Bone Marrow Hypocellularity, Decreased Platelet Counts and Colony Forming Units Serve as Prognostics Parameters for Early Complications after Autologous Peripheral Blood Stem Cell Transplantation.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5514-5514
Author(s):  
Antonia M.S. Mueller ◽  
Gabriele Ihorst ◽  
Denz Ulrich ◽  
Doeing Carsten ◽  
Wider Dagmar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Odds Ratio ◽  
Peripheral Blood Stem Cell ◽  
Median Number ◽  
Early Complications ◽  
Platelet Counts ◽  
Colony Forming Units ◽  
Group A ◽  
Group B ◽  
Blood Stem Cell Transplantation

Abstract High-dose chemotherapy with autologous peripheral blood stem cell transplantation (auto-PBSCT) offers a valid treatment option in cancer patients (pts) with advanced, relapsed or high-risk (HR) disease. Auto-PBSCT is in general a safe procedure, however, some pts may have a dismal outcome due to treatment related mortality (TMR), early relapse (ER) and/or failure of blood cell reconstitution (FBR). Risk factors predisposing for early complications after PBSCT have not yet been clearly assessed. From a total of 796 pts having been transplanted over a 10 year (y) period (6/93-5/03), we determined 50 pts (group A, m:f=29:21), who had primary FBR or died within 3 months after PBSCT. As a control group, 50 pts who had undergone PBSCT over the same period, were randomly selected (group B; m:f=25:25). Pre-PBSCT-parameters associated with early complications were examined by univariate analysis. Median age at transplant was similar in group A (52y) and group B (54y). Group A vs. B had underlying lymphoma in 31 vs. 17, solid tumors in 13 vs. 21 and leukemias in 6 vs. 12 pts, respectively. Notable differences were a lower performance status, more pretreatment chemotherapy (CX)-cycles, higher LDH levels, lower platelet counts, hypocellular bone marrow (BM) and lower colony forming units (CFU) in group A. Treatment before PBSCT in group A consisted of a median number of 7 CX (group B: 4 CX) cycles. Median number of retransfused CD34+-cells were similar (group A 4.1 vs. group B 3.7x10e6/kg bw). Total CFUs/1.5e5, determined by methylcellulose culture of PBSC grafts in group A were considerably decreased with 128 vs. 187 (group B), and BFU-E, CFU-GM, and CFU-GEMM were 51 vs. 79, 55 vs. 87 and 5 vs. 4, respectively. Hypocellular BM was observed in group A and B in 46% vs. 4% of pts (odds ratio 20.44 [p<0.001]), platelet counts were 98 vs. 170x10e9/L (odds ratio 13.5 [p<0.001]), respectively. Advanced stage at transplant was present in 90% vs. 78%, and residual BM-infiltration in 36% vs. 58% in group A and B, respectively. Age, number of CX-cycles and CD34+-transfused cells showed no significantly increased risk. Of pts in group A, 21 had early TRM (group A1: sepsis and multi-organ failure in 81%, fatal bleeding in 14%, CX-toxicity in 5%, leading to early death after a median of 23 days [d]). 26 pts (52%) died of early progression (group A2: after a median of 62d) and 3 pts (6%) had FBR (group A3). Median BFU-E, CFU-GM and CFU-GEMM were similar in group A1 and A2 and correlated with comparable CD34+-numbers. However, in group A1, 29% reached no WBC and 81% no platelet engraftment, whereas in group A2 only 12% and 23% did not reach WBC- and platelet reconstitution, respectively. Engraftment in group B (control pts) was regular with median WBC and platelet reconstitution on d+10. With a TRM of 2.64% and FBR in 0.38% in this HR-pt cohort, auto-PBSCT is in general a well tolerable treatment option. Nevertheless, distinct risk factors for early transplant complications can be determined and should be considered. We identified BM-hypocellularity and a decreased platelet count <100x10e9/L as the strongest prognostic parameters. Our analysis also suggests, that other pre-transplant parameters, including CFUs - more reliably than CD34+-cell numbers - provide additional valuable information on engraftment and complications after auto-PBSCT.

