[Comparison of three different types of donor hematopoietic stem cell transplantation for intermediate and high-risk myelodysplastic syndrome]

目的

比较半相合移植（Haplo-HSCT）、无关供者移植（MUD-HSCT）及同胞相合移植（MSD-HSCT）治疗中高危骨髓增生异常综合征（MDS）的疗效及其预后影响因素。

方法

回顾性分析2001年8月至2015年5月接受异基因造血干细胞移植（allo-HSCT）治疗的167例中高危MDS患者病例资料，比较不同移植方式下患者的预后特征及预后影响因素。

结果

存活患者中位随访60（12~177）个月。5年实际累积无病生存（DFS）率为67.8%（95% CI 60.0%~75.6%），其中MSD-HSCT组为68.0%（95% CI 54.1%~81.9%），MUD-HSCT组为77.4%（95% CI 62.1%~92.7%），Haplo-HSCT组为64.0%（95% CI 52.4%~75.6%），三组比较差异无统计学意义（P=0.632）。单因素分析结果显示移植前病程>12个月者累积DFS率明显低于≤12个月者（P=0.018）。5年累积复发死亡率和移植相关死亡率（TRM）与上面危险因素均无明显相关性。

结论

Haplo-HSCT治疗MDS疗效显著，可以作为重要的替代供者，特别是在缺乏MSD而病情紧急没有时间去等待搜索MUD的情况下，可以主动选择；移植前病程是影响DFS的重要因素。

[Effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation]

Objective: To analyze the effect of NCCN (2015) risk stratification on prognosis of patients with acute myeloid leukemia (AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: Retrospective analysis of 258 patients with AML in CR (186 cases in CR(1), 72 cases in CR(2)) who underwent allogeneic HSCT in our hospital between April 2012 and March 2015 according to NCCN (2015) risk stratification. Of them, 63 cases were classified as low risk, 112 cases intermediate risk and 83 cases high risk. Results: ①With the median follow up of 18 (5-41) months, two-year disease free surviva (DFS) in 258 patients was 78.0% (95% CI 60.4%-96.6%) . Two-year DFS in AML after transplantation was 78.6% (95% CI 61.0%-96.2%) in low risk, 76.0% (95% CI 84.0%-93.6%) in intermediate risk and 80.3% (95% CI 62.7%-97.9%) (P=0.886) in high risk groups respectively. ②Univariate analysis showed that DFS has no significant difference in patient age, the median disease course before HSCT, the WBC number at the beginning of the disease, blood routine and chromosomes examination before transplantation, extramedullary disease before transplantation, disease status before transplantation, conditioning regimen, donor type, donor and recipient sex, recipient blood type, transfused MNC number, transfused CD34(+) cell number and transfused CD3(+) cell number. DFS was significant lower in primary AML than that in secondary AML (P=0.006) and also lower in MRD positive than that in MRD negative (P=0.003) . The accumulative relapse was significant higher in CR(2) compared to that in CR(1) (P=0.046) . Accumulative non-relapse mortality (NRM) was significanlyt higher in secondary AML compared to that in primary AML (P=0.004) and also higher in MRD positive compared to that in MRD negative (P=0.010) . ③Multivariate analysis showed that MRD positive was the only significant factor in DFS and NRM. Conclusion: Allo-HSCT treatment of AML CR patients could achieve a high efficacy, which is similar between CR(1) and CR(2) patients. There is no significant correlation between NCCN (2015) risk stratification and the prognosis of AML patients with allo-HSCT treatment. Pre-conditioning MRD status monitored by multiparameter flow cytometry was the only impact factor on DFS and NRM in allo-HSCT for CR-AML patients.

