Finding predictors of chronic graft-versus-host disease (cGVHD) in children would be extremely useful. Because of recent data suggesting that cGVHD may be a Th-2-mediated process, a theoretical ...foundation linking eosinophilia and cGVHD exists. While an association between eosinophilia and cGVHD has been described in adults, it has never been described in children. We studied 53 patients that received allogeneic hematopoietic stem cell transplants (SCT) between 1999 and 2002. Ten (19%) of these patients developed eosinophilia (absolute eosinophil count (AEC) > 500x 10/L) after day 100. Of these ten, eight either had or later developed cGVHD. We conclude that following the peripheral eosinophil count in children post-SCT is useful, and a rise in the AEC may herald the development of cGVHD. Taking the AEC into account with other risk factors (such as previous grade II-IV acute GVHD, human leukocyte antigen (HLA)-mismatch, and unrelated donor (URD) transplant) may improve our ability to predict cGVHD.
Abstract Although transplant practices have changed over the last decades, no information is available on trends in incidence and outcome of chronic graft-versus-host disease (cGVHD) over time. This ...study used the central database of the Center for International Blood and Marrow Transplant Research (CIBMTR) to describe time trends for cGVHD incidence, nonrelapse mortality, and risk factors for cGVHD. The 12-year period was divided into 3 intervals, 1995 to 1999, 2000 to 2003, and 2004 to 2007, and included 26,563 patients with acute leukemia, chronic myeloid leukemia, and myelodysplastic syndrome. Multivariate analysis showed an increased incidence of cGVHD in more recent years (odds ratio = 1.19, P < .0001), and this trend was still seen when adjusting for donor type, graft type, or conditioning intensity. In patients with cGVHD, nonrelapse mortality has decreased over time, but at 5 years there were no significant differences among different time periods. Risk factors for cGVHD were in line with previous studies. This is the first comprehensive characterization of the trends in cGVHD incidence and underscores the mounting need for addressing this major late complication of transplantation in future research.
This work focuses on the fabrication and luminescent characterization of Tb-doped yttrium aluminum garnet (Y3Al5O12:Tb; YAG:Tb) ceramics produced using the laser sintering technique. In this ...technique, a CO2 laser is employed as the main heating source to promoting the sintering. YAG powders with different Tb concentrations were prepared by the polymeric precursor method and presented single cubic crystalline phase after calcination at 1000 °C in air for 2 h. Ceramic bodies were fabricated by laser sintering of uniaxially pressed pellets using a CO2 laser at a power level of 3.3 ± 0.1 W/mm2 for 90 s. To sintering, the green sample were put inside a sample holder, that improved the density, microstructure and avoided ablation effect. The resultant ceramics exhibited a high relative density of about 98–99 ± 1%, good microstructural homogeneity as verified by scanning electron microscopy, and a single cubic crystalline phase as determined by X-ray diffraction. X-ray absorption near edge structure measurements taken at the Tb LIII edge showed Tb to be exclusively in the trivalent state.
Abstract Background context Spinal fibromatosis is a unique subset of fibromatosis that is only anecdotally described in the literature in sporadic case reports. According to our review of the ...literature, only 11 cases of spinal fibromatosis have been previously documented. This paucity of clinical data limits our understanding of its presentation and treatment. Purpose The authors present the first two cases of spinal fibromatosis encountered at their institution, and review the literature of reported cases to elucidate the presentation and outcomes of patients with this rare tumor. Study design A report of two cases and review of the literature. Methods The two patients in our case report were women aged 45 and 38 years. Both of the patients presented to our clinic after previous excisional biopsy of a spinal mass, 17 years and 1 year later, respectively, with pain and paresthesias that recapitulated their former symptoms. Thirteen cases, including the two described in the current article, were culled from the literature. Results Magnetic resonance imaging revealed an enhancing lesion in the posterior elements of the spinal column in the first case and a paraspinal soft tissue mass in the second case. The tumors were histologically defined by haphazardly arranged, elongated, and slender spindle cells separated by abundant collagen without mitoses or necrosis. Surgical management resulted in intralesional resection in the first case and en bloc resection in the second case. By 40 and 10 months after surgery, both patients remain without neurologic deficits. Conclusions Among 13 cases of spinal fibromatosis, pain with or without a mass is the most common symptom at presentation. Tumor etiology is evenly distributed between de novo origin and surgical trauma. Treatment outcomes, although, cannot be determined from the limited data currently available.