Bone Marrow Hypocellularity, Decreased Platelet Counts and Colony Forming Units Serve as Prognostics Parameters for Early Events after Auto-Peripheral Blood Stem Cell Transplantation.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5448-5448
Author(s):  
Antonia M.S. Mueller ◽  
Gabriele Ihorst ◽  
Peter S. Haas ◽  
Dagmar Wider ◽  
Monika Engelhardt
Keyword(s):  
Risk Factors ◽  
Odds Ratio ◽  
Peripheral Blood Stem Cell ◽  
Median Number ◽  
Early Complications ◽  
Platelet Counts ◽  
Colony Forming Units ◽  
Group A ◽  
Group B ◽  
Blood Stem Cell Transplantation

Abstract High-dose chemotherapy with autologous peripheral blood stem cell transplantation (auto-PBSCT) offers a valid treatment option in cancer patients (pts) with advanced, relapsed or high-risk (HR) disease. Auto-PBSCT is in general a safe procedure, however, some pts at risk may have a dismal outcome due to treatment related mortality (TMR), early relapse/progression (ER) and/or failure of blood cell reconstitution (FBR). Risk factors predisposing for early events after PBSCT have not yet been clearly assessed. From a total of 796 pts having been transplanted over a 10 year (y) period (6/93–5/03), we determined 50 pts (group A, m:f=29:21), who had primary FBR or died within 3 months after PBSCT. As a control group, 50 pts who had undergone PBSCT over the same period, were randomly selected (group B; m:f=25:25). Pre-PBSCT-parameters associated with early complications were examined by univariate analysis. Median age at transplant was similar in group A (52y) and B (54y). Group A vs. B had underlying lymphoma in 31 vs. 17, solid tumors in 13 vs. 21 and leukemias in 6 vs. 12 pts, respectively. Notable differences were a lower performance status, more pretreatment chemotherapy (CX)-cycles, higher LDH levels, lower platelet counts, hypocellular bone marrow (BM) and lower colony forming units (CFU) in group A. Treatment before PBSCT in group A consisted of a median number of 7 CX (group B: 4 CX) cycles. Median number of retransfused CD34+-cells were similar (group A 4.1 vs. group B 3.7×10e6/kg bw). Total CFUs/1.5e5, determined by methylcellulose culture of PBSC grafts in group A were decreased with 128 vs. 187 (group B), and BFU-E, CFU-GM, and CFU-GEMM were 51 vs. 79, 55 vs. 87 and 5 vs. 4, respectively. Hypocellular BM was observed in group A and B in 46% vs. 4% of pts (odds ratio 20.44 [p<0.001]), platelet counts were 98 vs. 170×10e9/L (odds ratio 13.5 [p<0.001]), respectively. Advanced stage at transplant was present in 90% vs. 78%, and residual BM-infiltration in 36% vs. 58% in group A and B. Age, number of CX-cycles and CD34+-transfused cells showed no significantly increased risk. Of pts in group A, 21 had early TRM (group A1: sepsis and multi-organ failure in 81%, fatal bleeding in 14%, CX-toxicity in 5%; death after median of 23 days [d]). 26 pts (52%) died of early progression (group A2: after a median of 62d) and 3 pts (6%) had FBR (group A3). Median BFU-E, CFU-GM and CFU-GEMM were similar in group A1 and A2 and correlated with comparable CD34+-numbers. However, in group A1, 29% reached no WBC and 81% no platelet engraftment, whereas in group A2 only 12% and 23% did not reach WBC- and platelet reconstitution, respectively. Engraftment in group B (control pts) was regular (median WBC and platelet reconstitution on d+10). With a TRM of 2.64% and FBR in 0.38% in this HR-pt cohort, auto-PBSCT is in general a well tolerable treatment option. Nevertheless, distinct risk factors for early complications can be determined and should be considered. We identified BM-hypocellularity and a decreased platelet count <100×10e9/L as the strongest prognostic parameters. Our analysis also suggests, that other pre-transplant parameters, including CFUs - more reliably than CD34+-cell numbers - provide additional valuable information on engraftment and relevant events after auto-PBSCT.

