the expression of TLR-9 in memory B cells from HAE patients with autoantibodies was significantly higher than the control group (10 ± 4·7 versus 4·56 ± 1·6, P = 0·0002) and from that in HAE patients without autoantibodies (10 ± 4·7 versus 5·8 ± 0·9, P = 0·036). HAE patients have enhanced production of autoantibodies due most probably to the increased activation of B cells, which was found to be in association with a high expression of TLR-9.     

Evaluation of an asymptomatic COVID-19 patient post-surgery with chest radiography: A surgeon’s dilemma

Routine chest radiography is not a requirement in post-surgery cardiac bypass patients. However, the safety of abandoning routine chest radiographs in critically ill patients remains uncertain. Surgery in an asymptomatic coronavirus disease 2019 (COVID-19) patient presents additional challenges in postoperative management. Chest radiography remains a valuable tool for assessment of all patients, even a stable one. Management of surgical patients as an emergency in an asymptomatic COVID-19 case remains a surgeon’s dilemma.     

Recombinant human thrombopoietin augments mobilization of peripheral blood progenitor cells for autologous transplantation.

This study assessed the ability of various schedules of recombinant human thrombopoietin (rhTPO) to enhance mobilization of peripheral blood progenitor cells (PBPCs) in 134 patients with cancer undergoing high-dose chemotherapy and autologous PBPC transplantation. Patients received the study drug on days 1, 3, and 5 before initiation of granulocyte colony-stimulating factor (G-CSF) 10 microg/kg/day on day 5 and pheresis starting on day 9. Randomly assigned treatments on days 1, 3, and 5 were: group 1 (n=27) placebo, placebo, rhTPO 1.5 microg/kg; group 2 (n=27) rhTPO 1.5 microg/kg, placebo, placebo; groups 3 (n=28) and 4 (n=22) rhTPO 0.5 microg/kg on all 3 treatment days; and group 5 (n=30) placebo on all 3 treatment days. After high-dose chemotherapy and PBPC transplantation, groups 1 through 4 received rhTPO 1.5 microg/kg days 0, +2, +4, and +6 with either G-CSF 5 microg/kg/day (groups 1-3) or granulocyte-macrophage colony-stimulating factor 250 microg/m(2)/day (group 4). Group 5 received placebo plus G-CSF 5 microg/kg/day. The addition of rhTPO to G-CSF increased median CD34+ cell yield/pheresis in cohorts in which rhTPO was started before day 5, with higher yields in groups 2 (2.67 x 10(6)/kg) and groups 3 and 4 (3.10 x 10(6)/kg) than in group 1 (1.86 x 10(6)/kg) or group 5 (1.65 x 10(6)/kg) (P=.006 across groups). Comparing rhTPO to placebo, higher percentages of patients achieved the minimum yield of CD34+ > or =2 x 10(6)/kg (92% v 75%; P=.050) as well as the target yield of CD34+ > or =5 x 10(6)/kg (73% v 46%; P= .041). rhTPO-treated patients required fewer phereses to achieve minimum (P= .011) and target (P= .015) CD34+ cell values. rhTPO given after transplantation did not speed platelet recovery. No neutralizing antibodies were observed. We conclude that rhTPO can safely enhance mobilization of PBPC, reduce the number of leukapheresis, and allow more patients to meet minimal cell yield requirements to receive high-dose chemotherapy with PBPC transplantation.     

乐园化引导干预可提升儿童放疗摆位精度

目的:探讨乐园化引导干预对儿童放疗摆位精度的影响。方法:选取2020年3月～2022年5月在中山大学肿瘤防治中心放疗的儿童患者作为研究对象,按照是否参与乐园化引导干预分为试验组（24例）和对照组（21例）。试验组儿童患者在每次放疗前进行儿童乐园化诱导心理干预,待儿童患者完成心理适应后进行治疗;对照组实施常规放疗准备后治疗。比较两组儿童患者放疗实施的摆位精度。结果:试验组在左右（LR）、头脚（SI）、腹背（AP）方向的摆位误差分别为（-0.32±2.18）、（-0.12±2.24）、（-0.17±2.32） mm,对照组分别为（-0.93±1.91）、（0.79±1.75）、（-0.63±1.97） mm。两组摆位误差比较,在LR和SI方向的差异有统计学意义（LR:t=2.28, P=0.02;SI:t=-2.58, P=0.01）,而AP方向的差异无统计学意义（LR:t=1.63, P=0.11）。结论:乐园化引导干预可以提高儿童患者放疗的依从性,进而提高放疗的摆位精度,具有显著的临床应用意义和推广价值。