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Allogeneic hematopoietic cell transplantation (HCT) offers the potential to cure hematologic malignancies. In the absence of an HLA-matched donor, HLA mismatched unrelated donors may be used, although risks of GvHD and treatment-related mortality (TRM) are higher. Identification and avoidance of amino-acid substitution and position types (AASPT) conferring higher risks of TRM and GvHD would potentially improve the success of transplantation from single HLA mismatched unrelated donors. Using random forest and logistic regression analyses, we identified 19 AASPT associated with greater risks for at least one adverse transplant outcome: grade III-IV acute GvHD, TRM, lower disease-free survival or worse overall survival relative to HLA-matched unrelated donors and to other AASPT. When tested in an independent validation cohort of 3530 patients, none of the AASPT from the training set were validated as high risk, however. Review of the literature shows that failure to validate original observations is the rule and not the exception in immunobiology and emphasizes the importance of independent validation before clinical application. Our current data do not support avoiding any specific class I AASPT for unrelated donors. Additional studies should be performed to fully understand the role of AASPT in HCT outcomes.

AbstractObjectives:To review the cases receiving peripartum hysterectomies treated in this hospital during the period 1967–1995. Clinical characteristics, indications, and results were more closely analyzed.Study design:A chart review of all cases operated since January 1967 to December 1995 was done. Demographic and clinical data were extracted, coded, and entered into a computer file for analysis. Indications, type of operation, pre-op planning or emergency decision, blood loss, transfusion, complications, were compared and cross-tabulated. Statistical analysis included: chisquare and Fisher exact tests, where appropriate, and two-sample t test.Results:In 58% of 217 cases the operation was planned, and total hysterectomy was done in 94%. Indications changed through the years, from predominantly elective to almost exclusively emergencies. These were mostly bleeding complications, in particular placenta previa and/or accreta. The presence of a uterine scar or submucous fibroid was associated with 79% (26/33) of accretas, and 51% (19/37) of previas. Among the 126 planned, 57% did not receive a transfusion and 84% of 91 emergencies did have one. The average amount of blood received by the latter was 3009 ml compared to 1262 ml for the former (p < 0.0001). There was a direct relationship between amount of blood loss and volume transfused. There were 26% intraoperatory bleeding complications and 5% urinary tract injuries. Postoperatory morbidity such as bleeding, infections, wound dehiscence, and others was observed in 17% of planned, and 23% of emergencies. Twelve patients needed another operation to treat some of these complications. There were no deaths recorded.Conclusions:Peripartum hysterectomy is a major operation, and in current times almost always an emergency with high risk for significant blood loss. The obstetrician should be ready to do it, and an early decision should save blood and prevent complications. Postoperative complications, mostly bleeding and infections may be severe. Early intervention and proper technique facilitate good outcomes.

To determine whether appropriately timed administration of a short-acting benzodiazepine hypnotic, which has proven effective in an animal model of jet lag, also facilitates adaptation of circadian rhythmicity and sleep-wake homeostasis in a human model of jet lag.

Background: Cockroach allergen, Bla g 1, is an important indoor allergen. Although household exposure has been documented, little is known about the potential for exposure outside the home. Objective: We investigated the settled dust concentration of Bla g 1 in 147 samples collected from classrooms, kitchens, cafeterias, and other sites in four primary schools in the city of Baltimore. Methods: School authorities were questioned about characteristics of schools, teachers, and students, as well as cockroach control and cleaning procedures. Settled dust samples were collected with a hand-held vacuum cleaner from the floors of all classrooms, food-related areas, and other sites of the schools over a 3-week period. A sample collection in each school took 1 to 2 days. Dust samples from each room were pooled and analyzed as a single sample for Bla g 1 by using a two-site monoclonal ELISA. Results: One hundred two (69%) of the 147 samples had detectable Bla g 1 and were within the range reported by other investigators in inner city homes. There was no difference between the median levels of Bla g 1 in three schools: school 1 (5.2 U/gm), school 2 (3.0 U/gm), and school 4 (2.7 U/gm); but school 3 had a significantly lower level (<0.8 U/gm, p < 0.001). The median level from the food-related areas was significantly higher than the median classroom level (p = 0.048). School 3 had fewer students on subsidized lunch, fewer African-American students, and fewer students per teacher. Bla g 1 levels were compared in the different schools while controlling for potential confounding variables by a stepwise multiple regression analysis with a logit model for ordinal responses. On the basis of this analysis, Bla g 1 levels in schools 1, 2, and 4 differed significantly from levels in school 3 (p < 0.001 in each case). Food-related areas had significantly higher levels than classrooms (p = 0.048). Floor level, the presence of a sink, and the presence of carpeting did not have significant effects. Conclusions: We conclude that Bla g 1 is detectable at potentially significant concentrations in some inner city schools. Furthermore, the level of exposure is different between different schools and between sites within individual schools. (J Allergy Clin Immunol 1997;99:486-90.)

Inherent cellular radioresistance and repair of x-ray damage was studied in 19 early-passage squamous cell carcinoma lines derived from head- and neck-cancer patients with known clinical results following radiotherapy. Human tumor cells that were radioresistant and/or proficient in accumulation/repair of x-ray damage were cultured from patients unsuccessfully treated with radiotherapy. Thus, the presence of radiation-resistant and repair-proficient tumor cells was associated with clinical radiation failure, suggesting the possibility of a predictive assay based on in vitro radiobiological parameters.

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