Rush University Medical Center Research Articles

Effect of transitioning from conventional cardiac troponin to high-sensitivity cardiac troponin on resource utilization- a single center experience

BackgroundCompared to conventional cardiac troponin (cTn), the high-sensitivity cardiac troponin (hs-cTn) assay is associated with improved detection of myocardial infarction (MI). MethodsWe performed a descriptive retrospective analysis of resource utilization at Rush University Medical Center over the transition period (July 1, 2021) from a cTn to a hs-cTn assay. Inclusion criteria included emergency department (ED) encounters between January 1 to December 31, 2021, with chief complaints of “chest pain” or “dyspnea” with associated troponin orders. The primary endpoint was the percentage of ED discharges. Secondary endpoints included the number of cardiac studies ordered. Univariable comparisons of these endpoints were performed using Student's t-test for continuous variables and Chi-square tests for binary/categorical variables. ResultsA total of 5113 encounters were analyzed. Hs-cTn was associated with an overall increase in ED patient discharges with negative troponin tests (44.1% vs. 29.9%, P < 0.01). In terms of cardiac testing per encounter, hs-cTn was associated with significant increases in the number of troponin tests (1.9 vs. 1.6, P < 0.01), electrocardiograms (3.0 vs. 2.9, P = 0.01), and echocardiograms (0.5 vs. 0.4, P < 0.01). There was a significant decrease in the utilization of stress testing (0.21 vs. 0.26, P < 0.01). There was a significant increase in total coronary angiography use during the hs-cTn period compared to cTn (227/2471 (9.2%) vs. 195/2642 (7.4%), P = 0.02). ConclusionTransitioning from cTn to hs-cTn was associated with significantly increased ED discharges and an increase in troponin tests, ECG, echocardiograms, and coronary angiograms. There was a decrease in the number of stress tests.

Comparative Patient Outcomes following Awake vs Asleep STN DBS at Rush University Medical Center: A Retrospective Approach (P1-3.012)

Comparative Patient Outcomes following Awake vs Asleep STN DBS at Rush University Medical Center: A Retrospective Approach (P1-3.012)

Abstract 6682: Bile acid profiles and racial disparities in colorectal cancer: Exploring the protective role of secondary bile acid derivatives

Abstract Background: Colorectal cancer (CRC) is the third leading cause of cancer death in the United States, with diet and gut microbiota-derived bile acids implicated as long-term risk factors. The interplay between bile acids and immune cell differentiation, particularly of macrophages and T-cells, is a crucial aspect of the CRC microenvironment. Given the high-animal-fat diets' influence on the microbiome’s production of hydrophobic secondary bile acids such as deoxycholic acid (DCA) and lithocholic acid (LCA), this study investigates the potential immunomodulatory effects of their lower concentrations and their isomers in possibly fostering M2-like macrophage expansion. Methods: Clinical samples were obtained during colonoscopies with no tumor findings at Rush University Medical Center, Chicago. RNA was extracted from colonoscopy biopsies for NanoString RNA expression analysis, while bile acids were isolated from both lyophilized stool and frozen serum samples. To explore the immunological effects of secondary bile acids, the macrophage RAW 264.7 cell line, alongside peritoneal macrophages and bone marrow-derived macrophages (BMDMs) from C57BL/6J mice, were treated with LCA and LCA isomers. Following the bile acid treatment, LPS (100 ng/mL) or IL-4 (40 ng/ml) was added to elicit pro-inflammatory or anti-inflammatory states, respectively. After 48 hours, conditioned media were collected for enzyme-linked immunosorbent assay (ELISA), while cells were analyzed by flow cytometry and rt-qPCR. Results: Contrary to initial hypotheses, the levels of DCA and LCA levels were not significantly different between African American and non-Hispanic White subjects. Notably, allo-isomers and oxo-derivatives of these bile acids, which may promote Treg and M2-like macrophage expansion, were substantially lower in African American subjects. Ex vivo treatments with isoalloLCA and IsoLCA led to notable changes in the M2 macrophage differentiation and shifts in PGE2 production upon exposure to inflammatory or anti-inflammatory stimuli, suggesting a nuanced alteration in the macrophage-mediated inflammatory response. Conclusion: This study highlights a significant ethnic variation in bile acid profiles, with a potential impact on immune modulation and CRC risk. The reduced presence of certain bile acid isomers in African American subjects may influence the risk of CRC through altered macrophage differentiation and function. These findings emphasize the need for personalized dietary and therapeutic strategies to modulate the bile acid metabolome, potentially reducing CRC disparities. Citation Format: Hanchu Dai, Patricia G. Wolf, Lisa Tussing-Humphreys, Ece Mutlu, Jason M. Ridlon, Rex Gaskins. Bile acid profiles and racial disparities in colorectal cancer: Exploring the protective role of secondary bile acid derivatives [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6682.

