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1.
Texto & contexto enferm ; 29: e20180310, Jan.-Dec. 2020.
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: biblio-1101979

RESUMO

ABSTRACT Objective: to analyze adherence to the nursing guidelines for home care of bone marrow transplant recipients from an ecosystem perspective. Method: descriptive, exploratory study with a qualitative approach, using Content Analysis for data analysis, with theoretical and philosophical ecosystem support. The interviews, carried out in bone marrow transplant services, in Brazil and Spain, were guided by an instrument developed by the researchers which contained 25 closed and ten open questions. 40 users participated who met the inclusion criteria. Data collection was carried out from July 2016 to October 2017. Results: the Orientations category emerged from the data which then gave rise to the subcategories: Interactive relational actions; and, actions and behaviors that interfered in the success of the transplant. Some users, due to excessive information at the time of discharge, were unable to assimilate or carry out the guidelines received; others, during the hospitalization phase, apprehended them and absorbed them in order to use them in the home ecosystem space after transplantation. Conclusion: part of the users followed only the guidelines that best adapted to their daily lives and, for others, after hospital discharge, they caused doubts and insecurities regarding the care to be performed at home. It is necessary for the user to identify the constituent elements of their home ecosystem and learn, through communication and information, how they interfere in post-hospital discharge care. Therefore, it is necessary to create communication and information mechanisms that enable the dynamic process between the constituent elements of the ecosystem, biotic and abiotic, so that they have interaction and sustainability and can be practiced by the user.


RESUMEN Objetivo: analizar el cumplimiento de las directrices de la enfermera para el cuidado domiciliario de los receptores de trasplante de médula ósea en una perspectiva ecosistémica. Método: descriptivo, exploratorio, con un enfoque cualitativo, utilizando el análisis de contenido para el análisis de datos, con soporte teórico y filosófico del ecosistema. Las entrevistas, realizadas en los servicios de trasplante de médula ósea, en Brasil y España, fueron guiadas por un instrumento desarrollado por los investigadores, que contenía 25 preguntas cerradas y diez abiertas. Participaron 40 usuarios que cumplieron con los criterios de inclusión. La recolección de datos se realizó entre julio de 2016 y octubre de 2017. Resultados: la categoría Orientaciones surgió de los datos y originó las subcategorías: acciones relacionales interactivas, acciones y comportamientos que interfirieron en el éxito del trasplante. Algunos usuarios, debido a la información excesiva al momento del alta, no pudieron asimilar y llevar a cabo las pautas recibidas, otros, en el curso de la fase de hospitalización, los detuvieron para absorberlos para su atención en el espacio del ecosistema del hogar en el pos trasplante. Conclusión: parte de lós usuários siguió solo las pautas que mejor se adaptaron a su vida diaria y para otros, después del alta hospitalaria, causaron dudas e inseguridades com respecto a La atención que se practica em elhogar. Es necesario que el usuario identifique los elementos constitutivos del ecosistema de su hogar y aprenda, a través de la comunicación y la información, cómo interfieren en la atención hospitalaria posterior al alta. Por lo tanto, es necesario crear mecanismos de comunicación e información que permitan el proceso dinámico entre los elementos constitutivos del ecosistema, bióticos y abióticos, para que tengan interacción y sostenibilidad y puedan ser practicados por el usuario.


RESUMO Objetivo: analisar a adesão às orientações do enfermeiro para o cuidado domiciliar do transplantado de medula óssea na perspectiva ecossistêmica. Método: descritivo, exploratório, com abordagem qualitativa, utilizando-se para a análise dos dados a Análise de Conteúdo, com apoio teórico-filosófico ecossistêmico. As entrevistas, realizadas em serviços de transplante de medula óssea, no Brasil e Espanha, foram norteadas por um instrumento elaborado pelas pesquisadoras, contendo 25 questões fechadas e dez abertas. Participaram 40 usuários que cumpriram os critérios de inclusão. A coleta de dados foi realizada de julho de 2016 a outubro de 2017. Resultados: a categoria Orientações emergiu dos dados e originou as subcategorias: Ações relacionais interativas; e, ações e comportamentos que interferiram no sucesso do transplante. Alguns usuários, por excesso de informações no momento da alta, não conseguiram assimilar e desempenhar as orientações recebidas; outros, no transcorrer da fase de internação, as apreenderam absorvê-las para o cuidado no espaço ecossistêmico domiciliar no pós-transplante. Conclusão: parte dos usuários seguiu somente as orientações que melhor se adaptaram ao seu cotidiano e, para outros, no pós-alta hospitalar, ocasionaram dúvidas e inseguranças em relação ao cuidado a ser praticado no domicílio. Faz-se necessário que o usuário identifique os elementos constituintes do seu ecossistema domiciliar e conheça, por meio da comunicação e informação, como interferem no cuidado pós alta hospitalar. Portanto, é preciso criar mecanismos de comunicação e informação que possibilitem o processo dinâmico entre os elementos constituintes do ecossistema, bióticos e abióticos, para que tenham interação e sustentabilidade e possam ser praticados pelo usuário.


