Impact of Body Mass Index on Outcomes of Hematopoietic Stem Cell Transplantation in Adults.

This retrospective analysis of 2503 adult (age ≥20 years) allogeneic hematopoietic cell transplantation (HCT) recipients assessed the effect of body mass index (BMI) on transplantation outcomes. The median patient age was 51.7years. Patients with both nonmalignant and malignant diagnoses were included. Patients received either a myeloablative (52%) or a reduced-intensity (48%) conditioning regimen. Donors were either related (42%) or unrelated (58%). Cord blood recipients were excluded. Granulocyte colony-stimulating factor-mobilized peripheral blood cells were the stem cell source in 86% of transplantations. Graft-versus-host disease prophylaxis included at least 2 immunosuppressive agents, 1 of which was a calcineurin inhibitor. Patient groups were categorized as underweight, normal weight, overweight, obese, or very obese based on BMI. Endpoints included day +100 mortality, overall mortality, nonrelapse mortality (NRM), and relapse. Changes in nutritional status, based on laboratory parameters, were also examined. Underweight patients had significantly lower early and overall survival and greater NRM. Very obese patients had increased NRM, which was associated with the intensity of conditioning regimen. With long-term follow-up, increasing NRM was associated with both underweight and obese patients compared with normal-weight individuals. Changes in serum protein and albumin levels did not correlate with BMI. Although enteral nutrition is now recommended for some undernourished patients, the efficacy of enteral or parenteral nutrition has not been well studied. For obese patients, there are no guidelines regarding weight loss before transplantation, and acute weight loss in the pretransplantation period may be detrimental.

Nonvital tooth bleaching: a review of the literature and clinical procedures.

Tooth discoloration varies in etiology, appearance, localization, severity, and adhesion to tooth structure. It can be defined as being extrinsic or intrinsic on the basis of localization and etiology. In this review of the literature, various causes of tooth discoloration, different bleaching materials, and their applications to endodontically treated teeth have been described. In the walking bleach technique the root filling should be completed first, and a cervical seal must be established. The bleaching agent should be changed every 3-7 days. The thermocatalytic technique involves placement of a bleaching agent in the pulp chamber followed by heat application. At the end of each visit the bleaching agent is left in the tooth so that it can function as a walking bleach until the next visit. External bleaching of endodontically treated teeth with an in-office technique requires a high concentration gel. It might be a supplement to the walking bleach technique, if the results are not satisfactory after 3-4 visits. These treatments require a bonded temporary filling or a bonded resin composite to seal the access cavity. There is a deficiency of evidence-based science in the literature that addresses the prognosis of bleached nonvital teeth. Therefore, it is important to always be aware of the possible complications and risks that are associated with the different bleaching techniques.

Fracture resistance of endodontically treated molars restored with extensive composite resin restorations.

STATEMENT OF PROBLEM: When cuspal coverage is required, there is no evidence that indirect composite resin restorations are superior to direct restorations in terms of biomechanical behavior. PURPOSE: The purpose of this in vitro study was to compare the fracture resistance of cusp-replacing direct and indirect composite resin restorations in endodontically treated molars. MATERIAL AND METHODS: Forty-five human mandibular molars were selected and divided into 3 groups (n=15): DIR specimens, restored with direct composite resin (Estelite Sigma) restorations; IND specimens, restored with indirect composite resin (Estelite Sigma) restorations, and control specimens, which remained intact. Endodontic treatment was performed using NiTi ProTaper rotary instruments, and teeth were filled using lateral condensation of gutta-percha and sealer. Extensive Class II MO cavities were prepared, and the 2 mesial cusps were reduced, allowing a 2-mm layer of composite resin. All teeth were prepared to the same dimensions, considering reasonable human variation. Specimens were loaded to failure and the fracture loads were recorded (N). The mode of fracture was determined using a stereomicroscope and classified as favorable or unfavorable failure. The data were subjected to a Kruskal-Wallis test, multiple-comparison Mann-Whitney test, and a chi-square test (alpha=.05). RESULTS: Significant differences (P<.001) were observed between the control group and both DIR and IND groups. However, no significant difference was found between the DIR and IND groups. The chi-square test did not show a significant difference in the frequencies of favorable/unfavorable failure modes among the 3 groups (P=.981). CONCLUSIONS: No significant difference was observed in the fracture resistance of endodontically treated molars restored to original contours with an extensive cusp-replacing direct or indirect composite resin restoration.

A two-center evaluation of the blood gas immediate response mobile analyzer (IRMA).

The Immediate Response Mobile Analyzer (IRMA) is a selective and portable point-of-care testing (POCT) blood gas, electrolyte and hematocrit (Hct) analyzer. The overall analytical performance was evaluated in a two-center study involving two Italian hospital laboratories, following the guidelines suggested by the manufacturer (based on the NCCLS protocol), after a preliminary evaluation of their formal validity. The IRMA was compared to the analyzers used in the routine laboratory as reference. The considered parameters were pH, pO2, pCO2, Na+, K+, ionized calcium and Hct. When using the aqueous quality control material provided by the manufacturer most of the parameters showed good precision, with the exception of pCO2 and pO2 that showed high CVs on two of the three levels of the aqueous control. We could demonstrate that this imprecision was material-related and was reduced when using a different material (blood equilibrated by tonometry). With tonometred blood for pO2 and pCO2 and the aqueous material for the remaining parameters the CVs were all below 5%, ranging from 0.08% to 2.8%. The IRMA results correlated adequately with the comparison instruments, with the exception of sodium and ionized calcium where contradictory results were obtained in the two centers.