Bone Marrow Transplant Unit Research Articles

Virulence and resistance pattern of a novel sequence type of linezolid-resistant Enterococcus faecium identified by whole-genome sequencing.

Empirical use of linezolid has been advocated in neutropenic febrile patients colonised by vancomycin-resistant enterococci (VRE) because of the risk of bloodstream infection (BSI). This study aimed to genetically describe a vancomycin-resistant Enterococcus faecium (VREfm) BSI isolate resistant to linezolid (VRLRE) in a patient previously colonised by VREfm and to determine the incidence of colonisation and infection by VREfm in a bone marrow transplant unit over a 10-year period. Data for VREfm colonisation and infection were evaluated. PCR for the vanA and vanB genes, pulsed-field gel electrophoresis (PFGE) and microdilution antimicrobial susceptibility testing (vancomycin, teicoplanin, linezolid and aminoglycosides) were performed. Three isolates, including the VRLRE, were selected for whole-genome sequencing by Ion Torrent™, with E. faecium CP006620-Aus0085 used as a reference. Eighty-seven VREfm were analysed; all were linezolid-susceptible and harboured vanA, except for one blood isolate from a febrile neutropenic patient colonised by VREfm who received linezolid for 12 days and developed a BSI by VRLRE (linezolid MIC≥8μg/mL). Linezolid resistance was associated with a G2576T mutation in the 23SrRNA gene. PFGE analysis demonstrated that the 87 isolates belonged to four major clusters; however, the VRLRE presented only 50% similarity. Three sequence types (STs) were identified: ST412 (the predominant clone, which was more virulent compared with the other isolates); ST478 (linezolid-susceptible VREfm); and a novel ST named ST987 (VRLRE). SNP analysis showed a higher similarity between linezolid-susceptible VREfm and the predominant clone compared with VRLRE. VRLRE presented a G2576T mutation and belonged to a novel ST (ST987).

Access to oral care before hematopoietic stem cell transplantation: understand to improve.

Although the relevance of dental intervention before transplant is recognized, many patients are undergoing transplantation without receiving dental care. The objective of this study was to identify the searching profile, access, and use of dental services by candidates to hematopoietic stem cell transplantation (HSCT), and the difficulties faced by those candidates. All candidates for an allogeneic HSCT from a bone marrow transplant unit were invited to take part in this research from March 2014 to March 2015. A questionnaire was developed consisting of five sections with questions about personal information, hematologic disease, access to dental services, and history of dental treatment, patient's preferences, and knowledge. One hundred and ten candidates for allogeneic HSCT participated in this study. Fifty-five participants received professional oral care in the previous year of interview. The majority of patients (64%) went to a dentist not linked to transplant staff, and private dental service was the most visited (42%). To visit a dentist during the previous year was statistically associated with the habit of going to a dentist outside the hospital (p<0.001), which was statistically associated with the family income (p=0.001). The main barriers to access to dental treatment were lack of guidance (66%), apprehension (45%), and lack of confidence (29%) in an "external" dentist. Most of the barriers seem to be associated to lack of confidence and information among patients and professionals, as well as a lack of parameters for scheduling or referrals to dental care, especially for those with a low-socioeconomic background.

Emotional Overdrive: How to Pump the Brakes on Compassion Fatigue in Bone Marrow Transplant Nurses

The unique and long-standing relationships that bone marrow transplant (BMT) nurses develop with their patients and their families make end-of-life (EOL) care increasingly difficult and stressful for the nurse. Through continued exposure to suffering and pain, many BMT nurses experience compassion fatigue (CF) which can manifest as physical, emotional and spiritual distress. If left unaddressed, CF can eventually lead to burnout and BMT nurses leaving the field. In order to combat CF, literature shows that a variety of interventions including formal debriefing sessions, EOL and grief education programs as well as holistic and spiritual interventions have shown to be effective in reducing burnout and alleviating grief-related stress in BMT nurses. Prior to introducing any interventions, a needs-assessment survey was conducted on our 28-bed hematology/oncology & BMT unit. Forty-two staff members were surveyed and asked about their level of emotional fatigue and if they thought they would benefit from grief support programs. Overwhelmingly the response was “yes” (41 out of 42), so an initial roll out of four interventions were initiated: Condolence cards to be sent out and signed by staff members to families of patients who passed away on the unit Formal debriefing session led by a psychiatrist Group guided meditation and individual Reiki sessions led by an integrative health RN Remembrance/prayer box that staff members could write notes/thoughts/prayers in Initial feedback from RNs was positive, many saying they found “closure”, particularly with the sending out of condolence cards. A six-month post-intervention survey to be conducted in October. Compassion fatigue is not exclusive to field of hematology/transplantation. With no formal compassion fatigue program in place at our institution, we believe that this program could be implemented hospital-wide and serve as a template for other units to help their staff with this ongoing problem.

