South Shore Hospital

Abstract Introduction: Neoadjuvant chemotherapy (CT) with pembrolizumab (P) is standard for most patients (pts) with high-risk early TNBC. Biomarkers for the addition of P to CT are lacking. The prognostic and predictive value of TILs in pts who receive neoadjuvant CT+P vs CT alone and the significance of change in TILs from pre- to post-treatment samples remains unclear. Methods: From the prospective DFCI Multicenter TNBC Registry, pts with stage I-III TNBC who received neoadjuvant CT or CT+P were identified. Stromal TILs were scored in tumor samples at baseline (BL) and surgery (if residual disease, RD). TILs were evaluated as a continuous and binary variable using a threshold selected based on BL distribution. Fisher’s exact test was used to compare TILs between CT and CT+P, and between RCB groups. Association with pathologic complete response (pCR) and with recurrence-free (RFS), distant recurrence-free (DRFS) and overall survival (OS) were evaluated using logistic regression and Cox proportional hazards models, respectively, adjusting for clinical stage and neoadjuvant treatment. All statistical tests were two-sided (significance p < 0.05). Results: Between 5/2019-1/2024, 121 TNBC pts were identified; 18 (14.9%) stage I, 49 (40.5%) stage II, 52 (43.0%) stage III, 2 (1.7%) unknown. 19 (15.7%) had germline BRCA1/2 mutations. 49 (40.5%) received CT and 72 (59.5%) CT+P, with anthracycline-based CT in 40 (81.6%) and 62 (86.1%) pts, respectively. The pCR rate was 51.0% (25/49; 95% CI 36.3-65.6%) with CT alone and 58.3% (42/72; 95% CI 46.1-69.8%) with CT+P. Median follow-up was 2.2 years (interquartile range [IQR] 1.4-3.9): CT, 4.2 years (IQR 3.4-5.1); CT+P, 1.7 years (IQR 1.2-2.2). 115 pts had TILs scored at BL and 41 at RD, of whom 35 had paired samples. BL TILs (range 0-90%) were categorized by quartiles (5%, 10%, 30%) with 10% used for primary analysis. Both BL and RD TILs did not differ between CT vs CT+P as a continuous variable (BL p=0.11; RD p=0.56) or ≥10% cutoff (BL p=0.62; RD p=0.56). High BL TILs (≥ 10%) were significantly associated with pCR and this did not differ by treatment (interaction p=0.36). No association was observed between TILs (at BL or RD) and RCB class (TILs as continuous variable: BL p=0.36, RD p=0.84; or 10% cutoff: BL p=0.31, RD p=0.86). High BL TILs (≥ 10%) were associated with longer RFS (aHR 0.15, p=0.01), DRFS (aHR 0.17, p=0.01) and OS (aHR 0.19, p=0.05; or as a continuous variable, aHR per 5-unit increase 0.46, p=0.05). Neither TILs in RD nor increase from BL to RD (in 14/35 pts, 40%) were associated with RFS, DRFS or OS. Conclusion: In this multicenter TNBC cohort, BL TILs were reinforced as a prognostic marker for pCR, regardless of the addition of P to CT. TILs at RD and changes during neoadjuvant therapy were not prognostic. Additional follow-up for survival outcomes is ongoing. Citation Format: R. S. Lee, Q. Jin, B. Binboga Kurt, B. Koca, J. Gomez Tejeda Zanudo, A. Patel, A. Barkell, J. Baginska, O. M. Cunningham, C. E. Stever, T. S. Parker, T. Rahman, M. Luo, I. G. Martino, B. M. Drummey, S. A. Virani, K. Santos, J. Bsat, C. Snow, N. Tung, S. Lo, M. G. Faggen, N. Sinclair, N. Ahmad, M. Constantinou, S. Sinclair, J. L. Meisel, S. A. Kirschner, T. A. King, R. Salgado, E. A. Mittendorf, N. U. Lin, N. Tayob, E. P. Winer, E. C. de Bruin, S. M. Tolaney, A. Moeini, A. C. Garrido-Castro. Association of tumor-infiltrating lymphocytes (TILs) with outcomes in patients with early TNBC treated with neoadjuvant chemotherapy with or without pembrolizumab [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-07-18.

