scholarly journals Use of Cryopreserved Allogeneic PBSC Results in Delayed Engraftment and Increased Incidence of Poor Graft Function

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1778-1778
Author(s):  
Samar Kulkarni ◽  
John Murray ◽  
James Clarke ◽  
Mike Dennis ◽  
Amit Patel ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Graft Function ◽  
Back Analysis ◽  
Cell Loss ◽  
Blood Component ◽  
Published Data ◽  
Poor Graft Function ◽  
Group A ◽  
Group B ◽  
The Impact

Abstract Use of Cryopreserved Allogeneic PBSC Results in Delayed Engraftment And Increased Incidence of Poor Graft Function Introduction: During COVID Pandemic, national and international transplant centres agreed to use cryopreserve the donor PBSC as a safer option to deliver allogeneic transplants. Published data suggests that use of cryopreserved allogeneic PBSC is safe and comparable to use of fresh PBSC but cryopreservation of stem cells may lead to cell loss and hence efficacy. During COVID pandemic, use of cryopreserved allogeneic PBSC was adopted as policy on 01/06/2020. This look back analysis evaluates the impact of change in policy. Aims: Evaluate Engraftment time, compare with historical data, blood component support, and use of growth factors Methods and Materials: Data was collected from health records (paper and electronic) and laboratory records. Transplant features and engraftment kinetics were analysed. Results: Group A June 2020 to November 2020, 19 patients [M: 13; F: 6; median age: 50yr (range: 23-69)] who received cryopreserved allogeneic PBSC were compared to 35 patients [M:24; F:11; median age: 59yr (range: 21-71)] receiving fresh allogeneic PBSC for engraftment kinetics. There were no differences between two groups regarding underlying diagnosis (p=0.31), sex mismatch, CMV mismatch, blood group mismatch, reduced intensity conditioning [RIC](p=0.28), type of donor (p=0.98) or use of Alemtuzumab (p=0.88). Median infused Cell dose in group A was 5.3 (3.4-7.16) and in group B 4.9 (1.03-6.85), [p=0.11]. Neutrophil engraftment was significantly faster with fresh PBSC as compared to cryopreserved PBSC (16d vs. 25d, p=0.0025) predominantly with MUD (18d vs. 27d, p=0.009) and RIC (16d vs. 25d, p=0.009). Platelet engraftment to 25 was faster with fresh PBSC (13d vs. 20d, p=0.021) with delayed engraftment in MUD (20d vs. 13d, p=0.006) and RIC (23d vs. 13d, p=0.039). Day to engraftment per unit CD34 was shorter with fresh PBSC for neutrophils (median: 3.2, range: 2.0-7.7 vs. 5.3, range: 2.5-16.7; p=0.006) and platelets (median: 2.4, range: 1.7-25 vs. 3.8, range: 2.2-25; p=0.001) but only for MUD. This suggests 35-40% less efficiency with use of cryopreserved PBSC. There was no difference in the need for transfusion support [RBCs (6 units vs. 3 units, p=0.32); platelets (5 pools vs. 7 pools, p=0.33)]. G-CSF use was higher with cryopreserved PBSC in RIC (54% vs. 20%, p=0.031). Two patients experienced TRM before day 90 (3.7%). At day 90, 17/52 (32.7%) had cytopenia in one lineage and 8/52 (16%) had cytopenia in more than one lineage. Delayed engraftment was observed in 10 of 33 patients (30.3%) transplanted in 2020 and the only significant association was use of cryopreserved PBSC (0% vs. 53%, p=0.001). There was no difference in the incidence of aGVHD, hepatic VOD, microangiopathy and bacterial infections. Numbers are not sufficient to make disease specific comparisons. Conclusion: Cryopreserved PBSC result in delayed neutrophil and platelet engraftment predominantly with MUDS and RIC. Incidence of delayed engraftment and poor graft function is higher. Per unit CD34 dose, cryopreserved PBSC are 30-40% less efficient to achieve engraftment. Delayed engraftment with cryopreserved PBSC especially in MUD raises the possibility that time from harvest to cryopreservation contributes to reduced efficacy. Based on these findings it was decided to infuse higher CD34 dose (6-7x10^6/kg as compared to usual 4-5x10^6/kg) for cryopreserved MUD PBSC. Disclosures Bloor: Kite, a Gilead Company: Honoraria; Novartis: Honoraria.

