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Anaesthetic and Surgical Considerations in Post COVID-19 Patients Requiring Head and Neck Surgery. COVID-19后患者需要头颈部手术的麻醉和手术注意事项。
IF 0.6 Q1 Medicine Pub Date : 2023-12-01 Epub Date: 2023-07-11 DOI: 10.1007/s12070-023-04040-5
Kritant Bhushan, Priya Jeyaraj, Rajnish Sahu, Mansi Luthra Sharma

As the cases of COVID-19 have declined, the number of patients who have recovered from the dreaded disease is reporting for elective or emergency surgeries. Surgical planning in patients who have recovered from COVD-19 requires special considerations because of the morbidity and mortality associated with the infection and its devastating after-effects. There is a distinct paucity of literature on guidelines and protocols to follow in the perioperative management of these patients. With the help of experience gained over the past 2 years of the 'COVID-19 era', we have been able to establish important recommendations, guidelines and useful protocols during perioperative management of COVID-recovered patients. These protocols include important anesthetic and surgical considerations, which are both practical as well as implementable and are also in cognizance with government-laid down advisories. Although SARS-CoV-2 infection primarily affects the pulmonary and cardiac systems, it has the potential for serious and severely affect multiple organs and various other body systems in erratic and unpredictable manner. All of these factors can have significant implications that make the perioperative management of post-COVID-19 patients, difficult and challenging. Considering the far-reaching and long-lasting effects of this infection on the human body, the protocols and recommendations presented in this article can serve as a valuable guide for clinicians to effectively manage the surgical patient and help reduce perioperative complications attributable to COVID-19 infection.

随着COVID-19病例的减少,从这种可怕的疾病中恢复过来的患者正在报告进行选择性或紧急手术。由于与感染及其破坏性后遗症相关的发病率和死亡率,covid -19康复患者的手术计划需要特别考虑。在这些患者的围手术期管理中,关于指导方针和方案的文献明显缺乏。在过去两年“COVID-19时代”积累的经验的帮助下,我们能够在COVID-19康复患者的围手术期管理中建立重要的建议、指南和有用的方案。这些方案包括重要的麻醉和手术方面的考虑,既实用又可实施,也符合政府制定的建议。虽然SARS-CoV-2感染主要影响肺部和心脏系统,但它有可能以不稳定和不可预测的方式严重影响多个器官和各种其他身体系统。所有这些因素都可能产生重大影响,使covid -19后患者的围手术期管理变得困难和具有挑战性。鉴于这种感染对人体的影响深远而持久,本文提出的方案和建议可为临床医生有效管理手术患者提供有价值的指导,有助于减少COVID-19感染引起的围手术期并发症。
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引用次数: 0
Membrane-bound D-mannose isomerase of acetic acid bacteria: finding, characterization, and application. 醋酸菌的膜结合 D-甘露糖异构酶:发现、表征和应用。
IF 1.6 Q1 Medicine Pub Date : 2022-06-14 DOI: 10.1093/bbb/zbac049
Osao Adachi, Naoya Kataoka, Kazunobu Matsushita, Yoshihiko Akakabe, Toshihiro Harada, Toshiharu Yakushi

D-Mannose isomerase (EC 5.3.1.7) catalyzing reversible conversion between D-mannose and D-fructose was found in acetic acid bacteria. Cell fractionation confirmed the enzyme to be a typical membrane-bound enzyme, while all sugar isomerases so far reported are cytoplasmic. The optimal enzyme activity was found at pH 5.5, which was clear contrast to the cytoplasmic enzymes having alkaline optimal pH. The enzyme was heat stable and the optimal reaction temperature was observed at around 40 to 60˚C. Purified enzyme after solubilization from membrane fraction showed the total molecular mass of 196 kDa composing of identical four subunits of 48 kDa. Washed cells or immobilized cells were well functional at nearly 80% of conversion ratio from D-mannose to D-fructose and reversely 20-25% of D-fructose to D-mannose. Catalytic properties of the enzyme were discussed with respect to the biotechnological applications to high fructose syrup production from konjac taro.