Effective Use of a Chemotherapy/Stem Cell Champion on a Complex Bone Marrow Transplantation Unit

Effective Use of a Chemotherapy/Stem Cell Champion on a Complex Bone Marrow Transplantation Unit

Caring for the Cutaneous: Skin Resource Nurse on a Pediatric Bone Marrow Transplant Unit

Caring for the Cutaneous: Skin Resource Nurse on a Pediatric Bone Marrow Transplant Unit

Tailoring Education to Perceived Fall Risk in Hospitalized Patients With Cancer: A Randomized, Controlled Trial.

Patients with cancer carry a higher risk for falls, potentially resulting in increased morbidity, mortality, and financial costs, as well as lower quality of life. Few evidence-based interventions are tailored to the patient's perception of risk for falls. This study aimed to determine the effect of tailored, nurse-delivered interventions as compared to a control group on patient perception of risk for falls, confidence in fall prevention, and willingness to ask for assistance. A two-group, prospective, randomized, controlled design was used to test the intervention in a convenience sample of 91 patients on an adult bone marrow transplantation unit. The intervention consisted of video and printed education tailored to the nurse's risk assessment and the patient's perception of risk. Patient's self-reported perception, confidence, and willingness were measured at three time points. About one-third of patients perceived themselves to be at low risk for falls despite a nurse rating of high risk. A statistically significant difference existed in the proportion of patients who perceived themselves to be at high risk for falls pre- and postintervention (p = 0.01). Results suggest that tailoring education to the patients' perceived risk for falls can help patients become more aware of fall risk.

Retrospective Analysis on the Use of Amphotericin B Lipid Complex in Neutropenic Cancer Patients with Suspected Fungal Infections in Lebanon, a Single Center Experience and Review of International Guidelines.

Immunocompromised patients carry a high risk for invasive fungal disease (IFD), which is associated with high mortality. This is a retrospective chart review of a 4-year experience of amphotericin B lipid complex (ABLC) utilization for the management of suspected IFD at the Hematology/Oncology and Bone Marrow Transplantation unit at Makassed General Hospital, Beirut, Lebanon between January 2011 and December 2014. We focused on treatment strategy, response rate, and adverse drug events associated with ABLC therapy. We also reviewed ABLC indications in international guidelines beyond its Food and Drug Administration approval. A total of 89 patients received ABLC therapy for suspected fungal infection. Forty-eight percent were treated for a possible fungal infection, 19% for a problable fungal infection, 12% based on hospital guidelines, and 20% based on treating physician's recommendations. The overall response rate was 71%. Nephrotoxicity occurred in 24% of patients and serum creatinine improved in 10% of these patients. Moderate hypokalemia was observed in 61% of the patients and severe hypokalemia in 10% but was corrected in both cases. Hepatotoxicity was observed in 12% of the patients throughout ABLC therapy. Infusion-related reactions were observed in 36% of the patients. There was a decrease in the incidence of these reactions upon using combination of premedication drugs. In this study, ABLC proved to be an effective and safe option in the management of suspected IFD in immunocompromised patients failing previous therapies.

Professional attitudes toward patient safety culture in a bone marrow transplant unit.

