Allogeneic Stem Cell Transplantation from HLA-Mismatched Donors for Pediatric Patients with Acute Lymphoblastic Leukemia Treated According to the 2003 BFM and 2007 International BFM Studies: Impact of Disease Risk on Outcomes

Allogeneic hematopoietic stem cell transplantation (HSCT) is beneficial for pediatric patients with relapsed or (very) high-risk acute lymphoblastic leukemia (ALL) in remission. A total of 1115 consecutive patients were included in the ALL SCT 2003 BFM study and the ALL SCT 2007 I-BFM study and were stratified according to relapse risk (standard versus high versus very high risk of relapse) and donor type (matched sibling versus matched donor versus mismatched donor). A total of 148 patients (60% boys; median age, 8.7 years; B cell precursor ALL, 75%) were transplanted from mismatched donors, which was defined as either less than 9/10 HLA-compatible donors or less than 5/6 unrelated cord blood after myeloablative conditioning regimen (total body irradiation based, 67%) for high relapse risk (HRR; n?=?42) or very HRR (VHRR) disease (n?=?106). The stem cell source was either bone marrow (n?=?31), unmanipulated peripheral stem cells (n?=?28), T cell ex vivo depleted peripheral stem cells (n?=?59), or cord blood (n?=?25). The median follow-up was 5.1 years. The 4-year rates of overall survival (OS) and event-free survival were 56%?±?4% and 52%?±?4%, respectively, for the entire cohort. Patients transplanted from mismatched donors for HRR disease obtained remarkable 4-year OS and event-free survival values of 82%?±?6% and 80%?±?6%, respectively, whereas VHRR patients obtained values of 45%?±?5% and 42%?±?5% (P?<?.001), respectively. The cumulative incidence of relapse was 29%?±?4% and that of nonrelapse mortality 19%?±?3%. The cumulative incidence of limited and extensive chronic graft-versus-host disease was 13%?±?3% and 15%?±?4%, respectively, among the 120 patients living beyond day 100. Multivariate analysis showed that OS was lower for transplanted VHRR patients (P?=?.002; hazard ratio [HR], 3.62; 95% confidence interval [CI], 1.60 to 8.20) and for patients beyond second complete remission (CR2) versus first complete remission (P?<?.001; HR, 3.68; 95% CI, 1.79 to 7.56); relapse occurred more frequently in patients with VHRR disease (P?=?.026; HR, 3.30; 95% CI, 1.16 to 9.60) and for those beyond CR2 (P?=?.005; HR, 4.16; 95% CI, 1.52 to 10.59). Nonrelapse mortality was not significantly higher for cytomegalovirus-positive recipients receiving cytomegalovirus-negative grafts (P?=?.12; HR, 1.96; 95% CI, .84 to 4.58). HSCT with a mismatched donor is feasible in pediatric ALL patients but leads to inferior results compared with HSCT with better matched donors, at least for patients transplanted for VHRR disease. The results are strongly affected by disease status. The main cause of treatment failure is still relapse, highlighting the urgent need for interventional strategies after HSCT for patients with residual leukemia before and/or after transplantation     

B-flow imaging for assessment of 70% to 99% internal carotid artery stenosis based on residual lumen diameter.

OBJECTIVE: The purpose of this study was to use B-flow imaging (BFI) to investigate whether the minimal residual lumen diameter (MRLD) measurement can be used in place of the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method of measurement. METHODS: One hundred sixty-three consecutive patients with internal carotid artery (ICA) stenosis were examined with BFI and digital subtraction angiography. The diagnostic performances of the NASCET method of measurement with the BFI and MRLD measurements in determining 70% to 99% ICA stenosis were compared by performing receiver operating characteristic curve analysis. RESULTS: There was no difference between the performances of the two methods in estimating 70% to 99% ICA stenosis (area under the receiver operating characteristic curve was 0.979 for the NASCET method and 0.978 for the MRLD measurement; P = .899). In the assessment of ICA stenosis, an MRLD measurement of 1.5 mm was determined as the optimal threshold value. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of this threshold were 93%, 94%, 84%, 97%, and 94%, respectively. CONCLUSIONS: In the BFI examination, when the distal ICA, which is the denominator in the NASCET method of measurement, cannot be measured at all or cannot be measured accurately, an MRLD measurement that is equal to or less than 1.5 mm is the criterion that can be used with confidence in determining 70% to 99% ICA stenosis.     

Os efeitos condrotóxicos e apoptóticos de levobupivacaína e bupivacaína na articulação do joelho de coelhos

Background

A single dose injection or continuous infusion of local anesthetics into the joint space is considered to be a well‐defined analgesia technique. The aim of this study was to investigate the chondrotoxic and apoptotic effects of single‐dose intra‐articular injection of levobupivacaine and bupivacaine on rabbit knee joint tissues.

Pathophysiology underlying drooling in Parkinson’s disease: oropharyngeal bradykinesia

We aimed to investigate the association between drooling and possible etiological factors in Parkinson’s disease (PD) and to determine its effect on the quality of life. Demographic data of the 63 patients with idiopathic PD were recorded. Radboud Oral Motor Inventory for Parkinson’s disease (ROMP) test was administered to all patients to evaluate speech, swallowing functions, and saliva control. The freezing of gait questionnaire (FOGQ) was used to evaluate gait and freezing of gait. Dynamic Parkinson gait scale (DYPAGS) was administered for the objective quantification of PD gait features. Disease severity was assessed by UPDRS and modified Hoehn & Yahr Scale. PD specific health-related quality was evaluated by PDQ-39 questionnaire. Drooling was only significantly correlated to UPDRS score; a stronger association was found between drooling and UPDRS 3 motor score; and a more significant association was determined between drooling and the bradykinesia questions of the motor part of UPDRS 3. Interestingly, no significant association was found between sialorrhea score and PDQ-39 score. Based on the results of this study, we concluded that oropharyngeal bradykinesia may be responsible for drooling in PD. In contrast to a general expectation, we did not find any adverse impact of drooling on the quality of life.     