在醋酸细菌中发现了催化 D-甘露糖和 D-果糖之间可逆转换的 D-甘露糖异构酶(EC 5.3.1.7)。细胞分馏证实该酶是典型的膜结合酶,而迄今报道的所有糖异生酶都是细胞质酶。酶的最佳活性出现在 pH 值为 5.5 时,这与细胞质酶的碱性最佳 pH 值形成了鲜明对比。该酶具有热稳定性,最佳反应温度约为 40 至 60˚C。从膜馏分中溶解纯化后的酶显示总分子量为 196 kDa,由 48 kDa 的四个相同亚基组成。洗涤细胞或固定化细胞功能良好,D-甘露糖与 D-果糖的转化率接近 80%,D-果糖与 D-甘露糖的转化率为 20-25%。讨论了该酶的催化特性以及在魔芋高果糖浆生产中的生物技术应用。
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引用次数: 0
Human-induced pluripotent stem cells-derived retinal pigmented epithelium, a new horizon for cells-based therapies for age-related macular degeneration. 人类诱导多能干细胞衍生视网膜色素上皮,基于细胞的老年黄斑变性疗法的新视野。
IF 2.1 Q1 Medicine Pub Date : 2022-05-26 DOI: 10.1186/s13287-022-02894-0
Samaneh Dehghan, Reza Mirshahi, Alireza Shoae-Hassani, Masood Naseripour

Retinal pigment epithelium (RPE) degeneration is the hallmark of age-related macular degeneration (AMD). AMD, as one of the most common causes of irreversible visual impairment worldwide, remains in need of an appropriate approach to restore retinal function. Wet AMD, which is characterized by neovascular formation, can be stabilized by currently available therapies, including laser photocoagulation, photodynamic therapy, and intraocular injections of anti-VEFG (anti-vascular endothelial growth factor) therapy or a combination of these modalities. Unlike wet AMD, there is no effective therapy for progressive dry (non-neovascular) AMD. However, stem cell-based therapies, a part of regenerative medicine, have shown promising results for retinal degenerative diseases such as AMD. The goal of RPE cell therapy is to return the normal structure and function of the retina by re-establishing its interaction with photoreceptors, which is essential to vision. Considering the limited source of naturally occurring RPE cells, recent progress in stem cell research has allowed the generation of RPE cells from human pluripotent cells, both embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSC). Since iPSCs face neither ethical arguments nor significant immunological considerations when compared to ESCs, they open a new horizon for cell therapy of AMD. The current study aims to discuss AMD, review the protocols for making human iPSCs-derived RPEs, and summarize recent developments in the field of iPSC-derived RPEs cell therapy.

视网膜色素上皮(RPE)变性是老年性黄斑变性(AMD)的标志。老年黄斑变性是导致全球不可逆视力损伤的最常见原因之一,因此仍然需要一种适当的方法来恢复视网膜功能。湿性黄斑变性的特点是新生血管形成,目前可用的疗法包括激光光凝、光动力疗法、眼内注射抗血管内皮生长因子(anti-VEFG)疗法或这些疗法的组合,可以稳定湿性黄斑变性。与湿性AMD不同,目前还没有针对进展性干性(非血管性)AMD的有效疗法。不过,作为再生医学的一部分,干细胞疗法在治疗视网膜退行性疾病(如老年性黄斑变性)方面取得了可喜的成果。RPE细胞疗法的目标是通过重建RPE细胞与感光细胞之间的相互作用,恢复视网膜的正常结构和功能。考虑到天然 RPE 细胞的来源有限,干细胞研究的最新进展使得从胚胎干细胞(ESC)和诱导多能干细胞(iPSC)等人类多能细胞中生成 RPE 细胞成为可能。与胚胎干细胞相比,iPSC 既不存在伦理方面的争议,也不存在免疫方面的重大考虑,因此为 AMD 的细胞治疗开辟了新的前景。本研究旨在讨论老年性视网膜病变,回顾人类 iPSCs 衍生 RPEs 的制作方法,并总结 iPSC 衍生 RPEs 细胞疗法领域的最新进展。
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引用次数: 0
Goal-Oriented Monitoring of Cyclosporine Is Effective for Graft-versus-Host Disease Prevention after Hematopoietic Stem Cell Transplantation in Sickle Cell Disease and Thalassemia Major 定向监测环孢素对镰状细胞病和重度地中海贫血患者造血干细胞移植后移植物抗宿主病预防有效
IF 4.3 Q1 Medicine Pub Date : 2020-12-01 DOI: 10.1016/j.bbmt.2020.01.016
Alexandra Gauthier , Nathalie Bleyzac , Nathalie Garnier , Kamila Kebaili , Philippe Joly , Marie-Pierre Goutagny , Isabelle Mollet , Sylvain Goutelle , Cécile Renard , Yves Bertrand

