Mount Sinai Hospital Research Articles

Facilitators of Multiple Myeloma Treatment: A Qualitative Study.

To examine factors that lead to the facilitation of multiple myeloma (MM) treatment. 29 patients who had been diagnosed with MM at Mount Sinai Hospital in New York City. Semistructured qualitative interviews were administered by trained research staff. Interview topics included illness beliefs, illness experiences, treatment experiences, and treatment decision-making. Interviews were audio recorded and transcribed verbatim. Four coders independently coded the transcripts, and the authors analyzed data using interpretive description. The following facilitators of treatment were identified: (a) healthcare team trust and support, (b) personal resilience and initiative-taking, and (c) external support (emotional/social support and instrumental/organizational support). Healthcare team trust and support were established through rapport-building and compassion, accessibility and time spent with the patient, shared decision-making, and provider reputation. Personal resilience was manifested by patients through positive attitudes, taking control of their illness, and self-advocacy. Understanding factors that facilitate MM treatment may lead to better patient outcomes and can potentially inform oncology nursing practice by providing a framework for tailored health education and care management practices for patients with MM.

Hot or not? Investigating radiation safety and policy updating for the appropriate storage of radioactive specimens at Mount Sinai Hospital

PurposeThe current hospital policy for this study is stringent regarding the storage of radioactive sentinel lymph node (SLN) specimens, which requires the storage time of 24 hours before being handled by Pathology. Additional labeling along with separate containment of these specimens can be forgone if negligible radiation levels are found. The objective of this study was to determine whether the storage time needed for resected radioactive breast and primary site specimens to decay to twice the background radiation levels is less than 24 hours. MethodsThe investigators retrieved breast and primary site SLN specimens from the Pathology department on the same day of the biopsy. A dose calibrator was used to measure the dose, specimen, and concurrent background radioactivity in Megabecquerels (MBq). Radioactive decay calculations were used to further investigate when specimen activities reached twice the background levels. A retrospective analysis was performed using a one-sample t-test to determine if the time to reach double the background activity was significantly different from 24 hours. This study pertained to workflow optimization; thus, general procedure consent forms were sufficient. Both patient confidentiality and privacy were protected. The investigators followed the necessary radiation safety measures. ResultsThe mean time for specimens to reach twice the background level of radioactivity was 3.99 hours, significantly less than current storage time of 24 hours (p < 0.001). The mean time point for the SLNs to reach 1/16th of the original activity was 7.78 hours (p < 0.001). The average node activity was 0.14 MBq. ConclusionThe average sentinel node activity was less than 1 exemption quantity and the time to reach less than twice the background levels was significantly less than 24 hours, meaning that radioactive labels are not needed, and the 24-hour overnight specimen storage can be mitigated.

Cryopreservation of Allogeneic Hematopoietic Cell Products During COVID-19 Pandemic: Graft Characterization and Engraftment Outcomes

The COVID-19 pandemic triggered the deployment of unfamiliar measures to safeguard successful allogeneic hematopoietic cell transplantation (allo-HCT). Among these measures, cryopreservation offered logistical benefits that could outlast the pandemic, including graft availability and timely clinical service. The purpose of this study was to evaluate graft quality and hematopoietic reconstitution in patients transplanted with cryopreserved allogeneic stem cell products during the COVID-19 pandemic. We evaluated 44 patients who underwent allo-HCT using cryopreserved grafts consisting of hematopoietic progenitor cells (HPC) apheresis (A) and bone marrow (BM) products at Mount Sinai Hospital. Comparative analyses of 37 grafts infused fresh during the one-year period preceding the pandemic were performed. Assessment of cellular therapy products included total nucleated cell and CD34+ cell enumeration, viability, and post-thaw recovery. The primary clinical endpoint was the evaluation of engraftment (absolute neutrophil count [ANC] and platelet count) and donor chimerism (presence of CD33+ and CD3+ donor cells) at day +30 and +100 post-transplant. Adverse events related to cell infusion were also analyzed. Patient characteristics were comparable between the fresh and cryopreserved groups with 2 exceptions in the HPC-A cohort: the number of patients in the cryopreserved group that received haploidentical grafts was 6 times that in the fresh group, and the number of patients in the fresh group with a Karnofsky performance score >90 was double that in the cryopreserved group. The quality of HPC-A and HPC-BM products was not affected by cryopreservation, and all grafts met the release criteria for infusion. The pandemic did not affect the time between collection and cryopreservation (median, 24 hours) and time in storage (median, 15 days). Median time to ANC recovery was significantly delayed in recipients of cryopreserved HPC-A (15 vs 11 days, P=.0121), and there was a trend toward delayed platelet engraftment (24 vs 19 days, P=.0712). The delay in ANC and platelet recovery was not observed when only matched graft recipients were compared. Cryopreservation did not affect the ability of HPC-BM grafts to engraft and reconstitute hematopoiesis, and there was no difference in the rates of ANC and platelet recovery. Achievement of donor CD3/CD33 chimerism was not affected by cryopreservation of either HPC-A or HPC-BM products. Graft failure was observed in only 1 case, a recipient of cryopreserved HPC-BM. Three recipients of cryopreserved HPC-A grafts died before ANC engraftment from infectious complications. Remarkably, 22% of our studied population had myelofibrosis, and almost half received cryopreserved HPC-A grafts with no graft failure observed. Finally, patients receiving cryopreserved grafts were at a higher risk of infusion-related adverse events than those receiving fresh grafts. Cryopreservation of allogeneic grafts results in adequate product quality with minimal impact on short-term clinical outcomes, except for an increased risk of infusion-related adverse events. Cryopreservation is a safe option in terms of graft quality and hematopoietic reconstitution with logistical benefits, but additional data are needed to determine long-term outcomes and assess whether this is a suitable strategy for at-risk patients.

