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Abstract Title: A Systematic Review on Women’s Health in Abortion Legalized vs. Abortion Prohibited Nations Background: On June 24, 2022, the US Supreme Court overturned the landmark 1973 Roe v. Wade decision that affirmed the constitutional right to abortion. This study compares trends in women’s health and unmet contraceptive needs between abortion legalized and prohibited nations, as of July 20, 2022. Methods: A systematic review of data obtained from literature searches in Cochrane library, EMBASE, Medline, Guttmacher Institute, United Nations Children’s Fund (UNICEF) and World Health Organization (WHO) databases. Results: Among 195 nations in the world, 16 each were grouped into two categories. Group one included 16 nations where abortion is legalized, and group two included 16 nations where abortion is prohibited, with exceptions only in cases to save the pregnant person’s life. The mean adolescent birth rate per 1000 women aged 15-19 years was 13.7 (range, 3.53- 51.8) in abortion legal group compared to 77.9 (range, 49.5-142.8) in abortion illegal group. Further, while 50% of unintended pregnancies ended in abortion in abortion legalized nations, only 38.5% were terminated in abortion illegal countries. In addition, it was observed that there was a 12% to 74% unmet need for contraceptive and abortive services among abortion prohibited nations. The mean maternal age at first birth was 27 years in abortion legal group compared to 21 years in abortion illegal group. The mean maternal mortality rate per 100,000 live births was 43 among abortion legal group while it was 263.8 among abortion illegal group. Overall, average female literacy rate was 96.8% in abortion legal group compared to 68.8% in abortion illegal group. It was also noted that the average adolescent birth rates were as low as 0.29 in nations having established unrestricted abortion laws that date back to 1960. Conclusion: The high adolescent birth and maternal mortality rates alongside lower female literacy rates in abortion prohibited nations raises serious concerns about women’s health and restricted opportunities for higher education. Further research is needed to evaluate if liberalizing abortion policies would help improve women’s health and literacy.

Background: Targeted radionuclide therapy (TRT) is an emerging treatment for metastatic disease that delivers systemic radiation via a therapeutic radionuclide-linked, tumor-targeting vector. We have previously shown that low dose radiation delivery with 90Y-NM600 improves tumor response to immune checkpoint inhibitors (ICIs). NM600 is selectively taken up and retained in murine and human tumors. Understanding the effect of different radionuclide physical properties (emission type, linear energy transfer (LET), half-life, and tissue range) on immunomodulation of immunologically cold cancers can improve clinical treatment and avoid immunosuppression encountered with systemic external beam radiation therapy (EBRT). Here, we study 90Y, 177Lu, and 225Ac in immunologically cold syngeneic murine tumor models, MOC2 head and neck squamous cell carcinoma and B78 melanoma, monitoring cGAS/STING mediated type 1 interferon (IFN1) responses. We hypothesized that the radionuclide’s physical properties would differentially impact immunomodulation. Methods: 90Y, 177Lu, or 225Ac were added to culture media in activities estimated by the Medical Internal Radiation Dose method to deliver 12 Gy (MOC2) or 4 Gy (B78) to the cell monolayer by an infinite timepoint. qPCR was performed on cDNA from cells that were irradiated with EBRT, 90Y, 177Lu, or 225Ac, and harvested on days 1, 3, or 7. Mice bearing B78 WT or Tmem173 -/- CRISPR deletion B78 (STING KO) tumors were randomized to receive 1.5 Gy EBRT, an equivalent tumor dose of 90Y- or 177Lu-NM600 determined by the Monte Carlo-based RAPID platform, 0.5 μCi 225Ac-NM600, or no radiation on day 1. Tumors were harvested on days 4, 7, and 10 for RT-qPCR. Results: Expression of immune susceptibility markers (Mhc1, Pdl1) and IFN1 response- associated genes (Ifnβ1, Mx1) was upregulated in MOC2 and B78 cells following EBRT/TRT, compared to controls. The timing and magnitude of these effects correlated with radionuclide half-life and LET. Conclusion: These studies show the capacity to deliver immunomodulatory radiation to tumors using γ-, β- or α-emitting TRT. Understanding TRT effects on the tumor microenvironment may pave integration of TRT and immunotherapies into clinical care to enhance anti-tumor immunity.

