Loma Linda University Health Care

Sickle cell disease (SCD) is a chronic genetic disorder causing severe pain, anemia, and systemic complications that negatively affect patients' physical and mental well-being. The aim of this global cross-sectional study was to evaluate the relationship between oral pain medication (OPM) use frequency and health outcomes, emotional well-being, social participation, and satisfaction with care among people with SCD. Data were collected via an online survey across five continents from February to September 2024. A total of 123 participants were divided into two groups based on OPM use frequency: weekly or more (n=62) and once or twice a month (n=61). Participants in OPM weekly group reported poorer self-rated health, shortness of breath, more frequent hospitalizations, and missed school days due to SCD crises compared to the monthly group (p<0.05). However, use of treatments such as hydroxyurea and preventive screenings like transcranial Doppler was similar across groups. Emotional well-being also significantly differed in the weekly group, with lower happiness levels, difficulty in emotional regulation, and reduced social participation (p<0.01). Satisfaction with medical care was significantly lower among weekly OPM users (p<0.001). These findings suggest that higher OPM use is associated with poorer physical, emotional, and social outcomes. The results highlight the importance of comprehensive and multidisciplinary care approaches that may support the overall well-being of individuals with SCD and utilize OPM as a relevant clinical metric to assess disease burden in SCD. The authors have confirmed clinical trial registration is not needed for this submission.

The Coronary Artery Risk Development in Young Adults (CADIA) study of young overweight adults, black and white, demonstrated that dietary patterns characterised by increased dairy consumption had an inverse association with insulin resistance in their study population. The inclusion of low or non-fat dairy products, which provide additional calcium in the diet, may promote increased weight loss and improve insulin resistance. Therefore, supplementing dairy products to obese subjects on a caloric-restricted diet may be a useful strategy to enhance weight loss and improve insulin resistance. The study assesses dairy Calcium supplementation and its effects on body Fat, plasma leptin and glucose levels in obese postmenopausal women. This prospective randomised study of 3 months, parallel trial on the effect of non-fat / low-fat dairy calcium combined with energy restriction in overweight/obese postmenopausal women. The study therefore tested the short-term effects of supplementing 56 overweight or obese (body mass index [BMI] &gt;26 kg/m2) post menopausal women on a caloric-restricted diet (1,400 kilocalories [kcal]) with two levels of dairy as yoghurt on body composition, blood insulin, leptin and glucose concentration. The group consuming four supplemented dairy servings (DS-4) was provided ~1400 mg Ca/day, and the group consuming two supplemented dairy servings (DS-2) were provided ~800 mg Ca/day. Over the 3-months daily energy intake averaged 51% carbohydrate, 20.7% of protein and 27.6% of fat for both groups. At 3 months, the DS-4 group demonstrated decreased weight (87.7 to 86.2 kg, P=0.001), BMI (33.5 to 32.8 kg/m2, P &lt; 0.001), total fat (36.1 to 34.7 kg, P&lt;0.001), and trunk fat (18.3 to 17.6 kg, P &lt; 0.001). There were non-significant decreases in plasma glucose (74.7 to 71.1 mg/dl, P=0.494), leptin (32.5 to 31.3 µg/L, P=0.231) and insulin. For the DS-2 group, there was decreased weight (86.4 to 84.4 kg, p&lt;0.02), BMI (32.5 to 31.8 kg/m2, P=0.002), total fat (37.3 to 35.4 kg, P=0.003), trunk fat (17.1 to 16.5 kg, P = 0.27) and plasma leptin (27.8 to 25.2 µg/L, P=0.114). The DS-2 group demonstrated a surprising and significant increase in the fasting blood glucose, with a marginally significant increase in insulin resistance as measured by HOMA at 3 months. We observed a significant treatment effect between the DS-2 and DS-4 groups for: % energy from fat (P=0.025), % energy from protein (P=0.047) and leptin (P=0.044). The study report that in a population of obese/overweight postmenopausal women supplementing their diet with dairy which provided a total estimated calcium intake of ~1400 mg/day (i.e. DS-4) was successful in the reduction of trunk fat and plasma glucose, while dairy calcium and caloric restriction decreased weight, BMI, total body fat, and insulin and leptin during the intervention. In contrast, the supplemented group ingesting 800 mg/d of dairy calcium (i.e. DS-2) in combination with caloric restriction provided significant increases in plasma glucose and insulin resistance. Our study demonstrated the expected weight loss with caloric restriction, but a paradoxical increase in blood glucose levels with dairy supplementation provided to maintain baseline calcium intake. Increasing dairy supplementation abrogated this small increase in fasting blood glucose and insulin resistance. The benefits of dairy calcium supplementation may be dependent on both the dose and the context of overall caloric intake.

