骨髓增生异常综合征患者血清sICAM-1水平及其临床意义

目的探讨骨髓增生异常综合症（MDS）患者血清sICAM-1水平的改变及其临床意义。方法用ELISA法测定25例MDS患者治疗前及15例对照组患者sICAM-1水平,并监测MDS患者治疗后的sICAM-1水平。结果MDS中RA、RAS患者治疗前后sICAM-1水平与对照组及RAEB患者治疗后好转患者sICAM-1水平相比无显著差异（P〉0．05）,RA、RAS与RAEB、RAEB与对照组及RAEB治疗后好转患者sICAM-1水平相比有显著差异（P〈0．05）。结论sICAM-1水平测定有助于MDS中RAEB与RA、RAS的鉴别,也有助于MDS的疗效判定。     

生血汤治疗骨髓增生异常综合征56例临床观察

骨髓增生异常综合征（MDS）是一组克隆异常的恶性疾病分为难治性贫血（RA）、环形铁粒幼细胞性难治性贫血（RAS）、难治性贫血伴增生（RAEB）、难治性贫血伴原始细胞增多-转变型（RAEB-T）及慢性粒-单核细胞白血病（CMML）部分病例可能发展转化成急性白血病目前尚无较好的治疗方法,我们用生血汤治疗我院2006年1月-2007年12月收治的56例MDS患者,结果报道如下。     

环孢素A治疗骨髓增生异常综合征临床观察

 目的 观察环孢素A(CSA)为主治疗骨髓增生异常综合征(MDS)的疗效.方法 11例MDS患者(RA 8例,RAS1例,RAEB-Ⅰ 2例)口服CSA[3～5 mg/(kg·d)],分2次,疗程3个月(12个月).维持血CSA浓度150～300 ng/ml.结果 CSA治疗MDS获得较好近期疗效,最早见效时间为1～5 个月,部分缓解3/11例,血液学改善5/11例,未缓解3/11例.有效者为7例RA,1例RAS,IPSS为0.0～0.5分,不再依赖输血小板或红细胞;治疗无效者2例RAEB,1例RAS,IPSS为1.0～2.5分.结论 CSA治疗低危MDS有较好近期临床疗效,提高生活质量,需长期观察.     

一氧化氮中毒迟发性病变的病程及预后－附217例临床分析

目的：研究DEACMP的病程及预后。方法：对DEACMP患者217例的假愈期,临床表现,病程,预后,以及头部CT,MRI,SPECT所见进行对比分析。结果：（1）本组病例中,30天内病情开始好转者占59．44％,31－60天者占21．65％,＞60天者占17．97％,总临床治愈率为44．7％,有效率为99．07％。（2）无明显假愈期患者病程长,预后差,假愈期＜14天与＞15天者之间,前者病程显著长于后者,治愈及有效率无显著差异。（3）假愈期头部CT所见异常阳性率易发病,影像学所见与临床改善不平行,SPECT理能反映病情改善。结论：ECACMP的临床病程具有显著的自限性和可恢复性。     

肺结核患者血清白细胞介素—2及可溶性白细胞介素—2受体的研究

为探讨白细胞介素－２（ＩＬ－２）、可溶性白细胞介素－２受体（ｓＩＬ－２Ｒ）在肺结核发生发展中的作用，采用酶联免疫吸附法（ＥＬＩＳＡ）检测５０例肺结核患者血清ＩＬ－２、ｓＩＬ－２Ｒ水平的变化。结果：进展期肺结核患者ＩＬ－２明显降低，ｓＩＬ－２Ｒ明显增高，与对照组相比统计学差异有显著性意义（Ｐ〈０．０１）。提示：ＩＬ－２、ｓＩＬ－２Ｒ水平的变化与肺结核患者的病情及预后有一定关系。     

八次激发SE-EPI在肝脏MRI的应用

目的；比较八次激发SE－EPI与呼吸门控FSE及SSFSE T2WI在肝脏的应用。方法：对14例志愿者及21例肝病患者行上腹部呼吸门控FSE及SSFSE和屏气八次激发SE－EPI扫描。所有T2WI序列均运用脂肪抑制技术。定量分析肝脏、病灶的信噪比及肝脏－病灶的对比噪声比，评价各序列的图像质量及伪影。结果：八次激发SE－EPI与SSFSE及FSE在肝脏及病灶信噪比，肝脏－病灶对比度噪声比和图像质量方面无明显差异（P＞0．05）。其磁敏感伪影较FSE及SSFSE重（P＜0．01），SE－EPI化学位移伪影与SSFSE及FSE相比无明显差别（P＞0．05）。SE－EPI及FSE运动伪影明显比SSFSE重（P＜0．01），但SE－EPI运动伪影与FSE相比无明显差别（P＞0．05）。SE－EPI与FSE及SSFSE的图像质量无明显差别（P＞0．05）。结论：八次激发SE－EPI能够在较短时间里提供较高质量的上腹部T2WI。被检查者在扫描时可自由平静呼吸或屏气，可作为肝脏T2WI的补充序列。     