Assuntos
Humanos , Adulto , Adulto Jovem , Transplante , Medula Óssea , Transplante de Medula Óssea , Transplantes , Cuidados de Enfermagem , Enfermagem , Ecossistema , Transplantados , Cooperação e Adesão ao Tratamento , Habitação
2.
Lancet Oncol ; 21(10): e477-e487, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33002443

RESUMO

The use of total body irradiation as part of conditioning regimens for acute leukaemia is progressively declining because of concerns of late toxic effects and the introduction of radiation-free regimens. Total marrow irradiation and total marrow and lymphoid irradiation represent more targeted forms of radiotherapy compared with total body irradiation that have the potential to decrease toxicity and escalate the dose to the bone marrow for high-risk patients. We review the technological basis and the clinical development of total marrow irradiation and total marrow and lymphoid irradiation, highlighting both the possible advantages as well as the current roadblocks for widespread implementation among transplantation units. The exact role of total marrow irradiation or total marrow and lymphoid irradiation in new conditioning regimens seems dependent on its technological implementation, aiming to make the whole procedure less time consuming, more streamlined, and easier to integrate into the clinical workflow. We also foresee a role for computer-assisted planning, as a way to improve planning and delivery and to incorporate total marrow irradiation and total marrow and lymphoid irradiation in multi-centric phase 2-3 trials.


Assuntos
Transplante de Medula Óssea , Medula Óssea/efeitos da radiação , Leucemia Mieloide Aguda/terapia , Irradiação Linfática , Condicionamento Pré-Transplante , Humanos , Irradiação Linfática/efeitos adversos , Doses de Radiação , Planejamento da Radioterapia Assistida por Computador , Condicionamento Pré-Transplante/efeitos adversos , Condicionamento Pré-Transplante/tendências , Resultado do Tratamento , Irradiação Corporal Total/efeitos adversos
3.
Nat Commun ; 11(1): 4798, 2020 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-32968066

RESUMO

Myeloid cells are known mediators of hypertension, but their role in initiating renin-induced hypertension has not been studied. Vitamin D deficiency causes pro-inflammatory macrophage infiltration in metabolic tissues and is linked to renin-mediated hypertension. We tested the hypothesis that impaired vitamin D signaling in macrophages causes hypertension using conditional knockout of the myeloid vitamin D receptor in mice (KODMAC). These mice develop renin-dependent hypertension due to macrophage infiltration of the vasculature and direct activation of renal juxtaglomerular (JG) cell renin production. Induction of endoplasmic reticulum stress in knockout macrophages increases miR-106b-5p secretion, which stimulates JG cell renin production via repression of transcription factors E2f1 and Pde3b. Moreover, in wild-type recipient mice of KODMAC/miR106b-/- bone marrow, knockout of miR-106b-5p prevents the hypertension and JG cell renin production induced by KODMAC macrophages, suggesting myeloid-specific, miR-106b-5p-dependent effects. These findings confirm macrophage miR-106b-5p secretion from impaired vitamin D receptor signaling causes inflammation-induced hypertension.


