16 research outputs found
Expression of some ATP-binding cassette transporters in acute myeloid leukemia
No full textHematopoietic cells express ATP binding cassette (ABC) transporters in relation to different degrees of differentiation. One of the known multidrug resistance mechanisms in acute myeloid leukemia (AML) is the overexpression of efflux pumps belonging to the superfamily of ABC transporters such as ABCB1, ABCG2 and ABCC1. Although several studies were carried out to correlate ABC transporters expression with drug resistance, little is known about their role as markers of diagnosis and progression of the disease. For this purpose we investigated the expression, by real-time PCR, of some ABC genes in bone marrow samples of AML patients at diagnosis and after induction therapy. At diagnosis, ABCG2 was always down-regulated, while an up regulated trend for ABCC1 was observed. After therapy the examined genes showed a different expression trend and approached the values of healthy subjects suggesting that this event could be considered as a marker of AML regression. The expression levels of some ABC transporters such as ABCC6, seems to be related to gender, age and to the presence of FLT3/ITD gene mutation
Mechanical and environmental validation of a spherical multipurpose inflatable structure
No full textRecommendations for the prevention and treatment of haemolytic disease of the foetus and newborn
No full textRecommendations for the prevention and treatment of haemolytic disease of the foetus and newborn
Francesco Bennardello,1 Serelina Coluzzi,2 Giuseppe Curciarello,3 Tullia Todros,4 and Stefania Villa5, as Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) and Italian Society of Gynaecology and Obstetrics (SIGO) working group
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Introduction
The publication of the second edition of the “Recommendations for the prevention and treatment of haemolytic disease of the foetus and newborn” is the result of collaboration between the Italian Society of Transfusion Medicine and Immunohaematology (SIMTI, Società Italiana di Medicina Trasfusionale e Immunoematologia) and the Italian Society of Gynaecology and Obstetrics (SIGO, Società Italiana di Ginecologia e Ostetricia).
The recommendations published in 20061 have been revised in the light of current scientific evidence: the immunohaematological and instrumental investigations that should be performed in the antenatal and perinatal periods, the immunoprophylaxis (IP) to prevent the haemolytic disease of the foetus and newborn (HDFN due to RhD incompatibility and the treatment to use if HDFN develops are described.
The recommendations are focused on the prevention and management of HDFN, in particular that one due to RhD incompatibility, the most serious form of this condition. Although IP has dramatically reduced the number of cases of HDFN, this disease continues to occur and engage specialists in Transfusion Medicine, Obstetrics and Neonatology. The recommendations are aimed at Transfusion Structures (TS) and all public facilities pertaining to Mother and Child Departments, Family Planning Clinics and private structures managing pregnancies, including those in which the woman gives birth at home. The prevention of HDFN must be guaranteed, through organisational models adapted to local circumstances, to all pregnant women for whom it is deemed necessary and the women must also be ensured adequate information.
Besides HDFN due to RhD incompatibility, the recommendations also cover less frequent forms of the disease, caused by immunisation to other blood group antigens, and by ABO incompatibility, which is a more frequent laboratory finding, although of less importance from a clinical point of view.
These recommendations will be periodically reviewed in the light of evolving scientific knowledge, technology and clinical practice. They were developed on the basis of an analysis of current scientific literature (identified through bibliographic searches of Medline/PubMed and Ovid databases) and were submitted to the consensus of experts from SIMTI and SIGO. Protocols jointly agreed upon by the Transfusion Medicine and Immunohaematology Services (SIMT, Servizio di Immunoematologia e Medicina Trasfusionale) and Obstetricians-Gynaecologists working in the same territory, including at a regional level, should be drawn up to promote compliance among pregnant women.
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Purpose of the recommendations
The purpose of this document is to give correct guidance on the management and prevention of HDFN with the aim of promoting homogeneous practices throughout Italy, ensuring a minimum common denominator of quality that can be achieved in all health care structures2 used by pregnant women or females of childbearing potential*.
The dual value of these recommendations is that besides being a technical and scientific support for doctors making clinical decisions regarding the management of HDFN, they also provide updates on the risks associated with immunisation in females of childbearing potential.
