Northwestern Memorial Hospital Research Articles

Patency and disease-free status after oncovascular resection of truncal malignancies with major vascular invasion

BackgroundWith advances in current therapies, more patients are currently surgical candidates for oncologic resections that were previously deemed unresectable owing to vascular invasion. We analyzed our institution's outcomes of patients undergoing oncovascular resection of truncal malignancies with vascular invasion to identify factors associated with vascular reconstruction complications and oncologic recurrence. MethodsA retrospective chart review of all adult patients between January 1, 2002, and June 1, 2022, who underwent a surgical resection of a neoplasm at Northwestern Memorial Hospital and required vascular surgery intraoperative assistance was performed. Data on patient demographics, tumor anatomy and pathology, operative details, and clinical outcomes were extracted. Primary end points included 30-day and 1-year mortality, and 1-year primary patency of the vascular reconstruction. Secondary end points included vascular reintervention and tumor recurrence, both local and metastatic disease. ResultsA total of 104 patients (43.3% females) with a mean age of 58 years were included in the study. The median follow-up was 22.1 months (range, 0-207 months). The most common tumor pathology included advanced renal cell carcinoma (n = 58) and soft tissue and primary vascular sarcomas (n = 24). Vascular procedures included 98 venous interventions and 6 arterial interventions. The overall 30-day mortality was 1% and 1-year mortality was 14.4%. Primary vascular patency at 1 year among patients with ≥12 months of follow-up was 98.5%. No patients underwent a vascular reintervention. In total, 34 patients (38%) developed recurrent malignant disease (23.5% local and 76.5% metastatic) during the study period. The median time to tumor recurrence was 11.4 months (range, 1.2-100.0 months). ConclusionsOncovascular resections of truncal tumors involving major vascular structures can be performed safely with a low incidence of vascular complications; tumor recurrence remains the major contributor to morbidity. Further investigation of the factors associated with tumor recurrence in these patients may help to refine surgical techniques.

Length of stay is related to inpatient antipsychotic use in Alzheimer type dementia at a large US based tertiary care hospital.

AbstractBackgroundAntipsychotic(AP) medications carry a black box warning for increased risk of death in the elderly and should be used judiciously in a dementia population. Studies have shown that encounters with healthcare facilities increase the risk of AP exposure1. We wanted to know how admissions at our institution impacted antipsychotic use in patients with Alzheimer’s disease. Here we describe the results of a retrospective analysis of inpatient antipsychotic use in patients with Alzheimer’s disease at Northwestern Memorial Hospital(NMH), Chicago IL.MethodOur cohort was generated using NMH’s Enterprise Data Warehouse, including patients over 65 with a chart diagnosis of AD admitted to the hospital for over 48hrs between May 2005 and March 2018. We excluded patients with schizophrenia, schizotypal disorder, bipolar disorder, or psychotic illness due to primary psychiatric disease, enrollment in hospice, presence of tracheostomy or PEG‐tube and pervasive developmental disorder.Result1712 patients were admitted for a total of 4603 admissions amounting to 25,721 hospital days during the period of analysis. Demographic information is provided in Table 1. A higher proportion of admissions were four days or longer in encounters with an antipsychotic(Figure 1). Though longer LOS becomes progressively less common, this trend continued through a LOS of 20 days. When comparing LOS for encounters with an AP in the home medication list to encounters without, there was no impact on LOS. However, when comparing encounters with an AP prescribed while inpatient to encounters without, inpatient AP administration was associated with a longer length of stay (Table 2).ConclusionThese findings indicate that a longer LOS is associated with antipsychotic use. Because a longer length of stay was associated with new antipsychotic use but not the continuation of a home antipsychotic, our findings suggest that length of stay may contribute to behavioral and psychological symptoms of dementia requiring pharmacological treatment.1. Koponen M, Lavikainen P, Taipale H, et al. Accumulation of Hospital Days Among Antipsychotic Initiators With Alzheimer’s Disease. J Am Med Dir Assoc. 2019;20(12):1488‐1494.e3. https://doi.org/10.1016/j.jamda.2019.07.009

2706. Effectiveness and Safety of Shingrix Vaccination in Solid Organ Transplant Recipients at a Large Urban Transplant Center

Abstract Background The varicella zoster virus (VZV) recombinant subunit vaccine, Shingrix, was found to be safe in solid organ transplant recipients (SOTR) and is now approved and recommended for all immunocompromised patients. Given limited efficacy data, we preferred a single center retrospective study to demonstrate safety and effectiveness of the Shingrix vaccine in solid organ transplant recipients. Methods After IRB approval, clinical data from all SOTR at Northwestern Memorial Hospital (NMH) who received the Shingrix vaccine after their transplant, between January 1, 2017 and March 1, 2022 was collected from our Enterprise Data Warehouse (EDW). Extracted data includes age, race, ethnicity, date of transplant, organ transplanted, and date(s) of vaccine administration(s). Clinical outcomes were assessed by diagnosis of acute allograft rejection and/or HZ made post-vaccine administration. Descriptive statistics were utilized. This project is supported by the IDSA G.E.R.M. program. Results 309 of 338 eligible SOTR were included in the analysis of this study (characteristics and reasons for exclusion in Table 1). Only 1 (0.32%) patient experienced a new episode of acute allograft rejection within 3 months of Shingrix administration. 18/309 (5.8%) were diagnosed with HZ after vaccination with Shingrix. This represents a reduction in VZV reactivation events compared to the 9.1% incidence found in the 2021 meta-analysis of HZ in the general solid organ transplant population [Kwon, Transpl Infect Dis., 2021].Table 1.Characteristics of 338 solid organ transplant patients who received Shingrix vaccine. Conclusion The Shingrix vaccine, when administered to SOTR post-transplant, is safe and likely effective in reducing the rate of herpes zoster. This data supports the current recommendation to vaccinate all SOTR with Shingrix. Larger, multi-center data are needed to inform the true efficacy of the vaccine in SOTRs. Disclosures All Authors: No reported disclosures