scholarly journals Adolescents and primary herpetic gingivostomatitis: an Italian overview

2021 ◽  
Author(s):  
Elena Bardellini ◽  
Francesca Amadori ◽  
Federica Veneri ◽  
Giulio Conti ◽  
Alberto Paderno ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Antibiotic Therapy ◽  
Medical Records ◽  
Bacterial Infections ◽  
Group A ◽  
Acid Gel ◽  
Herpetic Gingivostomatitis ◽  
Group B ◽  
Italian Adolescents ◽  
Hyaluronic Acid Gel

Abstract Aim The aim of this study was to investigate the therapies administered to Italian adolescents with primary herpetic gingivostomatitis (PHGS) Methods The medical records of 74 adolescents with PHSG were reviewed. The following data were recorded: age, gender, day of onset, type of treatment, lesions’ severity, pain scoring, eating, and drinking ability. The oral examination was performed at the first evaluation (T0) and after one week (T1). Results All patients showed up at the first visit at least 48 h after the onset of symptoms. No patient was prescribed an antiviral therapy. An antibiotic therapy was prescribed in order to prevent secondary bacterial infections. Fifteen patients had been treated with non alcoholic chlorhexidine rinses (group A), 29 patients with non alcoholic chlorhexidine rinses plus hyaluronic acid gel (group B); 30 patients with non alcoholic chlorhexidine rinses plus Mucosyte® (group C). A significant improvement of the pain scoring and lesions’ severity was noted in group C. Conclusion In Italian adolescents, PHGS is diagnosed at least 48 h after onset and the antibiotic therapy is widely prescribed in order to prevent overinfections. Among topical therapies, an association of verbascoside and sodium hyaluronhate seems to favour a faster healing.

scholarly journals The Impact of Left Atrial Size in Catheter Ablation of Atrial Fibrillation Using Remote Magnetic Navigation

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Xiao-yu Liu ◽  
Hai-feng Shi ◽  
Jie Zheng ◽  
Ku-lin Li ◽  
Xiao-xi Zhao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Magnetic Navigation ◽  
Remote Magnetic Navigation ◽  
X Ray ◽  
Group A ◽  
Group B ◽  
The Impact

Objective. The objective of this study was to investigate the impact of left atrial (LA) size for the ablation of atrial fibrillation (AF) using remote magnetic navigation (RMN). Methods. A total of 165 patients with AF who underwent catheter ablation using RMN were included. The patients were divided into two groups based on LA diameter. Eighty-three patients had small LA (diameter <40 mm; Group A), and 82 patients had a large LA (diameter ≥40 mm; Group B). Results. During mapping and ablation, X-ray time (37.0 (99.0) s vs. 12 (30.1) s, P<0.001) and X-ray dose (1.4 (2.7) gy·cm2 vs. 0.7 (2.1) gy·cm2, P=0.013) were significantly higher in Group A. No serious complications occurred in any of the patients. There was no statistical difference in the rate of first anatomical attempt of pulmonary vein isolation between the two groups (71.1% vs. 57.3%, P=0.065). However, compared with Group B, the rate of sinus rhythm was higher (77.1% vs. 58.5%, P<0.001) during the follow-up period. More patients in Group A required a sheath adjustment (47/83 vs. 21/82, P<0.001), presumably due to less magnets positioned outside of the sheath. In vitro experiments with the RMN catheter demonstrated that only one magnet exposed created the sheath affects which influenced the flexibility of the catheter. Conclusions. AF ablation using RMN is safe and effective in both small and large LA patients. Patients with small LA may pose a greater difficulty when using RMN which may be attributed to the fewer magnets beyond the sheath. As a result, the exposure of radiation was increased. This study found that having at least two magnets of the catheter positioned outside of the sheath can ensure an appropriate flexibility of the catheter.

