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Factors Associated With Residual Disease on Re-Excision Specimens After Breast-Conserving Surgery for Breast Cancer.
No full textBACKGROUND: After breast-conserving surgery (BCS) for early-stage breast cancer, re-excision rates for positive or close margins remain high, although most re-excisions show no residual disease. This study aimed to identify clinicopathologic factors associated with residual disease to guide re-excision decisions.
METHODS: The study evaluated women with ductal carcinoma in situ (DCIS) or invasive breast cancer who underwent BCS and re-excision for positive or close margins from 2018 to 2024 at the Saint John\u27s Cancer Institute. The association between clinical-pathologic variables and residual disease was evaluated by multivariable logistic regression.
RESULTS: Of 932 patients treated with BCS, 184 (19.7 %) underwent re-excision for positive or close margins. Residual disease was found in 54 (29 %) patients, most commonly DCIS (n = 36, 66.7 %). In the multivariable analysis, residual disease was associated with three or more positive margins (odds ratio [OR], 9.87; 95 % confidence interval [CI], 3.23-30.17), DCIS at the margin (OR, 7.4; 95 % CI, 1.56-35.16), PR negativity (OR, 4.06; 95 % CI, 1.26-13.12), and mammographic microcalcifications (OR, 3.0; 95 % CI, 1.17-7.69). Conversely, reduced risk was associated with age ≥60 years (OR, 0.07; 95 % CI, 0.01-0.46), invasive carcinoma with extensive intraductal component (EIC: OR, 0.15; 95 % CI, 0.03-0.66), and pure DCIS (OR, 0.14; 95 % CI, 0.03-0.63).
CONCLUSIONS: Residual disease was found in fewer than one third of re-excision specimens. Factors reflecting margin burden and tumor biology, especially the number of positive margins, DCIS involvement of margin, and PR-negativity, were associated with residual malignancy, whereas EIC and older age were associated with a lower likelihood of residual disease. These findings support a risk-adapted, individualized approach to re-excision after BCS to minimize unnecessary surgery
DNA methylation signatures of frailty beyond age: a longitudinal study of female and male mice.
No full textFrailty is an age-related geriatric syndrome with largely unknown mechanisms. We conducted a longitudinal study of aging C57BL/6JNIA mice (females; n = 40, male; n = 49), measured frailty index and derived DNA methylation data from PBMCs. We selected frailty-related differentially methylated CpGs and determined differentially methylated regions (DMRs), focusing on both age-independent and -dependent frailty, and using both mixed-sex and sex-stratified subgroups. We propose a joint set of 925 frailty-related DMRs, perform an association study with frailty outcomes, build epigenetic frailty clocks and validate in mice with interventions. Notably, age-independent frailty DMRs are enriched in nervous and endocrine pathways, distinct from signaling and lipid metabolism pathways identified from age-dependent DMRs. We observe hypermethylation in signaling pathways and hypomethylation in lipid metabolism and cytochrome P450 pathways with frailty progression. 36 DMRs show consistent associations in validation. These findings highlight distinct epigenetic signatures underlying frailty and aging, with potential sex-specific mechanisms
Bridging the Gap: Improving Well-Child Care Engagement Post-discharge in Infants With Neonatal Opioid Withdrawal Syndrome.
No full textWe conducted a quality improvement study to increase well-child visit attendance for infants with neonatal opioid withdrawal syndrome. Our primary outcome was attendance at the postnatal visit. Secondary outcomes included attendance at the 1- and 6-month visits. We used health records data to examine the baseline (2/2022-9/2023) and intervention (1/2024-6/2024) periods. We implemented a series of targeted interventions focused on (1) strengthening community partnerships, (2) increasing support to help families schedule newborn follow-up appointments, and (3) enhancing discharge education. We used Bayesian logistic mixed-effects models to assess follow-up attendance probability. We identified 52 infants in the baseline and 33 infants in the intervention periods. Baseline attendance was 90%, 63%, and 73% at the postnatal, 1-, and 6-month visits, respectively. Following the intervention, attendance was 91% at the postnatal visit, and improved to 82% and 80% for the 1- and 6-month visits. The probability of follow-up increased by 1% (95% confidence interval [CI]: -0.12, 0.12) at the postnatal visit, 18% (95% CI: 0.01, 0.34) at 1 month, and 8% (95% CI: -0.10, 0.24) at 6 months, highlighting the effectiveness of an interdisciplinary approach in improving post-hospitalization follow-up
The location and degree of residual disease determines recurrence patterns and survival in patients with esophageal adenocarcinoma after trimodal therapy.
No full textKnown predictors of recurrence and survival include the total number of nodes and positive nodes resected, tumor stage, histology, and tumor differentiation. Patients with a complete response have the best survival, but residual tumor in the esophagus, nodes, or both may influence survival. This study assesses the risk of recurrence and survival of esophageal adenocarcinoma after trimodal therapy based upon the location residual disease in the resected specimen. Multicenter, retrospective study of patients with esophageal adenocarcinoma undergoing induction chemoradiation and transthoracic esophagectomy from 2010 to 2017. Overall survival (OS) and recurrence were compared based on the residual disease location using Kaplan-Meier analysis. Clinical factors associated with OS and time to recurrence were also assessed. There were 504 patients with a median follow-up of 63.4 months 95% confidence interval (CI):60.8-70.5 and an estimated overall 5-year survival of 55.8%. When subdivided by residual disease location, the estimated 5-year survival in patients with complete pathologic response and residual disease of only the esophagus was 68.3% and 65.0% hazard ratio (HR) = 1.05; P = 0.81. With increasing nodal positivity there was decreasing survival, 45.8% (N1) and 20.1% (N2). N3 patients did not survive past 36 months. Multivariable analysis demonstrates that any residual disease in the lymph nodes (HR = 3.14), taxane and fluoropyrimidine chemotherapy (HR = 3.34), neoadjuvant radiation dose \u3c 50 Gy (HR = 2.35), and fluoropyrimidine chemotherapy (HR = 1.88) were predictive of worse OS. Overall survival and recurrence are influenced by the location of residual disease. Residual disease in the esophagus and pathologic complete response behaves similarly. Survival is reduced as nodal counts increase
Accelerating evidence generation to implementation: Establishment of the Leading Awareness to Action through Implementation of Cardiometabolic Efforts (LATTICE) consortium.
