Trinity Health Oakland Hospital

BACKGROUNDDiabetes mellitus (DM) is a significant risk factor for cardiovascular diseases and can worsen the risk of cardiovascular events among patients with hypertrophic cardiomyopathy (HCM). However, strong evidence is needed to show the impact of DM on all-cause mortality (ACM) and atrial fibrillation (AF), which we explored in this systematic review and meta-analysis.AIMTo determine the impact of DM on ACM and AF in patients with HCM.METHODSPubMed, Google Scholar, and EMBASE databases were searched for studies showing the effect of DM on ACM and AF in HCM. A binary random effects model with a 95% confidence interval (CI) was used to pool odds ratios (ORs) for ACM and AF outcomes. Study quality was assessed using the Joanna Briggs Institute’s critical appraisal tool and leave-one-out sensitivity analysis. P < 0.05 was considered statistically significant.RESULTSFourteen studies (n = 106138) with a mean age of 61.76 ± 19.84 years and 61.55% males were included in our systematic review; ten studies (n = 102882) were eligible for meta-analysis. In the unadjusted analysis, DM was not significantly associated with ACM (OR = 0.96; 95%CI: 0.43-2.15; P = 0.93). However, after adjustment, DM showed a significant association with higher ACM risk (adjusted OR = 1.37; 95%CI: 1.16-1.61; P < 0.01). DM was significantly associated with AF in both unadjusted (OR = 2.02; 95%CI: 1.14-3.58; P = 0.04) and adjusted analyses (adjusted OR = 2.68; 95%CI: 1.68-4.27; P = 0.01). The Joanna Briggs Institute tool revealed a low risk of bias. Leave-one-out sensitivity analysis, performed by sequentially excluding each study, demonstrated no significant change in the overall effect estimates, indicating the robustness and stability of our results.CONCLUSIONDM significantly increased the risk of ACM and AF, highlighting the importance of tighter glycemic control and cardiovascular risk factor modification among patients with HCM.

Cardiac metastasis from neuroendocrine tumors (NETs) is exceptionally rare and poses diagnostic and therapeutic challenges. We report this case to highlight that cardiac metastases from NETs can be entirely silent yet clinically significant, with early recognition relying on vigilant, multimodal imaging rather than symptom-driven evaluation. We present the case of a 73‑year‑old man who was incidentally found to have a right ventricular mass during lung cancer screening. Imaging studies, including CT, cardiac MRI, and Ga‑68 DOTATATE PET‑CT, revealed a right ventricular apical mass with attachment to the interventricular septum, mesenteric primary tumor, and hepatic metastases. Pathological analysis confirmed a well‑differentiated NET with strong synaptophysin positivity. Despite asymptomatic presentation, he was initiated on octreotide therapy for stage IV disease. Six‑month follow‑up demonstrated stable disease. This case adds to the very limited literature on asymptomatic cardiac metastases from NETs by uniquely demonstrating an incidentally detected right ventricular lesion identified on screening CT rather than targeted cardiac evaluation, with no evidence of carcinoid valvular involvement. In particular, the septal attachment without valvular disease contrasts with most previously reported cardiac NET metastases, which commonly involve valvular structures. Furthermore, this case demonstrates the importance of multimodal imaging in detecting occult cardiac metastasis and highlights the role of somatostatin analogs in managing metastatic NETs. These findings highlight the importance of systematically reviewing cardiac structures during routine imaging to enhance early detection of clinically silent cardiac metastases in NETs. • Cardiac metastasis from small bowel NET found incidentally. • Diagnosed by CT, MRI, and PET-CT; treated with octreotide. • Disease stable at six months.

