Miracle-dz/UniFAR-FTUs huggingface dataset:
Relationship between obesity and clinical outcome in adults with acute myeloid leukemia: A pooled analysis from four CALGB (alliance) clinical trials

Obesity has been previously suggested as an adverse prognostic marker in patients with acute leukemia. To evaluate the relationship between obesity and clinical outcome, disease‐free survival (DFS) and overall survival (OS), in patients with acute myelogenous leukemia (AML), including acute promyelocytic leukemia (APL), we performed a pooled analysis of four CALGB (Alliance) clinical trials. Our study included 446 patients with APL from CALGB 9710, and 1,648 patients between 18 and 60 years of age with non‐APL AML from CALGB 9621, 10503, and 19808. Obesity was defined as BMI ≥30 kg/m2. Multivariate Cox proportional‐hazard regression models were fitted for DFS and OS. Obesity was seen in 50% and 38% of APL and non‐APL AML patients, respectively. In APL patients, obesity was associated with worse DFS (HR 1.53, 95% CI 1.03–2.27; P = 0.04) and OS (HR 1.72, 95% CI 1.15–2.58; P = 0.01) after adjusting for age, sex, performance status, race, ethnicity, treatment arm and baseline white blood cell count. Obesity was not significantly associated with DFS or OS in the non‐APL AML patients. In conclusion, our study indicates that obesity has significant prognostic value for DFS and OS in APL patients, but not for non‐APL AML patients. Am. J. Hematol. 91:199–204, 2016. © 2015 Wiley Periodicals, Inc.
Investigation of Bioabsorbable Screw Usage for Long Bone Fracture Repair in the Horse: Interfragmentary Compression and Axial Load Response in Equine Cadaver Longbone Fractures

Summary The purpose of the study was to compare biomechanical features of bioabsorbable, self-reinforced poly-L-lactic acid (SR-PLLA) and stainless steel (ASIF) 4.5 mm cortical screws. Tests were conducted in equine cadaver third metacarpal bones in which a simulated complete and displaced condylar fracture had been created by osteotomy. An evaluation of the amount of interfragmental compression achieved with each screw type was performed using electrical resistance strain gauges placed in proximity to the osteotomy. This revealed a substantial increase in interfragmental compression when ASIF screws were used compared to the SR-PLLA screw. A hybrid of the two screw types did however achieve adequate interfragmental compression. Comparison of the strength of fracture fixation through response to axial loading revealed significant difference between use of three ASIF screws and a hybrid of one SR-PLLA and two ASIF screws (p = 0.04) or two ASIF (p = 0.01) screws alone. It appeared that the hybrid configuration did have a mechanical advantage over the two ASIF screw arrangement. The results indicate that the SR-PLLA screw is inferior to the stainless steel screw as a means of primary fracture reduction in the horse. A less mechanically demanding role may yet enable usage of the bioabsorbable screws in equine fracture repair, although they proved inadequate in this testing environment. This study examined the inter-fragmental compression and response to axial loading of bioabsorbable and stainless steel 4.5 mm cortical screws in simulated condylar fractures in equine cadaver longbones. The stainless steel screw was superior in both compression and response to axial loading. It was concluded that the bioabsorbable screw did not possess characteristics that would allow it to bring about adequate primary fracture repair.
Hepcidin as a new biomarker for detecting autologous blood transfusion

Autologous blood transfusion (ABT) is an efficient way to increase sport performance. It is also the most challenging doping method to detect. At present, individual follow‐up of haematological variables via the athlete biological passport (ABP) is used to detect it. Quantification of a novel hepatic peptide called hepcidin may be a new alternative to detect ABT. In this prospective clinical trial, healthy subjects received a saline injection for the control phase, after which they donated blood that was stored and then transfused 36 days later. The impact of ABT on hepcidin as well as haematological parameters, iron metabolism, and inflammation markers was investigated. Blood transfusion had a particularly marked effect on hepcidin concentrations compared to the other biomarkers, which included haematological variables. Hepcidin concentrations increased significantly: 12 hr and 1 day after blood reinfusion, these concentrations rose by seven‐ and fourfold, respectively. No significant change was observed in the control phase. Hepcidin quantification is a cost‐effective strategy that could be used in an “ironomics” strategy to improve the detection of ABT. Am. J. Hematol. 91:467–472, 2016. © 2016 Wiley Periodicals, Inc.
Hodgkin lymphoma post‐transplant lymphoproliferative disorder: A comparative analysis of clinical characteristics, prognosis, and survival

