BCR-ABL protein expression in peripheral blood cells of chronic myelogenous leukemia patients undergoing therapy

Chronic myelogenous leukemia (CML) is a myeloproliferative disorder associated with the Philadelphia chromosome (Ph1) in more than 95% of these patients. The Ph1 and the resulting BCR-ABL fused genes are markers for this type of leukemia. In CML, the product of the fused BCR- ABL gene is typically a protein of approximately 2,000 amino acids termed P210 BCR-ABL. We have developed an assay for the BCR-ABL protein involving Western blotting of circulating white blood cells (WBC) with an anti-ABL monoclonal antibody that can detect P210 BCR-ABL and P145 ABL in peripheral blood cells from chronic phase Ph1-positive leukemia patients. This assay was used to analyze the BCR-ABL protein content of circulating WBC from CML patients before and after various treatments. In parallel to changes in percentages of Ph1-positive blood cells as determined by cytogenetic analyses of bone marrow samples, BCR-ABL protein expression in blood cells decreased or increased as patients entered remission or underwent relapse. Of interest, six Ph1-negative CML patients were BCR-ABL protein-positive. All except one had a rearrangement in the major breakpoint cluster region and that patient expressed P185 BCR-ABL and not P210. Our results indicate that the BCR- ABL Western blotting assay has clinical applications for both diagnosis and prospective evaluation of Ph1-positive and Ph1-negative CML patients.     

Temporal relationship between cancers of the lung and upper aerodigestive tract

We retrospectively reviewed the chart records at the Veterans General Hospital-Taipei for the period between January 1985 and December 1994 to examine the temporal relationship between cancers of the lung and upper aerodigestive tract. A total of 56 patients (54 males, 2 females) with histocytologically proven double primary cancers, with either lung cancer or upper aerodigestive tract cancers appearing first, were found. Squamous cell carcinoma was the most frequent histologic type of lung cancer (squamous 57%, adenocarcinoma 27%, poorly differentiated carcinoma 9%, small cell lung cancer 7%). The incidence of lung cancer patients with upper aerodigestive tract cancer was 0.9% (56/6412). There was no significant difference in the occurrence of upper aerodigestive tract cancer between non-small cell and small cell lung cancer (P > 0.05). However, the incidence of squamous cell lung cancer with upper aerodigestive tract cancer was higher than that of non-squamous cell lung cancer (P < 0.05). With regard to the location of lung cancer, the right lung was more commonly affected than the left (P < 0.001). The locations of upper aerodigestive tract cancers in these lung cancer patients were as follows: larynx 24, nasopharynx 11, esophagus 10, hypopharynx 4, pharyngeal tonsils 2, oral cavity 5. Most upper aerodigestive tract cancers were diagnosed before lung cancer (36/56, 64%), and lung cancer was diagnosed within 3 years in more than half of cases after the diagnosis of upper aerodigestive tract cancer (58.3%). Most lung cancers that preceded upper aerodigestive tract cancer were at an early stage at diagnosis (stage I 4, stage Illa 1), whereas the others, appearing either synchronously or after the diagnosis of upper aerodigestive tract cancer, were mostly at the late stage. There was no difference in survival between lung cancer patients with upper aerodigestive tract cancer and those without (P > 0.05).      

The sartorius myocutaneous island flap

Summary The vascular supply to the distal part of sartorius m. was studied in 37 limbs by dissection under magnification and after black ink and latex injections. The muscle or myocutaneous island flap pedicled on the saphenous artery (SA) is supplied by a retrograde circulation through anastomoses of the SA with the perforating branches of the posterior tibial artery and the medial inferior genicular artery. Three different vascular patterns were defined. Retrograde injection also showed good perfusion of the SA. The flap is useful for covering around the knee, the proximal and middle thirds of the lower leg, and the end of the amputation stump. Raising of the flap has not resulted in any functional or cosmetic defect. Eighteen operations have so far been performed, six using the muscle island flap and twelve using the myocutaneous island flap, and all survived completely.

