Metals and other trace elements in plasma and feathers of seabirds breeding in Svalbard.

We assessed the concentrations of metals and other trace elements in two of the most common seabird species breeding on Svalbard, the black-legged kittiwake (Rissa tridactyla) and the Brünnich's guillemot (Uria lomvia). Both of these species feed mostly on fish and crustaceans but have different foraging strategies, kittiwakes being surface feeders while guillemots are divers. We investigated the concentrations of arsenic (As), cadmium (Cd), chromium (Cr), copper (Cu), mercury (Hg), lead (Pb), selenium (Se) and zinc (Zn) in the plasma and body feathers of black-legged kittiwakes (n = 17), as well as in the body feathers of Brünnich's guillemots (n = 13). Samples were collected from adult birds at two time points, one week apart during July 2017 in Kongsfjorden, Svalbard. Of the non-essential trace elements, As was found at the highest median concentration at both the first (56.23 ng/g ww) and second (39.99 ng/g ww) sampling timepoints in the kittiwake plasma. When separating for the sexes, as well as sampling time, males sampled at the first sampling time point had significantly higher concentrations of As (median at 0.087 ng/g versus 0.039 ng/g) and Se (median 0.26 ng/g versus 0.16 ng/g) compared to males sampled at the second time point. There was no significant difference in plasma concentrations between females at first and second sampling time points. Kittiwake feathers contained significantly higher concentrations of As, Cd and Hg than guillemot feathers, while guillemot feathers had significantly higher concentrations of Cu, Pb and Zn. However, of the non-essential elements in both kittiwake and guillemot feathers Hg was found with the highest median concentrations at 5160 and 1080 ng/g, respectively, thus in kittiwakes exceeding the level of 5000 ng/g associated with adverse effect (e.g., impaired reproduction). Levels of Hg and Se found in the kittiwake feathers were higher than previous studies on seabirds in the Arctic.

The role of registries in hematological disorders.

Hematopoietic cell transplantation (HCT) was developed more than 65 years ago to treat malignant blood disorders and irreversible bone marrow failures, with the aim of replacing a diseased hematopoietic system with a healthy one (allogeneic HCT). Decades later, the procedure was adapted to apply maximal chemotherapy or radiotherapy, which would result in bone marrow failure, but could be remedied by an infusion of a patient's own cryopreserved bone marrow (autologous HCT). Both treatments are high-risk and complex, especially during the initial phases. However, concerted efforts, vision, and collaboration between physicians and centers worldwide have resulted in HCT becoming a standard of care for many hematological disorders with progressive improvements in outcomes. Registries and the collaboration of societies worldwide have enabled the delivery of this curative therapy to many patients with fatal hematological diseases. More than 1.5 million HCT were performed between 1957 and 2019, and activity is continuously increasing worldwide.

Robotic versus laparoscopic versus open nephrectomy for live kidney donors.

