Unique Patient Population Research Articles

Accelerated Structural Valve Deterioration in Systemic Sclerosis Patients Following Transcatheter Aortic Valve Replacement: A Case Series

Abstract Background Systemic sclerosis (SSc) is marked by an excessive systemic accumulation of collagen. Recent literature implies that aortic stenosis is more prevalent in patients with SSc than previously thought. While there are limited feasibility studies on transcatheter aortic valve replacement (TAVR) in this population, the long-term outcomes remain uncertain. Case summary We report two cases of patients with SSc who developed early structural valve deterioration following TAVR, necessitating successful redo-TAVR procedures. Both patients exhibited extensive soft tissue calcinosis as a manifestation of their underlying condition. Discussion The fibrotic and calcific processes inherent to certain SSc subtypes could potentially adversely impact the durability and functionality of transcatheter aortic valves. Our observation highlights the need for vigilant post-procedural surveillance and individualized management strategies in this unique patient population. Further investigation into the mechanisms underlying valve degeneration in this patient subset is warranted. Nevertheless, redo-TAVR procedure appears to be a viable option.

Sex differences in secondary prevention needs and recommendations among patients with spontaneous coronary artery dissection.

Spontaneous coronary artery dissection (SCAD) is increasingly recognized as a cause of heart attacks, particularly for female patients; however, approximately 10% of cases occur in male patients. While male and female differences pertaining to clinical outcomes and treatment protocols have been addressed in the literature, research is limited on sex differences in secondary prevention programming, such as cardiac rehabilitation. Cardiac rehabilitation is recommended for patients with SCAD to promote physical and mental recovery. This letter highlights sex-specific gaps in existing programming and reports patients' suggestions for enhancing the recovery of this unique patient population.

Intracranial substrates of meditation-induced neuromodulation in the amygdala and hippocampus

Meditation is an accessible mental practice associated with emotional regulation and well-being. Loving-kindness meditation (LKM), a specific subtype of meditative practice, involves focusing one's attention on thoughts of well-being for oneself and others. Meditation has been proven to be beneficial in a variety of settings, including therapeutic applications, but the neural activity underlying meditative practices and their positive effects are not well understood. It has been difficult to understand the contribution of deep limbic structures given the difficulty of studying neural activity directly in the human brain. Here, we leverage a unique patient population, epilepsy patients chronically implanted with responsive neurostimulation devices that allow chronic, invasive electrophysiology recording to investigate the physiological correlates of LKM in the amygdala and hippocampus of novice meditators. We find that LKM-associated changes in physiological activity were specific to periodic, but not aperiodic, features of neural activity. LKM was associated with an increase in γ (30 to 55 Hz) power and an alternation in the duration of β (13 to 30 Hz) and γ oscillatory bursts in both the amygdala and hippocampus, two regions associated with mood disorders. These findings reveal the nature of LKM-induced modulation of limbic activity in first-time meditators.

Harnessing Osteopathic Manipulative Treatment: A Trauma-Informed Approach to Healing a Survivor of Human Trafficking

Human trafficking is a global concern with a prevalence that likely exceeds 6.3 million people per year worldwide and a significant amount in the United States alone. This unique patient population requires high-quality trauma-informed care to address their complex medical and psychosocial needs. This case study examines the use of osteopathic manipulative treatment (OMT) in combination with trauma-informed care in the treatment of a survivor of human trafficking. The patient had many years of complex trauma and physical abuse, including multiple head injuries, with subsequent chronic migraines, but presented with an acute exacerbation. While awaiting further workup, cranial osteopathy treatment was performed with informed consent and trauma-informed considerations with significant relief of somatic symptoms. OMT, in conjunction with trauma-informed care, offers a unique opportunity to address the physical and psychological symptoms of this underserved population with many opportunities for further application and research.

