scholarly journals THROMBOLYTIC AND ANTICOAGULANT THERAPY FOR PULMONARY EMBOLISM: AN EFFECT ON PULMONARY PERFUSION (PART 2)

2018 ◽  
Vol 7 (2) ◽  
pp. 134-143
Author(s):  
O. V. Nikitina ◽  
I. P. Mikhailov ◽  
N. Y. Kudryashova ◽  
E. V. Migunova ◽  
O. A. Alekseyechkina ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Anticoagulant Therapy ◽  
Pulmonary Blood Flow ◽  
Systolic Pressure ◽  
Wilcoxon Test ◽  
Pulmonary Perfusion ◽  
Perfusion Scintigraphy ◽  
Whitney Test ◽  
Mann Whitney Test

Background.Perfusion scintigraphy reveals perfusion defects in the occlusion of pulmonary vessels of any caliber and makes it possible to quantify pulmonary blood flow disorders, which allows the method to be used for the comparison of the thrombolytic and anticoagulant therapy efficacy in patients with acute pulmonary embolism.Aim of study .To compare the efficacy of thrombolytic and anticoagulant therapy in the treatment of acute pulmonary embolism in the dynamics of pulmonary perfusion disorders.Study Design.A prospective non-randomized study. The quantitative result of pulmonary perfusion deficiency obtained during perfusion scintigraphy was compared in patients with pulmonary embolism treated with thrombolytics or anticoagulants before treatment and in dynamics. The dynamics was evaluated the next day after administration of thrombolytics and on day 4–5 after initiating anticoagulant therapy. Preliminary analysis of these parameters in the group with anticoagulant therapy a day after the start of administration (by analogy with TLT) revealed no statistically significant differences.Description of the method.Radionuclide and CT studies were performed on a hybrid system SPECT/CT “Discovery NM/CT 670” (GE, USA): perfusion was evaluated with 80–120 MBq of Macrotech 99mTc radiopharmaceutical (RP), CT angiography was performed with 70-100 ml of radiopaque substance “Visipaque.” To determine the total perfusion deficiency, each defect of accumulation with an area equal to the segment was taken as a perfusion deficiency of 5% (subsegmental — 2.5%), equal to the lower lobe — 25%, an area equal to the right lung — 55%, the left lung — 45%. Characteristics of the sample.The perfusion scintigraphy was performed in 381 cases out of 503 patients with a diagnosis of pulmonary embolism of high/intermediate risk of early death, treated in the Intensive Care Unit for Surgical Patients from 2011 to 2016. In 166 cases out of 381, thrombolysis was performed; in 215 cases, an anticoagulant was prescribed. The groups did not differ in age and gender composition: 60±16 years; Me 61 (50; 71) and 62±15 years; Me 63 (53; 74); p=0.22, Mann-Whitney test; men/women: 73/93 and 89/126; p=0.68, the Fisher test.Results of the study.In 96.1% (366/381), perfusion disorders were observed in both lungs; in 3.9% (15/381) there was a unilateral lesion. The comparison of the treatment efficacy was conducted in 169 patients: in 127 cases the next day after introduction of a thrombolytic and in 42 cases on day 4–5 of anticoagulant therapy. In the group with thrombolysis, the initial perfusion deficiency was statistically significantly higher than in the anticoagulant group: 50±10%; Me 50 (40; 60) vs. 39±10; Me 40 (30; 45); p<0.00001, the Mann–Whitney test. The level of pulmonary hypertension was also higher: the systolic pressure in the pulmonary artery was 56±17 Me 54 (45, 68) versus 40±24 Me 40 (22; 56); p<0.00001, the Mann–Whitney test. As a result of treatment, the perfusion deficiency statistically significantly decreased in both groups: in the group with TLT from 50±10%, Me 50 (40; 60) to 26±14%; Me 25 (15; 35); p<0.00000.1, Wilcoxon test; and in the treatment with anticoagulant it decreased from 39±10%, Me 40 (30; 45) to 23±15%; Me 15 (15; 30); p<0.0001, Wilcoxon test. In the TLT group, the perfusion disorders regression was stronger compared to ACT and was registered the next day after administration of a thrombolytic: the standardized effect Es=2.0 and Es=1.2. In the treatment with anticoagulants, statistically significant differences were detected only on day 4–5 from the beginning of its administration. The study power for both groups was 1.00. After thrombolysis the systolic pressure in the pulmonary artery decreased statistically significantly within the next 24 hours: from 56±17 mmHg, Me 54 (45, 68) to 36±14 mmHg, Me 35 (25; 43); p=0.0002, Wilcoxon test; Es=1.3; P=1.00. With anticoagulant treatment, no statistically significant changes in pulmonary arterial pressure occurred 4-5 days after the initiation of treatment: 40±24 mmHg, Me 40 (22; 56) and 50±31 mm Hg, Me 48 (30; 58) ); p=0.72, Wilcoxon test.Conclusion.The advantage of thrombolysis over anticoagulant therapy was the ability to improve pulmonary blood flow, reduce pulmonary hypertension, and stabilize the patients’ condition quickly. Anticoagulant therapy did not allow this effect to be achieved in a short time: the statistically significant reduction in pulmonary perfusion deficiency occurred only on day 4–5 of treatment and was less significant; the statistically significant regression of pulmonary hypertension did not occur at that time.

