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ABSTRACT Objective: to map common recurrent mental disorders in patients undergoing hematopoietic stem cell transplantation. Methods: this is a scoping review carried out in January 2022 in electronic databases and repositories of dissertations and thesis. Studies that answered the research question, met the objective of the study and were available in full electronically, in any language, were included. Results: the sample consisted of 28 studies, 14 of which were published in the United States of America. The common mental disorders found were depressive, anxiety, post-traumatic stress and mood disorders. Twenty symptoms were mentioned, among the most prevalent are fatigue and sleep disorders/insomnia. Conclusions: the difficulty and importance of carrying out the differential diagnosis of these disorders were highlighted, since their symptoms can be confused with other health problems and have a strong potential to interfere with patients' evolution.
RESUMEN Objetivo: mapear los trastornos mentales recurrentes comunes en pacientes sometidos a trasplante de células madre hematopoyéticas. Métodos: se trata de una revisión de alcance realizada en enero de 2022 en bases de datos electrónicas y repositorios de disertaciones y tesis. Se incluyeron publicaciones que respondieron a la pregunta de investigación, cumplieron con el objetivo del estudio y estaban disponibles en su totalidad en formato electrónico, en cualquier idioma. Resultados: la muestra estuvo compuesta por 28 estudios, 14 de los cuales fueron publicados en los Estados Unidos de América. Los trastornos mentales comunes encontrados fueron depresión, ansiedad, estrés postraumático y trastornos del estado de ánimo. Se mencionaron 20 síntomas, entre los más prevalentes se encuentran fatiga y trastornos del sueño/insomnio. Conclusiones: se destacó la dificultad e importancia de realizar el diagnóstico diferencial de estos trastornos, ya que sus síntomas pueden confundirse con otros problemas de salud y tienen un fuerte potencial de interferir en la evolución del paciente.
RESUMO Objetivo: mapear os transtornos mentais comuns recorrentes em pacientes submetidos ao transplante de células-tronco hematopoéticas. Métodos: trata-se de revisão de escopo realizada em janeiro de 2022 em bases de dados eletrônicas e repositórios de dissertações e tese. Foram incluídas publicações que respondessem à questão de pesquisa, atendessem ao objetivo do estudo e que estivessem disponíveis na íntegra em meio eletrônico, em qualquer idioma. Resultados: a amostra foi composta por 28 estudos, dos quais 14 foram publicados nos Estados Unidos da América. Os transtornos mentais comuns encontrados foram os transtornos depressivos, de ansiedade, estresse pós-traumático e de humor. Foram citados 20 sintomas, entre os mais prevalentes estão a fadiga e distúrbios do sono/insônia. Conclusões: evidenciaram-se a dificuldade e a importância de realizar o diagnóstico diferencial desses transtornos, uma vez que seus sintomas podem ser confundidos com outros problemas de saúde e têm forte potencial para interferir na evolução do paciente.
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ABSTRACT While first-line induction therapy for patients with multiple myeloma has changed over the years, autologous hematopoietic stem cell transplantation still plays a significant role, improving both depth of response and progression-free survival of myeloma patients. Our 25-year experience in mobilizing hematopoietic stem and progenitor cells for 472 transplant-eligible myeloma patients was retrospectively reviewed. Patients were stratified according to the remission induction therapy received, and the outcomes were compared among the cohorts that received vincristine, adriamycin and dexamethasone (VAD) (n = 232), bortezomib and dexamethasone (BD) (n = 86), cyclophosphamide, bortezomib and dexamethasone (CyBorD) (n = 82) and other regimens (n = 67). Cyclophosphamide plus granulocyte colony-stimulating factor was the predominant mobilization regimen given. A greater number of CD34+ cells (9.9 × 10E6/kg, p = 0.026) was collected with less hospital admissions in BD patients (13%, p = 0.001), when compared to those receiving VAD (7.5 × 10E6/kg, 29%), CyBorD (7.6 × 10E6/kg, 19%), or other regimens (7.9 × 10E6/kg, 36%). Induction therapy did not influence the overall rate of unscheduled visits or the length of hospitalization because of complications following mobilization. The myeloma response was not significantly deepened following the cyclophosphamide administered for mobilization. This analysis demonstrates the importance of monitoring the impact of initial treatment on downstream procedures such as stem cell mobilization and collection.
Subject(s)
Humans , Male , Female , Stem Cells , Remission Induction , Hematopoietic Stem Cells , Cyclophosphamide , Multiple Myeloma , Hematopoietic Stem Cell Transplantation , Hematopoietic Stem Cell MobilizationABSTRACT
El trasplante de células madre hematopoyéticas resulta un procedimiento muy beneficioso para el tratamiento de enfermedades hematológicas en las cuales la única posibilidad de cura es por medio de este método. Para realizar el trasplante existen varias opciones: trasplante autólogo y alogénico. Existen complicaciones que han tratado de evitarse adoptando medidas que en algunas ocasiones han resultado exitosas. El beneficio que este procedimiento representa ha hecho que sea adoptado por muchas personas y ha llevado al aumento de donantes a nivel mundial..(AU)
Hematopoietic stem cells transplantation is a very beneficial procedure for the treatment of hematological diseases in which the only possibility of cure is by this method. There are several options to perform the transplant: autologous and allogeneic transplant.There are complications that have been trying to avoid adopting measures that have sometimes been successful. The benefit that this procedure represents has made it adopted by many people and has led to the increase of donors worldwide..(AU)
Subject(s)
Humans , Survival Analysis , Hematopoietic Stem Cell TransplantationABSTRACT
Objective To study the effect of autologous bone marrow mesenchymal stem cells in the treatment of osteonecrosis .Methods 56 cases of osteonecrosis of femeral head ( ONFH) were treated with autologous bone marrow mesenchymal stem cells .DSA observed neovascularization after transplantation ,morphological changes of femoral head were observed by imaging method .Results Of the 30 patients who underwent autologous bone marrow stem cell transplantation,86.6％had resuscitation of hip pain,23.3％ had improved hip function,and 85.7％ had walking distance .Examination showed that the arterial artery was significantly increased before transplantation , thickening,faster blood flow.The femoral head area of the bone was significantly improved (100.0％) after 12 -24 months.Conclusion The method of transplantation of bone marrow mesenchymal stem cells is simple ,safe and effective.It is effective for stage I and II of the avascular necrosis of the femoral head .
