Relation of "lymphoid" phenotype and response to chemotherapy incorporating vincristine-prednisolone in the acute phase of Ph1 positive leukemia.

Forty-four patients with Ph positive leukemia (36 developing blast crisis after chronic phase and eight presenting in acute leukemia) were classified into subgroups on the basis of reactivity of blasts with an anti-serum made against non-T,non-B acute lymphoid leukemia (ALL+), levels of terminal transferase enzyme (TdT+) and morphology. Positivity with anti-ALL serum was the most sensitive and reliable marker, and TdT was an important aid. The presence of "lymphoid" blasts in blast crisis of CML was related to the response to chemotherapy incorporating Vincristine and Prednisolone (VP). Patients with ALL+ blasts frequently (14 of 15 cases) responded to therapy while 21 of 25 patients who had no ALL+ blasts failed to respond. The clinical course of the ALL+ patients was variable: eight patients remitted with return to the appearances of the chronic phase; four patients demonstrated elimination of the Ph1 positive clone with hypoplasia and this was followed by normal (Ph1 negative) marrow regeneration in two. Subsequent relapse was of either the ALL+ "lymphoid" or the ALL-myeloid type. A regimen incorporating VP should be the treatment of choice in "lymphoid" blast crisis of CML.     

慢性硬膜下血肿168例的诊治和预后

0　引言　 1 992 - 0 5～ 1 999- 0 5我科收治慢性硬膜下血肿 (CS-DH) 1 6 8例 ,其中 1 6 4例经颅骨钻孔冲洗引流术治疗 ,4例保守治疗 ,结果 1 6 5例治愈 ,3例死亡 .结论 :CSDH的诊断主要依靠 CT检查 ,手术简单 ,防止并发症可改善预后 .1　临床资料　男 1 6 3例 ,女 5例 ,年龄 32～ 79岁 ,平均 5 4岁 .有明确的外伤史 1 4 5例 (86 .3% ) ,原因不明 2 3例(1 3.7% ) ,病程 3wk～ 6 a.头昏、头痛、呕吐 1 1 6例 ,肢体运动障碍 6 8例 ,智力及精神障碍 46例 ,语言障碍 1 0例 ,感觉障碍2 1例 ,排尿障碍 5例 ,癫痫 3例 ,视乳头水肿 92例 ,锥体…     

Macronutrient disposal during controlled overfeeding with glucose, fructose, sucrose, or fat in lean and obese women

BACKGROUND: Previous short-term studies (< or =6 h) showed differences in energy expenditure (EE) and macronutrient oxidation in response to overfeeding with different types of dietary carbohydrate. This finding could have implications for obesity. OBJECTIVE: We used 96-h continuous whole-body calorimetry in 8 lean and 5 obese women to assess metabolic disposal (energy dissipation and glycogen or fat storage) of a controlled excess of dietary energy supplied as different carbohydrate sources or as fat. DESIGN: Five dietary treatments were applied in random order: energy balance (control) and overfeeding by 50% of energy requirements with fat (O(fat)) or predominantly with glucose, fructose, or sucrose (O(cho)). Macronutrient oxidation rates were assessed from nonprotein gaseous exchanges. Net macronutrient balances were calculated as cumulative differences between intake and oxidation. RESULTS: Increased EE in response to overfeeding dissipated 7.9% of the energy excess with a variation in EE of <1.7% across overfeeding treatments (NS). EE during the O(fat) treatment significantly exceeded that during the control treatment in the lean but not in the obese women. There were no significant differences between lean and obese women in macronutrient oxidation or balances, so data were pooled. O(cho) induced glycogen storage on day 1 ( approximately 100 g) but thereafter progressively stimulated carbohydrate oxidation so that balance was reached on days 3 and 4. Fat oxidation was proportionately suppressed. Of the excess carbohydrate, 74% was oxidized; there were no significant differences between the various O(cho) treatments. O(fat) stimulated fat oxidation by 18% and suppressed carbohydrate oxidation. On average, 12% of the excess energy was stored as glycogen and 88% as fat; there was no significant difference between overfeeding treatments. CONCLUSION: There was no significant difference in fat balance during controlled overfeeding with fat, fructose, glucose, or sucrose.     

Variation and trends in reasons for knee replacement revision: a multi-registry study of revision burden

Background and purpose — Studies describing time-related change in reasons for knee replacement revision have been limited to single regions or institutions, commonly analyze only 1st revisions, and may not reflect true caseloads or findings from other areas. We used revision procedure data from 3 arthroplasty registries to determine trends and differences in knee replacement revision diagnoses.Patients and methods — We obtained aggregated data for 78,151 revision knee replacement procedures recorded by the Swedish Knee Arthroplasty Register (SKAR), the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), and the Kaiser Permanente Joint Replacement Registry (KPJRR) for the period 2003–2017. Equivalent diagnosis groups were created. We calculated the annual proportions of the most common reasons for revision.Results — Infection, loosening, and instability were among the 5 most common reasons for revision but magnitude and ranking varied between registries. Over time there were increases in proportions of revisions for infection and decreases in revisions for wear. There were inconsistent proportions and trends for the other reasons for revision. The incidence of revision for infection showed a uniform increase.Interpretation — Despite some differences in terminology, comparison of registry-recorded revision diagnoses is possible, but defining a single reason for revision is not always clear-cut. There were common increases in revision for infection and decreases in revision for wear, but variable changes in other categories. This may reflect regional practice differences and therefore generalizability of studies regarding reasons for revision is unwise.

