Frequency and outcomes of melanoma subtypes in a diverse population: The Los Angeles County – University of Southern California (LAC-USC) Medical Center experience.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21063-e21063
Author(s):  
Gino Kim In ◽  
Dongyun Yang ◽  
Jacob Stephen Thomas ◽  
Anthony Pham ◽  
Arnab Basu ◽  
...  
Keyword(s):  
African Americans ◽  
Los Angeles ◽  
Medical Center ◽  
Prior History ◽  
P Value ◽  
Superficial Spreading ◽  
Braf Mutations ◽  
Exact Test ◽  
Number Of Patients ◽  
Melanoma Patients

e21063 Background: Melanoma is a biologically heterogeneous disease that varies by ethnicity and histology. While superficial spreading (SSM) histology is the most common subtype in non-Hispanic whites (NHW), acral lentiginous (ALM) and other subtypes occur more frequently in Hispanics, Asians and African Americans. There are no known risk factors for ALM, and further investigation is warranted. Methods: We retrospectively reviewed a database of melanoma patients diagnosed between 2001-2016 at LAC-USC. Overall survival (OS) was estimated using Kaplan-Meier methodology, and comparisons performed using log-rank testing. Fisher’s exact test was used to evaluate associations between relevant clinicopathological variables. A p-value < 0.05 was considered statistically significant. Results: Among 272 melanoma patients, there were 140 Hispanics (51.5%), 105 NHW (38.6%), 14 Asians, and 4 African Americans. The most frequent histology among Hispanics was ALM (30.7%), while SSM was the most frequent among NHW (33.3%). BRAF V600 mutations were found in 34.5% (10/29) and 58.8% (10/17) of Hispanics and NHW, respectively. A total of 52 patients with ALM were identified, including 43 Hispanics (82.7%). There was a significant association between no prior history of non-melanoma skin cancer (NMSC) and ALM (p < .0001). Median Breslow thickness for ALM was 4.2 mm, and 32.7% were ulcerated. The rate of BRAF V600 mutations among 13 ALM patients tested was 0%. NRAS mutations were found in 3 ALM patients; KIT amplification/mutations were found in 2 ALM patients. Conclusions: We identified a population enriched for Hispanic patients with ALM. We found an association between no prior NMSC and ALM, suggesting that UV exposure is not a causative risk factor. BRAF mutations are less common amongst Hispanics, and nearly absent in ALM. Survival differences were not statistically significant, but cannot be ruled out due to low number of patients in this early study. [Table: see text]

Clinical characteristics of melanoma patients with non-V600E/K BRAF mutations.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20036-e20036 ◽  
Author(s):  
Sasan Nowroozi ◽  
Zhuang Zuo ◽  
Keyur Patel ◽  
Sapna Pradyuman Patel ◽  
Rajyalakshmi Luthra ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Primary Melanoma ◽  
Stage Iv ◽  
Distant Metastases ◽  
Unknown Primary ◽  
Sequencing Analysis ◽  
Superficial Spreading ◽  
Braf Mutations ◽  
Number Of Patients ◽  
Melanoma Patients

e20036 Background: BRAF mutations are found in ~50% of melanoma. V600E/K substitutions are the most common and well-characterized. We analyzed the clinical characteristics of patients with non-V600E/K BRAF mutations. Methods: We identified 38 melanoma patients whose tumor contained a non-V600E/K BRAF mutation and reviewed the clinical characteristics. The sequencing analysis was performed with either pyrosequencing or next generation sequencing assay. Results: 38 patients were identified with non-V600E/K BRAF mutations. Mutations detected in more than 1 patient included V600R (n=14, 37%), K601E (5, 13%), G469E (3, 8%); L597S (3, 7%), D594G (2, 5%); 11 other mutations were identified in single patients. Median age was 57 yrs; 82% were men; 95% were white. The common primary subtypes were nodular (26%), superficial spreading (24%), unknown primary (21%); no one were acral, mucosal or uveal melanomas. Ten (26%) of 27 with known ulceration status had ulceration, and 3 (7%) of 22 with known mitosis status had < 1 mitosis /mm2. The sites of primary melanoma were located mostly in the head/neck and the trunk (63%), extremities (16%) and unknown primary (21%). The stage at diagnosis was I /II (29%), III (40%), IV (18%) and unknown (13%). Among 33 (87%) patients who ultimately developed distant metastases, 23(67%) had metastasis in the soft tissue/nodes, 21 (63%) in the lung, 9 (24%) in the brain, 7 (21%) in the liver, 6 (16%) in the bone, and 5 (15%) in the adrenal gland. Among patients (n=25) with initial stage I-III melanoma who later developed distant metastasis, the median duration between the time of initial diagnosis and distant metastases was 36 months. Among the 32 (84%) of the patients who developed stage IV melanoma, the median survival from the time of stage IV diagnosis was 18 months. Five patients received vemurafenib treatment, and 2 patients (K601E; T599_V600ins2) had stable disease and 2 patients (L597Q; G466E) had disease progression and 1 lost to follow up. Conclusions: Unexpectedly higher proportion of the patients with non-V600E/K mutant-melanoma had unknown primary melanoma and higher mitotic rate. In a small number of patients who received vemurafenib, the clinical response appears to be low.

