University Of Alabama In Birmingham Research Articles

Bibliometric analysis of mucosal immunity in IgA nephropathy from 1990 to 2022.

The study aimed to conduct a bibliometric analysis of mucosal immunity in IgA nephropathy (IgAN) and indicate its current status, hot sopts, and direction of future studies. The literature data was collected from the Web of Science Core Collection. CiteSpace 6.1.R3 was employed to conduct a visualization bibliometric analysis of mucosal immunity in IgA nephropathy, including authors, countries, journals, keywords, organizations, references, the bursts of keywords and references, and the timeline of keyword clusters and reference clusters. A total of 315 publications from 1990 to 2022 were included. The number of articles in this field has increased in recent years. Suzuki H, Coppo R, and Feehally J took the first place parallelly with 18 articles. Japan contributes the most articles, accounting for 27.3% of all the publications. The institutions with the most publications were Juntendo University and University of Alabama Birmingham. 453 keywords were concluded in the analysis, which mainly focus on the mucosal pathogenesis and therapy of the IgAN. The top five co-cited reference cluster are "aberrantly glycosylated IgA," "corticosteroids," "animal models," "o-glycosylationm" and "microRNA-630." The most recently burst of keyword is "tonsillectomy" and "gut." This was the first bibliometric analysis to systematically analyze the mucosal immunity in IgAN, which obtained the current status and indicated the future research hotspots and development trends. The gut microbiota and the related therapy-targeted mucosal immunity might be the future research hotspot.

Addressing Reproductive Education Among Young Adults with Sickle Cell Disease (SCD): Sickle Cell Reproductive Outreach and Education (ROE) Project

Background: As children with sickle cell disease (SCD) survive into adulthood, it is important to address emerging reproductive health concerns. This population faces unique fertility challenges, including balancing the desire for biological parenthood, risk of pregnancy-associated complications, unintended pregnancy, and fertility concerns with the use of SCD modifying therapies (DMTs) (Smith-Whitley, Blood, 2014, Pecker, Br J Haematol, 2021) . Recent research identified knowledge gaps that impact reproductive care for adults with SCD (Carrithers, Frontiers, 2023). To overcome these gaps, we need to evaluate the baseline knowledge of young adults with SCD regarding reproduction to understand the complex implications of reproductive decision-making. This study was done to gauge young adults' knowledge of reproduction, understanding of fertility, and current reproductive behaviors in order to develop educational material to support young adults' with SCD reproductive decisions. Methods: This IRB-approved, cross-sectional study included young adults living with SCD (ages 18-35) from University of Alabama-Birmingham's Lifespan Comprehensive SCD Center. Patients were recruited during routine clinic visits to complete an electronic 33-question survey to evaluate reproductive health topics adapted from the Sisters Informing Sisters About AIDS (SISTA) questionnaire (CDC, 2008), including demographics (age separated into younger age (18-25) and older age (26-35), sexual health behaviors (contraception, sexually transmitted infection (STI) prevention), family planning, patient advocacy, and attitudes towards reproductive education. Responses were recorded as “Yes, No, Don't Know”, unless questions specifically asked for participants to choose an option. Attitudes toward reproductive education were graded on 5-point Likert scale (1= strongly disagree to 5=strongly agree). Data analysis includes averages to evaluate subgroup comparisons and independent student's t-test to compare subgroups with statistical significance set at p<0.05. Results: We enrolled 47 participants (55% women and 51% were of older age). In this cohort, 87% completed high school and 60% were sexually active. Among those who were sexually active, 86% had previously undergone STI testing and 36% had prior history of STI (22% men vs. 77% women, 22% younger age vs. 77% older age, p<0.05). Thirty-eight percent identified personal or partner contraceptive use. Regarding children, 19% had birthed/fathered a child(ren) (55% men vs. 45% women, 22% younger age vs. 77% older age, p>0.005) among whom 11% knew their child had SCD, 55% knew their child had sickle cell trait (SCT), and 33% did not know if their child had SCD/SCT. Only 26% were aware of contraceptive options for people with SCD (17% men vs. 83% women, p<0.05). Importantly, 89% recognized high risk sexual activity as a risk factor for STIs but no one in the cohort recognized the risk of infertility due to STIs. When asking about their partners, 32% knew if their partner had SCD/SCT (20% men vs. 80% women, p<0.05). Notably, 79% desired biologic children. Among those who desired children, 41% felt that their SCD changed their decision to have children and 26% were previously told they could not have children due to SCD (12% men vs. 88% women, 25% younger age vs. 75% older age, p<0.05). Notably, 57% were interested in conceiving if pregnancy was planned (41% men vs. 59% women, 37% younger age vs. 63% older age, p<0.05). When asked if patients wanted to discuss their reproductive health, 87% wanted to discuss this with their hematologist but only 51% would discuss this with PCPs. Conclusion: In this study, we identified evaluated 4 tenets of reproductive health knowledge: contraceptive use, STI prevention, family planning, and patient advocacy. We identified gaps in knowledge in these areas that can be addressed to improve reproductive education in young adults with SCD. Young adults with SCD in our cohort have low contraceptive use and were often not aware of contraceptive options for people with SCD or their partner's SCD/SCT status. Our cohort also reported a significant history of STI but was unaware of the associated increasing risk for infertility. Importantly. young adults are especially interested in discussing reproductive health with their hematologists, which provides an opportunity to improve reproductive education within this unique population.