Graft-versus-host disease (GVHD) is an important challenge and a major cause of morbidity and mortality in children after hematopoietic stem cell transplant (HSCT). Herein we report our institution's experience of goal-oriented Bayesian monitoring for cyclosporine (CsA) used alone as GVHD prophylaxis during the post-transplant period in pediatric patients with thalassemia major (TM) or sickle cell anemia (SCA) undergoing HLA-matched HSCT. We also studied evolution of chimerism. Twenty-six consecutive patients (SCA, 14; TM, 12) underwent matched sibling donor (MSD) HSCT from 2004 to 2014. All patients received a myeloablative conditioning regimen. GVHD prophylaxis consisted of 20 mg/kg antithymocyte globulin in the conditioning regimens and then CsA alone in the post-transplant period. Target CsA trough blood concentration (TBC) was 150 ± 20 ng/mL. At last follow-up, all patients were alive and free of disease, even in cases of mixed chimerism. Engraftment occurred in all patients. No patient developed grades II to IV acute GVHD, 4 patients developed acute grade I skin GVHD, and only 1 presented with chronic pulmonary GVHD. A better control of GVHD and immunosuppression by a strict monitoring of CsA TBC as described herein is promising and could play a crucial role. Further investigations are required, but this study opens new perspectives to improve survival and safety of HSCT from alternative donors in TM and SCA to levels compatible with that obtained with MSDs.

移植物抗宿主病(GVHD)是儿童造血干细胞移植(HSCT)后发病和死亡的一个重要挑战和主要原因。在此,我们报告了本机构在接受hla匹配的HSCT的患有地中海贫血(TM)或镰状细胞贫血(SCA)的儿童患者移植后单独使用环孢素(CsA)作为GVHD预防的目标导向贝叶斯监测的经验。我们也研究了嵌合的进化。26例连续患者(SCA, 14例;2004年至2014年,12例患者接受了兄弟姐妹匹配供体(MSD) HSCT。所有患者均接受清髓调理方案。GVHD预防包括在调节方案中使用20 mg/kg抗胸腺细胞球蛋白,然后在移植后单独使用CsA。靶CsA血药浓度(TBC)为150±20 ng/mL。在最后的随访中,即使是混合嵌合的病例,所有患者都存活且无疾病。所有患者均有移植。没有患者发展为II至IV级急性GVHD, 4例患者发展为急性I级皮肤GVHD,仅有1例患者表现为慢性肺GVHD。本文所述的通过严格监测CsA TBC来更好地控制GVHD和免疫抑制是有希望的,并且可能发挥关键作用。需要进一步的研究,但这项研究为提高TM和SCA中替代供体的HSCT的存活率和安全性提供了新的视角,使其达到与MSDs相容的水平。
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引用次数: 3
Pre-Hematopoietic Stem Cell Transplantation Lung Computed Tomography as an Alternative to the Pulmonary Function Test during the COVID-19 Pandemic 在COVID-19大流行期间,造血前干细胞移植肺部计算机断层扫描作为肺功能测试的替代方案
IF 4.3 Q1 Medicine Pub Date : 2020-12-01 DOI: 10.1016/j.bbmt.2020.08.025
Masaharu Tamaki , Hideki Nakasone , Tadao Aikawa , Yuhei Nakamura , Masakatsu Kawamura , Shunto Kawamura , Junko Takeshita , Nozomu Yoshino , Yukiko Misaki , Kazuki Yoshimura , Shinpei Matsumi , Ayumi Gomyo , Aki Tanihara , Machiko Kusuda , Yu Akahoshi , Shun-ichi Kimura , Shinichi Kako , Noriko Oyama-Manabe , Yoshinobu Kanda