Objective To identify the attitude of health professionals toward the patient safety culture at a bone marrow transplant unit. Methods Quantitative research approach, cross-sectional survey conducted at a bone marrow transplant unit in Santa Catarina, Brazil. Data were collected using a Safety Attitudes Questionnaire with 33 health professionals in August and September of 2013. A total of 37 attitudes were assessed according to six safety dimensions of patient safety culture. Data were analysed by applying descriptive and inferential statistics, ANOVA and the Kruskal-Wallis test with a p value equal to or under 0.05. Results Attitudes regarding the dimension "job satisfaction" were positive for the patient safety culture, and there was a significant difference between the professionals in this dimension (p-value 0.05). The other dimensions were not assessed positively. Conclusion The attitudes of health professionals toward patient safety must be strengthened.

Changes in serologic markers of hepatitis B in autologous hematopoietic stem cell transplantation recipients

Introduction: Hepatitis B virus (HBV) infection is one of the most prominent health threats worldwide. Hepatitis B exacerbation is a significant cause of morbidity and mortality in patients who are the candidates of cytotoxic, immunosuppressive therapy and hematopoietic stem cell transplantation (HSCT) in areas where chronic hepatitis B infection is endemic. Patient and Methods: This retrospective study was conducted in Bone Marrow Transplantation Unit. A total of 64 patients, who underwent autologous HSCT were retrospectively reviewed. Results: A total of 64 patients with median age of 57 (22–79) years and gender distribution of 66% (n = 42) males and 34% (n = 22) females, who underwent autologous HSCT were included in the study. Three patients who were identified as hepatitis B surface antigen (HBsAg) positive prior to the transplantation had autologous HSCT under lamivudine prophylaxis. HBV reactivation had occurred in one of these patients. Hepatitis B infection (reverse seroconversion) was identified in one of the two patients who were HBsAg negative and hepatitis B core antibody (anti-HBc) positive prior to the treatment via serologic tests performed due to transaminase increases observed on day 407 in one case and on day 222 in the other. Conclusion: HBsAg positivity constitutes an independent risk factor for HSCT. In addition, it is necessary to administer prophylaxis and/or be more cautious in HBsAg negative patients prior to the transplantation and those with antibody positivity as they are more likely to develop reverse seroconversion.

Effect of comorbidities on hematopoietic stem cell transplantation outcome in adult patients with different hematologic diseases: a single-center experience in Egypt

Background Hematopoietic stem cell transplantation (HSCT) is a procedure that can restore marrow function in patients who have had severe marrow injury. It is either autologous or allogeneic. It has become increasingly important to optimize pretransplant risk assessment to improve hematopoietic cell transplantation (HCT) decision making. Single-organ comorbidity involving the liver, lung, heart, or kidney before HCT has been traditionally found to cause organ toxicity after HCT. The HCT-comorbidity index (HCT-CI) has provided better prediction of HCT-related morbidity and mortality compared with other non-HCT-specific indexes. Aim The aim of this study was to investigate the impact of various pretransplant comorbidities on the outcome of patients who had undergone either allogeneic or autologous HSCT in relation to treatment-related mortality, disease-related mortality, and overall survival. Patients and methods A retrospective study was conducted at the Bone Marrow Transplantation Unit, Ain Shams University, on 119 patients who were transplanted either using autologous or allogeneic HSCT. All of them were older than 18 years and had different types of hematologic diseases. The most frequent hematologic disease was acute myeloid leukemia (34.4%), followed by multiple myeloma (17.6%), acute lymphoblastic leukemia (16.8%), and lymphoma (10.9%), whereas aplastic anemia, myelodysplastic syndrome, chronic myeloid leukemia, and biphenotypic leukemia collectively represented 20.1%. They were either incomplete or partial remission. They were categorized on the basis of the HCT-CI as follows: mild score (0), 43 (36.2%) patients; moderate score (1-2), 60 (50.4%) patients; and severe score (΃3), 16 (13.4%) patients. The study data were collected from medical notes, pathology reports, and laboratory data. Results There was a statistically significant relation between the HCT-CI and overall survival ( P = 0.012), disease-free survival ( P = 0.007), mortality ( P = 0.047), and the incidence of graft failure ( P = 0.034). Conclusion We concluded that the HCT-CI is a better predictor for detecting the influence of comorbidity in patients with hematologic disorders on mortality, overall survival, and disease-free survival after HCT.

