Adv Exp Med Biol
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Venous thromboembolism (VTE) which includes deep vein thrombosis (DVT) and pulmonary embolism (PE) is a severe complication in critically ill patients generally affected by multiorgan disfunction associated with immobilization also prolonged. Nowadays, VTE prophylaxis is included in the requirements of hospital accreditation and evaluation of the maintenance of standards of quality of care. ICU patients are characterized by a dynamic day-to-day variation both of thromboembolic that bleeding risk and DVT incidence in presence of thromboprophylaxis ranges between 5 and 15 %. ⋯ DVT diagnosis is not clinical but imaging-based and in each ICU data on DVT incidence (DVT diagnosed 72 h after ICU admission) should be obtained by weekly ultrasound screening standardized for the anatomical sites of compression used, taking into account the persistence of DVT-risk throughout ICU stay. A role for mechanical thromboprophylaxis by elastic stockings or pneumatic compression was reported but no general consensus was reached about its use at the best. Much work has to be done but ICU remain the last frontier for VTE prophylaxis.
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Several factors must be considered to successfully integrate immunotherapy with radiation into clinical practice. One such factor is that concepts arising from preclinical work must be tested in combination with radiation in preclinical models to better understand how combination therapy will work in patients; examples include checkpoint inhibitors, tumor growth factor-beta (TGF-β) inhibitors, and natural killer (NK) cell therapy. ⋯ Traditional forms of radiation in particular pose challenges for combination trials with immunotherapy. This chapter explores these issues in more detail and provides insights as to how radiation therapy can be optimized to combine with immunotherapy.
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The role of the environment in surgical site infections is surprisingly understudied. UV disinfection holds promise for reducing the level of contamination in operating rooms and thereby lowering the risk of infection for patients. Issues such as the frequency, amount and locations for UV disinfection to have an impact on the risk of surgical site infection are recently emerging in the literature. As technologies and knowledge improve, UV disinfection will have a role to play in operating rooms in the future.
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Acute leukaemia is the major subtype of paediatric cancer with a cumulative risk of 1 in 2000 for children up to the age of 15 years. Childhood acute lymphoblastic leukaemia (ALL) is a biologically and clinically diverse disease with distinctive subtypes; multiple chromosomal translocations exist within the subtypes and each carries its own prognostic relevance. The most common chromosome translocation observed is the t(12;21) that results in an in-frame fusion between the first five exons of ETV6 (TEL) and almost the entire coding region of RUNX1 (AML1). ⋯ It has, however, been possible to backtrack this process through molecular analysis of appropriate clinical samples: (i) leukaemic clones in monozygotic twins that are either concordant or discordant for ALL; (ii) archived neonatal blood spots or Guthrie cards from individuals who later developed leukaemia; and (iii) stored, viable cord blood cells. Here, we outline our studies on the aetiology and pathology of childhood ALL that provide molecular evidence for a monoclonal, prenatal origin of ETV6-RUNX1+ leukaemia in monozygotic identical twins. We provide mechanistic support for the concept that altered patterns of infection during early childhood can deliver the necessary promotional drive for the progression of ETV6-RUNX1+ pre-leukaemic cells into a postnatal overt leukaemia.
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The review focuses on the current knowledge and the most pertinent hypotheses regarding the local host immune response as the key factor for the pathogenesis of implant-associated infections. Although bacterial biofilms have long been recognized as causative agents, the link between the infection and the devastating inflammatory response, particularly the localized tissue destruction and bone degradation is less well understood. Understanding these consequences of infection, however, is of utmost importance, because suppressing inflammation and preventing bone destruction could be a novel, alternative therapeutic option in cases when eradicating the infections fails.