1,721,033 research outputs found
Izvori grešaka i njihova kontrola: Model upravljanja neželjenim događajima u kliničkoj transfuziologiji
No full textRecent reports have identified medical errors as a significant cause of morbidity
and mortality among patients in a number of different countries. A variety
approaches have been implemented to identify errors and their causes. To gain
the better understanding of these phenomena, learn more about the incidence
and type of medical errors, and the factor contributing to these errors, we first
need to acquire a broad range of raw data relating to patient safety and quality
of care and perform a comprehensive analysis of the data.
Transfusion medicine lacks a standard method for the systematic collection and
analysis of event reports. The most frequent use is Medical Event Reporting
System for Transfusion Medicine (MERS-TM) which has been developed
decade ago by Kaplan and al. MERS-TM utilizes descriptive coding and causal
classification schemes. The Eindhoven Classification Model (Medical Version)
was adopted for causal classification and analysis.
The MERS-TM system is used in our hospital until 2002. The present study
analyzed 36 adverse events reported between 2002. and 2010. and 908 near
miss events reported in 2007. Sample collection and identification of patients
were found to be the highest risk step in the work process. The pediatric,
especially neonatal intensive unit, was identified as high-risk clinical area. The
data showed multiple causes for events. We identified clusters of identical
transfusion incidents and established database with suggesting solutions for
each case.
This study confirms that near miss events occur far more frequently than
adverse events causing harm. High risk errors occur most frequently outside the
transfusion service, and the bedside of the patient is the main location. Our data
can be used to identify areas where resources need to be targeted in order to
prevent future harm to patients, improving the overall safety of transfusion
The value of chromosomal findings in treatment of acute myeloid leukemia
No full textU istraživanje je uključeno 536 bolesnika s novootkrivenom akutnom mijeloičnom leukemijom. Medijan dobi iznosio je 36 godine u rasponu od 16-60 godina. Akutna mijeloična leukemija M2 podtipa dijagnosticirana je u 31% slučajeva, dok je AML-M6 dijagnosticirana u 3% slučajeva. Akutna promijelocitna leukemija dijagnosticirana je u 76/536 (14%). Akutna mijeloična leukemija M4 podtipa dijagnosticirana je u 75/536 (14%), dok je AML-M5 dijagnosticirana u 62/536 (12%) bolesnika. Eritroleukemija (AML-M6) dijagnosticirana je u 18/536 (3%) bolesnika. Medijan leukocita pri dijagnozi iznosio je 19x109/L, raspona od 0.8-323x109/L. Za analizu kromosoma primjenjene su standardne metode pruganja. Prema nalazu citogenetske analize bolesnici su razdijeljeni u tri prognostičke skupine. Bolesnici s translokacijom t(8;21), inverzijom inv(16), translokacijom t(15;17) nalaze se u tzv. povoljnoj skupini. Bolesnici s urednim nalazom bez kromosomskih promjena u kariotipu odnosno bolesnici sa citogenetskim promjenama nepoznate prognoze čine posebnu skupinu intermedijarne prognoze. Bolesnici u kojih je nađena trisomija 8, ili promjene kromosoma 5, 7, promjene lokusa 11q23, 3q26 nalaze se u nepovoljnoj skupini. Citogenetske promjene nađene su u 363 (68%) bolesnika. Povoljan citogenetski nalaz nađen je u 118 (22%) bolesnika. Intermedijarni tip citogenetske promjene utvrđen je u 260 (49%) bolesnika, dok je u 158 (30%) bolesnika utvrđena nepovoljna citogentska promjena. Kompletna remisija postignuta je u 76% bolesnika dobre citogenetske prognoze, u 70% bolesnika intermedijarne citogenetske prognoze, te u samo 45% bolesnika nepovoljne citogenetske prognoze (p=0.001). Vjerojatnost petogodišnjeg preživljenja bez znakova bolesti u bolesnika s povoljnom, intermedijarnom i nepovoljnom citogenetskom promjenom iznosi 43%, 34% i 9% (p=0.05). Vjerojatnost relapsa bolesti iznosi 82% za bolesnike s nepovoljnom citogenetskom promjenom, 68% za bolesnike s intermedijarnom citogenetskom promjenom i 56% za bolesnike s povoljnim citogenetskim nalazom (p=0.05).In our investigation 536 patients with de novo acute leukemia were included into prospective study. Median age was 36 years, ranged 16-60. The majority of patients have AML-M2 (31%) or AML-M6 subtype (3%) according to French-American-British classification. 