Medical Center Research Articles

Medical appraisal of Chinese military aircrew with abnormal results of coronary computed tomographic angiography

BACKGROUND Coronary artery diseases can cause myocardial ischemia and hypoxia, angina pectoris, myocardial infarction, arrhythmia, and even sudden death led to inflight incapacitation of aircrew. As the main cause of grounding due to illness, they severe threats to the health and fighting strength of military aircrew. Early warning in an early and accurate manner and early intervention of diseases possibly resulting in inflight incapacitation are key emphases of aeromedical support in clinic. AIM To figure out the flight factors and clinical characteristics of military aircrew with abnormal results of coronary artery computed tomographic angiography (CTA), thereby rendering theoretical references for clinical aeromedical support of military flying personnel. METHODS The clinical data of 15 flying personnel who received physical examinations in a military medical center from December 2020 to June 2023 and were diagnosed with coronary artery diseases by coronary artery CTA were collected and retrospectively analyzed, and a descriptive statistical analysis was conducted on their onset age, aircraft type and clinical data. RESULTS The 15 military flying personnel diagnosed with coronary artery diseases by coronary artery CTA were composed of 9 pilots, 1 navigator and 5 air combat service workers. Multi-vessel disease was detected in 9 flying personnel, among which 8 (88.9%) were pilots. Flying personnel with multi-vessel disease had higher content of cholesterol, low-density lipoprotein cholesterol and apolipoprotein B than those with single-vessel disease. CONCLUSION Coronary artery diseases are the major heart disease for the grounding of flying personnel due to illness, which can lead to inflight incapacitation. Coronary artery CTA is conducive to early detection and early intervention treatment of such diseases in clinic.

Oligohydramnios at term in the high-risk population- how severe is severe?

The term oligohydramnios is linked to pregnancy complications. We previously presented the outcome of the low-risk population (no pregnancy complications) with term oligohydramnios. This study aims to address the high-risk group (Any maternal complication during pregnancy, such as gestational diabetes, pre-gestational diabetes, chronic hypertension, preeclampsia, anemia, asthma, obesity, and multi parity.). This retrospective cohort study of 1,114 singleton term (≥37), oligohydramnios (AFI <50 mm) pregnancies from Shamir Medical Center between 2017 and 2021. Compering the low-risk to high-risk groups with subdivision by severity of oligohydramnios. A total of 211 subjects (19 %) were high-risk cases and 903 (81 %) low-risk cases. Comparing these two groups, subjects of the high-risk group were older (31.34±5.85 vs. 29.51 vs. 4.96), had earlier gestational age at delivery 39.53±1.18 vs. 40, had higher mean AFI (35±12.7 vs. 33±14.5), were subject to more labor inductions (81 vs. 69.7 %), and CS rate (19.9 vs. 12.4 %). Logistic regression revealed a need for more cesarean sections in the high-risk group. Additionally, more labor inductions and a higher risk of negative fetal outcomes. This study highlights the importance of considering pregnancy risk factors when we are approaching oligohydramnios in high-risk pregnancies.

Abstract A090: Comparing baseline knowledge and attitudes towards tobacco use and cessation among providers at substance use treatment centers and medical healthcare centers in rural and/or medically underserved areas of Texas

Abstract Introduction: Tobacco use intervention in healthcare settings is consistent with best practice guidelines and has been shown to facilitate tobacco cessation. Such intervention is particularly important in rural and medically underserved areas (MUAs), where tobacco use is elevated, as is cancer mortality. Providers’ knowledge and attitudes about the danger of tobacco use and their role in mitigating the same may play a role in whether their patients receive guideline-compliant care. This study investigates knowledge and attitudes toward tobacco use and cessation care delivery among providers at substance use treatment centers (SUTCs) and medical healthcare centers (MHCs; e.g., Federally Qualified Health Centers) in rural and/or MUAs of Texas to identify modifiable barriers to effective tobacco cessation treatment. Methods: Providers from healthcare centers (12 SUTCs, 9 MHCs) participating in a tobacco-free workplace program responded to a baseline solicitation assessing, among other things, their interest in receiving tobacco cessation care training and resources. In total, 347 providers from SUTCs (n=174) and MHCs (n=173) serving 49.6% of Texas’ counties responded to face-valid items assessing their knowledge and attitudes about tobacco use and provision of tobacco cessation care. Generalized or linear mixed models were used to analyze differences between SUTCs and MHCs. Results: More SUTC than MHC providers accurately identified that adults with mental health and/or non-nicotine substance misuse disorders are 2x more likely to smoke cigarettes than the general population (69% vs. 57%, p&amp;lt;0.008) and that quitting smoking can improve associated mental health symptomatology/substance misuse (61% vs. 54%, p&amp;lt;0.05), but also that patients’ tobacco product use is a personal decision that does not concern the direct service provider (30% vs. 19%, p&amp;lt;0.03). Conversely, more MHC than SUTC providers agreed that smoking cessation counseling is an important part of their job (66% vs. 41%, p&amp;lt;0.001), that their patients who smoke want to quit (38% vs. 21%, p&amp;lt;0.002), that providers should advise patients to quit even if it is not the reason for the visit (65% vs. 43%, p&amp;lt;0.001), that counseling by a provider motivates tobacco product users to quit (68% vs. 50%, p&amp;lt;0.005), and that providers should make appointments to specifically help patients quit tobacco product use (59% vs. 39%, p&amp;lt;0.003). Overall, only 48.4% of providers felt somewhat or completely prepared to help patients quit (56% MHC vs. 41% SUTCs, p&amp;lt;0.03). Conclusion: Addressing tobacco use in rural and/or MUAs of Texas where patients receive healthcare is critical to cancer prevention and achieving health equity. Responding SUTC and MHC providers evinced a need for training to enhance their understanding of tobacco use and to elevate the importance of cessation care provision. This is particularly the case in SUTCs, where providers primarily treat addiction. Findings will inform workplace interventions and their adaptation for use in each setting to facilitate guideline-compliant care provision. Citation Format: Sriya N. Kakarla, Brian J. Carter, Ammar D. Siddiqi, Maggie Britton, Tzuan A. Chen, Isabel Martinez Leal, Teresa Williams, Kathleen Casey, Hector Sanchez, Lorraine R. Reitzel. Comparing baseline knowledge and attitudes towards tobacco use and cessation among providers at substance use treatment centers and medical healthcare centers in rural and/or medically underserved areas of Texas [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A090.