Introduction Achyrocline bogotensis is a member of the Asteraceae family of flowering plants. While the Asteraceae family is well known for food crops (lettuce), ornamentals (chrysanthemum), or common weeds (dandelion); A. bogotensis, itself, is know as ‘vira vira’ (the plant of life). Found in the Andean region of South America, A. bogotensis has been used ethnomedically for thousands of years. Ground into a poultice or steeped to make tea, A. bogotensis has been said to help heal wounds, fight infections, reduce inflammation, and even possess anti-neoplastic qualities. Previous studies from our lab have shown that one compound isolated from A. bogotensis, 3,5 dihydroxy-7-methoxyflavone (Achyrocline B, Flavone B, FB), is cytotoxic to colorectal and pancreatic cancer cell lines1,2. Surgically unresectable colorectal and pancreatic carcinomas have a high rate of mortality as current treatment options are limited. One common chemotherapeutic used to treat these cancers is 5-flurouracil (5-Fu); however, treatment typically only serves to slow the progression of the disease and comes with many side effects due to 5-Fu’s intrinsic toxicity3-6. Thus, strategies to decrease the amount of 5-Fu used in treatment as well as reduce its off-target toxicity are paramount not only to better treatment of colorectal and pancreatic carcinomas, but also to improve patient quality of life. Methods Viability after treatment was measured in various colorectal and pancreatic cancer cell lines by MTT. Synergy analysis was performed using CompuSyn software. Results were supported by analysis of cellular lysates for apoptotic proteins by western. Xenograft implantation was done using HCT116 into nude mice. Mice were treated 3/week for six weeks with either saline, Achyrocline B + 5-Fu, or 5-Fu alone. Tissue was either flash frozen for western or paraformaldehyde fixed, paraffin embedded, and then analyzed using H&E. All statistical analyses was performed using GraphPad Prism. Results Synergy analysis revealed that cotreatment with Achyrocline B and 5-Fu was synergistic and as efficacious as a dose of 5-Fu four-fold higher in multiple colonic and pancreatic cell lines. These results were supported by western analysis of apoptotic proteins. Off target toxicity models showed an opposite profile in which less loss of viability and apoptosis was seen. In our xenograft model, Achyrocline B was shown to increase apoptosis in tumors leading to degeneration of the outer tumoral boundary. Furthermore, in 5-Fu treated animals it was found that Achyrocline B provided protection on both a histological and cellular level. Conclusion Our studies show that Achyrocline B efficiently allows for 5-Fu dose reduction and has dual actions: 1) It works synergistically with 5-Fu to kill cancer cells in vitro and in vivo and 2) protects tissue in vivo from the toxicity of 5-Fu. These results show promise for a new adjuvant therapy for colorectal and pancreatic carcinomas that not only reduces tumor progression, but more importantly has the potential to improve patient quality of life.