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RESUMO Objetivo: habilitar a equipe de Enfermagem de um serviço de transplante de células-tronco hematopoiéticas no manejo do cateter de Hickman®. Método: pesquisa descritiva e quantitativa. A coleta de dados ocorreu entre janeiro e março de 2017, em um hospital público do Sul do Brasil, por meio de questionários que foram analisados mediante estatística descritiva. Resultados: habilitaram-se 44 participantes. Das questões abordadas, tiveram melhor resultado após as orientações: definição de cateter venoso central de curta permanência (79,55% para 93,18%de acertos); material e posição do cateter (75% para 88,64%); características do cateter (54,55% para 65,91%); procedimentos imediatos à inserção do cateter (2,27% para 18,18%); lavagem, pressão positiva e refluxo induzido pela seringa (72,73% para 97,73%); bloqueio do cateter (84,09% para 97,73%); volume do priming(22,73%para 54,55%) Conclusão: o processo educativo desenvolvido possibilitou a instrumentalização dos profissionais para um conhecimento mais homogêneo no manejo do cateter de Hickman®.
RESUMEN Objetivo: Capacitar al equipo de Enfermería de un servicio de trasplante de células madre hematopoyéticas en el manejo del catéter de Hickman®. Método: Investigación descriptiva, cuantitativa. Datos recolectados entre enero y marzo de 2017 en hospital público delo Sur de Brasil, mediante cuestionarios, que fueron analizados por estadística descriptiva. Resultados: Recibieron capacitación los 44 participantes. Las cuestiones abordadas obtuvieron mejores resultados después de las indicaciones: definición de catéter venoso de corta permanencia (79,55% al 93,18% de aciertos); material y posición del catéter (75% al 88,64%); características del catéter (2,27% al 18,18%); higiene, presión positiva y reflujo inducido por jeringa (72,73% al 97,73%); bloqueo del catéter (84,09% al 97,73%) volumen del priming (22,73% al 54,55%). Conclusión: El proceso educativo desarrollado permitió el desarrollo por parte de los profesionales de un conocimiento más homogéneo en el manejo del catéter de Hickman®.
ABSTRACT Objective: to enable the nursing team of a hematopoietic stem cell transplantation service to manage Hickman® catheters. Method: descriptive and quantitative research. Data collection took place between January and March 2017, in a public hospital in the South of Brazil, using questionnaires that were analyzed through descriptive statistics. Results: Forty-four participants were enrolled. Of the issues addressed, the ones with better results after the guidelines were: definition of a short-term central venous catheter (79.55% for 93.18% of correct answers); material and position of the catheter (75% to 88.64%); characteristics of the catheter (54.55% to 65.91%); immediate procedures after catheter insertion (2.27% to 18.18%); flushing, positive pressure and syringe-induced reflux (72.73% to 97.73%); catheter lock (84.09% to 97.73%); and priming volume (22.73% to 54.55%). Conclusion: the educational process developed allowed the instrumentalization of professionals to a more homogenous knowledge in the management of Hickman® catheters.
Subject(s)
Hematopoietic Stem Cell Transplantation , Evidence-Based Nursing , Central Venous Catheters , Inservice TrainingABSTRACT
Estudo qualitativo descritivo com sugestões de aprimoramento de orientações para a alta hospitalar de crianças no pós-transplante de células-tronco hematopoiéticas. Realizado em serviço público de transplante de medula óssea do sul do Brasil com 58 participantes, entre eles profissionais da equipe multiprofissional e familiares cuidadores, entrevistados de janeiro de 2014 a março de 2016. Utilizou-se a análise de conteúdo temático categorial. As possibilidades de aprimoramento são capacitação dos profissionais envolvidos no cuidado, construção e aplicação de planejamento de alta pela equipe multiprofissional, inclusão da criança na orientação, utilização de formas variadas para orientar, e elaboração de material didático apropriado. O processo de alta hospitalar é complexo e a equipe envolvida na assistência ao paciente e cuidador é responsável por tornar esse momento de transição um período de aprendizagem, para auxiliá-los nos cuidados em casa (AU).
Qualitative descriptive study with suggestions for the improvement of guidelines for hospital discharge of children in post-hematopoietic stem cell transplantation. The study was conducted in a public service specialized in bone marrow transplantation in southern Brazil, with 58 participants, including professionals of the multidisciplinary team and family caregivers, interviewed in the January 2014-March 2016 period. Thematic content analysis was used. The possibilities of improvement identified here are as follows: training of the professionals involved in care, construction and implementation of discharge planning by the multidisciplinary team, guidance provided also to the patients (children), use of various ways to guide and prepare the appropriate teaching materials. The discharge process is complex, and the staff that supports patients and caregivers is responsible for turning this moment of transition of care from hospital to home into a period of learning, assisting them in home care (AU).
