Out of hospital needlestick injuries

Retrospective analysis showed that 67 children had presented in Edinburgh with needlestick injuries on 70 occasions over five years. Worryingly, 10 children sustained injuries pretending to be intravenous drug abusers. Despite risks of hepatitis B and HIV infection, protection and follow up were inadequate. Publicity about discarded needles and a treatment plan for use in accident and emergency departments are recommended.     

HLA-identical marrow transplantation during accelerated-phase chronic myelogenous leukemia: analysis of survival and remission duration

Results of HLA-identical allogeneic marrow transplantation were analyzed for 66 patients with accelerated-phase chronic myelogenous leukemia (CML). Multivariate proportional hazards regression models were used to determine disease-related and transplant-related factors associated with posttransplant mortality and relapse. The projected 5- year survival rate was estimated at 18% by the product-limit method. The major causes of death were interstitial pneumonia, infection, and relapse. Splenomegaly at initial diagnosis and longer time interval from diagnosis to transplant were associated with decreased overall survival and event-free survival. Sixteen patients have relapsed between 17 and 1,569 days (median, 486) posttransplant. The use of T- cell-depleted marrow and older age of the donor or recipient were associated with an increased probability of leukemic relapse. Ten of the 16 relapses occurred among the 15 patients who received T-cell- depleted marrow. The actuarial relapse risk 2.5 years posttransplant was 100% in patients administered T-cell-depleted marrow as compared with 25% in patients administered unmodified marrow. The data in this report emphasize the increased risks and relatively poor results that occur when marrow transplantation is deferred until after signs of acceleration appear. When compared with results for patients who received transplants during chronic phase, the poor results seen here in patients administered unmodified marrow stem primarily from increased transplant-related mortality rather than increased relapse risk. The strikingly increased relapse rate associated with the use of T-cell depletion would discourage its use for graft-v-host disease prevention in patients who receive transplants for CML.     

CLINICOPATHOLOGICAL PROFILE OF ABDOMINAL TUBERCULOSIS

SUMMARY The clinical and histopathological profile is presented of 145 patients with abdominal tuberculosis studied prospectively over a period of 5 years. The study highlights the role of various investigations and therapeutic response in this condition.     

强啡肽［DynA（1－8）］对体外神经细胞老化过程中细胞周期和总蛋白的影响

用小鼠神经母细胞瘤细胞无血清培养建立神经细胞老化实验模型。以流式细胞光度术观察ＤｙｎＡ（１－８）对老化过程中神经细胞的细胞周期和细胞总蛋白的影响。结果发现ＤｙｎＡ（１－８）可延缓细胞老化的细胞周期和细胞总蛋白的变化。提示ＤｙｎＡ（１－８）是通过使细胞周期和细胞总蛋白发生变化以发挥其延缓神经细胞老化的作用。     

纤维素三醋酸酯手性固定相分离药物对映体

用非均相乙酰化方法合成微晶纤维素三醋酸酯制备手性柱和手性薄层板用于HPLC和TLC,用95%乙醇或95%乙醇和缓冲液(pH10)的混合物为流动相分离特罗格尔碱、甲喹酮、氯美扎酮和氯喹对映体,讨论了流动相组成、pH、温度对分离对映体的影响。实验结果表明CTA手性板对流动相的组成和pH的变化较敏感,TLC流动相极性一般较HPLC流动相的极性大。上述4种对映体的HPLC分离度均达到0.6以上;TLC分离度均达到1.1以上。     

Malignant neoplasms following bone marrow transplantation

We undertook an analysis of 2,150 recipients of bone marrow transplant (BMT) at the University of Minnesota to determine the incidence of post- BMT malignant neoplasms (MNs). Fifty-one patients developed 53 MNs, compared with 4.3 expected from general population rates (standardized incidence ratio [SIR], 11.6, 95% confidence interval [CI], 8.2-14.5). These included 22 occurrences of B-cell lymphoproliferative disorder (BLPD), 17 solid nonhematopoietic tumors, 10 myelodysplastic syndromes (MDS), 1 acute myelogenous leukemia (AML), 2 non-Hodgkin's lymphoma (NHL), and 1 Hodgkin's disease (HD). The estimated actuarial incidence of any post-BMT malignancy was 9.9% +/- 2.3% at 13 years posttransplant. The cumulative probability of BLPD plateaued at 1.6% +/- 0.3% by 4 years from transplant and factors independently associated with increased risk included in vitro T-cell depletion of marrow (relative risk (RR) = 11.9, P < .001), HLA mismatch (RR = 8.9, P < .001), use of antithymocyte globulin (ATG) for graft versus host disease (GVHD) prophylaxis (RR = 5.9, P < .001) or in the preparative regimen (RR = 3.1, P = .03) and primary immunodeficiency (RR = 2.5, P = .06). The cumulative probability of developing solid malignancy was 5.6% +/- 2.2% at 13 years from BMT. Malignant melanomas were the most common (SIR, 10.3, 95% CI 1.9 to 25.4). The actuarial incidence of MDS/AML plateaued at 2.1% +/- 0.8% at 9 years and was seen most often in older patients receiving autologous peripheral blood stem cells for HD or NHL. These data document that BMT recipients are at an increased risk of later malignancy, which may add significant morbidity and mortality to the transplant process. Methods for screening and identification of individuals at increased risk need to be addressed in future studies.     

Do we need a nutrition-specific quality of life questionnaire for dialysis patients?

Food, eating, and quality of life are intimately related. Available generic and disease-specific health-related quality of life (HRQOL) instruments address nutrition only with respect to the ability to eat and omit more dynamic components of nutrition such as sensory enjoyment of food and food intake. For improved assessment and monitoring of nutrition-related quality of life in hemodialysis patients, a nutrition-specific questionnaire is recommended, consisting of two tools: the Appetite and Dietary Assessment Tool (ADAT), already used in many dialysis clinics, and the nutrition-specific Food Enjoyment in Dialysis (FED) questionnaire which asks 10 additional questions on sensory changes, thirst, gastrointestinal symptoms, side effects from medications and/or dialysis, and feelings of satisfaction and control. This nutrition-specific information should permit comprehensive evaluation and monitoring of changes in nutrition related quality of life. When coupled with generic and disease specific tools, it will provide a complete picture of quality of life in hemodialysis patients.     

Familial thrombocytosis in infancy presenting with a leukaemoid reaction

Familial thrombocytosis (FT) is a hereditary disorder probably involving the regulation of mega-karyopoiesis. This report is the first documented case of FT in infancy. The clinical course was complicated by a leukaemoid reaction which lasted for several months, in combination with failure to thrive and hepatosplenomegaly. At the age of 5 years the patient, with the exception of thrombocytosis, is healthy and without medication.