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Le lambeaux en îlot myo-cutané du muscle sartorius

Résumé L'apport artériel pour la partie distale du m. sartorius a été étudié sur 37 membres par dissection sous grossissement et après injection d'encre de Chine et de latex. Le lambeau en îlot, musculaire ou myo-cutané, pédiculé sur l'artère saphène (SA), est vascularisé par une circulation rétrograde à travers les anastomoses de la SA avec les branches perforantes de l'artère tibiale postérieure et l'artère inféro-médiale du genou. Trois schémas vasculaires différents ont été définis. L'injection rétrograde montrait aussi une bonne perfusion de la SA. Le lambeau est utile pour la couverture des régions proches du genou, des tiers proximal et moyen de la jambe et de l'extrémité des moignons d'amputation. La réalisation du lambeau n'a entraîné aucun dommage fonctionnel ou cosmétique. Dix-huit interventions ont été réalisées jusqu'ici, six utilisant le lambeau en îlot musculaire et douze utilisant le lambeau en îlot myocutané, sans aucune complication locale.

     

Origin of Allergy From In Utero Exposures to the Postnatal Environment

As the incidence of atopic conditions continues to increase, emphasis has been placed on understanding the origin of allergy with hope that prevention measures can be achieved. The perinatal environment is important for this understanding, given that both the immune system and microbiome start forming prenatally. Maternal exposure can greatly impact on fetal health. Additionally, the dysfunctional epithelial barrier is influential in allowing allergens and irritants to penetrate the skin or mucosa, leading to the release of proinflammatory cytokines and mediators to drive type 2 tissue inflammation and the onset of allergy. There are numerous factors related to skin, airway, and gut epithelial barriers dysfunction, and genetic predispositions are also present. Comprehensive birth cohort studies and further mechanistic studies will be keys to understanding the origin of allergy.     

不同来源间充质干细胞生物学特征的比较

目的:比较脐静脉、成人骨髓及胎儿骨髓3种不同来源的间充质干细胞体外生长特性及分化潜能。方法:①实验于2004-01/2006-06在苏州大学附属第二医院中心实验室完成。孕39～40周健康产妇正常分娩2h的脐带以及3～4月龄流产胎儿均由苏州大学附属第二医院妇产科提供,产妇及其家属均知情同意。正常成人骨髓由苏州大学附属第二医院血液科研究生捐献。本实验经医学伦理委员会批准。②脐带用含青、链霉素的磷酸盐缓冲液冲净静脉腔内残血,夹闭两端,经37℃预热的1.5g/L胶原酶消化,重悬于DMEM-LG(含体积分数为0.1的新生牛血清、20mmol/LHEPES、2mmol/L L-谷氨酰胺、1mmol/L丙酮酸钠),以108L-1密度接种于25cm2培养瓶常规培养,48h后弃上清,以后每两三天半量换液,3周后用5g/L胰酶消化传代。③抽取正常成人骨髓5～10mL,ficoll分离单个核细胞,收取白雾层及以上部分细胞,采用上述培养基按相同条件进行培养,约14～18d胰酶消化传代。④取流产胎儿,无菌条件下分离股骨,冲洗干净后采用两种方法分离间充质干细胞:直接将胎骨剪成约1mm3大小的碎片,磷酸盐缓冲液洗涤后加入少量上述培养基,置10cm培养皿培养;剪去股骨两端后,用上述培养基冲出骨髓腔内细胞,直接培养。⑤观察连续传代对3种不同来源间充质干细胞增殖的影响;免疫荧光及免疫组化分析所得细胞的表型;观察3种不同来源间充质干细胞在诱导培养条件下向成骨及成脂细胞分化的潜能。结果:①不同来源间充质干细胞的体外增殖特性:脐带、成人及胎儿骨髓内均存在间充质干细胞,且细胞形态相似。成人骨髓间充质干细胞的体外增殖能力较差,传至10～12代基本失去增殖能力。脐静脉间充质干细胞的增殖能力强于成人骨髓间充质干细胞,可体外连续传代15～18次。而胎儿来源的间充质干细胞增殖能力及体外传代更新能力均明显强于其他两种间充质干细胞,传至20代时基本保持原有的特性。②不同来源间充质干细胞免疫表型:3种间充质干细胞均高表达CD29、CD44、CD54及HLA-ABC分子,成人骨髓源间充质干细胞还表达中等量的CD106及少量HLA-DR。3种间充质干细胞均不表达造血细胞标志CD34和CD45,其中脐静脉来源的间充质干细胞αSMA呈阳性,vWF呈阴性。③不同来源间充质干细胞的分化潜能:在成脂或成骨条件培养基中,3种间充质干细胞均可向脂肪及成骨细胞分化,油红O及von Kossa染色呈阳性。结论:①脐带、成人及胎儿骨髓内均存在数量不等的间充质干细胞,其形态、生长特性及表面标志具有相似性。②脐静脉源间充质干细胞的增殖能力优于骨髓间充质干细胞,尽管略弱于胎源性间充质干细胞,但其来源广泛、分离方便、间充质干细胞得率高,且没有伦理限制,是一种较好的间充质干细胞来源。     