Estudio cualitativo descriptivo que trae sugerencias de perfeccionamiento de orientaciones para el alta hospitalar de niños en el pos trasplante de células madres hematopoyéticas. Fue realizado en el servicio público de trasplante de médula osea en sur de Brasil con 58 participantes, entre profesionales del equipo multiprofesional y familiares cuidadores. Estos fueron entrevistados de enero de 2014 a marzo de 2016. Se utilizó el análisis de contenido temático categorial. Las posibilidades de perfeccionamiento son capacitación de los profesionales participantes en cuidado, construcción y aplicación de planeamiento de alta por el equipo multiprofesional, inclusión del niño en la orientación, uso de formas distintas para orientar y elaboración de material didático adecuado. El proceso de alta hospitalaria es complejo, y el equipo integrado en la asistencia al paciente y cuidador es responsable por ayudar en los cuidados en casa y para que ese momento de transición sea un periodo de aprendizado (AU).
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Humans , Patient Care Team , Patient Discharge , Hematopoietic Stem Cell TransplantationABSTRACT
AIM:To investigate the combination therapeutic effect of Ginkgobalide B (GKB) and retinal stem cells (RSCs)transplantation on glaucoma in rats.METHODS:Rats were divided randomly into five groups:control group,glaucoma group,RSCs group,GKB group and RSCs combination therapy group.A chronic glaucoma model was established in rats,accordingly.The morphological changes in ocular tissues were analyzed by HE staining.Retinal ganglion cells apoptosis were analyzed by TUNEL staining.The protein expressions of Bcl-2,Bax,Cleaved caspase-3 and Cleaved caspase-9 were determined by Western blot.The mRNA levels of Bcl-2 and Bax were determined by qPCR.RESULTS:HE staining revealed that RSCs transplantation or GKB treatment decreased fiber interstitial edema and vacuole,as compared to glaucoma group.Furthermore,this improvement was more pronounced in combination therapy group than in single treatment alone.Combination therapy significantly inhibited retinal ganglion cells apoptosis,increased Bcl-2 mRNA and protein expression,but decreased Bax mRNA and protein expression.Moreover,the protein expression of Cleaved caspase-3 and Cleaved caspase-9 expression were decreased after combination therapy.CONCLUSION:Our data demonstrate that combination of Ginkgobalide B and retinal stem cells transplantation can inhibit retinal ganglion cells apoptosis and protect against glaucoma.These effects may be associated with the regulation of Bcl-2,Bax,Cleaved caspase-3 and Cleaved caspase-9 expression.
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RESUMO Objetivo: apresentar modelo teórico representativo da vivência do cuidado em casas transitórias de apoio a familiares de crianças em pós-transplante de células-tronco hematopoiéticas. Método: Teoria Fundamentada nos Dados, realizada com 18 participantes de três grupos amostrais. Para análise, utilizou-se o software QSR Nvivo10. Resultados: elaboraram-se quatro categorias: residindo em casa transitória de apoio; vivenciando o cuidado à criança em pós-transplante de células-tronco hematopoiéticas; cuidando do cuidador familiar; e retornando a uma nova vida no lar, as quais se inter-relacionam conforme o código teórico da família interativa. Conclusão: esta pesquisa contribui para compreensão da vivência do cuidado em casas transitórias de apoio a familiares de crianças em pós-transplante de células-tronco hematopoiéticas e subsidia as ações de enfermagem e saúde prestadas a esta população; contribui ainda para a elaboração de orientação de alta hospitalar e cuidado direcionado a essa clientela.
RESUMEN Objetivo: presentar un modelo teórico representativo de la vivencia del cuidado en casas transitorias de apoyo a familiares de niños en pos-trasplante de células madre hematopoyéticas. Método: Teoría Fundamentada en Datos, realizada con 18 participantes de tres grupos muestrales. Para el análisis, se utilizó el software QSR Nvivo10. Resultados: se elaboraron cuatro categorías: residiendo en casa transitoria de apoyo; vivir el cuidado al niño en pos-trasplante de células madre hematopoyéticas; cuidando del cuidador familiar; y retornando a una nueva vida en el lar, las cuales se inter-relacionan de acuerdo con el código teórico de la familia reactiva. Conclusión: esta investigación contribuye para la comprensión de la vivencia del cuidado en casas transitorias de apoyo a familiares de niños en pos-trasplante de células madre hematopoyéticas y subvenciona las acciones de enfermería y salud prestadas a esta población; aún contribuye para la elaboración de orientación de alta hospitalaria y cuidado direccionado a estos clientes.
ABSTRACT Objective: to present the theoretical model that represents the experience of care in transitional homes of support to families of children in a period of post-transplantation of hematopoietic stem cells. Method: grounded theory, performed with 18 participants from three different samples. For analysis, we used the QSR Nvivo10 software. Results: we elaborated four categories: living in the transitional support home; experiencing care of children in post-transplantation of hematopoietic stem cells; taking care of the family caregiver; and returning to a new life at home, which interrelate according to the theoretical code of the interactive family. Conclusion: this research contributes to understanding the experience of care in transitional support homes of families with children in post-transplantation of hematopoietic stem cells and subsidizes nursing and health actions provided to this population; it also contributes to the development of a hospital discharge guidance and care directed to this clientele.
