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PubMedDate not supplied

Retrospective comparison of nebulized levalbuterol and albuterol for adverse events in patients with acute airflow obstruction.

The objective of this study was to retrospectively compare the mean change in heart rate (HR) of patients with acute airflow obstruction treated with nebulized levalbuterol vs. albuterol. The study was conducted at the Akron General Medical Center, a 537-bed adult tertiary care teaching and research medical center. The participants were patients (> or = 18 years old) presenting to the emergency department with acute airflow obstruction. This was a retrospective chart review. Treatment groups received either levalbuterol (0.63 mg) or albuterol (2.5 mg). Respiratory care notes record HRs before and after nebulization of levalbuterol or albuterol. Primary analysis was conducted on days 1 and 3 of therapy to determine whether there is a difference between levalbuterol and albuterol with regard to mean change in HR with each treatment. In the primary analysis data, 35 subjects in each treatment group were compared. The mean age (+/- SD) was 65 +/- 16.4 and 68 +/- 16.5 for levalbuterol and albuterol, respectively. On day 1 of therapy, the difference in the mean change in HR with albuterol compared with levalbuterol was 1.0 bpm (95% CI, -1.6 to 3.7). On day 3, a statistically significant difference occurred in mean change in HR between treatment groups at 2.7 bpm (95% CI, 0.02 to 5.4). An increase in HR of 2.7 bpm by albuterol compared with levalbuterol on day 3 of therapy was the only significant finding among the analyses. However, this finding did not demonstrate dangerous elevations in HR following treatment with albuterol. Even the upper end of the confidence interval range at 5.4 bpm does not support a clinically significant difference in tachycardia with the pure isomer compared with the racemic mixture during acute airway obstruction.

Administration, Inhalation↗
PubMed2001

Comparison of vaccine coverage levels from the National Immunization Survey and the Texas Retrospective Immunization Survey.

The purpose of this study was to compare National Immunization Survey (NIS) vaccine coverage rates with Texas Retrospective Immunization Survey (TRIS) vaccine coverage levels. Up-to-date rates for children 19 through 35 months of age as of October 1, 1994, were calculated for single vaccines and two vaccine combinations. The TRIS weighted statewide up-to-date rates for 4-3-1 and 4-3-1-3 were 66 percent and 60 percent, respectively, versus 71 percent and 68 percent for the NIS. Existing retrospective survey procedures can be modified to produce results that may be compared with the NIS.

Child, Preschool↗
PubMedDate not supplied

Electrotherapy reverses inframalleolar ischemia: a retrospective, observational study.

OBJECTIVE: To determine if high-voltage pulsed current (HVPC) augments ischemic wound healing and increases periwound perfusion. DESIGN: A 5-year, retrospective, observational study was conducted on successive patients with ischemic wounds who were poor candidates for revascularization. INTERVENTION: HVPC was applied directly to wounds at greater than 100 volts, 100 pulses per second, 1 hour per day. In addition to HVPC, patients received standard care for ischemic wounds at the study facility. Ischemic wounds for which HVPC was not clinically indicated or not available received standard care alone. MAIN OUTCOME MEASURES: Wound area measured by planimetry, wound appearance observed by digital imaging techniques, and microcirculation monitored by transcutaneous oxygen (TcPo(2)) levels. RESULTS: The group that received HVPC plus standard care showed smaller wound areas from weeks 20 though 52 after the start of treatment compared with the group that received standard care alone (P <.05; Mann-Whitney test). One year after the start of treatment, 90% of HVPC-treated wounds were healed, compared with 29% of the wounds that received only standard care (P <.05; Fisher exact test). For the HVPC group, maximum periwound TcPo(2) improved during electrotherapy (6 +/- 8 mm Hg [standard deviation; SD] at baseline improved to 26 +/- 20 SD, during HVPC, P <.05; Wilcoxon signed rank test). CONCLUSION: The results of this retrospective trial demonstrate that HVPC plus standard care improved the healing rate of high-risk ischemic wounds. A direct relationship was shown between improved healing rates and increased periwound perfusion. A prospective randomized controlled trial is needed to further support these observational, preliminary findings.

Adult↗
PubMed2003

A middle ear implant, the Symphonix Vibrant Soundbridge: retrospective study of the first 125 patients implanted in France.

