急性髓样白血病患者骨髓干细胞CD200的表达及与临床疗效的关系

目的研究急性髓样白血病(AML)患者骨髓中CD200的表达情况及与临床疗效关系的相关研究。方法将51例急性髓样白血病患者根据初发时白细胞计数分为高白细胞组(18例)与非高白细胞组(33例),根据化疗效果分为完全缓解组(31例)和未缓解组(20例),同期选取51例缺铁性贫血或巨幼细胞贫血患者为对照组。采用流式细胞术检测AML患者化疗前后CD200、Foxp3~+/CD4~+的表达,酶联免疫吸附试验检测AML患者及对照组患者外周血白细胞介素17(IL-17)、IL-4和干扰素γ的水平。同时,采用Pearson线性相关分析研究AML患者中CD200表达水平与化疗前后血清IL-17、IL-4、干扰素γ水平及骨髓中Foxp3~+/CD4~+水平的关系。结果高白细胞组患者CD200阳性表达率明显高于非高白细胞组患者[(4.8±2.8)%vs.(3.7±2.2)%,t=4.961,P0.001]。未缓解组患者较完全缓解组患者明显偏高[(4.8±2.6)%vs.(3.1±1.6)%,t=5.716,P0.001]。对照组患者与AML患者化疗前比较,IL-17及干扰素γ水平均明显升高(t=26.970,P0.001;t=4.370,P0.001),IL-4水平及Foxp3~+/CD4~+细胞均明显降低(t=9.965,P0.001;t=7.346,P0.001)。而对照组患者与AML患者化疗后比较,仅IL-17及IL-4水平比较,差异有统计学意义(t=8.897,P0.001;t=3.965,P0.001)。与AML患者化疗前比较,化疗后IL-17[(147±42)ng/L vs.(332±68)ng/L,t=15.920,P0.001]及干扰素γ[(24±8)μg/L vs.(31±12)μg/L,t=3.576,P0.001]水平均明显升高,IL-4水平[(142±54)μg/L vs.(84±31)μg/L,t=6.644,P0.001]及Foxp3~+/CD4~+细胞[(7.5±2.4)%vs.(5.2±2.4)%,t=5.330,P0.001]均明显降低。Pearson线性相关分析发现,CD200表达水平仅与化疗后骨髓中Foxp3~+/CD4~+水平呈正相关(r=0.347,P=0.012)。结论 CD200可能通过抑制免疫相关因子影响AML患者临床疗效。     

骨髓中CDKN1C的表达在骨髓增生异常综合征和继发性急性髓系白血病患者中检测的临床意义

目的探讨骨髓中蛋白细胞周期激酶抑制剂1C(CDKN1C)的表达在骨髓增生异常综合征(MDS)和继发性急性髓系白血病(AML)患者中检测的临床意义。方法选取125例MDS/AML患者作为研究对象,同时选取20例健康人群作为健康对照组,分析MDS/AML患者骨髓CD34+细胞中CDKN1C mRNA和蛋白表达水平,比较不同CDKN1C的表达水平MDS患者生存率,采用Cox回归分析MDS和AML患者生存率影响因素,并分析治疗方法对不同CDKN1C的表达水平MDS患者生存率的影响。结果 MDS/AML患者骨髓CD34+细胞中CDKN1C mRNA和蛋白表达水平显著高于健康对照组(t=5.324,7.326,P=0.002,0.000),且与BM计数呈正相关(r=2.014,P=0.004);CDKN1C高表达水平组患者的生存率显著低于CDKN1C低表达水平组和CDKN1C中表达水平组(P0.05);Cox回归分析结果显示高龄、高BM计数、细胞遗传学风险差以及CDKN1C阳性显著影响MDS/AML患者生存率(95%CI=1.10～1.32,1.92～4.40,1.18～2.67,1.03～2.32,P=0.034～0.000);MDS/AML化疗的CDKN1C阳性表达组患者生存率显著低于CDKN1C阴性表达组患者(t=5.314,P=0.002)。结论 MDS/AML患者骨髓中CDKN1C的表达显著增高,CDKN1C高表达显著影响化疗MDS/AML患者的生存率。     

分化抑制因子nm23基因在急性白血病细胞中的表达及临床意义

目的 探讨分化抑制因子nm23在急性白血病细胞中的表达水平及临床意义。方法 应用RT-PCR半定量分析34例初诊急性白血病[22例急性髓系白血病(AML)，12例急性淋巴细胞白血病(ALL)]，9例临床完全缓解AML(AML-CR)，4例慢性粒细胞白血病(CML)患的骨髓标本中nm23-H1、nm23-H2的mRNA表达水平，并分析了其与一些临床指标的关系。结果 nm23-H1基因在急性白血病，尤其是粒-单核细胞及单核细胞白血病(M4,M5)中的表达水平明显增高；经化疗完全缓解后的AML患nm23基因表达显低于初诊AML患；在AML中，nm23-Hl的高表达与外周血白细胞计数、乳酸脱氢酶、CD7及髓外浸润等预后较差指标呈正相关性，而与特征性染色体异常如t(8；21)和t(15；17)呈负相关性。结论 nm23-Hl基因在急性白血病特别是粒．单核细胞白血病(M4,M5)中表达较正常人明显增高，可能是AML预后较差的一种标志。     