Implementation of single-port robotic urologic surgery: experience at a large academic center.

The Single-Port (SP) robotic system is increasingly being implemented in the United States, allowing for several minimally invasive urologic procedures to be performed. The present study aims to describe our single-center experience since the adoption of the SP platform. We retrospectively collected and analyzed consecutive SP cases performed at a major teaching hospital in the Midwest (Rush University Medical Center) from December 2020 to December 2023. Demographic variables were collected. Surgical and pathological outcomes were analyzed in the overall cohort and for each type of procedure. The study timeframe was divided into two periods to assess the evolution of SP technical features over time. In total, 160 procedures were performed, with robot-assisted radical prostatectomy (RARP) being the most common (49.4%). Overall, 54.4% of the procedures were extraperitoneal, with a significantly higher adoption of this approach in the second half of the study period (30% vs 74.3%, p < 0.001). A "plus one" assistant port was adopted in 38.1% of cases, with a shift towards a "pure" single-port surgery in the most recent procedures (21.1% vs 76.7%, p < 0.001). The median LOS was 33.5h (30-48), with a rate of any grade and CD ≥ 3 postoperative complications of 9.4% and 2.5%, respectively, and a 30-day readmission rate of 1.9%. SP robotic surgery can be safely and effectively implemented for various urologic procedures. With increasing experience, the SP platform allows shifting away from transperitoneal procedures, potentially minimizing postoperative pain, and shortening hospital stay and postoperative recovery.

Fetal MRI Analysis of Corpus Callosal Abnormalities: Classification, and Associated Anomalies.

Corpus callosal abnormalities (CCA) are midline developmental brain malformations and are usually associated with a wide spectrum of other neurological and non-neurological abnormalities. The study aims to highlight the diagnostic role of fetal MRI to characterize heterogeneous corpus callosal abnormalities using the latest classification system. It also helps to identify associated anomalies, which have prognostic implications for the postnatal outcome. In this study, retrospective data from antenatal women who underwent fetal MRI between January 2014 and July 2023 at Rush University Medical Center were evaluated for CCA and classified based on structural morphology. Patients were further assessed for associated neurological and non-neurological anomalies. The most frequent class of CCA was complete agenesis (79.1%), followed by hypoplasia (12.5%), dysplasia (4.2%), and hypoplasia with dysplasia (4.2%). Among them, 17% had isolated CCA, while the majority (83%) had complex forms of CCA associated with other CNS and non-CNS anomalies. Out of the complex CCA cases, 58% were associated with other CNS anomalies, while 8% were associated with non-CNS anomalies. 17% of cases had both. The use of fetal MRI is valuable in the classification of abnormalities of the corpus callosum after the confirmation of a suspected diagnosis on prenatal ultrasound. This technique is an invaluable method for distinguishing between isolated and complex forms of CCA, especially in cases of apparent isolated CCA. The use of diffusion-weighted imaging or diffusion tensor imaging in fetal neuroimaging is expected to provide further insights into white matter abnormalities in fetuses diagnosed with CCA in the future.

Longitudinal circulating tumor DNA monitoring for detection of molecular residual disease in patients with penile squamous cell carcinoma.

11 Background: Penile squamous cell carcinoma (SCC) is an extremely rare, aggressive disease, representing 0.4-0.6% of all malignancies in males in the U.S. and Europe. Early diagnosis is imperative, as lymphatic spread is associated with a dismal prognosis. The estimated 5-year survival rate in patients with pelvic lymph node involvement is 0%. Moreover, there are limited treatment options that carry significant toxicity risks. Accurate biomarkers to evaluate treatment response and guide treatment to improve outcomes are needed. Molecular residual disease monitoring with circulating tumor DNA (ctDNA) may be helpful in these scenarios. Methods: This is a retrospective analysis of a cohort of 7 patients with advanced HPV-unassociated penile SCC treated at Rush University Medical Center who monitored closely for molecular residual disease (MRD). Signatera (Natera Inc.), a personalized tumor-informed ctDNA assay, was utilized for detection and quantification of ctDNA in patients’ plasma samples, measured at regular intervals. Progression of disease was based on radiographic imaging. Results: In our cohort, personalized, tumor-informed ctDNA assays were designed for 100% (7/7) of the patients. ctDNA was detectable in at least one time point in all of the patients. One patient underwent partial penectomy and lymph node (LN) dissection with 1/11 LN involved. He is being monitored without adjuvant treatment and has sustained ctDNA clearance. Another patient underwent surgery, and had positive post-operative ctDNA. He was treated with adjuvant TIP (paclitaxel, ifosfamide, and cisplatin) with subsequent ctDNA clearance. In 3 of the patients, ctDNA was checked at regular intervals and rising ctDNA prompted imaging studies that showed progression. These patients proceeded to second line treatment options. The remaining 2 patients are non-surgical candidate with LN positivity, who will begin treatment with TIP and monitoring of ctDNA after each cycle of chemotherapy. Twenty-eight percent (2/7) of patients remain alive with sustained ctDNA clearance. Twenty-eight percent (2/7) of patients remain alive with ctDNA positivity, planned to initiate treatment and monitoring of ctDNA at regular intervals. Forty-three percent (3/7) of patients who had persistent ctDNA positivity are now deceased. Conclusions: Our data suggests that a personalized, tumor-informed ctDNA assay is not only useful for MRD monitoring, but also highly predictive of treatment response and imaging-based progression in patients with penile SCC. In our sample, MRD status correlated with both radiographic progression and clinical outcomes. Prospective studies are needed to better understand how ctDNA can be used to guide neoadjuvant and adjuvant approaches, including treatment intensification or de-escalation, in patients with penile SCC.

