Hawaii Pacific Health

BACKGROUND:Patients with multiple myeloma (MM) often have an increased risk of infection. Prophylactic immunoglobulin (Ig) supplementation has been considered a potential strategy to reduce the risk of infections, but its real-world benefit remains unclear. A prior systematic review and meta-analysis (SRMA) demonstrated a significant reduction in infection risk with Ig supplementation, but the findings may not reflect outcomes in the context of contemporary MM therapies. PATIENTS AND METHODS:We performed an updated SRMA including observational and randomized controlled trials comparing the outcomes in patients with MM who received prophylactic Ig versus those who did not. We systematically searched PubMed, Scopus, and Cochrane Central Register of Controlled Trials from inception to July 2025. RESULTS:A total of 10 studies were included in the systematic review. Of these, 7 studies comprising 2345 patients reported outcomes using comparable units and were included in the meta-analysis. Ig supplementation was associated with significantly lower cumulative incidence of severe infections (34.4% vs. 56.3%; P = .027). There was no difference in cumulative incidence of overall infections (50.0% vs. 38.6%; P = .70). Subgroup analysis for overall infections stratified by treatment type did not show significant differences. No differences were observed for overall survival (OS) (hazard ratio 0.57; P = .086). CONCLUSIONS:Prophylactic Ig supplementation significantly reduced the cumulative incidence of severe infections in patients with MM. Future prospective studies are warranted to verify the findings.

Background: Dance plays a significant but under appreciated impact on society. Approximately 10,400,000 children participate in some form of dance each year, resulting in about 25,000 dance related injuries presenting to the ED yearly. This study aims to provide a comprehensive and up to date investigation of pediatric injuries resulting from dance, comparing the most common body regions, final diagnoses, and mechanisms of injury, further stratified by age and sex. Insert text. Hypothesis: Dance-related injury presentation will differ between ages, sexes, and pre- and post-COVID-19 periods. Methods: This descriptive epidemiologic analysis utilized the National Electronic Injury Surveillance System (NEISS) between January 1, 2019 to December 31, 2023 to identify all pediatric age patients presenting to the emergency department (ED) for dance-associated injuries. Variables included demographics, body region injured, final diagnosis, and mechanism of injury. Patients were stratified by sex (male vs. female) and age groups (children (<10 years) and adolescents (10-17)). Injury trends were further stratified based on their occurrence during or after the COVID-19 pandemic., Linear regressions were used to analyze trends, Chi-squared analyses and post-hoc residual analyses were used to analyze categorical variables. Statistical significance was set to p<0.05. Results: A total of 3,600 (NE=93,062) cases were analyzed. There were 38,520 (41.2%) cases in the COVID group and 57,567 (58.8%) in the post COVID group. Overall, the most injured body regions were knees (20.8%), ankles (15.8%), and heads (13.3%). The most common final diagnoses were sprains/strains (31.4%), fractures (12.3%), and contusions/abrasions (8.0%). The most common mechanisms of injury included impacts with the floor (37.0%), ankle rolling (13.5%), and non-contact movements (10.4%). Male athletes more commonly injured their head (23.7%) compared to female athletes (11.5%). Compared to adolescents, children were more likely to sustain sprains/strains (35.5% vs 18.3%), injure knees (26.2% vs 5.5%) and ankles (17.5% vs 10.4%), and become injured due to ankle rolling (14.4% vs 8.1%) and non-contact movements (11.8% vs 2.3%). Adolescent dancers more often sustained fractures than pediatric dancers (14.4% vs 11.3%) (p<0.05). Conclusion: Knees and ankles are the most commonly injured body regions in youth dancers. Athletes commonly experience sprains/strains, fractures, and contusions/abrasions, often due to impact with the floor, ankle rolling, and non-contact movements. Females and younger children are more likely to sustain lower extremity sprains/strains, whereas males and adolescents more frequently sustain fractures. These findings may guide sports medicine societies to create specific and targeted injury prevention strategies for dancers of different ages and sexes.