MP46-17 LONG-TERM FOLLOW-UP IN ROBOT-ASSISTED FEMALE CYSTECTOMY: AN INTERNATIONAL MULTI-CENTER STUDY

You have accessJournal of UrologyCME1 Apr 2023MP46-17 LONG-TERM FOLLOW-UP IN ROBOT-ASSISTED FEMALE CYSTECTOMY: AN INTERNATIONAL MULTI-CENTER STUDY Linda Dey, Monish Aron, Jorge Ballon, Giovanni E. Cacciamani, Mihir M. Desai, Inderbir S. Gill, Abolfazl Hosseini, Arad Hosseini, Etienne Lavallee, Reza Mehrazin, Gus Miranda, Juhana Rautiola, Jordan Rich, John Sfakianos, Viktor Skokic, Gunnar Steineck, Yuan Shuo Wang, and Peter Wiklund Linda DeyLinda Dey More articles by this author , Monish AronMonish Aron More articles by this author , Jorge BallonJorge Ballon More articles by this author , Giovanni E. CacciamaniGiovanni E. Cacciamani More articles by this author , Mihir M. DesaiMihir M. Desai More articles by this author , Inderbir S. GillInderbir S. Gill More articles by this author , Abolfazl HosseiniAbolfazl Hosseini More articles by this author , Arad HosseiniArad Hosseini More articles by this author , Etienne LavalleeEtienne Lavallee More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , Gus MirandaGus Miranda More articles by this author , Juhana RautiolaJuhana Rautiola More articles by this author , Jordan RichJordan Rich More articles by this author , John SfakianosJohn Sfakianos More articles by this author , Viktor SkokicViktor Skokic More articles by this author , Gunnar SteineckGunnar Steineck More articles by this author , Yuan Shuo WangYuan Shuo Wang More articles by this author , and Peter WiklundPeter Wiklund More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Approximately one quarter of all bladder-cancer patients are females, and studies indicate that female patients may have an inferior oncological outcome. Radical cystectomy is the gold standard treatment for aggressive bladder cancer. However, the long-term outcome for females after robot-assisted radical cystectomy (RARC) is not well described in the scientific literature. Objectives: To describe the long-term oncological outcomes and complications after RARC in female patients. METHODS: In total, 270 females undergoing RARC due to urothelial cancer at 3 high-volume centers (Karolinska University Hospital, The Mount Sinai Hospital and USC) during 2004 to 2020 were followed. Data include age, cT-, pT-, N-, and M-stage, smoking, urinary diversion, and surgical strategy for pelvic organ preservation (POP). Outcome data for early and late complications according to Clavien-Dindo, readmission, re-operation, and cause of death were obtained. Median follow-up time was 952 days (inter-quartile range, 279 - 2089 days). RESULTS: Muscle invasive bladder cancer (MIBC; 71.5%) was more prevalent than non-muscle invasive bladder cancer (NMIBC; 24.9%). Fifteen percent received a neobladder and 17.7% underwent POP. Cancer-specific death (CSD) was 20.7% during the follow-up period (Figure 1). No patients with TIS grade cancer died from cancer during follow-up, while higher cT-stage was associated with earlier CSD. For cT-stages 1-4, CSD ceases over time. Complication-free surgery was reported for 52.6% (early) and 82.2% (late) of patients. The incidence of early complications by Clavien-Dindo were 35.1% for I-II and 12.3% for III or higher, respectively. Readmission within 30 days was 22.2% and re-operation within 30 days was 1.5%. CONCLUSIONS: The oncological outcome in our data appear to have no clear differences with published male cystectomy series. Also, the complication rates among women undergoing robot-assisted radical cystectomy seems comparable to other published series. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e639 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Linda Dey More articles by this author Monish Aron More articles by this author Jorge Ballon More articles by this author Giovanni E. Cacciamani More articles by this author Mihir M. Desai More articles by this author Inderbir S. Gill More articles by this author Abolfazl Hosseini More articles by this author Arad Hosseini More articles by this author Etienne Lavallee More articles by this author Reza Mehrazin More articles by this author Gus Miranda More articles by this author Juhana Rautiola More articles by this author Jordan Rich More articles by this author John Sfakianos More articles by this author Viktor Skokic More articles by this author Gunnar Steineck More articles by this author Yuan Shuo Wang More articles by this author Peter Wiklund More articles by this author Expand All Advertisement PDF downloadLoading ...