OBJECTIVE: The Vibrant Soundbridge is an active semi-implantable middle ear implant for the rehabilitation of patients with a sensorineural hearing loss who are not able to derive adequate benefit from conventional hearing aids. A retrospective study was performed to assess the overall level of satisfaction of implanted patients and to investigate the potential determinants of postoperative success. STUDY DESIGN: A retrospective survey of audiological data from repeated measures and subjective data from self-assessment scales administered postoperatively was conducted to determine the degree of benefit and satisfaction for Vibrant Soundbridge implantees. SETTING: Twenty-one tertiary referral and teaching hospitals. SUBJECTS: The first 125 VSB implantees implanted in France between August 1997 and May 2001 were included in the study. RESULTS: No clinically significant change was observed for residual hearing postoperatively. Most patients (83%) reported they were either satisfied or very satisfied with the Vibrant Soundbridge. Analysis of correlation revealed a moderate correlation (Pearson coefficient r = 0.59) between the degree of benefit reported via the patient survey and the degree of benefit reported via the Glasgow Benefit Inventory. A moderate correlation (Pearson coefficient r = 0.66) was observed between speech comprehension scores in quiet for the preoperative unaided condition and the postoperative aided Vibrant Soundbridge condition. No correlation was observed between subjective reports of satisfaction postoperatively and performance on preoperative objective tests or patient characteristics. CONCLUSION: The results indicate a high level of satisfaction with the VSB as a treatment of sensorineural hearing impairment in patients with a wide range of characteristics. Preoperative scores for unaided speech comprehension tests in quiet may be a potential indicator of success on aided Vibrant Soundbridge speech comprehension tests postoperatively but do not reflect patient satisfaction with the device reported on self-assessment scales.

Adult↗
PubMedDate not supplied

A retrospective chart review of risk factors for extravasation among neonates receiving peripheral intravascular fluids.

PURPOSE: To identify variables associated with extravasation and resulting tissue damage in neonates with peripheral intravascular therapy. DESIGN: A retrospective chart review was completed. SETTING AND SUBJECTS: Randomly selected medical records of 25 neonates admitted to a neonatal intensive care unit from January 2003 through April 2004 and who experienced peripheral intravascular infiltration were examined. INSTRUMENTS: The Neonatal Tissue Extravasation Tool was created to reflect common descriptive variables of the neonatal population and infused solutions used in their care. Tissue damage was classified with the scale from the Task Force of Pediatric Nursing Research Committee, 1994. RESULTS: Charts of 15 female and 10 male infants 24 to 39.6 weeks old were reviewed. Extravasation was not significantly related to age, weight, or sex. The most common intravenous medications were total parenteral nutrition (n = 19) and calcium (n = 18). Peripheral intravenous sites were secured with tape. The sites of the infiltrate were the arm (n = 16), foot/leg (n = 5), and scalp (n = 3) (one not recorded). Stages 0 (absence of redness, pain, swelling; flushes with ease) (n = 11) and 4 (severe swelling; blanching, pain, skin breakdown, etc.) (n = 6) were the most common stages. The site of the infiltrate was measured and care described in only 9 neonates. CONCLUSIONS: The intravascular solutions causing the most extensive damage from extravasation were similar to those reported in other studies. No other potential risk factors were identified, but poor documentation about the extravasation site and management of skin damage hampered data collection via retrospective chart review.

Extravasation of Diagnostic and Therapeutic Materi↗
PubMed2006

Natural history and chemotherapy effectiveness for advanced adenocarcinoma of the small bowel: a retrospective review of 113 cases.

BACKGROUND: Small bowel adenocarcinoma is a rare cancer that has generally been considered resistant to chemotherapy, although little has been published on the role of chemotherapy. A retrospective analysis was conducted of patients with advanced small bowel adenocarcinoma to explore chemotherapy use, and gain knowledge for ongoing management and future clinical trials. PATIENTS AND METHODS: All patients with advanced adenocarcinoma of the small bowel treated at Princess Margaret Hospital (PMH) between 1986 and 2004 were identified through the cancer registry. The medical records were reviewed for patient characteristics, treatment and outcome data. Survival statistics were estimated using the Kaplan Meier survival curves and Cox proportional regression model. RESULTS: Data on 113 patients was reviewed. Forty-four patients received palliative chemotherapy with an overall response rate (ORR) of 36% during a first or second line regimen (9% complete responses and 27% partial responses). Newer chemotherapy regimens including gemcitabine and irinotecan combinations appeared to have higher ORR, than older fluorouracil-based regimens. Some patients responded to more than one line of chemotherapy. Palliative chemotherapy predicted for overall survival (OS) in a multivariate analysis (HR 0.47, P = 0.035). CONCLUSION: Chemotherapy appears to have activity in adenocarcinoma of the small bowel. Prospective trials evaluating patient benefit are required to confirm this activity using newer systemic therapies, until such time retrospective reviews such as this will continue to guide treatment decisions.

