Ground Glass Opacities Observed in a 26-Year-Old Coronavirus Disease 2019 (COVID-19) Rule-Out Patient With a History of Vape Use

Pulmonary imaging findings in e-cigarette and vaping use associated lung injury (EVALI) and coronavirus disease 2019 (COVID-19) may be similar. One such pulmonary radiographic finding is ground glass opacities (GGOs). These GGOs present a wide differential that is narrowed down through diagnostic testing, deliberation of past medical history as well as medication use, and social history. This case presents GGOs observed in a COVID rule-out admission clinically correlated with EVALI.

Phase I Trial of MRI-Guided Prostate Cancer Lattice Extreme Ablative Dose (LEAD) Boost Radiation Therapy

PURPOSE

A phase I clinical trial was designed to test the feasibility and toxicity of administering high-dose spatially fractionated radiation therapy to magnetic resonance imaging (MRI)-defined prostate tumor volumes, in addition to standard treatment.

METHODS AND MATERIALS

We enrolled 25 men with favorable to high-risk prostate cancer and 1 to 3 suspicious multiparametric MRI (mpMRI) gross tumor volumes (GTVs). The mpMRI-GTVs were treated on day 1 with 12 to 14 Gy via dose cylinders using a lattice extreme ablative dose technique. The entire prostate, along with the proximal seminal vesicles, was then treated to 76 Gy at 2 Gy/fraction. For some high-risk patients, the distal seminal vesicles and pelvic lymph nodes received 56 Gy at 1.47 Gy/fraction concurrently in 38 fractions. The total dose to the lattice extreme ablative dose cylinder volume(s) was 88 to 90 Gy (112-123 Gy in 2.0 Gy equivalents, assuming an α-to-β ratio of 3).

RESULTS

Dosimetric parameters were satisfactorily met. Median follow-up was 66 months. There were no grade 3 acute/subacute genitourinary or gastrointestinal adverse events. Maximum late genitourinary toxicity was grade 1 in 15 (60%), grade 2 in 4 (16%), and grade 4 in 1 (4%; sepsis after a posttreatment transurethral resection). Maximum late gastrointestinal toxicity was grade 1 in 11 (44%) and grade 2 in 4 (16%). Two patients experienced biochemical failure.

CONCLUSIONS

External beam radiation therapy delivered with an upfront spatially fractionated, stereotactic high-dose mpMRI-GTV boost is feasible and was not associated with any unexpected events. The technique is now part of a follow-up phase II randomized trial.

Which hospitalized smokers receive a prescription for quit-smoking medication at discharge? A secondary analysis of a smoking cessation randomized clinical trial

OBJECTIVE

To determine the prevalence and predictors of receiving a smoking cessation medication prescription at discharge.

METHODS

Retrospective analysis of ongoing Human Studies Committee-approved clinical trial data at large tertiary care center, The University of Kansas Medical Center. Patients included were smokers over 18, either Spanish or English speaking, those admitted between October 1, 2016 through May 31, 2018. Other eligibility criteria include access to a telephone or mobile phone, not currently be pregnant or breastfeeding, have no significant co-morbidity that precludes participation (acute, life-threatening illness, and communication barriers such as tracheal tube or altered mental status). Those included in this analysis were those randomized into the trial who expressed interest in receiving a smoking cessation medication prescription at discharge.

RESULTS

Two hundred fourteen patients were recommended a prescription by their smoking cessation counselor, 88 patients (41.12%) were approved a prescription at discharge. Out of those approved, 50.70 (14.05 SD) was the average age, 12.84 (8.47 SD) was the average number of cigarettes used per day, 47 patients (53.41%) were White, 49 patients (55.68%) were admitted through the emergency department, 55 patients (62.50%) had used smoking cessation medication in the past, 49 patients (55.68%) had used inpatient smoking cessation, 36 patients (40.91%) had Medicaid. A binary logistic regression determined to show insurance status (P = 0.042) and use of inpatient smoking cessation medication use (P < 0.001) as statistically significant predictors of receiving a prescription at discharge.

CONCLUSION

It was determined that among the population recommended for medication, 41.12% actually received a prescription at discharge. The variables of "health insurance status" and "use of inpatient smoking cessation medication" demonstrated to be predictors of receiving a prescription. It is important to further study this as many patients rely on a prescription to afford these medications that are useful in a quit attempt.

