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AbstractBackground and AimThe impact of the Coronavirus disease‐2019 (COVID‐19) pandemic on patients with liver disease is not well described at the population level in the United States. We used the largest, nationwide inpatient dataset to describe inpatient liver disease outcomes in the United States during the first year of the pandemic (2020) using 2018 and 2019 as comparator years.MethodsUsing the National Inpatient Sample (2018–2020), we explored year‐to‐year and 2020 month‐to‐month trends in hospitalizations, length of stay, and inpatient mortality for liver‐related complications including cirrhosis, alcohol‐associated liver disease (ALD) and alcoholic hepatitis using regression modeling. We reported relative change (RC) in the study period.ResultsDecompensated cirrhosis hospitalizations decreased in 2020 compared with 2019 (RC: −2.7%, P < 0.001) while all‐cause mortality increased by 15.5% (P < 0.001). Hospitalizations for ALD increased compared with pre‐pandemic years (RC: 9.2%, P < 0.001) with a corresponding increase in mortality in 2020 (RC 25.2%, P = 0.002). We observed an increase in liver transplant surgery mortality during the peak months of the pandemic. Importantly, mortality from COVID‐19 was higher among patients with decompensated cirrhosis (adjusted odds ratio [OR] 1.72, 95% confidence interval [CI] [1.53–1.94]), Native Americans (OR 1.76, 95% CI [1.53–2.02]), and patients from lower socioeconomic groups.ConclusionsCirrhosis hospitalizations decreased in 2020 compared with pre‐pandemic years but were associated with higher all‐cause mortality rates particularly in the peak months of the COVID‐19 pandemic. In‐hospital COVID‐19 mortality was higher among Native Americans, patients with decompensated cirrhosis, chronic illnesses, and those from lower socioeconomic groups.

Abstract Background The impact of the Coronavirus disease-2019 (COVID-19) pandemic on patients with liver disease is not well described at the population level in the United States. Purpose We used the largest, nationwide inpatient dataset to describe inpatient liver disease outcomes in the United States during the first year of the pandemic (2020) using 2018 and 2019 as comparator years. Method Using the National Inpatient Sample (2018-2020), we explored year-to-year and 2020 month-to-month trends in hospitalizations, length of stay, and inpatient mortality for liver-related indications including compensated cirrhosis, decompensated cirrhosis, alcohol-associated liver disease (ALD), alcohol-associated hepatitis (AH), hepatocellular carcinoma (HCC), and variceal upper gastrointestinal bleeding (VUGIB) using regression modeling. We also looked at the impact of the COVID-19 pandemic on liver transplantation rates. A p-value &lt;0.05 was considered statistically significant. Result(s) Hospitalizations for both compensated and decompensated cirrhosis decreased in 2020 compared to 2019 (relative change [RC] of 1.5%, p &lt;0.001, Table 1). Interestingly, hospitalizations for ALD and AH increased in 2020 compared to pre-pandemic years (ALD RC=15.5% and AH RC 17.0%; p&lt;0.001). Despite the decrease in cirrhosis hospitalizations in 2020, all-cause inpatient mortality among patients with compensated cirrhosis increased from 30,135 in 2019 to 35,220 in 2020 (p&lt;0.001) and from 22,850 in 2019 to 26,390 in 2020 among patients with decompensated cirrhosis (p&lt;0.001). This was accompanied by a 27.8% increase in mortality for ALD (p=0.004) in comparison to pre-pandemic years. Corresponding to the peaks of the pandemic, we observed the fewest cirrhosis hospitalizations in April and December 2020 (Table 2), however, these months had the highest observed mortality rates (p-trend ≤ 0.004). Reassuringly, liver transplantation rates were not significantly impacted by the COVID-19 pandemic (p=0.51). Image Conclusion(s) Cirrhosis hospitalizations, in general, decreased in 2020 compared to pre-pandemic years but were associated with higher all-cause mortality rates particularly in the peak months of the COVID-19 pandemic (April and December 2020) possibly reflecting COVID-19 specific mortality. Alcoholic liver disease admissions also increased during the pandemic while liver transplantation rates were not significant impacted. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Introduction: Carotid revascularization is known to prevent stroke in patients with high-grade carotid stenosis, but whether carotid revascularization may slow the progression of hemispheric WMD in patients with carotid stenosis to prevent cognitive decline have not been well described. Methods: We conducted a longitudinal study involving patients age ≥40 years with carotid stenosis on ultrasound from 2011-2015 with serial brain MRI scans at least 1 year apart followed for radiographic and clinical outcomes to 2020. Severity of carotid stenosis was defined as moderate 50-69%, high-grade 70-99%, or occluded. Hemispheric WMD volume was quantified from axial T2 FLAIR images. Patients were stratified by revascularization status. Primary outcome was change in WMD volume per year ipsilateral or contralateral to the index carotid. Hemispheric differences in the annual rate of WMD progression (cc/yr) were compared between revascularized vs not revascularized using multivariable linear regression analysis adjusted for variables that differed between revascularization status. Results: Of the 150 patients, moderate stenosis was present in 37.3%, high-grade stenosis in 42.0%, and carotid occlusion in 20.7%. Mean age was 71±10 years, 36.7% were female. Seventy-three (48.7%) had carotid revascularization with a median follow-up of 5.1 years. Baseline WMD volume was 4.86cc ipsilateral and 4.39cc contralateral to the index carotid. Patients who underwent revascularization trended to have slower WMD progression in the hemisphere ipsilateral to the index carotid compared to those not revascularized (0.32cc/yr vs 0.63 cc/yr, p=0.340). The same trend was not observed in the contralateral hemisphere. In adjusted models, carotid revascularization was associated with a 0.33 cc per year decrease in WMD progression between hemispheres compared to those not revascularized (β= -0.33, p=0.070). Conclusions: In this study with a median follow-up of 5 years, we found that carotid revascularization resulted in a 50% reduction in the annual rate of WMD progression. Intervention trials should test whether carotid revascularization slows WMD progression in patients with cognitive impairment to prevent further cerebrovascular events and cognitive decline.