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Humans , Child , Family , Hematopoietic Stem Cell Transplantation , Transitional Care , Models, TheoreticalABSTRACT
Retinitis pigmentosa (RP) encompasses many different hereditary retinal degenerations that are caused by a vast array of different gene mutations and have highly variable disease presentations and severities.Work over the past 25 years has resulted in the identification of genes responsible for about 50％ of the RP cases,and it's predicted that most of the remaining disease-causing genes will be identified by the year 2020 or most likelysooner.This marked acceleration is the result of dramatic improvements in DNA-sequencing technologies and the associated analysis.The advent of two recent innovations, induced pluripotent stem cells (iPSCs) and clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated nuclease-9 (Cas-9) mediated genome editing,are changing the landscape of RP research, with causative genes being identified at an accelerated rate withgreat potential to translate these discoveries into personalized therapeutic strategies.
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Multiple sclerosis (MS) is the most common neurological disease in young adults, affecting approximately two million people worldwide nowadays. Unfortunately, there was no effective treatment and interventional method for MS at present. Even the current standard treatment consisting of disease-modifying drugs can only alleviate the clinical symptoms of MS, and these drugs may produce serious adverse side effects, and are ineffective in preventing disease progression in many MS patients. Mesenchymal stem cell therapy (MSCT) in animal models and primary clinical trials have shown potential effect consisting of neuroregeneration and immunomodulation. Therefore, the treatment with mesenchymal stem cells (MSCs) may present a promising tool for the treatment of MS patients.
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Objective To evaluate the effect of umbilical cord mesenchymal stem cell (UC-MSC) transplantation on cognitive function in endotoxemic rats.Methods Seventy-two pathogen-free male Wistar rats,aged 180-250 g,were randomly divided into 4 groups (n=18 each) using a random number table:control group (group C),endotoxemia group (group E),UC-MSC group (group M),and endotoxemia+ MSC group (group PM).Cognitive function was assessed using Morris water maze test.At 4 h before training on 2nd day of place navigation test,lipopolysaccharide 100 μg/kg was injected intraperitoneally in group E,the equal volume of normal saline was given in group C,UC-MSC suspension 300 μl (5× 105cells,the fluid was normal saline) was injected via the tail vein immediately after intraperitoneal lipopolysaccharide in group PM,and UC-MSCs were injected via the tail vein in group M.At 4 h after injection,Morris water maze test was continued.At 4,24 h and 5 days after intraperitoneal injection or injection via the tail vein (T1-3),6 rats were selected,and blood samples were collected from hearts.The rats were then sacrificed,and the hippocampus was removed.The levels of interleukin-lbeta (IL-1β),IL-6 and tumor necrosis factor-alpha (TNF-α) in serum and hippocampus were determined.Results Compared with group C,the escape latency was significantly prolonged on 2nd and 3rd days of Morris water maze test,the number of crossing the platform was significantly decreased,the percentage of swimming distance in 1 st quadrant in the total swimming distance was significantly decreased,and the levels of IL-1 β,IL-6 and TNF-α in serum and hippocampus were significantly increased at T1,2 in group E (P＜0.05).Compared with group E,the escape latency was significantly shortened on 2nd and 3rd days of Morris water maze test,the number of crossing the platform was significantly increased,the percentage of swimming distance in 1st quadrant in the total swimming distance was significantly increased,and the levels of IL-1β,IL-6 and TNF-α in serum and hippocampus were significantly decreased at T1,2 in group PM (P＜0.05).Conclusion UC-MSC transplantation can improve the cognitive decline in endotoxemic rats.
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Resumo: Este estudo objetivou identificar o perfil sociodemográfico e clínico de crianças em pós-transplante de células-tronco hematopoiéticas imediato em cuidado ambulatorial. Pesquisa quantitativa, transversal e retrospectiva, realizada no Serviço de Transplante de Medula Óssea do Complexo Hospital de Clínicas da Universidade Federal do Paraná. Dentre os critérios de inclusão estão prontuários de crianças com idade entre 0 e 12 anos incompletos, transplantadas no período de 2009 a 2013. Os dados foram coletados por meio de instrumento estruturado, com início em janeiro e término em julho de 2015, e analisados por métodos estatísticos simples com auxílio do programa Software Statistical Package for the Social Sciences® 19.0. Para avaliação da associação entre variáveis categóricas foi aplicado o Teste do qui-quadrado, sendo considerados os valores de p<0,05 com significância estatística. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa do Setor de Ciências da Saúde da Universidade Federal do Paraná, parecer 742.621, 07 de agosto/2014. A amostra foi composta por 138 prontuários, dos quais 66,7% do sexo masculino, 58,5% com idade igual ou superior a seis anos, 51,4% estudantes, 68,1% brancos e 68,1% católicos. Houve prevalência das síndromes de falência medular (51%), dentre as quais a Anemia de Fanconi (30,4%). Todos os transplantes foram alogênicos, sendo 51,4% não aparentados. A medula óssea foi a fonte de células-tronco mais utilizada (80,4%), seguida do sangue de cordão umbilical (19,6%). Os transplantes com doadores aparentados incompatíveis somaram 12,3%. Dos transplantes, 69,6% foram compatíveis, prevaleceu o condicionamento de intensidade reduzida (50,7%) e a mucosite apresentou prevalência de 92,8%. Colonização por microrganismos multirresistentes esteve presente em 26,1%. As perdas do cateter de Hickman somaram 8% e o uso de sonda nasoenteral 11,6%. A alta hospitalar ocorreu, em 61,6%, entre 21 e 30 dias após o transplante. As reinternações somaram 34,8%, sendo a febre a principal causa (23,9%). Quanto às intercorrências clínicas, as mais prevalentes foram dor (60,9%), tosse (57,2%), coriza e febre (47,1% cada), vômito (46,4%), náusea (35,5%), diarreia (39,1%) e infecção viral (37%). Esta última esteve relacionada a sintomas como tosse, coriza e febre, bem como com a incompatibilidade do antígeno leucocitário humano (p<0,05). Houve associação entre transplantes com sangue de cordão umbilical e infecção viral; e transplantes não aparentados e infecções fúngicas e virais. A doença do enxerto contra hospedeiro representou 26,8%, sendo a pele o órgão mais acometido (11,6%). Um total de 68,1% de participantes necessitou de antibiótico e a causa mais comum foi a febre (43,5%). Quanto aos antivirais, 51,4% utilizaram e a principal causa foi o Citomegalovírus (45,7%). A rejeição do enxerto aconteceu em 13%. Dos participantes, 42,8% realizaram até 5 transfusões e a reação transfusional somou 8,6%. A alta ambulatorial aconteceu após os 100 dias do transplante em 56,5%. Almeja-se que estes dados possam corroborar o desenvolvimento de estratégias de cuidado, criação de protocolos e capacitação da equipe para atender a essa população de crianças, a partir das necessidades identificadas, bem como contribuir com o desenvolvimento da prática profissional em transplante de células-tronco hematopoiéticas.
