Faculty Bibliography

In their relative infancy, intragastric balloons (IGB) offer a solution to patients who do not qualify for bariatric surgery due to their body mass index (BMI) or those reticent about major surgery with a promise of 10-15% of total body weight loss (TBWL%). Given a short implantation period of 6 months, weight regain following IGB removal has been commonly noted. This caveat prompted analysis of the addition of weight loss medications for improved efficacy in achieving sustained weight loss results post-IGB removal. In a single-center retrospective analysis from 2015 to 2018, 18 patients (mean age 39.72, 5 males, 13 females) with a saline-filled single intragastric balloon were evaluated for 12 months following IGB insertion. Exactly half of the patients (n=9) were on weight loss medications before, during, or after placement of IGB (IGB-M cohort) to compare to patients with IGBs only (IGB-O cohort). All patients were >18 years old, non-pregnant, and with no previous bariatric surgeries. Data was collected at 0, 3, 6, and 12 month intervals. Mean weight at baseline was 198.33lbs and 223lbs (p=0.814) and mean BMI was 32.79 kg/m2 versus 35.5 kg/m2 (p=0.546), in the IGB-O cohort versus the IGB-M cohort, respectively. At six months, the TBWL% in the IGB-O cohort versus the IGB-M cohort was 12.7% versus 13.1%, while mean BMI was 28.42 versus 31.62 (p=0.645), respectively. Attrition rate was 11.1% by 6 months and 72.2% by 12 months for both cohorts combined. At 12 months, TBWL% in the IGB-O cohort versus IGB-M cohort was 2.8% and 10.7%, while mean BMI was 33.77 and 29.17 (p=0.4), respectively. The most common class of medications utilized were glucagon-like peptide-1 (GLP-1) agonists (37.5%). Phentermine was the single most commonly prescribed medication (25%). The mean number of medications needed for a patient was 1.8. The TBWL% at six months demonstrated a slightly greater 0.4 TBWL% in the IGB-M cohort. This meant weight loss achieved with a balloon or weight loss pharmacotherapy was essentially equivalent in our study at the time of IGB removal at 6 months. However, a stark variance is noted at the 12 month mark in the IGB-O cohort with patients either partially regaining their previously lost weight or losing marginally further with a mean 2.8 TBWL% post IGB removal. Comparatively, the IGB-M cohort patients continued their weight loss or maintained their initial weight loss with a 10.7% TBWL creating a 7.9 TBWL% difference at the 12 month follow up between the two arms. Administration of medications might increase follow-up post IGB removal and decrease attrition rates. Results illustrate a two-pronged approach of combining weight loss medications with IGBs would culminate in a more clinically significant TBWL% with long term sustainability post IGB removal. Larger multi-center studies are recommended in order to achieve significant conclusions. [Formula presented] [Formula presented]
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BACKGROUND:Carbapenem-resistant Enterobacterales (CRE) are a global threat. We aimed to describe the clinical and molecular characteristics of Centers for Disease Control and Prevention (CDC)-defined CRE in the USA. METHODS:CRACKLE-2 is a prospective, multicentre, cohort study. Patients hospitalised in 49 US hospitals, with clinical cultures positive for CDC-defined CRE between April 30, 2016, and Aug 31, 2017, were included. There was no age exclusion. The primary outcome was desirability of outcome ranking (DOOR) at 30 days after index culture. Clinical data and bacteria were collected, and whole genome sequencing was done. This trial is registered with ClinicalTrials.gov, number NCT03646227. FINDINGS/RESULTS:1040 patients with unique isolates were included, 449 (43%) with infection and 591 (57%) with colonisation. The CDC-defined CRE admission rate was 57 per 100 000 admissions (95% CI 45-71). Three subsets of CDC-defined CRE were identified: carbapenemase-producing Enterobacterales (618 [59%] of 1040), non-carbapenemase-producing Enterobacterales (194 [19%]), and unconfirmed CRE (228 [22%]; initially reported as CRE, but susceptible to carbapenems in two central laboratories). Klebsiella pneumoniae carbapenemase-producing clonal group 258 K pneumoniae was the most common carbapenemase-producing Enterobacterales. In 449 patients with CDC-defined CRE infections, DOOR outcomes were not significantly different in patients with carbapenemase-producing Enterobacterales, non-carbapenemase-producing Enterobacterales, and unconfirmed CRE. At 30 days 107 (24%, 95% CI 20-28) of these patients had died. INTERPRETATION/CONCLUSIONS:Among patients with CDC-defined CRE, similar outcomes were observed among three subgroups, including the novel unconfirmed CRE group. CDC-defined CRE represent diverse bacteria, whose spread might not respond to interventions directed to carbapenemase-producing Enterobacterales. FUNDING/BACKGROUND:National Institutes of Health.

Matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) may soon replace routine electrophoretic methods for monitoring monoclonal proteins in patients with multiple myeloma. To further evaluate the clinical utility of this assay, we compared the performance of MALDI-TOF-MS head-to-head with an established bone marrow-based measurable residual disease assay by flow cytometry (Flow-BM-MRD), using Memorial Sloan Kettering Cancer Center's 10-color, single-tube method. Our results suggest that MALDI-TOF-MS adds value to bone marrow-based MRD testing and may be most useful for early detection of relapse in peripheral blood compared to current electrophoretic methods.

RATIONALE OBJECTIVES/UNASSIGNED:Excess z-axis scanning continues as an unnecessary source of radiation. This study seeks to determine patient, technologist and CT factors that affect excess scan length for chest CT. MATERIALS AND METHODS/METHODS:Retrospective evaluation of 1118 consecutive noncontrast chest CT scans, over twelve consecutive months, was performed for evaluation of scan length above and below the lung parenchyma. Scan length >2 cm was considered excessive. Bivariate analysis for mean excess scan length and presence of excess scan length analyzed technologist's exam volume during the study period, patient age, patient gender, day of week, and time of day as categorical variables. Technologists performing >100 chest CT scans during the study period were considered high-volume while all others were considered low-volume. RESULTS:Mean excess scan length was 5 mm, 29 mm, and 33 mm above the lungs, below the lungs, and total. 81% and 95% of studies had excess scanning above the lungs and below the lungs respectively. Multivariable analysis showed that high volume technologists, male patients, and patients younger than 65 had a greater amount of excess scan length and presence of excessive scanning above the lungs; high volume technologists and male patients had a greater amount of excess scan length below the lungs, and high volume technologists and patients older than 65 had greater presence of excessive scanning below the lungs, each p < 0.001. CONCLUSIONS:Excess scanning on chest CT is common, varies by patient age and gender and was significantly greater for high volume technologists.

INTRODUCTION:The Centers for Disease Control and Prevention estimated that, during 1999-2008, people born in 1945-1965 (the baby boomer generation) represented approximately 75% of people infected with hepatitis C virus and 73% of hepatitis C virus-associated deaths and are at greatest risk for hepatocellular carcinoma and liver disease. In 2012, the Centers for Disease Control and Prevention recommended one-time hepatitis C virus screening for people born during 1945-1965. In addition, New York State enacted a Hepatitis C Virus Testing Law in 2014. This analysis assesses the impacts of the 2012 recommendation and 2014 New York State Testing Law on hepatitis C virus screening rates among New York City Medicaid-enrolled recipients born during 1945-1965. METHODS:The eligible population was determined quarterly as the number of Medicaid recipients continuously enrolled for 12 months with neither a prior hepatitis C virus diagnosis nor antibody test since 2005. Quarterly screening rates during 2010-2017 were examined using interrupted time series analysis. Data were analyzed in 2018-2019. RESULTS:In 2010-2017, the highest screening rate occurred in the quarter immediately after the law (33.64 per 1,000 Medicaid recipients). There was no change in screening rates after the Centers for Disease Control and Prevention recommendation and a significant increase after the New York State Law, which was not sustained. CONCLUSIONS:Hepatitis C virus screening rates increased in the quarter after the 2014 New York State Hepatitis C Virus Testing Law became effective. Additional efforts are needed to screen baby boomers and people who were recently infected with hepatitis C virus related to opioid use.