Acute and chronic graft versus host disease (GVHD) remain the major barriers to successful hematopoietic cell transplantation. The induction of GVHD may be divided into three phases: recipient ...conditioning;donor T-cell activation; andeffector cells mediating GVHD. This review examines GVHD prevention and treatment using this conceptual model as framework. The various pharmacological agents discussed impact on different phases of the GVHD cascade. For example, keratinocyte growth factor and interleukin (IL)-11 are cytokines that may be useful in disrupting phase I of the GVHD cascade by blocking gastrointestinal tract damage, and lowering serum levels of lipopolysaccharide and tumour necrosis factor (TNF)-alpha. Cyclosporin, tacrolimus (FK-506) and sirolimus (rapamycin) are some of the main agents that disrupt phase II (donor T-cell activation). Mycophenolate mofetil and tresperimus probably act on this phase as well. Other novel drugs that affect phase II are tolerance-induction agents such as CTLA-4 and anti-CD40-ligand monoclonal antibodies, and preliminary results using CTLA-4 monoclonal antibody in GVHD prevention are encouraging. Examples of agents that disrupt phase III are the IL-2 receptor antagonist daclizumab and the anti-TNFalpha monoclonal antibody infliximab. These anti-cytokine antibodies have shown promising results in early studies. The most effective approach to GVHD prevention will probably be a combination regimen where the three phases of the GVHD cascade are disrupted. Once GVHD has occurred, all three phases of the cascade are activated. Developments of combination therapy for treatment of both acute and chronic GVHD are likely to yield better results than monotherapy. The numerous new treatment modalities presented should improve the outlook for patients with acute and chronic GVHD.
Family-centered rounds (FCRs) have become standard of care, despite the limited evaluation of FCRs' benefits or interventions to support high-quality FCR delivery. This work examines the impact of ...the FCR checklist intervention, a checklist and associated provider training, on performance of FCR elements, family engagement, and patient safety.
This cluster randomized trial involved 298 families. Two hospital services were randomized to use the checklist; 2 others delivered usual care. We evaluated the performance of 8 FCR checklist elements and family engagement from 673 pre- and postintervention FCR videos and assessed the safety climate with the Children's Hospital Safety Climate Questionnaire. Random effects regression models were used to assess intervention impact.
The intervention significantly increased the number of FCR checklist elements performed (β = 1.2,
< .001). Intervention rounds were significantly more likely to include asking the family (odds ratio OR = 2.43,
< .05) or health care team (OR = 4.28,
= .002) for questions and reading back orders (OR = 12.43,
< .001). Intervention families' engagement and reports of safety climate were no different from usual care. However, performance of specific checklist elements was associated with changes in these outcomes. For example, order read-back was associated with significantly more family engagement. Asking families for questions was associated with significantly better ratings of staff's communication openness and safety of handoffs and transitions.
The performance of FCR checklist elements was enhanced by checklist implementation and associated with changes in family engagement and more positive perceptions of safety climate. Implementing the checklist improves delivery of FCRs, impacting quality and safety of care.
While partial nephrectomy (PN) represents the standard surgical management for cT1 renal masses, its role for cT2 tumors is controversial. Robot-assisted PN (RAPN) is being increasingly implemented ...worldwide.
To analyze perioperative, functional, and oncological outcomes of RAPN for cT2 tumors.
Retrospective analysis of a large multicenter, multinational dataset of patients with nonmetastatic cT2 masses treated with robotic surgery (ROSULA: RObotic SUrgery for LArge renal mass).
Robotic-assisted PN.