Adenocarcinoma↗
PubMed2004

A retrospective radiographic review of hemophilic shoulder arthropathy.

Bleeding into large joints is the most common orthopaedic manifestation of hemophilia. Involvement of the shoulder rarely is reported, lending to its relative neglect in the orthopaedic literature. Through retrospective chart and radiographic reviews, the incidence and progression of radiographic and clinical changes that occur in the shoulder of patients with hemophilia is described. We retrospectively reviewed 822 patient charts and found 93 patients with symptomatic shoulders. Seventy-nine of these 93 patients were rated according to Pettersson's scoring method. The clinical charts were reviewed for the presence of shoulder symptoms and dysfunction. A spectrum of radiographic changes was seen beginning with mild subchondral irregularity and greater tuberosity cyst formation progressing to joint space narrowing, osteophyte formation, marginal erosion, and deformity. Of the 54 patients for whom an adequate shoulder history was available, the severity of symptoms correlated with the Pettersson score. The current study is the largest to date examining the type and progression of radiographic changes caused by hemophilic shoulder arthropathy. We observed a consistent pattern of radiographic changes, the severity of which correlated directly with shoulder symptoms.

Adolescent↗
PubMed2003

Orthopaedic implications in the management of pediatric vertebral and spinal cord tumors: a retrospective review.

STUDY DESIGN: Retrospective review of pediatric patients with vertebral and spinal cord tumors. OBJECTIVES: To identify clinical and radiographic features of diagnostic importance, and to evaluate the effectiveness of surgical treatment with respect to complications in pediatric patients with vertebral and spinal cord tumors. SUMMARY OF BACKGROUND: Vertebral and spinal cord tumors in children are uncommon and present a significant challenge in diagnosis, treatment, and management of complications. Because most signs and symptoms of these tumors are musculoskeletal in nature, it is imperative for orthopedic surgeons to be familiar with them. MATERIALS AND METHODS: Medical charts and radiographic records of 26 pediatric patients with documented vertebral and spinal cord tumors were reviewed retrospectively. RESULTS: There were 10 malignant and 16 benign tumors. Mean age at diagnosis was 10 years, and the male-to-female ratio was 1:1. Mean clinical follow-up was 25.8 months. The average delay in diagnosis was 10.9 months. The two most common reasons for presentation were pain (n = 20, 76%) and neurologic involvement (n = 14, 54%). Initial plain radiographs were positive in 72% of patients, whereas MRI showed the tumor in 96% of studies. Sixteen patients underwent spinal fusion after excision of the tumor. There were no perioperative deaths. Complications were common, with an average of 1.1 complications per patient. At latest follow-up, six patients had neurologic deficits, two patients had died, and one patient was terminally ill. CONCLUSION: Increased awareness of modes of presentation, use of modern imaging techniques, and an aggressive approach to spinal stabilization at the time of laminectomy should decrease morbidity in patients with vertebral and spinal cord tumors.

Adolescent↗
PubMed2006

The radiographic results and neurologic complications of instrumented reduction and fusion of high-grade spondylolisthesis without decompression of the neural elements: a retrospective review of 44 patients.

STUDY DESIGN: A retrospective review of all cases of high-grade spondylolisthesis treated by 1 surgeon between the years 1991 and 2003. OBJECTIVE: To report the radiographic results and neurologic complications following instrumented posterior reduction and fusion without decompression of the neural elements. SUMMARY OF BACKGROUND DATA: Despite a large number of published reviews of the clinical results of operative intervention, controversy remains about the surgical treatment of high-grade spondylolisthesis. METHODS: A retrospective review of the clinical charts and radiographs of all patients with L5-S1 spondylolisthesis and more than 50% anterior displacement of L5 on S1 who were treated by the same surgical team at 1 institution. RESULTS: With this technique, an average reduction in the displacement of L5 on S1 from 64% to 38% was achieved. At a minimum 2-year follow-up (41 patients), we have detected 5 cases with evidence of pseudarthrosis or loss of reduction (11.4%). Overall, a neurologic complication rate of 9.1% occurred in this series, with a 2.3% chance of a persistent motor deficit. We did not detect any loss of bowel or bladder function after surgery. At last follow-up, and after revision procedures, we were able to achieve good or fair clinical results in 40 (90.9%) of 44 patients. CONCLUSIONS: These data suggest that a posterior instrumented reduction and fusion of high-grade spondylolisthesis without decompression of the neural elements can be accomplished with acceptable radiographic and clinical results.