The recommendations are not intended in any way to replace either the physician’s clinical evaluation of individual cases or the doctor’s personal experience; they are, rather, a reference tool that can also be used to check the correctness of treatment. The final decision on a given treatment must always be taken by the doctor in the light of the clinical picture and resources available; however, substantial deviations from these recommendations should be documented and justified in the patient’s clinical records. For this purpose specific indicators for monitoring and evaluation have been identified to use in clinical audits.
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Expected benefits
The expected benefits of the dissemination of these recommendations for the prevention and management of HDFN are as follows:
- a decrease in the incidence of HDFN;
- a decrease in the incidence of alloimmunisation;
- an increase in appropriate clinical use of blood components in the foetal and neonatal periods;
- an increase in the appropriate clinical use of blood components in females of childbearing potential;
- an increase in the appropriate clinical use and dosages of anti-D immunoglobulin (Ig);
- greater involvement of patients in decisions related to the prevention and management of HDFN.
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Intended users of the recommendations
Doctors and healthcare workers involved in the prevention, diagnosis and treatment of HDFN.
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Applicability
These recommendations are applicable to females of childbearing potential, pregnant women at risk of HDFN and foetuses/neonates affected by haemolytic disease caused by materno-foetal alloimmunisation.
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Methodology of the Working Group and grades of recommendation
The process of developing these recommendations, in accordance with the indications contained in the methodology manual of the National Guidelines Programme3, was based on systematic reviews of the literature and updating of already existing recommendations on the subject. For most of the recommendations there is an explicit evaluation of the quality of the proof leading to the recommendation and the strength with which the recommendation is made. In the absence of clear proof, the recommendations are based on a consensus of published opinions of experts and that of the Working Group.
The methodology used to derive the grades of recommendation was based on that used by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group4–6. According to the GRADE system, recommendations are classified by grades, expressed in Arabic numbers (1, 2), depending on their strength, and by letters (A, B, C) depending on the quality and type of evidence provided by the studies on which the recommendations are based.
In detail:
- Grade 1: the authors are confident that the benefits for health clearly outweigh the undesirable effects, in terms of both risk and economic cost. This is, therefore, a strong recommendation.
- Grade 2: the authors are less certain and the difference between desirable and undesirable effects is less clear. This is, therefore, a weak recommendation.
As to the quality and type of evidence provided by the studies in support of the recommendations, there are three levels of classification:
- Grade A: high level of evidence.
The evidence derives from the analysis of numerous, substantial randomised studies without major limitations. It is unlikely that further research would alter the conclusions reached by these studies.
- Grade B: moderate level of evidence.
The evidence is derived from randomised clinical trials but with important limitations (for example, inconsistent results, wide confidence intervals, methodological problems). Grade B is also attributed to recommendations derived from strong evidence collected in observational studies or case series (for example, treatment effects or the demonstration of a dose-response effect). Further research could change the conclusions of these studies.
- Grade C: low or very low level of evidence.
The evidence is derived from an analysis of observational clinical studies with less consistent results or from the clinical experience/opinions of experts. Further research is required to consolidate or change the conclusions presented.
Generally speaking, it can be assumed that for all recommendations other than Grade 1A the authors recognise that other interpretations of the available evidence and other “clinical policies” are reasonable.
The conventional classification of evidence is based on mathematical and statistical criteria, with the “strength” of the evidence being assigned, in order, to: meta-analyses, randomised controlled trials, retrospective analyses, prospective follow-ups, cross-sectional population studies, reviews, anecdotal reports. This is correct as far as regards strictly clinical studies, especially if they are investigations of therapies and focused on objective evaluations of outcome.
Nevertheless, the recommendations in some fields are weak; in contrast, in other areas the availability of clinical studies carried out with rigorous methodology in large groups of subjects has enabled specific recommendations to be made with more confidence.
It was not always possible to use aggregate data from meta-analyses: these variables increase the margins for individual decisions by each doctor and for each patient.
As to transfusion support for HDFN in the antenatal and postnatal periods (intrauterine transfusion, exchange transfusion [ET], neonatal transfusion), the fundamental principles taken from the “Recommendations for transfusion therapy in neonatology”7 and subsequent amendments are reported in the appendix.