Abstract C172: Diversifying translational research models to address outcomes disparities in lung cancer

Abstract Introduction: Racial disparities in lung cancer remains a persistent and challenging problem, with African Americans experiencing the highest mortality of any race or ethnic group. Emerging evidence suggests that multiple biological factors affect the development and progression of lung cancer. Three-dimensional organoid culture models have become important instruments to use for biomarker analysis and drug sensitivity screening. Despite this strong rationale and potential, there is a lack of representative preclinical models from African American patients with lung cancer. Furthermore, there are no studies evaluating the ability to create organoids successfully using samples from different races. As such, our goal was to establish a diverse biobank of organoid models and determine the rate of successful development based on race and other factors. Methods: Patients with lung cancer from a large urban medical center were recruited to participate in the study from 2021 to 2024. Specimens were collected from surgical pulmonary resection or endobronchial biopsy. Each tissue specimen was divided into 3 pieces and allocated for genomic, transcriptomic and organoid development. Once collected, specimens allocated for organoid development were processed within 8 hours. Cells were isolated from tissues by mechanical and enzymatic dissociation and plated in Matrigel drops overlayed with optimized organoid media. Patient demographics, tumor characteristics and method of specimen collection were recorded. Results: A total of 29 patients consented to the study and had evaluable specimens collected. Mean age was 67 years. Fifty-five percent of patients (16/29) were female. White patients were 55 percent of cohort (16/29), while Black patients made up 45% (13/29). Approximately 62 (18/29) percent of patients were diagnosed with adenocarcinoma, followed by squamous cell carcinoma in 28 percent (8/29) of patients. Tumor stage was 55%, 28%, 3% and 14% for stages I, II, III and IV respectively. Overall, there was a successful organoid development rate of 69 percent (20/29). There was a strong trend toward higher success rates in Black patients compared to White patients (85% vs. 56%, p = 0.10). There were no significant differences in successful organoid development based on gender (p = 0.43), histology (p = 0.18) or tumor stage (p = 0.84). Conclusions: Establishment of a racially diverse set of organoid models will be an invaluable tool for biomarker discovery and for screening novel therapeutic agents. Black patients appear to have similar to improved propensity for successful organoid development. Future efforts should be focused on creating diverse biobanks to strengthen precision oncology efforts for Black patients, collectively helping to reduce racial outcomes disparities in patients with lung cancer. Citation Format: Amanda Pilling, Hollis Hutchings, Avi Cohen, Shirish Gadgeel, Ikenna Okereke. Diversifying translational research models to address outcomes disparities in lung cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C172.