Abstract: This study aimed to identify the sociodemographic and clinical profile of children in post-hematopoietic stem cells transplantation in outpatient care. This is a quantitative, transversal, and retrospective research, carried out at the Bone Marrow Transplant Service of the Clinics Hospital Complex of the Federal University of Paraná, Paraná State, Brazil. Records of children aged from 0 to incomplete 12 years old, transplanted from 2009 to 2013, were among the criteria of inclusion. Data were collected using a structured instrument, beginning in January and ending in July 2015, and were analyzed using Statistical Package for the Social Sciences® (SPSS) software, version 19. Chi-square test was applied to evaluate the association among categorical variables, and p<0.05 values were considered as statistical significance. This study was approved by the Research Ethics Committee of the Health Sciences Sector of the Federal University of Paraná, under Opinion n. 742,621 of 7 August 2014. One hundred thirty-eight medical records composed the sample; among them, 66.7% were male patients, 58.5% were equal or greater than six years old, 51.4% were students, 68.1% were white, and 68.1% were Roman Catholic. There was prevalence of bone marrow failure syndromes (51%), and the Fanconi anemia (30.4%) was among them. All of the transplants were allogeneic, and 51.4% were unrelated. The bone marrow was the most used source of stem cells (80.4%), followed by umbilical cord blood (19.6%). Transplants with mismatched related donors were 12.3%. Compatible transplants were 69.6%; reduced intensity conditioning (50.7%) was prevailed; and mucositis showed a prevalence of 92.8%. Colonization by multi-resistant microorganisms was present in 26.1% of the cases. Losses of the Hickman catheter were 8% and the use of nasogastric probe was 11.6%. The hospital discharge occurred in 61.6% in the period of 21 to 30 days after transplantation. Hospitalizations accounted for 34.8%, and the main cause was fever (23.9%). Regarding clinical complications, the most prevalent were pain (60.9%), cough (57.2%), runny nose and fever (47.1% each one), vomiting (46.4%), nausea (35.5%), diarrhea (39.1%), and viral infection (37%). Viral infection was related to symptoms such as coughing, runny nose and fever, as well as related to the incompatibility of the human leukocyte antigen (p<0.05). There was association among umbilical cord blood transplants and viral infection; and unrelated transplants were associated with fungal and viral infections. The graft-versus-host disease accounted for 26.8%, and the skin is the most affected organ (11.6%). A total of 68.1% of participants needed antibiotic and the most common cause was fever (43.5%). The main cause of viral infections was the Cytomegalovirus (45.7%), and antivirals were used in 51.4% of the cases. The graft rejection occurred in 13% of the transplants. A total of 42.8% of participants had up to five blood transfusions and 8.6% had transfusion reaction. The outpatient discharge of 56.5% took place after hundred days of transplant. It is expected that this data can confirm the development of care strategies, creation of protocols, and staff training to address this children population, considering the identified needs; it is expected also that it can contribute to the development of professional practice in hematopoietic stem cell transplantation.
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Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Patient Discharge , Child , Medical Records , Hematopoietic Stem Cell Transplantation , Nursing CareABSTRACT
We have retrospectively reviewed 137 medical records of patients older than 50 years receiving an allogeneic hematopoietic stem cell transplantation (HSCT) between January 1997 and July 2013. Median follow up was 1.3 years. Sex, age, diagnosis, disease stage, comorbidities (according to HCT-CI score), type of donor, histocompatibility, conditioning regimen and graft-versus-host disease (GVHD) prophylaxis were evaluated. The incidence and severity of acute and chronic GVHD, overall survival (OS), disease free survival (DFS), non-relapse mortality (NRM) and relapse were investigated according those variables. Acute GVHD incidence was 41% (7.3% GIII-IV). Patients with acute myeloid leukemia had lesser aGVH GII-IV (14% vs. 35%, p < 0.01) comparing to the entire population. Extensive cGVHD incidence was 9.4%. Global OS 1-3 years was 44-20%, DFS 33-20%, relapse 35-41% and NRM 36-43% respectively. The presence of comorbidities showed a significant increase in NRM (CT-CI 0 vs. 1 vs ≥ 2: 1-3 years 17-24% vs. 40-46% vs. 45-67%, p = 0.001, MA HR 2.03, CI 95% 1.02-5.29), as well as cyclosporine vs. tacrolimus (1-3 years 47-53% vs. 25-36%, p = 0.01). Tacrolimus patients had higher 1-3 years OS (49-25% vs. 31-13%, p = 0.01) and DFS (41-26% vs. 20-11%, p < 0.01). Age, type of donor and myeloablative conditioning showed no significant differences in any outcome. Allogeneic HSCT is a valid therapeutic option for older patients in Argentina. The main risk factor for a significantly increased NRM and a trend to inferior OS was the number of comorbidities. Age was not a factor for a worse result. The other factor having a significant effect in better outcome was tacrolimus administration.