Clinical and cognitive insight in patients with acute-phase psychosis: Association with treatment and neuropsychological functioning

Background: The severity of psychopathology cannot fully explain deficits in the multi-dimensional construct of insight.

Aims: The aim of this study was to evaluate the correlates and associations of clinical and cognitive insight in patients in an acute phase of psychosis and to analyse the impact of acute treatment on these variables.

Methods: This study examined 47 inpatients who were recently hospitalized with acute exacerbation of schizophrenia. All subjects were assessed at both admission and discharge with the Positive and Negative Syndrome Scale (PANSS), Schedule for the Assessment of Insight-Expanded Version (SAI-E), Beck Cognitive Insight Scale (BCIS), and a neurocognition battery.

Results: Patients with schizophrenia gained clinical insight after treatment. Cognitive insight did not change significantly after treatment. Insight showed significant negative correlations with positive symptoms and general psychopathology, but not with negative symptoms. Clinical insight was not associated with neuropsychological functioning in this cohort.

Conclusion: Gaining clinical insight in the acute phase of illness was associated with the remission of positive symptoms, but not with neuropsychological functioning. Some significant correlations between clinical and cognitive insights were detected, which suggests that cognitive insight contributes to clinical insight but is not treatment-dependent. Long-term treatment may be required to understand the contribution of insight to the outcome of patients with schizophrenia.     

Analytic hierarchy process for hospital site selection

Aim: This study investigated a decision support model for site selection to establish a new hospital based on the analytic hierarchy process (AHP). The main purpose of this study was to select the best site for a hospital using this process in Mu?la, Turkey.Method: AHP was employed as the methodological tool for the selection of the site. The study was based on 6 criteria and 19 sub-criteria. All districts in the province of Mu?la were evaluated as alternatives. These districts include: Bodrum, Dalaman, Datça, Fethiye, Kavakl?dere, Koyce?iz, Marmaris, Mente?e, Milas, Seydikemer, Ula, and Yata?an. The alternatives were ranked using a 1–9 Saaty scale. The analysis of the hierarchy model was conducted by using the Super Decisions 2.2.6 software program.Results: Results show that demand is the most important factor in determining the appropriate hospital site, followed by accessibility, competitors, government, related industry and environmental conditions. According to the results, Bodrum was chosen to be the best site to establish a new hospital.Conclusion: Due to limited resources in developing countries such as Turkey, it is critical that decisions are made as a result of scientific research. In this context, investors need to take into account some factors in line with this aim. The proposed evaluation criteria provide a reference for hospital administrators and investors in the selection of hospital sites using AHP.     

Effect of Doppler angle in diagnosis of internal carotid artery stenosis.

OBJECTIVE: The purpose of this study was to compare velocity measurements obtained with 2 fixed insonation angles and to investigate whether there is a difference in their ability in determining internal carotid artery (ICA) stenosis. METHODS: Eighty-seven patients with ICA stenosis were examined with color duplex ultrasonography. Velocity measurements were made at 60 degrees and 45 degrees insonation angles, and they were compared with Bland-Altman and receiver operating characteristic curve analysis. RESULTS: Peak systolic velocity (PSV) and end-diastolic velocity measurements obtained at the 60 degrees insonation angle were higher compared with those obtained at the 45 degrees insonation angle (24.2% and 24.7%, respectively). The ICA-to-common carotid artery PSV ratio, conversely, was slightly higher (3.9%). Although the threshold values for the same velocity parameters obtained at 2 different insonation angles were different, the accuracy ratios (sensitivity and specificity) were not. With application of the Society of Radiologists in Ultrasound consensus criteria to the data obtained at either of the 2 insonation angles, the accuracy ratios of PSV and end-diastolic velocity were found to be statistically different. In the ICA-to-common carotid artery PSV ratio, however, there were no statistically significant differences in the accuracy ratios. CONCLUSIONS: Doppler velocity measurements made at different fixed insonation angles show considerable differences. In determining ICA stenosis, although optimal thresholds are different, the diagnostic performance is not different. In determining ICA stenosis with color duplex ultrasonography, angle-specific thresholds must be determined, and examinations must be made at a fixed angle.     

Increased bone resorption in the proximal femur in patients with hemiplegia

OBJECTIVES: To investigate the relationship between the proximal femoral bone mineral density and bone resorption markers, determinants of calcium metabolism and vitamin D levels in elderly stroke patients. DESIGN: A total of 80 patients and 20 controls were enrolled in the study. Bone mineral density measurements were obtained at the proximal femur. In all subjects, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, intact parathyroid hormone, osteocalcin, deoxypyridinoline, and ionized calcium concentrations were measured. Barthel Index and Motricity Index Leg Score were recorded all patients. RESULTS: The serum concentrations of deoxypyridinoline, intact parathyroid hormone, and the mean serum ionized calcium levels were significantly higher in patients with stroke than that of the control subjects. The mean serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentrations in patients were significantly lower than those of the control group (P < 0.05). The bone mineral density of proximal femurs of paretic limbs was decreased significantly compared with those of the control group (P < 0.05). There were significant correlations between the Z score of the hemiplegic side and the patients' Barthel Index, Motricity Index Leg Score, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, calcium, and deoxypyridinoline. CONCLUSIONS: This study provides clear evidence that decreased mobility, vitamin D status, and bone turnover variables in patients after stroke are important factors in the greater bone loss in the paretic leg.