Abstract B141 Self-reported distress in multiple myeloma patients at first consultation at a transplant referral center

Abstract The National Comprehensive Cancer Network (NCCN) recommends screening all cancer patients for distress to facilitate psychosocial support and referrals. This distress is associated with treatment delays and other obstacles that may affect patient outcomes. The prevalence of distress in patients with multiple myeloma (MM) and its variation among underrepresented minorities and vulnerable groups is unknown. We hypothesized that patients with advanced disease, racial minorities, and vulnerable individuals would report higher distress levels. New patients with MM seen between 1/1/2015-12/31/2022 at a tertiary medical center were identified. All patients receive the NCCN Distress Thermometer (DT) survey for completion at initial consultation as standard of care. Baseline characteristics of patients who completed the survey were compared with those of patients who did not. Among those with survey data, DT score was categorized as &amp;lt;4 (low), 4–6 (moderate), and &amp;gt;6 (high). DT score was analyzed by sociodemographic and disease-related factors. The 2020 Social Vulnerability Index (SVI) at the county level was calculated using Zip codes and categorized as less vulnerable (score &amp;lt;50) or more vulnerable (&amp;gt;=50). Of 1,011 new MM patient consultations, 683 patients had an available DT survey at initial consultation. In patients without the survey (N=328), a higher proportion was older than 75 years (21% vs 16% P=0.04), non-Hispanic Black (NHB) [22% vs. 9%, P&amp;lt;0.01], and with more advanced disease (ISS III 20% vs 14%, P&amp;lt;0.01). There was lower autologous stem cell transplant utilization in the group with missing survey data (71% vs 79%, P&amp;lt;0.01). Among those with DT survey, younger age, female sex, advanced stage, and shorter time from diagnosis to consult was associated with higher distress. In patients with DT survey data and SVI (N=683), the mean SVI was 0.37 (std dev 0.31) and 166 (28%) had more vulnerability. Younger age and NHB race were associated with more vulnerability. The more vulnerable group also had a shorter time from diagnosis to consult (1.2 vs 1.8 months, P&amp;lt;0.01). In the more vulnerable group, high DT score was seen with younger age and NHB race. There was no difference in transplant utilization by SVI group. No significant differences were found in the proportion of patients reporting concerns for physical, practical, emotional, social concerns by vulnerability. In this tertiary referral center study, we observed the greatest disparity by the completion of the NCCN DT survey highlighting a missed opportunity to identify individuals who may benefit from additional services. Among those who completed the survey, patient-reported distress was influenced by age, sex, and MM stage. Younger age was associated with more vulnerability. This may be due to minority status as a theme in the SVI calculator and the known association of younger age at MM onset in NHB individuals. Next steps including an adjusted analysis will be shown in the final presentation. Citation Format: Noel Estrada-Merly, James F Wu, Anita D'Souza. Self-reported distress in multiple myeloma patients at first consultation at a transplant referral center [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B141.

Abstract A105: Clinical characteristics of Hispanic patients ages 50 and younger with lung adenocarcinoma: A multi-center experience

Abstract Introduction: While uncommon, there has been an increase in non-small cell lung cancer (NSCLC) cases in patients under the age of 50 with little data on young Hispanic patients with NSCLC. This multicenter study describes the clinical characteristics of young Hispanic lung adenocarcinoma patients between two cities with a large Hispanic population. Methods: This retrospective study examined 90 Hispanic patients (18-50 years old) with metastatic lung adenocarcinoma treated at University of Miami (Miami) Sylvester Comprehensive Care Center (n=50), University of Southern California (USC) Norris Comprehensive Care Center/Los Angeles General Medical Center (n=26), and the Memorial Cancer Institute at West (Memorial) (n=14) from 2009-2023. We looked at age at diagnosis, sex, smoking history, stage at diagnosis, brain metastasis at diagnosis, mutations, tyrosine kinase inhibitor (TKI) exposure, and survival status at 24 months, 36 months, and 60 months. Fisher’s exact test was used to compare differences between USC (n=26) in Los Angeles, California, USA and Miami/Memorial (n=64) in Miami, Florida, USA. Results: 63.33% (n=57) of the patients were female. The median age at diagnosis was 41.5 years, including 8.89% (n=8) diagnosed from age 18-30, 33.33% (n=30) diagnosed from age 31-40, and 57.78% (n=52) diagnosed from age 41-50. 63.33% (n=57) identified as never smokers, 30.00% (n=27) identified as former smokers, and 6.67% (n=6) identified as current smokers. 85.56% (n=77) were found to have metastatic disease at diagnosis, including 34.44% (n=31) with brain metastasis at diagnosis. 28.89% (n=26) had an EGFR mutation, 28.89% (n=26) were ALK positive, and 8.89% (n=8) had a KRAS mutation. 55 (61.11%) had been exposed to a TKI. Between treatment sites, there was a greater prevalence of brain metastasis at USC versus Miami/Memorial (15/26, 57.69% vs. 16/64, 25.00%, p&amp;lt;0.01) and a trend towards greater prevalence of EGFR and KRAS mutations (EGFR: 11/26 (42.31%) vs. 15/64 (23.44%), p = 0.12; KRAS: 4/26 (15.38%) vs. 4/64 (6.25%), p = 0.22) and TKI exposure (19/26, 73.08% vs. 36/64, 56.25%, p=0.15) at USC versus Miami/Memorial. Regarding survival for stage IV patients, 37/61 (60.65%) of patients were alive at 24 months, 22/51 (43.1%) at 36 months, and 14/46 (30.4%) at 60 months with a trend towards more USC patients being alive at 36 months (10/18, 55.56% vs. 12/33, 36.36%) and 60 months (6/15, 40% vs. 8/31 25.8%). Conclusion: Young Hispanic lung adenocarcinoma patients are predominantly female, never smokers, diagnosed with metastatic disease, and enriched in EGFR and ALK mutations. There are differences in prevalence of brain metastasis, EGFR and KRAS mutations, TKI exposure, and survival between the USC and Miami/Memorial young lung adenocarcinoma patients. These notable frequencies may be attributed to the different Hispanic subgroups in the west coast versus southeastern USA. This study highlights the need for more attention towards Hispanic ethnicity in the young lung cancer population. Citation Format: Kyle Edwards, Darin Poei, Suset Almuinas de Armas, Coral Olazagasti, Zhonglin Hao, Jorge J. Nieva, Luis E Raez, Gilberto Lopes, Estelamari Rodriguez, Robert Hsu. Clinical characteristics of Hispanic patients ages 50 and younger with lung adenocarcinoma: A multi-center experience [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A105.

