Preparative Regimen Dosing for Hematopoietic Stem Cell Transplantation in Patients with Chronic Kidney Disease: Analysis of the Literature and Recommendations

AbstractHematopoietic stem cell transplantation (HSCT) is a potentially life-saving therapy that has traditionally been associated with high treatment-related mortality due to direct regimen toxicity and a high incidence of graft-versus-host disease. Historically, pre-existing renal insufficiency has been considered an exclusion criterion for transplantation. The advent of nonmyeloablative conditioning regimens as a less toxic modality for treatment has made HSCT more accessible to elderly patients and patients with comorbidities, such as renal impairment. However, there is no clear standard for how to dose preparative regimens for patients with chronic renal impairment who undergo HSCT. This article serves as a review of the current literature to provide dosing recommendations for commonly used preparative agents in the setting of chronic kidney disease, with the aim of providing optimal dosing for this patient population

Speeds and arrival times of solar transients approximated by self-similar expanding circular fronts

The NASA STEREO mission opened up the possibility to forecast the arrival times, speeds and directions of solar transients from outside the Sun-Earth line. In particular, we are interested in predicting potentially geo-effective Interplanetary Coronal Mass Ejections (ICMEs) from observations of density structures at large observation angles from the Sun (with the STEREO Heliospheric Imager instrument). We contribute to this endeavor by deriving analytical formulas concerning a geometric correction for the ICME speed and arrival time for the technique introduced by Davies et al. (2012, ApJ, in press) called Self-Similar Expansion Fitting (SSEF). This model assumes that a circle propagates outward, along a plane specified by a position angle (e.g. the ecliptic), with constant angular half width (lambda). This is an extension to earlier, more simple models: Fixed-Phi-Fitting (lambda = 0 degree) and Harmonic Mean Fitting (lambda = 90 degree). This approach has the advantage that it is possible to assess clearly, in contrast to previous models, if a particular location in the heliosphere, such as a planet or spacecraft, might be expected to be hit by the ICME front. Our correction formulas are especially significant for glancing hits, where small differences in the direction greatly influence the expected speeds (up to 100-200 km/s) and arrival times (up to two days later than the apex). For very wide ICMEs (2 lambda > 120 degree), the geometric correction becomes very similar to the one derived by M\"ostl et al. (2011, ApJ, 741, id. 34) for the Harmonic Mean model. These analytic expressions can also be used for empirical or analytical models to predict the 1 AU arrival time of an ICME by correcting for effects of hits by the flank rather than the apex, if the width and direction of the ICME in a plane are known and a circular geometry of the ICME front is assumed.Comment: 15 pages, 5 figures, accepted for publication in "Solar Physics

A prospective randomized controlled study comparing short-term outcomes of closure and non-closure of peritoneum during elective caesarean section

Background: There is a rising trend of caesarean deliveries worldwide. Although a very commonly performed abdominal surgery, there is no ideal operative procedure in the literature. Several studies compared short term and long-term outcomes of closure and non-closure of peritoneum, but there is no consensus whether either procedure is beneficial to patients. Variability of results may be due to bias involved in these studies as two groups compared had different characteristics (including obstetrics and non-obstetrics laparotomies, elective and emergency caesareans, Pfannenstiel as well as vertical incisions; in the same study) which are likely to affect short term outcomes besides those due to peritoneal closer and non-closure. Aims and objectives of the study were to perform an unbiased assessment of short-term outcomes in elective LSCS in unscarred abdomens by Pfannenstiel incisions between closure (CG) and non-closure of peritoneum (NCG).Methods: Prospective randomised controlled study method used in the study.Results: The operating time was significantly more (p=0.01) with difference of additional 10 minutes in CG with standard error of mean for time being 3.7688. Pain score was more in CG on post-operative day 1 and 2 (p=0.0003 and 0.008 respectively). Additional anaesthesia and analgesia were not needed in this group.Conclusions: Apart from operative timing and pain score in early post-op period, there was no significant difference in short term outcomes between CG and NCG during elective caesarean section. Hence only long-term effects of these procedures need to be considered prior to recommending ideal steps of elective caesarean section procedure

