Outpatient management of febrile neutropenia in children with cancer

Optimizing the therapeutic strategies based on the results of randomized studies comparing different regimens led to a better prognosis of nearly all pediatric malignancies during the past four decades. Fever and neutropenia (FN) is a common complication in patients undergoing chemotherapy to treat cancer. There is no consensus on when standard therapy can be safely reduced; this lack of consensus leads to important variations in management of FN between different institutions, usually conducted according to local attitudes. To address this issue, the Infection working group of the Italian association for pediatric hematology oncology (AIEOP) organized a consensus meeting. This paper reports the agreement derived from this meeting

IgE Profiles of Bermuda Grass Pollen Sensitised Patients Evaluated by Phleum Pratense Allergens Phl P 1, 2, 4, 5, 6, 7, 11, 12

ABSTRACT Background Despite the difference in geographical dominance of certain grasses, a high degree of allergenic similarity or cross-reactivity between Bermuda grass pollen (BGP) and timothy grass pollen (TGP) has been previously demonstrated. The aim of the present study was to ascertain the sensitisation to TGP in 411 patients known for their reactivity to BGP extracts by analysing their reactivity to crude timothy pollen extract and timothy pollen purified allergens, establishing their specific IgE-profiles. Methods Using the immunoenzymatic CAP method we evaluated IgE-specific antibodies for BGP- and TGP-extracts and the timothy recombinant (r) and natural (n) allergens rPhl p 1, rPhl p 2, nPhl p 4, rPhl p 5, rPhl p 6, rPhl p 7, rPhl p 11, and rPhl p 12. Results BGP-IgE positive patients (median = 8.0 kUA/l, 2.8-22.2 kUA/l 25 th -75 th percentile) simultaneously had IgE positive results for TGP (100% of subjects) (median = 48.9 kUA/l, 19.8- > 100 kUA/l 25 th -75 th percentile) and high prevalence of sensitization to 6/8 Phleum pratense allergens (Phl p 1, 2, 4, 5, 6, 11, markers of genuine sensitisation to TGP) other than profilin and calcium binding protein. More than 72% of BGP allergic patients were co-sensitised to rPhl p 1, rPhl p 2, nPhl p 4, rPhl p 5, rPhl p 6. A decrease of total and specific IgE with patients' age was observed. Conclusions Our data show that all BGP-allergic patients simultaneously exhibit higher IgE antibody levels to recombinant and natural P . pratense allergens as well as to crude TGP extract. This suggests that when choosing an immunotherapeutic regimen for BGP-sensitised patients (after establishing their IgE profile via purified TGP-allergens), subcutaneous or sublingual TGP-extract vaccines in appropriate doses, in order to influence T epitope specificity, might be beneficial. Though extremely uncommon, in cases where a patient is exclusively BGP allergen-sensitised, BGP-extract therapy is the appropriate therapeutic response

Reply: Comparison of preoperative and postoperative lymphatic function is essential to understand the changes in lymphatic function

Reply to a Letter to Edito

Evaluation of two grass pollen extracts for immunotherapy by serum determinations of specific IgE and IgG4 antibodies towards purified Timothy grass pollen allergens (Phl p 1, 2, 4, 5, 6, 7, 11, 12) in patients undergoing hyposensitization treatment

ABSTRACTBackgroundThe diagnosis of allergic diseases with recombinant allergens allows us to detect antibodies specific for single allergens in extracts. The aim of the present study was to assess the early effect of grass pollen immunotherapy on IgE and IgG4 responses to eight purified grass pollen allergens in patients undergoing hyposensitization treatment.MethodsThe sera of 22 consecutive atopic individuals undergoing cluster regimen grass pollen immunotherapy were analyzed for IgE and IgG4 antibodies specific for grass pollen allergens (Phl p 1, 2, 4, 5, 6, 7, 11, 12). Two serum samples were taken, one before the start of therapy and one between 12 and 15 weeks after the first immunization. Immunotherapy was performed with two allergy vaccines comprising a standardized extract aluminum-adsorbed grass pollen mix and a standardized extract of grass pollen mix adsorbed onto calcium phosphate.ResultsOne treated patient showed a specific IgE conversion from negative (<0.35 kUA/L) to positive in the capsulated hydrophilic carrier polymer (CAP) test for Phl p 2, 1 and 4 (1.89, 0.84 and 0.68 kUA/L, respectively). The sera of 10 of 11 patients treated with alluminum-adsorbed grass pollen extract showed a significant increase in specific IgG4 towards natural Timothy grass pollen extract and purified allergens, as well as significant IgG4 levels towards Phl p 1 (P = 0.000238) Phl p 2 (P = 0.000289), Phl p 4 (P = 0.000585), Phl p 5 (P = 0.000364), Phl p 6 (P = 0.000346) and Phl p 11 (P = 0.039623; Mann–Whitney U-test) 12 weeks after the onset of immunotherapy. The sera of seven of 11 subjects treated with calcium phospate-adsorbed grass pollen extract had significant IgG4 levels against Timothy pollen allergens, as well as significant IgG4 titers against Phl p 1 (P = 0.004703), Phl p 4 (P = 0.000282), Phl p 5 (P = 0.015480), Phl p 6 (P = 0.013012) and Phl p 11 (P = 0.005178). Patients treated with aluminum-adsorbed grass pollen extract had higher levels of IgG4 towards Phl p 2, 4 and 6 and natural Timothy grass extract compared with patients treated with calcium phosphate-adsorbed grass pollen extract. Both the alluminum-adsorbed and calcium phosphate-adsorbed grass pollen extract allergy vaccines induced significant titers of specific IgG4 towards Phleum pratense pollen extract (P = 0.008376 and 0.01148, respectively).ConclusionsThese results indicate that grass pollen immunotherapy elicits an array of antibody specificities that reflect the allergen content and the potency of allergen extracts; this could be of pivotal importance to define optimal allergen extract doses