Hodgkin lymphoma post‐transplant lymphoproliferative disorder (HL‐PTLD) is an uncommon PTLD with unclear prognosis and differences between HL‐PTLD and immunocompetent HL are not well defined. Patient characteristics were compared among 192 patients with HL‐PTLD from the Scientific Registry of Transplant Recipients and 13,847 HL patients in SEER (HL‐SEER). Overall survival (OS) and disease‐specific survival (DSS) were compared after exact matching. Additionally, multivariable analyses were used to identify prognostic markers of survival and associations between treatment and survival. Median time from transplant to HL‐PTLD diagnosis was 88 months. When compared with HL‐SEER, patients with HL‐PTLD were older (median age, 52 vs. 36 years, P = 0.001), more likely male (73% vs. 54%, P < 0.001), Caucasian (81% vs. 70%, P = 0.02), and had extranodal disease (42% vs. 3%, P < 0.001). Five‐year OS for patients with HL‐PTLD was 57% versus 80% for HL‐SEER (P < 0.001); DSS was also inferior (P < 0.001). For patients with HL‐PTLD, the use of any chemotherapy was associated with decreased hazard of death (HR = 0.36, P < 0.001). Furthermore, patients who received no chemotherapy or nontraditional HL regimens had increased hazard of death (aHR = 2.94, P = 0.001 and 2.01, P = 0.04) versus HL‐specific chemotherapy regimens. In multivariable analysis, advanced age and elevated creatinine were associated with inferior OS (aHR = 1.26/decade P < 0.001 and 1.64/0.1 mg/dL increase P = 0.02). A prognostic score based on the number of these adverse factors (0, 1, 2) was associated with 10‐year OS rates of 79%, 53%, and 11%, respectively (P < 0.001). Altogether, HL‐PTLD patients have inferior survival when compared with HL‐SEER. Furthermore, treatment with HL‐specific chemotherapy was associated with improved OS, whereas age and creatinine identified patients with markedly divergent survival. Am. J. Hematol. 91:560–565, 2016. © 2016 Wiley Periodicals, Inc.
Diagnóstico de infarto miocárdico perioperatorio dentro de las primeras 72 horas posteriores a la cirugía cardiaca

One of the most frequent complications of cardiac surgery is the perioperative myocardial infarction (PMI). Incidence of PMI shows a wide variation because an accurate detection of this complication is difficult in the early postoperative stage. The objectives of the present study were to determine in our population of patients the incidence of PMI during the first seventy two hours after cardiac surgery as well as associations among the accepted criteria to diagnose this complication. Patients and methods: One hundred sixty four adults patients undergoing elective cardiac surgery were studied. With baselines preoperative studies, serial electrocardiographic, enzymatic [(determination of serum creatine kinase isoenzyme (CK-MB)] and echocardiographic studies were performed during the first 72 hours after cardiac surgery. Diagnosis of PMI was established with two or all the three positive criteria [electrocardiographic (ECG), enzymatic (CK-MB) and echocardiographic (ECHO)]. Results: In 24(15%) patients PMI was diagnosed. In this group 13(54%) all the three criteria were positive. In 8(33%) patients CK-MB and ECHO were positive. In 3(13%) patients CK-MB and ECG were positive. Conclusions: In our population the incidence of PMI (15%) is agree with the reported in previous studies. In most of cases of PMI all the three diagnostic criteria are positive. When diagnosis is established only with two criterial, in most of cases these are CK-MB and ECHO.
Unrelated donors are associated with improved relapse‐free survival compared to related donors in patients with myelodysplastic syndrome undergoing reduced intensity allogeneic stem cell transplantation

