Long-term follow-up of a phase III study of recombinant human granulocyte-macrophage colony-stimulating factor after autologous bone marrow transplantation for lymphoid malignancies

One hundred and twenty-eight patients with non-Hodgkin's lymphoma (NHL), Hodgkin's disease (HD), and acute lymphoblastic leukemia (ALL) previously reported from a phase III trial of rhGM-CSF or placebo following autologous bone marrow transplantation (ABMT) were investigated for the development of late toxicities. Median follow-up is 36 months. No apparent long-term deleterious effects on BM function were observed. Moreover, disease-free survival and overall survival were similar for patients on both treatment arms, arguing for the long- term safety of recombinant human granulocyte macrophage-colony- stimulating factor (rhGM-CSF). The only factors predictive for both a high risk of relapse over time and mortality were having the diagnosis of ALL and/or undergoing ABMT in resistant relapse. We attempted to identify clinical variables before BM harvest, at the time of marrow infusion, or events within the first 100 days posttransplant, which might predict speed of neutrophil recovery in the setting of placebo or rhGM-CSF administration after ABMT. Only previous exposure to agents that deplete stem cells led to a significant delay in neutrophil recovery, suggesting their avoidance in patients who may undergo ABMT. Nevertheless, even those patients benefited from rhGM-CSF. For all patients, rhGM-CSF and agents that deplete stem cells were the strongest independent predictors for neutrophil engraftment. With the increasing use of newer hematopoietic growth factors both alone and in combination, long-term follow-up is essential to confirm the same safety that we report with rhGM-CSF.     

Hypohydration reduces vertical ground reaction impulse but not jump height

This study examined vertical jump performance using a force platform and weighted vest to determine why hypohydration (~4% body mass) does not improve jump height. Measures of functional performance from a force platform were determined for 15 healthy and active males when euhydrated (EUH), hypohydrated (HYP) and hypohydrated while wearing a weighted vest (HYP_v) adjusted to precisely match water mass losses. HYP produced a significant loss of body mass [−3.2 ± 0.5 kg (−3.8 ± 0.6%); P < 0.05], but body mass in HYP_v was not different from EUH. There were no differences in absolute or relative peak force or power among trials. Jump height was not different between EUH (0.380 ± 0.048 m) and HYP (0.384 ± 0.050 m), but was 4% lower (P < 0.05) in HYP_v (0.365 ± 0.52 m) than EUH due to a lower jump velocity between HYP_v and EUH only (P < 0.05). However, vertical ground reaction impulse (VGRI) was reduced in both HYP and HYP_v (2–3%) compared with EUH (P < 0.05). In conclusion, this study demonstrates the failure to improve jump height when HYP can be explained by offsetting reductions in both VGRI and body mass.     

Hydration assessment using the cardiovascular response to standing

The cardiovascular response to standing (sit-to-stand change in heart rate; SSΔHR) is commonly employed as a screening tool to detect hypohydration (body water deficit). No study has systematically evaluated SSΔHR cut points using different magnitudes or different types of controlled hypohydration. The objective of this study was to determine the diagnostic accuracy of the often proposed 20?b/min SSΔHR cut point using both hypertonic and isotonic models of hypohydration. Thirteen healthy young adults (8M, 5F) underwent three bouts of controlled hypohydration. The first bout used sweating to elicit large losses of body water (mass) (>3?% sweat). The second two bouts were matched to elicit 3?% body mass losses (3?% diuretic; 3?% sweat). A euhydration control trial (EUH) was paired with each hypohydration trial for a total of six trials. Heart rate was assessed after 3-min sitting and after 1-min standing during all trials. SSΔHR was compared among trials, and receiver operator characteristic curve analysis was used to determine diagnostic accuracy of the 20?b/min SSΔHR cut point. Volunteers lost 4.5?±?1.1, 3.0?±?0.6, and 3.2?±?0.6?% body mass during >3?% sweat, 3?% diuretic, and 3?% sweat trials, respectively. SSΔHR (b/min) was 9?±?8 (EUH), 20?±?12 (>3?% sweat; P?<?0.05 vs. EUH), 17?±?7 (3?% diuretic; P?<?0.05 vs. EUH), and 13?±?11 (3?% sweat). The 20 beats/min cut point had high specificity (90?%) but low sensitivity (44?%) and overall diagnostic accuracy of 67?%. SSΔHR increased significantly in response to severe hypertonic hypohydration and moderate isotonic hypohydration, but not moderate hypertonic hypohydration. However, the 20 beats/min cut point afforded only marginal diagnostic accuracy.     

先天性无肛直肠舟状窝瘘手术186例

1临床资料1988-06/2003-12我院共186例,均为女性,无肛门,其中0～6月龄21例,0.5～1岁96例,1～3岁53例,3～8岁15例,13岁1例.以大便从会阴部舟状窝瘘口处排出而就诊,患儿有不同程度的排便困难,严重时伴腹胀呕吐,多数患儿有营养不良性贫血.瘘口直径0.3～0.6 cm,直肠盲端到肛穴皮肤之间的距离1.0～2.5 cm,属于中、低位肛门直肠畸形.本组有3例合并先天性心脏病-室间隔缺损,2例合并骶前囊肿,1例合并脐疝.     

学报发展之我见

国家最新的统计数据显示,在我国5000种科技期刊中,高等院校所办的期刊已经达到1347种,其中绝大多数为学报;在我国1124种医学期刊中,学报也占有较大的比例．尽管学报的数量不少,但从期刊的综合评价体系来看,其中高质量者寥寥无几;而获得过“首届国家期刊奖,第二届国家期刊奖提名奖”的第四军医大学学报无疑是其中的佼佼者、尽管我们取得过辉煌的成绩,但依旧无法回避今日严峻的现实．要使学报能够健康地发展,我认为以下几点不容忽视．