The appendix also contains some recommendations to be followed in order to avoid the risk of immunisation when transfusing females of childbearing potential, a summary of the investigations to carry out during pregnancy and the puerperium to enable the correct prevention of HDFN, and a flow-chart describing the immunohaematological monitoring of women during pregnancy and at delivery. Finally, the recommendations are summarised and reported with their classification at the end of the appendix.
Each member of the Working Group has signed a statement, which conforms with the one adopted by the National Guidelines Programme, declaring that they have no conflicts of interest3.
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Haemolytic disease of the foetus and newborn due to maternal-foetal RhD incompatibility
The anti-D alloantibody is the antibody most frequently responsible for HDFN8,9. Before the introduction of anti-D IP, HDFN secondary to anti-D immunisation affected 1% of neonates and was the cause of death of one in every 2,200 babies born10. Although the introduction of post-partum IP in RhD negative pregnant women drastically reduced the incidence of cases of HDFN11, HDFN due to anti-D continues to occur in 0.4 of every 1,000 births12–13 and red blood cell alloimmunisation still remains the most common cause of foetal anaemia14. There are various reasons for the continued occurrence of this disease: (i) the possible development of anti-D immunisation during a pregnancy as a result of an occult foetal-maternal haemorrhage (FMH), usually after the 28th week of gestation, which affects about 1% of RhD negative mothers of a RhD positive foetus15; (ii) lack of administration of IP; (iii) ineffective IP because the amount administered was not sufficient for the volume of the FMH; (iv) possible errors in the typing of the pregnant woman, puerpera or neonate; and (v) possible errors in the transfusion treatment of females of childbearing potential (transfusion of red blood cell concentrates with mismatched RhD antigen).
The fundamental cause of HDFN is the reaction between class IgG maternal antibodies and antigens on foetal red blood cells, leading to the destruction of these cells, mainly in the spleen.
HDFN rarely occurs during a first pregnancy, unless the mother has been previously sensitised by transfusions. Usually, during the first pregnancy primary immunisation takes place; this immunisation is characterised by the production of a small amount of IgM antibodies, immunoglobulins which do not cross the placenta. In subsequent pregnancies, and after further exposure to the antigen, as a result of the secondary immunisation, IgG antibodies, which can cross the placenta and cause haemolysis, are produced. The immune response depends on the entity of the FMH, the number of immunising events and the capacity of the woman’s response. ABO incompatibility between mother and foetus partially protects against immunisation.
In the natural history of HDFN, without any kind of intervention, in 50% of cases the foetus has only mild signs of the disease and recovers without any treatment; in 25% of cases the foetus develops haemolysis and kernicterus, if not treated adequately at birth; and in the remaining 20–25% of cases, HDFN due to anti-D may present in its most severe form (hydrops foetalis and death) before the 34th week of gestation16.
However, with the improvement of maternal and foetal monitoring and the current possibility of in utero treatment, the incidence of severe cases (hydrops and death) has now been reduced to about 10.
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Haemolytic disease of the foetus and newborn due to incompatibility for other red blood cell antigens
Besides the RhD antigen, other antigens belonging to the Rh system and other known blood group systems (with the possible exclusion of those of the Lewis, Chido and Rodgers, and Knops systems and of the I/i collection) can also induce the production of IgG antibodies and, therefore, provoke HDFN if a person lacking an antigen comes into contact with that antigen as a result of a pregnancy or transfusion. As a general rule, the forms of HDFN not due to RhD incompatibility are clinically benign, such that only 10% of them are clinically severe enough to require transfusion therapy; nevertheless, there are descriptions of fatal cases in the literature18.
The order of frequency of HDFN, after the forms due to RhD incompatibility and ABO incompatibility, are those caused by incompatibility for the c antigen (r′), the Kell antigen (K1), the C antigen and the antigens of the Duffy system19–20. Still in strict order of frequency, there are the forms of HDFN due to incompatibility for antigens of the Kidd, MNS, and Dombrock systems and others, which are all very rare. Anti-Cw, -Fyb, -Jka, -Jkb, -Jk3, -S, and -s usually only cause a positive direct antiglobulin test (DAT) in the neonate and treatment, if necessary is almost always limited to phototherapy21.
