Exchange transfusion the hard way: massive hemolysis following transplantation of bone marrow with minor ABO incompatibility

BACKGROUND: Bone marrow transplantation using donors with minor ABO incompatibility may result in the rapid production of donor-derived red cell isohemagglutinins, causing hemolysis of recipient red cells. CASE REPORT: The transplant of sibling-donor marrow with minor ABO incompatibility (group O donor marrow to group A recipient), using FK- 506 as an immunosuppressant to prevent graft-versus-host disease, is reported. Following early myeloid engraftment, the recipient developed hemolysis of her entire A red cell population between Day 8 and Day 11. This brisk hemolytic anemia was due to rapid donor lymphoid engraftment that resulted in the explosive production of donor-derived anti-A. CONCLUSION: Patients undergoing the transplantation of marrow from donors with minor ABO incompatibility in which the donor cells can produce isohemagglutinins against the recipient's red cells must be kept under vigilant observation for the possible development of severe hemolysis, particularly in the setting of profound T-cell suppression without B-cell suppression.     

THE DURATION OF ACTION OF INHALED FORMOTEROL DRY POWDER

SUMMARY The duration of action of formoterol inhaled as a dry powder formulation is compared with placebo and a reference treatment of salbutamol dry powder in patients with bronchial asthma. This single-centre, double-blind, cross-over study recruited 23 outpatients with clinically stable asthma. These patients were treated with 12μg formoterol, 400μg salbutamol or placebo in a randomly allocated sequence, with at least 2 days between treatments. Forced expiratory volume in 1s of expiration (FEV₁) was measured at specified time points from 15 min to 15 hours post-treatment. Formoterol produced significantly higher values of FEV₁ at the primary endpoint of 12 hours compared with placebo and salbutamol. No differences between FEV₁ values were seen for the active treatments of formoterol and salbutamol for the first 5 hours post-inhalation. Formoterol was significantly superior to placebo at all time points, whereas salbutamol was significantly superior to placebo for the first 5 hours.This study demonstrates that formoterol, when given as a dry powder inhalation, has a significantly longer duration of acute bronchodilator action than 400μg salbutamol inhaled as a dry powder. The duration of action of formoterol of at least 12 hours seen in this study is at least as long as that reported following administration from a metered dose inhaler (MDI) at the same dose level. The study also demonstrates that 12μg formoterol dry powder is well tolerated by patients.     

人视网膜色素上皮细胞增殖与川芎嗪的影响

目的:观察糖基化终产物(advanced glycation end products,AGEs)对人视网膜色素上皮细胞增殖的影响,以及川芎嗪对AGEs诱导的人视网膜色素上皮细胞增殖的拮抗作用。方法:实验于2003-09/2004-07在中南大学湘雅二医院中心实验室完成。①实验分组:原代培养人视网膜色素上皮细胞,第3￣8代用于实验,设空白对照组,DMEM培养基中不加入任何药物;AGEs对照物组,培养液中含100mg/L的AGEs对照物;AGEs组,培养液中含10,50,100,200,400mg/L的AGEs,分别干预视网膜色素上皮细胞24h及48h。②实验操作:川芎嗪干预实验:也设空白对照组;AGEs对照物组;AGEs组,培养液中含100mg/L的AGEs;AGEs 川芎嗪组,培养液中加入10,20,40,80,160,320,640mg/L川芎嗪30min后加入100mg/L的AGEs,分别干预视网膜色素上皮细胞24h。③实验评估:MTT微量酶比色法检测视网膜色素上皮细胞增殖情况。结果:①视网膜色素上皮细胞增殖情况:不同浓度AGEs组细胞增殖率均高于对照物组(P<0.01),100mg/LAGEs组增殖率(24,48h分别为39.45%,31.97%)高于其他组(P<0.01),48h与24h结果一致。②川芎嗪的抑制效应:与AGEs组比较,10,20,40,80,160mg/L川芎嗪对AGEs诱导的视网膜色素上皮细胞增殖无抑制作用(P>0.05),320及640mg/L川芎嗪有抑制作用,其抑制率为8.96%,15.08%(P<0.01)。结论:①AGEs可诱导人视网膜色素上皮细胞增殖。②低浓度川芎嗪对AGEs诱导的人视网膜色素上皮细胞增殖无抑制作用,高浓度川芎嗪具有抑制作用。     

