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A comprehensive five-year analysis of gastric cancer mortality disparities in the midwest region (2018-2023): Trends, factors, and implication
No full textBackground: Gastric cancer is a major public health issue, contributing to morbidity and mortality. In the U.S., disparities in gastric cancer mortality exist based on age, gender, race, ethnicity, and socioeconomic status. Despite a decline in overall mortality, some groups still face elevated risks. This study explores gastric cancer mortality trends in the Midwest (2018-2023). Methods: This retrospective study analyzed adults aged 25+ using CDC WONDER (2018-2023) and ICD-10 code C16. Mortality data were stratified by age, gender, race, and Hispanic status. Crude and age-adjusted mortality rates (AAMRs) per 100,000 were calculated, with 95% confidence intervals (CIs). Temporal trends and annual percentage changes (APCs) were assessed using Joinpoint regression. Results: A total of 12,047 deaths occurred in the Midwest, with an AAMR of 2.31 (APC -1.77, CI -2.78 to -0.76, p \u3c 0.001) and a crude rate of 2.93 (CI: 2.88-2.98). Mortality increased with age, peaking at 85+ years (AAMR 21.48; crude 21.49), followed by 75-84 (AAMR 14.71; crude 14.75), 65-74 (7.77), 55-64 (4.34), 45-54 (2.05), 35-44 (0.77), and 25-34 (0.19). Males had a higher AAMR (3.13; APC -2.33, CI -4.43 to -0.30, p = 0.025) than females (1.66), with CR of 3.63 (CI: 3.55-3.71) vs. 2.24 (CI: 2.17-2.30). Black individuals had the highest crude (4.20, CI: 4.01-4.39) andAAMR (4.52), followed by Asians (3.17, CI: 2.88-3.46; AAMR 3.98) and Whites (2.83, CI: 2.77-2.88; AAMR 2.08). AI/AN crude was 1.91 (CI: 1.49-2.42), and multiracial, 0.65 (CI: 0.50-0.82). Hispanics had a higher AAMR (4.13; APC -4.71, CI -8.11 to -1.18, p = 0.009) than non-Hispanics (2.24; APC -1.66, CI -3.20 to -0.11, p = 0.039), although their CR (2.43, CI: 2.26-2.59) was lower than non-Hispanics (2.97, CI: 2.92-3.03). Conclusions: Mortality rates were highest among older adults, males, Black individuals, and Hispanics, reflecting ongoing disparities. Structural inequities, including socioeconomic barriers and limited healthcare access, significantly influence these trends. Addressing these requires better preventive care, addressing social determinants, and implementing culturally competent interventions. These findings highlight the need for equitable healthcare policies to reduce mortality and improve outcomes
TCT-815 Rates of Paravalvular Leaks Requiring Percutaneous Repair With Plugs After Valve-in-Ring Transcatheter Mitral Valve Replacement, Large Single Center Experience
No full textBackground: Transcatheter mitral valve-in-ring (tViR) has been shown to be an effective alternative to re-do surgery for failed annuloplasty repairs. Mitral paravalvular leak (mPVL) is a sequela of mitral repair annuloplasty operations. The incidence of pre-existing concomitant versus new or worse mPVL after tViR is not well known. Methods: This was a single-center retrospective analysis of 58 patients who underwent tViR, between 2017 and 2025, for severe symptomatic MR due to failure of a pre-existing surgical ring. Pre- peri- and post-procedural TEEs were assessed for the presence of pre-existing or worsening mPVL after tViR, as well as management and outcome findings. Results: 12/58 (20%) patients undergoing mitral tViR had moderate or worse mPVL requiring PVL repair after valve deployment. 7 of the 12 (58%) had pre-existing mPVL on baseline TEE, with 2 of 7 having mild PVL that became severe, and 5 of 7 patients having moderate or worse PVL at baseline. 5 of the 12 (42%) patients had no PVL on baseline TEE assessment, with development of new moderate or worse PVL after tViR. All 12 patients underwent successful percutaneous PVL repair with Amplatzer plugs yielding final mild MR or less; 10 had the PVL repair at time of tViR and 2 had it in a staged intervention. Of note, 13/58 (22%) had skirt leak necessitating a second valve. There was no association between PVL repair and 1-yr mortality in this relatively small cohort. Conclusion: In this single center study, we found a higher than previously reported incidence of mPVL requiring percutaneous repair with plugs after mitral tViR (20%). 12% (7/58) of the cohort had pre-existing PVL that worsened or was baseline severe. 8.6% (5/58) of the cohort had new PVL after tViR. Close attention should be paid during mitral tViR procedures for the possibility of baseline mPVL and new or worsening mPVL, and these procedures should ideally be performed by teams capable of performing mPVL repair procedures. Categories: STRUCTURAL: Valvular Disease and Intervention: Mitra