Body Dysmorphic Disorder (BDD) is increasingly recognized in the aesthetic practice, yet it remains underdiagnosed and often misunderstood. With its high prevalence, particularly in cosmetic consultations, BDD poses significant ethical and clinical challenges. Aesthetic providers must be vigilant in identifying at-risk individuals and prioritizing psychological well-being alongside procedural outcomes. Artificial Intelligence (AI), with its capacity to analyze behavioral patterns, automate screening tools, and detect subtle indicators of cognitive distortion, presents a new frontier in managing BDD. However, integrating AI into clinical practice requires caution to prevent reinforcing appearance-focused biases and to ensure privacy and fairness. This commentary discusses the opportunities, limitations, and ethical considerations of leveraging AI to assist clinicians in detecting BDD, fostering safer patient outcomes, and advancing the compassionate practice of aesthetic medicine. AI should not accelerate aesthetic procedures but promote reflective, ethically sound decision-making. When integrated responsibly, it can enhance recognition of BDD, support psychological safety, and preserve patient trust through transparency, data protection, and clinician oversight.

Abstract Disclosure: M.J. Sheahan: None. L. Ranga: None. A. Ashkezari: None. Background: This case report details atrial fibrillation (Afib) in a 22-year-old male with a complex medical history, including morbid obesity, exogenous testosterone therapy, opioid use, and erythrocytosis. This case highlights the potential interplay between obesity, testosterone-induced erythrocytosis, and opioid use in the development of Afib. Clinical case: A 22-year-old male with a history of well-controlled diabetes mellitus (managed with Ozempic) and chronic back pain (treated with Belbuca and hydrocodone-acetaminophen) presented with palpitations and chest pain. His medical history was notable for morbid obesity, with a BMI of 66 in 2003, reduced to 47 by 2024 following significant weight loss. He was also receiving 200mg injections of testosterone cypionate for symptomatic low testosterone, alongside his other medications. In the emergency department, he was found to be in atrial fibrillation with Afib RVR at a heart rate of bpm, refractory to oral diltiazem but controlled with a continuous diltiazem infusion, reducing his heart rate to the 80s. Labs significant for elevated WBC at 14 x10^3/uL, suggesting possible infection or stress response. Labs also significant for elevated RBC at 6.69 x10^6/uL, Hemoglobin at 19 g/dL, and Hematocrit at 58.3%, with increased red cell distribution width (RDW) at 14.6%. Blood glucose levels were initially elevated at 177 mg/dL and trended down to 86 mg/dL. CTA negative for PE. Patient received TTE showing normal EF and no structural heart abnormalities. He was admitted for further management, including consideration for direct current cardioversion (DCCV), though he later converted to normal sinus rhythm with medical therapy alone. On initial evaluation, the patient was tachycardic, with a heart rate of up to 180 bpm in Afib RVR, resistant to oral diltiazem. A continuous intravenous diltiazem infusion successfully controlled his heart rate to the 80 bpm range. Patient started on 75mg metoprolol for rate control and eliquis for stroke prevention. He was subsequently started on a beta-blocker and returned to normal sinus rhythm without the need for TEE or DCCV. Conclusions: This case highlights the need for careful management of young patients with a complex medical history involving exogenous testosterone therapy, opioid use, and obesity. Clinicians should be vigilant in monitoring cardiovascular health and considering the risks of erythrocytosis in patients on testosterone therapy. Further research is needed to better understand the mechanisms linking hormonal therapy, erythrocytosis, and arrhythmias. Understanding these interactions can aid in the prevention and management of arrhythmias in similar patient populations. Presentation: Saturday, July 12, 2025

In the wake of COVID-19 and surrounding hospital closures, South Shore Health embarked on an evidence-based journey to quadruple their new graduate nurses annual hiring by creating a unique nurse residency program. Balancing growth with a high-quality orientation and skill acquisition to mediate the effect of fewer direct patient clinical experiences for nursing students during the pandemic. Further the health system was able to achieve a dramatic improvement in their first-year retention rates for registered nurses.

Emphysema's significant morbidity and mortality underscore the need for reliable outcome metrics in clinical trials. However, commonly accepted chronic obstructive pulmonary disease outcome measures do not adequately capture emphysema severity or progression. Computed tomography (CT) metrics have been validated as accurate indicators of pathological emphysema and predictors of chronic obstructive pulmonary disease progression, exacerbations, and mortality. This position paper reviews the evidence supporting CT densitometry as a biomarker for emphysema, establishes implementation standards, and highlights areas for future research. A systematic literature review addressed three key questions: whether CT densitometry can be used as a diagnostic biomarker of emphysema, whether CT densitometry can be used as a prognostic biomarker, and whether longitudinal change in densitometry can be used as a disease progression monitoring biomarker. Emphysema metrics, such as the percentage of low attenuation areas below -950 Hounsfield units, are validated, highly reproducible diagnostic and prognostic biomarkers. Volume-adjusted lung density is recommended for disease monitoring. Both metrics demonstrate a scan-rescan intraclass correlation coefficient of 0.99 with proper technique. The paper also discusses relevant CT physics, techniques, and sources of variation, including technical factors, physiological changes, and software analysis. Key recommendations for clinical trials include using standardized CT techniques, proper subject selection, and longitudinal evaluation with volume-adjusted lung density.

