bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brentuximab Vedotin Plus Chemotherapy As Pre-Autologous Stem Cell Transplantation Salvage Treatment in Heavily Pretreated Relapsed/Refractory Hodgkin Lymphoma: Real-World Data from Peru
Authors: Quintana Shirley , Vasquez Jule F , Lopez Lourdes , Alcarraz Cindy , Flores Claudio , Samanez-Figari Cesar 
Published: November 2020

Background:Brentuximab Vedotin (BV) is an active drug in patients with relapsed / refractory (R/R) Hodgkin Lymphoma (HL). Autologous stem cell transplantation (ASCT) remains standard of care for these patients and achieving a clinical response pre-ASCT predicts favorable outcomes. Pre-ASCT salvage chemotherapy combinations with BV have been explored in this setting.
Objective:To evaluate the efficacy and safety of the combination of BV and chemotherapy in heavily pretreated R/R HL patients eligible for ASCT.
Methods:We reviewed the clinical characteristics, treatment, response, safety, and survival of 21 heavily pretreated R/R HL patients in 2 Peruvian institutions between June 2018 and February 2020. Survival curves were estimated using the Kaplan-Meier method.
Results:A total of 21 patients (15 (71%) refractory and 6 (29%) relapsed) were included. The median age was 31 years (range, 19-55), 13 (62%) patients were female. The median of previous treatment lines was 3 (range, 1-4).
Patients received BV plus chemotherapy (CT) on day 1: Dexamethasone, Cytarabine and Cisplatin (DHAP) (43%), Gemcitabine-based CT (33%), Ifosfamide, Carboplatin and Etoposide (ICE) (14%), and other CT (ESHAP, Bendamustine) (10%).
After a median of 3 cycles of combination therapy (range, 2-7), the objective response rate was 81 %, with 8 (38%) patients achieving CR. 10 (48%) patients had successful peripheral blood stem cell (PBSC) collection. 7 (33%) patients underwent ASCT, the remaining responding patients had a delay in either collection or ASCT due to COVID-19 pandemic.
The most significant adverse events were thrombocytopenia (69%) (G3-4: 53%), neutropenia (47%) (G3-4: 28%), infections (37%), febrile neutropenia (33%) and G1-2 peripheral neuropathy (16%).
The Progression Free-Survival (PFS) at 1 year was 86% in ASCT patients.
Conclusion:The combination of Brentuximab and chemotherapy is active as a bridge for ASCT in heavily pretreated R/R HL patients. The CR rates were lower than previously reported and it could be related with the number of previous lines of treatment received; there was also a higher incidence of febrile neutropenia in our cohort. We could hypothesize that the combination of Brentuximab and chemotherapy provides greater benefit if it is administered earlier in patients with R/R HL.

Disclosures
No relevant conflicts of interest to declare.
Risk of Recurrent Venous Thromboembolism and Bleeding in Patients with Cancer Associated Thrombosis
Authors: Attia Doaa , Jia Xuefei , Wilks Mailey L , Tripp Barbara , D'Andrea Christopher , McCrae Keith R , Khorana Alok A , Angelini Dana E 
Published: November 2020

Background: The treatment paradigm for cancer associated thrombosis (CAT) has evolved over recent years from using low molecular weight heparin (LMWH) to direct oral anticoagulants (DOACs). Some randomized trials suggest decreased rates of recurrent venous thromboembolism (VTE) in CAT patients treated with DOACs compared to LMWH but also reported increased rates of bleeding. The Cleveland Clinic Taussig Cancer Center has been treating cancer thrombosis in a centralized CAT clinic since 2014. Here we report our rates of bleeding and recurrent VTE in cancer patients treated with anticoagulation.
Methods: We prospectively followed cancer patients referred to our clinic from 8/2014-10/2019. A total of 1548 patients were referred to the clinic, of whom 462 were diagnosed with an acute VTE. VTE events, including deep venous thrombosis, pulmonary embolism, and visceral thrombosis, were noted. The comparison of bleeding rates (defined using ISTH criteria for major and clinically relevant non major bleeding, CRNMB) among treatment groups (LMWH vs DOACs) was examined using chi-square test. Rate of recurrent VTE was analyzed using a competing model in which death was treated as a competing risk.
Results: The study population comprised 462 patients with acute VTE with a mean age of 62.67±12.23 and 51.8 % males. Of these, 234 (52.9%) received LMWH, 161(36.4%) received DOACs, and 47 (10.6%) received other agents including warfarin for initial anticoagulation. Overall, the 6-month, 1 year, and 2-year VTE recurrence rate was 5.9%, 6.6%, 7.9%, respectively. Recurrent VTE rates were similar for LMWHs, DOACs and other agents (P&gt;0.05). Of 368 patients for whom follow-up data was available, 74 (16.7%) had bleeding event , of which 25 (33.8%) had major bleeding and 49 (66.4%) had CRNMB at 6 month follow-up with no difference across three treatment groups (p=0.56).
Conclusion: In this real-world practice setting, rates of recurrent VTE and bleeding were similar for DOACs and LMWH suggesting that with careful patient selection the concern for higher bleeding with DOACs in cancer patients can be safely overcome.