14% patients have AML-M3 subtype. AML-M4 was observed in 75/536 (14%) and AML-M5 in 62/536 (12%) patients. In 3% patients AML-M6 was documented. Median WBC at diagnosis was 19x109/l, ranged 0.-323x109/l. For chromosome analysis standard banding was done. According to the cytogenetic finding patients were classified in three prognostic groups. Patients with translocations t(8;21) or t(15;17), inversion inv(16) were classified as a good prognostic group, while patients with trisomy 8, patients with chromosome 3, 11q23 abnormalities and patients with changes of chromosome 5 and 7 were classified as a poor prognostic group. Other patients were classified as an intermediate prognostic group. Cytogenetic abnormalities were found in 363 (68%) patients. 22% patients were classified as a good prognostic group and 158 (30%) as a poor prognosis group. Complete remission was obtained in 76% of patients with good karyotype, in 70% patients with intermediate karyotype and only 45% in poor prognostic group (P=0.001). Five year probability of disease free survival for patients with good, intermediate and poor karyotype is 43%, 34% and 9% respectively (P=0.05). Probability of relapse for patients with poor karyotype is 82%, for intermediate karyotype 68% and for patients with good karyotype is 56% (P=0.05)
Interleukin 6 i infekcija Epstein-Barrovim virusom u ne-Hodgkinovih limfoma : doktorska disertacija
No full textSažetak disertacije "Interleukin 6 i infekcija Epstein-Barrovim virusom u ne-Hodgkinovih limfoma" nije dostupan
Serumski citokini u djece i odraslih s akutnom autoimunom trombocitopenijom
No full textBackground: The etiology of AITP is unknown and it is caused by an inappropriate response of the immune system. Antibody-coated platelets are removed from circulation by the monocytic phagocytic system, resulting in a shortened platelet survival. Aims: This study was designed to determine if these defects are related to serum cytokine levels, to evaluate the differences in serum cytokines between children and adults, to determine the correlation between cytokine serum concentrations and circulating lymphocytes, and antibodies to viruses. Subjects: The study population consisted of 48 children and 26 healthy controls, 19 adults with AITP and 24 healthy controls. Methods: Serum concentrations of IL-1α, -2, -3, -4, -6, -10, TNF-a, IFN-a, and IFN-g, antibodies against CMV, EBV, HHV-6, adenovirus and parvovirus B19 were all determined by ELISA; absolute lymphocyte count, percentage of circulating lymphocyte T, B, T4, T8 and NK cells by flow cytometric analysis were measured in children and adults with AITP at diagnosis. Data were analyzed by SPSS 11.0 PC and Statistica 6.0 statistical programs. Student’s t-test with logarithmic transformation comparing the data on cytokine levels was performed. Cytokines and platelets were measured at diagnosis, after 8 weeks and after 6 months while the Friedman test evaluated the changes. Pearson’s correlation coefficients and multiple regression analysis were used to predict the platelet values (after 6 months in children, after 8 weeks in adults). A p < 0,05 value was considered as statistically significant. Results: Concentrations of IL-2 (p = 0,021), TNF-α (p = 0,009) in children and IL-10 (p = 0,041) in adult patients were lower, while IL-4 (p = 0,062) in children and IL-1α (p = 0,0,045) in adults where higher, compared to healthy controls. Children with AITP had lower IL-4 (p = 0,033), IL-6 (p = 0,004) and IFN-γ (p = 0,001), and higher IFN-α (p = 0,007) then adults. Th lymphocytes in 52,6% children and 27,6% adults were low. The research revealed that after 6 months the number of platelets in children could be predicted by the number of platelets after 8 weeks and IL-3, IL-4 and TNF-α at diagnosis. After 8 weeks the number of platelets in adults could be predicted by apsolute lymphocyte count, B-lymphocytes, NK cells and IFN-α at diagnosis. Conclusion: Although the immunopathogenesis of AITP is autoantibody-mediated, there is now evidence that T helper cells and the cytokines they produce are involved
