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An intensified myeloablative conditioning regimen, involving the addition of granulocyte colony-stimulating factor (G-CSF)-combined high-dose cytarabine (12 g/m2) to standard total body irradiation and cyclophosphamide, has been performed for adult patients with myeloid malignancies in single-unit cord blood transplantation (CBT) since 1998 in our institute. We update the results of CBT, as the first allogeneic hematopoietic cell transplantation after this conditioning regimen, in 169 patients with a median long-term follow-up of 10.4 years. The median age was 43 years (range, 16 to 59 years). Ninety-four patients (56%) were in non-remission at the time of CBT, and 124 patients (73%) were acute myeloid leukemia. The median cryopreserved cord blood total nucleated cell dose and CD34+ cell dose was 2.40 × 107/kg and 0.93 × 105/kg, respectively. The cumulative incidence of neutrophil recovery at 42 days was 94.4% (95% confidence interval [CI]: 88.6–97.3%). Among the whole cohort, 105 patients were still alive at the end of the study period. The cumulative incidences of relapse and non-relapse mortality at 10 years were 26.0% (95% CI: 19.5–33.0%) and 16.9% (95% CI: 11.4–23.4%), respectively. There was an overall survival probability of 62.5% (95% CI: 54.3–69.7%) at 10 years. Higher disease risk index alone significantly affected higher overall mortality (hazard ratio 2.21, P = 0.003) in multivariate analysis. These outcomes demonstrate that G-CSF-combined myeloablative conditioning could have favorable long-term remission rates for adult patients with myeloid malignancies undergoing single-unit CBT.

Background There is no consensus on the use of soap in skin care for atopic dermatitis in Japan. Thus, this study aimed to evaluate the efficacy of soap to maintain eczema remission in atopic dermatitis patients during the fall-winter period in Japan. Methods This assessor-blinded, pragmatic randomized, non-inferiority study enrolled atopic dermatitis patients whose eczema was controlled by regular steroid ointment application less than or equal to 2 days / week (tacrolimus ointment was permitted). For 8 ± 3 weeks, participants washed their upper and lower limbs on one side with soap (soap side) and on the other side with water alone (water side). The primary outcome was an Eczema Area and Severity Index score at week 8 ± 3. Results Twenty-nine participants were analyzed. The Eczema Area and Severity Index scores at week 8 ± 3 of the water and soap sides were 0.0 (0.0-0.4) and 0.0 (0.0-0.4), respectively (P = 0.18). The difference between both sides was -0.02 (-0.11-0.08), and the limits of the 95% confidence interval did not reach the prespecified non-inferiority margin. The average Patient-Oriented Eczema Measure score was 1.27 ± 1.7 and 1.32 ± 1.8 for the water and soap sides, respectively (P = 0.92). The total number of additional steroid ointment applications was four (0-20) times and six (0-23) times, respectively (P = 0.98). Participants were categorized according to self-assessments of the usefulness of soap, with 2, 24, and 3 participants in the water-effective, invariant, and soap-effective groups, respectively. Conclusions For children with controlled atopic dermatitis, washing with water alone was not inferior to washing with soap for maintaining remission of eczema during the fall-winter period in Japan.

Severe bacterial infections are a serious problem after cord blood transplantation (CBT). Colonization with multidrug-resistant Gram-negative rods (MRGNR) is associated with increased morbidity and mortality after allogeneic hematopoietic cell transplantation. However, its impact on outcomes after CBT is unclear. We aim to explore the impact of colonization with MRGNRs in adult patients undergoing CBT. We retrospectively analyzed 145 adult patients who received single-unit CBT in our institute. As a standard practice in our institute, all patients were screened for colonization with MRGNR by oral cavity swabs, urine, and stool specimens between the day of admission for CBT and the day of discharge or day 100 after CBT. There were 62 incidents of colonization with MRGNR in 52 patients, of which 25 involved Stenotrophomonas maltophilia, 19 multidrug-resistant Pseudomonas spp., and 18 extended-spectrum beta-lactamase-producing Enterobacteriaceae. On multivariate analysis, MRGNR persistence significantly affected increase in non-relapse mortality (NRM) (hazard ratio [HR], 8.96; 95% CI 1.85-43.46; P = 0.006) and the subsequent development of bloodstream infection due to MRGNR (HR 11.82; 95% CI 2.15-64.87; P = 0.004), but not MRGNR clearance, compared with non-colonized patients. These data suggest that persistent colonization with MRGNR is significantly associated with higher NRM in CBT for adults.

Objective: To describe the symptoms of radiotherapy in head and neck cancer patients and the time of initial onset of those. Material and Methods: All ethical precepts were followed, and the present study was approved by CEP number 92772318.8.0000.5546. The data collection in 41 head and neck cancer patients were performed by applying a questionnaire adapted by the researchers based on the EORTC QLQ-H & N35 protocol. The questionnaire consisted of 19 closed questions focusing on the adverse effects ofradiotherapy. Results: Most participants were male, with laryngeal cancer being the one with the highest incidence. Among the deleterious symptoms, the ones with more occurrence were weight loss, xerostomia, dysphagia and use of catheters. They appeared at the beginning of treatment, between the 6th and 10th session of radiotherapy. Symptoms such as social/family difficulties and oral communication had been present since the beginning of the treatment, extending to those who had completed the therapeutic procedure. Conclusion: Adverse symptoms are common in patients undergoing radiotherapy treatment for head and neck cancer, and mostly include aspects related to the eating process with involvement at the beginning of the treatment.

