Marrow transplantation for chronic myeloid leukemia: a randomized study comparing cyclophosphamide and total body irradiation with busulfan and cyclophosphamide

A prospective randomized study was conducted comparing two conditioning regimens for the treatment of patients with chronic myeloid leukemia in chronic phase by marrow transplantation from HLA identical siblings. Sixty-nine patients received 60 mg/kg of cyclophosphamide on each of 2 successive days followed by 6 fractions of total body irradiation each of 2.0 Gy (CY-TBI), and 73 patients received 16 mg/kg of busulfan delivered over 4 days followed by 60 mg/kg CY on each of 2 successive days (BU-CY). There was no significant difference between the CY-TBI and the BU-CY groups in the 3-year probabilities of survival (0.80 for both), relapse (0.13 for both), or event-free survival (CY-TBI, 0.68; BU-CY, 0.71) or in speed of engraftment or incidence of venocclusive disease of the liver. The 4-year probabilities of survival and event- free survival for patients transplanted within 1 year of diagnosis were 0.86 and 0.72, respectively, for each group. Significantly more patients in the CY-TBI group experienced major creatinine elevations. There was significantly more acute graft-versus-host disease in the CY- TBI group. Fever days, positive blood cultures, hospitalizations, and inpatient hospital days were significantly more common in the CY-TBI group than in the BU-CY group. In conclusion, the BU-CY regimen was better tolerated than, and associated with survival and relapse probabilities that compare favorably with, the CY-TBI regimen.     

Forced vergence fixation disparity parameters with and without a central fusion lock

The effect of a central fusion lock on forced vergence fixation disparity curve parameters, that is, magnitudes of fixation disparity and associated phoria, curve type and the central slope of the curve, was studied in 84 subjects because of ambiguity in the previous studies. It was found that the magnitudes of exo fixation disparity and exo associated phoria decreased significantly when they were measured with the central fusion lock. The central lock had no noticeable effect on the type of the curve, although, the central slope of the curve was flatter in the presence of the central lock.     

Rotator cuff lesions of the shoulder: evaluation by direct sagittal CT arthrography

Direct sagittal computed tomographic scanning (DSCT) of the shoulder was performed in 42 symptomatic patients, six healthy volunteers, and two cadaver shoulders. Axial CT scanning and double-contrast arthrography with plain radiographs were performed in 41 patients for comparison. DSCT enabled correct identification of 27 of 29 lesions in 24 patients. Seventeen patients had normal shoulders. Axial CT scanning and DSCT together enabled correct identification of all lesions and were markedly superior to plain-film arthrography. DSCT enabled diagnosis of all cases of complete rotator cuff tear plus three cases of incomplete tear and three of rotator cuff atrophy not identified by the other techniques. Axial CT scanning was better than DSCT for diagnosis of Bankart lesions.     

骨唾液酸蛋白在体外培养人骨髓间充质干细胞向成骨细胞分化中的角色

目的：骨唾液酸蛋白在骨矿化形成方面扮演重要角色，实验观察其是否能诱导体外培养的人骨髓间充质干细胞向成骨细胞分化。方法：实验于2005—10／2006—12在解放军广州军区广州总医院医学实验科完成。①材料来源：选取在本院体检的健康志愿者2人，对本实验均知情同意。采用Ni-NTA亲和纯化技术，从本室构建的毕赤酵母GS115／pPICZaA-hbsp发酵上清中纯化重组人骨唾液酸蛋白。②实验方法：对健康志愿者进行髂骨穿刺抽取骨髓液，采用贴壁法培养得到骨髓间充质干细胞。设立4组：骨唾液酸蛋白组添加0．1nmol／L骨唾液酸蛋白；成骨诱导液组添加10nmol／L地塞米松、10mmol／L磷酸甘油、50mg／L抗坏血酸；联合组添加上述两组的所有试剂；空白对照组不添加任何处理因素；各组均处理细胞12d。⑧实验评估：光镜及电镜观察培养的细胞形态；以细胞计数法测定生长曲线，应用流式细胞仪分析细胞周期，采用免疫荧光细胞化学法和流式细胞分析检测干细胞标志物STRO-1的表达；生化试剂盒测定碱性磷酸酶活性；von Kossa染色法检测钙沉积。结果：①单个骨髓间充质干细胞为长梭形，经骨唾液酸蛋白处理后细胞大而扁平，原来密集的克隆分散开。②与空白对照组比较，骨唾液酸蛋白组引起细胞生长曲线右移，细胞Go／G，期比例平均增加12．09％（P〈0．01），S期比例减少65．92％（P〈0．01），STRO-1阳性细胞百分率下降26．54％（P〈0．01）。⑧与空白对照组比较，骨唾液酸蛋白组细胞碱性磷酸酶活性增加50．0％，成骨诱导液组增加59．5％，联合组增加71．43％，并且随着处理时间的延长，活性增加越显著。④空白对照组细胞vonKossa染色呈阴性，其余各组均呈阳性。其中联合组的黑色矿化结节体积最大、数目最多；骨唾液酸蛋白组的结节体积较小、数目较少；成骨诱导液组居中。结论：骨唾液酸蛋白对人骨髓间充质干细胞有促进成骨分化和矿化作用，且与成骨诱导液联用效果更佳。     

Transfusion-associated graft-versus-host disease in immunocompetent patients: report of a fatal case associated with transfusion of blood from a second-degree relative, and a survey of predisposing factors

A patient without evident immune deficiency who received a transfusion of blood from a second-degree family member developed fatal transfusion- associated graft-versus-host disease (TA-GVHD). The donor was homozygous for an HLA haplotype for which the recipient was heterozygous (one-way HLA match). All 39 reported cases of TA-GVHD in immunocompetent patients were reviewed to ascertain the predisposing factors and to define the indications for irradiating blood for this population. HLA typing was described in 15 cases; in 13, including seven related and six unrelated donors, a one-way HLA match was present. Thirty-one (79%) of the 39 cases were reported from Japan (and 196 other cases are cited in the Japanese literature), but a one-way HLA match among unrelated donors at HLA-A, -B, -DR loci is only approximately two to four times more likely in Japanese persons than in whites. Fresh blood (< 96 hours old) was used in 29 (94%) of the 31 cases reported from Japan and in 33 (87%) of 38 cases overall (in one case, the age of the blood used was not reported). Thus, factors that appear to predispose to TA-GVHD in immunocompetent patients are a one- way HLA match, fresh blood, and, possibly, Japanese ancestry. Irradiating cellular blood components from all blood relatives of transfusion recipients will not completely eliminate the risk of TA- GVHD.     

The rs1990760 polymorphism within the IFIH1 locus is not associated with Graves' disease, Hashimoto's thyroiditis and Addison's disease

Background  

Three genes have been confirmed as major joint susceptibility genes for endocrine autoimmune disease:human leukocyte antigen class II, cytotoxic T-lymphocyte antigen 4 and protein tyrosine phosphatase non-receptor type 22. Recent studies showed that a genetic variation within the interferon induced helicase domain 1 (IFIH1) locus (rs1990760 polymorphism) is an additional risk factor in type 1 diabetes and Graves' disease (GD).