Anti-M, which may also be of the IgG class, rarely cause HDFN. The same applies for warm autoantibodies. Antibodies such as anti-I, -P, -Lea and -Leb can be ignored because the corresponding antigens are scarcely present at birth.
Various studies22–25 have shown that HDFN caused by anti-K differs from that due to anti-D in a number of ways. In women with anti-K, the obstetric history is not usually predictive of the severity of the disease; there is only a weak correlation between antibody titre and the severity of the disease, haemolysis and the consequent hyperbilirubinaemia are not dominant features of the disease and the suppression of foetal erythropoiesis, rather than haemolysis, is the most important pathogenic mechanism in causing foetal anaemia. Pregnancies in which anti-K maternal-foetal alloimmunisation has occurred, even when the antibody titre is low (1:8 or greater), must, therefore, be considered at risk, given the severity of the foetal and/or neonatal clinical manifestations.
The recent increase in migration to Italy has led to the diagnosis of other forms of HDFN due to antigens rarely observed in the Italian population. The search for irregular antibodies in these forms of HDFN is often falsely negative because of the lack of the relevant antigens in the test red cell panels commonly used, which are prepared with red blood cells from Caucasians. In these cases, the alloantibody involved can be detected and identified by using the father’s red cells (if ABO compatible with the mother’ ones), or, after delivery, the neonate’s cells. The protocols regarding investigations to carry out during pregnancy and in the perinatal and postnatal periods, as well as the treatment, are not different from those recommended for HDFN due to RhD incompatibility, to which the reader is referred.
Once an antibody specificity has been identified, the test red cells to use in controls, in determining the titre and in studies of the eluate of neonatal erythrocytes must express the antigen in question. In contrast, the red cells to use for a possible ET or for transfusion into the neonate must not carry the antigen involved.
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Haemolytic disease of the foetus and newborn due to maternal-foetal ABO incompatibility
HDFN due to ABO incompatibility is currently the most common neonatal haemolytic disease in the western world; indeed, in 15–20% of pregnancies in the white population there is incompatibility between a group O mother and a group A or B child; in 10% of these pregnancies, HDFN develops as a result of destruction of the foetal red blood cells, caused by IgG class anti-A and/or anti-B antibodies in the maternal serum. The mother-child serological combination in which a clinically relevant ABO HDFN develops most readily is a group O mother and a group A neonate.
However, only in about 1.5–2% of cases does the haemolytic disease require transfusion support26,27. There are various reasons for the prevailing modest clinical expression of HDFN due to ABO incompatibility:
- the expression of A and B antigens on foetal and neonatal red blood cells is low;
- the A and B substances, ubiquitously present on endothelial and epithelial cells, including placental ones, adsorb some of the maternal IgG that crosses the placenta;
- anti-A and anti-B IgG are predominantly IgG2, a subclass of Ig with a lesser capacity to cross the placental barrier actively.
Nevertheless, there are occasional reports in the literature of severe cases of haemolytic disease that have required ET and complex management28,29.
The incidence of HDFN due to ABO incompatibility is higher in African and Arab populations because of the more frequent expression of A and B genes in these populations. Given the migratory phenomena involving Italy (the 2013 CEDAP report [analysis of Birth Support Certificates] described that, in 2010, 18.3% of births were to women of non-Italian citizenship, with the peak being 28% in the region of Emilia Romagna), it can be predicted that the incidence of this type of HDFN will increase in the future30.
The incidence of HDFN due to ABO incompatibility is the same in first pregnancies as it is in subsequent pregnancies; the disease is, therefore, neither preventable nor predictable.
The search for anti-A and/or anti-B IgG during a pregnancy is of little use for predicting the development of ABO HDFN in the unborn child. In fact, most pregnant women, especially those with group O blood, have anti-A and/or anti-B (and anti-A,B) IgG in their serum, whereas relatively few neonates are affected by haemolytic disease, particularly clinically important forms.
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Investigations during pregnancy to prevent and manage haemolytic disease of the foetus and newborn
Immunohaematological tests to perform in all women (Table I)
Table I
Recommendations on immunohaematological tests to perform in all women.