Kidney Transplant Outcomes in Patients With Scleroderma an Experience at Northwestern Memorial Hospital, Chicago, Illinois

Scleroderma renal crisis (SRC) is a devastating complication of diffuse cutaneous systemic sclerosis (dcSSc) that occurs in 5% to 20% of patients in this population. End-stage kidney disease develops in 25% to 40% of SRC, and mortality occurs in 50% at 5 years. Kidney transplantation (KT) is a viable option, but little data exist on outcomes. We performed a retrospective study of all patients with dcSSc who underwent KT at Northwestern Hospital between 2000 and 2020. The objective of this study was to determine graft and patient survival at years 5 and 10 post-transplant. Both patient and graft survival were 78% and 100% at 5 and 10 years, respectively. Kidney transplantation is associated with favorable outcomes in patients and graft survival at 5 and 10 years in patients with dcSSc.

Improving the hematology/oncology paging system at Northwestern University.

45 Background: To page specific services within the Division of Hematology and Oncology (Heme/Onc) at Northwestern Memorial Hospital previously required hospital staff to enter the specific service name into the web-based paging system. Turnover of faculty and staff, hospital growth, and use of locums staffing contributed to an increasing number of erroneous pages (pages intended for a different service). In this quality improvement initiative, we restructured the paging system so that all services within the Division of Heme/Onc populated when “hem” was entered into the web-based system. We aimed to decrease the number of erroneous pages received by heme/onc fellows by 20% with a subsequent improvement in perceived workload burden and job satisfaction. Methods: Pre- and post-intervention surveys were administered to all heme/onc fellows to assess impact on workload burden and job satisfaction. Fellows were asked to log all erroneous pages for a five-month period pre- and post-intervention. Results: Pre-intervention, fellows logged a total of 48 erroneous pages with 10 pages (21%) occurring between the hours of 10 PM and 6 AM. Post-intervention, a total of 37 erroneous pages were logged with only 3 pages (8%) occurring overnight. Of the 12 (92.3%) fellows that responded to the pre-intervention survey, one (8.3%) reported that the number of incorrect pages significantly increased workload burden, 9 (75%) increased workload burden, and 2 (16.7%) neither increased nor decreased workload burden. Five responders (41.7%) reported the number of incorrect pages significantly decreased job satisfaction, 5 (41.7%) decreased job satisfaction, and 2 (16.7%) neither increased nor decreased job satisfaction. 100% of fellows responded to the post-intervention survey. One (7.7%) reported that the number of incorrect pages significantly increased workload burden, 8 (61.5%) increased workload burden, and 4 (30.8%) neither increased nor decreased workload burden. Two responders (16.4%) reported the number of incorrect pages significantly decreased job satisfaction, 6 (46.2%) decreased job satisfaction, and 5 (38.4%) neither increased nor decreased job satisfaction. Conclusions: By changing the departmental nomenclature to a structured format, we decreased the number of erroneous pages received over a 5-month period by 23% with a 70% reduction in overnight pages resulting in an improvement in perceived workload burden and job satisfaction among Hematology/Oncology fellows.

SAT114 Global Social Determinants Of Health Needs And Response For Those New To Insulin At Discharge

