Engraftment after autologous hematopoietic stem cell transplantation in patients mobilized with Plerixafor: A retrospective, multicenter study of a large series of patients.

Plerixafor (PLX) appears to effectively enhance hematopoietic stem-cell mobilization prior to autologous hematopoietic stem cell transplantation (auto-HCT). However, the quality of engraftment following auto-HCT has been little explored. Here, engraftment following auto-HCT was assessed in patients mobilized with PLX through a retrospective, multicenter study of 285 consecutive patients. Information on early and 100-day post-transplant engraftment was gathered from the 245 patients that underwent auto-HCT. The median number of PLX days to reach the stem cell collection goal (≥2 × 106 CD34+ cells/kg) was 1 (range 1-4) and the median PLX administration time before apheresis was 11 h (range 1-18). The median number of apheresis sessions to achieve the collection goal was 2 (range 1-5) and the mean number of CD34+ cells collected was 2.95 × 106/kg (range 0-30.5). PLX administration was safe, with only 2 mild and transient gastrointestinal adverse events reported. The median time to achieve an absolute neutrophil count (ANC) >500/µL was 11 days (range 3-31) and the median time to platelet recovery >20 × 103/µL was 13 days (range 5-69). At 100 days after auto-HCT, the platelet count was 137 × 109/L (range 7-340), the ANC was 2.3 × 109/L (range 0.1-13.0), and the hemoglobin concentration was 123 g/L (range 79-165). PLX use allowed auto-HCT to be performed in a high percentage of poorly mobilized patients, resulting in optimal medium-term engraftment in the majority of patients in whom mobilization failed, in this case mainly due to suboptimal peripheral blood CD34+ cell concentration on day +4 or low CD34+ cell yield on apheresis.

Imaging acute pancreatitis. / Pancreatitis aguda en imágenes.

OBJECTIVES: Acute pancreatitis is common; the clinical course of this potentially severe condition varies widely. This paper aims to review the role of different imaging techniques in the management of acute pancreatitis, describe the main imaging findings for this entity, and explain the terms and criteria used to classify them. CONCLUSIONS: Imaging techniques play a key role in the management of acute pancreatitis, from diagnosis and staging to identifying and treating complications, as well as in determining the underlying causes of the condition. For these reasons, radiologists should know the advantages and limitations of each imaging technique in the evaluation of acute pancreatitis, be familiar with the wide spectrum of imaging findings associated with it, and how to use the specific terminology derived from the Atlanta classification to ensure the standardization and quality of reports.

Agreements and uncertainties in autologous haematopoietic stem cell mobilization and collection. A Spanish consensus document.

Although many experts position statements on autologous stem cell mobilization have been published, there are some aspects that are still under discussion. A Spanish Hematologist expert group was summoned to settle on agreements and uncertainties on PBSCs mobilization, including factors not always considered; as apheresis and cytometry key factors that determine a successful PBSC collection. This document reviews critical factors that define poor mobilizer patients and the tools to better collect the desired stem cells for a successful autologous haematopoietic stem cell transplant.

Investigation of the exclusive 3He(e,e' pn)1H reaction.

Cross sections for the 3He(e,e' pn)1H reaction were measured for the first time at energy transfers of 220 and 270 MeV for several momentum transfers ranging from 300 to 450 MeV/c. Cross sections are presented as a function of the momentum of the recoil proton and the momentum transfer. Continuum Faddeev calculations using the Argonne V18 and Bonn-B nucleon-nucleon potentials overestimate the measured cross sections by a factor 5 at low recoil proton momentum with the discrepancy becoming smaller at higher recoil proton momentum.

Systematic review and meta-analysis of observational studies on the prevalence of fractures in coeliac disease.

BACKGROUND/AIMS: Evidence of an increased bone fracture risk in coeliac disease is on debate. Our aim was to review systematically the current published information on fractures in coeliac disease and to perform a meta-analysis. METHODS: Case-control and cohort designs were identified by searching MEDLINE (1966-April 2007) and LILACS (1982-April 2007). Participants were adult coeliac disease patients of any sex and the outcome measure was the presence of any fracture. Studies were screened for inclusion by two authors who independently extracted the data. Methodological quality was assessed using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology Statement) recommendations. Data were analysed using the RevMan Analyses statistical package in Review Manager (version 4.2.8) and reported as pooled odds ratio using a random effect model. Heterogeneity was investigated (standard chi(2) test) and sensitivity analysis was performed based on the reported quality and design type. RESULTS: While 60 of 405 studies met the initial screening criteria, only 8 met inclusion criteria after detailed review. These studies evaluated a total of 20,955 coeliac disease patients having 1819 (8.7%) fractures and 96,777 controls with 5955 (6.1%) fractures (pooled odds ratio=1.43; 95% confidence interval 1.15-1.78) with considerable heterogeneity among studies (p<0.00001). CONCLUSIONS: Our meta-analysis confirms a significant association between bone fractures and coeliac disease. However, qualitative and quantitative differences among studies were evident. Further research is necessary to investigate the relevance of this heterogeneity.

p53 and RB expression predict progression in T1 bladder cancer.