BACKGROUND: Waiting lists for kidney transplantation continue to grow. Live kidney donation significantly reduces waiting times and improves long-term outcomes for recipients. Major disincentives to potential kidney donors are the pain and morbidity associated with surgery. This is an update of a review published in 2011. OBJECTIVES: To assess the benefits and harms of open donor nephrectomy (ODN), laparoscopic donor nephrectomy (LDN), hand-assisted LDN (HALDN) and robotic donor nephrectomy (RDN) as appropriate surgical techniques for live kidney donors. SEARCH METHODS: We contacted the Information Specialist and searched the Cochrane Kidney and Transplant Register of Studies up to 31 March 2024 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing LDN with ODN, HALDN, or RDN were included. DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles and abstracts for eligibility, assessed study quality, and extracted data. We contacted study authors for additional information where necessary. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) or standardised mean difference (SMD) and 95% CI for continuous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS: Thirteen studies randomising 1280 live kidney donors to ODN, LDN, HALDN, or RDN were included. All studies were assessed as having a low or unclear risk of bias for selection bias. Five studies had a high risk of bias for blinding. Seven studies randomised 815 live kidney donors to LDN or ODN. LDN was associated with reduced analgesia use (high certainty evidence) and shorter hospital stay, a longer procedure and longer warm ischaemia time (moderate certainty evidence). There were no overall differences in blood loss, perioperative complications, or need for operations (low or very low certainty evidence). Three studies randomised 270 live kidney donors to LDN or HALDN. There were no differences between HALDN and LDN for analgesia requirement, hospital stay (high certainty evidence), duration of procedure (moderate certainty evidence), blood loss, perioperative complications, or reoperations (low certainty evidence). The evidence for warm ischaemia time was very uncertain due to high heterogeneity. One study randomised 50 live kidney donors to retroperitoneal ODN or HALDN and reported less pain and analgesia requirements with ODN. It found decreased blood loss and duration of the procedure with HALDN. No differences were found in perioperative complications, reoperations, hospital stay, or primary warm ischaemia time. One study randomised 45 live kidney donors to LDN or RDN and reported a longer warm ischaemia time with RDN but no differences in analgesia requirement, duration of procedure, blood loss, perioperative complications, reoperations, or hospital stay. One study randomised 100 live kidney donors to two variations of LDN and reported no differences in hospital stay, duration of procedure, conversion rates, primary warm ischaemia times, or complications (not meta-analysed). The conversion rates to ODN were 6/587 (1.02%) in LDN, 1/160 (0.63%) in HALDN, and 0/15 in RDN. Graft outcomes were rarely or selectively reported across the studies. There were no differences between LDN and ODN for early graft loss, delayed graft function, acute rejection, ureteric complications, kidney function or one-year graft loss. In a meta-regression analysis between LDN and ODN, moderate certainty evidence on procedure duration changed significantly in favour of LDN over time (yearly reduction = 7.12 min, 95% CI 2.56 to 11.67; P = 0.0022). Differences in very low certainty evidence on perioperative complications also changed significantly in favour of LDN over time (yearly change in LnRR = 0.107, 95% CI 0.022 to 0.192; P = 0.014). Various different combinations of techniques were used in each study, resulting in heterogeneity among the results. AUTHORS' CONCLUSIONS: LDN is associated with less pain compared to ODN and has comparable pain to HALDN and RDN. HALDN is comparable to LDN in all outcomes except warm ischaemia time, which may be associated with a reduction. One study reported kidneys obtained during RDN had greater warm ischaemia times. Complications and occurrences of perioperative events needing further intervention were equivalent between all methods.

Continuous and differential improvement in worldwide access to hematopoietic cell transplantation: activity has doubled in a decade with a notable increase in unrelated and non-identical related donors.

Promoting access to and excellence in hematopoietic cell transplantation (HCT) by collecting and disseminating data on global HCT activities is one of the principal activities of the Worldwide Network for Blood and Marrow Transplantation, a non-governmental organization in working relations with the World Health Organization. HCT activities are recorded annually by member societies, national registries and individual centers including indication, donor type (allogeneic/autologous), donor match and stem cell source (bone marrow/peripheral blood stem cells/cord blood). In 2018, 1,768 HCT teams in 89 countries (6 World Health Organization regions) reported 93,105 (48,680 autologous and 44,425 allogeneic) HCT. Major indications were plasma cell disorders and lymphoma for autologous, and acute leukemias and MDS/MPN for allogeneic HCT. HCT numbers increased from 48,709 in 2007. Notable increases were seen for autoimmune diseases in autologous and hemoglobinopathies in allogeneic HCT. The number of allogeneic HCT more than doubled with significant changes in donor match. While HCT from HLA-identical siblings has seen only limited growth, HCT from non-identical related donors showed significant increase worldwide. Strongest correlation between economic growth indicator of gross national income/capita and HCT activity/10 million population was observed for autologous HCT (correlation coefficient [r]=0.79). HCT from unrelated donors showed strong correlation (r=0.68), but only moderate correlation was detected from related donors (r=0.48 for HLA-identical sibling; r=0.45 for other). The use of HCT doubled in about a decade worldwide at different speed and with significant changes regarding donor match as a sign of improved access to HCT worldwide. Although narrowing, significant gaps remain between developing and non-developing countries.