Transfusion Reactions in Sickle Cell Disease (SCD) Patients Receiving Multiple Blood Transfusions.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 946-946
Author(s):  
Vishwas S. Sakhalkar ◽  
Diana M. Veillon ◽  
James D. Cotelingam ◽  
Linda M. Hawthorne ◽  
Gloria C. Caldito ◽  
...  
Keyword(s):  
Medical Center ◽  
Blood Type ◽  
P Value ◽  
Transfusion Reaction ◽  
Chi Square ◽  
Exact Test ◽  
Number Of Patients ◽  
Before And After ◽  
Patient Groups ◽  
Transfusion Reactions

Abstract Aim: To study transfusion reactions in our SCD patients before and after instituting the practice of transfusing C, E, K blood type negative (CEKneg) packed red blood cell (pRBC) units. Material and Methods: We retrospectively reviewed blood bank records of all SCD patients transfused pRBCs since 1990. Statistical analysis was performed using the Chi square test and Fischer’s exact test. Results: During 1990–2004, 500 SCD patients received pRBCs in our medical center. Of these, 387 received pRBC units crossmatched only for ABO and Rh blood types and suffered 37 transfusion reactions. Table I: General data of various patient groups Major patient groups Number of patients Median age in yrs # of pRBCs Tx Total (%) Sex (m/f) (range) Total units Median (range) Grand total of all patients 500 240/260 22 (0.7–79) 16617 14 (1–524) CEK (&ABO) matched transfusion patients 113 62/51 8 (0.5–35) 2354 10 (1–143) Regular (only ABORh) matched Tx patients 387 (100) 178/209 26 (0.7–79) 14263 18 (1–524) AlloAB forming patients 121 (31.3) 56/65 29 (5–70) 7338 26 (1–500) Non-alloAB forming pts 266 (68.7) 122/144 25 (0.7–79) 6925 12 (1–524) Table 2: Transfusion reactions in various patient groups Major patient groups Total # of pts Total # of pRBCs Transfusion reactions (% of pts) [Incidence/1000 Tx] Total Febrile Allergic dHTR CEK matched pts 113 2354 0 0 0 0 Regular (ABORh) Tx pts 387 14263 37 (10%)[2.594] 10 23 (6%)[1.61] 4 (1%)[0.28] AlloAB forming pts 121 7338 23 (19%)[3.134] 4 (3%)[0.55] 15 (12%)[2.04] 4 (3%)[0.55] Non-alloAB forming pts 266 6925 14 (5%)[2.0] 6(2%)[0.87] 8 (3%)[1.16] 0 P value (alloAB vs non-alloAB) # of pts 0.25 0.684 0.266 - P value (alloAB vs non-alloAB) # of Tx &lt;0.001 0.809 0.002 - 121 developed alloantibodies (alloABs). 113 patients always received CEKneg pRBCs (from 1997). The technologist required 30 more minutes and $153 extra in reagent costs for this extended CEK match. Most Rh negative pRBC units were also CEKneg. 90% of our donors are Caucasian. Discussion: ’Non-alloAB forming’ patients who received ABORh matched transfusions were 4 times less likely (and twice less likely when number of transfusions was considered) to develop allergic transfusion reaction (p=0.002), compared with ’alloAB forming’ counterparts. Similar finding is seen in patients receiving CEK matched pRBCs. It would be interesting to know if ’slow/rapid/non alloAB producer patients had any genetic predisposition accounting for early/slow/non-development of ABs and transfusion reactions or if alloAB formation transforms the immune system to a hyper-reactive state leading to autoAB formation/allergic reaction. Conclusions: This study showed that utilizing extended antigen (C, E, K) matching for pRBC transfusion ↓↓ alloAB(p&lt;0.01) and autoAB(p=0.005) formation in our SCD patients and eliminated transfusion reactions. Universal availability of leukopoor pRBCs may have eliminated febrile reactions. AlloAB forming patients were more prone to develop allergic transfusion reaction (p=0.002). AutoAB formation was more common in patients with alloABs and did not cause complications. dHTRs were rare and mild. CEK matching made it easier to find and transfuse blood due to less formation of ABs and reactions. However, it resulted in marked overuse of Rh negative pRBCs, extra cost and additional effort to find CEKneg pRBCs for every transfusion.

