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71.
Carpenter EH; Plant MJ; Hassell AB; Shadforth MF; Fisher J; Clarke S; Hothersall TE; Dawes PT 《Rheumatology (Oxford, England)》1997,36(4):473-478
Stomatitis is a troublesome adverse effect of disease-modifying anti-
rheumatic drug (DMARD) therapy in rheumatoid arthritis (RA) patients. This
review presents data to examine the incidence, clinical features and
consequences of DMARD-related stomatitis, and suggests an algorithm for its
clinical management. The specific objectives of the two studies presented
here were to determine the incidence of DMARD-related stomatitis and its
effect on DMARD continuation, and secondly to identify the clinical and
laboratory risk factors. We investigated two cohorts of patients: (i) a
retrospective survey of data collected from drug monitoring clinics run for
patients on DMARDs from 1987 to 1994 involving 1539 patients and 2394 drug
exposures; (ii) a prospective study of 25 consecutive RA patients
presenting with DMARD-related stomatitis compared to 29 RA controls with no
history of DMARD stomatitis. The retrospective survey showed that 2% of
DMARD patients stopped therapy because of stomatitis, but 55% of these were
able to resume the same therapy. In the case control study. 24% of patients
discontinued temporarily and 8% permanently. Cases of DMARD-related
stomatitis differed from controls in that they had a higher incidence of
previous mouth ulcers (40% vs 14%), they smoked less (8% vs 31%) and
Schirmer's test was more often abnormal (44% vs 21%). There were no
differences in RA severity, disease activity or oral hygiene. Haematinic
deficiencies were equally common in cases and controls: 30% for iron, 8%
for vitamin B12 and 24% for folic acid. Herpes simplex virus was involved
in a minority (8%) of cases. In conclusion, the occurrence of stomatitis in
RA patients on DMARD should not lead to cessation of drug therapy, but to a
careful evaluation so that patients may be maintained on effective
treatment.
相似文献
72.
Outcome of unrelated donor bone marrow transplantation in 40 children with Hurler syndrome 总被引:8,自引:4,他引:8
Peters C; Balthazor M; Shapiro EG; King RJ; Kollman C; Hegland JD; Henslee- Downey J; Trigg ME; Cowan MJ; Sanders J; Bunin N; Weinstein H; Lenarsky C; Falk P; Harris R; Bowen T; Williams TE; Grayson GH; Warkentin P; Sender L; Cool VA; Crittenden M; Packman S; Kaplan P; Lockman LA 《Blood》1996,87(11):4894-4902
Long-term survival and improved neuropsychological function have occurred in selected children with Hurler syndrome (MPS I H) after successful engraftment with genotypically matched sibling bons marrow transplantation (BMT). However, because few children have HLA-identical siblings, the feasibility of unrelated donor (URD) BMT as a vehicle for adoptive enzyme therapy was evaluated in this retrospective study. Forty consecutive children (median, 1.7 years; range, 0.9 to 3.2 years) with MPS I H received high-dose chemotherapy with or without radiation followed by BMT between January 27, 1989 and May 13, 1994. Twenty-five of the 40 patients initially engrafted. An estimated 49% of patients are alive at 2 years, 63% alloengrafted and 37% autoengrafted. The probability of grade II to IV acute graft-versus-host disease (GVHD) was 30%, and the probability of extensive chronic GVHD was 18%. Eleven patients received a second URD BMT because of graft rejection or failure. Of the 20 survivors, 13 children have complete donor engraftment, two children have mixed chimeric grafts, and five children have autologous marrow recovery. The BM cell dose was correlated with both donor engraftment and survival. Thirteen of 27 evaluable patients were engrafted at 1 year following URD BMT. Neither T-lymphocyte depletion (TLD) of the bone marrow nor irradiation appeared to influence the likelihood of engraftment. Ten of 16 patients alive at 1 year who received a BM cell dose greater than or equal to 3.5 x 10(8) cells/kg engrafted, and 62% are estimated to be alive at 3 years. In contrast, only 3 of 11 patients receiving less than 3.5 x 10(8) cells/kg engrafted, and 24% are estimated to be alive at 3 years (P = .05). The mental developmental index (MDI) was assessed before BMT. Both baseline and post-BMT neuropsychological data were available for 11 engrafted survivors. Eight children with a baseline MDI greater than 70 have undergone URD BMT (median age, 1.5 years; range, 1.0 to 2.4 years). Of these, two children have had BMT too recently for developmental follow-up. Of the remaining six, none has shown any decline in age equivalent scores. Four children are acquiring skills at a pace equal to or slightly below their same age peers; two children have shown a plateau in learning or extreme slowing in their learning process. For children with a baseline MDI less than 70 (median age, 2.5 years; range, 0.9 to 2.9 years), post-BMT follow-up indicated that two children have shown deterioration in their developmental skills. The remaining three children are maintaining their skills and are adding to them at a highly variable rate. We conclude that MPS I H patients with a baseline MDI greater than 70 who are engrafted survivors following URD BMT can achieve a favorable long-term outcome and improved cognitive function. Future protocols must address the high risk of graft rejection or failure and the impact of GVHD in this patient population. 相似文献
73.