[Effect of minimal residual disease monitoring by multiparameter flow cytometry pre-conditioning on prognosis of acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation]

目的

分析预处理前多参数流式细胞术（MFC）监测的骨髓微小残留病（MRD）对急性髓系白血病（AML）异基因造血干细胞移植（allo-HSCT）预后的影响，探讨MFC监测MRD在AML allo-HSCT预后评估中的价值。

方法

回顾性分析2012年4月至2015年3月行allo-HSCT的186例AML患者，预处理前骨髓细胞形态学均达第1次完全缓解（CR₁）。采用8色MFC对预处理前骨髓进行MRD检测，任何水平异常均定义为MRD阳性。

结果

①186例AML患者中151例MRD阴性；35例MRD阳性，其中25例MRD<1%，10例MRD为1%~3%。②2年总体无病生存（DFS）率为80.0%（95% CI 68.5%~92.3%）。与MRD阴性组比较，MRD阳性组DFS率低[62.9%（95% CI 50.6%~75.2%）对88.9%（95%CI 76.6%~100.0%），P<0.001]、复发率高[11.4%（95%CI 4.1%~29.0%）对3.3%（95%CI 0.6%~20.9%），P=0.003]、非复发死亡率（NRM）高[25.7%（95%CI 8.1%~43.3%）对7.9%（95%CI 1.3%~26.5%），P=0.001]。继发性AML组DFS率低（P=0.004），NRM高（P=0.003）。③多因素分析结果显示预处理前MFC检测的MRD阳性是DFS[HR=4.565（95%CI 2.918~9.482），P<0.001]、复发[HR=5.854（95% CI 1.538~22.288），P=0.010]及非复发死亡[HR=3.379（95%CI 1.361~8.391），P=0.009]的独立危险因素。

结论

预处理前MFC监测的MRD阳性是影响allo-HSCT治疗CR₁-AML独立危险因素，MFC监测MRD可用于AML allo-HSCT的预后评估。

Blood and marrow transplantation in mainland China

As of 1981, allogeneic bone marrow transplantation (allo-BMT) was applied in an acute leukaemia patient with success. Since then, the number of BMT has been increasing gradually, especially since the 1990s. Approximately 2000 BMTs per year have been performed in recent years in more than 100 BMT units in mainland China. A recent survey of 12 major BMT units indicates that the predominant types of transplantation performed are identical sibling (38.6%), related mismatched/haploidentical (19.4%), unrelated (17.2%), and autologous (24.5%). The indications of major disease entities are acute myeloid leukaemia (32.8%), acute lymphoblastic leukaemia (20%), chronic myeloid leukaemia (CML) [18.9%], and lymphoid malignancy (13.5%). The number of transplants from unrelated donor or related mismatched/haploidentical donor has been increasing significantly in recent 6 years. Granulocyte colony-stimulating factor-mobilised bone marrow plus peripheral blood are routinely used as a source of stem cells for haploidentical BMT. Umbilical cord blood is used less often. Although the total number of patients who received allo-BMT continues to increase, the increase in BMT for CML has been flattened since 2004. By the end of 2008, more than 960 000 volunteer's human leukocyte antigen (HLA) data are available in Chinese Marrow Donor Program (CMDP), and more than 1100 stem cell donations have been performed from it. Stem cells for unrelated BMT in mainland China are mainly from Taiwan Tzu Chi Stem Cell Center and CMDP. Related HLA-mismatched/haploidentical BMT has reached fairly good outcomes in terms of severe acute graft-versus-host disease (GVHD), chronic GVHD, relapse, treatment-related mortality, disease-free survival, and overall survival, which are comparable with HLA-identical-sibling BMT in the author's BMT units. Syngeneic BMT started successfully in 1964 and has still very good outcomes in more than 23 BMT units from the statistics of Chinese Society of Blood and Marrow Transplantation.

Unmanipulated haploidentical blood and marrow transplantation: where we are

Human leukocyte antigen (HLA)-mismatched/haploidentical blood and marrow transplants (haplo-BMT) from family donors have been intensively studied because of the decreasing family size in mainland China, and also because the Chinese Marrow Donor Program is still not big enough. The protocol for unmanipulated haplo-BMT has been designated as 'GIAC' by Dr DP Lu--'G' represents granulocyte colony-stimulating factor mobilisation; 'I' stands for immunosuppression during pre-conditioning being prolonged and intensified; 'A' stands for the use of antithymocyte globulin; 'C' means combined use of bone marrow and peripheral blood as the graft. Haplo-BMT with GIAC regimen has been shown to be feasible for many applications as reported in 2004. Under this protocol, haplo-BMT has achieved comparable outcomes in terms of severe acute graft-versus-host disease (GVHD), chronic GVHD, relapse, treatment-related mortality (TRM), disease-free survival (DFS), and overall survival with HLA-identical sibling transplantation. The probabilities of DFS at 2 years in haplo-BMT setting were 70.7%, 49.6%, 22.2% in standard-risk, high-risk, advanced disease groups, respectively. As the third party cells, cord blood co-infusion could significantly reduce the incidence and severity of acute GVHD, and also 100-day TRM. The majority of refractory cytomegalovirus, Epstein-Barr virus and aspergillus infections can be controlled by adoptive cellular therapy. Many patients who early relapsed after BMT and failed, or are ineligible for standard therapy, have been salvaged with dendritic cell-primed cytokine-induced killer cells. With these new strategies, the lower TRM and improved DFS have been attained. Therefore, it is better to consider haplo-BMT for the patients with otherwise incurable haematological malignancies at earlier stage, when matched sibling or unrelated donors are not available.