The pulmonary function test (PFT) is an important test for risk stratification before allogeneic transplantation (allo-HCT). However, it might be preferable to avoid PFT as much as possible in the recent era of coronavirus disease 2019 (COVID-19), because PFT requires forced expirations and might produce aerosols, increasing the risk of COVID-19 transmission. Therefore, we tried to predict normal PFT results before allo-HCT based on computed tomography (CT) findings. This study included 390 allo-HCT recipients at our center for whom lung CT images and PFT results before allo-HCT were available. Abnormal CT findings were less likely to be observed in the normal PFT group (47.0% versus 67.4%, P = .015), with a high negative predictive value of 92.9%. In a multivariate analysis, normal CT was significantly associated with normal PFT (odds ratio, 2.47; 95% confidence interval, 1.22 to 4.97; P = .012). A model for predicting normal PFT was constructed based on the results of a multivariate analysis, and the area under the curve of the receiver operating characteristic analysis was 0.656, which gave a sensitivity of 45.5% and a specificity of 86.0%. The relatively high specificity of the model suggested that PFT can be omitted in patients with normal CT findings before allo-HCT.

肺功能检查(PFT)是同种异体移植(alloc - hct)前危险分层的重要检查。然而,在最近的2019冠状病毒病(COVID-19)时代,最好尽可能避免PFT,因为PFT需要强制过期,并且可能产生气溶胶,增加了COVID-19传播的风险。因此,我们试图根据计算机断层扫描(CT)的结果来预测同种异体hct前的正常PFT结果。本研究纳入了我们中心的390名接受同种异体hct治疗的患者,他们在接受同种异体hct之前的肺部CT图像和PFT结果都是可用的。PFT正常组CT异常表现较少(47.0% vs 67.4%, P = 0.015),阴性预测值为92.9%。在多变量分析中,正常CT与正常PFT显著相关(优势比,2.47;95%置信区间为1.22 ~ 4.97;p = .012)。基于多变量分析的结果,建立了正常PFT预测模型,受试者工作特征分析曲线下面积为0.656,敏感性为45.5%,特异性为86.0%。该模型的相对高特异性表明,在同种异体CT前CT表现正常的患者可以忽略PFT。
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引用次数: 2
Officers and Directors of ASTCT ASTCT的官员和董事
IF 4.3 Q1 Medicine Pub Date : 2020-12-01 DOI: 10.1016/S1083-8791(20)30705-9
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引用次数: 0
Nonmyeloablative Conditioning Regimen before T Cell Replete Haploidentical Transplantation with Post-Transplant Cyclophosphamide for Advanced Hodgkin and Non-Hodgkin Lymphomas 晚期霍奇金淋巴瘤和非霍奇金淋巴瘤的移植后环磷酰胺T细胞单倍体移植前非清髓调节方案
IF 4.3 Q1 Medicine Pub Date : 2020-12-01 DOI: 10.1016/j.bbmt.2020.08.014
Catalina Montes de Oca , Luca Castagna , Chiara De Philippis , Stefania Bramanti , Jean Marc Schiano , Thomas Pagliardini , Aude Collignon , Samia Harbi , Jacopo Mariotti , Angela Granata , Valerio Maisano , Sabine Furst , Faezeah Legrand , Christian Chabannon , Carmelo Carlo-Stella , Armando Santoro , Didier Blaise , Raynier Devillier