Reduced intensity allogeneic stem cell transplantation (RI alloSCT) is a potentially curative treatment approach for patients with myelodysplastic syndrome (MDS). It is currently unclear if older related donors are better than younger unrelated donors for patients with MDS undergoing RI alloSCT. We retrospectively studied 53 consecutive MDS patients who underwent RI alloSCT between April 2007 and June 2014 and evaluated associations between donor type and outcomes with adjustment for significant covariates. 34 patients (median age: 64 years) and 19 patients (median age: 60 years) received allografts from unrelated and related donors, respectively. Unrelated donors were younger than related donors (median age: 32 vs. 60 years, P < 0.0001). There were no significant differences in baseline disease characteristics of patients receiving allografts from related or unrelated donors. Patients who received allografts from unrelated donors had a lower relapse risk (adjusted hazard ratio [aHR] = 0.35, P = 0.012) and improved relapse‐free survival (aHR = 0.47, P = 0.018). HLA mismatched unrelated donors were associated with a higher risk of grade 2–4 acute graft versus host disease (GVHD) (HR = 4.64, P = 0.002) without an accompanying increase in the risk of non‐relapse mortality (P = 0.56). Unrelated donors provided a higher mean CD8 cell dose (P = 0.014) and were associated with higher median donor T cell chimerism at day 60 (P = 0.003) and day 100 (P = 0.03). In conclusion, patients with MDS who received allografts from unrelated donors had a lower risk of relapse and improved relapse‐free survival when compared to patients who received allografts from related donors. These findings should be confirmed in a prospective study. Am. J. Hematol. 91:883–887, 2016. © 2016 Wiley Periodicals, Inc.
Incidence, etiology, and outcome of pleural effusions in allogeneic hematopoietic stem cell transplantation

Pleural effusion is a known entity in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT); however, the incidence, risk factors, and morbidity−mortality outcomes associated with pleural effusions remain unknown. We retrospectively evaluated pleural effusions in 618 consecutive adult patients who underwent allogeneic HSCT from January 2008 to December 2013 at our institution. Seventy one patients developed pleural effusion at a median of 40 days (range, 1 − 869) post‐HSCT with the cumulative incidence of 9.9% (95% CI, 7.7 − 12.5%) at 1 year. Infectious etiology was commonly associated with pleural effusions followed by volume overload and serositis type chronic GVHD. In multivariate analysis, higher comorbidity index (P = 0.03) and active GVHD (P = 0.018) were found to be significant independent predictors for pleural effusion development. Higher comorbidity index, very high disease risk index, ≤7/8 HLA matching, and unrelated donor were associated with inferior overall survival (OS) (P < 0.03). More importantly, patients with pleural effusion were noted to have poor OS in comparison to patients without pleural effusion (P < 0.001). Overall, pleural effusion is a frequently occurring complication after allogeneic HSCT, adding to morbidity and mortality and hence, early identification is required. Am. J. Hematol. 91:E341–E347, 2016. © 2016 Wiley Periodicals, Inc.
Determinants of resting cerebral blood flow in sickle cell disease

Stroke is common in children with sickle cell disease and results from an imbalance in oxygen supply and demand. Cerebral blood flow (CBF) is increased in patients with sickle cell disease to compensate for their anemia, but adequacy of their oxygen delivery has not been systematically demonstrated. This study examined the physiological determinants of CBF in 37 patients with sickle cell disease, 38 ethnicity matched control subjects and 16 patients with anemia of non‐sickle origin. Cerebral blood flow was measured using phase contrast MRI of the carotid and vertebral arteries. CBF increased inversely to oxygen content (r2 = 0.69, P < 0.0001). Brain oxygen delivery, the product of CBF and oxygen content, was normal in all groups. Brain composition, specifically the relative amounts of grey and white matter, was the next strongest CBF predictor, presumably by influencing cerebral metabolic rate. Grey matter/white matter ratio and CBF declined monotonically until the age of 25 in all subjects, consistent with known maturational changes in brain composition. Further CBF reductions were observed with age in subjects older than 35 years of age, likely reflecting microvascular aging. On multivariate regression, CBF was independent of disease state, hemoglobin S, hemoglobin F, reticulocyte count and cell free hemoglobin, suggesting that it is regulated similarly in patients and control subjects. In conclusion, sickle cell disease patients had sufficient oxygen delivery at rest, but accomplish this only by marked increases in their resting CBF, potentially limiting their ability to further augment flow in response to stress. Am. J. Hematol. 91:912–917, 2016. © 2016 Wiley Periodicals, Inc.
An MRI scale for assessment of haemophilic arthropathy from the International Prophylaxis Study Group