The value of chromosomal findings in treatment of acute myeloid leukemia
No full textU istraživanje je uključeno 536 bolesnika s novootkrivenom akutnom mijeloičnom leukemijom. Medijan dobi iznosio je 36 godine u rasponu od 16-60 godina. Akutna mijeloična leukemija M2 podtipa dijagnosticirana je u 31% slučajeva, dok je AML-M6 dijagnosticirana u 3% slučajeva. Akutna promijelocitna leukemija dijagnosticirana je u 76/536 (14%). Akutna mijeloična leukemija M4 podtipa dijagnosticirana je u 75/536 (14%), dok je AML-M5 dijagnosticirana u 62/536 (12%) bolesnika. Eritroleukemija (AML-M6) dijagnosticirana je u 18/536 (3%) bolesnika. Medijan leukocita pri dijagnozi iznosio je 19x109/L, raspona od 0.8-323x109/L. Za analizu kromosoma primjenjene su standardne metode pruganja. Prema nalazu citogenetske analize bolesnici su razdijeljeni u tri prognostičke skupine. Bolesnici s translokacijom t(8;21), inverzijom inv(16), translokacijom t(15;17) nalaze se u tzv. povoljnoj skupini. Bolesnici s urednim nalazom bez kromosomskih promjena u kariotipu odnosno bolesnici sa citogenetskim promjenama nepoznate prognoze čine posebnu skupinu intermedijarne prognoze. Bolesnici u kojih je nađena trisomija 8, ili promjene kromosoma 5, 7, promjene lokusa 11q23, 3q26 nalaze se u nepovoljnoj skupini. Citogenetske promjene nađene su u 363 (68%) bolesnika. Povoljan citogenetski nalaz nađen je u 118 (22%) bolesnika. Intermedijarni tip citogenetske promjene utvrđen je u 260 (49%) bolesnika, dok je u 158 (30%) bolesnika utvrđena nepovoljna citogentska promjena. Kompletna remisija postignuta je u 76% bolesnika dobre citogenetske prognoze, u 70% bolesnika intermedijarne citogenetske prognoze, te u samo 45% bolesnika nepovoljne citogenetske prognoze (p=0.001). Vjerojatnost petogodišnjeg preživljenja bez znakova bolesti u bolesnika s povoljnom, intermedijarnom i nepovoljnom citogenetskom promjenom iznosi 43%, 34% i 9% (p=0.05). Vjerojatnost relapsa bolesti iznosi 82% za bolesnike s nepovoljnom citogenetskom promjenom, 68% za bolesnike s intermedijarnom citogenetskom promjenom i 56% za bolesnike s povoljnim citogenetskim nalazom (p=0.05).In our investigation 536 patients with de novo acute leukemia were included into prospective study. Median age was 36 years, ranged 16-60. The majority of patients have AML-M2 (31%) or AML-M6 subtype (3%) according to French-American-British classification. 14% patients have AML-M3 subtype. AML-M4 was observed in 75/536 (14%) and AML-M5 in 62/536 (12%) patients. In 3% patients AML-M6 was documented. Median WBC at diagnosis was 19x109/l, ranged 0.-323x109/l. For chromosome analysis standard banding was done. According to the cytogenetic finding patients were classified in three prognostic groups. Patients with translocations t(8;21) or t(15;17), inversion inv(16) were classified as a good prognostic group, while patients with trisomy 8, patients with chromosome 3, 11q23 abnormalities and patients with changes of chromosome 5 and 7 were classified as a poor prognostic group. Other patients were classified as an intermediate prognostic group. Cytogenetic abnormalities were found in 363 (68%) patients. 22% patients were classified as a good prognostic group and 158 (30%) as a poor prognosis group. Complete remission was obtained in 76% of patients with good karyotype, in 70% patients with intermediate karyotype and only 45% in poor prognostic group (P=0.001). Five year probability of disease free survival for patients with good, intermediate and poor karyotype is 43%, 34% and 9% respectively (P=0.05). Probability of relapse for patients with poor karyotype is 82%, for intermediate karyotype 68% and for patients with good karyotype is 56% (P=0.05)
