Report on hematopoietic cell transplantations performed in 2018/2019 focusing on the trends of selection of stem cell sources in the Asia-Pacific region: APBMT Activity Survey.

The number of hematopoietic stem cell transplantations (HCTs) is increasing annually worldwide, and the Asia-Pacific (AP) region is no exception. We report on the absolute number of HCTs in 2018 and 2019 and the trends in graft selection and disease indication in the past few decades. In 2018, 24,292 HCTs were performed in the AP region, of which 8,754 (36.0%) were autologous and 15,538 (64.0%) were allogeneic. Among the allogeneic HCTs, 10,552 (67.9%) of the recipients were related to their donors, whereas 4,986 (32.1%) were unrelated. In 2019, 27,583 HCTs were reported, of which 17,613 (63.9%) were allogeneic and 9,970 (36.1%) were autologous. Although, in 2010, there was a nearly equal number of related and unrelated HCTs, the difference has shown an annual increase, with more than double (2.05) the number of related than unrelated HCTs in 2019. Recent trends in the AP region show that peripheral blood has overwhelmingly surpassed the bone marrow as a graft source for both related and unrelated HCTs, with the haploidentical donor type being preferred; however, their trends in each country/region were quite different among countries/regions. In 2019, the main conditions requiring HCT were acute myelogenous leukemia (n=6,629 [24.0%]), plasma cell disorders (PCD) (n=4,935 [17.9%]), malignant lymphoma (ML) (n=4,106 [14.9%]), acute lymphoblastic leukemia (AML) (n=3,777 [13.7%]), myelodysplastic syndrome or myelodysplastic/myeloproliferative neoplasm (n=1,913 [6.9%]), severe aplastic anemia (n=1,671 [6.1%]), and hemoglobinopathy (n=910 [3.3%]). PCD and ML were the main indications for autologous HCT, and the number of PCD cases has grown more prominent than the corresponding of ML. The increased number of allogeneic transplants for hemoglobinopathy remains prominent, as well as that of AML and acute lymphocytic leukemia for the past 5 years. There was a significant regional variation in the number of facilities performing HCTs, ranging from one in Mongolia and Nepal to 313 in Japan, and differing regional densities varying from 0.1 in Indonesia and Pakistan to 24.7 in Japan. The total transplant density per 10 million population in each country/region also differed (0.2 in Indonesia and 627 in New Zealand). This annual Activity Survey aims to help all participating countries/regions understand the changes in HCT, serve as an asset in promoting HCT activities in the AP region, and be used as a reference for comparison with other registries from Europe and the United States.

The Predictive Accuracy of the Delayed Spot Sign for Haematoma Expansion in Spontaneous Supratentorial Intracerebral Haemorrhage: A Systematic Review and Meta-Analysis.

Previous studies have shown that spot signs on imaging modalities such as CT perfusion, delayed phase CTA or post contrast CT imaging reportedly have greater ability to predict haematoma expansion (HE) than the traditional CT angiography spot sign. We performed a systematic review and meta-analysis of the diagnostic accuracy of the spot sign on delayed imaging modalities in predicting haematoma expansion. Pubmed, Excerpta Medica Database, and the Cochrane library were searched on the 11 November 2019. The search strategy utilised the following terms: CT angiography OR post contrast CT OR CT perfusion OR CT AND intracerebral haemorrhage (or synonyms) AND spot sign OR delayed spot sign OR dynamic spot sign. The area under the summary of receiver operating curves for diagnostic accuracy of delayed spot sign in predicting HE was calculated using bivariate random effects meta-analysis. 501 articles were identified, with 10 meeting inclusion criteria. The studies included 711 patients overall, with 272 (38%) demonstrating a spot sign. The presence of a delayed spot sign was associated with HE with a diagnostic odds ratio of 25.4 (12.7-50.9). Pooled sensitivity was 0.81 (0.72-0.88), with a pooled specificity of 0.82 (0.76-0.88). Pooled positive likelihood ratio was 4.30, with a pooled negative likelihood ratio of 0.26. The area under the receiver operating curve (AUC) was 0.88. The delayed spot sign has greater diagnostic accuracy in predicting haematoma expansion than the traditional CT angiography spot sign. Further research could determine the delayed imaging technique that has the greatest diagnostic accuracy.

