A Noninvasive Oral Neutrophil Assay To Monitor Engraftment, Neutrophil Function and Susceptibility to Infection Following Bone Marrow Transplantation (BMT) in Children and Adolescents.
Notice bibliographique
Résumé
Abstract BACKGROUND: A major problem in the post-BMT setting is the determination of neutrophil levels and function that are protective against life threatening infections. Conventional definitions of engraftment by circulating neutrophil counts are unreliable. Identifying successful engraftment of protective neutrophils earlier may negate the need for invasive marrow testing and help predict which patients need empirical antibacterial or antifungal therapy. Monitoring the timing of tissue delivery of neutrophils may serve as an indicator of neutrophil functionality and competence in these acutely neutropenic patients. Past findings suggest that neutrophil quantification in oral rinses can be a useful and practical method to monitor engraftment in adult patients undergoing BMT. The utility of this method in children has not been previously determined. METHODS: Subjects between 6 and 18 years of age undergoing BMT were asked to perform timed mouth-wash specimens prior to initiating conditioning therapy and then every 1–2 days until they were discharged from the hospital. Oral neutrophil numbers were determined from the rinse samples using fluorescent staining methods and a hemacytometer. These levels were compared to circulating neutrophil levels and clinical outcome measures. In the current BMT setting, engraftment is defined by an absolute neutrophil count of 0.5 x109/L or more for three consecutive days. We defined oral neutrophil engraftment as the day neutrophils reappeared in the oral cavity and were detected during analysis of the oral rinse samples collected from the patients post-BMT. This corresponds to a minimum oral neutrophil count of 0.25 x104/L in the original patient rinse samples. RESULTS: The patient population consisted of 22 patients (N=22) with either bone marrow failures or malignancies. Oral neutrophils reappeared and returned to a stable level 5.7±3.9SD days earlier in the mouth than in the blood following BMT, thus enabling to successfully predict engraftment much sooner than it was evident in their blood counts as per the conventional definition of engraftment. Furthermore, the time gap between oral and blood neutrophil engraftment was inversely related to the total number of febrile episodes that a patient endured following blood neutrophil engraftment (F 1,15 = 7.81 P = 0.0136). This implies that the timing of neutrophil tissue delivery can be a good indicator of neutrophil functionality and infection susceptibility in the post-BMT setting. Moreover, among patients with oral mucositis, severity declined sharply over the days following oral engraftment. We conclude that monitoring oral neutrophils can be useful in evaluating clinical outcomes in the post-BMT setting. Lastly, it is noteworthy that one of our patients developed severe graft vs. host disease soon after BMT. Although neutrophils were detected in his oral rinses, they were outnumbered by abnormal T cells (CD3+) which are normally not present in oral samples.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».