Early Surge Research Articles

The Impact of Surges on Hospital COVID-19 Mortality Rates

Background: Hospital mortality rates among COVID-19 admissions fell as early surges waned, critical supply shortages were addressed, and new treatment options became available. However, new surges in late 2020 provide an opportunity to understand whether and how regional COVID-19 surges might overwhelm hospital systems in ways that impact the survivability of the disease among admitted patients. Methods: Electronic health records representing all COVID-19 inpatient admissions from 52 hospitals in the western US between May 2020 and February 2021 were analyzed. Multilevel logistic regression was used to assess the relationship between COVID-19 surges (defined as the percent of a hospital’s total bed capacity occupied with COVID-19 patients) and in-hospital mortality among COVID-19 patients while adjusting for patient demographics, comorbidities, severity of illness at admission, and major treatment strategies. Participants included any patient admitted to a participating hospital with a lab-confirmed COVID-19 diagnosis between May 1, 2020 and February 28, 2021 (n=34,683 distinct admissions). Findings: Mortality rates for COVID-19 admissions went up when hospitals were filled with more COVID-19 patients. Holding constant the effects of patient characteristics, comorbidities, major treatments, and severity of illness at admission, a 5% increase in the proportion of hospital beds occupied by COVID-19 patients was associated with a 10% (OR=1.10, pInterpretation: Results suggest that “surge effects” are a significant driver of hospital mortality, even in the absence of the critical supply shortages and uncertainty about treatment options that characterized the early pandemic. Results were not driven by “enriched” risk among admitted patients during surge periods. Rather, hospital systems overwhelmed with large volumes of COVID-19 patients may face barriers to optimal care delivery that result in a higher mortality rate among admitted patients. Preventing COVID-19 surges may help decrease not just the number of deaths, but the rate of deaths as well. Funding: The authors received no special funding for this study.Declaration of Interests: None to declare. Ethics Approval Statement: This study was approved by PSJH IRB with number: STUDY2021000078

Surge Fault Detection of Aeroengines Based on Fusion Neural Network

Aeroengine surge fault is one of the main causes of flight accidents. When a surge occurs, it is hard to detect it in time and take anti-surge measures correctly. Recently, people have been applying detection methods based on mathematical models and expert knowledge. Due to difficult modeling and limited failure-mode coverage of these methods, early surge detection cannot be achieved. To address these problems, firstly, this paper introduced the data of six main sensors related to the aeroengine surge fault, such as, total pressure at compressor (high pressure rotor) outlet (Pt3), high pressure compressor rotor speed (N2), power level angle (PLA), etc. Secondly, aiming at preprocessing of data sets, this paper proposed a data standardization preprocessing algorithm based on batch sliding window (DSPABSW) to build a training set, validation set and test set. Thirdly, aeroengine surge fault detection fusion neural network (ASFDFNN) was provided and optimized to improve the detection accuracy of aeroengine surge faults. Finally, the experimental results showed that the model achieved 95.7%, 93.6% and 94.7% in precision rate, recall rate and F1_Score respectively and consequently it can detect the aeroengine surge fault 260 ms in advance.

Hospital El Salvador: a novel paradigm of intensive care in response to COVID-19 in central America

Hospital El Salvador: a novel paradigm of intensive care in response to COVID-19 in central America

Critical care transfers and COVID-19: Managing capacity challenges through critical care networks.

The intensive care units in North West London are part of one of the oldest critical care networks in the UK, forming a mature and established strategic alliance to share resources, experience and knowledge for the benefit of its patients. North West London saw an early surge in COVID-19 admissions, which urgently threatened the capacity of some of its intensive care units even before the UK government announced lockdown. The pre-existing relationships and culture within the network allowed its members to unite and work rapidly to develop agile and innovative solutions, protecting any individual unit from becoming overwhelmed, and ultimately protecting its patients. Within a short 50-day period 223 patients were transferred within the network to distribute pressures. This unprecedented number of critical care transfers, combined with the creation of extra capacity and new pathways, allowed the region to continue to offer timely and unrationed access to critical care for all patients who would benefit from admission. This extraordinary response is a testament to the power and benefits of a regionally networked approach to critical care, and the lessons learned may benefit other healthcare providers, managers and policy makers, especially in regions currently facing new outbreaks of COVID-19.

Roadmap: one anesthesiology department's strategic approach to COVID-19.