Allogeneic hematopoietic stem cell transplantation (allo-SCT) is a valid option in patients with refractory lymphomas. HLA haploidentical stem cell transplantation (haplo-SCT) expanded the accessibility to allogeneic hematopoietic cell transplantation. The aims of study were to retrospectively assess the toxicity and efficacy of haplo-SCT using nonmyeloablative conditioning in patients with advanced lymphoma. In total, 147 patients with advanced lymphoma at 2 partner institutions were included. Patients received a uniform nonmyeloablative conditioning regimen and graft-versus-host disease (GVHD) prophylaxis. The primary endpoints were progression-free survival (PFS), overall survival (OS), GVHD, nonrelapse mortality, and GVHD, relapse-free survival (GRFS). Median follow-up was 39 months (range, 6 to 114 months). The median age was 46 years (range, 19 to 71 years). Sixty-five percent of patients were in complete remission (CR) at transplantation. Cumulative incidence of grade II to IV acute GVHD was 30% (95% confidence interval [Cl], 23% to 38%). Two-year cumulative incidence of all grades of chronic GVHD was 13% (95% CI, 8% to 20%). Two-year cumulative incidence of disease relapse was 19% (95% CI, 14% to 27%), with a higher incidence in patients not being in CR at allo-HCT (CR versus not CR: 12% versus 33%, P = .006). Two-year PFS, OS, and GRFS were 66% (95% CI, 59-75), 73% (95% CI, 66-81), and 56% (95% CI, 48-65), respectively. Haplo-SCT with post-transplantation cyclophosphamide may be considered a valid option for patients with aggressive lymphoma and deserves further evaluation.

同种异体造血干细胞移植是治疗难治性淋巴瘤的有效方法。HLA单倍体干细胞移植(haploo - sct)扩大了异体造血细胞移植的可及性。本研究的目的是回顾性评估晚期淋巴瘤患者采用非清髓性条件下单倍体细胞移植的毒性和疗效。共纳入2家合作机构147例晚期淋巴瘤患者。患者接受统一的非清髓性调节方案和移植物抗宿主病(GVHD)预防。主要终点为无进展生存期(PFS)、总生存期(OS)、GVHD、非复发死亡率和GVHD、无复发生存期(GRFS)。中位随访为39个月(6至114个月)。中位年龄为46岁(范围19 - 71岁)。65%的患者移植后完全缓解(CR)。II级至IV级急性GVHD的累积发病率为30%(95%可信区间[Cl], 23%至38%)。所有级别慢性GVHD的两年累积发病率为13% (95% CI, 8% - 20%)。两年累积疾病复发率为19% (95% CI, 14% - 27%),在异位hct时未处于CR的患者中发病率更高(CR vs非CR: 12% vs 33%, P = 0.006)。两年PFS、OS和GRFS分别为66% (95% CI, 59-75)、73% (95% CI, 66-81)和56% (95% CI, 48-65)。单倍体sct移植后环磷酰胺可能被认为是侵袭性淋巴瘤患者的有效选择,值得进一步评估。
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引用次数: 4
Propylene Glycol-Free Melphalan versus PG-Melphalan as Conditioning for Autologous Hematopoietic Cell Transplantation for Myeloma 无丙二醇Melphalan与PG-Melphalan对骨髓瘤自体造血细胞移植的调节作用。
IF 4.3 Q1 Medicine Pub Date : 2020-12-01 DOI: 10.1016/j.bbmt.2020.08.030
Kathleen Monahan , Ariel Kleman , Bicky Thapa , Aniko Szabo , Anita D'Souza , Binod Dhakal , James H. Jerkins , Marcelo C. Pasquini , Mehdi Hamadani , Parameswaran N. Hari , Saurabh Chhabra

High-dose melphalan (Mel) conditioning before autologous hematopoietic cell transplantation (autoHCT) is standard of care for patients with transplantation-eligible multiple myeloma. The traditional lyophilized Mel formulation has inadequate solubility and stability after reconstitution, leading to the use of propylene glycol (PG) as a solubilizing agent. A newer PG-free Mel preparation (Evomela) uses beta cyclodextrin captisol as a solubilizing agent and was approved by the United States Food and Drug Administration as a conditioning agent based on a single-phase IIb study showing bioequivalence. We compared the outcomes of consecutive patients with myeloma undergoing autoHCT using the 2 formulations of Mel for conditioning as our center switched from using the older formulation (PG-Mel) to the newer one (PGF-Mel). Of 294 autoHCT recipients, 162 received PG-Mel conditioning and 132 received PGF-Mel conditioning. The PGF-Mel group was older and had a lower average Karnofsky Performance Status score. PGF-Mel was associated with faster neutrophil recovery (median, 12 days versus 13 days; P < .001), fewer grade 3-4 infections within 30 days of autoHCT (1.5% versus 8.0%; P = .048), and a lower 30-day rehospitalization rate (6.8% versus 17.9%; P = .04), as confirmed by propensity-weighted analysis. No significant between-group differences were detected in mucositis, organ toxicity, myeloma response, or 100-day mortality.