Abstract Disclosure: C.A. Bullock: None. K. Davis: None. K. Carthy: None. P. Wax: None. C. Smyrniotis: None. T. Pollack: None. C. Barnard: None. J. Holl: None. A. Wallia: Grant Recipient; Self; Novo Nordisk. Research Investigator; Self; UnitedHealth Group. Unmet social determinant of health (SDoH) needs of patients with diabetes who are discharged with newly prescribed insulin place these patients at high risk of poor outcomes. Yet, few system level initiatives exist to identify patients with these needs and address them. An SDoH screening and referral initiative, consisting of an integrated screening tool administered by nursing upon hospital admission, was launched at a Chicago academic health system that cares for a diverse patient population. The electronic health record (EHR) screener assesses six specific domains including medication affordability, transportation barriers, food insecurity, housing stability, usual source of care, and mental health needs and a follow-up question if the patient would like assistance (leading to social work consultation). Our goal was to review the identified SDOH needs of patients newly prescribed insulin at discharge, and for whom a certified diabetes care and education specialist consultation (CDCES) was placed. From 05/01/22- 09/30/22, 279 patients had a CDCES consultation at Northwestern Memorial Hospital (NMH) of which 3 expired during admission. Of the 131 patients (47%) discharged with a new prescription for insulin, 18 (14%) were non-English, of which 17 (95%) had a complete SDOH screener, and 113 were English-speaking (86%), of which 74% (N=84) had a complete SDoH screener. The 113 English speaking patients had an age range from 20-84 (mean 56, SD + 14), 37 (33%) identified as black, 58 (51%) were female, and a majority (N= 55 [49%]) had Medicaid, Medicare coverage or were uninsured. Of those who had a screener completed (N=84), 28 (33%) reported at least 1 need, while 8% (N=7) identified >=3 needs, and 11% (N=9) requested assistance. The most reported need was a usual source of care (N=14, 17%). Other identified SDoH needs included medication affordability (N=8), transportation need (N=8), food insecurity (N=7), and housing stability issue (N=6), but few (N=2) identified any mental health needs. Sixty-five patients in total had a Social Work consultation and of those patients who identified needs 58% had their SDoH needs addressed by a Social Worker. Of the 14 patients without a usual source of care, 5 (43%) were readmitted or seen in the emergency department within 90 days of discharge and 1 had > 8 visit, despite enrollment in a hospital transitional care program. Only one patient established a usual source of care. Overall, 2 patients (2%), both with no identified needs, died within 90 days. Our findings reveal that many hospitalized patients who had a CDCES consultation before discharge and were newly prescribed insulin, identified global (> 3 SDoH or requiring assistance) needs. The findings also suggest that CDCES, nurses, pharmacists, and/or social workers may need to facilitate and/or create new pathways to address the needs of hospitalized patients newly prescribed insulin. Presentation: Saturday, June 17, 2023

Variations in Determining Actual Orientations of Segmented Deep Brain Stimulation Leads Using the DiODe Algorithm: A Retrospective Study Across Different Lead Designs and Medical Institutions

Introduction: Directional deep brain stimulation (DBS) leads have become widely used in the past decade. Understanding the asymmetric stimulation provided by directional leads requires precise knowledge of the exact orientation of the lead in respect to its anatomical target. Recently, the DiODe algorithm was developed to automatically determine the orientation angle of leads from the artifact on postoperative computed tomography (CT) images. However, manual DiODe results are user-dependent. This study analyzed the extent of lead rotation as well as the user agreement of DiODe calculations across the two most common DBS systems, namely, Boston Scientific’s Vercise and Abbott’s Infinity, and two independent medical institutions. Methods: Data from 104 patients who underwent an anterior-facing unilateral/bilateral directional DBS implantation at either Northwestern Memorial Hospital (NMH) or Albany Medical Center (AMC) were retrospectively analyzed. Actual orientations of the implanted leads were independently calculated by three individual users using the DiODe algorithm in Lead-DBS and patients’ postoperative CT images. The deviation from the intended orientation and user agreement were assessed. Results: All leads significantly deviated from the intended 0° orientation (p < 0.001), regardless of DBS lead design (p < 0.05) or institution (p < 0.05). However, the Boston Scientific leads showed an implantation bias toward the left at both institutions (p = 0.014 at NMH, p = 0.029 at AMC). A difference of 10° between at least two users occurred in 28% (NMH) and 39% (AMC) of all Boston Scientific and 76% (NMH) and 53% (AMC) of all Abbott leads. Conclusion: Our results show that there is a significant lead rotation from the intended surgical orientation across both DBS systems and both medical institutions; however, a bias toward a single direction was only seen in the Boston Scientific leads. Additionally, these results raise questions into the user error that occurs when manually refining the orientation angles calculated with DiODe.

Association Among Race, Ethnicity, Insurance Type, and Postpartum Permanent Contraception Fulfillment.

To evaluate the association among race, ethnicity, insurance type, and fulfillment of permanent contraception requests. This is a secondary analysis of a retrospective cohort of patients who delivered at 20 or more gestational weeks in a 2-year time period at four hospitals across the United States: University of California San Francisco, Northwestern Memorial Hospital, MetroHealth Medical Center in Cleveland, and University of Alabama at Birmingham. All patients included had permanent contraception documented as their postpartum contraceptive plan. We used modified Poisson models to estimate the associations among race and ethnicity, insurance type, and fulfillment of permanent contraception before hospital discharge, within 6 weeks of delivery, and within 1 year of delivery, adjusting for age, parity, gestational age, delivery type, marital status, body mass index, insurance type, adequacy of prenatal care, and hospital site. Of 2,945 people in our cohort, 1,243 (42.2%) were non-Hispanic Black, and 820 (27.8%) were Hispanic, and 882 (30.0%) were non-Hispanic White. Overall, 1,731 of 2,945 patients (58.2%) who desired postpartum permanent contraception received it before hospital discharge, 1,746 of 2,945 (59.3%) received it within 6 weeks of delivery, and 1,927 of 2,945 (65.4%) received it within 1 year of delivery. Across all racial and ethnic groups, patients with Medicaid insurance were less likely to have their desired postpartum permanent contraception procedure fulfilled compared with patients with private insurance. In unadjusted models, non-Hispanic Black patients were less likely to have their desired postpartum permanent contraception procedure fulfilled. In an examination of interaction with insurance type, non-Hispanic Black patients with private insurance were less likely to have permanent contraception fulfilled compared with non-Hispanic White patients with private insurance before adjustment. After adjustment, there were no significant associations between race and postpartum permanent contraception fulfillment among those with Medicaid or private insurance. In unadjusted models, we find marked racial disparities in fulfillment of permanent contraception. Controlling for individual- and facility-level factors eliminated associations among race, ethnicity, insurance type, and fulfillment, likely because covariates are mediators on the pathway between racism and fulfillment.