The incidence of pediatric gallstone disease continues to rise, largely driven by increasing obesity rates. Laparoscopic cholecystectomy (LC) has been the standard surgical approach, with robotic-assisted cholecystectomy (RAC) utilized less frequently. This study aimed to evaluate the implementation of RAC and its outcomes compared to LC at a single institution. A retrospective cohort study was conducted of all pediatric cholecystectomies at our children's hospital from 2017 through 2024. Surgical outcomes were abstracted. Statistical tests were employed, with p < 0.05 considered significant. During the study, 420 cholecystectomies were performed: 196 LC and 224 RAC. Median age was 15.5 years, median BMI was 28.1 kg/m2, and 75 % of patients were female. The most common diagnoses were choledocholithiasis (179) and symptomatic cholelithiasis (135). Yearly cholecystectomies increased. LC was performed more often for urgent cases (p < 0.01). RAC was used more often in patients with obesity and severe obesity (p = 0.01). Median operative time slightly differed between LC and RAC (11 min; p < 0.01). There was one conversion to open (LC) and nine retained common duct stones. There was no difference in emergency department revisits (7.7 % LC vs 6.7 % RAC; p = 0.69) or readmissions (2.6 % LC vs 3.1 % RAC; p = 0.73). There were no bile leaks, common bile duct injuries or mortalities. In this largest reported cohort of pediatric RAC, RAC was found to be safe and effective compared with LC, particularly in pediatric patients with obesity. RAC can be integrated into practice without compromising patient safety. Further research evaluating educational and fiscal aspects of RAC is ongoing.

To measure the effects of varying configurations of nephroscope sheath, irrigation, instruments, and suction on intrarenal pressure (IRP) during percutaneous nephrolithotomy (PCNL). Kidney and ureter 3D printed models from a deidentified patient's CT scan were placed in a plaster and foam mould, simulating the torso of a prone patient. An Amplatz sheath was inserted into the kidney model. Fourteen different rigid nephroscope sheath (RNS), irrigation, instrument and suction configurations were compared. IRP was measured in a retrograde fashion. Comparisons were performed using the Wilcoxon Signed-Rank test followed by Bonferroni correction. The mean IRP with and without the RNS was 19.1 and 14.7 mm Hg, respectively (p< 0.001). Using the inflow port of the RNS for irrigation created a lower IRP (19.1 mm Hg) compared to the outflow port (32.7 mm Hg; p< 0.001). Addition of suction to all working scenarios significantly reduced IRP (p< 0.001). Insertion of instruments did not significantly alter IRP. In situations where the IRP should be low, removal of the RNS, irrigating through the inflow port, and frequent use of suction maintain the lowest pressures. If temporary increases in IRP are necessary to improve visualisation in the setting of bleeding, irrigating through the outflow port, minimising drainage and use of the RNS can be used to raise IRP.

690 Background: Most patients with pancreatic cancer (PC) present with late-stage (unresectable or metastatic) disease. Certain high-penetrance germline variants increase PC risk, for which there are imaging-based guidelines for screening to potentially diagnose patients earlier. This study aims to describe the screening compliance of patients with germline Pathogenic/Likely Pathogenic variants (PVs) at high-risk for developing PC. Methods: Patients who underwent genetic testing between 2021-2024 were identified from prospectively maintained Breast and Gastroenterology clinic databases. Genes with PVs for PC included ATM, BRCA2, CDKN2A, STK11, BRCA1 or PALB2 . After the date of genetic testing, abdominal imaging was reviewed including the modality (magnetic resonance imaging [MRI], computed tomography [CT], endoscopic ultrasound [EUS]), and whether imaging was for screening (intentional) or another reason unrelated to screening (incidental) based on the indication for ordering the study. The detection of PC and subsequent outcomes were longitudinally tracked. Results: Of 1,525 patients that underwent genetic testing, 192 had PVs for PC. Of those with PVs, 130 (68%) had subsequent imaging and 43 (33%) were screened intentionally to look for PC. The most common PVs included BRCA2 (63, 48%) ATM (13, 10%), BRCA 1 (68, 52%), CDKN2A (6, 4.6%), and PALB2 (8, 6.1%). The most commonly used modality was CT in 88 patients (68%), followed by MRI (41, 32%), and no patients underwent EUS. Three patients developed PC after genetic testing, however, none had PVs. Discussion: Our findings highlight a critical gap in guideline-recommended screening for patients with a genetic predisposition to PC. Despite 192 patients with PVs meriting PC screening, only a third were intentionally screened. Although MRI and EUS have a higher sensitivity for detection, CT scans were the most used modality. Conclusions: This large single center study supports the need for a more systematic, coordinated approach to pancreatic cancer screening in genetically high-risk patients. Future work will investigate costs related to pancreatic cancer screening as well as strategies for more effectively identifying patients at risk that may benefit from a screening program.