The COVID-19 pandemic has driven transformation in every aspect of the healthcare delivery system. The unpredictable onset and magnitude of COVID-19 infections resulted in wide gaps in preparedness for healthcare systems. The development of protocols to address both scarcity of resources and staff protection continues to be essential for risk mitigation. The northeast region of the United States had a rapid early surge of COVID-19 infections leading to the exhaustion of critical care capacity. In addition, northeastern hospitals experienced decrease in elective surgical interventions, including organ transplantation. Limited availability of COVID-19 testing and personal protective equipment further fueled the pandemic. This commentary highlights a comprehensive innovative approach to addressing the operating room and hospital demands, as well as the shortages in resources and staffing during the pandemic. The VCU Department of Anesthesiology operated at 40% of its regular operating room volume throughout the COVID-19 pandemic because of the increased demand from emergency cases. The delay in the peak surge allowed Virginia Commonwealth University, Department of Anesthesiology to develop a comprehensive infrastructure resulting in resulting is maximal workforce risk mitigation.

Pediatric COVID-19 and Appendicitis: A Gut Reaction to SARS-CoV-2?

We describe the temporal pattern of COVID-19 admissions to a tertiary care children's hospital in central New Jersey during the SARS-CoV-2 surge, covering the time period from March 29 to July 26, 2020. Medical charts were reviewed for the date of admission, past medical history, and demographic variables, presenting signs and symptoms, admitting laboratory values, diagnostic imaging, diagnosis, treatment modalities, and outcomes including length of stay and disease severity. Patients with symptomatic SARS-CoV-2 infection tended to present with pneumonia early during the study period, which coincided with the early surge in New Jersey cases. Approximately 2 weeks after the peak in reported SARS-CoV-2 cases in New Jersey, we began to see fewer pneumonia cases and an increase in admissions for Multi-Inflammatory Syndrome in Children and cases of acute appendicitis in association with a diagnosis of SARS-CoV-2 infection. We present a novel association of acute appendicitis in children infected with SARS-CoV-2 and postulate that it may represent a postinfectious hyperinflammatory complication of SARS-CoV-2 infection occurring 2 weeks after the early manifestation of acute pneumonia disease in children.

Modelling the impact of presemester testing on COVID-19 outbreaks in university campuses

ObjectivesUniversities are exploring strategies to mitigate the spread of COVID-19 prior to reopening their campuses. National guidelines do not currently recommend testing students prior to campus arrival. However, the impact...

Signal Processing Techniques to Detect Centrifugal Compressors Instabilities in Large Volume Power Plants

Abstract This paper shows signal processing techniques applied to experimental data obtained from a T100 microturbine connected with different volume sizes. This experimental activity was conducted by means of the test rig developed at the University of Genoa for hybrid systems emulation. However, these results can be extended to all advanced cycles in which a microturbine is connected with additional external components which lead to an increase of the plant volume size. Since in this case a 100 kW microturbine was used, the volume was located between the heat recovery unit outlet and the combustor inlet like in the typical cases related to small size plants. A modular vessel was used to perform and to compare the tests with different volume sizes. The main results reported in this paper are related to rotating stall and surge operations. This analysis was carried out to extend the knowledge about these risk conditions: the systems equipped with large volume size connected to the machine present critical issues related to surge and stall prevention, especially during transient operations toward low mass flowrate working conditions. Investigations conducted on acoustic and vibrational measurements can provide interesting diagnostic and predictive solutions by means of suitable instability quantifiers which are extracted from microphone and accelerometer data signals. Hence, different possible tools for rotating stall and incipient surge identification were developed through the use of different signal processing techniques, such as wavelet analysis and higher order statistics analysis (HOSA) methods. Indeed, these advanced techniques are necessary to maximize all the information conveyed by acquired signals, particularly in those environments in which measured physical quantities are hidden by strong noise, including both broadband background one (i.e., typical random noise) but also uninteresting components associated with the signal of interest. For instance, in complex coupled physical systems like the one it is meant to be studied, which do not satisfy the hypothesis of linear and Gaussian processes inside them, it is reasonable to exploit these kinds of tools, instead of the classical fast Fourier transform (FFT) technique by itself, which is mainly adapt for linear systems periodic analysis. The proposed techniques led to the definition of a quantitative indicator, the sum of all autobispectrum components modulus in the subsynchronous range, which was proven to be reliable in predicting unstable operation. This can be used as an input for diagnostic systems for early surge detection. Furthermore, the presented methods will allow the definition of some new features complementary with the ones obtainable from conventional techniques, in order to improve control systems reliability and to avoid false positives.

