非清髓异基因造血干细胞移植治疗重症再生障碍性贫血4例

为探讨非清髓性异基因外周血造血干细胞移植（NAPBSCT）在治疗重症再生障碍性贫血（SAA）中的作用。4例HLA完全相合的重症再生障碍贫血病人（2例肝炎相关性重症再生障碍性贫血,2例重症再生障碍性贫血）接受了NAPBSCT,结果4例均顺利度过造血抑制期并移植成功（完全性植入3例,嵌和性植入1例）,外周血象及骨髓造血功能快速恢复正常。4例均无急性移植物抗宿主病和间质性肺炎等并发症。本结果初步表明：NAPBSCT简单、安全、并发症轻、造血功能重建快,为SAA的治疗开辟了一条新途径。     

异基因外周血造血干细胞移植41例临床分析

为分析异基因外周血造血干细胞移植（allo-PBSCT)治疗恶性血液病的效果和并发症的防治，用allo-PBSCT治疗恶性血液病41例，急性移植物抗宿主病（GVHD）预防采用环孢素A（CsA）＋短程氨甲蝶呤（MTX）、霉酚酸酯（MMF）联合CsA＋短程MTX两种方案。结果显示，全部患者均顺利造血重建。HLA完全相合移植急性GVHDⅡ度以上者8例（21．05％）。慢性GVHD发生率76％。急性白血病CR1和慢性髓细胞白血病－慢性期（CML－CP）、HLA完全相合移植34例，复发3例（8．82％）；随访2年以上者存活率71．43％（10／14）。表明allo－PBSCT急性GVHD发生率并不高于骨髓移植，但慢性GVHD发生率明显高；感染和间质性肺炎是移植后死亡的主要原因。     

全身(全淋巴)照射后100例医源性急性放射病的临床分析

在造血干细胞移植治疗肿瘤过程中用全身照射（ＴＢＩ）或全淋巴照射（ＴＬＩ）预处理，研究受照不同剂量患者发生医源性急性放射病严重程度，治疗方法和造血恢复及相关合并症。方法１００例患者（白血病９１例，其他肿瘤９例）接受５００～１０００ｃＧｙＴＢＩ或ＴＬＩ和超大剂量化疗作预处理。结果均发生医源性急性放射病，白细胞降至（０～０．１５）×１０９／Ｌ，骨髓空虚，合并各种感染和出血。经造血干细胞移植，抗感染，应用ＧＭ－ＣＳＦ或Ｇ－ＣＳＦ积极支持治疗及保护隔离措施，９２例造血恢复，８例死于不同感染和出血。结论造血干细胞的移植起主要治疗作用，不同造血因子用于治疗急性放射病，可能是一种有希望的方法     

多位点不合的非清髓异基因外周血造血干细胞移植治疗慢性粒细胞性白血病1例

1998年以来，Slaven等学者率先开展非清髓异基因外周血造血干细胞移植(NAPBSCT)，治疗白血病等恶性血液病，取得显著效果。笔者采用白消安(Bus)、CY及环孢素(环孢菌素A，CsA)等，为1例HLA配型四个位点不合的慢性粒细胞性白血病(CML)患者成功进行NAPBSCT，现报告如下。     

造血干细胞移植治疗飞行人员急性白血病（摘要）

目的采用造血干细胞移植治疗4例空军飞行人员急性白血病,其中3例为急性非淋巴细胞性白血病,1例为急性淋巴细胞性白血病。方法自1993～2003年4例急性白血病飞行员接受造血干细胞移植治疗,3例接受自体外周血干细胞或自体骨髓移植,预处理方案为环磷酰胺（CY）／全身照射（TBI）,1例接受半相合异基因骨髓移植,预处理方案为CY／TBI／阿糖胞苷/噻替哌。     

异基因外周血造血干细胞移植后造血细胞嵌合状态的分析

为评估异基因外周血造血干细胞移植（ALLO－PBSCT）后的植入状况，采用细胞遗传学分析结合短串联重复序列－聚合酶链反应（STR－PCR），对30例Allo-PBSCT病人进行了1－25个月的随访观察。结果表明，不同性别移植的23例，21例完全嵌合（CC），1例混合嵌合（MC），1例为完全受者核型；相同性别移植的慢性髓性白血病（CML）7例，除2例外，其余均未检测到Ph染色体；STR－PCR检测结果与染色体分析结果完全一致。说明两种方面具有互补性，可结合使用。     

