Report of a case with twin anemia-polycythemia sequence and literature review / 中华儿科杂志

<p><b>OBJECTIVE</b>To summarize and review the clinical characteristics including clinical features, prenatal characteristics, diagnosis, treatments and short-term outcomes of the twin anemia-polycythemia sequence (TAPS) to improve the recognition of the disease.</p><p><b>METHOD</b>The clinical data of one case with twin anemia-polycythemia sequence and the reports of 15 cases seen in the past 5 years were reviewed and analyzed.</p><p><b>RESULT</b>There was an increasing number of reports of cases with TAPS. Prenatal manifestation: among the 16 cases, TAPS occurred in 13 cases naturally and in 3 cases occurred after laser treatment. Amniotic fluid volume showed no significant difference in 16 cases. Middle cerebral artery peak systolic velocity (MCA-PSV) > 1.5 multiples of the median (MoM) in the donor were 11/16 cases and 3/16 cases were not tested. MCA-PSV < 1.0 MoM in the recipient were seen in 10/16 cases and in 3/16 cases MCA-PSV was not tested. Hydrops fetalis was found in 6/16 cases. Intrauterine intervention: intrauterine blood transfusion was performed in 4/16 cases, fetoscopic laser occlusion of chorioangiopagus vessels was performed in 4/16 cases, umbilical cord occlusion selective feticide was done in 2/16 cases and intrauterine hemodilution in the recipient was performed in 1/16 case. Postnatal manifestation: average hemoglobin concentration in the anemic neonate was 95 g/L and in the polycythemic one was 208 g/L, intertwin Hb difference was > 80 g/L in 10/16 cases and < 80 g/L in 2/16 cases (after intrauterine laser treatment). Intertwin reticulocyte count ratio was > 1.7 in 5/16 cases and < 1.7 in 1/16 case (after intrauterine laser treatment). Postnatal treatment: 9/16 cases of donor had anemia, among them, 6/16 cases were given blood transfusions, 6/16 cases of recipient with hyperviscosity underwent partial exchange transfusions. Neurodevelopmental follow-up during neonatal period was normal in 11/16 cases, in our case, neurodevelopmental follow-up at the corrected gestational age 3 months was normal.</p><p><b>CONCLUSION</b>TAPS is a new atypical form of twin-twin transfusion syndrome (TTTS) that presents as a large intertwin hemoglobin difference with one twin developing anemia and the other developing polycythemia, without oligohydramnios-polyhydramnios sequence that is required for the diagnosis of TTTS. We suggest that routine doppler studies and MCA-PSV measurements should be performed during each follow-up visit in all uncomplicated monochorionic twin pregnancies, in order to find out the cases required intrauterine intervention to decrease neonatal mortality rates and improve the prognosis.</p>

Study of Cine-MRI for the soft palate in patients with obstructive sleep apnea hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study dynamic change and pathophysiology of airway obstruction of the soft palate in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) during wakefulness and natural sleep.@*METHOD@#Sixteen patients who were diagnosed as OSAHS by sleep questionnaires, medical examination and polysomnography were enrolled in this study in Shanghai Tenth People' Hospital from May to December during 2007. All patients were requested to keep awake prior to examination. Sequential midline sagittal images of the upper airway were obtained during awake and asleep state with Cine-MRI and been transmitted to portable computer. Morphologic change of the soft palate, the anterior-posterior pendulum angle of the soft palate, the anteroposterior diameter and the length of soft palate were measured. Statistical analysis was performed with paired t-test.@*RESULT@#During wakefulness: soft palate caused obstruction by floating backwards and widening anteroposterior diameter(distance between hard palate and uvula P > 0.05, included angle of hard palate and segmental vente of uvula P 0.05, included angle of hard palate and segmental dorsum of uvula P > 0.05, difference of included angle P < 0.01). Main obstruction site was on retroglottal region.@*CONCLUSION@#Morphologic change of soft palate in patients with OSAHS is multiple, and level of obstruction is deeper during natural sleep than during wakefulness. Main reason of airway obstruction is distinct during different state. The obstruction of upper airway of patients with OSAHS during wakefulness can't replace that during natural sleep.

Peripheral blood stem cell mobilization with low dose rhG-CSF in 56 unrelated healthy donors / 中国实验血液学杂志

The study was aimed to observe the effect of recombinant human granulocyte-colony stimulating factors (rhG-CSF) in low dose on peripheral blood stem cell (PBSC) mobilization in unrelated healthy normal donors. G-CSF was administered at 5 microg/(kg x d) subcutaneously for successive 5 or 6 days to 56 unrelated donors. Stem cells were harvested on the fourth and fifth days or on the fifth and sixth days. The numbers of mononuclear cells (MNC), CD34(+) cells and Hb, Plt, and CD3(+), CD4(+), CD8(+) and CD20(+) cells were determined during the mobilization. The results showed that most common adverse events were bone pain (17.9%, 10/56), agrypnia (8.9%, 5/56) and lassitude (4.5%, 3/56) during rhG-CSF mobilization, but all donors were suffered less than grade II according to the WHO criteria, and did not need to stop the mobilization and not need to give special treatment. In harvest on day 4 - 5 and 5 - 6, MNC count was (5.95 +/- 1.52) x 10(8)/kg and (7.19 +/- 2.12) x 10(8)/kg; CD34(+) cells count was (3.03 +/- 1.09) x 10(6)/kg and (7.92 +/- 2.50) x 10(6)/kg. There were no significant differences in hemoglobin level and platelet count, the percentage of CD3(+) cells, CD4(+) cells, CD8(+) cells and CD20(+) cells between pre-mobilization and post-mobilization of rhG-CSF. It is concluded that the low dose of rhG-CSF 5 microg/(kg x d) for peripheral blood stem cell mobilization in unrelated healthy normal donors is safe and effective.