Neurturin-containing laminin matrices support innervated branching epithelium from adult epithelial salispheres

Cell transplantation of autologous adult biopsies, grown ex vivo as epithelial organoids or expanded as spheroids, are proposed treatments to regenerate damaged branching organs. However, it is not clear whether transplantation of adult organoids or spheroids alone is sufficient to initiate a fetal-like program of branching morphogenesis in which coordinated branching of multiple cell types including nerves, mesenchyme and blood vessels occurs. Yet this is an essential concept for the regeneration of branching organs such as lung, pancreas, and lacrimal and salivary glands. Here, we used factors identified from fetal organogenesis to maintain and expand adult murine and human epithelial salivary gland progenitors in non-adherent spheroid cultures, called salispheres. These factors stimulated critical developmental pathways, and increased expression of epithelial progenitor markers such as Keratin5, Keratin14, FGFR2b and KIT. Moreover, physical recombination of adult salispheres in a laminin-111 extracellular matrix with fetal salivary mesenchyme, containing endothelial and neuronal cells, only induced branching morphogenesis when neurturin, a neurotrophic factor, was added to the matrix. Neurturin was essential to improve neuronal survival, axon outgrowth, innervation of the salispheres, and resulted in the formation of branching structures with a proximal-distal axis that mimicked fetal branching morphogenesis, thus recapitulating organogenesis. Epithelial progenitors were also maintained, and developmental differentiation programs were initiated, showing that the fetal microenvironment provides a template for adult epithelial progenitors to initiate branching and differentiation. Further delineation of secreted and physical cues from the fetal niche will be useful to develop novel regenerative therapies that instruct adult salispheres to resume a developmental-like program in vitro and to regenerate branching organs in vivo.

Ethnic heterogeneity and prostate cancer mortality in Hispanic/Latino men: a population-based study

BACKGROUND

Few studies focus on prostate cancer (PCa) outcomes in Hispanic/Latino men. Our study explores whether Hispanic/Latino subgroups demonstrate significantly different prostate cancer-specific mortality (PCSM) relative to Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) men.

METHODS

We extracted a population-based cohort of men diagnosed with local-regional PCa from 2000-2013 (n= 486,865). PCSM was measured in racial/ethnic groups: NHW (n=352,886), NHB (n= 70,983), Hispanic/Latino (n= 40,462), and Asian American/Pacific Islander (n= 22,534). PCSM was also measured in Hispanic/Latino subgroups: Mexican (n= 8,077), Puerto Rican (n= 1,284), South or Central American (n= 3,021), Cuban (n= 788), and Dominican (n= 300). We conducted univariable and multivariable analyses (MVA) to compare risk for PCSM.

RESULTS

Compared to NHW men, results showed worse outcomes for NHB men with similar outcomes for Hispanic/Latino men. In MVA with NHW men as a reference, NHB (HR= 1.15, p <0.001) men had significantly worse PCSM and Hispanic/Latino (HR= 1.02, p= 0.534) men did not show a significant difference. In a second MVA, Puerto Rican (HR= 1.71, p <0.001) and Mexican (HR= 1.21, p= 0.008) men had significantly higher PCSM. With NHB men as a reference, the MVA showed Puerto Rican (HR= 1.50, p= 0.006) men with higher PCSM and Mexican (HR= 1.08, p= 0.307) men with no significant difference.

CONCLUSIONS

Our findings indicate previously unknown disparities in PCSM for Puerto Rican and Mexican American men.

Abstract PR04: Ethnic heterogeneity and prostate cancer mortality in Hispanic/Latino men

Purpose: Few studies have focused on the rapidly growing and extremely diverse Hispanic/Latino population in regards to prostate cancer outcomes. Our study explores whether heterogeneity between Hispanic/Latino men of diverse ancestry potentially contributes to unexplored disparities in five-year prostate cancer-specific mortality and all-cause mortality.

Patients and Methods: From the Surveillance, Epidemiology, and End Results program (SEER), we designed a population-based cohort of men diagnosed with local-regional prostate cancer (n= 432,356) from 2000-2012. Five-year cumulative incidence of prostate cancer-specific mortality was obtained using competing risks analysis and all-cause mortality was determined by using one minus the Kaplan-Meier survival estimate of overall survival. This was examined for different racial and/or ethnic groups: Non-Hispanic White (n= 313,514), Non-Hispanic Black (n= 62,346), Hispanic/Latino (n= 36,407), and Asian American/Pacific Islander (n= 20,089). We also measured prostate cancer-specific and all-cause mortalities in Hispanic/Latino subgroups: Mexican (n= 7,273), Puerto Rican (n= 1,174), South or Central American (n= 2,666), Cuban (n= 747), and Dominican (n= 292).

Results: In all racial/ethnic groups, five-year cumulative incidence rates were highest for Non-Hispanic Black men at 15.96% (95% CI: 15.6 - 16.3) and were lowest in Hispanic/Latino men at 13.08% (95% CI: 12.6 - 13.5) and Asian American/Pacific Islander men at 13.33% (95% CI: 12.7 - 13.9). Within ethnic subgroups, Puerto Rican men at 22.06% (95% CI: 19.4 - 25.1) and Cuban men 20.91% (95% CI: 17.8 - 24.5) showed significantly higher five-year all-cause mortality than all other groups. Mexican men showed the third highest rate of all groups with 16.47% (95% CI: 15.4 - 17.6). For five-year prostate cancer-specific mortality, both Non-Hispanic Black and Hispanic/Latino men showed similar rates that were higher than other racial/ethnic groups with 3.39% (95% CI: 3.22 - 3.57) and 3.29% (95% CI: 3.07 - 3.52), respectively. For ethnic subgroups, Puerto Rican men at 5.26% (95% CI: 3.88 - 6.92) and Mexican men at 4.77% (95% CI: 4.19 - 5.40) showed significantly higher five-year prostate cancer-specific mortality than all other groups. Cuban and Dominican men showed high rates of both five-year all-cause and prostate cancer-specific mortality, but without significance.