自体造血细胞移植(autoHCT)前大剂量美法兰(Mel)调理是适合移植的多发性骨髓瘤患者的标准治疗方法。传统的冻干梅尔配方在重组后的溶解度和稳定性不足,导致使用丙二醇(PG)作为增溶剂。一种新的不含pg的Mel制剂(Evomela)使用-环糊精captisol作为增溶剂,并被美国食品和药物管理局批准作为调理剂,基于一项显示生物等效性的单相IIb研究。我们比较了连续接受自体hct的骨髓瘤患者使用两种配方的Mel进行调节的结果,我们的中心从使用旧配方(PG-Mel)切换到使用新配方(PGF-Mel)。在294例自体hct受体中,162例接受PG-Mel调节,132例接受PGF-Mel调节。PGF-Mel组年龄较大,平均Karnofsky表现状态评分较低。PGF-Mel与更快的中性粒细胞恢复相关(中位数,12天对13天;P & lt;.001), 30天内3-4级感染较少(1.5%对8.0%;P = 0.048), 30天再住院率较低(6.8%对17.9%;P = .04),倾向加权分析证实了这一点。在粘膜炎、器官毒性、骨髓瘤反应或100天死亡率方面,两组间无显著差异。
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引用次数: 2
Clinical and Neuroimaging Correlates of Post-Transplant Delirium 移植后谵妄的临床和神经影像学相关性
IF 4.3 Q1 Medicine Pub Date : 2020-12-01 DOI: 10.1016/j.bbmt.2020.09.016
Patrick Smith , Jillian C. Thompson , Elena Perea , Brian Wasserman , Lauren Bohannon , Alessandro Racioppi , Taewoong Choi , Cristina Gasparetto , Mitchell E. Horwitz , Gwynn Long , Richard Lopez , David A. Rizzieri , Stefanie Sarantopoulos , Keith M. Sullivan , Nelson J. Chao , Anthony D. Sung

Delirium is common among adults undergoing hematopoietic stem cell transplantation (HCT), although the clinical and neuroimaging correlates of post-HCT delirium have not been adequately delineated. We therefore examined the frequency of delirium and neuroimaging correlates of post-transplant delirium in a retrospective cohort of 115 adults undergoing neuroimaging after allogeneic HCT. Delirium was established using previously validated methods for retrospective identification of chart-assessed postprocedural delirium. Chart reviews were independently conducted by a multidisciplinary team with expertise in HCT, psychiatry, and psychology on consecutive allogeneic HCT patients who underwent neuroimaging assessments and transplantation at a single center between January 2009 and December 2016. Neuroimaging markers of white matter damage and brain volume loss were also recorded. In total, 115 patients were included, ranging in age from 20 to 74 years (mean [SD] age, 49 [13]). Fifty-three patients (46%) developed post-HCT delirium. In an adjusted model, delirium incidence was associated with older age (odds ratio [OR], 1.92 [1.28, 2.87] per decade, P = .002), greater severity of white matter hyperintensities (OR, 1.95 [1.06, 3.57], P = .031), and conditioning intensity (OR, 6.37 [2.20, 18.45], P < .001) but was unrelated to cortical atrophy (P = .777). Delirium was associated with fewer hospital-free days (P = .023) but was not associated with overall survival (hazard ratio, 0.95 [0.56, 1.61], P = .844). Greater incidence of delirium following HCT was associated with greater age, microvascular burden, and conditioning intensity. Pre-HCT consideration of microvascular burden and other neuroimaging biomarkers of risk may be warranted.

