Therapy of patients with human T-cell lymphotrophic virus I-induced adult T-cell leukemia with anti-Tac, a monoclonal antibody to the receptor for interleukin-2

Human T-cell lymphotropic virus I (HTLV-I)-induced adult T-cell leukemia (ATL) cells constitutively express interleukin-2 (IL-2) receptors identified by the anti-Tac monoclonal antibody (MoAb), whereas normal resting cells do not. This observation provided the scientific basis for a trial of intravenous anti-Tac in the treatment of nine patients with ATL. The patients did not suffer untoward reactions and did not have a reduction in the normal formed elements of the blood, and only one of the nine produced antibodies to the anti-Tac MoAb. Three patients had transient mixed, partial, or complete remissions lasting from 1 to more than 8 months after anti-Tac therapy, as assessed by routine hematologic tests, immunofluorescence analysis of circulating cells, and molecular genetic analysis of HTLV-I provirus integration and of the T-cell receptor gene rearrangement. The precise mechanism of the antitumor effects is unclear; however, the use of a MoAb that prevents the interaction of IL-2 with its receptor on ATL cells provides a rational approach for the treatment of this malignancy.     

EFFECTS OF IMPLEMENTATION OF 18 CLINICAL PATHWAYS ON COSTS AND QUALITY OF CARE AMONG PATIENTS UNDERGOING UROLOGICAL SURGERY

PURPOSE: We evaluated the effects on the costs and quality of care of implementation of 18 clinical pathways for urological operations. MATERIALS AND METHODS: From April 1997 to March 1998 patients undergoing 1 of 18 urological operations were treated according to clinical pathways. The outcomes in terms of length of hospital stay and admission charges of these patients were compared with those of patients treated between April 1996 and March 1997 before clinical pathways were implemented. We also selected 7 clinically relevant quality indicators to assess the quality of care before and after clinical pathway implementation. RESULTS: Of the 1,784 patients undergoing urological surgery from April 1997 to March 1998, 1,382 (77.5%) were treated according to 1 of the 18 clinical pathways. Before implementation 1,279 of 1,615 patients (79.2%) underwent these procedures. The length of hospital stay decreased from 5.5 to 4.9 days (p < 0.01) and the average hospital admission charges decreased by 12.9% (p < 0.01) after implementation. Five of the quality indicators, including the rate of surgical complications, were significantly improved after pathway implementation. The hospitalization rate was not affected (1.3 before versus 0.8% after implementation, p = 0.18). Variations from the clinical pathways occurred in 543 cases (39.3%) and affected the length of hospital stay only (11.6%) or the admission charge only (12.9%) more often than both (7.8%, p < 0.01) or neither (7.0%, p < 0.01). The most common variances in these patients were patient related (30.8%). CONCLUSIONS: Implementation of multiple clinical pathways in a urology department can improve urological practice by decreasing the length of hospital stay, admission charges and rate of surgical complications, and by improving the quality of care.     

小牛血去蛋白提取物对胃溃疡患者的疗效评价

目的：探讨小牛血去蛋白提取物(DCBE)对胃溃疡的治疗作用。方法：选择年龄20～70岁之间，经胃镜检查确诊为活动期胃溃疡的住院患60例。治疗组32例采用静脉滴注DCBE(800mg，qd)和法莫替丁(100mg,bid)治疗；对照组28例采用静脉滴注法莫替丁(100mg，bid)单独治疗。用药2、4wk行胃镜检查，观察自觉缓解症状、时间、愈合率和总有效率。结果：治疗组自觉症状缓解时间明显缩短；给药后2、4wk治疗组及对照组胃镜检查溃疡愈合率分别为78.1％，46.4％及84.4％，71.4％。结论：DCBE能显促进胃溃疡的愈合。     

α-珠蛋白生成障碍性贫血干预效果分析

目的探讨α-珠蛋白生成障碍性贫血产前诊断在降低出生缺陷中的效果。方法选择2003年1月至2012年7月进行α-珠蛋白生成障碍性贫血产前诊断的妊娠1 037例,采用聚合酶链反应结合琼脂糖凝胶电泳和反向点杂交技术对脐带血和原位培养后的羊水或绒毛组织检测α珠蛋白基因,同时对合并β-珠蛋白生成障碍贫血者进行β-珠蛋白基因检测。结果 1 037例妊娠中α-珠蛋白生成障碍性贫血检出率为79.27%,其中血红蛋白H（Hb Bart′s）胎儿水肿综合征292例,HbH病45例;同时检出中间型、重型β-珠蛋白生成障碍贫血5例,β-珠蛋白生成障碍贫血杂合子28例,包括α复合β-珠蛋白生成障碍贫血26例,终止妊娠339例。结论α-珠蛋白生成障碍性贫血产前干预是防止该类患儿出生的有效措施,同时应加强复合型珠蛋白生成障碍贫血的干预。     

自闭症患儿父母心理状况调查及健康教育意义分析

目的分析自闭症儿童父母的心理状况,实施及时有效的健康教育。方法采用症状自评量表（SCL-90）、抑郁自评量表（SDS）、焦虑自评量表（SAS ）对89例自闭症儿童父母进行测评。并对这些父母实施有效的健康教育,对健康教育前的测评结果分别同国内常模、健康教育后比较。结果在健康教育实施前,自闭症儿童父母SCL-90、SAS、SDS得分均高于全国常模,差异有统计学意义（P＜0．01）;健康教育前后得分比较差异有统计学意义（P＜0．01）。结论自闭症儿童父母普遍存在心理问题,及时开展健康教育能改善其心理状况。     

Left Atrial Voltage during Atrial Fibrillation in Paroxysmal and Persistent Atrial Fibrillation Patients

Background: Left atrial (LA) endocardial voltage characteristics assessed during atrial fibrillation (AF) have not been previously compared in different AF types. This study was aimed at investigating the LA voltages and volumes in patients with paroxysmal and persistent AF. Methods: LA electroanatomic voltage maps acquired during AF were compared between consecutive patients without major structural heart disease undergoing first catheter ablation for paroxysmal AF (n = 100) or persistent AF (n = 100). The groups were comparable in baseline clinical characteristics. Results: Patients with persistent AF presented with lower median LA voltage (median 0.41, interquartile range [IQR] 0.31–0.51 mV versus median 0.99, IQR 0.47–1.56 mV; P < 0.001), and maximum LA voltage (4.07 ± 1.76 vs 6.42 ± 2.16 mV; P < 0.001). They also had a higher proportion of the LA points exhibiting voltage <0.2 mV (30 ± 20 vs 12 ± 11%; P < 0.001) and voltage 0.2–1.0 mV (55 ± 15 vs 42 ± 19%; P < 0.001). They further displayed higher LA volume/body surface area (75 ± 16 vs 58 ± 13 mL/m²; P < 0.001). In the multivariate regression model, both LA voltage (P < 10^?9) and LA volume (P < 10^?5) were significant determinants of AF type. Conclusion: Patients with persistent AF had significantly lower LA voltage compared with patients with paroxysmal AF even after adjustment for differences in indexed LA volume. LA voltage represents an independent covariate of clinical manifestation of AF. (PACE 2010; 541–548)