Late relapse after hematopoietic stem cell transplantation for acute leukemia: a retrospective study by SFGM-TC.

peer reviewedLate relapse (LR) after allogeneic hematopoietic stem cell transplantation (AHSCT) for acute leukemia is a rare event (nearly 4.5%) and raises the questions of prognosis and outcome after salvage therapy. We performed a retrospective multicentric study between January 1, 2010, and December 31, 2016, using data from the French national retrospective register ProMISe provided by the SFGM-TC (French Society for Bone Marrow Transplantation and Cellular Therapy). We included patients presenting with LR, defined as a relapse occurring at least 2 years after AHSCT. We used the Cox model to identify prognosis factors associated with LR. During the study period, a total of 7582 AHSCTs were performed in 29 centers, and 33.8% of patients relapsed. Among them, 319 (12.4%) were considered to have LR, representing an incidence of 4.2% for the entire cohort. The full dataset was available for 290 patients, including 250 (86.2%) with acute myeloid leukemia and 40 (13.8%) with acute lymphoid leukemia. The median interval from AHSCT to LR was 38.2 months (interquartile range [IQR], 29.2 to 49.7 months), and 27.2% of the patients had extramedullary involvement at LR (17.2% exclusively and 10% associated with medullary involvement). One-third of the patients had persistent full donor chimerism at LR. Median overall survival (OS) after LR was 19.9 months (IQR, 5.6 to 46.4 months). The most common salvage therapy was induction regimen (55.5%), with complete remission (CR) obtained in 50.7% of cases. Ninety-four patients (38.5%) underwent a second AHSCT, with a median OS of 20.4 months (IQR, 7.1 to 49.1 months). Nonrelapse mortality after second AHSCT was 18.2%. The Cox model identified the following factors as associated with delay of LR: disease status not in first CR at first HSCT (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.04 to 1.64; P = .02) and the use of post-transplantation cyclophosphamide (OR, 2.23; 95% CI, 1.21 to 4.14; P = .01). Chronic GVHD appeared to be a protective factor (OR, .64; 95% CI, .42 to .96; P = .04). The prognosis of LR is better than in early relapse, with a median OS after LR of 19.9 months. Salvage therapy associated with a second AHSCT improves outcome and is feasible, without creating excess toxicity

Réalisation d'une plateforme inter-applicative de gestion de flux de données

Due to some modifications of the information system of the human ressources of the SNCF, the original application to manage datas flow was not able to process the expected quantity. After studying several alternatives, the decision was made to proceed of the development of a New data Flow plateform. A study of needed did to appear new elements to take account, in the development of the new platform, in addition of what the old application can do. The realization of this application has required a subdivision of functionalities, to respect schedule constraints. Finally, once the established architecture, we have had to overcome several technical difficulties.Suite à des modifications au sein du système d’information des ressources humaines de la SNCF, l’outil gérant les flux de données, initialement en place s’est vu dans l’incapacité de pouvoir traiter le volume attendu. Après une étude de plusieurs solutions, la décision fut prise de procéder au développement d’une Nouvelle Plateforme de Flux. Une étude de besoin fit apparaître de nouveaux éléments à prendre en compte, dans le développement de la nouvelle plateforme, en plus de ce qu’est capable de faire l’ancienne application. La réalisation de cette application a nécessité un lotissement des fonctionnalités afin de respecter des contraintes liées au planning. Enfin, une fois l’architecture établie, il a fallu relever plusieurs difficultés d’ordre technique

Réalisation d'une plateforme inter-applicative de gestion de flux de données

Due to some modifications of the information system of the human ressources of the SNCF, the original application to manage datas flow was not able to process the expected quantity. After studying several alternatives, the decision was made to proceed of the development of a New data Flow plateform. A study of needed did to appear new elements to take account, in the development of the new platform, in addition of what the old application can do. The realization of this application has required a subdivision of functionalities, to respect schedule constraints. Finally, once the established architecture, we have had to overcome several technical difficulties.Suite à des modifications au sein du système d’information des ressources humaines de la SNCF, l’outil gérant les flux de données, initialement en place s’est vu dans l’incapacité de pouvoir traiter le volume attendu. Après une étude de plusieurs solutions, la décision fut prise de procéder au développement d’une Nouvelle Plateforme de Flux. Une étude de besoin fit apparaître de nouveaux éléments à prendre en compte, dans le développement de la nouvelle plateforme, en plus de ce qu’est capable de faire l’ancienne application. La réalisation de cette application a nécessité un lotissement des fonctionnalités afin de respecter des contraintes liées au planning. Enfin, une fois l’architecture établie, il a fallu relever plusieurs difficultés d’ordre technique