Se efectuó un análisis retrospectivo de 137 historias clínicas de pacientes mayores de 50 años que recibieron un trasplante alogénico de precursores hematopoyéticos (TAPH). Se evaluaron las siguientes características: sexo, edad, enfermedad, estadio, comorbilidades (según el HCT-CI), donante, acondicionamiento e inmunosupresión. Se analizó la incidencia de enfermedad injerto vs. huésped aguda (aEICH) y crónica (cEICH), supervivencia global (SG), supervivencia libre de enfermedad (SLE), recaída y mortalidad libre de enfermedad (MLE). Los trasplantes fueron realizados entre 1997-2013, mediana de seguimiento 1.3 años. La incidencia de aEICH fue de 41% (7.3% GIII-IV). Los pacientes con leucemia mieloide aguda presentaron menor incidencia de EICHa GII-IV (14% vs. 34%, p < 0.01). La incidencia de EICHc extenso fue de 9.4%. La SG a 1-3 años fue 44-20%, SLE 33-20%, recaída 35-41% y la MLE 36-43%. Los pacientes con comorbilidades tuvieron un aumento significativo de la MLE (HCT-CI 0 vs. 1 vs. ≥2: 1-3 años 17-24% vs. 40-46% vs. 45-67%, p = 0.001, AMV HR 2.03, IC 95% 1.02-5.29), al igual que el uso de ciclosporina vs. tacrolimus (1-3 años 47-53% vs. 25-36%, p = 0.01). Los pacientes que recibieron tacrolimus tuvieron una mayor SG (1-3 años 49-25% vs. 31-13%, p = 0.01) y SLE (1-3 años 41-26% vs. 20-11%, p < 0.01). La edad, tipo de donante y acondicionamiento no resultaron significativos para ningún evento. El TAPH es una herramienta terapéutica válida en pacientes mayores. Los factores pronósticos que inciden mayormente en el trasplante son las comorbilidades y no la edad. El otro factor que demostró un efecto significativo fue el uso de tacrolimus.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Hematopoietic Stem Cell Transplantation/mortality , Graft vs Host Disease/mortality , Time Factors , Retrospective Studies , Risk Factors , Age Factors , Tacrolimus/therapeutic use , Cyclosporine/therapeutic use , Graft vs Host Disease/prevention & control , Immunosuppressive Agents/therapeutic useABSTRACT
RESUMO Objetivo Mensurar a carga de trabalho de enfermagem requerida por pacientes submetidos ao transplante de células-tronco hematopoiéticas (TCTH), autólogo e alogênico e analisar as atividades do Nursing Activities Score (NAS) executadas pela equipe de enfermagem durante a internação para o TCTH. Método Coorte prospectiva realizada de janeiro/2013 a abril/2014 com 62 pacientes internados na unidade de TCTH de um hospital universitário de Campinas/SP, Brasil. Mediu-se a carga de trabalho por meio do NAS e analisaram-se os dados utilizando os testes Qui-quadrado ou Exato de Fisher, Mann-Whitney e o coeficiente de correlação de Spearman; considerou-se nível de significância de 5%. Resultados A média da carga de trabalho de enfermagem foi de 67,3% (DP 8,2) em pacientes de TCTH autólogo e de 72,4% (DP 13,0) no TCTH alogênico (p=0,1380). O item Monitorização e controles apontou, em mais de 50% das observações, que os pacientes demandaram intensificação deste cuidado, exigindo duas horas ou mais em algum turno de trabalho por motivos de segurança, gravidade ou terapia. Conclusão A carga de trabalho de enfermagem e os itens do NAS mais pontuados refletem a magnitude, complexidade e especificidade dos cuidados demandados pelos pacientes submetidos ao TCTH.
RESUMEN Objetivo Medir la carga de trabajo de enfermería requerida por los pacientes sometidos al trasplante de células madre hematopoyéticas (TCTH), autólogo y alogénico, analizando actividades del Nursing Activities Score (NAS) emprendidas por equipo de enfermería en la internación para el TCTH. Método Cohorte prospectiva realizada entre enero/2013 y abril/2014 con 62 pacientes internados en la unidad de TCTH de hospital universitario en la ciudad de Campinas/SP (BR). En el análisis se utilizaron las pruebas Chi-cuadrado o test Exacto de Fisher, las no paramétricas Mann-Whitney o Kruskal-Wallis y el coeficiente de correlación de Spearman, conforme apropiado. Fijos los niveles de significación en 5%. Resultados La media de la carga de trabajo fue de 67,3% (DP 8,2) para los pacientes de TCTH autólogo y de 72,4% (DP 13,0) para los de TCTH alogénico (p=0,1380). El ítem Monitorización y controles apuntó que los pacientes, en más 50% de las observaciones, demandaban intensificación del cuidado por dos horas o más en algunos turnos de trabajo por cuestiones de seguridad, gravedad o terapia. Conclusión La carga de trabajo en enfermería y los ítems del NAS puntuados reflejan la magnitud, complejidad y especificidad de los cuidados demandados por los pacientes sometidos al TCTH.