Disparities in Liver Transplant Recipients Between 2014 and 2024 Using Organ Procurement and Transplantation Network Data
No full textPurpose: Liver transplantation is a critical treatment option for patients with end-stage liver disease. Previous studies have highlighted notable disparities in access to liver transplants and in transplant outcomes based on diagnosis, race, and gender. This study examines the differences in the representation of liver transplant recipients by diagnosis, gender, and race between 2014 and 2024. Methods: The national data regarding the state of liver transplantation was obtained through the website of Organ Procurement and Transplantation Network(OPTN) based on OPTN data. The patients were divided into the major groups, 2014 and 2024 liver transplant recipients. A chi-square test was used to compare the recipients’ characteristics across the two groups. Results: In 2024, a total of 10,528 liver transplants were performed, compared to 6,730 in 2014. In both years, a higher number of male patients received liver transplants than female patients. However, the gender gap in 2024 was significant smaller than in 2014 (P\u3c0.001). A similar trend is observed when considering ethnicity. White individuals represented the largest percentage in both years, with 69.9% in 2014 and 65.9% in 2024 (P=0.002). There was a higher proportion of elderly recipients, with individuals over 65 years old representing 21.8% of transplant recipients in 2024, compared to 15.7% in 2014 (P\u3c0.001). Additionally, there was a higher representation of patients under the age of 1 in 2024, accounting for 2.1% of recipients, compared to 1.4% in 2014. In both years, more than 90% of recipients were U.S. citizens, and over 94% received a liver from a deceased donor. The proportion of liver recipients with private insurance decreased from 52.3% in 2014 to 46.2% in 2024 (P \u3c0.001). Indicating notable changes in liver transplant indications over the decade, the proportion of recipients with non-cholestatic cirrhosis decreased dramatically from 58.0% in 2014 to 23.3% in 2024 (P\u3c0.00001), while the proportion with malignant neoplasm decreased significantly from 17.6% in 2014 to 10.4% in 2024 (P\u3c0.0001). The proportion of liver transplant recipients testing negative for Hep C increased significantly from 60.3% in 2014 to 81.9% in 2024 (P\u3c0.00001). Conclusions: Our findings offer valuable insights into the evolving landscape of liver transplantation, pointing to changes in patient demographics, and disease etiology but also emphasize ongoing challenges in healthcare access and equity. Further studies are needed to explore the underlying causes of these trends and their implications for liver transplant outcomes. [Formula presented] CITATION INFORMATION: Aburumman R., Nabeel S. Disparities in Liver Transplant Recipients Between 2014 and 2024 Using Organ Procurement and Transplantation Network Data AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: R. Aburumman: None
Compliance and Collections: Making Medical Archives More Accessible
No full textCurators and archivists working with medical collections often face a difficult balancing act: promoting access to important historical materials while upholding legal and ethical responsibilities around privacy. At the Claude Moore Health Sciences Library, we have navigated this challenge by actively engaging with institutional compliance officers and revisiting legacy restrictions in light of current HIPAA guidelines. In this lightning talk, I will share how our department undertook a multi-year effort to review and open access to previously restricted collections. Rather than a how-to, this presentation offers a case study that may inspire similar work elsewhere. Our process began with a detailed inventory of our manuscript holdings to identify materials with potential HIPAA concerns. We then worked closely with our institution’s compliance officer—not only to explain the nature and value of our collections, but also to build mutual understanding about privacy risks and research needs. The result was a memo that clarifies how archival staff can responsibly provide access within the bounds of the law. We also developed workflows for processing and flagging sensitive content more effectively. By demystifying our approach, I hope to spark ideas for how other institutions might rethink restrictive practices and build stronger relationships with their compliance teams