Soluble urokinase plasminogen activator receptor and cardiotoxicity in doxorubicin-treated breast cancer patients: a prospective exploratory study

BackgroundSoluble urokinase plasminogen activator receptor is an inflammatory biomarker that may prognosticate cardiovascular outcomes. We sought to determine the associations between soluble urokinase plasminogen activator receptor and established markers of cardiotoxicity in breast cancer patients receiving doxorubicin.MethodsWe conducted a prospective cohort study of women with newly diagnosed breast cancer receiving standard-dose doxorubicin (240 mg/m2) at Rush University Medical Center and Rush Oak Park Hospital (Chicago, IL) between January 2017 and May 2019. Left ventricular ejection fraction, global longitudinal strain, and cardiac biomarkers (N-terminal prohormone B-type natriuretic peptide, troponin-I, and high-sensitivity C-reactive protein) were measured at baseline and at intervals up to 12-month follow-up after end of treatment. The associations between soluble urokinase plasminogen activator receptor and these endpoints were evaluated using multivariable mixed effects linear regression.ResultsOur study included 37 women (mean age 47.0 ± 9.3 years, 60% white) with a median baseline soluble urokinase plasminogen activator receptor level of 2.83 ng/dL. No participant developed cardiomyopathy based on serial echocardiography by one-year follow-up. The median percent change in left ventricular strain was -4.3% at 6-month follow-up and absolute changes in cardiac biomarkers were clinically insignificant. There were no significant associations between soluble urokinase plasminogen activator receptor and these markers of cardiotoxicity (all p > 0.05).ConclusionsIn this breast cancer cohort, doxorubicin treatment was associated with a very low risk for cardiotoxicity. Across this narrow range of clinical endpoints, soluble urokinase plasminogen activator receptor was not associated with markers of subclinical cardiotoxicity. Further studies are needed to clarify the prognostic utility of soluble urokinase plasminogen activator receptor in doxorubicin-associated cardiomyopathy and should include a larger cohort of leukemia and lymphoma patients who receive higher doses of doxorubicin.

Genomic Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 in a County Jail.

In the coronavirus disease 2019 (COVID-19) pandemic, correctional facilities are potential hotspots for transmission. We examined the genomic epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) early in the pandemic in one of the country's largest urban jails. Existing SARS-CoV-2 isolates from 131 detainees at the Cook County Jail in Chicago, Illinois, from March 2020 through May 2020 were analyzed by whole-genome sequencing. Contemporaneous isolates from Rush University Medical Center (Chicago, Illinois) and the Global Initiative on Sharing All Influenza Data (GISAID) were used to identify genetic clusters containing only jail isolates. Transmission windows were identified for each pair of detainees using the date of the SARS-CoV-2-positive test and location data to determine if detainees overlapped in the jail, within a specific building, or within particular living units during transmission windows. We identified 29 jail-only clusters that contained 75 of the 132 SARS-CoV-2 isolates from detainees; of these clusters, 17 (58.6%) had individuals who overlapped in the jail during putative transmission windows. Focusing on specific buildings revealed that 2 buildings, a single- and double-cell style of housing. were associated with having detainees infected with similar SARS-CoV-2 genomes during their infectious time period (P < .001). Our findings suggest that there was transmission of SARS-CoV-2 in the jail, in the setting of extensive importation of COVID-19 from the community. Numerous infection control practices at intake and during incarceration were implemented in the jail to limit viral spread. Our study shows the importance of genomic analysis in this type of settings and how it can be utilized within infection control protocols.

