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Reply: Artificial intelligence as a door opener for a new era of human reproduction. Hum Reprod Open 2023; 2023:hoad045. [PMID: 38033328 PMCID: PMC10686939 DOI: 10.1093/hropen/hoad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
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Differences in Radiotherapy-Treated Members with Cancer during COVID-19 Pandemic Using Nationwide Claim Data. Int J Radiat Oncol Biol Phys 2023; 117:e567. [PMID: 37785733 DOI: 10.1016/j.ijrobp.2023.06.1892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) This study aimed to identify the impact of the pandemic on radiotherapy activity among members with cancer. MATERIALS/METHODS This retrospective study included fully-insured commercial members of a large national payor with cancer aged ≥18 years undergoing radiotherapy from March 1, 2018 to February 28, 2022. Radiotherapy activity was defined as the mean weekly number of treatment courses and attendances (fractions) per month pre-COVID (March 2018 to February 2020); during COVID (March 2020 to February 2021); and post-COVID (March 2021 to February 2022). T-tests assessed differences between pre-COVID and post-COVID on radiotherapy activity by age, gender, and cancer type. Interrupted time series analysis (ITS) assessed change in activity overtime, controlling for pre-COVID trends and other potential confounders. A p-value of <0.05 was considered significant. RESULTS The study included 9,275 members, 10,121 courses, and 169,257 fractions; most members were female (57%), the mean age was 57 years (SD = 12). Overall, there was a decline in mean weekly number of courses from the pre-COVID to post-COVID (-18%, p<0.05) timeframe. Females < 70 years experienced the largest decline in mean weekly number of courses (-23%, p<0.05) followed by males aged 70+ (-16%, p<0.05) and males < 70 years (-16%, p<0.05). All cancer types saw a significant decline (p<0.05); breast cancer reported the largest decline (-21%, p<0.05). Fraction numbers significantly declined overall by 27% (p<0.05) from the pre-COVID to post-COVID timeframe. The largest decline in fraction numbers was observed in females < 70 (-28%, p<0.05) followed by males < 70 years (-24%, p<0.05) and males aged 70+ (-22%, p<0.05). No difference between COVID and pre-COVID weeks for courses was observed once pre-COVID trends were accounted for using ITS. Females aged 70+ received 25% (p<0.05) fewer fractions during COVID compared to pre-COVID; a decline which continued to grow even as the pandemic eased (March 2021 to February 2022). Males aged 70+ also experienced a decreased level of fractions during the pandemic (-30%, p<0.05), but increased in the recovery period (+24%, p<0.05). Males < 70 years had an increased level of fractions during the pandemic (+14%, p<0.05). CONCLUSION Radiation mean weekly number of courses and fractions between pre-COVID and post-COVID declined with the effect more pronounced in females < 70 years. A decrease in fraction number was observed in all cancer types; specifically, breast cancer had the largest decline. ITS analysis revealed no difference between COVID and pre-COVID weeks for courses as the downward trend was already present prior to the pandemic. These findings suggest while radiotherapy courses and fractions were significantly impacted, fractionation was decreased to a greater extent, indicating an increased adoption of hypofractionation during the pandemic.
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Embryo selection through artificial intelligence versus embryologists: a systematic review. Hum Reprod Open 2023; 2023:hoad031. [PMID: 37588797 PMCID: PMC10426717 DOI: 10.1093/hropen/hoad031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/17/2023] [Indexed: 08/18/2023] Open
Abstract
STUDY QUESTION What is the present performance of artificial intelligence (AI) decision support during embryo selection compared to the standard embryo selection by embryologists? SUMMARY ANSWER AI consistently outperformed the clinical teams in all the studies focused on embryo morphology and clinical outcome prediction during embryo selection assessment. WHAT IS KNOWN ALREADY The ART success rate is ∼30%, with a worrying trend of increasing female age correlating with considerably worse results. As such, there have been ongoing efforts to address this low success rate through the development of new technologies. With the advent of AI, there is potential for machine learning to be applied in such a manner that areas limited by human subjectivity, such as embryo selection, can be enhanced through increased objectivity. Given the potential of AI to improve IVF success rates, it remains crucial to review the performance between AI and embryologists during embryo selection. STUDY DESIGN SIZE DURATION The search was done across PubMed, EMBASE, Ovid Medline, and IEEE Xplore from 1 June 2005 up to and including 7 January 2022. Included articles were also restricted to those written in English. Search terms utilized across all databases for the study were: ('Artificial intelligence' OR 'Machine Learning' OR 'Deep learning' OR 'Neural network') AND ('IVF' OR 'in vitro fertili*' OR 'assisted reproductive techn*' OR 'embryo'), where the character '*' refers the search engine to include any auto completion of the search term. PARTICIPANTS/MATERIALS SETTING METHODS A literature search was conducted for literature relating to AI applications to IVF. Primary outcomes of interest were accuracy, sensitivity, and specificity of the embryo morphology grade assessments and the likelihood of clinical outcomes, such as clinical pregnancy after IVF treatments. Risk of bias was assessed using the Modified Down and Black Checklist. MAIN RESULTS AND THE ROLE OF CHANCE Twenty articles were included in this review. There was no specific embryo assessment day across the studies-Day 1 until Day 5/6 of embryo development was investigated. The types of input for training AI algorithms were images and time-lapse (10/20), clinical information (6/20), and both images and clinical information (4/20). Each AI model demonstrated promise when compared to an embryologist's visual assessment. On average, the models predicted the likelihood of successful clinical pregnancy with greater accuracy than clinical embryologists, signifying greater reliability when compared to human prediction. The AI models performed at a median accuracy of 75.5% (range 59-94%) on predicting embryo morphology grade. The correct prediction (Ground Truth) was defined through the use of embryo images according to post embryologists' assessment following local respective guidelines. Using blind test datasets, the embryologists' accuracy prediction was 65.4% (range 47-75%) with the same ground truth provided by the original local respective assessment. Similarly, AI models had a median accuracy of 77.8% (range 68-90%) in predicting clinical pregnancy through the use of patient clinical treatment information compared to 64% (range 58-76%) when performed by embryologists. When both images/time-lapse and clinical information inputs were combined, the median accuracy by the AI models was higher at 81.5% (range 67-98%), while clinical embryologists had a median accuracy of 51% (range 43-59%). LIMITATIONS REASONS FOR CAUTION The findings of this review are based on studies that have not been prospectively evaluated in a clinical setting. Additionally, a fair comparison of all the studies were deemed unfeasible owing to the heterogeneity of the studies, development of the AI models, database employed and the study design and quality. WIDER IMPLICATIONS OF THE FINDINGS AI provides considerable promise to the IVF field and embryo selection. However, there needs to be a shift in developers' perception of the clinical outcome from successful implantation towards ongoing pregnancy or live birth. Additionally, existing models focus on locally generated databases and many lack external validation. STUDY FUNDING/COMPETING INTERESTS This study was funded by Monash Data Future Institute. All authors have no conflicts of interest to declare. REGISTRATION NUMBER CRD42021256333.