Rec. n. Recommendation GoR
1 It is recommended that the ABO group and RhD factor are determined and a search for irregular antibodies is carried out with an IAT in all pregnant women, independently of their RhD status, within the first trimester of pregnancy in a Transfusion Structure. 1B
2 It is suggested that the samples for immunohaematological investigations are identified as samples for pre-transfusion tests and carry the surname, name and date of birth of the patient and the signature of the person who took the sample. 2C
3 It is suggested that all pregnant women are notified of their RhD status because of the possible need for prophylaxis with anti-D Ig. 2B
4 It is suggested that the search for irregular antibodies is repeated in all pregnant women at 28 weeks of gestation, regardless of their RhD status. In RhD negative women receiving antenatal prophylaxis at 28 weeks of gestation, the IAT should be performed before the IP is administered. 2B
5 If the search for antibodies is positive, for the purpose of evaluating the risk of HDFN, it is suggested that the specificity, titre and origin of the antibodies are determined and that a careful immunohaematological and obstetric history of the woman is taken. 2B
6 It is suggested that RhD typing and screening and identification of irregular antibodies is performed using methods in line with those set out in the SIMTI Standards. 2C
7 It is recommended that anti-A and anti-B immune antibodies are not searched for or monitored in pregnant women. 2B
- ABO blood group and RhD factor must be determined in all pregnant women, preferably within the first trimester of pregnancy. The tests must be performed in a TS using validated methods9,31–32.
- Samples of blood from pregnant women must carry the surname, name and date of birth of the patient and the signature of the person who took the sample33,34. The patient’s personal data must be transcribed in the presence of the patient herself, who must confirm the data.
- Two different monoclonal anti-D reagents, which must not recognise the DVI variant of the RhD antigen, must be used to determine the RhD type32,33. Determination of weak D antigen is not recommended since this is not useful and could lead to a dangerous omission of IP in the absence of in depth investigations, which cannot be carried out in all immunohaematology laboratories.
- All pregnant RhD negative women should be giv
Long-term outcome and prospective validation of NIH response criteria in 39 patients receiving imatinib for steroid-refractory chronic GVHD
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Tirosin Kinase Inhibitors in Chronic Graft versus Host Disease: From Bench to Bedside
No full textChronic Graft Versus Host Disease (cGVHD) is a major complication of allogeneic stem-cell transplantation (SCT). In many inflammatory fibrotic diseases, such as Systemic Scleroderma (SSc) and cGVHD with fibrotic features, an abnormal activation of transforming growth factor (TGFβ) and platelet-derived growth factor receptor (PDGF-R) pathways have been observed. Tyrosin Kinase Inhibitors (TKIs), which are currently used for treatment of patients with Chronic Myeloid Leukemia (CML), share potent antifibrotic and antiinflammatory properties, being powerful dual inhibitors of both PDGF-R and TGFβ pathways. Moreover accumulating in vitro data confirm that TKIs, interacting with the TCR and other signalling molecules, carry potent immunomodulatory effects, being involved in both T-cell and B-cell response. Translation to the clinical setting revealed that treatment with Imatinib can achieve encouraging responses in patients with autoimmune diseases and steroid-refractory cGVHD, showing a favourable toxicity profile. While the exact mechanisms leading to such efficacy are still under investigation, use of TKIs in the context of clinical trials should be promoted, aiming to evaluate the biological changes induced in vivo by TKIs and to assess the long term outcome of these patients. Second-generation TKIs, with more favourable toxicity profile are under evaluation in the same setting
Prospective assessment of NGS-detectable mutations in CML patients with non-optimal response: the NEXT-in-CML study
