慢性粒-单核细胞白血病的实验室观察

慢性粒-单核细胞白血病（CMML）是一种异质性的恶性造血干细胞疾病，其临床与实验室多数仍然缺乏特异性诊断。笔者通过对14例CMML患者的骨髓涂片与活检病理学观察并做出比较分析。1资料与方法 1.1一般资料 本文所观察的病例均为笔者所在医院血液科2007年7月至2009年3月的住院及门诊患者，共14例，男8例，女6例；     

混合移植治疗慢粒白血病

慢性粒细胞白血病起病缓慢,约75%～85%的患者在1～5年由稳定期转入急变期。此时半敷以上病例在3个月内死亡,仅个别病例生存期能超过1年。因此,慢性粒细胞白血病治疗的关键,是阻止进入加速期及急变     

多参数流式细胞术在慢性粒单核细胞白血病诊断中的应用

目的本研究应用多参数流式细胞仪分析正常人反应性单核细胞增多以及慢性粒单核细胞白血病(CMML)中单核细胞的免疫表型,以探究流式细胞术在CMML诊断中的应用价值。方法分析10例正常骨髓单核细胞免疫表型,选取其中表达稳定的抗原,比较反应性单核细胞增多及CMML患者单核细胞抗原表达情况,通过积分的方式,找出应用流式细胞术鉴别单核细胞是否肿瘤来源的方法。结果将单核细胞出现CD56阳性表达、HLA-DR表达减弱积1分,出现其它抗原表达异常以及CD14中等荧光强度表达细胞20%积2分,以积分≥4分作为诊断CMML的依据,敏感度为75%、特异度为95%,以积分≥5分作为诊断CMML的依据,敏感度为50%、特异度为100%。结论 CMML和反应性增多的单核细胞免疫学分型结果存在较多差异,应用流式细胞术综合这些鉴别点进行分析可辅助区分单核细胞是否为肿瘤来源,对CMML的诊断具有重要意义。     

慢性髓细胞白血病治疗的现状和未来

慢性髓细胞白血病 (chronicmyelogenousleukemia,chronicmyeloidleukemia,CML) ,既往认为它与慢性粒细胞白血病 (chronicgranuloyticleukemia,CGL)是等同语 ,但现认为它是一个广义的概念 ,包括CGL ,不典型慢性粒细胞白血病(aCML即Ph -BCR -的慢粒 )、慢性粒单细胞白血病(CMML)、慢性中性粒细胞白血病 (CNL)及幼儿型慢性粒细胞白血病 (JCML)五个类型。由于篇幅所限 ,本文所提出的治疗方法主要为CGL的治疗。1　治疗现状1 1　化学药物1 1 1　羟基脲　正在替代白消安成为CML慢性期治疗的首选药。在加速期和急变期亦可使用。本…     

耐药大肠埃希菌插入序列与接合性质粒遗传标记研究

目的调查耐药大肠埃希菌分离株中插入序列和接合性质粒遗传标记的存在情况。方法收集医院2009年6月-2010年6月临床分离的耐药大肠埃希菌共20株,采用聚合酶链反应(PCR)方法分析4种插入序列:IS26I、S903I、SEcp1I、SCR1和2种接合性质粒遗传标记:traAt、rbC。结果 20株耐药大肠埃希菌共检出3种插入序列:IS26 17株,占85.0%,ISEcp1 12株,占60.0%,IS903 5株,占25.0%;2种接合性质粒遗传标记:traA 15株,占75.0%,trbC 8株,占40.0%,只有ISCR1未检测到。结论同时检测耐药大肠埃希菌的插入序列IS26、IS903I、SEcp1I、SCR1和接合性质粒遗传标记traAt、rbC等基因尚为国内首次报道;菌株对各类抗菌药物耐药率均不低,这可能与插入序列和接合性质粒高携带率相关。     

五粒回春丸加减治疗水痘的方法与疗效

目的 观察五粒回春丸加减对30例水痘患儿的临床疗效。方法 将60例确诊为水痘的患儿随机分为两组,治疗组30例服用五粒回春丸加减方,对照组30例服用西药阿昔洛韦及对症治疗。记录退热、止痒、疱疹结痂时间,治疗7 d后根据治愈率评定疗效。结果 治疗组治愈30例,治愈率100%。对照组治愈27例,治愈率90%。治疗组在痊愈时间及症状体征消退上都明显优于对照组,差异具有统计学意义(P<0.05)。结论 中药五粒回春丸加减治疗水痘具有良好的疗效。     