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First Report on the Performance of the National OCS Program (NOP) in U.S. Heart and Lung Transplants. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Abstract OT3-25-01: Neoadjuvant HER2-targeted Therapy +/- Immunotherapy with Pembrolizumab (neoHIP): An Open Label Randomized Phase II Trial. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-ot3-25-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Immune checkpoint inhibition (ICI) is synergistic with HER2-directed therapy in pre-clinical models. Clinically, pembrolizumab (K)-mediated ICI plus HER2-directed therapy with trastuzumab (H) was safe and demonstrated modest activity in H-resistant HER2-positive (HER2+) metastatic breast cancer. Because ICI may confer more robust activity when administered earlier in the course of disease, H and K administered in the curative-intent, treatment-naive setting may allow for de-escalation of cytotoxic chemotherapy; confer life-long, tumor-specific immunity; and ultimately, improve cure rates. Moreover, the synergy of H and K with paclitaxel (T) may overcome the need for dual HER2-blockade with H plus pertuzumab (P). In this randomized, multicenter, phase II, open-label, multi-center trial the efficacy and safety of neoadjuvant THP vs THP-K vs TH-K are explored. Methods: 174 patients (pts) ≥18y with previously untreated, stage II-III, HER2+ breast cancer will be randomized and stratified by clinical nodal status (positive vs. negative) and hormone receptor status (positive vs. negative). In arm A, pts receive T at 80mg/m2 weekly for 12 weeks, H at 8mg/Kg (loading dose) and then 6mg/Kg every 3 weeks x 3 doses, P at 840 mg (loading dose) and then 420mg/Kg every 3 weeks x 3 doses (THP). In arm B, pts receive THP plus K at 200mg every 3 weeks x 4 doses (THP-K). In arm C, pts receive TH-K; however, in a preplanned interim analysis, arm C did not meet the pre-defined efficacy threshold and this arm was subsequently closed. Enrollment to arms A and B continue. Definitive surgery is 3-6 weeks after the last dose. After surgery, pts are treated per the treating physician’s discretion including radiotherapy per local clinical standard. Pts whose tumors are hormone-receptor positive will receive hormone therapy per local standard-of-care. The primary end point is pathologic complete response (pCR) rate in the breast and axilla (ypT0/Tis ypN0). Secondary end points include pCR rate by ypT0ypN0 and ypT0/Tis, residual cancer burden index, event free survival, breast conserving surgery rate, safety and overall survival. Exploratory correlative studies will characterize potential immune biomarkers predictive of efficacy and/or toxicity. Funding sources: BCRF, Merck NCT03747120
Citation Format: Heather McArthur, Jorge Henrique Santos Leal, Christina DiLauro Abaya, Sangeetha Reddy, Meredith Carter, Reva Basho, Michelle Phillips, David Chan, Hugo Hool, Dorothy Park, Mary El-Masry, Philomena McAndrew, Swati Sikaria, Laura M. Spring, Aditya Bardia, Mourad Tighiouart, Farnaz Dadmanesh, Armando Giuliano, Stephen Shiao, David B. Page. Neoadjuvant HER2-targeted Therapy +/- Immunotherapy with Pembrolizumab (neoHIP): An Open Label Randomized Phase II Trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-25-01.
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Abstract No. 103 Changes in the Match: Results of an IR Applicant and Program Director Survey Regarding Virtual Interviews and Step 1 Pass/Fail. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Abstract P2-06-04: Effects of BMI velocity on outcomes in patients with metastatic breast cancer in the Dallas Metastatic Breast Cancer Study. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-06-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
BACKGROUND: The Dallas Metastatic Breast Cancer Study (DMBCS) is a clinical database that was established in 2021 at a single academic medical system to track patient demographics, associated pathology, treatments, and other variables that are not widely available in the Surveillance, Epidemiology, and End Results (SEER) Program for metastatic breast cancer (MBC). One of many ongoing studies as part of the DMBCS is to investigate how weight loss after diagnosis affects outcomes in MBC patients. Although previous studies have shown that significant weight loss is associated with poorer outcomes in certain cancer types, little is known about its role in breast cancer. METHODS: 139 patients who were diagnosed with MBC between 2009-2021 were included in this data collection. BMI at the time of diagnosis of MBC and within 6 months of death or last follow-up were recorded. BMI velocity was calculated by dividing the difference between BMI at diagnosis and BMI at time of death (or last follow-up) by the number of months between initial diagnosis and time of death (or last follow-up). The BMI velocity represents the rate at which patients lost or gained weight during their disease course. A negative BMI velocity indicates weight loss, and a positive BMI velocity indicates weight gain over the defined period. The absolute value of the BMI velocity indicates how rapidly someone gains or loses weight. The association of BMI velocity on the primary outcome (overall survival (OS) and progression-free survival (PFS)) was assessed using Cox proportional hazard (PH) model. Adjusted hazard ratios (HR) with 95% confidence intervals were computed using the multivariable Cox PH model. RESULTS: At the time of diagnosis of MBC, 40% were obese and 33% were overweight. At the time of death or last follow-up, 27% were obese and 31% were overweight. The mean BMI velocity was -0.13 per month. Contrary to previous studies that have shown a negative effect of obesity on OS, we found that obesity at the time of diagnosis of MBC did not statistically worsen OS and PFS. However, compared to patients who had negative BMI velocities, improved OS (lower hazard ratio) was noted for patients with stable or increasing BMI velocities (HR = 0.53; 95% CI = 0.32-0.88, p = 0.014). A greater rate of weight loss was also associated with worse OS (HR = 0.23; 95% CI = 0.12 - 0.47, p < 0.001) and PFS (HR = 0.29; 95% CI = 0.16 - 0.52, p < 0.001). Improved PFS was seen for patients with stable or increasing BMI velocities in the unadjusted analysis (HR = 0.65; 95% CI = 0.42 - 0.99, p = 0.047). CONCLUSION: Our study found that contrary to previously published results in patients with early-stage breast cancer, obesity did not statistically worsen OS or PFS. However, the rate of weight loss, which we defined as BMI velocity, is associated with higher mortality in MBC. Our findings can be applied to clinical practice when advising MBC patients regarding healthy changes in weight during their disease course. BMI velocity could be used as a prognostic indicator to predict outcomes in patients with MBC. In future studies, we aim to quantify the amount of weight loss that is associated with worse outcomes.
