Mediport use as an acceptable standard for CAR T cell infusion.

Introduction: Mediport use as a clinical option for the administration of chimeric antigen receptor T cell (CAR T cell) therapy in patients with B-cell malignancies has yet to be standardized. Concern for mediport dislodgement, cell infiltration, and ineffective therapy delivery to systemic circulation has resulted in variable practice with intravenous administration of CAR T cell therapy. With CAR T cell commercialization, it is important to establish practice standards for CAR T cell delivery. We conducted a study to establish usage patterns of mediports in the clinical setting and provide a standard of care recommendation for mediport use as an acceptable form of access for CAR T cell infusions. Methods: In this retrospective cohort study, data on mediport use and infiltration rate was collected from a survey across 34 medical centers in the Pediatric Real-World CAR Consortium, capturing 504 CAR T cell infusion routes across 489 patients. Data represents the largest, and to our knowledge sole, report on clinical CAR T cell infusion practice patterns since FDA approval and CAR T cell commercialization in 2017. Results: Across 34 sites, all reported tunneled central venous catheters, including Broviac® and Hickman® catheters, as accepted standard venous options for CAR T cell infusion. Use of mediports as a standard clinical practice was reported in 29 of 34 sites (85%). Of 489 evaluable patients with reported route of CAR T cell infusion, 184 patients were infused using mediports, with no reported incidences of CAR T cell infiltration. Discussion/Conclusion: Based on current clinical practice, mediports are a commonly utilized form of access for CAR T cell therapy administration. These findings support the safe practice of mediport usage as an accepted standard line option for CAR T cell infusion.

Scanning probe microscopy examination of the surface properties of keratin fibres.

A Scanning Probe Microscope (SPM) was used to investigate the mechanical properties of the surface of hair and wool fibres. Using stiff cantilevers, penetration was achieved on the fibres under ambient conditions and at increased relative humidity (RH). The Young's modulus of the exocuticle was estimated to be 2.1GPa under ambient conditions, decreasing to 0.6GPa at 96% RH. Contrary to findings by other authors [Crossley, J.A.A., Gibson, C.T., Mapledoram, L.D. , Huson, M.G., Myhra, S., Pham, D.K., Sofield, C.J., Turner, P.S., Watson, G.S., 2000. Atomic force microscopy analysis of wool fibre surfaces in air and under water. Micron 31, 659-667; Gibson, C.T., Watson, G.S., Mapledoram, L.D., Kondo, H., Myhra, S., 1999. Characterisation of organic thin films by atomic force microscopy-application of force vs. distance analysis and other modes. Applied Surface Science 144-145, 618-622; Blach, J., Loughlin, W., Watson, G.S., Myhra, S., 2001. Surface characterization of human hair by atomic force microscopy in the imaging and f-d modes. Journal of Cosmetic Science 23, 165-174], the surface lipid layer could not be penetrated using soft cantilevers in force-distance (f-d) mode in water. Attempts were made to remove the lipid layer from the surface both physically and chemically so as to examine the influence of the lipid on f-d measurements. Using both techniques, it was not possible to remove lipid without damaging the fibre, suggesting that the lipid is an integral part of the surface rather than a discrete surface layer. Adhesion measurements on the surface of wool, nylon and polyethylene, showed that in water and at high RH, the surface of keratin fibres is more akin to a polyamide. At low RH and in liquid paraffin, the surface is more akin to a hydrocarbon, suggesting it is capable of altering its structure in response to different environments.

Molecular characterization of the glycoproteins from two warm water rhabdoviruses: snakehead rhabdovirus (SHRV) and rhabdovirus of penaeid shrimp (RPS)/spring viremia of carp virus (SVCV).

We have determined the complete coding sequences for the glycoprotein (G) genes from two rhabdoviruses that infect warm water aquatic animals, the snakehead rhabdovirus (SHRV) and rhabdovirus of penaeid shrimp (RPS). Surprisingly, the G nucleotide sequence from RPS, a virus which has been isolated from diseased shrimp in Hawaii on numerous occasions, was over 99% identical to the G nucleotide sequence from spring viremia of carp virus (SVCV), a fish virus from Europe and Asia. This is the first report of SVCV isolation outside of Europe and Asia, and it is also the first report of SVCV infecting a non-vertebrate species. The G gene from SHRV was most closely related to the G genes from the three Novirhabdoviruses, viral hemorrhagic septicemia virus (VHSV), infectious hematopoietic necrosis virus (IHNV), and hirame rhabdovirus (HIRRV), with 47, 37, and 36% amino acid identity, respectively. In addition, a phylogenetic analysis using the amino acid sequence from rhabdovirus G genes indicated that SHRV should be classified within the Novirhabdovirus genus. Finally, the SHRV-G gene was successfully expressed in mammalian cells under the control of the cytomegalovirus (CMV) promoter, establishing that it can potentially be used in the production of pseudotyped retroviruses designed to infect fish.