Disclosures
McCrae: Momenta Pharmaceuticals: Consultancy; Novartis: Honoraria; Rigel: Consultancy; Dova: Consultancy. Khorana:Merck: Research Funding; Medscape: Honoraria; Leo Pharma: Honoraria; Seattle Genetics: Honoraria; Pharmacyte: Honoraria; Pharmacyclics: Honoraria; Array: Other: Research funding (to institution); Janssen: Honoraria; Bayer: Honoraria; Pfizer: Honoraria; Sanofi: Honoraria; BMS: Honoraria, Research Funding; Leap: Research Funding.
Clinical Outcomes in Relapsed/Refractory Multiple Myeloma Patients Receiving Sequential Elotuzumab and Daratumumab: A Single Center Experience
Authors: Basher Fahmin , Paul Yonette , Hoffman James E. 
Published: November 2020

Daratumumab and elotuzumab are monoclonal antibodies approved by the FDA in November 2015 for the treatment of relapsed/refractory multiple myeloma (RRMM). Daratumumab was approved as a single therapy targeting plasma cell surface CD38, while elotuzumab was approved as part of combination therapy (with lenalidomide), targeting SLAMF7 to impact natural killer cell activation. While both therapies are involved in the recruitment of cellular cytotoxic mechanisms against multiple myeloma, the efficacy of each after a patient has relapsed on the other therapy is unclear.
We conducted a retrospective analysis of 26 patients with RRMM at the University of Miami Sylvester Comprehensive Cancer Center that received both elotuzumab and daratumumab between January 2016 and December 2018 to determine if progression-free survival (PFS) with each monoclonal antibody is affected by previous treatment with the other. Median age at time of treatment was 59.7 years, and 58% of patients were female. Median number of treatments prior to first monoclonal antibody was 4, and median time to first monoclonal antibody was 58 months. Seventeen patients received daratumumab prior to elotuzumab, while nine patients received elotuzumab prior to daratumumab. Patients that received daratumumab first received on average 2 treatments before receiving elotuzumab, while patients receiving elotuzumab first received 1 treatment on average before receiving daratumumab, and time between treatments was significantly shorter for patients receiving daratumumab first (3.7 months vs. 12.4 months, p = 0.0009). Overall survival (OS) and cumulative PFS trended higher in patients receiving elotuzumab first but did not reach significance (OS 37 months vs. 21.7 months, p = 0.07, and PFS 15.5 months vs. 7.6 months, p = 0.09). PFS with initial elotuzumab was higher than with initial daratumumab (11.9 months vs. 3.5 months, p = 0.0124). PFS on daratumumab trended favorably when elotuzumab was administered first (9.4 months vs. 3.0 months), although not significant (p = 0.19). In patients receiving daratumumab, 47% initially demonstrated response, all with eventual progression, with 40% responding to later elotuzumab therapy. Conversely, 56% of patients receiving elotuzumab first demonstrated a response, with 44% eventually progressing over time, and 56% responding to subsequent daratumumab therapy.
These results generate a plausible hypothesis related to a possible potentiating effect of elotuzumab that extends after therapy regimen has changed and warrants further investigation into the sequencing of these two therapies in RRMM and the interplay of their different immunologic impact.

