Citations

Abstract Purpose Gastric cancer is a leading cause of mortality worldwide, with pronounced variations in outcomes across populations. This study investigates U.S. trends in age-adjusted mortality rates (AAMRs) for gastric cancer from 1999 to 2023, examining differences by sex, race, region, and urbanization to uncover critical patterns and inequities. Methods Data were extracted from the CDC WONDER database using ICD-10 code C16 to identify gastric cancer-related deaths in adults aged 25 and older. AAMRs per 1,000,000 population were calculated and stratified by year, sex, race/ethnicity, geographic region, and urban-rural classification. Trends were analyzed using Joinpoint regression to determine annual percentage changes (APC) and 95% confidence intervals (CI). Statistical significance was set at p < 0.05. Results From 1999 to 2023, there were 312,300 gastric cancer deaths (185,391 men, 126,909 women). Overall, AAMRs declined consistently, with APCs of -3.4 for the period 1999 to 2007, -2.2 for 2007 to 2018, and − 1.2 for 2018 to 2023. Men showed a more pronounced decline, with APCs of -3.6 for 1999 to 2009 and − 2.2 for 2009 to 2023, compared to women, who had APCs of -3.1 for 1999 to 2008, -1.9 for 2008 to 2018, and − 0.8 for 2018 to 2023. Non-Hispanic Black populations experienced a decline in AAMR with an APC of -3.3 for 1999 to 2020, while Hispanic/Latino and Asian/Pacific Islander populations showed declines with APCs of -2.8 for 1999 to 2011 and − 3.8 for 1999 to 2020, respectively. Metropolitan areas saw AAMR reductions with APCs of -3.3 for 1999 to 2008 and − 2.2 for 2008 to 2020, while non-metropolitan areas had larger initial declines with an APC of -3.6 for 1999 to 2006 but slower decreases with an APC of -2.0 for 2006 to 2020. Geographically, the Northeast had the highest AAMR (62.9), followed by the West (61.7), South (57.4), and Midwest (50.9). Hawaii recorded the highest state-level AAMR (96.5), while Wyoming had the lowest (36.6). States in the top 90th percentile included Alaska, California, and New York, whereas Utah, Idaho, and Iowa were among the lowest. Conclusion Gastric cancer mortality in the U.S. has declined over the past two decades, but the pace of reduction has slowed in recent years. Significant disparities persist across sex, racial, and geographic groups, underscoring the need for targeted interventions to address these inequities and improve outcomes in vulnerable populations.

Abstract Amiodarone is a commonly used class III antiarrhythmic medication with a rare but well-known adverse effect of pulmonary toxicity. This case illustrates the importance of knowing the risk factors for the development of amiodarone-related lung toxicity, particularly in patients with pre-existing lung disease. Additionally, intensivists must remain mindful of non-infectious causes of ARDS, including acute medication-related lung toxicity. A 73-year-old man was admitted to the Medical Intensive Care Unit (MICU) for worsening hypoxic respiratory failure and progressive pulmonary infiltrates. He has a past medical history of vocal cord malignancy, lung cancer s/p left upper lobe lobectomy and had a left mainstem bronchus stent placed a month prior to presentation. Three weeks before coming to our ICU, the patient was being treated in the outpatient setting for pneumonia post stent placement and was started on rate controlling agents for newly diagnosed atrial fibrillation with rapid ventricular rate. He was ultimately loaded with amiodarone and switched to maintenance for rhythm control. During his stay in the MICU, he underwent a bronchoscopy with bronchoalveolar lavage (BAL), ECHO and repeat CT chest imaging to further investigate his hypoxemia. He was empirically being treated with vancomycin and meropenem. His chest CT compared to one month prior had developed diffuse ground glass opacities and his BAL was limited and unrevealing. He ultimately had progression of disease and was transitioned to comfort care. Amiodarone lung toxicity is a diagnosis of exclusion and presents as interstitial lung disease. A lung biopsy with histopathology is the gold standard for diagnosis and would show foamy laden macrophages. BAL findings include elevated cellular count with 50% of the cases showing eosinophilia. Amiodarone can have an acute, subacute and chronic presentation, with acute being the more aggressive subtype. A double-blind controlled study concluded that the incidence of severe lung fibrosis was 1.2% in doses ranging from 300-800mg compared to &lt; 200mg daily [1] Another retrospective study in Japan found that there is an association with higher incidence of amiodarone induced lung toxicity in age greater than 60. [2] This case highlights a patient presenting with worsening hypoxic respiratory failure, and CT changes, shortly after receiving a second loading dose of amiodarone for atrial fibrillation. He continued to decompensate despite being on appropriate antibiotics and lack of improvement with diuretics. His chest CT was revealing new bilateral ground glass opacities with restrictive physiology on ventilator mechanics, and other causes were ruled out.