1259. Successful Inpatient Penicillin Delabeling in Minimal and Low Risk Penicillin Allergic Patients

Abstract Background In the US, 10% of adults report a Penicillin (PCN) allergy but true IgE-mediated or serious reactions are rare. A PCN allergy label carries risk for harm including fewer first-line treatment options, increased antimicrobial resistance, toxicities, surgical site infections, and death. The objective of this study was to identify and safely remove penicillin allergy labels in eligible hospitalized patients. Methods Between June 2022 - February 2023, the Antimicrobial Stewardship team electronically identified hospitalized patients with documented PCN allergy admitted to adult internal medicine wards at Rush University Medical Center (RUMC), an academic hospital in Chicago, IL. Patients with possible minimal or low risk PCN allergy reactions via chart review were administered a standardized questionnaire, followed by triage into Minimal, Low, and Moderate Risk PCN allergy categories (Figure 1). Minimal Risk patients were delabeled by history alone, or per patient request, after amoxicillin challenge. Low risk patients were offered an amoxicillin challenge with a single 500mg oral dose. Moderate or high risk patients were excluded. Penicillin Allergy Risk Stratification Results Of 47 interviewed patients, 31 patients (20 minimal and 11 low risk) were appropriate for delabeling. 27 of 31 (87%) were successfully delabeled via history or amoxicillin challenge; 4 were not delabeled, due to patient discomfort or early discharge. 14 of the 31 (45%) were delabeled based on history alone; all had tolerated amoxicillin before. 13 amoxicillin challenges were administered, 9 of 11 patients in low risk, 4 of 20 in minimal risk group per patient request. 100% of amoxicillin challenges were well tolerated and patients successfully delabeled. Only 1 patient was relabeled at a subsequent hospitalization. Penicillin Delabeling Results Conclusion In this proof-of-concept intervention, patients with a minimal or low risk penicillin allergy were safely delabeled as inpatients by history or amoxicillin challenge. Expanding this to a larger scale on the inpatient and outpatient settings would enable more patients with PCN allergy to be delabeled, leading to use of standard of care antibiotics and improved outcomes. Disclosures All Authors: No reported disclosures

Abstract 13612: Association Between B-Type Natriuretic Peptide and Inferior Vena Cava Diameter as a Measure of Hypovolemia in Cancer Patients

Introduction: Hypovolemia is frequently seen in cancer patients due to catabolism, cachexia, and decreased oral intake. However, volume status assessment in this population is often difficult due to competing comorbid conditions such as edema. Elevated B-type natriuretic peptide (BNP) is an established biomarker of myocardial wall stress in patients with hypervolemia. We sought to determine if very low BNP could be an objective marker of hypovolemia in cancer patients Hypothesis: In cancer patients undergoing treatment, is low BNP level (&lt;10 pg/mL) associated with small inferior vena cava (IVC) diameter (&lt; 1.4 cm) - an established marker of hypovolemia on transthoracic echocardiography (TTE)?We hypothesize that BNP &lt;10 pg/mL is associated with small IVC as a marker of hypovolemia in cancer patients. Methods: We conducted a retrospective study (N=91) with solid malignancies, undergoing chemo- and/or radiation therapy (RT), divided into 3 groups based on BNP values in pg/mL: low (BNP &lt;10), normal (BNP 10-100) and high (BNP&gt;100). Retrospective data were obtained between 2016-2023 from Rush University Medical Center Cardio-Oncology Registry. IVC measurements by 2 medial trainees (Cohen’s intraclass correlation coefficient = 0.87, p &lt; 0.01) were acquired from formal TTEs obtained within 1 week of BNP measurements. Linear regression was used to calculate the adjusted means (for age, sex, BMI, blood pressure, creatinine, RT, TSH) of the 2 measured IVC diameters per datapoint. Mean difference in IVC diameters was compared between the 3 BNP groups. Results: The population mean age was 59.99 ± 12.19, 67% women. Adjusted mean IVC measurements were 1.89cm, 1.55cm, and 1.26cm for the high, normal, and low BNP groups respectively. The mean difference in IVC diameters between high and low BNP groups was 0.628 ±0.164 cm (p&lt;0.01). Conclusions: In cancer patients undergoing treatment, very low BNP (&lt;10pg/mL) was associated with small IVC as a marker of hypovolemia. In this group of patients, BNP measured with routine lab data is a readily available tool to identify individuals with hypovolemia where other measures of volume status such as physical exams might be uncertain.