肾移植术后乙型肝炎病毒拉米夫定耐药的治疗

目的:观察肾移植术后乙型肝炎病毒患者发生拉米夫定耐药后,应用新一代核苷类抗乙型肝炎病毒药物阿德福韦和恩替卡韦的治疗效果。方法:选择2001-05/2006-09于南方医科大学南方医院器官移植科就诊的乙型肝炎病毒感染并发生病毒多聚酶催化域YMDD基序变异,对拉米夫定耐药的肾移植患者4例,患者均知情同意。定期复查血清丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、乙型肝炎病毒DNA定量及乙型肝炎病毒YMDD变异情况,先后采用拉米夫定、阿德福韦及恩替卡韦进行治疗,并观察其治疗效果。结果:①4例患者分别随访16,26,63,67个月,移植肾功能良好。②4例患者分别在服用拉米夫定14,24,51和62个月(术后12个月)时出现乙型肝炎病毒YMDD变异,乙型肝炎病毒DNA升高至105～109拷贝/mL,肝功能异常。2例加用阿德福韦3个月后撤除拉米夫定,单用阿德福韦治疗,乙型肝炎病毒DNA均降为104拷贝/mL,肝功能正常,其中1例单用阿德福韦9个月后乙型肝炎病毒YMDD变异转阴,另1例单用阿德福韦2个月,乙型肝炎病毒YMDD变异仍为阳性;2例停用拉米夫定,直接换为恩替卡韦,其中1例2个月后肝功能正常,乙型肝炎病毒DNA阴性,乙型肝炎病毒YMDD变异阴性,另1例服药2个月后肝功能正常,乙型肝炎病毒DNA降为104拷贝/mL,乙型肝炎病毒YMDD变异仍为阳性。结论:新型抗乙型肝炎病毒药物阿德福韦和恩替卡韦可有效抑制拉米夫定耐药的乙型肝炎病毒复制,有利于乙型肝炎病毒阳性肾移植患者长期存活。     

贲门失弛缓症术后并发食管旁疝致胃底绞窄坏死1例

介绍1例贲门失弛缓症Heller术后16 a并发食管旁疝致胃底绞窄坏死的病例．报告本例患者的详细病历资料和诊治经过．患者起病5 d后剖胸探查,发现胃底疝入左侧胸腔并绞窄坏死,行近端胃大部切除,修复食管裂孔．术后随访1 a无复发．食管旁疝发生嵌顿时,应立即插入胃管减压．如减压不成功或症状不改善,应急诊手术探查．