Forced vergence fixation disparity parameters with and without a central fusion lock

The effect of a central fusion lock on forced vergence fixation disparity curve parameters, that is, magnitudes of fixation disparity and associated phoria, curve type and the central slope of the curve, was studied in 84 subjects because of ambiguity in the previous studies. It was found that the magnitudes of exo fixation disparity and exo associated phoria decreased significantly when they were measured with the central fusion lock. The central lock had no noticeable effect on the type of the curve, although, the central slope of the curve was flatter in the presence of the central lock.     

Rotator cuff lesions of the shoulder: evaluation by direct sagittal CT arthrography

Direct sagittal computed tomographic scanning (DSCT) of the shoulder was performed in 42 symptomatic patients, six healthy volunteers, and two cadaver shoulders. Axial CT scanning and double-contrast arthrography with plain radiographs were performed in 41 patients for comparison. DSCT enabled correct identification of 27 of 29 lesions in 24 patients. Seventeen patients had normal shoulders. Axial CT scanning and DSCT together enabled correct identification of all lesions and were markedly superior to plain-film arthrography. DSCT enabled diagnosis of all cases of complete rotator cuff tear plus three cases of incomplete tear and three of rotator cuff atrophy not identified by the other techniques. Axial CT scanning was better than DSCT for diagnosis of Bankart lesions.     

骨唾液酸蛋白在体外培养人骨髓间充质干细胞向成骨细胞分化中的角色

目的：骨唾液酸蛋白在骨矿化形成方面扮演重要角色，实验观察其是否能诱导体外培养的人骨髓间充质干细胞向成骨细胞分化。方法：实验于2005—10／2006—12在解放军广州军区广州总医院医学实验科完成。①材料来源：选取在本院体检的健康志愿者2人，对本实验均知情同意。采用Ni-NTA亲和纯化技术，从本室构建的毕赤酵母GS115／pPICZaA-hbsp发酵上清中纯化重组人骨唾液酸蛋白。②实验方法：对健康志愿者进行髂骨穿刺抽取骨髓液，采用贴壁法培养得到骨髓间充质干细胞。设立4组：骨唾液酸蛋白组添加0．1nmol／L骨唾液酸蛋白；成骨诱导液组添加10nmol／L地塞米松、10mmol／L磷酸甘油、50mg／L抗坏血酸；联合组添加上述两组的所有试剂；空白对照组不添加任何处理因素；各组均处理细胞12d。⑧实验评估：光镜及电镜观察培养的细胞形态；以细胞计数法测定生长曲线，应用流式细胞仪分析细胞周期，采用免疫荧光细胞化学法和流式细胞分析检测干细胞标志物STRO-1的表达；生化试剂盒测定碱性磷酸酶活性；von Kossa染色法检测钙沉积。结果：①单个骨髓间充质干细胞为长梭形，经骨唾液酸蛋白处理后细胞大而扁平，原来密集的克隆分散开。②与空白对照组比较，骨唾液酸蛋白组引起细胞生长曲线右移，细胞Go／G，期比例平均增加12．09％（P〈0．01），S期比例减少65．92％（P〈0．01），STRO-1阳性细胞百分率下降26．54％（P〈0．01）。⑧与空白对照组比较，骨唾液酸蛋白组细胞碱性磷酸酶活性增加50．0％，成骨诱导液组增加59．5％，联合组增加71．43％，并且随着处理时间的延长，活性增加越显著。④空白对照组细胞vonKossa染色呈阴性，其余各组均呈阳性。其中联合组的黑色矿化结节体积最大、数目最多；骨唾液酸蛋白组的结节体积较小、数目较少；成骨诱导液组居中。结论：骨唾液酸蛋白对人骨髓间充质干细胞有促进成骨分化和矿化作用，且与成骨诱导液联用效果更佳。     

Transfusion-associated graft-versus-host disease in immunocompetent patients: report of a fatal case associated with transfusion of blood from a second-degree relative, and a survey of predisposing factors

