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Molecular profiling of 50,734 bethesda iii-vi thyroid nodules by thyroseq v3 genomic classifier: Implications for personalized management [Meeting Abstract]

Chiosea, S; Hodak, S; Yip, L; Baldwin, C; Baloch, Z; Hannoush, Z; Haugen, B; Joseph, L; Kargi, A; Khanafshar, E; Livhits, M; Patel, K; Patel, S; Randolph, G; Shaha, A; Sharma, J; Staii, A; Stathatos, N; Van, Zante A; Carty, S; Nikiforov, Y; Nikiforova, M
Comprehensive genomic analysis of thyroid nodules for multiple classes of molecular alterations, including TERT mutations and copy number alterations (CNA), have not been reported in a large series of fine-needle aspiration (FNA) samples. The goal of this study was to determine the prevalence of clinically relevant molecular alterations in consecutive Bethesda III-VI thyroid nodules analyzed by ThyroSeq v3 Genomic Classifier. Retrospective analysis of 50,734 consecutive FNA samples from thyroid nodules clinically tested by ThyroSeq v3 Genomic Classifier (GC) included 40,622 (80%) Bethesda III; 7,725 (15%) Bethesda IV; 2,028 (4%) Bethesda V; and 359 (1%) Bethesda VI cytology samples. Among all FNA samples, 65.3% were reported as Negative, 33.9% as Positive, 0.2% as Positive for medullary carcinoma, and 0.6% Positive for parathyroid. Of the 48,347 Bethesda III/IV samples, 67.8% were Negative, whereas of the 2,387 Bethesda V-VI cytology samples, 84.8% were Positive. Among the test-positive nodules, BRAF V600E mutation was found in 8.8% of BIII-IV and in 65.8% of BV-VI samples (p < 0.001), whereas RAS mutations were more prevalent among BIII-IV as compared to BV-VI nodules (46.5% vs. 8.8%, p < 0.001). Among prognostically significant highrisk mutations, TERT promoter mutations were more prevalent in BV-VI (9.1%) vs. BIII-IV (4.6%) nodules (p < 0.001). Fusions involving RET, ALK, NTRK1, NTRK3, ROS1, and BRAF were more prevalent in BV-VI than in BIII-IV nodules (9.6% vs 4.2%; p < 0.001). ThyroSeq v3 GC detection of novel RTK gene fusion partners by differential expression of TK over EC domain of the gene were confirmed by RNA-Seq in 98.2% of cases. CNA of Hurthle cell type were more prevalent in BIII-IV (11.5%) than BV-VI nodules (5.5%) (p < 0.001). In this large series of consecutive FNA samples, 68% of Bethesda III-IV nodules were classified as negative by ThyroSeq v3 GC, allowing avoidance of diagnostic surgeries in these patients. Genetic alterations were identified in 85% of Bethesda V-VI nodules, with higher prevalence of BRAF V600E and TERT mutations and targetable gene fusions as compared to Bethesda III-IV nodules, offering valuable prognostic and therapeutic information for personalized management of patients with thyroid cancer diagnosed preoperatively
EMBASE:636273335
ISSN: 1557-9077
CID: 5179422

Update on rfa increasing use of cardiac and pulmonary rehabilitation in traditional and community settings nih-funded trials: Addressing clinical trial challenges presented by the covid-19 pandemic [Note]

Shero, S T; Benzo, R; Cooper, L S; Finkelstein, J; Forman, D E; Gaalema, D E; Joseph, L; Keteyian, S J; Peterson, P N; Punturieri, A; Zieman, S; Fleg, J L
EMBASE:635936006
ISSN: 1932-7501
CID: 4997532

Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City

Caplin, Nina J; Zhadanova, Olga; Tandon, Manish; Thompson, Nathan; Patel, Dhwanil; Soomro, Qandeel; Ranjeeta, Fnu; Joseph, Leian; Scherer, Jennifer; Joshi, Shivam; Dyal, Betty; Chawla, Harminder; Iyer, Sitalakshmi; Bails, Douglas; Benstein, Judith; Goldfarb, David S; Gelb, Bruce; Amerling, Richard; Charytan, David M
ORIGINAL:0015108
ISSN: n/a
CID: 4874982

Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City

Caplin, Nina J; Zhdanova, Olga; Tandon, Manish; Thompson, Nathan; Patel, Dhwanil; Soomro, Qandeel; Ranjeeta, Fnu; Joseph, Leian; Scherer, Jennifer; Joshi, Shivam; Dyal, Betty; Chawla, Harminder; Iyer, Sitalakshmi; Bails, Douglas; Benstein, Judith; Goldfarb, David S; Gelb, Bruce; Amerling, Richard; Charytan, David M
Background:The COVID-19 pandemic strained hospital resources in New York City, including those for providing dialysis. New York University Medical Center and affiliations, including New York City Health and Hospitals/Bellevue, developed a plan to offset the increased needs for KRT. We established acute peritoneal dialysis (PD) capability, as usual dialysis modalities were overwhelmed by COVID-19 AKI. Methods:Observational study of patients requiring KRT admitted to Bellevue Hospital during the COVID surge. Bellevue Hospital is one of the largest public hospitals in the United States, providing medical care to an underserved population. There were substantial staff, supplies, and equipment shortages. Adult patients admitted with AKI who required KRT were considered for PD. We rapidly established an acute PD program. A surgery team placed catheters at the bedside in the intensive care unit; a nephrology team delivered treatment. We provided an alternative to hemodialysis and continuous venovenous hemofiltration for treating patients in the intensive-care unit, demonstrating efficacy with outcomes comparable to standard care. Results:From April 8, 2020 to May 8, 2020, 39 catheters were placed into ten women and 29 men. By June 10, 39% of the patients started on PD recovered kidney function (average ages 56 years for men and 59.5 years for women); men and women who expired were an average 71.8 and 66.2 years old. No episodes of peritonitis were observed; there were nine incidents of minor leaking. Some patients were treated while ventilated in the prone position. Conclusions:Demand compelled us to utilize acute PD during the COVID-19 pandemic. Our experience is one of the largest recently reported in the United States of which we are aware. Acute PD provided lifesaving care to acutely ill patients when expanding current resources was impossible. Our experience may help other programs to avoid rationing dialysis treatments in health crises.
PMCID:8815539
PMID: 35372895
ISSN: 2641-7650
CID: 5219412

Acute peritoneal dialysis in obese patients during the COVID-19 pandemic [Meeting Abstract]

Joseph, L; Ranjeeta, F; Caplin, N J; Amerling, R
Background: Due to increased risk for infection, fluid leak, metabolic complications and poor uremic solute clearance, concerns have been raised in using peritoneal dialysis in obese patients. However, due to unprecedented need for renal replacement therapy (RRT) in New York City during the COVID-19 pandemic, acute peritoneal dialysis (APD) was initiated in patients regardless of body mass index (BMI).
Method(s): 36 patients who received PD between April 8, 2020 and May 8,2020 were categorized into 3 groups based on BMI calculated using admission height and weight. Group 1 with BMI < 30, Group 2 with BMI 30-40 and Group 3 with BMI > 40 kg/ m2. Treatment goals included correction of hyperkalemia, hyperphosphatemia, acid-base abnormalities, reduction in blood urea nitrogen (BUN), creatinine and maintaining euvolemia. All patients were initially started on manual exchanges every 1-2 hours (Total volume 10-13L/24 hours) and eventually most were changed to automated PD (Total volume 18-20L/24 hours). We compared the frequency of treatment-related complications among the groups.
Result(s): Of the 36 patients, 13 had BMI < 30, 18 patients had BMI 30-40, and 5 had BMI > 40, one of whom had BMI > 50 kg/ m2. Patients showed improvement in serum creatinine, BUN, phosphorus, potassium, and bicarbonate. All had adequate ultrafiltration and improved volume status after optimization of PD prescription. No differences were observed between groups in achievement of treatment goals. No patients in any group required discontinuation of PD because of treatment-related complications or insufficient dialysis.
Conclusion(s): Acute PD was successfully performed in obese, and morbidly obese patients during the COVID-19 pandemic. Treatment goals were achieved based on relevant parameters and there were no increases of treatment related complications compared to non-obese patients. Acute PD should not be restricted based on elevated BMI
EMBASE:633703544
ISSN: 1533-3450
CID: 4750212