Identification of a novel HLA-DRB1 allele (HLA-DRB1*111902*)

In this paper, we report a new HLA-DRB1 allele identified in a male acute myeloid leukaemia Chinese patient. This sample was initially typed as DRB1*11XX using commercial polymerase chain reaction-sequence-specific primers kit. When it was typed using a chip-based sequence-specific oligonucleotide technique, a novel hybridization pattern that does not match any known alleles was observed. Through sequencing, we have identified this allele as a new HLA-DRB1 allele, which was later named HLA-DRB1*111902 by the WHO Nomenclature Committee. The sequence of this new allele differs from DRB1*111901 by one nucleotide (from G to C) at 203nt of exon 2 but does not cause any amino acid substitution.

Managing acute withdrawal syndrome on patients with heroin and morphine addiction by acupuncture therapy

Though there are articles and case reports about using acupuncture to detoxify and to break the narcotic addiction, few articles describe in the West about using acupuncture therapy to treat the emergence of acute withdrawal symptom due to heroin, opium, or morphine. Most often the method of treatment are using the methadone or benzodiazepine and phenoziazine drugs this article describes many years of clinical experience with non-drug approach to treat the acute withdrawal symptoms with acupuncture therapy. Unlike the drug approach, which usually has side effects, there is no adverse effect with acupuncture therapy.

Trophic signals acting via phosphatidylinositol-3 kinase are required for normal pre-implantation mouse embryo development

The growth and survival of the preimplantation mammalian embryo may be regulated by several autocrine trophic factors that have redundant or overlapping actions. One of the earliest trophic factors to be produced is embryo-derived platelet-activating factor (1-O-alky-2-acetyl-sn-glyceryl-3-phosphocholine). The addition of platelet-activating factor to embryo culture media exerted a trophic effect, but structurally related lipids (3-O-alky-2-acetyl-sn-glyceryl-1-phosphocholine, 1-O-alky-sn-glyceryl-3-phosphocholine, octadecyl-phosphocholine) had no effect. Platelet-activating factor induced a pertussis toxin-sensitive [Ca(2+)](i) transient in two-cell embryos that did not occur in platelet-activating factor-receptor null (Pafr-/-) genotype embryos. Fewer Pafr-/- mouse zygotes developed to the blastocyst stage in vitro compared with Pafr+/+ zygotes (P<0.02), those that developed to blastocysts had fewer cells (P<0.001) and more cells with fragmented nuclei (P<0.001). The inhibition of 1-O-phosphatidylinositol 3-kinase (LY294002 (3 microM and 15 microM) and wortmannin (10 nM and 50 nM)) caused a dose-dependent inhibition of platelet-activating factor-induced [Ca(2+)](i) transients (P<0.001). The two-cell embryo expressed 1-O-phosphatidylinositol 3-kinase catalytic subunits p110 alpha, beta, gamma and delta, and regulatory subunits p85 alpha and beta. LY294002 and wortmannin each caused a significant reduction in the proportion of embryos developing to the morula and blastocyst stages in vitro, reduced the number of cells within each blastocyst, and significantly increased the proportion of cells in blastocysts with fragmented nuclei. The results indicate that embryo-derived platelet-activating factor (and other embryotrophic factors) act through its membrane receptor to enhance embryo survival through a 1-O-phosphatidylinositol 3-kinase-dependent survival pathway.

Expression of cytokeratins (CKs) 8, 13 and 18 and their mRNA in epithelial linings of radicular cysts: implication for the same CK profiles as nasal columnar epithelium in squamous epithelial lining

OBJECTIVE

Our objective was to specify cytokeratin (CK) patterns in lining epithelia of radicular cysts which are sometime lined with ciliated columnar epithelia as seen in the nasal epithelia.