HF02-05 THE FIRST TEXTBOOKS ON PEDIATRIC UROLOGY

You have accessJournal of UrologyCME1 Apr 2023HF02-05 THE FIRST TEXTBOOKS ON PEDIATRIC UROLOGY Sutchin R. Patel, Ronald Rabinowitz, Richard Hurwitz, and Anthony A. Caldamone Sutchin R. PatelSutchin R. Patel More articles by this author , Ronald RabinowitzRonald Rabinowitz More articles by this author , Richard HurwitzRichard Hurwitz More articles by this author , and Anthony A. CaldamoneAnthony A. Caldamone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003242.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Early publications in pediatric urology set the stage for the development of the first certified subspecialty in urology. Our objective was to review the history behind these publications as well as their content. METHODS: We review and compare Disease of the Urinary Tract in Children (1930) by Edwin Beer and Abraham Hyman to Pediatric Urology (1937) by Meredith Campbell. We also reviewed the authors of the text and the corpus of knowledge in the field of pediatric urology at that time. RESULTS: Beer and Hyman’s text reviews the pediatric urology experience at Mount Sinai Hospital. In the preface they write "the whole subject dealt with in these pages is… still in the stage of development." Beer, a pioneer in endoscopic technology, describes his invention of the first pediatric cystoscope in the text. The authors describe the style of their text as "each chapter is more or less a separate essay in which the material is not arranged as in the ordinary textbook." The text is comprised of 14 chapters, with "illustrative cases" at the end of nine of the chapters to help the reader recognize how the pediatric patient should be approached differently from the adult patient. Campbell’s text is 2 volumes and is composed of 12 chapters. The end of each chapter has an extensive bibliography citing other studies in the literature that were used in the chapter. In the preface, Dr. Campbell writes, “Pediatric urology is still in its diaper age and as yet comparatively few physicians are experienced in it.” He writes “much of its rapidly increasing literature is in the nature of case reports rather than conclusions drawn from the studies of case series.” Dr. Campbell aims to correct this in his text as he presents data of relatively large case series from his practice. He also includes an extensive necroscopy experience, writing “pathology is the true basis of medicine and for this volume the uropathology as recorded in 26,480 autopsies.” His text chapters are supplemented with organized outlines to help classify disease processes, illustrations used to help teach the etiology of various conditions and anatomic drawings. The strength of Campbell’s text is its systematic approach to and organization of various pediatric disease processes. His last chapter on “Urosurgery” is a mini-surgical atlas. CONCLUSIONS: Beer and Hyman’s text was a collection of essays that illustrated the dearth of knowledge in the field of pediatric urology at the time. Campbell’s text was the first comprehensive pediatric urology textbook as it systematically organized the corpus of knowledge of the time and presented operative and clinical case series with the aim to teach pediatric urology. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e251 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sutchin R. Patel More articles by this author Ronald Rabinowitz More articles by this author Richard Hurwitz More articles by this author Anthony A. Caldamone More articles by this author Expand All Advertisement PDF downloadLoading ...

Autonomic Neuropathy as a Predictor of Morbidity and Mortality in People Living With HIV: A Retrospective, Longitudinal Cohort Study.

HIV-associated autonomic neuropathy (HIV-AN) is common; however, its clinical effect is unclear. Previously, it was shown that the composite autonomic severity score is associated with markers of morbidity such as the Veterans Affair Cohort Study index. In addition, it is known that cardiovascular autonomic neuropathy due to diabetes is associated with poor cardiovascular outcomes. This study aimed to evaluate whether HIV-AN is predictive of important adverse clinical outcomes. The electronic medical records of HIV-infected participants who underwent autonomic function tests at the Mount Sinai Hospital between April 2011 and August 2012 were reviewed. The cohort was stratified into those who had no or mild autonomic neuropathy (HIV-AN [-], CASS ≤3) and those with moderate or severe autonomic neuropathy (HIV-AN [+], CASS >3). The primary outcome was a composite of the incidence of death from any cause, new major cardiovascular or cerebrovascular event, or development of severe renal or hepatic disease. Time-to-event analysis was performed using Kaplan-Meier analysis and multivariate Cox proportional hazards regression models. One hundred eleven of 114 participants had follow-up data (median follow-up for HIV-AN (-) was 94.00 months, and HIV-AN (+) was 81.29 months) and were included in the analysis. Participants were followed until March 1, 2020. The HIV-AN (+) group (N = 42) was significantly associated with the presence of hypertension, higher HIV-1 viral load, and more abnormal liver function. Seventeen (40.48%) events occurred in the HIV-AN (+) group, and 11 (15.94%) occurred in the HIV-AN (-) group. Six (14.29%) cardiac events occurred in the HIV-AN (+) group, whereas 1 (1.45%) occurred in the HIV-AN (-) group. The other subgroups of the composite outcome had a similar trend. The adjusted Cox proportional hazards model showed that the presence of HIV-AN predicted our composite outcome (HR 3.85, CI 1.61-9.20). These findings suggest that HIV-AN is associated with the development of severe morbidity and mortality in people living with HIV. People living with HIV with autonomic neuropathy may benefit from closer cardiac, renal, and hepatic surveillance.

Research trends of omics in ulcerative colitis: A bibliometric analysis.

