Diagnosis of transfusion-associated graft-versus-host disease by genetic fingerprinting and polymerase chain reaction

A patient with Hodgkin's disease (clinical stage IIIB) received chemotherapy and total nodal irradiation. After the transfusion of filtered packed red cells, this patient developed transfusion-associated graft-versus-host disease (TA-GVHD). The genetic fingerprint of the patient's peripheral blood lymphocytes (PBLs) differed completely from that of her other body tissues. Normally, after transfusion, only the patient's own genetic fingerprints are observed in the PBLs, as exemplified in more than 10 control cases in which the transfused blood had not been filtered before transfusion. No signal bands corresponding to those of the blood donor could be demonstrated in samples of the patient's tissue DNA. Moreover, chimerism was detected in the hybridization pattern of the patient's PBLs on the ninth day after the onset of symptoms. Polymorphic simple repeats in the HLA-DRB gene after amplification by polymerase chain reaction were also investigated, which confirmed the fingerprinting results. The advantages of these methods for the diagnosis of TA-GVHD include the rapid and unequivocal diagnosis as well as the fact that there is no need for the relatives to be HLA typed.     

激光老视逆转术治疗老视的两组临床报告

目的：了解激光老视逆转手术(LAPR)治疗老视的安全性、有效性及稳定性。方法：来自于阿根廷的35例61眼(A组)、印度的14例26眼(B组)接受手术治疗。年龄40～60岁，近视、远视和散光均小于1．0D，双眼未矫正视力大于或等于20／40，近附加度数大于 1．0D。采用紫外或红外激光于角巩缘外的巩膜区对称性放射状切开4对(8条)切口，每条切口长度约4．5mm，深度约500μm至600μm，宽度约0．6—0．7mm，观察术后结果。结果：进行LAPR手术的87眼中有6_4眼术后近视力达到J3或更好。A组平均年龄为53．2岁，随访6m后发现：21眼(34．4％)近视力达J1，16眼(26．2％)近视力达J2，4眼(6．6％)近视力达J3，2眼(3．3％)近视力达J4，2眼(3．3％)近视力达J5，8眼(13．1％)近视力达J6。如果排除6个薄巩膜或切削浅的患者，结果则为：51％的患者近视力达J1或更好，90％的患者近视力达J2或更好，100％的患者近视力达J3以上。术后随访发现近视力无明显回退(最长随访时间为12m)。术前近附加为 1．0至 3．0D(平均 2．27D)，术后近附加为0．0至 2．0D(平均 0．31D)。B组平均年龄为46．1岁，最短随访时间为8m，最长随访时间为28m，术前无一患者近视力可达J3，术后87．5％的患者可达到J3或更好。平均调节幅度由术前1．9D提高到术后3．6D(Kadlambi-Ranger调节测量尺测量)，近附加由术前 1．7D到术后 0．2D。2眼(7．7％)术后3m近视力回退，1眼(3．8％)近视力无明显改善。术后远视力无明显改变，眼压平均降低2—3mmHg，然而大多数患者术后一段时间内眼压会逐渐恢复到术前值，且无明显并发症的发生。结论：阿根廷和印度等国的研究结果表明LAPR手术是安全、有效、低回退性的一种老视逆转术。     

PGD13 Does the Duration of Pulmonary Rehabilitation Affect the Magnitude of Patient Response?

OBJECTIVE: To determine if there is a dosage effect associated with the length of pulmonary rehabilitation (PR).
METHODS: We used a battery of outcome measures to quantify the amount of change that was achieved from baseline to discharge in 286 patients completing a PR program in 1 of 12 institutions participating in PROAS. The programs were of varying durations. Paired t-tests indicated overall that while the pulmonary rehabilitation programs did not yield improvements in physiologic (FEV1, FVC, % predicted FEV1) outcomes, the patients did achieve significant improvements in symptomatic (Borg score), functional (6-minute walk), general healthrelated quality of life [SF-36 Health Survey (SF-36)], and disease-specific HRQL [Chronic Respiratory Disease Questionnaire (CRQ) variables.
RESULTS: Based on a series of stepwise multiple regressions using the amount of change in each outcome variable as the dependent variable and adjusting for the corresponding baseline value and 11 clinical and sociodemographic characteristics, the number of hours of education (HREDU, 13.5 hr ± 6.7), activities of daily living (HRADL, 2.2 hr ± 6.6), and psychosocial support (6.5 hr ± 5.6) both individually and collectively (42.4 hr ± 11.8) generally did not contribute to explaining the magnitude of change achieved by the patients. However, the number of hours of supervised exercise (HREX, 25.4 hr ± 9.2) did contribute to explaining increases in 5 of the 8 SF-36 domains: physical function (p = 0.027), physical role (p = 0.0002), health perceptions (p = 0.0167), vitality (p = 0.034), and social function (p = 0.0035).
CONCLUSION: These data suggest that outcomes specifically related to pulmonary diseases are not affected by a longer duration for this type of intervention, but that broader, population-based assessments may need an additional period of intervention, or elapsed time, to detect improvement.     

Efficient pulse sequence for multisection dual-repetition time MR image acquisition

A magnetic resonance imaging pulse sequence was developed in which multisection spin-echo image data are simultaneously acquired for two repetition time (TR) intervals (TR1 and TR2) in one imaging sequence. In a conventional multisection image at a single TR, the number of sections is limited to TR/TS, where TS is the readout time. With this new sequence, the number of sections that can be imaged at both TRs in one acquisition is equal to (TR1 + TR2)/(TS1 + TS2), where TS1 and TS2 may be different for the two TRs. Imaging time is equal to that for a single image at a TR of TR1 + TR2. Clinical images were obtained with the new sequence from 15 patients and compared with images acquired at the same TR/TE by means of standard multisection single-TR methods. Relative image quality was assessed by three radiologists in 37 comparisons. In general, the dual-TR results at the long TR were judged equivalent to those from a single-TR image. Dual-TR results at the short TR had a modest reduction in contrast, but in none of 15 cases were any pathologic features missed.