MATERIALS AND METHODS

We examined the CK expression in 52 radicular cysts obtained from 32 maxillary and 20 mandibular lesions and investigated CK-mRNA expression using in situ hybridization in 24 maxillary and 13 mandibular cysts and reverse transcription-polymerase chain reaction (RT-PCR) in 24 maxillary cysts.

RESULTS

Of the maxillary cysts, 20, 29 and 19 squamous epithelial linings were positive for CK8, CK13 and CK18, respectively; of the mandibular cysts, 10, 20 and 11 linings were positive for these CKs, respectively. The expression patterns of CK18(+)-CK13(-), CK18(+)-CK13(+) and CK18(-)-CK13(+) were observed in 3, 16 and 13 linings of the maxillary cysts and 0, 11 and 9 linings of the mandibular cysts, respectively. In situ hybridization revealed the expression of CK18-mRNA in 9 and 4 linings of 24 maxillary and 13 mandibular cysts examined, respectively. With RT-PCR, we explored that both CK18- and CK13-mRNA were expressed not only in the normal nasal and gingival epithelia but also in the examined maxillary cyst linings although their expression levels differed correlating with the difference in CK staining.

CONCLUSION

It is concluded that CK13- and CK18-mRNA are constitutively expressed in columnar and squamous epithelial cells, respectively, and that the variant CK expression patterns with CK18-mRNA expression in maxillary radicular cysts are indicative of the possibility of phenotypic transformation in the cyst linings.

Acupuncture and clinical hypnosis for facial and head and neck pain: a single crossover comparison

Despite their long histories, acupuncture and hypnosis have only recently been acknowledged as valuable by the medical establishment in the U.S. Few studies have used rigorous prospective measurement to evaluate the individual or relative merits of hypnosis and acupuncture in specific clinical settings. In this study, 25 patients with various head and neck pain were studied. Each had an initial assessment of their pain, as well as of their attitudes and expectations. All patients received acupuncture, followed by a reassessment of their pain. After a washout period they received another assessment of pain before and after hypnosis therapy. Preferences for therapy were sought following the hypnotic intervention. Both acupuncture and hypnosis were effective at relieving pain under these conditions. The average relief in pain reported was 4.2 units on a ten point scale, with hypnosis reducing pain by a mean of 4.8 units, compared to 3.7 for acupuncture (p = 0.26). Patient characteristics appeared to impact the effectiveness of treatment: patients with acute pain benefited most from acupuncture treatment, whereas patients with psychogenic pain were more likely to benefit from hypnosis. Patients with chronic pain had more variation in their results. Patients who received healing suggestions from a tape during a hypnotic trance benefited more than those who received no such suggestion, and acupuncture patients who were needle phobic benefited less than those who were not fearful of needles. This study demonstrates the benefits of well designed studies of the effectiveness of these alternative modalities. More work is needed to help practitioners identify which patients are most likely to benefit from these complementary therapies.

[Studies on the cell suspension culture of Saussarea medusa in a stirred tank bioreactor]

The cell suspension culture of Saussarea medusa in a 2L aerated and agitated bioreactor with a four-pitch-blade impeller was investigated. The effects of agitation speed, aeration and inoculum size on cell growth and flavonoids production were studied and it was found that cells had optimum growth and flavonoids production when cultivated at 75 r/min, 700-1000 L/min and an inoculum of 4.0-5.0 g/L. A high cell biomass of 13.8 g/L and flavonoids production of 416 mg/L were achieved after 12 days of cultivation. Time course study revealed that flavonoids biosynthesis was growth-associated. The studies on aggregates size distribution in the bioreactor showed that the aggregates break-up caused by hydrodynamic stress might adversely affect cell growth and lead to significant reduction of cell biomass and flavonoids production.