0301 Associations between sleep and cognitive function in patients with Neurological post-acute sequelae of SARS-CoV-2 infection

Abstract Introduction Fatigue and sleep disturbance are among the most common neurological post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC). We tested the hypothesis that impaired sleep and disrupted rest-activity rhythms are associated with impaired cognitive performance and greater burden of self-reported Neuro-PASC symptoms. Methods Forty adults (mean age 45 years, 69% female, 15% hospitalized post COVID) recruited from the Neuro-COVID-19 Clinic at Northwestern Memorial Hospital. Patients were evaluated via clinical assessment/history, chart review, patient reported outcomes for symptom severity (PROMIS cognitive function, fatigue, sleep disturbance, anxiety, depression), cognitive performance tests (NIH Toolbox modules for processing speed, attention, executive function, working memory), and 7 days of wrist actigraphy with a sleep log. We tested associations between objective and subjective measures using Pearson’s correlation and difference from population normative data using Student’s t test. Results 39 participants provided sufficient data for analysis. The median number of discrete neurologic symptoms attributed to PASC was 6 with 87% reporting ≥4 neurologic symptoms. Fatigue, insomnia, and depression were common (~70% reporting each). Participants reported significant symptom burden in all PROMIS domains, and had measurably worse attention function along with borderline executive function, compared to population normative data (all p&amp;lt; 0.001 except executive cognition p=0.056). Actigraphy showed Neuro-PASC patients had lower sleep efficiency and greater sleep latency (both p&amp;lt; 0.001) but similar wakefulness after sleep onset (WASO) compared to age-matched population controls. Self-reported cognitive symptoms were correlated with severity of fatigue (p&amp;lt; 0.001), anxiety (p=0.05), and depression (p&amp;lt; 0.01), but not subjective sleep disturbance. There were no associations between actigraphy-measured sleep or rest-activity characteristics and self-reported symptoms. Patients with abnormal sleep characteristics (WASO, sleep efficiency, sleep latency) demonstrated impaired objective attention and executive function. Conclusion Neuro-PASC patients presenting to a post-COVID clinic have a significant burden of subjective mental health, sleep, fatigue and cognitive impairment symptoms, along with objectively abnormal cognitive performance and sleep, compared to population controls. Interventions to improve sleep could benefit cognitive performance. Prospective studies including larger populations of patients are needed to fully determine the interplay of sleep/circadian rhythm disruption on the cognitive function and quality of life in patients with PASC. Support (if any) Center for Circadian and Sleep Medicine

Change in major ocular biometry parameters axial length and keratometry in adults over time.

The goal of this study was to determine how much axial length (AL) and average keratometry (KER) change over time in elderly patients and to assess clinical necessity of repeating biometry in instances where the second eye is operated on 6 months or more after the first. Northwestern Memorial Hospital, Chicago, IL, U.S. Retrospective study of biometry data measured with the IOL Master 700 (Zeiss, Germany) from January 1, 2016 to September 15, 2020. Inclusion criteria were patients over 35 years, with two biometry measurements over 6 months apart. Patients were excluded if they had any other intraocular surgery besides cataract. A linear mixed model and SPSS software was used to compare measurements among time points. A total of 201 patients (402 eyes) were included (average age 73.3, 59.3% female). Average time between biometry measurements was 21.5 months (range 6-48 months). The mean change in AL was 0.04 mm (95% CI: 0.03 to 0.05, p=0.10). The mean change in KER was 0.01 D (95% CI: -0.10 to 0.30, p=0.33). At the 6 months to 1-year interval (n=73), mean change in AL was 0.04 mm. Mean change in AL did not significantly increase with greater time intervals. There was no correlation between time and ΔAL (p=0.70), nor between time and ΔKER (p=0.98). In our cohort, biometric parameters did not change significantly over time. Repeating biometry at a 1 to 2-year interval for elderly patients receiving monofocal implants may offer limited benefit.