Although the survivorship of knee arthroplasty has improved over the last 15 years, the increased volume of primary knee replacement has led to growing numbers of revision procedures (Kumar et al. 2015, Patel et al. 2015). A prior study we undertook outlined changes in the volume and incidence of revision rates in Sweden, Australia, and the Kaiser Permanente registry from the USA (Lewis et al. 2020b).Factors influencing revision change with time. Patient factors may affect the rate of primary procedures, such as rising patient and surgeon acceptance of knee replacement (Hamilton et al. 2015), increasing rates of osteoarthritis (Hunter and Bierma-Zeinstra 2019), growing use in younger patients (Leyland et al. 2016, Karas et al. 2019), and also survivorship, such as longer life expectancy, increasing obesity, and higher physical activity of those receiving a replacement (Hamilton et al. 2015). In addition, prosthesis designs change to improve perceived shortcomings such as wear, instability, and patellofemoral pain and tracking (Lewis et al. 2020a). Methods to improve surgical precision, such as computer navigation (Jones and Jerabek 2018), image-derived instrumentation (Kizaki et al. 2019), and robotic assistance (Jacofsky et al. 2016) may decrease revision requirements (Price et al. 2018)These changing factors alter the reasons for revision. Previous studies observed a decrease in revisions for wear and loosening (Sharkey et al. 2014, Thiele et al. 2015), and related this to improved prosthesis design and materials. Other studies note infection is now the most common reason for revision (Koh et al. 2017, Postler et al. 2018). Studies of changing knee replacement failure modes are limited by being derived from single institutions or regions and may not accurately reflect what is occurring elsewhere (Sharkey et al. 2014, Thiele et al. 2015, Dyrhovden et al. 2017, Koh et al. 2017, Lum et al. 2018, Postler et al. 2018). Additionally, these studies do not show the true revision burden as they are restricted to 1st revision procedures, or only revisions of previous total knee replacements (TKR), and do not include revisions of partial knee replacement procedures.Combining registry data can be difficult due to inconsistency in the definition of revision (Liebs et al. 2015), and lack of consensus in defining modes of failure, with different terminologies used (Niinimaki 2015, Siqueira et al. 2015). Some have attempted to overcome this by defining equivalent diagnoses (Havelin et al. 2011, Paxton et al. 2011, Rasmussen et al. 2016).We determined variations and trends in reasons for knee replacement revision using data on all knee arthroplasty revision procedures from the national registries of Sweden and Australia and the institutional registry of Kaiser Permanente in the USA by using equivalent diagnosis groups (Table 1, see Supplementary data).     

Openness to experience predicts intrinsic value shifts after deliberating one’s own death

Individual differences that might moderate processes of value shifting during and after deliberating one’s own death remain largely unexplored. Two studies measured participants’ openness and relative intrinsic-to-extrinsic value orientation (RIEVO) before randomly assigning them to conditions in which they wrote about their own death or dental pain for 6 days, after which RIEVO was assessed again up to 12 days later. When participants confronted thoughts about their own death over a sustained period, high openness to experience helped them shift toward intrinsic values. Implications for understanding openness’ role in value reorientation from existential deliberation processes are discussed.     

Induction of immune tolerance in patients with hemophilia A and inhibitors treated with porcine VIIIC by home therapy

Home therapy with porcine factor VIIIC was safe and effective when administered to five hemophilic patients over periods of 8 1/2, 6, 4, 3 1/2, and 2 years. No significant transfusion reactions occurred. Before treatment with porcine factor VIIIC, all five had high-level, high- responding anti-human VIIIC inhibitors initially lacking anti-porcine factor VIIIC activity. Although specific anti-porcine VIIIC inhibitors arose in all patients, these were generally transient, and only one patient became refractory to treatment. We believe that porcine factor VIIIC is the treatment of choice in patients whose inhibitors do not cross-react. All five patients lost their original anti-human VIIIC inhibitors after starting treatment with porcine VIIIC, permitting the reintroduction of human VIIIC in three of them. There has been no recurrence of anti-human VIIIC inhibitor activity during 2 to 3 years of regular treatment with human VIIIC in these patients. This suggests that tolerance to human VIIIC has arisen as a result of treatment with porcine VIIIC. Porcine VIIIC may have a role in the desensitization of some factor VIIIC inhibitor patients.