ABSTRACT Objective Measure nursing workload required by patients submitted to autologous and allogeneic hematopoietic stem cell transplantation (HSCT) and analyze the Nursing Activities Score (NAS) of the nursing team during the hospitalization period for HSCT. Method A prospective cohort study conducted from January 2013 to April 2014 with 62 patients hospitalized in the HSCT unit of a university hospital in Campinas, São Paulo, Brazil. The workload was measured through NAS and data analysis was through chi-square test or Fisher’s exact test, Mann-Whitney test and Spearman’s correlation coefficient; with 5% significance level. Results Mean nursing workload was 67.3% (SD of 8.2) in autologous HSCT patients and 72.4% (SD of 13.0) in allogeneic HSCT patients (p=0.1380).Monitoring and titration showed, in more than 50% of the time, patients demanded intensified care, requiring two hours or more in a nursing shift for reasons of safety, severity or therapy. Conclusion The nursing workload and the NAS items with the highest scores reflect the magnitude, complexity and specificity of care required by patients submitted to HSCT.
Subject(s)
Humans , Costs and Cost Analysis , Drug Industry/economics , Immunologic Factors/economics , Immunosuppressive Agents/economics , Multiple Sclerosis/drug therapy , Multiple Sclerosis/economics , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Tumor Necrosis Factor-alpha/economicsABSTRACT
Background Stem cell transplantation represents a promising treatment option for patients suffering from degenerative disorders.Accumulating evidences indicate that mesenchymal stem cells (MSCs) are able to differentiate into retinal pigment epithelial (RPE)-like cells.However,MSCs are difficult to obtain.Human adipose mesenchymal stem cells (ADSCs) are proved to have similar properties to MSCs,but relevant study is less.Objective This study was to assess the feasibility of human ADSCs differentiating into RPE-like cells and the safety of its application in vivo.Methods The third generation of human ADSCs were incubated into 6-well plate,and 100 ng/ml epithelial growth factor,50 μ mol/L taurine and 5×10-7 mol/L retinoic acid were added into the medium 12 hours after cultured to induce the cells,and conventional cultured cells were used as the control group.Induced cells were traced with PKH26,and Pan-cytoke ratin (Pan-CK) monoclonal antibody was used to identify the cells under the fluorescence microscope.Induced RPE-like cell suspension of 1 μl was intravetreally injected in the right eyes of 6 BALB/c mice,and equal volume of PBS was used in the same way in another 6 mice.The animals were sacrificed 1 month after injection,and the retinal morphology was examined by histopathology under the optical microscope.The ultrastructure of retinal ganglion cells (RGCs) was examined by the transmission electron microscope.The use and care of the animals complied with Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission.Results Cultured human ADSCs grew well with the slender polygone shape.Cell membranes showed the red fluorescence for PKH26 after induced.In addition,Pan-CK was expressed in the cell membranes with the red fluorescence in the induced cells,but the response was absent in the control cells.One month after intravitreal injection,induced cells located on the retinal surface,and the retinal morphology was clear under the optical microscope.No abnormality in RGCs was seen under the transmission electron microscope.Conclusions Human ADSCs can differentiate into RPE-like cells after induction.PKH26 can mark induced cells well.There is no adverse effect of induced cells on retina after intravitreal injection in a short-term duration in mice.
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Objective To explore the effect of neural stem cells (NSCs) transplantation on neurogenesis in an alzheimer' disease mouse model and its related mechanism.Methods A total of 16 12-month old aPP/PS1 double transgenic aD mice were randomly divided into two groups:NSC group (receiving NSCs transplantation in the bilateral hippocampi,n=8) and PBS group as the negative control group (receiving an equal quantity of 0.01M/L phosphate buffer saline,n=8).another 8 wild type mice without any treatment were selected as the positive control group (Wt group).at five weeks after transplantation,the expressions of doublecortin (DCX) and nestin in the hippocampal dentate gyrus (DG) and subgranular zone (SGZ) were analyzed by immunofluorescence staining,the number of positive cells in these regions were counted by confocal microscopy,and Morris water maze (MWM) test was used to assess cognitive function in all mice.Results NSC group showed the enhanced spatial learning and memory ability in Morris water maze (MWM) as compared to PBS group,but it was still lower than that in Wt mice (both P＜0.05).Immunofluorescence staining showed NSCs induced the increased positive cells expressing DCX and nestin in the NSC group as compared with PBS group (F＝85.400 and 55.687,both P＜0.001).However,the number of DCX positive cells was still lower in NSC group than in Wt group (P＜0.05).There was no significant difference in the number of Nestin-positive cells between the NSC group and the Wt group (P＞ 0.05).Conclusions NSCs transplantation can promote endogenous neurogenesis via the increased expression of DCX-and Nestin positive cells in the hippocampal DG/SGZ in aD mice,which improves the cognitive abilities in aD mice in some extent.
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Objective To summarize the experience of nursing cancer patients with anal fistula treated with blood stem cells transplantation (BSCT). Method 8 critical cancer patients with anal fistula treated with BSCT from August 2013 to November 2014 were intervened by nursing measures such as prevention of constipation and diarrhea , protecting the anus from infection and health education . Results Two patients of them contracted with mild crissum infection , 1 moderate , 0 severe . With the pertinent nursing intervention , no serious complications occurred . The hospital stay was 20~30 d , with an average of ( 24 . 75 ± 2 . 30 ) . Conclusion The nursing measures including preventing constipation and diarrhea, keeping the anus from infection and health education can be effective in avoiding anal fistula infection and its related complications and reducing patients′pain , which are worth clinical promotion .
