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Derived Neutrophil-to-Lymphocyte Ratio as a Potential Biomarker for Lung Cancer Survival [Meeting Abstract]

Imperato, A E; Li, Y; Smith, R L; Sauthoff, H; Felner, K; Segal, L N; Sterman, D H; Tsay, J J
RATIONALE: Derived neutrophil-to-lymphocyte ratio (dNLR) of peripheral blood, a marker of host inflammation and cytokine activation, may be a surrogate for more aggressive disease. It is a biomarker that has been associated with survival and response to immunotherapy in non-small cell lung cancer (NSCLC), although an optimal threshold value has not been established. We had previously found in a NSCLC cohort that a dNLR cutoff of 2 was an optimal cutoff to predict survival at 6 months in patients with NSCLC; median survival was significantly shorter in patients with a >=2 dNLR (7.0 months) versus those with a <2 dNLR (64.5 months; p = 0.004). Here we present an interim analysis aiming to validate the use of this biomarker in a second cohort.
METHOD(S): A veteran cohort (n=42) from the VA New York Harbor Healthcare System, who underwent diagnostic bronchoscopy and found to have NSCLC, was used as a validation cohort. Peripheral blood was obtained pre-treatment and at or near the time of diagnosis. The dNLR was calculated as ANC/(W
EMBASE:635310166
ISSN: 1535-4970
CID: 4915442

Lower airway dysbiosis affects lung cancer progression

Tsay, Jun-Chieh J; Wu, Benjamin G; Sulaiman, Imran; Gershner, Katherine; Schluger, Rosemary; Li, Yonghua; Yie, Ting-An; Meyn, Peter; Olsen, Evan; Perez, Luisannay; Franca, Brendan; Carpenito, Joseph; Iizumi, Tadasu; El-Ashmawy, Mariam; Badri, Michelle; Morton, James T; Shen, Nan; He, Linchen; Michaud, Gaetane; Rafeq, Samaan; Bessich, Jamie L; Smith, Robert L; Sauthoff, Harald; Felner, Kevin; Pillai, Ray; Zavitsanou, Anastasia-Maria; Koralov, Sergei B; Mezzano, Valeria; Loomis, Cynthia A; Moreira, Andre L; Moore, William; Tsirigos, Aristotelis; Heguy, Adriana; Rom, William N; Sterman, Daniel H; Pass, Harvey I; Clemente, Jose C; Li, Huilin; Bonneau, Richard; Wong, Kwok-Kin; Papagiannakopoulos, Thales; Segal, Leopoldo N
In lung cancer, enrichment of the lower airway microbiota with oral commensals commonly occurs and ex vivo models support that some of these bacteria can trigger host transcriptomic signatures associated with carcinogenesis. Here, we show that this lower airway dysbiotic signature was more prevalent in group IIIB-IV TNM stage lung cancer and is associated with poor prognosis, as shown by decreased survival among subjects with early stage disease (I-IIIA) and worse tumor progression as measured by RECIST scores among subjects with IIIB-IV stage disease. In addition, this lower airway microbiota signature was associated with upregulation of IL-17, PI3K, MAPK and ERK pathways in airway transcriptome, and we identified Veillonella parvula as the most abundant taxon driving this association. In a KP lung cancer model, lower airway dysbiosis with V. parvula led to decreased survival, increased tumor burden, IL-17 inflammatory phenotype and activation of checkpoint inhibitor markers.
PMID: 33177060
ISSN: 2159-8290
CID: 4663012

RAPID DETERIORATION IN A PATIENT WITH SPONTANEOUS OTOGENIC PNEUMOCEPHALUS [Meeting Abstract]

Walsh, Brandon; Rozman, Peter; Deep, Nicholas; Knoll, Brianna; Henderson, Ian; Jafar, Jafar; Tsay, Jun-chieh; Felner, Kevin
ISI:000582625300616
ISSN: 0012-3692
CID: 4848772

Lung Cancer Survival and Prognosis Is Affected by Lower Airway Oral Commensal Enrichment [Meeting Abstract]

Tsay, J.; Sulaiman, I.; Wu, B.; Gershner, K.; Schluger, R.; Meyn, P.; Li, Y.; Yie, T.; Olsen, E.; Perez, L.; Franca, B.; El-Ashmawy, M.; Li, H.; He, L.; Badri, M.; Morton, J.; Clemente, J.; Shen, N.; Imperato, A.; Scott, A. S.; Bessich, J. L.; Rafeq, S.; Michaud, G. C.; Felner, K.; Sauthoff, H.; Smith, R. L.; Moore, W. H.; Pass, H. I.; Sterman, D. H.; Bonneau, R.; Wong, K.; Papagiannakopoulos, T.; Segal, L. N.
ISI:000556393505233
ISSN: 1073-449x
CID: 4930102

Development and Evaluation of a Cognitive Aid Booklet for Use in Rapid Response Scenarios