Abstract Introduction:AFOP is a pattern of lung injury with intra-alveolar fibrin balls and organizing pneumonia. In 2013, the ATS/ERS revised their classification of idiopathic-interstitial-pneumonia to include acute-fibrinous-organizing-pneumonia(AFOP) in their rare histologic patterns. Methods: MEDLINE(PubMed), EMBASE, and Cochrane were searched for AFOP-related case reports/case series. Mesh terms used included (“acute fibrinous and organizing pneumonia” OR AFOP OR “acute fibrinous organizing pneumonia” OR (“acute fibrinous” AND “organizing pneumonia”) OR (“acute fibrinous” AND “organizing pneumonia”). A total of 177 patients were synthesized in these 169 articles, 9 of which were case series and the rest individual case reports. A quality review and data extraction was done on Covidence using a JBI checklist.Results:Mean age of 52.2 +/- 17.4 years with 55% of them were males. The associations were; malignancy (16%), smoking (14%), organ transplant (13%), Hypertension (10%), and use of immunosuppressive agents (6%) were frequent risk factors. Cough (73%), shortness of breath (71%), and fever (61%) were found highly frequent symptoms. Predominant radiological findings were multifocal infiltrates/consolidation (50%) and ground glass appearance (39%). Leukocytosis and inflammatory markers were elevated in most cases. Transbronchial/EBUS (32%), open surgical (29%), imaging-guided (22%), and VATS (14%) were common modes of lung biopsy. Treatment is usually steroids (88%) and antibiotics (69%). Death occurred in 23% of the cases, clinical or radiological improvement was achieved in 69%, while only three recurrences were reported. Most cases are either idiopathic or associated with myelodysplastic syndrome as causative factors reported by authors. DiscussionAFOP presents non-specific symptoms and a community-acquired pneumonia-like clinical picture. Treatment included antibiotics, corticosteroids, and other immunosuppressants with variable outcomes. Discontinuation of suspected drug was the sole treatment strategy reported in some cases. Partial lobectomy/lesion resection was a successful treatment in some instances with localized disease.The survival in AFOP was significantly worse than obliterative bronchiolitis (median time to death 101 vs. 294 days; P = 0.02). A statistically non-significant trend towards higher mortality associated with higher body mass index (BMI) and a long interval between symptom onset and diagnosis of AFOP was reported by Kim et al. in a cohort from South Korea. Conclusion:AFOP being a rare histological pattern of acute lung injury, is a relatively new entity that requires a better clinical and radiologic understanding for the clinical challenge it poses. This systematic review will be able to provide answers to clinicians to think in that direction and manage acute lung injury accordingly.