An Evaluation of Snake Bites and Antivenin Use at a Regional Medical Center

2010 ◽  
Vol 76 (7) ◽  
pp. 755-758
Author(s):  
Larry I. Watson ◽  
Christy Spivey ◽  
Cen Rema Menon ◽  
Cyrus A. Kotwall ◽  
Thomas V. Clancy ◽  
...  
Keyword(s):  
Medical Center ◽  
Length Of Hospital Stay ◽  
Clinical Information ◽  
P Value ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Snake Bites ◽  
Regional Medical ◽  
Regional Medical Center ◽  
Physical Findings

Snake bites are a rare but challenging problem for surgeons. The purpose of our study was to evaluate our experience with snake bites at a regional medical center. We reviewed patients treated for snake bites from 2004 to July 2008. Demographics, clinical information, and outcomes were documented. Descriptive statistics were used, and χ2, t test, and Fisher exact test were used to compare patients based on antivenin use. A P value < 0.05 was considered significant. Over the study period, 126 patients presented to the emergency department with 44 (35%) requiring hospital admission. The average age was 38 years (range, 2 to 76 years); 66 per cent were male and 95 per cent white. Bites most commonly occurred in the summer and fall months with none from December through March. Copperhead bites accounted for 50 per cent of bites. An average of 4.8 vials of antivenin was given to 61 per cent of admitted patients with 93 per cent receiving the drug within 6 hours. Minor reactions to antivenin occurred in three patients (11%). Two patients required surgery (5%), and the readmission rate was 7 per cent. There was no known morbidity or mortality. When comparing patients who received antivenin with patients who did not, the only significant clinical variables were an increased prothrombin time (12.1 vs 11.7, respectively; P = 0.048) and a longer length of hospital stay (3 vs 1.8 days, P = 0.0006) in patients receiving antivenin. The majority of patients with snake bites can be treated with supportive care and antivenin when indicated. Antivenin use at our institution is largely based on physical findings and not related to laboratory values.

Clinical characteristics of melanoma in an ethnically diverse population of adolescents and young adults.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21043-e21043
Author(s):  
Kimberly Ann Miller ◽  
Anthony Pham ◽  
Jacob Stephen Thomas ◽  
Myles G Cockburn ◽  
David Robert Freyer ◽  
...  
Keyword(s):  
Young Adults ◽  
Los Angeles ◽  
Clinical Characteristics ◽  
Ethnically Diverse ◽  
Adolescents And Young Adults ◽  
P Value ◽  
Diverse Population ◽  
Acral Lentiginous Melanoma ◽  
Significant Difference ◽  
Melanoma Patients

