Pre-Engraftment Syndrome after Unrelated Cord Blood Transplantation: A Predictor of Engraftment and Acute Graft-versus-Host Disease

AbstractPre-engraftment syndrome (PES) is poorly characterized, and its clinical significance and the prognostic impact after unrelated cord blood transplantation (CBT) are unclear. To address these issues, we retrospectively analyzed the incidence, risk factors, and clinical outcomes of PES in unrelated CBT recipients. Data of 381 patients who received unrelated CBT from 18 medical centers in Korea were reviewed. PES was defined as unexplained fever >38.3°C not associated with infection, and/or unexplained skin rash with or without evidence of fluid retention before neutrophil recovery. PES developed in 102 patients (26.8%) at a median of 7 days after CBT. Of these patients, 74 patients (72.5%) received intravenous corticosteroid at a median dose of 1 mg/kg/day, and of these, 95% showed clinical improvement. Risk factors for developing PES included low risk disease, myeloablative conditioning, graft-versus-host disease (GVHD) prophylaxis without methotrexate or corticosteroid, and >5.43 x 107/kg infused nucleated cells. Absence of PES was one of the risk factors for graft failure in multivariate analysis. The cumulative incidence of grade II to grade IV acute GVHD by 100 days after CBT was higher in patients with PES than in those without PES (56.0% versus 34.4%, P < .01). PES was not associated with chronic GVHD, treatment-related mortality, relapse, or overall survival. PES seems to be common after CBT and may be associated with enhanced engraftment without significant morbidity

Can a routine follow-up blood culture be justified in Klebsiella pneumoniae bacteremia? a retrospective case–control study

Background : The need for mandatory confirmation of negative conversion in Klebsiella pneumoniae bacteremia (KpB) has not been adequately addressed. We conducted a retrospective case–control study of adult patients with KpB over a 5-year period in two tertiary-care hospitals to determine the risk factors for persistent bacteremia and to reevaluate the necessity of follow-up blood culture in KpB. Methods : Persistent KpB is defined as the finding of K. pneumoniae in more than two separate blood-culture samples for longer than a two-day period in a single episode. The case- and control-groups were patients with persistent and non-persistent KpB, respectively, and they were matched 1-to-3 according to age and gender. Results : Among 1068 KpB episodes analyzed after excluding polymicrobial infection and repeated KpB, follow-up blood cultures were performed in 862 cases (80.7%), 62 of which (7.2%) were persistent. Independent risk factors for persistence were intra-abdominal infection, higher Charlsons comorbidity weighted index score, prior solid organ transplantation, and unfavorable treatment response, which was defined as positivity for at least two parameters among fever, leukocytosis, and no decrease of C-reactive protein on the second day after initial culture. A proposed scoring system using four variables, namely, intra-abdominal infection, nosocomial KpB, fever and lack of C-reactive protein decrease, the last two being assessed on the second day after the initial blood culture, showed that only 4.9% of the patients with no risk factors or with only intra-abdominal infection had persistent KpB. Conclusions : Though persistent KpB is uncommon, follow-up blood culture was performed in as many as 80% of the cases in this study. A more careful clinical assessment is warranted to reduce the cost and patient inconvenience involved in follow-up blood culture.Peer Reviewe

Tropical and subtropical Asia's valued tree species under threat

Tree diversity in Asia's tropical and subtropical forests is central to nature-based solutions. Species vulnerability to multiple threats, which affects the provision of ecosystem services, is poorly understood. We conducted a region-wide, spatially explicit vulnerability assessment (including overexploitation, fire, overgrazing, habitat conversion, and climate change) of 63 socio-economically important tree species selected from national priority lists and validated by an expert network representing 20 countries. Overall, 74% of the most important areas for conservation of these trees fall outside of protected areas, with species severely threatened across 47% of their native ranges. The most imminent threats are overexploitation and habitat conversion, with populations being severely threatened in an average of 24% and 16% of their distribution areas. Optimistically, our results predict relatively limited overall climate change impacts, however, some of the study species are likely to lose more than 15% of their habitat by 2050 because of climate change. We pinpoint specific natural forest areas in Malaysia and Indonesia (Borneo) as hotspots for on-site conservation of forest genetic resources, more than 82% of which do not currently fall within designated protected areas. We also identify degraded lands in Indonesia (Sumatra) as priorities for restoration where planting or assisted natural regeneration will help maintain these species into the future, while croplands in Southern India are highlighted as potentially important agroforestry options. Our study highlights the need for regionally coordinated action for effective conservation and restoration