P-2265. Treatment Patterns of Extended-Spectrum Beta-Lactamases (ESBL)-producing Enterobacterales (ESBLs) In Individuals With Immunocompromised Conditions: Real-World Experiences From An USA Research Network Study

Abstract Background We sought to characterize the antibiotic preferences, switches, and pathways of treatment of ESBL-producing Enterobacterales bacteremia among immunocompromised individuals by using real-world data.FigureSunburst diagram of treatment choices for ESBL enterobacterales bacteremia in individuals with immunocompromised conditions The sunburst illustrates how patients switched between treatments across the lines of antibiotic treatment. The inner ring displays the first line of therapy following the index event. The next ring displays the switch to in the second line of treatment, and so on. The size of each ring corresponds to the proportion patients who followed that pathway. The gray ring color is unknown or other non-listed antibiotic treatment; Carbapenems: includes meropenem, imipenem or ertapenem; Quinolones= includes ciprofloxacin or levofloxacin; PipTaz=piperacillin-tazobactam. The / symbol represents when 2 or more antibiotics were present on the patient’s record for 3 consecutive days. Methods We captured treatment patterns within the TrinetX platform for all individuals ≥18 years from January 2020 to December 2023 with the 1st episode of ESBL bacteremia. Four different populations were selected by using ICD-10 codes: 1) Solid Organ Transplant Recipients (SOTr), 2) Steam Cell Transplant Recipients (SCTr), 3) Hematological Malignancies (HM) without transplantation and 4) Primary immunodeficiencies (PI) without transplantation. Treatment patterns were assessed within 7 days following ESBL enterobacterales bacteremia diagnosis (index event). The index event was defined based on LOINC codes. A line of treatment was defined as receipt of the same antibiotic within 3 days of index event, and it was considered completed once absent from the patient’s record for 3 consecutive days. The analysis was performed by using the TriNetX package. Results We identified 809 individuals with the first episode of ESBL enterobacterales bacteremia [PI 390 (48.2%), HM 340 (42%), SOTr 59 (7.3%) and SCTr 20 (2.5%)] The population was mainly white non-Hispanic and female with average age at index event for PI (59.4 years), HM (68.4) SOTr (59.2) and SCTr (62.9). The most common initial antibiotic treatment in patients with ESBL bacteremia was carbapenems among all 4 groups. The average time to carbapenems initiation after index event between groups was [PI (19h±36), HM (19h±40.8) SOTr (36h±58) and SCTr (8h±14). The average duration of carbapenem therapy was slightly longer in the SCTr (6.6±2.3 days) compared to the other groups [PI (4.3days±2.7), HM (4.2days±2.4) SOTr (4.2days±3.1)] Other initial antibiotic treatment strategies differed between all groups (Figure). Treatment switches were more frequent in the PI and HM group compared to transplant recipient populations. (Figure) Conclusion Our results showed differences in antibiotic therapy practices for ESBL bacteremia across diverse immunosuppressed populations. There is room for improving stewardship interventions in this unique patient population. Disclosures All Authors: No reported disclosures

P-347. Investigating Risk Factors for Candida auris Bloodstream Infections: A Case-Control Study from Los Angeles County

Abstract Background Candida auris (C. auris) has emerged as a significant pathogen due to its ability to cause bloodstream infections (BSIs) in highly vulnerable patient populations. Understanding the risk factors associated with C. auris BSIs is crucial for implementing targeted interventions to mitigate the burden of infection and ensure patient safety. In Los Angeles County (LAC), all C. auris cases are reportable to the Department of Public Health (DPH). Methods We conducted a case-control study to identify risk factors associated with C. auris BSIs. Using data reported to LAC from June 2019 to April 2024, cases included persons initially colonized with C. auris who subsequently developed confirmed C. auris BSI, while controls consisted of persons colonized with C. auris without C. auris identified from a clinical specimen site. C. auris cases and controls were identified via required laboratory and provider reporting of all positive C. auris tests. Data on various risk factors were collected from provider case reports that were completed on all C. auris-positive persons, excluding cases with missing risk factor data. We used logistic regression to estimate the adjusted odds ratios of a colonized case acquiring a C. auris BSI compared to only colonized persons, adjusting for age, sex, race/ethnicity, and healthcare facility where the positive specimen was collected. Results Of the 174 cases and 2,602 controls identified, increased odds of BSI were observed among patients with prior antifungal use (OR: 3.58, 95% CI: 1.12-11.41) and hemodialysis (OR: 2.33, 95% CI: 1.05-5.16). Other risk factors such as ventilator use, tracheostomy, central venous catheter presence, and wound presence showed no statistically significant associations. Conclusion Targeted infection prevention strategies are vital to mitigate C. auris BSI burden. Rigorous aseptic techniques during hemodialysis and judicious use of antifungal agents may reduce C. auris BSI risk. Although adjusted for in this analysis, specialized attention to infection control in healthcare facilities such as long-term acute care hospitals may be warranted, given their unique patient populations and care settings. Further investigation is warranted to identify additional strategies to mitigate C. auris BSI risk. Disclosures All Authors: No reported disclosures