No full textIn chronic myeloid leukemia (CML) patients, tyrosine kinase inhibitors (TKIs) may select for drug-resistant BCR-ABL1 kinase domain (KD) mutants. Although Sanger sequencing (SS) is considered the gold standard for BCR-ABL1 KD mutation screening, next generation sequencing (NGS) has recently been assessed in retrospective studies. We conducted a prospective, multicenter study ('NEXT-in-CML') to assess the frequency and clinical relevance of low level mutations and the feasibility, cost and turnaround times of NGS-based BCR-ABL1 mutation screening in a routine setting. A series of 236 consecutive CML patients with Failure (F; n=124) or Warning (W; n=112) response to TKI therapy were analyzed in parallel by SS and by NGS in one of four reference laboratories. Fifty-one patients (22 F, 29 W) who were negative for mutations by SS had low level mutations detectable by NGS. Moreover, 29 (27F, 2W) of 60 patients who were positive for mutations by SS showed additional low level mutations. Thus, mutations undetectable by SS were identified in 80/236 (34%) patients, of whom 42 (18% of the total) had low level mutations somehow relevant for clinical decision-making. Prospective monitoring of mutation kinetics demonstrated that TKI-resistant low level mutations are invariably selected if the patients are not switched to another TKI or if they are switched to a inappropriate TKI or TKI dose. The NEXT-in-CML study provides for the first time robust demonstration of the clinical relevance of low level mutations, supporting the incorporation of NGS-based BCR-ABL1 KD mutation screening results in the clinical decision algorithms
Plerixafor Added to Chemotherapy Plus G-CSF Is Safe and Allows Adequate PBSC Collection in Predicted Poor Mobilizer Patients with Multiple Myeloma or Lymphoma
No full textWe evaluated the safety and efficacy of plerixafor, subsequent to disease-specific chemotherapy followed by granulocyte-colony stimulating factor (G-CSF), in 37 multiple myeloma (MM) or lymphoma patients, who were candidates for autologous stem cell transplantation (ASCT) predicted as poor mobilizers (PMs). Patients were identified as predicted PMs according to the history of a previously failed mobilization attempt or the presence of ≥1 factors predicting an unsuccessful harvest, such as advanced disease, prior extensive radiotherapy, or prolonged treatment, with stem cell poisons, advanced age, or extensive bone marrow involvement. Plerixafor (0.24 mg/kg) was administered subcutaneously for up to 3 consecutive days while continuing G-CSF for 9 to 11 hours before the planned apheresis. Plerixafor administration was safe and no significant adverse events were recorded. We observed a median 4-fold increase (range: 1.4-32) in the number of circulating CD34+ cells following plerixafor compared with baseline CD34+ cell concentration (from a median of 5 cells/μL, range: 1-32, to a median of 32 cells/μL, range: 6-201). Twenty-seven of the 37 patients (14 of 17 with MM and 13 of 20 with lymphoma) had ≥2×106 CD34+ cells/kg collected in 1-3 apheretic procedures. Of the 27 patients rescued with plerixafor, 24 (13 MM, 11 lymphoma) have been transplanted with plerixafor-mobilized peripheral blood stem cells, showing a rapid and durable hematologic recovery. Our results suggest that the addition of plerixafor to G-CSF after disease-oriented chemotherapy is safe and allows for a satisfactory harvest in order to perform a safe ASCT, in a relevant proportion of lymphoma and MM patients considered to be PMs
Larval ecology of malaria vectors and the impact of larviciding on malaria transmission in The Gambia
No full textThe study reported in this thesis explored the ecology of aquatic stages of mosquitoes in the middle reaches of the Gambia River in order to assess the feasibility and impact of microbial larviciding on malaria transmission in large river ecosystems in sub- Saharan Africa. All accessible water bodies in four study zones covering 400 km(^2) were mapped and sampled for mosquitoes. Microbial larvicides were applied in the four zones in across-over design and the impact of larviciding on mosquito densities assessed. Anopheline and culicine mosquitoes were found in all sampled habitats, apart from those with moving water. Similarly, all habitats, except puddles and water channels, had similar larval and pupal densities. Anopheles gambiae sensu lato, the major malaria vector in Africa, exploited a wide range of habitats and despite a decrease in population density during the dry season, could be found in breeding sites throughout the year. Mosquitoes shared habitats with other invertebrates including their predators. A closer look at rice fields revealed that mosquitoes were abundant in rice fields closer to the landward edge of the floodplains where water is fresher and contains high quantifies of nutrients. Mosquitoes of The Gambia were highly susceptible to both Bacillus thuringiensis var. israelensis (Bti) and B. sphaericus microbials, however no residual activity against anopheline larvae was observed. The basic training of personnel in identification of habitats, calibration of application equipment and active larviciding proved to be successful. Routine larviciding was associated with > 91 % reducfion (p < 0.001) in anophelines late stage larval density and 72 % (p < 0.001) in culicines. Overall, larviciding was associated with a 28% (p = 0.005) reduction in the number of adult female Anopheles gambiae s.l. found indoors, although this rose to 42%, when the study zone with the greatest abundance of breeding sites was excluded from the analysis. No significant reduction in adult culicines was observed. Ground application of Bti in areas with extensive floodplains is unlikely to contribute to a substantial reduction in malaria transmission in The Gambia, therefore vector control in such areas should target adult mosquitoes