The optimal clinical management of minimally invasive (stage T1) bladder cancer is controversial. T1 bladder cancers share characteristics of both noninvasive (Ta) papillary cancer and high stage, muscle-invasive bladder cancers. Patients with T1 bladder cancer have a higher risk of cancer progression and death than do patients with Ta bladder cancer. However, this risk is much lower than that of patients with high-stage bladder cancers. Methods of identifying T1 bladder cancer patients at greatest risk for progression may significantly improve clinical management. We retrospectively evaluated two tumor suppressor genes, p53 and RB, as potential prognostic markers for progression in a cohort of 45 patients with pT1 bladder cancer. Median follow-up for these individuals was greater than 3.5 years. Of this group, 58% had altered p53 expression based on positive p53 immunostaining. Three patterns for RB nuclear protein staining were observed: absent, heterogeneous (normal), and strongly homogeneous. Progression-free survival was similar for patients with loss of RB protein expression and those with apparent overexpression of RB protein. Therefore, both staining patterns were considered abnormal. Patients with normal expression of both proteins (i.e., p53 negative and RB heterogeneously positive) had an excellent outcome, with no patient showing disease progression, whereas patients with abnormal expression of either or both proteins had a significant increase in progression (P = 0.04 and P = 0.005, respectively). These data support the stratification of T1 bladder cancer patients based on p53 and RB nuclear protein status and suggest that patients with normal protein expression for both genes can be managed conservatively, whereas patients with alterations in one and particularly both genes require more aggressive treatment.

Effects of preweanling chronic naltrindole administration on stress-induced antinociceptive responses in rats.

The effect of a daily injection of the delta-selective opioid antagonist naltrindole (1 mg/kg), from birth to postnatal day 19, on the development of stress-induced-antinociception (SIA) and on the antinociceptive response to the mu-selective agonist alfentanil (65 microg/kg) in female rats was investigated. Functional blockade of the delta-receptor during the preweanling period markedly reduced the antinociceptive response to swim-stress in 25-day-old rats, and SIA was only mediated by delta-receptors at this age. In 20-day-old rats and in adults, SIA was predominantly mu-receptor mediated and unaffected by delta-receptor blockade. The lack of interference with mu-receptor function was confirmed as alfentanil responses were unaffected by preweanling naltrindole treatment. The data show independence of mu- and delta-receptors in the control of SIA during development and an impairment of delta- but not mu-mediated SIA after chronic delta-antagonist treatment.

Naltrindole administration during the preweanling period and manipulation affect adrenocortical reactivity in young rats.

The effect of a daily injection of the delta-selective opioid antagonist naltrindole (1 mg/kg), from birth to postnatal day 19, on basal and post-stress corticosterone levels in 25-day old rats of both sexes was investigated. The effects of manipulation were studied by including two control groups, one group received daily injections of saline and a second one was not manipulated. The stress protocol consisted of a 3 min swimming session in water at 20 degrees C. Corticosterone determinations were performed by radioimmunoassay. Control non-manipulated animals showed a significant increase in corticosterone levels in response to stress. Manipulation decreased basal hormone levels in females and prevented the stress-induced rise in corticosterone in males. Functional blockade of the delta-receptor during the preweanling period by the naltrindole treatment inhibited the corticosterone response to stress in females. The results indicate the existence of sex differences in the effects of manipulation on hypothalamus-pituitary-adrenal axis activity and the involvement of the delta-opioid receptor in the modulation of the adrenocortical response to stress during the postnatal period.

Effects of neonatal naltrindole treatment on antinociceptive and behavioral responses to mu and kappa agonists in rats.

