Bon Secours Hospital

7540 Background: The combination of a proteasome inhibitor (PI) with lenalidomide (R) and dex (d) has been a common initial therapy for newly diagnosed myeloma (NDMM). We designed a randomized phase 3 trial to examine if carfilzomib (K), a next generation PI, improved progression free survival (PFS) compared with bortezomib (V) when either is combined with Rd for initial treatment of NDMM. Initial analysis at a median follow up of 15.3 months (mos) showed comparable PFS for both triplets. We present the long-term results of the trial with ~70 months median follow up. Methods: Patients (Pts) with NDMM, were randomized 1:1 to receive VRd or KRd for 36 weeks followed by a 2 nd randomization (1:1) to indefinite versus 2 yrs of R maintenance. Pts without del17p, t(14;16), t(14;20), plasma cell leukemia or high-risk GEP70 profile, were enrolled. VRd arm included V 1.3 mg/m 2 on days(d) 1, 4, 8, and 11 (d1, 8 for cycles 9-12), R 25 mg d1-14, and d 20 mg d1, 2, 4, 5, 8, 9, 11, 12 of a 3-week (wk) cycle for 12 cycles, while pts in the KRd arm received K 36 mg/m 2 d1, 2, 8, 9, 15, 16 with R 25 mg daily on d1-21 and d 40 mg wkly, in 4 wk cycles for 9 cycles. Maintenance used 15 mg R d1-21 q4 wks. Results: The study accrued 1087 pts (VRd=542, KRd=545). Median age was 65y; baseline characteristics including intent to transplant were similar across the arms. Median induction duration (mos; IQR) was 7.2 (3.4-8.9) and 8.4 (5.1-9.1) for VRd and KRd, respectively; 59.8% in VRd and 45.3% in KRd did not proceed to Step 2. Median PFS (mos) was VRd=41.9 and KRd=44.6; HR = 0.89 (0.76-1.04). Toxicity data, PFS sensitivity analyses and OS probabilities are as in the table. Conclusions: In this randomized trial, with median follow up of nearly 6 years, KRd and VRd had comparable PFS and OS in an intent to treat analysis. While similar numbers proceeded to SCT in the 2 arms, more did so during induction in the VRd arm while more patients in the KRd arm went to SCT later. VRd remains a standard triplet induction regimen in standard and intermediate risk NDMM, and a suitable backbone for 4 drug combinations. Clinical trial information: NCT01863550 . N (%) VRd(n=527) KRd(n=526) SCT anytime 186 (34.3) 183 (33.6) SCT without Step 2 registration 146 112 Median Time to SCT (mos; range) 7.7 (3.5-83.9) 10.6 (3.7-70.6) Grade 3-4 Treatment-Related Toxicity 315 (59.8) 344 (65.4) Grade 5 Treatment-Related Toxicity 2 (0.4) 9 (1.7) Grade 5 All Events 11 (2.1) 20 (3.8) Survival outcomes HR Median (95% CI) Median (95% CI) PFS Primary: PD or death within 3 months of last evaluation as events 0.89(0.76-1.04) 41.9(35.7, 50.3) 44.6(38.2, 51.9) PFS Sensitivity: All deaths as events, 0.87(0.75-1.02) 39.5(34.9, 46.0) 42.8(37.4, 49.7) PFS Sensitivity: Censor at alternate Rx 0.83(0.69-0.99) 35.0(31.3, 42.6) 38.7(34.7, 49.0) PFS Sensitivity: Event at alternate Rx 0.84(0.73-0.97) 18.0(14.2, 23.0) 24.4(20.9, 27.9) Overall survival 0.92(0.75-1.12) 119(100, NE) 118(103-NE)

For patients with non-small-cell lung cancer (NSCLC), the outcomes for patients with resectable disease are historically poor compared with other solid organ malignancies. In recent years, there have been significant advances in multidisciplinary care, which have resulted in improved outcomes. Innovations in surgical oncology include the use of limited resection and minimally invasive techniques. Recent data in radiation oncology have suggested refinements in pre- and postoperative radiation therapy, resulting in optimization of techniques in the curative setting. Finally, the success of immune checkpoint inhibitors and targeted therapies in the advanced setting has paved the way for inclusion in the adjuvant and neoadjuvant settings, resulting in recent regulatory approvals for four regimens (CheckMate-816, IMpower010, PEARLS, ADAURA). In this review, we will provide an overview of the seminal studies informing advancements in optimal surgical resection, radiation treatment, and systemic therapy for resectable NSCLC. We will summarize the key data on survival outcomes, biomarker analyses, and future directions for perioperative studies.

