4,250 research outputs found
Haploidentical bone marrow transplants for hematological malignancies using non-myeloablative conditioning therapy and post-transplant immunosuppression with cyclophosphamide: results from a single Australian centre
Background: HLA haploidentical bone marrow transplantation is a treatment option in patients with hematological malignancies who have no available HLA matched donor, but is limited by conditioning regimen toxicity, graft failure, relapse and graft versus host disease.
Aims: To demonstrate safety and efficacy of haploidentical bone marrow transplantation with nonmyeloablative conditioning and high-dose post-transplant cyclophosphamide in adult patients with leukaemia or lymphoma.
Methods: 12 patients, median age of 51 years, underwent transplantation with T cell replete bone marrow from a haplotype matched relative. The conditioning regimen consisted of cyclophosphamide, fludarabine, and low-dose TBI. Post-transplant immunosuppression consisted of a single dose of cyclophosphamide 50 mg/kg on day 3, followed by oral tacrolimus and mycophenolate mofetil. Outcomes reported are overall survival, engraftment and chimerism, toxicity, and clinical outcome.
Results: All patients had neutrophil recovery (median 14.5 days), and 11 of 12 had platelet engraftment (median 17 days). Two patients had autologous reconstitution. Seven of 9 assessable patients had complete donor chimerism. Four patients had grade II-III GvHD, and none had grade IV GvHD. Four patientsdeveloped limited stage chronic GvHD. Five patients with AML relapsed. Two patients died of non-relapse causes, both from other malignancies, and 5 patients remain alive and relapse free. Median overall survival was 324 days (range 88-1163).
Conclusion: This regimen is feasible and well-tolerated in older patients with high risk leukemia or lymphoma, with minimal short-term toxicity, and low rates of GVHD. The proportion of disease-free survivors indicates a graft versus malignancy effect is present in survivors.
Keywords: hematological malignancy, bone marrow transplant, haploidentical, post-transplant cyclophosphamid
Haploidentical bone marrow transplants for hematological malignancies using non-myeloablative conditioning therapy and post-transplant immunosuppression with cyclophosphamide: results from a single Australian centre
Background: HLA haploidentical bone marrow transplantation is a treatment option in patients with hematological malignancies who have no available HLA matched donor, but is limited by conditioning regimen toxicity, graft failure, relapse and graft versus host disease. Aims: To demonstrate safety and efficacy of haploidentical bone marrow transplantation with nonmyeloablative conditioning and high-dose post-transplant cyclophosphamide in adult patients with leukaemia or lymphoma. Methods: 12 patients, median age of 51 years, underwent transplantation with T cell replete bone marrow from a haplotype matched relative. The conditioning regimen consisted of cyclophosphamide, fludarabine, and low-dose TBI. Post-transplant immunosuppression consisted of a single dose of cyclophosphamide 50 mg/kg on day 3, followed by oral tacrolimus and mycophenolate mofetil. Outcomes reported are overall survival, engraftment and chimerism, toxicity, and clinical outcome. Results: All patients had neutrophil recovery (median 14.5 days), and 11 of 12 had platelet engraftment (median 17 days). Two patients had autologous reconstitution. Seven of 9 assessable patients had complete donor chimerism. Four patients had grade II-III GvHD, and none had grade IV GvHD. Four patientsdeveloped limited stage chronic GvHD. Five patients with AML relapsed. Two patients died of non-relapse causes, both from other malignancies, and 5 patients remain alive and relapse free. Median overall survival was 324 days (range 88-1163). Conclusion: This regimen is feasible and well-tolerated in older patients with high risk leukemia or lymphoma, with minimal short-term toxicity, and low rates of GVHD. The proportion of disease-free survivors indicates a graft versus malignancy effect is present in survivors. Keywords: hematological malignancy, bone marrow transplant, haploidentical, post-transplant cyclophosphamid
Supersymmetric geometries of IIA supergravity I
IIA supergravity backgrounds preserving one supersymmetry locally admit four
types of Killing spinors distinguished by the orbits of on the
space of spinors. We solve the Killing spinor equations of IIA supergravity
with and without cosmological constant for Killing spinors representing two of
these orbits, with isotropy groups and .