No full textRecent scientific advancements have led to the availability of innovative therapies to reduce the risk of cardiometabolic events, offering new tools to address the world\u27s leading cause of mortality. The length of time from evidence generation to implementation in healthcare settings remains far from optimal, resulting in missed opportunities to improve morbidity and mortality and unrealized population-level benefit. Established in 2023, the Leading Awareness to Action through Implementation of Cardiometabolic Efforts (LATTICE™) consortium\u27s mission is to unite partners dedicated to improving cardiometabolic health by creating an inclusive platform for sharing evidence-based tools, methodologies, and strategies to address gaps in care at scale. The LATTICE consortium aims to accomplish this by 1) exploring novel strategies for translating evidence-based advancements across diverse clinical practice settings and 2) disseminating successful strategies through a unique collaboration among clinicians, healthcare systems, payors, patients, patient advocacy groups, and life science companies. The LATTICE consortium is prioritizing projects that rigorously test strategies grounded in implementation science and hold significant promise for uptake at scale. Success of the LATTICE consortium will be assessed through improved awareness, access, and implementation of effective, scalable, and sustainable health care strategies that address cardiometabolic gaps in care
In-Hospital mortality in Spondylodiscitis: Risk factors assessed through the National Inpatient Sample analysis.
No full textObjective: Spondylodiscitis (SD) poses an increasing challenge to healthcare providers by its insidious onset and diverse clinical manifestations, concurrent with an aging population, immunocompromising conditions and various influencing comorbidities. Overall mortality remains relatively high, up to 7.3%, despite advancements in diagnostics and treatment. Past studies have struggled to differentiate leading causes for mortality. With this study we want to utilize the large data group available through the National Inpatient Sample (NIS) to assess the in-hospital mortality in patients with SD in different age-groups and to identify risk factors.
Methods: Utilizing the 2020 NIS, Healthcare Utilization Project (HCUP) adults (\u3e18 years) were screened using the primary diagnosis of SD by ICD-10 Code (M46.2x, M46.3x and M46.4x). Demographic information, admission details, clinical data, comorbidities, and surgical treatment were extracted using the Clinical Classifications Software Refined (CSSR) categories. Comorbidities include pre-existing conditions and those acquired during hospitalization. Age was categorized into 3 groups (\u3c 65 years; 65-79: ≥ 80). The primary outcome was in-hospital mortality, with multivariable logistic regression analysis used to identify independent risk factors.
Results: In total 3,975 patients met our inclusion criteria resulting with an in-hospital mortality rate of 0.9 %. The mortality group was significantly older (70.86 years to 58.74 years compared to the survival group) with elective admission being more common (p=\u3c 0.001) with a similar sex distribution. Patients ages 65-79 were more common in the mortality group. Overall fourteen comorbidities differed significantly between the two groups. Chronic diseases were more common in the mortality group, whereas alcohol and substance abuse were more prevalent in the survival group. Age, especially patients \u3c 65 years, elective admission status, paralysis and pneumonia were identified as independent risk factors for mortality.
Conclusion: Management of SD remains complex. Our study revealed a lower rate of in-hospital mortality and length of stay than previous studies. Elective admission status was the strongest predictor of mortality, highlighting the benefits of early diagnosis and treatment. Patients \u3e 65 years, especially octogenarians, were identified to be particular at risk. Risk factors contributing to mortality in SD may differ from etiological risk factors, highlighting areas for potential further research
XBB.1.5 mRNA COVID-19 vaccine protection against inpatient or emergency department visits among adults infected with SARS-CoV-2 JN.1 and XBB-lineage variants.
No full textAs part of a multi-state viral genomic surveillance program, we conducted a case-only analysis to evaluate the effectiveness of XBB.1.5-adapated mRNA vaccines in preventing severe illness among individuals with medically attended SARS-CoV-2 infection. We compared prior receipt of an XBB.1.5-adapted mRNA vaccine between SARS-CoV-2-infected adults with inpatient or emergency department (ED) visits (as a proxy for severe illness) vs those with outpatient visits (as a proxy for mild illness). Among 6,551 patients between September 2023 and January 2024, 6.1% with inpatient or ED visits vs 12.0% with outpatient visits had received XBB.1.5 vaccination (adjusted odds ratio [aOR]=0.41; 95% confidence interval [CI]: 0.32-0.53). This protective association was weaker among JN.1 (aOR=0.62; 95% CI: 0.40-0.96) vs XBB-lineage (aOR=0.28; 95% CI: 0.18-0.43) variant infections (interaction, p=0.003). XBB.1.5 vaccines protect against severe illness, but protection may be weaker against JN.1 vs XBB-lineage variants. This study highlights the need for COVID-19 vaccines to be routinely updated to align with circulating strains and for individuals to stay up to date with recommended vaccines
Region 10 Special Pathogen Transport Preparedness
No full texthttps://digitalcommons.providence.org/special_pathogens_conferences/1006/thumbnail.jp