scholarly journals Thrombolytic and Anticoagulant Therapy for Pulmonary Embolism with High and Intermendiate Risk of Early Death. Part 3. An Effect on Pulmonary Perfusion with High and Intermediate Risk of Early Death

2018 ◽  
Vol 7 (3) ◽  
pp. 209-216
Author(s):  
O. V. Nikitina ◽  
I. P. Mikhailov ◽  
N. Y. Kudryashova ◽  
E. V. Migunova ◽  
A. G. Dorfman ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Thrombolytic Therapy ◽  
Anticoagulant Therapy ◽  
Therapy Group ◽  
Early Death ◽  
Wilcoxon Test ◽  
Pulmonary Perfusion ◽  
Intermediate Risk ◽  
Effective Equivalent Dose

Background The advantage of thrombolytic therapy (TLT) over anticoagulant therapy(ACT) in patients with a high risk of early death (hemodynamic disorders) in acute pulmonary embolism is considered proven. But the advantage of thrombolytic therapy over anticoagulant therapy remains uncertain in patients with an intermediate risk. Perfusion lung scintigraphy helps provide a quantitative comparison of changes in pulmonary blood flow with the use of different treatment methods in subgroups of high and intermediate risk of an adverse outcome.The aim of study is to compare the effectiveness of thrombolytic and anticoagulant therapy in the treatment of acute pulmonary embolism in patients with a high and intermediate risk of early death in terms of the dynamics of pulmonary perfusion disorders.Study design: a prospective non-randomized study. The introduction of a thrombolytic was cosidered as intervention. The comparison group consisted of patients who received an anticoagulant. Thrombolysis in patients with intermediate risk was indicated in the absence of a potential threat of hemorrhagic complications, a deficit of pulmonary perfusion above 40%, a high level of pulmonary hypertension and a high probability of cardiac decompensation. The method of comparison was the quantitative result of pulmonary perfusion deficiency.Description of the method Radionuclide and CT studies were carried out using a hybrid system SPECT/CT Discovery NM/CT 670 (GE, USA): the perfusion was evaluated with 80–120 MBq of 99mTc macrotech radiopharmaceutical (RP) (effective equivalent dose of 0.8–1.3 mSv), CT angiography was performed with 70–100 ml of radiopaque substance Visipaque (effective equivalent dose of irradiation 9.4–10.3 mSv). The accumulation deficit of an area equal to a segment was counted as a perfusion deficiency of 5% (subsegmental 2.5%), inferior lobe — 25%, an area equal to the right lung — 55%, the left lung — 45%.Characteristics of the sample In a sample of 503 patients who received treatment at the Intensive Care Unit for Surgical Patients of the N.V. Sklifosovsky Institute for Emergency Medicine from 2011 to 2016, the overall mortality rate was 14.7% (95% CI 11.7; 18.1) (74/503); anticoagulation therapy — 17.8% (95% CI 13.5; 22.8) (50/281); thrombolytic therapy — 10.8% (95% CI 7.1; 15.6) (24/222); p=0.031, Fisher’s test, P=0.60. At a high risk of death, the mortality rate in the thrombolytic therapy group was 30.2% (19/63) versus 47.1% (32/68) in the anticoagulant therapy group; p=0.051, the Fisher’s test; P=0.51. At an intermediate risk, it was 3.2% (5/158) and 8.4% (8/214); p=0.049, the Fisher’s test, P=0.54. Changes in pulmonary perfusion deficiency as a result of treatment were performed in 169 patients who promptly underwent a primary and repeated dynamic scintigraphic study: 127 patients after thrombolysis (of which 38 patients had a high risk and 88 had an intermediate risk) and 42 patients who were treated with an anticoagulant (5 — high risk, 37 — intermediate risk). The groups did not differ in age and gender composition: the mean age was 59±16; Me 61 (49; 71) and 57±14 years; Me 58 (43; 67), respectively; p=0.50 (Mann–Whitney test); men/women: 50/77 and 12/30; p=0.27, the Fisher’s test. The groups differed in the presence of cancer: in the ACT group, the proportion of patients with cancer was 21.4% (9/42), and in the TLT group it was 4.7% (6/127), p=0.003, the Fisher’s test, P=0.85.Results Patients of high and intermediate risk, who received thrombolysis, were in a significantly more serious condition in terms of baseline characteristics. Both methods of treatment were effective. In high-risk patients, perfusion deficiency regressed: from 57±10% (Me 60 (50; 65)) to 31±15% (Me 30 (20; 40)), p<0.00001 (Wilcoxon test), Es=2.08, P=1.00 after TLT; from 38±9% (Me 40 (35; 40)) to 14±8% (Me 10 (10; 20)), p=0.043 (Wilcoxon test), Es=2.72, P=0.93 after ACT. In patients with intermediate risk, perfusion deficiency regressed: from 48±9% (Me 50 (40, 55)) to 24±13% (Me 20 (15; 30)), p<0.00001 (Wilcoxon test) after TLT; from 38±11% (Me 40 (30; 45)) to 24±15% (Me 15 (15; 30)), p=0.00003 (Wilcoxon test) after ACT. The effect size for TLT was Es=2.16, for ACT Es=1.13. The power of the study was P=1.00 and P=0.99.Conclusion Thrombolytic therapy was more effective in restoring pulmonary perfusion compared to anticoagulants in patients with an intermediate risk of early death: the effect of thrombolysis was greater than that of anticoagulant therapy (Es=2.16 and Es=1.13). The absence of the effect of restoring pulmonary perfusion during thrombolysis was noted less frequently compared to the results of anticoagulant therapy: in 5.5% (95% CI 2.2–11.0) vs. 19.0% (95% CI 8.6–34.1).