肺结核患者血清白细胞介素－2及可溶性白细胞介素－2受体的研究

为探讨白细胞介素－２（ＩＬ－２）、可溶性白细胞介素－２受体（ｓＩＬ－２Ｒ）在肺结核发生发展中的作用，采用酶联免疫吸附法（ＥＬＩＳＡ）检测５０例肺结核患者血清ＩＬ－２、ｓＩＬ－２Ｒ水平的变化。结果：进展期肺结核患者ＩＬ－２明显降低，ｓＩＬ－２Ｒ明显增高，与对照组相比统计学差异有显著性意义（Ｐ＜０．０１）。提示：ＩＬ－２、ｓＩＬ－２Ｒ水平的变化与肺结核患者的病情及预后有一定关系     

高原予适应对重返高原时再发生高山病的影响

如果能适应高原环境，就能防止急性高山病（AMS）的发生，当适应性增强时．AMS的症状就将减轻。假如保留部份适应性．重返高原时AMS的发生或其严重性将会降低。因此6名平原人在适应了4300m高原之后（16天）让他们返回平原（PA）．8天后将他们重新置于4300m低压仑内30小时（RA）．AMS症状的严重程度通过每天所给的环境症状调察向卷表来积累分值而决定（AMS－C）．结果：AMS－C的平均分值降低．从高原（HA）第一天（HA1）的0．6降到RA的0．1（P＜0．05）．HA1期中有4人“病了”．AMS－C＞0．7，RA期仅有一人“病了”。RA与H…     

类风湿因子分型对诊断类风湿关节炎的临床意义

目的：探讨RF分型在类风湿关节炎中的临床应用。方法：ELISA法。结果：①ESR升高的患者中血清各型RF浓度显著高于ESR正常的RA患者。且ESR正常的RA患者血清各型RF浓度也明显高于健康人群;②ESR升高的活动期RA患者,治疗后ESR转为正常期血清中各型RF的变化,结果显示各型RF都有明显降低,尤以IgG-RF降低更为突出（P〈0.01）。结论：尽管ESR是一种判定RA炎症活动度和病情缓解的可靠指标,但特异性不强,且阳性率不高,而测定血清各型RF更能反映患者病情状况;并能对临床治疗效果、患者恢复程度及预后做出判断。     

模拟失重4周大鼠动脉血管局部肾素-血管紧张素系统表达的改变

目的 探讨局部肾素－血管紧张素系统（RAS）在模拟失重所致血管分化性适应中的作用。方法 大鼠通过尾部悬吊模拟失重，悬吊4周后，处死大鼠，分别取基底动脉，颈总动脉，腹主动脉和股动脉组织，提取总核糖核酸（RAN），用逆转录酶－多聚酶链式反应（RT－PCR），半定量检测各动脉组织局部RAS关键成份血管紧张素原（AGT）和血管紧张素转化酶（ACE）mRNA的表达水平，并通过脱氧核糖核酸（DNA）测定对PCR结果进行验证。结果 正常大鼠4种不同部位的动脉组织均有AGT和ACE基因表达；4周模拟失重后，悬吊组大鼠基底动脉AGT和ACEmRNA水平明显升高（P＜0．05），股动脉AGTmRNA水平下降（P＜0．05），其余两种血管组织则未见上述基因表达的明显变化。结论 生理条件下的大鼠基底动脉，颈总动脉，腹主动脉和股动脉均有局部RAS关键成份的表达；模拟失重后基底动脉和股动脉局部RAS表现出现了性质相反的变化，提示局部RAS很可能参与了模拟失重后动脉血管结构和功能的重塑。     