Democratizing insights into hospital cost reports

The Centers for Medicare and Medicaid Services (CMS) provides annual reports of costs, charges, utilization, payment, penalty, payroll, and general institutional characteristics for thousands of Medicare-certified hospitals. However, beyond the small fraction of features offered in dated finalized public use files, the size and complexity of cost report data can make it difficult to use. To gain a greater breadth of up-to-date insights, hospitals and researchers must either pay for third party services or acquire the appropriate expertise. To democratize insights into cost report data, we first developed an open-source public repository of 6908 hospital-specific dataset, each containing 2843 labeled features and spanning years between 2010 and 2023. We then developed an open-source application for analyzing and downloading these data. Users can download and run the application locally or access it online (https://hcris-app.herokuapp.com/), and compare cost report features among hospitals and across time, explore relationships between features, and design new cost report variables. As examples of insights gained from our application, we present results from comparing Rush University Medical Center to 66 non-governmental acute care Illinois hospitals. We look forward to developing our open-source resources according to feedback from the healthcare community.

Evaluation of Sentinel Lymph Node Drainage Patterns in Early-Stage Oral Cavity Cancer

Surgery is the mainstay for squamous cell carcinoma of the oral cavity (OSCC), which includes an elective neck dissection. To limit morbidity of neck dissection, sentinel lymph biopsy (SLNB) has been introduced to identify patients at risk for nodal metastasis. While the data has thoroughly examined the relationship between SLNB in patients with unilateral lymph node drainage, little information exists on the rate of bilateral lymph node drainage patterns in lateralized OSCC. This study sought to examine the incidence of bilateral lymph node drainage patterns using sentinel node mapping in early stage OSCC. This retrospective review of the electronic medical records at Rush University Medical Center focused on patients who underwent a SLNB based on CPT codes 38724, 38900, 38542, and 38510. From this cohort, we limited our analysis to patients with primary clinical T1 or T2 OSCC. Primary outcome was the rate of bilateral nodal drainage on sentinel node mapping based on the SPECT-CT. A total of 54 patients were diagnosed with clinical T1/T2N0 OSCC and underwent a SLNB with SPECT-CT. (1) From the cohort of 54, 15 patients (27.78%) had bilateral sentinel lymph node drainage on SPECT-CT, while 39 patients (72.22%) had unilateral sentinel lymph node drainage. (2) Eleven patients (73.3%) from the bilateral drainage cohort completed appropriate SLN mapping with bilateral nodal assessments. (3) Four patients who had SPECT-CT evidence of bilateral drainage completed unilateral nodal assessment alone. (4) Of the patients with bilateral nodal assessment, 1 (9.1%) patient had a positive sentinel node on the ipsilateral side, 2 (18.2%) were found to have a positive sentinel node in the contralateral neck. (5) Overall, 3 patients (20%) had local-regional recurrence in the bilateral sentinel lymph drainage cohort. Management of early-stage OSCC has evolved to include SLN mapping and biopsy. Our results found that contralateral drainage occurs in 18% of our patients with 2 patients having positive sentinel node in the contralateral neck. Therefore, the rate of contralateral drainage is not clinically insignificant and this result furthers the importance of lymphatic mapping in the early-stage OSCC treatment algorithm.

APOE-ε4 and BIN1 increase risk of Alzheimer’s disease pathology but not specifically of Lewy body pathology

Lewy body (LB) pathology commonly occurs in individuals with Alzheimer’s disease (AD) pathology. However, it remains unclear which genetic risk factors underlie AD pathology, LB pathology, or AD-LB co-pathology. Notably, whether APOE-ε4 affects risk of LB pathology independently from AD pathology is controversial. We adapted criteria from the literature to classify 4,985 subjects from the National Alzheimer’s Coordinating Center (NACC) and the Rush University Medical Center as AD-LB co-pathology (AD+LB+), sole AD pathology (AD+LB–), sole LB pathology (AD–LB+), or no pathology (AD–LB–). We performed a meta-analysis of a genome-wide association study (GWAS) per subpopulation (NACC/Rush) for each disease phenotype compared to the control group (AD–LB–), and compared the AD+LB+ to AD+LB– groups. APOE-ε4 was significantly associated with risk of AD+LB– and AD+LB+ compared to AD–LB–. However, APOE-ε4 was not associated with risk of AD–LB+ compared to AD–LB– or risk of AD+LB+ compared to AD+LB–. Associations at the BIN1 locus exhibited qualitatively similar results. These results suggest that APOE-ε4 is a risk factor for AD pathology, but not for LB pathology when decoupled from AD pathology. The same holds for BIN1 risk variants. These findings, in the largest AD-LB neuropathology GWAS to date, distinguish the genetic risk factors for sole and dual AD-LB pathology phenotypes. Our GWAS meta-analysis summary statistics, derived from phenotypes based on postmortem pathologic evaluation, may provide more accurate disease-specific polygenic risk scores compared to GWAS based on clinical diagnoses, which are likely confounded by undetected dual pathology and clinical misdiagnoses of dementia type.

