Favorable outcome to glucocorticoid therapy for engraftment syndrome in pediatric autologous hematopoietic cell transplant

ES remains an important cause of morbidity and mortality in children undergoing auto‐HCT. Glucocorticoid use in ES is an area of debate. We retrospectively analyzed single‐institution experience from September 2000 through December 2012 to evaluate the use of glucocorticoids in auto‐HCT patients. ES was defined by the occurrence of new onset of non‐infectious fever plus diarrhea, rash, or pulmonary infiltrates 24‐h before or within five days after neutrophil engraftment. Sixty‐five pediatric patients (<21 yr) with different solid tumors underwent auto‐HCTs in the study period. Fifteen patients (23%) fulfilled criteria for ES, of which 13 received methylprednisolone (2 mg/kg IV for 3–5 days). Clinical improvement occurred in all patients within 48 h without significant complications. In the non‐ES group, 11 patients received glucocorticoid without significant complications as well. MEL‐based regimens were found to be significant factor for ES (p < 0.05). Fever, edema, non‐infectious diarrhea, and serum albumin concentration were statistically different between the two groups. Median hospital length of stay was higher in the ES group. Conclusion: ES is a common complication in children after auto‐HCT and short‐course glucocorticoid therapy is an effective and well‐tolerated treatment, even in those who did not completely fulfill diagnostic criteria.     

The Predicting Response to Inhaled Corticosteroid Efficacy (PRICE) trial

BACKGROUND: Although guidelines recommend anti-inflammatory therapy for persistent asthma, recent studies suggest that 25% to 35% of patients with asthma may not improve lung function with inhaled corticosteroids. OBJECTIVE: To evaluate potential biomarkers of predicting short-term (6-week) response to inhaled corticosteroid with subsequent evaluation of responders and nonresponders to asthma control over a longer interval (16 additional weeks). METHODS: Eighty-three subjects with asthma off steroid were enrolled in this multicenter study. Biomarkers and asthma characteristics were evaluated as predictors of inhaled corticosteroid response over a 6-week trial for changes in FEV(1) and methacholine PC(20). After this, an additional 4-month trial evaluated asthma control. RESULTS: Although multiple baseline predictors had significant correlations with improvements for short-term inhaled steroid success, the only strong correlations (r >or= +/- 0.6) were albuterol reversibility (r = 0.83; P < .001), FEV(1)/forced vital capacity (r = -0.75; P < .001), and FEV(1) % predicted (r = -0.71; P < .001). Dividing the subjects in the short-term inhaled steroid trial into responders (>5% FEV(1) improvement) and nonresponders (相似文献   

Associated movement in hemiplegia: the effects of force exerted, limb usage and inhibitory training.

The intensity of associated movement or motor overflow in the contralateral limb during a unimanual task was evaluated in postacute traumatic brain injured (TBI) young adults with left side hemiplegia and age-matched controls. Both groups demonstrated increased overflow with increasing active limb force, although the trend was for greater overflow to occur in the TBI group, particularly when the spastic limb was active. Following three successive days of inhibitory training with electromyographic feedback, TBI subjects were able to significantly reduce the amount of overflow in the contralateral limb, greater inhibition occurring in the noninvolved limb during spastic limb movement. The results are discussed in terms of a dual model of inhibitory control and the role of such processes in uncoupling the limbs for independent limb usage.     

The novel use of a biodegradable stent placed by percutaneous transhepatic cholangiography for the treatment of a hepaticojejunostomy biliary leak following an extended left hepatectomy and pancreaticoduodenectomy

A 61-year-old man presented with jaundice, and subsequently underwent an extended left hepatectomy and pancreaticoduodenectomy for a cholangiocarcinoma invading the head of the pancreas. The patient developed sepsis due to a biliary leak at the hepaticojejunostomy. We describe the original use of a biodegradable stent, deployed via percutaneous transhepatic cholangiography into the Roux limb, resulting in good drainage and resolution of sepsis. The chief benefit of this procedure is the lack of need for subsequent removal as well as purported reduced biofilm accumulation. We believe this to be the first reported case of this type and the literature surrounding the subject is also discussed.