Disclosures
Hoffman: Seattle Genetics: Research Funding; Loxo: Current equity holder in publicly-traded company; Celgene: Honoraria, Speakers Bureau.
Inpatient Outcomes and 60-Day Unplanned Readmissions after Hip Arthroplasty in Sickle Cell Patients with Avascular Necrosis
Authors: Lingamaneni Prasanth , Moturi Krishna , Ba Aqeel Sheeba , Upadhyay Banskota Shristi , Baral Binav , Zia Maryam 
Published: November 2020

Background: Avascular necrosis (AVN) afflicts up to 10% of patients with sickle cell disease (SCD), and results in significant impairment in mobility and quality of life. The femoral head is the most common site for involvement of AVN in SCD patients. Total hip arthroplasty has a higher rate of perioperative complications in SCD patients, when compared to the general population. In this study, we aimed to evaluate the rates of readmissions in SCD patients undergoing hip arthroplasty as well as examine the causes behind these readmissions.
Methods: The Nationwide Readmissions Database (NRD) was queried to include all adults who underwent hip arthroplasty in the years 2016 and 2017. SCD patients with AVN of the hip were compared to those undergoing hip arthroplasty for other reasons. T-test was used to compare means of continuous variables and Chi-square test to compare proportions of categorical variables. Multivariable logistic regression was used to evaluate risk factors for inpatient mortality, increased length of hospital stays, and hospitalization charges. We also examined risk factors for readmissions and the most common causes of readmissions in both sickle cell and non-sickle cell cohorts.
Results: A total of 1,167,675 hip arthroplasties were performed in 2016 and 2017, of which 0.1% were for SCD patients with AVN. As expected, those with SCD were younger (mean age 40.6 vs 68.2 years, p&lt;0.0001), with an equal gender distribution (57.8% female) in the two groups. Sickle cell patients were more likely to be from lower income neighborhoods and were also more likely to be treated at teaching hospitals. After adjusting for demographic variables and comorbidity burden, sickle cell disease was associated with higher risk of inpatient mortality (aOR 9.50, 95% CI 2.39-37.77, p&lt;0.01), longer length of hospital stay by 3.2 days (95% CI 2.5-3.9 days, p&lt;0.001), and higher hospitalization costs by roughly 20,000 USD per admission (95% CI 12,000-29,000 USD, p&lt;0.001).
On multivariate analysis, sickle cell patients were more likely to be readmitted within 60 days (aOR 5.25, 95% CI 4.01-6.87, p&lt;0.001). 65% of these readmissions were due to SCD itself. Procedural complications resulted in a 60-day readmission rate of 3% in both the SCD and non-SCD groups, whereas, infectious complications accounted for a higher rate of readmission in those with SCD (2.4% vs 1.3%).
Conclusions: Hip arthroplasty is associated with inferior inpatient outcomes and higher resource utilization in those with sickle cell disease. This can be attributed to high incidence of sickle cell crises post-procedure, as well as, intraoperative surgical complications (femoral fractures and perforations) and high rates of postoperative infections in the functionally asplenic sickle cell disease population.

Disclosures
No relevant conflicts of interest to declare.
Development and evaluation of an online education tool on attention deficit hyperactivity disorder for general practitioners: the important contribution of co-production
Authors: French B. , Daley D. , Perez Vallejos E. , Sayal K. , Hall C. L. 
Published: November 2020

Abstract

Background
Attention deficit hyperactivity disorder (ADHD) is underdiagnosed in the UK and the assessment and diagnosis pathway often involves a general practitioner (GP) referral to secondary care services. GPs’ levels of knowledge and understanding about ADHD is often a significant barrier in patients accessing care. The development of an online education resource could improve GPs knowledge of ADHD and optimise appropriate referrals. Involving end-users in co-creating interventions may enhance their clinical utility and impact routine clinical practice. However, there is limited published evidence describing how to meaningfully involve stakeholders in both the design and development components of co-production.

Method
We report a step wise, co-production approach towards developing an online ADHD education intervention for GPs. Preparatory work highlighted the relevant topics to be included in the intervention, from which educational videos were then developed. Workshops were then conducted with GPs, leading to further refinement of the video content and subsequently the final intervention. A pilot usability study (n = 10 GPs) was then conducted to assess the intervention’s acceptability, feasibility and accessibility.

Results
The development of the online intervention was greatly facilitated by the involvement of GPs. Having a co-production development process ensured the consistent adaptation of the intervention to meet GPs’ needs. The usability study showed that the content of the intervention was suitable, easily accessible, engaging and delivered at an acceptable level of intensity, validating the development approach taken.