Assuntos
Hipertensão Renal/metabolismo , Hipertensão/metabolismo , Macrófagos/metabolismo , MicroRNAs/metabolismo , Nefrite/metabolismo , Renina/metabolismo , Animais , Medula Óssea , Transplante de Medula Óssea , Modelos Animais de Doenças , Fator de Transcrição E2F1/metabolismo , Estresse do Retículo Endoplasmático , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Células Mieloides , Receptores de Calcitriol , Vitamina D
4.
Nat Commun ; 11(1): 4549, 2020 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917889

RESUMO

Arterial macrophages have different developmental origins, but the association of macrophage ontogeny with their phenotypes and functions in adulthood is still unclear. Here, we combine macrophage fate-mapping analysis with single-cell RNA sequencing to establish their cellular identity during homeostasis, and in response to angiotensin-II (AngII)-induced arterial inflammation. Yolk sac erythro-myeloid progenitors (EMP) contribute substantially to adventitial macrophages and give rise to a defined cluster of resident immune cells with homeostatic functions that is stable in adult mice, but declines in numbers during ageing and is not replenished by bone marrow (BM)-derived macrophages. In response to AngII inflammation, increase in adventitial macrophages is driven by recruitment of BM monocytes, while EMP-derived macrophages proliferate locally and provide a distinct transcriptional response that is linked to tissue regeneration. Our findings thus contribute to the understanding of macrophage heterogeneity, and associate macrophage ontogeny with distinct functions in health and disease.


Assuntos
Artérias/citologia , Arterite/imunologia , Diferenciação Celular/fisiologia , Homeostase/fisiologia , Macrófagos/fisiologia , Envelhecimento/fisiologia , Angiotensina II/administração & dosagem , Angiotensina II/imunologia , Animais , Artérias/fisiologia , Medula Óssea/fisiologia , Transplante de Medula Óssea , Linhagem da Célula , Modelos Animais de Doenças , Feminino , Células-Tronco Hematopoéticas/fisiologia , Humanos , Masculino , Camundongos , Camundongos Transgênicos , RNA-Seq , Regeneração/fisiologia , Análise de Célula Única , Quimeras de Transplante
5.
PLoS One ; 15(8): e0237401, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32841277

RESUMO

Implantation of bone marrow-derived cells (BMCs) into mouse hearts post-myocardial infarction (MI) limits cardiac functional decline. However, clinical trials of post-MI BMC therapy have yielded conflicting results. While most laboratory experiments use healthy BMC donor mice, clinical trials use post-MI autologous BMCs. Post-MI mouse BMCs are therapeutically impaired, due to inflammatory changes in BMC composition. Thus, therapeutic efficacy of the BMCs progressively worsens after MI but recovers as donor inflammatory response resolves. The availability of post-MI patient BM mononuclear cells (MNCs) from the TIME and LateTIME clinical trials enabled us to test if human post-MI MNCs undergo a similar period of impaired efficacy. We hypothesized that MNCs from TIME trial patients would be less therapeutic than healthy human donor MNCs when implanted into post-MI mouse hearts, and that therapeutic properties would be restored in MNCs from LateTIME trial patients. Post-MI SCID mice received MNCs from healthy donors, TIME patients, or LateTIME patients. Cardiac function improved considerably in the healthy donor group, but neither the TIME nor LateTIME group showed therapeutic effect. Conclusion: post-MI human MNCs lack therapeutic benefits possessed by healthy MNCs, which may partially explain why BMC clinical trials have been less successful than mouse studies.


Assuntos
Transplante de Medula Óssea , Ensaios Clínicos como Assunto , Infarto do Miocárdio/terapia , Animais , Masculino , Camundongos , Camundongos Endogâmicos C57BL , MicroRNAs/genética , Infarto do Miocárdio/genética , Resultado do Tratamento
6.
PLoS Biol ; 18(8): e3000807, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32760056

