Outcomes of adolescents with acute lymphoblastic leukaemia.

INTRODUCTION: Compared with young children who have acute lymphoblastic leukaemia (ALL), adolescents with ALL have unfavourable disease profiles and worse survival. However, limited data are available regarding the characteristics and outcomes of adolescents with ALL who underwent treatment in clinical trials. The aim of this study was to investigate the causes of treatment failure in adolescents with ALL. METHODS: We retrospectively analysed the outcomes of 711 children with ALL, aged 1-18 years, who were enrolled in five clinical trials of paediatric ALL treatment between 1993 and 2015. RESULTS: Among the 711 children with ALL, 530 were young children (1-9 years at diagnosis) and 181 were adolescents (including 136 younger adolescents [10-14 years] and 45 older adolescents [15-18 years]). Compared with young children who had ALL, adolescents with ALL were less likely to have favourable genetic features and more likely to demonstrate poor early response to treatment. The 10-year overall survival and event-free survival rates were significantly lower among adolescents than among young children (77.9% vs 87.6%, P=0.0003; 69.7% vs 76.5%, P=0.0117). There were no significant differences in the 10-year cumulative incidence of relapse, but the 10-year cumulative incidence of treatment-related death (TRD) was significantly greater among adolescents (7.2%) than among young children (2.3%; P=0.002). Multivariable analysis showed that both younger and older adolescents (vs young children) had worse survival and greater incidence of TRD. CONCLUSION: Adolescents with ALL had worse survival because they experienced a greater incidence of TRD. There is a need to investigate optimal treatment adjustments and novel targeted agents to achieve better survival rates (without excessive toxicity) among adolescents with ALL.

Evaluation of thermal comfort conditions in a classroom with three ventilation methods.

UNLABELLED: Thermal sensation is studied experimentally under mixing ventilation, displacement ventilation, and stratum ventilation in an environmental chamber. Forty-eight subjects participated in all tests under the same boundary conditions but different ventilation methods in the classroom. Thermal comfort analysis was carried out according to the designated supply airflow rate, room temperature, and relative humidity for the three ventilation methods. The thermal neutral temperature under stratum ventilation is approximately 2.5 °C higher than that under mixing ventilation and 2.0 °C higher than that under displacement ventilation. This result indicates that stratum ventilation could provide satisfactory thermal comfort level to rooms of temperature up to 27 °C. The energy saving attributable to less ventilation load alone is around 12% compared with mixing ventilation and 9% compared with displacement ventilation. PRACTICAL IMPLICATIONS: The confirmation of the significantly elevated thermal neutral temperature can have a number of implications for both thermal comfort in an air-conditioned room and energy consumption of the associate air-conditioning system. With respect to the former, it provides scientific basis for the feasibility of elevated room temperatures, and with respect to the latter, it reveals considerable potentials for energy saving.

Conversion of operating theatre from positive to negative pressure environment.

The severe acute respiratory syndrome (SARS) crisis led to the construction of a negative pressure operating theatre at a hospital in Hong Kong. It is currently used for treatment of suspected or confirmed airborne infection cases, and was built in anticipation of a return of SARS, an outbreak of avian influenza or other respiratory epidemics. This article describes the physical conversion of a standard positive pressure operating theatre into a negative pressure environment, problems encountered, airflow design, and evaluation of performance. Since entering regular service, routine measurements and observations have indicated that the airflow performance has been satisfactory. This has also been confirmed by regular air sampling checks. Computational fluid dynamics, a computer modelling technique, was used to compare the distribution of room air before and after the design changes from positive to negative pressure. The simulation results show that the physical environment and the dispersion pattern of bacteria in the negative pressure theatre were as good as, if not better than, those in the original positive pressure design.

Ventilation performance in the operating theatre against airborne infection: numerical study on an ultra-clean system.