Abstract B105: Quality and Accessibility of Online Information Regarding CAR-T Therapy in Hematologic Malignancies

Abstract Background Chimeric antigen receptor T-cell (CAR-T) therapies have changed the treatment landscape for various hematologic malignancies and are currently under development and being tested in clinical trials for multiple solid tumors. Given that patients commonly use the internet as a source of health-related information, we sought to investigate the quality, understandability, and readability of online information regarding CAR-T therapy. Methods We conducted a search in a commonly used search engine (Google) of five pre-determined search terms to identify 100 unique web pages regarding CAR-T therapy. Scientific publications were excluded. Validated instruments were used to ascertain health information quality (DISCERN), understandability (Patient Education Materials Assessment Tool; PEMAT), and readability (Flesch-Kincaid, Gunning Fog, and SMOG indices). Results were summarized using descriptive statistics. Results Among the 100 web pages reviewed, 68% originated from academic medical centers, and 64% included links to clinical trials. Only 11% of the web pages included references to primary literature. 17% of web pages were available in a language other than English, with Spanish (15%) and Arabic (7%) being the most common. Moderate-to-high quality information (DISCERN ≥ 3) was presented by 47% of web pages, and only 31% of web pages were considered understandable (PEMAT ≥ 70%). Average readability scores were 10.6 (SD = 2.09), 12.6 (SD = 2.3), and 13.1 (SD = 1.7) using the Flesch-Kincaid, Gunning Fog, and SMOG indices, respectively. Conclusion Our study highlights that online information for CAR-T therapies commonly features low-quality health information that is typically not understandable to the general population. Further, contrary to recommendations from federal agencies and medical societies, available online information requires, on average, high school reading comprehension. Healthcare teams and stakeholders should strive to improve existing content and ensure patients have access to trusted, high-quality information given the unique complexities, processes, and toxicities associated with receiving CAR-T therapy. Citation Format: Luis C. Garcia, Ana I. Velázquez. Quality and Accessibility of Online Information Regarding CAR-T Therapy in Hematologic Malignancies [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B105.

A Developmental Approach to Mid-Career Faculty Leadership Training at Two Academic Medical Centers

A Developmental Approach to Mid-Career Faculty Leadership Training at Two Academic Medical Centers

Cerebrospinal fluid lactate levels as a prognostic indicator in HIV-negative patients with cryptococcal meningitis: a retrospective cohort study

Abstract Background Cryptococcal meningitis (CM) is a severe central nervous system infection. In patients with human immunodeficiency virus (HIV) infections and coexisting CM, elevated baseline cerebrospinal fluid (CSF) lactate levels can predict increased mortality. However, the CSF lactate level’s significance in HIV-negative patients with CM remains unclear, necessitating further investigation to elucidate the potential distinctions and enhance patient management. This study investigated the CSF lactate level significance in HIV-negative patients with CM. Methods This retrospective study utilized data from the clinical databases of patients who underwent lumbar punctures at a medical center in Kaohsiung City, Southern Taiwan. Demographic data, CSF lactate levels, routine CSF analyses, and hematological and neurological findings were evaluated. The optimal CSF lactate threshold value was determined using the Youden index. Results This retrospective study included 70 patients with CM, among whom 44 (63%) and 26 (37%) tested negative and positive for HIV, respectively. The group without HIV exhibited higher CSF lactate levels, with an optimal CSF lactate cut-off point for predicting 90-day mortality of 7.935 mmol/L, resulting in significant predictive accuracies (area under the curve, 0.755; sensitivity, 57.1%; specificity, 100%); this value was an independent mortality predictor in HIV-negative patients. In HIV-negative patients with CM, CSF lactate levels ≥7.935 mmol/L correlated with higher mortality rates but without statistical significance. All HIV-negative patients with CM and CSF lactate levels ≥7.935 mmol/L died within 3 months of admission. Conclusions HIV-negative patients with CM had elevated CSF lactate levels that correlated with adverse outcomes, enabling early identification of high-risk individuals.