Conclusions: Our findings indicate previously unknown disparities in five-year prostate cancer-specific mortality in Mexican and Puerto Rican men. We also note the increased all-cause mortality within Puerto Rican men diagnosed with prostate cancer, of which may be influenced by comorbid disease. These findings should be further explored and considered in screening and management guidelines.

Citation Format: Felix M. Chinea, Vivek N. Patel, Deukwoo Kwon, Chris J. Lopez, Narottam Lamichhane, Sanoj Punnen, Erin Kobetz, Matthew C. Abramowitz, Alan Pollack. Ethnic heterogeneity and prostate cancer mortality in Hispanic/Latino men. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr PR04.

Going the distance: validation of Acuros and AAA at an extended SSD of 400 cm

Accurate dose calculation and treatment delivery is essential for total body irradiation (TBI). In an effort to verify the accuracy of TBI dose calculation at our institution, we evaluated both the Varian Eclipse AAA and Acuros algorithms to predict dose distributions at an extended source‐to‐surface distance (SSD) of 400 cm. Measurements were compared to calculated values for a 6 MV beam in physical and virtual phantoms at 400 cm SSD using open beams for both 5×5 and 40×40 cm2 field sizes. Inline and crossline profiles were acquired at equivalent depths of 5 cm, 10 cm, and 20 cm. Depth‐dose curves were acquired using EBT2 film and an ion chamber for both field sizes. Finally, a RANDO phantom was used to simulate an actual TBI treatment. At this extended SSD, care must be taken using the planning system as there is good relative agreement between measured and calculated profiles for both algorithms, but there are deviations in terms of the absolute dose. Acuros has better agreement than AAA in the penumbra region.

PACS number(s): 87.55.kd

Lack of Association between COX-2 Staining Level and Biochemical Recurrence Following Salvage Radiation Therapy for Recurrent Prostate Cancer

OBJECTIVE

The ability to predict which men will experience biochemical recurrence (BCR) after salvage radiation therapy (SRT) for recurrent prostate cancer following radical prostatectomy has potential for improvement. Cyclooxygenase-2 (COX-2) overexpression has previously correlated with poor clinical outcomes following primary treatment for prostate cancer, however its predictive ability in the specific setting of SRT has not been examined to date. This study evaluated the association between COX-2 staining intensity and BCR following SRT for recurrent prostate cancer.

METHODS

We utilized a cohort of 151 patients who underwent SRT between July 1987 and July 2003. COX-2 staining intensity in primary tumor samples was detected using monoclonal antibodies and quantified using a computer-assisted method. The association between COX-2 staining intensity and BCR was evaluated using multivariable Cox regression models.

RESULTS

When examining COX-2 staining level as three-level categorical variable (low, moderate, high) based on approximate sample tertiles, there was no evidence of an association with BCR (P=0.18). More specifically, in comparison to patients with low staining intensity, there was no significant difference in risk of BCR for moderate (Relative risk [RR]: 1.17, P=0.56) or high (RR: 0.72, P=0.22) COX-2 staining intensity patients. This lack of association was also observed when considering COX-2 staining intensity as a continuous variable (RR: 0.83, P=0.15).

CONCLUSION

Our results indicate that COX-2 staining intensity is likely of little use in discriminating prognosis of SRT. It appears that the search for prognostic factors associated with BCR should continue elsewhere in order to further enhance patient selection for SRT.

High prevalence of suspected HIV-associated dementia in adult Malawian HIV patients

HIV-associated dementia (HAD) has received little attention in sub-Saharan Africa, and there are no data available from Malawi. We used the International HIV Dementia Scale (IHDS), a cross-cultural, simple and validated screening tool to study the prevalence of suspected HAD, defined as an IHDS score <or=10, in adult patients of a large urban antiretroviral (ART) clinic in Blantyre, Malawi. Use of the IHDS was feasible in our setting. The overall prevalence of suspected HAD was 14.0% (95% confidence interval 8.9-19.1%); there was no significant difference in prevalence between 134 patients on ART for at least six months and 45 patients not on ART (13.4% versus 15.6%; P = 0.722). Male gender and low education level were independent risk factors of suspected HAD. More knowledge of the value of the IHDS to predict ART outcomes is required.