The effects of a daily injection of the delta selective opioid antagonist naltrindole (1 mg/kg), from birth to postnatal day 19, on antinociceptive and behavioral responses to the mu selective agonist alfentanil (65 microg/kg) and the kappa selective agonist CI-977 (50 microg/kg) in 20-day-old male rats were investigated. Antinociception was assessed using the tail immersion test and behavioral testing was performed by employing an open field. The functional blockade of the delta receptor by naltrindole blocked the antinociceptive response to alfentanil but did not affect the antinociception induced by CI-977. The effects of alfentanil (increased exploration) and CI-977 (a marked hypoactivity) in the open field were not modified by neonatal naltrindole treatment. The results suggest a functional interaction between delta and mu receptors in the postnatal period but not between delta and kappa receptors. The data also suggest differences in the delta and mu receptors interacting in the modulation of antinociception and those involved in behavioral responses in the open field.

[Superior vena cava syndrome secondary to intracavitary implantation of a pacemaker]. / Síndrome de vena cava superior secundario a implantación de marcapasos intracavitario.

The appearance of superior vena cava syndrome secondary to benign disease is rare, and it is extremely rare for this condition to develop as a result of the presence of intraluminal catheters. We report two cases of superior vena cava syndrome secondary to implantation of intracavitary pacemakers. We discuss different types of treatment.

[Personalized nursing care and perceived quality of care in hospitals]. / Personalización enfermera y calidad percibida del cuidado en el ámbito hospitalario.

OBJECTIVE: To determine whether there is an association between the Primary Nursing Model and perceived quality of care. METHOD: An observational, descriptive, cross-sectional study in four hospital wards with Primary Nursing organization. Over a 12-month period, all the patients discharged from each ward were included in this study. The degree of development of Primary Nursing was measured by using the Personalization of Nursing Care Index and the perceived quality of care was measured with the LOPSS-12. Bivariate statistical analysis was carried out through ANOVA and Student's t-tests. Multivariate linear regression analysis was then applied to correlated variables (p < 0.05). RESULTS: 817 patients were included, 447 from two medical wards and 370 from two surgical wards. After a preliminary data analysis performed 6 months after the start of the study, four items were removed from the LOPSS-12 and each of the remaining items were analyzed separately. Scores for both patient satisfaction and the introduction of the Primary Nursing Model were higher in the surgical wards. Bivariate and multivariate regression analyses showed a statistically significant (p < 0.05) association between implantation of the model and all except one of the items included in the questionnaire. CONCLUSIONS: The introduction of the Primary Nursing Model in hospital wards allows the presence of a primary nurse for each patient and consequently improves the nurse-patient relationship, increasing perceived quality of care among patients.

Exercise-induced asthma in asthmatic children. Predisposing factors.

BACKGROUND: Exercise-induced bronchoconstriction (EIB) has a high prevalence in children with asthma, and this is a common problem, even in case of controlled asthma, because of the high levels of physical activity in the childhood. OBJECTIVES: The aim of our study was to identify factors associated with the development of EIB in children with controlled asthma. METHODS: We studied children evaluated for asthma. A personal and familiar history was collected from each patient to estimate asthma severity, precipitating factors, exercise ability, immunotherapy treatment and atopic familiar disorders. Skin prick tests for inhalant allergens, pulmonary function tests (PFTs) and exercise challenge test (ECT) measurements were realized in every patient. We used the Chi Squared test to compare qualitative variables, the Student's-t test for quantitative variables and a logistic regression analysis to estimate the independent effect of the variables. RESULTS: We evaluated 132 asthmatic patients. Eighty-two, 6 to 14 years old (average 110 +/- 36.9 months), were included in the study. Forty one have coughing or wheezing with exercise at least three months ago, in addition to a positive ECT; 9 of these children had solitary EIB (group A), and 32 (group B) had controlled chronic asthma, 27 intermittent and 5 moderately persistent. Forty one controlled asthmatic children, 39 intermittent, 1 mildly persistent and 1 moderately persistent (group C) had a good tolerance for exercise with a negative ECT. No differences were found in familiar history, asthma severity or evolution time in B vs C group. We found that 35 patients (42,68 %) patients were sensitized to indoor allergens: 24 (58,53 %) were patients suffering EIB and 11 (26,8 %) allowed to group C. Precipitating factors of asthma were in group B: respiratory infections in 19 cases, pollen in 20 and in 10 indoor allergens exposure. In group C: 14 patients had asthmatic symptoms with viral respiratory infections, 32 with pollen and 2 with indoor allergens exposure. A patient from group A had allergy rhinitis after exposure to cats. Allergy to indoor allergens demonstrated an direct association to EIB suffering (p = 0,026). Twenty six patients with allergic asthma followed pollen immunotherapy treatment, 7 of group B (33,3 %) and 19 (59,3 %) of group C. This treatment was inversely associated with EIB suffering (p = 0,048). A logistic regression analysis confirmed the independence of both variables as predisposing and protecting factors in EIB suffering. CONCLUSIONS: Allergy to indoor allergens might be considered a risk factor for EIB. Immunotherapy treatment could be a protective factor against the development of EIB in children with allergic asthma.

