ABSTRACT
Autologous stem-cell transplantation (ASCT) is the standard of care for the management of multiple myeloma and has a well-established role in the treatment of some types of lymphoma. Over the last decades, the number of ASCT performed has increased significantly, leading to elevated pressure and cost for healthcare services. Conventional model of ASCT includes the admission of patients to a specialized Transplant Unit at any stage of the procedure. To optimize healthcare provision, ambulatory (outpatient/at-home) setting should be the focus moving forward. Thus, ambulatory ASCT model permits reducing average hospital stays and pressures on healthcare services, with significant cost-saving benefits and high degree of patient and caregiver satisfaction. In addition, it facilitates the bed resource for other complex procedures such as allografts or CAR-T cell therapy. The aim of this systematic review is to document the health impact, feasibility and safety of the outpatient/at-home ASCT models, which are increasingly being applied around the world.
Subject(s)
Ambulatory Care , Transplantation, Autologous , Humans , Hematopoietic Stem Cell Transplantation/methods , Multiple Myeloma/therapy , Stem Cell TransplantationABSTRACT
Introducción: El objetivo de este estudio fue determinar los niveles de los principales reactantes de fase aguda (proteína C reactiva y eritrosedimentación) en el posoperatorio de una reconstrucción artroscópica del ligamento cruzado anterior sin complicaciones y analizar si diferentes variables del tratamiento realizado podrían alterar esos valores. Materiales y Métodos: Se llevó a cabo un estudio prospectivo de todas las reconstrucciones del ligamento cruzado anterior realizadas en nuestro Hospital, entre diciembre de 2012 y diciembre de 2013. Los niveles en sangre de proteína C reactiva, eritrosedimentación y leucocitos fueron determinados un día antes de la intervención, y a las 24 horas y a los 15 y 30 días de la cirugía. Se recogieron diferentes variables de la intervención: tiempo de isquemia, tiempo de cirugía, tipo de injerto y diferentes gestos asociados a la reconstrucción (sutura meniscal, microfracturas, etc.). Resultados: De los tres reactantes analizados, la proteína C reactiva es la que presenta un ascenso más elevado en el posoperatorio, es la única que vuelve a valores basales a los 30 días de la intervención (p >0,05). En cuanto a las variables analizadas, sólo el tiempo de isquemia se relacionaba con valores más elevados de proteína C reactiva. Conclusiones: La monitorización de la proteína C reactiva es una prueba práctica y sensible para detectar complicaciones después de la cirugía de ligamento cruzado anterior. Ante valores elevados a partir de los 15 días y si existe sospecha de infección debe realizarse una punción articular. Nivel de evidencia: IV
Background: The purpose of this report was to determine the levels of inflammatory blood markers over the time after a successful arthroscopic anterior ligament reconstruction and to analyze if any variable of surgical treatment alter this blood marker. Methods: A prospective review was conducted including all anterior cruciate ligament reconstructions performed in our institution between December 2012 and December 2013. C-reactive protein, erythrocyte sedimentation rate and white blood cell count were determined before surgery and at days 1, 15 and 30 postoperatively. Different variables of surgical treatment were collected: ischemic and surgical time, type of graft, associated injuries or type of treatment (meniscal suture, microfractures, etc.). Results: C-reactive protein rose abruptly with surgery and decreased progressively over the time. This was the only marker that returned to preoperative levels by day 30 (P >0.05). Ischemic time was associated with high levels of C-reactive protein. None of the associated treatments had significant effect on C-reactive protein, erythrocyte sedimentation rate or white blood cell count. Conclusions: Blood levels of C-reactive protein can help to take a therapeutic decision when an infection is suspected. If elevated C-reactive protein levels persist after 15 days postsurgery, the presence of infection through arthrocentesis must be ruled out. Level of evidence: IV.
Subject(s)
Humans , Male , Female , Adult , Arthroscopy , Blood Sedimentation , Anterior Cruciate Ligament/surgery , Biomarkers , C-Reactive Protein/metabolism , Anterior Cruciate Ligament Reconstruction/methods , Knee Injuries/surgery , Arthritis, Infectious , Postoperative Period , Prospective StudiesABSTRACT
An integrated multidisciplinary approach that combined structure-based drug design, multicomponent reaction synthetic approaches and functional characterization in enzymatic and cell assays led to the discovery of new kinesin spindle protein (KSP) inhibitors with antiproliferative activity. A focused library of new benzimidazoles obtained by a Ugi+Boc removal/cyclization reaction sequence generated low-micromolar-range KSP inhibitors as promising anticancer prototypes. The design and functional studies of the new chemotypes were assessed by computational modeling and molecular biology techniques. The most active compounds-20 (IC50 =1.49 µM, EC50 =3.63 µM) and 22 (IC50 =1.37 µM, EC50 =6.90 µM)-were synthesized with high efficiency by taking advantage of the multicomponent reactions.
Subject(s)
Antineoplastic Agents/chemistry , Antineoplastic Agents/pharmacology , Benzimidazoles/chemistry , Benzimidazoles/pharmacology , Drug Design , Kinesins/antagonists & inhibitors , Antineoplastic Agents/chemical synthesis , Benzimidazoles/chemical synthesis , Cell Line, Tumor , Cell Proliferation/drug effects , Drug Screening Assays, Antitumor , Humans , Kinesins/chemistry , Kinesins/metabolism , Molecular Docking Simulation , Neoplasms/drug therapy , Neoplasms/metabolism , Small Molecule Libraries/chemical synthesis , Small Molecule Libraries/chemistry , Small Molecule Libraries/pharmacology , Structure-Activity RelationshipABSTRACT
En el Hospital Nacional Edgardo Rebagliati Martins, se atiende a los hijos de los asegurados menores de 14 años. Este es un estudio descriptivo (exploratorio) del cáncer en niños en el período (1987-1989) realizado en forma retrospectiva recopilando la información de los archivos del Departamento de Patología y de Estadística de egresos hospitalarios del HNERM/IPSS (Hospital General). Para el trienio 87-89 encontramos 85 casos de neoplasias pediátricas, 44 niños y 41 niñas: en primer lugar la leucemia con 32 casos; en segundo lugar, los linfomas con 12 casos; en tercer lugar, tumores del sistema nervioso con 11 casos. En la casuística publicada en el INEN, Orlandini presenta una serie de 12 años (1960-1972) con 865 casos; Gálvez-Brandon muestra una serie de 3 años (1968-1970) con 233 caos. En las tres series se cumple que las neoplasias linfohematopoyétiacs son primeras en frecuencia y los niños son más afectados que las niñas.