scholarly journals The Influence of the Physiotherapeutic Program on Selected Static and Dynamic Foot Indicators and the Balance of Elderly Women Depending on the Ground Stability

2021 ◽  
Vol 18 (9) ◽  
pp. 4660
Author(s):  
Joanna Matla ◽  
Katarzyna Filar-Mierzwa ◽  
Anna Ścisłowska-Czarnecka ◽  
Agnieszka Jankowicz-Szymańska ◽  
Aneta Bac
Keyword(s):  
Elderly Women ◽  
Statistical Significance ◽  
Exercise Program ◽  
Control Group ◽  
Balance Assessment ◽  
Motor Functions ◽  
Static Test ◽  
Group A ◽  
Group B ◽  
The Impact

Seniors are a constantly growing group of people in many societies. It is necessary to develop physiotherapeutic programs to improve their mobility. The aim of this study was to assess the impact of the physiotherapeutic program conducted unstable ground on selected indicators of motor functions of elderly women. Sixty women (60–80 years) participated in the research. Group A (N = 20) underwent a 12-week physiotherapeutic program on stable ground, group B (N = 20) followed an exercise program on unstable ground, and group C (N = 20) (control group) had no therapeutic intervention. The effects of the therapy were assessed by using a FreeMed platform (foot load analysis) and a Biosway balance system. The results were compared using ANOVA (the one-way analysis), the Kruskal–Wallis test and also the post hoc tests (Tukey’s test and the multiple comparison test). In group A, a statistically significant change was observed in the static test and balance assessment, in group B this was observed in the static and dynamic foot tests and balance assessment, in group C, no statistical significance was achieved. The authors’ physiotherapeutic program had a statistically significant effect on changes in the balance and selected indicators of the motor functions of the examined people. Comparing the results before and after the therapy more improvement changes were noted in women training on an unstable ground compared to women training on a stable ground.

Pharmacist Impact on Physician Practices Related to Diabetes Management

2021 ◽  
Vol 8 (4) ◽  
pp. 560-575
Author(s):  
Amina Ammar ◽  
Lindsay M. Darghali ◽  
Wassim Tarraf ◽  
Helen D. Berlie ◽  
Linda A. Jaber
Keyword(s):  
Blood Pressure ◽  
Diabetes Management ◽  
Individual Treatment ◽  
Diabetic Patients ◽  
Composite Target ◽  
Physician Practices ◽  
Physical Presence ◽  
Group A ◽  
Group B ◽  
The Impact

To examine the impact of a pharmacist’s physical presence on (1) the achievement of individual and combined targets for hemoglobin A1c (A1C), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) (composite target), and (2) physician practices in relation to the American Diabetes Association (ADA) standards of medical care.   Methods A retrospective, comparative study of randomly selected diabetic patients seen within an underserved primary care setting at least twice annually between June 1, 2018- December 31, 2019. Patients were allocated by whether they had received care in one of the physician-pharmacist clinics (Group A) or the physician-only clinic (Group B). Study outcomes included the proportion of patients achieving the composite and individual treatment targets for A1C, BP, and LDL-C.   Results A total of 394 patients were included; Majority were underserved African Americans. The composite target was attained by 20% of participants in Group A and 13% in Group B (p=0.09). There were no statistically significant differences in achievement of individual targets between groups. A significantly higher proportion of participants in Group A achieved better control of diastolic blood pressure control (85% vs. 74%), had microalbuminuria tested (50% vs. 12%), were prescribed aspirin (43% vs. 32%), and had lower utilization of non-insulin glucose-lowering agents relative to those in Group B.   Conclusion The impact of a pharmacist’s physical presence on physician practice demonstrated a general trend towards improvement in clinical outcomes related to diabetes management. Future studies are needed to further characterize the impact provided by the physician-pharmacist relationship.