Antifungal Prophylaxis with Posaconazole in Allogeneic Hematopoietic Stem Cell Transplantation Using Sirolimus for Prevention of Graft-Versus-Host Disease

Invasive fungal infections (IFI) have emerged as a leading cause of morbidity and infection-related mortality among allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients over the past two decades. Several new drugs have recently been introduced as antifungal prophylaxis, supported by results of prospective randomized trials. In agreement with the international guidelines, a mold-active antifungal prophylaxis is strongly recommended in high-risk patients receiving allo-HSCT, considering efficacy, different pharmacokinetic, drug-drug interactions, and toxicity profile of the various antifungal drugs.Posaconazole, a triazole with broad-spectrum antifungal activity and a favorable toxicity profile, is the drug of choice for patients with graft versus host disease (GVHD). Consequently, posaconazole prophylaxis in allo-HSCT recipients is administered in combination with immunosuppressive drugs for GVHD prophylaxis and/or treatment, most commonly cyclosporine (CsA) or tacrolimus.Sirolimus is an inhibitor of mammalian target of rapamycin (mTOR), largely used for GVHD prevention and treatment, but extensively metabolized by CYP3A4. As posaconazole strongly inhibits CYP3A4 its coadministration with sirolimus is contraindicated by the manufacturer of posaconazole, and up to now poorly described in literature.In the San Raffaele Haematology and Bone Marrow Transplantation Unit, from 2010 to 2015, we retrospectively identified sixty-six patients that received posaconazole oral suspension as primary (n=43) or secondary (n=23) antifungal prophylaxis after allo-HSCT.The majority of patients were affected by acute leukaemia (67%), not in remission at time of allo-HSCT (55%), and with a previous allo-HSCT reported for 50% of them, carrying an high risk for developing a post-transplant IFI. Median follow up was 357 days (range 43-1884) after HSCT. Posaconazole administration was given for a median of 221 days (range 13-966).Thirty-two patients (49%) received posaconazole during engraftment phase, while 28 (42%) and 19 (29%) patients for IFI prophylaxis in the setting of acute or chronic GvHD respectively.A concomitant administration of sirolimus was performed in 49 patients (74%). Sirolimus concentrations were monitored two times a week, while posaconazole was controlled in patients' serum on a weekly basis, during the first two months of treatment.We observed a 55-70% steady-state dose reduction of sirolimus in 19 patients, after posaconazole introduction. Alternatively, patients with ongoing posaconazole prophylaxis received an initial empiric sirolimus dose reduction at 1 mg/day.The co-administration of posaconazole and sirolimus resulted safe. Discontinuation was reported mainly in patients with documented IFI, who required a change of the antifungal drug. No adverse events potentially associated with sirolimus overexposure (i.e. sinusoidal obstructive syndrome, sirolimus-related thrombotic microangiopathy) were reported, although one-third of the patients experienced a transient and moderate elevation of sirolimus serum levels in the first week of coadministration.In this analysis post-transplant IFI occurred in 14 cases. The risk of developing IFI was influenced by type of prophylaxis, resulting in 12% and 39% of IFI during primary and secondary prophylaxis respectively (p value 0.013; OR 4.89, CI 1.39-17.11). However the most significant and strong association was reported in concomitant with insufficient posaconazole serum levels (<0.5 ml/L), a known reported limitation of the oral solution formulation especially in patients with intestinal GVHD and/or diarrhea (p value <0,0001; OR 35.14, CI 6.43-192).In patients with adequate posaconazole serum levels (>0.5 ml/L) the incidence of IFI was 5%, supporting the utility of therapeutic drug monitoring (TDM) in such conditions and generating interest for the use of the upcoming posaconazole tablets with improved bioavailability in allo-HSCT recipients.In our experience concurrent sirolimus and posaconazole use was well tolerated, with a 55% to 70% sirolimus dose reduction at posaconazole initiation and close monitoring of serum sirolimus and posaconazole trough levels in the first months of co-administration. DisclosuresNo relevant conflicts of interest to declare.