Influence of chronotype on sleep quality and menstrual regularity in nurses on monthly shift rotations

Abstract Objectives This study was to investigate factors that influence the sleep quality and menstrual cycles of female rotating-shift nurses. Methods A cross-sectional study was conducted in which 213 female rotating-shift nurses between the ages of 20 and 45 were recruited from a medical center in Taiwan from November 1, 2023, to December 31, 2023. Binary logistic regression analysis was performed with regard to sleep quality or menstrual cycle. Results Female rotating-shift nurses who perceived a higher level of stress (p &amp;lt; .001), were late chronotypes (p = .020), or were working the night shift (p = .006) were more likely to have poor sleep quality. Late-type nurses working the day shift were more likely to have poor sleep quality than were early- and intermediate-type nurses (p &amp;lt; .001). With regard to menstrual cycles, female rotating-shift nurses who perceived a higher level of stress (p = .008), were working the night shift (p &amp;lt; .001), or had poor sleep quality (p = .001) were more likely to have irregular menstrual cycles. Late-type nurses working the day shift were more likely to have irregular menstrual cycles than were early- and intermediate-type nurses (p = .013). Conclusions A higher likelihood of poor sleep quality was found in female rotating-shift nurses when they perceived high levels of stress, and the interactions between chronotype and shift type could influence sleep quality. Shift type and the interactions between chronotype and shift type could also influence menstrual regularity.

Prevention and management of allergic-like reactions to iodine contrast media: a best practice implementation project.

With the wide application of iodine contrast media (ICM), the occurrence of allergic-like reactions to iodine contrast media (ALR-ICM) has increased. Strategies for the prevention and management of ALR-ICM need to be identified to provide quality care to patients undergoing enhanced computed tomography. The overarching aim of this project was to improve the prevention and management of ALR-ICM at a medical imaging center of a nearly 5,000-bed tertiary hospital in China. This project was guided by the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit strategy. A baseline audit was conducted to measure current practices against recommended best practices. Feedback from the audit was used to identify barriers and design strategies to improve practice. A follow-up audit was conducted to measure changes in compliance with best practices. The results revealed a positive change in compliance with best practices. More than 60% compliance with the four audit criteria was observed. The overall ALR-ICM rate decreased from 0.56% to 0.19%, while emergency equipment management dramatically increased from 37.50% to 100%. The smallest improvement was observed for pre-procedure prophylactic treatment of high-risk patients (27.66%). Most audit criteria showed moderate improvements in compliance with best practices. Further testing of this program in more hospitals is needed. http://links.lww.com/IJEBH/A269.

Correlation of gastrointestinal symptom rating scale and frequency scale for the symptoms of gastroesophageal reflux disease with endoscopic findings

Background Gastroesophageal Reflux Disease (GERD) is caused by the reflux of gastric contents into the esophagus and has a 13% global prevalence that is increasing. GERD symptoms negatively impact physical, social, and emotional quality of life. The Frequency Scale for the Symptoms of GERD (FSSG) and the Gastrointestinal Symptom Rating Scale (GSRS) determine the efficacy of treatment but may not correlate with endoscopically estimated esophageal mucosal injury severity. We aimed to probe the correlation between FSSG, GSRS, and esophageal injury severity to evaluate whether these scores can predict GERD severity. Methods A total of 2962 patients who underwent physical examinations, including upper gastrointestinal endoscopy, at the Kyoto Kuramaguchi Medical Center, Japan, were enrolled in this study. Upper gastrointestinal endoscopy was used to diagnose fundic mucosal atrophy, reflux esophagitis based on the Los Angeles (LA) classification, gastroesophageal flap value function (GEFV) based on Hill’s classification, and Barrett’s esophagus. Endoscopic diagnoses were examined for correlations with FSSG and GSRS scores. Results In reflux esophagitis, FSSG and GSRS scores correlated with LA-B and LA-C endoscopic diagnosis but not with LA-M and LA-A endoscopic findings. Multiple regression analysis results were similar. FSSG scores reflected advanced fundic gland mucosal atrophy, while GSRS scores associated with high grade of GEFV. Conclusions This is the first report to examine the correlation between FSSG and GSRS scores and endoscopic findings in a relatively large patient population. Our findings suggest that these scores can diagnose the severity of reflux esophagitis.

