Central venous catheter–associated complications in pediatric patients diagnosed with Hodgkin lymphoma: implications for catheter choice

Purpose The purpose of this study was to determine the most optimal central venous catheter (CVC) for pediatric patients with Hodgkin lymphoma (HL) in terms of complications.Methods A retrospective study including patients diagnosed with HL from 2015 to 2021 at the Princess Maxima Center was performed. Patients were followed from CVC insertion until removal or 06-2021, whichever came first. The primary outcome was the CVC-related complication incidence rate (IR) per 1000 CVC-days. Furthermore, the incidence rate ratio (IRR) was calculated by comparing complication IRs between peripherally inserted central catheters (PICC) and totally implantable venous access ports (TIVAP). Additionally, risk factors for central venous thrombosis (CVT) were identified.Results A total of 98 patients were included. The most frequently observed complications were local irritation/infections (18%; IR 0.93), malfunctions (15%; IR 0.88), and CVC-related CVTs (10%; IR 0.52). Single lumen PICCs were associated with a higher risk of complications (49% vs. 26%; IRR 5.12, CI95% 2.76-9.50), severe complications (19% vs. 7%; IRR 11.96, CI95% 2.68-53.42), and early removal (18% vs. 7%; IRR 9.96, CI95% 2.18-45.47). A single lumen PICC was identified as a risk factor for CVC-related CVT when compared to TIVAPs (12% vs. 7%, IRR 6.98, CI95% 1.45-33.57).Conclusion The insertion of a TIVAP rather than a PICC should be recommended for pediatric patients with HL, especially in the presence of CVT-related risk factors. Future trials should evaluate the efficacy and safety of direct oral anticoagulants for the primary prevention of CVT in pediatric patients with a PICC and other CVT-related risk factors.Analysis and Stochastic

Reducing pain in children with cancer: Methodology for the development of a clinical practice guideline

Abstract Although pain is one of the most prevalent and bothersome symptoms children with cancer experience, evidence-based guidance regarding assessment and management is lacking. With 44 international, multidisciplinary healthcare professionals and nine patient representatives, we aimed to develop a clinical practice guideline (following GRADE methodology), addressing assessment and pharmacological, psychological, and physical management of tumor-, treatment-, and procedure-related pain in children with cancer. In this paper, we present our thorough methodology for this development, including the challenges we faced and how we approached these. This lays the foundation for our clinical practice guideline, for which there is a high clinical demand

Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with 'refractoriness to treatment': a cohort study

Background: The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of persistent postpartum haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common definitions that are either based on estimations of blood loss or transfused units of packed red blood cells (RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured by these three types of definitions. Methods: In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive women with postpartum haemorrhage who received either ≥4 units of RBC or a multicomponent transfusion. Clinical characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation and intensive care unit admission. Results: One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h following birth, compared to 819/1391 (58.7%) applying the definition of ≥1 L blood loss and 37/845 (4.4%) applying the definition of ≥4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal outcomes (91.3%), compared to 471/471 (100%) for ≥1 L blood loss and 383/471 (81.3%) for ≥4 units of RBC. Persistent postpartum haemorrhage did not capture all adverse outcomes because of missing data on timing of initial, first-line treatment. Conclusion: The definition persistent postpartum haemo

The potential/pH diagram of silver in aqueous ammonium salt solution

The potential/pH diagram of silver in aqueous ammonium salt solution at 25°C has been calculated and verified experimentally. Calculations were carried out on the basis of the standard potential of the silver/silver-ion couple, the dissociation constants of the silver mono- and di-ammonia complex, and the dissociation constant of the ammonium ion, the total silver and nitrogen content being kept constant. The calculated diagram was verified by measuring the potential of the silver electrode at pH values varying from 2 to 12. The measured diagram agrees well with the calculated one; minor differences (up to 15 mV) occur only in the alkaline range. The establishment of the potential is sufficiently rapid to record the entire diagram on a suitable pen-and-ink X/Y recorder within a few minutes. Accordingly, such a recording may serve well as a lecture demonstration on potential/pH diagrams

Everyday cognitive failure in sarcoidosis: the prevalence and the effect of anti-TNF-alpha treatment.