Objectives: Thromboembolism prophylaxis after biologic aortic valve replacement (BAVR) is recommended for 3 months postoperatively. We examined the continuation of oral anticoagulation (OAC) treatment and its effect on the long-term prognosis after BAVR.Methods: We used nation-wide register data from 4,079 individuals who underwent BAVR. We examined the association between warfarin and the non-vitamin K antagonist oral anticoagulant use with death, stroke and major bleeding in 2010 – 2016.Results: The risk of stroke was higher (HR 2.39, 95% CI 1.62 – 3.53, p < 0.001) and the risk of death was lower (HR 0.79, 95% CI 0.65 – 0.96, p = 0.016) in OAC-users compared to individuals without OAC. We observed no significant associations between OAC use and bleeding risk.Conclusion: OAC use after BAVR was associated with increased risk of stroke and decreased risk of death. These observational findings warrant validation in randomized controlled trials before any clinical conclusions can be drawn.

Background Biologic prostheses are preferred for surgical aortic valve replacement (SAVR) in patients more than 70 years of age in clinical practice. This study investigated differences in long-term outcomes between SAVR-treated patients more than 70 years of age who received mechanical or biologic prosthetic valves. Methods All patients (excluding those with endocarditis) who were more than 70 years of age and who underwent isolated first-time SAVR (with or without coronary artery bypass grafting) in Finland between 2004 and 2014 were retrospectively studied (n = 4227). Propensity score matching (1:3) was used to account for baseline differences (n = 296 with mechanical prostheses and n = 888 with biologic prostheses). Outcomes were 10-year survival, major bleeding (all, gastrointestinal, intracranial), ischemic stroke, infective endocarditis, and aortic valve reoperation. Mean age was 75.8 years, and mean follow-up was 8.3 years. Results Survival at 10 years was 46.1% with mechanical prostheses and 57.8% with biologic prostheses (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.21 to 1.80; P Conclusions Mechanical aortic valve prosthesis is associated with worse long-term survival and increased bleeding after SAVR in patients more than 70 years old. The study results suggest caution when considering mechanical aortic valve prostheses in elderly patients.

Objectives. To investigate nationwide changes in procedure rates, patient selection, and prognosis after all surgical aortic valve replacements. Design. Patients undergoing primary surgical...

Micafungin (MCFG) is an echinocandin antifungal drug used for prophylaxis and treatment of fungal infections after allogeneic hematopoietic cell transplantation (HCT). However, its efficacy and safety in patients undergoing cord blood transplantation (CBT) has not been clarified. We retrospectively analyzed the efficacy and safety of MCFG in 92 adult patients undergoing CBT in our institute. Of the entire cohort, 83 patients (90%) received MCFG for empirical or preemptive therapy. Documented breakthrough fungal infection occurred in 2 patients during MCFG treatment. Among the 49 patients who received MCFG as empirical therapy for febrile neutropenia, 41 (84%) patients had resolution of fever during neutropenia. Elevation of serum levels of hepatobiliary parameters during MCFG treatment was commonly observed, but grade 3 or higher elevation was rare. We also compared the efficacy and safety of 2 different initial daily doses of MCFG (150 mg vs. 300 mg). There were no significant differences of efficacy and safety between the two groups. These data suggest that MCFG was effective and safe for adult patients undergoing CBT. The optimal daily dose of MCFG treatment is a matter of future investigation for adult patients undergoing CBT.

Objective This study aimed to identify the relationship between prenatal distress and postpartum psychosocial conditions in Indonesia. Method This cross-sectional study involved 162 pregnant women in Cianjur, West Java, Indonesia, selected by two stages of cluster sampling. We used Indonesian versions of the Prenatal Distress Questionnaire (PDQ) and Postnatal Risk Questionnaire (PNRQ) as research instruments. Results The results showed more than a quarter of pregnant women (34%) experience high prenatal distress and are at risk of postpartum psychosocial conditions (27%). It was also found that prenatal distress was associated with postpartum psychosocial conditions (p Conclusions Postpartum psychosocial conditions are influenced by prenatal distress. This study suggests screening for prenatal distress in mothers from early pregnancy. Awareness of psychosocial state during the prenatal period is essential for preventing problems in the postpartum period.

The different effects of pre-engraftment syndrome (PES) and acute graft-versus-host disease (aGVHD) on outcomes after cord blood transplantation (CBT) are unclear. We retrospectively evaluated the impact of PES and aGVHD on relapse and survival after single-unit CBT in 138 adult patients with hematologic malignancies at our institution between 2004 and 2016. Multivariate analysis demonstrated that development of grade III-IV aGVHD, particularly with gut or liver involvement, significantly contributed to higher nonrelapse mortality (P.001), but PES and grade II-IV aGVHD did not. In subgroup analyses of underlying disease type, the development of PES had a significant effect on decreased relapse (P = .032) and better disease-free survival (DFS) (P = .046) in patients with acute myelogenous leukemia (AML). These data suggest that PES is associated with a reduced relapse rate and better DFS in AML, indicating that the early immune reaction before neutrophil engraftment may provide a unique graft-versus-leukemia effect after single-unit CBT.

Increased red blood cell (RBC) transfusion requirements are associated with morbidity and mortality after allogeneic hematopoietic cell transplantation. However, its impact on the outcomes after cord blood transplantation (CBT) is unclear. We retrospectively analyzed the data of 278 adult patients who received single-unit CBT in our institute. The median number of RBC transfusions for each patient was 12 units (range, 4-66) by day 30 and 14 units (range, 4-70) by RBC engraftment. Sex, cord blood CD34+ cell dose, cytomegalovirus serostatus, total body irradiation dose in the conditioning regimen, ABO blood group incompatibility, and pre-CBT RBC transfusion requirements were significantly associated with the number of RBC transfusion units in the linear regression analysis. In the multivariate analysis, RBC transfusion ≥18 units by day 30 was significantly associated with higher overall mortality (hazard ratio, 1.86; P = 0.018). These data suggested that early RBC transfusion burden was significantly associated with overall mortality in adult patients undergoing single CBT. Early RBC transfusion burden might be a surrogate marker for poor outcomes after single CBT.