Abstract: Background: Trends in patch testing for allergic contact dermatitis (ACD) have not been well characterized in Black patients. Despite similar incidence of ACD in Black and White patients, there are differences in allergen profiles. Understanding patch testing trends in Black patients furthers knowledge that has considerable impact on the management of ACD in the Black population. Objective: The purpose of this study was to review the results of patch testing in Black patients at Mayo Clinic over a decade. Methods: We retrospectively reviewed the results of patch testing to the standard, extended standard, or hairdresser series in 149 Black patients seen at Mayo Clinic (Rochester, MN; Scottsdale, AZ; and Jacksonville, FL) from January 1, 2011, to December 31, 2020. Results: During the 10-year period, 149 Black patients (mean age, 49.2 years [SD, 17.1 years]; female 67.1%) were patch tested at Mayo Clinic to the standard, extended standard, or hairdresser series. Most common sites of dermatitis were generalized (30.9%), hands (18.8%), leg (16.8%), trunk (16.1%), and arm (14.8%). Overall, 109 patients (73.2%) had at least 1 positive reaction and 74 patients (50%) had 2 or more positive reactions. Overall, the 10 allergens with the highest reaction rates (from highest to lowest) identified in our study population were 4-amino-2-hyroxytoluene (33.3%), thimerosal (20.4%), nickel sulfate (18.9%), methylisothiazolinone (16.5%), methyldibromo glutaronitrile (13.4%), methyldibromo glutaronitrile/phenoxyethanol (12.5%), captan (12.5%), carmine (12.5%), methylchloroisothiazolinone/methylisothiazolinone (11.5%), and hydroperoxide of linalool 1% (11.3%). Conclusions: We describe patch test results in Black patients over a decade at Mayo Clinic. The top 10 allergens were preservatives, hair dyes, and fragrances. Differing patterns of allergens may occur in Black patients due to different patterns of exposures related to cultural practices.