Molecular basis of intrahepatic cholestasis

Intrahepatic cholestasis, or impairment of bile flow, is an important manifestation of inherited and acquired liver disease. In recent years, human genetic and molecular studies have identified several genes, the disruption of which results in cholestasis. ATP8B1 (FIC1), ABCB11 (BSEP), and ABCB4 (MDR3) are disrupted in forms of progressive familial intrahepatic cholestasis (PFIC) and related disorders. Mutations in BAAT, TJP2 (ZO‐2), and EPHX1 have been identified in patients with hypercholanemia. A CLDN1 mutation was recently reported in patients with ichthyosis, leukocyte vacuoles, alopecia and sclerosing cholangitis (ILVASC), and North American Indian childhood cirrhosis (NAIC) is associated with a missense mutation in CIRH1A. Alagille syndrome patients carry mutations in JAG1, and mutations in VPS33B have been identified in patients with arthrogryposis, renal dysfunction and cholestasis syndrome (ARC). Identification of these genes, and characterization of the proteins they encode, is enhancing our understanding of the biology of the enterohepatic circulation in health and disease.     

Improved hair restoration method for burns

Background

Extracted partial longitudinal follicular units can be used as complete follicular units to regenerate completely differentiated hair growth. The partial follicular units that remained in the dermis in the donor area can survive and produce hairs. This technique enables us to multiply hair follicles in vivo, while preserving the donor area and therefore is suitable in persons, who have a relative small donor area compared to the recipient area, as in scalp burns.

Objectives

With this study, we try to determine if partial longitudinal follicular unit transplantation (PL-FUT) can be used for facial and/or scalp burns.

Materials and methods

Four burn victims (age 22-39 years, mean 27.75 years) were treated in the face (eyebrows, and beard) and/or on the scalp with PL-FUT. The grafts were harvested with hollow wave-tipped needles with an inner diameter of 0.6 mm from the occipital area of the scalp. The suitable longitudinal partial follicular units were impregnated with a preservative medium, and implanted into the recipient area. Hair growth in the donor area as well as the recipient area was observed before treatment, and at intervals of 1 week, 3 months and 1 year after the treatment.

Results

After evaluation of the donor area, sometimes a few little white spots were visible, but almost all hair follicles in the donor site re-produce hairs after 2 years. All treated patients had satisfactory or very satisfactory cosmetic results in the treated area.

Conclusions

Longitudinal partial follicular unit transplantation (LP-FUT) may represent the first reliable patient-friendly method to generate two hair follicles from one hair follicle with consistent results and preservation of the donor area. Therefore, this method is very suitable for people with facial and/or scalp burns.     

Microbial Burden of Some Herbal Antimalarials Marketed at Elele, Rivers State

Herbal antimalarials still remain an alternative to our traditional communities who can not afford orthodox antimalarials. This study was aimed at investigating the microbial quality of six herbal antimalarials using standard microbiological methods. Of the six preparations analyzed, “schnapps”, palm wine and water were the media of preparation; the water base preparations recorded higher microbial load. The mean microbial load was 159.5×10⁵ cfu/ml and 217.4×10²cfu/ml in water and alcohol base preparations respectively. The microbial profile of the preparations showed that the schnapps base preparations were predominantly contaminated with Bacillus sp (Aerobic spore bearers) and Mucor spp. The palm wine preparation harboured Bacillus sp, yeasts and Mucor spp while the water base preparations had several isolates such as Staphylococcus epidermidis, Pseudomonas aeruginosa, Escherichia coli 0157H7, Proteus mirabilis, Enterococcus feacalis, Serratia marcensces, Staph. aureus, Bacillus spp and Mucor spp. Conclusively, this study underlines the public health importance of these preparations given the high burden of such human pathogen as Ecoli O157H7, Ps aeruginosa, Stahp aureus, etc. in the preparations.