A Risk Adapted Approach Utilizing Plerixafor in Autologous Peripheral Blood Stem Cell Mobilization.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3211-3211 ◽  
Author(s):  
Ivana Micallef ◽  
Stephen M Ansell ◽  
Francis Buadi ◽  
David Dingli ◽  
Angela Dispenzieri ◽  
...  
Keyword(s):  
Stem Cell ◽  
Peripheral Blood ◽  
Peripheral Blood Stem Cell ◽  
Median Number ◽  
Blood Stem Cell ◽  
Stem Cell Mobilization ◽  
High Dose ◽  
Group A ◽  
Cell Mobilization ◽  
Group B

Abstract Abstract 3211 Poster Board III-148 Although autologous stem cell transplantation (ASCT) has become standard of care for many patients with hematologic malignancies, many patients fail to collect a minimum number of CD34 + stem cells to support high dose chemotherapy and ASCT. Recently, plerixafor, a CXCR4 antagonist, was FDA approved for use in combination with G-CSF for autologous peripheral blood stem cell mobilization in patients with NHL or Multiple Myeloma. In February 2009, we commenced a risk adapted approach to the utilization of plerixafor. The study was restricted to patients mobilized with GCSF alone and patients undergoing chemotherapy primed PBSC mobilization were excluded. Peripheral blood stem cell mobilization was commenced with G-CSF at 10 mcg/kg/day. On day 4, a peripheral blood (PB) CD34 count was measured. For patients whose PB CD34 was ≥10/μL, apheresis was commenced the following morning. For patients whose PB CD34 was <10/μL, it was measured again on day 5; if ≥10/μL then apheresis was commenced the following morning. If PB CD34 was <10/μL on day 5, plerixafor (0.24 mg/kg sc) was administered on the evening of day 5 and apheresis was commenced the following day (Group A). In addition, during apheresis, for patients whose collection yield was < 0.5 × 106 CD34/kg, in the absence of instrument failure or problems with the collection procedure, plerixafor was added (Group B). Morning administration of G-CSF and evening dosing of plerixafor continued daily until apheresis was complete. From February to July 2009, 174 mobilization attempts occurred; 27 with chemotherapy and 147 with cytokines alone. The 147 pts who underwent mobilization with cytokines alone are presented here. The underlying diagnosis was as follows: Myeloma 61 pts, NHL 54 pts, Amyloid 17 pts, Hodgkin 10 pts, POEMS 4 pts and 1 pt with a solid tumor. For the entire group the median number of CD34 cells collected was 5.5 × 106 CD34/kg (range 0.1-17). The median number of apheresis was 3 (range 1-12). 67 patients (46%) received plerixafor; 37 patients started plerixafor during mobilization (Group A) and 30 patients during collections due to a poor yield (Group B). 12 pts of the 37 received plerixafor on day 4 because of prior mobilization failure or high risk of mobilization failure and are included in Group A. Table 1 outlines the details of mobilization and collection by groups. By disease category, of the 61 patients with MM, 28 (46%) received plerixafor (8 Group A and 20 Group B). Median apheresis in all the MM pts was 2 (range 1-12) with a total of 6.8 × 106 CD34/kg (2.2-16.7). In the 54 NHL pts, 32 (59%) received plerixafor (24 Group A and 8 Group B). Median apheresis for all pts with NHL was 3 (range 1-7) with a total of 4.6 × 106 CD34/kg (range 0-11.4). Overall, only 7 of 147 (5%) mobilization attempts failed to achieve a minimum of 2 × 106 CD34/kg. This compares to a 22% failure rate prior to institution of this risk adapted approach. In conclusion, implementing this risk adapted approach allows poor mobilizers to be identified promptly and for plerixafor to be initiated during mobilization and collection, thereby reducing the number of mobilization failures. In patients who predictably would not have successful collection based on a PB CD34 <10/μL, addition of plerixafor results in a majority of patients achieving an adequate collection. This risk adapted approach may be more cost effective than reattempting mobilization after a prior failure or utilizing combination G-CSF and plerixafor for upfront mobilization. Table 1. Mobilization and Collection data. All patients N=147 Group A1 N=37 Group B2 N=30 No Plerixafor N=80 PB CD34 day 4     Median 11 0 7 19     Range 0-331 0-7 0-32 0-331 PB CD34 day 5     Median 10 4.5 12 15     Range 0-51 2-9 11-23 9-51 Apheresis Yield     Median 5.5 4.4 6.0 6.2     Range 0.1-17 3.1-12.7 3.0-12.2 2-17 Number of Apheresis     Median 3 3 5 2     Range 1-12 1-7 4-12 1-8 Days of Plerixafor     Median n/a 3 2 n/a     Rang 1-7 1-8 1 Group A – Plerixafor initiated prior to apheresis 2 Group B – Plerixafor initiated during apheresis Disclosures No relevant conflicts of interest to declare.

