Cyclosporine as prophylaxis for graft-versus-host disease: a randomized study in patients undergoing marrow transplantation for acute nonlymphoblastic leukemia

Seventy-five patients, 13 to 49 years of age, with acute nonlymphoblastic leukemia in first remission were treated with cyclophosphamide, fractionated total body irradiation, and marrow transplantation from an HLA-identical sibling and randomized to receive either cyclosporine (CSP) (n = 36) or methotrexate (MTX) (n = 39) as prophylaxis for graft-v-host disease (GVHD). All patients engrafted, and 22 who were given CSP and 21 who were given MTX, are alive at 20 to 47 (median, 35) months (P = .5). Engraftment as assessed by granulocyte recovery (P less than .0005) and platelet transfusion requirement (P = .01) was faster in patients on CSP. Twelve patients (33%) on CSP and 22 (56%) on MTX developed acute GVHD of grades II through IV (P = .07) and 15 of 30 on CSP and 14 of 32 on MTX that were at risk developed chronic GVHD. The most frequent causes of death were interstitial pneumonitis and marrow relapse of leukemia, which occurred with similar frequency in both groups. Beneficial effects observed in patients on CSP included less severe mucositis and shorter duration of hospitalization; adverse effects included renal function impairment and hypertension. These data confirm that CSP is a useful immunosuppressant in patients undergoing marrow transplantation but fail to show a significant improvement in survival as compared with the standard regimen of MTX.     

Endothelial cell proliferation in myelofibrosis

The distribution of laminin and collagen type IV in normal human bone marrow appeared to be limited to a small number of capillary and sinusoidal basement membranes. Cellular elements including megakaryocytes showed a negative staining reaction. In contrast, myelofibrotic bone marrow showed markedly increased quantities of both laminin and collagen type IV. This was consistent with a proliferation of endothelial cells within the marrow as confirmed by factor VIII RAG staining. It is suggested that in myelofibrosis in addition to a marked fibrous reaction proliferation of vascular elements is also prominent.     

Active surveillance is superior to radical nephrectomy and equivalent to partial nephrectomy for preserving renal function in patients with small renal masses: Results from the DISSRM registry

Purpose

We compared renal function outcomes among patients in the surveillance and intervention arms of the DISSRM registry.

高压培养对血管内皮细胞t-PA和PAI-1的影响及卡托普利干预的效果

目的：高血压常伴有纤溶功能的异常,但其机制尚不清楚。本研究拟观察高静水压培养对人脐静脉内皮细胞（HUVECs）t-PA和PAI-1的影响以及卡托普利的干预效果,并探讨其可能的作用机制。方法：选用第4～6代HU-VECs,接种于24孔培养板中。依培养压力分为3组：大气压组（0mmHg）,中压组（90mmHg）,高压组（180mmHg）。在同一压力组,根据不同药物干预又分为两个亚组。即对照组（Ctrl）和卡托普利组（Cap,10^-5mol/L）。每组6份标本。采用ELISA法测定上清液t-PA和PAI-1的抗原浓度,并用细胞内总蛋白进行标化（单位：ng/μg proteins）。同时测定细胞内Ca^2＋浓度（nmol/L）。结果：与大气压组相比,中压和高压组t-PA浓度均显著降低,PAI-1浓度显著增高,t-PA/PAI-1比值显著降低,[Ca^2＋]i也显著增高。卡托普利对大气压组的t-PA、PAI-1和[Ca^2＋]i无显著影响,但在两个高压组,卡托普利显著升高t-PA浓度,显著降低PAI-1浓度,t-PA/PAI-1比值显著升高,[Ca^2＋]i显著地降低。结论：高静水压可损害内皮细胞的纤溶功能,而卡托普利的干预可降低高压所升高的[Ca^2＋]i,并改善高静水压对内皮细胞纤溶功能的影响。     

The immunohistology of follicle lysis in lymph node biopsies from homosexual men

Follicle lysis is a characteristic alteration of B cell follicles described recently in lymph node biopsies from homosexual men. It consists of disruption of germinal centers by aggregates of small mature lymphocytes variably associated with erythrocyte extravasation. We studied the immunohistology of follicle lysis identified in lymph node biopsies from 11 homosexual men. The results indicate that follicle lysis has two principal immunohistologic features: (1) intrafollicular aggregates of small lymphocytes predominantly of polytypic mantle B cell phenotype (T015+/Leu-8+/mu+/delta+/k+ or lambda+), and (2) disruption of the normal, unified follicular meshwork of R4/23+ dendritic reticulum cells by these B cell aggregates. These structural alterations may affect the functional integrity of the germinal center as it pertains to the abnormal B cell effector function and the increased prevalence of B cell lymphoma recently documented in the acquired immunodeficiency syndrome and related disorders. Because dendritic reticulum cells weakly express the Leu-3 (T4) antigen, which is known to be an essential component of the receptor for human T- lymphotropic virus type III/lymphadenopathy-associated virus (HTLV- III/LAV) retrovirus infection, it is possible that retroviral infection of dendritic reticulum cells may play a role in the pathogenesis of follicle lysis.