e21043 Background: Melanoma is the third most common cancer among adolescents and young adults (AYAs; aged 15-39). Disease characteristics have not been well-described in this age group, particularly among diverse populations. We describe clinical features of AYAs diagnosed with melanoma at a large public hospital serving an ethnically diverse population. Methods: We reviewed medical chart data from patients diagnosed with melanoma between 2001-2016 at Los Angeles County + USC Medical Center. We describe clinical characteristics of AYA patients and compare to non-AYAs (aged ≥40) using Fisher’s exact test. A p-value < 0.05 was considered statistically significant. Results: Of the 273 melanoma patients identified, 47 (17.3%) were AYAs (mean age 32.3; SD±4.45; lower age range 18). The majority of patients were Hispanic (AYA, 53.2%; non-AYA, 51.1%), followed by non-Hispanic whites (AYA, 38.3%; non-AYA, 38.7%). A greater proportion of AYA patients were female (59.6%) compared to non-AYAs (38.2%) (p < 0.01). No AYA patients reported prior skin cancer compared to 19.9% of non-AYAs; 8.5% of AYAs reported family history of melanoma compared to 6.3% of non-AYAs. For all patients, superficial spreading melanoma was the most common histological subtype (AYA, 21.3%; non-AYA, 20.9%). Nodular melanoma was the second most common subtype in AYAs (17.02%) in contrast to acral lentiginous melanoma among non-AYAs (20.9%). Median Breslow depth was 3.0 mm for AYAs and 2.55 mm among non-AYAs. A slightly higher percentage of AYAs were diagnosed with regional disease (31.9%) than non-AYAs (24.4%), and a greater proportion of non-AYAs presented with distant metastases (AYA, 6.4%; non-AYA, 18.7%). The most common site of diagnosis were the extremities for all patients (AYA, 45.0%; non-AYA, 29.3%). Conclusions: We found similar clinical characteristics between AYA and non-AYA melanoma patients. However, we found a statistically significant difference for gender. The increased incidence of melanoma in female AYAs may be driven by biological factors such as sex hormones or genotype, or tanning behaviors. Further research is warranted to identify predictive and prognostic factors of melanoma among diverse AYAs, particularly females.

scholarly journals THER-10. IMPACT OF BRAF MUTATIONAL STATUS ON THE EFFICACY OF IMMUNOTHERAPY FOR MELANOMA BRAIN METASTASES

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i12-i13
Author(s):  
Adam Lauko ◽  
Soumya Sagar ◽  
Addison Barnett ◽  
Wei Wei ◽  
Samuel Chao ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Tertiary Care ◽  
Rank Test ◽  
P Value ◽  
Wild Type ◽  
Braf Mutations ◽  
Mutational Status ◽  
Melanoma Brain Metastases ◽  
Melanoma Patients ◽  
Braf Mutant

Abstract BACKGROUND: BRAF mutations occur in 50% of melanoma patients. Targeted agents – BRAF and MEK inhibitors and immunotherapy improve survival of melanoma patients with BRAF mutations. These agents have intracranial efficacy as shown in clinical trials. However, the efficacy of immunotherapies (immune checkpoint blockade) in melanoma brain metastases and the correlation with BRAF status is not as well characterized. METHODS: We reviewed 351 patients with melanoma brain metastases treated at our tertiary care center between 2000 and 2018, 75 of which received immunotherapy with known BRAF mutational status. Two-year, 5-year, and median overall survival (OS) was calculated from the start of immunotherapy to compare the efficacy of immunotherapy in BRAF mutant and BRAF wild type patients using the log-rank test. RESULTS: At the time of diagnosis of brain metastasis, the median age was 61 (23–87) years, median KPS was 80 (50–100), number of intracranial lesions was 2 (1–15), and 79% had extra-cranial metastases. Sixty-three patients were treated with stereotactic radiosurgery (SRS), 27 underwent whole brain radiation (WBRT) and 21 underwent surgery. When treated with immunotherapy, BRAF mutant and BRAF wild type median survival was 15.7 months (95% CI=9.4 – 42.4) and 6.9 (95% CI=4.1– 26.7) months (p-value=0.205), respectively. Two-year BRAF mutant and BRAF wild type survival was 35% (95% CI=21 – 58) and 28% (95% CI=16 – 51), and 5-year survival was 22% (95% CI=10 – 46) and 23% (95% CI=11 – 47), respectively. CONCLUSIONS: Twenty percent of patients with BRAF mutant and BRAF wild-type patients treated with immunotherapy derive a long-term benefit from immunotherapy and multimodality treatment and are alive 5 years from diagnosis of brain metastases. This was rarely seen in the pre-immunotherapy era in melanoma brain metastases. There was no difference in outcome based on the BRAF mutational status with use of immunotherapy in melanoma brain metastases.

Evaluating end-of-life (EOL) care at the University of Rochester Medical Center (URMC) using quality oncology practice initiative (QOPI) metrics.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 12-12
Author(s):  
Titas Banerjee ◽  
Jason Harold Mendler ◽  
Nabeel Badri ◽  
Dwight Hettler ◽  
Julie Ann Berkhof ◽  
...  
Keyword(s):  
End Of Life ◽  
Medical Center ◽  
Statistical Significance ◽  
Inpatient Mortality ◽  
Exact Test ◽  
Number Of Patients ◽  
Advanced Malignancies ◽  
Oncology Practice ◽  
The University ◽  
Eol Care