Epidemiological insights into paratuberculosis in camels in Saudi Arabia: Bayesian estimation of true prevalence and identification of risk factors.

Paratuberculosis, caused by Mycobacterium avium subsp. paratuberculosis (MAP), is a significant concern in the camel population of Saudi Arabia. This study aimed to provide epidemiological insights into the disease by estimating the true prevalence in camels in the Eastern Province and Riyadh, using a Bayesian estimation framework, and exploring the associated risk factors through a frequentist approach. A total of 1200 camel blood samples were collected and analyzed using an indirect ELISA method. The true herd-level prevalence was estimated at 0.7 (95% probability interval: 0.57 to 0.81), and the mean expected true animal-level prevalence was 0.17 (0.14 to 0.20). Risk factors associated with Map seropositivity were identified, including sex, breed, raising system, and production type. Females, single breed camels, and nomadic raising systems were found to have lower odds of seropositivity, while camels used for racing and show had significantly higher odds. The study's Bayesian approach, adjusting for the imperfect accuracy of MAP tests, provides a nuanced understanding of the disease's prevalence in the region. The integration of true prevalence estimates with risk factor analysis offers a comprehensive framework that can guide future policies and strategies in the fight against paratuberculosis in Saudi Arabia. The findings emphasize the importance of targeted control measures, underscoring the urgent need for interventions in Saudi Arabia's camel population. By understanding the true disease prevalence and its associated risk factors, we can enhance disease management strategies, offering valuable insights for future control and eradication efforts in the region.

Estimation of genetic components, heterosis and combining ability of elite Pakistani wheat varieties for yield attributing traits and stripe rust response.

Wheat (Triticum aestivum L.) is a staple food and major source of dietary calories in Pakistan. Improving wheat varieties with higher grain yield and disease resistance is a prime objective. The knowledge of genetic behaviour of germplasm is key. To achieve this objective, elite wheat varieties were crossed in 4 by 3, line × tester design, and tested in 2019 in a triplicate yield trial to estimate genetic variance, general and specific combining ability, mid-parent heterosis and stripe rust (Puccinia striiformis L.). High grain 3358 kg·ha-1 was recorded in F1 hybrid (ZRG-79 × PAK-13). Analysis of variance (ANOVA) revealed significant genotypic variance in grain yield. Broad sense heritability (H2) was recorded in the range of 28 to 100 %. General combining ability (GCA) significant for grain yield in parents except FSD-08 and PS-05 was recorded, while specific combining ability (SCA) was recorded to be highly significant for grain yield only in two crosses (ZRG-79 × NR-09 and ZRG-79 × PAK-13). Mid-parent heterosis was estimated in the range of -28 to 62.6 %. Cross combinations ZRG-79 × PAK-13 depicted highly significant mid-parent heterosis (62.6 %). Highly significant correlation was observed among spike length, spikelets per spike, plant height and 1000-grain weight. Rust resistance index was recorded in the range of 0 to 8.5. These findings suggest exploitation of GCA for higher grain yield is important due to the presence of additive gene action and selection in the filial generations will be effective with improved rust resistance, while cross combinations ZRG-79 × PAK-13 high GCA are best suited for hybrid development.

A comprehensive review of security threats and solutions for the online social networks industry.

The term "cyber threats" refers to the new category of hazards that have emerged with the rapid development and widespread use of computing technologies, as well as our growing reliance on them. This article presents an in-depth study of a variety of security and privacy threats directed at different types of users of social media sites. Furthermore, it focuses on different risks while sharing multimedia content across social networking platforms, and discusses relevant prevention measures and techniques. It also shares methods, tools, and mechanisms for safer usage of online social media platforms, which have been categorized based on their providers including commercial, open source, and academic solutions.

Soil nutrients and plant uptake parameters as related to greenhouse gas emissions.