Comparison of four different strategies of stem cell mobilization in patients with multiple myeloma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 7039-7039
Author(s):  
Jeffrey Michael Sivik ◽  
Sesilya Whaley ◽  
Joseph Mierski ◽  
William J. Castellani ◽  
Mitzi Lowe ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Stem Cell ◽  
Peripheral Blood Stem Cell ◽  
Median Number ◽  
Cd34 Cells ◽  
Group A ◽  
The Mean ◽  
Cell Mobilization ◽  
Group B ◽  
Group D

7039 Background: There is no consensus among institutions for the optimal strategy of peripheral blood stem cell (PBSC) collection for autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM). Methods: We retrospectively analysed the outcomes of PSBC collection in MM patients using the following mobilization regimens: cyclophosphamide 5,000 mg/m2 + etoposide 1,000 mg/m2 + G-CSF 5 mcg/Kg/day (Group A, n = 49); cyclophosphamide 2,000-3,000 mg/m2+ G-CSF 5 mcg/Kg/day (Group B, n = 25); G-CSF 16 mcg/Kg/day (Group C, n = 21); G-CSF 16 mcg/kg/day + plerixafor 0.24 mg/Kg (Group D, n = 128). Results: The median number of PBSC collected was 28.1 (range, 2.1-134), 4.5 (0.1-39.7), 4.0 (0-7.3) and 8.4 (0.2-41.2) million CD34+/kg in groups A, B, C and D, respectively (p <0.001). The mean number of collection days was 1.3, 2.2, 2.4, and 1.3 in groups A, B, C, and D, respectively (p <0.001). Febrile neutropenia occurred in 16 (32.7%), 1 (4%), 0, and 0 patients in groups A, B, C, and D, respectively. One patient who received CTX 3 g/m2 died of septic shock during the neutropenic phase. Failure to collect PBSC, defined as <2x106 CD34+ cells/Kg for a planned single ASCT or <4x106 for planned tandem ASCTs, was observed in 2/49 (4%), 5/25 (20%), 4/21 (19%), and 9/128 (7%) patients in groups A, B, C, and D respectively (p=0.037). Conclusions: Plerixafor + G-CSF provided the greatest benefit to risk ratio for PSBC collection in MM patients.

