JAK-2 inhibitors and allogeneic transplant in myelofibrosis

7The activation of the JAK1/JAK2 pathway plays a crucial role in the pathogenesis of myelofibrosis. Treatment with the JAK2 inhibitor ruxolitinib demonstrated to reduce splenomegaly and symptoms in patients affected by myelofibrosis, leading to a significant improvement of overall survival in comparison with the supportive therapies. Taking in account this recent therapeutic progress, it is necessary to redefine the role of the allogeneic hematopoietic stem cell transplantation, which has been considered the only curative option for fit myelofibrosis patients up to now. In the era of JAK2 inhibitors, allogeneic transplant is still indicated in patients with intermediate-2 and high-risk myelofibrosis or red blood cell transfusion dependent patients or patients with unfavourable karyotype. There is no direct evidence to recommend which conditioning regimen should be preferentially adopted. Graft failure, relapse and transplant related mortality are still current issues of the allogeneic stem cell transplantation, particularly from unrelated donors. Ruxolitinib can be efficaciously included in the platform of allogeneic transplant. In fact, ruxolitinib treatment for 3-4 months before transplant has demonstrated to reduce spleen and improve performance status in about 30-50% of patients, without impairing the outcome of the subsequent transplant. Ruxolitinib has to stopped the day before conditioning to avoid rebound phenomenon. There are no sufficient data to recommend ruxolitinib administration after transplant with the aim of eradicating minimal residual disease and preventing relapse.openopenPatriarca, F; Sperotto, A; De Marchi, R; Perali, G; Cigana, C; Lazzarotto, D; Fanin, RPatriarca, Francesca; Sperotto, A; De Marchi, R; Perali, G; Cigana, C; Lazzarotto, D; Fanin, Renat

Cytomegalovirus Prophylaxis versus Pre-emptive Strategy: Different CD4(+) and CD8(+) T Cell Reconstitution after Allogeneic Hematopoietic Stem Cell Transplantation

Reconstitution of T cells after transplantation is a determinant of the long-term success of the procedure, and the correlation with T cell recovery and cytomegalovirus reactivation and disease is well known. We evaluated 110 patients who underwent transplantation: 55 received pre-emptive antiviral treatment, and in the other 55 patients, prophylaxis with letermovir was employed. A progressive statistically significant difference in T cell reconstitution between the 2 groups was observed, starting from day +60 with faster recovery in the pre-emptive group. Moreover, a higher incidence of cytomegalovirus reactivation was observed in prophylactic group after discontinuation of letermovir, and subsequent antiviral treatment has been necessary. Our findings confirm, as previously reported, that cytomegalovirus reactivation is a potent stimulator of T cell function

Inter- and intra-rater reliabilities of the Beighton Score compared to the Contompasis Score to assess Generalised Joint Hypermobility

Objectives: Generalized Joint Hypermobility [GJH] is a common connective tissue disorder associated with a range of musculoskeletal complaints. An effective screening tool to assess GJH may influence our understanding and choice of management. Diagnosis is clinical, using tools such as the Beighton Hypermobility Score and the Contompasis Scoring System. The comparable reliability of these tools has not been previously reported. The aim of the present study was to compare the intra- and the inter-rater reliability of the Beighton Score to the Contompasis Score to assess GJH. Methods: This was an observational study assessing 36 pain-free participants; 27 females and nine males; aged 18–32 years. Participants were assessed in random order, by two researchers over two sessions to determine intra- and inter-rater analyses. Intraclass Correlation Coefficient [ICC] and weighted Kappa statistics were used to calculate the level of agreement. Results: The intra- [ICC: 0.71–0.82] and the inter- [ICC: 0.72–0.80] rater reliability of the Beighton Score was substantial to almost perfect. The Contompasis Score displayed substantial to almost perfect intra-rater [ICC: 0.73–0.82] reliability and moderate to substantial inter-rater [ICC: 0.58–0.62] reliability. Conclusions: The present study provides an indication of the measurement capabilities of the Beighton and Contompasis Scores. The Beighton score appears to be superior compared with the Contompasis score particularly based on inter-rater reliability

Caracterização de leveduras isoladas de uvas da cultivar Malbec de Campo Belo do Sul/SC da Safra de 2016 - Série MCBS16.