Fertilizer and water management practices have short- and long-term effects on soil chemical and physical properties and, in turn, greenhouse gas (GHG) emissions. The goal of this 4-yr field study was to establish the relationships between soil properties, agronomic practices, and GHG (CO2 and N2 O) emissions under different fertilizer and water table management practices. There were two fertilizer treatments: inorganic fertilizer (IF) and a mix of solid cattle manure and inorganic fertilizer (SCM), combined with tile drainage(DR) and controlled drainage with subirrigation(CDS). The cropping system was a maize (Zea mays L.)-soybean [Glycine max (L.) Merr.] rotation. Nitrogen in biomass (BMN) and N in grain (GRN) were measured and used to calculate other plant N parameters. Nitrous oxide and CO2 fluxes were collected weekly, and their respective cumulative emissions were calculated. The results show that soil organic matter (OM), soil total carbon (C), and soil total nitrogen (N) were greater in SCM than IF by 23.7, 35.2, and 24.4%, respectively. Water table management did not significantly affect soil N and C. Increased CO2 emissions were witnessed under higher soil OM, soil total C, and total N. Plant N uptake parameters were negatively correlated with N2 O and CO2 emissions. Higher plant N uptake can reduce environmental pollution by limiting N2 O and CO2 emissions.

Ethnobotanical investigation of medicinal plants used in Lingchuan county, Shanxi, China.

Medicinal plants are the primary sources of healthcare among the people of developing countries in villages and local towns. Documenting and reporting the traditional knowledge of medicinal plants may contribute to pharmaceutical research development. For this reason, we present our findings on ethnomedicinal plants from Lingchuan County, Shanxi, China, an unexplored area rich in medicinal plant resources. Information of ethnomedicinal plants were collected through questionnaire/semi-structured interviews from 180 informants, including traditional healers. Field surveys were conducted in 53 villages of Lingchuan County from 2017 to 2018. Informed consent was obtained from each participant before conducting the interview process. Quantitative analysis was performed for each recorded species, such as Relative Frequency Citation (RFC), Use Value (UV), and Factor of Informant Consensus (FIC). Diseases were categorized into twelve groups. A total 138 species of medicinal plants were recorded, belonging to 123 genera of 58 families. Asteraceae was the dominant plant family with 19 species, followed by Rosaceae and Fabaceae. Herbs were dominant among plant life-forms with 96 species, followed by shrubs and trees (15 species each). Roots were the most commonly used plant parts with 58 species, followed by whole plants and fruits (28 species each). Most plant species were reported non-toxic (84, 60%), followed by unknown toxicity (35, 25%), poisonous, and less toxic (19, 14%). Quantitative analysis revealed that Forsythia suspensa was with higher (0.33) RFC value, and Scutellaria baicalensis was recorded with a higher (0.91) UV. Treated diseases were categorized in 12 groups and evaluated by their FIC value, in which gynecological diseases have higher (0.93) FIC value followed by urinary system diseases. Most medicinal plants are used to clear away heat and relieve the surface. The present study revealed that local people of Lingchuan County confidently use ethnomedicinal plants for their healthcare needs. The higher indices value of a plant species resulted from quantitative analysis warrants further investigation, which may possess valuable phytochemical compounds that may result in new drugs for treating various human disorders.

Aspect based sentence segregated dataset of hybrid car's consumers online reviews.

Dataset presented in this paper is obtained from the top online automobile selling and purchasing websites. A total of 1000 reviews related to hybrid cars in the form of text reviews are extracted with the help of the Web Scraper tool. The dataset presents the customers sentiments in the form of reviews related to hybrid cars. Various aspects are taken into consideration while annotating the reviews such as driving, performance, comfort, safety features, interior, exterior and accessories. The annotation of data is done at three levels by three annotators i.e., (1) overall polarity of a review, (2) segregation of the sentence term in which aspect is discussed, (3) polarity of the discussed aspect. Cohen's Kappa score of 0.90 was achieved among the authors while annotating the reviews. Dataset can be used for sentiment analysis, information retrieving, lexicon analysis, and grammatical and morphological analysis.

Feathers as an integrated measure of organohalogen contamination, its dietary sources and corticosterone in nestlings of a terrestrial bird of prey, the northern Goshawk (Accipiter gentilis).