Hygienic characteristics of the cosmetologists' lifestyle

2020 ◽  
Vol 60 (12) ◽  
pp. 958-963
Author(s):  
Natalia I. Latyshevskaya ◽  
Tatyana L. Yatsyshena ◽  
Elena L. Shestopalova ◽  
Irina Yu. Krainova
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Information And Communication Technologies ◽  
Health Risks ◽  
Healthy Lifestyle ◽  
Personal Hygiene ◽  
Risk Category ◽  
Essential Components ◽  
Group A ◽  
Group B

Modern trends in the deterioration of health and the growth of non-communicable diseases among the adult working-age population, including medical workers, actualize the importance of a healthy lifestyle for maintaining health and professional longevity. There were almost no studies related to cosmetologists' experienced group as representatives of aesthetic medicine. There is no scientific evidence on behavioral risks of this group. It justifies the relevance of this study. The study aims to analyze the essential components of the cosmetologists' lifestyle depending on age and the argumentation of priority behavioral health risk factors for preventive and recreational work justification. Sixty women (practicing cosmetologists in Volgograd at the age of 28-39 years (group A) and 40-53 (group B)) took part in the study. Lifestyle assessment included a modified questionnaire. The questionnaire consists of 5 blocks (block 1 - nutrition; 2 - physical activity, including hardening and active rest; 3 - daily regimen; 4 - personal hygiene; 5 - bad habits). It allows the analysis of the adherence to a healthy lifestyle based on the provision of quantitative data. Statistical data processing was carried out using the Excel package. The authors identified the essential and statistically significant differences in the cosmetologists' lifestyle depending on age. The respondents of group B demonstrated hygienically rational indicators in all blocks of the lifestyle more often. They had a more formed adherence to a healthy lifestyle: 504 answers in the category "insignificant risk" of respondents in group B versus 354 in group A. Distribution of answers in the "high risk" category: 119 responses in group B and 185 in group A. The lifestyle of 46.7% of the respondents in group B refers to a healthy lifestyle. 3.3% of the group B respondents have an anxious lifestyle, 50% have health risks. 10% of Group A respondents' lifestyle refers to a healthy lifestyle. 13.3% of Group A respondents' lifestyle refers to an anxious lifestyle; 76.7% of this group have health risks. There was almost no complex hygienic research profession of medical cosmetologists. Cosmetologists of the older age group (40-53 years old) are more conscious of maintaining a hygienically rational lifestyle. The most significant defects among cosmetologists aged 28-39 years are low physical activity, nutritional defects, insufficient duration of night rest, and excessive use of information and communication technologies for rest, accompanied by manifestations of neurotization and signs of pronounced fatigue. The obtained results argue the need to develop and implement informational and educational measures to prevent risk behavior patterns, taking into account the age of cosmetologists and the priority of the identified behavioral risk factors.

scholarly journals High Basal Maximal Standardized Uptake Value (SUVmax) in Follicular Lymphoma Identifies Patients with a Low Risk of Long-Term Relapse

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2876
Author(s):  
Giovanni Manfredi Assanto ◽  
Giulia Ciotti ◽  
Mattia Brescini ◽  
Maria Lucia De Luca ◽  
Giorgia Annechini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Follicular Lymphoma ◽  
Standardized Uptake Value ◽  
Metabolic Tumor Volume ◽  
Late Relapse ◽  
Prognostic Role ◽  
Pet Ct ◽  
Group A ◽  
Group B