P-189. Clinical Presentations, Treatments, Outcomes, and Epidemiology of Neurocysticercosis: A 30 Year Pilot Study of Newly Diagnosed Hospitalized Patients in Florida

Abstract Background Neurocysticercosis (NCC) is a parasitic disease of the CNS caused by the pork tapeworm, Taenia solium, and is the leading cause of acquired seizure disorder worldwide. This study is the first to explore the clinical characteristics and courses of NCC patients in Florida.Figure 1:Countries of Origin76% of patients reported a country of origin outside of the United States (Mexico, 12; Guatemala, 4; Haiti, Nepal, El Salvador, 2; Dominican Republic, Honduras, India, Mozambique, Nepal, Peru, 1) The remainder of patients did not specify a country of origin. Methods The inclusion criteria for this retrospective chart review included any patient presenting to UF Health Shands Hospital, Gainesville, FL, with symptomatic NCC diagnosed between June 1993-June 2023 given an ICD-9 or ICD-10 code of NCC confirmed by imaging, serology, or biopsy.Table 1:Epidemiological Characteristics of NCC PatientsSelected epidemiological characteristics of 34 identified patients represented as percentages. Results 34 patients met inclusion criteria. Demographic characteristics of these patients included country of origin (76% non-USA, 24% unspecified), sex (59% Male, 41% Female), ethnicity (65% Hispanic, 32% non-Hispanic, 3% unspecified), age (68% 21-50, 18% 51-70, 15% 0-20), race (47% white, 12% black/AA, 9% Asian, 3% AIAAN, 29% unspecified), insurance status (41% uninsured, 21% insured, 38% unspecified), language preferred for medical correspondence (47% Spanish, 38% English, 6% other, 9% unspecified), and per capita income of Florida county of origin (53% bottom 50%, 41% top 50%, 6% unspecified). Select pre-, intra-, post-hospitalization features and outcomes were recorded. 52% of patients' cysts were staged. Symptoms at time of presentation included headaches (25%), seizures (20%), systemic symptoms (e.g. fever, chills, malaise) (15%), and CNS deficits (10%). 97% of patients reported NCC symptoms prior to receiving an NCC diagnosis and 72% of patients presented to at least one healthcare facility for similar symptoms without receiving a diagnosis of NCC. Out of the 52% who were staged, 56% received incorrect medical management; these patients either received medications for inactive infection (18%) or did not receive proper medication for active infection (38%). 21% of patients were readmitted at least once for NCC symptoms or complications. 18% of patients stayed in the hospital for more than 10 days.Figure 2:Symptoms Prior to PresentationSymptoms patients reported experiencing prior to the time of their diagnostic presentation. Conclusion This research identifies a unique population of patients burdened by NCC and characterizes delays in patient presentation and diagnosis. This may aid clinicians in identifying common patient presentations associated with NCC to promote prompt and accurate diagnosis, appropriate treatment, and close follow-up.Table 2:NCC Cyst StagingCyst staging was performed for 53% of patients (18 in total); 27 cysts in total were staged representing multiple patients with more than one visible NCC cyst that was staged. Disclosures All Authors: No reported disclosures

P-1666. Hematology-Oncology Unit-Specific Antibiogram: A Decade of Experience at a Large Academic Medical Center