A qualidade das leveduras que participam do processo fermentativo é de suma importância para se obter um vinho de qualidade. As leveduras atuam na transformação do açúcar do mosto em etanol. Esta funcionalidade e a velocidade de fermentação dependem, entre outros fatores, da linhagem utilizada. A espécie Saccharomyces cerevisiae se destaca por produzir os mais elevados teores de etanol. Tanto os gêneros Saccharomyces como os não-Saccharomyces possuem características únicas, podendo atribuir qualidades ou defeitos ao vinho. O objetivo deste trabalho foi avaliar o perfil de leveduras isoladas de bagas de uva Malbec de Campo Belo do Sul/SC. Foram isoladas 47 linhagens e caracterizadas quanto ao metabolismo fermentativo, produção de H₂S, capacidade de produção do fator killer e sensibilidade ou neutralidade ao fator killer.(Embrapa Uva e Vinho. Documentos, 99

Feasibility and Predictive Performance of a Triage System for Patients with Cancer During the COVID-19 Pandemic

Background: Triage procedures have been implemented to limit hospital access and minimize infection risk among patients with cancer during the coronavirus disease (COVID-19) outbreak. In the absence of prospective evidence, we aimed to evaluate the predictive performance of a triage system in the oncological setting. Materials and Methods: This retrospective cohort study analyzes hospital admissions to the oncology and hematology department of Udine, Italy, during the COVID-19 pandemic (March 30 to April 30, 2020). A total of 3,923 triage procedures were performed, and data of 1,363 individual patients were reviewed. Results: A self-report triage questionnaire identified 6% of triage-positive procedures, with a sensitivity of 66.7% (95% confidence interval [CI], 43.0%–85.4%), a specificity of 94.3% (95% CI, 93.5%–95.0%), and a positive predictive value of 5.9% (95% CI, 4.3%–8.0%) for the identification of patients who were not admitted to the hospital after medical review. Patients with thoracic cancer (odds ratio [OR], 1.69; 95% CI, 1.13–2.53, p =.01), younger age (OR, 1.52; 95% CI, 1.15–2.01, p <.01), and body temperature at admission ≥37°C (OR, 9.52; 95% CI, 5.44–16.6, p <.0001) had increased risk of positive triage. Direct hospital access was warranted to 93.5% of cases, a further 6% was accepted after medical evaluation, whereas 0.5% was refused at admission. Conclusion: A self-report questionnaire has a low positive predictive value to triage patients with cancer and suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptoms. Differential diagnosis with tumor- or treatment-related symptoms is always required to avoid unnecessary treatment delays. Body temperature measurement improves the triage process's overall sensitivity, and widespread SARS-CoV-2 testing should be implemented to identify asymptomatic carriers. Implications for Practice: This is the first study to provide data on the predictive performance of a triage system in the oncological setting during the coronavirus disease outbreak. A questionnaire-based triage has a low positive predictive value to triage patients with cancer and suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) symptoms, and a differential diagnosis with tumor- or treatment-related symptoms is mandatory to avoid unnecessary treatment delays. Consequently, adequate recourses should be reallocated for a triage implementation in the oncological setting. Of note, body temperature measurement improves the overall sensitivity of the triage process, and widespread testing for SARS-CoV-2 infection should be implemented to identify asymptomatic carriers

The importance of sex as a risk factor for hospital readmissions due to pulmonary diseases

BACKGROUND: Pulmonary diseases are a common and costly cause of 30-day readmissions. Few studies have focused on the difference in risk for rehospitalization between men and women in older patients. In this study we analyzed the association between sex and the risk of readmission in a cohort of patients admitted to the hospital for chronic obstructive pulmonary disease (COPD) exacerbation and other major pulmonary diseases. METHODS: This was a retrospective cohort study based on administrative data collected in the Veneto Region in 2016. We included 14,869 hospital admissions among residents aged 6565\u2009years for diagnosis related groups (DRGs) of the most common disorders of the respiratory system: bronchitis and asthma, pneumonia, pulmonary edema, respiratory failure, and COPD. Multilevel logistic regressions were performed to test the association between 30-day hospital readmission and sex, adjusting for confounding factors. RESULTS: For bronchitis and asthma, male patients had significantly higher odds of 30-day readmission than female patients (adjusted odds ratio (aOR), 2.07; 95% confidence interval (CI), 1.11-3.87). The odds of readmission for men were also significantly higher for pneumonia (aOR, 1.40; 95% CI, 1.13-1.72), for pulmonary edema and respiratory failure (aOR, 1.28; 95% CI, 1.05-1.55), and for COPD (aOR, 1.34; 95% CI, 1.00-1.81). CONCLUSIONS: This study found that male sex is a major risk factors for readmission in patients aged more than 65\u2009years with a primary pulmonary diagnosis. More studies are needed to understand the underlying determinants of this phenomena and to provide targets for future interventions