Omics has emerged as a promising biological science to shed light on the etiology, pathogenesis, and treatment of ulcerative colitis (UC). At present, although research on the omics of UC has drawn global attention, there is still a lack of bibliometric analysis in this field. This study aimed to access the trends and hotspots of omics in UC research. Publications related to omics in UC from 1 January 2000 to 15 October 2022 were retrieved from the Web of Science Core Collection database. VOSviewer, CiteSpace, and the online bibliometric analysis platform "Bibliometrix" were adopted to extract and visualize information. A total of 385 publications were finally included and the annual number of publications fluctuated. The trend in publications increased rapidly after 2019. The United States showed its dominant position in several publications, total citations, and international collaborations. The top five research organizations for publications on the research of omics in UC were Harvard Medical School, the Icahn School of Medicine at Mount Sinai, Karolinska Institutet, the Brigham and Women's Hospital, and the Massachusetts General Hospital. Ashwin Ananthakrishnan from the Massachusetts General Hospital was the most productive author, and Séverine Vermeire from the Catholic University of Leuven was co-cited most often. Inflammatory bowel disease was the most popular and co-cited journal in this field. The reference with citation bursts and trend topics showed that "ulcerative colitis," "inflammatory bowel disease," "microbiome," "transcriptomics," "genomics," "metabolomics," "proteomics," "dysbiosis," "biomarkers," "loci," and "therapy" are currently research hotspots. Our study presents several important insights into the research trends and developments in the field of omics in UC, which will provide key information for further research.

Acute Severe Ulcerative Colitis Is Associated With an Increased Risk of Acute Pouchitis.

Pouchitis occurs in up to 80% of patients after total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA) and has been associated with microbial and host-related immunological factors. We hypothesized that a more robust immune response at the time of colectomy, manifested by acute severe ulcerative colitis (ASUC), may be associated with subsequent acute pouchitis. This was a retrospective cohort analysis of all patients with UC or indeterminate colitis complicated by medically refractory disease or dysplasia who underwent TPC with IPAA at Mount Sinai Hospital between 2008 and 2017 and at least 1 subsequent pouchoscopy. Acute pouchitis was defined according to the Pouchitis Disease Activity Index. Cox regression was used to assess unadjusted relationships between hypothesized risk factors and acute pouchitis. A total of 416 patients met inclusion criteria. Of the 165 (39.7%) patients who underwent urgent colectomy, 77 (46.7%) were admitted with ASUC. Acute pouchitis occurred in 228 (54.8%) patients a median of 1.3 (interquartile range, 0.6-3.1) years after the final surgical stage. On multivariable analysis, ASUC (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.04-2.17) and a greater number of biologics precolectomy (HR, 1.57; 95% CI, 1.06-2.31) were associated with an increased probability of acute pouchitis, while older age at colectomy (HR, 0.98; 95% CI, 0.97-0.99) was associated with a decreased probability. Time to pouchitis was significantly less in patients admitted with ASUC compared with those not (P = .002). A severe UC disease phenotype at the time of colectomy was associated with an increased probability of acute pouchitis.

A91 INTERACTIONS BETWEEN PREGNANCY, DELIVERY, AND ILEAL POUCH-ANAL ANASTOMOSIS FOR INFLAMMATORY BOWEL DISEASE: A RETROSPECTIVE CHART REVIEW

Abstract Background Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) that affects people in their reproductive years of life. Surgical treatment for medically refractory UC involves surgery over 2-3 stages, which includes a subtotal colectomy followed by creation of an ileal pouch-anal anastomosis (IPAA), known as a “J pouch”. The IPAA allows preservation of fecal continence and avoids the psychosocial impacts of a stoma. The IPAA procedure is a deep pelvic surgery, which may impact pregnancy outcomes. Caesarean section (C-section) delivery is often performed to avoid anal sphincter and J pouch damage from vaginal delivery. However, literature demonstrates conflicting results regarding the risks of C-section compared to vaginal delivery, including the impact on pouch function. Surveys of clinicians also report varying delivery recommendations. Purpose To describe the delivery methods, pregnancy outcomes and postpartum course of IBD patients with IPAA at Mount Sinai Hospital. Method A retrospective chart review is being performed for female patients at Mount Sinai Hospital (Toronto, Ontario) with a diagnosis of IBD and an IPAA. Eligible patients completed a pregnancy from January 1, 2002-February 1, 2021 post-IPAA surgery and had variables of interest accessible in their electronic medical record. Variables of interest include demographics, pregnancy history, IBD characteristics, IPAA surgery details, pregnancy outcomes, mode of delivery and characteristics, and postpartum complications. Clinical data will be presented as means, medians and frequencies. Differences between variables of interest will be evaluated with Student’s t-test or chi-squared test. Result(s) Three avenues of patient identification yielded 1113 patients to be screened. Inclusion criteria were met for 71 patients and chart review is complete for 36 patients who had a total of 53 pregnancies and delivered 56 babies. Most patients (49%) had a two-stage IPAA surgery, 21% required a three-stage surgery and 30% were undocumented. Most patients’ (55%) IPAA was created through laparotomy, while 13% was through laparoscopic procedure and 32% was undocumented. Seventy-four percent of deliveries were through C-section (75% of primiparous), 69% of which were indicated to protect the patient’s J pouch and 31% for an obstetrical indication. The remaining 26% of deliveries were vaginal, 29% of which were assisted with forceps or vacuum, 57% had tears (37.5% first-, 37.5% second-, and 25% third-degree) and 50% had an episiotomy. Conclusion(s) At Mount Sinai Hospital, most IBD patients with an IPAA who completed a pregnancy had a history of laparotomy to create their IPAA. Most patients (74%) with IBD and an IPAA are delivering through C-section, and mainly to protect their J pouch, which is in line with reports in the literature. Most patients had a tear or episiotomy during vaginal delivery. Rates of third-degree tears may be higher than in the general population. Trends will be further elucidated with advancement of the study. Disclosure of Interest None Declared