Abstract Background Antibiograms are an important stewardship tool that can inform optimal empiric therapy; most antibiograms are hospital-wide. Unit-specific antibiogram data for unique patient populations including intensive care unit and pediatrics is robust; however, published experience with unit-specific antibiograms in the hematology-oncology (heme-onc) population is limited. These patients are unique because of the common use of antimicrobial prophylaxis, prolonged broad-spectrum antibiotics, and an immunocompromised state. We sought to examine the trends in antibiogram antimicrobial susceptibility over time. Methods This retrospective quality initiative included microbiology results (first isolates per patient per timeframe) from Mayo Clinic Rochester from 2012 to 2022. Eligible cultures were those identified as being obtained from one of 8 hematology, oncology, or bone marrow transplant inpatient units. Agar dilution susceptibility testing and Clinical and Laboratory Standards Institute (CLSI) breakpoints were used. Screening PCRs (eg, VRE PCR) were excluded. Culture and susceptibilities were identified by an EMR based report, compiled annually, and reported for two-year periods. Susceptibility rates were compared using the Chi-square test and Chi-square analysis for trends. Results There were 4 gram-negative and 5 gram-positive organism groups that met CLSI antibiogram criteria of ≥ 30 isolates and were included (tables 1-4). There were several significant differences in comparison to the hospital-wide antibiogram, with lower antibiotic susceptibility rates in the heme-onc units for multiple organisms, notably fluoroquinolones to E.coli and P. aeruginosa and several cephalosporins to Enterobacterales as well as penicillin and levofloxacin to Viridans group Streptococcus and vancomycin to E. faecium (tables 1&2). Over the period of 2012-2013 to 2021-2022, susceptibility rates remained stable among the heme-onc antibiogram, with few significant changes (tables 3&4). Conclusion Heme-onc antibiograms illustrated susceptibility rate differences compared to our hospital-wide antibiograms, particularly for antimicrobials used as prophylaxis. Through population-specific antibiograms, providers may be able to improve empiric antibiotic selection. Disclosures Christina G. Rivera (O'Connor), Pharm.D, Gilead Sciences: Board Member

Understanding the Lived Experience after Colectomy and Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: A Qualitative Study

Abstract BACKGROUND The patient experience after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) remains poorly defined, resulting in heterogeneity in clinical assessments and research. We performed a qualitative study to better understand the experience of patients after IPAA for UC, with a focus on the symptoms experienced by patients and the resultant effects on quality of life (QoL). METHODS We conducted semi-structured focus groups among patients who had undergone IPAA for UC. We invited patients with a variety of pouch-related conditions, including patients reporting normal pouch function and those with diagnosed inflammatory conditions of the pouch. We included questions on patients' experiences and symptoms after IPAA based on 4 thematic areas identified by a previously performed systematic review: bowel symptoms, activities, general issues and quality of life, and psychosocial. RESULTS We interviewed 15 individuals over the course of four focus groups. Participants described the significant impact that bowel symptoms after IPAA had on other activities including work and daily life, and their subsequent relation to QoL themes. Participants noted symptoms of frequency, urgency, and incontinence after IPAA, and many shared how these symptoms required them to change their lifestyle, particularly by altering their daily schedule or changing their diet. Nevertheless, most participants reported QoL improvement after IPAA. CONCLUSION In this qualitative study evaluating the experience of patients after IPAA, multiple bowel-related symptoms impact other areas of life and overall QoL. Patients undergoing IPAA for UC represent a unique patient population, and thus patient-centered outcome measures should be designed to standardize their assessment.

Diagnosis and Management of Cancers in Pregnancy: The Results of a Dual Battle Between Oncological Condition and Maternal Environment—Literature Review

Cancer during pregnancy presents considerable challenges that arise from various factors, including the diagnostic, prognostic and therapeutic implications of managing cancer in this unique patient population. There is a crucial need for an integrated approach that aligns medical interventions for both the pregnant patient and the developing embryo or fetus. Furthermore, the distinct characteristics associated with each stage of gestation may significantly influence the treatment protocols that can be proposed. Due to all of these factors, the importance of collaboration among healthcare professionals from different specialties (to ensure that both mother and child receive optimal care throughout the pregnancy) is often neglected. This review is designed to provide a thorough overview of the current standard procedures regarding the diagnosis and treatment options for cancer in pregnant patients in order to ensure the safety of mother and child. Furthermore, the review describes the feasibility of current fertility preservation methods, highlights the psychological effects of cancer during pregnancy and examines the risks and benefits of breastfeeding.

