Donor Lymphocyte Infusion for the Treatment of Relapse after Allogeneic Hematopoietic Stem Cell Transplantation

The results of donor lymphocyte infusion (DLI) for treatment of relapse after bone marrow transplantation (BMT) are reviewed. Durable complete remission can be achieved at the molecular level for a majority (more than 70%) of patients with CML, when treated at early relapse. Results are less favourable for acute leukemias, although useful responses have been reported. Data are scarce though promising for myelodysplastic syndromes and multiple myeloma. Major treatment-associated toxicities are GVHD and bone marrow aplasia. The latter complication can be predicted by evaluating the level of residual donor-derived hematopoiesis. Modification of infused cells (CD8 negative selection or transduction with a suicide gene), addition of peripheral blood stem cells, and early implementation of escalating doses may counteract the complications and increase the response rate. Response rate is variably influenced by the presence of chronic GVHD after initial BMT, T-cell depleted BMT, underlying disease and stage at relapse, and the level of mixed chimerism. DLI is a direct demonstration of the graft-versus-leukemia effect (GVL). Because GVL after BMT is sometimes the predominant cause of cure, it may be advisable in such situations to redirect the conditioning regimens for BMT towards engraftment and less immediate cytotoxicity.     

Randomized trial comparing monthly low-dose leucovorin and fluorouracil bolus with weekly high-dose 48-hour continuous-infusion fluorouracil for advanced colorectal cancer: A Spanish Cooperative Group for Gastrointestinal Tumor Therapy (TTD) study

Purpose: The objective of this multicenter study was to compare the efficacy and toxicity profiles of a combination of 5-fluorouracil (5-FU) given by bolus injection together with intravenous leucovorin (LV) versus high-dose 5-FU in continuous infusion (CI) in the treatment of advanced colorectal cancer.Patients and methods: A total of 306 patients were randomized to receive either 5-FU 425 mg/m² given by bolus injection on days 1–5 plus intravenous (i.v.) LV 20 mg/m² every four to five weeks or 5-FU 3.5 g/m²/week in a 48-hour CI. Therapy was continued until disease progression. Second-line chemotherapy was allowed in both arms.Results: The response rates in 306 patients with measurable lesions were 19.2% (modulated arm) and 30.3% (CI arm, P < 0.05). The median progression-free survival times were 23.5 weeks (modulated arm) and 25 weeks (CI arm, P = NS). Median survival times were 42.5 weeks (modulated arm) and 48 weeks (CI arm, P = NS). There were no significant differences in grade 3–4 toxicity profiles but if we consider all grades we observed more mucositis in the modulated arm and more hand-foot syndrome in the CI arm.Conclusions: In terms of response rate, the continuous infusion regimen was more effective than the modulated regimen. There was no significant difference in survival and time to progression, and none in grade 3–4 toxicity.     

自体癌性胸腹腔积液蛋白质回输临床疗效观察

目的观察浓缩分离的癌性胸腹腔积液蛋白质自体静脉回输的临床疗效.方法采用透析、冷凝、变速离心和抽滤等技术对癌性积液中的蛋白质进行分离提取,将可溶性蛋白稀释在盐水中用于静脉回输.结果该方法提取的蛋白质可浓缩9.78倍,蛋白质浓度可达(262.32±52.36)g/L,其中IL-2、IL-4、IFN 和TNF的浓度(pg/L)分别达到53.34±9.67,47.55±9.25,57.43±15.75和73.50±15.17,提取后浓度明显增加(P<0.05).自体蛋白液回输后无一例发生发热、过敏等副反应,同时水肿也得到一定程度的控制.CD3 、CD8 细胞百分率,总蛋白及IgG浓度均无明显改变(P>0.05),但CD4 细胞百分率和CD4 /CD8 比值明显增加(P<0.05 ).结论通过透析、变速离心及抽滤等技术,可从癌性胸、腹腔积液中浓缩分离出适于静脉输注的蛋白质提取液.自体蛋白质回输以后,水肿得到一定程度的控制,并使CD4 细胞百分率和CD4 /CD8 比值提高.     

一次性输液连接管和输液针对硝酸甘油的吸附作用研究

目的:研究微泵维持静脉注射时一次性输液连接管和输液针对硝酸甘油的吸附作用。方法:模拟临床微泵维持静脉注射,用高效液相色谱法、紫外分光光度法定量分析硝酸甘油在注射过程中的浓度变化。结果:一次性输液连接管和输液针对硝酸甘油具有显著的吸附作用,8h内平均吸附率为(73 .88±2. 05) %。结论:硝酸甘油经微泵维持静脉注射时,不宜使用对硝酸甘油具有吸附作用的一次性输液连接管和输液针     

术中液体治疗量对100例妇科腔镜患者术后恶心呕吐的观察

目的　比较术中补充30 ml/kg乳酸林格液与10 ml/kg乳酸林格液的妇科腔镜患者术后恶心呕吐的发生率。方法　选择100名ASAⅠ~Ⅱ级择期行妇科腔镜不孕查因的患者, 随机分为两组, Ⅰ组患者入手术室至手术结束出麻醉恢复室前共接受30 ml/kg 乳酸林格液, Ⅱ组患者入手术室至手术结束出麻醉恢复室前接受10 ml/kg乳酸林格液, 观察术后发生恶心呕吐的患者例数及需要补救止吐药例数。结果　两组患者年龄、体重、禁食时间、手术操作时间差异无显著性; 术后48h恶心呕吐发生率, 30 ml/kg组较10 ml/kg组明显降低(P<0 05),需要补救止吐药人数30 ml/kg组较10 ml/kg组明显降低(P<0 05)。结论　与输注10 ml/kg乳酸林格液相比,术中输注30 ml/kg乳酸林格液可以降低妇科腔镜患者术后恶心呕吐的发生率。     