INTRODUCTION After the first appearance of peripheral blood neutrophils, recipients from adult donor sources have a rapid increase in neutrophil recovery, whereas cord blood transplantation (CBT) recipients have a slow increase. However, the momentum of neutrophil recovery after CBT varies widely among individuals, but optimal methods to evaluate the momentum of neutrophil recovery and their clinical impacts are yet to be clarified. METHODS We retrospectively examined the prognostic effect of the momentum of neutrophil recovery in the last 7 days until neutrophil engraftment, which was calculated by an exponential growth model, after single CBT following myeloablative conditioning for 207 adults. RESULTS Among patients who achieved each hematopoietic lineage recovery by day 100, the momentum of neutrophil recovery, which was represented as a growth constant, was associated with the day of neutrophil engraftment (P

INTRODUCTION The appearance of erythroblasts (EBLs) in peripheral blood occurs in a variety of serious conditions and has been associated with mortality in critically ill patients. However, the incidence, risk factor, and outcomes of EBLs after cord blood transplantation (CBT) remain unclear. METHODS We have investigated the impact of EBLs on transplant outcomes on 225 adult patients who underwent single-unit CBT at our single institute. RESULTS The cumulative incidences of EBL ≥200 × 106 /L and EBL ≥1000 × 106 /L at 60 days after CBT were 17% and 4%, respectively, detected after a median of 35 days and 36.5 days. Multivariate analysis using erythroblastosis as time-dependent covariates demonstrated the significant association of EBL ≥1000 × 106 /L, but not EBL ≥200 × 106 /L, with the development of grade III-IV acute graft-versus-host disease (GVHD, hazard ratio [HR]: 18.56; P

Introduction There is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. Methods Data collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results 540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. Conclusions The present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem.

Background and aims Severe asthma is burdened by frequent exacerbations and use of oral corticosteroids (OCS) which worsen patients’ health and increase healthcare spending. Aim of this study was to assess the clinical and economic effect of adding mepolizumab (MEP) for the treatment of these patients. Methods Patients >18 years old, referred to 8 asthma clinics, starting MEP between May 2017 and December 2018, were enrolled and followed-up for 12 months. Information in the 12 months before mepolizumab were collected retrospectively. The evaluation parameters included: OCS use, number of exacerbations/hospitalizations, concomitant therapies, comorbidity, and annual number of working days lost due to the disease. The primary objective was to compare the annual total cost per patient pre- and post-MEP. Secondary outcomes included rates of exacerbations and number of OCS-dependent patients. Results 106 patients were enrolled in the study: 46 male, median age 58 years. Mean annual cost pre- and post-MEP (cost of biologic excluded) was €3996 and €1,527, respectively. Total savings due to MEP resulted in €2469 (95%CI 1945–2993), 62% due to exacerbations reduction and 33% due to productivity increase. Such savings could fund about 22% of the total cost of MEP for one year. The introduction of MEP induced a clinical benefit by reducing both OCS-dependent patients (OR = 0.12, 95%CI 0.06–0.23) and exacerbation rate (RR = 0.19, 95%CI 0.15–0.24). Conclusions Patients with severe eosinophilic asthma experienced a clinical benefit in asthma control adding MEP to standard therapy. Biologic therapy can be, partially, funded by the savings produced by patients’ improvement.

Background: Adenomyosis is known to cause reduced clinical pregnancies and increased miscarriage rates in ART (Assisted Reproductive Technology) cycles. The detrimental effect was found to be enhanced if these women would undergo fresh embryo transfer without optimal suppression by GnRH agonist treatment. Several mechanisms were proposed as causative factors such as increased myometrial contractions, decreased implantation and altered endometrial receptivity. But the conclusions from previous studies were mutually conflicting. To ensure adequate regression of the disease prior to embryo transfer, these women would commonly undergo freeze-all and subsequent frozen embryo transfer. On contrary to this, fresh embryo transfer may be necessary in certain justifiable clinical situations. The present study was designed as a retrospective case-control study to compare the ICSI-fresh embryo transfer outcomes of women with adenomyosis to those with tubal factor infertility. This study is aimed to find the extent to which adenomyosis compromises the outcomes of fresh embryo transfer in ICSI cycles. Methods: The data of the eligible patients as per the study criteria, was obtained from the hospital medical records of a tertiary care University teaching hospital, in Chennai, South India. The study groups (Group A: women with adenomyosis, GroupB; women with tubal factor infertility) were compared for the fresh embryo transfer outcomes such as pregnancy rate, clinical pregnancy rate, miscarriage and live birth rates. SPSS version 17 software was used and and PResults: The data of 89 women included in the study (Group A: 47, and Group B: 42) were analysed. The data analysis showed significantly reduced pregnancy, clinical pregnancy, implantation and live birth rates in Group A compared to Group B (25.7 vs. 52.4%; 23.4 vs. 52.4%; 7.6% vs. 26.2%; 17.0 vs. 47.6%, respectively).Conclusions: We found that adenomyosis is associated with a less favourable outcome in ICSI -fresh embryo transfer. Though these results are justifiable if performed with appropriate indications, the cost-effectiveness and indications of such an approach needs to be evaluated on a larger prospective data.

