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Post-ASCT brentuximab vedotin (BV) consolidation improves PFS in pts with high-risk relapse as per ATHERA criteria: early relapse [ER], primary refractory disease [PRD] or extra nodal disease (END). B Background: b Salvage chemotherapy and autologous stem cell transplant (ASCT) have cure rates of 60-70% in relapsed refractory (R/R) classic Hodgkin lymphoma (cHL). In propensity score weighted analysis, BV consolidation was associated with better survival in the subgroup of pre-ASCT PMR but not pre-ASCT CMR. [Extracted from the article]

Abstract: Background: Solid organ transplant recipients are especially vulnerable to Clostridium difficile infection (CDI) due to cumulative risk factors including increased exposure to healthcare settings, persistent immunosuppression, and higher rates of antimicrobial exposure. We aimed to identify risk factors associated with CDI development in kidney transplant recipients including implications of immunosuppressive therapies and acid‐suppressing agents. Methods: This was a single‐center, non‐interventional, retrospective case‐control study of adult subjects between June 1, 2009 and June 30, 2013. During this time, 728 patients underwent kidney transplantation. Overall, 22 developed CDI (cases) and were matched 1:3 with 66 controls. Cases and controls were also matched for induction agent, kidney allograft type (living or deceased), and time from transplant to CDI result (±60 days). Results: The majority of subjects received a deceased donor kidney (77.3%) and basiliximab induction therapy (86.4%). The overall CDI incidence was 3%. Factors independently associated with CDI were average tacrolimus trough (AOR = 1.25, 95% CI = 1.00‐1.56, P = .048) and antibiotic exposure for urinary tract infections (UTI) (AOR = 4.17, 95% CI = 1.12‐15.54, P = .034). Proton pump inhibitor use was not associated with CDI (OR = 0.81, 95% CI = 0.29‐2.29, P = .691). Conclusion: Maintaining a clinically appropriate tacrolimus trough and judicious antibiotic use and selection for UTI treatment could potentially reduce CDI in the kidney transplant population. [ABSTRACT FROM AUTHOR]

Although in nature most microorganisms are known to occur predominantly in consortia or biofilms, data on archaeal biofilm formation are in general scarce. Here, the ability of three methanoarchaeal strains, Methanobrevibacter smithii and Methanosphaera stadtmanae, which form part of the human gut microbiota, and the Methanosarcina mazei strain Gö1 to grow on different surfaces and form biofilms was investigated. All three strains adhered to the substrate mica and grew predominantly as bilayers on its surface as demonstrated by confocal laser scanning microscopy analyses, though the formation of multi layered biofilms of M. stadtmanae and M. smithii was observed as well. Stable biofilm formation was further confirmed by scanning electron microscopy analysis. M. mazei and M. smithii also formed multi-layered biofilms in uncoated plastic μ-dishes™, which were very similar in morphology and reached a height of up to 40 μm. In contrast, biofilms formed by M. stadtmanae reached only a height of 2 μm. Staining with the two lectins ConA and IB4 indicated that all three strains produced relatively low amounts of extracellular polysaccharides most likely containing glucose, mannose and galactose. Taken together, this study provides the first evidence that methanoarchaea can develop and form biofilms on different substrates and thus, will contribute to our knowledge on the appearance and physiological role of M. smithii and M. stadtmanae in the human intestine. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Like medical and health sciences libraries throughout the country, the Lamar Soutter Library (LSL) at the University of Massachusetts Medical School is dealing with ever-increasing outreach needs in times of diminishing funding. With the goal of reshaping the library's outreach program to better serve our patron groups, the Outreach Study Group was formed to investigate existing models of outreach. METHODS: The group initially examined the current literature and subsequently conducted a nationwide survey of medical and health sciences libraries to identify trends in outreach. This article details the methods used for the survey, including establishing criteria for selecting participants, determining the focus, and developing and conducting the survey. RESULTS: Of the 40 libraries invited to participate, 63% completed the survey. An analysis of the data revealed successes, problems, and trends. The group's conclusions led to recommendations for the LSL's future outreach efforts. CONCLUSIONS: Analysis of the data revealed key findings in the areas of strategic planning, funding, and evaluation. A thoughtful definition of outreach ensures that outreach activities are expressions of the library's mission. Funding shifts require flexible programs. Evaluation provides data necessary to create new programs, sustain successful ones, and avoid repeating mistakes. [ABSTRACT FROM AUTHOR]

