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PI Lobo C Spencer MT Douglas WC Stevenson TL Pruett 《Canadian Metallurgical Quarterly》1993,55(5):1063-1066
Recent reports indicate a higher incidence of both acute and chronic liver allograft rejection when, at the time of transplantation, the recipients serum contains donor-specific anti-HLA antibodies. From 9/89 to 5/91, 133 liver allografts were performed at our institution. Thirteen liver recipients had donor-specific IgG anti-HLA antibodies (complement-fixing) at the time of transplantation. In eleven patients, antibodies reacted to donor class I antigens while in 1 patient the donor-specific antibody had class II reactivity. Twelve patients have been followed for a minimum of 12 months (median 18 months, range 28-12 months). No hyperacute rejection was seen in any of the cases and four patients had acute rejections. Thus far only one of the twelve patients has biopsy evidence suggestive of chronic liver injury. The remaining have normal liver enzymes and bilirubin. Three of these twelve patients died (one from a myocardial infarction and the others from sepsis) accounting for a one-year graft survival of 75%. There was no significant statistical difference in the one-year graft survival in those recipients without donor-specific antibodies (i.e., 80.5%). In eight of the twelve patients, pretransplant preformed antibody level (PRA) was > 50%. In six of the thirteen patients donor-specific antibody was present at dilutions greater than 1:64. As previously reported, the donor-specific antibody disappeared from the serum posttransplant within hours and did not reappear. In vitro studies demonstrated no factor in portal or hepatic artery blood that could inhibit rabbit complement mediated lysis of anti-HLA antibodies. We conclude that it is not a contraindication to do liver transplants in the presence of donor-specific anti-HLA antibodies. 相似文献
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BACKGROUND: Despite recognition of the high prevalence of alcoholism among patients with head and neck cancer, the prognostic importance of alcoholism has not been evaluated adequately. Previous investigators have speculated that alcoholic patients may have a poorer prognosis than nonalcoholic patients because of more advanced stage of cancer, the immunosuppressive effects of alcohol, and an increased rate of death due to other alcohol-related diseases. PURPOSE: The goal of this population-based study was to identify the features of alcoholism that are associated with survival for patients with head and neck cancer and to develop an alcoholic severity staging system from a composite of the independent features of alcoholism. METHODS: This prospective study included 649 patients who were diagnosed with cancer of the oral cavity, oropharynx, hypopharynx, or larynx during the period from September 1, 1983, through February 28, 1987, in a three-county area of western Washington state that participates in the Surveillance, Epidemiology, and End Results Program of the U.S. National Cancer Institute. Details on lifetime alcohol consumption, treatment for alcoholism, abstinence from alcohol prior to the diagnosis of cancer, and alcohol-related health problems were ascertained through in-person interviews near the time of diagnosis. Patients were classified as either nonalcoholics or alcoholics according to their responses to questions from the Michigan Alcoholism Screening Test. The measures of alcohol consumption and abuse that were found to be independently associated with 5-year survival by logistic regression analysis were combined using conjunctive consolidation to create a final composite variable, called an alcoholic severity stage. Cox proportional hazards regression analysis was done to estimate the relative risk (R) of death within 5 years due to specific causes of death for each of the alcoholic severity stages. RESULTS: Alcoholism (RR = 2.06; 95% confidence interval [CI] = 1.43-2.98) and a history of alcohol-related systemic health problems (i.e., liver disease, pancreatitis, delirium tremens, or seizures) (RR = 2.76; 95% CI = 1.69-4.49) were associated with an increased risk of death, whereas abstinence (i.e., the consumption of fewer than one drink per week at 1 year prior to the diagnosis of cancer) (RR = 0.62; 95% CI = 0.39-0.97) was associated with a decreased risk of death. These associations were independent of age, site of cancer, anatomical stage, histopathologic grade, smoking, and type of antineoplastic treatment. Patients in the two worst alcoholic severity stages had an increased risk of dying not only of head and neck cancer but also of cardiovascular disease, pulmonary disease, and other alcohol-related causes. CONCLUSIONS: Alcohol abuse, measured by alcohol consumption, functional impairment, a history of alcohol-related health problems, or abstinence, can provide important prognostic information for patients with head and neck cancer. Our results suggest that sobriety among alcoholic patients can lead to prolonged survival. 相似文献
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PURPOSE: To demonstrate a superselective intraarterial chemotherapy as a therapeutic alternative in the treatment of previously treated recurrent lymph node metastases in breast cancer. METHODS: 14 patients with recurrent lymph node metastases in cases of breast cancer were presented to be treated by intraarterial chemotherapy of 25 mg mitoxantrone/m2 over a period of 24 hours. In two patients with superclavicular lymph node involvement an intraarterial therapy could not be carried out because of a vascular connection to the anterior spinal artery. Involved lymph stations could be reached in superselective technique by side branches of the subclavian artery. Heparin coverage was given intravenously. Every patient had had surgery, radiation, systemic chemo- and hormonal therapy before and was now graded as inoperable. Therapy indication was given by local tumour-induced symptoms. RESULTS: In the 12 treated cases complete remission was seen in three, partial remission in 4, a steady state in two and a progressive disease in three. There were no complications or severe side effects. CONCLUSION: Intraarterial chemotherapy is an effective and well tolerated treatment in recurrent lymph node metastases in cases of breast cancer even if conventional therapies can no longer be used. 相似文献
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This article critically analyzes social psychology's assumption that psychological states can explain social behavior. On the basis of an analysis of the logic of classification systems, the author argues that there are no procedures available to independently verify the existence of these psychological states. As a consequence, explanations of social behavior are subject to continual challenge and replacement. Furthermore, it is argued that focusing on psychological states serves to inhibit the systematic study of societal changes (particularly changes in technology) that are affecting and shaping all aspects of human existence. This article describes an alternate paradigm that coordinates one dimension of societal events—technology—with changes in people's consciousness and subsequent behavior. A taxonomy of technology is described in the closing section of the article. (PsycINFO Database Record (c) 2010 APA, all rights reserved) 相似文献
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The benefits of using a comprehensive annotation strategy (employing underlining/circling, making connections, asking questions, and making comments) with knowledge maps (spatial/verbal arrays) and traditional, linear text to improve free recall scores for learners with individual differences in vocabulary and comprehension ability were examined. Types and frequencies of annotations generated were also examined for each stimulus format condition. Multiple regression analyses indicate that the frequency of use of two component annotation strategies, asking questions and making connections, were significant predictors of recall scores, while frequency of underlining/circling and generating elaborations failed to predict recall scores. Text users generated more underlining/circling, while knowledge map users generated more connections between ideas, suggesting that knowledge maps may facilitate the application of more productive annotation strategies. Also examined were the interrelationships between vocabulary ability, comprehension ability, and free recall scores. Copyright 1997Academic Press 相似文献
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Considerable scholarly effort in social psychology is devoted to the development of techniques that change behavior. In this article, the social and political forces that have guided the development of these techniques are examined. Also, ethical and psychological issues associated with the use of behavior technologies are discussed. These issues arise from the fact that to change behavior, it must first be controlled. (PsycINFO Database Record (c) 2010 APA, all rights reserved) 相似文献
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K Okano S Wu X Huang CJ Pirola H Juppner AB Abou-Samra GV Segre K Iwasaki JA Fagin TL Clemens 《Canadian Metallurgical Quarterly》1994,135(3):1093-1099