scholarly journals PELATIHAN KOMUNIKASI INTERPERSONAL UNTUK MENINGKATKAN KOMITMEN ORGANISASI KARYAWAN

2019 ◽  
Vol 9 (2) ◽  
pp. 151-159
Author(s):  
Nira Gusfika
Keyword(s):  
Organizational Commitment ◽  
Interpersonal Communication ◽  
Communication Training ◽  
Wilcoxon Test ◽  
Control Group ◽  
Test Results ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Before And After ◽  
Experimental Group

This study aims to determine the improvement of organizational commitment through interpersonal communication training. The hypothesis of this research is that there is a difference of organizational commitment to employees between before and after being given interpersonal communication training on experimental group, where the level of commitment of employee organization after being given interpersonal communication training is higher than the level of organizational commitment of the employees before being given interpersonal communication training. Second hypothesis, there is difference of posttest organizational commitment level between experiment group and control group, where posttest of organizational commitment in experiment group is higher than control group.The subject of this research is 17 employees at STAI YAPPTI Balaiselasa. Characteristics of the subjects of this study are employees who have levels of organizational commitment and interpersonal communication in the category very low, low and medium. The design used was Pretest-Posttest Control Group, while the data was collected using organizational commitment scale then analyzed using Mann Whitney test to see the difference of score between the experimental group who were given interpersonal communication training with the control group who were not given interpersonal communication training. Furthermore, Wilcoxon test was done for see experimental group scores between before and after interpersonal communication training.Based on Mann Whitney test results found Z = -3.447 (p <0.01), meaning there is a difference in scores between experimental groups who were trained with control groups who were not trained. Based on Wilcoxon test results found there was a difference between organizational commitment score in the experimental group between before and after being given interpersonal communication training with Z = -2,668 (p<0,01).

scholarly journals Efektifitas endorphin massage terhadap fungsi seksual perempuan pada masa menopause