scholarly journals Stopping Disease-Modifying Therapy in Nonrelapsing Multiple Sclerosis

2017 ◽  
Vol 19 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Gary Birnbaum
Keyword(s):  
Multiple Sclerosis ◽  
Acute Disease ◽  
Published Data ◽  
Secondary Progressive ◽  
Disease Modifying Therapy ◽  
Scale Scores ◽  
Group A ◽  
Multiple Variables ◽  
Disease Modifying ◽  
Group B

Background: Current disease-modifying therapies (DMTs) are of benefit only in people with relapsing forms of multiple sclerosis (RMS). Thus, safely stopping DMTs in people with secondary progressive MS may be possible. Methods: Two groups of patients with MS were studied. Group A consisted of 77 patients with secondary progressive MS and no evidence of acute central nervous system inflammation for 2 to 20 years. These patients were advised to stop DMTs. Group B consisted of 17 individuals with RMS who stopped DMTs on their own. Both groups were evaluated at treatment cessation and for a minimum of 1 year thereafter. Multiple variables were assessed to determine those that predicted recurrent acute disease. Results: Nine patients in group A (11.7%) and ten patients in group B (58.8%) had recurrent acute disease, almost always within 1 to 2 years of stopping treatment. The only variable of significance in group A distinguishing stable and relapsing patients was age (P = .0003), with relapsing patients being younger. Group B patients were younger and had significantly lower Expanded Disability Status Scale scores than group A, with no significant differences in age between relapsed and stable patients. Conclusions: The DMTs can be stopped safely in older patients with MS (≥7 decades) with no evidence of acute disease for 2 years or longer, with an almost 90% probability of remaining free of acute recurrence. The high proportion of untreated patients with RMS experiencing recurrent acute disease is consistent with published data.

P1652IMPACT OF HEPATITIS C VIRUS AND DIRECT ACTING ANTIVIRALS ON JAPANESE RENAL ALLOGRAFT RECIPIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Kazuaki Okino ◽  
Keita Yamazaki ◽  
Keiichiro Okada ◽  
Keiji Fujimoto ◽  
HIROKI ADACHI ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Allograft ◽  
Patient Survival ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Direct Acting Antivirals ◽  
Group A ◽  
Group B ◽  
Direct Acting ◽  
The Impact

Abstract Background and Aims The impact of hepatitis C virus (HCV) infection on patient survival after renal transplantation was worse. Previously, we found that continuous HCV infection was a significant independent risk factor for actuarial survival (especially at ≥20 years after the transplant procedure) among Japanese renal allograft recipients. This study evaluates the impact of HCV and of the new direct acting antivirals (DAAs) on patient outcomes in renal allograft recipients. Method We studied 46 cases (28 males, 18 females; 37 living-donor cases, 9 deceased-donor cases; mean follow-up period 305 months ranging from 2 to 420 months) out of the 315 renal transplanted patients who underwent the first renal transplantation in Kanazawa Medical University since 1974. They had antibodies against HCV: 11 were positive for HCV RNA and received DAAs (Group A, all of them genotype 1b); 27 were HCV RNA positive and did not receive any treatment (Group B); 8 were negative for HCV RNA (Group C) (Fig.1). Results All Group A patients had HCV RNA negativity after 2-12 weeks of treatment started, and 11 (100%) achieved a sustained virological response (SVR) at 24 weeks. All of them had no adverse effects by the use of DAAs. In this cohort, no patients in Group A died. On the other hand, 15 (55.5％) of 27 in Group B and 3 (37.5%) of 8 in Group C died. Causes of death among Group B were liver cirrhosis (5 cases), hepatocellular carcinoma (2 case), infections complicated with chronic hepatitis (6 cases) in chronic phase, fibrosing cholestatic hepatitis due to HCV (1 case) after surgery, and cardiovascular disease (1 case). The patient survival rate was significantly higher in Group A patients who received DAAs by Kaplan- Meier life table method (Log Rank test, Kay-square 11.7, p=0.004) (Fig.2). Conclusion Our results support the notion that continuous HCV infection was a harmful and that new DAAs were efficient and safe to treat HCV infection after renal transplantation.