Background: Despite that the unfavorable prognostic role of a high Total Metabolic Tumor Volume (TMTV) in Follicular Lymphoma has been demonstrated, the role of SUVmax alone at baseline PET/CT could have a different prognostic role. Patients and Methods: We performed a retrospective observational monocentric cohort study. All patients affected by FL who underwent a basal PET/CT were included. Two subgroups were identified and compared in terms of PFS and OS: (A) Basal SUVmax ≤ 6; and (B) Basal SUVmax > 6. Results: Ninety-four patients were included, 34 in group A (36.2%) and 60 in group B (63.8%). The PFS at two years was comparable in the two groups (97%). The five-year PFS was 73.5% for group A and 95% for group B (p 0.005). The five-year PFS in the whole cohort was 87.5%. A clear advantage was confirmed in group A in the absence of other risk factors. Patients with SUVmax ≤ 6 and no risk factors showed a 5-year PFS of 73% against 83% for patients with SUVmax > 6 and at least two risk factors. Conclusion: A high FDG uptake favorably correlated with PFS. A low basal SUVmax reflected a higher rate of late relapse requiring a prolonged follow-up. The basal SUVmax is an approachable parameter with prognostic implications.

scholarly journals Ultrasound evaluation of intima media thickness of carotid arteries in dialysis patients and correlation with proposed risk factors

2003 ◽  
Vol 131 (9-10) ◽  
pp. 382-388 ◽  
Author(s):  
Tatjana Damjanovic ◽  
Nada Dimkovic
Keyword(s):  
Risk Factors ◽  
Carotid Arteries ◽  
Intima Media Thickness ◽  
Cardiovascular Morbidity ◽  
Dialysis Patients ◽  
Media Thickness ◽  
Ultrasound Evaluation ◽  
Cardiovascular Morbidity And Mortality ◽  
Group A ◽  
Group B

Atherosclerosis is significant risk factor for cardiovascular morbidity and mortality in dialysis patients. Aim of the study was ultrasound evaluation of intima media thickness on carotid arteries (as a marker of atherosclerosis), in dialysis patients and its correlation with proposed risk factors. Intima media thickness was measured in 45 dialysis patients with no signs of cardiovascular diseases (15 on peritoneal dialysis, group I,30 on hemodialysis, group II) and 20 healthy controls. The mean carotid artery intima media thickness was significantly higher in dialysis patients than in control group. According to intima media thickness, dialysis patients were divided in group A (patient with intima media thickness less or equal 0,720 mm) and group B (intima media thickness higher then 0,720mm). Intima media thickness in bout group was correlated with proposed risk factors. In group A there was not significant correlation of intima media thickness with risk factors. In group B significant correlation have been found between intima media thickness and LDL, VLDL cholesterol, body mass index and systolic, diastolic and mean blood pressure. Although atherosclerosis was not the only cause for cardiovascular morbidity and mortality, it has a dominant role in dialysis patients. Augmented intima media thickness could be early marker of atherosclerosis. The risk factors of great influence on intima media thickness are lipid disturbances, obesity and hypertension.

The Effect of Gongronema Latifolum (Utazi) on Some Haematological Parameters of Rabbit

2020 ◽  
Author(s):  
Obeagu Emmanuel Ifeanyi
Keyword(s):  
Mean Value ◽  
Control Group ◽  
Mean Values ◽  
Platelet Counts ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Differential White Blood Cell ◽  
Group D ◽  
Gongronema Latifolium

The hematological features of Gongronema latifolium, aqueous leaves extract was evaluated using standard methods. After 10 days of consecutive infusions into 9 experimental animals (rabbits). The rabbits were monitored and the following parameters determined; hemoglobin (HB), PCV, Platelet, WBC, Differential White Blood Cell. The Rabbits were grouped into 4, one consisting of control (group A), group B was fed with 0.5 mg/kg, group C with 1.0 mg/kg, and Group D with 1.5mg/kg of the aqueous extract of Gongronemalatifolium. The mean values obtained for hemoglobin estimation for the control group is 5.9 ± 4.1 g/dl, 9.1 ± 2.9 g/dl for group B 10.2 ± 1.8 g/dl for group C and 12.8 ± 0.1 g/dl for group D with no significant increase on the PCV estimation, the mean value for the control (group A) is 17.7 ± 12.3%, 27.3 ± 8.7% for group B, group C (30.6 ± 5.4%) and D (28.4 ± 0.3) show increase that statistically significant (p > 0.01). the platelet counts of group C (600 ± 0 x 109/L) and D(600 ± 0 x 109/L) show significant increase (p > 0.01) when compared with the control (600 ± 00). But the platelet value of group B (550 ± 50 x 109/L) shows no difference. No significant changes were observed in the White Blood Counts of the test groups B (3.5 ± 0.5 x 109/L), C (1.9 + 2.1 x 109/L) and D(3.6 ± 0.4) when compared with the control group (2.9 ± 1.9). The values obtained from the differential White Blood Counts (Neutrophils, Lymphocytes, Eosinophils and Monocytes) were not significant. Therefore, Gongronemalatifolium, when properly taken as a nutritional diet, causes beneficial changes on hemoglobin, packed cell volumes and platelet counts of consumers.