Toward Optimised Intrapulmonary and Systhemic Hemostatic Interventions in Diffuse Alveolar Hemorrhage, a Single Center Experience

Background: We observed diffuse alveolar hemorrhage (DAH) relatively frequently at our Bone Marrow Transplant and Nephrology Units (ANCA positive vasculitis + DAH). We tried to refine DAH medical treatments, cooperating with intensive care specialists. During the last 3 years we treated 14 DAH cases (4 posttransplant, 1 cirrhosis, and 9 pulmonary vasculitis).Patients, treatmentsThe patient cohorts according to the underlying disease, DAH severity (micro or macro DAH according to Uptodate recommendations), hemostatic drug dose, way of application, responses are summarised in Table I. Table 1Patient cohortsDAH severityrFVIIa dose way of applicationintratraecheal tranexamic acid doserepeatedreponse commentBone marrow transplant related DAH (amyloidosis, AML, CNS lymphoma)macro 3 micro 150 ug/kg in 10 ml bronchoscopy500 mg in 5 ml bronchoscopy1 day later 1x, few days later 2x inhalationbleeding stopped combined with iv rFVIIa + tranexamic acid in 2 cases with systhemic bleedingPrimary biliary cirrhosis, liver failuremacro50 ug/kg 10 ml bronchoscopy500 mg in 5 ml bronchoscopyinhalation 1 day later 1xbleeding stoppedANCA positive vasculitis induced DAHmacro 3 micro 450 ug/kg 10 ml bronchoscopy 40 ug/kg rFVIIa,500 mg in 5 ml bronchoscopyinhalation 1 day later 1x 2 hoursbleeding stopped bleeding stoppedThe diagnostic evaluation of DAH was run according to international standard requirements, based upon repeated bronchoalveolar lavage. Platelet transfusions and factor supplementation were applied according to the recommendations. Standard non-specific DAH related intensive care was provided for all casesThe basis of our DAH drug treatment approach was intrapulmonary (bronchoscopical/intratracheal or inhalatory) or systhemic (iv) recombinant FactorVIIa (Novoseven) application, combining with systhemic or local tranexamic acid. Novoseven (rFVIIa) has received Orphan Drug Status from FDA and EMA recently. Novoseven is usually combined in severe systhemic bleedings with tranexamic acid, however, there is very limited information available on the combined approach in DAH.Results, discussionAll of our DAH bleeding was stopped or impressively reduced after rFVIIa+tranexamic acid interventions. However, overall survival was determined mostly by the underlying condition (i.e. amyloid heart disease, refractory AML, etc.)The pattern of bleeding was somewhat different according to etiology: posttransplant and hematological background predisposed to more macro DAH, bleeding cessation could be well achieved, usually repeated interventions were necessary. Patients with non malignant disease (vasculitis, liver failure) had both micro and macro DAH, bleed slightly less, interventions seemed to produce more durable responses.DAH seemed to be less modifyed by systhemic hemostatic parameters, than some other bleeds. Platelet transfusion alone rarely achieved significant improvement. We did not observe thrombotic events in our cases following intratracheal or iv treatments..In conclusion: if DAH develops, the combined application of systhemic (iv) and/or intrapulmonary rFVIIa/tranexamic acid combination achieves a relatively quick bleeding cessation and improvement of respiration, allowing time for other interventions to improve underlying conditions and outcome. For micro DAH iv rFVIIa (40 ug/kg, repeated 2 hourly if needed) +tranexamic acid seems to be safe and effective. For fulminant macro DAH we do suggest to apply rFVIIa 50 ug/kg+tranexamic acid 50 mg in 10-15 ml volume, which stops bleeding quickly, improves respiration and can be life saving. This intervention might be repeated after 24 hours, usually by inhalation. In less severe makro DAH the inhalatory approach might be useful.We do support to register DAH treatment approaches to further optimalise results. DisclosuresNo relevant conflicts of interest to declare.

Reducing Central Line-Associated Bloodstream Infections on Inpatient Oncology Units Using Peer Review.

The purpose of this article is to describe a peer-to-peer program and the outcomes of interventions to reduce the incidence of central line-associated bloodstream infections in patients in bone marrow transplantation, medical, and surgical oncology units. The article reviews the process and describes tools used to achieve success in a Magnet®-designated academic medical center.

Donor Lymphocyte Infusion in Hematologic Malignancies--Good to be Fresh?