The internal jugular approach for baffle puncture and ablation of atrial arrhythmias in patients with atrial switch procedures: a retrospective analysis.

Patients with transposition of the great arteries (TGA) who undergo atrial switch procedures may develop symptomatic atrial arrhythmias necessitating ablation. We present a single-centre retrospective analysis of a novel approach using jugular access for catheter ablation in this unique patient population. A 5-year retrospective analysis was conducted on patients referred for atrial arrhythmia ablation following atrial switch procedures. Procedures were performed by experienced operators, and data on patient demographics, procedural characteristics, and outcomes were collected. Statistical analysis was performed to compare outcomes between jugular and femoral access groups. Jugular access (N = 9) and femoral access (N = 13) cohorts were comparable in age, gender distribution, and clinical characteristics. Procedural success rates were high in both groups, with no significant difference in recurrence rates. Jugular access demonstrated a comparatively safe profile compared to femoral access. The jugular approach offers a viable alternative to femoral access for atrial arrhythmia ablation in patients with atrial switch procedures. The trajectory from the internal jugular vein to the baffle is straightforward, reducing vascular complications. Success rates and procedural times were comparable, highlighting the feasibility and safety of the jugular approach. The option for rapid post-procedural mobilisation adds to its appeal. Atrial arrhythmia ablation with jugular access in patients with atrial switch procedures is safe and effective, providing an alternative in cases where femoral access may pose challenges. This approach warrants consideration in the management of atrial arrhythmias in this unique patient population.

Effectiveness and Safety of Dupilumab and Tralokinumab for Treating Atopic Dermatitis and Pruritic Skin Disorders in Oncological Patients: A Narrative Review.

Atopic dermatitis (AD) and pruritic skin disorders are increasingly recognized in cancer patients. The management of these conditions in patients with a history or with concomitant cancer presents unique challenges, as traditional systemic therapies may pose risks due to their immunosuppressive effects. In recent years, biologic agents such as dupilumab and tralokinumab have emerged as promising treatments for AD, offering targeted modulation of the immune response with potentially fewer systemic side effects. This article aims to review the current evidence on the safety and efficacy of dupilumab and tralokinumab in treating AD and pruritus among cancer survivors, addressing the potential benefits and considerations for this unique patientpopulation. A comprehensive analysis of the current medical literature was performed on the PubMed, Ovid, Scopus, Embase, and Cochrane Library databases until December 15, 2024. In conducting this narrative review, Medical Subject Headings (MeSH) terms and medical terminology related to clinical trials and real-life studies were employed, focusing on the pharmacological agents dupilumab, and tralokinumab. Patients with active or past cancer are typically excluded from clinical trials of new medications, complicating the evaluation of cancer progression or recurrence risks in these patients setting. The potential use of biologic drugs like dupilumab and tralokinumab in oncological patients marks a significant breakthrough for treating conditions such as eczema and pruritus, which are common in this patient group. Although there are no explicit contraindications for using dupilumab and tralokinumab in patients with active cancer or a history of malignancy, there is no definitive guidance on their use in such cases. Real-world data is emerging, facilitated by collaboration between dermatologists and oncologists, supporting the effectiveness and safety of dupilumab and tralokinumab for managing AD in cancer patients. Nonetheless, larger studies with longer follow-up periods and dedicated pharmacovigilance programs are needed to substantiatethesefindings.

Breast Implant Surgery: The Importance of Informed Health Care Decisions and Outcome Monitoring.