To describe outcomes in patients with periprosthetic distal femur fractures (PPDFF) who underwent retrograde intramedullary nailing (rIMN), including subsequent revision total knee arthroplasty (TKA) and subjective and/or objective evidence of flexion instability (FI). The hypothesis of this study is flexion instability can occur following rIMN in cruciate-retaining total knee arthroplasty (CR-TKA), possibly due to iatrogenic PCL damage. Design: Retrospective review. Single academic Level-I trauma center. All patients who sustained a PPDFF, OTA/AO 33A, between 2008-2022 who were treated with a rIMN by a trauma fellowship trained orthopedic surgeon with >3 months follow-up were included. Patients with < 3 months follow-up, treated with locked plating, nail-plate combinations or whose surgery was not performed by a trauma fellowship trained orthopedic surgeon were excluded. The primary outcome was rate of revision TKA for instability. Secondary outcomes included radiographic measurements (posterior tibial translation, femoral component ratio, and final coronal and sagittal alignment) and complications. 73 patients (61, 83.6% female) were included. Average age was 73.8 ± 12.3 years and median length of follow-up was 294 days (IQR: 156, 411 days). There were 4 (6.2%) revision TKA, performed; 3 CR-TKAs and 1 PS-TKA. All three CR-TKA knees revised were for instability. There were 16 (20.5%) complications requiring return to the OR. Median time to return to OR was 204.5 days (IQR of 135-390.25 days). The most common indication was irritable hardware (n=4, 5.5%) and nonunion (n=4, 5.5%) followed by primary instability (n=3, 4.1%). All 3 nonunions underwent revision ORIF. Five (6.8%) patients reported symptoms and 7 (9.6%) had positive physical exam findings suggestive of FI. There were 22 (30.1%) patients with radiographic posterior tibial translation. This retrospective review suggests that flexion instability secondary to damage of the posterior cruciate ligament is a potential complication following retrograde intramedullary of periprosthetic distal femur fractures. Level III.

7066 Background: Three CAR-T cell therapies i.e. axicabtagene ciloleucel, tisagenlecleucel and lisocabtagene maraleucel are currently approved for relapsed refractory DLBCL after 2 or more prior lines of treatment. Landmark trials have shown promising efficacy however, a notable concern with CAR-T therapy is the potential development of secondary primary malignancies. Methods: A retrospective study was performed using TriNetX, a global research de-identified database with data from 145 health care organisations as of January 2025. ICD-10 codes were used for associated diagnosis and medications. The database was queried to identify RR-DLBCL patients who had received any of axi-cel, tisa-cel or liso-cel. These treatments were set as the index event for outcome analysis. Demographics and prevalence of comorbidities were extracted. Outcome analysis queried for several hematological and solid tumor malignancies. The Measure of Association Analysis was used to calculate Odds Ratio. Results: 1842 adult patients with RR-DLBCL received one of the 3 CAR-T cell treatments as listed above and 12,431 patients with RR-DLBCL did not receive any of the 3 treatments. There were 1:1 propensity score matched adjusting for age, race, sex and tobacco use. Final number for both groups was 1842. For both cohorts, 1367 (73.8%) were white, 1055 were male (57%). The cohort had a mean follow up of 497 days, median follow up of 331.5 days. The CAR-T group had higher rates of MDS (3.9% vs 0.8%, p=&lt;0.001) and AML (3.2% vs 1.2%, p=&lt;0.001) in our database review of the US population. It did not show higher rates of other reported SPMs like Mature T/NK cell lymphoma, Hodgkin's lymphoma, multiple myeloma or solid tumours like lung, breast, prostate primary or malignant melanoma. Data on other SPMs is shown in Table 1. Conclusions: In our retrospective study of real-world population, RR-DLBCL patients who received CAR-T cell therapy with any of axi-cel, tisa-cel or liso-cel showed higher rates of MDS and AML compared to propensity matched patients with RR-DLBCL who did not receive CAR-T cell therapy while rates of other reported SPMs were not significantly different. Frequency of SPMs in CAR-T receiving and no CAR-T receiving patients with RR-DLBCL. SPM Received CAR-T cohort (%) Did not receive CAR-T cohort (%) Odds Ratio p-value MDS 3.9 0.8 4.852 (2.767-8.507) &lt;0.001 AML 3.2 1.2 2.668 (1.624-4.382) &lt;0.001 Mature T/NK cell lymphoma 0.7 1.5 0.466 (0.238-0.909) 0.022 Hodgkin's lymphoma 0.9 1.9 0.469 (0.257-0.854) 0.011 Follicular lymphoma 3.8 3.6 1.055 (0.721-1.545) 0.781 Mantle cell lymphoma 1.0 0.5 1.792 (0.825-3.893) 0.135 Multiple Myeloma 1.4 2.4 0.566 (0.341-0.938) 0.025 Primary Lung site 0.7 0.5 1.292 (0.565-2.954) 0.543 Primary Breast site 0.5 0.7 0.815 (0.351-1.892) 0.634 Prostate cancer 0.5 0.6 0.902 (0.382-2.129) 0.814