RESUMO

Radiotherapy is a commonly used conditioning regimen for bone marrow transplantation (BMT). Cytotoxicity limits the use of this life-saving therapy, but the underlying mechanisms remain poorly defined. Here, we use the syngeneic mouse BMT model to test the hypothesis that lethal radiation damages tissues, thereby unleashing signals that indiscriminately activate the inflammasome pathways in host and transplanted cells. We find that a clinically relevant high dose of radiation causes severe damage to bones and the spleen through mechanisms involving the NLRP3 and AIM2 inflammasomes but not the NLRC4 inflammasome. Downstream, we demonstrate that gasdermin D (GSDMD), the common effector of the inflammasomes, is also activated by radiation. Remarkably, protection against the injury induced by deadly ionizing radiation occurs only when NLRP3, AIM2, or GSDMD is lost simultaneously in both the donor and host cell compartments. Thus, this study reveals a continuum of the actions of lethal radiation relayed by the inflammasome-GSDMD axis, initially affecting recipient cells and ultimately harming transplanted cells as they grow in the severely injured and toxic environment. This study also suggests that therapeutic targeting of inflammasome-GSDMD signaling has the potential to prevent the collateral effects of intense radiation regimens.


Assuntos
Células da Medula Óssea/efeitos da radiação , Transplante de Medula Óssea , Proteínas de Ligação a DNA/genética , Inflamassomos/efeitos da radiação , Peptídeos e Proteínas de Sinalização Intracelular/genética , Proteína 3 que Contém Domínio de Pirina da Família NLR/genética , Proteínas de Ligação a Fosfato/genética , Animais , Células da Medula Óssea/citologia , Células da Medula Óssea/metabolismo , Proteínas de Ligação a DNA/deficiência , Feminino , Fêmur/citologia , Fêmur/metabolismo , Regulação da Expressão Gênica , Inflamassomos/metabolismo , Peptídeos e Proteínas de Sinalização Intracelular/deficiência , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Proteína 3 que Contém Domínio de Pirina da Família NLR/deficiência , Proteínas de Ligação a Fosfato/deficiência , Piroptose/genética , Piroptose/efeitos da radiação , Transdução de Sinais , Baço/metabolismo , Baço/patologia , Baço/efeitos da radiação , Transplante Isogênico , Irradiação Corporal Total , Raios X
7.
Transplantation ; 104(8): 1580-1590, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732835

RESUMO

BACKGROUND: Although short-term outcomes for liver transplantation have improved, patient and graft survival are limited by infection, cancer, and other complications of immunosuppression. Rapid induction of tolerance after liver transplantation would decrease these complications, improving survival and quality of life. Tolerance to kidneys, but not thoracic organs or islets, has been achieved in nonhuman primates and humans through the induction of transient donor chimerism. Since the liver is considered to be tolerogenic, we tested the hypothesis that the renal transplant transient chimerism protocol would induce liver tolerance. METHODS: Seven cynomolgus macaques received immune conditioning followed by simultaneous donor bone marrow and liver transplantation. The more extensive liver surgery required minor adaptations of the kidney protocol to decrease complications. All immunosuppression was discontinued on postoperative day (POD) 28. Peripheral blood chimerism, recipient immune reconstitution, liver function tests, and graft survival were determined. RESULTS: The level and duration of chimerism in liver recipients were comparable to those previously reported in renal transplant recipients. However, unlike in the kidney model, the liver was rejected soon after immunosuppression withdrawal. Rejection was associated with proliferation of recipient CD8 T effector cells in the periphery and liver, increased serum interleukin (IL)-6 and IL-2, but peripheral regulatory T cell (Treg) numbers did not increase. Antidonor antibody was also detected. CONCLUSIONS: These data show the transient chimerism protocol does not induce tolerance to livers, likely due to greater CD8 T cell responses than in the kidney model. Successful tolerance induction may depend on greater control or deletion of CD8 T cells in this model.


Assuntos
Transplante de Medula Óssea/efeitos adversos , Rejeição de Enxerto/prevenção & controle , Transplante de Fígado/efeitos adversos , Quimeras de Transplante/imunologia , Condicionamento Pré-Transplante/métodos , Aloenxertos/imunologia , Animais , Medula Óssea/imunologia , Transplante de Medula Óssea/métodos , Modelos Animais de Doenças , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto/imunologia , Humanos , Fígado/imunologia , Transplante de Fígado/métodos , Macaca fascicularis , Linfócitos T Citotóxicos/imunologia , Tolerância ao Transplante , Transplante Homólogo/efeitos adversos
8.
Rev Bras Enferm ; 73 Suppl 2: e20200476, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32667574