Overview of tivozanib (tivo) safety in phase 3 clinical trials in patients with metastatic renal cell carcinoma (mRCC)
No full textBackground: Tivo is a potent and highly selective VEGFR inhibitor designed to optimize VEGF blockade and minimize off-target toxicities. In TiNivo-2, patients with mRCC who had previous exposure to ICI, were randomized to receive study treatment as 2L or 3L with Tivo alone at 1.34mg, or at 0.89mg in combination with the ICI nivolumab (nivo).[1] The addition of nivo to tivo in second line (2L) or third-line treatment (3L) did not improve outcomes, and tivo monotherapy showed activity as a 2L treatment in the post ICI setting. In TIVO-3, randomized patients had at least two previous systemic treatments and received tivo or sorafenib. We carried out a safety review of tivoza - nib monotherapy in these 2 randomized trials in the context of popu - lations that had been previously exposed to VEGFR-TKI and ICI treatment. Methods: The safety profile of tivo monotherapy was evaluated in these two phase 3 trial cohorts that consisted of the tivo monotherapy arms of TiNivo-2 (N =171), and TIVO-3 (N =173).[2] Results: Patient baseline characteristics of the two tivo monotherapy cohorts showed some differences, most notably in the distribution of previous exposure to VEGFR target therapy and ICIs: in TIVO-3, exposure to two prior VEGFR-TKI was 45%, to prior ICI plus VEGFR-TKI was 27%, and to a prior VEGFR-TKI plus other agent was 28%. Whereas inTiNivo-2, exposure to prior ICI was 100% (71% as the most recent line of therapy), while exposure to VEGFR-TKI was: none 31%, one 56% and two 13%. Additionally, 94% of TIVO-3 participants were white, compared with 62% of those in TiNivo-2. The incidence of grade 3-4 TEAEs and serious AEs was lower in TiNivo-2, however there was consistency in the incidence of any cause TEAEs, as well as those leading to death or treatment modifications in both cohorts (Table 1). For TEAEs ≥ Grade 3, hypertension was the most common, occurring in approximately 20% of patients in each cohort; while the incidence of all other TEAEs ≥ Grade 3 was lower, they also occurred at similar rates in each cohort (Table 1). Conclusions: Here, results show that tivo has a manageable safety profile across phase 3 trials. The better tolerability of tivo in the TiNivo-2 study vs TIVO-3 is driven in part by more patients enrolled in the earlier lines of treatment (2L)
Preliminary results of a first-in-human phase 1b (aCCeleR8-001) study of S- 531011, a humanized anti-CCR8 monoclonal antibody, in patients with advanced solid tumors
No full textBackground: C-C motif chemokine receptor 8 (CCR8) is selectively upregulated in tumorinfiltrating regulatory T cells (TI-Tregs) in multiple cancers, inhibiting anti-tumor activity of the host immune system. S-531011, a humanized IgG1 monoclonal antibody, is anticipated to deplete CCR8-positive TI-Tregs, restoring anti-tumor immunity without inducing autoimmunity. Methods: An aCCeleR8-001 study is a Phase 1b/2, multicenter, open-label study of S-531011 which consists of Phase 1b Dose Escalation part (Parts A-1 and A-2) and Phase 2 Dose Expansion part. The safety/tolerability, pharmacokinetic (PK), pharmacodynamic, and anti-tumor activity of S-531011 as monotherapy and in combination with pembrolizumab (Merck & Co., Inc.) were evaluated in patients with various types of locally advanced or metastatic solid tumors. S-531011 monotherapy was administered at 8, 24, 80, 240, 800, or 1600 mg/kg intravenously every 3 weeks (Q3W) in Part A-1, whereas patients in Part A-2 received S-531011 at 80, 240, 800, or 1600 mg/kg in combination with pembrolizumab 200 mg/ kg Q3W. The data were analyzed when all patients in Dose Escalation cohorts