12 Background: Inpatient mortality, defined as death within 30 days of an acute hospital admission, is often used as a quality benchmark for healthcare institutions and is an important metric for evaluating quality of care of patients with advanced malignancies. In this study we aimed to utilize QOPI performance data to identify areas of weakness in our practice that may contribute to inpatient mortality. Methods: We analyzed 11 EOL measures within the QOPI database which we collected between 2015 and 2018. These included all EOL measures related to hospice enrollment (measure IDs 42-47), chemotherapy administered within the last 2 weeks of life (ID 48), percentage of patients who died from cancer with at least one emergency department (ED) visit in the last 30 days of life (ID 49ed), and the percentage of patients who died from cancer admitted to the Intensive Care Unit (ICU) in the last 30 days of life (ID 49icu). Our rate was calculated for each measure and compared against QOPI aggregate data. We used a fisher’s exact test to determine statistical significance for each metric. Results: The number of patients from our institution included in each analysis ranged from 27 to 46. Compared to our peers, patients treated at our institution were more likely to visit an ED in the last 30 days of life (68% vs. 32%; P < 0.0001), more likely to be admitted to the ICU in the last 30 days of life (29% vs. 9%; P = 0.0003), and more likely to be enrolled on hospice within the last 7 days of death (63% vs. 32%; P = 0.001). Conclusions: Analysis of QOPI EOL performance scores identified several metrics that may contribute to inpatient mortality at URMC. Ongoing participation in QOPI with a focus on EOL metrics will strengthen this analysis. We plan to use this data to guide quality improvement initiatives aimed at reducing impatient mortality and improving end of life care at our institution.

scholarly journals Chance to cut: defining a negative exploration rate in patients with suspected necrotizing soft tissue infection

2019 ◽  
Vol 4 (1) ◽  
pp. e000264 ◽  
Author(s):  
Erin C Howell ◽  
Jessica A Keeley ◽  
Amy H Kaji ◽  
Molly R Deane ◽  
Dennis Y Kim ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Medical Center ◽  
Disease Process ◽  
P Value ◽  
Small Subset ◽  
Initial Operation ◽  
Level Of Evidence ◽  
Exact Test ◽  
Surgical Exploration ◽  
Cell Counts

BackgroundNecrotizing soft tissue infections (NSTI) are aggressive infections associated with significant morbidity and mortality. Despite multiple predictive models for the identification of NSTI, a subset of patients will not have an NSTI at the time of surgical exploration. We hypothesized there is a subset of patients without NSTI who are clinically indistinguishable from those with NSTI. We aimed to characterize the differences between NSTI and non-NSTI patients and describe a negative exploration rate for this disease process.MethodsWe conducted a retrospective review of adult patients undergoing surgical exploration for suspected NSTI at our county-funded, academic-affiliated medical center between 2008 and 2015. Patients were identified as having NSTI or not (non-NSTI) based on surgical findings at the initial operation. Pathology reports were reviewed to confirm diagnosis. The NSTI and non-NSTI patients were compared using χ2test, Fisher’s exact test, and Wilcoxon rank-sum test as appropriate. A p value <0.05 was considered significant.ResultsOf 295 patients undergoing operation for suspected NSTI, 232 (79%) were diagnosed with NSTI at the initial operation and 63 (21%) were not. Of these 63 patients, 5 (7.9%) had an abscess and 58 (92%) had cellulitis resulting in a total of 237 patients (80%) with a surgical disease process. Patients with NSTI had higher white cell counts (18.5 vs. 14.9 k/mm3, p=0.02) and glucose levels (244 vs. 114 mg/dL, p<0.0001), but lower sodium values (130 vs. 134 mmol/L, p≤0.0001) and less violaceous skin changes (9.2% vs. 23.8%, p=0.004). Eight patients (14%) initially diagnosed with cellulitis had an NSTI diagnosed on return to the operating room for failure to improve.ConclusionsClinical differences between NSTI and non-NSTI patients are subtle. We found a 20% negative exploration rate for suspected NSTI. Close postoperative attention to this cohort is warranted as a small subset may progress.Level of evidenceRetrospective cohort study, level III.