Mitchell, Oscar J L; Lehr, Andrew; Lo, Michelle; Kam, Lily M; Andriotis, Anthony; Felner, Kevin; Kaufman, Brian; Madeira, Charles
INTRODUCTION/BACKGROUND:Rapid response teams (RRTs) have become ubiquitous among hospitals in North America, despite lack of robust evidence supporting their effectiveness. Many RRTs do not yet use cognitive aids during these high-stakes, low-frequency scenarios, and there are no standardized cognitive aids that are widely available for RRTs on medicine patients. We sought to design an emergency manual to improve resident performance in common RRT calls. METHODS:Residents from the New York University School of Medicine Internal Medicine Residency Program were asked to volunteer for the study. The intervention group was provided with a 2-minute scripted informational session on cognitive aids as well as access to a cognitive aid booklet, which they were allowed to use during the simulation. RESULTS:Resident performance was recorded and scored by a physician who was blinded to the purpose of the study using a predefined scoring card. Residents in the intervention group performed significantly better in the simulated RRT, by overall score (mean score = 7.33/10 and 6.26/10, respectively, P = 0.02), and by performance on the two critical interventions, giving the correct dose of naloxone (89% and 39%, respectively, P < 0.001) and checking the patient's blood glucose level (93% and 52%, respectively, P = 0.001). CONCLUSIONS:In a simulated scenario of opiate overdose, internal medicine residents who used a cognitive aid performed better on critical tasks than those residents who did not have a cognitive aid. The use of an appropriately designed cognitive aid with sufficient education could improve performance in critical scenarios.
PMID: 31116168
ISSN: 1559-713x
CID: 3920662

Assessing and Improving Resident Stress During Rapid Response Scenarios [Meeting Abstract]

Mitchell, O.; Lehr, A.; Lo, M.; Kam, L. M.; Andriotis, A.; Kaufman, B.; Felner, K. J.; Madeira, C.
ISI:000449980304117
ISSN: 1073-449x
CID: 3512922

Development and Evaluation of a Cognitive Aid Booklet for Use in Rapid Response Scenarios [Meeting Abstract]

Lehr, A.; Mitchell, O.; Lo, M.; Kam, L. M.; Andriotis, A.; Felner, K. J.; Kaufman, B.; Madeira, C.
ISI:000449980303171
ISSN: 1073-449x
CID: 3512982

The Utility of High-Fidelity Simulation for Training Critical Care Fellows in the Management of Extracorporeal Membrane Oxygenation Emergencies: A Randomized Controlled Trial

Zakhary, Bishoy M; Kam, Lily M; Kaufman, Brian S; Felner, Kevin J
OBJECTIVE: Although extracorporeal membrane oxygenation volume has increased, proficiency in the technology requires extensive training. We compared traditional water-drill-based extracorporeal membrane oxygenation training with simulation-based extracorporeal membrane oxygenation training with the hypothesis that simulation-based training is superior. DESIGN: Randomized controlled trial. SETTING: Academic medical center. SUBJECTS: Pulmonary/critical care fellows. INTERVENTIONS: Participants had a preintervention simulated extracorporeal membrane oxygenation emergency (Sim1-recirculation) then randomized into simulation and traditional groups. Each group participated in three teaching scenarios, via high-fidelity simulation or via water-drills. After 6 weeks and after 1 year, participants returned for two simulated extracorporeal membrane oxygenation emergencies (Sim2-pump failure and Sim3-access insufficiency). Sim2 was a case encountered during teaching, whereas Sim3 was novel. A critical action, necessary for resolution of each scenario, was preidentified for timing. MEASUREMENTS AND MAIN RESULTS: Primary outcome was time required to perform critical actions. Twenty-one fellows participated in the study (simulation, 10; traditional, 11). Groups had similar scenario scores (p = 0.4) and times to critical action (p = 0.8) on Sim1. At 6 weeks, both groups had similar scenario scores on Sim2 (p = 0.5), but the simulation group scored higher on Sim3 (p = 0.03). Times to critical actions were shorter in the simulation group during Sim2 (127 vs 174 s, p = 0.004) and Sim3 (159 vs 300 s; p = 0.04). These findings persisted at 1 year. CONCLUSIONS: In novice critical care fellows, simulation-based extracorporeal membrane oxygenation training is superior to traditional training. Benefits transfer to novel scenarios and are maintained over the long term. Further studies evaluating the utility of simulation in other learner groups and for maintenance of proficiency are required.
PMID: 28422779
ISSN: 1530-0293
CID: 2532632

Randomized Trial of Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults: More Data, More Questions

Mendelson, Jonathan S; Felner, Kevin J; Kaufman, Brian S
PMID: 28291110
ISSN: 1530-0293
CID: 2488512

Did Video Kill the Direct Laryngoscopy Star? Not Yet!

Mendelson, Jonathan S; Felner, Kevin J; Kaufman, Brian S
PMID: 28362525
ISSN: 2325-6621
CID: 2519312