Postmarketing surveillance study of KOGENATE® Bayer with Bio-Set® in patients with haemophilia A: evaluation of patients' satisfaction after switch to the new reconstitution system

Summary.  KOGENATE^® Bayer (rFVIII-FS) with Bio-Set^® is designed to prevent patient contact with exposed needles during recombinant factor VIII reconstitution. This postmarketing surveillance study evaluated patient satisfaction before and after switching to the new Bio-Set reconstitution method. Male children and adults with haemophilia A were enrolled from nine European countries. A preference questionnaire was administered to patients after Bio-Set training and at the end of the observation period (≥20 exposure days or 3 months). Physician assessments of patient compliance and satisfaction were conducted at the end of the observation period. Patients ( N  = 306) received a mean ± SD of 28 ± 23 infusions of rFVIII-FS with Bio-Set. A majority of patients (82%) preferred the Bio-Set method, with domain scores for ease of use, safety from needlesticks, and speed of reconstitution being highest after training and at the end of the observation period. The Bio-Set method received higher mean scores than previous reconstitution methods for worry/safety and ease/confidence domains at both time points. Physician-reported patient compliance with the Bio-Set method was similar or greater compared with the previous method for 94% of the patients, with physicians reporting that 92% of the patients were satisfied or very satisfied with Bio-Set. Thirteen adverse events (AEs) occurred in nine patients, and five serious AEs occurred in five patients; none was related to rFVIII-FS. No de novo or recurrent inhibitor development was observed during the observation period. rFVIII-FS with Bio-Set was well tolerated and well accepted by haemophilia A patients, which may improve treatment compliance.     

Human papillomavirus in the era of highly active antiretroviral therapy for human immunodeficiency virus: an immune reconstitution‐associated disease?

Human immunodeficiency virus (HIV)-related cutaneous and anogenital disease in the highly active antiretroviral therapy (HAART) era presents challenging problems for dermatologists. Immune reconstitution-associated diseases (IRADs) are common and important consequences of HAART. Dermatologists should be aware of the cutaneous manifestations of IRAD. The prevalence of clinical human papillomavirus (HPV)-related disease is increased in HIV and does not appear to be diminished by HAART. Many patients on HAART are dogged by persistent cutaneous warts. Anogenital precancer is also common in HIV and may be burgeoning with HAART. Clinicians should be aware of the increased risk of cervical, penile and vulval/vaginal cancers in treated and untreated patients with HIV. The increase in HPV infection in HIV-infected individuals may be, at least partly, due to increased exposure to diverse HPV types, particularly high-risk types that might be able to persist for longer in anogenital regions. Alternatively, persistent/emergent HPV disease in HIV infection might represent persistent or modulated immunodysregulation after HAART and be viewed as a form of IRAD. The immunopathogenesis of HPV IRAD is fascinating and possibly determined by host genotype.     

中医药学实验课程的重构

实验课是培养学生操作能力、提高教学质量的一个主要手段。以培养学生动手能力和创新能力为目的，增加综合性实验、设计性实验和创新性实验为原则，对实验课程进行了重构，以期达到实验课程相对独立，且能涵盖多门相关课，节省实验资源，减少重复课时的目的。     

IL-2基因疗法对骨髓移植后免疫及造血重建的影响

本文以大剂量化疗后骨髓功能严重损伤做为实验模型．动态观察了成纤维细胞介导的IL-2基因疗法对同基因骨髓移植后免疫及造血功能重建的影响。结果表明，IL-2基因疗法能显著增强实验小鼠骨髓细胞的NK活性、LAK活性及ConA刺激的增殖反应，但对骨髓CFU-GM，CFU-MK、CFU-E集落形成无影响，提示成纤维细胞介导的IL-2基因疗法能加快和增强骨髓移植后的免疫功能重建过程，提高骨髓移植抗肿瘤作用，并可减少骨髓移植后感染等并发症。该结果为IL-2基因疗法应用于骨髓移植提供了一定的实验依据．     

Changes of isoagglutinin titres after ABO-incompatible allogeneic stem cell transplantation

We investigated the changes in isoagglutinin titres in 62 patients who underwent ABO-incompatible allogeneic stem cell transplantation. After major [and/or (+/-) minor] ABO-incompatible transplantation, recipient-derived isoagglutinins against donor-type red blood cells (RBCs) disappeared more rapidly in unrelated recipients (P = 0.006) and in patients with acute graft-versus-host disease (GVHD, P = 0.025) than in sibling recipients and in patients without acute GVHD respectively. Pure red cell aplasia (PRCA) developed in 10 out of 35 evaluable patients who underwent major (+/- minor) ABO-incompatible transplantation, and the post-transplant increase of isoagglutinin titres was a significant predictor for the occurrence of PRCA. In five out of 36 patients who underwent minor (and/or (+/-) major) ABO-incompatible transplantation, donor-derived isoagglutinins against recipient RBCs were detectable without clinically overt haemolysis. Isoagglutinin titres against ABO antigens absent both on recipient and donor RBCs decreased during the early post-transplant period then rose subsequently in 24 out of 29 patients at (median) d 59 post transplant. Our study showed that changes in isoagglutinin titres might have clinical implications in the occurrence of immunohaematological complications such as PRCA or immune-mediated haemolysis, and might reflect immunohaematological reconstitution after transplantation. Furthermore, our data regarding time to disappearance of recipient-derived isoagglutinins against donor-type RBCs after major ABO-incompatible transplantation suggest the presence of a graft-versus-plasma cell effect.     

The association between immunodeficiency and congenital heart disease

Summary The predilection of children with congenital heart disease (CHD) to infection may be explained in part by an underlying immunodeficiency disorder. Some 13 syndromes in which immunodeficiency and CHD may coexist have been reported in the medical literature. In addition, immunoglobulin and T-cell deficiencies have been found in nonsyndromal patients with CHD. The diagnosis of immunodeficiency should be entertained in such children, as early recognition of an immunodeficiency disorder can result in improved antimicrobial and immunological management.     

Immune recovery after conventional and non-myeloablative allogeneic stem cell transplantation

The immune recovery of 66 patients undergoing allogeneic stem cell transplantation with either conventional or non-myeloablative conditioning regimen was studied. Infections post-transplant were enumerated and quantitative immunoglobuilins (IgG, IgA, IgM) and lymphocyte sub-sets 3, 6 and 12 months post-transplant were measured. A significant difference was found in the immunologic recovery of non-myeloablative and conventional ASCT in the patient population. The T-helper cell reconstitution was significantly faster after NMA than conventional transplantation and the recovery of B cells was faster after conventional transplantation. Regarding immunoglobulin levels, a faster recovery of IgM levels after NMA-ASCT and a delayed recovery of IgA levels was observed in both groups. These were accompanied by a significant difference in the frequency and severity of infectious episodes.     

Antibiotic granules for reconstitution as syrups: product uniformity and stability dependent upon reconstitution procedure

The penicillin content and stability of diluted antibiotic syrups, prepared according to the manufacturers' recommendations and other, non-approved, methods have been investigated. Methods which involve portioning the granules before reconstitution are hazardous and may result in preparations which range from very little antibiotic content to a double strength preparation. The choice of diluent controls the stability of the preparation. Phenoxymethylpenicillin syrups become less stable as the sucrose content increases. This is not always true with ampicillin syrups where the system is more complex. Although syrups prepared according to the manufacturers' instructions are not always the most stable, the effect of different diluents on the stability of syrups, especially suspensions, suggests that syrups should always be reconstituted and diluted according to the directions provided with the product.