Providers Respond to USPSTF Report on Screening for Breast Cancer

Providers Respond to USPSTF Report on Screening for Breast Cancer

Comment on “Evaluation of pharmacy residency recruitment and interview processes during the COVID‐19 pandemic”

JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACYVolume 6, Issue 6 p. 654-654 LETTER TO THE EDITOR Comment on “Evaluation of pharmacy residency recruitment and interview processes during the COVID-19 pandemic” Jessica Kulawiak Pharm.D., Corresponding Author Jessica Kulawiak Pharm.D. [email protected] Rush University Medical Center, Chicago, Illinois, USA Correspondence Jessica Kulawiak, Rush University Medical Center, Chicago, IL 60612-3801, USA. Email: jessicakul[email protected]Search for more papers by this authorSara Hovey Pharm.D., Sara Hovey Pharm.D. orcid.org/0000-0002-1438-3247 University of Illinois at Chicago, Chicago, Illinois, USASearch for more papers by this authorKirsten Ohler Pharm.D., FCCP, Kirsten Ohler Pharm.D., FCCP orcid.org/0000-0002-9984-9754 University of Illinois at Chicago, Chicago, Illinois, USASearch for more papers by this author Jessica Kulawiak Pharm.D., Corresponding Author Jessica Kulawiak Pharm.D. [email protected] Rush University Medical Center, Chicago, Illinois, USA Correspondence Jessica Kulawiak, Rush University Medical Center, Chicago, IL 60612-3801, USA. Email: [email protected]Search for more papers by this authorSara Hovey Pharm.D., Sara Hovey Pharm.D. orcid.org/0000-0002-1438-3247 University of Illinois at Chicago, Chicago, Illinois, USASearch for more papers by this authorKirsten Ohler Pharm.D., FCCP, Kirsten Ohler Pharm.D., FCCP orcid.org/0000-0002-9984-9754 University of Illinois at Chicago, Chicago, Illinois, USASearch for more papers by this author First published: 07 June 2023 https://doi.org/10.1002/jac5.1825Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCES 1Wingler MJB, Cretella DA, Wagner JL, Barber KE, Bookstaver PB, Freeman L, et al. Evaluation of pharmacy residency recruitment and interview processes during the COVID-19 pandemic (2020-2021 application cycle). J Am Coll Clin Pharm. 2023; 6(3): 241– 51. https://doi.org/10.1002/jac5.1684 2Beechinor RJ, Eche IM, Edmonds N, Mordino J, Serafin H, Roller L, et al. Perceptions of a virtual interview process for pharmacy residents during the COVID-19 pandemic: a multisite survey of residency candidates, preceptors, and residency program directors. Am J Health Syst Pharm. 2022; 79(16): 1385– 92. https://doi.org/10.1093/ajhp/zxac130 3Hovey SW, Arif SA, Khan AM, Hyderi AF, Varughese C, Peksa GD, et al. More than a buzz word: building diversity, equity, and inclusion into pharmacy residency recruitment. J Am Coll Clin Pharm. 2023; 6: 154– 64. https://doi.org/10.1002/jac.5.1716 4Fischetti BS, Ciaramella C, Kim EM, Papamanolis IC. Evaluation of the use of social media and virtual meeting platforms in the pursuit of pharmacy residency training. J Pharm Pract. 2022. [Online ahead of print]. https://doi.org/10.1177/08971900221088806 5Breitkopf D, Albold C, Barlow J, Bellamkonda V, Dorcent C, Sadosty A, et al. Virtual residency recruitment: future directions in the new era. Ann Med. 2022; 54(1): 3342– 8. https://doi.org/10.1080/07853890.2022.2148732 Volume6, Issue6June 2023Pages 654-654 ReferencesRelatedInformation

The first cold atmospheric plasma phase I clinical trial for the treatment of advanced solid tumors: A novel 4th treatment arm for cancer.