A bibliometric analysis of complement in IgA nephropathy from 1991 to 2022.

Introduction: IgA nephropathy is a common glomerular disease on a global scale, which has resulted in significant economic burdens. The complement system plays a vital role in enhancing the efficacy of antibodies and phagocytic cells in eliminating microbes and damaged cells, and promoting inflammation. Complement activation has been found to contribute to the progression of various renal diseases, including IgA nephropathy. Methods: In this study, a thorough analysis was conducted on publications related to complement in IgAN from 1991 to 2022, retrieved from the Web of Science Core Collection and Scopus database. The analysis focused on various aspects such as annual publications, country, institution, author, journal, keywords, and co-cited references, utilizing Citespace and Vosviewer. Results: A total of 819 publications were obtained, and while there were slight fluctuations in annual publications, an overall upward trend was observed. China, Japan and the United States were the leading countries in terms of publications, with China having the highest number of publications (201). Collaborative network analysis revealed that England, University of Alabama Birmingham, and Robert J Wyatt were the most influential country, institution, and author, respectively, in this field of research. Furthermore, the analysis of references and keywords indicated that complement activation contributes to IgAN, and immunosuppression in IgAN are a hot topic of research. Discussion: This study identifies current research hotspots and advanced tendencies in the study of complement in IgAN, providing scholars with crucial directions in this research area.

A clinical application of fair value estimate (FVE) for R50%: Separating overlapping 50% isodose volumes in single isocenter multiple targets SRS.

In the treatment of single isocenter multiple targets (SIMT) stereotactic cranial cases with linac-based, multi-leaf collimated delivery, one encounters cases when the 50% isodose clouds (IDC50%s) of planning target volumes (PTVs) in close proximity overlap and cannot easily be separated. In such cases, it is difficult to assign an IDC50% to each individual PTV, which is necessary to allow evaluation of individual PTV intermediate dose spill for comparison to established intermediate dose spill metrics for plan quality assessment. The Fair Value Estimate (FVE) for R50% (R50%FVE ) is a method to unambiguously apportion the overlapping volume of IDC50% to allow calculation of the intermediate dose spill metric R50% (defined as volume of IDC50% / volume of PTV). Full application of R50%FVE requires knowing the surface area of the PTVs. Since surface area information is not always available, we develop a spherical PTV approximation to R50%FVE-sphere and compare this to R50%FVE . Then we apply the R50%FVE-sphere to clinical data from the University of Alabama, Birmingham (UAB) that catalogs 68 PTVs from various SIMT plans with overlapping IDC50%. The UAB dataset reports intermediate dose spill as Falloff Index. While Falloff Index looks mathematically equivalent to R50%, the Falloff Index attributes the "entire overlapping IDC50% of PTVs in close proximity" to each individual PTV in the cluster. R50%FVE-sphere provides a value that is conceptually correct and numerically smaller relative to the Falloff Index data reported by UAB in all cases. This reprocessing of the UAB data places many of the PTVs with very high intermediate dose spill within recently proposed R50% guidelines.

Feasibility of the Poverty-Targeted Pediatric Cancer Resource Equity (PediCARE) intervention.