Evening anti-hypertensive dosing improves blood pressure control and reduce cardiovascular events in hypertensive: a meta-analysis of 40 trials in 44,167 patients

Abstract Introduction Nocturnal blood pressure (BP) and early morning BP surge have consistently been found to be a better prognostic marker of cardiovascular outcome than daytime BP. Most anti-hypertensive show greater blood pressure-lowering effect in the first 12 hours compared to the next 12 hours. Several prospective studies have shown better BP regulation and improved cardiovascular risk when anti-hypertensive are ingested at bedtime versus at awakening. Purpose In patients with hypertension does evening dosing of anti-hypertensive compared to morning dosing led to better reduction in pressure, blood pressure control and reduced cardiovascular morbidity. Methods A meta-analysis was performed based on randomized controlled trials obtained from Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline and Medline ahead of print published between 2000 and 2020. Main outcome measures include mean 24 hour systolic and diastolic blood pressure, cardiovascular events as well as prevalence of blood pressure in control. Data synthesis and analysis was done using RevMan 5.3 using a random effects model. Results A total of 40 randomized controlled trials, representing 44,167 patients were included in this meta-analysis. Most studies evaluate the administration of mixed anti-hypertensive with ≥1 medication ingested at bedtime, calcium channel blockers (CCBs) or angiotensin receptor blockers (ARBs) with sample sizes ranging from 30 to 19,084 patients. Evening administration of anti-hypertensive was found to significantly lower 24-hour systolic blood pressure (Mean difference = −1.05, 95% CI: −2.01 to −0.10, p=0.03) and 24-hour diastolic blood pressure (Mean difference = −1.09, 95% CI: −1.68 to −0.50, p=0.0003). Prevalence of controlled blood pressure was found to significantly increase with evening dosing (RR=1.15, 95% CI: 1.03 to 1.28, p=0.01). Significant reduction in cardiovascular events were found in the evening dosing group (RR=0.48, 95% CI: 0.03 to 0.68, p=<0.00001). Discussion Reduction in night-time blood pressure especially among non-dippers as reported in previous studies and higher prevalence of controlled blood pressure may explain the greater than 50% reduction in cardiovascular events in the evening dosing group. This marked benefit from a simple and inexpensive strategy certainly has great potential to benefit patients in practice. Even so, few studies have reported the prevalence of blood pressure in control (9 studies) and cardiovascular events (6 studies). Few has also studied this in geriatric populations where night-time hypotension and hypoperfusion may bring the most impact. Conclusion For patients with hypertension, evening dosing significantly improves blood pressure control and reduces the risk for cardiovascular events. Careful selection of anti-hypertensive administration time in patients is recommended given the possible benefits. Anti Hypertensive Dosing Forest Plot Funding Acknowledgement Type of funding source: None

Experts discuss cancer care and research in the age of COVID-19: Findings presented at the American Association for Cancer Research's virtual meeting could shift clinicians' thinking about immunotherapy and point to encouraging changes in the way that clinical trials are being conducted during the pandemic.

Experts discuss cancer care and research in the age of COVID-19: Findings presented at the American Association for Cancer Research's virtual meeting could shift clinicians' thinking about immunotherapy and point to encouraging changes in the way that clinical trials are being conducted during the pandemic.

Spectrum of Coronavirus Disease 2019 Outcomes in Kidney Transplant Recipients: A Single-Center Experience

PurposeWe reviewed the clinical experience of kidney transplant recipients diagnosed with severe acute respiratory syndrome coronavirus 2 infection in order to understand the impact of the current coronavirus disease 2019 (COVID-19) pandemic infection on transplant recipients. Given that early reports from heavily affected areas demonstrated a very high mortality rate amongst kidney transplant recipients, ranging between 30% and 40%, we sought to evaluate outcomes at a center with a high burden of cases but not experiencing acute crisis due to COVID-19. ProceduresIn this single center retrospective observational study, medical records of all kidney transplant recipients at the UCLA Medical Center were reviewed for a diagnosis of COVID-19 by polymerase chain reaction, followed by chart review to determine kidney transplant characteristics and clinical course. Main findingsA total of 41 kidney transplant recipients were identified with COVID-19 positive polymerase chain reaction. Recipients had been transplanted for a median of 47 months before diagnosis. The large proportion of infected individuals were minorities (Hispanic 65.9%, black 14.6%), on prednisone, tacrolimus, and mycophenolate mofetil (95.1%, 87.8%, and 87.8%, respectively), and had excellent allograft function (median 1.25 mg/dL). The most common presenting symptoms were fever, dyspnea, or cough. Most patients were hospitalized (63.4%); mortality was 9.8% and occurred only in patients in the intensive care unit. The most common treatment was reduction or removal of antimetabolite (77.8%). Approximately 26.9% presented with AKI. ConclusionsCOVID-19 infection in kidney transplant recipients results in a higher rate of hospitalization and mortality than in the general population. In an area with a high number of infections, the mortality rate was lower compared with earlier reports from areas experiencing early surge and strain on the medical system. Minorities were disproportionately affected. Future studies are needed to determine optimal approach to treatment and management of immunosuppression in kidney transplant recipients with COVID-19 infection.

