PURPOSE: Prolonged emergency department (ED) lengthof-stay (LOS) may cause ED overcrowding and worse outcome in traumatic surgical critically ill patients. In this study, we examined characteristics to be associated with prolonged ED LOS, including use of CT scanning and other ED-based special procedures (eg, radiologic diagnostic tests or therapeutic procedures performed in the ED). METHODS: A retrospective cohort study was conducted at an academic medical center with 458 traumatic surgical critically ill patients from 2003 to 2004. Critical care patients were defined as those sent to the operating room (OR) or intensive care unit (ICU) directly from the ED. Information was extracted from each ED chart on use and the number of CT scanning, other special radiologic diagnostic procedures (eg, magnetic resonance imaging, angiogram, cystogram), the number of plain radiographs performed, the emergent therapeutic procedures (intubation, closed thoracotomy, central venous line), the waiting times and number of consultants called, and holding times for decision of admission. ED LOS was defined as the time from presentation until transfer to the OR or ICU. To assess the effect of multiple simultaneous factors affecting ED LOS, a Cox proportional hazard model of time-to-ED discharge was used. RESULTS: The average overall ED LOS was 256.4+/-153.2 minutes (16 to 1465 minutes). Use of special radiologic diagnostic procedures was most strongly associated with an increased ED LOS. Use of either CT scanning or emergent therapeutic procedures, the number of plain radiographs, waiting times and numbers of consultants, and holding times for decision of admission were also affected a prolonged ED LOS independently. CONCLUSION: ED-based patient management decisions such as use of CT and ED-based special diagnostic and therapeutic procedures strongly associated affected ED LOS in traumatic surgical critically ill patients.
Academic Medical Centers ; Cohort Studies ; Consultants ; Critical Care ; Critical Illness* ; Diagnostic Tests, Routine ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intensive Care Units ; Length of Stay* ; Magnetic Resonance Imaging ; Operating Rooms ; Overall ; Proportional Hazards Models ; Retrospective Studies ; Thoracotomy ; Tomography, X-Ray Computed

BACKGROUND: To identify potential molecular prognostic markers in core binding factor (CBF) AML, we analyzed incidences and prognostic impacts of mutations in c-KIT, WT1, CEBPA, CBL, and a number of epigenetic genes in CBF AML. METHODS: Seventy one and 21 AML patients with t(8;21) and inv(16) were enrolled in this study, respectively. NPM1, CEBPA, c-KIT, IDH1/2, DNMT3A, EZH2, WT1, and CBL mutations were analyzed by direct sequencing. Patients were categorized with respect to c-KIT and WT1 mutation status, and both clinical features and prognoses were compared. RESULTS: The incidences of FLT3 internal tandem duplication (ITD), NPM1, CEBPA, IDH1/2, DNMT3A, EZH2, and CBL mutations were low (< or =5%) in CBF AML patients. However, c-KIT and WT1 mutations occurred frequently (10.9% and 13.8%, respectively). t(8;21) patients with c-KIT mutations showed significantly shorter overall survival (OS) and disease free survival (DFS) periods than those without mutations (P<0.001, for both); however, although the limited number of t(8;21) patients were analyzed, WT1 mutation status did not affect prognosis significantly. Relapse or death during follow-up occurred more frequently in t(8;21) patients carrying c-KIT mutations than in those without the mutation, although the difference was significant only in a specific patient subgroup with no WT1 mutations (P=0.014). CONCLUSIONS: The incidences of mutations in epigenetic genes are very low in CBF AML; however, c-KIT and WT1 mutations occur more frequently than others. The poor prognostic impact of c-KIT mutation in t(8;21) AML patients only applies in a specific patient subgroup without WT1 mutations. The prognostic impact of WT1 mutation in CBF AML is not evident and further investigation is required.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group/*genetics ; CCAAT-Enhancer-Binding Proteins/*genetics ; Child ; Core Binding Factors/genetics ; Disease-Free Survival ; Epigenesis, Genetic ; Female ; Humans ; Incidence ; Leukemia, Myeloid, Acute/*diagnosis/epidemiology/genetics ; Male ; Middle Aged ; Mutation ; Prognosis ; Proto-Oncogene Proteins c-cbl/*genetics ; Proto-Oncogene Proteins c-kit/*genetics ; Republic of Korea/epidemiology ; Survival Rate ; Translocation, Genetic ; WT1 Proteins/*genetics ; Young Adult

