Effect of Induction Therapy Protocols on Transplant Outcomes in Crossmatch Positive Renal Allograft Recipients Desensitized with IVIG

Here we retrospectively examine the efficacy of two antibody induction regimens using Zenapax or Thymoglobulin in patients with positive complement-dependent cytotoxicity crossmatches (CDC-CMXs) desensitized with IVIG (intravenous immunoglobulin). Between January 1999 and March 2005, 97 patients with (+) CDC-CMXs received kidney transplants (43 deceased donors/54 living donors). All patients received at least 2 g/kg IVIG (maximum four doses) until an acceptable CMX was obtained. Patients were divided into two groups: 1. IVIG + Zenapax (n = 58), 2. IVIG + Thymoglobulin (n = 39). A total of 94% of patients in Group 1 and 84% in G2 have at least 2 years of follow up. Patient and graft survival was 96%/84% in Group 1 and 100%/90% in Group 2, p = NS. The number and severity of AR episodes were similar (36% Group 1 vs. 31% Group 2, p = NS) as was the incidence of C4d (+) antibody-mediated rejection (AMR) (Banff Grade II/III) (22% Group 1 vs. 21% Group 2). Mean serum creatinines (SCrs) at 24 months were similar (Group 1: 1.4 +/- 0.7 vs. G2: 1.5 +/- 0.7 mg/dL). Induction therapy with Zenapax or Thymoglobulin results in excellent patient, graft survival and graft function at 2 years. There was no increased risk of viral infections or malignancies with either agent. Neither agent was effective in reducing the incidence of AMR.     

系统康复治疗对年轻肩关节脱位患者肩关节稳定性的作用

目的对年轻患者肩关节脱位进行系统的康复治疗,以检验系统康复疗法疗效优于单纯固定的假设。方法根据所采用的治疗方法,将43例40岁以下的急性肩关节脱位患者分成实验组23例,对照组20例。实验组患者进行包括关节活动范围锻炼、发展肩胛骨周围肌的肌力训练、发展肩袖肌的肌力、适度的外展、外旋锻炼及耐力训练在内的系统康复治疗。对照组只进行单纯固定后未经系统康复治疗。对两组患者的临床效果进行比较。结果实验组复发率为17%(4/23),对照组复发率为45%(9/20),两组复发率比较差异有显著性意义(χ2=3.866,P<0.05);随访结果显示肩关节ASES评分实验组为90.9±4.87,对照组为75.4±4.94,两组差异有非常显著性意义(t=9.94,P=2.99×10-12<0.01)。结论肩关节脱位年轻患者进行系统的康复锻炼,可以提高患肩的稳定性。     

针刺配合穴位注射治疗中风后遗症78例临床观察

用穴位注射复方丹参注射液配合针刺的方法治疗恢复期及后遗症期中风病78例,总有效率达96%,并与单纯用针刺治疗73例疗效比较,发现穴位注射复方丹参注射液配合针刺的疗效优于单纯针刺治疗,经统计学处理,有显著性差异P<0·01。     

腺病毒介导MDA-7/IL-24选择性杀伤肝癌 细胞HepG2的研究

目的 ：观察MDA-7/IL-24基因对肝癌的选择性杀伤作用，为肝癌的基因治疗提供理论基础。 方法 ：将携带人MDA-7/IL-24基因的腺病毒Ad.mda-7感染人正常肝细胞L02和肝癌细胞HepG2;用RT-PCR法观察MDA-7/IL-24基因的表达;ELISA方法检测细胞培养上清液中MDA-7/IL-24蛋白的浓度;4甲基偶氮唑蓝染色法（MTT）及Hoechst染色观察MDA-7/IL-24对肝癌细胞的生长抑制和杀伤作用;Annexin-V和PI双染后流式细胞仪检测2种细胞的凋亡;用流式细胞仪检测细胞周期。 结果 ：复制缺陷型腺病毒能介导外源基因MDA-7/IL-24在肝癌细胞株HepG2和正常细胞L02中的高效表达;细胞培养上清液中有MDA-7/IL-24蛋白的表达; MDA-7/IL-24能明显抑制肝癌细胞生长并可促进肝癌细胞的凋亡;MDA-7/IL-24阻滞肝癌细胞于G2/M期，能选择性杀伤肝癌细胞而对正常的肝细胞无阻滞作用和毒性作用。结论 ：复制缺陷型重组腺病毒载体Ad.mda-7能介导MDA-7/IL-24基因在人肝癌细胞中高效表达，促使细胞增殖阻滞及诱导肿瘤细胞凋亡，选择性地杀伤肝癌细胞HepG2，而对正常肝细胞L02无任何毒性作用。     

Prediction and Detection of Secondary Hemorrhages after Thrombolytic Therapy in Ischemic Stroke

Abstract It is well established that thrombolytic therapy increases the risk of secondary intracerebral hemorrhage in ischemic stroke patients. However, the term “intracerebral hemorrhage” (ICH) covers a wide spectrum from tiny spots of blood to massive space-occupying hematoma. We will review the etiology and clinical consequences of secondary hemorrhage after thrombolysis in ischemic stroke patients and discuss the ability of magnetic resonance imaging (MRI) to predict this phenomenon. MRI is a highly sensitive tool for detection of hemorrhagic transformation after ischemic stroke. The definitions of a so-called symptomatic hemorrhage after ischemic infarction differ considerably and will also be described. Attributing a causal relationship of a clinical deterioration to a secondary hemorrhage is not easy and should be only addressed when it exceeds at least 30% of the infarct volume. In other patients, secondary hemorrhage might be regarded as side effect of reperfusion within the region with the most severe perfusion deficit. Cerebral microbleeds (CMBs) are a frequent finding in patients with leukoaraiosis and appear to be a general marker of various types of bleeding- prone small vessel disease and a predictor of recurrent vascular events. Current data do not support the hypothesis that the detection of CMBs is a useful diagnostic criterion for the exclusion of patients with CMBs from thrombolytic therapy. However, an increased risk for the rare patients with numerous CMBs can not be ruled out.      