Evaluation of prophylactic treatment of haemophilia requires sensitive methods. To design and test a new magnetic resonance imaging (MRI) scale for haemophilic arthropathy, two scales of a combined MRI scoring scheme were merged into a single scale which includes soft tissue and osteochondral subscores. Sixty‐one joint MRI's of 46 patients with haemophilia were evaluated by four radiologists using the new and older scales. Forty‐six of the joints were evaluated using two X‐ray scales. For all MRI scores, interreader agreement and correlations with X‐ray scores and lifetime number of haemarthroses were analysed. The interreader agreement intraclass correlation coefficient was 0.82, 0.89 and 0.88 for the soft tissue and osteochondral subscores and the total score, as evaluated according to the new MRI scale, compared to 0.80 and 0.89 as for the older scales. The total score and osteochondral subscore according to the new scale, as well as scores according to the older scales were correlated (P < 0.01) with number of haemarthroses (Spearman correlation 0.35–0.68) and with the X‐ray scores (Spearman correlation 0.40–0.76), but no correlation (P > 0.05) was found between the soft tissue subscore of the new MRI scale and the X‐ray scores. The new MRI scale is simpler to apply than the older and has similar reader reliability and correlation with lifetime number of haemarthroses, and by separating soft tissue and osteochondral changes it gives additional information. The new scale is useful for analyses of early and moderate stages of arthropathy, and may help to evaluate prophylactic haemophilia treatment.
Low incidence of pneumocystis pneumonia utilizing PCR‐based diagnosis in patients with B‐cell lymphoma receiving rituximab‐containing combination chemotherapy

Recent literature has demonstrated concern over the risk of Pneumocystis jirovecii pneumonia (PJP) when administering rituximab with combination chemotherapy such as in R‐CHOP; however, the exact risk and potential need for prophylaxis is unknown. We sought to determine the incidence of PJP infection following R‐CHOP administration in patients with B‐cell lymphoma. Consecutive patients diagnosed with B‐cell lymphoma receiving R‐CHOP were evaluated from chemotherapy initiation until 180 days after the last administration. The primary outcome was cumulative incidence of PJP infection. Secondary endpoints included the association of rituximab, prednisone and subsequent chemotherapy with PJP infection risk. A total of 689 patients (53% male, median age 66 years) were included. Seventy‐three percent of patients completed at least 6 cycles of R‐CHOP treatment. Median rituximab and prednisone cumulative doses were 3950 mg and 5325 mg, respectively. Median daily prednisone dose through end of treatment was 45 mg (range 7.6 mg to 119 mg). The cumulative incidence of PJP was 1.51% (95% CI 0.57–2.43, at maximum follow‐up of 330 days), below 3.5%, the conventional threshold for prophylaxis. Univariate analysis did not detect a statistically significant association between PJP and rituximab, steroids, or receipt of additional chemotherapy in this patient population. Our results demonstrate a low occurrence of Pneumocystis pneumonia during R‐CHOP treatment of B‐cell lymphoma and argue against universal anti‐Pneumocystis prophylaxis in this setting. Further investigations should focus on targeted anti‐Pneumocystis prophylaxis for patients presenting with high‐risk baseline characteristics or when receiving rituximab‐inclusive intensive combination chemotherapy regimens as treatment for other aggressive lymphoma subtypes. Am. J. Hematol. 91:1113–1117, 2016. © 2016 Wiley Periodicals, Inc.
Resistance exercise plus to aerobic activities is associated with better lipids' profile among healthy individuals: the ATTICA study.

