Regulatory T cells for tolerance

Regulatory T cells (Tregs) are critical mediators of immune homeostasis and hold significant promise in the quest for transplantation tolerance. Progress has now reached a critical threshold as techniques for production of clinical therapies are optimised and Phase I/II clinical trials are in full swing. Initial safety and efficacy data are being reported, with trials assessing a number of different strategies for the introduction of Treg therapy. It is now more crucial than ever to elucidate further the function and behaviour of Tregs in vivo and ensure safe delivery. This review will discuss the current state of the art and future directions in Treg therapy.     

Eculizumab Bridging before Bone Marrow Transplant for Marrow Failure Disorders Is Safe and Does Not Limit Engraftment

Paroxysmal nocturnal hemoglobinuria (PNH) often develops secondary to other bone marrow failure (BMF) disorders, especially aplastic anemia (AA). Patients with the AA/PNH syndrome may require treatment with both eculizumab to reduce intravascular hemolysis and the risk of thrombosis and allogeneic stem cell transplant for the severe BMF. There has been concern that eculizumab could adversely affect the outcomes for transplant in these patients. This is a retrospective, single-center study of severe AA (SAA)/PNH patients treated with eculizumab immediately before the start of conditioning for transplant. Metrics of engraftment and infectious outcomes are described. Eight patients with SAA/PNH and PNH-related symptoms were treated with eculizumab and then proceeded to transplant. All were successfully transplanted without adverse events related to C5 blockage before conditioning. All were also cured of their both PNH and SAA. Eculizumab is safe and efficacious in patients with PNH clones who require transplant. This is sometimes required to “bridge” patients before bone marrow transplantation and does not appear to adversely impact outcomes even when using HLA matched unrelated or haploidentical donors.     

蛋氨酸合酶基因A275 6G位点多态性与非综合征型唇腭裂的关联性研究

Objective To study the association of the A2756G polymorphism of the methionine synthase (MS) gene with nonsyndromie cleft lip with or without cleft palate (NSCL/P) in Chinese. Methods Ninety-seven NSCL/P case-parent triads were selected as the case group. One hundred and four healthy subjects and their biological parents were selected as control group. For all subjects the A2756G polymorphism of the MS gene was examined by PCR-RFLP method. Results There was no statistical difference in genotype and allele frequencies for MS A2756G variants among family members between case group and control group. The GG genotype was not detected in the offsprings and mothers. The odds ratio and confidence interval of genotype AG in offspring, father and mother were 1.78(0.74-4.34), 0.80(0. 36-1.79) and 1.26(0. 54-2.93) respectively. The odds ratio and confidence interval of allele G in offspring, father and mother were 1.70(0.78-3.73), 0. 88(0. 49-1. 75) , and 1.23(0.59-2.60) respectively. The G allele did not increase the risk of NSCL/P. Transmission disequilibrium test (TDT) analysis yielded no evidence of linkage disequilibrium (χ2=0.034,P>0. 05). The results of haplotype-based haplotype relative risk (HHRR) analysis (χ2=0.03,P>0.05) and family-based association tests (FBAT) (Z=0. 186, P> 0.05) failed to show association between the MS A2756G variant and the risk of NSCL/P. Conclusion The A2756G polymorphism of the MS gene was not associated with NSCL/P in Chinese in the present study.     

子宫内膜癌抑癌基因研究进展

子宫内膜癌是妇女常见的恶性肿瘤之一,发病率有逐年上升的趋势。随着分子生物学和免疫学的发展,关于子宫内膜癌分子水平的致癌机制研究日益深入,如癌基因、抑癌基因、DNA错配修复基因、雌激素代谢酶相关基因、甾体激素受体基因和细胞周期调控蛋白等。综述目前研究热点——抑癌基因的进展,为进一步探讨子宫内膜癌的发生发展、临床治疗及预后的判断提供重要依据。     

胎母输血综合征

胎母输血综合征(fetomaternal hemorrhage,FMH)是指一定量胎儿血液通过破损的胎盘绒毛间隙进入母体血液循环,引起胎儿不同程度的失血以及母亲溶血性输血反应的临床征候群。该病是一种少见的产科疾病,是胎儿非免疫     

妊娠合并血液系统疾病诊治

妊娠合并血液系统的疾病如贫血、血小板减少、白血病等都会引起孕妇产前或产后出血。产科医生应与血液科医生加强合作,密切监护孕妇,制定适宜的治疗与保健方案,争取胎儿正常发育,减少甚至避免产科出血。     

Safety, feasibility, and acceptability of visual inspection with acetic acid and immediate treatment with cryotherapy in rural Laos

Objective

To assess the safety, acceptability, and feasibility of visual inspection with acetic acid (VIA) followed by immediate treatment with cryotherapy as a single-visit approach for the prevention of cervical cancer among women in rural Laos.