Conclusion
While further studies are needed to evaluate the efficacy of the developed intervention, preliminary findings demonstrated that it was acceptable and well received. The importance of co-development was highlighted in developing an intervention that addresses specific needs for GPs. This development approach may be useful for other researchers and developers of clinical interventions.
Barriers and facilitators of videoconferencing psychotherapy implementation in veteran mental health care environments: a systematic review
Authors: Muir Samuel D. , de Boer Kathleen , Nedeljkovic Maja , Meyer Denny 
Published: November 2020

Abstract

Background
Whilst treatment for mental health issues has traditionally been conducted in-person, advances in technology has seen a recent growth in the use of online video therapy services to help overcome access-to-care barriers faced by those living in rural locations and those unable to travel. These barriers are particularly apparent in the case of veteran populations, which is the focus of this review. Whilst the research investigating the efficacy of online video therapy to treat mental health issues among veterans is promising, widespread adoption and utilisation of this modality remains low with efforts often failing to progress past the pilot phase to implementation. This review focuses on the implementation of online video therapy in veteran mental health care settings and aims to identify the potential barriers and facilitators relevant to implementing the modality in military organisations.

Methods
A systematic search of three databases (PsycInfo, PubMed, and Web of Science) was conducted. To be eligible for inclusion, studies had to investigate the challenges, lessons learnt, or factors operating as barriers and/or facilitators to the implementation of online video therapy in veteran health care systems.

Results
The initial search revealed a total of 202 articles. This was reduced to 133 when duplicates were removed. After screening the titles and abstracts a further 70 articles were excluded leaving 63 to be retrieved for full review. A total of 10 studies were included in this review. The most commonly reported barriers were related to clinician concerns, logistical problems, and technology. Other barriers included access to resources as well as challenges posed by collaborations, policy and recruitment. Facilitators included experience using the modality and having dedicated staff responsible for promoting and managing the new service (e.g., on-site champions and telehealth technicians).

Conclusions
This review suggests that numerous barriers must be identified and addressed before attempting to implement an online video therapy service in veteran organisations. Further research is needed to establish best practice for implementation, particularly across geographically dispersed sites. It is hoped that the findings of this review will be used to help inform future implementation efforts and research initiatives in this space.
β-lactamase-mediated resistance in MDR-Pseudomonas aeruginosa from Qatar
Authors: Sid Ahmed Mazen A. , Khan Faisal Ahmad , Sultan Ali A. , Söderquist Bo , Ibrahim Emad Bashir , Jass Jana , Omrani Ali S. 
Published: November 2020

Abstract

Background
The distribution of β-lactam resistance genes in P. aeruginosa is often closely related to the distribution of certain high-risk international clones. We used whole-genome sequencing (WGS) to identify the predominant sequence types (ST) and β-lactamase genes in clinical isolates of multidrug-resistant (MDR)-P. aeruginosa from Qatar

Methods
Microbiological identification and susceptibility tests were performed by automated BD Phoenix™ system and manual Liofilchem MIC Test Strips.

Results
Among 75 MDR-P. aeruginosa isolates; the largest proportions of susceptibility were to ceftazidime-avibactam (n = 36, 48%), followed by ceftolozane-tazobactam (30, 40%), ceftazidime (n = 21, 28%) and aztreonam (n = 16, 21.3%). All isolates possessed Class C and/or Class D β-lactamases (n = 72, 96% each), while metallo-β-lactamases were detected in 20 (26.7%) isolates. Eight (40%) metallo-β-lactamase producers were susceptible to aztreonam and did not produce any concomitant extended-spectrum β-lactamases. High risk ST235 (n = 16, 21.3%), ST357 (n = 8, 10.7%), ST389 and ST1284 (6, 8% each) were most frequent. Nearly all ST235 isolates (15/16; 93.8%) were resistant to all tested β-lactams.