Adolescent↗
PubMed2005

A retrospective cohort study of prognostic factors associated with outcome in pediatric severe sepsis: what is the role of steroids?

OBJECTIVE: Systemic corticosteroids remain controversial in the treatment of pediatric patients with severe sepsis. Recent studies in septic adults have shown decreased mortality with the use of hydrocortisone in patients with relative adrenal insufficiency. We conducted this large retrospective cohort study to further characterize severe sepsis in infants and children and correlates of outcome, including the use of steroids. DESIGN: Retrospective cohort study. SETTING: The Pediatric Health Information System (PHIS), an administrative database of the Child Health Corporation of America (CHCA), was queried for inpatients 0-17 yrs of age with severe sepsis (defined here as an International Classification of Disease 9th edition code for infection with use of simultaneous mechanical ventilation and vasoactive infusions) from 2001 to 2002. In addition to demographic information, use of systemic corticosteroids (hydrocortisone, methylprednisolone, or dexamethasone) concurrent with the ventilatory and vasoactive support was collected. SUBJECTS: Data from PHIS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients (n = 6693) were identified at 27 PHIS-participating CHCA member hospitals. Overall mortality was 24%; univariate predictors of death included use of steroids (odds ratio [OR], 1.9; 95% confidence interval (CI), 1.7, 2.2), older age (e.g., 13-17 yrs vs. neonates; OR, 1.6; 95% CI, 1.3, 2.0), a hematologic-oncologic diagnosis (OR, 5.87; 95% CI, 4.19, 8.23), and moderate vs. high case volume (OR, 1.25; 95% CI, 1.09, 1.44). Age, hematologic-oncologic diagnosis, case volume, and use of steroids remained independent predictors of mortality in multivariable analysis. CONCLUSIONS: From this administrative database analysis, there is no evidence that steroids are associated with improved outcome in critically ill infants and children with sepsis. Although steroids may be given preferentially to more severely ill children, their use was associated with increased mortality. Clinicians should maintain equipoise on this topic pending prospective randomized clinical trials.

Adolescent↗
PubMed2002

Long-term results of MISTI gold breast implants: a retrospective study.

MISTI Gold breast implants (Bioplasty, St. Paul, Minn.) filled with polyvinylpyrrolidone-hydrogel were developed as a promising alternative to silicone-filled implants. Some studies have reported on the positive effects of the implant, such as improved radiolucency and biocompatibility of the gel; however, there are also reports that such implants increased in volume and were subject to capsular contracture in the human body, resulting in demands for their removal. The purpose of this retrospective study was to analyze the long-term results of a series of patients with MISTI Gold breast implants. Between 1991 and 1993, the authors inserted 83 MISTI Gold implants in 61 patients with an average age of 46 years (range, 16 to 69). The authors were able to follow up 48 patients with 71 MISTI Gold implants. The average follow-up was 68 months (range, 10 to 108 months). The retrospective study found that 59 percent of all MISTI Gold implants were removed after an average period of 4.14 years. The main reason for implant removal was an increase in volume of 38 percent, followed by capsular contracture in 14 percent of all 71 MISTI Gold implants. The average increase in volume of all removed MISTI Gold implants was 43 percent. Capsular contracture was graded as Baker I and II in 63 percent and as Baker III and IV in 37 percent. In conclusion, the authors believe that MISTI Gold implants do not fulfill the criteria of safe breast implants, and they agree with the December of 2000 opinion of the Medical Devices Agency of the Department of Health in London that the hydrogel-filled breast implants should not be used until more information about the filler material and its metabolic fate is available.

Adolescent↗
PubMed2004

Retrospective assessment of risk factors to predict tunneled hemodialysis catheter outcome.