e14596 Background: Local recurrence contributes to the poor prognosis for patients with Stage IV metastatic or recurrent solid tumors, despite advances in standard care. We report the clinical outcome of intra-operative Cold Atmospheric Plasma (CAP) combined with standard surgical procedures. Methods: The trial was a Phase I, multi-center, open-label, prospective, controlled study. Eligible patients undergoing surgery for advanced Stage IV metastatic or recurrent solid tumors were enrolled and preoperative treatments (neoadjuvant chemotherapy, immunotherapy, radiation, and primary surgery) were permitted. Participants were recruited from Rush University Medical Center in Chicago, Illinois and Sheba Medical Center in Tel HaShomer, Israel. Twenty patients (age 26-85 years) between March 2020 to April 2021 received intra-operative CAP treatment following surgical macroscopic tumor removal. The primary endpoint was safety, and the secondary endpoint was ablation of the local microscopic tumor bed without damaging the surrounding normal tissue. Results: Physiological data (blood pressure, pulse, body temperature, End Tidal CO2, and oxygen saturation) was recorded continuously throughout surgery. There were no significant changes (p &gt; 0.05) during intra-operative CAP treatment. One adverse event grade 3 or higher was reported but no adverse events were related to CAP. As of February 13, 2023, 10 patients died of their disease between 3-32 months. Kaplan-Meier overall survival curves show the interim 31-month rate is 24% (95% confidence interval [CI], 5.0 – 100.0%). Median survival is 23 months. For R0 patients, the Kaplan Meier local non-recurrence probability showed that the interim 28-month rate is 75% (n=8; 95% CI, 50.3 – 100.0%) as of February 13, 2023. Histological staining, TUNEL assay, and confocal imaging of the surgical margins revealed cancer cell death and no damage to the surrounding normal tissue. Primary culture of the tumor confirmed total cessation of cancer cell survival. Conclusions: CAP treatment in combination with surgery for high-risk stage IV solid tumors is safe and induces cancer cell death at the surgical bed without damaging non-cancerous tissue. The survival rate in R0-resected CAP-treated patients was significantly improved compared to R1 and R2 patients and local non-recurrence rate for R0 patients was noteworthy. Clinical trial information: NCT04267575 . [Table: see text]

Combat Medical Readiness: The Rush University Medical Center Advanced Trauma Training Program

Combat Medical Readiness: The Rush University Medical Center Advanced Trauma Training Program

PO-01-160 POST-PROCEDURE ANTICOAGULATION IN PATIENTS RECEIVING PULMONARY VEIN ISOLATION WITH LEFT ATRIAL APPENDAGE OCCLUSION DEVICES: A SINGLE CENTER RETROSPECTIVE COHORT STUDY

Embolic events are a major complication of atrial fibrillation (AF). To prevent these events systemic anticoagulation is given based on an individual’s calculated risk using validated scoring systems (e.g., CHA2DS2-VASC score). In individuals for whom long-term oral anticoagulation (OAC) is not possible, placement of left atrial appendage occlusion (LAAO) devices is a reasonable alternative. Occasionally, individuals with prior LAAO device implantation undergo pulmonary vein isolation (PVI) for rhythm control, which typically warrants a short-term period of at least 6 weeks of systemic OAC post-PVI. It is not clear, however, whether prior placement of a LAAO device negates the need for 6 weeks of OAC. To determine the impact of truncated OAC duration the first 6 weeks post-PVI compared to those completing 6 weeks of OAC in individuals with high bleeding risk and prior placement of a LAAO device. We retrospectively examined patients 665 patients from Rush University Medical Center that received pulmonary vein isolation from March 2017 to December 2021. Of these patients, 18 had successful implantation of a LAAO device prior to PVI. Nine patients completed a 6-week course of OAC and 9 patients completed < 6 weeks of OAC after ablation. The primary clinical outcome was the incidence of thromboembolic events during the peri-and post-procedural period. Secondary outcome was the incidence of major or minor bleeding events while on OAC using standard definitions. The median age was 65 years. Fifty-five percent of patients in each arm were diagnosed with persistent atrial fibrillation. Mean CHA2DS2-VASc was 3 and mean HAS-BLED score was 2.8. Reasons for shorter course of OAC in the truncated group were variable and based on shared decision making between the provider and the patient. There were no thromboembolic events post-PVI in either group. Two patients (29%) who received 6 weeks of OAC had bleeding events with no bleeding events in the group who received truncated duration of OAC post-PVI. In this small proof of concept study, patients with prior LAAO device placement who underwent subsequent PVI and received < 6 weeks of OAC during the post-PVI period did not have an increased rate of thromboembolic events compared to those who received 6 weeks of OAC. Conversely, bleeding events occurred more frequently in LAAO patients who received the full 6 weeks of OAC post-PVI. Larger prospective or randomized clinical trials are needed to validate these findings.Tabled 1Patient, Watchman & Pulmonary Vein Isolation CharacteristicsSix Weeks Post-PVILess than Six Weeks Post-PVICo-morbiditiesTachycardia Mediated Cardiomyopathy (%)2 (22.2)2 (22.2)Hypertension (%)8 (88.9)9 (100)Diabetes Mellitus (%)1 (11.1)5 (55.6)Ischemic Stroke/TIA (%)2 (22.2)2 (22.2)Coronary Artery Disease (%)3 (33.3)2 (22.2)Peripheral Vascular Disease (%)01 (11.1)Thrombocytopenia (%)1 (11.1)2 (22.2)Chronic Kidney Disease (%)2 (22.2)3 (33.3)History of GI Bleeds (%)5 (55.6)4 (44.4)Watchman IndicationsHistory of Bleeding (%)5 (55.6)5 (55.6)High Risk of Bleeding (%)3 (33.3)3 (33.3)High Risk Employment (%)01 (11.1)Drug Interaction (%)1 (11.1)0Pulmonary Vein IsolationAnticoagulation prior to PVI (%)6 (66.7)5 (55.6)TEE prior to PVI (%)5 (55.6)5 (55.6)PVI Modality & ProcedureCryo-balloon ablation (%)3 (33.3)3 (33.3)Radio-Frequency Ablation (%)4 (44.4)2 (22.2)Laser Balloon Ablation (%)2 (22.2)4 (44.4)Cardioversion During PVI (%)4 (44.4)5 (55.6)Concomitant Atrial Flutter Ablation (%)8 (88.9)4 (44.4) Open table in a new tab