非清髓异基因造血干细胞移植治疗急性白血病的临床研究

采用非清髓预处理（环胞霉素A、环磷酰胺、阿糖胞苷及CD3单克隆抗体或抗淋巴细胞球蛋白）的异基因外周造血干细胞移植治疗急性白血病5例。5例病人均顺利度过造血抑制期并移植成功。2例例经嵌合性植入转为完全植入,另3例为嵌合性植入。5例中2例发生Ⅱ～Ⅲ度GVHD,经治疗后治愈。5例中4例仍无病存活。结果表明,非清髓异基因造血干细胞移植简便安全,并发症少,疗效较好,为急性白血病的治疗提供了新手段。     

造血干细胞移植术后患者巨细胞病毒感染发生率及临床转归

采用免疫组化法对100例异体造血干细胞移植（Allo-HSCT）和14例自体造血干细胞移植（Auto-HSCT)术后患者、17例非移植患者以及27例正常供者CMVpp6抗原血症检出率进行分析。100例Allo-HSCT术后患者随访观察18（4－36）个月。结果：AlloHSCT者91％，在不同病期出现CMVpp65阳性（CMV－I），其中56％出现CMV疾病；急性移植物抗宿主病（GVHD）发生率为54％，时间为25（11－27天）；慢性GVHD52.9%，CMV相关性死亡率为21％，在各种死因中占主要地位。CMV－I在异体移植后好发，而在AutoHSCT术后患者、非移植患者以及正常人群极为少见，提示，CMV感染与急慢性GVHD呈显著相关性，是影响预后的主要因素。     

供者同后造血干细胞输注在非清髓异基因造血干细胞移植中的应用

为探讨供者造血干细胞输注 (DSI)在非清髓异基因外周血干细胞移植 (NAPBSCT)中的作用 ,6例NAPBSCT患者分别在移植后 +7～ +90天进行DSI治疗 ,共输注单个核细胞 (MNC) (0 .6～ 7.6 )× 10 8/kg ,CD34 + 细胞 (0 .3～ 3.4)× 10 6/kg ,CD3+ 细胞 (0 .3～ 5 .1)× 10 8/kg。 6例中 5例有明显促进植入的作用 ,其中 3例由嵌合体转为完全性植入。 4例有较明确的移植物抗白血病效应 (GVL) ,均未见造血抑制等并发症。初步结果表明 ,DSI能促进NAPBSCT后供者嵌合体的增加 ,有利于NAPBSCT后供者细胞植入并具较好的GVL效应 ,而且并发症少 ,在NAPBSCT中具有较好的应用前景。     

Flud＋Bu＋CCNU＋Ara-C预处理单倍体造血干细胞移植治疗白血病13例的疗效

目的 初步探讨使用＂氟达拉滨（Flud）＋马利兰（Bu）＋司莫司汀（CCNU）＋阿糖胞苷（Ara-C）＂预处理方案行异基因造血干细胞移植治疗白血病的临床疗效.方法 13例患者中,慢性粒细胞白血病（CML）5例,急性淋巴细胞白血病5例,急性非淋巴细胞白血病3例.预处理方案为Flud 30 mg/（m2·d）×4 d,Bu 1 mg/（kg·次）×4 d,CCNU 250 mg/m2×1 d,Ara-C 2-4 mg/m2×2 d.供者均为亲缘HLA配型半相合;输注外周血造血干细胞有核细胞数（3.5-4.5）×108/kg受体体重（中位数为4×108/kg）,骨髓有核细胞数（3.5~4.5）×108/kg受体体重（中位数为4×108/kg受体体重）.采用＂ATG＋环孢霉素＋短疗程甲氨喋呤＋晓悉＂预防移植物抗宿主病（GVHD）.前列腺素E1（PGE1）＋低分子肝素钠＋丹参预防肝静脉闭塞症.结果 骨髓移植后全部患者重建造血,移植后骨髓嵌合及基因检测证实患者骨髓中造血细胞为完全供者细胞植入.结论 Flud＋Bu＋CCNU＋Ara-C预处理方案移植治疗白血病疗效较好,安全可行,为无HLA完全相合供者白血病患者提供了有效的治疗手段.     

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.     

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.     

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).     

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.