Application of autologous peripheral blood stem cell transplantation in children with malignant tumor

Objective To investigate if low dose total body irradiation (TBI, 6.0-9.0 Gy) combined with intensified chemotherapy followed by autologous peripheral blood stem cell transplantation results in better survival in children with refractory leukemia or solid tumors. Methods Twenty-one children with malignant tumors were included in this study.There w ere 14 males and 7 females aged 3.5-12 years.Underlying disease included high -risk acute lymphoblastic leukemia (ALL, CR(1) in 3 children and CR(2) in 5 ch ildren), acute myeloblastic leukemia (AML, 9 children), non-Hodgkin’s lymphoma stage Ⅳ ( 2 children), and neuroblastoma stage Ⅳ (2 children).The peripheral hematopoi etic stem cells were collected six to eleven months after complete response, mob ilized with high dose chemotherapy alone or combined with GM-CSF or G-CSF.Th e conditioning regimen consisted of chemotherapy with two to three combinations of the following drugs: cyclophosphamide, arabinosylcytosine, McNU, etopside, an d Idarubicin on the basis ofTBI (6.0-9.0 Gy).A mean of (1.8±0.5) ×10(8)/kg autologous mononuclear cells were transplanted.The patients were followed up after transplantation. Results Severe bone marrow suppression occurred in all patients around day +7.Peripher al white blood cell count decreased to 0 in all patients at day +4.8±2.9, and platelet count decreased to less than 20×10(9)/L at day +9.0±2.6.Succ essful engraftment was achieved in 21 patients, but four died of infection at da y +17, +20, +31 and +67, respectively.Recovery of white blood cell (WBC) to 10×10(9)/L, absolute neutrophil count to 0.5×10(9)/L, platelet count to 20 ×10(9)/L occurred on 21±12, 26±13, and 27±10 days, respectively.During the follow up period, three patients relapsed at +5 months, +1.5 years, and +2 yea rs 10 months, respectively.One patient died of intracranial hemorrhage at +8 m onths.Thirteen patients had event-free survival for 2-12 years, with a mean o f 6.7±3.4 years.Conclusion Our preliminary data suggest that myeloablative therapy with low dose TBI (6.0 -9.0 Gy) combined with intensified chemotherapy followed by autologous periphe ral blood stem cell transplantation might be associated with favorable results i n children with refractory leukemia or solid tumors.     

Do physicians have a bias toward action? A classic study revisited

In an attempt to replicate the findings of a classic study of medical decision making, the authors studied decision making in modern pediatrics practice. They prepared case scenarios and surveyed pediatricians for three common clinical decisions: tympanostomy tube placement, radiography orders, and emergency room referrals. Initial reviewers rated the cases according to the likelihoods that they would take the clinical actions mentioned. Subsequently, other physicians presented with a subset of scenarios in which the initial reviewers were least likely to act tended to be more active in the tympanostomy (p = 0.004) and radiography (p = 0.076) decisions. In these cases the physicians appeared to have a bias toward action. For a subset of scenarios in which the initial reviewers were most likely to act, subsequent reviewers were neither more nor less likely to act than the initial reviewers.     

抗癌抗生素C1027与单克隆抗体Fab片段偶联物的抗肝癌作用

抗人肝癌单克隆抗体(单抗)3A₅用木瓜蛋白酶消化得到Fab片段。单抗3A₅和Fab片段分别与抗癌抗生素C1027偶联,偶联物经克隆生成法测定对肝癌细胞有很强的杀伤作用,C1027,Fab-C1027和3;3A₅-C1027的IC₅₀分别为6.5×10^-16,8.6×10^-16和4.2×10^-14mol·L^-1;Fab-C1027偶联物对非靶细胞(KB)的IC₅₀值为1.4×10^-13mol·L^-1,与靶细胞(BEL-7402)的IC₅₀值相比,两者相差160倍。说明Fab-C1027的杀伤活性强于3A₅-C1027,并对靶细胞呈选择性杀伤作用。给皮下移植人肝癌的裸鼠iv剂量0.1 mg·kg^-1,结果C1027和Fab-C1027的抑瘤率分别为59和85%,说明Fab片段与C1027偶联物比游离C1027的疗效更高。     

1,1-二烷基-4-(3-溴丙酰基)-哌嗪溴化物的合成及生物活性研究

设计合成了七种新的1,1-二烷基-4-(3-溴丙酰基)哌嗪季铵盐溴化物,通过IR,¹HNMR和元素分析证实其结构。初步生物活性试验结果表明,Ⅵa,Ⅵc和Ⅵe～g有明显的镇痛活性,Ⅵe～g还有较好的抗氧化SOD活性,但未发现有抗肿瘤作用。     

Physicians’ reports of focused expertise in clinical practice

Little is known about the prevalence of focused expertise (special areas of expertise within a clinical field) among physicians, yet such expertise may influence how care is delivered. We surveyed general internists, pediatricians, cardiologists, infectious disease specialists, and orthopedic surgeons to describe the prevalence of focused expertise and identify associated physician and practice characteristics. About one quarter of generalists and three quarters of specialists reported a focused expertise within their primary specialty. Hospital-based physicians more often reported such expertise, and physicians reimbursed by capitation less often reported expertise. Learning how focused expertise affects processes and outcomes of care will contribute to decisions about physician training and staffing of medical groups. Dr. Keating was the recipient of a National Research Service Award from the Agency for Healthcare Research and Quality, Rockville, MD, Dr. Ayanian was a Generalist Physician Faculty Scholar of the Robert Wood Johnson Foundation, Princeton, NJ. This study was supported by the Primary Care Research and Education Fund of Brigham and Women’s Hospital.     

Information technology as a tool to improve the quality of American Indian health care

The American Indian/Alaska Native population experiences a disproportionate burden of disease across a spectrum of conditions. While the recent National Healthcare Disparities Report highlighted differences in quality of care among racial and ethnic groups, there was only very limited information available for American Indians. The Indian Health Service (IHS) is currently enhancing its information systems to improve the measurement of health care quality as well as to support quality improvement initiatives. We summarize current knowledge regarding health care quality for American Indians, highlighting the variation in reported measures in the existing literature. We then discuss how the IHS is using information systems to produce standardized performance measures and present future directions for improving American Indian health care quality.     

Hyperphosphorylation and accumulation of neurofilament proteins in Alzheimer brain and the possible mechanism

Hyperphosphorylation and accumulation of neurofilament proteins in Alzheimer brain and the possible mechanism