Outcomes of in-hospital cardiac arrest managed with and without a specialized code team: A retrospective observational study

Background In-hospital cardiac arrest (IHCA) still has a poor prognosis despite medical advancements in recent decades. Early and high-quality cardiopulmonary resuscitation (CPR), as well as good teamwork, are important prognostic factors. There are no clear guidelines regarding the composition of a dedicated hospital CPR team. We compared outcomes of IHCA treated by a dedicated hospital CPR team compared to ward medical staff with advanced cardiac life support (ACLS) training. Methods A single-center retrospective observational study based on the cardiopulmonary resuscitation database of Soroka University Medical Center from January 2016 until December 2019. We compared the results of resuscitations conducted by regular ward medical staff, certified in ACLS, versus those conducted by the dedicated hospital’s CPR team. Results Of the 360 CPR events analyzed, 141 (39.1%) ended in return of spontaneous circulation, 70 (19.4%) patients were alive after 24 hours, 23 (6.4%) survived for 30 days, and 18 (5%) survived to discharge. Of those who survived to discharge, 11 (61.1%) had a cerebral performance category (CPC) score of 1–2, and 7 (38.9%) had a score of 3–4 (mean 2.09). Survival-to-discharge was significantly higher in the CPR-team group compared to the ward-team group (7.6% vs. 1.9%, p = 0.013). However, with propensity score analysis the difference in survival became insignificant (RR = 1.97, 95% CI: 0.40–9.63, p = 0.40). Conclusion We found no difference in survival between IHCA treated by a dedicated hospital CPR team compared to a standard ward team, both trained with biennial ACLS training. Nevertheless, crude survival-to-discharge was significantly higher in the CPR-team group.

Creating realistic anterior segment optical coherence tomography images using generative adversarial networks

AimsTo develop a generative adversarial network (GAN) capable of generating realistic high-resolution anterior segment optical coherence tomography (AS-OCT) images.MethodsThis study included 142 628 AS-OCT B-scans from the American University of...

Patients' use of Danish emergency medical services before and during the COVID-19 pandemic: a register-based study

BackgroundDuring the COVID-19 pandemic, disturbing images of ambulances unable to respond to the demands for prehospital assistance appeared from several parts of the world. In Denmark, however, a notion occurred that the demands for emergency medical assistance declined. The purpose of this study was to compare the patients' use of the Danish Emergency Medical Services (EMS) before and during the COVID-19 pandemic. Furthermore, we investigated the overall mortality of the ambulance population, the main reason for calling the emergency medical dispatch centre, and the diagnosis assigned to the admitted patients.MethodsThe study was a nationwide registry-based cohort study based on the national prehospital medical records and the Danish National Patient Registry. The primary outcome was the requested number of ambulances. Secondary outcomes included the primary reason for contact with the dispatch centre (reflected by the dispatch criteria), patient mortality, and the diagnoses assigned to the patients transported to the hospital by ambulance during the COVID-19 pandemic in Denmark in March–December 2020. Comparisons were made using a similar period in 2019 before the pandemic.ResultsIn comparison with the baseline values before the pandemic, the total number of patients treated by the EMS was reduced by 4.5% during the COVID-19 pandemic. The number of patients transported to the hospital during the pandemic was similarly reduced by 3.5%. Compared with baseline values, fewer were patients hospitalised with respiratory diseases during the pandemic (a reduction of 53.3% from April 2019 to April 2020).Compared to the baseline period, there were significant increases in both the 48-h mortality (from 1.4% to 1.5%) and the 30-day mortality (from 4.9% to 5.4%) (p < 0.03 and p < 0.001, respectively), in patients hospitalised during the pandemic.ConclusionDuring the first wave of the COVID-19 pandemic, the Danish EMS experienced an overall reduction in the requests for and the use of ambulances and, especially, in the number of patients admitted to hospitals for respiratory diseases. Despite the overall reduction in EMS requests, the mortality of the ambulance population increased, indicating that despite the reduced ambulance use, the prehospital population was more severely ill during the pandemic.

Repeated rebiopsy for detection of EGFR T790M mutation in patients with advanced-stage lung adenocarcinoma: Associated factors and treatment outcomes of Osimertinib

Objectives This study was performed to investigate the detection rate of EGFR T790M mutation by repeated rebiopsy, to identify the clinical factors related to repeated rebiopsy, and to assess survival outcomes according to the methods and numbers of repeated rebiopsies in patients with lung adenocarcinoma who received sequential osimertinib after failure of previous 1st or 2nd generation EGFR-tyrosine kinase inhibitors. Methods This retrospective study included patients with advanced-stage lung adenocarcinoma who were confirmed to have EGFR T790M mutation and to have received osimertinib from January 2020 to February 2021 at Samsung Medical Center. The presence of T790M mutation was assessed based on either plasma circulating tumor DNA (ctDNA) or tissue specimens. Results A total of 443 patients underwent rebiopsy, with 186 (42.0%) testing positive for the T790M mutation by the sixth rebiopsy. The final analysis included 143 eligible patients. Progression-free survival was not significantly different in terms of the methods (tissue: 13.3 months, 95% confidence interval [CI]: [9.4, 23.5] vs plasma: 11.1 months, 95% CI: [8.1, 19.4], p = 0.33) and numbers (one: 13.4 months, 95% CI: [9.4, 23.5] vs two or more: 11.0 months, 95% CI: [8.1, 14.8], p = 0.51) of repeated rebiopsies. Longer overall survival (OS) was found in patients in whom T790M was detected by tissue specimens rather than by plasma ctDNA (2-year OS rate: 81.7% for tissue vs 63.9% for plasma, p = 0.0038). Factors related to the lower numbers of rebiopsies included age and bone metastasis. Factor associated with T790M detection in tissue rather than in plasma was pleural metastasis, while advanced tumor stage was related to T790M confirmation in plasma rather than in tissue. Conclusions Repeated rebiopsy for T790M detection in patients with NSCLC can increase the detection rate of the mutation. Detection of T790M by plasma ctDNA might be related to poor survival outcomes.