Eosinophilic esophagitis is a chronic, immune-mediated esophageal condition that may lead to impairment of quality of life in pediatric and young adult patients. We performed a prospective, cross-sectional study on 40 patients between the ages of 2-21 years with an established diagnosis of eosinophilic esophagitis. The study evaluated physical, emotional, social, and school functioning in patients undergoing treatment with proton pump inhibitors, dietary elimination, or swallowed corticosteroids. There were no statistically significant differences in total or domain-specific quality of life scores between proton pump inhibitors, dietary elimination, and swallowed corticosteroid therapy. Overall, total and domain-specific quality of life were well-preserved in patients with eosinophilic esophagitis, with the highest scores reported in social functioning. There were also no statistically significant associations between clinical, endoscopic, and histologic features and quality-of-life measures.

BackgroundMechanical thrombectomy (MT) indications for acute stroke treatment have expanded in the last few years to include medium vessel occlusions. However, limited data is available about the safety and efficacy of MT in the distal anterior cerebral artery (ACA) segments (A2/A3). This study aims to assess the feasibility and outcomes of MT in stroke patients presenting with acute A2 and A3 occlusions in a large multicenter registry.MethodsThis is a retrospective analysis from the Stroke Thrombectomy and Aneurysm registry (STAR) which maintains data from 40 stroke centers in the United States, Europe, Asia, and South America. We included patients who presented with A2/A3 occlusions and were treated with MT using second generation thrombectomy devices between January 1, 2014, and December 31, 2020. Primary outcome of this analysis was the final modified treatment in cerebral infarction (mTICI) score. Other endpoints included the modified Rankin Scale (mRS) score at 90 days and the rate of symptomatic intracranial hemorrhage (sICH).ResultsWe identified 27 patients who met the inclusion criteria. Median age was 61 (IQR 53-81) years, 15 (55.6%) were female, and 14 (51.9%) were white. A2 segment occlusion was seen in 20 (74.1%) patients and A3 segment in 7 (25.9%) patients. Fourteen (51.9%) in patients received intravenous tissue plasminogen activator (tPA) prior to MT. Regarding MT technique used, contact aspiration first line (ADAPT) was used in 14 (51.9%) patients, stent retriever first-line was used in 4 (14.8%) patients, and a combination of both techniques was used in 9 (33.3%). Intraarterial tPA was used in 6 (22.2%) patients. Final mTICI ≥ 2B was recorded in 20 (74.1%) patients (13 [48.1%] had mTICI of 2C or 3). Periprocedural complications were seen in 4 (14.8%) patients and sICH occurred in 1 (3.7%) patient. At 90 days, 17 (63%) patients achieved functional independence (mRS 0-2).ConclusionIn this multicenter study, MT for distal ACA occlusions in the A2/A3 segments seem to be feasible and associated with low complication and symptomatic hemorrhage rates. Future studies are needed to compare the functional outcome of MT versus medical management for stroke patients presenting with A2/A3 occlusions.DisclosuresD. Pullmann: None. E. Almallouhi: None. S. Al Kasab: None. A. Alawieh: None. R. Chalhoub: None. R. Starke: None. R. De Leacy: None. D. Raper: None. A. Rai: None. T. Dumont: None. S. Wolfe: None. P. Jabbour: None. C. Ogilvy: None. M. Park: None. M. Levitt: None. A. Polifka: None. R. Crowley: None. A. Arthur: None. J. Osbun: None. R. Crosa: None. I. Maier: None. J. Kim: None. W. Casagrande: None. A. Shaban: None. J. Grossberg: None. S. Chowdhry: None. M. Mokin: None. C. Matouk: None. I. Fragata: None. S. Webb: None. A. Yoo: None. J. Mascitelli: None. M. Psychogios: None. M. Azab: None. A. Spiotta: None.