Energy management in hybrid systems coupling PV and electrical storage

In this contribution the possible benefits of the integration of a storage system (ST) and a photovoltaic power plant (PV) are investigated by means of a Heuristic Rules System (HRS), used both for the determination of the optimal size of the components and for the power production scheduling. The HRS takes into account the well-known electrical constraints and aims at satisfying the electrical demand following a priority order (PV, ST, main grid). Experimental results in the case of four possible scenarios are presented and discussed

Horrorshow: a ultraviolência como elemento distópico em Laranja mecânica

O presente artigo busca analisar a relação entre violência e distopia presente no romance Laranja mecânica (1962), de Anthony Burgess. A interpretação da obra é baseada em textos teóricos do próprio autor em conjunto com textos da crítica literária sobre os gêneros utópico e distópico, bem como os que analisam a ficção científica como gênero literário do qual a distopia faz parte. Um elemento muito presente no gênero é o teor político, por isso não poderiam ser ignoradas as análises políticas a respeito dos eventos do século XX que servem como plano de fundo para a contextualização do enredo e de suas críticas, para que ao fim se possa verificar como a violência é o tema central da obra e como diversas perspectivas e debates são levantados pelo romance no que se refere à reabilitação, criminalidade e sociedade.This article aims to analyze the relationship between violence and dystopia in the novel A Clockwork Orange (1962), by Anthony Burgess. The interpretation of the work is based on theoretical texts by the author himself together with texts from literary criticism on the utopian and dystopian genres, as well as those that analyze Science Fiction as a literary genre of which dystopia is part. A very present element in the genre is the political content, which is why political analysis regarding the events of the 20th century serves as a background for the contextualization of the plot and its criticisms, so that in the end it can be verified how violence is the central theme of the work and how different perspectives and debates are raised by the novel regarding rehabilitation, criminality and society

A simple strategy to optimally design and manage a photovoltaic plant integrated with a storage system for different applications

The main goal of the present paper is that of proposing a methodology for the optimal sizing of a Photovoltaic (PV) unit and a Storage (ST) device, basing on data concerning typical load and PV production profiles. To achieve this result, a set of simple requirements to manage the charging/discharging of the storage is firstly proposed. Then, the overall cost of the whole system is deduced as a function of two variables (PV and ST sizes) and minimized in order to find the optimal sizing of the system. Finally, an economic analysis is presented to determine whether or not the investment is profitable

Public Private Partnerships: A General Overview in Italy

The aim of this paper is to analyze the application of Public Private Partnership (PPP) in Italy. The paper would like to study weakness and strength of these partnerships. This is a descriptive paper based on secondary data. The research defines and describes the importance of PPPs in a period of financial difficulties for national and local governments, with a special focus on Italy experiences. Partnership between public and private haven’t a large diffusion in Italy and don’t concern big or national structure but local structure like cemeteries, local stadium for swimming competition, and little harbor for private ships. PPPs in Italy context require important reflections because there isn’t a high level of collaboration between private and public actors, for many reasons. For example, one of the main causes is represented by a very low level of preparation of local offices and the consequent difficulties of public local actor to manage the partnership

Prolonged extracorporeal membrane oxygenation therapy for severe acute respiratory distress syndrome in a child affected by rituximab-resistant autoimmune hemolytic anemia: a case report

<p>Abstract</p> <p>Introduction</p> <p>Autoimmune hemolytic anemia in children younger than 2 years of age is usually characterized by a severe course, with a mortality rate of approximately 10%. The prolonged immunosuppression following specific treatment may be associated with a high risk of developing severe infections. Recently, the use of monoclonal antibodies (rituximab) has allowed sustained remissions to be obtained in the majority of pediatric patients with refractory autoimmune hemolytic anemia.</p> <p>Case presentation</p> <p>We describe the case of an 8-month-old Caucasian girl affected by a severe form of autoimmune hemolytic anemia, which required continuous steroid treatment for 16 months. Thereafter, she received 4 weekly doses of rituximab (375 mg/m²/dose) associated with steroid therapy, which was then tapered over the subsequent 2 weeks. One month after the last dose of rrituximab, she presented with recurrence of severe hemolysis and received two more doses of rrituximab. The patient remained in clinical remission for 7 months, before presenting with a further relapse. An alternative heavy immunosuppressive therapy was administered combining cyclophosphamide 10 mg/kg/day for 10 days with methylprednisolone 40 mg/kg/day for 5 days, which was then tapered down over 3 weeks. While still on steroid therapy, the patient developed an interstitial pneumonia with Acute Respiratory Distress Syndrome, which required immediate admission to the intensive care unit where extracorporeal membrane oxygenation therapy was administered continuously for 37 days. At 16-month follow-up, the patient is alive and in good clinical condition, with no organ dysfunction, free from any immunosuppressive treatment and with a normal Hb level.</p> <p>Conclusions</p> <p>This case shows that aggressive combined immunosuppressive therapy may lead to a sustained complete remission in children with refractory autoimmune hemolytic anemia. However, the severe life-threatening complication presented by our patient indicates that strict clinical monitoring must be vigilantly performed, that antimicrobial prophylaxis should always be considered and that experienced medical and nursing staff must be available, to deliver highly specialized supportive salvage therapies, if necessary, during intensive care monitoring.</p