Willow : extending Herby's semantic tree theorem-proving heuristics

This thesis describes a first-order logic automated theorem prover named Willow. Like its predecessor Herby, Willow solves theorems by constructing closed semantic trees. The main goal of Willow is to facilitate the closure of semantic trees by incorporating techniques found useful in other theorem provers. Extensions include the handling of equality via demodulation and paramodulation, the use of free variables, the heavy use of hash tables, and the use of new inference rules. Willow also contains simplification operations such as the detection of unused and useless atoms, and the reuse of subsumed subtrees. Willow is integrated in a graphical user interface, and is currently available for Windows 95/NT and UNIX-like operating systems

A meta-analysis of the effect of paper versus digital reading on reading comprehension in health professional education

Objective. Despite a rise in the use of digital education in health professional education (HPE), little is known about the comparative effectiveness of paper-based reading and its digital alternative on reading comprehension. The objectives of this study were to identify, appraise, and synthesize the evidence regarding the effect of how media is read on reading comprehension in the context of HPE. Methods. Observational, quasi-experimental, and experimental studies published before April 16, 2021, were included if they compared the effectiveness of paper-based vs digital-based reading on reading comprehension among HPE students, trainees, and residents. Random-effects meta-analyses were performed using standardized mean differences. Results. From a pool of 2,208 references, we identified and included 10 controlled studies that had collectively enrolled 817 participants. Meta-analyses revealed a slight but nonsignificant advantage to students reading paper-based HPE texts rather than digital text (standardized mean difference, -0.08; 95% CI -0.28 to 0.12). Subgroup analyses revealed that students reading HPE-related texts had better reading comprehension when reading text on paper rather than digitally (SMD 5 -0.36; 95% CI -0.69 to -0.03). Heterogeneity was low in all analyses. The quality of evidence was low because of risks of bias across studies. Summary. Current evidence suggests little to no difference in students’ comprehension when reading HPE texts on paper vs digitally. However, we observed effects favoring reading paper-based texts when texts relevant to the students’ professional discipline were considered. Rigorous studies are needed to confirm this finding and to evaluate new means of boosting reading comprehension among students in HPE programs

Difference Between Persistent Aneurysm, Regressed Aneurysm, and Coronary Dilation in Kawasaki Disease: An Optical Coherence Tomography Study

BACKGROUND Coronary artery (CA) aneurysms are a serious complication of Kawasaki disease (KD). Conventional imaging techniques often described segments with regressed aneurysms as normal, whereas studies have shown significant endothelial dysfunction. METHODS KD patients with aneurysms scheduled for routine coronary angiography underwent optical coherence tomography (OCT) imaging between 2013 and 2016. Microstructural coronary changes were compared between normal CA segments and those with dilation, regressed aneurysms, and persistent aneurysms. RESULTS OCT was performed on 33 patients aged 12.0 ± 5.4 years, 8.5 ± 5.4 years after KD diagnosis. Of the 79 segments analyzed, 25 had persistent aneurysms, 22 regressed aneurysms, 11 CA dilation, and 21 no CA involvement. Intimal thickness was 489 ± 173 μm, 304 ± 158 μm, 102 ± 68 μm, and 63 ± 29 μm, respectively (P < 0.001). There was a linear correlation between the maximum aneurysm size and the intimal thickness, as well as coronary dimension at the time of OCT. Fibrosis (54 segments, 68%) and cellular infiltration (22 segments, 28%) were found more often in segments with CA involvement, but also those without (P = 0.01; P = 0.02). Destruction of the media (34 segments, 43%), calcifications (6 segments, 8%), neovascularization (18 segments, 23%), and white thrombi (8 segments, 10%) were found almost exclusively in segments with a history of aneurysms. CONCLUSIONS Intimal hyperplasia, fibrosis, and cellular infiltration were found in all categories of CA involvement, whereas calcification, destruction of the media, neovascularization, and white thrombi were found essentially only in segments with saccular or fusiform aneurysms. Prospective studies with outcome correlations are needed to see if this is associated with an increased risk of late adverse events