A high proportion of patients with acute myeloid leukemia who achieve minimal residual disease negative status ultimately relapse because a fraction of pathological clones remains undetected by ...standard methods. We designed and validated a high-throughput sequencing method for minimal residual disease assessment of cell clonotypes with mutations of
,
and/or
-single nucleotide variants. For clinical validation, 106 follow-up samples from 63 patients in complete remission were studied by sequencing, evaluating the level of mutations detected at diagnosis. The predictive value of minimal residual disease status by sequencing, multiparameter flow cytometry, or quantitative polymerase chain reaction analysis was determined by survival analysis. The sequencing method achieved a sensitivity of 10
for single nucleotide variants and 10
for insertions/deletions and could be used in acute myeloid leukemia patients who carry any mutation (86% in our diagnostic data set). Sequencing-determined minimal residual disease positive status was associated with lower disease-free survival (hazard ratio 3.4,
=0.005) and lower overall survival (hazard ratio 4.2,
<0.001). Multivariate analysis showed that minimal residual disease positive status determined by sequencing was an independent factor associated with risk of death (hazard ratio 4.54,
=0.005) and the only independent factor conferring risk of relapse (hazard ratio 3.76,
=0.012). This sequencing-based method simplifies and standardizes minimal residual disease evaluation, with high applicability in acute myeloid leukemia. It is also an improvement upon flow cytometry- and quantitative polymerase chain reaction-based prediction of outcomes of patients with acute myeloid leukemia and could be incorporated in clinical settings and clinical trials.
The measurement of minimal residual disease (MRD) by multiparametric flow cytometry (MFC) before hematopoietic stem cell transplantation (HSCT) in patients with acute myeloid leukemia (AML) is a ...powerful prognostic factor. The interaction of pretransplant MRD and the conditioning intensity has not yet been clarified.
The aim of this study is to analyze the transplant outcomes of patients with AML who underwent HSCT in complete remission (CR), comparing patients with positive MRD (MRD+) and negative MRD (MRD-) before HSCT, and the interaction between conditioning intensity and pre-HSCT MRD.
We retrospectively analyzed the transplant outcomes of 118 patients with AML who underwent HSCT in CR in a single institution, comparing patients with MRD+ and MRD- before HSCT using a cutoff of 0.1% on MFC, and the interaction between conditioning intensity and pre-HSCT MRD.
Patients with MRD+ before HSCT had a significantly worse 2-year (2y) event-free survival (EFS) (56.5% vs. 32.0%,
= 0.018) than MRD- patients, due to a higher cumulative incidence of relapse (CIR) at 2 years (49.0% vs. 18.0%,
= 0.002), with no differences in transplant-related mortality (TRM) (2y-TRM, 19.0% and 25.0%, respectively,
= 0.588). In the analysis stratified by conditioning intensity, in patients who received MAC, those with MRD- before HSCT had better EFS (
= 0.009) and overall survival (OS) (
= 0.070) due to lower CIR (
= 0.004) than MRD+ patients. On the other hand, the survival was similar in reduced intensity conditioning (RIC) patients regardless of the MRD status.
Patients with MRD+ before HSCT have worse outcomes than MRD- patients. In patients who received MAC, MRD- patients have better EFS and OS due to lower CIR than MRD+ patients, probably because they represent a more chemo-sensitive group. However, among RIC patients, results were similar regardless of the MRD status.
Objective
This in‐vitro study measured the differences in surface roughness for computer assisted design/computer assisted manufacturing (CAD/CAM) resilient ceramic and CAD/CAM composite materials.
...Materials and Methods
The materials included Lava Ultimate (3 M), Cerasmart (GC America), Vita Enamic (Vita Zahnfabrik), and Brilliant Crios (Coltene). One calibrated operator polished each material with three polishing sytems: spiral polishers (Diacomp FeatherLite/Brasseler), rubbercup polishers (Enhance/DentsplyCaulk), and brush‐paste (Diashine/VH Technologies). Surface roughness was assessed using a confocal laser microscope (Lext OLS4000/Olympus).