RESUMO

OBJECTIVE: To describe the experience of nursing, in adopting containment measures, in the care of patients undergoing hematopoietic stem cell transplantation to avoid COVID-19. METHODS: Experience report. RESULTS: Containment measures involve those recommended by major health organizations, such as hand hygiene, social isolation, identification and monitoring of suspected or confirmed cases; and also the local measures implemented in the health service, such as the reduction in the number of hospitalizations for transplantation, clinical screening of outpatients entering the service, monitoring of respiratory signs and symptoms, the allocation of specific isolation rooms for those suspected of the disease and testing of symptomatic patients. Final considerations: The nurse is responsible for the challenge of planning nursing care to prevent the spread of coronavirus in a high-risk population and to implement measures based on available evidence, periodically updated.


Assuntos
Transplante de Medula Óssea/enfermagem , Transplante de Medula Óssea/normas , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/normas , Programas de Rastreamento/normas , Cuidados de Enfermagem/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Betacoronavirus , Humanos
9.
Lancet HIV ; 7(9): e602-e610, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32649866

RESUMO

BACKGROUND: Allogeneic blood or marrow transplantation (alloBMT) is a potentially life-saving treatment for individuals with HIV and haematological malignancies; challenges include identifying donors and maintaining antiretroviral therapy (ART). The objectives of our study were to investigate interventions to expand donor options and to prevent ART interruptions for patients with HIV in need of alloBMT. METHODS: This single-arm, interventional trial took place at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center (Baltimore, MD, USA). Individuals with HIV who were at least 18 years of age and referred for alloBMT for a standard clinical indication were eligible. The only exclusion criterion was a history of documented resistance to enfuvirtide. We used post-transplant cyclophosphamide as graft-versus-host disease (GVHD) prophylaxis to expand donor options and an optimised ART strategy of avoiding pharmacoenhancers and adding subcutaneous enfuvirtide during post-transplant cyclophosphamide and during oral medication intolerance. Our primary outcome was the proportion of participants who maintained ART through day 60 after alloBMT. We measured the HIV latent reservoir using a quantitative viral outgrowth assay. This study is registered on ClinicalTrials.gov, NCT01836068. FINDINGS: Between June 1, 2013, and August 27, 2015, nine patients who were referred for transplant provided consent. Two patients had relapsed malignancy before donor searches were initiated. Seven patients had suitable donors identified (two matched sibling, two matched unrelated, two haploidentical, and one single-antigen mismatched unrelated) and proceeded to alloBMT. All patients maintained ART through day 60 and required ART changes (median 1, range 1-3) in the first 90 days. One patient stopped ART and developed HIV rebound with grade 4 meningoencephalitis at day 146. Among six patients who underwent alloBMT and had longitudinal measurements available, the HIV latent reservoir was not detected post-alloBMT in four patients with more than 95% donor chimerism, consistent with a 2·06-2·54 log10 reduction in the HIV latent reservoir. In the two patients with less than 95% donor chimerism, the HIV latent reservoir remained stable. INTERPRETATION: By using post-transplant cyclophosphamide as GVHD prophylaxis, we successfully expanded alloBMT donor options for patients with HIV. Continuing ART with a regimen that includes enfuvirtide post-alloBMT was safe, but life-threatening viral rebound can occur with ART interruption. FUNDING: amfAR (the Foundation for AIDS Research), Johns Hopkins University Center for AIDS Research, and National Cancer Institute.


Assuntos
Transplante de Medula Óssea , Ciclofosfamida/uso terapêutico , Infecções por HIV/complicações , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/terapia , Adulto , Terapia Antirretroviral de Alta Atividade , Transplante de Medula Óssea/efeitos adversos , Transplante de Medula Óssea/métodos , Terapia Combinada , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Estudos de Viabilidade , Feminino , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/etiologia , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Condicionamento Pré-Transplante , Transplante Homólogo , Resultado do Tratamento , Carga Viral
12.
Medicine (Baltimore) ; 99(25): e20509, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569171