2018 ◽  
Vol 13 (1) ◽  
pp. 88-94
Author(s):  
Sri Wahyuni ◽  
Tutik Rahayu
Keyword(s):  
Data Processing ◽  
Sexual Function ◽  
Wilcoxon Test ◽  
P Value ◽  
Female Sexual Function ◽  
Z Score ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Before And After

Abstract: The purpose of this study is to identify the effectiveness ofendorphine massage on female sexual function during menopause inNgampel District of Kendal Regency. Sampling was done by samplingcriteria acsidental aged less than 60 years old, have a husband, in a healthycondition. Data processing was performed using the Wilcoxon test todetermine differences in sexual function before and after the interventionwhile endorphine effectiveness of massage performed by using MannWhitney.Hasil research: Wilcoxon test showed that there are significantdifferences in sexual function before and after being given endorphineMassage with p value 0.00. While Mann Whitney test showed p value of0.13 and the value of z score of -2.828, which means there is a stronginfluence among endorphine Massage to increased sexual function soendorphine Massage is effective for improving sexual function.

scholarly journals HUBUNGAN ACTIVITY DAILY LIVING (ADL) DENGAN KONTROL KADAR GLUKOSA DARAH (KGD) PADA PASIEN DIABETES MELITUS (DM) TIPE 2

2018 ◽  
Vol 4 (2) ◽  
pp. 94-98
Author(s):  
Ratna Dewi ◽  
Wina Anggraeny
Keyword(s):  
Daily Living ◽  
Wilcoxon Test ◽  
Cross Sectional ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Diabetes Melitus

Aktivitas fisik merupakan salah  satu penatalaksanaan DM tipe 2 yang bersifat nonfarmakologis dapat mempermudah perpindahan glukosa ke dalam sel-sel dan meningkatkan kepekaan terhadap insulin. Kedua tipe DM tipe 1 dan DM tipe 2 dengan melakukan aktivitas dan latihan fisik atau olahraga terbukti dapat meningkatkan pemakaian glukosa oleh sel sehingga KGD turun. Permasalahan penelitian adalah bagaimana hubungan ADL dengan kontrol KGD pada pasien DM tipe 2. Tujuan penelitian untuk menguji hubungan ADL dengan kontrol KGD pada pasien DM tipe 2. Jenis penelitian adalah korelasi dengan pendekatan pengamatan sewaktu (cross sectional). Penelitian dilaksanakan di . Sampel adalah seluruh penderita DM tipe 2 yang kontrol ke Puskesmas Bromo Medan sebesar 84 orang yang dibagi menjadi 2 kelompok, yaitu kelompok intervensi dan kontrol. Alat pengumpulan data menggunakan kuesioner. Uji yang digunakan adalah Wilcoxon test dan Mann whitney test.  Hasil penelitian menunjukkan pesan singkat secara signifikan (p<0,05) memberikan dampak patuh terhadap aturan minum obat dan kontrol nilai KGD dibandingkan pasien DM tipe 2 yang tidak dilakukan pengiriman pesan singkat. Kesimpulan penelitian adalah pengiriman pesan singkat efektif meningkatkan kepatuhan minum obat dan kontrol nilai KGD untuk meningkatkan kulitas hidup penderita DM tipe 2. Disarankan kepada keluarga untuk rutin dalam perawatan dirumah dan mengingatkan cek KGD, pihak puskesmas mengadakan penyuluhan tentang pengelolaan penyakit DM setiap minggu, dan diharapkan pihak BPJS menambah program aktifitas reminder SMS dengan pengingat aturan minum obat ke peserta prolanis yang dilakukan pengiriman setiap hari.

scholarly journals Pengaruh Range Of Motion Untuk Menurunkan Nyeri Sendi Pada lansia Dengan Osteoartritis di Wilayah Puskesmas Godean I Sleman Yogyakarta

2018 ◽  
Vol 6 (1) ◽  
pp. 36
Author(s):  
Maruli Taufandas ◽  
Elsye Maria Rosa ◽  
Moh Afandi
Keyword(s):  
Range Of Motion ◽  
Wilcoxon Test ◽  
Control Group ◽  
P Value ◽  
Control Group Design ◽  
Whitney Test ◽  
Group Design ◽  
Mann Whitney Test