scholarly journals The Impact of Visual Aids on the Retention of English Word Stress Patterns

2018 ◽  
Vol 7 (2) ◽  
pp. 225 ◽  
Author(s):  
Farid Ghaemi ◽  
Fahimeh Rafi
Keyword(s):  
English Word ◽  
Placement Test ◽  
Visual Aids ◽  
Word Stress ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
The Impact ◽  
Stress Patterns

The present study aimed at comparing the effectiveness of three different techniques on learners’ long term memorization of English word stress patterns. After administering a quick placement test, 67 Iranian EFL elementary learners at language institutes were selected to participate in the study. Then they were divided into three groups. Before starting the instruction, a pretest was conducted to classify the participants’ abilities on word stress patterns. Then the new techniques were used to teach English word stress patterns. In all three groups, words were printed largely on a piece of paper and the syllables were clearly specified by dots. In group ‘A’, pronunciation and stress pattern of new words were taught aurally through the repetition of the words. In group ‘B’, all the procedure was exactly similar to that of group ‘A’, the only difference was that the stressed syllables were printed in bold. In group ‘C’, all the procedure was exactly similar to that of group ‘B’,  except that the stressed syllables were not only printed in bold, but also introduced by teacher’s hand gesture. After two weeks, a delayed posttest was conducted to check long term memorization of the word stress patterns. The results of the study indicated that there was a significant difference between pretest and delayed posttest in all three groups. But the most meaningful difference belonged to group ‘C’. That is, the participants in the third group (gesture group) outperformed those in the other groups. Finally, some implications and suggestions provided for further research.   

scholarly journals The Impact of Unilateral or Bilateral Cataract Surgery on Visual Acuity and Life Quality of Elderly Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Lei Zuo ◽  
Haidong Zou ◽  
Xinfeng Fei ◽  
Weiqi Xu ◽  
Jianhong Zhang
Keyword(s):  
Visual Acuity ◽  
Elderly Patients ◽  
Cataract Surgery ◽  
Life Quality ◽  
Weighted Average ◽  
Bilateral Cataract ◽  
Surgical Methods ◽  
Group A ◽  
Group B ◽  
The Impact

In the current study, the CLVQOL was used to assess VRQOL before unilateral or bilateral cataract surgery and at the end of the follow-up period in order to determine the greater beneficial mode of surgery for patients, if one of the two surgical methods is more beneficial over the other. The patients were classified as receiving unilateral (group A) and bilateral cataract surgery (group B). There were no significant differences between groups A and B before the operation in terms of life quality scores, binocular weighted average LogMAR BCVA, age, educational level, gender, systematic and ocular comorbidities, and the complications of the operation. It was shown that visual acuity improved more significantly with bilateral cataract surgery than with unilateral surgery in elderly patients with a high preoperative disease burden in Shanghai city. However, the improvement in life quality was not different in patients receiving either bilateral or unilateral cataract surgery.

Energy-Based Devices Affect the Aesthetic Outcome of Cervical Thyroidectomy and Parathyroidectomy. A Retrospective Study

2021 ◽  
Vol 39 ◽  
Author(s):  
Antonella Pino ◽  
◽  
Lorenzo Gasco ◽  
Daqi Zhang ◽  
Paolo Carcoforo ◽  
...  
Keyword(s):  
Body Dysmorphic Disorder ◽  
The Body ◽  
University Hospital ◽  
Aesthetic Outcome ◽  
Aesthetic Result ◽  
Scar Assessment ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
The Impact