A View from the Frontline: Palliative and Ethical Considerations of the COVID-19 Pandemic.

A View from the Frontline: Palliative and Ethical Considerations of the COVID-19 Pandemic.

Prostate tumor-derived GDF11 accelerates androgen deprivation therapy-induced sarcopenia.

Most prostate cancers depend on androgens for growth, and therefore, the mainstay treatment for advanced, recurrent, or metastatic prostate cancer is androgen deprivation therapy (ADT). A prominent side effect in patients receiving ADT is an obese frailty syndrome that includes fat gain and sarcopenia, defined as the loss of muscle function accompanied by reduced muscle mass or quality. Mice bearing Pten-deficient prostate cancers were examined to gain mechanistic insight into ADT-induced sarcopenic obesity. Castration induced fat gain as well as skeletal muscle mass and strength loss. Catabolic TGF-β family myokine protein levels were increased immediately prior to strength loss, and pan-myokine blockade using a soluble receptor (ActRIIB-Fc) completely reversed the castration-induced sarcopenia. The onset of castration-induced strength and muscle mass loss, as well as the increase in catabolic TGF-β family myokine protein levels, were coordinately accelerated in tumor-bearing mice relative to tumor-free mice. Notably, growth differentiation factor 11 (GDF11) increased in muscle after castration only in tumor-bearing mice, but not in tumor‑free mice. An early surge of GDF11 in prostate tumor tissue and in the circulation suggests that endocrine GDF11 signaling from tumor to muscle is a major driver of the accelerated ADT-induced sarcopenic phenotype. In tumor-bearing mice, GDF11 blockade largely prevented castration-induced strength loss but did not preserve muscle mass, which confirms a primary role for GDF11 in muscle function and suggests an additional role for the other catabolic myokines.

Effect of lidocaine with adrenaline and landiolol on hemodynamics in spontaneously hypertensive rats.

Administration of local anesthetics with adrenaline can cause tachycardia and hypertension. This study assessed whether combined administration of landiolol with adrenaline and lidocaine would induce local anesthesia without causing hemodynamic changes. Normal saline (NS), lidocaine with adrenaline (LA), and lidocaine with adrenaline and landiolol (LLA) were injected into Wistar Kyoto (WKY/Izm) or spontaneously hypertensive (SHR/Izm) rats, followed by measurement of the pulse rate (PR), and the systolic, diastolic and mean blood pressures (SBP, DBP and MBP). In the LLA group, the increase in PR was significantly suppressed in both SHR/Izm and WKY/Izm rats relative to those in the LA group. Although SBP was significantly reduced in WKY/Izm rats given LLA, relative to those given NS or LA, it was elevated in SHR/Izm rats given LLA. Landiolol-induced changes in PR may be due to blockade of adrenaline-induced β1 receptor stimulation, which suppresses cardiac hyperactivity, whereas the early surge of blood pressure in SHR/Izm rats given LLA may be due to the dominant alpha-adrenergic effects of β1 receptor inhibition. The anti-adrenergic effects of LLA were safe and effective in WKY/Izm rats, although the unexpected early hypertensive surge in SHR/Izm rats indicates the need for caution.

Inflation Expectations and the Pass-through of Oil Prices

Do inflation expectations and the associated pass-through of oil price shocks depend on demand and supply conditions underlying the global market for crude oil? We answer this question with a novel structural vector autoregressive model of the global oil market that jointly identifies transmissions of oil demand and supply shocks through the real price of oil to both expected and realized inflation. Our main insight is that US households form their expectations of inflation differently when faced with long sustained increases in the price of oil, such as the early millennium oil price surge of 2003 to 2008, as compared to short and sharp price fluctuations that characterized much of the twentieth century. We also find that oil demand and supply shocks can explain a large proportion of expected and realized inflation dynamics during multiple periods of economic significance, and resolve disagreements around the role of oil prices in explaining the missing deflation puzzle of the Great Recession.

