Peripheral blood monoclonal plasma cells as a predictor of survival in patients with multiple myeloma [see comments]

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.     

Hemopathologic consequences of protracted gamma irradiation: alterations in granulocyte reserves and granutocyte mobilization

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.     

Lower limb vasodilatory capacity is not reduced in patients with moderate COPD

We compared exercise capacity (peak O₂ uptake; V̇O_2peak) and lower limb vasodilatory capacity in 9 patients with moderate COPD (FEV₁ 52.7 ± 7.6% predicted) and 9 age-matched healthy control subjects. V̇O_2peak 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 V̇O_2peak 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. V̇O_2peak 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.     

Apparent Acute Reversible Right Ventricular Pacing‐Induced Left Ventricular Dysfunction

Apparent Acute Reversible Right Ventricular Pacing‐Induced Left Ventricular Dysfunction . We report the case of a 70‐year‐old Caucasian male with a dual chamber (right atrium/right ventricle) pacemaker implanted for sinus node dysfunction and not pacemaker (PM) dependent who was found to have an apparent acute worsening of left ventricular (LV) function with right ventricular (RV) apical pacing caused by the mode switch to VVI pacing as battery depletion occurred. LV dysfunction resolved immediately with RV pacing turned off. To our knowledge, this is the first report of this phenomenon. (J Cardiovasc Electrophysiol, Vol. 24, pp. 224‐226, February 2013)     

Coronary Angioplasty in Low Risk Patients with Low Dose Heparin and Immediate Withdrawal of the Femoral Sheath

This study reports our preliminary experience of percutaneous coronary angioplasty with low dose heparin and immediate withdrawal of the femoral sheath. After selection, 120 patients underwent a procedure with a low dose of heparin (4,300 ± 700 IU). A total of 120 of 123 lesions (97.6%) were treated successfully by the femoral route. There were no major cardiac complications during the procedure and hospital stay. Patients were allowed to be ambulant 6 hours after the procedure. No significant bleeding occurred. There was no need for surgery relative to the approach route nor for blood transfusion. The use of low dose heparin and immediate withdrawal of the femoral sheath did not increase the risk of coronary angioplasty in these selected patients. The period of bed confinement was shortened and the patients were ambulant earlier, leading to a reduction in their hospital stay with no increase in costs.     

贯叶金丝桃愈伤组织的诱导及其有效成分的定性

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     

IL－2对NOD鼠糖尿病的影响

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。     

Do men undergoing sterilizing cancer treatments have a fertile future?

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.