RESUMO

BACKGROUND: This study used the meta-analytic approach to assess the safety and treatment efficacy of bone marrow stem cells (BMSCs) with core decompression (CD) for osteonecrosis of the femoral head (ONFH) based on randomized controlled trials (RCTs). METHODS: Electronic database of PubMed, Embase, Google Scholar, China National Knowledge Infrastructure (CNKI), and Wanfang database was searched up to December 26, 2019 for relevant RCTs about combined utilization of BMSCs and CD versus CD alone for ONFH. Gray literature sources were also searched. We conducted a meta-analysis following the guidelines of the Cochrane Reviewer's Handbook. Two independent reviewers performed the data extraction and assessed study quality. Our outcomes included the Harris hip scores (HHS) at 12 months, HHS at 24 months, necrotic area of femoral head, conversion to total hip arthroplasty (THA), visual analog pain scale at final follow-up, and adverse effects. The meta-analysis was performed with Stata 12.0. RESULTS: A total of 15 published studies with 688 patients fulfilled the requirements of inclusion criteria. Across all populations, participants in combined utilization of BMSCs group showed a statistical significance with higher HHS at 12 months (standard mean difference [SMD] 0.53, 95% confidence interval [CI] 0.29-0.77) and 24 months (SMD 0.57, 95% CI 0.36-0.77). Similarly, participants in combined utilization of BMSCs group had more advantages in reducing necrotic area of femoral head (SMD -1.05, 95% CI -1.73 to -0.38) and the rate of conversion to THA (risk ratio [RR] = 0.53, 95% CI 0.38-0.74, P = .000). No significant differences were identified regarding postoperative adverse effects postoperatively (RR = 1.03, 95% CI 0.64-1.67, P = .893). CONCLUSION: Compared with CD treated alone in the treatment of ONFH, combined utilization of CD and autologous BMSCs implantation has a better pain relief and clinical outcomes and can delay the collapse of the femoral head more effectively.


Assuntos
Transplante de Medula Óssea , Descompressão Cirúrgica , Necrose da Cabeça do Fêmur/cirurgia , Transplante de Células-Tronco , Artroplastia de Quadril , Humanos , Transplante Autólogo , Resultado do Tratamento
14.
Angiol Sosud Khir ; 26(2): 34-40, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32597883

RESUMO

AIM: The study was aimed at comparing the efficacy of implantation of autologous bone marrow cells with that of revascularizing osteotrephination in treatment of lower limb chronic critical ischaemia in patients with a poor distal vascular bed. PATIENTS AND METHOD: We analysed the results of comprehensive examination and treatment of a total of 60 patients presenting with lower limb chronic critical ischaemia due to atherosclerotic lesions of the femoropopliteal-tibial segment. According to the technology of treatment, the patients were divided into two statistically homogenous groups of 30 people each. Group One patients underwent standard revascularizing osteotrephination and Group Two patients in accordance with the original technique received intramuscular implantation of 40 ml of autologous bone marrow cells, with this volume distributed in 2-ml injections to 20 points of the muscles of the crus and femur along the internal and external surface. RESULTS: The use of the original technique of treatment made it possible to achieve the clinical status in the form of moderate or minimal improvement 6 months after bone marrow cells implantation in 29 (96.7%) patients and after 12 months in 28 (93.3%) patients, whereas after revascularizing osteotrephination in 25 (83.3%) and 20 (66.7%) patients, respectively. In the remote period after 12 months, the limb was saved in 28 (93.3%) and 26 (86.7%) patients in Group Two and Group One, respectively. The patients of the second group as compared with those of the first group after 12 months demonstrated a statistically significant increase in the physical health component by 19.8% and the mental health component by 9.8%. CONCLUSION: Implantation of autologous bone-marrow cells in chronic critical limb ischaemia is pathogenetically substantiated and makes it possible to optimize the results of treatment of patients.


Assuntos
Isquemia/etiologia , Doenças Vasculares Periféricas , Transplante de Medula Óssea , Humanos , Perna (Membro) , Extremidade Inferior , Transplante Autólogo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
15.
Clin Orthop Surg ; 12(2): 151-157, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32489535