Interleukin 6 i infekcija Epstein-Barrovim virusom u ne-Hodgkinovih limfoma : doktorska disertacija
No full textSažetak disertacije "Interleukin 6 i infekcija Epstein-Barrovim virusom u ne-Hodgkinovih limfoma" nije dostupan
The value of chromosomal findings in treatment of acute myeloid leukemia
No full textU istraživanje je uključeno 536 bolesnika s novootkrivenom akutnom mijeloičnom leukemijom. Medijan dobi iznosio je 36 godine u rasponu od 16-60 godina. Akutna mijeloična leukemija M2 podtipa dijagnosticirana je u 31% slučajeva, dok je AML-M6 dijagnosticirana u 3% slučajeva. Akutna promijelocitna leukemija dijagnosticirana je u 76/536 (14%). Akutna mijeloična leukemija M4 podtipa dijagnosticirana je u 75/536 (14%), dok je AML-M5 dijagnosticirana u 62/536 (12%) bolesnika. Eritroleukemija (AML-M6) dijagnosticirana je u 18/536 (3%) bolesnika. Medijan leukocita pri dijagnozi iznosio je 19x109/L, raspona od 0.8-323x109/L. Za analizu kromosoma primjenjene su standardne metode pruganja. Prema nalazu citogenetske analize bolesnici su razdijeljeni u tri prognostičke skupine. Bolesnici s translokacijom t(8;21), inverzijom inv(16), translokacijom t(15;17) nalaze se u tzv. povoljnoj skupini. Bolesnici s urednim nalazom bez kromosomskih promjena u kariotipu odnosno bolesnici sa citogenetskim promjenama nepoznate prognoze čine posebnu skupinu intermedijarne prognoze. Bolesnici u kojih je nađena trisomija 8, ili promjene kromosoma 5, 7, promjene lokusa 11q23, 3q26 nalaze se u nepovoljnoj skupini. Citogenetske promjene nađene su u 363 (68%) bolesnika. Povoljan citogenetski nalaz nađen je u 118 (22%) bolesnika. Intermedijarni tip citogenetske promjene utvrđen je u 260 (49%) bolesnika, dok je u 158 (30%) bolesnika utvrđena nepovoljna citogentska promjena. Kompletna remisija postignuta je u 76% bolesnika dobre citogenetske prognoze, u 70% bolesnika intermedijarne citogenetske prognoze, te u samo 45% bolesnika nepovoljne citogenetske prognoze (p=0.001). Vjerojatnost petogodišnjeg preživljenja bez znakova bolesti u bolesnika s povoljnom, intermedijarnom i nepovoljnom citogenetskom promjenom iznosi 43%, 34% i 9% (p=0.05). Vjerojatnost relapsa bolesti iznosi 82% za bolesnike s nepovoljnom citogenetskom promjenom, 68% za bolesnike s intermedijarnom citogenetskom promjenom i 56% za bolesnike s povoljnim citogenetskim nalazom (p=0.05).In our investigation 536 patients with de novo acute leukemia were included into prospective study. Median age was 36 years, ranged 16-60. The majority of patients have AML-M2 (31%) or AML-M6 subtype (3%) according to French-American-British classification. 14% patients have AML-M3 subtype. AML-M4 was observed in 75/536 (14%) and AML-M5 in 62/536 (12%) patients. In 3% patients AML-M6 was documented. Median WBC at diagnosis was 19x109/l, ranged 0.-323x109/l. For chromosome analysis standard banding was done. According to the cytogenetic finding patients were classified in three prognostic groups. Patients with translocations t(8;21) or t(15;17), inversion inv(16) were classified as a good prognostic group, while patients with trisomy 8, patients with chromosome 3, 11q23 abnormalities and patients with changes of chromosome 5 and 7 were classified as a poor prognostic group. Other patients were classified as an intermediate prognostic group. Cytogenetic abnormalities were found in 363 (68%) patients. 22% patients were classified as a good prognostic group and 158 (30%) as a poor prognosis group. Complete remission was obtained in 76% of patients with good karyotype, in 70% patients with intermediate karyotype and only 45% in poor prognostic group (P=0.001). Five year probability of disease free survival for patients with good, intermediate and poor karyotype is 43%, 34% and 9% respectively (P=0.05). Probability of relapse for patients with poor karyotype is 82%, for intermediate karyotype 68% and for patients with good karyotype is 56% (P=0.05)