Ciliated foregut cysts involving the hepatopancreaticobiliary system: a clinicopathological evaluation with focus on atypical features

AimsForegut cystic malformations are rare developmental abnormalities, which may involve the hepatopancreaticobiliary tract (HPBT). These cysts are composed of inner ciliated epithelium; subepithelial connective tissue layer; smooth muscle layer; and...

Testing a Consumer Wearables Program to Promote the Use of Positive Airway Pressure Therapy in Patients With Obstructive Sleep Apnea: Protocol for a Pilot Randomized Controlled Trial.

Although positive airway pressure (PAP) therapy is considered first-line treatment for obstructive sleep apnea (OSA), nonadherence is common. Numerous factors influence PAP use, including a belief that the therapy is important and effective. In theory, providing information to patients about their blood oxygen levels during sleep (which may be low when PAP is not used), juxtaposed to information about their PAP use, may influence a patient's beliefs about therapy and increase PAP use. With the advent of consumer wearable smartwatches' blood oxygen saturation monitoring capability (and the existing routine availability of PAP use data transmitted via modem to clinical dashboards), there is an opportunity to provide this combination of information to patients. This study aims to test the feasibility, acceptability, and preliminary efficacy of the Chronic Care Management With Wearable Devices in Patients Prescribed Positive Airway Pressure Therapy (mPAP), a program that augments current PAP therapy data with consumer-grade wearable device to promote self-management of PAP therapy for OSA in a pilot randomized waitlist-controlled clinical trial. This is a single-blinded randomized controlled trial. We will randomize 50 individuals with a history of OSA, who receive care from a Department of Veterans Affairs medical center in the Los Angeles area and are nonadherent to prescribed PAP therapy, into either an immediate intervention group or a waitlist control group. During a 28-day intervention, the participants will wear a study-provided consumer wearable device and complete a weekly survey about their OSA symptoms. A report that summarizes consumer wearable-provided oxygen saturation values, PAP use derived from modem data, and patient-reported OSA symptoms will be prepared weekly and shared with the patient. The immediate intervention group will begin intervention immediately after randomization (T1). Assessments will occur at week 5 (T3; 1 week after treatment for the immediate intervention group and repeat baseline for the waitlist control group) and week 11 (T5; follow-up for the immediate intervention group and 1 week after treatment for the waitlist control group). The primary outcome will be the change in 7-day PAP adherence (average minutes per night) from T1 to T3. The primary analysis will be a comparison of the primary outcome between the immediate intervention and the waitlist control groups (intention-to-treat design), using a 2-sample, 2-sided t test on change scores (unadjusted). Recruitment began in October 2023. Data analysis is expected to begin in October 2024 when all follow-ups are complete, and a manuscript summarizing trial results will be submitted following completion of data analysis. Findings from the study may provide additional insights on how patients with OSA might use patient-generated health data collected by consumer wearables to inform self-management of OSA and possibly increase their use of PAP therapy. ClinicalTrials.gov NCT06039865; https://clinicaltrials.gov/study/NCT06039865. DERR1-10.2196/60769.

The impact of maternal vulnerability on stress biomarkers and first-trimester growth: the Rotterdam Periconceptional Cohort (Predict Study)