A laminar airflow study was performed in a standard operating theatre in Hong Kong, the design of which followed the requirements of the UK Health Technical Memorandum. The study of the ultra-clean ventilation system investigated the effectiveness of the laminar flow in: (i) preventing bioaerosols released by the surgical staff from causing postoperative infection of the patient; and (ii) protecting the surgical team against infection by bacteria from the wound site. Seven cases of computer simulation are presented and the sensitivity of individual cases is discussed. Air velocity at the supply diffuser has been identified as one of the most important factors in governing the dispersion of airborne infectious particles. Higher velocity within the laminar regime is advantageous in minimizing the heat-dissipation effect, and to ensure an adequate washing effect against particulate settlement. Inappropriate positioning of the medical lamps can be detrimental. Omission of a partial wall may increase the infection risk of the surgical team due to the ingression of room air at the supply diffuser periphery. This paper stresses that a successful outcome in preventing airborne infection depends as much on resolving human factors as on overcoming technical obstacles.

Effects of freezing and drying grass products prior to fatty acid extraction on grass fatty acid and lipid class composition--a technical note.

Grass and grass silage represent a rich and natural source of omega-3 polyunsaturated fatty acids, in particular linolenic acid, for ruminants. Recent research, focusing on improving the content of these beneficial fatty acids in grass, requires storage of the forage samples prior to analysis. In this study, we evaluated whether conservation of fresh grass and grass silage by freezing (1 and 4 weeks,--18 degrees C) and/or drying (24h, 50 degrees C) affected its fatty acid content and induced shifts between lipid classes. FA were extracted using chloroform/methanol (2/1, v/v) and triacylglycerols (TAG), free fatty acids (FFA) and polar lipids (PL) were separated by thin layer chromatography. Fatty methyl esters (FAME) were identified by gas chromatography. Loss of thawing liquor might provoke a dramatic decrease in extractable lipid after frozen storage of both grass and grass silage. Morever, after frozen storage, fatty acids in grass but not in grass silage seem subjected to a higher rate o f lipolysis and oxidation, as suggested by increased quantities of FFA (3.1, 7.6, 8.4 % of total FAME) and reduced proportions of poly-unsaturated fatty acids (79.5, 73.6 and 74.1 % of total FAME) when analysing fresh grass samples directly or after 1 and 4 weeks of frozen storage, respectively. Drying of fresh grass did not provoke changes in FA composition, but distribution of FA over lipid classes was significantly altered, with an increase in TAG (5.1 to 17.9 % of total FAME) and FFA (2.4 to 14.9 % of total FAME) and lower proportions of PL (90.7 to 55.7 % of total FAME).

Ventilation performance in operating theatres against airborne infection: review of research activities and practical guidance.

Surgical site infection risk due to airborne bacteria is a key area of consideration in developing operating theatre ventilation design and monitoring procedures. This paper reviews the recent extensive research into operating theatre ventilation development in relation to the design concepts in operating theatre layout, pressurization and ventilation, particularly the evolvement of ultra-clean ventilation. The findings that led to the current technical standards and the developments of microbial measurements and numerical techniques are discussed. Since the late 1980s, computational fluid dynamics has been a fast developing tool used in the prediction of room air distribution and contaminant dispersion. The basic principles and current practice applying to operating theatre ventilation studies are introduced.

Diagnostic ultrasound in the management of patients using intrauterine contraceptive devices.

A group of 80 patients was scanned by ultrasound within 24 hours of insertion of an intrauterine contraceptive device (IUCD) and re-examined clinically and/or by ultrasound after the next menstrual period. An attempt was made to identify factors such as uterine size, uterine flexion and the position of the IUCD which might be related to its expulsion or removal when, on initial scanning, the device was not located in the fundal area; removal was necessary in 5 out of 6 patients. In patients with an endometrial cavity of less than 40 mm length and/or acute uterine flexion, the overall figure for expulsion and removal was 54 per cent (13 out of 24). It is hoped that a consideration of these factors will lead to a reduction of the failure rate of the IUCD.