In this study, we evaluated the suitability of body feathers, preen oil and plasma for estimation of organohalogen compound (OHC) exposure in northern goshawk Accipiter gentilis nestlings (n = 37; 14 nests). In addition, body feathers received further examination concerning their potential to provide an integrated assessment of (1) OHC exposure, (2) its dietary sources (carbon sources and trophic position) and (3) adrenal gland response (corticosterone). While tetrabromobisphenol A was not detected in any sample, the presence of polychlorinated biphenyls, organochlorine pesticides, polybrominated diphenyl ethers and hexabromocyclododecane in body feathers (median: 23, 19, 1.6 and 3.5 ng g-1 respectively), plasma (median: 7.5, 6.2, 0.50 and 1.0 ng g-1 ww, respectively) and preen oil (median: 750, 600, 18 and 9.57 ng g-1 ww, respectively) suggests analytical suitability for biomonitoring of major OHCs in the three matrices. Furthermore, strong and significant associations (0.20 ≤ R2 ≤ 0.98; all P < 0.05) among the OHC concentrations in all three tissues showed that body feathers and preen oil reliably reflect circulating plasma OHC levels. Of the dietary proxies, δ13C (carbon source) was the most suitable predictor for variation in feather OHCs concentrations, while no significant relationships between body feather OHCs and δ15N (trophic position) were found. Finally, body feather corticosterone concentrations were not related to variation in OHC concentrations. This is the first study to evaluate feathers of a terrestrial bird of prey as an integrated non-destructive tool to jointly assess nestling ecophysiology and ecotoxicology.

Prevalence of Enterohaemorrhagic and Enteroaggregative E. coli among Children with Diarrhea in Najaf, Iraq.

Diarrhea is one of the leading causes of morbidity and mortality among children under 5 years old in developing countries. The classification of diarrheagenic E. coli (DEC) strains among children with diarrhea is still receiving low attention. The present study aimed at determining the prevalence of enterohaemorrhagic E. coli (EHEC) and enteroaggregative E. coli (EAEC) among children under 5 years old suffering from acute diarrhea. Stool samples (n=100) were collected from children under 5 years old suffering from acute diarrhea for the molecular detection of EHEC (using stx1 and stx2) and EAEC (using aat) by polymerase chain reaction technique. The results showed a high percentage of isolation of EHEC from stool samples, in compression to EAEC; accordingly, among 75 identified DEC isolates, 15.9% belonged to EHEC, while 5.3% belonged to EAEC. Among EHEC, stx1 was highly prevalent among isolates (9.3%), in comparison to stx2 (6.6%). A high frequency of EHEC was detected in males in the age group of 7-12 months, whereas EAEC was found in females in the age group of 13-19 months. In conclusion, EHEC and EAEC were associated with bloody and watery diarrhea among children under 5 years old. Genes associated with virulence factors (i.e., stx1, stx2, and aat) could be used as genetic markers for the detection of EHAE and EAEC.

Saudi Heart Rhythm Society Task Force on Management of Potential Arrhythmogenicity Associated with Pharmacotherapy for COVID-19.

Evidence of cardiovascular complications associated with the COVID-19 global pandemic continues to evolve. These include direct and indirect myocardial injury with subsequent acute myocardial ischemia, and cardiac arrhythmia. Some results from a limited number of trials of antiviral medications, along with chloroquine/hydroxychloroquine and azithromycin, have been beneficial. However, these pharmacotherapies may cause drug-induced QT prolongation leading to ventricular arrhythmias and sudden cardiac death. Mitigation of the potential risk in these susceptible patients may prove exceptionally challenging. The Saudi Heart Rhythm Society established a task force to perform a review of this subject based on has recently published reports, and studies and recommendations from major medical organizations. The objective of this review is to identify high-risk patients, and to set clear guidelines for management of patients receiving these pharmacotherapies.

An association between exposure to Middle East Respiratory Syndrome (MERS) and mortality rate of Coronavirus Disease 2019 (COVID-19).