Trends in disease indications for hematopoietic stem cell transplantation in the Asia-Pacific region: A report of the Activity Survey 2017 from APBMT.

The Asia-Pacific Blood and Marrow Transplantation Group (APBMT) has been conducting annual surveys on the activity of hematopoietic stem cell transplants since 2007. The APBMT Data Center collected the following data in 2017. A total of 21,504 transplants were registered from 733 transplant centers of 20 countries/regions in the Asia-Pacific (AP) region. Five countries/regions comprised 89.4% of all transplants - China (6,979), Japan (5,794), South Korea (2,626), India (2,034), and Australia (1,789). The number of centers in these five countries/regions also comprised 88.9% of all centers: Japan (373), China (123), India (66), Australia (45), and South Korea (44). The overall ratio between autologous and allogeneic transplants was 37.0% and 63.0%, respectively, but the ratios varied significantly among countries/regions. Autologous transplants have surpassed allogeneic transplants in Thailand, Australia, Vietnam, New Zealand, Singapore, and Iran. In contrast, the proportion of allogeneic transplants comprised over 70% of all transplants in Pakistan, China, and Hong Kong. These ratios were compared by the Data Center among countries/regions that performed more than 50 transplants. The proportion of related and unrelated transplants also differed among countries/regions. The number of unrelated transplants was more than related ones in Japan (2,551 vs. 1,202) and Australia (329 vs. 291), whereas more than 80% of all transplants were related transplants in Malaysia (90.9%), India (89.5%), Iran (87.2%), Vietnam (85.7%), China (80.9%), and Thailand (80.6%). All transplant activities were related transplants in Pakistan, the Philippines, Myanmar, and Nepal, and no allogeneic transplants were performed in Bangladesh and Mongolia. Regarding the indications for transplants, acute myeloid leukemia (AML) was the most common disease for allogeneic transplant (4,759, 35.1% of allogeneic transplants), while plasma cell disorder (PCD) was the most common disease for autologous transplant (3,701, 27.3% of all autologous transplants). Furthermore, the number of transplants for hemoglobinopathy has steeply increased in this region compared with the rest of disease indications (677, 3.1% of all transplants). APBMT covers a broad area globally, including countries/regions with diverse disease distribution, development of HSCT programs, population, and economic power. Consistent and continuous activity surveys considering those elements in each country/region revealed the HSCT field's diverse characteristics and background factors in this region.

Advances in hematopoietic stem cell transplantation in the Asia-Pacific region: the second report from APBMT 2005-2015.

Between 2005 and 2015, 138,165 hematopoietic stem cell transplantation (HSCT) were reported in 18 countries/regions in the Asia-Pacific region. In this report, we describe current trends in HSCT throughout the Asia-Pacific region and differences among nations in this region and various global registries. Since 2008, more than 10,000 HSCTs have been recorded each year by the Asia-Pacific Blood and Marrow Transplantation Group Data Center. Between 2005 and 2015, the greatest increase in the number of HSCTs was observed in Vietnam. Allogeneic HSCT was performed more frequently than autologous HSCT, and a majority of cases involved related donors. Regarding allogeneic HSCT, the use of cord blood has remained steady, especially in Japan, and the number of cases involving related HLA non-identical donors has increased rapidly, particularly in China. The incidence of hemoglobinopathy, a main indication for allogeneic HSCT in India, China, Iran, and Pakistan, increased nearly six-fold over the last decade. Among the 18 participating countries/regions, the transplant rate per population varied widely according to the absolute number of HSCTs and the national/regional population size. We believe that this report will not only benefit the AP region but will also provide information about HSCT to other regions worldwide.