Breast cancer is the leading cause of cancer-related mortality in African American (AA) women. In this study we evaluated the serum proteomic profile of AA women with breast cancer using an integrated proteomic framework with multivariate pattern analysis. Using 2D-DIGE, thousands of serum protein spots were detected across 33 gels; 46 spots met criteria for presence, statistical significance, and differential expression. Proteins from the spots were identified by MALDI-TOF/TOF and matched in curated databases, highlighting serum biomarkers including ceruloplasmin, alpha-2-macroglobulin, complement component C3 and C6, alpha-1-antitrypsin, alpha-1B-glycoprotein, alpha-2-HS-glycoprotein and haptoglobin-related protein. LC–MS/MS analysis revealed 163 differentiating peptides after imputing and filtering 286 peptides. These were evaluated using cumulative distribution function (CDF) analysis, a nonparametric method suited for limited sample sizes. Peptide patterns were explored with Random Forest, showing concordance with CDF. The model achieved an AUC of 0.85 at the peptide level. This workflow identified differentiating proteins (CERU, A2MG, CO3, VTDB, HEMO, APOB, APOA4, CFAH, CO4A, AACT, K1C10, ITIH2, ITIH4), highlighting CERU, A2MG, and CO3 with overexpression and reproducible identification across platforms. We present an integrated, non-invasive serum protein biomarker signature panel specific to AA women, through reproducible proteomic sensor framework to support early detection and breast cancer prevention.

• Patients with identical baseline features showed divergent 5-year outcomes. • Genetic and α-synuclein status did not predict clinical trajectories. • Findings underscore the need for individualized, patient-centered PD care. Parkinson’s disease (PD) is characterized by heterogeneity. While previous efforts have aimed to categorize patients by clinical subtypes, these classifications have not reliably predicted outcomes, underscoring the complexity and variability of disease progression. Using data from the Parkinson’s Progression Markers Initiative (PPMI), we conducted a longitudinal analysis of 209 individuals with PD over five years. We used cluster analysis to identify trajectory clusters in the progression of motor symptoms. Participants were categorized based on baseline variables, including age, sex, race, BMI, genetic mutation status, medical history, presence of jaw and limb tremors, and alpha-synuclein seeding status. Motor and non-motor outcomes, such as gait abnormalities, dyskinesia, motor fluctuations, dystonia, cognitive impairment, hallucinations, and others, were evaluated, along with the progression of the levodopa equivalent daily dose (LEDD). Sankey plots illustrated patient trajectories from baseline to outcome groups over time. Trajectory cluster analysis of MDS-UPDRS Part III scores identified three progression patterns: slow, intermediate, and rapid, with higher baseline BMI associated with faster motor progression (P < 0.01). Grouping based on baseline features identified 136 distinct patient groups, with substantial dispersion across clinical outcomes. Patients with identical baseline profiles frequently diverged into separate outcome groups. Genetic/SAA stratification also showed marked variability in progression with no significant association across trajectory clusters (P > 0.05). These findings highlight the existence of highly individualized clinical trajectories, even among patients with similar baseline characteristics, within the specific set of baseline variables examined in this study. This emphasizes the need for a personalized, patient-centered approach in both the management and study of Parkinson’s disease.

ABSTRACTObjectivesThis study evaluates variability in obstructive sleep apnea (OSA) physical exam templates, contrasts documentation between institutional settings, and identifies inter‐specialty differences in documentation.MethodsCross‐sectional analysis was performed using the Epic Community Library, a shared database of user‐created documentation templates from institutions using the Epic electronic medical record system. Physical exam templates assessing sleep apnea were identified and evaluated against a checklist of 25 key physical exam characteristics from a clinical guideline.ResultsOf 6621 templates from 478 institutions, 579 relevant templates were identified. The most frequently included features were vital signs (89.1%), tonsil size (69.5%), and septal deviation (60.2%). The least frequently recorded features were waist‐hip ratio (0.8%), hyomental distance (1.6%), and Cottle maneuver (1.6%). The median template included only 7 out of our 25 key features, with an IQR of 5. Body mass index (BMI) was documented in 36.7% of exams. Of the templates from academic centers, 63% were unique compared to 14% from community centers and 27% from health networks. Otolaryngology templates documented nasal cavity and nasopharyngeal features and specialized airway techniques significantly more frequently than sleep medicine, pulmonology, and unspecified templates. In contrast, sleep medicine and pulmonology documented neck circumference more often than otolaryngology, and sleep medicine recorded Mallampati scores more frequently.ConclusionSignificant variability exists in OSA physical exam documentation across institutions and specialties. This may contribute to disparities in patient evaluation and treatment. Standardized OSA physical exam templates could provide a more consistent and comprehensive anatomic exam, facilitate subspecialty communication, and support more accurate patient treatment selections.Level of EvidenceLevel 3.