Introduction: Thyroid and parathyroid diseases are very common. Most of these cases are in women and may be amenable to surgery. The patient’s perception that these are not life-threatening diseases leads them to expect an excellent aesthetic result, since the surgical incision area is clearly visible. Objective: To evaluate different scarring outcomes using three different energy-based devices (Harmonic Focus®, Johnson & Johnson, New Brunswick, NJ; Thunderbeat Open Fine Jaw®, Olympus Medical, Tokyo, Japan; LigaSure Small Jaw®, Medtronic, Dublin, Ireland) and to determine the impact of post-thyroidectomy/parathyroidectomy scars on the patient’s quality of life. Methods: One hundred female patients who underwent thyroidectomy or parathyroidectomy between September 2017 and September 2019 at the Endocrine and Minimally Invasive Surgery Department of Messina University Hospital were recruited. A retrospective analysis assessed the thickness of the cervical scar via ultrasound imaging, and the patient’s degree of satisfaction through the Patient and Observer Scar Assessment Scale (POSAS) and the Body Dysmorphic Disorder Questionnaire (BDDQ). Results: The patients were divided into three groups according to the energy-device used: group A (LigaSure SJ (n=38), group B (Harmonic F, n=32) and group C (Thunderbeat OFJ, n=30). The three groups were homogeneous with respect to number of patients, age and surgical procedures. The best aesthetic result, which correlated with the lowest scar thickness, was observed in group A; these patients were more satisfied than those in the other two groups. Moreover, correlations between scar thickness and quantitative variables (such as age or BMI) were not found in any of the groups. Conclusions: Based on the data collected and our experience, the LigaSure Small Jaw® (Medtronic) seems to offer the best aesthetic outcome in patients who undergo transverse cervicotomy for thyroid and parathyroid diseases. However, further prospective studies involving a greater number of cases are needed.

scholarly journals Magnetic resonance imaging and computed tomography of equine cheek teeth and adjacent structures: comparative study of image quality in horses in vivo, post-mortem and frozen-thawed

2019 ◽  
Vol 61 (1) ◽  
Author(s):  
Christin Röttiger ◽  
Maren Hellige ◽  
Bernhard Ohnesorge ◽  
Astrid Bienert-Zeit
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Post Mortem ◽  
Mr Images ◽  
Adjacent Structures ◽  
Group A ◽  
Group B ◽  
The Impact ◽  
Ct And Mri

Abstract Background The use of cadavers for radiology research methodologies involving subjective image quality evaluation of anatomical criteria is well-documented. The purpose of this method comparison study was to evaluate the image quality of dental and adjacent structures in computed tomography (CT) and high-field (3 T) magnetic resonance (MR) images in cadaveric heads, based on an objective four-point rating scale. Whilst CT is a well-established technique, MR imaging (MRI) is rarely used for equine dental diagnostics. The use of a grading system in this study allowed an objective assessment of CT and MRI advantages in portraying equine cheek teeth. As imaging is commonly performed with cadaveric or frozen and thawed heads for dental research investigations, the second objective was to quantify the impact of the specimens’ conditions (in vivo, post-mortem, frozen-thawed) on the image quality in CT and MRI. Results The CT and MR images of nine horses, focused on the maxillary premolar 08s and molar 09s, were acquired post-mortem (Group A). Three observers scored the dental and adjacent tissues. Results showed that MR sequences gave an excellent depiction of endo- and periodontal structures, whereas CT produced high-quality images of the hard tooth and bony tissues. Additional CT and MRI was performed in vivo (Group B) and frozen-thawed (Group C) in three of these nine horses to specify the condition of the best specimens for further research. Assessing the impact of the specimens’ conditions on image quality, specific soft tissues of the maxillary 08s and 09s including adjacent structures (pulps, mucosa of the maxillary sinuses, periodontal ligament, soft tissue inside the infraorbital canal) were graded in group B and C and analysed for significant differences within CT and MR modalities in comparison to group A. Results showed that MRI scores in vivo were superior to the post-mortem and frozen-thawed condition. Conclusions On comparing the imaging performance of CT and MRI, both techniques show a huge potential for application in equine dentistry. Further studies are needed to assess the clinical suitability of MRI. For further research investigations it must be considered, that the best MR image quality is provided in live horses.

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