The purpose of this study was to quantitate the number and labeling index of monoclonal plasma cells in the blood of patients with newly diagnosed multiple myeloma (MM) to learn if these values were independent prognostic factors for survival. Patients were candidates for this study if they had untreated myeloma requiring therapy, were evaluated at our institution between 1984 and 1993, and had a sample of blood analyzed with a sensitive immunofluorescence technique for monoclonal plasma cells and the blood B-cell labelling index (BLI). The % blood monoclonal plasma cells (%BPC) and the BLI were analyzed along with stage, marrow plasma cell LI, % marrow plasma cells, calcium, creatinine, albumin, beta-2-microglobulin, and C-reactive protein as univariate and multivariate factors for survival. Eighty percent of the 254 patients accrued to this study had monoclonal BPC detected. The median % BPC was 6% and 57% (144 of 254) of patients had a high number (> or = 4%). Patients with > or = 4% BPC had a median survival of 2.4 years vs 4.4 years for those with < 4% BPC (P < .001). The BLI was also prognostic (P = .008). In a multivariate analysis, the % BPC, age, albumin, stage, marrow plasma cell LI, and the BLI were independent factors for survival. The %BPC and the marrow plasma cell LI best separated the group into low, intermediate, and high risk myeloma with median survivals of 52, 35, and 26 months, respectively. Patients with high %BPC were less likely to have lytic bone disease from their MM (P = .002). The %BPC and the BLI are independent prognostic factors for survival and are useful in identifying patients as low, intermediate, and high risk. Clonal cells in the blood should be quantified in future clinical trials for myeloma. 相似文献
74.
Aplastic anemia and myelogenous leukemia are prominent pathologic effects in beagles exposed to continuous, daily, low-dose gamma irradiation. In the present work, granulocyte reserves and related mobilization functions have been sequentially assessed by the endotoxin stress assay during the preclinical and clinical phases of these hemopoietic disorders. Characteristic patterns of granulocyte reserve mobilization are described that reflect given stages of pathologic progression. For radiation-induced leukemia, a five stage pattern has been proposed. In contrast, a simple pattern of progressive, time- dependent contraction of granulocyte reserves and mobilization capacity was noted in the development of terminal aplastic anemia. Early preclinical phases of radiation-induced leukemia appear to involve an extensive depletion of the granulocyte reserves ((phase I) during the first approximately 200 days of exposure followed by a partial renewal of the reserves and associated mobilization functions approximately 200 and 400 days (phase II). Sustained, subnormal granulocyte mobilizations (phase III) following endotoxin stress typify the responses of dogs during the intermediate phase, whereas late preclinical, preleukemic stages (phase IV) are characterized by a further expansion of the reserves and in the mobilization capacities, particularly of the less mature granulocytes. Such late alterations in the pattern of granulocyte mobilization, together with other noted cellular aberrancies in the peripheral blood and marrow, appear to indicate leukemia (phase V) onset. 相似文献
75.
Surendran Sabapathy Marc F Awater Donald A Schneider Rebecca A Kingsley Maria TE Hopman Norman R Morris 《INT J CHRONIC OBSTR》2006,1(1):73-81
We compared exercise capacity (peak O2 uptake; V̇O2peak) and lower limb vasodilatory capacity in 9 patients with moderate COPD (FEV1 52.7 ± 7.6% predicted) and 9 age-matched healthy control subjects. V̇O2peak was measured via open circuit spirometry during incremental cycling. Calf blood flow (CBF) measurements were obtained at rest and after 5 minutes of ischemia using venous occlusion plethysmography. While V̇O2peak was significantly lower in the COPD patients (15.8 ± 3.5 mL·kg−1·min−1) compared with the control group (25.2 ± 3.5 mL·kg−1·min−1), there were no significant differences between groups in peak CBF or peak calf conductance measured 7 seconds post-ischemia. V̇O2peak was significantly correlated with peak CBF and peak conductance in the control group, whereas no significant relationship was found between these variables in the COPD group. However, the rate of decay in blood flow following ischemia was significantly slower (p < 0.05) for the COPD group (−0.036 ± 0.005 mL·100 mL−1·min−1·s−1) when compared with controls (−0.048 ± 0.015 mL·100 mL−1·min−1·s−1). The results suggest that the lower peak exercise capacity in patients with moderate COPD is not related to a loss in leg vasodilatory capacity. 相似文献
76.