Breast implant surgery is a popular, globally performed, and frequently requested cosmetic and reconstructive surgical procedure. Breast implant surgery can cause implant-associated systemic symptoms and types of implant-associated cancers, so it is vital to monitor patient outcomes. Most patients who undergo breast implant surgery do not experience health problems. However, patients who do experience health problems as a result of breast implant surgery form a unique patient population. When plastic and aesthetic surgeons, nurses, and other healthcare providers are knowledgeable and experienced in recognizing and treating patients with health problems related to breast implant surgery, the health outcomes of this patient population improve. This article aims to promote informed decision-making and increase patient safety by providing information about the health problems associated with breast implant surgery. This article also highlights recent safety announcements and updates from the United States Food and Drug Administration (FDA). Ensuring the safety of patients undergoing breast implant surgery is a responsibility shared by plastic and aesthetic surgeons, nurses, and other healthcare providers; the general medical community; breast implant manufacturers; and the FDA. These entities must collaborate and coordinate as a united group to accomplish this important goal. The nursing profession can contribute to these collaborative efforts by serving as professional liaisons to these entities and advocating for continued collaborative efforts to increase the safety of patients who have undergone breast implant surgery.

The Role of GLP-1 Agonists in Esthetic Medicine: Exploring the Impact of Semaglutide on Body Contouring and Skin Health.

Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, have revolutionized the treatment of diabetes and obesity by promoting significant weight loss through incretin effects. However, rapid weight reduction induced by these medications often leads to esthetic challenges, including facial volume loss, skin laxity, and body contour irregularities. This commentary reviews the esthetic consequences of GLP-1-induced weight loss and explores solutions for managing these concerns in clinical practice. This review synthesizes available literature and clinical observations to identify key esthetic concerns associated with GLP-1-induced weight loss. It examines various treatment modalities, including dermal fillers, biostimulatory agents, energy-based devices, and surgical procedures. The discussion highlights gaps in empirical data, optimal timing for interventions, and the need for personalized, multimodal treatment strategies. Imaging tools and psychological support are also considered as complementary approaches. As GLP-1 agonists become a cornerstone in obesity management, their esthetic implications necessitate a proactive response from esthetic practitioners. Effective management of facial volume loss, skin laxity, and body contour challenges requires a combination of injectable treatments, energy-based devices, and, in some cases, surgical interventions. Future research should focus on understanding the molecular mechanisms of skin and fat changes and developing standardized guidelines for treating this unique patient population. Additionally, a holistic approach that addresses both physical and psychological outcomes is critical to ensuring patient satisfaction and long-term well-being.

Implementation of Diabetic Remote Patient Monitor for Underserved Population.

A nurse-led interprofessional clinic adopted the use of remote patient monitoring (RPM) for glucose monitoring to better serve their patient population of uninsured patients with uncontrolled diabetes. The adoption of the RPM system required an infrastructure design to connect multiple data points and adapt to the needs of the clinic's unique patient population for a seamless provider and patient experience. Implementation requirements were addressed in three phases: protocol adaptation, enrollment workflow, and clinic management of RPM patients.

A Systematic Review and Meta-Analysis of the Safety and Efficacy of SGLT2 Inhibitors in Chronic Heart Failure in ACHD Patients.

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have become a first-line therapy for heart failure (HF) in adults. However, data on their use in HF associated with adult congenital heart disease (ACHD) are limited. This systematic review and meta-analysis evaluated the safety, tolerability, and efficacy of SGLT2is in ACHD HF patients, supplementing guideline-directed medical therapy. A comprehensive systematic search and meta-analysis were conducted on studies examining SGLT2i use in ACHD HF patients. The primary endpoint was the change in the New York Heart Association (NYHA) functional class (FC), with secondary endpoints including changes in ventricular function and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels. Additionally, the safety and tolerability of SGLT2is were evaluated. The meta-analysis included eight studies with 287 patients aged 19-67 years (median age 37.5 years). Adding SGLT2is to combined therapies significantly improved NYHA FC (log odds ratio 1.3, 95% confidence interval [CI] 0.37-2.23, p = 0.01) and reduced NT-proBNP levels (mean difference [MD] -0.43, 95% CI -0.70 to -0.16, p < 0.001). A notable decrease in systolic blood pressure was observed (MD -0.32, 95% CI -0.51 to -0.14, p = 0.00). The adverse effect profile was comparable to that seen in routine HF, with fewer HF hospitalizations post-SGLT2i initiation. Urinary tract infections occurred in 14 patients (5%), with no instances of hypoglycemia or ketoacidosis reported. Medication withdrawal due to adverse effects was noted in 19 patients (7%). SGLT2is are well tolerated in ACHD HF patients. Notably, SGLT2is improved NYHA FC and reduced NT-proBNP levels across a diverse ACHD HF patient cohort. However, further prospective, multicenter studies are needed to confirm the safety and efficacy of SGLT2is in this unique patient population.