The effect of two low-dose propofol infusions on the relationship between six-pulse transcranial electrical stimulation and the evoked lower extremity muscle response

BACKGROUND: Transcranial stimulation of the motor cortex using high-voltage electrical stimuli given in train is a method of monitoring the integrity of the motor pathways during thoracoabdominal aortic aneurysm surgery. The purpose of this study was to assess the relationship between the stimulus intensity and the corresponding amplitude of the myogenic motor evoked potential (tcMEP) in response to six-pulse transcranial electrical stimulation during two levels of low-dose propofol infusion and stable fentanyl/nitrous oxide anaesthesia. METHODS: Nine patients (37-78 yr) scheduled to undergo surgery on the thoracoabdominal aorta were studied. After achieving a stable anaesthetic state the output voltage was decreased with 50 V intervals from 350 V to 200 V during a target propofol infusion aimed at a plasma steady-state concentration of 0.7 microg x ml(-1) and increased with 50 V intervals from 200 V to 450 V during a target propofol infusion aimed at a plasma steady-state concentration of 1.4 microg x ml(-1). TcMEPs were recorded from the right tibialis anterior muscle. RESULTS: Doubling the target propofol infusion to 1.4 microg x ml(-1) resulted in a 30-50% decrease in tcMEP amplitude. The largest tcMEP amplitude using the six-pulse paradigm was found during a propofol infusion aimed at a plasma concentration of 0.7 microg x ml(-1) and demanded a stimulus output of 350 V, corresponding to a charge density of 7.5 microC x cm(-2) per phase. CONCLUSION: Doubling the target propofol infusion to 1.4 microg x ml(-1) provides less robust, but still recordable tcMEPs in response to six-pulse electrical stimulation. Safety guidelines are discussed.     

便携式输液设备的研制

本文介绍一种由8031单片机控制的便携式输液设备，阐述了其原理和组成，它可以自动控制输液速度和输液量，具有报警功能，成本低但性能好，可以广泛应用于临床输液以及药品成分分析等场合。     

一次性使用输液（血）器化学分析问题与探讨

分析了某些一次性使用输液(血)器中部分化学性能测定结果重现性差并常常引起不合格的原因,提出生产工艺改进的建议.     

靶控输注全凭静脉麻醉与静吸复合麻醉对术后认知功能影响的比较

【目的】比较靶控输注瑞芬太尼和丙泊酚全凭静脉麻醉与地氟醚和芬太尼静吸复合麻醉对术后认知功能的影响。【方法】选择ASAⅠ～Ⅱ级，年龄18～65岁（男27例，女17例）择期行鼻内镜手术的病人44例，随机分两组：靶控输注瑞芬太尼加丙泊酚全凭静脉麻醉组（TCI组）24例，地氟醚加芬太尼静吸麻醉组（DF组）20例。于麻醉诱导前及术后1、3、24h应用mini—mental state（MMS）测试方法评定其认知功能。比较两组术后麻醉苏醒恢复情况及手术后并发症。【结果】①两组病人在相同麻醉深度下，即脑电双频指数（bispeetral index，BIS）术中维持在40～60，各时间点MMS评分组间比较差异无统计学意义（P〉0．05）；组内比较仅在术后1h均较术前显著降低，术后3h即恢复至术前水平。术后1h TCI组有6例（25％）、DF组有9例（42．9％）病人有明显的认知功能降低，术后3hDF组有2例（10％）病人的MMS值较低（〈28分），而TCI组所有病人认知功能已恢复。②TCI组呼吸恢复时间、听从指令时间及定向力恢复时间均早于DF组，差异有统计学意义（P分别为0．02，0．03和0．02）。拔管时间，呼之睁眼时间也早于DF组，但无统计学意义。③TCI组在拔管即刻的OAAS评分高于DF组，有统计学意义（P=0．007）。④两组病人术后恶心呕吐发生率无差异，两组均无术中知晓发生。【结论】靶控输注瑞芬太尼和丙泊酚全凭静脉麻醉用于鼻内镜手术可引起一过性术后认知功能障碍，与地氟醚和芬太尼静吸复合麻醉相似。     

黄芪注射液加纳洛酮治疗急性脑出血53例

目的初步探讨黄芪注射液加纳洛酮治疗急性脑出血的临床疗效。方法分别采用黄芪注射液治疗方案(A组:51例)、纳洛酮治疗方案(B组:49例)、黄芪注射液加纳洛酮治疗方案(C组:53例),对153例急性脑出血患者进行治疗,并于入院后第7、14、28天分别进行血肿体积、水肿容积测量和临床神经功能缺损程度评分。结果入院后第7天三组血肿体积、水肿容积、临床神经功能缺损程度评分比较差异均无统计学意义(P>0.05);入院后第14天C组分别与A、B组比较,血肿体积、水肿容积均显著减小(P<0.05),但A与B比较差异无统计学意义(P>0.05),三组临床神经功能缺损程度评分比较差异无统计学意义(P>0.05);入院后第28天C组分别与A、B组比较,血肿体积、水肿容积、临床神经功能缺损程度评分均有显著减少(P<0.05)。结论黄芪注射液加纳洛酮治疗方案是一种治疗急性脑出血更有效、更安全的方法。