A219 BIOLOGIC USE DURING PREGNANCY IN WOMEN WITH INFLAMMATORY BOWEL DISEASE AND ASSOCIATED NEONATAL OUTCOMES: A RETROSPECTIVE CHART REVIEW

Abstract Background Biologics are the mainstay of therapy for patients with advanced inflammatory bowel disease (IBD). Most biologics readily undergo placental transfer during the second trimester and remain detectable in infant serum for up to 12 months. Therefore, most clinical guidelines currently recommend avoiding live vaccines in the first 6 to 12 months for exposed infants. In Canada, the rotavirus vaccine is the only live vaccine administered before 6 months. Emerging evidence is suggesting that the vaccine may safely be given to infants with normal immune function, even if serum biologic level is detectable. Specialist assessment of infant immune function may help guide decision-making about rotavirus vaccine administration, but there remains a large gap in our knowledge of the impact of biologic exposure on the immune function of infants, necessitating further study. Purpose In this single-centre retrospective chart review, we aim to study the clinical outcomes, immune function, and rotavirus vaccine recommendations for infants exposed to biologics in utero during their first year of life. Method The study included mothers seen at the Pregnancy IBD Clinic at Mount Sinai Hospital in Toronto, ON, who were offered a referral to the Special Immunization Clinic (SIC) at The Hospital for Sick Children due to biologic exposure in utero. Data was collected on the recommendations made by paediatric specialists at SIC, based on complete blood count, lymphocyte phenotyping, and T-cell receptor excision analysis. Data was obtained on adverse neonatal outcomes in the first year of life, including prematurity, congenital malformations, and infections based on post-partum surveys completed by mothers and follow-up letters from SIC. Result(s) 43 patients were referred to and seen by paediatric specialists at SIC between 2 to 12 months of age. 18 infants (42%) were exposed to Adalimumab in utero, 16 (37%) to Infliximab, 5 (12%) to Vedolizumab, and 4 (9%) to Ustekinumab. The rotavirus vaccine was recommended to 34 infants (81%) and not recommended to 3 (7%) for reasons including gastrointestinal illness, neutropenia, and low lymphocyte counts. Recommendation is pending for 6 infants (14%). Two infants (5%) had premature births. Four infants (9%) were admitted to the NICU for reasons including respiratory distress, and prematurity (9%). One infant (2%) had a congenital malformation, specifically bilateral sensorineural hearing loss. Six infants (14%) had upper respiratory tract infections, none of which required hospital admission or antibiotics. Conclusion(s) This study is currently in progress. Further data is required to assess whether biologic exposure in utero has a significant impact on neonatal immune function, especially beyond the first year of life, and whether there is a significant difference in vaccine recommendations and response based on the type of biologic received. Disclosure of Interest None Declared

A181 HIGHER CUMULATIVE HISTOLOGIC INFLAMMATORY BURDEN SCORE IS ASSOCIATED WITH THE RISK OF DEVELOPMENT OF COLORECTAL NEOPLASIA IN ULCERATIVE COLITIS