Renal Allograft Biopsies with Borderline Changes: Predictive Factors of Clinical Outcome

The clinical outcome and appropriate management for patients showing 'borderline changes' on allograft biopsy after renal transplantation is still controversial. In an attempt to identify predictive factors of clinical outcome of patients with such lesions, we reviewed the clinical course of 91 patients with borderline changes. Multivariate analysis revealed significant and independent effects of histological stage (i + t < or = or > 2) and time to borderline changes (< or = or > 3 months after transplant) on serum creatinine levels at 1 year from borderline changes episodes (respectively, p = 0.04 and p = 0.02) and only a significant effect of time to borderline changes on serum creatinine levels at 2 years (p = 0.005). Renal function at 1 year and 2 years as 5- and 8-year graft survival were not significantly different in the group of patients treated with antirejection therapy (T group, n = 49) compared with the untreated group (UT group, n = 42). This study strongly suggests that borderline changes with histological score (i + t) > 2 and late episodes of borderline changes should be considered to be of poor prognosis.     

北京地区rt-PA静脉溶栓治疗超早期脑梗死患者临床分析

目的分析北京地区12所医院202例超早期脑梗死患者经不同剂量重组组织型纤溶酶原激活剂(rt- PA)静脉溶栓治疗后的疗效及其不良事件,探讨使用rt-PA的最佳剂量及其安全性与可行性。方法287例发病6h以内的脑梗死患者,男201例,女86例,年龄38～80岁,平均64岁。所有患者均伴有偏瘫,头颅CT未见出血及责任梗死灶,无溶栓禁忌证。202例接受rt-PA治疗,分为A组与B组,A组88例,给予rt-PA 0．9 mg/kg。B组114例,给予rt- PA0．6～0．8 mg/kg。C组(对照组)85例患者给予低分子右旋糖酐、复方丹参等治疗。分别比较治疗前与治疗后11d、21 d、90 d的美国国立卫生院神经功能缺损评分(NIHSS)、Barthel指数,并进行疗效评定。结果A组、B组分别与C组90 d的NIHSS评分、Barthel指数相比有显著差异。A组、B组及C组的基本痊愈及显著改善率分别为69%、77%及40%．A组、B组分别与C组脑出血的发生率为7．96%、4．38%及0%。症状性出血(4．55%、2．63%及0%),非症状性出血(2．63%、1．75%及0%)。结论超早期脑梗死静脉应用rt-PA溶栓治疗是安全有效的。不同剂量的rt-PA均减轻了脑梗死的致残率,但两组间无明显差异。中国人rt-PA溶栓治疗最佳剂量尚需要进一步进行大样本的前瞻性、多中心、随机对照研究．     

Subjective leisure experiences of older Australians

Background:  Previous studies into leisure have employed methodologies that may understate the significance of experiential components. This exploratory study investigated the leisure experiences of retired Australians over 65 years of age.
Methods:  Five semistructured interviews were used to explore the leisure experience of older people from metropolitan Adelaide. Data were coded and analysed thematically.
Results:  Relaxation and engrossment emerged as commonly expressed experiences, yet were found to emerge as a result of engagement in occupations predefined as leisure. Experiences of freedom from both necessary duties and a sense of obligation were discussed as potential determinants of leisure consciousness.
Practice implications:  This study highlights a need for therapists to actively access clients' subjective leisure experiences to enable engagement in personally meaningful leisure occupations.     

用Lyman NTCP模型分析原发性肝癌三维适形放疗引起的放射性肝病

目的建立原发性肝癌三维大分割适形放疗Lyman NTCP模型的参数和探讨放射性肝病的影响因素。方法109例患者进行大分割三维适形放疗,其中93例患者肝硬化Child-Pugh分级A级,16例为B级。患者每星期治疗3次,每次间隔48h,(4．8±0．5)Gy/次,平均剂量(53．5±5．5)Gy。用最大拟然比方法分别得到Child-A和Child-B患者Lyman模型中的NTCP参数。结果共有17例发生放射性肝病,发生在Child-A组8例,Child-B组9例。多因数分析表明,肝硬化分级程度是与放射性肝病相关的独立因素(P=0．000)。所有患者的NTCP参数为n=1．1,m=0．35,TD_(50) (1)=38．5Gy；Child-A级为n=1．1,m=0．28,TD_(50)(1)=40．5Gy；Child-B级为n=0．7,m=0．43,TD_(50)(1)=23Gy。结论肝硬化分级是预测放射性肝病发生的危险因子。Child-B患者进行适形放疗易引起放射性肝病。