Abstract Durable objective response rate (ORR) remains a meaningful endpoint in recurrent cancer; however, the target ORR for single-arm recurrent glioblastoma trials has not been based on historic information or tied to patient outcomes. The current study reviewed 68 treatment arms comprising 4793 patients in past trials in recurrent glioblastoma in order to judiciously define target ORRs for use in recurrent glioblastoma trials. ORR was estimated at 6.1% [95% CI 4.23; 8.76%] for cytotoxic chemothera + pies (ORR = 7.59% for lomustine, 7.57% for temozolomide, 0.64% for irinotecan, and 5.32% for other agents), 3.37% for biologic agents, 7.97% for (select) immunotherapies, and 26.8% for anti-angiogenic agents. ORRs were significantly correlated with median overall survival (mOS) across chemotherapy (R2= 0.4078, P &lt; .0001), biologics (R2= 0.4003, P = .0003), and immunotherapy trials (R2= 0.8994, P &lt; .0001), but not anti-angiogenic agents (R2= 0, P = .8937). Pooling data from chemotherapy, biologics, and immunotherapy trials, a meta-analysis indicated a strong correlation between ORR and mOS (R2= 0.3900, P &lt; .0001; mOS [weeks] = 1.4xORR + 24.8). Assuming an ineffective cytotoxic (control) therapy has ORR = 7.6%, the average ORR for lomustine and temozolomide trials, a sample size of ≥40 patients with target ORR&gt;25% is needed to demonstrate statistical significance compared to control with a high level of confidence (P &lt; .01) and adequate power (&gt;80%). Given this historic data and potential biases in patient selection, we recommend that well-controlled, single-arm phase II studies in recurrent glioblastoma should have a target ORR &gt;25% (which translates to a median OS of approximately 15 months) and a sample size of ≥40 patients, in order to convincingly demonstrate antitumor activity. Crucially, this response needs to have sufficient durability, which was not addressed in the current study.

Objectives: The diagnosis of lymphoma on cytologic preparations and core needle biopsies (CNBs) is often challenging due to limited material that precludes additional ancillary testing for accurate classification. We describe our institutional experience with patients who ultimately received a diagnosis of lymphoma using cytologic preparations and CNB material along with additional ancillary testing. Material and Methods: All patients whose cytology material (fluids, cytologic smears, and cell block) and CNB resulted in a diagnosis of lymphoma, atypical lymphoid population, or suspicious for lymphoma were retrieved. Diagnoses of lymphoma followed the established nomenclatures of the World Health Organization (WHO). For all cases, the ancillary test profiles were captured and summarized. Results: Of 389 cases identified, 17 (4.4%) were diagnosed as atypical lymphoid cells and 31 (7.9%) were suspicious for lymphoma resulting in an indeterminate rate of 12.3%. The rest of the malignant cases (341; 87.7%) were classified using 2017 WHO lymphoid classification system. Six low-grade and 26 high-grade B-cell lymphomas were not further classified because of limited tissue. B-cell lymphomas were the largest category (73.0%): Primarily diffuse large B-cell lymphoma (21.4%), followed by follicular lymphoma (17.5%) and chronic lymphocytic leukemia/small lymphocytic lymphoma (10.9%). A total of 140 cases (36.0%) had flow cytometry results, but 30 specimens (21.4%) were insufficient. Cytogenetic and molecular studies were performed for 78 cases (20.0%). Conclusion: Full classification of lymphomas is possible with combined cytologic preparations and CNB material and it is an attractive first sampling modality in the diagnostic process for this disease group.

Thyroid cancers exist in multiple forms. Papillary and follicular carcinomas of the thyroid are often referred to as well-differentiated thyroid cancers. Well-differentiated thyroid cancers rarely present as a distant metastatic cancer on initial diagnosis. Papillary thyroid cancer tends to have a good prognosis; however, if distant metastasis of PTC is present, there is usually a poor clinical outcome with a less favorable prognosis. In this study, we report a 90-year-old female who presented with right-sided abdominal discomfort. A renal ultrasound revealed bilateral upper pole renal masses. A percutaneous biopsy was ordered, and the microscopic examination revealed bilateral renal metastasis with a follicular variant of papillary thyroid carcinoma. The patient underwent thyroidectomy and sustained radiation therapy for her bilateral renal metastases. She died 6 years after her initial diagnosis, due to sepsis. This is the second study in literature to report bilateral renal metastasis of follicular variant of papillary thyroid cancer.