BACKGROUND The influence of different types of exercise on risk factors for cardiovascular diseases has rarely been investigated. The aim of the present work was to evaluate the effect of adding resistance exercise to aerobic activities on lipid-lipoprotein profile, in a representative sample of men and women from the province of Attica, Greece. METHODS We randomly enrolled 1514 and 1528 healthy men and women, respectively, stratified by city, age and gender distribution. Participants were classified as inactive (INA), sufficiently active (SA) and highly active for either aerobic activities (HAA) alone or a combination of aerobic plus resistance exercise (HAC). The main outcome measures are lipid-lipoprotein profile [total, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, apolipoprotein-A1, apolipoprotein-B] and anthropometric indices. RESULTS From those participating in aerobic activities, 480 (31.7%) men and 502 (32.9%) women were classified as SA, 100 men (6.6%) and 93 women (6.1%) as HAA and 90 men (5.9%) and 49 women (3.2%) as HAC. After various adjustments were made, men from the HAC group had an average of 23% lower plasma triacylglycerol concentration (P = 0.04) and 10% lower LDL-cholesterol (P = 0.01) when compared with the HAA group. Moreover, women from the HAC group had 13% lower LDL-cholesterol when compared with HAA group (P = 0.051). CONCLUSION These data suggest that combining aerobic and resistance-type activities may confer a better effect on lipoprotein profile in healthy individuals than aerobic activities alone.
Daily pain in adults with sickle cell disease—a different perspective

Previous reports demonstrated that patients with sickle cell disease (SCD) experience pain on more than half of the observed days. Yet, these high incidences do not seem to match observations in our population. In this prospective cohort study, we aimed to assess the frequency and characteristics of daily, self‐reported pain among adult SCD patients in the Netherlands. Consecutive patients were enrolled during routine outpatient visits and followed up to 6 months. A total of 55 patients completed 5,982 diary observation days. Median age was 27 years (IQR 23‐43). Patients reported SCD related pain on 17% of the observed days; on 13% of these days this pain was not defined as a painful crisis, while 3% was reported as a painful crisis but managed at home, and on 1% of the observed days patients were admitted to the hospital. Analgesics were used on 52% of days with pain with a relatively infrequent use of oral opioids (9% of pain days). This first European study on pain in SCD indicates that pain appears to be significantly less frequent in our population as compared to previous study cohorts from the United States, and may be more representative for current SCD populations in other Western countries. Besides a more widespread use of hydroxycarbamide in modern disease management, differences in organization and accessibility of healthcare between countries may also explain this discrepancy.
Serum ferritin values between 300 and 800 ng/mL in nontransfusion‐dependent thalassemia: A probability curve to guide clinical decision making when MRI is unavailable

cedures, there are no published reports to date of those requiring a heart transplant. Heart transplant surgery is a long procedure requiring the use of CPB. It results in widespread activation of the hemostatic system therefore requiring systemic anticoagulation, and poses many challenges, including dilutional coagulopathy, consumption of coagulation factors, fibrinolysis, inflammatory reactions, and platelet and endothelial activation. Many strategies exist to mitigate bleeding, such as administration of concentrated clotting factors. These products have been used off-label to supplement transfusion protocols for bleeding after CPB in adults, however, efficacy data are limited. In this patient, dabigatran was chosen prior to heart transplant for stroke prevention in NVAF for ease of administration with the knowledge that idarucizumab was available should the patient develop bleeding or a donor heart become available. Although andexanet-alpha is currently being evaluated for its use to reverse factor Xa inhibitors, such as apixaban, rivaroxaban, enoxaparin, and edoxaban, for patients with life-threatening bleeding, this agent is not yet commercially available. Other options for reversal such as 4PCC or activated prothrombin complex concentrate such as factor eight inhibitor bypassing activity, have been studied and have uncertain efficacy when reversing anticoagulation with DOACs. Based on these considerations, dabigatran was chosen for oral anticoagulation in this patient. Patients with an unpredictable timing of surgery or procedures requiring CPB pose a challenge for those requiring long-term oral anticoagulation, unlike elective procedures that allow time for periprocedural anticoagulation management when holding doses may be sufficient. In this case, idarucizumab was shown to successfully neutralize dabigatran activity and enable heart transplant on CPB without excess bleeding, blood transfusions, re-operation for bleeding, or for repeat dose of idarucizumab. Despite institutional guidelines addressing emergent use, detailed procedures regarding administration time and laboratory testing for urgent peri-operative use were not incorporated. Retrospective review by our inpatient anticoagulation management stewardship service identified a number of areas for improved guidance in this real world case, including timing of administration in relation to surgery, and appropriate lab testing. Detailed administration guidelines and education are needed at the institutional level for optimal use of idarucizumab.