Abstract Background Ulcerative colitis (UC) patients have an elevated risk of colorectal neoplasia (CRN). Younger age at diagnosis, extent of colitis, and longer duration of colitis, as well as increased severity, which is a component of the cumulative inflammatory burden score (CIB), have been associated with the development of CRN. CIB was developed based on a large cohort of UC patients from St. Mark’s Hospital (UK) but needs further validation in independent cohorts. Purpose We analyzed the association between higher histologic CIB and development of CRN in longstanding UC patients. Method A matched case-control cohort of UC patients with at least 8 years of disease duration was analyzed at Mount Sinai Hospital. Patients with primary sclerosing cholangitis were excluded. Cases consisted of UC patients with colitis-associated neoplasia defined as indefinite for dysplasia (IND), low-grade dysplasia (LGD), high-grade dysplasia (HGD), or colorectal cancer (CRC). Each case was matched to two controls by age at disease onset, disease duration, and histological extent of colitis. Histologic reports obtained by colonoscopy were reviewed and histological activity was assessed as quiescent/normal (0), mild (1), moderate (2), and severe (3). The colonic area with the higher score was utilized and the CIB was calculated by summing each score and multiplying it by the interval of surveillance. A mean CIB (mCIB) was also calculated for each patient dividing the CIB by the number of colonoscopies. Continuous variables including CIB scores and mCIB scores were summarized as median and interquartile range (IQR) and differences between groups were compared by Mann-Whitney test. Result(s) Fifty-four UC patients were analyzed with 18 having CRN (6 CRC, 2 HGD, 3 LGD and 7 IND) and 36 controls without CRN. The clinical characteristics of the total cohort, cases and controls are depicted in the Table. Median age at last colonoscopy assessed was 45 years (36-55) and 40.7% were female. The median age at onset of UC was 23 years (19-37) and median duration of UC was 16 years (11-23). All patients had extensive histologic colonic disease. There were no differences between cases and controls in interval of surveillance evaluated (7.5 vs 7.8 years, p = 0.7) and median number of colonoscopies with histologic assessment (4 vs 4, p =0.6). Cases with CRN had significantly higher CIB (11.4 vs 7.9, p = 0.02) and mCIB (2.9 vs 2.0, p = 0.02) compared to controls. Image Conclusion(s) The histologic CIB score is associated with an increased risk of developing CRN in UC patients with similar age at onset of disease, disease duration and colitis extent. Given CIB reflects the severity of histologic inflammation over the years, treatment strategies to improve histologic inflammation could reduce the incidence of CRN in UC. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

A209 ASSESSMENT OF OUTCOMES OF PATIENTS ADMITTED WITH ACUTE, SEVERE ULCERATIVE COLITIS ON ESTABLISHED BIOLOGIC THERAPY: A SINGLE CENTRE RETROSPECTIVE ANALYSIS

Abstract Background Acute, severe, ulcerative colitis (ASUC) is associated with a high morbidity and mortality. Current guidelines recommend the initiation of high dose intravenous steroids, followed by anti-TNF therapy if a satisfactory therapeutic response is not rapidly achieved. However, guidelines are agnostic on how to manage patients who are admitted for ASUC despite being on established biologic therapy. Furthermore, short-term clinical outcomes in this population are not well characterized. Purpose The aim of this study is to assess the differences in short-term clinical outcomes in patients admitted with ASUC who are on established biologic therapy compared to those not on established biologic therapy. Method We conducted a retrospective chart review of patients admitted with ASUC to Mount Sinai Hospital (MSH) in Toronto, Ontario from January 2018 until December 2021. Patients were included if they were deemed to have a severe flare, defined as having 6 or more loose bowel movements per day with at least one of the following features: temperature of 38.0 Celsius, tachycardia, anemia, or elevated inflammatory markers. Included subjects were considered to be on established biologic therapy if they had a biologic within 56 days prior to admission, all other admitted subjects were included as controls. Our primary outcome was the difference in hospital length of stay (HLOS). We also contrasted duration of intravenous steroids, rates of surgical consultation, rates of in-hospital colectomy, and readmission rates within 90 days of discharge. Result(s) 130 charts were included in our study, 53 of which were patients on established biologic therapy, and 77 of which were patients not on established biologic therapy. The HLOS between the two groups was not significantly different, (7.23 days [established biologic therapy] vs.7.47 days [not on biologic therapy], p value = 0.77). Patients on established biologic therapy were more likely to receive an inpatient surgical consultation (33.96% vs 7.79%, p-value &amp;lt;0.001). However, rates of colectomy prior to discharge were not statistically different (1.89% vs 0%, p-value = 0.23). Patients on established biologic therapy were significantly more likely to be readmitted within 90 days of discharge (30.19% vs 12.99%, p-value = 0.016). Image Conclusion(s) Although there were no differences in HLOS and colectomy rates between the 2 groups, patients with ASUC on established biologic therapy were more likely to be readmitted within 3 months of discharge. Further work is required to define optimal medical management of persons admitted with ASUC who are failing biologic therapies. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Editorial Comment.

No AccessJournal of UrologyAdult Urology6 Mar 2023Editorial CommentThis article comments on the following:Health-related Quality of Life After Robotic-assisted vs Open Radical Cystectomy: Analysis of a Randomized Trialis a letter which has replyReply by Authors Reza Mehrazin Reza MehrazinReza Mehrazin Department of Urology, Mount Sinai Hospital, New York, New York More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003201.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, Publish Ahead of Print, pp. – REFERENCES 1. . Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO guideline. J Urol.2017; 198(3):552-559. Link, Google Scholar 2. . Health-related quality of life after robotic-assisted vs open radical cystectomy: analysis of a randomized trial. J Urol.2023; 209(5):000-000. Google Scholar 3. . Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: a randomized clinical trial. Eur Urol.2015; 67(6):1042-1050. Crossref, Medline, Google Scholar 4. . Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. Lancet.2018; 391(10139):2525-2536. Crossref, Medline, Google Scholar 5. . Effect of robot-assisted radical cystectomy with intracorporeal urinary diversion vs open radical cystectomy on 90-day morbidity and mortality among patients with bladder cancer: a randomized clinical trial. JAMA.2022; 327(21):2092-2103. Crossref, Medline, Google Scholar Submitted October 7, 2022; accepted January23, 2023; published 000. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology1 Feb 2023Health-related Quality of Life After Robotic-assisted vs Open Radical Cystectomy: Analysis of a Randomized TrialJournal of Urology6 Mar 2023Reply by Authors Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Reza Mehrazin Department of Urology, Mount Sinai Hospital, New York, New York More articles by this author Expand All Submitted October 7, 2022; accepted January23, 2023; published 000. Advertisement PDF downloadLoading ...