Clinically Designed Improvisatory Music Interventions for Well-Being and Burnout Prevention for Neurology, Psychiatry, and Other Health Professionals: Preliminary Findings (S11.003)

<h3>Objective:</h3> To evaluate feasibility and effectiveness of Clinically Designed Improvisatory Music (CDIM) to reduce work-related stress for Neurology, Psychiatry, and other health professionals. <h3>Background:</h3> Chronic stress characterizes healthcare providers’ lives. Music interventions show reductions in stress in the work setting. Our previous research showed that CDIM reduced cardiovascular burden and feelings of stress and anxiety in neurology patients. In this study, we investigated whether CDIM could also be used for Neurology and Psychiatry health care providers to decrease levels of stress. <h3>Design/Methods:</h3> CDIM is a form of clinical music designed along neuropsychiatric principles of felt safety. I was played by a certified music practitioner for 30 minutes. We used CDIM in three settings: 1. Neurology Department, 2. Psychiatric social workers, 3. Physician Recuperation Room located at Northwestern Memorial Hospital. All participants rated their experience on a scale of 1–10 reporting changes in emotions and states pertinent to burnout (likelihood to recommend [LTR], positive emotion, degree of tension, ability to experience pleasure, and energy levels). <h3>Results:</h3> Four hundred twenty nine (429) healthcare providers took part in CDIM interventions. Participants recommended CDIM at a rate of 93% (+ 9%). They reported positive effects on emotion at 80% (+ 19%), decreased tension at 82% (+ 15%). Eighty percent (80%) found the intervention pleasurable and reported increased levels of energy following CDIM. Changes in energy levels went up from 60% (+ 16%) to to 80% (+ 16%). This latter change was significant at p= 0.0001. <h3>Conclusions:</h3> The CDIM interventions resulted in improvements in tension, energy, and of pleasure, which suggest an increase in capacity. These preliminary results indicate feasibility and effectiveness of CDIM as a viable intervention for supporting wellness and fighting burnout. We plan to provide and disseminate CDIM more widely to include more healthcare providers and staff, and to include physiologic measures by using wearable devices. <b>Disclosure:</b> Ms. Takarabe has nothing to disclose. Rajan Shah has nothing to disclose. Mrs. Walesa has nothing to disclose. Miss Ngo has nothing to disclose. Dr. Wall has nothing to disclose. Mr. Pause has nothing to disclose. Gaurava Agarwal has nothing to disclose. Dr. Bonakdarpour has nothing to disclose.

MP47-12 SINGLE LAYER CORTICAL RENORRHAPHY AS A SAFE ALTERNATIVE TO DUAL LAYER RENORRHAPHY DURING ROBOTIC PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP47-12 SINGLE LAYER CORTICAL RENORRHAPHY AS A SAFE ALTERNATIVE TO DUAL LAYER RENORRHAPHY DURING ROBOTIC PARTIAL NEPHRECTOMY Tarek El-Ghazaly, Jonathan Rosenfeld, Shilajit Kundu, Robert Nadler, and Kent Perry Tarek El-GhazalyTarek El-Ghazaly More articles by this author , Jonathan RosenfeldJonathan Rosenfeld More articles by this author , Shilajit KunduShilajit Kundu More articles by this author , Robert NadlerRobert Nadler More articles by this author , and Kent PerryKent Perry More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic partial nephrectomy (RPN) is being increasingly adopted in the management of renal masses amenable to nephron-sparing surgery. Robotic renorraphy techniques, including dual layer repairs, have carried over from laparoscopic partial nephrectomy (LPN) which was initially associated with higher bleeding and urine leak rates compared to open partial nephrectomy (OPN). Dual layer repair has been shown in previous studies to prolong warm ischemia time, while potentially leading to a higher rate of pseudoaneurysm formation and worse long term renal function parameters. Our aim is to compare single cortical robotic renorrhaphy (SCRR) to dual-layer robotic renorrhaphy (DLRR) in terms of bleeding rates secondary to pseudoaneurysm formation, urine leak rates, and long-term renal functional outcomes. METHODS: A prospectively maintained list of all RPN procedures at Northwestern Memorial Hospital from January 2018 to July 2022 was retrospectively reviewed. 247 RPNs were identified, including 71 cases with SCRR carried out, and 176 cases with DLRR. Preoperative imaging was used to calculate nephrometry scores using R.E.N.A.L. (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, location relative to polar lines, hilar) measurements. Charts of patients with a length of stay longer than 72 hours, or with any readmissions under the urology service were closely examined for bleeding or leakage complications. Other examined parameters included drain fluid-to-serum creatinine ratios, as well as short term and long term changes in glomerular filtration rates (GFR). RESULTS: Comparing SCRR to DLRR, similar nephrometry scores were seen across both groups undergoing RPN (6.6 vs 7, p=0.29), including equivalent tumor sizes (34 mm vs 30 mm, p=0.11) and nearness to the collecting system (p=0.25). No significant differences in rates of bleeding secondary to pseudoaneurysms (0.03% vs 0.02%, p=0.8), urine leak rates (0% vs 0%), or changes in GFR (p=0.25) were seen between both groups of this study. CONCLUSIONS: No significant changes in urine leakage or bleeding rates secondary to pseudoaneurysm formation or changes in renal functions were found when comparing SLRR to DLRR during RPN for masses of equivalent sizes, depth and nephrometry scores. Single layer cortical repair seems to offer a safe method of shortening renorrhaphy and warm ischemia times compared to dual layer repairs. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e648 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tarek El-Ghazaly More articles by this author Jonathan Rosenfeld More articles by this author Shilajit Kundu More articles by this author Robert Nadler More articles by this author Kent Perry More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract P3-08-03: Establishment of patient-derived xenograft tumor models from breast cancer patients for quantitative elemental profiles and testing candidate therapies