Patients’ demographics, lesion characteristics, perioperative variables, renal functional data, pathology, and oncological data were analyzed. Univariable and multivariable regression analyses assessed the relationships with the risk of intra-/postoperative complications, recurrence, and survival.
A total of 298 patients were analyzed. Median tumor size was 7.6 (7–8.5) cm. Median RENAL score was 9 (8–10). Median ischemia time was 25 (20–32) min. Median estimated blood loss was 150 (100–300) ml. Sixteen patients had intraoperative complications (5.4%), whereas 66 (22%) had postoperative complications (5% were Clavien grade ≥3). Multivariable analysis revealed that a lower RENAL score (odds ratio OR 0.46, 95% confidence interval CI 0.21–0.65, p=0.02) and pathological pT2 stage (OR 0.51, 95% CI 0.12–0.86, p=0.001) were protective against postoperative complications. A total of 243 lesions (82%) were malignant. Twenty patients (8%) had positive surgical margins. Ten deaths and 25 recurrences/metastases occurred at a median follow-up of 12 (5–35) mo. At univariable analysis, higher pT stage was predictive of a likelihood of recurrences/metastases (p=0.048). While there was a significant deterioration of renal function at discharge, this remained stable over time at 1-yr follow-up. The main limitation of this study is its retrospective design.
RAPN in the setting of select cT2 renal masses can safely be performed with acceptable outcomes. Further studies are warranted to corroborate our findings and to better define the role of robotic nephron sparing for this challenging indication.
This report shows that robotic surgery can be used for safe removal of a large renal tumor in a minimally invasive fashion, maximizing preservation of renal function, and without compromising cancer control.
This large multicenter experience suggests that robot-assisted partial nephrectomy for clinical T2 renal masses is feasible, it offers good surgical outcomes, and it allows preservation of renal function. Overall, the outcomes of a robotic approach compare favorably with those reported for open nephron-sparing surgery for this challenging indication.
There are no validated criteria to measure skin response in chronic GVHD. In a prospectively assembled, multicenter cohort of patients with chronic GVHD (N = 458), we looked for correlation of change ...in several different scales recommended by the National Institutes of Health (NIH) Consensus with clinician and patient perception of change and overall survival. Of the clinician scales, the NIH composite 0-3 skin score was the only one that correlated with both clinician and patient perception of improvement or worsening. Of the patient-reported scales, the skin subscale of the Lee Symptom Scale was the only one that correlated with both clinician and patient perception of improvement or worsening. At study entry, NIH skin score 3 and Lee skin symptom score > 15 were both associated with worse overall survival. Worsening of NIH skin score at 6 months was associated with worse overall survival. Improvement in the Lee skin symptom score at 6 months was associated with improved overall survival. Our findings support the use of the NIH composite 0-3 skin score and the Lee skin symptom score as simple and sensitive measures to evaluate skin involvement in clinical trials as well as in the clinical monitoring of patients with cutaneous chronic GVHD.
We report three novel Nb-containing oxide-fluorides, Cs
(Nb
O
F
)
F, Cs
K
(Nb
O
F
)
F, and Cs
(Nb
O
F
)
Cl, which were prepared as high-quality single crystals via a HF-based mild hydrothermal route. ...The compounds all crystallize in the trigonal crystal system with space group
3̅
1. All three compositions form the same framework structure consisting of isolated Nb
O
F
dimers that create hexagonal channels that are occupied by disordered halide species. Upon excitation by UV light at room temperature, these compounds display broad band emission with a maximum at 440 nm for Cs
(Nb
O
F
)
F. The broad band emission of these compounds is attributed to the charge-transfer transitions of Nb-O bonds within the Nb
O
F
dimers. All three compounds scintillate blue under X-ray irradiation. Radioluminescence (RL) measurements performed on Cs
(Nb
O
F
)
F demonstrate that the RL emission intensity decreases with increasing temperature and that the integrated RL emission (300-750 nm) is 4% of Bi
Ge
O
(BGO) powder. Thermogravimetric analysis confirms that Cs
(Nb
O
F
)
F has excellent thermal stability up to 600 °C and no structural phase transition is observed prior to sample decomposition.
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