双次自体造血干细胞移植治疗恶性血液病

目的 探讨双次自体造血千细胞移植（DAHSCT）治疗恶性血液病的疗效、造血重建及生存情况。方法 对6例恶性血液病患者，其中急性白血病3例，多发性骨髓瘤（MM）3例，第一次预处理方案白血病组为CY＋TBI，MM组为HDM（马法兰200mg／m^2）；第二次预处理方案白血病组为MEC（马法兰140mg／m^2，VP-16，CY120mg／kg），MM组仍为HDM。结果 6／6例患者均获造血重建（9～20d），5例至今仍无进展存活（PFS）14—26m，1例MM除出现慢性肾功能不全以外，其他病人病情稳定。结论 DAHSCT意者相关死亡率低，无病生存率较高，以此方案行双次自体千细胞移植是治疗恶性血液病的有效方法。     

自体造血干细胞移植治疗恶性血液病晚期肺癌(附11例报告)

目的观察自体造血干细胞移植(AHSCT)治疗恶性血液病和晚期肺癌(ALC)的疗效。方法8例急性白血病(AL)、2例恶性淋巴瘤(ML)和1例ALC用AHSCT治疗。AL、ML、ALC分别用MAC(马法兰、阿糖胞苷、环磷酰胺)、MeEAM(甲基环己亚硝脲、足叶乙甙、阿糖胞苷、马法兰)、MeEEC(甲基环己亚硝脲、足叶乙甙、表阿霉素、环磷酰胺)方案预处理。结果11例患者移植后均获造血重建,中位随访9(4～23)个月,7例患者已持续缓解14(4～23)个月,4例患者分别在移植后3、4、5、12个月复发。结论初步结果提示AHSCT能延长AL、ML和ALC患者的无病存活期。     

影响采集异基因供者外周血干细胞的因素探讨

目的　探讨采集异基因供者外周血干细胞相关因素对干细胞得率的影响。方法　采用COBE -spectra血细胞分离机采集异基因外周血干细胞供者 2 1例 ,分析供者每次采集前后外周血WBC、有核细胞数 (NC)、单个核细胞比例 (MNC)等参数对干细胞采集得率的影响。选用不同剂量的G -CSF动员供者所采出CD3 4 + 细胞数量进行比较。结果　 2 1例供者的外周血均值变化为WBC( 4 1± 7 7)× 10 9/L ,MNC( 12± 2 9) % ,此时采集到的有核细胞数为 ( 2 7± 0 8)× 10 8/L ,而且得率较高。通过相关多元统计分析2 1例供者后得出NC对采集的单个核细胞得率之间存在直线正相关关系 (r =0 87,P <0 0 0 0 1)。结论　应用COBE -spectra血细胞分离机采集异基因供者外周血干细胞得率高 ,供者痛苦小 ,红细胞混杂率少、移植后成活率高。该方法目前仍是一种较为安全、快捷采集外周血干细胞的方法。     

美罗培南在自体造血干细胞移植合并感染时的应用

自体外周血造血干细胞移植(APBSCT)是治疗恶性血液病的有效办法之一。我们对2000-2004年20例APBSCT患者合并感染者应用美罗培南治疗,取得满意效果。现报道如下。1资料与方法1.1病例选择自体外周血造血干细胞移植患者20例,男11例,女9例;年龄16~52岁,平均年龄30.1岁,急性粒细胞白血病11例,急性淋巴细胞白血病5例,恶性淋巴瘤3例,多发性骨髓瘤1例。所有病例均符合自体外周血造血干细胞移植条件。1.2动员方案除急性粒细胞白血病采用大剂量阿糖胞苷(HD-Ara-C)动员外,其他均应用大剂量环磷酰胺(HD-Cy)动员。1.3自体造血干细胞的采集、冻存…     

恶性淋巴瘤患者采用MAG方案进行干细胞动员的疗效观察

目的　观察恶性淋巴瘤患者进行自体外周血造血干细胞移植(APBSCT)前采用MAG方案动员干细胞的疗效.方法对进行APBSCT的12例恶性淋巴瘤患者,移植前动员均采用MAG方案,具体为阿糖胞苷(Ara-C)2g/m2每12h　1次,第1、2天；米托蒽醌(MTZ)　10　mg/m2,第2、3天.白细胞(WBC)计数＜1.0×109/L时开始使用重组人粒细胞集落刺激因子(rhG-CSF)　150μg/d,WBC　计数＜0.5×109/L时采用rhG-CSF　300μg/d,WBC计数开始回升时,每日检测血常规和观察外周血涂片,当外周血涂片中出现原始或幼稚细胞时给予rhG-CSF　300μg,每12h　1次,使用CS-3000血细胞分离机连续2d采集外周血干细胞并冻存备用.结果12例患者经MAG方案动员后,并发症主要为轻度感染.经两次采集,共采集到单个核细胞(MNC)(5.24±0.81)×108/kg,CD34+细胞(8.16±2.25)×　106/kg,均达到采集要求.结论恶性淋巴瘤患者采用MAG方案进行干细胞动员、采集,结果稳定可靠,安全性好.     