A patient without evident immune deficiency who received a transfusion of blood from a second-degree family member developed fatal transfusion- associated graft-versus-host disease (TA-GVHD). The donor was homozygous for an HLA haplotype for which the recipient was heterozygous (one-way HLA match). All 39 reported cases of TA-GVHD in immunocompetent patients were reviewed to ascertain the predisposing factors and to define the indications for irradiating blood for this population. HLA typing was described in 15 cases; in 13, including seven related and six unrelated donors, a one-way HLA match was present. Thirty-one (79%) of the 39 cases were reported from Japan (and 196 other cases are cited in the Japanese literature), but a one-way HLA match among unrelated donors at HLA-A, -B, -DR loci is only approximately two to four times more likely in Japanese persons than in whites. Fresh blood (< 96 hours old) was used in 29 (94%) of the 31 cases reported from Japan and in 33 (87%) of 38 cases overall (in one case, the age of the blood used was not reported). Thus, factors that appear to predispose to TA-GVHD in immunocompetent patients are a one- way HLA match, fresh blood, and, possibly, Japanese ancestry. Irradiating cellular blood components from all blood relatives of transfusion recipients will not completely eliminate the risk of TA- GVHD.     

Surgical management of primary and metastatic sarcoma of the mobile spine

OBJECT: Sarcomas of the spine are a challenging problem due to their frequent and extensive involvement of multiple spinal segments and high recurrence rates. Gross-total resection to negative margins, with preservation of neurological function and palliation of pain, is the surgical goal and may be achieved using either intralesional resection or en bloc excision. The authors report outcomes of surgery for primary and metastatic sarcomas of the mobile spine in a large patient series. METHODS: A retrospective review of patients undergoing resection for sarcomas of the mobile spine between 1993 and 2005 was undertaken. Sarcomas were classified by histology study results and as either primary or metastatic. Details of the surgical approach, levels of involvement, and operative complications were recorded. Outcome measures included neurological function, palliation of pain, local recurrence, and overall survival. RESULTS: Eighty patients underwent 110 resections of either primary or metastatic sarcomas of the mobile spine. Twenty-nine lesions were primary sarcomas (36%) and 51 were metastatic sarcomas (64%). Intralesional resections were performed in 98 surgeries (89%) and en bloc resections were performed in 12 (11%). Median survival from surgery for all patients was 20.6 months. Median survival for patients with a primary sarcoma of the spine was 40.2 months and was 17.3 months for patients with a metastatic sarcoma. Predictors of improved survival included a chondrosarcoma histological type and a better preoperative functional status, whereas osteosarcoma and a high-grade tumor were negative influences on survival. Multivariate analysis showed that only a high-grade tumor was an independent predictor of shorter overall survival. American Spinal Injury Association scale grades were maintained or improved in 97% of patients postoperatively, and there was a significant decrease in pain scores postoperatively. No significant differences in survival or local recurrence rates between intralesional or en bloc resections for either primary or metastatic spine sarcomas were found. CONCLUSIONS: Surgery for primary or metastatic sarcoma of the spine is associated with an improvement in neurological function and palliation of pain. The results of this study show a significant difference in patient survival for primary versus metastatic spine sarcomas. The results do not show a statistically significant benefit in survival or local recurrence rates for en bloc versus intralesional resections for either metastatic or primary sarcomas of the spine, but this may be due to the small number of patients undergoing en bloc resections.     

Sickle cell anemia patients have low erythropoietin levels for their degree of anemia

We have studied serum immunoreactive erythropoietin (SIE) levels in 28 patients with sickle cell anemia (SCA) without renal insufficiency and in 17 patients with nonhemoglobinopathy anemias of comparable severity using a sensitive radioimmunoassay procedure. An exponential relationship between SIE level and degree of anemia was noted in all patients. However, in nonhemoglobinopathy anemia, a sharp rise in the SIE level occurred as hemoglobin (Hb) levels fell below about 12 g/dL, whereas in sickle cell patients the increase was not marked until hemoglobin fell to about 9 g/dL. The response was more blunted in older SCA patients than in younger ones. A linear regression model relating SIE level to Hb level, presence/absence of SCA, and age explained 63% of the variation in SIE. We conclude that the serum erythropoietin levels in SCA increased at a lower hemoglobin concentration and are of a lower magnitude than that of the other anemias.