Is it worth using daclizumab induction therapy with mycophenolate mofetil-based immunosuppressive regimens in live related donor kidney transplantation? A long-term follow up

Background/Aims The aim of this work is to determine the long-term therapeutic benefit(s) of daclizumab induction therapy with triple immunosuppressive protocols including prednisolone, cyclosporine microemulsion (CsA), and mycophenolate mofetil (MMF) in the living related donor kidney transplantation. Methods Twenty-one adult recipients of their first kidney allograft were allocated to receive daclizumab with triple immunosuppressive therapy (steroids, CsA, and MMF). They were compared to 50 recipients of their first grafts who received a maintenance triple immunosuppressive therapy (steroids, CsA, and azathioprine). The patients were followed up for 5 years. Results Daclizumab group significantly experienced a marked reduction of acute rejection (7/21) when compared to the control group (31/50) with subsequent significant reduction of cumulative steroids doses at the end of 5 years. The overall incidence of post-transplant complications was comparable among the two treatment groups. There was no significant difference in patients and graft survival; 5-year patient and graft survival were 95.3%, 85.7% for daclizumab and 96%, 88% for control group, respectively. Conclusions Although prophylactic daclizumab with triple immunosuppressive protocol including MMF have drastically reduced the incidence of acute rejections, the graft and patient survival are unchanged in this long-term follow up.     

Accuracy in precordial ECG lead placement: Improving performance through a peer-led educational intervention

Background and objectives

Inaccurate electrocardiography (ECG) lead placement may lead to erroneous diagnoses, such as poor R wave progression. We sought to assess the accuracy of precordial ECG lead placement amongst hospital staff members, and to re-evaluate performance after an educational intervention.

以拓扑替康为基础的联合诱导方案治疗难治及复发急性粒细胞白血病16例报告

目的：评价以拓扑替康为基础的联合诱导方案治疗难治及复发急性粒细胞白血病(AML)的疗效及不良反应。方法：采用以拓扑替康为基础的联合诱导方案治疗难治及复发AML患者16例。所有患者接受1个疗程拓扑替康组成的联合化疗方案(拓扑替康、环磷酰胺、阿糖胞苷)后，定期检查血细胞计数、骨髓中白血病细胞比例，定期复查肝、肾功能等。结果：7例患者在接受1个疗程诱导缓解化疗后达到完全缓解，2例达部分缓解，总缓解率为56．3％；7例患者无反应。主要不良反应为骨髓抑制。结论：以拓扑替康为基础的诱导缓解方案对部分难治及复发AML患者具有确切疗效。     

舌下含服米索前列醇配伍米非司酮终止中期妊娠的临床研究

【目的】比较舌下含服与阴道后穹隆放药米索前列醇配伍米非司酮在中期妊娠流产中的效果。【方法】16～24w中期妊娠妇女随机分为舌下组、阴道组，经米非司酮150mg预治疗48h，分别给予米索前列醇200μg舌下含服、阴道后穹隆放药，3h重复1次，直到有规律宫缩。主要的观察指标是引流时间、24h内分娩率、完全流产率、阴道流血量、药物的不良反应。【结果】舌下组比阴道组引流时间明显缩短，24h内分娩率、完全流产率、阴道流血量、药物不良反应两组间均无明显差异。【结论】舌下含服米索前列醇能缩短引流时间，使用方便，更易被患接受。     

成人急性淋巴细胞白血病的治疗现状及展望

近年来随着科学的发展,成人急性淋巴细胞白血病的治疗有了很大的进展。诱导治疗至少应用一次糖皮质激素+长春新碱+蒽环类药,尽量加用门冬酰胺酶,强烈的诱导治疗必须权衡利弊。在强烈的诱导和巩固后维持治疗仍然是急性淋巴细胞白血病患者的标准治疗。高危患者在第一次完全缓解时推荐干细胞移植,标危者不推荐。中枢神经系统白血病的预防性治疗是防止中枢神经系统受累或复发的基础。总之,成人急淋应根据预后因素及患者特点等确定个体化治疗。     