同种异基因造血干细胞移植术后巨细胞病毒感染的有效防治

目的：巨细胞病毒（CMV）感染和巨细胞病毒疾病是异基因造干细胞移植(allo-HSCT)术后的主要并发症,如发现和处理不及时则病死率高。我院对70例异基因造血干细胞移植者于移植后进行巨细胞病毒血症监测,以指导CMV感染防治,方法：采用CMVpp^65单克隆抗体免疫组化法监测。结果：移植后CMV抗原血症见于94．3％（66／70）患者。61．4％（43／70）发展为CMV疾病。其中35例为CMV相关性间质性肺炎（CMV－IP）。随讠－24个月,25例（25／70,35．7％）,病故,其中CMV疾病相关性死亡率为19例（19／25,765）,巨细胞病毒感染和急性移植物抗宿主病（GVHD）之间密切相关。CMV疾病伴Ⅲ-Ⅳ度急性GVHD或慢性GVHD者占CMV疾病例数的54．3％（19／43）。症状前治疗组与CMV疾病组比较显示,CMV疾病组的CMV疾病发生率,继发细菌、真菌感染,严重GVHD发生率以及死亡率均显著高于症状前治疗组（P＜0．001）,随讠－24个月,CMV疾病组的总体生存率仅为31．3％（10／32）而症状前治疗组为93．8％（30／32）。结论：HSCT后CMV感染和CMV疾病常见,于CMV疾病之前的症状前期及时进行抗CMV治疗多可挽救患者生命,急取较好的临床转归。     

In vivo measurements of the T1 relaxation processes in the bone marrow in patients with myelodysplastic syndrome. A magnetic resonance imaging study

Nine patients with myelodysplastic syndrome (MDS) were examined with magnetic resonance imaging and in vivo T1 relaxation time measurements of the vertebral bone marrow in a 1.5 tesla whole body scanner. Two patients underwent transformation to acute myeloid leukemia and were evaluated at follow-up examinations. At the time of diagnosis the T1 relaxation times of the vertebral bone marrow were significantly prolonged compared with normal values. The T1 relaxation times of the vertebral bone marrow in patients with MDS showed significantly lower values compared with patients with acute leukemia and did not differ from patients with polycythemia vera.     

Long-term results of the treatment of severe osteoarthritis and rheumatoid arthritis with 193 total knee replacements

We undertook a clinical and surgical study with evaluation of the long-term results (average 5 years, range 1–9 years) of 193 stabilized posterior cemented total knee replacements (TKRs) type Insall-Burstein in patients with severe osteoarthritis (OA) and rheumatoid arthritis (RA), carried out consecutively by the same surgeon from January 1986 to January 1995, at our COT Unit at the Central Military Hospital “Gomez Ulla” in Madrid, in collaboration with the Departments of Traumatology and Morphological Sciences of the University of Alcalá de Henares (Madrid). The principal purpose was to examine the success rate of this type of prothesis implanted during primary surgery, according to severity of the case. Six methodology protocols were produced in this study (exploratory, surgical technique in primary surgery, revision surgery, rehabilitation, evaluation and clinical revisions), and satisfactory statistical results (SPSS/ PC+) were obtained with the three scales of evaluation: Harris Galante, The Hospital for Special Surgery and Knee Society. These were: 90.5% ± 0.8% excellent and good results for the OA series, and 83.9% ± 5% for the RA series. The analysis of survival after long-term monitoring was also statistically significant, with a 96.95% survival rate. Complications arose in 3.10% of cases (6 revisions: 4 aseptic loosenings and 2 loosenings due to infection), which were treated with a constrained prosthesis, and in cases of infection with an arthrodesis. After undertaking a comparative study with other series, we conclude that the Insall-Burnstein stabilized posterior total knee prosthesis, is an excellent Primary replacement associated with long-term survival in patients with a severe degree of articular destruction and functional incapacity, and we give some specific recommendations to reduce complications. Received: 1 July 1996 Accepted: 17 December 1996     

Secondary myelodysplastic syndrome after autologous transplantation of hematopoietic stem cells in a female patient with Hodgkin's disease

Secondary acute myeloid leukemia with threelineage displasy (sAML/MDS) has been described as a complication of therapeutic approach with high-dose chemotherapy and autologous stem cell transplantation (SCT) in the patients with Hodgkin's disease (HD). It is not yet clear whether the sAML/MDS is a consequence of a standard therapeutic regimen, applied before transplantation, or a high-dose chemotherapy. In a female patient with initially resistant form of HD at III-B-b clinical stadium (bulky disease in neck and mediastinum) after the initial treatment (MOPPx4; ABVDx3; BEA-COPPx2), high-dose chemotherapy has been applied according to BEAM protocol with autologous SCT. In a period after transplantation, radiotherapy (RT) has been applied at initial region of the disease and a patient reached complete remission (CR), which lasted for a 27 months. After that period sAML/MDS has been observed. Application of more standard therapeutic cycles and characteristic cytogenetic findings are the facts that support the opinion that sAML/MDS is a consequence of standard treatment before transplantation, rather than high-dose chemotherapy. That finding implies the need for correct choice of the HD patients suitable for early SCT therapeutic approach.     