Serum TNFalpha levels in patients with acute graft-versus-host disease after bone marrow transplantation

Tumor necrosis factor alpha (TNFalpha) has been implicated in the pathogenesis of graft-versus-host disease (GVHD). In this study, serum levels of TNFalpha were assessed by ELISA in 243 sera samples from 40 patients who had undergone allogeneic bone marrow transplantation (BMT). Serum TNFalpha levels were measured before BMT and at different time points after BMT. The results were correlated with acute GVHD (aGVHD), infection and conditioning regimen. Serum TNFalpha levels were significantly higher in patients with grades II-IV aGVHD than in those with grade 0 or I aGVHD, but there was no clear correlation between serum TNFalpha and severity of aGVHD. Serum TNFalpha levels in infected patients were not statistically different from those in patients without infection. The conditioning regimen did not cause a significant rise in TNFalpha levels. These results indicate that TNFalpha may be useful for the diagnosis of aGVHD and for differentiating between aGVHD and other BMT-related complications, such as infection.

Characterization and functional significance of calcium transients in the 2-cell mouse embryo induced by an autocrine growth factor

Growth of preimplantation embryos is influenced by autocrine trophic factors that need to act by the 2-cell stage, but their mode of action is not yet described. This report shows that late zygote and 2-cell stage mouse embryos responded to embryo-derived platelet-activating factor (PAF) with transient increases in intracellular calcium concentration ([Ca(2+)](i)). [Ca(2+)](i) transients were single global events and were specifically induced by embryo-derived PAF. They were blocked by inhibition of phospholipase C (U 73122) and an inositol trisphosphate (IP(3)) receptor antagonist (xestospongin C), indicating the release of calcium from IP(3)-sensitive intracellular stores. Transients were also inhibited by the absence of calcium from extracellular medium and partially inhibited by treatment with dihydropyridine (nifedipine, 10 micrometer), but not pimozide (an inhibitor of an embryonic T-type calcium channel). (+/-)BAY K8644 (an L-type channel agonist) induced [Ca(2+)](i) transients, yet these were completely inhibited by nifedipine (10 micrometer). The complete inhibition of BAY K8644, but only partial inhibition of PAF by nifedipine shows that L-type channels were only partly responsible for the calcium influx. Depolarization of 2-cell embryos by 50 mm K(+) did not inhibit PAF-induced calcium transients, showing that the influx channels were not voltage-dependent. Depletion of intracellular calcium stores by thapsigargin revealed the presence of store-operated channels. The interdependent requirement for IP(3)-sensitive internal calcium stores and extracellular calcium in the generation of PAF-induced transients may be explained by a requirement for capacitative calcium entry via store-operated channels. A functionally important role for the PAF-induced transients is supported by the observation that inhibition of [Ca(2+)](i) transients by a PAF-antagonist (WEB 2086) or an intracellular calcium chelator (1,2-bis(2-aminophenoxy)-ethane-N,N,N',N'-tetraacetic acid tetrakis-acetoxymethyl ester; BAPTA-AM) caused marked inhibition of early embryo development. Growth inhibition by BAPTA-AM was relieved by addition of exogenous PAF.

Acupuncture/acupressure to treat gagging dental patients: a clinical study of anti-gagging effects

Noninvasive methods advocated by some clinicians are not very successful in dealing with patient gagging, while sedation approaches run the risk of the patient aspirating foreign bodies. The P-6 Neikuan acupuncture point, located on the wrist, has been used in the Far East for thousands of years for its anti-nausea and anti-anxiety properties. In the West, it is the acupuncture point most studied. Only recently has interest been shown in the P-6 point for its possible anti-gagging effect. The anti-gagging effect of P-6 stimulation is documented in this article. The P-6 point has remarkable anti-gagging effects if stimulation is applied correctly. Clinicians may apply thumb pressure at the P-6 point to achieve some effect, although this is not as effective as acupuncture. Nevertheless, a substantial percentage of gagging patients would be able to go through dental procedures without gagging when the P-6 point is stimulated.

Clinical management of needle-phobia patients requiring acupuncture therapy

Both acupuncture and hypnosis have their distinct applications in the health profession, but combining acupuncture therapy with hypnosis has rarely been done for the purpose of therapeutic treatment, perhaps because few clinicians have proper training in both disciplines. For needle phobic patients, acupuncture treatment can be a dreadful experience, as multiple needles are usually used. It is stressful for both clinicians and patients when the patients are put in an extremely apprehensive state. Our research for combining both acupuncture and hypnosis has revealed that synergy does exist in both, and that hypnosis does augment the effect of acupuncture, resulting in better treatment outcomes. Since many acupuncture patients who are needle phobic do not return for further treatment even though acupuncture has rendered good therapeutic results for them, stress reduction with hypnosis is, therefore, a welcome complimentary adjunct that would enable them to return for further needed acupuncture treatment if and when the factor of fear of the needle is removed.