Methods

In 2009, women from 2 provinces in Laos were recruited for cervical cancer screening using VIA. If the inspection of the cervix showed a well-defined acetowhite lesion close to the os, immediate cryotherapy was offered.

Results

Of the 1926 women who were included, 134 (7.0%) tested positive on VIA. Of these, 113 (84.3%) underwent immediate cryotherapy and none declined treatment. One year after immediate cryotherapy, 77 (68.1%) women returned for a follow-up assessment and 68 (88.3%) were now VIA-negative. There was no report of a major complication during or after treatment. The acceptance of both VIA and cryotherapy was high.

Conclusion

Visual inspection with acetic acid is a simple test that requires minimal infrastructure and expenditure. Integration of VIA with cryotherapy at the primary care level may constitute a feasible program for the prevention of cervical cancer in Laos.     

Effectiveness of cervical cancer screening using visual inspection with acetic acid in Peru

Objective

To evaluate the effectiveness of screening using visual inspection with acetic acid (VIA).

Methods

In a low-resource area of Peru in 2005-2008, a randomly selected sample of women who had previously screened negative by VIA and Pap (intervention group), and a group of eligible women previously unscreened by VIA (comparison group) were screened by VIA. The outcome measures were histologically confirmed cervical intraepithelial neoplasia (CIN) 2-3 and invasive cervical cancer.

Results

There were 4252 women in the intervention group and 4392 in the comparison group. Histologically confirmed CIN 2 or worse was diagnosed in 31 (0.7%) and 115 (2.6%) women, and invasive cancer was diagnosed in 4 women (0.09%) and 43 women (1.00%), in the intervention and comparison groups, respectively. The adjusted odds ratio was 4.2 (95% confidence interval [CI], 2.7-6.4) for CIN 2 or worse, and 13.9 (95% CI, 4.9-39.6) for invasive cervical cancer in the comparison group.

Conclusion

A lower prevalence of CIN 2-3 and invasive cervical cancer was seen in women previously screened by VIA, as compared with women not previously screened by VIA, implying that a single VIA screening can lower the population risk for cervical cancer.     

眼睑肌阵挛失神综合征的临床与脑电图特征

目的：探讨眼睑肌阵挛失神综合征（EMA）的临床、脑电图（EEG）特点及治疗。方法：回顾我院诊治的2例EMA患者的临床资料,并结合文献分析。结果：2例均为儿童期起病,表现为反复的眼睑肌阵挛,伴或不伴短暂失神,EEG特征为泛化性的、双侧基本对称的2．5～4Hz棘慢波或多棘慢波发放。结论：EMA由于症状复杂,常被漏诊。EEG对EMA的诊断是必需的。     

乳腺癌化疗患者癌性疲乏、应对方式与生活质量的相关性

目的:探讨乳腺癌化疗患者癌性疲乏、应对方式与生活质量之间的相关性.方法:本研究是横断面研究,采用方便抽样法选择乳腺癌改良根治术后行药物化疗的女性患者120例,用癌性疲乏自评量表 (the Revised Piper Fatigue Scale,PFS)、Jalowiec的应对量表 (Jalowiec Coping Scale,JCS)和欧洲癌症研究与治疗组织开发的癌症患者生命质量测定系列量表的核心问卷[Quality of Life Questionnaire-Core 30,QLQ-C30(V3.0)]和针对乳腺癌人群的特异性问卷 (Quality of Life Questionnaire-Breast 23,QLQ-BR23),分别测评患者的癌性疲乏水平、应对方式和生活质量状况.采用Spearman相关分析患者癌性疲乏状况、应对方式以及生活质量三者之间的相关性.结果:乳腺癌化疗患者的癌性疲乏总分与QLQ-C30的功能和总体健康状况呈负相关(r＝-0.24,-0.39;均P<0.01);积极的应对方式如勇敢面对、乐观与PFS的感知维度呈负相关(r＝-0.25,-0.18;均P<0.05),与QLQ-BR23的功能维度呈正相关(r＝0.35,0.21;均P<0.05);消极应对方式如情感、听天由命与PFS的认知维度呈正相关(r＝0.33,0.18;均P<0.05),与QLQ-BR23的功能维度呈负相关(r＝-0.40,-0.32;均P<0.05),与QLQ-BR23症状维度呈正相关(r＝0.40,0.28;均P<0.05).结论:乳腺癌化疗患者所经历的癌性疲乏状况、采取的应对方式及其生活质量三者间存在一定程度的关联,此发现对临床护理有指导意义.