Results
A two‐way ANOVA revealed statistically significant differences in mean surface roughness values (Sa) among materials and polishers. Tukey multiple comparisons showed that mean Sa values for Lava Ultimate, Enamic, Cerasmart and Brilliant Crios polished with brush‐paste as well as Lava Ultimate and Cerasmart values polished with spiral polishers were not significantly different from each other.
Conclusions
The finished surfaces were significantly smoother than milled surfaces for all materials. The brush‐paste polishing technique created the lowest surface roughness values for all CAD/CAM materials and values were comparable to what was achieved by spiral polishers for Lava Ultimate and Cerasmart. Rubber polishers did not provide a clinically smooth surface for CAD/CAM resilient ceramic/composite materials.
Clinical significance
The results of the study indicate that polishing creates smooth surfaces for CAD/CAM resilient ceramic and CAD/CAM composite restorations.
Introducción. El Beliefs about Medicines Questionnaire (BMQ) permite valorar las representaciones cognitivas que engloban las creencias sobre la medicación de los pacientes, sobre tomar medicamentos ...para su enfermedad en diferentes culturas. Objetivo. Determinar la validez de constructo y confiabilidad del cuestionario BMQ adaptado a pacientes hipertensos colombianos. Materiales y métodos. Estudio psicométrico de tipo instrumental, realizado en una muestra de 238 pacientes hipertensos en edad promedio de 65 años (DE= 11,4) con predominio del sexo femenino (70%). La validez de constructo se evaluó mediante Análisis Factorial Exploratorio y Confirmatorio. Se calculó la confiabilidad utilizando el método coeficiente de alfa de Cronbach. Resultados. Se obtuvo una versión reducida de 16 ítems; en la sección BMQ-General los 7 ítems se agruparon en dos factores que explicó el 64% de la varianza común y buen ajuste ( = 61.46; gl = 13; p = 0.000; CFI = 0.917; NNFI = 0.89; CFI=0.917; SRMR=0.054; RMSEA = 0.125; IC 90% 0,10, 0,16). En el BMQ-Específico los 9 ítems agrupados en dos factores que explicaron el 63,17% de la varianza común con un ajuste aceptable ( = 122.4; gl = 26; p = 0.000; CFI = 0.88; NNFI = 0.84; CFI=0.88; SRMR=0.106; RMSEA = 0.125; IC 90% 0.10, 0.15). La confiabilidad por alfa de Cronbach para el BMQ-General y Específico fue de 0.82 y 0.78 respectivamente. Discusión y conclusiones. La versión del BMQ adaptada a pacientes hipertensos colombianos, poseen características psicométricas adecuadas, su uso es recomendado en la investigación.
Objective. This work sought to design and validate a self-care instrument to prevent diabetic foot in Colombian adults with diabetes.
Methods. Psychometric study in which an instrument was designed ...to measure self-care to prevent diabetic foot according to the Medium Range Theory of Self-care in chronic diseases. With a sample of 230 people with type-2 diabetes, construct validity was determined through exploratory and confirmatory factor analysis. Internal consistency was calculated with Cronbach's alpha coefficient.
Results. Favorable evidence of construct validity was obtained with a model consisting of three scales: self-care maintenance with a three-factor structure (accumulated variance 43%), α = 0.7, with good fit (???2= 64.698, p = 0.001; RMSEA = 0.066; RMSSR = 0.071; CFI = 0.936, NNFI = 0.910). Monitoring of self-care with presence of symptoms a two-factor structure was found, α = 0.950, with good fit (???2 = 266.837, p = 0.000; RMSEA = 0.321; RMSSR = 0.057; CFI = 0.848; NNFI = 0.789); and without symptoms, a single-factor structure (cumulative variance 84%), α = 0.9, acceptable fit (???2= 377.327, p < 0.001; RMSEA = 0.355; RMSSR = 0.073; CFI = 0.832; NNFI = 0.764). And self-care management with two-factor structure (cumulative variance 53.7%) α = 0.7, with good fit (???2 = 14.317, p = 0.014; RMSEA = 0.144; RMSSR = 0.063; CFI = 0.905; NNFI = 0.809).