10009 Background: Children with cancer living in poverty are more likely to relapse and die, even when treated uniformly on clinical trials. No evidence-based interventions targeting poverty as a risk factor for disparate outcomes exist in pediatric oncology. We previously developed and refined the Pediatric Cancer Resource Equity (PediCARE) intervention—a centrally-delivered, household material hardship (HMH)-targeted intervention that provides transportation and groceries to low-income pediatric oncology families. We report feasibility of administering PediCARE as a randomized intervention across 2-centers. Methods: We conducted a pilot randomized controlled trial (RCT) of PediCARE versus usual care at Dana-Farber Cancer Institute (DFCI) and University of Alabama Birmingham (UAB) between May 2019 and August 2021 (NCT03638453). Eligible participants included children age < 18 years with de novo cancer diagnosed in the prior 2-months, who were planned to receive at least 4-cycles of chemotherapy and lived in a household that screened positive for HMH (food, housing, utility or transportation insecurity). Participants were randomized 1:1 by site to receive PediCARE or usual care for 6-months. Parent/guardians completed a household survey at baseline and at completion of the 6-month intervention. The primary outcome was feasibility defined a priori as a recruitment and consent to randomization rate of > = 75% and < 20% attrition per arm—endpoints intended to justify the feasibility of a subsequent efficacy RCT. Secondary outcomes included proportion of recipients who successfully received the intervention and intervention acceptability. Results: A total of N = 40/40 eligible families (n = 12 UAB; n = 28 DFCI) were approached and offered an opportunity to participate (100% consent rate). Among participants, there was 0% attrition in either arm following randomization and the 6-month intervention period; 100% of parent/guardians completed both baseline and 6-month surveys. Among those randomized to PediCARE, 100% (n = 20) successfully received grocery and transportation resources; 100% reported that it was "easier to buy food for my family," 85% reported it was easier to get to and from the hospital, and 95% reported they would be “very likely to recommend the intervention to other families”. Conclusions: Stark disparities exist in pediatric oncology. Advancement in health equity science must include establishment of a robust, evidence-based portfolio of scalable health equity interventions for evaluation in the Children’s Oncology Group (COG) drug trial setting. Findings from this pilot RCT support feasibility and utility of a poverty-targeted intervention from the clinical oncology setting—as evidenced by 100% of parent/guardians consenting to randomization with 0% attrition across 2-centers. Immediate next steps include randomized efficacy evaluation in a COG trial-embedded study. Clinical trial information: NCT03638453 .

Assessment of Neurodevelopment in Infants With and Without Exposure to Asymptomatic or Mild Maternal SARS-CoV-2 Infection During Pregnancy

Associations between prenatal SARS-CoV-2 exposure and neurodevelopmental outcomes have substantial public health relevance. A previous study found no association between prenatal SARS-CoV-2 infection and parent-reported infant neurodevelopmental outcomes, but standardized observational assessments are needed to confirm this finding. To assess whether mild or asymptomatic maternal SARS-CoV-2 infection vs no infection during pregnancy is associated with infant neurodevelopmental differences at ages 5 to 11 months. This cohort study included infants of mothers from a single-site prospective cross-sectional study (COVID-19 Mother Baby Outcomes [COMBO] Initiative) of mother-infant dyads and a multisite prospective cohort study (Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 in Pregnancy and Infancy [ESPI]) of pregnant individuals. A subset of ESPI participants was subsequently enrolled in the ESPI COMBO substudy. Participants in the ongoing COMBO study were enrolled beginning on May 26, 2020; participants in the ESPI study were enrolled from May 7 to November 3, 2021; and participants in the ESPI COMBO substudy were enrolled from August 2020 to March 2021. For the current analysis, infant neurodevelopment was assessed between March 2021 and June 2022. A total of 407 infants born to 403 mothers were enrolled (204 from Columbia University Irving Medical Center in New York, New York; 167 from the University of Utah in Salt Lake City; and 36 from the University of Alabama in Birmingham). Mothers of unexposed infants were approached for participation based on similar infant gestational age at birth, date of birth, sex, and mode of delivery to exposed infants. Maternal symptomatic or asymptomatic SARS-CoV-2 infection. Infant neurodevelopment was assessed using the Developmental Assessment of Young Children, second edition (DAYC-2), adapted for telehealth assessment. The primary outcome was age-adjusted standard scores on 5 DAYC-2 subdomains: cognitive, gross motor, fine motor, expressive language, and receptive language. Among 403 mothers, the mean (SD) maternal age at delivery was 32.1 (5.4) years; most mothers were of White race (240 [59.6%]) and non-Hispanic ethnicity (253 [62.8%]). Among 407 infants, 367 (90.2%) were born full term and 212 (52.1%) were male. Overall, 258 infants (63.4%) had no documented prenatal exposure to SARS-CoV-2 infection, 112 (27.5%) had confirmed prenatal exposure, and 37 (9.1%) had exposure before pregnancy or at an indeterminate time. In adjusted models, maternal SARS-CoV-2 infection during pregnancy was not associated with differences in cognitive (β = 0.31; 95% CI, -2.97 to 3.58), gross motor (β = 0.82; 95% CI, -1.34 to 2.99), fine motor (β = 0.36; 95% CI, -0.74 to 1.47), expressive language (β = -1.00; 95% CI, -4.02 to 2.02), or receptive language (β = 0.45; 95% CI, -2.15 to 3.04) DAYC-2 subdomain scores. Trimester of exposure and maternal symptom status were not associated with DAYC-2 subdomain scores. In this study, results of a novel telehealth-adapted observational neurodevelopmental assessment extended a previous finding of no association between prenatal exposure to maternal SARS-CoV-2 infection and infant neurodevelopment. Given the widespread and continued high prevalence of COVID-19, these data offer information that may be helpful for pregnant individuals who experience asymptomatic or mild SARS-CoV-2 infections.

