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BACKGROUND Relationships between microbiota composition and clinical outcomes after allogeneic hematopoietic-cell transplantation have been described in single-center studies. Geographic variations in the composition of human microbial communities and differences in clinical practices across institutions raise the question of whether these associations are generalizable. METHODS The microbiota composition of fecal samples obtained from patients who were undergoing allogeneic hematopoietic-cell transplantation at four centers was profiled by means of 16S ribosomal RNA gene sequencing. In an observational study, we examined associations between microbiota diversity and mortality using Cox proportional-hazards analysis. https://www.selleckchem.com/ALK.html For stratification of the cohorts into higher- and lower-diversity groups, the median diversity value that was observed at the study center in New York was used. In the analysis of independent cohorts, the New York center was cohort 1, and three centers in Germany, Japan, and North Carolina compoutable to graft-versus-host disease. Baseline samples obtained before transplantation already showed evidence of microbiome disruption, and lower diversity before transplantation was associated with poor survival. CONCLUSIONS Patterns of microbiota disruption during allogeneic hematopoietic-cell transplantation were similar across transplantation centers and geographic locations; patterns were characterized by loss of diversity and domination by single taxa. Higher diversity of intestinal microbiota at the time of neutrophil engraftment was associated with lower mortality. (Funded by the National Cancer Institute and others.). Copyright © 2020 Massachusetts Medical Society.BACKGROUND Previous trials showed promising antitumor activity and an acceptable safety profile associated with pembrolizumab in patients with early triple-negative breast cancer. Whether the addition of pembrolizumab to neoadjuvant chemotherapy would significantly increase the percentage of patients with early triple-negative breast cancer who have a pathological complete response (defined as no invasive cancer in the breast and negative nodes) at definitive surgery is unclear. METHODS In this phase 3 trial, we randomly assigned (in a 21 ratio) patients with previously untreated stage II or stage III triple-negative breast cancer to receive neoadjuvant therapy with four cycles of pembrolizumab (at a dose of 200 mg) every 3 weeks plus paclitaxel and carboplatin (784 patients; the pembrolizumab-chemotherapy group) or placebo every 3 weeks plus paclitaxel and carboplatin (390 patients; the placebo-chemotherapy group); the two groups then received an additional four cycles of pembrolizumab or placebo, and both g, had local or distant recurrence or a second primary tumor, or died from any cause (hazard ratio, 0.63; 95% CI, 0.43 to 0.93). Across all treatment phases, the incidence of treatment-related adverse events of grade 3 or higher was 78.0% in the pembrolizumab-chemotherapy group and 73.0% in the placebo-chemotherapy group, including death in 0.4% (3 patients) and 0.3% (1 patient), respectively. CONCLUSIONS Among patients with early triple-negative breast cancer, the percentage with a pathological complete response was significantly higher among those who received pembrolizumab plus neoadjuvant chemotherapy than among those who received placebo plus neoadjuvant chemotherapy. (Funded by Merck Sharp & Dohme [a subsidiary of Merck]; KEYNOTE-522 ClinicalTrials.gov number, NCT03036488.). Copyright © 2020 Massachusetts Medical Society.BACKGROUND After the mechanical preparation of a root canal, the canal walls are covered with a smear layer. In order to deeply clean the dentinal tubules, removal of the smear layer is recommended. There is no consensus on the length of time of rinsing with chelating agents or irrigation with alternating chelating agents and sodium hypochlorite (NaOCl). OBJECTIVES The aim of the study was to evaluate the effectiveness of smear layer removal using 4 irrigation protocols. MATERIAL AND METHODS We prepared 42 straight root canals to size ISO40/04 and assigned them into 4 study groups (n = 10) and a control group (n = 2). The root canals were irrigated as follows in the control group, 180 s with 5.25% NaOCl; in group 1, 60 s with 40% citric acid (CA) and 120 s with NaOCl; in group 2, 120 s with CA and 120 s with NaOCl; in group 3, 30 s CA, 30 s with NaOCl, 30 s CA and 120 s with NaOCl; and in group 4, 60 s with CA, 30 s with NaOCl, 60 s with CA, and 120 s with NaOCl. The roots were split longitudinally and the root canals were observed under ×200-500 magnification. The root canal walls were analyzed in areas 2 mm, 6 mm and 10 mm from the apex. RESULTS In the apical and medial sections, the best effects were achieved in groups 3 and 4. In coronal sections, no significant differences between experimental groups were found. CONCLUSIONS Within the limitations of this study, it can be concluded that irrigation with alternating NaOCl and CA was the most effective at smear layer removal, regardless of the irrigation time.There are more than 200 different diseases classed as interstitial lung diseases (ILDs). For epidemiological and practical purposes, ILDs are classified into diseases of known and unknown etiology. The aim of this review is to evaluate our current knowledge about the efficacy and safety of pulmonary rehabilitation (PR) in patients with ILDs. Other issues, such as ILD pathogenesis, prevalence and comorbidity, are also elaborated in the review. Pulmonary rehabilitation is an important part of comprehensive care for patients with ILDs. In comparison to PR for patients with chronic pulmonary obstructive disease (COPD), the number of clinical studies concerning PR for patients with ILDs is small. The majority of trials have been performed in relatively small groups of patients. The principles of PR in this group of patients are the same as for patients with COPD. Exercise-induced desaturation is frequently observed during PR, which is the main source of complications in patients with ILDs. Major differences between ILD and COPD patients include poorer exercise tolerance and faster development of respiratory failure in patients with ILDs.
My Website: https://www.selleckchem.com/ALK.html
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