A prior history of cancer was associated with higher non-relapse mortality or overall mortality in patients undergoing allogeneic haematopoietic cell transplantation. Because it is unclear whether the outcomes after cord blood transplantation are influenced by a prior history of cancer, we retrospectively assessed the prevalence and prognostic impact of a prior history of cancer in adult patients undergoing myeloablative single-unit cord blood transplantation in our institute between 2004 and 2020. The univariate analysis showed that a prior history of cancer did not affect the probability of overall survival; the cumulative incidence of relapse; or non-relapse mortality. In the multivariate analysis, prior history of cancer was not associated with overall mortality, relapse or non-relapse mortality. No patients with a prior history of cancer had experienced prior cancer relapse. A prior history of cancer was not associated with non-relapse mortality or overall mortality following single-unit cord blood transplantation.

STUDY QUESTION Is exclusive use of intragestational sac potassium chloride (KCl) and methotrexate (MTX) effective in the management of viable cesarean scar pregnancy (CSP)? SUMMARY ANSWER Exclusive use of intragestational sac KCl and MTX was effective in the management of viable CSP. WHAT IS KNOWN ALREADY Owing to a paucity of randomized studies on management of CSP, evidence-based management remains unclear. Intragestational sac KCl or MTX along with either systemic MTX or surgical intervention, such as uterine artery embolization or dilation and curettage, has proved to be effective in the management of CSP. Furthermore, there are limited data in the literature on the use of exclusive intragestational sac KCl and MTX for management of CSP and subsequent fecundity. STUDY DESIGN, SIZE, DURATION A prospective cohort study was conducted from June 2017 to September 2019. We recruited nine CSP patients referred to our unit. There was no lost to follow-up noted. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients with an ultrasound diagnosis of CSP who fulfilled the inclusion criteria were recruited. The study was conducted in a tertiary care center. Clinical symptoms, pregnancy viability, gestational age and human chorionic gonadotrophin (HCG) values determined the management in each individual case. Accordingly, patients were grouped into the expectant management (Group I, n = 3) and intragestational sac KCl with MTX (Group II, n = 6) groups. Demographic details, clinical characteristics, ultrasound details at diagnosis, post-treatment HCG normalization time, menses resumption, mass resolution and subsequent fecundity were noted. Descriptive statistics were used for analyses. MAIN RESULTS AND THE ROLE OF CHANCE Of the nine patients with CSP, six patients had viable CSP and required intervention. Out of these, four patients expressed a desire for future fertility. Mean gestational age at treatment among patients in Group II was 54.33 ± 7.51 days (range 46–65). Mean HCG value at the time of diagnosis was 84 110 ± 38 679.39 IU/l in Group II patients as compared with 2512 ± 709.36 in Group I. HCG had decreased by 92.7 ± 3.78% 2 weeks after intervention and normalized ( LIMITATIONS, REASONS FOR CAUTION The main limitation of our study was small sample size. All the patients were asymptomatic at presentation and hence we cannot comment on use of this method in those presenting with active vaginal bleeding. WIDER IMPLICATIONS OF THE FINDINGS Intragestational sac KCl plus MTX may be a highly effective approach for the management of viable CSP despite high initial HCG values. There seems to be no need for any further intervention. It can be considered as the first line minimally invasive treatment option in patients desirous of future fertility. Nevertheless, accumulation of further cases is required to validate this treatment modality. STUDY FUNDING/COMPETING INTERESTS No specific funding was received to undertake this study. The authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A

Context: A multidisciplinary approach is one of the many forms of professional practice that can be utilized by sports medicine professionals to provide care to injured athletes. While this approach has been empirically supported in the health care domain, studies supporting its utilization in the sport injury rehabilitation context—particularly at the high school level—are limited. Objective: To investigate former high school athletes’ experiences of a multidisciplinary model of care for sport injury rehabilitation. Design: Cross-sectional survey design. Setting: In-person, in a classroom setting at 2 Division I universities. Patients: A total of 186 former high school athletes. Main Outcome Measure: An author-constructed instrument developed using the multidisciplinary model of care for sport injury rehabilitation as a guide. Results: Family, athletic coaches, and athletic trainers were the closest professionals/individuals that injured athletes reported interacting with during sport injury rehabilitation. The data also revealed that these professionals/individuals had the closest and most direct relationships with the injured athletes. Conclusions: The findings from the present study provided support for the utilization of the multidisciplinary model of care for sport injury rehabilitation with high school athletes.

Platelet transfusion refractoriness (PTR) is frequently observed after allogeneic hematopoietic cell transplantation (HCT). However, the incidence of and risk factors for PTR, and impact of PTR on transplant outcomes after cord blood transplantation (CBT) have not been fully investigated. We retrospectively analyzed 185 adult patients who received single-unit CBT in our institute. The mean 16-hour corrected count increment (CCI) for the 5840 platelet transfusions was 3.68 × 109/L. Among them, 3196 transfusions (54.7%) were associated with a PTR with 16-hour-CCI

Resumo A toracotomia mediana é uma via de acesso que atravessa longitudinalmente o esterno e pode ser subdividida em vertical total, parcial superior e parcial inferior. Na prática cirúrgica, o uso da esternotomia mediana parcial é uma alternativa que proporciona menor agressão cirúrgica. O tronco braquiocefálico é um dos grandes vasos torácicos mais acometidos em traumas e sua abordagem classicamente é feita por esternotomia mediana. Neste trabalho, apresenta-se o uso da esternotomia parcial superior em “T” invertido como possibilidade de via de acesso em situação de lesão traumática iatrogênica do tronco braquiocefálico.