c-MPL在急性髓系白血病患者白血病干细胞中的表达

本研究通过检测c-MPL在急性髓系白血病(AML)患者骨髓细胞中的表达,探讨c-MPL表达与CD34、CD38的相关性,以确定c-MPL在白血病干细胞的表达。通过流式细胞术检测29例初诊AML患者的c-MPL和CD34、CD38阳性细胞比例;比较患者c-MPL表达水平与正常对照的差别及与临床指标的关系;分析患者的c-MPL表达水平与CD34、CD38各部分细胞分群的关系及它们之间的相关性。结果表明:AML患者骨髓细胞中c-MPL表达水平显著高于正常对照组(P<0.05);c-MPL的表达与患者的年龄、性别、白细胞计数、AML1-ETO融合基因、化疗后缓解情况无关;c-MPL在M2和M5分型中的表达显著高于正常对照组(P<0.05)。CD34阳性AML患者组的c-MPL表达水平显著高于CD34阴性AML患者组(P<0.01)。AML患者c-MPL在CD34+细胞中的表达显著高于CD34-细胞(P<0.001);AML患者中c-MPL在CD34+CD38+和CD34+CD38-两群细胞中的表达无显著性差异(P>0.05);c-MPL和CD34的表达呈正相关(r=0.380,P=0.042)。结论:c-MPL在AML患者中高表达,且与CD34的表达水平具有一定的正相关性,c-MPL表达于白血病干细胞。     

急性髓系白血病患者131例免疫表型与预后的相关性分析

目的 探讨急性髓系白血病(AML)免疫表型与预后的相关性.方法 采用多色流式细胞术对131例AML患者进行检测,分析其免疫表型与患者年龄、初诊时WBC、PLT和Hb的关系,及其对完全缓解率(CR)的影响.结果 AML患者中髓系抗原表达阳性率最高的是CD13、CD33和髓过氧化物酶(MPO),急性早幼粒细胞白血病(M3)亚型中CD34和HLA-DR表达率较低,淋巴细胞抗原CD19和CD7表达最常见,阳性率分别为15.4%和14.6%.CD7阳性组患者的年龄明显高于阴性组患者年龄(t=-2.27,P＜0.05),CD14阳性组患者的初诊WBC计数明显高于阴性组(Z=-2.284,P＜0.05).131例AML患者的总CR率为56.5%,CD34阳性组(82例)的CR率为45.1%,CD34阴性组(49例)的CR率为75.6%,两组间差异有统计学意义(x2=11.524,P＜0.05).CD34和HLA-DR双阳性组(74例)的CR率为41.9%,单阳性组(38例)CR率为78.9%,双阴性组(19例)CR率为68.4%,3组问差异有统计学意义(Z=-3.492,P＜0.01).CD7、CD19、CD13、CD33、CD38、CD15、CD64、CD14及MPO等抗原表达阳性组和阴性组间CR率的差异无统计学意义(P均＞0.05).多因素回归分析显示,患者年龄大于60岁、初诊时WBC大于50×109/L、PLT大于30×109/L、Hb小于60 g/L以及CD34阳性是低CR率的独立风险因素.结论 AML患者年龄,初诊时WBC、PLT和Hb计数以及CD34表达与CR率有关,免疫表型的检测对于判断AML预后有一定价值,有助于指导临床治疗和判断预后.     

PD-1、TIM-3、VISTA在急性髓系白血病患者T细胞上的表达及意义

目的:研究多种负性共刺激分子在急性髓系白血病(AML)患者外周血T细胞上的表达及其对预后的影响。方法:收集初治、完全缓解(CR)、未缓解(NR)AML患者外周血标本,采用流式细胞术检测CD4~+和CD8~+T细胞PD-1、VISTA、TIM-3的表达水平,并收集患者临床资料进行统计分析。结果:初治AML组患者CD4~+和CD8~+T细胞PD-1、VISTA、TIM-3表达水平均较对照组显著增高(P0.05),CR组CD4~+和CD8~+T细胞PD-1、TIM-3、VISTA表达水平均较初治组及NR组显著降低(P0.05);初治AML患者CD4~+和CD8~+T细胞TIM-3表达水平与VISTA表达水平正相关(r=0.85,r=0.73);初治AML患者,首次诱导化疗未缓解组及高危组患者CD4~+T细胞PD-1、VISTA表达水平显著上升(P0.05),高危组CD8~+T细胞TIM-3表达水平显著上升(P0.05),CBFβ-MYH11突变阳性组CD8~+T细胞VISTA表达水平显著降低(P0.05)。结论:PD-1、TIM-3、VISTA在AML外周血T细胞上的表达可能参与AML的免疫逃逸,并可能成为急性髓系白血病患者的治疗靶点。     