Citation Format: Mir Lim, Mona Pathak, Meng Cao, Anna Moscowitz, Jonathan Ladner, Sangeetha Reddy, Isaac Chan. Effects of BMI velocity on outcomes in patients with metastatic breast cancer in the Dallas Metastatic Breast Cancer Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-06-04.
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Abstract OT1-19-01: A Single Arm Phase 2 Study of Peri-Operative Checkpoint-Mediated Immune Therapy and Cryoablation in Women with Hormone Receptor-Negative, HER2-Negative Early Stage/Resectable Breast Cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-ot1-19-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Local tumor destruction with cryoablation (cryo) induces inflammation and releases antigens that can activate tumor-specific immune responses. Pre-clinically, cryo with immune checkpoint inhibition (ICI)-augmented tumor-specific immune responses and prevented recurrence. Clinically, we established that peri-operative (peri-op) cryo with ipilimumab (ipi) +/- nivolumab (nivo) was not only safe in patients (pts) with operable, early stage breast cancer (ESBC) but also generated robust intra-tumoral and systemic immune responses. In this phase 2 study, we evaluate the disease specific impact of peri-op ICI in women with residual triple negative breast cancer (TNBC) after neoadjuvant chemotherapy (NAC), a subset at high risk of early relapse. Methods: Eligible pts are ≥18y, with ER < 10%, PR < 10%, HER2 negative (per ASCO/CAP definition), ≥ 1.0 cm, residual operable disease after taxane-based NAC. Approximately 80 pts will be enrolled and treated with ipi/nivo/cryo followed by breast surgery and adjuvant nivo across multiple institutions. Pts undergo percutaneous, image-guided cryo with concurrent research core biopsy 7-10 days prior to surgery and will receive ipi (1mg/kg IV) with nivo (240mg IV) 1 to 5 days prior to cryo. After surgery, pts will receive 3 additional doses of nivo at 240mg IV Q2 weeks. Adjuvant capecitabine is recommended for all patients per local standard-of-care. Patients will be stratified by NAC platinum administration, NAC anthracycline administration, and clinical nodal status (positive versus negative). The primary endpoint is 3-year Event Free Survival (EFS). Secondary endpoints include Invasive Disease-Free Survival (IDFS), Distant Disease-Free Survival (DDFS), overall survival (OS) and safety. Exploratory correlative studies will be performed on tumor and serum to characterize the immunologic impact of the intervention and to explore predictors of efficacy and toxicity. Funding sources: Susan G. Komen, ASCO Conquer Cancer Foundation, Breast Cancer Research Foundation, Bristol-Myers Squibb, BTG International Ltd. NCT03546686
Citation Format: Heather McArthur, Elizabeth Comen, Yolanda Bryce, Stephen Solomon, Jorge Henrique Santos Leal, Christina DiLauro Abaya, Cristal Martinez, Reva Basho, Dorothy Park, Philomena McAndrew, Brigid Larkin, William Mills, David B. Page, Staci Mellinger, Nicole Fredrich, Nicole Moxon, Sangeetha Reddy, Meredith Carter, Sujata Patil, Larry Norton. A Single Arm Phase 2 Study of Peri-Operative Checkpoint-Mediated Immune Therapy and Cryoablation in Women with Hormone Receptor-Negative, HER2-Negative Early Stage/Resectable Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT1-19-01.
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Abstract P4-03-43: Disease characteristics and outcomes of people with metastatic breast cancer in a single center cohort study: The Dallas Metastatic Breast Cancer Study. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p4-03-43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Breast cancer is the most common cancer in women, and metastatic disease accounts for most breast cancer related deaths. Identifying risk factors for the onset and progression of metastatic breast cancer (MBC) can help us understand how to address and improve morbidity and mortality due to MBC. Large national databases, such the Surveillance, Epidemiology, and End Results (SEER) Program are limited in their ability to capture granular details from patients’ cancer histories. The Dallas Metastatic Breast Cancer Study (DMBCS) is a clinical database established at a single academic medical system to track patient demographics, associated pathology, treatments, and other variables to improve outcomes for patients with MBC. Methods: The DMBCS database was generated from a registry of breast cancer patients submitted to the National Cancer Institute from 2010 to 2021. Patients were initially excluded if they were identified as non-metastatic from this list. Chart review was then done to identify MBC patients from this subsequent group. Demographics, clinical history, pathologic features, lines of treatment, and subsequent recurrences were collected for all patients. Clinical data was stored in REDCap, a secure data collection platform for entering and managing data. Results: 230 cases were included in this preliminary data set. Of the 230 cases, 185 cases were metastatic at time of diagnosis while 45 cases were metastatic recurrences of breast cancer. At diagnosis, 14.8% were less than 40 years of age, 17.3% were 40-49, 35.7% were 50-59, 18.7% were 60-69, and 13.5% were greater than 70 years of age. In terms of ethnicity, 63.5% were White, 27.4% were Black, and 21.7% identified as Hispanic. At time of diagnosis, 30.9% of patients had a BMI classified as overweight and 40.4% were considered obese. Medical comorbidities included hypertension in 43% of cases, diabetes (18.3%), hyperlipidemia (27.4%), and autoimmune disease (13.0%). Clinical subtype analysis revealed 57.8% of patients were hormone receptor positive, 24.8% HER2 positive, and 17.4% triple negative, at diagnosis. 14.8% of cases were diagnosed as inflammatory breast cancer. The most common site of metastasis at presentation was bone with 69.1% of cases, followed by lung (33.9%), liver (30.0%), and brain (15.2%). Over 90% of patients were treated with at least one antineoplastic regimen and 39.6% underwent at least 4 therapies. Calculated 1-year survival after diagnosis was 85.7%. Conclusions: The introduction of the DMBCS will allow continued investigation into clinical drivers of MBC. In this first cohort of patients, we characterized key, yet often underreported, variables and outcomes. Potential applications of this database include investigating the association between obesity and overall survival in patients with MBC, understanding how socioeconomic disparities affects outcomes of patients with MBC, and exploring correlations between autoimmune disease and the progression of MBC.
Citation Format: Meng Cao, Mir Lim, Anna Moscowitz, Jonathan Ladner, Christine Hodgdon, Julia Maues, Sangeetha Reddy, Isaac Chan. Disease characteristics and outcomes of people with metastatic breast cancer in a single center cohort study: The Dallas Metastatic Breast Cancer Study. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-43.