Conclusion
MDR-P. aeruginosa isolates from Qatar are highly resistant to antipseudomonal β-lactams. High-risk STs are predominant in Qatar and their associated MDR phenotypes are a cause for considerable concern.
Retrieving similar substructures on 3D neuron reconstructions
Authors: Yang Jian , He Yishan , Liu Xuefeng 
Published: November 2020

Abstract
Since manual tracing is time consuming and the performance of automatic tracing is unstable, it is still a challenging task to generate accurate neuron reconstruction efficiently and effectively. One strategy is generating a reconstruction automatically and then amending its inaccurate parts manually. Aiming at finding inaccurate substructures efficiently, we propose a pipeline to retrieve similar substructures on one or more neuron reconstructions, which are very similar to a marked problematic substructure. The pipeline consists of four steps: getting a marked substructure, constructing a query substructure, generating candidate substructures and retrieving most similar substructures. The retrieval procedure was tested on 163 gold standard reconstructions provided by the BigNeuron project and a reconstruction of a mouse’s large neuron. Experimental results showed that the implementation of the proposed methods is very efficient and all retrieved substructures are very similar to the marked one in numbers of nodes and branches, and degree of curvature.
Reconstruction of the middle hepatic vein using a vein graft from the resected portion of the liver
Authors: Yang ShiWei , Han DongDong , Wang Liang , Gong Lei , Xiang CanHong 
Published: November 2020

Abstract

Background
The middle hepatic veins are often infiltrated by intrahepatic cholangiocarcinoma. Reconstruction of the hepatic vein plays a critical role in preserving more of the residual liver volume and reducing the risk of postoperative liver failure in extreme hepatectomy. We here report a novel way to reconstruct middle hepatic vein by using vessel grafts from wasted liver.

Case presentation
Case 1: A 64-year-old man was diagnosed with intrahepatic cholangiocarcinoma. The bifurcation and left branch of the portal vein were stenosed, and the root of the middle hepatic vein was infiltrated by the tumor. An extended left hepatectomy was performed, the portal vein was resected and reconstructed, and the middle hepatic vein was reconstructed by anastomosing the proximal left hepatic vein to the distal middle hepatic vein. Case 2: A 69-year-old woman was diagnosed with intrahepatic cholangiocarcinoma. The tumor was located in the left lobe of the liver and the left and middle hepatic veins were infiltrated by the tumor. An extended left hepatectomy was performed, and the left portal vein was used as a vein graft to reconstruct the middle hepatic vein. Both of the two patients’ postoperative ultrasound showed vessel graft patency.

Conclusion
Using a vein graft from the resected portion of the liver to reconstruct the middle hepatic vein was a useful technique and showed good result.
Elective staged proctocolectomy and living donor liver transplantation for colon cancer with sclerosing cholangitis-related ulcerative colitis: a case report
Authors: Miyagi Yoshihiro , Kinjo Tatsuya , Yoshizumi Tomoharu , Harada Noboru , Arakaki Shingo , Kinjo Tetsu , Hokama Akira , Takatsuki Mitsuhisa 
Published: November 2020

Abstract

Background
Primary sclerosing cholangitis (PSC) is a well-known complication of ulcerative colitis (UC), but it is rare to encounter patients requiring both living donor liver transplantation (LDLT) and proctocolectomy. We report a case of elective two-stage surgery involving proctocolectomy performed after LDLT for a patient with early colon cancer concurrent with PSC-related UC. To our knowledge, this is the first report of concurrent cancer successfully treated with both LDLT and proctocolectomy.

Case presentation
A 32-year-old Japanese man with colon cancer associated with UC underwent restorative proctocolectomy at 3 months after living donor liver transplantation (LDLT) for PSC. He was diagnosed with PSC and UC when he was a teenager. Conservative therapy was initiated to treat both PSC and UC. He had experienced recurrent cholangitis for years; therefore, a biliary stent was placed endoscopically. However, his liver function progressively deteriorated. Colonoscopic surveillance revealed early colon cancer; hence, surgical treatment was considered. PSC progressed to cirrhosis and portal hypertension; hence, LDLT was performed before restorative proctocolectomy. Three months after LDLT, we performed restorative proctocolectomy with ileal pouch–anal anastomosis. The postoperative course was uneventful. The patient was well, with good liver and bowel functions and without tumor recurrence, more than 1 year after proctocolectomy.

Conclusions
With strict patient selection and careful patient management and follow-up, elective proctocolectomy may be performed safely and effectively after LDLT for concurrent early colon cancer with PSC-related UC. There are no previous reports of the use of both LDLT and proctocolectomy for the successful treatment of PSC-related UC and concurrent cancer.