HeartMate-3 Ventricular Assist Devices Versus the Total Artificial Heart for Biventricular Support: A Single-Center Series.

The SynCardia total artificial heart (TAH) is the only device approved for biventricular support. Continuous flow ventricular assist devices (VAD) in a biventricular configuration (BiVAD) have been used with variable results. The purpose of this report was to examine differences in patient characteristics and outcomes between two HeartMate-3 (HM-3) VADs in comparison with TAH support. All patients who received durable biventricular mechanical support from November 2018 to May 2022 at The Mount Sinai Hospital (New York) were considered. Baseline clinical, echocardiographic, hemodynamic, and outcome data were extracted. Primary outcomes were postoperative survival and successful bridge-to-transplant (BTT). A total of 16 patients received durable biventricular mechanical support during the study period, of which 6 (38%) patients received two HM-3 VAD pumps as BiVAD support and 10 (62%) patients received a TAH. Overall, TAH patients had a lower median lactate ( p < 0.05) at baseline compared to those on HM-3 BiVAD support yet had higher operative morbidity, lower 6-month survival ( p < 0.05), and a higher rate of renal failure (80 vs . 17%; p = 0.03). However, survival declined to the same rate at 1 year (50%) and was largely because of extracardiac adverse events related to underlying comorbidities (particularly, renal failure and diabetes, p < 0.05). Successful BTT was achieved in 3 out of 6 HM-3 BiVAD patients and in 5 out of 10 TAH patients. In our single center experience, similar outcomes were observed among patients BTT with HM-3 BiVAD compared to those BTT on TAH support despite lower Interagency Registry for Mechanically Assisted Circulatory Support level.

SVINnovation Challenge: Fostering Innovation in Vascular and Interventional Neurology

SVINnovation Challenge: Fostering Innovation in Vascular and Interventional Neurology

Survival outcomes and toxicity in older adults with metastatic castration-resistant prostate cancer (mCRPC) treated with androgen receptor targeted (ART) therapies.

117 Background: Prostate cancer (PCa) and especially advanced PCa largely affects older adults with a median age of diagnosis of 67. Despite ART’s role as a mainstay of treatment (tx) in advanced PCa, little is known about its risks/benefits in older adults. We aimed to examine survival outcomes and safety in patients (pts) with mCRPC ≥75 years-old (y.o) on ART. Methods: The records of mCRPC pts treated with ART at the Mount Sinai Hospital between 2010 and 2021 were screened for demographics, medical history, ART course, tx toxicity, and survival outcomes. PSA progression free survival (PFS) between pts ≥75 y.o and pts ≤75 y.o was assessed as the primary outcome. Secondary outcomes were overall survival (os) and tx toxicity. Tx toxicity was evaluated using physician documented tx side-effects (SE)s. Fischer’s exact was used to compare baseline characteristics and tx SEs. Cox proportional hazards models were used to compare survival outcomes. Results: Of 153 pts, 97 were &lt; 75 y.o and 56 were ≥75 y.o. Within the &lt;75 y.o group, 17 (17.5%) were post-chemo compared to 7 (12.5%) in the ≥75 group (p = .493) Relevant baseline characteristics (ECOG ≥2, Race, Gleason 4-5, hospitalizations, and CCI) were not significantly different. Median PSA PFS was 14.2 (≥75 y.o) and 17.3 months (&lt;75 y.o) with no significant difference on univariate or multivariate analysis (HR: 1.1 [0.69, 1.74;] p = 0.697. Median OS was 32.4 months for the ≥75 y.o cohort and 32.3 months for the &lt;75 y.o cohort (HR: 1.38 [0.88, 2.17;] p = 0.156). The 5 most common SEs by group are reported below. Of note, adults ≥75 y.o were more likely to report edema compared to the &lt;75 y.o pts (8.2% vs 21.4%, p-value = .026). Conclusions: Pts ≥75 on ART experienced similar survival benefits compared with pts &lt;75. While older adults were more likely to report edema, overall tx toxicity profiles did not differ significantly. Ultimately, these findings ground evidence-based counseling and tx for older adults with mCRPC considering ART. [Table: see text]

Dilemmas of modern neonatology: care of extremely preterm infants.