Identifying neuronal correlates of dying and resuscitation in a model of reversible brain anoxia

We developed a new rodent model of reversible brain anoxia and performed continuous electrocorticographic (ECoG) and intracellular recordings of neocortical neurons to identify in real-time the cellular and network dynamics that successively emerge throughout the dying-to-recovery process. Along with a global decrease in ECoG amplitude, deprivation of oxygen supply resulted in an early surge of beta-gamma activities, accompanied by rhythmic membrane depolarizations and regular firing in pyramidal neurons. ECoG and intracellular signals were then dominated by low-frequency activities which progressively declined towards isoelectric levels. Cortical neurons during the isoelectric state underwent a massive membrane potential depolarizing shift, captured in the ECoG as a large amplitude triphasic wave known as the “wave-of-death” (WoD). This neuronal anoxic depolarization, associated with a block of action potentials and a loss of cell integrative properties, could however be reversed if brain re-oxygenation was rapidly restored (within 2–3.5 min). The subsequent slow repolarization of neocortical neurons resulted in a second identifiable ECoG wave we termed “wave-of-resuscitation” since it inaugurated the progressive regaining of pre-anoxic synaptic and firing activities. These results demonstrate that the WoD is not a biomarker of an irremediable death and unveil the cellular correlates of a novel ECoG wave that may be predictive of a successful recovery. The identification of real-time biomarkers of onset and termination of cell anoxic insult could benefit research on interventional strategies to optimize resuscitation procedures.

Diversity of and initiatives for hypertension management in Asia-Why we need the HOPE Asia Network.

The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network was set up to improve the management of hypertension in Asia with the ultimate goal of achieving "zero" cardiovascular events. Asia is a diverse continent, and the prevalence of hypertension has increased over the last 30years. There are a number of Asia-specific features of hypertension and hypertension-related cardiovascular complications, which means that a region-specific approach is needed. White-coat hypertension will become more of an issue over time as Asian populations age, and masked hypertension is more prevalent in Asian than in Western countries. Identifying and treating masked hypertension is important to reduce cardiovascular risk. Abnormal patterns of blood pressure (BP) variability common in Asia include exaggerated early morning BP surge and nocturnal hypertension. These are also important cardiovascular risk factors that need to be managed. Home blood pressure monitoring (HBPM) is an important tool for detecting white-coat and masked hypertension, and monitoring BP variability, and practices in Asia are variable. Use of HBPM is important given the Asia-specific features of hypertension, and strategies are needed to improve and standardize HBPM usage. Development of HBPM devices capable of measuring nocturnal BP along with other information and communication technology-based strategies are key developments in the widespread implementation of anticipation medicine strategies to detect and prevent cardiovascular events in patients with hypertension. Region-wide differences in hypertension prevalence, control, and management practices in Asia highlight the importance of information sharing to facilitate best practices.

Reconstitution of T-Cell Subsets Following Thymoglobulin-Induced Depletion in High Immunologic Risk and Donation After Cardiac Death Renal Transplant Recipients

IntroductionDepletion therapy in high immunologic risk (HR) patients by antithymocyte globulin (rATG) induces lymphopenia and subsequent compartmental repopulation of T-cell subsets. rATG is also given to patients receiving kidneys from donations after cardiac death (DCDs) to mitigate innate immune activation associated with the DCD process. MethodsWe compared the T-cell response with rATG in both HR and DCD kidney recipients. We examined the reconstitution of T-cell subsets after rATG treatment in HR and DCD recipients (n = 19 per group) by multicolor flow cytometry. ResultsFollowing treatment, there was a rapid drop in the frequency of T cells in both groups, which persisted over 28 days. HR patients had an early surge in the frequency of CD4+ naïve, effector-memory, and regulatory T cells. Although we found a significant proliferation of the T cells in both groups, the DCD cohort had a blunted response as well as reduced CD4+ T-cell immune-reactivity compare with the HR group. ConclusionsOur data suggest that there is a lack of significant homeostatic proliferative response in DCD recipients following rATG, and CD4+ T cells may be less reactive in the DCD group than previously thought, indicating that rATG treatment may not have to be considered a first-line induction therapy in DCD recipients.

