Effects Of Infectious Complications Research Articles

The Effect of Infectious Complications During Ventricular Assist Device Use on Outcomes of Pediatric Heart Transplantation.

To describe the impact of infectious adverse events (IAEs) during ventricular assist device (VAD) support on graft loss, infection, and rejection after pediatric heart transplant (HT). Pedimacs data were linked to Pediatric Heart Transplant Society (PHTS) data for patients receiving a VAD followed by HT between September 2012 and December 2016. Linked patients were categorized into IAE on VAD (group A) and no IAE on VAD (group B). Infectious adverse event locations included nondevice, device (external or internal), and sepsis. Post-HT outcomes for analysis were graft loss, infection, and rejection. Time-dependent analysis included Kaplan-Meier and multiphase parametric hazard function analysis. We linked 207 patients (age 9.4 ± 6.3 years). Post-HT follow-up was 19.4 patient-months (<8 days-4.1 years). Group A included 42 patients (20%) with 62 IAEs. Group B included 165 patients without an IAE. Group A patients were younger (7.4 ± 6.1 vs. 9.5 ± 6.3 years; p = 0.03), waited longer for HT (5.3 ± 4.1 vs. 2.9 ± 2.5 months; p = 0.0005), and were hospitalized longer post-HT (42 ± 59 vs. 23 ± 22 days; p = 0.05). VAD-related IAEs were rare (N = 11). Groups A and B had similar freedom from first post-HT infection, rejection, and graft loss (all p > 0.1). However, patients with VAD-related IAE were somewhat more likely to experience rejection (p = 0.03) and graft loss (p = 0.01). Children with an IAE on VAD who survive to HT are younger, wait longer for HT, and remain hospitalized longer than those without an IAE on VAD. Overall, IAE on VAD did not impact post-HT outcomes, but VAD-related IAE may be associated with graft loss and rejection.

Особенности трофологического статуса у пострадавших в чрезвычайных ситуациях с длительными нарушениями сознания вследствие черепно-мозговой травмы

The aim of the study was to investigate peculiarities of trophological status, to identify prevalence, severity and types of trophological insufficiency and to analyze the effect of infectious complications on the severity of protein-energy malnutrition in victims of emergency situations with long-term impairment of consciousness due to traumatic brain injury. Materials and research methods. The study involved 126 victims of various age groups, who underwent primary screening using NRS-2002 scale, indicators of trophological status and the effect of infectious complications on the severity of protein-energy malnutrition were assessed. Research results and their analysis. Screening showed a high risk of malnutrition in all patients. Indicators of trophological status were less than the reference values. In all age groups, both men and women, moderate protein-energy malnutrition prevailed (82.5%). For young patients, marasmus (64.6%) and marasmic kwashiorkor (34.3%) were most typical. The trophological status of the victims – regardless of the severity and in more than half of the cases – was represented by marasmus and, less often, by kwashiorkor. Patients with infectious complications had a high risk of moderate and severe protein-energy malnutrition development, p &lt;0.001.

Prognostic impact of infectious complications after curative gastric cancer surgery

IntroductionThere have been few studies about the effect of infectious complications on recurrence or long-term survival outcome after curative gastric cancer surgery in large populations. This study was conducted to investigate the impact of infectious complications on long-term survival after curative gastrectomy in high volume center. MethodFrom January 2002 to December 2012, patients who underwent curative gastrectomy were enrolled. Infectious complications were defined as wound infection, intra-abdominal infection or postoperative pneumonia. Five-year overall survival was compared between two groups and followed by multivariable analysis using a Cox proportional hazards model. ResultOf 6585 patients who underwent curative gastrectomy, 413 (6.2%) had infectious complications after curative gastrectomy. The five-year overall survival rate was 86.0% in non-complication patients and 74.1% in infectious complications patients (P < 0.001). In univariate analysis, Age over 70 years, male sex, higher ASA score, total or proximal gastrectomy, advanced stage and infectious complication had statistically worse survival. A Cox proportional hazards model indicated that the infectious complication was independent prognostic factor (HR = 1.478, CI 95% 1.242–1.757 p < 0.001) as well as age over 70 years (HR = 2.434, CI 95% 2.168–2.734 p < 0.001), male sex (HR = 1.153, CI 95% 1.022–1.302 p = 0.014), higher ASA score (p < 0.001) and advanced Stage (p < 0.001). Local recurrence (P = 0.044), LN recurrence (P = 0.038) and hematologic recurrence (P = 0.033) were significantly associated with infectious complications. ConclusionPostoperative infectious complication was an independent prognostic factor for five-year overall survival after curative gastrectomy as well as known factors. A significant association between infectious complications and recurrence were also noted. The surgeon should try to prevent the infectious complications in gastric cancer surgery to improve the long term survival.

The Effect of Infectious Complications During Ventricular Assist Device Use on Outcomes of Pediatric Heart Transplantation

Infectious adverse events (IAE) occur frequently in children on ventricular assist device (VAD) support. We aimed to describe the impact of IAE during VAD support on outcomes after heart transplant (HT) in patients (pt) <18 years (yr).

The use of monoclonal antibodies for the treatment of graft-versus-host disease following allogeneic stem cell transplantation

Introduction: Graft-versus-host disease (GVHD) remains the leading cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Steroids along with calcineurin inhibitors remain the standard initial therapy, however, less than half of the patients completely respond and there is no uniformly accepted therapy for patients with steroid-resistant GVHD.Areas covered: This paper reviews the current role and ongoing development of mAbs in the treatment of GVHD. Various mAbs to cell surface antigens on GVHD effector cells have been investigated for the treatment of acute GVHD: these include anti-TNF-α antibodies, IL-2 receptor antagonists, anti-CD3 and anti-CD52 mAbs, while anti-CD20 mAb has been extensively investigated in the setting of chronic GVHD. Overall, response rates have been reported to be greater than 60%, although it should be emphasized that the long-term survival still remains suboptimal, mainly due to the detrimental side effects of infectious complications, progressive GVHD and relapse of underlying malignancy.Expert opinion: Future challenges will include more appropriate definition of these agents in the therapeutic scenario of GVHD. Combinations of mAbs or mAb combined with newer immunosuppressive drugs might potentially achieve greater success, especially if used early in the disease process.

Proteasome inhibitor clioquinol as a candidate drug in prophylaxis and treatment of acute graft-versus-host disease

Graft-versus-host disease (GVHD) is one of the most severe complications after allogeneic bone marrow transplantation. It exhibits a complex pathophysiology resulting from donor T cell recognition of a genetically disparate recipient that is unable to reject the donor cells following allogeneic hematopoietic stem-cell transplantation (HSCT) and ultimately causes multiple organs destruction. Currently practiced prophylaxis of GVHD includes T-cell depletion (TCD) and/or immunosuppressive medication. However, immunosuppressive agents may have serious side effects and selective removal of T cells from the graft significantly reduces the beneficial effects of donor T cells, especially anti-tumor activity. These deleterious side effects of infectious complications and relapse of underlying malignancy remain barriers to successful approaches. The proteasomal pathway of protein degradation plays a key role in different key cell functions such as cell cycle regulation, apoptosis and costimulation. Proteasome inhibition in cancer cells leads to induction of tumor cell death and also plays critical roles in T cell activation, proliferation, and apoptosis, in part, because of blockade of NF-κB activation. Recently it was reported clioquinol can inhibit the proteasomal chymotrypsin-like activity and induce apoptotic cell death in leukemia and myeloma. We hypothesized that proteasome inhibitor clioquinol could be a candidate drug for pharmacological prophylaxis and treatment of GVHD with retention of graft-versus-tumor (GVT) effect.