Intralobar bronchopulmonary sequestration presenting as hemoptysis: evidence for an acquired cause.

A 26-year-old pregnant female was treated for an intralobar sequestration presenting as exsanguinating hemoptysis. The case brings forth strong evidence supporting an acquired rather than a congenital cause of some intralobar sequestrations. We discuss the anatomy, epidemiology, and pathogenesis of bronchopulmonary sequestrations.

The Ross Procedure: current registry results.

BACKGROUND: The pulmonary autograft procedure for the treatment of aortic valve disease was developed and performed by Ross in 1967. The results he published in 1987 prompted increasing interest in the procedure. The International Registry of the Ross Procedure was established in 1993 to further examine longitudinal clinical outcomes. METHODS: The results from the Ross registry document the continued and growing interest in the procedure with 2,523 patients currently enrolled, representing 122 centers and 166 surgeons worldwide. RESULTS: Mortality (1987 to present) reported in the registry is 2.5%. It should be noted that follow-up stands at 70%. The most important issues for the registry to track are the incidence of reoperation for autograft failure and the fate of the pulmonary homograft. Reoperation for all valve-related problems is low (5.4%), with an autograft explant rate of 1.9%. Overall registry data indicate that the right ventricular outflow tract revision rate is 2.8%, with this decreasing by half to 1.3% in the 1987 to present subgroup. CONCLUSIONS: Rigorous analysis of outcomes is difficult with registry follow-up currently at 70%; however, the general conclusions derived from the registry are supported by other individual series with excellent follow-up. Success of the registry depends on judicious efforts by all participating surgeons and coordinators in documenting long-term patient results and reporting them to the registry.

Video-assisted thoracic surgery: primary therapy for spontaneous pneumothorax?

BACKGROUND: This study assessed the role of video-assisted thoracic surgery (VATS) in current therapy for spontaneous pneumothorax. METHODS: We compared a retrospective series of 89 patients treated conventionally with a consecutive group of 30 patients undergoing VATS pleural abrasion. The 89 earlier patients were predominantly male (81%). Treatment groups included observation/aspiration (7 or 17%), tube thoracostomy (32 or 36%), multiple tubes (7 or 9%), and thoracotomy (43 or 48%). Of the 30 patients treated with VATS, 18 (66%) were male. Primary indications for operation were recurrent pneumothorax (17) and persistent air leak (9). RESULTS: Hospital lengths of stay (LOS) for the earlier group were 5 days for simple tube and 7 days for primary thoracotomy; LOS for initial intervention followed by thoractomy exceeded 15 days in all subgroups. The average LOS in the VATS group was 13 days; 6 patients treated with primary VATS (no chest tube) had a mean LOS of 6.5 days. Complications included 3 (10%) prolonged air leaks (more than 7 days) and 2 (7%) early recurrences. CONCLUSIONS: We do not recommend VATS as primary therapy for spontaneous pneumothorax; tube thoracostomy remains the treatment of choice. However, we strongly support surgical intervention early (3 days) in patients with a persistent air leak, and as primary therapy in a nonurgent situation if standard indications exist. This study shows no advantage of VATS over conventional thoracotomy in hospital stay or complication rate.

Prevention of distal limb ischemia during cardiopulmonary support via femoral cannulation.

The indications for prolonged cardiopulmonary support or extracorporeal membrane oxygenation are expanding. A potential serious complication of these techniques is distal limb ischemia. Techniques have been developed to provide the distal limb with blood flow. Unfortunately, specialized skills and materials are required. We describe a simple method of providing distal limb perfusion using ordinary pressure tubing and a standard cordis catheter. This technique is capable of reproducing normal superficial femoral artery blood flow.

Appendicitis. Improvements in diagnosis and treatment.

The results of therapy in cases of suspected acute appendicitis were reviewed in 844 consecutive cases of appendicitis occurring over a 3-year period. A diagnostic accuracy of 87.4 per cent was found as well as a perforation rate of 18.4 per cent. Complication rates varied with the clinical state of the appendix: 16 per cent in perforated, 5.6 per cent in nonperforated, and 11.3 per cent in normal appendices. Excellent results were routinely obtainable employing early operative intervention, perioperative antibiotics, and a systematic surgical approach.