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Abstract GS5-06: InteractPrint predicts clinically meaningful interactions between cancer epithelial cells and immune cells: Lessons from a single-cell breast cancer atlas. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-gs5-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
BACKGROUND: While immunotherapy has revolutionized the treatment of many solid tumors, the efficacy of immunotherapy regimens is comparatively lower in breast cancer. Immunotherapy efficacy is often negatively correlated with intratumor heterogeneity. Novel immunotherapy approaches in breast cancer should leverage how cancer epithelial cell heterogeneity affects immune cells in the tumor microenvironment. However, current definitions of cancer epithelial cell heterogeneity in breast cancer have limited resolution. Single cell RNA-seq (scRNA-seq) provides an unprecedented opportunity to further define cancer epithelial cell heterogeneity and identify how heterogeneity influences interactions with immune cells. METHODS: We generated a novel scRNA-seq dataset of 236,363 cells from 119 primary breast tumors biopsied from 88 patients taken from 8 publicly available datasets, currently the largest published scRNA-seq dataset in breast cancer. To define cancer epithelial cell heterogeneity, we performed unsupervised clustering and supervised clustering based on molecular subtype and expression of clinical target genes on all cancer epithelial cells. This identified 11 gene elements (GEs), which reflect key molecular features that vary between cancer epithelial cells. Receptor-ligand pairing analysis allowed us to determine how cells that highly express each GE interact with various immune cells. We developed InteractPrint, a score to predict the predominant tumor-interacting immune cells, based on the GE composition of an individual patient tumor. RESULTS: In our dataset, 17% of samples were HER2+, 41% were HR+, and 42% were TNBC. This dataset was statistically powered to characterize cancer epithelial cell heterogeneity. For each of the 11 GEs, we predicted interactions with immune cells. Experimentally, GEs with predicted NK cell interactions showed sensitivity to NK cell cytotoxicity. In a spatially resolved transcriptomics dataset, GEs with predicted T cell interactions demonstrated colocalization with CD8+ T cells, while those with limited predicted T cell interactions did not. To infer GE-immune interactions at the patient level (GEs define cell-level interactions), we developed InteractPrint. To validate InteractPrint, we assessed the accuracy of the T cell InteractPrint in predicting response to anti-PD-1 therapy. Across two trials and all breast cancer subtypes, T cell InteractPrint demonstrated significant improvement over PD-L1 in predicting response to anti-PD-1 therapy. In an scRNA-seq dataset of samples from patients treated with pembrolizumab, we observed AUC of 85% (p < 0.005) for T cell InteractPrint vs. 61% (p > 0.05) for PD-L1 in predicting response to anti-PD-1 therapy. In patients treated with paclitaxel + pembrolizumab in the I-SPY 2 trial, we observed AUC of 81% (p < 0.00001) for T cell InteractPrint versus 72% (p = 0.001) for PD-L1. CONCLUSIONS: Our results demonstrate considerable cancer epithelial cell heterogeneity across primary breast tumor samples and clinical subtypes. We defined this heterogeneity and leveraged it to predict immune cell interactions within a patient’s tumor. We developed T cell InteractPrint to capture heterogeneous interactions between cancer epithelial cells and CD8+ T cells. T cell InteractPrint is predictive of response to anti-PD-1 immune checkpoint inhibition at higher AUC than PD-L1. This provides a path forward for the interpretation of cancer epithelial cell heterogeneity in a clinically meaningful way.
Citation Format: Lily Xu, Kaitlyn Saunders, Hildur Knutsdottir, Kenian Chen, Julia Maues, Christine Hodgdon, Evanthia T. Roussos Torres, Sangeetha Reddy, Lin Xu, Isaac Chan. InteractPrint predicts clinically meaningful interactions between cancer epithelial cells and immune cells: Lessons from a single-cell breast cancer atlas [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr GS5-06.
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Abstract No. 109 Integrated IR Residency: Perspectives of Applicants and Program Directors from the 2022 Match. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Abstract OT2-17-01: Phase 1 trial of anthracycline chemotherapy in combination with CD40 agonist and Flt3 ligand in metastatic triple-negative breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-ot2-17-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Only a subset of patients with metastatic triple-negative breast cancers (TNBC) demonstrate response to FDA approved PD-1 immune checkpoint blockade (ICB), and few have durable responses. Data suggests that breast cancers have defects in antigen presentation and that antigen presenting cells especially the DC1 subtype of dendritic cells (DCs) are required for response to ICB. CD40 agonists activate antigen presenting cells including DCs and B cells and also repolarize macrophages to an anti-tumor phenotype. Flt3 ligand is a growth factor that increases differentiation and expansion of DCs. We recently demonstrated in pre-clinical TNBC models that the combination of liposomal-doxorubicin chemotherapy, a CD40 agonist, and a Flt3 ligand improves outcomes compared to alternate combinations. Methods: This is a single arm phase I pilot study of liposomal-doxorubicin, CDX-1140 (CD40 agonist), and CDX-301 (Flt3 ligand) combination therapy in patients with metastatic or unresectable locally advanced metastatic TNBC. Patients will be randomized to 3 lead-in arms (triplet therapy, doublet immunotherapy only, or liposomal-doxorubicin only) for 1 cycle prior to receiving triplet therapy with fresh tissue biopsies before and after the lead-in treatment. CDX-301 will be discontinued after 2 cycles; liposomal-doxorubicin and CDX-1140 will be continued until disease progression or clinically limiting toxicities. Primary endpoint is determination of a recommended phase 2 dose based on treatment-related adverse events including dose-limiting toxicities. Secondary endpoints include anti-tumor immune response after triplet therapy, after immunotherapy alone, and after liposomal-doxorubicin alone; median progression-free survival, overall response rate, duration of response, and clinical benefit rate. Key eligibility criteria are unresectable stage III or stage IV TNBC (ER ≤10%, PR ≤10%, HER2/neu negative), 1st to 3rd line metastatic treatment setting (1st line patients need to be PD-L1 negative by 22C3 assay), measurable disease by RECIST 1.1 criteria, consent for pre-treatment and on-treatment biopsies of amenable soft tissue tumor lesions, no prior treatment with an anti-CD40 antibody or a Flt3 ligand, no anthracycline treatment in the metastatic setting, no prior progression while on anthracycline-based therapy or within 6 months of completing neoadjuvant chemotherapy, and no history of non-infectious pneumonitis or current pneumonitis. This trial will enroll up to 45 patients across multiple sites (NCT05029999).
Citation Format: Sangeetha Reddy, Meredith Carter, Isaac Chan, Nisha Unni, Namrata Peswani, Dawn Klemow, Samira Syed, Shahbano Shakeel, Farjana Fattah, Chul Ahn, Yisheng Fang, Heather McArthur, Nicole Sinclair, Michael Yellin, Denise Yardley, Nan Chen, Joyce O’Shaughnessy, Rita Nanda, Suzanne D. Conzen, Carlos Arteaga. Phase 1 trial of anthracycline chemotherapy in combination with CD40 agonist and Flt3 ligand in metastatic triple-negative breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT2-17-01.