MULTİPLE SKLEROZ’DA REHABİLİTASYONUN BİLİMSEL HARİTALAMA YÖNTEMİYLE ANALİZİ

This study is about scientific analysis of Multiple sclerosis rehabilitation. For this purpose, scientific mapping method was used in the analysis of publications. Scientific studies published in the Web of Science (WoS) database on rehabilitation in patients with multiple sclerosis between 1986-2021 were analyzed by bibliometric analysis method. VOSviewer package program was used to analyze the data. The data were analyzed in terms of variables such as the author of the publications, countries, active journal, citations, institutions, keywords. As a result of the study, regarding the publications on multiple sclerosis and its rehabilitation; the highest number of studies were published between 2018-2021, with the USA in the first place in this regard; Researchers affiliated with the University of Alabama Birmingham have the most publications on this subject; most publications were published in the journal Disability and Rehabilitation; the researcher who contributed the most to the subject is Robert W. Motl; It was seen that the most cited publication on multiple sclerosis belongs to Kurtzke JF. From Turkey, Idiman E. is at the forefront of the names that contribute to this field. As a result of the findings, it has been observed that the publications on multiple sclerosis and its rehabilitation have increased in recent years. This study can provide researchers with useful information about research directions and limitations, and coauthorship of publications. Focus on research base and collaborations should be increased for high quality multiple sclerosis rehabilitation studies.

Meet the First Authors.

Meet the First Authors.

Abstract IA013: Disparities in uterine cancer incidence and mortality

Abstract Background: Hysterectomy-corrected uterine cancer incidence rates increased have increased by about 1% per year in the U.S. from 2003-2015, with the sharpest increases observed among Hispanic, non-Hispanic Asian, and non-Hispanic Black women, respectively. These increases have been primarily related to rates of aggressive non-endometrioid subtypes, which have been increasing among all women and are particularly high among Non-Hispanic Black women. Non-Hispanic Black women also have substantially lower survival, irrespective of stage at diagnosis or histologic subtype. To follow-up on these findings, we conducted an incidence-based mortality analysis to evaluate subtype- and stage-specific uterine cancer mortality rates by race and ethnicity. Methods: We used the U.S. Surveillance, Epidemiology, and End Results (SEER)-18 Incidence-Based Mortality database, with hysterectomy correction based on hysterectomy prevalence data from the Behavioral Risk Factor Surveillance System. We included uterine cancer deaths occurring between 2010-2017 among cases diagnosed between 2000-2017. Uncorrected and corrected mortality rates were age adjusted to the 2000 US standard population and expressed per 100,000 person-years according to tumor histology, stage at diagnosis, and race and ethnicity. Annual percent changes in rates were calculated using log-linear regression. Results: There were 16,797 uterine cancer deaths between 2010-2017, corresponding to a hysterectomy-corrected mortality rate of 15.7 per 100,000 person-years. Rates were highest among Blacks, overall, by histologic subtype, and stage at diagnosis. Among all women, uterine cancer mortality rates increased significantly by 1.8% per year from 2010-2017, as did rates of non-endometrioid carcinomas (2.7%), with the sharpest increases occurring among Hispanics (6.7%), followed by Blacks (3.5%), Asians (3.4%), and Whites (1.5%). In contrast, endometrioid carcinoma mortality rates remained stable over time. Conclusions: The underlying causes for the significant increase of non-endometrioid uterine carcinoma mortality rates, aligning with recent incidence trends, are not understood. Collectively, our findings underscore the importance of understanding the factors that contribute to the remarkable rise in non-endometrioid carcinoma incidence among all women, and the disproportionately higher incidence of these subtypes among Black women. We intend to follow-up these findings in our clinical study, DETECT, in collaboration with the University of Alabama Birmingham. Citation Format: Megan A. Clarke. Disparities in uterine cancer incidence and mortality [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA013.

