Validation of donor fraction cell-free DNA with biopsy-proven cardiac allograft rejection in children and adults

ObjectivesDonor-specific cell-free DNA shows promise as a noninvasive marker for allograft rejection, but as yet has not been validated in both adult and pediatric recipients. The study objective was to validate donor fraction cell-free DNA as a noninvasive test to assess for risk of acute cellular rejection and antibody-mediated rejection after heart transplantation in pediatric and adult recipients.MethodsPediatric and adult heart transplant recipients were enrolled from 7 participating sites and followed for 12 months or more with plasma samples collected immediately before all endomyocardial biopsies. Donor fraction cell-free DNA was extracted, and quantitative genotyping was performed. Blinded donor fraction cell-free DNA and clinical data were analyzed and compared with a previously determined threshold of 0.14%. Sensitivity, specificity, negative predictive value, positive predictive value, and receiver operating characteristic curves were calculated.ResultsA total of 987 samples from 144 subjects were collected. After applying predefined clinical and technical exclusions, 745 samples from 130 subjects produced 54 rejection samples associated with the composite outcome of acute cellular rejection grade 2R or greater and pathologic antibody-mediated rejection 2 or greater and 323 healthy samples. For all participants, donor fraction cell-free DNA at a threshold of 0.14% had a sensitivity of 67%, a specificity of 79%, a positive predictive value of 34%, and a negative predictive value of 94% with an area under the curve of 0.78 for detecting rejection. When analyzed independently, these results held true for both pediatric and adult cohorts at the same threshold of 0.14% (negative predictive value 92% and 95%, respectively).ConclusionsDonor fraction cell-free DNA at a threshold of 0.14% can be used to assess for risk of rejection after heart transplantation in both pediatric and adult patients with excellent negative predictive value.     

降黄散熏蒸联合捏脊、推拿治疗湿热蕴蒸型新生儿病理性黄疸临床研究

目的:观察降黄散熏蒸联合捏脊、推拿治疗湿热蕴蒸型新生儿病理性黄疸的临床疗效。方法:将92例湿热蕴蒸型病理性黄疸患儿按随机数字表法分为观察组和对照组各46例。对照组给予蓝光照射治疗,观察组在对照组基础上加降黄散熏蒸联合捏脊、推拿治疗,2组均治疗5 d。对比2组临床疗效和治疗前后的血清总胆红素水平、免疫球蛋白(Ig)及T细胞亚群的变化,记录黄疸消退时间。结果:观察组临床疗效优于对照组,差异有统计学意义(P<0.05)。治疗后,2组血清总胆红素水平均较治疗前下降(P<0.05),观察组血清总胆红素水平比对照组下降更明显(P<0.05);观察组黄疸消退时间短于对照组(P<0.05)。治疗后,2组血清IgA、IgG、IgM水平均较治疗前升高(P<0.05),观察组IgA、IgG、IgM水平均比对照组升高更明显(P<0.05)。治疗后,2组CD3^+、CD4^+、CD4^+/CD8^+值均较治疗前升高(P<0.05),观察组CD3^+、CD4^+、CD4^+/CD8^+值均比对照组升高更明显(P<0.05)。结论:降黄散熏蒸联合捏脊、推拿治疗湿热蕴蒸型新生儿病理性黄疸,可以有效降低患儿的血清总胆红素水平,缩短退黄时间,提高机体免疫功能。     

Outcomes after neoadjuvant or adjuvant chemotherapy for cT2-4N0-1 non–small cell lung cancer: A propensity-matched analysis

Objective

Comparative survival between neoadjuvant chemotherapy and adjuvant chemotherapy for patients with cT2-4N0-1M0 non–small cell lung cancer has not been extensively studied.

Pathologic Versus Native Hip Fractures: Comparing 30-day Mortality and Short-term Complication Profiles

BackgroundA large body of research on native hip fractures has resulted in several evidence-based guidelines aimed at improving postsurgical care for these patients. In contrast, there is a paucity of data on pathologic hip fractures, and whether native hip fracture protocols are generalizable to this population is unknown. The purpose of this study was to compare mortality rates and complication profiles between patients with pathologic and native hip fractures.MethodsUsing the American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) database, we identified patients who underwent surgical treatment for pathologic and native hip fractures from 2007 to 2017 and 2601 matched pairs were identified using propensity scoring. Baseline covariates were controlled for, and rates of 30-day postoperative complications and mortality were compared using McNemar’s test.ResultsPathologic hip fracture patients experienced significantly higher rates of death (6.3% vs 4.3%, P < .001), serious adverse events (17.3% vs 13.5%, P < .001), minor complications (34.3% vs 29.1%, P < .001), extended postoperative lengths of stay (30.2% vs 25.9%, P < .001), readmissions (11.9% vs 8.4%, P < .001), thromboembolic complications (3.0% vs 1.6%, P < .001), and perioperative transfusions (31.5% vs 26.4%, P < .001) compared to native hip fracture patients.ConclusionPathologic hip fractures result in significantly higher complication rates than native hip fractures after surgical treatment, suggesting that guidelines for native hip fractures may not be generalizable for pathologic hip fractures. Orthopedic surgeons should closely monitor these patients for deep vein thrombosis, utilize blood sparing techniques, and employ a multidisciplinary approach to help manage and prevent a more heterogenous profile of postsurgical complications.     

Neoadjuvant therapy and breast specimen processing and reporting

Neoadjuvant therapy (NAT) is becoming a common approach to treat breast cancers. The most important advantage of NAT is the opportunity to evaluate the tumor response to treatment within few months after starting the medication. Pathology is the gold standard to determine the post therapy changes and response. An accurate and reproducible pathology report requires a multidisciplinary approach, a standard and appropriate handling of the gross specimen and recognizing the microscopic changes associated with a post NAT specimen. This review focuses on the standard approach for a post NAT breast specimen, based on the available guidelines and other related articles.     

A Pre-Protocol/Post-Protocol Quality Improvement Initiative Specific to One Hospital for Security of Pathologic Specimen

ObjectiveThe objective of this study was to reduce errors in a pathologic specimen with the help of a protocol systematizing the pathology specimen management process in the operating room.Materials and methodThis quasi-experimental study was carried out in the operating room unit of a research and training hospital. A protocol systematizing the process of specimen management in secure surgical pathology and prepared in light of the current literature was used as an intervention, and the effectiveness of the protocol was tested.ResultsIt was determined that the rate of adverse events decreased from .3226% (68 of 21,078) to .032% (6 of 18,706) after the protocol systematizing the surgical pathology specimen management process prepared by the researchers, and the protocol was found to be effective by 90% (P = .03).ConclusionBased on the data obtained in this study, we recommend the use of a pathologic specimen management protocol in the operating room.     

银屑病皮损血管内皮细胞CD105的表达

目的 探讨转化生长因子β的结合蛋白CD105在银屑病皮损血管内皮细胞的表达及其作用。方法 采用免疫组化方法检测TGF-β1、TGF-βRⅠ、TGF-βRⅡ和CD105在银屑病皮损及正常对照皮肤的血管内皮细胞的表达。结果 与正常皮肤相同,TGF-β1、TGF-βRⅠ在银屑病皮损血管内皮细胞均无明显表达;TGF-βRⅡ在银屑病皮损和正常皮肤的血管内皮细胞均有明显表达,但两者差异无显著性;CD105在银屑病皮损血管内皮细胞的表达明显强于正常皮肤,差异有显著性（P〈0．01）。结论 CD105在银屑病皮损血管内皮细胞的表达明显上调可能与银屑病真皮浅层血管增生、炎症细胞浸润的病理机制有关。