1,721,059 research outputs found
Fotoaferesi extracorporea come terapia di prima linea nel trattamento della GVHD cronica dopo trapianto allogenico di cellule staminali
Full text linkIntroduzione. La malattia del trapianto verso l’ospite cronica (cGVHD) è la più importante complicanza dopo trapianto di cellule staminali emopoietiche. La terapia standard è l’associazione di ciclosporina (CyA) e cortisone; le complicanze infettive correlate alla terapia immunosoppressiva (ISS) o la insoddisfacente risposta al trattamento sono la principale causa di mortalità. La fotoaferesi extracorporea (ECP) si è dimostrata efficace nel trattamento della cGVHD, ma il suo utilizzo è stato prevalentemente limitato alla cGVHD resistente a trattamento di prima linea.
Scopo dello studio. Il presente studio pilota ha l’obiettivo di valutare la fattibilità di un programma di ECP in associazione a terapia standard per il trattamento di prima linea della cGVHD ad alto rischio. Il rischio elevato si definisce in base alla presenza di parametri che predicono una elevata mortalità cGVHD correlata. Obiettivi secondari sono la risposta e la incidenza di complicanze (sicurezza).
Pazienti. Su 10 pazienti che rispettavano i criteri di arruolamento, 2 hanno rifiutato di aderire allo studio per problemi logistici o rifiuto di un protocollo sperimentale, 8 sono stati arruolati. L’età media è stata di 40 anni. Il donatore era un donatore familiare HLA identico in 7 casi e un donatore non familiare in 1 caso. Tutti i pazienti presentavano cGVHD estesa o moderato/severa; lo score prognostico (secondo Akpek) era >0 in 3/8 pazienti.
Trattamento. I pazienti hanno iniziato il trattamento con Prednisone (PDN) 1 mg/kg e CyA alla diagnosi di cGVHD; la ECP è stata iniziata con una frequenza di 4 sedute / mese nei primi 3 mesi e 2 / mese per i successivi 9 mesi; PDN e CyA sono stati lentamente scalati sino alla sospensione se possibile, altrimenti modulati. La durata dello studio è stata di 1 anno. I criteri di uscita dallo studio erano la sospensione della ECP, la necessità di inserire altri farmaci immunosoppressivi per progressione della cGVHD o infezioni severe. La risposta è stata valutata secondo criteri standard come progressione, risposta parziale (PR), ottima PR (vgPR) o risposta completa (CR).
Risultati. La aderenza al protocollo è stata: 6/8 pazienti a 3 mesi, 4/8 a 6 e 9 mesi, 3/8 a 12 mesi; l’uscita dallo studio è stata determinata da complicanze infettive in 2 pazienti, sospensione della ECP in 1 paziente a acusa di una trombosi correlata al catetere venoso (CV) femorale inserito per le procedure di ECP, in 2 pazienti per chiara progressione della cGVHD. Nei pazienti valutabili la risposta (CR + vgPR / <=PR) per trimestre è stata 4/6, 2/4 and 3/4 al I, II e III trimestre rispettivamente; dopo il IV trimestre di trattemento sono state osservate 1 vgPR, 2 PR e 1 progressione. Complicanze sono state osservate in 4 pazienti per un totale di 9 episodi: 1 caso di polmonite, 1 caso di infezione delle vie urinarie, 3 casi di riattivazione di CMV, 1 caso di condilomatosi, 1 caso di infezione CVC correlata, 1 caso di trombosi CV femorale correlata, 1 caso di sindrome uremicoemolitica. Ad 1 anno 2 pazienti su 8 sono deceduti (1 caso per mortalità trapianto correlata, 1 caso per recidiva).
Conclusioni. La ECP in associazione a terapia standard è fattibile; la incidenza di complicanze sembra essere sovrapponibile a quella osservata nei pazienti non sottoposti a ECP. Per valutare adeguatamente la risposta e la sicurezza di questo trattamento sarà necessario un numero più ampio di pazienti.Background. Chronic graft versus host disease (cGVHD) is the major late complication after allogeneic stem cell transplantation. Standard therapy is steroid and Cyclosporine-A (CyA); however, immune suppression (ISS) related infections or unresponsiveness to ISS, are major mortality causes. Extracorporeal photopheresis (ECP) has shown activity in treatment of cGVHD, but its use has been limited to first-line-unresponsive cGVHD.
Aim of the study. This is a single center pilot study testing feasibility of a programme of photopheresis in association with standard therapy as first line treatment in high risk cGVHD. High risk was defined as the presence of parameters predicting high cGVHD-related mortality. Secondary objectives were response and complications incidence.
Patients. Among 10 pts fitting enrolling criteria, 2 refused due to logistic problem or low compliance with the procedure, 8 were enrolled. Median age was 40. Donor was HLA identical sibling in 7 cases and MUD in 1. All cases presented with extensive/moderate-severe cGVHD; Akpek score was > 0 in 3/8 pts.
Treatment plan. Pts started with Prednison (PDN) 1 mg/kg and CyA at cGVHD diagnosis; ECP was started with a frequency of 4 application/month in the first 3 months and 2/month for the subsequent 9 months; PDN and CyA were slowly reduced until suspension, or otherwise modulated. Study duration was 1 year. Pts were ruled out the study in case of ECP suspension, requirement of other ISS drugs in case of GVHD progression unresponsive to standard therapy, or severe infections. Response was evaluated with standard criteria, as progression, partial response (PR), very good PR (vgPR) or complete response (CR).
Results. Adherence to protocol was: 6/8 pts at 3 months, 4/8 at 6 and 9 months, 3/8 at 12 mm; exit from the study was due to infectious complications (2), ECP suspension due to venous access related thrombosis (1) and clear cGVHD progression (2). In evaluable pts, response (CR+very good PR / <=PR) per trimester was 4/6, 2/4 and 3/4 at I, II and III respectively; at the IV trimester, 1 very good PR, 2 PR and 1 progression were observed. Complications were observed in 4 pts with : 1 case of pneumonia, 1 case of urinary tract infection, 3 cases of CMV antigenemia activation, 1 case of condilomatosis, 1 case of catheter related infection, 1 case of catheter related thrombosis and 1 case of hemolitic uremic syndrome. At 1 year, 2/8 pts died (1 TRM, 1 relapse).
Conclusion. ECP in association with standard therapy is feasible; complications incidence seems to be similar to those observed in patients not treated with ECP; a larger group of patients is needed to evaluate response in this setting
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
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Aphthous oral ulceration and its successful management by Lactobacillus brevis CD2 extract in an adult haemophilic patient
No full textSuccessful re-treatment with azacitidine in a patient with low blast count AML transformed from MDS after suspension of this agent.
No full textDispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
Chronic myelomonocytic leukemia coexisting with monoclonal gammopathy: concomitant response to azacitidine of both disorders.
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