CD73在NPM1突变型急性髓系白血病患者中的表达及其临床意义

目的:探讨CD73在NPM1突变型及野生型急性髓系白血病(AML)患者中的表达及对其治疗疗效和预后的判断价值。方法:选取2015年6月-2019年6月本院收治的初治AML患者160例,同期选取本院非AML者的骨髓样本40例作为对照,分别比较健康者、NPM1突变型AML及NPM1野生型AML患者中CD73的表达,分析CD73表达与其临床病理特征及疗效的关系,对患者进行随访,进一步分析CD73对不同AML患者预后的影响。结果:CD73在AML患者中的阳性表达率(23.75%)显著高于健康对照组(0.62%),NPM1突变AML患者CD73+表达率(74.75%)显著高于NPM1野生型(25.51%)(P<0.001);AML患者CD73+表达与年龄、FAB分型、疾病危险程度分级及NPM1基因突变状况有关(P均<0.05);NPM1基因突变AML患者总体生存率为75.98%,显著高于NPM1野生型AML患者的34.68%(P<0.001),NPM1基因突变AML患者中CD73+组中位生存时间为21个月,显著长于CD73-组患者的11个月(P<0.001),NPM1野生型AML患者中CD73+组中位生存时间为13个月,显著短于CD73-组患者的18个月(P<0.001)。结论:CD73在NPM1基因突变AML患者中表达增加,CD73在不同NPM1基因突变型AML患者中有不同的预后意义。结合AML患者临床病理特征、CD73表达及NPM1基因情况有助于判断其预后,并指导有关治疗方案的制定。     

急性髓系白血病免疫分型特点及与疗效相关性分析简

本研究旨在探讨急性髓系白血病（acute myeloid leukemia,AML）的免疫分型特点及其与疗效的关系.收集516例初发AML患者骨髓标本,采用流式细胞术检测AML的免疫表型.结果表明,①516例AML中髓系相关抗原阳性表达率较高,依次为MPO（95.0％）、CD33（93.0％）、CD13（88.8％）、CD117 （69.4％）,而CD14、CD15、CD64、CD71表达较低,其中145例AML伴淋系抗原表达,分别为CD7 21.5％、CD19 6.0％、CD2 0.78％、CD100.58％、CD20 0.58％;CD71在M6中阳性表达率为100％,CD64在M5中阳性表达率最高（30.2％）;CD34总阳性表达率为57.8％.②首次化疗后完全缓解（CR）率为64.7％,M3组中CD34＋患者CR率低于CD34-组（P=0.019）.非M3组CD34阳性组的CR明显低于CD34阴性组（P=0.002）;CD19＋患者CR率高于CD19-组（P=0.028）;CD7＋患者CR率明显低于CD7-组（P =0.002）;CD71＋患者CR率低于CD71-组（P=0.013）;MPO＋患者CR率高于MPO-组（P=0.015）;CD11b、CD13、CD33表达阳性组与相应阴性组的CR率相比,差异无统计学意义（P＞0.05）.结论：免疫分型是诊断AML的必备条件,它有助于指导白血病的临床分型诊断、治疗方案的选择及预后的判断.     

t(8;21)急性髓系白血病的免疫表型特点

目的研究用流式细胞术免疫表型分析t(8;21)(q22;q22)急性髓系白血病(AML)的免疫表型特点.方法采用常规细胞形态学/细胞化学、流式细胞术间接免疫荧光标记技术和R显带核型分析(MIC)进行分型,部分加用RT-PCR检测AML1/ETO融合基因.结果①294例初治AML患者中,64例t(8;21)AML,占21.8%,在M2中高达54.7%.64例t(8;21)AML中M2占81.3%;②与对照组比较,t(8;21)AML高表达CD19和CD34,低表达CD33(P＜0.001);③以20%阳性细胞作为阳性标准,CD19阳性率在AML为13.6%(294例中40例),t(8;21)AML为50%(64例中32例),显著高于无t(8;21)AML组的3.5%(230例中8例)(P＜0.001);④在t(8;21)AML患者中,CD19+和(或)CD34+58例(90.6%)、CD19-和(或)CD34-6例(9.4%).结论t(8;21)AML特别是M2/t(8;21)高表达CD19与CD34,CD19与t(8;21)密切相关,CD19是预测t(8;21)的指标之一.     

135例急性髓细胞白血病免疫表型特点及意义

目的探讨急性髓系白血病(AML)免疫表型的特点及意义。方法应用流式细胞术,采用CD45/SSC双参数方案对135例AML患者进行免疫表型分析。结果在135例急性髓系白血病中表达较高的抗原依次是MPO(94.8%)、CD33(94.8%)、CD13(90.4%)、HLA-DR(74.1%)、CD117(65.2%)和CD34(61.5%)。CD14仅表达于急性粒-单细胞白血病(M4)和急性单核细胞白血病(M5)。AML伴淋系抗原表达以CD7(32.6%)最为多见,其次为CD56(26.7%)和CD19(10.4%)。共发现4例急性双表型白血病(ABL),同时具有髓系和淋系抗原表达。结论 MPO、CD33、CD13是诊断AML最敏感的抗原。CD7、CD56、CD19在AML诊断及预后判断具有重要意义。免疫表型分析有助于AML的诊断及预后判断。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.