Salah satu penyakit degeneratif pada lansia yang sering dialami yaitu osteoartritis, yang ditandai dengan adanya nyeri pada ekstremitas bawah dan prevalensinya semakin meningkat dengan bertambahnya usia. Penatalaksanaan non farmakologi merupakan komponen yang sangat penting dalam mengatasi nyeri, salah satu bentuknya adalah latihan Range of Motion. Tujuan: Penelitian ini bertujuan untuk mengetahui pengaruh Range of Motion untuk menurunkan nyeri sendi pada lansia dengan osteoartritis di wilayah kerja Puskesmas Godean I Sleman Yogyakarta. Metode :Penelitian ini adalah study intervensi berupa penelitian kuantitatifdengan rancangan Quasi Eksperiment Design: Pretest-Posttest Control Group Design. Penelitian dilakukan di dua dusun di Kabupaten Sleman yaitu di dusun Mertosutan dan dusun Ngabangan.Sampel pada penelitian ini sebanyak 36 orang lansia dengan masing-masing 18 lansia sebagai kelompok intervensi dan 18 lansia sebagai kelompok kontrol.Pengambilan sampel menggunakan teknik purposive sampling.Analisis data yang digunakan adalah Wilcoxon Test dan Mann Whitney Test. Hasil : Setelah melakukan latihan Range of Motionselama 4 minggu, didapatkan hasil bahwa terdapat pengaruh Range of Motion terhadap skala nyeri sendi pada lansia dengan osteoartritis dengan p value 0,000 (α < 0,05). Kesimpulan :Range of Motion berpengaruh secara signifikan terhadap penurunan tingkat skala nyeri sendi pada lansia dengan osteoartritis

scholarly journals Pengaruh Diabetes Self Management Education (DSME) terhadap Self Management pada Pasien Diabetes Mellitus

2019 ◽  
Vol 12 (2) ◽  
Author(s):  
Trina Kurniawati ◽  
Titih Huriah ◽  
Yanuar Primanda
Keyword(s):  
Diabetes Mellitus ◽  
Management Education ◽  
Intervention Group ◽  
Simple Random Sampling ◽  
Wilcoxon Test ◽  
Self Management ◽  
Control Group ◽  
P Value ◽  
Whitney Test ◽  
Mann Whitney Test

AbstrakEdukasi kepada pasien Diabetes Mellitus (DM) yang dapat memperbaiki hasil klinis adalah Diabetes Self Management Education (DSME). DSME merupakan salah satu metode yang dapat memfasilitasi pengetahuan dan keterampilan. Penelitian ini bertujuan untuk mengetahui pengaruh Diabetes Self Management Education terhadap Self Management pada pasien DM. Penelitian ini menggunakan metode penelitian quasi experimental dengan control group pre test- post test design. Teknik pengambilan sampel menggunakan teknik Simple random sampling dengan jumlah sampel sebanyak 46 orang yang terbagi menjadi 23 orang pada kelompok intervensi mendapatkan DSME sebanyak 4 sesi dalam satu bulan dan 23 orang pada kelompok kontrol mendapatkan edukasi dari Program PERSADIA. Instrumen yang digunakan menggunakan kuesioner. Analisis statistik menggunakan Wilcoxon dan Mann Whitney test. Hasil penelitian menunjukkan bahwa P value uji Wilcoxon test sebesar 0,000 pada kelompok intervensi, P value uji Mann Whitney test adalah 0,000 pada variabel self management. Berdasarkan hasil uji statistik didapatkan p<0,05 yang menunjukkan bahwa terdapat perbedaan nilai self management antara kelompok intervensi dengan kelompok kontrol secara signifikan. Kesimpulan penelitian ini adalah DSME dapat meningkatkan self management pada pasien DM. Disarankan petugas kesehatan dapat memberikan DSME untuk meningkatkan self management pasien diabetes dan menggunakan DSME sebagai program promosi kesehatan.Kata kunci: Diabetes Mellitus; DSME;Self Management  The Influnce of Diabetes Self Management Education (DSME) to the Self Management on the Diabetes Patient AbstractEducation to patients Diabetes Mellitus (DM) who can improve clinical outcomes is Diabetes Self Management Education (DSME). DSME is one method that can facilitate knowledge and skills. The purpose of this research is to determine the effect of Diabetes Self Management Education (DSME) to Self Management on the diabetes patients. This study is used the quasi experimental research method with control group pre test post test design. The sampling technique used Simple random sampling with a samples of 46 people and it is devided 23 people in the intervention group get DSME as much as 4 sessions in one month and 23 people in the control group get education programe at PERSADIA. The instrument used was questionnaire. Statistical analysis used Wilcoxon and Mann Whitney test. The results showed that P value of Wilcoxon test  was 0.000 in the intervention group, P test value of Mann Whitney test was 0.000 in self management variable. Based on statistical test results obtained p <0.05 which indicates that there are differences in self-management value between the intervention group and the control group significantly. The conclusions of this research is DSME can improve self-management on the patients with diabetes. It is recommended that health workers can provide DSME to improve self-management  in diabetic patients and use DSME as a health promotion program.Keywords  : Diabetes Mellitus, DSME, Self Management