Impact of stem cell source on allogeneic stem cell transplantation outcome in hematological malignancies

BACKGROUND/AIM: Peripheral blood (PB) is used more frequently as a source of stem cells (SCs) for allogeneic transplantation. However, the influence of cell source on the clinical outcome of SC transplantation is not yet well established. The aim of this study was to compare the results of PBSC transplantation (PBSCT) with bone marrow transplantation (BMT) on the basis of engraftment, frequency and severity of immediate (mucositis, acute Graft versus Host Disease--aGvHD) and delayed (chronic GvHD--cGvHD) complications, as well as transplant-related mortality (TRM), transfusion needs, relapses and overall survival (OS). METHODS: We analyzed 158 patients, women/men ratio 64/94 median age 29 (range 9-57), who underwent allogeneic SC transplantation between 1989 and 2009. All included patients had diseases as follows: acute myeloid leukemia (AML)--39, acute lymphoblastic leukemia (ALL) 47, chronic myeloid leukemia (CML)--32, myelodysplastic syndrome (MDS)--10, Hodgkin's lymphoma (HL)- 2, multiple myeloma (MM) 3, granulocytic sarcoma (GrSa) 3, severe aplastic anemia (sAA)--22. The patients underwent transplantations were divided into two groups: BMT group (74 patients) and PBSCT group (84 patients). Each recipient had HLA identical sibling donor. SCs from bone marrow were collected by multiple aspirations of iliac bone and from PB by one "Large Volume Leukapheresis" (after recombinant human granulocyte colony stimulating factor, rHuG-CSF) application (5-12 microg/kgbm, 5 days). Conditioning regimens were applied according to primary disease, GvHD prophylaxis consisted of combination of a cyclosporine A and methotrexate. Results. Engraftment, according to the count of polymorphonuclear and platelets, were significantly (p < 0.001) faster in the PBSCT vs BMT group. The needs for transfusion support were significantly (P < 0.01) higher in the BMT group. Those patients had more frequently oropharingeal mucositis grade 3/4 (33.3% vs 10.0%, p < 0.05). There were no significant differences in the incidence of aGvHD and cGvHD between the two groups. The patients who underwent PBSCT had more frequently extensive cGvHD in comparison with the BMT group (29.1% vs 11.29%, p < 0.05). SC source (SCS) had no significant influence on the TRM (21.62% vs 23.8%, p = 0.64) and the incidence of relapses (21.6% vs 29.7%, p = 0.32). Finally, the patients treated by BMT hd a significantly better OS (logrank 2.33, p < 0.05). Conclusion. SCs harvesting from PB resulted in improved cell yield, faster engraftment, as well as in a decrease of immediate transplantation related complications with a reduced treatment cost. Allogeneic PBSCT were associated with more frequent extensive cGvHD, while the influence of SCS in TRM and relapses was not observed. Finally, the long-term OS was better in the patients treated by BMT. To verify impact of SC source on transplantation (PBSCT vs BMT) overall efficacy, more larger randomized clinical studies are needed.     

Angioplasty for Non-arteriosclerotic Renal Artery Stenosis: The Efficacy of Cutting Balloon Angioplasty Versus Conventional Angioplasty

Purpose

We examined the efficacy of conventional balloon angioplasty and cutting balloon angioplasty (CBA) for the treatment of non-arteriosclerotic renal artery stenosis (RAS).

Materials and Methods

From 1993 to 2005, 20 patients underwent 27 percutaneous transluminal renalangioplasty (PTRA) for non-arteriosclerotic RAS (men: 8, women: 12, 25.5 +/? 2 years old; 16 fibromuscular dysplasia (FMD), 4 Takayasu disease). We evaluated the efficacy of CBA by comparing the rate of initial technical success and surgical conversion.

Results

Before the clinical authorization of CBA, three of twelve patients (25 %) underwent surgical bypass due to the failure of PTRA due to the hardness of the lesion. After the approval of cutting balloon, we performed CBA in four cases (2 FMD,2 Takayasu disease) to dilate hard lesions, within which a properly sized balloon could not dilate due to their hardness, or to reduce the risk of local dissection. Initial successes were obtained in all patients (8/8, 100%) and none of the patients underwent surgical conversion. Despite of the good initial result, restenosis was observed in three cases within 6 month (3/4, 75 %). Additional interventions were performed in all patients, then, the severity of the restenotic lesion was found not to be exceeded comparing with the initial lesion.

