Described herein is the use of a laser sintering technique to produce persistent luminescence CaAl2O4:Eu2+Dy3+ ceramics exhibiting enhanced translucency in the visible/near infrared spectral range. ...In this technique, a CO2 laser was used as the main heating source for sintering with no atmospheric control. The ceramics sintered at a power density of 1.2 W/mm2 yielded single monoclinic CaAl2O4 phase, homogeneous grain size distributions and transmittance up to 45% in the range of 400 nm–900 nm. Upon conventional sintering in air, the ceramics exhibited the characteristic blue emission from the Eu2+ ions corresponding to the 5d → 4f transition at 440 nm, and weak emission from Eu3+ ions between 550 nm and 700 nm, corresponding to the 5D0 → 7FJ transitions.
•CaAl2O4:Eu2+Dy3+ translucent ceramics were fabricated by the first time.•We present the first report of CaAl2O4:Eu2+Dy3+ laser-sintered ceramics.•The ceramics were produced in air and the reduction of Eu3+ to Eu2+ was observed.•Total laser processing time was 10 min, remarkably lower than conventional sintering.•The samples exhibited persistent luminescence for more than 12 h.
•Remission at second transplantation extends survival.•The same donor preferred for both transplantations.•Mismatched cord blood should be avoided for a second transplantation.
Children with acute ...leukemia who relapse after hematopoietic cell transplantation (HCT) have few therapeutic options. We studied 251 children and young adults with acute myelogenous or lymphoblastic leukemia who underwent a second HCT for relapse after their first HCT. The median age at second HCT was 11 years, and the median interval between first and second HCT was 17 months. Most of the patients (n = 187; 75%) were in remission, received a myeloablative conditioning regimen (n = 157; 63%), and underwent unrelated donor HCT (n = 230; 92%). The 2-year probability of leukemia-free survival (LFS) was 33% after transplantation in patients in remission, compared with 19% after transplantation in patients not in remission (P = .02). The corresponding 8-year probabilities were 24% and 10% (P = .003). A higher rate of relapse contributed to the difference in LFS. The 2-year probability of relapse after transplantation was 42% in patients in remission and 56% in those in relapse (P = .05). The corresponding 8-year probabilities were 49% and 64% (P = .04). These data extend the findings of others showing that patients with a low disease burden are more likely to benefit from a second transplantation. Late relapse led to a 10% decrement in LFS beyond the second year after second HCT. This differs from first HCT, in which most relapses occur within 2 years after HCT.
T-cell depletion of the marrow graft using counterflow centrifugal elutriation reduces the risk of graft-versus-host disease (GVHD). However, because of high rates of graft failure and relapse, ...elutriation alone has not improved survival. We have carried out a phase II clinical trial in 54 pediatric patients to determine if CD34+ selection to rescue pluripotent stem cells from the small lymphocyte fraction improves engraftment. The processed grafts contained a mean of 5.5 x 10(7) cells/kg IBW, 4.7 x 10(6) CD34+ cells/kg IBW, and 6.3 x 10(5) CD3+cells/kg IBW. Patients achieved an ANC >500 at a median of 16 days and platelet count >20 000 at a median of 28 days. The incidence of clinically significant GVHD was 19%. In total, 10 patients enrolled in this study experienced graft failure, with eight of the 14 patients transplanted for nonmalignant indications failing to engraft stably. Graft failure was statistically significantly associated with nonmalignant diagnosis (P<0.001), but was not associated with CMV seropositivity, donor gender, or cell counts of the allograft. We conclude that although time to engraftment is similar to that seen with unmanipulated grafts, graft failure remains a significant problem in patients with hereditary, nonmalignant diseases. Future efforts will seek to preserve the benefits of elutriation with CD34+ selection by increasing immune ablation of the preparative regimen and/or increasing posttransplant immune suppression.
Human graft-versus-host disease (GVHD) biology beyond 3 months after hematopoietic stem cell transplantation (HSCT) is complex. The Applied Biomarker in Late Effects of Childhood Cancer study ...(ABLE/PBMTC1202, NCT02067832) evaluated the immune profiles in chronic GVHD (cGVHD) and late acute GVHD (L-aGVHD). Peripheral blood immune cell and plasma markers were analyzed at day 100 post-HSCT and correlated with GVHD diagnosed according to the National Institutes of Health consensus criteria (NIH-CC) for cGVHD. Of 302 children enrolled, 241 were evaluable as L-aGVHD, cGVHD, active L-aGVHD or cGVHD, and no cGVHD/L-aGVHD. Significant marker differences, adjusted for major clinical factors, were defined as meeting all 3 criteria: receiver-operating characteristic area under the curve ≥0.60, P ≤ .05, and effect ratio ≥1.3 or ≤0.75. Patients with only distinctive features but determined as cGVHD by the adjudication committee (non-NIH-CC) had immune profiles similar to NIH-CC. Both cGVHD and L-aGVHD had decreased transitional B cells and increased cytolytic natural killer (NK) cells. cGVHD had additional abnormalities, with increased activated T cells, naive helper T (Th) and cytotoxic T cells, loss of CD56bright regulatory NK cells, and increased ST2 and soluble CD13. Active L-aGVHD before day 114 had additional abnormalities in naive Th, naive regulatory T (Treg) cell populations, and cytokines, and active cGVHD had an increase in PD-1− and a decrease in PD-1+ memory Treg cells. Unsupervised analysis appeared to show a progression of immune abnormalities from no cGVHD/L-aGVHD to L-aGVHD, with the most complex pattern in cGVHD. Comprehensive immune profiling will allow us to better understand how to minimize L-aGVHD and cGVHD. Further confirmation in adult and pediatric cohorts is needed.