Dr. Bobby Wilson and Southeastern Geographer

Dr. Bobby Wilson and Southeastern Geographer Brian Williams (bio) Professor Bobby Wilson’s enduring and paradigm-shifting influence on the geographical study of race and the United States South is evident in his longstanding engagement with the Southeastern Division of the American Association of Geographers, and his extensive contributions to this journal. The lifetime of scholarship that he leaves behind is a testament to his unwavering commitment to critically understanding and situating racism, resistance, and Black experience historically, and geographically. His scholarship is remarkable in its attention to both the everyday dimensions of racism, and the multiscalar political-economic relations that shape and reconstitute place and region. Dr. Wilson took a job at the University of Alabama-Birmingham in 1974, and published six articles in Southeastern Geographer over the next three decades (Wilson 1977, Wilson 1985, Wilson 1989, Wilson 1995, Wilson 2002a, Wilson 2007). As Dr. Wilson recounted in a 2019 interview, when he first moved to Birmingham, he frequented the public library downtown for his research. There, on a wall in the southern history section, he noticed a racial zoning map: They didn’t try to hide it…for a number of years it stayed up there. And that was a pivotal moment in my research. I finally figured out what I needed to do. And that’s where it all began. Birmingham. The industrial city of the South. Also one of the most significant places in the civil rights struggle. The dogs. The water hoses turned loose on kids remains a vivid issue in our heads today…I started from that point, I started from that particular point (Wilson 2019). His scholarly commitment to geographies of justice in the South started with place — in a library, in Birmingham, with racial zoning maps and the brazenly displayed injustice of institutionalized inequity — and tirelessly worked to situate, to reveal, to explain, and to denaturalize oppression. This anti-essentialist attention to tracing, contextualizing, and situating the geographies of racism and injustice animated his subsequent work. His project of “critically understanding race-connected practices” (Wilson 2002b, 32), as he would later term it, represented a lifetime of scholarship that transformed and enlivened both Southeastern Geographer and the discipline of geography more broadly. His first article in Southeastern Geographer looked at segregation patterns and the role of multifamily housing units and single family housing in housing opportunities for Black families in Birmingham (Wilson 1977). This article exhibited Dr. Wilson’s meticulous attention to the ways that racism takes place and shapes space. Though written in [End Page 192] the language of spatial science that dominated urban geographical scholarship in the pages of this journal at that time, this article exemplified his keen attention to the deep historical dynamics that shape racially uneven outcomes. Though in one sense modest in its scope and claims, this intervention represented a radical challenge to the work that dominated the pages of Southeastern Geographer at the time. In fact, readers of that issue of Southeastern Geographer would have first encountered Merle Prunty’s 1976 presidential address to SEDAAG, a sweeping discourse on southern industrialization, modernization, and culture, which universalizes the perspective of white southern men as the view of “the southerner” (Prunty 1977). Dr. Wilson published his second article in Southeastern Geographer at the height of the Reagan era, focusing on the history and reality of racial segregation in Birmingham, and its implications for Black residents of Birmingham (Wilson 1985). A crucial part of this history was the Medical Center Expansion Urban Renewal Project, which displaced almost 1,000 Black families to make way for the UAB medical center. Dr. Wilson only briefly mentions this fact in his article, but the brief implication of his employing institution must have represented a conscious decision, one borne of conviction and a scholarly dedication to justice. Although these first articles were couched in the conventional language of spatial science, they were strategic and important interventions, guided by his enduring commitment to people and place in Birmingham. They were also radical departures from the standard fare of Southeastern Geographer. From 1977 to 1985, the years of his first and second articles in Southeastern Geographer, there were only eight articles that focused on...

