Risk of human immunodeficiency virus (HIV) transmission by blood transfusions before the implementation of HIV-1 antibody screening. The Transfusion Safety Study Group

Little information is available regarding the risk of human immunodeficiency virus type 1 (HIV-1) infection for patients transfused before routine anti-HIV-1 screening of blood donors was instituted in March 1985. A model was developed for estimating both the proportion and the number of transfusion recipients in the San Francisco Bay area who were infected by HIV-1 during each of the 7 years preceding routine donor screening for anti-HIV-1. The model is based on analysis of 1) donation histories of HIV-1-infected donors identified at the regional blood center; 2) HIV-1 seroprevalence estimates for homosexual and bisexual men in San Francisco; and 3) HIV-1 infection and survival rates for recipients traced by the Transfusion Safety Study and Irwin Memorial Blood Centers' Look Back Program. The incidence of transfusion-associated HIV-1 infection is estimated to have risen rapidly from the first occurrence in 1978 to a peak in late 1982 of approximately 1.1 percent per transfused unit. The decrease after 1982 coincided with the implementation of high-risk donor deferral measures. It is estimated that, overall, approximately 2135 transfusion recipients were infected with HIV-1 in the San Francisco region alone. This number suggests a higher prevalence of transfusion-associated HIV-1 infection than has been generally recognized and indicates the need for continued tracing of potentially exposed recipients. The data also strongly support the effectiveness of early donor education and self-exclusion measures and emphasize the importance of continued research and development in this area.     

Transfusion practices in human immunodeficiency virus-infected patients

BACKGROUND: The reported immunomodulatory effects of transfusion raise concern about the potential for virus activation and tumor growth in human immunodeficiency virus (HIV)-infected patients. In the absence of “standards” of transfusion practice for such patients, a survey of transfusion policies among institutions specializing in the care of HIV- infected patients was performed to delineate current practices. STUDY DESIGN AND METHODS: A survey developed by the Transfusion Practices Committee of the American Association of Blood Banks was sent to 47 AIDS clinical trial units and 14 regional hemophilia centers in North America. RESULTS: Forty-three percent of centers completed the survey. Most centers observed more than 200 HIV-infected patients each. The key findings were that 1) 81 percent of centers used identical red cell transfusion criteria for HIV-infected and noninfected patients; 2) 52 percent used recombinant human erythropoietin as initial treatment for zidovudine-induced anemia, while 46 percent used recombinant human erythropoietin for anemia not associated with zidovudine; 3) 35 percent of centers used white cell-reduced blood components in lieu of cytomegalovirus (CMV)-seronegative components when administering transfusion(s) to CMV-seronegative patients; 4) 27 percent gamma- radiated cellular components, but no case of graft-versus-host disease had been observed; 5) > 85 percent of centers used monoclonal factor VIII for pediatric and adult hemophiliacs infected with HIV; 6) approximately one-third of centers routinely white cell-reduced cellular components; and 7) the most common reasons for white cell reduction included reduction of febrile reactions and CMV risk, reduction of platelet alloimmunization, and delay of immunomodulatory consequences of transfusion. CONCLUSION: There is marked heterogeneity in transfusion practice for HIV-infected patients. Modification of cellular components to achieve different objectives is routine in many centers.     

应用以案例为基础的教学法提高皮肤外科教学效果的探索

目的将以案例为基础的教学法(CBL)应用于皮肤外科教学中,并探讨其效果及可行性。方法以第四军医大学西京医院烧伤与皮肤外科2013年32名进修生为教学对象,随机分为CBL组和对照组,每组各16名。CBL组采用CBL教学法,对照组采用传统教学法进行皮肤外科学授课,对两组教学效果进行比较。结果两组理论考试成绩比较,CBL组中优秀者9名,良好者6名,及格者1名,无不及格者;而对照组测试优秀者5名,良好者7名,及格者3名,不及格者1名。CBL组优秀率高于对照组(56.2%比31.2%),差异有统计学意义(P<0.05)。而在病例分析与手术操作技能考核中,CBL组中优秀者10名,良好者5名,及格者1名,无不及格者;而对照组中优秀者6名,良好者4名,及格者4名,不及格者2名,CBL组优秀率高于对照组(62.5%比37.5%),差异有统计学意义(P<0.05)。结论 CBL教学法有利于学生学习观念的转变,能明显提高其自主学习能力,值得在皮肤外科临床教学中应用推广。     

Rearrangement of both immunoglobulin and T-cell receptor genes in a prolymphocytic variant of hairy cell leukemia patient resistant to interferon-alpha [published erratum appears in Blood 1989 Feb;73(2):624]

We describe a patient with the so-called "prolymphocytic variant" form of hairy cell leukemia (HCL) resistant to treatment with interferon- alpha (IFN-alpha). Analysis of immunoglobulin (Ig) and T-cell receptor- beta (TCR beta) gene rearrangements from serial peripheral blood mononuclear cell specimens (MNCs) confirmed not only the B-cell nature of the disease, but also the subsequent emergence of a morphologically indistinguishable population of cells with a clonal TCR beta rearrangement in addition to the original Ig gene rearrangement. With the exception of a transient increase in peripheral blood T cells during treatment with deoxycoformycin (DCF), the MNCs remained essentially constant throughout therapy with no evidence of a co- existing T-cell clone to account for the TCR beta rearrangement. Although MNCs from this patient bound significantly less IFN-alpha than did MNCs from other HCL patients, the binding was of high affinity with a kd similar to that of control cells. The number of IFN-gamma receptors on our patient's MNCs was four times higher than the number of IFN-alpha receptors and was similar to the number of IFN-alpha receptors on MNCs from HCL patients responsive to IFN-alpha. While various treatments including IFN-alpha, DCF, chlorambucil, splenectomy, leukopheresis, and IFN-gamma were not able to change the clinical progression of the disease, they may have provided an opportunity for the divergent TCR beta rearranged clone to expand and displace the initially dominant clone.     

Myocardial ischemia after Cabrol operation

A 33-year-old woman who had undergone a Cabrol-type aortic root replacement for acute aortic dissection during labor 27 months ago was admitted with chest pain. Electron-beam tomography and coronary angiography showed stenosis at the level of the anastomosis. Urgent coronary revascularization was performed using bilateral internal mammary artery grafts. Although graft occlusion after the Cabrol procedure is an infrequent complication, it should be considered during follow-up.     

SIRT1在血管相关性疾病中的研究进展

沉默信息调节因子2相关酶类1（ silent mating type information regulation 2 homolog-1,SIRT1）是一种依赖于烟酰胺腺嘌呤二核苷酸（ nicotinamide-adenine dinucleotide, NAD）的去乙酰化酶,其可对组蛋白和非组蛋白发挥去乙酰化作用从而调节能量代谢、细胞衰老及凋亡等众多生命过程。在多种血管相关性疾病中,SIRT1通过对相关因子去乙酰化增加细胞能量供应、减少细胞凋亡、减轻炎症反应、抵抗氧化应激、改善血管内皮细胞功能,从而在血管相关性疾病中发挥重要作用。该文旨在对SIRT1在缺血性脑卒中、动脉粥样硬化及肿瘤这3种常见血管相关性疾病中的作用的研究进展及相应的信号通路进行综述。