Donor lymphocyte infusion (DLI) has been used with variable success in a variety of hematologic malignancies. We conducted a retrospective analysis of all patients who were treated with DLI for persistent or relapsed disease at the Temple University Bone Marrow Transplant Unit from July 1, 1993 to December 31, 2013 to evaluate the effect of the type of DLI (fresh vs. cryopreserved) on event-free survival (EFS) and overall survival (OS). Median follow-up was 64.8 months (range, 0.3-142.6 months). We found that EFS and OS were similar between patients receiving cryopreserved cells and those receiving fresh DLI (median OS for cryopreserved cells, 0.39 years; median OS for fresh cells, 0.32 years; P = .793; median EFS for cryopreserved cells, 0.410 years; median EFS for fresh cells, 0.420 years; P = .4264). In the setting of relapsed disease, treatment with any chemotherapy regimen before receiving DLI did not significantly impact OS (n = 63; P = .2203) or EFS (n = 40; P = .542). A subgroup analysis limited to patients with acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS) (32 patients) showed that differences in OS and EFS between cryopreserved and fresh DLI approached significance (median OS for cryopreserved cells, 0.34 years; median OS for fresh cells, 0.17 years; P = .16; median EFS for cryopreserved cells, 0.37 years; median EFS for fresh cells, 0.094 years; P = 0.11). We conclude that the use of fresh cells versus cryopreserved cells does not have an impact on outcomes, and selected patients can achieve long-term survival with DLI for treatment of relapse after transplantation, although the overall outcomes remain dismal.

Editorial introductions

Editorial introductions

Horizontal infection prevention measures and a risk-managed approach to vancomycin-resistant enterococci: An evaluation

The use of infection control measures in the management of vancomycin-resistant enterococci (VRE) is hotly debated. A risk-managed approach to VRE control after the introduction of 2 horizontal infection prevention measures-an environmental cleaning (EC) and an antimicrobial stewardship (AMS) program-was assessed. Routine screening for VRE was discontinued 6 and 4 months after introduction of the EC and AMS programs, respectively. Only 4 units (intensive care, burns-trauma, solid organ transplant, and bone marrow transplant units) where patients were deemed to be at increased risk for VRE infection continued screening and contact precautions. Cost avoidance and value-added benefits were monitored by the hospital finance department. VRE monitoring on these high-risk units and facility-wide comprehensive bacteremia surveillance continued as per established protocols. Surveillance for methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infection (CDI) remained unchanged. VRE bacteremia rates did not increase with the change to the VRE risk-managed approach. The number of patients requiring VRE isolation in all areas of the hospital decreased from an average of 32 to 6 beds per day. Statistically significant reductions in CDI and MRSA rates were observed possibly related to the aggressive decluttering, equipment cleaning, and AMS program elements. A risk-managed approach to VRE can be implemented without adverse consequences and potentially with significant benefits to a facility.

Useful properties of undifferentiated mesenchymal stromal cells and adipose tissue as the source in liver-regenerative therapy studied in an animal model of severe acute fulminant hepatitis

Background aimsEnd-stage liver diseases frequently require liver transplantation. Cell therapy could be an alternative. This study aimed to analyze whether undifferentiated mesenchymal stromal cells (U-MSCs) or MSC-derived hepatocyte-like cells (DHLCs) from adipose tissue (AT), umbilical cord blood (UCB) and bone marrow (BM) would better restore damaged liver. MethodsAT was obtained from lipo-aspiration, UCB from an Umbilical Cord Blood Bank and BM from a BM Transplantation Unit. AT (collagenase digestion), UCB and BM (Ficoll gradient) were cultured (Dulbecco's modified Eagle's medium, low glucose, FBS) for 3 days. Detached adherent cells, at passage 4, were characterized as MSCs. Genetic stability was investigated by means of telomerase enzyme activity and karyotype. Hepatocyte differentiation protocol was performed with the use of Dulbecco's modified Eagle's medium, hepatocyte growth factor, basic fibroblast growth factor and nicotinamide (7 days); maturation medium (oncostatin, dexamethasone, insulin, transferrin and selenium) was added at 36 days. Hepatogenesis analyses were performed by use of morphology and albumin, AF, tyrosine-aminotransferase and glutamine synthetase gene expression and quantitative reverse transcription–polymerase chain reaction on days 9, 18, 25 and 36. Functionality was assessed through glycogen storage detection, indocyanine green absorption and transplantation procedure. U-MSCs and DHLCs were injected 48 h after induced fulminant hepatitis (intraperitoneal injection of carbon tetrachloride) in SCID/BALB-c mice. Histopathologic analyses were performed on days 7 and 15. Human origin included albumin and CK19 human markers. ResultsAll MSCs differentiated into functional hepatocyte-like cells, stored glycogen and absorbed indocyanine green. AT-MSC DHLC gene expression was more consistent with a normal hepatogenic-differentiation profile. UCB-MSCs expanded weakly, impairing their use for the transplantation procedure. AT and BM U-MSCs and DHLCs regenerated liver injury equally. Regenerated hepatocytes exhibited human origin. ConclusionsAT might be the source and U-MSCS the stem cells useful for liver-regenerative therapy.