Leadless pacemaker (LPM) offers a favorable safety profile for bradyarrhythmia, especially in patients at high risk for infection from transvenous pacemaker (TPM). However, its use for bradyarrhythmia after transcatheter aortic valve replacement (TAVR) remains unexplored. We conducted a systematic search from the inception of PubMed to November 2025. Eligible studies included adults who received a pacemaker after TAVR. Primary endpoints were overall complications and device-related complications. Secondary endpoints included all-cause mortality, device-related mortality, hospitalization for heart failure, procedure time, fluoroscopy time, and length of stay after pacemaker implantation. We included a total of 11 studies involving 11,750 patients who underwent TAVR (1243 with LPM and 10,507 with TPM). None of the patients in the LPM group experienced device-related complications, with significantly lower rates compared to the TPM group [adjusted hazard ratio (aHR) 0.35, 95% confidence interval (CI): 0.13-0.97; I2 = 0%]. Similarly, no device-related mortality was observed in the LPM group. All-cause mortality and hospitalization for heart failure were comparable between the LPM and TPM groups (aHR 1.02, 95% CI, 0.05-20.68; I2 = 25% and aHR 0.87, 95% CI, 0.24-3.17; I2 = 0%, respectively). The feasibility of LPM was also similar to TPM in terms of procedural time (MD -28.66 minutes, 95% CI, -92.36 to 35.03; I2 = 11%), fluoroscopy time (MD -1.36 minutes, 95% CI, -6.30 to 3.59; I2 = 0%), and length of stay (MD -0.53 days, 95% CI, -1.33 to 0.27; I2 = 6%). In conclusion, LPM could serve as a first-line pacing strategy in bradyarrhythmia post-TAVR due to its safer profile with comparable efficacy and feasibility to TPM.

OBJECTIVES:Chimeric antigen receptor T-cell (CAR-T) therapy has become an established treatment for hematological malignancies. Lymphodepleting (LD) chemotherapy is a preparatory step that facilitates CAR-T cell expansion and persistence. While fludarabine and cyclophosphamide (Flu/Cy) are a standard LD regimen, bendamustine has emerged as a potential alternative. METHODS:We performed a systematic review and meta-analysis comparing the efficacy and safety of bendamustine versus Flu/Cy as LD regimens. We systematically searched PubMed, Scopus, and the Cochrane Central Register of Controlled Trials from inception to July 2025. RESULTS:Nine retrospective studies comprising 768 patients were included. The bendamustine cohort demonstrated a lower incidence of all-grade cytokine release syndrome (CRS) compared with Flu/Cy (60.2% vs. 71.7%; p = 0.011), whereas no difference was observed in grade ≥ 3 CRS. Overall infections were less frequent with bendamustine (18.3% vs. 53.7%; p < 0.001). There were no significant differences between groups in the incidence of immune effector cell-associated neurotoxicity syndrome, overall response rate, overall survival, and progression-free survival. CONCLUSION:Bendamustine LD therapy significantly reduced the incidence of all-grade CRS and overall infections without compromising CAR-T efficacy. These findings suggest that bendamustine may serve as a viable alternative LD regimen.

Prostate cancer is one of the most commonly diagnosed cancers in men worldwide. Radiation therapy is a widely used treatment for prostate cancer, but it carries the risk of adverse effects on adjacent organs such as the rectum. Therefore, to provide additional protection for the rectum during prostate radiation, perirectal spacers are inserted into Denonvilliers’ space, the thin fascial layer located behind the prostate gland and in front of the anterior rectal wall. Polyethylene glycol (PEG)-based hydrogels and recently FDA-approved stabilized hyaluronic acid (sHA) spacers have been designed to create a biodegradable space between the prostate and rectum, with each having its own unique characteristics and both having the potential to infiltrate the rectum. We present two clinical cases of rectal infiltration associated with either the insertion of a PEG-based hydrogel or an sHA spacer. Due to the distinct characteristics of the two spacer types, rectal infiltration was managed with either a conservative or definitive approach. With the PEG-based hydrogel, we implemented conservative management with antibiotics and close monitoring. In sharp contrast, for the sHA spacer, we proactively reversed the infiltration with hyaluronidase (Hyal) prior to starting radiation. These cases illustrate the clinical utility of these management approaches and contribute to the growing body of evidence on the management of potential complications associated with perirectal spacers, potentially supporting the use of newer spacer technologies.