Clinical outcomes in COVID-19 patients with cancer who are treated with chemo- or immunotherapy.

e18699 Background: Cancer patients infected with COVID-19 are very vulnerable to increased complications and mortality while actively being treated with chemotherapy or immune checkpoint inhibitors (ICIs). The full impact of COVID-19 infections on this subset of patients has not been fully defined. Our goal was to track clinical outcomes in patients with an underlying malignancy and COVID-19 infection who received chemotherapy or ICIs. Methods: We performed a retrospective chart review of 121 patients (age > 18 years) at the University of Alabama-Birmingham from January 2020 till November 2021 with an advanced solid malignancy that were treated with chemotherapy or ICIs within 12 months of their COVID-19 diagnosis. The aim of this study was to track clinical outcomes including: hospitalization rates, ICU admissions, treatments, and deaths of any cause. Results: A total of 121 patients were examined in this study and 61 received immunotherapy treatment within 12 months. The median age at diagnosis for the ICI group was 62.3 years and 54% were male while for the patients that receive chemotherapy the median age at diagnosis was 65.1 years and 53% were male (Table1). The 3 most common cancers represented in the ICI cohort were lung (30%, NSCLC), liver (13%, HCC) and renal (11%, RCC). While in the chemotherapy group, the 3 most cancers were NSCLC (40%), HCC (12%,), and head & neck (10%, H&N). 25% of patients on ICIs died while only 13% of patients died post chemotherapy. Of the ICI patients that died, 33% were admitted to the intensive care unit (ICU) and 53% received oxygen, steroids and antiviral therapy. For the chemotherapy patients that died, 25% were admitted to the ICU and 50% received oxygen, steroids and antiviral therapy. Patients with lower ECOG (0.98) had lower mortality compared to patients with worse functional status (0.98 vs 1.52; t = 3.20; p < 0.01). Factors associated with increased admission were higher ECOG (1.07 vs 1.67; f = 3.05; p = 0.05), higher AST (21.2 vs 40.9, f = 10.2; p < 0.001), lower absolute lymphocyte count (1122.8 vs 408.9, f = 5.99; p < 0.01) and higher oxygen needs (0.02 vs 1.11, f = 29.5; p < 0.001). Conclusions: ICI mortality was higher compared to patients receiving chemotherapy, especially for those with reduced functional status. Factors for hospitalization included: higher ECOG, higher AST, lower lymphocyte count and increased oxygen needs. However, further investigation still needs to be undertaken to understand if the PD-1-PD-L1 pathway with the subsequent inflammatory cascade post COVID-19 can impact overall survival.[Table: see text]

The World Society for Pediatric and Congenital Heart Surgery: 2021 Update of the World Database for Pediatric and Congenital Heart Surgery.

The World Database for Pediatric and Congenital Heart Surgery (WDPCHS), sponsored by the World Society for Pediatric and Congenital Heart Surgery (WSPCHS), provides complex programmatic outcomes analyses for all members of the WSPCHS. The Data center, currently at Kirklin Institute for Research in Surgical Outcomes (KIRSO), University of Alabama, Birmingham (USA), provides biannual reports to all active members of the database. This report presents a descriptive analysis of these procedures submitted from January 1, 2017 to December 31, 2020. A total of 37,386 procedures were submitted with an overall mortality of 4.3%. The majority of submissions were from Asian countries. The majority of cases submitted from these countries were of Society of Thoracic Surgeons (STS)-European Association for Cardio-Thoracic Surgery (STAT) Mortality Categories I and II. The WSPCHS accomplished one of its missions in 2017 when the WDPCHS began accepting data from pediatric and congenital heart surgery programs across the globe. In doing so, it became one of the first organizations to create a platform for the exchange of knowledge and experience, regardless of the socioeconomic status of the particular program or country.

Commissioning a multileaf collimator virtual cone for the stereotactic radiosurgery of trigeminal neuralgia.