Massive Transfusion Protocols: Indications, Ratios and Mortality in the Non-Trauma Setting

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2348-2348 ◽  
Author(s):  
Robert A. DeSimone ◽  
Cheryl A. Goss ◽  
Yen-Michael S. Hsu ◽  
Thorsten Haas ◽  
Melissa M. Cushing
Keyword(s):  
Blood Product ◽  
Massive Transfusion ◽  
Conflicts Of Interest ◽  
Medical Center ◽  
Binary Logistic Regression ◽  
Blood Bank ◽  
P Value ◽  
Trauma Patients ◽  
Number Of Patients ◽  
Significant Difference

Abstract Background: Many institutions have implemented massive transfusion protocols (MTPs) to prevent hemodilution and to restore normal coagulation function, with the ultimate goal of controlling hemorrhage and reducing complications. Our institution issues two different MTPs: trauma (T-) and non-trauma (NT-). T-MTPs have a 1:1 ratio for red blood cell (RBC):plasma issued by the blood bank, whereas NT-MTPs have a 1.8:1 ratio. Appropriate blood product ratios, indications and patient outcomes in the NT-MTP setting are not well studied. To determine how various MTP parameters impact 24-hour patient mortality, we retrospectively reviewed MTP activations at our large academic urban medical center. Methods: All activated MTPs over a 3-year period (2012-2014) were reviewed. Data was collected from blood bank quality assurance and inpatient electronic medical records. NT-MTPs were sub-classified into indication by type of hemorrhage. All statistical analyses (binary logistic regression, Kruskal-Wallis) were performed using STATA version 11. A p value of <0.05 was considered significant. Results: From 2012-2014, there were 177 MTP activations for 167 patients, of which 98 were male (59%) and 69 were female (41%). The average age of all patients was 56 years, with a range of 7 months to 95 years. Trauma patients (mean age 40 years) tended to be younger than non-trauma patients (mean age 60 years). Refer to Table 1 for types of hemorrhage and ratios of blood products transfused. Thirty-eight patients (22.8%) died within 24 hours of MTP activation, including 10 (30.3%) of the trauma patients and 28 (21.7%) of the non-trauma patients (Figure 1). Mortality did not vary significantly by type of hemorrhage or by ratio of RBC:plasma transfused, including patients receiving no plasma. For each additional RBC unit transfused, patients had a higher chance of dying (odds ratio [OR] 1.17; p=0.002, confidence interval 1.1-1.3) within 24 hours, after controlling for number of platelet, plasma, and cryoprecipitate units received. The overall median RBC:plasma ratio transfused was 1.7 (interquartile range [IQR] 1.3-2); T-MTPs had a median ratio of 1.4 (IQR 1.1-1.9) and NT-MTPs had a median ratio of 1.7 (IQR 1.3-2.1). There was no significant difference in RBC:plasma ratios clinicians transfused for different types of hemorrhage, despite the blood bank issuing different ratios to the clinicians for T-MTPs and NT-MTPs. The total number of RBCs, platelet units, and plasma units transfused did not differ by type of hemorrhage. In all MTPs, transfusion of platelets did not have a significant impact on 24-hour survival. Conclusions: We found that only the number of RBC units transfused had a significant association (OR 1.17) with 24-hour mortality during an MTP. The RBC:plasma ratio, number of platelets or plasma, and use of platelets during an MTP did not affect 24-hour mortality. The number of RBC units transfused most likely reflects the clinician's assessment of the severity of the situation, and does not imply that the RBCs affected the 24-hour mortality. We found the ratio of products issued during an MTP was not what was actually transfused to patients, indicating that clinicians were not transfusing according to protocol. Specifically, for NT-MTPs overall, the RBC:plasma ratio transfused was lower than what the blood bank issued, indicating clinicians are choosing to infuse more plasma despite a lack of evidence in the non-trauma setting. Prospective randomized trials comparing different RBC:plasma:platelet ratios in NT-MTPs are warranted. Table 1. Blood Product Ratios Transfused by Type of Hemorrhage Type of Hemorrhage Number of Patients (%) RBC:Plasma - Median (IQR) RBC:Platelets - Median (IQR) Overall 167 (100%) 1.7 (1.3-2) 5 (4-7) Trauma 33 (20%) 1.4 (1.1-1.9) 5.5 (3.7-8.4) Postoperative 50 (30%) 1.6 (1.3-1.8) 5 (3.5-6) Gastrointestinal 29 (17%) 2 (1.7-2) 5 (4-7) Intraoperative 20 (12%) 1.6 (1.3-2.7) 6.2 (3.3-7.5) Abdominal 11 (7%) 2 (1.3-3.3) 6 (4-7) Vascular 9 (5%) 1.3 (1-2) 5 (2-5) Obstetrical 8 (5%) 2.2 (2-2.3) 5 (4-7) Central Nervous System 4 (2%) 1.8 (1.2-4) 4.2 (4-4.3) Pulmonary 2 (1%) 2 2 Superficial Soft Tissue 1 (0.5%) 1 N/A Figure 1. 24-Hour Mortality by Type of Hemorrhage Figure 1. 24-Hour Mortality by Type of Hemorrhage Disclosures No relevant conflicts of interest to declare.