RESUMO

Backgroud: Untreated osteonecrosis of the femoral head ultimately leads to secondary coxarthrosis. The aim of this study was to determinate if the core decompression of the femoral head combined with implantation of autologous bone marrow concentrate with tricalcium phosphate could be used to prevent radiographic progression of early stage osteonecrosis of the hip. We also sought to determine whether this treatment improved clinical outcomes and reduced the need for total hip arthroplasty. Methods: Eighteen hips were included in the present study. All of them underwent core decompression of the femoral head combined with implantation of autologous bone marrow concentrate with tricalcium phosphate between 2007 and 2012. The cell concentrate was obtained from the posterior iliac crest and processed and implanted during the same surgical procedure. Patient demographic data, clinical data including modified Harris hip score, and radiological data were collected preoperatively, postoperatively, and during the follow-up period. Also, survival endpoints were analyzed: time of femoral head collapse and need for total hip arthroplasty. Results: The mean age of patients was 37.8 years (standard deviation [SD], 9.31 years). The mean follow-up was 68.9 months (SD, 15.0 months). In most cases (70.6%), the etiology of the osteonecrosis of the femoral head was corticosteroid use; in the remaining cases, secondary to alcohol use. Core decompression of the femoral head combined with implantation of autologous bone marrow concentrate with tricalcium phosphate did not prevent progression to collapse (< 80% at 5 years) although modified Harris hip scores improved. Overall median survival with the total hip arthroplasty as endpoint was 23 months (95% confidence interval [CI], 14.9 to 31.1 months). Overall median survival time with any degree of collapse as endpoint was 7 months (95% CI, 2.0 to 12.0 months). Conclusions: The results obtained in this study suggest that core decompression combined with implantation of autologous bone marrow concentrate and tricalcium phosphate will not prevent radiographic progression of early stage osteonecrosis of the hip. These finding also suggest that the absence of indications for hip replacement alone is not an indicator of good response to the treatment, and it is important to note the radiological results.


Assuntos
Transplante de Medula Óssea , Fosfatos de Cálcio/uso terapêutico , Descompressão Cirúrgica , Necrose da Cabeça do Fêmur/terapia , Adulto , Materiais Biocompatíveis/uso terapêutico , Terapia Combinada , Avaliação da Deficiência , Progressão da Doença , Feminino , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Humanos , Ílio/transplante , Masculino , Pessoa de Meia-Idade , Transplante Autólogo
16.
Med Oncol ; 37(7): 58, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: covidwho-425728

RESUMO

Currently world is fighting with global pandemic of coronavirus disease 2019 (COVID-19). At this time of uncertainty, oncologists are struggling to provide appropriate care to cancer patients. They have to weigh risk and benefit of giving cancer treatment vs chances of getting them infected with COVID-19. As cancer patients are immunocompromised and there are high chances of exposure during hospital visits and if they get infected, outcome can be fatal. So through the column of this article, we would like to provide basic guideline in management of cancer patients during COVID-19 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Neoplasias/terapia , Pandemias , Pneumonia Viral/terapia , Antineoplásicos/administração & dosagem , Transplante de Medula Óssea/métodos , Transplante de Medula Óssea/tendências , Infecções por Coronavirus/epidemiologia , Humanos , Neoplasias/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Resultado do Tratamento
17.
Med Oncol ; 37(7): 58, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32472216

RESUMO

Currently world is fighting with global pandemic of coronavirus disease 2019 (COVID-19). At this time of uncertainty, oncologists are struggling to provide appropriate care to cancer patients. They have to weigh risk and benefit of giving cancer treatment vs chances of getting them infected with COVID-19. As cancer patients are immunocompromised and there are high chances of exposure during hospital visits and if they get infected, outcome can be fatal. So through the column of this article, we would like to provide basic guideline in management of cancer patients during COVID-19 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Neoplasias/terapia , Pandemias , Pneumonia Viral/terapia , Antineoplásicos/administração & dosagem , Transplante de Medula Óssea/métodos , Transplante de Medula Óssea/tendências , Infecções por Coronavirus/epidemiologia , Humanos , Neoplasias/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Resultado do Tratamento
18.
Biol Blood Marrow Transplant ; 26(7): e161-e166, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32389803