PURPOSE: We investigated the clinical outcome of bone marrow (BM) involvement in patients with diffuse large B-cell lymphoma (DLBCL) who received rituximab-based therapy. MATERIALS AND METHODS: A total of 567 consecutive patients with newly diagnosed DLBCL treated with rituximab-CHOP (RCHOP) between November 2001 and March 2010 were included in the current study. All of the patients underwent a BM study at the initial staging and the clinical characteristics and prognosis of these patients with or without BM involvement were analyzed retrospectively. RESULTS: The total cohort included 567 patients. The overall incidence of BM involvement was 8.5%. With a median follow-up duration of 33.2 months (range, 0.1 to 80.7 months) for patients who were alive at the last follow-up, the five-year overall survival (OS) and event-free survival (EFS) rate in patients without BM involvement (76.3% and 67.5%, p<0.001) was statistically higher than that in patients with BM involvement (44.3% and 40.1%, p<0.001). In multivariate analysis, among total patients, BM involvement showed a significant association with OS and EFS. In univariate and multivariate analyses, even among stage IV patients, a significant association with worse EFS was observed in the BM involvement group. CONCLUSION: BM involvement at diagnosis affected the survival of patients with DLBCL who received RCHOP. Although use of RCHOP can result in significant improvement of the therapeutic effect of DLBCL, BM involvement is still a negative prognostic factor of DLBCL patients in the era of rituximab.
Antibodies, Monoclonal, Murine-Derived ; B-Lymphocytes ; Bone Marrow ; Cohort Studies ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Lymphoma, B-Cell ; Multivariate Analysis ; Prognosis ; Rituximab

BACKGROUND: In multiple myeloma (MM), the idiotype (ID) determinant of the paraprotein has been used for immunotherapy using dendritic cells (DCs). However, ID-specific immune responses showed limited clinical responses after the Id vaccination. Therefore, an alternative approach using DCs pulsed with other tumor antigens is required. METHODS: We investigated the possibility of immunotherapy for MM using myeloma cell line-specific cytotoxic T lymphocytes (CTLs), that were stimulated in vitro by monocyte-derived DCs pulsed with the myeloma cell line ysates. CD14+ cells isolated from the peripheral blood of HLA-A0201+ healthy donors were cultured in the presence of GM-CSF and IL-4. On day 6, the immature DCs were pulsed with the myeloma cell line lysates (IM-9: HLA0201+ and ARH-77: HLA0201+), and then maturation of DCs was induced by the addition of TNF- alpha for 2 days. CTL lines were generated by a 2 time stimulation with DCs to the autologous CD3+ T cells. RESULTS: DCs pulsed with myeloma cell lysates showed the production of IL-12p70, but less than that of unpulsed DCs. CTLs lines stimulated with the DCs pulsing, for the myeloma cell line lysates, showed potent cytotoxic activities against autologous target cells, but not against HLA-A2-cell lines (RPMI-8226). Mature DCs pulsed with the myeloma cell line lysates showed a higher stimulatory capacity for autologous CTL when compared with mature non-pulsed DCs. CONCLUSION: These results suggest that DCs pulsed with the myeloma cell line lysates can generate potent myeloma cell line-specific CTLs for the myeloma cell-based immunotherapeutic approach in MM.
Antigens, Neoplasm ; Cell Line* ; Dendritic Cells* ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans ; Immunotherapy ; Interleukin-4 ; Multiple Myeloma ; T-Lymphocytes ; T-Lymphocytes, Cytotoxic* ; Tissue Donors ; Vaccination