scholarly journals Pulmonary embolism after thrombolysis of hemodialysis grafts.

1997 ◽  
Vol 8 (9) ◽  
pp. 1458-1461
Author(s):  
H F Smits ◽  
P P Van Rijk ◽  
J W Van Isselt ◽  
W P Mali ◽  
H A Koomans ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Symptoms ◽  
Interventional Procedure ◽  
Pulmonary Perfusion ◽  
Perfusion Scintigraphy ◽  
Substantial Risk ◽  
Pulmonary Embolization ◽  
Hemodialysis Graft

The aim of this study was to determine the incidence of pulmonary embolization occurring after mechanical or pharmacomechanical percutaneous intravascular thrombolysis in 23 patients with occluded hemodialysis grafts. In all patients, pulmonary perfusion scintigraphy was performed before and immediately after thrombolysis. In eight (35%) of the patients, there was evidence of pulmonary embolism resulting from the interventional procedure; however, in only one was there clinical symptoms. It is concluded that there is substantial risk of pulmonary embolism in patients undergoing percutaneous intravascular thrombolysis for an occluded hemodialysis graft.

scholarly journals Frequency and Functional Analysis of Myeloid-Derived Suppressor Cells (MDSCs) in the Peripheral Blood and Bone Marrow of Patients with Chronic Idiopathic Neutropenia (CIN)

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 26-27
Author(s):  
Nikoleta Bizymi ◽  
Athina Damianaki ◽  
Maria Velegraki ◽  
Konstantina Zavitsanou ◽  
Anastasios Karasachinidis ◽  
...  
Keyword(s):  
Bone Marrow ◽  
T Cell ◽  
Suppressor Cells ◽  
Wilcoxon Test ◽  
Healthy Controls ◽  
Myeloid Derived Suppressor Cells ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Chronic Idiopathic Neutropenia ◽  
Paired Analysis

