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Background@#Allogeneic hematopoietic stem cell transplantation (alloSCT) is a potentially curative treatment option for acute leukemia. We aimed to identify the comorbidity factors affecting survival outcomes after alloSCT and develop a new comorbidity index tool for predicting overall survival (OS). @*Methods@#A Korean nationwide cohort of 3,809 adults with acute leukemia treated with alloSCT between January 2002 and December 2018 was analyzed as the development cohort.A retrospective cohort comprising 313 consecutive adults with acute leukemia who underwent alloSCT between January 2019 and April 2020 was analyzed as the validation cohort. @*Results@#In the development cohort, advanced age, male sex, and comorbidities such as previous non-hematologic malignancy, hypertension, and coronary or cerebral vascular disease were significantly related to poor OS. Subsequently, a new comorbidity scoring system was developed, and risk groups were created, which included the low-risk (score ≤0.17), intermediate-risk (0.17＜ score ≤0.4), high-risk (0.4＜ score ≤0.55), and very high-risk (score ＞0.55) groups. The 1-year OS rates were discriminatively estimated at 73.5%, 66.2%, 61.9%, and 50.9% in the low-risk, intermediate-risk, high-risk, and very high-risk groups in the development cohort, respectively (P ＜0.001). The developed scoring system yielded discriminatively different 1-year OS rates and 1-year incidence of non-relapse mortality according to the risk group (P =0.085 and P =0.018, respectively).Furthermore, the developed model showed an acceptable performance for predicting 1-year non-relapse mortality with an area under the curve of 0.715. @*Conclusion@#The newly developed predictive scoring system could be a simple and reliable tool helping clinicians to assess risk of alloSCT in adults with acute leukemia.
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Background@#Allogeneic hematopoietic stem cell transplantation (alloSCT) is a potentially curative treatment option for acute leukemia. We aimed to identify the comorbidity factors affecting survival outcomes after alloSCT and develop a new comorbidity index tool for predicting overall survival (OS). @*Methods@#A Korean nationwide cohort of 3,809 adults with acute leukemia treated with alloSCT between January 2002 and December 2018 was analyzed as the development cohort.A retrospective cohort comprising 313 consecutive adults with acute leukemia who underwent alloSCT between January 2019 and April 2020 was analyzed as the validation cohort. @*Results@#In the development cohort, advanced age, male sex, and comorbidities such as previous non-hematologic malignancy, hypertension, and coronary or cerebral vascular disease were significantly related to poor OS. Subsequently, a new comorbidity scoring system was developed, and risk groups were created, which included the low-risk (score ≤0.17), intermediate-risk (0.17＜ score ≤0.4), high-risk (0.4＜ score ≤0.55), and very high-risk (score ＞0.55) groups. The 1-year OS rates were discriminatively estimated at 73.5%, 66.2%, 61.9%, and 50.9% in the low-risk, intermediate-risk, high-risk, and very high-risk groups in the development cohort, respectively (P ＜0.001). The developed scoring system yielded discriminatively different 1-year OS rates and 1-year incidence of non-relapse mortality according to the risk group (P =0.085 and P =0.018, respectively).Furthermore, the developed model showed an acceptable performance for predicting 1-year non-relapse mortality with an area under the curve of 0.715. @*Conclusion@#The newly developed predictive scoring system could be a simple and reliable tool helping clinicians to assess risk of alloSCT in adults with acute leukemia.
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No abstract available.
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Humanos , Catéteres , Oxigenoterapia , Oxigênio , Microangiopatias TrombóticasRESUMO
No abstract available.
Assuntos
Humanos , Catéteres , Oxigenoterapia , Oxigênio , Microangiopatias TrombóticasRESUMO
Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.
Assuntos
Humanos , Angioplastia com Balão , Aspirina , Vasos Coronários , Dilatação , Dilatação Patológica , Cirrose Hepática , Fígado , Infarto do Miocárdio , Inibidores da Agregação Plaquetária , Prognóstico , Stents , TromboseRESUMO
Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.
Assuntos
Humanos , Angioplastia com Balão , Aspirina , Vasos Coronários , Dilatação , Dilatação Patológica , Cirrose Hepática , Fígado , Infarto do Miocárdio , Inibidores da Agregação Plaquetária , Prognóstico , Stents , TromboseRESUMO
This study was to develop a technique for creating gastroschisis by fetal surgery on a pregnant New Zealand white rabbit and to develop a technique for full-term delivery of a mature fetal rabbit after the repair of the abdominal wall incision in the fetal rabbit. The fetal surgery was done on the 24th or the 25th day of pregnancy and the experiment was divided into two parts: the creation of gastroschisis in the fetal rabbit and celiotomy-repair in the fetal rabbit. To creat gastroschisis, celiotomy and evisceration of the intes-tine in the fetal rabbit was made at both cornua on the 24th or the 25th day of pregnancy. After 6 days, a Caesarean section was done to deliver two gastroschisis fetal rabbits and two normal fetal rabbits. For the celiotomy-repair, celiotomy-evisceration and immediate repair of the fetal rabbit was made at both cornua on the 24th or the 25th day of pregnancy. After 6 days, a Caesarean section was done to deliver two experimental fetal rabbits and two normal fetal rabbits. Gastroschisis was successfully produced in 10 out of the 38 fetal rabbits operated on. Celiotomy-repair was done in 38 fetal rabbits. The abdominal wound was successfully repaired in 9 out of these 38 cases. Microscopically, inflammation or scarring was found neither at the gastroschisis wall margin nor at the repaired abdominal wound; however, fibroblast proliferation was found at the repaired abdominal wound. This result coincided with the general tissue finding of the fetal surgery. The conclusions are as follows: 1. By fetal surgery, experimental gastroschisis was created in fetal rabbits, and 2. The experimental abdominal wound was successfully repaired by surgery on the fetal rabbits.