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BACKGROUND:The production and release of a large amount of inflammatory factors caused by immune system inflammatory response mainly contributes to secondary spinal cord injury. OBJECTIVE:To investigate the effects of umbilical cord Wharton’s jely mesenchymal stem cel transplantation on repair of injured neurological function and expression of inflammatory factors monocyte chemoattractant protein 1 and interleukin 10 in rats with acute spinal cord injury. METHODS: Eighty-one healthy adult male Sprague-Dawley rats were randomly and equaly divided into sham operation, model and cel transplantation groups, with 27 rats per group. Rats in the latter two groups were subjected to hemisection of the spinal cord to establish acute spinal cord injury models. Rat models in the cel transplantation group received umbilical cord Wharton’s jely mesenchymal stem cel injection (1×106)via the tail vein. Rat neurological function was evaluated using the BBB score at different time points after spinal cord injury. The expression of monocyte chemoattractant protein 1 and interleukin 10 in injured spinal cord tissue was detected using ELISA assay at different time points after spinal cord injury. Migration and neuronal differentiation of umbilical cord Wharton’s jely mesenchymal stem cels in the injured spinal cord tissue were determined using immunohistochemical staining method. RESULTS AND CONCLUSION:Compared with the sham operation and model groups, rat neurological function was significantly recovered in the cel transplantation group (P < 0.05). Compared to the model group, monocyte chemoattractant protein 1 level in the serum and monocyte chemoattractant protein 1 mRNA and protein expression in the injured spinal cord tissue were significantly lower (P < 0.05), but interleukin 10 mRNA and protein expression in the injured spinal cord tissue was significantly higher (P < 0.05), in the cel transplantation group. In the cel transplantation group, umbilical cord Wharton’s jely mesenchymal stem cels could migrate to the injured region and express glial fibrilary acidic protein. These findings suggest that umbilical cord Wharton’s jely mesenchymal stem cels promote rat neurological function recovery by regulating the inflammatory response in the injured spinal cord tissue, which is likely to be one of mechanisms by which transplantation of umbilical cord Wharton’s jely mesenchymal stem cels treats spinal cord injury.
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Stem cells have drawn extraordinary attention from scientists and the general public due to their potential to generate effective therapies for incurable diseases. At the same time, the production of embryonic stem cells involves a serious ethical issue concerning the destruction of human embryos. Although adult stem cells and induced pluripotential cells do not pose this ethical objection, there are other bioethical challenges common to all types of stem cells related particularly to the clinical use of stem cells. Their clinical use should be based on clinical trials, and in special situations, medical innovation, both of which have particular ethical dimensions. The media has raised unfounded expectations in patients and the public about the real clinical benefits of stem cells. At the same time, the number of unregulated clinics is increasing around the world, making direct offers through Internet of unproven stem cell therapies that attract desperate patients that have not found solutions in standard medicine. This is what is called stem cells tourism. This article reviews this situation, its consequences and the need for international cooperation to establish effective regulations to prevent the exploitation of patients and to endanger the prestige of legitimate stem cell research.
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Humans , Medical Tourism , Stem Cell Research , Stem Cells , Chile , Embryo Disposition , Embryo Disposition/legislation & jurisprudence , Medical Tourism/legislation & jurisprudence , Patient Education as Topic , Personal AutonomyABSTRACT
Objective We want to study the therapeutic efficiency of autologous ADMSC transplantation in myocardial infarction.And we try to find out a good way to improve the therapeutic efficiency by using the combination of gene therapy and cell therapy.Anti-apoptotic protein XIAP was selected to fight against the ischemic environment of myocardic infaction.Methods ADMSC was isolated from rat inguinal fat tissue.ADMSC was cultivated with DMEM.XIAP experession plasmid was elertco-transduced to ADMSC.The anti-apototic function of XIAP was tested by serum stavation induced apotosis.The method of ligation of the left anterior descending artery was used to prepare the Myocardial infarction model.Then rats were randomly separated into three groups to receive direct epicardial injections of normal saline,or ADMSCs cell suspension or XIAP modified ADMSCs cell suspension at five sites in central zones of myocardial infarction and border zone.Cardiac function and the infarct size were evaluated 4 weeks after ADMSCs transplantation.Results West blotting suggest that,XIAP over-expression block serum starvation induced apotosis.It showed that there are significant statistic difference among XIAP modified ADMSC transplantation group,ADMSC transplantation group and control group 4 weeks after myocardial infarction (P ＜ 0.05).Left ventricular ejection fraction(LVEF) showed a significant improvement in ADMSCs transplantation group compared to control group (P ＜0.05).Left ventricular end systolic diameter(LVDs) and left ventricular end diastolic diameter(LVDd) of ADMSCs group were smaller than control group(P ＜ 0.05).The area of myocardial infarction was significantly reduced in the ADMSCs transplantation group compared to the saline group(P ＜0.05).Compared to ADMSCs transplantation group,effect of the XIAP modified ADMSC in rats with myocardial infarction is more obvious.The reduction of LVEF of XIAP modified ADMSCs group was signific antly lower(9％) than the ADMSCs group(16％) (P ＜ 0.01).Infarction area in XIAP modified ADMSCs group(3.26 ±0.95)％ was smaller than ADMSCs group(5.17 ±2.03)％ (P ＜0.05).Conclusion Autologus ADMSC transplantation is an efficient therapeutic tool in myocardial infarction therapy.Over expression of XIAP can partly inhibit lowserum induced apotosis of ADMSC in vitro,and it can improve left ventricular function better in vivo.Over expression XIAP of ADMSC can improve the therapeutic efficiency compare to ADMSC transplantation.