非清髓性CD34+细胞自身移植治疗难治性系统性红斑狼疮

目的观察非清髓性化疗结合CD34+细胞分选的自体外周血干细胞移植(APBSCT)在难治性系统性红斑狼疮(RSLE)的治疗效果及安全性.方法难治性系统性红斑狼疮患者2例,采用异环磷酰胺加重组人粒细胞集落刺激因子(G-CSF)动员、百特CS-3000血细胞分离机采集外周血,获取单个核细胞,通过CD34+细胞分选仪分别得到了2.6×106/kg、2.1×106/kg CD34+细胞;预处理回输前6 d每日应用氟达拉滨50 mg/d(共5 d)+回输前3 d始每日应用抗胸腺细胞球蛋白(ATG)80 mg/(kg·d),共5 d.结果2例患者的临床症状完全缓解,异常免疫学指标基本恢复正常,抗体全部阴转,肾功能、尿常规恢复正常.结论非清髓性化疗结合CD34+细胞分选的APBSCT治疗难治性系统性红斑狼疮近期疗效满意.     

同胞脐血移植治疗重型β-地中海贫血的临床研究

【目的】　探讨同胞脐血移植治疗重型 β 地中海贫血 (以下简称地贫 )的疗效。 　【方法】　用HLA全相合或不全相合同胞脐血移植治疗重型 β 地中海贫血患儿 7例。供给受者的有核细胞 ( 4 .5 5～ 16.0 )× 10 7/kg ,CD3 4 + 细胞 ( 0 .11～ 1.0 3 )× 10 6/kg ,粒 巨噬细胞集落形成单位 ( 0 .3 1～ 1.18)× 10 5/kg。移植的预处理方案HLA全相合的患儿采用马利兰 +环磷酰胺 +抗胸腺细胞球蛋白方案 ;HLA 2个位点不全相合者采用高剂量输血 +连续静注去铁胺 +羟基脲 +氟哒拉膑 +马利兰 +环磷酰胺 +抗胸腺细胞球蛋白方案。　【结果】　 7例患儿均获得植入 ,其中 6例患儿为长期稳定植入 ,1例植入后发生排斥。 7例患儿均发生急性移植物抗宿主病 ,其中Ⅰ度 5例 ,Ⅱ度 2例。脱离地贫状态生存 6例 ,血红蛋白一直维持正常 ,1例恢复地贫状态。　【结论】　同胞脐血移植可根治本病。     

859例原发培阳肺结核全程督导短程化疗效果与耐药性分析

目的　分析 85 9例原发培阳肺结核病人其耐药性与全程督导短程化疗 (DOTS)效果的关系。方法　药敏试验采用比例法 ,培养基中药物浓度分别为 S4 μg/ m l、H0 .2 μg/ m l、R4 0 μg/ ml和 E2 μg/ ml;病人治疗采用卫 项目统一规定的全程间歇短化方案 (2 S3H3R3/ 4 H3R3)。结果　 85 9例病人经 6个月的治疗后 ,除 8例失访外 ,其中治愈 771例 (89.8% ) ,完成治疗 6 7例 (7.8% ) ,失败 9例 (1 .0 % )。化疗失败病人耐单药和耐二药组与敏感组无显著性差异 (P>0 .0 5 )。结论　对于原发敏感和耐一或二种药物的病例采用 6个月短程化疗方案是合理有效的     

60例特发性血小板减少性紫癜静注免疫球蛋白及地塞米松临床效果观察

我院对 30例特发性血小板减少性紫癜 (ＩＴＰ)用静注免疫球蛋白 (ＩＶＩＧ)及地塞米松 (ＤＸＭ)治疗 ,疗效优于单纯地塞米松治疗组 ,现报告如下。对象与方法1　对象　 1994年 1月到 1999年 10月 ,住院的ＩＴＰ患儿 6 0例 ,男 32例 ,女 2 8例 ,年龄 6个月～ 13岁 ,其中血小板计数 <2 5× 10 9/Ｌ2 0例 ,2 5～ 5 0× 10 9/Ｌ2 2例 ,>5 0× 10 9/Ｌ并<10 0× 10 9/Ｌ8例 ,全部符合第二届全国血液学术会议所定的ＩＴＰ诊断标准。随机分为单纯ＤＸＭ治疗组及ＩＶＩＧ加ＤＸＭ治疗组各 30例。2　治疗方法　单纯ＤＸＭ治疗组 ,以ＤＸＭ0 5ｍｇ/Ｋ…     

放射治疗同步化疗治疗晚期食管癌的临床研究

目的　探讨晚期食管癌放射治疗合并化疗的疗效和毒副反应。方法　对符合入组条件的 86例晚期食管癌随机分为 :综合组 46例 ,外照射同常规放射治疗组 ,放射治疗当日及外照射达DT40Gy时 ,同时合并化疗 ,化疗方案 :氟尿嘧啶 ( 5 -FU)5 0 0mg·d-1,5d ;顺铂 (DDP) 3 0mg·d-1,5d ;亚叶酸钙 (CF) 2 0 0mg·d-1,5d ;常规放射治疗组 46例 (单放组 )食管癌常规外照射总量DT60～ 64Gy/ 6～ 7周 ,每次 2Gy ,每周 5次。均采用 8MVX线照射。结果　全部病人随访 3年以上 ,随访率 98 4%。近期疗效完全缓解率综合组和单放组分别为 40 3 %和 2 9 0 % ( χ2 =1 2 6P >0 0 5 ) ;综合组和单放组的 1、2、3年生存率分别为 :72 5 8%、5 1 61%、3 7 10 %和 5 8 10 %、3 2 2 6%、2 0 97%。 2、3年生存率差异有显著性 (P <0 0 5 )。两组的毒副反应综合组高于单放组。结论　放疗合并DF方案加CF化疗优于单纯放疗 ,是治疗中晚期食管癌的一种有效方法     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.