ANNELINE S.J.M. TE RIELE M.D. CYNTHIA A. JAMES Ph.D. BINU PHILIPS M.D. NEDA RASTEGAR M.D. ADITYA BHONSALE M.D. JUDITH A. GROENEWEG M.D. BRITTNEY MURRAY M.S. CRYSTAL TICHNELL M.G.C. DANIEL P. JUDGE M.D. JEROEN F. VAN DER HEIJDEN M.D. Ph.D. MAARTEN J.M. CRAMER M.D. Ph.D. BIRGITTA K. VELTHUIS M.D. Ph.D. DAVID A. BLUEMKE M.D. Ph.D. STEFAN L. ZIMMERMAN M.D. IHAB R. KAMEL M.D. Ph.D. RICHARD N.W. HAUER M.D. Ph.D. HUGH CALKINS M.D. HARIKRISHNA TANDRI M.D. 《Journal of cardiovascular electrophysiology》2013,24(12):1311-1320
77.
目的 :诱导出贯叶金丝桃的愈伤组织 ,并确定其中含有金丝桃素。方法 :在不同条件下采用组织培养技术 ,进行贯叶金丝桃的愈伤组织诱导研究 ,用HPLC方法确定其中含有的金丝桃素。结果和结论 :最佳诱导条件是MS基本培养基加入生长调节物质 2 ,4 D(4μg·L- 1 )和 6 BA(0 .2 μg·L- 1 )。叶腋等分生组织较多的部位易于诱导愈伤组织。诱导出的愈伤组织 ,经HPLC方法确定其含金丝桃素 相似文献
78.
79.
张志利 《中华微生物学和免疫学杂志》1994,(3)
NOD鼠是人类胰岛素依赖型糖尿病的动物模型,其发病与自身免疫有关。环磷酰胺(CP)可以加速这一过程,使NOD鼠糖尿病的发病率提高或提前。一些研究表明:NOD鼠的淋巴细胞在淋巴细胞混合反应中(MLR),在有或无刺激物的存在下,白细胞介素2(IL-2)的产量均明显低于正常鼠的淋巴细胞。该实验对注射了一次大剂量的CP(300mg/kg体重)后的NOD鼠试用了IL-2治疗。结果显示:对于年幼的NOD鼠IL-2治疗14无可以明显减轻注射CP后的胰岛破坏加速。病理检查显示三组胰岛炎严重程度积分分别为29;81;88。IL-2处理组明显低于ConA处理组与对照组。这个研究还显示,对于12周龄的NOD鼠,经14天的IL-2治疗,可以完全预防CP诱导的糖尿病的发生。糖尿病发病率在IL-2组为0/12;对照组为7/12。但对已发病的NOD鼠自发性糖尿病IL-2不能使其缓解。 相似文献
80.
Naysmith TE; Blake DA; Harvey VJ; Johnson NP 《Human reproduction (Oxford, England)》1998,13(11):3250-3255
This study was designed to assess the effect of cancer treatments on the
natural and assisted reproductive potential of men. A cohort of men with
cancer, in whom radiotherapy and/or chemotherapy was planned, were invited
to participate. Twenty-two pre- and post-treatment semen samples were
analysed. The reproductive potential of participants was assessed with
respect to the current range of fertility treatment options available.
Abnormal sperm concentrations were found in 27% of patients pre-treatment
compared to 68% post-treatment following a mean latency of 20 months from
treatment. Fifty-nine percent of patients experienced a clinically
significant decrease in sperm, concentration following radiotherapy and/or
chemotherapy; 23% developed azoospermia following treatment. Eighty-two
percent of patients with testicular malignancy had oligo- or azoospermia
post-treatment. Only one patient had a clinically significant reduction in
the percentage of motile spermatozoa post-treatment. Cryopreservation of
semen prior to treatment improved the fertility prospects of 55% of
patients. Intracytoplasmic sperm injection (ICSI) enhanced the fertility
prospects of a further 14%. In the absence of, or after depletion of,
cryopreserved semen, ICSI could enhance the fertility prospects of 45% of
patients. Fertilization has been achieved by ICSI using spermatozoa
retrieved by testicular biopsy from an azoospermic testicular cancer
survivor 8 years after chemotherapy. It was concluded that chemotherapy
and/or radiotherapy may depress semen concentration to the extent of
rendering a man infertile. The severity of the reduction in sperm
concentration following treatment is unpredictable but likely to be most
severe in those with testicular malignancy and those treated with
radiotherapy or alkylating chemotherapy agents. Not all men are keen to
undergo an appraisal of their post-treatment fertility potential, for
reasons which are unclear. Improving awareness and education of patients
concerning the effects of both cancer and cancer treatments on reproductive
potential is essential. With the advent of ICSI, it is possible to offer a
very reasonable chance of conception in all men with cancer who present for
cryopreservation of semen prior to treatment in whom spermatozoa (even in
very low concentrations) are present in the ejaculate.
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