Transplant Programs in APBMT: Blood and Marrow Transplant Activity Report from Myanmar APBMT Meeting 2018, Taiwan.

Hematopoietic stem cell transplantation (HSCT) was introduced in Myanmar in 2014 and was first performed in a patient with multiple myeloma at the North Okkalapa General and Teaching Hospital. From 2014 to 2016,transplantation activities were in the preliminary stage of establishing the infrastructure and gradually developing capacity-building. In 2016, the Yangon General Hospital also commenced autologous transplantation for myeloma. Five autologous transplants were performed in Myanmar during 2016 in patients with myeloma, using high-dose melphalan and non-cryopreserved peripheral blood stem cell rescue. Despite the lack of a National Registry system, all cases were reported in the activity survey due to their small number. The National Marrow Donor Program has not been implemented in Myanmar yet. The major limitation in promoting HSCT in Myanmar is the unavailability of health insurance coverage for blood and marrow transplantation (BMT). The patients who received transplantation were partly supported by the government and partly by their families through out-of-pocket expenses. However, despite limited resources, there has been substantial progress in the human resource development for BMT in Myanmar. Under the leadership of The Asia Pacific Blood and Marrow Transplantation Group (APBMT), several transplant centers in the Asia-Pacific region have been supporting Myanmar to establish transplantation activities and capacity-building for promoting HSCT in patients from Myanmar.

Predictive Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Colonisation among Adults in Acute Care Settings: A Systematic Review.

BACKGROUND: Asymptomatically colonised MRSA carriers serve as a substantial reservoir for person-to-person transmission of MRSA in the acute care setting. Although many studies have evaluated prognostic risk factors for MRSA colonisation on patient admission to an acute care setting, a comprehensive review of all the prognostic risk factors was not identified in a preliminary search of the literature. OBJECTIVES: A systematic review was performed to identify and evaluate the association between risk factors and MRSA colonisation. INCLUSION CRITERIA: Studies that included all adult patients on admission in acute care settings were considered in this review.All independent risk factors of MRSA colonisation were analysed in this review.Cohort and case-control studies are main designs associated identifying the independent risk factors for MRSA colonisation.The primary outcome of interest was presence and absence of MRSA on admission, and then independent risk factors associated with MRSA colonisation on admission were identified. SEARCH STRATEGY: MEDLINE, EMABSE, and CINAHL databases were searched for prognostic studies published between 1990 and 2010 that examined the association between risk factors and MRSA colonisation. The search included both published and unpublished studies written in the English language. METHODOLOGICAL QUALITY: Included studies were assessed using a standardised critical appraisal instrument that was developed for prognostic studies in infection control field. DATA COLLECTION: Data were collected from included papers in the review using the standardised data extraction tool from the JBI SUMARI Program; and the data extraction form was modified based on the characteristics of prognostic studies for infection control. DATA SYNTHESIS: All risk factors in included studies were aggregated depending on their clinical characteristics. Data of any aggregated factors was pooled into meta-analysis based on univariate estimates and multivariate estimates separately when more than two groups of data in selected studies were available. RESULTS: Fifteen prospective studies, including a total 16,467 patients, were eligible for inclusion in the meta-analyses. More than 30 independent risk factors were identified and aggregated. The risk factors associated with MRSA colonisation in the meta-analyses include hospitalisation within the last 24 months, previous admission to a long-term care facility (LTCF) or a rehabilitation facility within the last 18 months, antibiotic use within the past 12 months, the presence of skin lesion, surgical intervention within the last 60 months, indwelling urinary catheter, intensive care unit (ICU) admission in the last 5 years, previous MRSA colonisation, intra-hospital transfer, male sex, comorbidity of chronic health evaluation class C or D, and the presence of fatal illness. CONCLUSIONS: The identification of risk factors for MRSA colonisation on admission may contribute to improved effectiveness and efficiency of current MRSA prevention strategies and control MRSA spread and acquisition in acute care settings. The outcomes of this review may facilitate prediction model development to quickly identify potential MRSA carriers before admission.