Genes, culture and agriculture : an example of human niche construction
No full textK. N. Laland was supported by an ERC Advanced Grant (EVOCULTURE).Theory and empirical data from a variety of disciplines strongly imply that recent human history involves extensive gene-culture coevolution, much of it as a direct result of human agricultural practices. Here we draw on niche-construction theory (NCT) and gene-culture coevolutionary theory (GCT) to propose a broad theoretical framework (NCT-GCT) with which archaeologists and anthropologists can explore coevolutionary dynamics. Humans are enormously potent niche constructors, and understanding how niche construction regulates ecosystem dynamics is central to understanding the impact of human populations on their ecological and developmental environments. We use as primary examples the evolution of dairying by Neolithic groups in Europe and Africa and the rise of the “sickle-cell allele” among certain agricultural groups in West Africa and suggest that these examples are broadly representative of much of human recent history. Although the core aspects of these case studies are familiar, we lay out the examples with a specific NCT-GCT focus, which allows us to highlight how archaeology, when coupled with genetic research, can play an important role in better understanding human history. Finally, we suggest that the NCT-GCT perspective is likely to be of widespread general utility because it inherently promotes consideration of the active agency of humans, and other organisms, in modifying their ecological and developmental niches and naturally draws attention to the various forms of feedback that flow from human activities at multiple levels, in multiple populations, and across multiple species.Peer reviewe
Emotional status and fear in patients scheduled for elective surgery during COVID-19 pandemic: a nationwide cross-sectional survey (COVID-SURGERY)
No full textBackground
Fragmented data exist on the emotional and psychological distress generated by hospital admission during the pandemic in specific populations of patients, and no data exists on patients scheduled for surgery. The aim of this multicentre nationwide prospective cross-sectional survey was to evaluate the impact of pandemic on emotional status and fear of SARS-CoV-2 contagion in a cohort of elective surgical patients in Italy, scheduled for surgery during the COVID-19 pandemic.
Results
Twenty-nine Italian centres were involved in the study, for a total of 2376 patients surveyed (mean age of 58 years ± 16.61; 49.6% males). The survey consisted of 28 total closed questions, including four study outcome questions. More than half of patients had at least one chronic disease (54%), among which cardiovascular diseases were the commonest (58%). The most frequent type of surgery was abdominal (20%), under general anaesthesia (64%). Almost half of the patients (46%) declared to be frightened of going to the hospital for routine checkups; 55% to be afraid of getting SARS-CoV-2 infection during hospitalization and 62% were feared of being hospitalised without seeing family members. Having an oncological disease and other patient-related, centre-related or perioperative factors were independently associated with an increased risk of fear of SARS-CoV-2 infection during hospitalization and of being hospitalised without seeing family members. A previous infection due to SARS-COV-2 was associated with a reduced risk of worse emotional outcomes and fear of SARS-CoV-2 infection during hospitalization. Patients who showed the most emotionally vulnerable profile (e.g. use of sleep-inducing drugs, higher fear of surgery or anaesthesia) were at higher risk of worse emotional status towards the hospitalization during COVID-19 pandemic. Being operated in hospitals with lower surgical volume and with COVID-19 wards was associated with worse emotional status and fear of contagion.
Conclusions
Additional fear and worse emotional status may be frequent in patients scheduled for elective surgery during COVID-19 pandemic. More than half of the participants to the survey were worried about not being able to receive family visits. Psychological support may be considered for patients at higher risk of psychological distress to improve perioperative wellbeing during the pandemic
