摘要
Objective:To investigate the safety and efficacy of haplo-identical hematopoietic stem cell transplantation (haplo-HSCT) conditioning with the same dosage form of antithymoglobulin (ATG) in patients with severe aplastic anemia (SAA) failure to ATG.Methods:This was a retrospective cohort study. A total of 65 patients with SAA who failed ATG treatment and received haplo-HSCT conditioning with the same dosage of ATG at the Institute of Hematology, Peking University People′s Hospital between July 2008 and October 2020 were included as the ATG treatment failure group. An additional 65 SAA patients who applied ATG for the first time during haplo-HSCT were randomly selected by stratified sampling as the first-line haplo-HSCT group. Baseline clinical data and follow-up data of the two groups were collected. Conditioning-related toxicity within 10 days after ATG application and long-term prognosis were analyzed. The Kaplan-Meier was used to calculate the overall survival rate, and the Log-rank test was applied to compare the rates of the two groups.Results:In the ATG treatment failure group, there were 36 males and 29 females, and the age at the time of transplantation [ M ( Q1, Q3)] was 16 (8, 25) years. In the first-line haplo-HSCT group, there were 35 males and 30 females, with a median age of 17 (7, 26) years. Within 10 days of ATG application, the incidence of noninfectious fever, noninfectious diarrhea, and liver injury in the ATG treatment failure group was 78% (51 cases), 45% (29 cases), and 28% (18 cases), respectively, and in the first-line haplo-HSCT group was 74% (48 cases), 54% (35 cases), and 25% (16 cases), respectively; the difference between the two groups was not statistically significant for any of these three parameters (all P>0.05). For graft-versus-host disease (GVHD), there was no significant difference between the ATG treatment failure group and the first-line haplo-HSCT group in the development of 100 day Ⅱ to Ⅳ acute GVHD (29.51%±0.35% vs. 25.42%±0.33%), Ⅲ to Ⅳ acute GVHD (6.56%±0.10% vs. 6.78%±0.11%), and 3-year chronic GVHD (26.73%±0.36% vs. 21.15%±0.30%) (all P>0.05). Three-year overall survival (79.6%±5.1% vs. 84.6%±4.5%) and 3-year failure-free survival (79.6%±5.1% vs. 81.5%±4.8%) were also comparable between these two groups (both P>0.05). Conclusions:Compared with no exposure to ATG before HSCT, similar early adverse effects and comparable survival outcomes were achieved in patients with SAA who failed previous ATG treatment and received haplo-HSCT conditioning with the same dosage form of ATG. This might indicate that previous failure of ATG treatment does not significantly impact the efficacy and safety of salvaging haplo-HSCT in patients with SAA.
摘要
BACKGROUND:Vacuum sealing drainage is currently considered as a safe and effective for fasciotomy wounds in the treatment of compartment syndrome. But the wounds after treatment are often not self-closed, which needs skin grafts that can cause secondary injury. Studies have shown that shoelaces technology is useful for leg fasciotomy wounds in the surgical treatment of lower leg compartment syndrome, but so far there are few domestic reports. OBJECTIVE:To compare the vacuum sealing drainage and shoelace technique for treatment of leg fasciotomy wounds. METHODS:A total of 36 patients, with 46 leg fasciotomy wounds, were randomized into vacuum sealing drainage and shoelace technique groups, 23 wounds in each group. In the vacuum sealing drainage group, patients were subjected to vacuum sealing drainage after fasciotomy based on fracture reduction and external fixation;in the shoelace technique group, the fasciotomy wounds were covered with polyethylene/ethanol hydrated seaweed salt foam fol owed by shoelace technique. After 1 month, wound size, wound closure time, infection, further intervention and daily treatment cost were compared between the two groups. RESULTS AND CONCLUSION: Wound closure time was significantly higher in the vacuum sealing drainage group compared to the shoelace technique group (P < 0.05). Eight wounds in the vacuum sealing drainage group required skin grafts; while, no skin graft was necessary in the shoelace technique group. In the shoelace technique group, the vessel loops had to be replaced in five wounds. There was no wound infection, increased compartment pressure and skin flap necrosis postoperatively in both two groups. Both vacuum sealing drainage and the shoelace technique are safe, reliable and effective methods for closure of leg fasciotomy wounds. Vacuum sealing drainage requires longer time to definite wound closure and is far more expensive than the shoelace technique, especially when additional skin grafting is required.
摘要
Objective To study the stability of the toxicity,antigenicity and immunogenicity of Neisseria meningitidis serogroup A/C[CMCC(B)29201/29205],and to analyze the quality of the capsular polysaecharide extracted from Neisseria meningitidis.Methods The toxicity of the 3rd,5th,10th,15th,20th,25th and 30th passage of the Neisseria meningitidis was assayed in mice,and the antigenicity of each passage was measured by the tube agglutination test(TAT)and ELISA.The effect of individual 30 passages of Neisseria nveningitidis on the brain tissue and the immunogenicity of each passage were tested in mice,and the capsular polysaccharide was purified and analyzed.Resuits The LD50 of the strains CMCC(B)29201/29205 of each passage was low(≥109/ml),and all the 30 passages of the two strains had no effect on the brain tissue of the mice.The titer of each passage was 1∶320 in TAT and more than 1∶3752 in ELISA.After immunization with individual 30 passages of the Neisseria meningitidis the titers in serum bactericidal assay (SBA)were all more than 1∶32.The capsular polysaccharide purified from Neisseria meningitidis met the quality standard of the requirement.Conclusion The strains of Neisseria meningitidis serogroup A/C used in the manufacture of the meningococcal conjugate vaccine,are stable in the toxicity,antigenicity and immunogenicity.And the capsular polysaccharide has met the quality standard.