completed the dose-limiting toxicity (DLT) observation period. Results: As of the data cutoff date (30 Sep 2024), 40 and 35 patients were enrolled in Parts A-1 and A-2, respectively. No DLTs were reported at any dose level and themaximumadministered dose of S-531011 was 1600mgin both parts. One patient reported an infusion-related reaction in Part A. Immune-related adverse events (irAEs) were reported in two patients (5.0%; Grade 1/2 only) in Part A-1, whereas 15 irAEs were reported in 10 patients (28.6%; including four Grade 3 irAEs in four patients) in Part A-2. PK of S-531011 was approximately dose proportional with a terminal elimination half-life of 10 to 12 days regardless of dose level. CCR8 receptors in PBMCs were occupied at doses of 80 mg or higher. PK/CCR8 receptor occupancy modeling analysis indicated that \u3e 90% of receptors in tumor tissues were occupied in the range of 80 to 800 mg. Multiplex immunohistochemistry analysis demonstrated proof of mechanism as evidenced by CCR8-positive Treg depletion in tumor tissue at doses of 24mgor higher. Among 62 evaluable patients dosed at 80 to 1600mgin Part A, four patients (6.5%) had confirmed partial response, three of whom had colorectal cancer (CRC). Twenty patients (32.3%) had disease control for≥6 weeks. Response rate was not correlated with dose (80 to 1600 mg). Following a comprehensive data review, tentative recommended Phase 2 doses were determined to be 80 to 800 mg in both parts. Conclusions: S-531011 was well tolerated up to 1600 mg as monotherapy and in combination with pembrolizumab. A higher response rate in patients with CRC warrants further exploration of this tumor type in Phase 2 Dose Expansion part. Phase 2 CRC cohorts are currently ongoing
Eyelash Serums: A Consumer Analysis of the Rising Demand for Topical Eyelash Enhancement Products
No full textUse of Imaging to Prevent Unnecessary Workup and Answer a Clinical Question
No full textWith a fair percentage of all medical care deemed unnecessary for diagnosis and treatment, it is paramount that clinicians consider the rationale for each order and whether it is truly warranted. We present the case of a 71-year-old male with a history of Roux-en-Y gastric bypass who presented with choledocholithiasis and was found to have an incidental finding of a persistently narrowed segment of the right bile duct. With the usage of multiple imaging modalities, particularly CT angiography and intravascular ultrasound via an endobiliary route during biliary drain management, it was confirmed that the narrowing of concern was caused by a benign vascular compression by the right hepatic artery as opposed to a malignancy. This case demonstrates how minimally invasive imaging can reduce further potentially unnecessary tests, and thus costs, for patients
Effects of individual, health system and neighborhood risks on diabetes health outcomes among emerging adults with type 1 diabetes
No full textAIMS: To test associations between individual, health system and neighborhood-level risk and protective factors, and health outcomes in a diverse sample of emerging adults (EAs) with type 1 diabetes (T1D).
METHODS: Data were drawn from the baseline data collection of a clinical trial. One hundred and thirteen EAs [47.8 % White/non-Hispanic; mean age = 20.9 years; mean HbA1c = 9.5 % (IFCC = 81 mmol/mol)] completed self-report questionnaires on diabetes-self efficacy, diabetes distress, communication with diabetes health care provider, neighborhood crime and diabetes management. Structural equation modelling estimated the direct and indirect effects of individual, health care provider, and neighborhood factors on diabetes management and glycemic control.
RESULTS: In the final model, self-efficacy for diabetes care was the only significant predictor of diabetes management (β = 0.32, p \u3c 0.001). Neighborhood crime (β = 0.17, p \u3c 0.05) and diabetes management (β = -0.28, p \u3c 0.05) had significant direct effects on glycemic control, while diabetes self-efficacy had a significant indirect effect though diabetes management (β = -0.090; p \u3c 0.01).
CONCLUSIONS: Individual factors such as higher self-efficacy for diabetes management and neighborhood factors such as lower crime rates have protective effects on the diabetes health of EAs with T1D