Myeloid-derived suppressor cells (MDSCs) are myeloid cells with immunoregulatory properties characterized mainly by suppression of T-cell responses (Bizymi et al, HemaSphere 2019). They are divided in HLA-DRlow/-/CD11b+/CD33+/CD15+ polymorphonuclear (PMN-MDSCs) and HLA-DRlow/-/CD11b+/CD33+/CD14+ monocytic (M-MDSCs) subsets and they are implicated in inflammatory and malignant diseases. Chronic idiopathic neutropenia (CIN), is a (usually benign) neutrophil disorder characterized by persistent and unexplained neutropenia following a detailed clinical/laboratory investigation including anti-neutrophil antibody testing, bone marrow (BM) biopsy and karyotype (Dale & Bolyard, Curr Opin Hematol 2017). Previous studies have shown that neutropenia in CIN is associated with increased apoptosis of BM granulocytic progenitor cells due to an inflammatory BM microenvironment consisting of oligoclonal T-lymphocytes, proinflammatory monocytes and proapoptotic cytokines. The aim of the present study is to explore the possible involvement of the MDSCs in the pathophysiology of CIN by investigating their number in peripheral blood (PB) and BM in association with their functional characteristics. We have studied 100 CIN patients and 49 age- and sex-matched healthy controls. The patients fulfilled the previously described diagnostic criteria for CIN (Papadaki et al, Blood 2003) and had mean neutrophil counts 1095.67 ± 479.52 (median 1215, range 100-1700). MDSC subsets were quantitated by flow cytometry in the PB mononuclear cell (PBMC) fraction using the combination of CD33PC7/CD15PC5/HLA-DRECD/CD14PE/CD11bFITC monoclonal antibodies and the Kaluza analysis software. MDSC subsets were also studied in the BMMC fraction of 24 CIN patients and 8 healthy controls from the study population. The T-cell suppression function of patient MDSCs was evaluated in coculture experiments of immunomagnetically sorted, CFSE stained, normal CD3+ cells with immunomagnetically sorted M-MDSCs and PMN-MDSCs from 4 patients and 4 healthy donors using recombinant human IL-2 as activating factor. CFSE staining was detected in the CD3+ cells on day 0 and day 3 of coculture and analysis was performed with the Fcs Express 7 software. Statistical analysis was performed with the Statistica software. We found that the proportion of PB M-MDSCs was statistically significant lower in CIN patients (1.45% ± 1.82%) compared to controls (3.68% ± 3.12%, Mann-Whitney test, p &lt; 0.0001) (Figure a) whereas the proportion of PB PMN-MDSCs, although lower in patients, did not differ significantly from the controls. The proportion of BM M-MDSCs did not differ significantly between CIN patients and controls whereas the proportion of BM PMN-MDSCs was statistically significant lower in patients (13.27% ± 11.27%) compared to controls (19.49% ± 4.46%; Mann-Whitney test, p = 0.0291) (Figure b). Paired analysis showed that the proportion of PMN-MDSCs were higher in the BMMC compared to PBMC fraction in both CIN patients (13.27% ± 11.27% vs 1.14% ± 1.64%, respectively; Wilcoxon test, p = 0.005) (Figure c) and healthy controls (19.49% ± 4.46% vs 9.92% ± 9.08%, respectively; Wilcoxon test, p = 0.0118). Interestingly, the proportion of increase of PMN-MDSCs (in BMMC vs PBMC fraction) was significantly higher in patients (86.71% ± 21.26%) compared to controls (55.95% ± 38.59%; Mann-Whitney test, p = 0.0357) (Figure d). The above data indicate low production of PMN-MDSCs in CIN patients compared to controls but a trend for accumulation of these cells in patients' BM. No statistically significant difference was documented in paired analysis of M-MDSCs between BMMC and PBMC fractions in either CIN patients or healthy controls. Patient PMN-MDSCs and M-MDSCs displayed normal capacity to suppress T-cell proliferation as was indicated by the T-cell generations in coculture experiments of normal CD3+ cells in the presence or absence of patient MDSCs (Figure e). In conclusion, CIN patients display low proportion of MDSCs in the PB and lower proportion of PMN-MDSC in the BM compared to normal individuals. Patient MDSCs display normal capacity to suppress T-cell activation. The low proportions of MDSCs may sustain the inflammatory process associated with CIN whereas the accumulation of PMN-MDSCs in the BM represents probably a compensatory mechanism to suppress the inflammatory processes within patients' BM microenvironment. Figure Disclosures Papadaki: Genesis pharma SA: Membership on an entity's Board of Directors or advisory committees, Research Funding.

EFEKTIVITAS PEER EDUCATION UNTUK REMAJA DALAM MENINGKATKAN PENGETAHUAN DAN SIKAP PENCEGAHAN HIV AIDS

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Dewi Ariyani Wulandari ◽  
Nur Yeti Syarifah
Keyword(s):  
Sustainable Development ◽  
Peer Education ◽  
Wilcoxon Test ◽  
Sustainable Development Goal ◽  
Development Goal ◽  
Whitney Test ◽  
Group Design ◽  
Mann Whitney Test ◽  
Peer Educator ◽  
Hiv Aids