Case Summary: A 5-month-old male castrated domestic shorthair cat was evaluated for acute onset of emesis. Abdominal radiographs identified a suspected colonic foreign body and abdominal-focused assessment with sonography for trauma, triage and tracking (AFAST) evaluation revealed a large amount of peritoneal effusion. Cytology of the peritoneal effusion was consistent with a septic exudate. An exploratory celiotomy identified a ruptured ileocecocolic mass and a resection and anastomosis was performed. No foreign material was identified and histopathology confirmed that the ruptured mass was a colonic duplication cyst. Recurrent septic peritonitis was diagnosed based on cytologic evaluation of fluid from a silicone bulb reservoir of a closed suction drain. No abnormalities were surgically identified, the cat recovered without complication, was discharged at 7 days postoperatively and has continued to remain healthy 8 months after surgical intervention., Relevance and Novel Information: To our knowledge, this is the first known instance of a histopathologically confirmed non-communicating colonic duplication cyst causing septic peritonitis in the veterinary literature., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Some people with multiple sclerosis (pwMS) avoid exercise due to overheating. Evidence from a variety of cooling treatments shows benefits for pwMS., Objective: Conduct a randomized controlled trial of antipyretic treatment before exercise in pwMS., Methods: Adults over age 18 diagnosed with relapsing-remitting MS reporting heat sensitivity during exercise were randomly assigned to one of six sequences counterbalancing aspirin, acetaminophen, placebo. At each of three study visits separated by ≥ one week, participants received 650-millograms of aspirin, acetaminophen, or placebo before completing a maximal exercise test. Primary outcomes were body temperature change and total time-to-exhaustion (TTE), secondary outcomes were physiological and patient-reported outcomes (PROs)., Results: Sixty participants were enrolled and assigned to treatment sequence; 37 completed ≥ one study visit. After controlling for order effects, we found that body temperature increase was reduced after aspirin (+ 0.006 ± 0.32 degrees Fahrenheit, p < 0.001) and after acetaminophen (+ 0.31 ± 0.35; p = 0.004) compared to placebo (+ 0.68 ± 0.35). TTE after aspirin (331.6 ± 76.6 s) and acetaminophen (578.2 ± 82.1) did not differ significantly from placebo (551.0 ± 78.4; p's > 0.05). Aspirin benefited all secondary outcomes compared to placebo (all p's < 0.001); acetaminophen showed broadly consistent benefits., Conclusion: These results support antipyretic treatment as effective for reducing overheating during exercise in pwMS and failed to support antipyretics for increasing TTE in the context of a maximal exercise test. Benefits were shown for physiological markers of exercise productivity and PROs of fatigue, pain, and perceived exertion., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Myelodysplastic neoplasms (MDS) are clonal disorders of bone marrow failure exhibiting a variable risk of progression to acute myeloid leukemia. MDS exhibit certain prognostic genetic or cytogenetic abnormalities, an observation that has led to both the pathologic reclassification of MDS in the 2022 World Health Organization (WHO) and International Consensus Classification (ICC) systems, as well as to an updated prognostic schema, the Molecular International Prognostic Scoring System (IPSS-M). This single-institution study characterized the molecular patterns and clinical outcomes associated with the 2022 WHO and ICC classification schemas to assess their clinical utility. Strikingly, with the exception of one individual, all 210 patients in our cohort were classified into analogous categories by the two pathologic/diagnostic schemas. Most patients (70%) were classified morphologically while the remaining 30% had genetically classified disease by both criteria. Prognostic risk, as assessed by the IPSS-M score was highest in patients with MDS with biallelic/multi-hit TP53 mutations and lowest in pts with MDS-SF3B1. Median leukemia-free survival (LFS) was shortest for those with MDS with biallelic/multi-hit TP53 (0.7 years) and longest for those with MDS with low blasts (LFS not reached). These data demonstrate the clear ability of the 2022 WHO and ICC classifications to organize MDS patients into distinct prognostic risk groups and further show that both classification systems share more similarities than differences. Incorporation of the IPSS-M and IPSS-R features provide additive prognostic and survival components to both the WHO and ICC classifications, which together enhance their utility for evaluating and treating MDS patients., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Peter Greenberg reports financial support was provided by William E Walsh Leukemia Research Fund. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Although dyspnea is a primary symptom of chronic obstructive pulmonary disease (COPD), its treatment is suboptimal. In both COPD and acute anxiety, breathing patterns become dysregulated, contributing to abnormal CO 2 , dyspnea, and inefficient recovery from breathing challenges. While pulmonary rehabilitation (PR) improves dyspnea, only 1-2% of patients access it. Individuals with anxiety who use PR have worse outcomes., Methods: We present the protocol of a randomized controlled trial designed to determine the feasibility and acceptability of a new, four-week mind-body intervention that we developed, called "Capnography-Assisted Learned, Monitored (CALM) Breathing," as an adjunct to PR. Eligible participants are randomized in a 1:1 ratio to either CALM Breathing program or Usual Care. CALM Breathing consists of 10 core, slow breathing exercises combined with real time biofeedback (of end-tidal CO 2 , respiratory rate, and airflow) and motivational interviewing. CALM Breathing promotes self-regulated breathing, linking CO 2 changes to dyspnea and anxiety symptoms and targeting breathing efficiency and self-efficacy in COPD. Participants are randomized to CALM Breathing or a Usual Care control group., Results: Primary outcomes include feasibility and acceptability metrics of recruitment efficiency, participant retention, intervention adherence