A multileaf collimator (MLC), virtual‐cone treatment technique has been commissioned for trigeminal neuralgia (TGN) at Tri‐Cities Cancer Center (TCCC). This novel technique was initially developed at the University of Alabama in Birmingham (UAB); it is designed to produce a spherical dose profile similar to a fixed, 5‐mm conical collimator distribution. Treatment is delivered with a 10‐MV flattening‐filter‐free (FFF) beam using a high‐definition MLC on a Varian Edge linear accelerator. Absolute dose output and profile measurements were performed in a 20 × 20 × 14 cm3 solid‐water phantom using an Exradin W2 scintillation detector and Gafchromic EBT3 film. Dose output constancy for the virtual cone was evaluated over 6 months using an Exradin A11 parallel plate chamber. The photo‐neutron dose generated by these treatments was assessed at distances of 50 and 100 cm from isocenter using a Ludlum Model 30–7 Series Neutron Meter. TGN treatments at TCCC have been previously delivered at 6‐MV FFF using a 5‐mm stereotactic cone. To assess the dosimetric impact of using a virtual cone, eight patients previously treated for TGN with a 5‐mm cone were re‐planned using a virtual cone. Seven patients have now been treated for TGN using a virtual cone at TCCC. Patient‐specific quality assurance was performed for each patient using Gafchromic EBT‐XD film inside a Standard Imaging Stereotactic Dose Verification Phantom. The commissioning results demonstrate that the virtual‐cone dosimetry, first described at UAB, is reproducible on a second Edge linear accelerator at an independent clinical site. The virtual cone is a credible alternative to a physical, stereotactic cone for the treatment of TGN at TCCC.

310. Cryptococcal Infection Following COVID-19 infection in Solid Organ Transplant Recipients: A Case Series

BackgroundFungal infections have been identified with or following SARS-CoV-2 infection, most commonly COVID associated pulmonary aspergillosis. Cryptococcus species are ubiquitous in the environment and the third most common invasive fungal infection following Solid Organ Transplant (SOT). We describe four cases of concurrent or subsequent cryptococcal infection within 90 days following COVID-19 infection.MethodsWe conducted a retrospective study of patients presenting with proven cryptococcosis either concurrently or within 90 days following COVID-19 diagnosis. Cases were identified March 2020 through May 2021. All were seen at the University of Alabama in Birmingham, a regional referral and comprehensive transplant center. Exemption for this review was approved by our IRB.ResultsFour cases were identified, all were SOT recipients. Case details are provided in Table 1. No patients required ICU level care at any point. COVID-19 treatment included 10 days of increased steroids for 3 patients, remdesivir for 2, and 1 received no treatment for COVID-19. In contrast to the typical time-course for cryptococcal infection post-SOT (median time approx. 500 days post-transplant), three patients were greater than 2 years post-transplant and were without rejection or recent changes in immunosuppression. Patient 1 was less than 6 months post liver-kidney transplant and was diagnosed at time of admission with concurrent COVID-19 and cryptococcal pneumonia. Infection was disseminated in the other 3 cases including positive blood cultures in 2 patients and cryptococcal meningitis (CM) in 2 patients. CM cases presented later following COVID-19 and had the longest delay between symptom onset (headache, neurologic symptoms) and CM diagnosis. One patient had CM 8 years prior, but had done extremely well off fluconazole for over 6 years prior to this recurrence. All patients are doing well at most recent follow-up evaluations.Table 1. Summary of Cases ConclusionWe describe the first case series with a temporal association between SARS-CoV-2 infection and cryptococcosis. All cases were immunocompromised due to SOT. Some symptoms were attributed to post-COVID syndrome leading to significant delays in diagnosis for those patietns, highlighting the importance of considering this association for at-risk patients.Disclosures Todd P. McCarty, MD, Cidara (Grant/Research Support)GenMark (Grant/Research Support, Other Financial or Material Support, Honoraria for Research Presentation)T2 Biosystems (Consultant)

About the Contributors

About the Contributors

Legends of allergology and immunology: Per Brandtzaeg - Pillar of mucosal immunology.

After graduating dental school,Per Brandtzaeg joined the Norwegian army for his mandatory national service. During his military service, he was able to workon gingivitis and his passionfor research was lit. In 1962,he obtained a Fulbright scholarship to joinFrederick W. Kraus's laboratory at University of Alabama in Birmingham, where he became involved in the work on the immunological defense of human mucous membranes. His work was based on immunofluorescence for the localization of immunoglobulins and other proteins in human tissue sections.