Asian Pacific cooperative study of allogeneic bone marrow transplantation

The first cooperative study of the Asian Pacific bone marrow transplantation group included 75 patients with early leukemia who received human leukocyte antigen-matched sibling bone marrow transplants and were randomized into granulocyte colony-stimulating factor and control groups. The selected patients were registered from 10 centers in six countries and areas within Asia (Beijing, Taipei, Hong Kong, Japan, Korea, and Malaysia). The incidence of grades II-IV acute graft-vs.-host disease was 22.2%, and the 2-year survival rate was 62.7%. The period of protective isolation (27.1-66.7 days), period of hospitalization (38.6-130.5 days), and medical costs for 4 months (US $10,300-US $80,803) varied considerably. Good cooperation, i.e., low rate of protocol violation or rapid and precise presentation of case reports, was obtained.

Hypnosis and pharmacological sedation for medically compromised patients

Sedating medically compromised patients (i.e., geriatric patients, patients with cardiac, kidney, or liver diseases, and those with other severe systemic conditions) for dental procedures can increase the risk of adverse events for this group of patients and can also increase the risk of liability for the clinician. The authors treated 17 apprehensive dental patients with a combination technique using hypnosis and sedative drugs. The use of hypnosis reduced the amount of sedative agent required and alleviated patient anxiety. The results indicate that hypnosis effectively allows for a reduction in the sedative dosage and provides successful and comfortable dental treatment.

Augmenting sedation with hypnosis in drug-dependent patients

The successful use of conscious sedation in patients physically dependent on centrally acting drugs is problematic for the dental anesthesiologist because of the concomitant development of tolerance to standard sedative agents. Dosage requirements necessary to adequately sedate these patients are often higher than recommended and carry an increased risk of drug overdose. The following report summarizes our experience with 18 drug-dependent patients in whom hypnosis was employed in conjunction with a standard sedation regimen. Attempts to complete various dental procedures while employing sedation alone on these patients had previously failed. All patients exhibited highly fearful or phobic behavior toward dental treatment as assessed by the Corah Dental Anxiety Scale. If an intravenous sedative regimen (midazolam or diazepam plus methohexital) was employed, hypnotic induction preceded the administration of the sedative drugs. If an intramuscular sedative regimen was employed (meperidine plus promethazine), the hypnotic induction took place after drug administration. With the combined hypno-sedative approach, treatment outcomes were judged to be good or excellent in 11 of 18 patients. Interestingly, in five of seven patients for whom the treatment outcome was rated poor or fair, the possibility of tolerance or cross-tolerance existed between a drug being abused and the sedative regimen. In contrast, this possibility existed in only 1 of 11 patients with good or excellent treatment outcomes. We conclude that hypnosis can augment the effects of sedation in this patient population. However, it is also important to choose a sedative regimen where tolerance is unlikely to exist.

Safety, efficacy, and acceptance of intramuscular sedation: assessment of 900 dental cases

Intramuscular (IM) sedation techniques remain the least used by clinicians, possibly because of their limited exposure in the undergraduate and graduate dental curricula. To assess the safety and efficacy of these techniques, the authors conducted a retrospective study of 900 dental cases. A total of 308 patients received ketamine, 356 received a meperidine/promethazine combination, and 236 received midazolam. Results revealed a high safety record, efficacy, and good evaluations from clinicians and patients, in addition to some advantages over other sedation techniques.

Intra-canal dissolution of Sargenti paste

Although the efficacy and safety of the Sargenti technique have remained controversial for more than a decade, the technique still is widely used by many dentists throughout the world. The following report describes a retrospective analysis of 367 cases that looked at the contribution of instrumentation technique and fill adequacy to paste dissolution.