In-field prostate cancer recurrence following radical prostatectomy and salvage radiation.

To define the natural history, patterns of recurrence and treatment modalities for local prostate cancer (PCa) recurrence following radical prostatectomy (RP) and radiation therapy (RT), and to investigate factors that could predict metastasis-free survival (MFS) in this unique patient population. We queried a prospectively maintained PCa registry to identify men developing in-field recurrence (IFR) following RP and RT from 2008 to 2021 at a single institution. IFR was defined as biopsy-proven recurrent PCa or the presence of persistent positron emission tomography-avid lesions in the prior radiation field without evidence of metastasis. Cox regression was conducted to determine predictors of MFS. Kaplan-Meier methods were used to calculate MFS, cancer-specific survival (CSS) and overall survival (OS) for patients in three primary therapy categories: cryoablation, androgen deprivation therapy (ADT) alone, and surveillance. Of 4575 patients from our registry, 108 (2.3%) with IFR were identified. The median (interquartile range [IQR]) time to IFR from salvage treatment was 78 (50-126) months. A total of 29 patients (26%) were managed with cryoablation, 23 (21%) with ADT, and 28 (25%) with surveillance. The median (IQR) follow-up was 76 (48-100) months. There were no statistically significant differences in MFS (P = 0.67) or OS (P = 0.07) among the three primary treatment cohorts. Patients treated with ADT or cryoablation had longer CSS compared to patients managed with surveillance (P = 0.047). We found that IFR may present years after completion of primary treatment for PCa. While curative management strategies may be attempted, local and distant metastatic recurrence is common and often requires systemic therapy.

Risk factors for hospitalization in subspecialty patients with severe persistent asthma

Background and objectivesChildren with severe persistent asthma managed by subspecialists represent a unique patient population. The factors predisposing these children to hospital admission are poorly understood. This study aimed to identify factors associated with future emergency department (ED) visits and hospitalization in this group. MethodsA chart review was conducted for children with severe persistent asthma evaluated by a pulmonologist between January 1, 2021 and June 30, 2022. Asthma-related ED visits and hospitalizations were recorded from electronic medical records. Chi-square testing, mixed effects modeling, and logistic regression were used to analyze associations between patient characteristics and hospitalization. A secondary analysis evaluated factors contributing to ED visits. ResultsWe identified 244 unique patients with 487 pulmonary clinic visits. Of these, 56 % were black, 58 % had public insurance, and 32 % had a history of ICU admission for asthma. In the 12 months following a clinic visit, 84 (34 %) patients had an ED visit, and 46 (19 %) had at least one hospitalization. Secondhand smoke exposure (OR 2.74, 95 % CI 1.16–6.45), public insurance (OR 3.37, 95 % CI 1.46–7.82), and prior ICU admission (OR 2.29, 95 % CI 1.09–4.79) were positively associated with hospitalization for asthma exacerbation. Among hospitalized patients, bronchopulmonary dysplasia (BPD) and gastroesophageal reflux disease (GERD) were linked to shorter time to admission. ConclusionsDespite subspecialty care, children with severe persistent asthma exposed to cigarette smoke, with prior ICU admission, or with public insurance are at higher risk of subsequent ED visits and hospitalization. These findings will inform targeted interventions to prevent hospitalization in this patient population.

Patient-Reported Outcomes in RLBP1 Retinal Dystrophy: Longitudinal Assessment in a Prospective Natural History Study.