EFFECT OF RENAL DENERVATION IN ATTENUATING THE MORNING SURGE IN BLOOD PRESSURE

Objective: Results from the prospective, randomized, sham-controlled SPYRAL HTN-ON MED trial to assess blood pressure (BP) reduction post-renal denervation (RDN) have been previously published. We wished to examine the impact of RDN on individual patterns of BP during the critical “morning surge” period, as inappropriately high sympathetic tone may lead to increased hypertensive cardiovascular risk, especially during the early morning surge period. Design and method: A total of 80 patients were randomized to RDN (N = 38) or sham control (N = 42) in the trial and BP was measured at baseline, 3 and 6 months. Hourly systolic (SBP) and diastolic BP (DBP) plots were created by plotting the mean BP measured with ambulatory BP monitoring at each hour across 24 hours. We calculated the slopes of hourly BP data separately for each subject during the morning hours (6–10AM) using linear regression models. Morning slopes were compared between baseline, 3 and 6 months within each treatment group using paired t-tests, and between RDN and control groups at each timepoint using unpaired t-tests. Results: Mean DBP morning slope at baseline, 3 and 6 months were 4.1, 2.8, and 1.1 mmHg/hour for the RDN group and 3.8, 4.5 and 3.6 mmHg/hour for the control group, respectively. DBP morning slopes were significantly lower for RDN vs. control groups at 6 months (1.1 vs. 3.6; p = 0.029). Within the RDN group, DBP morning slopes were significantly lower at 6 months compared to baseline (4.1 vs. 1.1; p = 0.006). Similar patterns were observed for mean SBP morning slope but did not reach statistical significance. Conclusions: DBP morning slope, an index of the sympathetically mediated morning BP surge, significantly decreased from baseline to 6 months in the RDN group indicating a drop in late morning BP relative to early morning/nocturnal BP. A similar decrease was not seen in the control group. Thus, RDN appears effective in attenuating the morning surge in DBP.

Abstract 1273: Molecular dynamics prediction of the mechanism of acquired resistance to EGFR inhibitors in EGFR-mutant lung cancer

Abstract Background Acquired drug resistance is the most challenging problem in treating nonsmall cell lung cancer (NSCLC) patients with EGFR tyrosine kinase inhibitor (TKI). We evaluated whether resistance cell subclones significantly increased shortly after treatment with EGFR-TKIs could determine the final resistance phenotype for EGFR-TKIs in the tumor with EGFR mutations. Methods We generated 2 EGFR-mutant lung cancer cell lines (PC9GR and HCC827GR) resistant to gefitinib and evaluated the resistance mechanisms in each cell line. In parent cell lines (PC9 and HCC827) the amounts of EGFR T790M mutation and C-MET and VIMENTIN mRNA expression were measured before and after 48 hours treatment with gefitinib or paclitaxel. Using a cell line derived directly from tumors of treatment-naïve NSCLC patient with EGFR mutation, the above tests were repeated. We prospectively collected the bloods from 4 NSCLC patients with EGFR mutations at baseline and eight weeks after EGFR-TKI treatment and measured the level of T790M mutation in circulating tumor DNAs (ctDNA) from their bloods by colourimetric assay. Results EGFR T790M mutation was detected in PC9GR cells whereas C-MET amplification in HCC827GR cells. The proportion of EGFR T790M mutation significantly increased in the PC9 cells treated with gefitinib whereas not in the same cells treated with paclitaxel or not in the HCC827 treated with gefitinib or paclitaxel. The mRNA expression of C-MET was significantly increased in the HCC827 treated with gefitinib. The VIMENTIN mRNA expression was not changed in both cell lines. When we treated the patient-derived cells with gefitnib, the frequency of T790M significantly increased whereas C-MET mRNA expression decreased and VIMENTIN mRNA expression was not changed. In the corresponding resistance tumor tissue, only T790M mutation was detected without C-MET amplification and VIMENTIN overexpression. Two cases whose T790M mutation level in their ctDNAs increased at 8 weeks by more than 50% revealed T790M mutation in their final resistance tumor tissue. But, in other cases without an early surge of T790M mutation in their ctDNAs, T790M mutation was not detected in posttreatment biopsy sample. Conclusions Early-on-treatment quantitative change of resistance-related gene alterations may predict the final mechanism of resistance to EGFR-TKI. Citation Format: Youngjoo Lee, Yu-Ra Choi. Molecular dynamics prediction of the mechanism of acquired resistance to EGFR inhibitors in EGFR-mutant lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1273.