A 30-year-old nulliparous woman was referred with suspected left ovarian ectopic pregnancy. She had undergone laparoscopic left salpingectomy for ruptured tubal ectopic pregnancy 3 weeks earlier, following treatment with medications for ovulation induction. Sonological examination revealed a left ovarian ectopic pregnancy corresponding to 8 0/7 weeks with cardiac activity. She underwent ultrasound-guided intrasac therapy with intrasac instillation of 3 mEq of potassium chloride followed by 50 mg of methotrexate. She was followed with weekly measurements of serum beta human Chorionic Gonadotropin (hCG) which returned to baseline after 65 days of the intrasac therapy. This case not only highlights the need for continued follow-up of the serum beta hCG after definitive management of an ectopic pregnancy in cases with multiple ovulations, but also the option of medical management in cases of advanced ovarian ectopic pregnancy. It also accentuates the necessity for adequate counselling to avoid conception in a multiple ovulation cycle.

Low cryopreserved total nucleated cell (TNC) dose in a cord blood (CB) unit has been shown to be associated with engraftment failure and mortality after single-unit cord blood transplantation (CBT) in adults. Although CB banks offer specific characteristics of cryopreserved cell dose, such as TNC, CD34+ cells, and colony-forming unit for granulocyte/macrophage (CFU-GM), the impact of each cell dose on engraftment and outcomes after single-unit CBT in adults remains unclear. We retrospectively analyzed the results of 306 CBTs for 261 adult patients in our institution between 1998 and 2016. The median age was 43 years (range, 16 to 68), the median actual body weight (ABW) was 56.2 kg (range, 36.2 to 104.0), the median ideal body weight (IBW) was 62.3 kg (range, 39.7 to 81.3), the median TNC dose was 2.46 × 107/ABW kg (range, 1.07 to 5.69), the median CD34+ cell dose was .91 × 105/ABW kg (range, .15 to 7.75), and the median CFU-GM dose was 24.46 × 103/ABW kg (range, .04 to 121.81). Among patients who achieved engraftment, the speed of neutrophil, platelet, and red blood cell engraftment significantly correlated with CD34+ cell dose, but not with TNC and CFU-GM dose, based on both ABW and IBW. In multivariate analysis, the incidence of extensive chronic graft-versus-host disease (GVHD) was significantly higher in patients receiving the highest CD34+ cell dose, based on both ABW and IBW. Nevertheless, no cell dose was associated with survival, transplantation-related mortality, and relapse. In conclusion, cryopreserved CD34+ cell dose was the best predictor for hematopoietic recovery and extensive chronic GVHD after CBT. The cryopreserved CD34+ cell dose should be used for unit selection criteria in single-unit CBT for adults.

This study documented the lived career-ending injury experiences among elite Irish rugby football union (IRFU) players. Three players took part in semistructured one-on-one interviews. Interpretative phenomenological analysis (Smith, 1996) revealed that the process of psychosocial injury rehabilitation and the subsequent transition process was for the most part a distressing one and evolved in a cyclical, yet stage-like (Heil, 1994), manner. The nature of the postinjury career transition appeared to be dependent on the interactional balance of participants’ psychosocial responses to injury, existing coping mechanisms, and other factors related to the injury and career transition process. Appropriate social support network, use of sport medicine and counseling professionals, as well as organizational officials are needed to best prepare elite rugby players for life outside of sport, and to ensure a healthy career transition (Taylor & Ogilvie, 1994) out of sport.

Sport injury rehabilitation has moved from predominately physical treatment to a more holistic care. However, limited research has explored the views and experiences of those involved in such an approach. The purpose of this study was to preliminarily investigate sport psychology consultants' (SPCs') views and experiences of an interprofessional team approach to sport injury rehabilitation. A cross-sectional online survey previously used with athletic trainers was distributed via a US-based sport/exercise psychology list-serve (N = 1245). A total of 62 (27 men, 35 women, M age 38.2 years, age range: 22-73 years) participants with 10.6 (SD = 9.8) years of experience as an SPC were included in the final analyses. On average, SPCs felt that it was very important (M = 6.6; SD = 0.6) for athletes to have access to an interprofessional care team. Of the sample, 64.5% (n = 40) typically worked as part of an interprofessional care team 44.7% of the time. The SPCs (n = 28; 45.2%) also indicated that the primary treatment providers (e.g., athletic trainer, physical therapist) were typically serving as the primary point person for such teams. Since gaining entry to sport medicine can be an area SPCs struggle with, building effective working relationships with treatment providers can help promote and increase SPCs involvement in providing holistic, interprofessional care to athletes with injuries. To ensure athletes' successful biopsychosocial return to sport, different individuals and professionals should work together for the benefit of the athlete by adopting holistic care during sports injury rehabilitation.

The conditioning regimen used for allogeneic hematopoietic cell transplantation (HCT) must eradicate residual tumor cells and provide sufficient immunosuppression to facilitate donor engraftment. H...

Objectives Women are considered to have poorer prognoses after cardiac surgery, although evidence is scarce. The authors studied sex differences and long-term outcomes after surgical aortic valve replacement (SAVR). Design Nationwide retrospective cohort study. Setting Six public hospitals and 2 private hospitals. Participants All first-time SAVR (±coronary artery bypass surgery) patients (excluding endocarditis) aged ≥18 with a prosthetic valve were retrospectively identified from a national registry (n = 7616). Propensity score matching identified 2814 men and 2814 women with comparable baseline features. Interventions No intervention. Measurements and Main Results Outcomes were survival, major bleeding, ischemic stroke, infective endocarditis, and reoperation. Ten-year survival was 66.8% in men and 67.5% in women (hazard ratio [HR] 1.09; p = 0.107). Major bleeding occurred in 21.5% of men and 19.7% of women (HR 1.36; confidence interval [CI] 1.13-1.63; p = 0.0009) within 10 years, with similar results for mechanical and biological prosthesis. Bleeding was gastrointestinal in 38.5%, intracranial in 27.6%, and 33.9% in other sites with no sex difference in location. Ischemic stroke occurred in 12.5% of men and 13.3% of women within 10 years (HR 1.06; p = 0.614), and 4.7% of men and 2.6% of women (HR 1.77; CI 1.24-2.51; p = 0.001) had infective endocarditis, but association was present only with biological prosthesis (interaction p = 0.02). Aortic valve re-surgery was more common in men at 1 (HR 2.98; CI 1.27-7.00; p = 0.013) and 5 years after SAVR, but not at 10 years (2.4% v 3.8%; p = 0.189). Conclusions Baseline-matched long-term survival after SAVR is similar between sexes. Men had increased risk of bleeding, early re-surgery after SAVR, and infective endocarditis when using biological prosthesis.

