Juravinski Hospital

•Placental site trophoblastic tumors (PSTT) express PD-L1, making them ideal targets for PD-1 and PD-L1 inhibitors.•For this PSTT patient seeking fertility-sparing treatment, PD-1 inhibition demonstrated complete and sustained response.•Despite anti PD-1 toxicity, there is potential for significant benefit when no alternative fertility-sparing options exists.

ABSTRACT Skin disorders are often associated with ocular symptoms. In this review, we aim to identify the most common ocular manifestations observed in selected dermatological diseases, specifically psoriasis, atopic dermatitis, rosacea, and pemphigus. We highlight key ophthalmological conditions linked to these diseases to raise awareness among ophthalmologists who may encounter patients with these dermatological conditions in their clinical practice. Analyzing the original studies, the most common ocular manifestations include various types of inflammation, such as conjunctivitis and blepharitis. Additionally, more severe conditions, such as keratitis, uveitis, and meibomian gland dysfunction, are frequently observed. Ocular symptoms in pemphigus vulgaris and rosacea can precede dermatological signs. Dry eye disease is commonly seen across various dermatological conditions. Treatments like calcineurin inhibitors (used for atopic dermatitis and psoriasis) have shown efficacy for both dermatological and ocular symptoms. In atopic dermatitis, the use of dupilumab has been linked to increased rates of conjunctivitis, necessitating collaboration between dermatologists and ophthalmologists to distinguish drug side effects from disease manifestations. Psoriasis treatments, including phototherapy and biologics like secukinumab and ustekinumab, require careful monitoring for potential ocular effects, as their safety profiles are still being evaluated. For ocular rosacea, cyclosporine has demonstrated superior efficacy over doxycycline in managing symptoms such as burning and corneal involvement. This review underscores the importance of recognizing the interplay between dermatological and ocular health. Early diagnosis, interdisciplinary collaboration, and tailored treatments are essential for managing these complex conditions effectively.

Background: Guidelines suggest the Liver Imaging Reporting and Data System (LI-RADS) may not be applicable for some populations at risk for hepatocellular carcinoma (HCC). However, data assessing the association of HCC risk factors with LI-RADS major features are lacking. Purpose: To evaluate whether the association between HCC risk factors and each CT/MRI LI-RADS major feature differs among individuals at-risk for HCC. Methods: Databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus) were searched from 2014 to 2022. Individual participant data (IPD) were extracted from studies evaluating HCC diagnosis using CT/MRI LI-RADS and reporting HCC risk factors. IPD from studies were pooled and modelled with one-stage meta-regressions. Interactions were assessed between major features and HCC risk factors, including age, sex, cirrhosis, chronic hepatitis B virus (HBV), and study location. A mixed effects model that included the major features, as well as separate models that included interactions between each risk factor and each major feature, were fit. Differences in interactions across levels of each risk factor were calculated using adjusted odds-ratios (ORs), 95% confidence-intervals (CI), and z-tests. Risk of bias was assessed using QUADAS-2. (Protocol: https://osf.io/tdv7j/). Results: Across 23 studies (2958 patients and 3553 observations), the associations between LI-RADS major features and HCC were consistent across several HCC risk factors (P-value range: .09-.99). A sensitivity analysis among the 4 studies with a low risk of bias did not differ from the primary analysis. Conclusion: The association between CT/MRI LI-RADS major features and HCC risk factors do not significantly differ in individuals at-risk for HCC. These findings suggest that CT/MR LI-RADS should be applied to all patients considered at risk by LI-RADS without modification or exclusions, regardless of the presence or absence of the risk factors evaluated in this study.

This study determined the impact of pre-operative abdominal MRI on all-cause mortality for patients with resected PDAC. All adult (≥18 years) PDAC patients who underwent pancreatectomy between January 2011 and December 2022 in Ontario, Canada, were identified for this population-based cohort study (ICD-O-3 codes: C250, C251, C252, C253, C257, C258). Patient demographics, comorbidities, PDAC stage, medical and surgical management, and survival data were sourced from multiple linked provincial administrative databases at ICES. All-cause mortality was compared between patients with and without a pre-operative abdominal MRI after controlling for multiple covariates. A cohort of 4579 patients consisted of 2432 men (53.1%) and 2147 women (46.9%) with a mean age of 65.2 years (standard deviation: 11.2 years); 2998 (65.5%) died while 1581 (34.5%) survived. Median follow-up duration post-resection was 22.4 months (interquartile range: 10.8-48.8 months), and median survival post-pancreatectomy was 25.9 months (95% confidence interval [95% CI]: 24.8, 27.5). Patients who underwent a pre-operative abdominal MRI had a median survival of 33.1 months (95% CI: 30.7, 37.2) compared to 21.1 months (95% CI: 19.8, 22.6) for all others. A total of 2354/4579 (51.4%) patients underwent a pre-operative abdominal MRI, which was associated with a 17.2% (95% CI: 11.0, 23.1) decrease in the rate of all-cause mortality, with an adjusted hazard ratio (aHR) of 0.828 (95% CI: 0.769, 0.890). Pre-operative abdominal MRI was associated with improved overall survival for PDAC patients who underwent pancreatectomy, possibly due to better detection of liver metastases than CT. Northern Ontario Academic Medicine Association (NOAMA) Clinical Innovation Fund.