Conclusions. The resulting instrument has adequate psychometric properties, consistent with the theoretical model of self-care in chronic diseases. Its use is recommended to evaluate self-care to prevent diabetic foot in populations similar to the study population.
Acute myeloid leukemia (AML) in the elderly remains a clinical challenge, with a five-year overall survival rate below 10%. The current ELN 2017 genetic risk classification considers cytogenetic and ...mutational characteristics to stratify fit AML patients into different prognostic groups. However, this classification is not validated for elderly patients treated with a non-intensive approach, and its performance may be suboptimal in this context. Indeed, the transcriptomic landscape of AML in the elderly has been less explored and it might help stratify this group of patients. In the current study, we analyzed the transcriptome of 224 AML patients > 65 years-old at diagnosis treated in the Spanish PETHEMA-FLUGAZA clinical trial in order to identify new prognostic biomarkers in this population. We identified a specific transcriptomic signature for high-risk patients with mutated
or complex karyotype, revealing that low expression of
gene with high expression of
gene identifies a subset of high-risk AML patients surviving more than 12 months. This result was further validated in the BEAT AML cohort. This unique signature highlights the potential of transcriptomics to identify prognostic biomarkers in in elderly AML.
This study aimed to determine how personal factors influence health-promoting behavior in university students using a structural equation modeling approach guided by the Health Promotion Model.
An ...analytical cross-sectional study was conducted. The study included 763 health science students from four universities in Cali, Colombia, who answered a questionnaire on personal factors and Health Promoting Lifestyle Profile II, Spanish version, which was validated in the study population. The direct and indirect relationships between personal factors and health-promoting behaviors were assessed using structural equation modeling. Data analysis was performed using descriptive statistics and structural equation modeling.
A significant relationship was noted between the biological and psychological personal factors of the measurement model (p < 0.05). Psychological personal factors (self-esteem and perceived health status) positively influence health promoting behavior in university students (Hypothesis 2). It's not possible to demonstrate that health promoting behavior is positively influenced by personal biological factors (Hypothesis 1) and by personal sociocultural factors (Hypothesis 3).
There is a need for interventions that help improve the health-promoting lifestyle profile and are focused on enhancing the self-esteem and perceived health status of university students.
Background
Donor specific antibodies (DSAs) can be responsible for graft failure (GF) in the setting of mismatched hematopoietic stem cell transplantation (HSCT). The aim of our study is to report ...the experience of the Madrid Group of Hematopoietic Transplant (GMTH) in patients with DSAs undergoing haplo-HSCT.
Methods
Patients undergoing haplo-HSCT in centers from the GMTH from 2012 to 2020 were included in the study. DSAs were analyzed with a solid-phase single-antigen immunoassay; monitoring was performed during desensitization on days -14, -7, 0 and in a weekly basis until neutrophil engraftment. Desensitization strategies varied depending on center experience, immunofluorescence intensity, complement fixation and type of antibodies.
Results
We identified a total of 20 haplo-HSCT in 19 patients performed with DSAs in 5 centers. 10 (53%) patients presented anti-HLA class I DSAs (6 of them with > 5000 mean fluorescence intensity (MFI)), 4 (21%) presented anti-HLA class II (1 with > 5000 MFI) and 5 (26%) presented both anti-HLA class I and II (5 with > 5000 MFI). 90% of patients received at least two treatments as desensitization strategy and all experienced a decrease of MFI after desensitization (mean reduction 74%). Only one patient who developed progressive increase of MFI after infusion developed GF. Desensitization treatments used included rituximab, immunoglobulins, therapeutic plasma exchange, incompatible platelets, buffy coat and immunosuppressors. Seventeen (90%) patients achieved neutrophil engraftment; one patient died before engraftment because of infection and one patient with class I DSAs developed primary GF despite an intensive desensitization. After a median follow-up of 10 months, OS and EFS were 60% and 58%, respectively, cumulative incidence of relapse was 5% and NRM was 32%.
Conclusions
Despite the optimal strategy of DSAs desensitization remains unclear, the use of desensitization treatment guided by DSAs intensity kinetics constitute an effective approach with high rates of engraftment for patients with DSAs in need for an haplo-HSCT lacking an alternative suitable donor.
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