Management system of home transfusion in Japan: A nationwide survey in 2019.

BACKGROUND AND OBJECTIVES: In Japan, there are various opinions on the pros and cons of home transfusion because of safety concerns. We hence aimed to elucidate the safety and availability of home transfusion in Japan, which has not been clarified to date. MATERIALS AND METHODS: Clinics throughout Japan that provide home care and have experience in performing blood transfusions were surveyed. The analysis period was February to December 2019. Basic information about the clinics, their collaboration system with core hospitals, storage method of red blood cells (RBCs) and the system for the management of patient information regarding transfusion reactions were investigated. RESULTS: Detailed information was obtained regarding the implementation of home transfusions by 51 clinics. The proportion of home care clinics performing home transfusions was 17.6%, and they were more frequently performed in urban regions. Approximately half of the clinics collaborated with a core hospital for emergency responses to transfusion reactions. At 84% of the clinics, RBC units were stored in refrigerators that were not exclusively allocated to blood storage. Nurses and family members were involved as patient attendants in 83% and 77% of the home transfusions, respectively. No serious transfusion reactions were reported among the 150 patients in 2019, nor the 623 patients up to 2018. CONCLUSION: From data on its availability and safety, home transfusions are considered to be in the developing phase in Japan. Increased cooperation between hospitals and clinics is crucial towards improving the home transfusion system in Japan in the future.

Home transfusions are implemented using diverse approaches in Japan.

BACKGROUND AND OBJECTIVES: Japan's ageing society has increased the need for home healthcare, including home transfusions. We hence aimed to elucidate the purpose and utilization of home transfusions in Japan, which has not been clarified to date. MATERIALS AND METHODS: Clinics throughout Japan that provide home care and have experience in performing blood transfusions were surveyed. The study period was February to December 2019, and information of patients receiving home red blood cell transfusions, including patient background, pre-transfusion laboratory data and the purpose of the transfusions, was collected. RESULTS: Haematological malignancies and solid tumours accounted for 70% of the patients' underlying diseases, with the former being significantly more common in urban areas. Regarding the purpose of the home transfusions, haematologists focused on symptom improvement, whereas gastroenterology surgeons focused on life support. Furthermore, maintenance of life was more likely to be the aim in the group of patients with the lowest level of activities of daily living. The main items that were significantly associated with a low haemoglobin level before transfusion included age ≥90 years and a gastroenterologist being the physician in charge. CONCLUSION: Home transfusions were found to be performed in a restrictive and diverse manner in Japan. Life support is the second most common purpose of home transfusion in Japan, and optimizing effective home transfusion remains a challenge.

Anti-CD38 monoclonal antibody interference with blood compatibility testing: Differentiating isatuximab and daratumumab via functional epitope mapping.

BACKGROUND: There are two FDA-approved anti-CD38 monoclonal antibodies for treatment of multiple myeloma: isatuximab and daratumumab. Owing to expression of CD38 on reagent red blood cells (RBCs), these antibodies interfere with indirect antiglobulin tests (IATs). We sought to understand differences in such interference by performing binding experiments. STUDY DESIGN AND METHODS: In vitro experiments to compare the binding to RBCs of isatuximab and daratumumab alone or in the presence of a mouse anti-human CD38 antibody (HB-7 or AT13/5) or a nicotinamide adenine dinucleotide-analog CD38 inhibitor were performed and quantified by flow cytometry, imaging, mass spectrometry, surface plasmon resonance, and LigandTracer technologies. Serologic testing was performed on plasma samples spiked with isatuximab or daratumumab. RESULTS: CD38 expressed on RBCs can be directly bound by daratumumab, whereas isatuximab requires a co-factor, such as HB-7, AT13/5, or a CD38 inhibitor, suggesting that the isatuximab epitope on RBCs is masked in vitro. Daratumumab samples more frequently showed interference and had stronger reactions than isatuximab samples. Dithiothreitol treatment was equally effective in mitigating the interference caused by either drug. DISCUSSION: Both isatuximab and daratumumab interfere with IATs but at different magnitudes, reflecting distinct binding to CD38 on RBCs. From the binding studies, we conclude that the isatuximab epitope on RBCs is masked in vitro and binding requires a certain CD38 conformation or co-factor. This circumstance may explain why interference is seen only in a subset of patients receiving isatuximab when compared with interference seen in most patients on daratumumab therapy.

An international investigation into O red blood cell unit administration in hospitals: the GRoup O Utilization Patterns (GROUP) study.

BACKGROUND: Transfusion of group O blood to non-O recipients, or transfusion of D- blood to D+ recipients, can result in shortages of group O or D- blood, respectively. This study investigated RBC utilization patterns at hospitals around the world and explored the context and policies that guide ABO blood group and D type selection practices. STUDY DESIGN AND METHODS: This was a retrospective study on transfusion data from the 2013 calendar year. This study included a survey component that asked about hospital RBC selection and transfusion practices and a data collection component where participants submitted information on RBC unit disposition including blood group and D type of unit and recipient. Units administered to recipients of unknown ABO or D group were excluded. RESULTS: Thirty-eight hospitals in 11 countries responded to the survey, 30 of which provided specific RBC unit disposition data. Overall, 11.1% (21,235/191,397) of group O units were transfused to non-O recipients; 22.6% (8777/38,911) of group O D- RBC units were transfused to O D+ recipients, and 43.2% (16,800/38,911) of group O D- RBC units were transfused to recipients that were not group O D-. Disposition of units and hospital transfusion policy varied within and across hospitals of different sizes, with transfusion of group O D- units to non-group O D- patients ranging from 0% to 33%. CONCLUSION: A significant proportion of group O and D- RBC units were transfused to compatible, nonidentical recipients, although the frequency of this practice varied across sites.