PURPOSE: To identify factors that may influence the function, outcome, and complications associated with tunneled hemodialysis catheters. MATERIALS AND METHODS: Radiology reports and hemodialysis, medical, and Clinical Information System (computerized patient medical record system) records were retrospectively reviewed in 221 consecutive patients who underwent tunneled hemodialysis catheter placement by interventional radiologists between January 11, 1996 and January 13, 2000 at Dartmouth-Hitchcock Medical Center. Various patient characteristics (diabetes, smoking, hypertension, age, sex, atherosclerotic cardiovascular disease, history of cardiac catheterization, coumadin use, functional status, and obesity) were assessed for their relationship to the outcome of hemodialysis catheters. Catheter outcome was examined by calculating infection rate, thrombosis rate, fibrin formation rate, mechanical malfunction rate, and total complication rate. With these patient characteristics and outcome variables, multiple regression analysis was performed with STATA (College Station, TX) statistical analysis software. RESULTS: Of the 221 patients reviewed, 39 patients were lost to follow-up. Among the remaining 182 patients, 427 catheters were placed for a total number of 36994 catheter-days. For overall complication rate, multiple regression analysis revealed a statistically significant positive correlation only for hypertension (P =.032). Total complication rate was 0.76 events per 100 catheter-days (95% CI: 0.53-1.00) for patients with a documented history of hypertension and 0.27 events per 100 catheter-days (95% CI: 0.08-0.45) for patients without (P =.024, paired student t test). For patients with diabetes versus patients without, the infection rates were 0.34 episodes per 100 catheter-days (95% CI: 0.15-0.53) and 0.12 episodes per 100 catheter-days (95% CI: 0.06-0.18), respectively, (P =.011, paired student t test). Thrombosis rate for patients on coumadin was 0.13 events per 100 catheter-days (95% CI: -0.14-0.40), while thrombosis rate for patients not taking coumadin was 0.03 events per 100 catheter-days (95% CI: 0-0.05) (P =.036, paired student t test). CONCLUSION: Hypertension is a risk factor for poor outcome of tunneled hemodialysis catheters as measured by total complication rate requiring catheter removal or exchange. In this retrospective study, no other specific risk factors predicted an increased need for removal or exchange of tunneled hemodialysis catheters.

Adolescent↗
PubMed2005

Immunosuppression with cyclosporine A and mycophenolate mofetil after penetrating high-risk keratoplasty: a retrospective study.

BACKGROUND: Graft-prognosis after penetrating high-risk keratoplasty has improved considerably with the use of systemic immunosuppressive medications. In this retrospective investigation we analyzed the long-term results of 417 high-risk keratoplasties with systemic immunosuppression (cyclosporine A [CsA] or mycophenolate mofetil [MMF]). METHODS: A total of 417 high-risk keratoplasties with postoperative systemic immunosuppression were evaluated retrospectively: CsA has been given in 252 keratoplasties since 1987, aiming at blood trough levels of 120 to 150 ng/mL. Systemic MMF at a daily dose of 2 x 1 g was administered in 149 surgical procedures. After 16 high-risk keratoplasties, combined systemic immunosuppression with CsA and MMF was administered. Systemic immunosuppression was scheduled for 6 to 12 months. All patients received fluocortolone 1 mg/kg body weight per day, tapered over 3 weeks, and topical prednisolone acetate 1%, tapered over 5 months. RESULTS: Rejection-free graft survival after 1 year was 75% in the CsA group and 89% in the MMF group; 60% of the grafts in the CsA group and 72% of the grafts in the MMF group were rejection-free 3 years postoperatively (Kaplan-Meier log-rank test P=0.03). Clear graft survival after 1 and 3 years was 92% and 77% (CsA) and 96% and 87% (MMF), respectively. The MMF-treated patients showed fewer side effects than the CsA-treated patients. The side effects attributable to both drugs were reversible. CONCLUSIONS: We found a statistically significant, stronger effect of MMF compared with CsA in preventing immune reactions after high-risk keratoplasty, despite a shorter MMF administration compared with CsA. Both systemic immunosuppressants were shown to have comparable potency regarding clear graft survival and were well tolerated.

Cyclosporine↗
PubMed2006

Kidney transplantation from anti-HBc+ donors: results from a retrospective Italian study.