Personalización enfermera y calidad percibida del cuidado en el ámbito hospitalario / Personalized nursing care and perceived quality of care in hospitals

Objetivo Determinar si hay relación entre el modelo organizativo «Enfermería Primaria» y la calidad de los cuidados percibida por el paciente. Método Estudio observacional, descriptivo, de corte transversal, que incluyó a los pacientes dados de alta, durante 12 meses, en cuatro unidades organizadas según el modelo de asignación «Enfermería Primaria». El grado de aplicación del modelo se evaluó mediante el Índice de Personalización del Cuidado, y la calidad percibida por los pacientes con el cuestionario LOPSS12 de satisfacción con los cuidados enfermeros. Se realizó un análisis bivariado mediante ANOVA y t de student, y un análisis multivariado mediante regresión lineal con las variables que habían mostrado asociación (p<0,05).Resultados Se incluyeron 817 pacientes, 447 de dos unidades médicas y 370 de dos unidades quirúrgicas. Tras un análisis preliminar realizado a los 6 meses de iniciado el estudio se eliminaron cuatro ítems del cuestionario LOPSS 12 y se analizaron por separado cada uno de los ítems restantes. Tanto la implantación del modelo como la satisfacción alcanzaron valores más altos en las unidades quirúrgicas. Los análisis bivariado y multivariado demostraron una asociación estadísticamente significativa (p<0,05) entre la implantación del modelo y los ítems del cuestionario, a excepción de uno de ellos. Conclusiones La organización de las unidades de hospitalización con el modelo de asignación «Enfermería Primaria», que reconoce la figura de la enfermera referente y permite personalizar los cuidados, se asocia a una mayor calidad percibida de los cuidados enfermeros(AU)

Objective To determine whether there is an association between the Primary Nursing Model and perceived quality of care. Method An observational, descriptive, cross-sectional study in four hospital wards with Primary Nursing organization. Over a 12-month period, all the patients discharged from each ward were included in this study. The degree of development of Primary Nursing was measured by using the Personalization of Nursing Care Index and the perceived quality of care was measured with the LOPSS-12. Bivariate statistical analysis was carried out through ANOVA and Student's t-tests. Multivariate linear regression analysis was then applied to correlated variables (p<0.05).Results817 patients were included, 447 from two medical wards and 370 from two surgical wards. After a preliminary data analysis performed 6 months after the start of the study, four items were removed from the LOPSS-12 and each of the remaining items were analyzed separately. Scores for both patient satisfaction and the introduction of the Primary Nursing Model were higher in the surgical wards. Bivariate and multivariate regression analyses showed a statistically significant (p<0.05) association between implantation of the model and all except one of the items included in the questionnaire. Conclusions The introduction of the Primary Nursing Model in hospital wards allows the presence of a primary nurse for each patient and consequently improves the nurse-patient relationship, increasing perceived quality of care among patients(AU)

[Histopathological changes of the Fallopian tubes during treatment with norethisterone enanthate]. / Cambios histopatologicos de las trompas de falopio durante el tratamiento con enantato de nor-etisterona.

PIP: Although less distinct than those of the endometrium, the Fallopian tubes show definite changes due to ovarian hormones. The effect of the hormones on the tubes determines certain modifications in their secretions and activities. The estrogens increase the secretions, but progesterone decreases the effect of the estrogens. In the study, a single dose of 200 mgm of norethisterone enanthate was given im on the 6th day of the cycle to 10 patients of fertile age. The effects were studied using conventional histological methods. During the first 6 weeks there was a definite decrease in growth and differentiation of the epithelial cells and gradual recovery toward the end of the 12 weeks of observation. The salpingian mucus in the first 6 weeks indicated a state of rest, similar to that of menopause. This aspect gradually modified itself with the increase in the volume of cells and the appearance of cellular secretions. In the last 2 weeks, cellular hypertrophy, and the appearance of intercalary cells indicated the anatomical and functional recovery of the epithelium. As a possible explanation it was suggested that during the first 6 weeks the action of the estrogens was inhibited, but by the 7th week their proliferative effects became dominant. It is implied that the changes were due to the contraceptive action of norethindrone enanthate.^ieng