三氧化二砷联合小剂量MA方案治疗慢性粒细胞白血病的分析

目的:探讨三氧化二砷(As2O3)联合小剂量MA方案治疗慢性粒细胞白血病(CML)后的血液学、细胞遗传学缓解率及急变率的改变,从而为治疗慢性粒细胞白血病寻找的新的方法。方法:三氧化二砷联合小剂量MA方案:三氧化二砷10mg/d,d 1～28;小剂量的MA方案:米托蒽醌10mg/d;d 1～3;阿糖胞苷(Ara-c)50 mg/d,d 1～14;28d为1个疗程。3个疗程结束后统计血液学缓解率,每半年检查pH染色体,并且与单独使用羟基脲治疗CML对照比较。结果:三氧化二砷联合小剂量MA方案治疗25例,3个月后有21例获得血液学完全缓解,缓解率80.4%;羟基脲组25例,3个月后有13例获得血液学完全缓解,缓解率52%(P<0.05)。观察36个月,三氧化二砷联合小剂量MA方案治疗组中有11例获得遗传学完全或部分缓解,缓解率44%,仅1例发生急变,急变率为4%。羟基脲对照组36个月无1例出现细胞遗传学缓解,有7例出现加速或急变,急变率为28%。两者比较差异有统计学意义(P<0.05)。结论:三氧化二砷联合小剂量MA方案可显著提高CML患者血液学和细胞遗传学缓解率,减少pH染色体阳性细胞,降低急变率,从而延长CML患者的生存期。     

米非司酮对粒黄体细胞的形态学影响

为研究米非司酮对粒黄体细胞的影响,我们选用孕2天的C_(57)小鼠,每日晨一次空腹灌胃给药米非司酮(1mg/kg体重)。分别在服用2、3、4天时,取小鼠卵巢,光镜与电镜下观察粒黄体细胞的形态变化。光镜观察:粒黄体细胞的体积变小,细胞核染色加深,细胞质浓缩。超微结构:粒黄体细胞的细胞核内异染色质增多,呈块状,聚集在核膜下;细胞质中的滑面内质网,线粒体与脂滴几乎全部消失。上述结构变化提示:米非司酮对早孕小鼠粒黄体细胞的功能有明显的抑制作用。     

巨和粒治疗白血病患者化疗后口腔溃疡的疗效观察

目的探讨巨和粒在白血病患者化疗后出现口腔溃疡时的疗效情况。方法选取80例接受化疗后出现口腔溃疡的白血病患者,平均分为治疗组40例,对照组40例,治疗组予以巨和粒配置的漱口液进行治疗,对照组予以重组人粒细胞刺激因子注射液配置的漱口液进行治疗。结果两组患者采取不同漱口液含漱后,口腔溃疡的平均愈合时间也有不同,其中治疗组平均时间为5.8天,对照组平均时间为7.6天(P0.05)。口腔黏膜的反应分度及口腔溃疡的愈合时间均为治疗组优于对照组。结论采取巨和粒对接受化疗后出现口腔溃疡的白血病患者进行治疗,疗效较为理想,对化疗计划能够顺利完成有较大的帮助。     

18例慢性粒细胞性白血病的染色体观察

本文介绍了我院采用的骨髓细胞染色体直接制备法及对18例慢粒病人的骨髓细胞染色体的检查,发现Ph′染色体阳性率达94.4％,核型均为9:22易位,1例阴性者为男性老年慢粒缓解期的病人。文章对Ph′染色体在慢粒中的发现率、临床意义、慢粒病人染色体的其他变化及急变时可出现的改变,以及慢粒病人染色体的改变与疗效的关系等问题作一简要的讨论。     

A Case-Control Study of Chronic Myelomonocytic Leukemia (CMML) in Shanghai,China: Evaluation of Risk Factors for CMML,With Special Focus on Benzene

ABSTRACT

The authors report the results of a hospital-based case-control study of all patients diagnosed with chronic myelomonocytic leukemia (CMML) (n = 36) from 28 participating hospitals over a 4-year period. Diagnoses were made by a single laboratory using 2001 World Health Organization (WHO) criteria. Subjects were matched to 2 control patients and interviewed concerning previous diseases, work histories, and exposures to potential etiologic agents. Peripheral blood and bone marrow findings revealed clinical features of both myelodysplastic syndromes (MDSs) and myeloproliferative neoplasms (MPNs), consistent with hematopoietic disease category of MDS/MPN. The frequency of clonal cytogenetic abnormalities in all CMML cases was 31%, with no consistent pattern identified. A select number of risk factors associated with occupational exposure, nonoccupational exposure, and prior medical or family history of disease were extracted from the questionnaire. The results were compared between the case and control subjects. A total of 5 study subjects (2 CMML cases and 3 control subjects) were determined to have had some benzene exposure. In addition, none of the highlighted risk factors associated with nonoccupational exposure to etiologic agents was significantly different among the study subjects. These results do not support an increased risk for developing CMML associated with historical exposures to benzene.     