•Profiling of immune cell populations and plasma markers at day 100 post-HSCT demonstrates biological differences between cGVHD and L-aGVHD.•Immune profiling differences between patients meeting NIH diagnostic criteria and those with distinctive features only were similar.
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Measles inclusion body encephalitis (MIBE) is a disease of the immunocompromised host and typically occurs within 1 year of acute measles infection or vaccination. We report a 13-year-old boy who had ...chronic granulomatous disease and presented 38 days after stem cell transplantation with afebrile focal seizures that progressed despite multiple anticonvulsants. After an extensive diagnostic evaluation, brain biopsy was performed, revealing numerous intranuclear inclusion bodies consistent with paramyxovirus nucleocapsids. Measles studies including reverse transcriptase-polymerase chain reaction and viral growth confirmed measles virus, genotype D3. Immunohistochemistry was positive for measles nucleoprotein. Despite intravenous ribavirin therapy, the patient died. MIBE has not been described in stem cell recipients but is a disease of immunocompromised hosts and typically occurs within 1 year of measles infection, exposure, or vaccination. Our case is unusual as neither the patient nor the stem cell donor had apparent recent measles exposure or vaccination, and neither had recent travel to measles-endemic regions. The patient had an erythematous rash several weeks before the neurologic symptoms; however, skin biopsy was consistent with graft-versus-host disease, and immunohistochemistry studies for measles nucleoprotein were negative. As measles genotype D3 has not been seen in areas where the child lived since his early childhood, the possibility of an unusually long latency period between initial measles infection and MIBE is raised. In addition, this case demonstrates the utility of brain biopsy in the diagnosis of encephalitis of unknown cause in the immunocompromised host.
A series of new ternary lanthanide-based chlorides, Cs2EuCl5(H2O)10, Cs7LnCl10(H2O)8 (Ln = Gd or Ho), Cs10Tb2Cl17(H2O)14(H3O), Cs2DyCl5(H2O)6, Cs8Er3Cl17(H2O)25, and Cs5Ln2Cl11(H2O)17 (Ln = Y, Lu, or ...Yb), were prepared as single crystals via a facile solution route. The compounds with compositions of Cs7LnCl10(H2O)8 (Ln = Gd or Ho) and Cs5Ln2Cl11(H2O)17 (Ln = Y, Lu, or Yb) crystallize in a monoclinic crystal system in space groups C2 and P21/c, respectively, whereas Cs2EuCl5(H2O)10, Cs10Tb2Cl17(H2O)14(H3O), and Cs8Er3Cl17(H2O)25 crystallize in orthorhombic space groups Pbcm, Pnma, and P212121, respectively. Cs2DyCl5(H2O)6 crystallizes with triclinic symmetry in space group P1̅. All of these compounds exhibit complex three-dimensional structures built of isolated lanthanide polyhedral units that are linked together by extensive hydrogen bonds. Cs2EuCl5(H2O)10 and Cs10Tb2Cl17(H2O)14(H3O) luminesce upon irradiation with 375 nm ultraviolet light, emitting intense orange-red and green color, respectively, and Cs10Tb2Cl17(H2O)14(H3O) scintillates when exposed to X-rays. Radioluminescence (RL) measurement of Cs10Tb2Cl17(H2O)14(H3O) in powder form shows that the RL emission integrated in the range of 300–750 nm was ∼16% of BGO powder.
Transparent Y2O3 ceramics singly-doped with either Eu3+ or Tm3+ were fabricated by means of sequential consolidation steps at high pressure and temperature. These ceramics were characterized for ...their luminescence and thermal lensing behaviors, and the results compared to data on single crystals reported in literature. Thermal diffusivity, D, and conductivity, K, values of D=26×10−3cm2/s and K=5.8W/mK, respectively, for 1.0mol% Eu3+ and 0.5mol% Tm3+ singly-doped Y2O3 transparent ceramics were obtained. These values are about half of those for single crystal analogs. A small temperature coefficient of the optical path length change, ds/dT=3×10−6K−1, was determined, making these materials suitable for applications requiring nearly athermal response. Selected spectroscopic properties were obtained by means of Judd–Ofelt analysis and together with thermal lens results provided absolute values for the fluorescence quantum efficiency of several levels, particularly 62% for the 5D0 level of Eu3+ and 84% for the 3F4 level of Tm3+.