Genetic Diversity and Structure of Pinus densiflora Siebold &amp; Zucc. Populations in Republic of Korea Based on Microsatellite Markers

Pinus densiflora Siebold &amp; Zucc. is a widely distributed conifer species in the Republic of Korea with economic and ecologic importance. However, P. densiflora is negatively influenced by various factors, such as forest fires, clearing of large numbers of trees infected with Pinus disease, and dieback. We aimed to use microsatellite markers to estimate the genetic diversity, differentiation, and structure of P. densiflora populations in the Republic of Korea. A total of 1844 samples from 60 populations were evaluated using 11 polymorphic microsatellite markers. The observed heterozygosity and expected heterozygosity were 0.652 and 0.673, respectively. The mean genetic differentiation among the populations was 0.013. Moreover, P. densiflora showed high genetic diversity and low genetic differentiation compared with conifer species, including Pinus species with similar life histories. Principal coordinates analysis and Bayesian clustering showed that P. densiflora has a weak geographical structure. The P. densiflora population at Mt. Halla, Jeju Island, showed the lowest genetic diversity and significant genetic differentiation compared with other mainland populations due to genetic drift and restricted gene flow. These findings can be useful for designing new conservation, management, and breeding strategies for P. densiflora populations in response to future environmental changes

The complete chloroplast genome of Torreya nucifera (Taxaceae) and phylogenetic analysis

Torreya nucifera (L.) Siebold & Zucc. (Taxaceae) is a tertiary relict tree species with a distribution that is limited to South Korea and Japan. In the present study, the complete chloroplast (cp) genome of T. nucifera was sequenced and analyzed. The genome was 136,985 bp in length and contained 118 genes, including 82 protein-coding genes, 33 tRNA genes, and 4 rRNA genes. Fifteen of the genes contained a single intron, whereas ycf3 contained two introns and there were no inverted repeat sequences in the genome. Phylogenetic analysis supported the monophyly of Torreya species within the Taxaceae and T. nucifera was closely related to its congener T. grandis

Feasibility of Percutaneous Dilatational Tracheostomy with a Light Source in the Surgical Intensive Care Unit

Background Although percutaneous dilatational tracheostomy (PDT) under bronchoscopic guidance is feasible in the intensive care unit (ICU), it requires extensive equipment and specialists. The present study evaluated the feasibility of performing PDT with a light source in the surgical ICU. Methods The study involved a retrospective review of the outcomes of patients who underwent PDT with a light source performed by a surgery resident under the supervision of a surgical intensivist in the surgical ICU from October 2015 through September 2016. During the procedure, a light wand was inserted into the endotracheal tube after skin incision. Then, the light wand and the endotracheal tube were pulled out slightly, the passage of light through the airway was confirmed, and the relevant point was punctured. Results Fifty patients underwent PDT with a light source. The average procedural duration was 14.0 ± 7.0 minutes. There were no procedure-associated deaths. Intraoperative complications included minor bleeding in three patients (6%) and paratracheal placement of the tracheostomy tube in one patient (2%); these were immediately resolved by the surgical intensivist. Two patients required conversion to surgical tracheostomy because of the difficulty in light wand insertion into the endotracheal tube and a very narrow trachea, respectively. Conclusions PDT with a light source can be performed without bronchoscopy and does not require expensive equipment and specialist intervention in the surgical ICU. It can be safely performed by a surgical intensivist with experience in surgical tracheostomy

Analysis of the Relationship between Socioeconomic Status and Incidence of Hysterectomy Using Data of the Korean Genome and Epidemiology Study (KoGES)

Hysterectomy remains a frequent gynecologic surgery, although its rates have been decreasing. The aim of this study was to investigate whether socioeconomic status affected the risk of hysterectomy in Korean women. This prospective cohort study used epidemiologic data from 2001 to 2016, from the Korean Genomic and Epidemiology Study (KoGES). Multivariate logistic regression analyses were performed to estimate the association between household income or education level and hysterectomy. Among 5272 Korean women aged 40–69 years, 720 who had a hysterectomy and 4552 controls were selected. Variable factors were adjusted using logistic regression analysis (adjusted model). Adjusted odds ratios (aORs) for insurance type and hysterectomy were not statistically significant. The aOR was 1.479 (95% confidence interval (CI): 1.018–2.146, p p < 0.001). Overall, the present study elucidated that lower socioeconomic status could increase the incidence of hysterectomy. Our results indicate that the implementation of stratified preventive strategies for uterine disease in those with low education and low income could be beneficial