YSTEMIC ACTIVATION OF COAGUlation and thrombus formation in the microvasculature accompanies organ dysfunction and excess mortality in severe sepsis. 1 Tissue factor (thromboplastin) is a major initiator of the blood coagulation process. 2 Tissue factor is a transmembrane cell surface receptor for plasma clotting factor VII and exhibits homol-Author Affiliations, Financial Disclosure, and the OPTIMIST Study Group are listed at the end of this article.
Multivariate proportional hazards regression was used to compare outcome by donor type and identify other prognostic factors. Most transplant recipients were younger than 5 years (79%), had a pretransplantation performance score greater than or equal to 90% (63%), received pretransplantation preparative regimens without radiation (82%), and had non-Tcell-depleted grafts (77%). Eighty percent received their transplant after 1986. The 5-year probability of survival (95% confidence interval) for all subjects was 70% (63%-77%). Probabilities differed by donor type: 87% (74%-93%) with HLAidentical sibling donors, 52% (37%-65%) with other related donors, and 71% (58%-80%) with unrelated donors (P ؍ .0006).
In patients who receive an allogeneic bone marrow transplant as treatment for acute myelogenous or lymphoblastic leukemia, chronic myelogenous leukemia, or aplastic anemia and who are free of their original disease two years later, the disease is probably cured. However, for many years after transplantation, the mortality among these patients is higher than that in a normal population.
Adipokinetic hormone, isolated from locust corpora cardiaca, has been identified as a blocked peptide: PCA-Leu-Asn-Phe-Thr-Pro-Asn-Trp-Gly-Thr-NH2. The detailed structure is based on mass spectrometric data, substantiated in part by dansyl-Edman and carboxypeptidase data on thermolytic fragments. This is the first peptide hormone from an insect neuroendocrine organ to be fully characterised.
This study assessed the safety and efficacy of filgrastim (r-metHuG-CSF [recombinant human methionine granulocyte colony-stimulating factor]), when combined with intravenous (IV) antibiotics, in the treatment of hospitalized adult patients with multilobar community-acquired pneumonia (CAP). Four hundred eighty patients were randomized to receive placebo (n=243) or filgrastim 300 microg/day (n=237), in addition to standard therapy. Treatment with study drug was continued for 10 days, until the peak white blood cell (WBC) count reached 75x109/L, until discharge from the hospital, until death, or until IV antibiotics were discontinued. Study-related observations continued through day 29. Filgrastim increased WBC counts (baseline median, 13.3x109/L; median peak, 43. 8x109/L). The 2 treatment groups were not statistically different with respect to the study end points; however, there was a trend toward reduction of mortality in patients with pneumococcal bacteremia. Although further studies will be required to validate this observation, filgrastim was safe and well tolerated when administered to patients with multilobar CAP.
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