TiO2: rGO doped material is deposited on glass and Si substrates. These hetero nanostructures have multiple applications in photovoltaic because of their charge transport properties. In this study, we prepared tetragonal TiO2: rGO doped material is deposited on glass and Si substrates (NCs) using Thermal Evaporation method. The morphological properties of the NCs were investigated using X-ray diffraction, Field-emission scanning electron microscopy with EDAX analysis, Atomic force microscopy, and Photovoltaic studies analysis. The results showed that the surface area of the deposited films increased significantly and the anatase TiO2: rGO doped material is deposited on glass and Si substrates was efficient photovoltaic performance with the other nanocomposites or the bare individual nanoparticles. It may be attributed to the increased active surface area, the increased adsorption of the light and target surface atoms, as well as efficient electron–hole transformation.

The Respiratory Nurses Association of Ireland,recognised inconsistencies and regional variations in delivery of oxygen therapy. Nationally the Patient Safety First Programme set requirments for improvements in quality and safety for patients regarding oxygen therapy. Aim: A national guideline on Long Term Oxygen Therapy. Method: Between 2014 and 2015 Respiratory Nurse Specialists,Respiratory Physician and Respiratory Physiotherapist examined practice and completed a literature review.Stakeholders dealing with patients were involved; Department of Public Health,Nursing and Midwifery Planning and Development Office,Irish Thoracic Society, National Respiratory Clinical Care Programme,State Claims Agency,Society of Chartered Physiotherapists,Association of Respiratory Scientists, Health Products Regulatory Authority,Health Service procurement and the community reform progamme. Results: Currently oxygen is requested through 34 different health service centres with many not having relevant testing and no standard prescription form.A comprehensive guideline was devised and disseminated via all stakeholders.This study highlights the benefits of multidisciplinary co-ordination.Following this the National Respiratory Therapies group, 2016 researched issues in relation to respiratory therapies including oxygen therapy noting delays due to inaccurate/inappropriate prescriptions (77.27%), financial approval (50%) and delivery (50%). Conclusion: The groups work is disseminated nationally, envisioning changes in the holistic delivery system of oxygen therapy for patients will occur.Currently there is a lack of Irish research into oxygen therapy use. This study has the potential to inform our current practice.

Launching a new journal in the field of neuroscience is a formidable task. With thousands of articles being published yearly in a number of existing journals, what can another journal add to the field that is not already available? What can attract neuroscientists to submit their best articles to an unproven journal when so many exist with clear track records? Rigorous standards in what is considered acceptable are necessary if a journal is to have true impact on the field, but who wishes to consider subjecting one’s work to such standards when the journal’s future is unknown? Can a new journal actually set any kind of new standard that does not already exist? When we were asked to lead AIMS Neuroscience, these questions and many more caused us to hesitate. We had to choose a goal and navigate a course toward a niche not filled by any other journal. When surveying the landscape based on recent developments, there was one consistent aspect we saw. The massive European Union Human Brain Project, the US BRAIN project, and the Research Domain Criteria emphasis of NIMH each seem focused on producing new technologies and massive amounts of data. However, we had to agree with the observation made by many others. Where is the theory to guide all of these activities? This is the niche we hope to fill. Our goal is a lofty one in that we wish to provide a forum in which to expedite the speed with which theoretical neuroscience progresses toward generating testable hypotheses. In the presence of current and developing technology that offers unprecedented access to functions of the nervous system at all levels and the ability to analyze data via supercomputers, we want to serve the role of providing the widest variety of the best theoretical views leading to suggested studies to facilitate “intelligent” use of that technology. In the past, dominant theories tended to result in direct and indirect suppression of newer ideas. Criticism of the peer review process have been made [1], noting that anonymous reviewers may have a conflict of interest. Common sense says that the theories of the most influential scientists in the field are those that tend to be perpetuated, and the “Good Old Boys” club related to funding agencies is familiar to all. However, the introduction of new technologies in neuroscience has resulted in quite