Early fluid overload has been associated with poor transplant outcomes after allogeneic hematopoietic cell transplantation. However, its effects on the outcomes after cord blood transplantation (CBT) are unclear. We retrospectively analyzed the data of 227 adult patients who received single-unit CBT in our institute. The cumulative incidence of grade ≥2 fluid overload was 4% at day 30 after CBT with a median onset at 16 days (range, 9-30 days) after CBT. In the multivariate analysis, grade ≥2 fluid overload was significantly associated with higher non-relapse mortality (hazard ratio [HR], 5.73; P = 0.011) and overall mortality (HR, 3.81; P = 0.006). Among the entire cohort, 133 patients were treated with low-dose dopamine (0.5-2 µg/kg/min) with a median time of initiation of low-dose dopamine therapy at 10.5 days after CBT. Use of low-dose dopamine significantly increased daily urine output and decreased body weight. These data suggested that early fluid overload was significantly associated with non-relapse and overall mortality after single CBT. The early intervention of low-dose dopamine to prevent early fluid overload is a matter of future investigation for patients undergoing allogeneic hematopoietic cell transplantations (HCT), particularly for CBT.

Genetic mutation is one of the most powerful prognostic factors for adult patients with acute myeloid leukemia (AML). The FMS-like tyrosine kinase 3 (FLT3) gene mutations, including internal tandem...

Hematogones are normal B-lymphocyte precursors identified in the regenerative state of the bone marrow following allogeneic hematopoietic stem cell transplantation (HSCT). To evaluate the impact of hematogones on long-term outcomes after single-unit cord blood transplantation (CBT), we retrospectively analyzed 134 adult patients at our institute. At the median time of 41 days (range, 20 to 77 days) after CBT, the median proportion of morphological hematogones in bone marrow was found to be 2.4% (range, 0 to 13.0%). In the patients with standard-risk, the higher proportion of morphological hematogones was associated with lower transplant-related mortality (TRM) after CBT. The proportion of hematogones did not affect the subsequent absolute lymphocyte counts in the peripheral blood and serum immunoglobulin G levels six months later after CBT. These data shows that morphological hematogones in the routine bone marrow analysis might be a practical and easily evaluable method of predicting outcomes aft...

Coexisting hematopoiesis from donor and recipient origin, called a mixed chimerism status, can occur in patients after myeloablative allogeneic hematopoietic stem cell transplantation. However, its impact on the outcomes of cord blood transplantation (CBT) has yet to be clarified. We retrospectively analyzed 150 adult patients who received myeloablative single-unit CBT for hematological malignancies in our institute. At the median time of first bone marrow analysis of 41 days after CBT, mixed chimerism was observed in 16 of the 150 patients. Among patients with mixed chimerism, 4 patients relapsed. The remaining 12 patients were alive and in remission at a median follow-up of 50 months. Bone marrow-mixed chimerism did not have a significant impact on the incidences of disease-free survival, relapse, or transplant-related mortality after CBT. These data show that early phase mixed chimerism did not have a significant impact on long-term outcomes after myeloablative single-unit CBT for hematological malignancies.

The Perceived Susceptibility to Sport Injury (PSSI) scale is a measure that has recently surfaced in the sport injury literature. The factor structure of the PSSI scale has not been subjected to a rigorous factor analysis; thus, the factorial validity of the measure in athlete populations is unknown. To establish the validity of the PSSI scale in sports medicine research, the purpose of this study was to examine the factor structure and measurement invariance across gender of the PSSI scale. Male and female intercollegiate athletes (N = 217) completed the PSSI scale during the off-season. The factor structure was analyzed using confirmatory factor analysis (CFA) procedures and maximum likelihood estimation. The measurement invariance analysis was conducted via comparisons of fit indices within a series of hierarchically constrained models. Results of the CFA yielded a very good fit of the measurement model: χ2 (2) = 4.535, P = 0.104; RMSEA = 0.076; SRMR = 0.018; CFI = 0.995; NNFI = 0.985. Results of the measurement invariance analysis demonstrated strict invariance across gender, and no significant latent mean differences emerged between men and women. Study results support the factorial validity of the PSSI scale for use in future sports medicine research.

The novel composite endpoint of graft-versus-host disease/relapse-free survival (GRFS) was proposed to evaluate ideal healthy recovery without ongoing morbidity in patients undergoing allogeneic hematopoietic cell transplantation (HCT). We herein analyzed long-term GRFS based on the data of 256 patients with hematological malignancies who underwent allogeneic HCT after myeloablative conditioning. The probabilities of GRFS in the entire cohort were 60.1% at 1 year, and 48.6% at 5 years. Compared with unrelated cord blood, the probability of treatment failure as defined by GRFS at 5 years was similar with matched sibling donor (hazard ratio [HR]: 1.33; p = 0.28), but was significantly higher with matched unrelated donor (HR: 1.96; p = 0.01) in multivariate analysis. Unrelated cord blood achieved the highest proportion of patients who had not experienced any GRFS events at 5 years. These data suggest that long-term GRFS after HCT was similar in matched sibling donor recipients to unrelated cord blood recipients.

