Research Spotlight

Escobar, M., Shaffer, L., Holguin, M., McCavit, T., Amega, N.S. and Rajan, S.K. (2021). “Immune tolerance induction with antihaemophilia factor (human) in poor prognosis patients with haemophilia A.” Haemophilia Feb 3. [Epub ahead of print].

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The formation of inhibitors (neutralizing antibodies) to factor VIII (FVIII) is a serious complication of haemophilia A (FVIII deficiency).1 Since the 1970s, immune tolerance induction (ITI) therapy using repeated dosing with FVIII concentrates has remained the standard of care to eradicate inhibitors.2 Although the non‐factor, bispecific monoclonal antibody emicizumab (approved by the Food and Drug Administration in 2017) was shown effective as prophylaxis to significantly reduce bleeding in patients with haemophilia A and inhibitors,3, 4 it does not prevent bleeds completely.2 Thus, most clinicians treating haemophilia still recommend that patients with inhibitors receive at least one round of ITI. [No abstract; excerpt from article].

Hatem, M. and Martin, H.D. (2021). “Low Back Pain Improves After Surgery for Lesser Trochanteric-Ischial Impingement.” Arthroscopy Jan 15;S0749-8063(21)00017-7. [Epub ahead of print].

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PURPOSE: To assess the effects of surgery for lesser trochanteric-ischial impingement (LTI) on low back pain. METHODS: The records of patients with LTI who underwent endoscopic partial resection of the lesser trochanter (LT) between May of 2017 and February of 2019 were reviewed. Inclusion criteria were the presence of low back pain in association with hip pain, diagnosis of LTI, and partial resection of the LT to treat LTI. Exclusion criteria were less than 12 months of postoperative follow-up and hip or spine surgery after the LTI surgery. Patients were assessed before surgery and at the most recent follow-up with the modified Harris Hip Score and Oswestry Disability Index for lumbar spine. RESULTS: Thirty patients (31 hips) met the inclusion criteria. Four patients were lost to follow-up. Two patients with borderline dysplasia and grade 1 and 2 osteoarthritis underwent total hip arthroplasty after the partial resection of the LT. The results are presented considering the remaining 24 patients (25 hips). The average age at surgery was 51 years (range 32-65 years). The mean follow-up after the surgery for LTI was 19 months (range 12-35 months). The mean ± SD ODI improved from 48% ± 15 before the LTI surgery to 21% ± 22 (P < .001) at the most recent follow-up. Improvement in the Oswestry Disability Index above the minimal clinical important difference was observed in 16 patients (67%) following the LTI surgery. The mean ± SD modified Harris Hip Score improved from 55.8 ± 14 before LTI surgery to 81.3 ± 14.3 (P < .001). CONCLUSIONS: Decrease in low back pain above the minimal clinically important difference is observed in 2 of 3 patients after partial resection of the LT. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Taylor, C.M., 2nd, Baer, H., Edgar, L., Jenkins, J.G., Harada, N., Helkowski, W.M., Zumsteg, J.M., Francisco, G.E., Sabharwal, S., Hamilton, R.G. and Mallow, M. (2021). “Improving the Assessment of Resident Competency: Physical Medicine and Rehabilitation Milestones 2.0.” Am J Phys Med Rehabil 100(2S Suppl 1): S45-s50.

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In 2015, the Accreditation Council for Graduate Medical Education published the Physical Medicine and Rehabilitation Milestones 1.0 as part of the Next Accreditation System. This was the culmination of more than 20 yrs of work on the part of the Accreditation Council for Graduate Medical Education to improve graduate medical education competency assessments. The six core competencies were patient care, medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills. While providing a good foundation for resident assessment, the Physical Medicine and Rehabilitation Milestones 1.0 was not without faults. With input from program directors, national organizations, and the public, the Physical Medicine and Rehabilitation Milestones 2.0 strives to further advance resident assessment, providing improvements through the integration of the harmonized Milestones and the addition of a supplemental guide.

Kanwar, M.K., Khush, K.K., Pinney, S., Sherman, C., Hall, S., Teuteberg, J., Uriel, N. and Kobashigawa, J. (2021). “Impact of cytomegalovirus infection on gene expression profile in heart transplant recipients.” J Heart Lung Transplant 40(2): 101-107.

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BACKGROUND: Cytomegalovirus (CMV) infection has been implicated in the pathogenesis of allograft rejection in heart transplant (HT) recipients. The effect of a CMV infection on the gene expression profiling (GEP, AlloMap) scores in the absence of acute rejection is not known. METHODS: Data from 14,985 samples collected from 2,288 adult HT recipients enrolled in Outcomes AlloMap Registry were analyzed. Patients with known CMV serology at the time of HT who had at least 1 AlloMap score reported during follow-up were included. AlloMap scores for those patients with CMV (but no ongoing rejection) were compared with those who were never infected. An exploratory analysis on the impact of CMV on available donor-derived cell-free DNA (AlloSure) was also performed. RESULTS: A total of 218 patients (10%) were reported to have CMV infection after transplantation. AlloMap score in those samples with CMV infection (n = 311) had a GEP score (34; range: 29-36) significantly higher than the GEP score from samples (n = 14,674) obtained in the absence of CMV infection (30; range: 26-34; p < 0.0001). Both asymptomatic viremia and CMV disease demonstrated significantly higher AlloMap scores than no CMV infection samples (median scores: 33, 35, and 30, respectively; p < 0.0001). AlloSure levels, available for 776 samples, were not significantly different (median: 0.23% in 18 samples with CMV infection vs 0.15% in 776 samples without CMV infection; p = 0.66). CONCLUSIONS: CMV infection in HT recipients is associated with an increase in AlloMap score, whereas AlloSure results do not appear to be impacted. This information should be considered when clinically interpreting abnormal/high AlloMap scores in HT recipients.

Pennington, M.L., Dupree, J., Coe, E., Ostiguy, W., Kimbrel, N.A., Meyer, E.C. and Gulliver, S.B. (2021). “Working near a supervised injection facility: A qualitative study of perspectives of firefighter-emergency medical responders.” Am J Ind Med Feb 1. [ Epub ahead of print].

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BACKGROUND: While firefighter-emergency medical responders (FF-EMR) are important stakeholders in cities considering the implementation of a supervised injection facility (SIF), there is little information on perspectives of first responders who serve these communities. The aim of the present study was to identify FF-EMR perspectives on working near a SIF. METHODS: FF-EMRs from Vancouver Fire and Rescue Services completed an online survey that queried participant perspectives on working near a SIF. RESULTS: Four main themes were identified: positive effects, negative effects, duration of assignment, and sense of duty. Similar percentages of first responders reported positive (22.2%) and negative aspects (25.9%) of working near the SIF, while some (18.5%) indicated preference for a short-term assignment to the SIF area. FF-EMRs most commonly described a sense of duty (35.2%). CONCLUSIONS: To our knowledge, our study is the first to identify FF-EMR perspectives related to work near a SIF. Perspectives and concerns of first responders should be considered in policy debates about implementation of new SIFs to guarantee an adequately-prepared first responder workforce.