Bone marrow transplantation in the People's Republic of China. Chinese Bone Marrow Transplant Registry

Bone marrow transplantation, both allogeneic and autologous, has been undertaken in People's Republic of China (PRC) since the beginning of 1980s at a steadily increasing rate. Eight BMT units can be regarded as active. Altogether 230 cases of allogeneic- and syngeneic-BMT have been reported to the Chinese BMT Registry (CBMTR) by the end of October 1993. More than 85% of the cases were acute or chronic leukemia. The incidence of acute grade II-IV GVHD was 29.5% in matched sibling BMT. The special problems of BMT in China include decreasing family size, financial difficulties and relatively high incidence of various viral infections. A number of unique approaches to treatment have been tested with benefit including mixed infusion of fetal cells for prophylaxis of acute GVHD and intravenous placental globulin for the treatment of chronic GVHD. Garlic ingredient has been shown to be effective against CMV and has been used in the clinic with encouraging results. The overall outcome of allogeneic and autologous BMT are comparable to those in the other major BMT centers in the world.

[Intravenous placental immunoglobulin for treatment of chronic graft versus host disease]

Intravenous placental immunoglobulin (IV Pt IG) was used for the treatment of chronic graft versus host disease (CGVHD) in 30 patients who are refractory to steroid and cyclosporinic A. 15 (50%) patients showed excellent response and 11 (36.66%) good response. The total response rate is 86.66%. The dosage of IV Pt IG was 4 gm/day in adults by intravenous infusion. Effectiveness of IV PtIG was discerned within 2 weeks. The plasma levels of IgG, IgA and IgM were tested before and after IV PtIG treatment. There was no significant statistical difference between the plasma IgG, IgA, IgM levels in pre- and post-treatment period. The efficacy of IV PtIG against CGVHD is therefore ascribed to its pharmacological effect.

Alternative method for removing gutta-percha from canals

A simple method of removing gutta-percha from root canals has been presented. This method is less time consuming, and may reduce some of the complications that result from endodontic retreatment.

The use of hypnosis for smooth sedation induction and reduction of postoperative violent emergencies from anesthesia in pediatric dental patients

Hypnosis combined with chemical sedation is uncommonly utilized by physicians, however, the combination of hypnosis and sedation can be an effective modality in the management of uncooperative pedodontic patients. In order to examine the efficacy of this combination technique, we selected 13 pedodontic patients for Ketamine sedation combined with hypnosis. The patients ranged from four to 11 years of age, and all had previous histories of violent emotional reactions before and after dental treatment. We found the combination technique to be extremely effective in successfully overcoming the stressful and frightening aspects of dental care for these pedodontic patients.

Demonstration of the anti-viral activity of garlic extract against human cytomegalovirus in vitro

The in vitro anti-viral activity of garlic extract (GE) on human cytomegalovirus (HCMV) was evaluated by tissue culture, plaque reduction and early antigen assay. A dose dependent inhibitory effect of GE was evident when GE was applied simultaneously with HCMV. But the effect was stronger when the monolayers were pretreated with GE. In addition, the anti-viral effect of GE persisted long in infected cells after its being removed from the culture medium. The strongest anti-viral effect of GE was demonstrated when it was applied continuously. It is therefore recommended that clinical use of GE against HCMV infection should be persistent and the prophylactic use of GE is preferable in immunocompromised patients.

A chemomechanical system for caries removal and glass ionomer cement to restore fixed partial denture abutments

When a fixed partial denture fails due to recurrent caries under the casting of the abutments, a remake process usually requires a great deal of cooperation, multiple lengthy appointments, and financial resources. Many patients with special needs may not have the cooperation, tolerance, and resources to support such treatment. This paper describes an alternative method that utilizes a chemomechanical system for caries removal followed by a conventional restorative material to treat those patients.

Allogeneic bone marrow transplantation for the treatment of leukemia

Eighteen patients with leukemia have received HLA-identical allogeneic bone marrow transplantation (BMT) at our hospital since 1981. Fifteen of these patients have been living without relapse. for prophylaxis of GVHD, MTX was used in 8 patients, and cyclosporine (CSP) together with MTX in 6 patients, 3 received multiple agents at much smaller dosage, including monoclonal antibody. All patients received intravenous placental gamma-globulin, and 16 received garlic extract. Three patients died. One, who neither received MTX, nor CSP died of hyperacute GVHD, one who did not receive garlic extract died of GMV pneumonia, and the third one died of tuberculosis 18 months after BMT.