ABSTRAKSalah satu target tujuan dari pembangunan berkelanjutan (Sustainable Development Goal/SDG) adalahmenghentikan epidemik HIV AIDS di dunia tahun 2030. Usia remaja adalah usia berpotensi terinfeksiHIV AIDS. Salah satu upaya pencegahan HIV AIDS pada remaja adalah pendidikan kesehatan denganmetode peer education (pendidikan teman sebaya). Kelompok teman sebaya merupakan sumber referensiutama bagi remaja dalam hal persepsi dan sikap yang berkaitan dengan gaya hidup. Tujuan Penelitian iniadalah mengetahui efektivitas peer education terhadap pengetahuan dan sikap upaya pencegahan HIVAIDS remaja di Kabupaten Sleman. Desain penelitian quasi eksperimen dengan pre-post and post-testcontrol group design. Sampel penelitian ini terdiri atas 76 responden. Kelompok intervensi terdiri atas 38responden menggunkan teknik peer education dengan melatih peer educator dan kelompok kontrol terdiriatas 38 responden menggunakan metode ceramah. Pemilihan sampling mengguakan teknik purposivesampling yang dilakukan pada dua SMA. Instrumen penelitian menggunakan kuesioner. Tahapan analisisdata dengan menggunakan Wilcoxon dan Mann Whitney test untuk analisa bivariat. Hasil penelitiandengan menggunakan Wilcoxon test menunjukkan bahwa terdapat perbedaan tingkat pengetahuan(p=0,000) dan sikap (p=0,000) secara bermakna antara sebelum dan sesudah intervensi metode peereducation maupun metode ceramah. Hasil Mann Whitney test menunjukkan bahwa terdapat perbedaanbermakna tingkat pendidikan (p=0,000) dan sikap (0,000) antara metode peer education dengan metodeceramah. Pendidikan kesehatan dengan metode peer education lebih efektif meningkatkan pengetahuandan sikap upaya pencegahan HIV AIDS pada remaja.

Increase in Proportion of Th-17 Lymphocytes in Blood Heralds Overt Acute Graft Versus Host Disease in HSCT Patients.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2226-2226
Author(s):  
Andrzej Lange ◽  
Dorota Dlubek ◽  
Emilia Jaskula ◽  
Daria Drabczak-Skrzypek ◽  
Mariola Sedzimirska ◽  
...  
Keyword(s):  
Opportunistic Infections ◽  
Clinical Symptoms ◽  
Early Stage ◽  
Wilcoxon Test ◽  
Cd4 Cells ◽  
Post Transplantation ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Th 17

Abstract IL-17 is involved in chronic inflammation and autoimmunity, this cytokine producing cells are well characterized in the mouse model. In man, situation is more complex due to the genetic variability, co-morbidities and environmental factors influencing the immune response. In patients post HSCT alloreactivity with the presence of aGvHD is a major factor affecting the outcome of transplantation. Understanding of the role of cells involved in regulation of the immune system is crucial for the treatment tailoring to favour tolerance but not making the recipient more prone to opportunistic infections and leukaemia relapse. In this study 27 patients post HSCT were investigated for the presence of regulatory cells and those producing IFNgamma and IL-17 in blood. Blood was collected at the time of haematological recovery or when the first clinical symptoms of aGvHD became apparent and then in one week intervals until +60 day post transplantation. PBMC were stimulated for 4 hrs with BD Leukocyte Activation Cocktail in the presence of Golgi Stop (BD, Erembodegen, Belgium) and then stained extracellularly with anti-CD4, permeabilized with Fixation/Permeabilization Concentrate and Diluent (eBioscience, San Diego, CA) and finally stained with anti-IFNgamma (BD), anti-IL-17 (eBioscience) anti FoxP3 (eBioscience). CD4+ cells subpopulations were analysed according to the expression of the stained features. It was found: FoxP3+CD4+ cells were in higher proportions in pts with aGvHD (results from all time-points taken together) (9.93%±0.61 vs 8.2%±0.50, n=98, p=0.040, U Mann-Whitney test) IFNgamma producing CD4+ lymphocytes were in higher proportions (0,34 vs 0.14, ns) in blood samples taken from patients lacking as compared to those having aGvHD. CD4+IL-17+ lymphocytes proportions increased from 1.39%±0.42 to 5.33%±2.45 (p=0.04, Wilcoxon Test for pairs) one week before aGvHD. Notably, at the time of full blown aGvHD the proportions of CD4+IL-17+ cells were lower as compared to the results of previous measurements (0.74%±0.29, p=0.008, Wilcoxon Test for pairs). Taking all results together the proportion of CD4+IL17+ lymphocytes were lower in patients having as compared to those lacking aGVHD (0.93%±0.27 vs 1,53%±0,41, p=0.05, U Mann-Whitney test). It appears that: FoxP3 positive cells expand during aGvHD likely as a response to alloreactive stimulation. INFgamma+ CD4+ cells benefit the course post HSCT making the patients less susceptible to aGvHD. CD4+IL17+ cells are likely involved at the early stage of aGvHD patho-mechanism heralding the clinical manifestation of this complication, but then they disappear from blood, possibly being marginalized in the inflamed tissues.

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