scholarly journals Comparative study of knowledge about oral cancer among undergraduate dental students

2016 ◽  
Vol 14 (3) ◽  
pp. 338-345
Author(s):  
Samara Ribeiro da Silva ◽  
Yara Juliano ◽  
Neil Ferreira Novo ◽  
Ilan Weinfeld
Keyword(s):  
Risk Factors ◽  
Oral Cancer ◽  
Undergraduate Students ◽  
Dental Students ◽  
Clinical Aspects ◽  
Significance Level ◽  
First Semester ◽  
Group A ◽  
Group B ◽  
Self Examination

ABSTRACT Objective: To evaluate and compare the knowledge of dental undergraduate students about oral cancer. Methods: The students were divided into two groups according to semester attended in the undergraduate course: Group A, the first semester; and Group B, seventh semester. They were asked to answer a questionnaire about epidemiology, risk factors, clinical aspects, therapeutic solutions and oral self-examination. For statistical analysis, the Fisher's exact test, the Cochran's G test and Kendall's concordance test were used, with significance level set at 0.05. Results: Regarding the prevalent sex, only 8.0% of Group A and 56.0% of Group B judged males as the frequent affected by the disease (p=0.0006). In terms of age, 84.0% of the Group B and 44.0% of the Group A estimated that most cases were diagnosed over 40 years (p=0.0072). Smoking was identified as the major risk factor for 64.0% and 91.6% of Groups A and B, respectively (p=0.0110). On issues related to sex, ethnicity, age, risk factors, self-examination, treatment, professional responsible for treatment and profile of an individual with the disease, the seventh-semester showed significantly higher correct answer percentages than first-semester undergraduates. Conclusion: There was significant correlation between the right and wrong answers given by first and seventh semester students, making necessary a specific approach directed to their lack of knowledge.

scholarly journals Risk factors for critical limb ischemia in patients undergoing femoral cannulation for venoarterial extracorporeal membrane oxygenation: Is distal limb perfusion a mandatory approach?

Perfusion ◽  
2019 ◽  
Vol 34 (6) ◽  
pp. 453-459 ◽  
Author(s):  
Tim Kaufeld ◽  
Eric Beckmann ◽  
Fabio Ius ◽  
Nurbol Koigeldiev ◽  
Wiebke Sommer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Extracorporeal Membrane Oxygenation ◽  
Limb Ischemia ◽  
Distal Limb ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Limb Perfusion ◽  
Group A ◽  
Group B