and fidelity, PR facilitation, patient satisfaction, and favorable themes from interviews. Secondary outcomes include breathing biomarkers, symptoms, health-related quality of life, six-minute walk distance, lung function, mood, physical activity, and PR utilization and engagement., Conclusion: By disrupting the cycle of dyspnea and anxiety, and providing a needed bridge to PR, CALM Breathing may address a substantive gap in healthcare and optimize treatment for patients with COPD., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To investigate physical activity levels of individuals with ataxia and correlate fitness to ataxia severity., Design: An observational study SETTING: An outpatient ataxia clinic in a large, tertiary, urban hospital in the US., Participants: Individuals with cerebellar ataxia (N=42)., Intervention: Not applicable., Main Outcome Measure: Participants were classified as sedentary or physically active using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Maximal oxygen consumption (V̇o 2 max) as an indicator of fitness level was measured, and ataxia severity was determined by the Scale for the Assessment and Rating of Ataxia (SARA). Mixed effect models were used to correlate ataxia severity to fitness levels., Results: Most participants (28 out of 42) lived sedentary lifestyles, and these individuals had poor fitness levels (only 67.3% of their predicted measure). The main barriers to physical activity included lack of energy, lack of time, and fear of falling. There were no differences in age, sex, disease type, disease duration, ataxia severity, fatigue level, and medication use between sedentary and active groups. Measures of V̇o 2 max, maximal work, maximal heart rate, and anerobic threshold demonstrated statistically significant differences between groups whereas maximal respiratory rate and expired ventilation/carbon dioxide production were similar between groups. When adjusting for age, sex, functional mobility status, and disease duration, ataxia severity was inversely correlated with fitness level in the sedentary group. There was no relationship between ataxia severity and fitness level in the 14 individuals who were physically active., Conclusions: Lower fitness levels were associated with more ataxia symptoms in the sedentary group. This relationship was not seen in individuals who were more active. Given the poor health outcomes associated with low fitness, physical activity should be encouraged in this population., (Copyright © 2023 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Intratumoral hypoxia in non-Hodgkin's Lymphoma (NHL) may interfere with chimeric antigen receptor T-cell (CAR-T) function. We conducted a single-center pilot study (clinicaltrials.gov ID NCT04409314) of [ 18 F]fluoroazomycin arabinoside, a hypoxia-specific radiotracer abbreviated as [ 18 F]FAZA, to assess the feasibility of this positron emission tomography (PET) imaging modality in this population., Methods: Patients with relapsed NHL being evaluated for CAR-T therapy received a one-time [ 18 F]FAZA PET scan before pre-CAR-T lymphodepletion. A tumor to mediastinum (T/M) ratio of 1.2 or higher with regard to [ 18 F]FAZA uptake was defined as positive for intratumoral hypoxia. We planned to enroll 30 patients with an interim futility analysis after 16 scans., Results: Of 16 scanned patients, 3 had no evidence of disease by standard [ 18 F]fluorodeoxyglucose PET imaging before CAR-T therapy. Six patients (38%) had any [ 18 F]FAZA uptake above background. Using a T/M cutoff of 1.20, only one patient (a 68-year-old male with relapsed diffuse large B-cell lymphoma) demonstrated intratumoral hypoxia in an extranodal chest wall lesion (T/M 1.35). Interestingly, of all 16 scanned patients, he was the only patient with progressive disease within 1 month of CAR-T therapy. However, because of our low overall proportion of positive scans, our study was stopped for futility., Conclusions: Our pilot study identified low-level [ 18 F]FAZA uptake in a small number of patients with NHL receiving CAR-T therapy. The only patient who met our pre-specified threshold for intratumoral hypoxia was also the only patient with early CAR-T failure. Future plans include exploration of [ 18 F]FAZA in a more selected patient population., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Wound related complications (WRC) are a significant source of morbidity in kidney transplant recipients, and may be mitigated by surgical approach. We hypothesize that the anterior rectus sheath approach (ARS) may decrease WRC and inpatient opiate use compared to the Gibson Approach (GA)., Methods: This double-blinded randomized controlled trial allocated kidney transplant recipients aged 18 or older, exclusive of other procedures, 1:1 to ARS or GA at a single hospital. The ARS involves a muscle-splitting paramedian approach to the iliopsoas fossa, compared to the muscle-cutting GA. Patients and data analysts were blinded to randomization., Results: Seventy five patients were randomized to each group between August 27, 2019 and September 18, 2020 with a minimum 12 month follow-up. There was no difference in WRC between groups (p = .23). Nine (12%) and three patients (4%) experienced any WRC in the ARS and GA groups, respectively. Three and one Clavien IIIb complications occurred in the ARS and GA groups, respectively. In a multiple linear regression model, ARS was associated with decreased inpatient opioid use (β = -58, 95% CI: -105 to -12, p = .016)., Conclusions: The ARS did not provide a WRC benefit in kidney transplant recipients, but may be associated with decreased inpatient opioid use., (© 2023 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.)