Crossmatch-compatible platelets improve corrected count increments in patients who are refractory to randomly selected platelets

BACKGROUND: HLA-matched platelets and crossmatch-compatible platelets are used to support thrombocytopenic patients who are refractory to randomly selected platelets. Data supporting the effectiveness of crossmatch-compatible platelets are limited, being essentially restricted to the subset of refractory patients previously shown to be alloimmunized. The authors' hospital does not test for alloimmunization. To determine the effectiveness of crossmatch- compatible platelets in an unselected group of refractory patients, the use of such platelets for all patients who are refractory to random- donor platelets was reviewed. STUDY DESIGN AND METHODS: All patients who received crossmatch-compatible platelets between January 1991 and May 1994 were retrospectively reviewed. All study patients were refractory to random-donor platelets, having two consecutive corrected count increments (CCIs) of < 10,000. A solid-phase red cell adherence method was used for platelet crossmatching, and CCI was used to monitor the effectiveness of each platelet transfusion. RESULTS: A total of 475 crossmatch-compatible platelet components were administered to 66 evaluable patients who were refractory to random-donor platelets. A significant improvement was found in the mean CCI when crossmatch- compatible platelets were compared with randomly selected platelets (p < 0.0001): an increase of 8000 +/? 6100 (mean +/? SD). In 59 percent (39/ 66) of the patients, the mean CCI improved to at least 7,500 and in 41 percent (27/66) to at least 10,000. If the 10 patients for whom crossmatch-compatible platelets were not identified are included, the mean CCI in 51 percent (37/76) of the refractory patients improved to at least 7,500; in 36 percent (27/76), it improved to at least 10,000. The effectiveness of crossmatch-compatible platelets did not decline with continued use. CONCLUSION: Crossmatch-compatible platelet components significantly improve the mean CCI for approximately one- half of patients who are refractory to random-donor platelets, even when the patients are not preselected for having alloimmunization to explain their refractory state.     

LANSOPRAZOLE PLUS CLARITHROMYCIN: EVALUATION OF A NEW DUAL THERAPY FOR Helicobacter pylori ERADICATION

SUMMARY The aim of this pilot study was to evaluate the efficacy and safety of lansoprazole plus clarithromycin for eradication of Helicobacter pylori. A total of 26 patients with H. pylori infection were randomised to receive clarithromycin, 500 mg t.i.d. for 14 days, plus either lansoprazole, 30 mg o.m., (group L30, n=13) or lansoprazole, 30 mg b.i.d., (group L60, n=13). H. pylori status was determined pre-treatment and four to six weeks after completion of the study medication by histology and ¹³C-urea breath test. Two patients were unable to complete the course of medication. Of the remaining 24 patients, 14 (58%) successfully eradicated H. pylori — 8/12 (67%) patients in group L30 and 6/12 (50%) in group L60. Side-effects were experienced by 17/26 (65%) of patients, most commonly a taste disturbance. The results from this pilot study suggest that dual therapy with lansoprazole plus clarithromycin is only a moderately effective regimen for eradicating H. pylori.     

COR TRIATRIATUM: UNUSUAL CAUSE OF TRANSIENT ISCHAEMIC ATTACKS IN A 67-YEAR-OLD MAN

SUMMARY Cor triatriatum is a rare congenital cardiac malformation, and in its most common form is characterised by a membrane that separates the left atrium into a proximal and distal chamber. First manifestation in adulthood has been reported previously, but at 67 years of age this patient is one of the oldest to present for the first time. It was diagnosed after a probable TIA, episodic vertigo and central retinal artery occlusion. The value of echocardiography in patients with neurological disease of presumed embolic origin is demonstrated here.     

Analytical approaches to detect maternal/fetal genotype incompatibilities that increase risk of pre-eclampsia

Background

Kabuki syndrome (KS) is a multiple congenital anomaly syndrome characterized by specific facial features, mild to moderate mental retardation, postnatal growth delay, skeletal abnormalities, and unusual dermatoglyphic patterns with prominent fingertip pads. A 3.5 Mb duplication at 8p23.1-p22 was once reported as a specific alteration in KS but has not been confirmed in other patients. The molecular basis of KS remains unknown.

Methods

We have studied 16 Spanish patients with a clinical diagnosis of KS or KS-like to search for genomic imbalances using genome-wide array technologies. All putative rearrangements were confirmed by FISH, microsatellite markers and/or MLPA assays, which also determined whether the imbalance was de novo or inherited.

Results

No duplication at 8p23.1-p22 was observed in our patients. We detected complex rearrangements involving 2q in two patients with Kabuki-like features: 1) a de novo inverted duplication of 11 Mb with a 4.5 Mb terminal deletion, and 2) a de novo 7.2 Mb-terminal deletion in a patient with an additional de novo 0.5 Mb interstitial deletion in 16p. Additional copy number variations (CNV), either inherited or reported in normal controls, were identified and interpreted as polymorphic variants. No specific CNV was significantly increased in the KS group.

Conclusion

Our results further confirmed that genomic duplications of 8p23 region are not a common cause of KS and failed to detect other recurrent rearrangement causing this disorder. The detection of two patients with 2q37 deletions suggests that there is a phenotypic overlap between the two conditions, and screening this region in the Kabuki-like patients should be considered.     

地特胰岛素与甘精胰岛素控制2型糖尿病患者血糖情况的随机、交叉、双盲比较研究

地特胰岛素和甘精胰岛素均是基础胰岛素类似物，适用于每日1次单药治疗或与其他降糖药物联合治疗2型糖尿病。葡萄糖钳夹试验显示地特胰岛素和甘精胰岛素的作用时间相似。此研究旨在采用连续血糖监测系统（CGMS）比较地特胰岛素和甘精胰岛素控制24h血糖的情况。     

Effects of medications on hypoxia-inducible factor in the retina: A review

Hypoxia-inducible factor (HIF) plays a critical role in the mechanisms that allow cells to adapt to various oxygen levels in the environment. Specifically, HIF-1⍺ has shown to be widely involved in cellular repair, survival, and energy metabolism. HIF-1⍺ has also been found in increased levels in cancer cells, highlighting the importance of balance in the hypoxic response. Promoting HIF-1⍺ activity as a potential therapy for degenerative diseases and inhibiting HIF-1⍺ as a therapy for pathologies with overactive cell proliferation are actively being explored. Digoxin and metformin, HIF-1⍺ inhibitors, and deferoxamine and ⍺-ketoglutarate analogues, HIF-1⍺ activators, are being studied for application in age-related macular degeneration, diabetic retinopathy, and retinitis pigmentosa. However, these same medications have retinal toxicities that must be assessed before implementation of therapeutic care. Herein, we highlight the duality of therapeutic and toxic potential of HIF-1⍺ that must be carefully assessed prior to its clinical application in retinal disorders.