12138 Background: Cancer prevalence is rising, with a corresponding increase in hospitalizations across the cancer continuum. However, little is known about how in-hospital patterns of care and outcomes of cancer survivors compare with non-cancer survivors as administrative data may not capture in-hospital details (e.g., investigations and medications) required for characterization. Understanding differences in how cancer and non-cancer inpatients are managed and their outcomes can help optimize their acute care delivery. Methods: In a multicenter registry of all patients (pts) admitted to medical wards across 26 hospitals (Ontario, Canada) from 2015-2022, we deterministically linked population-level administrative data, including ambulatory oncology data for cancer survivors, with each hospital’s electronic information (pharmacy, orders, notes, laboratory, imaging) at the patient level. Multivariable regression models compared resource use and outcomes between cancer and non-cancer pts for the top 5 discharge diagnoses among non-cancer pts. Results: Of 1,221,067 hospitalizations belonging to 666,569 pts, 30% of medical ward hospitalizations were for pts with a cancer history, with median admission date 4 years post-diagnosis; most common cancer sites were genitourinary (21%), gastrointestinal (20%), breast (12%), lung (10%). Most common discharge diagnoses among cancer pts were heart failure (HF) (5%), palliative care (5%), urinary tract infection (UTI) (2%), pneumonia (2%) renal failure (2%); while for non-cancer pts were HF (5%), myocardial infarction (3%), coronary artery disease (3%), COPD (2%) and UTI (2%). Compared to non-cancer pts, cancer pts were older (72 vs 66), had greater length of stay (LOS; 10 vs 8.7 days), in-hospital mortality (11% vs 6%) and 30 day re-admission rates (16% vs 11%) and were more likely to receive CTs (21% vs 15%), MRIs (9% vs 8%) and interventional procedures (6% vs 4%) (p < 0.001, all comparisons). When evaluating the top 5 discharge diagnoses among non-cancer patients, cancer survivors had higher LOS (aOR=1.06 95% [1.05-1.07] p<0.001), in-hospital mortality (aOR=1.20 [1.14-1.26] p<0.001), and 30 day re-admission rates (aOR=1.24 [1.14-1.35] p<0.001) and were more likely to receive CTs (aOR=1.25 [1.21-1.30] p<0.001), MRIs (aOR=1.36 [1.25-1.48] p<0.001) and interventional procedures (aOR=1.36 [1.25-1.47] p<0.001). Subgroup analyses focusing on cancer survivors admitted 3 and 5 years out from their diagnosis showed resource use and outcomes were closer to non-cancer patients. Conclusions: Cancer survivors represent a unique population on medical wards and have higher resource use, mortality and LOS compared to non-cancer patients, even for the same non-cancer diagnoses. Specialized models of care for hospitalized cancer survivors may be warranted, in particular for those admitted closer to their diagnosis date.

Per- and polyfluoroalkyl substances (PFAS) are a group of man-made chemicals that are persistent in the environment and have been found in soil, water, air, and living organisms. PFAS have been linked to a range of health problems, including cancer, thyroid disease, and developmental effects on fetuses and infants. As a result, there is a growing need for effective treatment methods to remove PFAS from contaminated water sources. This abstract presents an overview of PFAS fundamentals and treatment options. It begins with an introduction to PFAS, including their sources, uses, and health effects. The focus then shifts to PFAS treatment methods, which can be broadly categorized as physical, chemical, and biological. Physical treatment options include adsorption, membrane filtration, and advanced oxidation processes, while chemical treatments include ion exchange, precipitation, and coagulation/flocculation. Biological treatment methods, such as bioremediation and phytoremediation, are less commonly used for PFAS removal but have shown promise in laboratory settings. The effectiveness of PFAS treatment methods depends on several factors, including the type and concentration of PFAS, the presence of other contaminants, and the specific treatment technology used. Some treatment methods, such as granular activated carbon (GAC) adsorption, have been widely adopted and are effective for a range of PFAS compounds. Other methods, such as membrane filtration, may require pre-treatment to remove particulate matter and other fouling agents. Overall, there is a need for continued research and development of PFAS treatment technologies to address the growing threat of PFAS contamination in water sources. Advances in materials science, chemistry, and microbiology offer promising avenues for improving the efficiency, effectiveness, and scalability of PFAS treatment methods.