BACKGROUND: The risk of transmitting a hepatitis B virus (HBV) infection from donor kidneys with a past HBV serological profile may be negligible. Data on HBV transmission to kidney transplant recipients from donor organs that were anti-HBc/HBsAg in Italy has not been previously reported. Anti-HBc testing in cadaver organ donors has been mandatory in Italy since 2002, when anti-HBc determinations were included in the National Guidelines for donor evaluation. Therefore, prior to that date kidney recipients from anti-HBc/HBsAg donors can be identified retrospectively where stored serum is available for testing. METHODS: The prevalence of anti-HBc Italian organ donors, the incidence of HBV transmission according to the recipients' HBV status (vaccinated, recovered, or naive), and the clinical impact (5-year graft and patient survival rates) in the North Italy Transplant program was evaluated by retrospectively screening for anti-HBc antibodies in the sera of cadaver kidney donors used in transplants from 1997 to 1999. RESULTS: Two hundred and ten donors were found to have been anti-HBc. At the time of the study, no active infection was observed in any of the 344 HBsAg recipients, but 4/140 (2.86%) of the vaccinated recipients were found to have been anti-HBc/HBsAg. None of these patients, however, had any biochemical or clinical history of HBV infection. Patient and graft survival rates of anti-HBc or anti-HBc kidney recipients did not differ statistically. CONCLUSION: Kidney grafts from anti-HBc donors should be considered in all recipients because the benefit obtained from the transplantation out weighs the negligible risk of HBV transmission.

Adolescent↗
PubMed1984

Congenital coxa vara. A retrospective review.

Forty-two cases of coxa vara were retrospectively reviewed. All 42 cases were classified based on their history and roentgenographic appearance. Twenty-two cases of true congenital coxa vara were identified and are the primary focus of this review. In this study we have introduced the Hilgenreiner epiphyseal (HE) angle as measured on standard AP roentgenograms of the hip. Retrospectively, this angle was measured to aid in deciding candidacy for surgery, as well as a means of determining the amount of surgical correction necessary to prevent a recurrence of the deformity. The indication for surgery should be an HE angle of greater than 60 degrees. HE angles of less than 60 degrees and greater than 45 degrees represent a "gray zone" and should be observed. HE angles of less than 45 degrees will generally correct spontaneously without surgery.

Adolescent↗
PubMed2025

Recipient-derived vs. donor-derived CAR-T-cell therapy in relapsed B-cell acute lymphoblastic leukemia patients after transplantation: A multi-center retrospective study.

BACKGROUND: Chimeric antigen receptor T (CAR-T) cells have been demonstrated to be an effective treatment for relapsed B-cell acute lymphoblastic leukemia (B-ALL) following allogeneic hematopoietic stem cell transplantation (allo-HSCT). T cells for CAR-T therapy can be derived from the peripheral blood (recipient) of the patient or donor. Despite having identical genomes, the different maturation environments of these T cells can lead to functional differences. This study aimed to compare the clinical outcomes of CAR-T cells derived from these two sources. METHODS: This multicenter, retrospective cohort study collected clinical data from 36 patients who experienced B-ALL relapse after allo-HSCT and received CD19 CAR-T cell therapy between January 2016 and October 2023 across seven centers. The primary endpoint was complete remission (CR)/CR with an incomplete hematologic recovery (CRi) rate at 28 days post-CAR-T cell infusion. Secondary endpoints included the 2-year overall survival (OS) rate, 2-year event-free survival (EFS) rate, incidence of graft-versus-host disease (GVHD), cytokine release syndrome (CRS), and CAR-T cell-related encephalopathy syndrome (CRES). RESULTS: A retrospective analysis was performed on 36 patients: 12 in the recipient group and 24 in the donor group. The recipient and donor groups showed no statistically significant differences in CR/CRi rates (83.3% vs. 100.0%, P = 0.105), 2-year EFS rates (50.8% vs. 51.6%, P = 0.617), or 2-year OS rates (49.5% vs. 63.6%, P = 0.215). In addition, the incidences of GVHD, CRS, and CRES did not significantly differ between the two groups. Further analysis within the donor group revealed 12 matched sibling donors (MSDs) and 12 haploidentical donors (HIDs). The 2-year EFS rate was statistically significantly greater in the HID group than in the MSD group (75.0% vs. 30.7%, P = 0.043), whereas no significant differences were observed in the CR/CRi rates, 2-year OS, or the incidence of GVHD, CRS, and CRES between these subgroups. CONCLUSIONS: Both recipient-derived and donor-derived CD19 CAR-T cell therapies are effective treatment options for B-ALL relapsed post-allo-HSCT patients. HID-derived CAR-T cells offer a longer EFS and may be considered the optimal choice. TRIAL REGISTRATION: Chinese Clinical Trial Registry, No. ChiCTR2400085297.