Abstract #1402660: Association of Social Vulnerability Index Themes and Pre-Diabetes in Chicago Neighborhoods

Pre-diabetes, defined as a glycosylated hemoglobin between 5.7% and 6.4%, is a common condition that is amenable to intervention to ameliorate progression to diabetes. The distribution of pre-diabetes at the census tract level in diverse urban communities and the neighborhood factors that may influence community pre-diabetes rates are not well understood. The social vulnerability index (SVI) was created by the Centers for Disease Control and Prevention to study how communities may be affected following natural disasters. SVI scores range from 0 to 1 with higher SVI scores representing increased social vulnerability. SVI is composed of four neighborhood level themes — socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. The objective of this proof-of-concept project was to determine the distribution of pre-diabetes in patients from census tracts served by a single academic health center and to understand how census tract SVI scores amongst the four SVI themes may be associated with pre-diabetes. For data available in 2018, pre-diabetes rates varied from 0.5% to 16.7% for 1,203 out of the 1,313 census tracts for which there were at least 25 adult patients seen at Rush University Medical Center. A linear regression model was used to assess the change in SVI theme score with the rate of pre-diabetes. Each 0.1 unit increase in SVI theme score for the socioeconomic status, household composition and disability, and minority status and language themes were associated with a 0.37% (SE = 0.027; p-value < 0.0001), 0.36% (SE = 0.027; p-value < 0.0001), and 0.14% (SE = 0.029; p-value = 0.0045) increase in the rate of pre-diabetes, respectively. However, the housing and transportation theme had a non-significant 0.08% decreased rate of pre-diabetes per 0.1-unit change (SE = 0.029, p-value = 0.07). While there was significant heterogeneity of SVI theme scores and pre-diabetes rates in census tracts served by a single, urban health center, this proof-of-concept work shows a potential relationship between SVI themes and pre-diabetes rates at the census-tract level. If confirmed in future studies, SVI could be a tool for future targeted neighborhood-specific interventions to reduce the health impact of pre-diabetes, such as providing more resources to address disparities in socioeconomic status, household composition and disability, and minority status and language domains.

Edema to Hematoma Ratio is Elevated in COVID-19 ICH Patients (P2-7.002)

<h3>Objective:</h3> The objective of this study was to evaluate whether COVID-19 infection affected perihematomal edema volume in relation to hematoma size in patients with spontaneous intracerebral hemorrhage. <h3>Background:</h3> Perihematomal edema (PHE) is an indicator of secondary brain injury in patients with spontaneous intracerebral hemorrhage (ICH). The complement cascade plays a central role in PHE development. Thus, since COVID-19 infection is known to activate multiple complement cascade pathways, we hypothesized that COVID-19 infection would increase edema to hematoma volume ratio in patients with ICH relative to ICH patients not infected with COVID-19. <h3>Design/Methods:</h3> Patients at Rush University Medical Center with COVID-19 and spontaneous ICH, both diagnosed at admission from April 2020 to June 2021 were identified (N=12) and compared to randomly selected patients with ICH, but without COVID-19 diagnosis in the same time period (N=12). Patient characteristics, presenting factors, and admission CT imaging were abstracted from the electronic health record. Edema and hematoma measurements were made using semiautomatic segmentation software on admission CT scans for greatest accuracy. <h3>Results:</h3> Average hematoma and perihematomal edema volumes were 18.10 mL and 12.12 mL in the non-COVID ICH patients and 18.56 mL and 15.62 mL in COVID ICH patients, respectively (p=0.477, p=0.264). However, edema volume to hematoma volume ratio was 0.75 and 2.47 in non-COVID and COVID patients, respectively (p&lt;0.05). <h3>Conclusions:</h3> Patients with both ICH and COVID-19 have edema volumes significantly greater in relation to their hematoma size compared to ICH patients without COVID-19. As the COVID-19 pandemic has continued, more data is warranted to corroborate these findings and evaluate therapies that minimize edema expansion and promote positive clinical outcomes. <b>Disclosure:</b> Mr. Sim has nothing to disclose. Mr. Pang has nothing to disclose. Dr. Da Silva has nothing to disclose.