To evaluate the performance of two non-disease-specific patient-reported outcome (PRO) instruments, the National Eye Institute Visual Function Questionnaire-25 (VFQ-25) and the Low Luminance Questionnaire (LLQ), in patients with retinaldehyde-binding protein 1 retinal dystrophy (RLBP1 RD). PROs were assessed using the VFQ-25 and LLQ. Rasch analysis was conducted to estimate person and item measures of the VFQ-25 and LLQ questionnaires to determine the association between the two PROs. In addition, the association between these two instruments and their correlations to weighted measures of visual function and disease progression were analyzed in this three-year PRO-focused sub-study of a five-year prospective natural history study. Forty-two patients participated, with most of them having completed at least two PRO follow-up visits at least one year apart. The mean VFQ-25 scores were lowest for distance activities (39.2-49.0) and peripheral vision (37.5-52.4), with mean LLQ subscale scores generally low (<41), except for the emotional distress subscale. Using Rasch analysis, calibrated item and person measures along with their standard errors were estimated for both ePROs. This indicated that the distribution of the VFQ-25 and LLQ item measures well covered the distribution of person function in this group. This suggests that the item difficulties well cover the person-level performance in this population. As well, the two PROs showed a strong and significant correlation at all assessed time points as assessed with Pearson correlation coefficient (0.81, 0.91, 0.81 and 0.87 at baseline, 1/1.5, 2/2.5 (P < 0.001) and 3/3.5 years (P = 0.002)). The composite scores of both PRO questionnaires strongly correlated with clinical measures of visual function. At 2 to 2.5 years of follow-up, meaningful statistically significant declines in peripheral vision (both VFQ-25 and LLQ), distance vision (VFQ-25), and extreme lighting in dark and bright light (LLQ) subscales were noted. This study demonstrated a strong association between VFQ-25 and LLQ scores and their association with clinical measures of visual function. PRO instruments can provide insights into the specific disabilities of this unique patient population and help to guide appropriate outcome measures for future clinical trials.

Abstract 4144553: Fully Automated Machine Learning Based Echocardiographic Assessment of Global Longitudinal Strain in Breast Cancer Patients Receiving Cardiotoxic Chemotherapy

Background: Global longitudinal strain (GLS) is considered the most sensitive echocardiographic marker for detecting cardiotoxicity and subclinical changes in cardiac function in patients receiving cardiotoxic therapies. Despite literature that has shown less inter-observer variability for GLS compared to left ventricular ejection fraction, there remains significant variability in GLS measurement across observers and vendors. US2.AI is a novel, machine learning-based artificial intelligence (AI) algorithm for automated echocardiographic interpretation. We aim to demonstrate the feasibility of AI-based GLS assessment and hypothesize that AI-based GLS measurement is more reproducible compared to human-based measurement Methods: A total of 27 transthoracic echocardiograms were selected at random from a population of female cardio-oncology breast cancer patients and were run through the US2.AI algorithm twice to calculate GLS. The same echocardiograms were then analyzed by two board-certified cardiologists in a blinded fashion to calculate GLS using QLAB software (Philips). The two methods of GLS measurement (AI versus humans) were compared using linear regression, as assessed by the Pearson correlation coefficient. Reproducibility for each method was assessed using the intra-class correlation coefficient (ICC). Results: A total of 27 studies were analyzed with a mean age of 55.6 ± 11.3 and all patients were female. The feasibility of US2.AI for the assessment of GLS was demonstrated with a strong correlation between AI-based and human reads (r = 0.80, p &lt; 0.00001). The reproducibility of AI-based GLS assessment was superior to that of human readers as assessed by an ICC of 1.0 versus 0.52, respectively. Conclusion: AI-based assessment of GLS was shown to be both feasible and more reproducible compared to expert human readers in a population of breast cancer patients receiving cardiotoxic chemotherapy. Given the important clinical implications of GLS in cardio-oncology patients, more widespread implementation of AI-based strain assessment has the potential to significantly improve the reproducibility of GLS measurement in this unique patient population.