Abstract Breast cancer (BC) is a heterogeneous disease comprising different clinical, histopathological, and molecular subtypes. Triple negative breast cancer (TNBC) is among the most aggressive clinical manifestations of breast cancer (BC), and represents a significant clinical challenge to the effective treatment of early metastatic and treatment-refractory disease because of its poor outcomes. Therefore, there exists a need to develop pre-clinical models that retain the characteristics of the original TNBC tumor—e.g., PDX tumor models—to better understand the mechanisms of drug resistance in metastatic TNBC and to effectively evaluate the effects of anti-cancer drugs on patients with this disease. Furthermore, quantitative changes in cellular element signatures, which indicate levels of enzymatic activity, are emerging new biomarkers for cancer in the clinic, but are of yet systematically understudied in tumor samples from breast cancer patients or/and PDX models of these tumors. Due to limitations in current cellular element signature quantitation profiles, there also exists a need to investigate further. Seven samples of advanced BC patient pleural effusion were obtained from Northwestern Memorial Hospital to establish a PDX tumor model in immunodeficient NSG female mice using breast fat pad xenografting and to develop derived 3D spheroid cultures for anti-cancer drug evaluation. To authenticate, STR profiling against with original patient tumor DNA was conducted. Five developed BC PDX tumor models were shown by pathology to have highly heterogeneous characteristics and the metastatic features of the origin patient tumor. Liver and lung metastases were observed in breast fat pad xenografted PDX tumor mice. 3D tumor spheroid cultures were successfully established from original BC pleural effusion or/and PDX tumor cultures. Using the newly developed, highly sensitive, and reliable Wash-Free Inductively Coupled Plasma Mass Spectrometry (WF ICP-MS) method, we evaluated the inorganic phenotypes from samples of breast cancer patient tumor tissue and of the established PDX tumor to quantify the mobile elements (Na, K, and Ca) and less mobile elements (P, Mg, Mn, Fe, Cu, and Zn) simultaneously within the same sample. The data was collected for further analysis of breast cancer inorganic signatures from normal and tumor cells. Our results suggested that BC 3D spheroid cultures and PDX tumor models could serve as models to further study the mechanisms of MBC and serve as promising tools for in vivo and in vitro quick testing and mechanistic studies of novel antitumor drugs respectively. Identifying quantitative elemental profiles is fundamental to understanding the pathologies of various metal-related cancers and thus opens up new opportunities for disease management and therapeutic intervention Citation Format: Wenan Qiang, Haimei Chen, Yi Yang, Andrew Crawford, Demirkan B. Gursel, Jian-Jun Wei, Thomas O’Halloran, Massimo Cristofanilli. Establishment of patient-derived xenograft tumor models from breast cancer patients for quantitative elemental profiles and testing candidate therapies [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-08-03.

Do Fertility Preservation Outcomes in Patients Diagnosed with Lymphoma Differ Based on Cancer Stage?

Purpose: This study aims to investigate whether oocyte stimulation outcomes in fertility preservation (FP) vary in patients with different stages of lymphoma. Methods: This is a retrospective cohort study conducted at Northwestern Memorial Hospital (NMH). Between 2006 and 2017, 89 patients were identified with a diagnosis of lymphoma who contacted the FP navigator at NMH. Anti-müllerian hormone (AMH) levels and FP ovarian stimulation outcomes were collected for analysis. The data were analyzed using chi-squared and analysis of variance tests. A regression analysis was also done to adjust for potential confounding variables. Results: Of the 89 patients who contacted the FP navigator, there were 12 patients (13.5%) with stage 1 lymphoma, 43 patients (48.3%) with stage 2, 13 patients (14.6%) with stage 3, 13 patients (14.6%) with stage 4, and 8 patients (9.0%) where staging information was not available. Forty-five of the patients proceeded with ovarian stimulation before initiating cancer treatment. Patients who underwent ovarian stimulation had a mean AMH level of 2.62 and median peak estradiol levels of 1772.0 pg/mL. Median oocytes retrieved was 16.77, mature oocytes were 11.00 and median oocytes frozen after completing FP was 8.00. These measures were also stratified by stage of lymphoma. Conclusion: We found no significant difference in number of retrieved, mature or vitrified oocytes between different cancer stages. There was also no difference in AMH levels in the different cancer stage groups. This suggests that even in higher stages of lymphoma, many patients respond to ovarian stimulation techniques and have a successful stimulation cycle.