Background: The United States Preventive Services Task Force recommends colorectal cancer (CRC) screening for all average-risk adults aged 45 years and up1. Fecal Immunochemical Tests (FIT) and FIT/DNA (Cologuard) test are the two most widely used non-invasive tests used for this screening. In the event of a positive test, a diagnostic colonoscopy is recommended within three months of the positive result. As the Covid-19 pandemic continues, hospitals have implemented policies that include strict screening guidelines before procedures such as colonoscopies. The effect of these guidelines and restrictions on elective procedures such as colonoscopy on the interval between a positive non-invasive screening test (NIST) and diagnostic colonoscopy (DC) is not clear. Study aim: to quantify the interval between a positive NIST (FIT, FIT/DNA) and DC, and to compare these findings to non-pandemic findings from the previous year. Methods: In this retrospective, time-trend analysis, we identified patients within a major hospital system in Indiana who had a positive NIST between January 1, 2019 and June 30. After our original query, we noticed FIT/DNA tests were not coded into the EMR before June 10, 2020, and had to use data from campus-based public and private hospitals to supplement for this time period. Once identified, chart review was performed to determine if/when a patient underwent DC . If a patient’s chart did not show evidence of a DC, we examined the EMR notes to discern whether, when, or why colonoscopy was / was not completed. We measured the interval between NIST result and DC by quarter, comparing results between corresponding times during 2019 and 2020 as well as the first two quarters of 2021. We also measured and compared the proportion of patients with a positive non-invasive test who had not had colonoscopy by 60, 90, and 180 days. Results: Of the 1,379 patients reviewed, 930 (68%) underwent subsequent colonoscopy in the 30-month study timeframe. Colonoscopy completion rates were 72% for the FIT/DNA group, and 47% for the FIT group over the 30-month timeframe. Of the 293 persons who did not elect to have a subsequent colonoscopy, 21 (7.2%) reported that the pandemic kept them from undergoing the procedure. Concern for acquiring COVID-19 from the colonoscopy site was the most common reason for declining colonoscopy in this group, having been mentioned by 8 of the 21 individuals. Other reasons included waiting to get a COVID vaccine before undergoing a procedure or issues with completing required COVID screening before the procedure. Only two individuals (0.7%) were found to have delayed colonoscopy due to a recent COVID infection. The proportion of patients completing a colonoscopy within 90 days of a positive NIST were 83%, 79%, and 83% for 2019, 2020, and 2021, respectively. Conclusion/Impact: Overall, the rate of DCs following a positive NIST test did not appear to be significantly affected by the COVID-19 pandemic. Concern of contracting COVID-19 was a more common reason for delay when compared to actual COVID infection. A study evaluating the rate of COVID infection following a colonoscopy procedure may be useful to address the validity of these concerns, the results of which could alleviate (or exacerbate) this issue in the setting of future outbreaks. When compared to Cologuard, patients who had a positive FIT test were more likely to wait longer for a DC. This discrepancy suggests the relationship between providers and their use of FIT vs. Cologuard should be further probed. In addition, studying patient perceptions of both screening procedures may identity reasons for delay. 1. US Preventive Services Task Force. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(19):1965–1977. doi:10.1001/jama.2021.6238

As the novel COVID-19 pandemic was on the rise, its impact on the healthcare system was devastating. Patients became more reluctant to present to the hospital and elective procedures were being postponed for patient safety. We wanted to assess the effects of the COVID-19 pandemic on the door-to-device time in our small community hospital in the heart of Trenton, New Jersey. We created a retrospective study that evaluated all STEMI cases that presented to our institute from January 2018 until the end of May 2021. Our primary outcome was the door-to-device time. Secondary outcomes were the length of hospital stay, ICU admission, length of ICU stay, cardiac arrest, and death during the hospitalization. We studied 114 patients that presented with STEMI to our emergency department, 77 of these patients presented pre-COVID-19, and 37 presented post-COVID-19 pandemic. Our median door-to-device for STEMI cases pre and post-COVID-19 pandemic were 70 minutes (IQR 84-57) and 70 minutes (IQR 88-59) respectively with no significant difference found (P-value 0.55, Mann Whitney Test). It is, however, interesting to note that the number of STEMI admissions significantly decreased during the post-pandemic era. There are limitations to our study, most noticeably the number of STEMI cases at our small community hospital which limits its generalizability. Moreover, we did not assess other comorbidities which might have confounded our outcomes and we were also unable to follow patients post-discharge to assess the long-term sequela of their STEMI admission. Therefore, more dedicated studies of this clinical conundrum are required to further assess and implement guidelines for the future.