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in young women. Insulin resistance (IR) may play a substantial part in the pathogenesis of PCOS, which leads to type 2 diabetes mellitus (T2DM), cardiovascular disorders and ovarian cancer. Metformin is an insulin sensitizing agent, however its role in PCOS is still controversial. Methods: Sixty women newly diagnosed with PCOS and healthy age matched controls between 18 to 45 years were enrolled after obtaining informed consent. Women in the PCOS group were started on metformin-SR 1gram orally, which was then increased to 1.5 grams after two weeks and continued for 6 months. Fasting blood sugar (FBS), fasting insulin (FI), SHBG, TT, free androgen index (FAI), homeostatic model assessment of Insulin resistance (HOMA-IR), homeostatic model assessment of β- cell function (HOMA-B), homeostatic model assessment of Insulin sensitivity (HOMA-S) and quantitative insulin sensitivity check index (QUICKI) were measured in the control group as well as PCOS group before and after metformin therapy. Results: After six months of metformin-SR therapy, PCOS group showed significant reduction in FI, HOMA-IR, HOMA- β, HOMA-S QUICKI, TT and FAI and significant increase in SHBG levels. Conclusions: Six months of metformin-SR therapy favorably altered markers of IR, TT, SHBG, anovulation and hyperandrogenism in normoglycemic women with PCOS.

BACKGROUND: Serum estradiol (E2) levels are measured in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), to assess the ovarian response and to predict ovarian hyperstimulation syndrome. The impact of peak E2 levels on IVF-ICSI outcome was found to be inconsistent in the previous studies. AIM: To evaluate the impact of the serum E2 levels on the day of ovulation trigger with the reproductive outcome of ICSI. SETTINGS AND DESIGN: Retrospective observational study. ART Center, at a Tertiary Care University Teaching Hospital. SUBJECTS AND METHODS: Eighty-nine infertile women, who underwent ICSI with fresh embryo transfer over a period of 3 years, were included in the study. The study subjects were grouped based on the serum E2 level on the day of ovulation trigger:- Group I - 4000 pg/ml. The baseline characteristics and controlled ovarian hyperstimulation (COH) outcome were compared among the study groups. STATISTICAL ANALYSIS USED: Chi-square test, Student's t-test, ANOVA, and logistic regression analysis. RESULTS: The study groups were comparable with regard to age, body mass index, ovarian reserve. Group V had significantly higher number of oocytes retrieved than I and II (18.90 vs. 11.36 and 11.33; P = 0.009). Group IV showed significantly higher fertilization rate than I, III, and V; (92.23 vs. 77.43, 75.52, 75.73; P = 0.028). There were no significant differences in the implantation rates (P = 0.368) and pregnancy rates (P = 0.368). CONCLUSION: Higher E2 levels on the day of ovulation trigger would predict increased oocyte yield after COH. E2 levels in the range of 3000–4000 pg/ml would probably predict increased fertilization and pregnancies in ICSI cycles.

Markers of inflammatory and nutritional status, such as the Controlling Nutritional Status (CONUT) score, Prognostic Nutritional Index, Glasgow Prognostic Score, and C-reactive protein-albumin ratio (CAR) has been demonstrated to be associated with poor prognosis in patients with various cancers. Although the relatively low cell dose of a single cord blood unit restricts the indication for cord blood transplantation (CBT) to pediatric and relatively smaller and lighter adult patients, the impact of malnutrition on outcomes after CBT is unclear. We retrospectively analyzed 165 adult patients who underwent myeloablative single-unit CBT in our institute. In multivariate analysis, a higher CONUT score, which is indicative of poor inflammatory and nutritional status, was significantly associated with poor outcomes, including low neutrophil engraftment and development of extensive chronic graft-versus-host disease. A higher CAR, which is also suggestive of poor inflammatory and nutritional status, was significantly associated with poor neutrophil engraftment and higher overall mortality. Body mass index (BMI) was not associated with transplantation outcomes. These data suggest that poor pretransplantation inflammatory and nutritional status might be a more practical parameter than lower BMI, for predicting transplantation outcomes after single CBT for adults.

The optimal intensity of a conditioning regimen might be dependent on not only age and comorbidities but also disease activity and the type of graft source. We evaluated the outcome of unrelated single cord blood transplantation (CBT) using a conditioning regimen of fludarabine 180 mg/m2, i.v. busulfan 9.6 mg/kg, 4 Gy total body irradiation, granulocyte colony-stimulating factor–combined high-dose cytarabine (12 g/m2) in 23 elderly patients (median, 64 years) with nonremission myeloid malignancies between 2013 and 2018 in our institution. All but 1 patient achieved neutrophil engraftment at a median of 23.5 days (range, 18 to 50). With a median follow-up of 28 months, the probabilities of overall survival (OS), disease-free survival (DFS), and cumulative incidence of relapse at 2 years were 62%, 52%, and 26%, respectively. The cumulative incidences of nonrelapse mortality at 100 days and 2 years were 9% and 22%, respectively. In the univariable analysis a higher proportion of blasts in bone marrow and in peripheral blood and a monosomal or complex karyotype were significantly associated with inferior OS and DFS. Poor cytogenetics were significantly associated with inferior DFS and increased relapse incidence. These data demonstrate that this reduced-toxicity myeloablative conditioning regimen was tolerable and effective in terms of engraftment, relapse, and survival in single CBT for elderly patients with nonremission myeloid malignancies.