BackgroundDistinguishing surgical intensive care unit (ICU) patients with ongoing bleeding who require hemorrhage control interventions (HCI) can be challenging. Guidelines recommend risk-stratification with clinical variables and prediction tools, however supporting evidence remains mixed.MethodsThis retrospective study evaluated adult patients admitted to the surgical ICU with concern for ongoing hemorrhage under our institution's "Hemorrhage Watch" (HW) protocol and aimed to derive a clinical prediction model identifying those needing HCI with serial vital signs (VS) and serum biomarkers. The HW protocol included ICU admission followed by a 3-h observation period with VS monitoring every 15 min and hourly biomarkers. The primary outcome was the need for HCI (operative and endovascular interventions) within nine hours of ICU arrival. Secondary outcomes included in-hospital mortality, blood transfusions, and ICU and hospital length-of-stay. A clinical prediction model was developed by utilizing the variables most associated with HCI in a best subsets regression, which was subsequently internally validated using a Bootstrap algorithm.Results305 patients were identified for inclusion and 18 (5.9%) required HCI (3 operative, 15 endovascular). The median age was 70 years (IQR 54, 83), 60% had traumatic injuries, and 73% were enrolled from the emergency department. Blood product transfusion and mortality were similar between the HCI and no-HCI groups. Our analysis demonstrated that a model based on the minimum hemoglobin (9.9 vs 8.1 g/dL), minimum diastolic (57 vs 53 mm Hg) and systolic blood pressures (105 vs 90 mm Hg), and minimum respiratory rate (15 vs 18) could predict HCI with an area under the Receiver Operating Characteristics curve (AUROC) of 0.87, outperforming the Shock Index (SI) (AUROC = 0.64).ConclusionsIn this study of surgical ICU patients with concern for ongoing bleeding, a prediction model using serial VS and biomarkers outperformed the SI and may help identify those requiring HCI.

Preclinical studies for wound healing disorders are an essential step in translating discoveries into therapies. Also, they are an integral component of initial safety screening and gaining mechanistic insights using an in vivo approach. Given the complexity of the wound healing process, existing guidelines for animal testing do not capture key information due to the inevitable variability in experimental design. Variations in study interpretation are increased by complexities associated with wound aetiology, wounding procedure, multiple treatment conditions, wound assessment, and analysis, as well as lack of acknowledgement of limitation of the model used. Yet, no standards exist to guide reporting crucial experimental information required to interpret results in translational studies of wound healing. Consistency in reporting allows transparency, comparative, and meta-analysis studies and avoids repetition and redundancy. Therefore, there is a critical and unmet need to standardise reporting for preclinical wound studies. To aid in reporting experimental conditions, The Wound Reporting in Animal and Human Preclinical Studies (WRAHPS) Guidelines have now been created by the authors working with the Wound Care Collaborative Community (WCCC) GAPS group to provide a checklist and reporting template for the most frequently used pre-clinical models in support of development for human clinical trials for wound healing disorders. It is anticipated that the WRAHPS Guidelines will standardise comprehensive methods for reporting in scientific manuscripts and the wound healing field overall. This article is not intended to address regulatory requirements but is intended to provide general guidelines on important scientific considerations for such studies.

To determine Dysphoric Milk Ejection Reflex (DMER) incidence. Secondary objectives were to describe the symptom profiles and patient characteristics of DMER and assess DMER familiarity. A prospective observational study of people who initiated breastfeeding after delivery between December 2022 and May 2023 at two hospitals in New York. Participants filled out an Initial Survey, assessing prior DMER familiarity, and recurring DMER Symptoms Surveys, assessing symptom presence, severity, and transiency. Medical records were reviewed for patient demographics and clinical history. Descriptive and basic inferential statistics were performed. A p<0.05 was considered statistically significant. Based on the DMER definition utilized, incidence was 26.9 % (n=21), and symptom severity was mostly very mild to moderate. Those with DMER had similar baseline characteristics to those without, apart from a significantly higher rate of having delivered via cesarean section (71.4.0 vs. 33.3 %, p<0.01). Among the 55 patients who completed the initial survey, 61.8 % were unfamiliar with the condition. DMER is described as brief, abrupt, negative emotions experienced by breastfeeding individuals prior to milk letdown. We found that more than 1 in 4 participants screened positive. Future research could better define, quantify, qualify, and publicize this condition to inform clinical practices and facilitate successful breastfeeding relationships.