美国国家骨髓库无关供者造血干细胞移植20年回顾

自美国国家骨髓库(NMDP)开展第一例无关供者移植以来,至今已有20年.NMDP目前的库容量已逾700万,已为6大洲提供了30 000多份无关供者造血干细胞.这一辉煌成就是美国国家骨髓库600多名工作人员共同努力的结果,同时也得益于广泛的国际合作,包括171个移植中心,73个供者中心,24个脐血库,97个骨髓采集中心,91个血液净化中心,26个HLA分型实验室和26个合作供者登记处.本文回顾了美国国家骨髓库的历史,阐述了20年来移植病人、移植物来源和预处理方案几方面的主要变化趋势.     

Congenital chylothorax in siblings

We describe two cases of congenital chylothorax in siblings with important differences from previously described familial cases. Our findings support the likelihood of an autosomal recessive inheritance in some cases of this condition, rather than X-linked recessive inheritance, which has also been suggested. Autopsy findings from one of these cases and others previously described suggest that the pathophysiological mechanisms involved may be variable.     

TOTAL PARENTERAL NUTRITION

Total parenteral nutrition has been used in clinical practice for over a quarter of a century. It has revolutionized the management of potentially fatal condition like the short bowel syndrome in infants as well as adults. Refinements in techniques have led to development of sophisticated catheters and delivery systems. Better understanding of human nutrition and metabolic processes has lead to formulation of scientific parenteral solutions to suit specific situations. This article addresses the role of total parenteral nutrition in modern surgical practice.KEY WORDS: Parenteral nutrition total     

Computers in otorhinolaryngology; new horizons

There has been an explosion in the computers and information technology in the past couple of years. Otorhinolaryngology has also seen a number of new applications of computers. This article aims to familiarize the reader with different uses of computers as applied to the field of Otorhinolaryngology. It deals with the role in medical literature search, patient and doctor education, medical record keeping telemedicine, internet and E-mail, creating virtual environments and its role in FESS. skull base tumours and plastic surgery.     

Interspecies plasmid transfer appears rare in sequential infections with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae

From a cohort of 1836 Swedish patients infected with ESBL-producing Enterobacteriaceae (EPE) during 2004–2014, 513 patients with recurrent EPE infection were identified. Only in 14 of the 513 patients was a change of species (ESBL-E. coli to ESBL-K. pneumoniae or vice versa) found between the index and subsequent infection. Eleven sequential urine isolates from 5 of the 14 patients were available for further analysis of possible transfer of ESBL-carrying plasmids. The plasmid content was studied using optical DNA mapping (ODM), PCR-based replicon typing, and ESBL gene sequencing. ODM allowed us to directly compare whole plasmids between isolates and found similar ESBL-carrying plasmids in 3 out of the 5 patients. The ODM results and the rarity in shift of species between ESBL-E. coli and ESBL-K. pneumoniae imply that in recurrent EPE infections interspecies plasmid transfer is uncommon.     

基于3D Slicer应用程序构建大鼠小脑外形微细结构信息数据库

目的:建立大鼠小脑外形三维重构的可视化数据集,为小脑中央核团的三维重建摸索一个可行的方案。方法:实验于2003-03/2005-05在首都医科大学解剖教研室实验室完成。取SD大鼠5只,麻醉后处死取小脑,固定后进行冰冻连续切片、贴片,后经尼氏染色,用扫描仪对各切片进行投射扫描,图像大小为(1868×1491),获取原始图像数据库,并通过首都医科大学生物工程学院开发的配准软件及图像处理软件photoshop7.0对数据库中的数据进行半自动配准及人工分割,应用哈佛大学开发的图像处理专业软件3DSlicer对分割后的数据库进行三维重建。并应用牙科Cad-cam仪器对小脑外形进行扫描,获取完整的小脑外形图像。结果:①小脑尼氏染色获得的原始图像共159张,图像边缘清晰,可见深染的皮质和浅染的白质部分,白质间的小脑中央核深染,边界清晰。②共获得159个小脑外形的三维表面模型数据库(.vtk文件)。在3DSlicer应用程序上可选择小脑外形的三维表面模型数据进行三维显示,并构建了它们的动画显示文件(.gif),使用WindowsMediaPlayer应用软件即可以播放;与应用牙科Cad-cam仪器对小脑表面扫描获取的小脑表面的图像比较,信息更饱满,图像更真实,层次感强。结论:通过切片、配准、分割等方法获得了大鼠小脑外形微细结构信息的数据库,此法更适用于组织微细结构的三维重建。     

Recombinant human interleukin-1 receptor antagonist in the treatment of steroid-resistant graft-versus-host disease

Acute graft-versus-host disease (GVHD) that is resistant to therapy is a highly lethal complication of marrow transplantation. Inflammatory cytokines such as interleukin-1 (IL-1) may be critical mediators of this process. If so, specific inhibition of IL-1 activity with recombinant human IL-1 receptor antagonist (IL-1Ra), a naturally occurring competitive inhibitor of IL-1, may ameliorate acute GVHD. We performed an open-label, phase I/II trial to evaluate the safety and efficacy of IL-1Ra in 17 patients with steroid-resistant GVHD. The IL- 1Ra was administered as a 24-hour continuous infusion over 7 days. The dose was escalated in cohorts of patients from 400 to 3,200 mg/d. Acute GVHD was evaluated in each affected organ and as an overall grade. Stage-specific improvement of acute GVHD occurred in the skin (8 of 14, 57%), gut (9 of 11, 82%), and liver (2 of 11, 18%). Overall, acute GVHD improved by at least one grade in 10 of 16 (63%) patients. Response to therapy was associated with a reduction of tumor necrosis factor-alpha (TNF-alpha) mRNA levels in blood mononuclear cells (P = .001). The only toxicity attributable to IL-1Ra was reversible transaminase elevation in two patients. Inhibition of IL-1 activity with IL-1Ra is safe and has demonstrable efficacy in acute GVHD that failed to respond to conventional treatment. These data provide further evidence that IL-1 is a mediator of GVHD.