ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
Vast applications and services have been enabled as the number of mobile or sensing devices with communication capabilities has grown. However, managing the devices, integrating networks or combining services across different networks has become a new problem since each network is not directly connected via back-end core networks or servers. The issue is and has been discussed especially in wireless sensor and actuator networks (WSAN). In such systems, sensors and actuators are tightly coupled, so when an independent WSAN needs to collaborate with other networks, it is difficult to adequately combine them into an integrated infrastructure. In this paper, we propose drone-as-a-gateway (DaaG), which uses drones as mobile gateways to interconnect isolated networks or combine independent services. Our system contains features that focus on the service being provided in the order of importance, different from an adaptive simple mobile sink system or delay-tolerant system. Our simulation results have shown that the proposed system is able to activate actuators in the order of importance of the service, which uses separate sensors' data, and it consumes almost the same time in comparison with other path-planning algorithms. Moreover, we have implemented DaaG and presented results in a field test to show that it can enable large-scale on-demand deployment of sensing and actuation infrastructure or the Internet of Things (IoT).
ABSTRACT
It has been demonstrated that inhibitors of advanced glycation end products (AGE), such as aminoguanidine, can suppress peritoneal AGE in rats on peritoneal dialysis (PD). However, it is unknown whether late administration of a putative crosslink breaker, alagebrium, could reverse peritoneal AGE. We therefore compared alagebrium with aminoguanidine in their ability to reverse peritoneal AGE in rats on PD. Male Sprague-Dawley rats were randomly divided into 3 groups: group I dialyzed with 4.25% glucose solution for all exchanges; group II dialyzed with 4.25% glucose solution containing aminoguanidine, and group III dialyzed with 4.25% glucose solution containing alagebrium for last 8 weeks of 12-week dialysis period. Dialysis exchanges were performed 2 times a day for 12 weeks. Immunohistochemistry was performed using a monoclonal anti-AGE antibody. One-hour PET was performed for comparison of transport characteristics. The immunolabelling of AGE in peritoneal membrane was markedly decreased in the alagebrium group. Consistent with this, the alagebrium group exhibited significantly higher D/Do glucose and lower D/P urea, suggesting low peritoneal membrane transport. But there were no significant differences between the control and the aminoguanidine group. These results suggest that the alagebrium may be the optimal therapeutic approach, compared with treatment with inhibitors of AGE formation, in rats on PD.
Subject(s)
Animals , Male , Rats , Biological Transport , Body Weight , Cell Membrane/metabolism , /metabolism , Guanidines/metabolism , Immunohistochemistry/methods , Peritoneal Dialysis/methods , Peritoneum/metabolism , Permeability , Rats, Sprague-DawleyABSTRACT
PURPOSE: Peritoneal dialysis related peritonitis remains one of the most common causes of hospitalization and discontinuation of peritoneal dialysis. Patient education and the individual environment play a significant role in improving the clinical outcomes. Therefore, this study focused on the preventive effects of practical training on the spot for peritoneal dialysis related peritonitis in continous ambulatory peritoneal dialysis (CAPD) patients. METHODS: Fifty-eight patients who were started on CAPD were as the primary intended treatment modality. The patients were given to a questionnaire regarding their gender, age, place of residence, level of education, economic status, sterile technique, knowledge of personal hygiene, placing a correct region for exchanging a fluid bag, and their duration of CAPD. During a home visit, the patients were instructed in how to sterilize the region of dialysis and maintain sterility in dialysis. RESULTS: Seventy four cases of peritonitis from 35 patients were identified over the 2 year's period. In the rural residences where there is a lower socio-economic status, the rates of peritonitis decreased in those patients who had received training on the spot within 6 months from the start of peritoneal dialysis compared with the patients after the 6 month period. Lower rates of peritonitis were noted in the patients who received training earlier (r=0.19, p=0.03). CONCLUSION: Ongoing and repetitive individualized education is needed to prevent peritoneal dialysis related peritonitis. The incidence of peritoneal dialysis related peritonitis can be reduced by educating these patients individually.