RESUMO

With the COVID-19 pandemic and the ensuing barriers to the collection and transport of donor cells, it is often necessary to collect and cryopreserve grafts before initiation of transplantation conditioning. The effect on transplantation outcomes in nonmalignant disease is unknown. This analysis examined the effect of cryopreservation of related and unrelated donor grafts for transplantation for severe aplastic anemia in the United States during 2013 to 2019. Included are 52 recipients of cryopreserved grafts who were matched for age, donor type, and graft type to 194 recipients who received noncryopreserved grafts. Marginal Cox regression models were built to study the effect of cryopreservation and other risk factors associated with outcomes. We recorded higher 1-year rates of graft failure (hazard ratio [HR], 2.26; 95% confidence interval, 1.17 to 4.35; P = .01) and of 1-year overall mortality (HR, 3.13; 95% CI, 1.60 to 6.11; P = .0008) after transplantation of cryopreserved compared with noncryopreserved grafts, with adjustment for sex, performance score, comorbidity, cytomegalovirus serostatus, and ABO blood group match. The incidence of acute and chronic graft-versus-host disease did not differ between the 2 groups. Adjusted probabilities of 1-year survival were 73% (95% CI, 60% to 84%) in the cryopreserved graft group and 91% (95% CI, 86% to 94%) in the noncryopreserved graft group. These data support the use of noncryopreserved grafts whenever possible in patients with severe aplastic anemia.


Assuntos
Anemia Aplástica/terapia , Transplante de Medula Óssea/métodos , Infecções por Coronavirus/epidemiologia , Criopreservação/métodos , Rejeição de Enxerto/patologia , Doença Enxerto-Hospedeiro/patologia , Transplante de Células-Tronco de Sangue Periférico/métodos , Pneumonia Viral/epidemiologia , Doença Aguda , Adolescente , Adulto , Idoso , Anemia Aplástica/imunologia , Anemia Aplástica/mortalidade , Anemia Aplástica/patologia , Criança , Pré-Escolar , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/mortalidade , Doença Enxerto-Hospedeiro/imunologia , Doença Enxerto-Hospedeiro/mortalidade , Teste de Histocompatibilidade , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Irmãos , Análise de Sobrevida , Condicionamento Pré-Transplante/métodos , Estados Unidos/epidemiologia , Doadores não Relacionados
20.
PLoS One ; 15(5): e0233497, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32442182

RESUMO

Mixed hematopoietic chimerism enables donor-specific tolerance for solid organ grafts. This study evaluated the influence of different serological major histocompatibility complex disparities on chimerism development, graft-versus-host disease incidence and subsequently on solid organ tolerance in a rat model. For bone marrow transplantation conditioning total body irradiation was titrated using 10, 8 or 6 Gray. Bone marrow transplantation was performed across following major histocompatibility complex mismatched barriers: complete disparity, MHC class II, MHC class I or non-MHC mismatch. Recipients were clinically monitored for graft-versus-host disease and analyzed for chimerism using flow cytometry. After a reconstitution of 100 days, composition of peripheral leukocytes was determined. Mixed chimeras were challenged with heart grafts from allogeneic donor strains to define the impact of donor MHC class disparities on solid organ tolerance on the basis of stable chimerism. After myeloablation with 10 Gray of total body irradiation, chimerism after bone marrow transplantation was induced independent of MHC disparity. MHC class II disparity increased the incidence of graft-versus-host disease and reduced induction of stable chimerism upon myelosuppressive total body irradiation with 8 and 6 Gray, respectively. Stable mixed chimeras showed tolerance towards heart grafts from donors with MHC matched to either bone marrow donors or recipients. Isolated matching of MHC class II with bone marrow donors likewise led to stable tolerance as opposed to matching of MHC class I. In summary, MHC class II disparity was critically associated with the onset of graft-versus host disease and was identified as obstacle for successful development of chimerism after bone marrow transplantation and subsequent donor-specific solid organ tolerance.


Assuntos
Transplante de Medula Óssea , Antígenos de Histocompatibilidade Classe II/imunologia , Quimeras de Transplante/imunologia , Tolerância ao Transplante/imunologia , Aloenxertos , Animais , Doença Enxerto-Hospedeiro/imunologia , Transplante de Coração , Humanos , Masculino , Modelos Animais , Modelos Imunológicos , Transplante de Órgãos , Ratos , Ratos Endogâmicos BN , Ratos Endogâmicos Lew , Doadores de Tecidos , Condicionamento Pré-Transplante , Irradiação Corporal Total
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