Effects of mouthwash on periodontal pathogens and glycemic control in patients with type 2 diabetes mellitus.

Periodontitis is known to be associated with type 2 diabetes mellitus (T2DM), and gargling with mouthwash is known to reduce the incidence of periodontitis by inhibiting periodontal pathogens. However, the effects of mouthwash on oral and systemic conditions in patients with T2DM remain unknown. In this study, we investigated the effects of gargling with mouthwash on the number of red complex species, including Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, and HbA1c levels in patients with T2DM. Patients were instructed to gargle with water for 6 months, followed by gargling with mouthwash containing chlorhexidine gluconate for the subsequent 6 months. At each clinic visit, saliva was collected and bacterial DNA was extracted to detect red complex species using the polymerase chain reaction technique. The HbA1c level was determined using a blood sample. The number of red complex species significantly decreased in younger or male patients who gargled with mouthwash. Furthermore, HbA1c levels significantly decreased in younger patients or patients with higher HbA1c levels who gargled with mouthwash. These results suggest that gargling with mouthwash reduces the number of red complex species and improves the hyperglycemic status in patients with T2DM, especially younger patients.

Community Detection Using Restrained Random-Walk Similarity.

In this paper, we propose a restrained random-walk similarity method for detecting the community structures of graphs. The basic premise of our method is that the starting vertices of finite-length random walks are judged to be in the same community if the walkers pass similar sets of vertices. This idea is based on our consideration that a random walker tends to move in the community including the walker's starting vertex for some time after starting the walk. Therefore, the sets of vertices passed by random walkers starting from vertices in the same community must be similar. The idea is reinforced with two conditions. First, we exclude abnormal random walks. Random walks that depart from each vertex are executed many times, and vertices that are rarely passed by the walkers are excluded from the set of vertices that the walkers may pass. Second, we forcibly restrain random walks to an appropriate length. In our method, a random walk is terminated when the walker repeatedly visits vertices that they have already passed. Experiments on real-world networks demonstrate that our method outperforms previous techniques in terms of accuracy.

Pharmacology of intraperitoneal CPT-11.

CPT-11 is clearly one of the most important new anticancer drugs developed in the last few decades, and CPT-11 combined with 5-fluorouracil (5-FU) and leucovorin is considered as reference first-line chemotherapy in the treatment of metastatic colorectal cancer. CPT-11 has a complex pharmacologic profile in vivo, and it needs caboxylesterase-mediated biotransformation to SN-38 before production of its cytotoxic effect. Intraperitoneal administration of CPT-11 has been studied recently in murine models and presented some potential advantage over the intravenous (i.v.) route. Intraperitoneal administration of CPT-11 may be more effective than i.v. administration not only for peritoneal seeding but also for liver metastases. Also, these effects may occur with less toxicity by intraperitoneal administration. Intraperitoneal chemotherapy containing CPT-11 might be an essential option for prevention and treatment of cancerous dissemination of gastrointestinal malignancy.

Effect of PMMA filler particles addition on the physical properties of resin composite.

The aim of this study was to evaluate the effect of additional polymethyl methacrylate (PMMA) fillers on the physical properties of experimental resin composites. PMMA particles (d=30 µm) were added to an experimental methacrylate-based resin composite in five concentrations of 0, 2.0, 4.8, 9.1, and 23.1 wt%. Properties such as contact angle, water sorption and compressive strength were measured and the fractured specimens were observed with a scanning electron microscope. The results showed that a small amount (2 wt%) of additional PMMA fillers inhibited the crack propagation and enhanced compressive strengths of the resin composites, without a significant change in water contact angle of surface or increased water sorption. However, in higher portions, the mechanical properties were not improved as a debonding at the interface between untreated fillers and the matrix, or failure within the organic filler could reduce the compressive yield strength of the composite.

Microtensile bond strengths to cavity floor dentin in indirect composite restorations using resin coating.

PURPOSE: The aims of this study were (1) to evaluate the effect of a resin coating on the microtensile bond strengths (mu-TBSs) of indirect composite restorations bonded to dentin with resin cement and (2) to compare the mu-TBSs with that of a directly placed composite. MATERIALS AND METHODS: Class I cavities were prepared in extracted human molars. The specimens were divided into five groups: For the indirect restorations, the cavity surfaces of the control group were left uncoated (group 1), while the surfaces of the experimental groups were resin coated with a dentin bonding system, Clearfil Protect Bond (PB; groups 2 and 3), or with a combination of PB and a flowable resin composite, Protect Liner F (PLF; group 4). The cavities were temporized for 1 day. Indirect composite restorations (Estenia) were cemented with a resin cement (Panavia F). Pretreatment with ED Primer II was performed in the groups 1, 3, and 4. For the direct restorations, the cavities were restored with PB and a direct composite (Clearfil AP-X; group 5). After 24 hours of water storage, mu-TBSs were measured at a crosshead speed of 1 mm/min. The data were analyzed with one-way analysis of variance and Sheffe's test (p < 0.05). In addition, fracture modes were determined visually and by scanning electron microscopy. RESULTS: A combination of PB and PLF showed significantly higher bond strengths compared with the original bond strength of Panavia F and the single use of PB (p < 0.05). However, the highest bond strengths were obtained when PB was used for direct composite restorations (p < 0.05). CONCLUSION: The application of a resin coating consisting of a self-etching primer dentin bonding system and a flowable resin composite significantly improved the mu-TBS of indirect restorations bonded to dentin using resin cement. CLINICAL SIGNIFICANCE: A resin coating should be required to improve dentin bonding performance of Panavia F in indirect restorations. However, direct composite restorations still provide higher bond strength compared to indirect restorations.