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Abstract No. 33 End-Stage Renal Disease and Risk of Major Adverse Limb Events Following Peripheral Vascular Intervention. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Predicting Total Hospitalizations and Emergency Visits in Radiotherapy Patients: A Claims-Based Model. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Defining the Cost Variation by Site-of-Care for Radiotherapy: A Claims-Based Analysis. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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A CASE OF AN UNRECOGNIZED AUTOINFLAMMATORY DISEASE. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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To Assess the Factors Affecting Employee Engagement in Organizations during a COVID-19 Crisis. CARDIOMETRY 2022. [DOI: 10.18137/cardiometry.2022.23.292309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: To identify the steps taken by organizations during the time of crisis concerning Human Capital and understand the impact each of these steps has on the employee engagement for the employees within the organization. Proposed Design/Methodology/Approach: Post the literature review, qualitative research is conducted through indepth interviews with the Managers, who were part of the decision-making, in the organizations that went through crisis period (Sample size: 20-30) and a quantitative study is conducted to capture the perspectives of the employees from those organizations (Sample size: 70-100). Practical/Theoretical Implication: The study results enable organizations to stay cognizant of the pros and cons of the decisions they make in terms of employee engagement, which helps in successfully overcoming the crisis with minimal traction. Originality/Value: While there are standalone papers on each topic, this paper converges them coherently to study the overall effect from both employee’s and the organization’s perspectives.
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759 Mechanical tension mobilizes Lgr6+ epidermal stem cells to drive skin growth. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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457 Single Vs Biplane 3d Augmented Overlay Guidance To Assist Congenital Cardiac Catheterisation Interventions. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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O-261 In-vitro supplementation of vitamin B12 to improve post-thaw viability and DNA integrity. Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Does the supplementation of vitamin B12 protect the spermatozoa against damage caused by the freeze-thaw process further improving the overall post-thaw survival and DNA integrity?
Summary answer
The antioxidant property of vitamin B12 protects the spermatozoa and improves the post thaw motility, vitality, and reduces DNA damage caused by freeze-thaw process.
What is known already
Cryopreservation of spermatozoa is an effective way of fertility preservation in humans, often used in Assisted Reproductive Technology(ART). Despite the refinement in cryopreservation, the salvage of post-thaw sperms remains poor. The reactive oxygen species(ROS), that is formed as a result of freeze-thaw process is known to decrease the motility, plasma membrane integrity and increase the DNA fragmentation. Most vitamins have antioxidant properties, that protect the mammalian cells from oxidative stress one such vitamin is cyanocobalamin(vitamin B12). Vitamin B12 modulates oxidative stress through methionine synthase activity and also acts as a scavenger of ROS. Thus protecting the DNA against free radicals.
Study design, size, duration
This prospective observational study was performed for a period of 6 months in 111 men, who attended the fertility clinic. The study population included all semen samples except men with azoospermia, surgically retrieved samples and men on vitamin supplements. The study population contained men ageing between 21-40 years.
Participants/materials, setting, methods
Semen samples were analysed according to WHO 5th edition and were assessed for DNA fragmentation index (DFI) using sperm chromatin dispersion assay (SCD). The ejaculates were split into two as group A: semen samples with equal amount of cryoprotectant and group B: semen samples with equal amount of cryoprotectant supplemented with Vitamin B12 (2mg/ml). They were frozen for a minimum of 24 hrs. Post-thaw motility, vitality and DFI were assessed and compared.
Main results and the role of chance
The mean age of patients in our study was 34.26±4.7yrs. 58.5% of the study population had primary infertility. 37.8% of the study population had male factor infertility, 32.4% had oligoasthenoteratozoospermia(OAT), 31.1% had normozoospermia 16.2% had asthenoteratozoospermia, 13.5% had teratozoospermia, 3.6% had oligozoospermia and rest 2.7% had asthenozoospermia.
There was an overall increase in post thaw motility (41.59±18.09 vs 32.3±18.8,p=0.0005), progressive motility (21.54±13.02 vs 15.91±11.80,p=0.0005), vitality (57.14±15.09 vs 46.76±16.45,p=0.0005) and a significant decrease in DFI (26.69±10.03 vs 32.09±10.00,p=0.0005) in group B compared to group A.
Our study also demonstrated that, Normozoospermia patients had a significant increase in vitality (67.17±13.8 vs 58.51±12.0, p = 0.007) and lower DFI (22.68±9.3 vs 27.6±8.9, p = 0.02) in group B than in group A.
OAT patients had a significant increase in total motility (26.25±12.15 vs 15.7±11.4,p=0.0003), progressive motility (11.69±8.8 vs 6.14±5.8,p=0.0028), vitality (46.06±11.34 vs 34.31±12.99,p=0.0001) and significantly lower DFI (30.22±9.87 vs 36.08±9.7,p=0.012) in group B.
Teratozoospermia patients showed significant increase in progressive motility in group B (27.87±8.81 vs 19.33±10.69,p=0.02) and
Asthenoteratozoospermia patients showed significant increase in total motility (40.72± 13.14 vs 30.89±13.06,p=0.02) and vitality (54.39±12.28 vs 43.78±14.14,p=0.02) in group B.
However, in asthenozoospermic patients the parameters were comparable in both the groups.
Limitations, reasons for caution
Due to ethical reasons the samples were not used for in vitro procedures such as intrauterine insemination(IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection(ICSI). Hence, no inference was obtained regarding the fertilization rates/ pregnancy rates.
Wider implications of the findings
Our study demonstrated that with supplementation of vitamin B12 the recovery rate significantly increased and also preserved the DNA content. Among the various categories, supplementation of vitamin B12 to OAT samples was more beneficial as it improved the overall viability of the sperms.