In both cases, we identify the geometry of spacetime and express the fluxes in
terms of the geometry. We find that the geometric constraints of backgrounds
with a invariant Killing spinor are identical to
those found for heterotic backgrounds preserving one supersymmetry.Comment: 21 page
Dosimetry during intramedullary nailing of the tibia: Patient and occupational exposure
Background Intramedullary nailing under fluoroscopic guidance is a common operation. We studied the intraoperative radiation dose received by both the patient and the personnel
Prevalence Rates of Mental Disorders in Chilean Prisons
PMCID: PMC371883
Search for Exotic Strange Quark Matter in High Energy Nuclear Reactions
We report on a search for metastable positively and negatively charged states
of strange quark matter in Au+Pb reactions at 11.6 A GeV/c in experiment E864.
We have sampled approximately six billion 10% most central Au+Pb interactions
and have observed no strangelet states (baryon number A < 100 droplets of
strange quark matter). We thus set upper limits on the production of these
exotic states at the level of 1-6 x 10^{-8} per central collision. These limits
are the best and most model independent for this colliding system. We discuss
the implications of our results on strangelet production mechanisms, and also
on the stability question of strange quark matter.Comment: 21 pages, 9 figures, to be published in Nuclear Physics A (Carl Dover
memorial edition
Pattern of seat belt use by drivers in Trinidad and Tobago, West Indies
<p>Abstract</p> <p>Background</p> <p>In Trinidad and Tobago, the law on the mandatory use of seat belts was passed in 1995, but this law is hardly enforced. The objective of this study was to determine the frequency and predictors of seat belt use by motor vehicle drivers in the country.</p> <p>Findings</p> <p>A cross-sectional study of 959 motor vehicle drivers using a self-administered questionnaire. Data analysis included Pearson Chi square test and multinomial logistic regression analysis in order to determine the possible predictors of seat belt use by the drivers in Trinidad and Tobago. A majority of the drivers sometimes (51.8%) or always (31.6%) use a seat belt. About 16.7%, 29% and 54.2% of the drivers perceived that the other drivers use their seat belts more frequently, with the same frequency and less frequently respectively compared to themselves. The main reason for not using seat belt by the drivers was given as frequent stops (40.7%) and the main motivation to use seat belt by the drivers was given as stiffer penalties for non-compliance with the seat belt law (44.5%). The predictors of seat belt use were male driver, no formal or lower level of education, driving for less than 10 years, and the perception that the other drivers use seat belts with the same or higher frequency compared to the respondents.</p> <p>Conclusion</p> <p>Only a small proportion of the drivers in Trinidad and Tobago always use a seat belt when driving. There is the need to enforce the seat belt legislation in the country.</p
Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review
Background: Polypharmacy, and the associated adverse drug events such as non-adherence to prescriptions, is a
common problem for elderly people living with multiple comorbidities. Deprescribing, i.e. the gradual withdrawal
from medications with supervision by a healthcare professional, is regarded as a means of reducing adverse effects
of multiple medications including non-adherence. This systematic review examines the evidence of deprescribing
as an effective strategy for improving medication adherence amongst older, community dwelling adults.
Methods: A mixed methods review was undertaken. Eight bibliographic database and two clinical trials registers
were searched between May and December 2017. Results were double screened in accordance with pre-defined
inclusion/exclusion criteria related to polypharmacy, deprescribing and adherence in older, community dwelling
populations. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal and an a priori data collection
instrument was used. For the quantitative studies, a narrative synthesis approach was taken. The qualitative data was
analysed using framework analysis. Findings were integrated using a mixed methods technique. The review was
performed in accordance with the PRISMA reporting statement.
Results: A total of 22 original studies were included, of which 12 were RCTs. Deprescribing with adherence as an
outcome measure was identified in randomised controlled trials (RCTs), observational and cohort studies from 13
countries between 1996 and 2017. There were 17 pharmacy-led interventions; others were led by General Practitioners
(GP) and nurses. Four studies demonstrated an overall reduction in medications of which all studies corresponded with
improved adherence. A total of thirteen studies reported improved adherence of which 5 were RCTs. Adherence was
reported as a secondary outcome in all but one study.
Conclusions: There is insufficient evidence to show that deprescribing improves medication adherence. Only 13
studies (of 22) reported adherence of which only 5 were randomised controlled trials. Older people are particularly
susceptible to non-adherence due to multi-morbidity associated with polypharmacy. Bio-psycho-social factors
including health literacy and multi-disciplinary team interventions influence adherence. The authors recommend
further study into the efficacy and outcomes of medicines management interventions. A consensus on priority
outcome measurements for prescribed medications is indicated
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