Zobrazení zdroje stránky Limlundgren4301

Stem cell transplantation remains the curative option for many patients with hematological malignancies. The long-term effects of these treatments on the patients and their immune systems have been extensively investigated, but there remains a paucity of data regarding autoimmune manifestations post-transplant, although these effects are well recognized.Herein we present the clinical picture and therapeutic approach in three patients (cases 1-3), with varied presentations of autoimmune disease post-transplant. Case 1 exhibited autoimmune hemolytic anemia and other autoimmune manifestations (serositis, thyroiditis), that were probably linked to graft versus relapsed leukemia effect. Cases 2 and 3 had pure red white cell aplasia and pure red cell aplasia, respectively, which were associated with hyperglobulinemia and a clonal T cell expansion.<br /><br /> Intensive care unit (ICU) care is routinely required after the operation to initiate mandibular distraction osteogenesis (MDO) in infants with Robin sequence (RS). Many patients are also managed in the ICU after subsequent device removal. It is uncertain if ICU care, which is expensive and limited, is necessary after this second operation. The objective of this study was to evaluate the incidence of respiratory events following device removal. We hypothesized that respiratory events would be infrequent and non-ICU inpatient monitoring would be adequate.<br /><br /> This is a retrospective study of patients with RS from 2013 to 2018.<br /><br /> Patients were included if they had MDO and distractor removal during the first year of life. Patients were excluded if they had a tracheostomy or remained intubated after distractor removal.<br /><br /> Postoperative respiratory events.<br /><br /> Twenty-five (60% male) patients were included. Mean age and weight at distractor removal were 142 ± 79 days of life and 5.5 ± 1.1 kg. Mean apnea-hypopnea index after completion of distraction was 1.1 ± 1.5 events/hour. Two (8%) patients experienced postoperative respiratory events that required intervention. In 1 (4% of sample) of these, the event was deemed to have benefited from ICU-level care. Two variables were significantly associated with these events congenital heart disease (<br /><br /> = .020) and concomitant procedure performed during the same operation (<br /><br /> = .020).<br /><br /> Intensive care unit-level care is rarely needed after distractor removal in infants with RS. Intensive care unit admission should be considered in patients with congenital cardiac disease and when having multiple operations during the same anesthetic.<br /><br />Intensive care unit-level care is rarely needed after distractor removal in infants with RS. Intensive care unit admission should be considered in patients with congenital cardiac disease and when having multiple operations during the same anesthetic.<br /><br /> This study is the third in a series of investigations that explored the role of project user groups and how they impact on the design of a healthcare facility. Previous studies focused on a wide range of users, whereas this study sought the views of project clients.<br /><br /> The "project client" represents the organization responsible for the procurement of a healthcare facility. "Users" will work in or "use" that building. With the input of project clients, this research focused on the user group process required for Australian and New Zealand publicly funded healthcare projects. It sought lessons to improve the process for future projects.<br /><br /> Previous research findings, and an expanded literature review examining participatory design, were used to develop questions for semistructured interviews with selected project clients. Responses were transcribed and analyzed in terms of themes and subthemes using reflexive thematic analysis to develop a narrative that reports and discusses the findings.<br /><br /> Although not all are recognized, many stakeholders influence design decisions. [https://www.selleckchem.com/products/gdc-0068.html see more] No history, rationale, terms of reference, or evaluations of the user group process were found, suggesting that although it is a "given," the process could be enhanced. Useful suggestions for improving the user group process are offered.<br /><br /> Evaluating the user group process, and learning from alternative approaches, may improve its outcomes. A project charter and terms of reference would support more effective decision making, while best practice guidelines and education for user group participants should be considered.<br /><br />Evaluating the user group process, and learning from alternative approaches, may improve its outcomes. A project charter and terms of reference would support more effective decision making, while best practice guidelines and education for user group participants should be considered.<br /><br /> To provide an inventory of oronasal fistula repair techniques alongside expert commentary on which techniques are appropriate for each fistula type.<br /><br /> A 4-stage approach was used to develop a consensus on surgical techniques available for fistula repair (1) in-person discussion of oronasal fistula cases among cleft surgeons, (2) development of a schema for fistula management using transcripts of the in-person case discussion, (3) evaluation of the preliminary schema via a web-based survey of additional cleft surgeons, and (4) revision of the management schema using survey responses.<br /><br /> Six cleft surgeons participated in the in-person case discussion. Eleven additional surgeons participated in the web-based survey. Participants had diverse training experiences, having completed residency and fellowship at 20 different hospitals.<br /><br /> A schema for fistula management was developed, organized by fistula location. The schema catalogues all viable approaches for each location. For fistulae involving the soft palate, the schema stresses the importance of evaluating for velopharyngeal insufficiency (VPI) and incorporating VPI management into fistula repair. For fistulae involving the hard palate, the schema separately enumerates the techniques available for nasal lining repair and for oral lining repair in each region. The schema also catalogues the diversity of approaches to lingual- and labioalveolar fistula, including variation in timing, orthodontic preparation, and simultaneous alveolar bone grafting.<br /><br /> This study employed consensus methods to create a comprehensive inventory of available fistula repair techniques and to identify preferential techniques among a diverse group of surgeons.<br /><br />This study employed consensus methods to create a comprehensive inventory of available fistula repair techniques and to identify preferential techniques among a diverse group of surgeons.