Trial registration number
CSP/21/JUL/96/389
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POS-022 CLINICO-PATHOLOGICAL PROFILE AND OUTCOMES OF CHILDREN WITH C3G IN RESOURCE LIMITED SETTING. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract No. 284 Demographic trends in female interventional radiology trainees with the advent of the integrated interventional radiology residency: a 12-month update. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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TB testing in HIV-positive patients prior to antiretroviral treatment. Int J Tuberc Lung Dis 2022; 26:224-231. [PMID: 35197162 PMCID: PMC8886959 DOI: 10.5588/ijtld.21.0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: TB diagnosis in patients with HIV is challenging due to the lower sensitivities across tests. Molecular tests are preferred and the Xpert® MTB/RIF assay has limitations in lower-income settings. We evaluated the performance of loop-mediated isothermal amplification (LAMP) and the lipoarabinomannan (LAM) test in HIV-positive, ART-naïve clinic patients.METHODS: A total of 783 eligible patients were enrolled; three spot sputum samples of 646 patients were tested using TB-LAMP, Xpert, smear microscopy and culture, while 649 patients had TB-LAM testing. Sensitivity, specificity, and negative and positive predictive values were estimated with 95% confidence intervals.RESULTS: Sensitivities for smear microscopy, TB-LAMP and Xpert were respectively 50%, 63% and 74% compared to culture, with specificities of respectively 99.2%, 98.5% and 97.5%. An additional eight were positive on TB-LAM alone. Seventy TB patients (9%) were detected using standard-of-care testing, an additional 27 (3%) were detected using study testing. Treatment was initiated in 57/70 (81%) clinic patients, but only in 56% (57/97) of all those with positive TB tests; 4/8 multidrug-resistant samples were detected using Xpert.CONCLUSION: TB diagnostics continue to miss cases in this high-burden setting. TB-LAMP was more sensitive than smear microscopy, and if followed by culture and drug susceptibility testing as required, can diagnose TB in HIV-positive patients. TB-LAM is a useful add-in test and both tests at the point-of-care would maximise yield.
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Electrocardiographic optimization of PR interval in Left Bundle Area Pacing. Indian Pacing Electrophysiol J 2022. [DOI: 10.1016/j.ipej.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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25
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Feasibility and Short-term Outcomes of Left Bundle Pacing in Pediatric Patients: A Case Series. Indian Pacing Electrophysiol J 2022. [DOI: 10.1016/j.ipej.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract GS2-10: Nimbus: A phase 2 trial of nivolumab plus ipilimumab for patients with hypermutated her2-negative metastatic breast cancer (MBC). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-gs2-10] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: While high tumor mutational burden (TMB-H) has been used as a tissue-agnostic biomarker for approval of immune checkpoint inhibitors (ICI), there is a paucity of data regarding efficacy of ICI in TMB-H MBC. The aim of this study was to evaluate if patients with TMB-H HER2-negative MBC benefit from the combination of nivolumab plus ipilimumab. Methods: This is an open-label, single-arm, multicenter, phase 2 study assessing the efficacy of nivolumab 3 mg/kg intravenously (IV) every 14 days plus ipilimumab 1 mg/kg IV every 6 weeks in subjects with TMB-H HER2-negative MBC. Eligible patients were required to have measurable HER2-negative MBC, TMB ≥9 Mut/Mb assessed by a cancer-gene panel evaluating > 300 genes and performed in a CLIA-certified laboratory, and 0-3 prior lines of chemotherapy in the advanced setting. The primary objective was overall response rate (ORR) according to RECIST 1.1. Secondary objectives include safety and tolerability, progression-free survival (PFS), and overall survival (OS). The study followed a two-stage design. In the first stage, 14 patients were enrolled. The study required at least 1 objective response in order to continue to the second stage where an additional 16 patients were enrolled. At least 4 objective responses among the 30 patients would suggest the regimen is worthy of further study. If the true response rate is 25%, the chance that the regimen is declared worthy of further study is > 90%. Tumor biopsies, peripheral blood mononuclear cells, circulating tumor DNA, and stool collection were mandatory and were obtained at baseline and on treatment (end of cycle 1). Results: From February 2019 to June 2021, 31 patients were enrolled across 3 different academic institutions. Among 30 patients who initiated study treatment, the median age was 63 yo, 20 had hormone-receptor positive (HR+) breast cancer and 10 had triple-negative breast cancer (TNBC), and median number of prior lines of chemotherapy was 1.5 (0-3). Among the 10 patients with TNBC, PD-L1 status was known in 7 patients (3 positive and 4 negative). Median TMB was 10.9 Mut/Mb and 16.7% (n = 5) of patients had a TMB ≥14 mut/Mb. After a median follow-up of 9.7 (4.4 - 16.4) months, 4 (13.3%) patients achieved a confirmed objective response (all partial responses) meeting the primary endpoint of this study. The median duration of response has not been reached and 3 of these patients are still progression-free for at least 15 months. Two patients have short follow-up, and one has an unconfirmed partial response and the other has a stable disease at the time of the data cut. Median PFS and OS was respectively 1.4 (95% CI 1.3 - 9.5) months and 8.8 (95% CI 4.2 - not reached). Exploratory analysis did not show a difference in response rate according to HR status and PD-L1 status (data not shown) but tumors with TMB ≥14 mut/Mb had a response rate of 60% vs 4% in the group with TMB between ≥9 and <14 mut/Mb (p = 0.01). The treatment was associated with a favorable toxicity profile, with only three patients developing grade 3 immune-related adverse events (1 had adrenal insufficiency and cardiac troponin elevation, and two other had hepatitis). There were no reported grade 4-5 events. Data regarding TIL, PD-L1 and CD8 immunohistochemistry will be presented at the symposium. Conclusion: This study of nivolumab plus ipilimumab in TMB-H MBC achieved the primary endpoint and demonstrated a confirmed ORR of 13.3%. While patients with TMB ≥ 14 Mut/Mb were minority in this study, the 60% of ORR in this subgroup highlights the need to better evaluate the optimal TMB cutoff to predict benefit to immunotherapy in MBC.
Citation Format: Romualdo Barroso-Sousa, Tianyu Li, Sangeetha Reddy, Leisha A. Emens, Beth Overmoyer, Paulina Lange, Molly K Dilullo, Victoria Attaya, Jeffrey Kimmel, Eric P. Winer, Elizabeth A. Mittendorf, Nabihah Tayob, Sara M. Tolaney. Nimbus: A phase 2 trial of nivolumab plus ipilimumab for patients with hypermutated her2-negative metastatic breast cancer (MBC) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr GS2-10.