Adolescent↗
PubMed2004

Primary sepsis in a university hospital in northern Sweden: a retrospective study.

BACKGROUND: Severe sepsis and septic shock are associated with high mortality rates. Data on sepsis outcome from Scandinavian countries are sparse. The aim of this study was to examine the length of stay (LOS) in the ICU, ICU mortality and costs of care for adult patients with primary sepsis in a university hospital in northern Sweden. METHODS: We performed a retrospective data analysis of records of 92 patients admitted over a 3-year period, under the diagnosis of sepsis or urosepsis. Demographic data, admission category, APACHE II score, aetiology and severity of sepsis, ICU LOS, mortality and TISS were analyzed. RESULTS: Eighty-one adult patients were identified by standard definitions as suffering from sepsis. The median ICU length of stay was 4.2 days, 6 days for survivors and 2.1 days for non-survivors. Thirteen out of 20 deaths occurred within the first 3 days after admission. Overall ICU mortality rate was 24.7% while the ICU mortality for patients with septic shock was 57.7%. The mean costs of care for patients with sepsis were 3139 Euros day(-1) and the cost of care per patient surviving sepsis was 38,494 Euros. CONCLUSION: The incidence of primary sepsis in our ICU was low. Previous reports on high mortality in association with severe sepsis and septic shock are valid also at our hospital. The ICU-LOS was shorter than previously reported, while our costs of care were in the same range as stated by others. This retrospective analysis is valid for interpretation of the applicability of currently available sepsis therapies.

Adolescent↗
PubMed2004

Improvement of malignant/benign ratio in excised melanocytic lesions in the 'dermoscopy era': a retrospective study 1997-2001.

BACKGROUND: Because of the many limitations of studies based on the diagnostic setting of excised lesions, the impact of dermoscopy (epiluminescence microscopy, dermatoscopy) in melanoma screening during practice remains to be established. OBJECTIVES: We assumed that effects of the use of dermoscopy on some indicators of diagnostic performance in melanoma screening should be traceable retrospectively; therefore, we analysed the impact of routine dermoscopy use on the malignant/benign ratio in excised melanocytic lesions. METHODS: Preoperative and histological diagnosis of 3053 melanocytic lesions [319 melanomas (10.4%)] consecutively diagnosed and excised at the Department of Dermatology, University of Florence in the period 1997-2001 inclusive were retrieved. Six dermatologists who selected the lesions to excise and who performed preoperative diagnosis were divided into two groups according to their use of dermoscopy in routine activity (n = 2 dermoscopy users and n = 4 nonusers). The study period was divided into a predermoscopy period (1997), a shift phase (1998) and a dermoscopy period (1999-2001). RESULTS: During the study period, the malignant/benign ratio improved in dermoscopy users only (from 1 : 18 to 1 : 4.3, P = 0.037). No significant difference was found for nonusers (from 1 : 11.8 to 1 : 14.4). Dermoscopy users were more likely to have a melanoma diagnosed within a series of excised lesions than nonusers, even taking into account potential confounders such as sex, age and study period by means of multivariate analysis (odds ratio 1.55, 95% confidence interval 1.17-2.01). The percentage of 'problem' naevi (naevi with architectural disorder with or without cytological atypia and Spitz or Reed naevi) over the total number of excised lesions was higher in dermoscopy users than in nonusers (year 2001, 51.6% vs. 40.9%, P = 0.014). Similar findings were obtained after exclusion from the data set of lesions excised for cosmetic reasons. CONCLUSIONS: The adoption of dermoscopy in routine melanoma screening is followed by an improvement of the malignant/benign ratio in excised lesions, suggesting a more appropriate selection of pigmented lesions referred to surgery. Because of the possible limitations of a retrospective study design, future confirmation of this finding by means of a prospective, randomized study is advisable. The introduction of dermoscopy in routine practice may have major implications in large-scale melanoma screening with cost savings and a reduction of the dermosurgery workload.

Female↗