The status and perspective of diabetes health education in China: inspiration from Australia.

This paper discusses possible approaches to improving diabetes care and developing effective education models in China based on the experience of diabetes education in Australia. The prevalence of diabetes mellitus in China is increasing rapidly. China is currently second on the list of the top 10 countries with the highest diabetes burden. Enormous impact of diabetes on China health system is daunting and the urgent action is needed. Diabetes education is the keystone of diabetes care and structured self-management education is considered to be the key to successful outcomes. Although many diabetes education programmes have been initiated in China, barriers have been identified for implementation of the programmes. These include: lack of public awareness of diabetes; lack of standards of practice for diabetes educators; and lack of evaluation programmes to assess their performance. We suggest four possible approaches to addressing the current problems of diabetes education in China.

Fluid regimens for colostomy irrigation: a systematic review.

BACKGROUND: Various techniques for managing faecal evacuation have been proposed; however, colostomy irrigation is favoured as it leads to better patient outcomes. Alternative fluid regimens for colostomy irrigation have been suggested to achieve effective evacuation. AIM: The objective of this review was to summarise the best available evidence on the most effective fluid regimen for colostomy irrigation. SEARCH STRATEGY: Trials were identified by electronic searches of CINAHL, PubMed, MEDLINE, Current Contents, the Cochrane Library and EMBASE. Unpublished articles and references lists from included studies were also searched. SELECTION CRITERIA: Randomised controlled trials and before-and-after studies investigating any fluid regimen for colostomy irrigation were eligible for inclusion. Outcomes measured included fluid inflow time, total wash-out time, haemodynamic changes during irrigation, cramps, leakage episodes, quality of life and level of satisfaction. DATA COLLECTION AND ANALYSIS: Trial selection, quality appraisal and data extraction were carried out independently by two reviewers. Differences in opinion were resolved by discussion. MAIN RESULTS: The systematic literature search strategy identified two cross-over trials that compared water with another fluid regimen. Owing to the differences in irrigating solutions used, the results were not pooled for analysis. Both the polyethylene glycol electrolyte solution and glyceryl trinitrate performed significantly better than water. CONCLUSION: There is some evidence to support the effectiveness of fluid regimens other than water, such as polyethylene glycol electrolyte and glyceryl trinitrate, for colostomy irrigation. Further well-designed clinical trials are required to establish solid evidence on the effectiveness of other irrigating solutions that might enhance colonic irrigation.

The effectiveness of active blood glucose management on the prevention of further CVA complications within 24 hours in adult patients: a systematic review.

: The objective of this systematic review was to determine the effectiveness of active blood glucose management within 24 hours of the occurrence of a cerebrovascular accident (CVA). The search strategy covered all major databases and including MEDLINE, CINAHL, Current Contents, Embase and the Cochrane Library. Only one study met the review inclusion criteria and is reported in this paper. Results were summarised by a narrative discussion. The study used a randomised controlled trial design. In this study, 50 acute stroke patients with mild to moderate hyperglycemia were randomised to receive either a 24-hour infusion of 0.9% saline or a glucose potassium insulin (GKI) infusion. Twenty-five patients received GKI, 1 of whom required intravenous glucose for symptomatic hypoglycemia. Plasma glucose levels were not significantly lower in the GKI group throughout the infusion period. Four week mortality in the GKI group was 7 (28%), compared with 8 (32%) in the control group. The results from this included study confirming that the GKI infusion in mild to moderate hyperglycemia following acute stroke is a safe, practical and pragmatic intervention which effectively lowers the plasma glucose level to within the normal range without significant risk of hypoglycemia, cardiovascular adverse events or excess mortality at 4 weeks. The small numbers involved in this pilot study mean that an assessment of the clinical effectiveness of GKI therapy is impossible at this early stage. Therefore, at present there is little evidence based knowledge on active glucose modulation after stroke.