环丙沙星体外诱导肺炎链球菌耐药机制研究

目的探讨环丙沙星体外诱导肺炎链球菌耐药的分子机制。方法10株临床分离的肺炎链球菌体外用不同浓度梯度环丙沙星逐级诱导成为耐药株,检测诱导前后菌株对环丙沙星的MICs,PCR扩增诱导前后菌株parC/parE和gyrA/gyrB基因喹诺酮耐药决定区(QRDR)、测序并与GenBank公布序列比对。结果8株临床菌株成功诱导为耐药株,诱导后MICs是诱导前16倍以上,诱导后2株只发现parC/parE基因的QRDR有突变其耐药水平较低MICs分别为8μg/ml和16μg/ml,6株parC/parE和gyrA/gyrB基因的QRDR同时存在点突变耐药水平较高,MICs分别为64μg/ml和128μg/ml。结论逐步增加药物浓度可以诱导肺炎链球菌parC/parE和/或gyrA/gyrB基因的QRDR点突变导致对环丙沙星耐药。     

Short topotecan-based induction regimen in newly diagnosed high-risk neuroblastoma

Purpose

Topotecan is an active drug in relapsed neuroblastoma. We investigated the efficacy and toxicity of a topotecan-based induction regimen in newly diagnosed neuroblastoma.

Methods

Patients older than 1 year with either metastatic or localised stage 2-3 MYCN-amplified neuroblastoma received 2 courses of high-dose topotecan (HD-TPT) 6 mg/m² and high-dose cyclophosphamide (HD-CPM) 140 mg/kg, followed by 2 courses of ifosfamide, carboplatin and etoposide (ICE) every 28 days. After surgery on primary tumour, a fifth course with vincristine, doxorubicin and CPM was given, followed by high-dose chemotherapy with stem cell support. Response was assessed in accordance with the International Neuroblastoma Response Criteria.

Results

Of 35 consecutive patients, 33 had metastatic disease. The median length of induction phase was 133 days (range 91-207) and time to high-dose chemotherapy was 208 days (range 156-285). The median tumour volume reduction was 55% after two HD-TPT/HD-CPM courses and 80% after four courses. Radical surgery was performed in 16/27 patients after chemotherapy. After the fifth course, 29/34 patients (85%) had achieved a partial remission (12) or a CR/very good partial remission (17). CR of metastases was achieved in 13/32 (41%) and bone marrow was in complete remission in 16/24 patients (67%). Grade 4 neutropenia and/or thrombocytopenia occurred in 100% of HD-TPT/HD-CPM and in 95% of ICE courses, while non-haematological toxicities were manageable.

Conclusions

These data indicate that our induction regimen is feasible and well tolerated. A major response rate of 85% with 41% complete metastatic response confirms this regimen as effective induction in high-risk neuroblastoma.     

控释地诺前列酮栓用于延期及过期妊娠引产的临床观察

目的:观察控释地诺前列酮(商品名欣普贝生)用于延期妊娠及过期妊娠引产的有效性及安全性。方法:回顾性分析2007—2010年我院98例延期及过期妊娠者,观察组48例,于阴道后穹窿放置控释地诺前列酮引产,对照组50例,静脉滴注催产素引产,应用统计学分析比较两组在给药前和给药后12h的宫颈Bishop评分,引产成功率,宫缩过强,胎儿窘迫,新生儿窒息,产后出血等情况。结果:两组病例在用药后12h宫颈评分比较,观察组明显优于对照组(P<0.01);观察组阴道分娩率高于对照组,剖宫产率低于对照组(P<0.01);两组发生宫缩过强情况,新生儿阿氏评分,产后出血差异无统计学意义(P>0.05)。结论:普贝生用于延期妊娠及过期妊娠引产效果优于催产素引产,并且无降低引产的安全性,是安全有效的引产药物。     

两种新的维生素D3类似物对白血病细胞的体外作用

为了寻找更加有效的诱导分化剂，我们测试了两种新的维生素Ｄ３类似物（ＥＢ１０８９和ＭＣ９０３）对人早幼粒细胞白血病细胞系（ＨＬ－６０）和人巨核细胞白血病细胞系（ＨＩＭｅｇ－１）的体外抑制生长和诱导分化作用。集落形成试验结果显示ＥＢ１０８９，ＭＣ９０３和１，２５（ＯＨ）２Ｄ３抑制ＨＬ－６０细胞生长的ＥＤ５０分别为９×１０＾－９ｍｏｌ／Ｌ，１×１０＾－８ｍｏｌ／Ｌ和７×１０＾－８ｍｏｌ／Ｌ；它们抑制ＨＩ