•Thermal lens and spectroscopy coupled with Judd–Ofelt analysis were used.•Thermal and optical properties of Y2O3:Eu3+ and Y2O3:Tm3+ transparent ceramics.•The thermal conductivity of Y2O3 ceramic is half that of Y2O2 single-crystal.•Fluorescence quantum efficiencies of several levels of Eu3+ and Tm3+ were determined.
Abstract Caring for the critically ill patient with acute right ventricle (RV) failure is a diagnostic and management challenge. A thorough understanding of normal RV anatomy and physiology is ...essential to manage RV failure. Despite the fact that the RV is essentially a volume chamber that ejects into a low-pressure system, the left ventricle contributes significantly to RV function through maintenance of the transseptal gradient (TSG). Preserving systemic mean arterial pressure maintains the TSG and RV perfusion. Various pathological states cause acute RV failure by decreasing the TSG and RV perfusion and/or increasing pulmonary vascular resistance. Early diagnosis prevents rapid progression of RV failure due to the “double hit phenomenon,” which is acute intra-abdominal multiple organ system failure as a result of a reduced blood pressure and elevated central venous pressure. Management includes hemodynamic support and reversal of the precipitating cause through optimizing RV rate and rhythm, determining ideal RV filling pressure, reducing RV afterload through nonpharmacologic and pharmacological means, and selecting the appropriate RV inotrope or mechanical support.
Chronic graft-versus-host disease (cGVHD) is the most common cause for non-relapse mortality postallogeneic hematopoietic stem cell transplant (HSCT). However, there are no well-defined biomarkers ...for cGVHD or late acute GVHD (aGVHD). This study is a longitudinal evaluation of metabolomic patterns of cGVHD and late aGVHD in pediatric HSCT recipients. A quantitative analysis of plasma metabolites was performed on 222 evaluable pediatric subjects from the ABLE/PBMTC1202 study. We performed a risk-assignment analysis at day + 100 (D100) on subjects who later developed either cGVHD or late aGVHD after day 114 to non-cGVHD controls. A second analysis at diagnosis used fixed and mixed multiple regression to compare cGVHD at onset to time-matched non-cGVHD controls. A metabolomic biomarker was considered biologically relevant only if it met all 3 selection criteria: (1) P ≤ .05; (2) effect ratio of ≥1.3 or ≤0.75; and (3) receiver operator characteristic AUC ≥0.60. We found a consistent elevation in plasma α-ketoglutaric acid before (D100) and at the onset of cGVHD, not impacted by cGVHD severity, pubertal status, or previous aGVHD. In addition, late aGVHD had a unique metabolomic pattern at D100 compared with cGVHD. Additional metabolomic correlation patterns were seen with the clinical presentation of pulmonary, de novo, and progressive cGVHD. α-ketoglutaric acid emerged as the single most significant metabolite associated with cGVHD, both in the D100 risk-assignment and later diagnostic onset analysis. These distinctive metabolic patterns may lead to improved subclassification of cGVHD. Future validation of these exploratory results is needed. This trial was registered at www.clinicaltrials.gov as #NCT02067832.
•Plasma α-ketoglutaric acid was consistently elevated both before and at the onset of cGVHD in children and adolescents.•Metabolomics profiling of a large pediatric cohort found distinctive patterns in cGVHD, late aGVHD, and clinical presentations of cGVHD.
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The 2005 National Institutes of Health (NIH) consensus criteria for chronic GVHD have set standards for reporting. Many questions, however, have arisen regarding their implementation and utilization. ...To identify perceived areas of controversy, we conducted an international survey on diagnosis and scoring of chronic GVHD. Agreement was observed for 50-83% of the 72 questions in 7 topic areas. There was agreement on the need for modifying criteria in six situations: two or more distinctive manifestations should be enough to diagnose chronic GVHD; symptoms that are not due to chronic GVHD should be scored differently; active disease and fixed deficits should be distinguished; a minimum threshold body surface area of hidebound skin involvement should be required for a skin score of 3; asymptomatic oral lichenoid changes should be considered a score 1; and lung biopsy should be unnecessary to diagnose chronic GVHD in a patient with bronchiolitis obliterans as the only manifestation. The survey also identified 26 points of controversy. Whenever possible, studies should be conducted to confirm the appropriateness of any revisions. In cases where data are not available, clarification of the NIH recommendations by consensus is necessary. This survey should inform future research in the field and revisions of the current consensus criteria.
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