Non-linear significant relationship between use of glycopeptides and isolation of vancomycin-resistant Enterococcus species in a university hospital setting.

BackgroundEmergence of colonization and infection with vancomycin-resistant enterococci (VRE) has become a worldwide challenge. To investigate whether the increasing incidence of VRE isolation can be correlated with use of glycopeptides in the hospital setting, we conducted a hospital-wide two-year study in the university hospital of Vienna.MethodsWithin the period from January 2011 through December 2012 all patients with isolation of invasive or non-invasive VRE were retrospectively included. Specialty-specific data concerning the consumption of vancomycin and teicoplanin, fluoroquinolones and third generation cephalosporins in defined daily doses (DDDs) from June 2010 through May 2012 were extracted from the hospital pharmacy computer system. To assess the relationship between the usage of those antibiotics and the incidence of VRE (VRE-rate per 10 000 patients) a Poisson regression was performed.FindingsIn the study period 266 patients were colonized or infected with VRE. Specialty-specific VRE isolation was as follows: general surgical units (44 patients), bone marrow transplant unit (35 patients), general medical units (33 patients), cardiothoracic surgery (27 patients), nephrology (26 patients), haematooncology (22 patients), gastroenterology (17 patients), urology (17 patients), and the infectious diseases unit (11 patients). Hospital-wide consumption of glycopeptides was higher for teicoplanin than for vancomycin (26 242 versus 8677 DDDs). Specialty-specific VRE incidence significantly increased with the use of glycopeptides, fluoroquinolones or third generation cephalosporins (p < 0.001). The results of the Poisson regression for vancomycin (p = 0.0018) and teicoplanin (p < 0.0001) separately were both highly significant. Spearman’s correlation coefficient indicated a strong correlation between the two variables (rho = 0.8).ConclusionOverall usage of glycopeptides, fluoroquinolones or third generation cephalosporins contributed to the emergence of VRE in the hospital setting.

Identification of the origin of circulating endothelial progenitor cells

Identification of the origin of circulating endothelial progenitor cells

Determine the difficulties of home care in children following haematopoietic stem cell transplantation

The aim of this study was to determine the difficulties regarding the home care of children following haematopoietic stem cell transplantation (HSCT). The sample of the study includes the families of 73 children in a bone marrow transplant unit between 2010 and 2013, Turkey. Data were collected using a form included descriptive information and questions about the difficulties and complications of home care. Families were telephoned and problems they had encountered were recorded. Mann-Whitney U-test and the logistic regression analysis were used. The average age of the children was 10.65±5.03years, the average age was 8.89±4.9 when HSCT was performed, and the average year after HSCT was 1.79±0.74. 41.1% of the children underwent transplantation with diagnoses of anaemia. Primary physical problems that were found after discharge from the hospital were fever (43.8%), decreased appetite (37%), rash (34.2%) and pain (26%). Socially, 43.8% of families reported that their children had difficulties with school. Primary difficulties regarding care and follow-up were reported as skin care (34.2%) and catheter care (33.3%). In the post-transplantation period, it is important to provide information about potential problems and care to patients and families in order to increase the quality of life.