OBJECTIVE: Our objective was to find an association between exposure of a population to Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and mortality rate due to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) across different countries worldwide. MATERIALS AND METHODS: To find the relationship between exposure to MERS-CoV and mortality rate due to SARS-CoV-2, we collected and analyzed data of three possible factors that may have resulted in an exposure of a population to MERS-CoV: (1) the number of Middle East Respiratory Syndrome (MERS) cases reported among 16 countries since 2012; (2) data of MERS-CoV seroprevalence in camels across 23 countries, as working with camels increase risk of exposure to MERS-CoV; (3) data of travel history of people from 51 countries to Saudi Arabia was collected on the assumption that travel to a country where MERS is endemic, such as, Saudi Arabia, could also lead to exposure to MERS-CoV. RESULTS: We found a significantly lower number of Coronavirus disease 2019 (COVID-19) deaths per million (deaths/M) of a population in countries that are likely to be exposed to MERS-CoV than otherwise (t-stat=3.686, p<0.01). In addition, the number of COVID-19 deaths/M of a population was significantly lower in countries that reported a higher seroprevalence of MERS-CoV in camels than otherwise (t-stat=4.5077, p<0.01). Regression analysis showed that increased travelling history to Saudi Arabia is likely to be associated with a lower mortality rate due to COVID-19. CONCLUSIONS: This study provides empirical evidence that a population that was at an increased risk of exposure to MERS-CoV had a significantly lower mortality rate due to SARS-CoV-2, which might be due to cross-protective immunity against SARS-CoV-2 in that population because of an earlier exposure to MERS-CoV.

Electrocardiographic changes following intracranial haemorrhage: a retrospective cohort study.

OBJECTIVE: To improve the understanding of the association between electrocardiographic (ECG) abnormalities and clinical outcomes of patients with all types of intracranial hemorrhage (ICH). METHODS: A retrospective cohort study was conducted in a tertiary healthcare hospital on patients with ICH without cardiac disease or renal disease requiring dialysis. Demographic and clinical data were collected from hospital records. ECG record were obtained within 24 hours of presentation and prior to treatment. Records were interpreted for this study by a cardiologist blinded to other data. RESULTS: Assessment of 291 patients (228 adults and 63 children) showed that subdural hemorrhage was the most common type of ICH (31.6%) followed by intraparenchymal hemorrhage (23.0%). ECG records were available for 98 patients. ECG abnormalities were most commonly nonspecific ST-segment changes (32.6%). In adults, history of neurological disease was associated with atrioventricular block (p=.004) and QTc prolongation (p=.041). Pediatric patients exhibited associations between ST-segment changes (p=.045) and sinus tachycardia (p=.027) and type of ICH. However, ECG changes were not statistically associated with clinical outcomes in adults or children. CONCLUSION: Significant ECG changes frequently occurred in patients with all types of ICH but did not consistently predict the outcome in this study. Close observation of patients is still recommended to detect ECG changes that could affect the treatment.

'We need to share our stories': the lives of Pakistanis with intellectual disability and their guardians.

INTRODUCTION: The experiences of Pakistanis with intellectual disabilities (IDs) and their family members have been underexplored empirically. METHOD: The present study sought to address this gap by understanding the lives of five Special Olympics Pakistan athletes and their guardians through PhotoVoice. FINDINGS: Through thematic analysis, we present the primary theme concerning Pakistan's cultural context that provides an empirical exploration of cultural beliefs about intellectual disability, cultural expectations and support received by people with intellectual disabilities and their guardians. DISCUSSION: We discuss implications for research and practice.

The Role of Donor Lymphocyte Infusion (DLI) in Post-Hematopoietic Cell Transplant (HCT) Relapse for Chronic Myeloid Leukemia (CML) in the Tyrosine Kinase Inhibitor (TKI) Era.