Abstract STUDY QUESTION Is the degree of maternal vulnerability positively associated with stress biomarkers (stress hormones, C-reactive protein, tryptophan metabolites, and one-carbon metabolites), and does long-term exposure to stress hormones reduce first-trimester growth? SUMMARY ANSWER The maternal vulnerability risk score is positively associated with concentrations of hair cortisol and cortisone and negatively with tryptophan, while higher hair cortisol concentrations are associated with reduced first-trimester growth without mediation of tryptophan. WHAT IS KNOWN ALREADY A high degree of maternal vulnerability during the periconception period is associated with impaired first-trimester growth and pregnancy complications, with consequences for long-term health of the child and future life course. However, due to the challenges of early identification of vulnerable women, the uptake of periconception care is low in this target group. STUDY DESIGN, SIZE, DURATION Between June 2022 and June 2023, this study was conducted in a sub-cohort of 160 pregnant women participating in the Rotterdam Periconceptional Cohort (Predict Study), an ongoing prospective tertiary hospital-based cohort. PARTICIPANTS/MATERIALS, SETTING, METHODS One hundred and thirty-two women with ongoing pregnancies and available stress biomarker data were included in the analysis. Data on periconceptional social, lifestyle, and medical risk factors were collected via self-administered questionnaires, and these factors were used for the development of a composite maternal vulnerability risk score. Stress biomarkers, including stress hormones (hair cortisol and cortisone) and inflammatory and oxidative stress biomarkers (C-reactive protein, total homocysteine, and tryptophan metabolites) were determined in the first trimester of pregnancy. First-trimester growth was assessed by crown–rump length (CRL) and embryonic volume (EV) measurements at 7, 9, and 11 weeks gestation by making use of an artificial intelligence algorithm and virtual reality techniques using 3D ultrasound data sets. The associations between the maternal vulnerability risk score and stress biomarkers were identified using linear regression models, and between stress hormones and CRL- and EV-trajectories using mixed models. A mediation analysis was performed to assess the contribution of tryptophan. All associations were adjusted for potential confounders, which were identified using a data-driven approach. Several sensitivity analyses were performed to check the robustness of the findings. MAIN RESULTS AND THE ROLE OF CHANCE The maternal vulnerability risk score was positively associated with concentrations of hair cortisol and cortisone (pg/mg) (β = 0.366, 95% CI = 0.010–0.722; β = 0.897, 95% CI = 0.102–1.691, respectively), and negatively with tryptophan concentrations (µmol/L) (β = –1.637, 95% CI = –2.693 to –0.582). No associations revealed for C-reactive protein and total homocysteine. Higher hair cortisol concentrations were associated with reduced EV-trajectories (3√EV: β = –0.010, 95% CI = –0.017 to –0.002), while no associations were found with CRL-trajectories. Mediation by tryptophan was not shown. LIMITATIONS, REASONS FOR CAUTION Residual confounding cannot be ruled out, and the external validity may be limited due to the study’s single-center observational design in a tertiary hospital. WIDER IMPLICATIONS OF THE FINDINGS There is mounting evidence that a high degree of maternal vulnerability negatively affects maternal and perinatal health, and that of the future life course. The results of our study emphasize the need to identify highly vulnerable women as early as possible, at least before conception. Our findings suggest that the chronic stress response and alterations of the maternal tryptophan metabolism are involved in maternal vulnerability, affecting first-trimester growth, with potential impact on the long-term health of the offspring. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Departments of Obstetrics and Gynecology and Clinical Chemistry of the Erasmus MC, University Medical Center, Rotterdam, the Netherlands, and the Junior Award granted by the De Snoo—van ’t Hoogerhuijs Foundation in March 2022. There are no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.

Quantitative aortic Na[18F]F positron emission tomography computed tomography as a tool to associate vascular calcification with major adverse cardiovascular events

Abstract Purpose Sodium[18F]fluoride (Na[18F]F) used in positron emission tomography (PET) binds to active calcification and correlates consistently with higher cardiovascular risk. This study aims to investigate the feasibility of aortic Na[18F]F-PET in hybrid combination with low-dose computed tomography (CT) as a risk model for major adverse cardiovascular events (MACE). Methods Patient data and Na[18F]F-PET/CT scans from January 2019 to February 2022 were retrospectively collected at the University Medical Center Groningen (UMCG), the Netherlands. MACE-outcome was a composite of time to first documented myocardial infarction, cerebral vascular accident (CVA), acute heart failure hospitalization, and aortic aneurysms. MACE dates were recorded from the day of the scan until follow-up in December 2023. The aorta was manually segmented in all low-dose CT scans. To minimize spill-over effects from the vertebrae, the vertebrae were automatically segmented using an open-source model, dilated with 10 mm, and subtracted from the aortic mask. The total aortic Na[18F]F corrected maximum standardized uptake value (cSUVmax) and total aortic Agatston score were automatically calculated using SEQUOIA. Kaplan–Meier and Cox regression survival analysis were performed, stratifying patients into high, medium, and low cSUVmax and Agatston categories. Cox regression models were adjusted for age. Results Out of 280 identified scans, 216 scans of unique patients were included. During a median follow-up of 3.9 years, 12 MACE occurred. Kaplan–Meier survival analysis demonstrated a significant difference in MACE-free survival among the high cSUVmax group compared to the medium and low groups (p = 0.03 and p &lt; 0.01, respectively). Similarly, patients with high Agatston scores had a significantly lower MACE-free survival probability compared to those with medium and low scores (both p &lt; 0.01). Conclusion This study highlights the potential clinical utility of Na[18F]F-PET/CT as an imaging tool to predict the risk of MACE. Clinical validation of this novel proof-of-concept method is needed to confirm these results and expand the clinical context.