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POS-594 CEFUROXIME AS AN OUTPATIENT HAEMODIALYSIS-BASED ANTIBIOTIC REGIME FOR THE TREATMENT OF MSSA BACTERAEMIA. RETROSPECTIVE ANALYSIS OF A NOVEL THERAPEUTIC APPROACH USING CEFUROXIME OVER VANCOMYCIN. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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POS-979 EFFICACY AND SAFETY OF RITUXIMAB IN COMPLICATED STEROID DEPENDENT AND REFRACTORY STEROID RESISTANT CHILDHOOD NEPHROTIC SYNDROME. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Real-world cost for first-line treatment for prostate cancer: A comparative cost analysis in the public sector. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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POS-742 HEALTH RELATED QUALITY OF LIFE (HRQOL) IN PAEDIATRIC CHRONIC KIDNEY DISEASE (CKD) AND CAREGIVER BURDEN (CB) – A PROSPECTIVE MIXED-METHODS STUDY. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Outcomes of Salvage Robot-Assisted Radical Prostatectomy (S-RARP) post focal ablation for prostate cancer in comparison with primary Robot-assisted Radical Prostatectomy (RARP); A matched analysis. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Variation of Chargemaster Price Listings for Hysterectomy Procedures across Five States. J Minim Invasive Gynecol 2021. [DOI: 10.1016/j.jmig.2021.09.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Burden of arrhythmias in patients with obstructive sleep apnea and its impact on mortality: a descriptive study from the National Inpatient Sample. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Obstructive sleep apnea (OSA) accounts for significant mortality and morbidity worldwide. A limited but emerging literature has revealed increased risk of sudden cardiac death in patients with OSA. There is paucity of data on arrhythmia burden in patients with OSA, particularly in hospitalized patients.
Purpose
Therefore, we sought to study the prevalence of atrial and ventricular arrhythmias among hospitalized patients with OSA and examine its impact on sudden cardiac death and in-hospital mortality.
Methods
All patients over 18 years of age with OSA were extracted from the National Inpatient Sample (NIS) from 2009–10 using 9th revision of International Classification of Diseases (ICD-9) code 327.23. Demographic data, hospital characteristics, comorbid conditions, and arrhythmia burden including different types of arrhythmia were identified. Clinical outcomes were in-hospital mortality, length of stay and sudden cardiac death. Logistic regression analysis was performed to determine the impact of arrhythmia on in-hospital mortality in patients with OSA. Hospital level discharge weights provided by NIS were used to obtain national estimates of OSA hospitalizations.
Results
OSA was prevalent in 2.8% (n=1,114,297) of all hospitalizations among which 20.1% had any arrhythmia (n=223,974). Patients with arrhythmia were older, more likely to be males, and had higher prevalence of risk factors and comorbid conditions except for chronic liver disease, and smoking (p<0.0001 for all). Arrhythmia burden analysis revealed increase prevalence of both atrial and ventricular arrhythmia in patients with OSA compared to general population. In-hospital mortality (3.48% vs 1.27%; p<0.0001), length of hospital stay (6.4±0.1 vs 5±0.1; p<0.001) and sudden cardiac death (1.34% vs 0.4%; p<0.0001) were higher in OSA patients with arrhythmia compared to OSA patients without arrhythmia. Presence of arrhythmia in OSA patients was associated with increased in-hospital mortality in both unadjusted [OR 2.79 (2.62–2.98); p<0.001] and multivariable model adjusted for all risk factors and comorbid conditions [OR 1.83 (1.69–1.98); p<0.001].
Conclusion
Arrhythmia burden was higher in patients with OSA compared to the general population. Presence of arrhythmia among OSA patients was independently associated with increased in-hospital mortality and longer hospital stays. Routine evaluation to assess arrhythmia burden in patients in OSA could be a potential target to decrease sudden cardiac death in this high risk population.
Funding Acknowledgement
Type of funding sources: None.
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P–077 Performance of the postwash total motile sperm count as a predictor of pregnancy at the time of intrauterine insemination. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is the performance of the postwash total motile sperm count a predictor of pregnancy at the time of intrauterine insemination?
Summary answer
The number of motile spermatozoa inseminated (NMSI) in IUI can be used to define clear range of pre /postwash sperm parameters.
What is known already
There is no consensus about the optimal number of motile spermatozoa inseminated (NMSI) required for a reasonable chance of pregnancy after IUI. A meta-analysis of 16 studies assessing NMSI and IUI outcomes, concluded that at cut-off levels between 0.8 and 5 million, defined as the ability to predict failure to become pregnant. The purpose of this study is to determine the range of NMSI as a predictor of success in IUI.
Study design, size, duration
This prospective study includes 60 patients who underwent semen analysis at an academic infertility centre (SRIHER) during the month of December 2020 and January 2021.
Participants/materials, setting, methods
A total of 60 infertile couples who underwent IUI at our academic centre were enrolled in our study. A detailed history and infertility work up was done before proceeding for IUI, as per the department protocol. The semen was prepared by discontinuous 2 layered density gradient method. The results were analyzed by patient factors including age, BMI, semen parameters, NMSI. The NMSI were divided into 4 groups: A (<1), B (1–4), C (5–9), D (>10).
Main results and the role of chance
The mean age of the infertile couples who underwent IUI was (28.2 ± 3.8) in females and (31.8 ± 3.8) in males respectively. The sperm parameters such as concentration (21.8 ± 14.8), motility (53.15 ± 13.22), morphology (2.43 ± 1.33) respectively. When the NMSI was group C (5–9 x 10 6) the pregnancy rate was 38.5% whereas the pregnancy rate was 37.5% in group D ( >10 x 10 6). In the other sub groups such as group A(<1 x 10 6) and group C (1–4 x 10 6) the pregnancy rate was 14.2% and 12.5% respectively.
Limitations, reasons for caution
Infertile men with Azoospermia, Men with Retrograde ejaculation, Testicular samples, Epididymal samples, Infected samples. All of the above samples were avoided. It cannot be used for counselling during the initial infertility workup, but only during/after the IUI procedure.
Wider implications of the findings: The results suggest that NMSI can be a predictor of success in IUI in patients who are < 30 years of age & ≥35 years, NMSI does not appear to be a useful. The effect of NMSI on pregnancy rate needs to evaluated on a larger scale .