Abstract Durable overall response rate (ORR) remains a meaningful endpoint in recurrent GBM; however, the target ORR for single arm recurrent GBM trials has not been based on historic information or tied to patient outcomes. The current study reviewed past trials in recurrent GBM in order to judiciously define target ORRs for use in recurrent GBM trials. After reviewing 69 treatment arms comprising 4,971 patients, ORR was 6.1%[95% CI 4.23; 8.76%] for cytotoxic chemotherapies (ORR=7.59% for CCNU, 7.57% for TMZ, 0.64% for CPT-11, and 5.32% for other agents), 3.37% for biologic agents, 7.97% for immunotherapies (select trials), and 26.8% for anti-angiogenic agents. ORRs were significantly correlated with median overall survival (mOS) across chemotherapy (R2=0.4078, P&lt; 0.0001), biologics (R2=0.4003, P=0.0003), and immunotherapy trials (R2=0.8994, P&lt; 0.0001), but not anti-angiogenic agents (R2=0, P=0.8937). Pooling data from chemotherapy, biologics, and immunotherapy trials, a meta-analysis indicated a strong correlation between ORR and mOS (R2=0.3164, P&lt; 0.0001; mOS[weeks]=0.6xORR+28.9), suggesting an ORR &gt;20% results in an mOS of &gt; 40.9 weeks, which is double the survival estimate of a treatment with ORR=0% and ≥ 2 months longer than treatments with ORR=5%. Assuming an ineffective therapy (control) has ORR=5%, a trial of 32 patients with a target ORR=20% leads to the 95% confidence interval higher than the control group. We conclude that single arm phase II studies in recurrent GBM with ≥ 32 patients should have a target ORR ≥ 20%. This was associated with a median OS of approximately 1 year. Importantly, durability of response should also be considered and was not assessed in the current meta-analysis.

A healthy 23-year-old female developed generalized pruritus over a year that began on her feet and gradually progressed to involve more than 50% of her entire body surface area. Punch skin biopsies were inconclusive, whereas a two-view chest x-ray was suspicious for lymphadenopathy. A chest computed tomography scan with contrast identified an anterior mediastinal mass which was biopsied and diagnosed as a nodular sclerosis type of Hodgkin’s lymphoma. Subsequently, appropriate therapy was initiated resulting in complete resolution of the patient’s chronic itch. This case underscores the clinical significance of a comprehensive systemic evaluation in chronic pruritus of unclear etiology.

Importance Individuals with allergic contact dermatitis to one topical corticosteroid may also react to other corticosteroids. Corticosteroid classification models have been proposed to predict such copositivity, recommend representative screening corticosteroids, and guide allergen avoidance. Objective To use patient data to determine copositivity patterns between corticosteroids and evaluate against previous corticosteroid classification models. Design, Setting, and Participants This qualitative study included a retrospective analysis of the Mayo Clinic Contact Dermatitis Group corticosteroid patch test data from 2010 to 2019. Among patients undergoing patch testing with the Mayo Clinic’s standard or steroid series who consented to research participation, 5637 patients were included in the analysis. Copositivity rates were determined between corticosteroids and analyzed by hierarchical clustering for comparison to previous classification models. Main Outcomes and Measures The frequency of patch test positivity to each of the analyzed corticosteroids was noted and compared with previously published patch test positivity rates. Copositivity rates between each pair of corticosteroids were determined, and overall copositivity patterns were analyzed and evaluated against known steroid classes. Results A total of 49 472 individual patches were applied to 5637 patients, testing 18 corticosteroids. Patch test positivity rates ranged between 0.3% and 4.7%. The fluocinonide positivity rate corresponded to the highest copositivity rate with other corticosteroids (mean [SD], 50.7% [26.1%]). Tixocortol-21-pivalate, 0.1%, and tixocortol-21-pivalate, 1%, positivity rates corresponded to the lowest copositivity rates (mean [SD], 4.1% [1.7%] and 3.6% [1.4%], respectively). Hierarchical clustering elucidated patterns that did not support previous corticosteroid classification models. Conclusions and Relevance In this qualitative study, copositivity rates were variable between corticosteroids, and overall patch test positivity for allergy to topical corticosteroids was rare. Previously published corticosteroid classifications are not supported by real patient-derived data and may not be accurate in predicting corticosteroid copositivity.