782. Infectious Complications of Lung Transplant for COVID-Associated Lung Injury (CALI)

Abstract Background More than 200 orthotopic lung transplants (OLT) have been performed in the United States for patients (pts) with severe CALI. While some outcomes have been reported to generally be good, we conducted this study to describe the infectious outcomes. Methods After IRB approval, a retrospective case review was conducted of pts at Northwestern Memorial Hospital who had undergone OLT for CALI between June 1, 2020 and January 31, 2022. Data was collected from our Enterprise Data Warehouse and primary chart review to describe pts demographics and epidemiology of infectious complications. Results 35 OLTs were included (33 bilateral, 2 single lung; see Table 1). In the two weeks prior to transplant, 65.7% of pts were treated for bacterial, fungal, or mycobacterial infections (Table 2). Post-transplant, 32 (91.4%) of OLTs developed infections (Table 2), with most (28, 80%) developing pneumonia within 30 days of transplant. Five (14.3%) pts had airway complications, 7 (20%) pts required hemodialysis, and 3 (8.6%) pts died within one year of follow-up. Conclusion Infections remain a significant cause of morbidity post-OLT for CALI. Enhanced immunosuppression, long ICU stays post-tx, high rates of primary graft dysfunction and deconditioning likely contributed to this high rate of infection. A matched control group is being collected to compare these outcomes to other OLT pts. Disclosures Michael G. Ison, MD MS, GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support.

Implementation of pharmacogenomics into inpatient general medicine.

Pharmacogenomics is a crucial piece of personalized medicine. Preemptive pharmacogenomic testing is only used sparsely in the inpatient setting and there are few models to date for fostering the adoption of pharmacogenomic treatment in the inpatient setting. We created a multi-institutional project in Chicago to enable the translation of pharmacogenomics into inpatient practice. We are reporting our implementation process and barriers we encountered with solutions. This study, 'Implementation of Point-of-Care Pharmacogenomic Decision Support Accounting for Minority Disparities', sought to implement pharmacogenomics into inpatient practice at three sites: The University of Chicago, Northwestern Memorial Hospital, and the University of Illinois at Chicago. This study involved enrolling African American adult patients for preemptive genotyping across a panel of actionable germline variants predicting drug response or toxicity risk. We report our approach to implementation and the barriers we encountered engaging hospitalists and general medical providers in the inpatient pharmacogenomic intervention. Our strategies included: a streamlined delivery system for pharmacogenomic information, attendance at hospital medicine section meetings, use of physician and pharmacist champions, focus on hospitalists' care and optimizing system function to fit their workflow, hand-offs, and dealing with hospitalists turnover. Our work provides insights into strategies for the initial engagement of inpatient general medicine providers that we hope will benefit other institutions seeking to implement pharmacogenomics in the inpatient setting.

Delayed Neutrophil Engraftment in Autologous Transplant Patients with Very High CD34+ Cell Collections in a Single Apheresis

Background: The number of CD34+ cells infused during autologous hematopoietic stem cell transplantation (auto-HSCT) is the most important determinant of the speed of engraftment and neutrophil recovery. Increasing the infused CD34+ cell doses results in faster neutrophil recovery, but infusion of more than 5-10 x 106/kg CD34+ cells typically does not hasten engraftment any further. In contrast, we have noticed cases of delayed engraftment when the number of CD34+ cells collected has been extraordinarily high. We report a single center experience of engraftment in auto-HSCT patients with very high CD34+ cell numbers collected in a single apheresis session (typically 20 L blood volume). Methods: Utilizing the database of the Stem Cell Transplantation and Cell Therapy Program and the Mathews Center for Cellular Therapy, we studied apheresis and engraftment data on patients undergoing auto-HSCT for hematologic malignancies at Northwestern Memorial Hospital from January 2000 through June 2022. Inclusion criteria were age ≥18 years, ≥20 x 106/kg CD34+ cells collected in a single aphaeresis session, and available neutrophil engraftment data. Time to neutrophil engraftment was defined as days from stem cell infusion to the first of three consecutive days of absolute neutrophil count ≥0.5 x 109/L. Delayed engraftment was defined as ≥20 days to neutrophil recovery. Fisher's exact test of independence was utilized to determine the statistical significance of the difference between variables. Results: We identified 214 patients with a yield of ≥20 x 106/kg CD34+ cells in one apheresis session. Patients were divided into two groups depending on the number of CD34+ cells collected; ≥20 but <50 (group A; n=93) and ≥50 (group B; n=121). Group A had a median collection of 31.1 x 106/kg CD34+ cells and group B had 66.8 x 106/kg. For group A, the median time to neutrophil recovery was 12 days, compared with 11 days for group B. Zero out of 93 patients in group A had delayed engraftment compared with 7 of the 121 patients (6%) in group B (P=0.022). All 7 patients with delayed engraftment were mobilized with single-agent granulocyte-colony stimulating factor. Four patients had myeloma, 2 acute promyelocytic leukemia (APL), and 1 Waldenstrom's macroglobulinemia (WM) (Table 1). Patients with myeloma and WM (all in first partial remission) received high-dose melphalan conditioning and patients with APL (both in second complete remission) received busulfan-cyclophosphamide. For the 7 patients with delayed engraftment, the median number of CD34+ cells infused was 14.5 x 106/kg (range 9.5-19.6) with a median time to neutrophil engraftment of 24 days (range 20-38). Conclusions: We describe an uncommon phenomenon of delayed engraftment in some patients with very high CD34+ cell yields in a single apheresis. Additional studies on stored autologous stem cells are needed to elucidate the cause of this peculiar finding. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