骨髓增生异常综合征的诊断分类和治疗

WHO将骨髓增生异常综合征分为六种类型,除保留了FAB分类中的RA、RARS、RAEB三型外,CMML、RAEB-T则不再作为MDS的类型,而分别归于MDS/MPS和AML中,增加了5q-综合征,RCMD、MDS-U.免疫抑制剂、造血干细胞移植为主要治疗方法.     

The role of TNF-alpha in myelodysplastic syndrome: immunoserologic and immunohistochemical studies]

TNF alpha is a highly active cytokine which plays an important role in the regulation of apoptotic cell death, a mechanism involved in the pathophysiology of myelodysplastic syndrome (MDS). In this study we investigated the expression of TNF alpha on the bone marrow trephine biopsies by immunohistochemical method and the TNF alpha production of peripheral blood mononuclear cells by ELISA method in 15 patients affected by MDS. Five of seven patients without excess of blasts showed high or intermediate TNF alpha expression in the bone marrow biopsies, whereas two patients with excess of blasts were negative and one had low expression. The five CMML patients revealed low or intermediate expression. The production of TNF alpha by the PBMC was analysed in 10 patients, four patients with RA and two with CMML produced higher level of TNF alpha which increased after stimulation with phorbol myristic acetate, but none of the RAEB patients revealed increase in TNF alpha production. In conclusion we suppose that increased TNF alpha expression and production by PBMC may be a further indirect evidence of the role of increased apoptosis in low risk MDS patients, in the course of progression the cytokine expression and production decreases.     

Identification of factors influencing the response of antiretroviral treatment

OBJECTIVE: The authors had an aim to define the ideal patient profile by determining the factors responsible for an initial variation of CD4 lymphocytes and viral load, and the effect of these factors on the therapeutic response after 12 months of treatment in HIV infected patients. PATIENTS AND METHOD: A retrospective study was made on data concerning the clinical stage, the HIV phenotype strain, the therapeutic status, and the type of treatment. This data was compared to the CD4 count and the viral load before and after 12 months of treatment. RESULTS: Initially, CD4 lymphocytes values were low in case of: phenotype SI (p = 0.012), patient in clinical stage C (p < 0.0001), or treated with protease inhibitor (p < 0.0002). The viral loads were high for patients in stage C (p < 0.0002) and treated with protease inhibitor (p < 0.0001). After 12 months of treatment, the increase of CD4 count was lower in patients with phenotype SI (p = 0.05). Furthermore, the viral load was statistically more important in naive patient (p < 0.0001). CONCLUSION: According to our study, the ideal patient is naive and presents with phenotype NSI.     

Evaluating the treatment of eating disorders from the patient's perspective

OBJECTIVE: This study investigated the evaluation of treatment of eating disorders (EDs) from the patient's perspective in a large community based sample in the Netherlands. It investigated perceived helpfulness of different types of treatment. Furthermore it investigated which patient and treatment characteristics contribute to the evaluation of treatment. METHOD: The Eating Disorder Examination questionnaire was administered to 44 anorexia nervosa (AN), 43 bulimia nervosa (BN), 69 EDNOS (ED not otherwise specified), and 148 former ED patients. A questionnaire specifically designed for the purpose of this study addressing treatment history and patient's evaluation of their treatment was administered. RESULTS: There is a substantial patient and doctor delay in seeking and finding treatment. Treatment in specialized ED centers, self-help groups, and treatment with a partner were reported to be most helpful. Beneficial components of treatment reported in specialized ED centers refer to the communication skills of professionals, the therapist-patient working alliance, the contact with peers, and the focus of treatment on both ED symptoms as well as underlying issues. CONCLUSION: The patient's perspective on treatment of EDs does provide recommendations for the improvement of treatment of EDs that will facilitate clinical decision making and treatment planning.     

无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭效果观察

目的:分析无创正压通气治疗慢性阻塞性肺疾病并呼吸衰竭的临床价值。方法:此次研究中入组人员共为120例,入院治疗时间在2017年9月~2018年12月,分为观察组和对照组,对照组患者的治疗方案为常规方案治疗,观察组患者的治疗方案则在常规治疗的基础上加入无创通气治疗。结果:观察组患者的治疗效果明显高于对照组。治疗前动脉血气、呼吸频率、心率等数据,两组差异极小,P>0.05,但是治疗后,观察组患者的相关数据明显优于对照组,且在生活质量分值方面,观察组数据也较高。结论:针对于患有慢阻肺合并呼吸衰竭的患者,在治疗中采用无创正压通气治疗的效果比较可观,可以有效改善患者的相关指标,提升生活质量,保证患者的健康。     

Diagnosis and treatment of esophageal cancer in the Netherlands: wide variation in the second line