Activity of human placental gamma globulin in blocking immune functions in vitro and in abrogating the xenogeneic, local graft-versus-host reaction

In order to understand the mechanism of immunosuppression caused by infusion of placental gamma globulin (PGG) in patients with renal allografts, rheumatoid arthritis, and graft-versus-host disease (GVHD) following bone marrow transplantation (BMT), we have examined the effect of PGG in vitro and in a model of the xenogeneic, local graft-versus-host reaction (LGVHR). PGG inhibited lymphocyte proliferation in mixed lymphocyte cultures (MLC) (P less than 0.005) and depressed interleukin-2 (IL-2) levels in such cultures at 72 hours (P less than 0.01). In contrast phytohemagglutinin (PHA)- and pokeweed mitogen (PWM)-induced T and B lymphocyte blastogenesis was not affected by such PGG treatment. PGG neither decreased the [3H] TdR pulse incorporation in unstimulated lymphocytes nor affected cell viability. Cell cycle analysis by flow cytometry showed that PGG reduced the percentage of cells in S and G2, M phases during the MLC, but did not alter cell cycling during PWM-stimulated proliferation. An immunosuppressive effect of PGG on the LGVHR was tested in a model of intracutaneous transplantation of PGG-treated human lymphocytes into cyclophosphamide-immunosuppressed rats. Lymphoprep-separated human tonsillar lymphocytes were incubated with RPMI-1640 buffer containing: (1)PGG, 4 mg/ml, (2) human plasma albumin, 4 mg/ml, (3) mitomycin-C, 25 micrograms/ml, or (4) no additive. Cells of each preparation (3 X 10(7) cells in 0.1 ml) were injected intracutaneously into cyclophosphamide-treated male rats at separate abdominal locations. A fifth site received only the buffer solution. Five days after injection of cells, each rat received [125I]UdR (10 muCi) intraperitoneally and was killed after 5 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Synthesis of 6-deoxymaltooligosaccharides and a study of their lipid-binding properties

Amylose reacted in N,N-dimethylformamide with crystalline bromomethylenedimethylammonium bromide (Vilsmeier bromide) to give 6-bromo-6-deoxyamylose with a high degree of substitution. Reduction of the bromoamylose with sodium borohydride yielded 6-deoxyamylose that, following controlled acetolysis, gave 6-deoxymaltooligosaccharides. Such oligosaccharides, of appropriate chain-length, formed stable complexes with long-chain fatty acids that have a dissociation constant of about 2 microM in their interaction with parinaric acid (trans-9,11,13,15-octadecatetraenoic acid). Treatment of 6-bromoamylose with sodium methoxide in dimethyl sulfoxide produced a 3,6-anhydroamylose that contains few unaltered D-glucose units. This anhydroamylose also bound to a palmitoyl-resin column, suggesting that the polymer may be partially helical and somewhat lipophylic. Finally, reaction of 6-bromoamylose with methylvinyl ether led to the 2,3-di(methoxyethyl) ether that, on reaction with sodium methoxide, gave the 6-methyl ether from which 6-O-methylamylose was obtained by mild acid hydrolysis.

Intentional replantation of periodontally involved and endodontically mistreated tooth

This article presents a case in which a tooth was intentionally replanted after it was endodontically mistreated; there was also a severe periodontal involvement. The unusually long period of time that the tooth survived might be attributed to a different approach to the replantation technique, such as occlusion adjustment prior to replantation, preoperative reduction of oral cavity bacteria and of the harmful aerosols commonly found in the dental operatory, placement of a noneugenol periodontal packing under the acrylic splint to prevent residual liquid monomer from seeping into the periodontal space, use of the patient's own blood and no other material to moisten the root while it was out of the socket, a short extraoral period, loose splinting, complete isolation of the operative site in the oral cavity, and completion of periodontal therapy before intentional replantation.

Halitosis: an etiologic classification, a treatment approach, and prevention

Halitosis, a condition that causes a severe social handicap to those who suffer from it, has a multifactorial etiology. Since patients with this condition seek professional consultation from dentists much more frequently than from physicians, dentists, who treat diseases of the oral cavity, should have an understanding of the local as well as the systemic factors which cause halitosis. This article presents an extensive review of the information available, with an etiologic classification of this condition to help clinicians develop the diagnostic acumen to distinguish one type of halitosis from another. Once the etiology of this condition is ascertained for the patient who suffers from it, treatment can be readily rendered.