Hospital readmissions have been used as a prognostic indicator for patients receiving allogeneic hematopoietic cell transplantation (HCT). However, the impact of readmission during early and mid-phase of cord blood transplantation (CBT) on long-term outcomes has not been fully investigated. We retrospectively analyzed 156 adult patients who received single-unit CBT in our institute. Among this cohort, thirteen patients (8%) were readmitted within 30 days after discharge, and 27 (17%) were readmitted within 90 days after discharge. The most common causes for readmission within 30 and 90 days of discharge were infection, chronic graft-versus-host disease, and relapse. Higher cryopreserved cord blood CD34+ cell count was only significantly associated with lower readmission within 90 days after discharge. The probabilities of overall survival were significantly lower in patients readmitted within 90 days after discharge compared with those who were not readmitted within 90 days after discharge in univariate and multivariate analysis. These data suggest that readmission within 90 days after discharge may have a significant impact on long-term mortality after single-unit CBT.

Liposomal amphotericin B (L-AMB) is widely used for empirical or preemptive therapy and treatment of invasive fungal infections after cord blood transplantation (CBT). We retrospectively examined the efficacy and safety of low-dose L-AMB in 48 adult patients who underwent CBT between 2006 and 2017 in our institute. Within the entire cohort, 42 patients (88%) received L-AMB as empirical or preemptive therapy. The median daily dose of L-AMB and the median cumulative dose of L-AMB were 1.20 mg/kg/day (range, 0.62 to 2.60 mg/kg/day) and 30.6 mg/kg (range, 0.7 to 241.5 mg/kg), respectively. The median duration of L-AMB administration was 21.5 days (range, 1 to 313 days). A documented breakthrough fungal infection occurred in 1 patient during L-AMB treatment, and 43 patients (90%) survived for at least 7 days after the end of L-AMB treatment. Grade 3 or higher hypokalemia and hepatotoxicity were frequently observed during L-AMB treatment. However, no patient developed an increase in serum creatinine levels of grade 3 or higher. In univariate analyses using a logistic regression model, a duration of L-AMB treatment of more than 21 days and a cumulative dose of L-AMB of more than 30 mg/kg were significantly associated with nephrotoxicity and grade 3 hypokalemia. These data suggest that low-dose L-AMB may be safe and effective in adult patients undergoing CBT.

The efficacy of second allogeneic stem cell transplantation (SCT2) using cord blood (CB) for patients with relapsed hematological malignancies after initial allogeneic stem cell transplantation (SCT1) is unknown. We analyzed the results of SCT2 using single-unit unrelated CB in 34 adult patients with relapsed hematological malignancies after SCT1 in our institution. The patients had acute myeloid leukemia (n = 23), acute lymphoblastic leukemia (n = 7), chronic myelogenous leukemia (n = 2), and myelodysplastic syndrome (n = 2). The cumulative incidence of neutrophil and platelet engraftment was 81.6% at 30 days and 68.5% at 100 days, respectively. With a median follow-up of 40 months, the probability of overall survival at 3 years was 29.0%. The cumulative incidence of relapse and transplant-related mortality at 3 years were 60.7% and 27.2%, respectively. The use of CB could offer the opportunity to receive SCT2 for patients who experienced disease relapse after SCT1 without HLA-identical related or unrelated donors.

Taste disorders are one of the most common complications in patients undergoing allogeneic hematopoietic cell transplantation (HCT). They persist in some patients as a late complication 3 months or more after HCT. Therefore, we conducted a cross-sectional study to evaluate the prevalence and predictive factors of late taste disorders, with the help of a self-reporting and closed-ended questionnaire, which was distributed among 91 patients in our institute. The median age at this study was 50 (range, 25-69) years. The median follow-up period was 54 (range, 3-234) months after HCT. Taste disorders were observed in 43 patients (47%). The most frequent form of late taste disorders was reduced appetite in 18 patients (20%). The most frequent form of decline of basic taste was umami, which was observed in 12 patients (13%). Almost all taste disorders were mild in their severity. Multivariate logistic regression analyses showed that the duration of less than 1 year post HCT and the presence of oral chronic graft-versus-host disease are important risk factors for late taste disorders in survivors of HCT. These data suggested that taste disorders usually return to normal levels more than a year after HCT in most recipients.

Background: Recent literature suggests that Active Video Games (AVGs) may offer potential psychological benefits during the rehabilitation of musculoskeletal injuries and their corresponding deficiencies. Objectives: To review existing literature regarding the potential psychological benefits of AVGs within the context of rehabilitation from musculoskeletal injury or debilitation. Method: A narrative review of the literature that used the Population, Intervention, Comparison, and Outcomes PICO method was conducted. The literature review included studies that discussed and/or investigated potential psychological benefits of AVGs during musculoskeletal rehabilitation. Of the total 163 papers that were identified, 30 met the inclusion criteria. Results: The Nintendo® WiiTM (Nintendo Co., Ltd, Kyoto, Japan) was the most commonly-used games console that was employed in AVG interventions (15 out of 21), and these studies that investigated potential psychological benefits were typically conducted with elderly populations. These studies reported that using AVGs in musculoskeletal rehabilitation resulted in a number of positive psychological effects (e.g., enjoyment, effects on self). However, most studies lacked a clear theoretical framework, and varied greatly in their designs and methodologies. Conclusion: Despite encouraging findings of AVG use, insufficient evidence exists to reliably verify or refute the potential psychological benefits of AVGs in musculoskeletal rehabilitation. It is recommended that future studies in this area contain a theoretical framework to ensure greater consistency in the methodology used and the execution of the intervention. The potential findings of such investigations may result in the development of optimal, client-tailored rehabilitation programmes.