OBJECTIVE: To survey the diagnostic procedures and treatment strategies currently employed in hospitals for patients with oesophageal cancer. DESIGN: Questionnaire. METHOD: A questionnaire was sent to all clinicians working in the field of gastroenterology in the Netherlands. This questionnaire focused on clinical preferences regarding diagnostic procedures and treatment strategies for oesophageal cancer. Also, six hypothetical patient vignettes were presented in order to investigate which factors affected choice of treatment, in particular surgical treatment. RESULTS: The response rate was 64% (426/667); 336 questionnaires were relevant to the investigation. Almost 90% of the clinicians treated fewer than 20 patients annually, usually in their own hospital. CT was the most frequently used staging procedure; endoscopic ultrasound was less frequently used (42% used it in less than half the patients). The treatment choice for the patient vignettes varied widely among clinicians. Factors influencing the choice to operate or not were: metastases, loco-regional tumour ingrowth, poor general health, and advanced age with 8, 22, 20, and 53%, respectively, of the clinicians still considering surgery in the presence of one of these factors as opposed to 99% if none of these factors were present. Surgeons opted for operation more often than internists and gastroenterologists. Stent placement was the most frequently chosen method to palliate malignant dysphagia. CONCLUSION: There is a wide variation in the use of diagnostic procedures and treatment strategies for patients with oesophageal cancer in the Netherlands. This stresses the need for scientifically based practice guidelines, taking into account specific patient and tumour characteristics.     

盆底重建术治疗盆腔器官脱垂的治疗效果评价

目的:评价应用网片盆底重建术治疗盆腔器官脱垂的临床疗效。方法:选择2008年以来新疆维吾尔自治区人民医院盆腔器官脱垂行网片盆底重建术患者80例,以POP-Q分期作为客观疗效评价指标,以盆腔器官脱垂生活质量问卷(P-QOL)量表作为主观治愈指标。结果:手术均顺利完成,术后恢复良好,无1例血管损伤、尿道损伤、膀胱及直肠损伤。术后3个月定期随访,无感染、无复发、无性生活障碍,补片侵蚀发生1例经治疗后好转,肛门坠胀感1例,穿刺处及大腿区疼痛1例,术后早期尿频、尿急、排尿不尽2例。结论:网片盆底重建术用于盆腔器官脱垂的治疗安全、有效,术后并发症少,值得推广,仍需长期随访。     

宫颈环行电切术诊治宫颈病变的临床应用

目的:探讨宫颈环行电切术(LEEP)诊治宫颈病变的临床应用价值。方法:对478例LEEP诊治的宫颈病变患者进行回顾性分析,所有病例均行宫颈细胞学检查,阴道镜检查和LEEP术后病理诊断,在炎症和赘生物病变外缘3 mm进出电极,对于宫颈上皮内瘤变(corvical intraepithelial neoplasm,CIN)患者,电极在病变边缘外5 mm进出。结果:LEEP治疗的宫颈病变治愈率为97.91%,CIN残留率(1.27%)和复发率(1.27%)低。结论:LEEP对炎症、赘生物、CIN等宫颈病变是一种非常理想的诊断、治疗手段。但术后仍需定期和规范的随访,以防止宫颈癌的发生和发展。     

Variation in the provision of chemotherapy for colorectal cancer

OBJECTIVE: To quantify the impact of patient, area and hospital characteristics on variations in the provision of chemotherapy for colorectal cancer. SUBJECTS: Incident cases of colorectal cancer (ICD 153-154), aged under 75 years and resident in Scotland, derived from linked hospital discharge records and death records for the period January 1990 to June 1994. The final analysis was carried out on 7852 patients resident in 823 areas and first admitted to one of 59 hospitals. MAIN OUTCOME MEASURE: Whether a patient received chemotherapy (OPCS4 procedure code X35.2) during any hospital episode in the six months after their first admission. METHODS: Multilevel logistic regression to separate effects of patients, areas and hospitals. RESULTS: During the study period, 8% (n = 626) of the study population received chemotherapy within six months of their first admission. Adjusting for comorbidities and emergency admissions, both age and deprivation were significantly associated with the treatment. The odds ratios (OR) of chemotherapy relative to patients aged 65-74 were 2.13 and 4.50 for patients aged 55-64 and under 55 respectively. Relative to patients resident in the most affluent areas, the OR of chemotherapy for patients resident in the most deprived areas was 0.73. Area level availability of the treatment was not significantly associated with a patient's odds of receiving the treatment while on site provision of chemotherapy at the hospital of first admission was (OR = 4.32). There was significant unexplained variation between hospitals of first admission but not between areas of residence; between hospital variation decreased by 22% during the study period. CONCLUSION: Differences according to age may reflect both clinical and patient decisions regarding the benefits of the treatment relative to its toxicity. Lower treatment rates in deprived areas may indicate inequitable access to services. Hospital differences may reflect consultant effects and it would be expected that these should decrease now that the efficacy of the treatment has been recognised and guidelines have been issued.