Analysis of age, tumor-sidedness, and mismatch repair (MMR) genes with response to immune checkpoint inhibitors (ICIs) in MMR-deficient (dMMR) colorectal cancer (CRC) patients (pts): A multi-institutional study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15029-e15029
Author(s):  
Ibrahim Halil Sahin ◽  
Wanqi Chen ◽  
Mohamad Bassam Sonbol ◽  
Satya Das ◽  
Zhengjia Chen ◽  
...  
Keyword(s):  
Checkpoint Inhibitors ◽  
Medical Center ◽  
Braf Mutations ◽  
Exact Test ◽  
Mmr Genes ◽  
Cox Proportional Hazard ◽  
Predictors Of Response ◽  
Best Response ◽  
Emory University ◽  
The Impact

e15029 Background: ICIs induce durable responses in dMMR CRC pts with overall response rates (ORR) of 30-50%. Even though the loss of expression of any MMR gene predicts ICIs response, it is unknown if ORRs are similar across all MMR genes (MLH1, PMS2, MSH2, and MSH6). In this study, we analyzed the impact of each specific MMR gene loss and clinical characteristics of pts with best response to ICIs. Methods: Pts were eligible if they had confirmed dMMR CRC by IHC or microsatellite instability-high (MSI-H) by PCR, and received ICIs between 01/01/2012 and 10/01/2018 at Winship Cancer Institute of Emory University, Mayo Clinic or Vanderbilt University Medical Center. Due to the pattern of frequent concurrent loss and functional dependency, the groups were categorized as MLH1 ±PMS2 vs. MSH2 ±MSH6. Cox proportional hazard model and Fisher’s exact test were used for the best response and the distribution of variable among the subgroups. Results: A total of 45 pts with dMMR CRC were identified. ORRs in MLH1 ±PMS2 and MSH2 ±MSH6 groups were 68% and 57.1% respectively without statistical difference (Table). Pts with age < 50 and 50-65 years old had better ORRs compared to pts with age >65 (58.3%, 85.7% and 42.1% respectively, P=0.036). Left-sided tumors had a trend toward higher ORRs compared to right-sided tumors (83.3% vs 51.5% P=0.086). Gender and BRAF status were not predictors of response. BRAF mutations were more common in right-sided tumors (29.6% vs 11.1% respectively) and in older patients. Conclusions: Our data suggest that MSI-H CRC pts aged 50-65 treated with ICIs, have improved ORR compared to pts > 65; pts with left-sided tumors have a trend toward improved ORR compared to those with right sided tumors. [Table: see text]

Toxicology test-ordering patterns in a large urban general hospital during five years: an update.

1978 ◽  
Vol 24 (3) ◽  
pp. 507-511 ◽  
Author(s):  
C B Walberg ◽  
V A Pantlik ◽  
G D Lundberg
Keyword(s):  
Los Angeles ◽  
Medical Center ◽  
Analytical Data ◽  
Clinical Toxicology ◽  
Similar Data ◽  
University Of Southern California ◽  
Urban Hospital ◽  
Number Of Patients ◽  
Clinically Significant ◽  
Test Ordering

Abstract Analytical data from the clinical toxicology laboratory of a large urban hospital, the Los Angeles County--University of Southern California Medical Center, are reported for the year 1976 and are compared to similar data previously documented for the year 1972. Drugs assayed, number of tests requested, and number of positive results are collated. Data on 58 assays show that the overwhelming majority of the requests continue to be for those tests that were originally classified as tests with 4-h turn-around time in the patient-focused concept for a clinical toxicology service in 1972. Total workload increased by 70%. The number of patients on whom some toxicologic assay was requested doubled in spite of a decrease in the number of patients admitted to the hospital during this five-year period. The data show that assays for some socially and clinically significant drugs--ethanol diazepam, tricyclics, and phencyclidine--increased disproportionally while others remained relatively constant, or even decreased.

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