谵妄在接受造血干细胞移植(HCT)的成年人中很常见,尽管HCT后谵妄的临床和神经影像学相关因素尚未得到充分的描述。因此,我们对115名接受同种异体HCT后神经影像学检查的成年人进行回顾性队列研究,检查了移植后谵妄的频率和神经影像学相关因素。谵妄是使用先前验证的方法来回顾性鉴定经图表评估的术后谵妄。2009年1月至2016年12月,一个具有HCT、精神病学和心理学专业知识的多学科团队对在同一中心连续接受神经影像学评估和移植的同种异体HCT患者进行了独立的图表审查。同时记录脑白质损伤和脑容量损失的神经影像学指标。共纳入115例患者,年龄20 ~ 74岁(平均[SD]年龄49岁[13])。53例患者(46%)出现hct后谵妄。在一个调整后的模型中,谵妄的发病率与年龄较大(比值比[OR],每十年1.92 [1.28,2.87],P = 0.002)、白质高信号的严重程度(OR, 1.95 [1.06, 3.57], P = 0.031)和调节强度(OR, 6.37 [2.20, 18.45], P <.001),但与皮质萎缩无关(P = .777)。谵妄与较少的无院天数相关(P = 0.023),但与总生存率无关(风险比,0.95 [0.56,1.61],P = 0.844)。HCT后谵妄的高发生率与较大的年龄、微血管负荷和调节强度相关。hct前考虑微血管负荷和其他神经成像生物标志物的风险可能是有必要的。
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引用次数: 0
Guidelines for Cord Blood Unit Selection 脐带血单位选择指南
IF 4.3 Q1 Medicine Pub Date : 2020-12-01 DOI: 10.1016/j.bbmt.2020.07.030
Ioannis Politikos , Eric Davis , Melissa Nhaissi , John E. Wagner , Claudio G. Brunstein , Sandra Cohen , Elizabeth J. Shpall , Filippo Milano , Andromachi Scaradavou , Juliet N. Barker , American Society for Transplantation and Cellular Therapy Cord Blood Special Interest Group

Optimal cord blood (CB) unit selection is critical to maximize the likelihood of successful engraftment and survival after CB transplantation (CBT). However, unit selection can be complex because multiple characteristics must be considered including unit cell dose, donor-recipient human leukocyte antigen (HLA) match, and unit quality. This review provides evidence-based and experience-based comprehensive guidelines for CB unit selection. Topics addressed include the use of both the TNC and the CD34+ cell dose, as well as the CD34+ cell to TNC content ratio to evaluate unit progenitor cell content and engraftment potential, the acceptable TNC and CD34+ cell dose criteria that define an adequate single-unit graft, and the indication and acceptable cell dose criteria for double-unit grafts. The acceptable criteria for 6-loci (HLA-A, -B antigen, -DRB1 allele) and 8-allele (HLA-A, -B, -C, -DRB1) donor-recipient HLA match, the evaluation of patients with donor-specific HLA antibodies, and the multiple determinants of unit quality are also reviewed in detail. Finally, a practical step-by-step guide to CB searches and the principles that guide ultimate graft selection are outlined.

最佳脐带血(CB)单位选择是最大限度地提高脐带血移植(CBT)成功植入和存活的可能性的关键。然而,单位选择可能很复杂,因为必须考虑多种特征,包括单位细胞剂量、供体-受体人类白细胞抗原(HLA)匹配和单位质量。本综述为CB单元的选择提供了基于证据和经验的综合指南。讨论的主题包括TNC和CD34+细胞剂量的使用,以及CD34+细胞与TNC含量的比值来评估单位祖细胞含量和移植潜力,定义适当的单单位移植的可接受TNC和CD34+细胞剂量标准,以及双单位移植的适应症和可接受细胞剂量标准。对6位点(HLA- a, -B抗原,-DRB1等位基因)和8位点(HLA- a, -B, -C, -DRB1)供体-受体HLA匹配的可接受标准,供体特异性HLA抗体患者的评估,以及单位质量的多个决定因素也进行了详细综述。最后,对CB搜索和指导最终移植物选择的原则进行了概述。
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引用次数: 38
期刊
Biology of Blood and Marrow Transplantation
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