Conclusion

The cutting balloon angioplasty may be safe and useful procedure for hard lesions of RAS caused by non-arteriosclerotic disease? especially fibromuscular dysplasia. The cutting balloon may provide the initial success, but the effect on long-term patency is still controversial.

     

Does computed tomography permeability predict hemorrhagic transformation after ischemic stroke?

AIM: To use perfusion-derived permeability-surface area product maps to predict hemorrhagic transformation following thrombolytic treatment for acute ischemic stroke. METHODS: We retrospectively analyzed our prospectively kept acute stroke database over five consecutive months for patients with symptoms of acute ischemic stroke (AIS) who had computed tomography (CT) perfusion (CTP) done at arrival. Patients included in the analyses also had to have a follow-up CT. The permeability-surface area product maps (PS) was calculated for the side of the ischemia and/or infarction and for the contralateral unaffected side at the same level. The cerebral blood flow map was used to delineate the ischemic territory. Next, a region of interest was drawn at the centre of this territory on the PS parametric map. Finally, a mirror region of interest was created on the contralateral side at the same level. The relative permeability-surface area product maps (rPS) provided an internal control and was calculated as the ratio of the PS on the side of the AIS to the PS on the contralateral side. A student t-test was performed after log conversion of rPS between patients with and without hemorrhagic transformation. Log conversion was used to convert the data into normal distribution to use t-test. For the group of patients who experienced intracranial bleed, a student t-test was performed between those with only petechial hemorrhage and those with more severe parenchymal hematoma with subarachnoid haemorrhage. RESULTS: Of 84 patients with AIS and CTP at admission, only 42 patients had a follow-up CT. The rPS derived using the normal side as the internal control was significantly higher (P = 0.003) for the 15 cases of hemorrhagic transformation (1.71 + 1.64) compared to 27 cases that did not have any (1.07 + 1.30). Patients with values above the overall mean rPS of 1.3 had an increased likelihood of subsequent hemorrhagic transformation. The sensitivity of using this score to predict hemorrhagic transformation was 71.4, the specificity was 78.6, with a positive predictive value of 62.5 and negative predictive value of 84.6. The accuracy was 76.2. The odds ratio of an event occurring with such an rPS was 9.2. Of the 15 cases of hemorrhagic transformation, there was no difference (P = 0.35) in the rPS between the eight cases of petechial and the seven cases of more severe hemorrhagic events. CONCLUSION: Pretreatment PS can predict the occurrence of hemorrhagic transformation on follow-up of AIS patients with relatively high sensitivity, specificity, positive and negative predictive value.     

Prospective Study of Radial Artery Occlusion Following Transradial Arterial Access during IR Procedures

PurposeTo prospectively determine the rate of radial artery occlusion (RAO) in patients undergoing transradial access for intra-arterial interventions.Materials and MethodsSeventy-seven patients undergoing transradial access from August 2019 to March 2021 for 120 intra-arterial procedures (yttrium-90 mapping [n = 39] and radioembolization [n = 38], uterine artery embolization [n = 19], transarterial chemoembolization [n = 10], active bleed embolization [n = 8], angiomyolipoma embolization [n = 4], and other [n = 2]) were enrolled. The average patient age was 59 years ± 13.1 (range, 30–90 years), and 43 (55.8%) of the 77 patients were men. The patients underwent radial artery (RA) palpation, ultrasound evaluation, the Barbeau test, and the reverse Barbeau test prior to and following the intervention. Verapamil, nitroglycerin, and heparin were administered in a total of 114 (95%) of the 120 procedures prior to starting the procedure. The incidence of RAO and radial artery spasm (RAS) was calculated, and univariate logistic regression was performed to analyze the predictors of RAS.ResultsThe preprocedural RA diameter (3.0 mm ± 0.67) was not significantly different from the postprocedural RA diameter (3.0 mm ± 0.65, P = .904). The RAO rate was determined to be 0.8% (1/120), and this artery recanalized within 1 week. Due to the small number of occlusions, statistical analysis of predictors of RAO was not performed. The rate of RAS was 22.7% (27/119). None of the variables tested—including age, sex, RA diameter, initial versus repeat access, operator experience, and artery puncture technique—showed significant prediction for RAS. Patients were seen for follow-up after 111 (92.5%) of the 120 procedures.ConclusionsTransradial access resulted in a <1% rate of RAO.