Predictive factors for acute graft-versus-host disease in patients transplanted with HLA-identical bone marrow

To identify predictive parameters for incidence and severity of acute graft-versus-host disease (GVHD), 136 patients, transplanted with histocompatible marrow as therapy for aplastic anemia and hematologic malignancies, were examined using univariate and multivariate analyses. The risk of GVHD increased in patients with acute lymphocytic leukemia (p less than 0.05), in sex-mismatched donor-recipient pairs (p less than 0.01), and in patients older than 23.7 yr (p less than 0.05). No other commonly observed factors appeared to have any relationship to GVHD except the presence of certain alleles. The presence of a Cw4 allele or of the Bw21 specificities B49 and B50 were associated with significantly increased risks of GVHD (p less than 0.05), whereas the presence of Aw19 (or the related specificities A29, Aw30, Aw31 , Aw32, Aw33 ) was associated with a significantly decreased risk (p less than 0.01). Using these factors, a regression equation can be constructed that estimates the risk of a given patient to develop clinically significant acute GVHD.     

Cytoplasmic factor required for entry of malaria parasites into RBCs

Resealed ghosts of human RBCs, containing diluted cytosol, are susceptible to invasion by Plasmodium falciparum. If ATP is present, a dilution of up to about 30-fold, corresponding to an intracellular hemoglobin concentration of approximately 10 mg/mL, can be tolerated without total loss of susceptibility to invasion. Up to a dilution of about one-half this, the parasites also develop normally. When the cytosol is diluted by more than the critical amount, invasion of the resulting resealed ghosts falls off abruptly. If the diluent buffer is replaced by extraneous concentrated hemolysate, an indefinite dilution is possible without loss of invasion. There is thus an intracellular constituent, which must be present at a concentration above some critical level if the parasite is to enter the cell. The factor in question is not dialyzable. It is largely inactivated when the hemolysate is kept for approximately 1 day in the cold or for approximately 20 minutes at 45 degrees C. The inability of a heat- treated hemolysate to support invasion is not due to the generation of inhibitory products, because such a solution can be used as a diluent of a fresh hemolysate without inhibition of invasion. When the inactivated hemolysate is present as a major component, however, the parasites fail to develop to the trophozoite stage. The invasion-linked factor remains in the strongly adsorbed nonheme fraction when a batchwise separation from hemoglobin on an anion exchanger is made and is thus probably acidic in character; the adsorbed fraction, recovered from the ion-exchanger, substantially restores capacity for invasion when sealed into ghosts. Its activity is destroyed by treatment with trypsin. The adsorbed fraction contains many proteins. When fractionated on a gel filtration column by fast liquid chromatography, active material eluted at a volume corresponding to a mol wt for a globular protein in the region of 10,000. A component of apparent subunit mol wt of 13,000 was observed in sodium dodecyl sulfate- polyacrylamide gel electrophoresis (SDS-PAGE) of this eluate fraction.     

XH-超高频手术仪治疗咖啡斑420例

0引言咖啡斑边缘规则的色素沉着斑,从幼儿期为淡褐色斑,形状不一,随着年龄增大,数目加多,影响了容貌和生活质量,1995年以来我们自行发明研制的XH-超高频皮肤手术治疗仪[1]治疗咖啡斑420例,收到良好效果.     

A systematic review of interventions to improve recall of medical advice in healthcare consultations

Background

In order for patients to adhere to healthcare advice, it is essential that they are able to recall this following a consultation. Although psychological research exists which highlights techniques and factors postulated to influence recall, only a limited body of work has been conducted to evaluate their effectiveness in a clinical context.

Aim

To carry out a systematic review of intervention trials designed to enhance recall of medical information.

Methods

We searched Medline (1950–April 2007); Embase (1980–April 2007); Cinahl (1982–April 2007); PsychINFO (1969–2007); and the Cochrane Library Collection. Secondary searches were made through reference to relevant journals and reference lists from relevant papers/review papers.

Results

From 69 papers provisionally identified, 34 papers met the inclusion criteria. Nine recall interventions had been evaluated (audio recordings, written materials, adjunct questions, prompt sheets, visual aids, cognitive strategies, rehearsal, communication styles and personalized teaching). Despite the experimental and theoretical evidence which could have informed cognitive interventions to enhance recall of healthcare advice, most studies primarily focused on the use of written and/or audio-recorded medical instructions. Although the majority of studies supported these approaches insofar as they enhanced recall, the findings were equivocal.

Conclusion

While written and tape-recorded instructions appear to improve recall in most situations, a dearth of interventions incorporating psychological theory was readily apparent. Further research is required in clinical settings to determine if cognitive interventions based on a more over-arching psychological model of recall are effective.     

Arterial occlusive disease below the knee: treatment with percutaneous transluminal angioplasty performed with low-profile catheters and steerable guide wires

In 98 patients with arterial occlusive disease below the knee who were candidates for limb salvage surgery, percutaneous transluminal angioplasty (PTA) was performed with a low-profile balloon catheter and steerable guide wire system. Sixteen patients had bilateral disease; thus, there were 114 endangered limbs and 145 diseased vessels, including 19 with a single stenosis, 94 with multiple stenoses, and 32 with total occlusions. Primary anatomic success was achieved in all stenosed vessels and in 28 occluded vessels. Initial limb healing without amputation was achieved in 88% of limbs. In four patients occluded vessels could not be recanalized; thus, the four affected limbs were amputated. Two years after PTA, 32 of 37 patients available for follow-up had viable pain-free extremities. Cumulative limb salvage rate at 2 years was 86%. At this time, below-the-knee PTA is still recommended only for limb salvage candidates. However, with this new catheter and guide wire system, success rates have been increased and complication rates decreased. PTA may be useful in selected patients with severe claudication.