Treatment for relapse of chronic myeloid leukemia (CML) following hematopoietic cell transplantation (HCT) includes tyrosine kinase inhibitors (TKIs) with or without donor lymphocyte infusions (DLIs), but the most effective treatment strategy is unknown. This study was performed through the Center for International Blood and Marrow Transplant Research (CIBMTR) database. We retrospectively reviewed all patients reported to the CIBMTR registry from 2002 to 2014 who underwent HCT for CML and were alive 30 days postrelapse. A total of 215 HCT recipients relapsed and were analyzed in the following groups: (1) TKI alone (n = 128), (2) TKI with DLI (n = 48), and (3) DLI without TKI (n = 39). In multivariate analysis, disease status prior to HCT had a significant effect on overall survival (OS). Patients who received a DLI alone compared with a TKI with a DLI had inferior survival (hazard ratio, 2.28; 95% confidence interval, 1.23 to 4.24; P= .009). Those who received a TKI alone had similar survival compared with those who received a TKI with a DLI (P = .81). These data support that despite use of TKIs pretransplantation, TKI salvage therapy continues to provide significant survival following relapse in patients with CML following HCT. These data do not suggest that adding a DLI to a TKI adds an improvement in OS.

Maintenance Tyrosine Kinase Inhibitors Following Allogeneic Hematopoietic Stem Cell Transplantation for Chronic Myelogenous Leukemia: A Center for International Blood and Marrow Transplant Research Study.

It remains unknown whether the administration of tyrosine kinase inhibitors (TKIs) targeting BCR-ABL1 after allogeneic hematopoietic cell transplantation (HCT) is associated with improved outcomes for patients with chronic myelogenous leukemia (CML). In this registry study, we analyzed clinical outcomes of 390 adult patients with CML who underwent transplantation between 2007 and 2014 and received maintenance TKI following HCT (n = 89) compared with no TKI maintenance (n = 301), as reported to the Center for International Blood and Marrow Transplant Research. All patients received TKI therapy before HCT. The majority of patients had a disease status of first chronic phase at HCT (n = 240; 62%). The study was conducted as a landmark analysis, excluding patients who died, relapsed, had chronic graft-versus-host disease, or were censored before day +100 following HCT. Of the 89 patients who received TKI maintenance, 77 (87%) received a single TKI and the other 12 (13%) received multiple sequential TKIs. The most common TKIs used for maintenance were dasatinib (n = 50), imatinib (n = 27), and nilotinib (n = 27). As measured from day +100, the adjusted estimates for 5-year relapse (maintenance, 35% versus no maintenance, 26%; P = .11), leukemia-free survival (maintenance, 42% versus no maintenance, 44%; P = .65), or overall survival (maintenance, 61% versus no maintenance, 57%; P = .61) did not differ significantly between patients receiving TKI maintenance or no maintenance. These results remained unchanged in multivariate analysis and were not modified by disease status before transplantation. In conclusion, our data from this day +100 landmark analysis do not demonstrate a significant impact of maintenance TKI therapy on clinical outcomes. The optimal approach to TKI administration in the post-transplantation setting in patients with CML remains undetermined.

Spatial distribution and accessibility to public sector tertiary care teaching hospitals: case study from Pakistan.

BACKGROUND: Public sector provision of health care services is important for addressing health morbidity and mortality burden for population health in developing countries like Pakistan. Physical accessibility and spatial distribution of healthcare facilities affect their utilization for improving population health. AIMS: This study aimed to analyze the spatial distribution of five public sector, tertiary care, teaching, general hospitals in the city of Lahore, Pakistan. METHODS: The point locations of all five hospitals were obtained from Google Earth. While the vector road network file was downloaded from the OpenStreetMap website. GIS software ArcGIS 10.5 and the Network Analyst extension were used for processing, analysis and mapping. The Lahore city shapefiles and the hospital point locations were projected to ensure correct spatial distance analysis. RESULTS: The five hospitals are located in the northeastern and east-central parts of Lahore. Most of the Lahore "towns" (administrative subdivisions) are either partially or completely covered by the 12-kilometre buffer as well as the 12-kilometre service area around these five selected hospitals. However, either the 12-kilometre buffer or service area did not cover large swaths of Wagha, Nishtar, and Iqbal towns. CONCLUSIONS: Availability of geographic and attribute data on road network and population characteristics would facilitate planning for allocating locations for new health care facilities based on utilitarian principles.