Trial registration number
Not applicable
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PO-1645 Dosimetric comparison of radiotherapy techniques for left breast, axilla and supraclavicular fossa. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08096-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Biplane 3D Overlay Guidance For Congenital Heart Disease To Assist Cardiac Catheterization Interventions - A Pilot Study. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Association between Oncotype DX Genomic Prostate Score (GPS) and adverse tumor pathology after radical prostatectomy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01393-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Application of deep learning convolutional neural network in prediction of stone location, skin to stone distance and composition in renal lithiasis: A single center pilot study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00624-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Patient surgical satisfaction following da vinci single port and multi port robotic-assisted radical prostatectomy: A propensity score matched analysis. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Application of Artificial Intelligence-based classifiers to predict the outcome measures and stone-free status following percutaneous nephrolithotomy for staghorn calculi: Cross-validation of data and estimation of accuracy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01348-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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41
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Technical details comparing the da Vinci SP and da Vinci Xi approach to radical prostatectomy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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New horizons in imaging and surgical assessment of breast cancer lymph node metastasis. Breast Cancer Res Treat 2021; 187:311-322. [PMID: 33982209 DOI: 10.1007/s10549-021-06248-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/29/2021] [Indexed: 01/09/2023]
Abstract
Axillary nodal status is one of the most important prognostic factors in breast cancer. While sentinel lymph node biopsy (SLNB) is a safe and validated procedure for clinically node-negative patients, axillary management of clinically node-positive patients has been more controversial. Patients with clinically detected axillary metastases often benefit from neoadjuvant chemotherapy (NAC). Those who convert to node-negative disease following NAC are important to identify, since they can often be spared significant morbidity from axillary dissection. SLNB has shown widely varying false-negative rates (FNR) but with the use of dual mapping and surgical biopsy of 3 or more nodes, it is considered an acceptable method to stage the axilla in clinically node-positive patients who receive NAC. Various methods including targeted axillary dissection (TAD) have been shown to decrease the FNR of SLNB. We will review appropriate methods to identify a metastatic node and subsequent ultrasound-guided biopsy with tissue marking techniques. We underscore key points in monitoring axillary response, techniques to accurately localize the biopsied and clipped known metastatic node for surgical excision and the effect of various methods in reducing the FNR of SLNB, including the emerging concept of TAD on patient care.
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Relationship between online cognition and personality traits: A questionnaire based study of medical college students. Eur Psychiatry 2021. [PMCID: PMC9480402 DOI: 10.1192/j.eurpsy.2021.1538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Current classification systems are not sure where to place the internet use disorder. Is it an addiction, an impulse control disorder, a consequence of another psychiatric morbidity or a consequence of personality trait/personality disorder? Objectives We intended to study which personality traits associated with online cognition may contribute towards Problematic internet use(PIU). We also analysed the relationship between number of hours of use/week of internet and PIU along with its relation with two ‘screening’ questions. Methods Online cognition scale and Abbreviated Eysenck Personality questionnaires were our measurements of choice in addition to demographic measures and some questions pertaining to online behaviour patterns. Results Total 163 responses were analysed. The demographic pools consisted mostly of young adults who had, on average, used the internet for 5.2 years at present rate of 21.81hours/week. We observed significantly higher mean OCS scores in men, in people who thought that the internet interfered with their lives and in those who felt the need to ‘cut-down’. A moderate positive and significant correlation was observed between hpurs/week of internet use and OCS scores. Also, significant positive correlation was observed between Neuroticism and OCS, impulsivity, and loneliness/depression scores. Significant negative correlations were observed between the Lie trait and impulse control. Neuroticism and Lie together contributed to 21.8% of variance in OCS scores. Conclusions Neuroticism and Lie traits (representing need for social acceptance) were found to the causing significamn varience in the OCS scores of the subjects. High number of hours/week use of internet was related to the feeling of ‘need to cut down use’.
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Standard of Care and Survival for Signet-ring Cell and Non-Signet-ring Cell Gastric Cancer are More Achievable at Academic Cancer Centers. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2020.11.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Enteric virus detection from acute gastroenteritis cases in a tertiary care hospital before and after rotavirus vaccine introduction, India: 2012–2019. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Gastrointestinal side effects of upper gastrointestinal cancer surgery. Best Pract Res Clin Gastroenterol 2020; 48-49:101706. [PMID: 33317793 DOI: 10.1016/j.bpg.2020.101706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/21/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023]
Abstract
In this chapter, we describe the gastrointestinal side effects of oesophagectomy, gastrectomy and pancreaticoduodenectomy for cancer, with a focus on long-term functional impairments and their management. Improvements in upper gastrointestinal cancer surgery have led to a growing group of long-term survivors. The invasive nature of these surgeries profoundly alters the upper gastrointestinal anatomy, with lasting implications for long-term function, and how these impairments may be treated. Successfully maintaining a high quality of survivorship requires multidisciplinary approach, with survivorship care plans focused on function as much as the detection of recurrence.
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Preoperative anthropomorphic radiographic measurements can predict postoperative pancreatic fistula formation following pancreatoduodenectomy. Am J Surg 2020; 222:133-138. [PMID: 33390246 DOI: 10.1016/j.amjsurg.2020.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/06/2020] [Accepted: 10/19/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Postoperative pancreatic fistulae (POPF) are a major contributing factor to pancreatoduodenectomy-associated morbidity. Established risk calculators mostly rely on subjective or intraoperative assessments. We hypothesized that various objective preoperatively determined computed tomography (CT) measurements could predict POPF as well as validated models and allow for more informed operative consent in high-risk patients. METHODS Patients undergoing elective pancreatoduodenectomies between January 2013 and April 2018 were identified in a prospective database. Comparative statistical analyses and multivariable logistic regression models were generated to predict POPF development. Model performance was tested with receiver operating characteristics (ROC) curves. Pancreatic neck attenuation (Hounsfield units) was measured in triplicate by pancreatic protocol CT (venous phase, coronal plane) anterior to the portal vein. A pancreatic density index (PDI) was created to adjust for differences in contrast timing by dividing the mean of these measurements by the portal vein attenuation. Total areas of subcutaneous fat and skeletal muscle were calculated at the L3 vertebral level on axial CT. Pancreatic duct (PD) diameter was determined by CT. RESULTS In the study period 220 patients had elective pancreatoduodenectomies with 35 (16%) developing a POPF of any grade. Multivariable regression analysis revealed that demographics (age, sex, and race) were not associated with POPF, yet patients resected for pancreatic adenocarcinoma or chronic pancreatitis were less likely to develop a POPF (10 vs. 24%; p = 0.004). ROC curves were created using various combinations of gland texture, body mass index, skeletal muscle index, sarcopenia, PDI, PD diameter, and subcutaneous fat area indexed for height (SFI). A model replacing gland texture with SFI and PDI (AUC 0.844) had similar predictive performance as the established model (p = 0.169). CONCLUSION A combination of preoperative objective CT measurements can adequately predict POPF and is comparable to established models relying on subjective intraoperative variables. Validation in a larger dataset would allow for better preoperative stratification of high-risk patients and improve informed consent among this patient population.
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Effect of Doxorubicin on Myocardial Bicarbonate Production From Pyruvate Dehydrogenase in Women With Breast Cancer. Circ Res 2020; 127:1568-1570. [PMID: 33054563 DOI: 10.1161/circresaha.120.317970] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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794 RNase L is a regeneration repressor gene. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Caught in the crossfire: hepato-bilio-pancreatic cancer surgery in the midst of COVID-19. Br J Surg 2020; 107:e309-e310. [PMID: 32567691 PMCID: PMC7362061 DOI: 10.1002/bjs.11764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 11/29/2022]
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