Moja przygoda z geografią. Program nauczania – IV etap edukacji, zakres rozszerzony

Program nauczania geografii w szkołach ponadgimnazjalnych, w ramach IV etapu nauczania, z uwzględnieniem wymagań reformy programowe

Neutropenic enterocolitis and multidrug-resistant bacteria colonization in lymphoma patients undergoing autologous stem cell transplantation

Introduction: There is little iterature data regarding neutropenic enterocolitis (NE) development after autologous hematopoietic cell transplantation (auto-HCT) in non-Hodgkin lymphoma (NHL) patients. The aim of this study was to determine the incidence, risk factors, and clinical outcome of NE after auto-HCT in NHL patients with respect to the impact of multidrug-resistant Gram-negative bacteria (MDRG) and vancomycin-resistant enterococci colonization on the early outcome after auto-HCT. Material and methods: This retrospective single-center analysis included a total of 65 NHL patients who underwent auto-HCT after BEAM (BCNU, etoposide, cytosine arabinoside, melphalan) conditioning (BEAM-auto-HCT). Results: NE was diagnosed in nine (13.8%) patients, a median four days after auto-HCT. In 6/9 (66%) patients, septic shock following NE was diagnosed. In univariate analysis, MDRG colonization before BEAM-auto-HCT was the only factor significant for NE development [odds ratio (OR) 2.4 (1.14–5.0), p = 0.027], although this was not confirmed in multivariate analysis. Additionally, NE [OR 5.2 (1.9–13.9), p = 0.001] and MDRG colonization prior to transplant [OR 2.7 (1.0–7.0), p = 0.041] were independent factors for septic shock development. Conclusions: Our findings suggest that NHL patients presenting with MDRG colonization before transplant should be kept under careful surveillance because of the high risk of the development of early severe infectious complications, including abdominal ones

Safety and cost effectiveness of outpatient autologous hematopoietic stem cell transplantation for multiple myeloma — single-center experience of a pilot Early Discharge Program

Introduction: Multiple myeloma (MM) is the leading indication for autologous stem cell transplantation (ASCT), with over 12,000 transplants per year in Europe. Due to low toxicity, an entirely outpatient procedure or an early discharge after ASCT can be considered as alternatives to inpatient transplantation. Thus, we launched an Early Discharge Program (EDP) for patients qualified for ASCT due to MM who were under 60 years of age, without significant comorbidities, who had a caregiver available 24/7, and who lived within a 60-minute drive of our hospital. Material and methods: Patients spent 72 hours in the hospital being administered melphalan 200 mg/m2 intravenous followed by an infusion of hematopoietic stem cells. They were eventually discharged and remained under outpatient care. The program was launched in September 2019 and was temporarily halted due to the coronavirus disease 19 (COVID-19) pandemic in early 2020. Five patients were enrolled to the EDP. Results: Non-hematological toxicity was mild and manageable in an outpatient setting. Only one patient was readmitted due to exacerbation of ulcerative colitis that was probably not related to ASCT. We observed neither infections nor bleeding. Due to hematological toxicity, three of the five patients received platelet transfusion on the 6th day after ASCT as outpatients. No packed erythrocytes were transfused. The EDP demonstrated lower costs compared to an inpatient approach. Conclusions: We believe that early discharge, which is an intermediate step to full at-home transplantation due to patients’ wellbeing, reduction of infections caused by resistant microorganisms, and costs, will eventually replace a full inpatient procedure for a significant population of patients suffering from multiple myeloma and indeed other diseases

CAR-T cell therapy – toxicity and its management

Chimeric antigen receptor T-cell (CAR-T) therapy is an effective new treatment for hematologic malignancies. Two anti-CD19 CAR-T products, namely axicabtagene ciloleucel and tisagenlecleucel, have been approved for the management of relapsed/refractory large B-cell lymphoma after two lines of systemic therapy. Additionally, tisagenlecleucel is indicated for refractory acute lymphoblastic leukemia in pediatric patients and young adults up to 25 years of age. CAR-T cells are undoubtedly a major breakthrough therapy in hematooncology resulting in up to 90% response rate with durable remissions in population with refractory high-risk disease. However, there are serious side effects resulting from CAR-T therapy, including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Manifestations of CRS mostly include fever, hypotension, hypoxia, and end organ dysfunction. Neurologic toxicities are diverse and include encephalopathy, cognitive defects, dysphasia, seizures, and cerebral edema. Since the symptoms are potentially severe, practitioners need to familiarize themselves with the unique toxicities associated with these therapies. In this article, we present a practical guideline for diagnosis, grading and management of CRS and CAR-T neurotoxicity. In addition, infectious complications and late toxicities including prolonged cytopenias and hypogammaglobulinemia are discussed

Road to clinical implementation of CAR-T technology in Poznań

The objective of this paper is to present the process of the national and international accreditation leading to the establishment of the first certified chimeric antigen receptor T (CAR-T) Cell Unit in Poland on the basis of the Department of Hematology and Bone Marrow Transplantation in Poznan University of Medical Sciences and first successful CAR-T therapy in Poland. During 12 months from the initial decision to establish the CAR-T Cell Unit to the application of CAR-T cell treatment in the first patient, the center had to undergo the multidisciplinary external and internal training, as well as the adaptation of multiple procedures within the Transplant Unit and Stem Cell Bank. In order to get accreditation for the implementation of CAR-T cell therapy, an initial training of the team involved in handling cellular products and patient care was organized and updated as a continuous process. The Department fulfilled the site-selection international criteria. The first patient diagnosed for refractory/relapsed DLBCL was qualified, and finally CAR-T cells were administered with successful clinical outcome