Background: Gastric cancer is the third most common cause of cancer death worldwide. In the US, gastric cancer incidence for Chinese Americans is nearly twice that for non-Hispanic whites. Cancer is the leading cause of death among Chinese New Yorkers who experience higher mortality for gastric cancer than other New Yorkers overall. The bacterium Helicobacter pylori (H. pylori) is the strongest risk factor for gastric cancer, and eradication of H. pylori through triple antibiotic therapy is the most effective prevention strategy for gastric cancer. Despite the elevated burden, there are no culturally and linguistically tailored evidence-based intervention strategies to address H. pylori medication adherence and gastric cancer prevention for Chinese Americans in NYC, a largely foreign-born (72%), limited English proficient (61%), and low-income (21% living in poverty) population.
Objective(s): The study objective was to develop and pilot a community health worker (CHW)-delivered linguistically and culturally adapted gastric cancer prevention intervention to improve H. pylori treatment adherence and address modifiable cancer prevention risk factors, including improved nutrition for low-income, LEP, Chinese American immigrants.
Method(s): We used a mixed methods and community-engaged research approach to develop and pilot the intervention curriculum and materials. Methods included: 1) a comprehensive scoping review of the peer-reviewed and grey literature on gastric cancer prevention programs and strategies targeting Chinese Americans; 2) 15 key informant interviews with gatekeepers and stakeholders serving the New York Chinese immigrant community to assess the knowledge and perception of H. pylori infection and gastric cancer among Chinese New Yorkers; and 3) pilot implementation of the collaboratively developed intervention with H. pylori-infected LEP Chinese immigrant participants (n=7).
Result(s): Study process findings and pilot results will be presented. Preliminary results indicate high patient- and community-level need and acceptability for the intervention. Baseline and 1-month post-treatment outcomes and survey data, qualitative data analysis of the CHW session notes, and key informant interviews will be presented.
Conclusion(s): Findings suggest that a CHW-delivered culturally adapted gastric cancer prevention intervention can result in meaningful health information and treatment adherence for at-risk, low-income Chinese immigrant communities. Study findings are being applied to inform a randomized controlled trial being implemented in safety net hospital settings

BACKGROUND:Atrioventricular nodal reentrant tachycardia (AVNRT) is treatable by catheter ablation. Advances in mapping-system technology permit fluoroless workflow during ablations. As national practice trends toward fluoroless approaches, easily obtained, reproducible methods of slow-pathway identification and ablation become increasingly important. We present a novel method of slow-pathway identification and initial ablation results from this method. METHODS AND RESULTS/RESULTS:We examined AVNRT ablations performed at our institution over a 12-month period. In these cases, the site of the slow pathway was predicted by latest activation in the inferior triangle of Koch during sinus rhythm. Ablation was performed in this region. Proximity of the predicted site to the successful ablation location, complication rates, and patient outcomes were recorded. Junctional rhythm was seen in 40/41 ablations (98%) at the predicted site (mean, 1.3 lesions and median, 1 lesion per case). One lesion was defined as 5mm of ablation. The initial ablation was successful in 39/41 cases (95%); in 2 cases, ≥2 echo beats were detected after the initial ablation, necessitating further lesion expansion. In 8/41 cases (20%), >1 lesion was placed during initial ablation before attempted reinduction. Complications included 1 transient heart block and 1 transient PR prolongation. During follow up (median, day 51), 1 patient had lower-extremity deep-vein thrombosis and pulmonary embolus, and 1 had a lower-extremity superficial venous thrombosis. There was 1 tachycardia recurrence, which prompted a redo ablation. CONCLUSIONS:Mapping-system detection of late-activation, low-amplitude voltage during sinus rhythm provides an objective, fluoroless means of identifying the slow pathway in typical AVNRT. This article is protected by copyright. All rights reserved.