Background: Cognitive symptoms, such as concentration problems, are frequently recorded by sarcoidosis patients. Objectives: The aim of this study was to assess the prevalence of perceived everyday cognitive failure in sarcoidosis patients and healthy controls. Furthermore, the effect of treatment on cognitive functioning was examined. Methods: The study included 343 sarcoidosis patients (44.6% females; age 49.3 +/- 11.0 years). They completed the Cognitive Failure Questionnaire (CFQ) and Fatigue Assessment Scale (FAS) at baseline and the 6-month follow-up to evaluate the effect of treatment on cognitive functioning. The control group consisted of 343 age- and sex-matched healthy controls. Results: The mean CFQ score was significantly higher in sarcoidosis patients (37.3 +/- 16.1) compared with the controls (31.3 +/- 10.1; p /=43) was found in 35.0% of the patients and only 14.3% of the controls. No relation with disease severity and duration, or tumor location was found. The proportion of patients receiving treatment did not differ among the groups with high and normal CFQ score. At the 6-month follow-up, only patients recently treated with anti-TNF-alpha therapy (n = 42) demonstrated a significant improvement in the CFQ score (Delta -7.07 +/- 7.23) compared with the untreated patients (Delta -0.08 +/- 9.35) and patients treated with prednisone with or without methotrexate (Delta 1.67 +/- 9.22; p < 0.0001). After adjustment for the concomitant decrease in fatigue, the effect of anti-TNF-alpha therapy remained high and significant. Conclusions: Subjective cognitive failure is a substantial problem in sarcoidosis patients regardless of disease severity. Anti-TNF-alpha therapy had a positive effect on cognition, fatigue and other symptoms of sarcoidosis

Body composition profiling in a Dutch sarcoidosis population

Abstract Muscle atrophy is a common problem in many chronic inflammatory diseases. It may occur as part of a generalized wasting process (cachexia) or be hidden due to preservation of fatmass (sarcopenia, sarcopenic obesity). Objectives: The aim of this study was to assess the prevalence of cachexia and muscle atrophy in sarcoidosis and their association with disease activity and severity. Methods: A cross-sectional study was performed in 423 sarcoidosis patients. Fat-free mass was assessed as an indirect measure of muscle mass by bioelectrical impedance analysis. Patients were stratified based on body mass index (BMI) and fat-free mass index (FFMI).Muscle atrophy was defined as FFMI &lt;15 kg/m2 for women and &lt;17 kg/m2 for men corresponding to &lt;10th percentile of current reference values; cachexia as BMI &lt;20 combined with muscle atrophy.Multivariate linear regression models were used to adjust for potential confounders. Results: Of the patients examined, 58% were categorized as overweight (37%) or obese (21%), whereas 7% were underweight.Muscle atrophy was present in 25% and cachexia in 5%. Patients with muscle atrophy showed significantly worse lung function (DLCO, FEV1, FVC, all p-values &lt;0.01) and impaired exercise capacity (VO2max, p&lt;0.001). The associations were most pronounced in patients with cachexia. Associations remained significant after adjustment for potential confounders. Conclusions: Muscle atrophy was present in 25% of sarcoidosis patients and was associated withmore severe pulmonary disease. Prospective studies with longitudinal design are needed to assess the association between muscle atrophy and disease severity in sarcoidosis

Occipital glutamate in interictal migraine patients measured with 7T MR spectroscopy (MRS)

Paroxysmal Cerebral Disorder

Progress in the Development of the HFML 45 T Hybrid Magnet

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Fabrication and Testing of the 20 kA Binary Current Leads for the NHMFL Series-Connected Hybrid Magnet

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