QOL-06. PREDICTING VENOUS THROMBOEMBOLISM IN PATIENTS WITH ADULT-TYPE DIFFUSE GLIOMAS

Abstract Venous thromboembolism (VTE) is a common paraneoplastic complication in patients with adult-type diffuse gliomas. VTE greatly diminishes quality-of-life, and can even be life-threatening. While effective VTE prediction models exist for other cancers, those models do not work for gliomas. Thus, there are no standard guidelines for thromboprophylaxis in glioma patients. To address this deficiency, arterial blood, tumor tissue, and comprehensive clinical-pathologic data (including next generation sequencing) were obtained from 258 newly diagnosed WHO grade 2-4 adult-type diffuse glioma patients at Northwestern Memorial Hospital. Forty-six out of 258 grade 2-4 glioma patients (17.8%) experienced a subsequent VTE. Intratumoral expression of two proteins that have been associated with VTE risk in other cancers, thromboplastin and podoplanin, was higher in IDH wild-type than IDH mutant gliomas. Tissue expression of both markers was associated with increased VTE risk, but in the circulation, only thromboplastin positively correlated with VTE. LASSO time-to-event analysis showed that older patient age, elevated body mass index, elevated WBC count, hypertension, a preoperative history of VTE, asthma, and higher WHO grade predicted increased postoperative VTE risk, whereas hypothyroidism, IDH mutation, and MGMT promoter methylation were negative risk factors. Together, these 10 variables generated a receiver operating characteristic curve for 3, 6, 9, and 12 months from original surgery resulting in estimated AUC value of 0.82 in the Northwestern discovery cohort, 0.72 in the UCLA validation cohort (N=68), and 0.68 in the Duke validation cohort (N=157). We created an online prediction tool based on this model, which estimates VTE risk up to 1 year from original surgery. To the best of our knowledge, this is the first externally validated VTE risk prediction tool designed specifically for adult-type diffuse glioma patients. This tool, based on readily obtainable information, provides treating physicians with more objective risk estimates on which to base thromboprophylaxis decision-making.

Alternative Nerve Transfer for Shoulder Function: Thoracodorsal and Medial Triceps to Anterior Axillary Nerve

Introduction:We describe a reliable approach for double nerve transfer of the medial triceps branch and thoracodorsal nerve to the axillary nerve to increase axonal input. We present a review of outcomes for both end-to-end and reverse end-to-side nerve transfer.Methods:A retrospective review of patients who underwent nerve transfer for improvement of shoulder abduction at Harborview Medical Center and Northwestern Memorial Hospital between 2012 and 2021 was conducted. Patients were prospectively contacted to fill out a 30 item Disabilities of the Arm, Shoulder and Hand questionnaire, with an option to upload a video demonstrating active range of motion.Results:Twenty-one patients with 23 affected extremities were included in the final analysis. Fifteen patients completed the prospective arm of the study (71% response rate). Seventy-nine percent of patient limbs achieved a Medical Research Council Motor Scale (MRC-MS) of 4 or greater, and measured shoulder abduction active range of motion (AROM) was 139.2 degrees (range, 29–174 degrees) and 140.9 degrees (range, 60–180 degrees) (P = 0.95) for end-to-end and reverse end-to-side, respectively. Comparing end-to-end with reverse end-to-side neurorrhaphy, outcomes, including follow-up, mean postoperative MRC-MS, mean change in MRC-MS, Disabilities of the Arm, Shoulder and Hand, abduction AROM, and flexion AROM, were not statistically different.Conclusions:We showed improvements in shoulder abduction with the thoracodorsal nerve, in addition to the medial triceps branch, to increase axonal donation and power the axillary nerve without sacrificing the spinal accessory nerve. Furthermore, we demonstrated improvements with reverse end-to-side coaptation when intraoperative stimulation of the axillary nerve revealed residual function.

Microvascular Reconstruction of the Anterior Skull Base.

Anterior skull base defects present a unique reconstructive challenge. Risk factors such as previous operation, radiation and infection require a multidisciplinary approach to create a stable wound. Reconstructive microsurgery serves an important role when attempts with pericranial flap placement and nonvascularized graft obliteration fail. Our series analyzes the outcomes of 5 patients who underwent vascularized reconstruction of craniofacial defects at Northwestern Memorial Hospital from 2014-2021. Each patient presented with a complex, hostile scalp and bony wound. Common risk factors included previous craniotomy, failed obliteration, chemoradiation, osteomyelitis and epidural abscess. Patients underwent multi-stage procedures to obtain wound source control, reconstruct the frontal sinus and skull base, and frontal bone cranioplasty. Each patient underwent successful free flap reconstruction without flap loss or donor site complications. No patients suffered ongoing symptomatic CSF leak or pneumocephalus. However, only two patients have had sustained success with their alloplastic cranioplasty. A perfect, watertight seal is required to prevent seeding the implant and avoiding infection. Overall, free flap reconstruction of the skull base and frontal sinus is a necessary solution when patients fail more conservative locoregional options. Close collaboration with neurosurgery can help with diagnosis and establish the optimal timing for surgical care.