Background: Annual well-child visits (AWCV) are important for evaluating children’s well-being. During AWCV, one’s health, development, and anticipatory guidance are discussed, along with any unmet medical/social needs. Many families have barriers to attending AWCV due to social factors including transportation, housing, and childcare. Addressing socioeconomic barriers may improve access to AWCVs. The CATCH program utilizes tele-outreach to schedule AWCVs for patients lost to follow-up and offers access to community-based resources to address families’ unmet social needs in Pittsburgh, PA. This study assessed the efficacy of the CATCH program in scheduling pediatric AWCV and providing access to community resources. Methods: This was a retrospective analysis of pediatric patients lost to follow-up (not seen for AWCV for 12 months since last visit), from 1/2021-6/2022. Families were contacted through phone calls. Each call inquired about interest in scheduling AWCV, identified preferred clinics, assessed families’ unmet social needs, and provided access to local resources. Telephone encounters were made in EPIC to notify pediatric offices of scheduled AWCVs. Chart review was performed to determine attendance rates of scheduled appointments. Results: A total of 459 families were contacted, of which 266 (58%) were unreachable. Of the 193 families reached, 79 (17%) had already attended AWCV within a year, and 22 (5%) patients had reached adulthood and transitioned care, and were thus excluded from our sample. Among the remaining 92 families, 41 AWCVs (45%) were scheduled. Cited reasons for declining scheduling assistance included residence/pediatrician change, guardianship issues, and personal preference. 19 of 41 scheduled appointments (46%) were attended. Community resources were universally provided, with 32 families connected with over 71 resources. These spanned areas of health care/insurance, COVID-19, food, housing, transportation, legal services, childcare, and general community resource hubs. Conclusion: The tele-outreach of the CATCH program increased rates of AWCV scheduling, and connected families with local resources to address unmet social needs. This model offers support for phone call-based outreach to contact families of children lost to follow-up and suggests its role in addressing health care and socioeconomic barriers. CATCH may serve as a model for other tele-outreach programs in underserved communities.

Background: Herpes infections can be dormant and recurrent in patients and in the eye, can cause corneal scarring. This coupled with cataracts in patients leaves them blinded with no treatment options since the herpetic scars will reoccur if removed. Case Presentation: A 72 year old Caucasian female was referred with a Herpetic corneal scar post a prior LASIK surgery. Her best corrected vision was a distorted 20/60 with an irregular cornea. Using Excimer Laser Corneoplastique™, her cornea was brought to a measurable outcome which then allowed her to undergo accurate premium cataract surgery. Discussion: By using a two step surgical method, the patient was able to achieve emmetropia, a feat normally not possible for most herpes patients. Each problem was separately addressed: first the corneal scar secondary to herpes, and next the cataracts with a Corneoplastique technique.

Abstract Title: Reverse Total Shoulder Arthroplasty: The Impact of Implant Design on Postoperative Internal Rotation Background Reverse total shoulder arthroplasty (rTSA) is a ubiquitous surgical procedure indicated for numerous glenohumeral pathologies. Repeated evidence demonstrates its efficacy in improving shoulder function and reducing pain; however, improvements in rotational motion have been inconsistent. Attention has recently shifted toward internal rotation (IR) as an important component of activities of daily living (ADL). Subsequently, IR has been strongly associated with post-operative patient satisfaction. To date, there has been little discussion regarding implant design on IR. As the community shifts toward more lateralized center-of-rotation and varus humeral implants, it is unclear how this will impact rotational motion. Methods A systematic review was performed following PRISMA guidelines. Search strategies were implemented in PubMed with the keywords (internal rotation) AND (reverse) AND (shoulder). Inclusion criteria included a minimum 12-month follow-up, reporting of IR, and implant description. Exclusion criteria included rTSA solely for proximal humerus fractures, oncologic reconstruction, or severe glenoid deformity, revision rTSA, and procedures including latissimus dorsi or tendon transfers. After review, 56 studies from 332 unique citations were selected. Results Analysis was performed on 56 studies consisting of 7788 shoulders treated with rTSA at a mean follow-up of 42.4 months. IR was reported for 7288 shoulders (94%). Measurement systems were highly heterogeneous necessitating conversion to a common metric. This permitted comparative analysis of 46 studies encompassing 6123 shoulders (79%). Varus (135°) humeral implant neck shaft angles (NSA) were associated with the greatest post-operative IR, though intermediate (145-147°) and valgus (150-155°) NSA produced comparable results. Varus and intermediate NSA outperformed valgus NSA in terms of mean change in IR. Accounting for humeral NSA, lateralized glenospheres resulted in greater post-operative IR. When classifying implant systems with the Werthel global offset system, highly lateralized and very highly lateralized systems produced greater post-operative IR than medialized systems. Conclusion The results of this systematic review indicate that lateralization of the center-of-rotation and varus humeral NSA optimize IR. A classic Grammont-style rTSA, a medialized center-of-rotation with a valgus NSA, was associated with predictably poor IR. This review suggests trends toward lateralized center of rotation and varus NSA will result in improved IR.