Hematopoietic stem cell mobilization with the reversible CXCR4 receptor inhibitor plerixafor (AMD3100)—Polish compassionate use experience

Recent developments in the field of targeted therapy have led to the discovery of a new drug, plerixafor, that is a specific inhibitor of the CXCR4 receptor. Plerixafor acts in concert with granulocyte colony-stimulating factor (G-CSF) to increase the number of stem cells circulating in the peripheral blood (PB). Therefore, it has been applied in the field of hematopoietic stem cell mobilization. We analyzed retrospectively data regarding stem cell mobilization with plerixafor in a cohort of 61 patients suffering from multiple myeloma (N = 23), non-Hodgkin’s lymphoma (N = 20), or Hodgkin’s lymphoma (N = 18). At least one previous mobilization attempt had failed in 83.6% of these patients, whereas 16.4% were predicted to be poor mobilizers. The median number of CD34+ cells in the PB after the first administration of plerixafor was 22/μL (range of 0–121). In total, 85.2% of the patients proceeded to cell collection, and a median of two (range of 0–4) aphereses were performed. A minimum of 2.0 × 106 CD34+ cells per kilogram of the patient’s body weight (cells/kg b.w.) was collected from 65.6% of patients, and the median number of cells collected was 2.67 × 106 CD34+ cells/kg b.w. (0–8.0). Of the patients, 55.7% had already undergone autologous stem cell transplantation, and the median time to neutrophil and platelet reconstitution was 12 and 14 days, respectively. Cases of late graft failure were not observed. We identified the diagnosis of non-Hodgkin’s lymphoma and previous radiotherapy as independent factors that contributed to failure of mobilization. The current report demonstrates the satisfactory efficacy of plerixafor plus G-CSF for stem cell mobilization in heavily pre-treated poor or predicted poor mobilizers

Emergencies in patients undergoing hematopoietic stem cell transplantation

Despite its high effectiveness, hematopoietic stem cell transplantation (HSCT) can sometimes be associated with multiple peri-transplant complications requiring urgent intervention. Life-threatening complications in the transplantation unit affect non-relapse mortality. This article sets out a practical approach to the essential peri-transplant clinical conditions, divided into infectious complications and complications related to immune response and endothelial damage. An early diagnosis of life-threatening conditions, and prompt implementation of the best therapy, can save patients’ lives. This is especially the case regarding infectious complications in neutropenic patients and in the advanced stages of immunological complications such as graft-versus-host disease, veno-occlusive disease, graft failure, diffuse alveolar hemorrhage, and thrombotic microangiopathy associated with HSCT. These emergencies are discussed below, along with their risk factors and a summary of the management of patients in the early post-transplant period

Design and Testing of Apparatus for Producing Dry Fog

Dry fog is a specific form of aerosol that is used in many branches of industry and many aspects of everyday life. It can be used, inter alia, to disinfect rooms or to control the level of humidity. One of its greatest advantages is undoubtedly its ability to work in the vicinity of electrical devices. Although the process of its formation and the very phenomenon of its occurrence are extremely simple things to describe, there are still many aspects that can be discovered, which are the focus of research by scientists around the world. One of the main parameters that influence the production process of dry fog is the pressure of the supplied gas, as well as the environmental conditions in which the aerosol is formed. This work focuses on the production of dry fog with the use of the designed and constructed apparatus, the structure of which is based on a jet nebulizer. The test and measurement stand is equipped with a compressor with a built-in pressure gauge for reading air pressure, a valve that allows the flow to be regulated, and an air supply and heating device that operates at various power values. The aim of this research was to check the impact of the power that is supplied to the system, as well as the impact of changing selected parameters such as gas pressure (which is one of the required media), on the liquid spraying process. The analysis of the results obtained during the experimental tests was based on the photographic method and allowed the mean Sauter volume–surface diameters of the obtained droplets to be compared. The analysis also showed that an increase in the power of the air supply and heating device translates directly into an increase in the ambient temperature in which the dry fog is formed, and contributes to the reduction of the diameter of the generated droplets. Changing the pressure of the atomized gas has a direct impact on the size of droplets in the generated aerosol—the higher the pressure, the smaller the droplets

The influence of information about food safety management system on purchase decisions of individual consumers Wpływ informacji o systemie zapewnienia bezpieczeństwa żywności na decyzje nabywcze konsumentów indywidualnych

The article presents the result of research on the influence of information about food safety management system on purchase decisions of consumers

Analysis of the dedusting process in a rectangular chamber filter

Purifying air from dust is a very important, current topic. There are many methods to minimize the amount of dust, one of them being chamber filters. This paper presents the research results of a newly designed rectangular chamber filter. The efficiency of the dedusting process is influenced by contamination properties, but also by the construction of the apparatus, inlet, and outlet location, the ratio of certain dimensions, and the gas flow rate. The airflow containing solid particles is a multi-phase, difficult-to-describe issue, therefore an attempt to determine the trajectory of particle movement in the apparatus was carried out using the PIV method. A decrease in the dedusting efficiency was observed with the increase of the gas flow rate, as well as for smaller diameters of the solid particles. The obtained values of the efficiency of the apparatus are comparable with the values obtained for the constructions discussed in other papers