Implementation of Low Power Rail-To-Rail Dynamic Latch Comparator With Modified Adaptive Power Control Technique

this paper presents a modified technique of power reduction for the preamplifier based dynamic latch comparator. The comparator presented in this paper is having a preamplifier, which is followed by a dynamic latch topology. The comparator is having cross coupled latch to achieve high speed and at a same time kickback effect is also reduced. A modified power control technique is presented to minimize the power consumption, having good reduction in the power compared to other technique presented in the literature. The rail to rail input range and low power comparator which can be suitably used in low-to-medium speed Analog to Digital Converters is implemented in 90nm technology using HSPICE. The simulation results have shown that the power consumption of comparator is 916.9μw at the clock frequency of 200MHz and 1V supply voltage with a delay of 80.3p

Increased Risk of Cervical Dysplasia in Long-Term Survivors of Allogeneic Stem Cell Transplantation—Implications for Screening and HPV Vaccination

AbstractAs more women survive allogeneic stem cell transplantation (SCT), the development of genital human papilloma virus (HPV)-related squamous intraepithelial lesions (SIL) warrants study. Thirty-five of 38 females followed prospectively long-term after SCT for hematological malignancies (median: 7 years posttransplant) were adults and had cervical cytology testing. Acute graft-versus-host-disease (aGVHD) occurred in 9 and chronic (cGVHD) in 34 patients. Six (17%) continued receiving systemic immunosuppressive therapy (IST) for cGVHD >3 years after SCT. Of 15 (43%) with abnormal cytology, 12 (34%) patients had HPV-related SIL (median time to SIL 51 months, range: 22-108) including high-grade SIL in 7 (20%). Patients requiring continued IST had the highest risk (odds ratio [OR] 4.6, 95% confidence interval [CI] 1.1-16.4; P = .019). This high incidence of SIL in long-term SCT survivors underscores the importance of gynecologic assessment after transplantation, especially in those requiring IST. This may portend an increased risk of genital or other HPV-related malignancies

The Longitudinal Properties of a Solar Energetic Particle Event Investigated Using Modern Solar Imaging

We use combined high-cadence, high-resolution, and multi-point imaging by the Solar-Terrestrial Relations Observatory (STEREO) and the Solar and Heliospheric Observatory to investigate the hour-long eruption of a fast and wide coronal mass ejection (CME) on 2011 March 21 when the twin STEREO spacecraft were located beyond the solar limbs. We analyze the relation between the eruption of the CME, the evolution of an Extreme Ultraviolet (EUV) wave, and the onset of a solar energetic particle (SEP) event measured in situ by the STEREO and near-Earth orbiting spacecraft. Combined ultraviolet and white-light images of the lower corona reveal that in an initial CME lateral "expansion phase," the EUV disturbance tracks the laterally expanding flanks of the CME, both moving parallel to the solar surface with speeds of ~450 km s^(–1). When the lateral expansion of the ejecta ceases, the EUV disturbance carries on propagating parallel to the solar surface but devolves rapidly into a less coherent structure. Multi-point tracking of the CME leading edge and the effects of the launched compression waves (e.g., pushed streamers) give anti-sunward speeds that initially exceed 900 km s^(–1) at all measured position angles. We combine our analysis of ultraviolet and white-light images with a comprehensive study of the velocity dispersion of energetic particles measured in situ by particle detectors located at STEREO-A (STA) and first Lagrange point (L1), to demonstrate that the delayed solar particle release times at STA and L1 are consistent with the time required (30-40 minutes) for the CME to perturb the corona over a wide range of longitudes. This study finds an association between the longitudinal extent of the perturbed corona (in EUV and white light) and the longitudinal extent of the SEP event in the heliosphere