Financial distress amongst older adults with gastrointestinal (GI) malignancies.

517 Background: Many patients with cancer report financial distress (FD); however, the magnitude of FD in the growing number of older adults with cancer remains less clear, particularly in those with GI malignancies. The purpose of this study was to evaluate the proportion of older adults with GI malignancies reporting FD and to characterize geriatric assessment (GA) and cancer-related factors associated with FD. Methods: Older adults ( ≥ 60yrs) seen in the GI oncology clinic at the University of Alabama Birmingham (UAB) were asked to fill out a patient-reported GA, entitled the Cancer & Aging Resilience Evaluation (CARE), at their visit. The CARE includes questions pertaining to patient’s independence in Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), falls, physical function, polypharmacy, and comorbidity. A single item question regarding FD from the patient satisfaction questionnaire (PSQ-18) was included. FD was defined as agreement with the phrase “Do you have to pay for more medical care than you can afford.” Demographic and GA characteristics were compared between those with and without FD using Chi-square and t-tests. Results: 233 patients completed the CARE a median of 71 days after diagnosis. Median age 68y (60-96); 54.5% male and 76.0% non-Hispanic white. Most common cancer types included colorectal (39.1%) and pancreatic cancers (20.6%). A total of 62 patients (26.6%) had FD. Patients with FD were more likely to be younger (68.1 vs. 70.1y, p = 0.04), of black race (37.1% vs. 15.8%, p = 0.007), have low education ( ≤ high school: 74.2% vs. 59.6%, p = 0.02), have one or more falls (31.5% vs. 19.9%, p = 0.077), to be limited a lot in walking 1 block (54.4% vs. 27.4%, p = 0.0003), take more than 4 medications (88.3% vs. 70.8%, p = 0.007), to have more than one comorbid condition (93.1% vs. 82.6%, p = 0.052), to report impaired IADLs (61.3% vs. 43.9%, p = 0.055), and impaired ADL (27.4% vs. 14.6%, p = 0.069). No associations were found with GI cancer type or stage, marital status, time from diagnosis, or hearing/vision impairments. Conclusions: Over a quarter of the older adult population with GI malignancies report FD. Several GA and demographic factors were associated with FD that may help identify older patients at risk for FD.

Personalizing health careHugh Kaul Personalized Medicine Institute, University of Alabama Birmingham

Hugh Kaul personalized medicine institute, University of Alabama Birmingham

Implementation and utilization of the molecular tumor board to guide precision medicine.

BackgroundWith rapid advances in genomic medicine, the complexity of delivering precision medicine to oncology patients across a university health system demanded the creation of a Molecular Tumor Board (MTB) for patient selection and assessment of treatment options. The objective of this report is to analyze our progress to date and discuss the importance of the MTB in the implementation of personalized medicine.Materials and MethodsPatients were reviewed in the MTB for appropriateness for comprehensive next generation sequencing (NGS) cancer gene set testing based on set criteria that were in place. Because profiling of stage IV lung cancer, colon cancer, and melanoma cancers were standard of care, these cancer types were excluded from this process. We subsequently analyzed the types of cases referred for testing and approved with regards to their results.Results191 cases were discussed at the MTB and 132 cases were approved for testing. Forty-six cases (34.8%) had driver mutations that were associated with an active targeted therapeutic agent, including BRAF, PIK3CA, IDH1, KRAS, and BRCA1. An additional 56 cases (42.4%) had driver mutations previously reported in some type of cancer. Twenty-two cases (16.7%) did not have any clinically significant mutations. Eight cases did not yield adequate DNA. 15 cases were considered for targeted therapy, 13 of which received targeted therapy. One patient experienced a near complete response. Seven of 13 had stable disease or a partial response.ConclusionsMTB at University of Alabama-Birmingham is unique because it reviews the appropriateness of NGS testing for patients with recurrent cancer and serves as a forum to educate our physicians about the pathways of precision medicine. Our results suggest that our detection of actionable mutations may be higher due to our careful selection. The application of precision medicine and molecular genetic testing for cancer patients remains a continuous educational process for physicians.

Obituary - In Memoriam Per Brandtzaeg.

Obituary - In Memoriam Per Brandtzaeg.