Background: Venoarterial extracorporeal membrane oxygenation support is a well-established tool in the care of severe refractory cardiac and respiratory failure. The application of this support may serve as a bridge to transplant, recovery or to implantation of a ventricular assist device. Venoarterial extracorporeal membrane oxygenation support can be administered through an open surgical access via the common femoral or axillary artery or a percutaneous approach using Seldinger technique. Both techniques may obstruct the blood flow to the lower limb and may cause a significant ischemia with possible limb loss. Malperfusion of the distal limb can be avoided using an ipsilateral distal limb perfusion, which may be established by adding a single-lumen catheter during venoarterial extracorporeal membrane oxygenation treatment to overcome the obstruction. The aim of this study is to distinguish the presence or absence of a distal limb perfusion regarding the incidence of distal limb ischemia. Furthermore, expected risk factors of open and percutaneous femoral venoarterial extracorporeal membrane oxygenation installation were evaluated for the development of distal limb ischemia. Methods: Between January 2012 and September 2015, 489 patients received venoarterial extracorporeal membrane oxygenation support at our institution. In total, 307 patients (204 male, 103 female) with femoral cannulation were included in the analysis. The cohort was distinguished by the presence (group A; n = 237) or absence (group B; n = 70) of a distal limb perfusion during peripheral venoarterial extracorporeal membrane oxygenation treatment. Furthermore, a risk factor analysis for the development of distal limb ischemia was performed. Results: The main indications for venoarterial extracorporeal membrane oxygenation therapy were a low cardiac output syndrome (LCOS) (53%) and failed weaning of extracorporeal circulation (23%). A total of 23 patients (7.49%) under venoarterial extracorporeal membrane oxygenation support developed severe distal limb malperfusion (3.38% in group A vs 21.42% in group B). Preemptive installation of distal limb perfusion extended the intervention-free intervals to 7.8 ± 19.3 days in group A and 6.3 ± 12.5 in group B. A missing distal limb perfusion (p = 0.001) was identified as a main risk factor for critical limb ischemia. Other comorbidities such as arterial occlusion disease (p = 0.738) were not statistically significantly associated. Surgical intervention due to vascular complications after extracorporeal membrane oxygenation explantation was needed in 14 cases (4.22% in group A and 5.71% in group B). Conclusion: We were able to identify the absence of distal limb perfusion as an independent risk factor for the development of critical distal limb ischemia during femoral venoarterial extracorporeal membrane oxygenation treatment. The application of a distal limb perfusion should be considered as a mandatory approach in the context of femoral venoarterial extracorporeal membrane oxygenation treatment regardless of the implantation technique.

Prostaglandin E1-Therapie vermindert zirkulierende Adhäsionsmoleküle (ICAM, E-Selectin, VCAM-1) bei Patienten mit peripherer arterieller Verschlusskrankheit

VASA ◽  
2000 ◽  
Vol 29 (3) ◽  
pp. 179-185 ◽  
Author(s):  
Palumbo ◽  
Oguogho ◽  
Fitscha ◽  
Helmut Sinzinger
Keyword(s):  
Risk Factors ◽  
Vascular Disease ◽  
Prostaglandin E1 ◽  
Therapy Group ◽  
Individual Response ◽  
Peripheral Vascular ◽  
Group A ◽  
Human Atherosclerosis ◽  
Group B ◽  
Circulating Levels

Background: It has been postulated that adhesion molecules (AM) may be involved in development and progression of human atherosclerosis. We examined whether prostaglandin (PG) E1 affects circulating levels of the AM (ICAM-1, VCAM-1 and E-selectin) in peripheral vascular disease (PVD) patients. Methods and results: AM are significantly (p < 0.01) increased in PVD (n = 65) as compared to controls (n = 31). There was no influence of risk factors. 26 PVD-patients received 2 different schemes of PGE1-therapy (group A [n = 17]; 5 ng PGE1/kg/min × 6 h × 5 d × 4 wk; group B [n = 9]; 60 mug PGE1/2 h × 5 d × 2 wk). PGE1 decreases all the AM significantly (p < 0.01) using both therapeutic schemes. Stopping PGE1-therapy reverses values within about 4 weeks. Details on therapeutic regimens (dose, duration, route, etc.) and individual response still need to be assessed. Conclusion: Our results indicate that PGE1-treatment of PVD is associated with a significant benefit on circulating AM. These findings are in line with the described anti-inflammatory actions of PGE1 and may represent a further contributing factor to the great variety of beneficial actions of PGE1 on human atherosclerosis.

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