Plasmacytoid dendritic cells, effector T-lymphocytes and inflammatory cytokines in graft-versus-host disease
No full textGVHD continues to be a major source of morbidity and mortality following allogeneic stem cell transplantation (allo-SCT). Previous studies established the role of Th17 subpopulation of lymphocytes and the plasmacytoid dendritic cells (pDC) in the pathophysiology of several autoimmune diseases. The aim of this research was to evaluate the role of pDC and Th17 in the peripheral blood of patients at day 100 after allo-SCT in acute and chronic GVHD and GVL effect. The other aim of the study was to expand the search for chronic GVHD biomarkers by validating cytokines in the blood of patients at day 100 after allo-SCT and to determine a composite prognostic score for prediction of chronic GVHD.
This study included peripheral blood mononuclear cells (PBMC) of 79 patients taken at day 100 after allo-SCT and 152 serums from patients who underwent allo-SCT between 2005 and 2011 in Centre Hospitalier Universitaire de Nantes, France. For functional analysis of pDC, PBMC from 79 blood samples were stimulated with TLR7 and TLR9 ligands in the presence of IL-3 over 6 hours, and then stained for surface markers and intracellular cytokines (IFN alpha, TNF alpha and IL6). Th17 were evaluated quantitatively on the same PBMC by staining for specific surface markers. Forty-one serum cytokine and chemokine was studied in all 152 serums using Luminex xMAP technology.
We observed a significant decrease of total and activated pDC, as well as Th17 and IFN gamma producing cells in the blood of patients with grade 2-4 acute GVHD as compared to patients with grade 0-1 acute GVHD. After dividing patients into 2 distinct groups, using the median value of pDC and Th17, we observed that a low pDC count predicts relapse and worse overall survival and low Th17 predicts more extensive chronic GVHD. In the multivariate analysis, low pDC count retained it’s predictive value for worse overall survival together with the older age of the patients while low Th17 count stayed the only independent predictor of extensive chronic GVHD.
Independently from all relevant clinical factors, 10 cytokines were found to be significantly correlated with the development of extensive chronic GVHD. Based on the significant cytokines and clinical factors, we established a practical prognostic score using the traditional multivariate Cox model combined with“time-dependent ROC curves”. The area under the time-dependent ROC curve of 0.80 indicated that such composite score is a powerful predictor of the risk of extensive chronic GVHD.
In concordance with previous GVHD studies, the significant decrease of both pDC and Th17 cells in peripheral blood on day 100 after allo-SCT in patients with clinically severe acute GVHD could be the result of the migration of these cells to target tissues of GVHD. Therefore, this study provides evidence for a potential new pathophysiological link between pDC and Th17 in human acute GVHD, and identifies these cells as potential new targets for prophylaxis and treatment of GVHD. Moreover, we established pDC and Th17 counts in the peripheral blood of patients at day 100 after allo-SCT as valuable predictors of overall survival, relapse and chronic GVHD and have proposed that these cells, have an important role in both GVHD and GVL effect. Monitoring pDC and Th17 count could allow for early classification of patients according to the risk for adverse events and allow for potential early therapeutical interventions to improve their clinical outcomes.
Furthermore, new noninvasive score developed in this study to accurately predict the risk of extensive chronic GVHD after allo-SCT could be used as a decision tool in the clinical management of allo-SCT
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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