At 21 + 5 weeks’ gestation with a dichorionic diamniotic twin pregnancy, Shakina and Kevin presented at a community hospital with Shakina in threatened preterm labour. She was transferred to Mount Sinai Hospital, Toronto, for further evaluation and management of the pregnancy. One hour after

Multi-center retrospective cohort study applying deep learning to electrocardiograms to identify left heart valvular dysfunction

BackgroundAortic Stenosis and Mitral Regurgitation are common valvular conditions representing a hidden burden of disease within the population. The aim of this study was to develop and validate deep learning-based screening and diagnostic tools that can help guide clinical decision making.MethodsIn this multi-center retrospective cohort study, we acquired Transthoracic Echocardiogram reports from five Mount Sinai hospitals within New York City representing a demographically diverse cohort of patients. We developed a Natural Language Processing pipeline to extract ground-truth labels about valvular status and paired these to Electrocardiograms (ECGs). We developed and externally validated deep learning models capable of detecting valvular disease, in addition to considering scenarios of clinical deployment.ResultsWe use 617,338 ECGs paired to transthoracic echocardiograms from 123,096 patients to develop a deep learning model for detection of Mitral Regurgitation. Area Under Receiver Operating Characteristic curve (AUROC) is 0.88 (95% CI:0.88–0.89) in internal testing, and 0.81 (95% CI:0.80–0.82) in external validation. To develop a model for detection of Aortic Stenosis, we use 617,338 Echo-ECG pairs for 128,628 patients. AUROC is 0.89 (95% CI: 0.88-0.89) in internal testing, going to 0.86 (95% CI: 0.85-0.87) in external validation. The model’s performance increases leading up to the time of the diagnostic echo, and it performs well in validation against requirement of Transcatheter Aortic Valve Replacement procedures.ConclusionsDeep learning based tools can increase the amount of information extracted from ubiquitous investigations such as the ECG. Such tools are inexpensive, can help in earlier disease detection, and potentially improve prognosis.

Outcomes with panobinostat in heavily pretreated multiple myeloma patients

Panobinostat is an oral pan histone-deacetylase inhibitor used in the treatment of relapsed and refractory multiple myeloma. Previously published studies of panobinostat demonstrated synergy with bortezomib but included few patients exposed to newer agent combinations (ie, panobinostat plus daratumumab or carfilzomib). Here, we report outcomes of panobinostat-based combinations at an academic medical center among patients whose disease had been heavily pretreated with modern agents. We retrospectively analyzed 105 patients with myeloma treated with panobinostat at The Mount Sinai Hospital in New York City between October 2012 and October 2021. These patients had a median age of 65 (range 37–87) and had received a median of 6 prior lines of therapy while in 53% the disease was classified as triple class refractory and in 54% the disease had high-risk cytogenetics. Panobinostat was most commonly utilized at 20 mg (64.8%) as part of a triplet (61.0%) or quadruplet (30.5%). Aside from steroids, panobinostat was most commonly administered in combination with lenalidomide, pomalidomide, carfilzomib, and daratumumab in descending order of frequency. Among the 101 response-evaluable patients, the overall response rate was 24.8%, clinical benefit rate (≥minimal response) was 36.6%, and median progression-free survival was 3.4 months. Median overall survival was 19.1 months. The most common toxicities ≥grade 3 were hematologic, primarily neutropenia (34.3%), thrombocytopenia (27.6%), and anemia (19.1%). Panobinostat-based combinations produced modest response rates in patients with heavily pretreated multiple myeloma, over half of whom had triple-class refractory disease. Panobinostat warrants continued investigation as a tolerable oral option for recapturing responses in patients whose disease has progressed after receipt of standard-of-care therapies.

P894 Diagnostic yield of routine stool pathogen tests during the relapse of Inflammatory Bowel Disease

Abstract Background To make the diagnosis of Inflammatory bowel disease (IBD) flare, it is traditionally necessary to exclude infectious colitis, including bacteria and parasites. Furthermore, Infectious colitis prevalence varies between geographic areas of the world. It has been a routine clinical practice of sending broad stool testing and cultures to the laboratory before starting targeted therapy for IBD flare. The purpose of this study is to examine the yield of stool testing in adult patients with inflammatory bowel disease flare. Methods It is a retrospective study. We reviewed the medical records of the admitted patients with IBD flare at Mount Sinai Hospital, Toronto, Canada between October 2018, and August 2019. We used a computer-generated list of patients admitted with a diagnosis of IBD. We excluded patients with no confirmed diagnosis of IBD or admitted for reasons other than IBD flare. A number of variables were recorded, such as the patient's demographics, concurrent and previous IBD therapy, steroid use, presenting symptoms, vital signs, and the results of the initial laboratory investigation Results This study included 96 adult patients admitted with IBD flare. A total of ninety-four of our samples were tested for C. difficile at the time of admission. Only 9.4% were positive for C. difficile. Six of them had ulcerative colitis and three had Crohn’s disease. The percentage of patients evaluated with stool cultures was 86%, while the percentage of patients evaluated for ova and parasites was 51% at the time of patient admission. Only 34% of the population had colonic biopsies stained for Cytomegalovirus (CMV) of which 74% had ulcerative colitis. None of the stool cultures nor CMV tests were positive in our population. The risk of acquiring C difficile infection was not significantly correlated with the patient's disease phenotype, the biological therapy they were receiving, or their smoking history. In our sample, clinical tests and routine laboratory tests did not predict infectious colitis. The CRP level, as well as the neutrophil and eosinophil counts, were not associated with positive C. difficile infection. Conclusion In IBD flare, we did not routinely identify pathogens besides C difficile. Aside from areas where bacterial or parasitic infections are prevalent, routine stool testing with cultures and parasites has a low yield.