Abstract Background: Rectosigmoid endometriosis (RSE) presents with a diverse array of MRI findings that impact surgical planning. No standardized reporting and data system has been established for RSE. Purpose: We propose a novel MRI scoring system designed to predict the likelihood of muscularis propria (MP) involvement in RSE, which would, in turn, influence surgical planning. Material and Methods: The records of patients with bowel endometriosis treated surgically from May 2018 to June 2022 were retrieved. Surgery was classified as partial thickness discoid, full thickness discoid, or segmental resection. Each pre-treatment MRI was scored based on the mutual agreement of two abdominal radiologists (reference score). The MRI score was defined as (1) score 0: no evidence of RSE, (2) score 1: minimal tethering involving the serosal surface without MP involvement, (3) score 2: intermediate soft tissue thickening involving the rectosigmoid colon with indeterminate MP involvement, or (4) score 3: definite mushroom cap sign or definite MP involvement. In the reader study, two radiologists independently scored each exam. The area under the curve (AUC) was evaluated for predicting the need for segmental or full thickness discoid resection. Results: The cohort consisted of 95 patients (median age: 36 years); 16, 14, 30, and 35 patients had MRI score 0, 1, 2, and 3, respectively. Patients with MRI scores 3 and 2 underwent partial thickness discoid (6% vs 50%), full thickness discoid (6% vs 17%), and segmental resection (89% vs 33%), respectively. All patients with MRI scores 1 or 0 either underwent partial thickness discoid resection or did not undergo rectosigmoid surgery. The AUCs were 92.2%, 84.5% and 93.9% for MRI scores of the reference, reader 1, and 2, respectively. Conclusion: Our MRI scoring system based on suspected depth of bowel invasion showed good diagnostic performance to predict the type of surgical intervention needed. Summary Statement This novel MRI scoring system for rectosigmoid endometriosis is a concise and qualitative scale based on suspected depth of bowel wall invasion to best guide operative planning.

ABSTRACT In 2005, the Paediatric Radiation Oncology Society (PROS), a multi‐professional association to promote radiotherapy for children and young people, was created. Its mission has been to educate those involved in this field, and to improve the standards of radiation oncology care for children, adolescents, and young adults across the globe, not least in less privileged settings where the majority of the world's children, and most with cancer, live. Through regular congresses, and joint meetings with the International Society of Paediatric Oncology (SIOP), PROS has facilitated a focus on this treatment modality, and advocated on behalf of those who might benefit from it.

Background As the population continues to age, the number of adults receiving care for hydrocephalus is expected to increase. Here, we assess trends in the utilization and physician reimbursement for ventriculoperitoneal shunts (VPS), lumboperitoneal shunting (LPS), and endoscopic third ventriculostomy (ETV) for adult hydrocephalus. Methods The Medicare Part B National Summary Data files from 2000 to 2021 were collected, and information was extracted on procedures performed per year, total charges billed, and actual payments. Linear mixed-model regression analyses were conducted to assess the significance of changes in procedural volume and physician reimbursement over time while adjusting for inflation. Results Over the period studied, there was a 26% increase in VPS placement (P = 0.11), 11.34% increase in ETV utilization (P < 0.01), and 43.1% decrease in LPS utilization (P < 0.01). This corresponded to annualized changes of + 4.29% for ETV procedures, −8.78% for LPS, and + 45.8% for VPS. There was a statistically significant difference in the change of rate of number of procedures annually between LPS and VPS (P = 0.04). In both inflation-unadjusted and inflation-adjusted analyses, all procedures experienced an annual decline in reimbursement with inflation-adjusted changes of −11.54%/year for ETV, −4.13% for LPS, and −13.12% for VPS. There was a statistically significant difference in the change of rate of reimbursement between LPS procedures and both ETV (P < 0.01) and VPS (P < 0.01). Conclusion Medicare reimbursement data shows that a commensurate decline in physician reimbursement has accompanied the ongoing rise in adult hydrocephalus procedures.

Objective: There is little existing literature describing the evaluation and treatment of patients referred to surgical subspecialities for recurrent urinary tract infections (rUTIs). We hypothesised female patients referred to urology and urogynaecology for rUTI undergo multiple diagnostic tests and few would undergo surgery. Materials and Methods: This is a retrospective review of female patients referred to urology or urogynaecology at a single institution between 2016 and 2019. Data on demographics, provider speciality, diagnostic tests performed, and surgeries were abstracted. Descriptive statistics were used and a logistic regression was performed to determine the adjusted odds ratio of undergoing a surgery. Results: A total of 990 patients were included with a mean age of 62 and on average underwent 3.7 different testing modalities, including genitourinary (GU) examination (62.3%), urodynamic testing (72.7%), cystoscopy (66.0%), and imaging (70.7%). Urologists more commonly pursued urodynamic testing, cystoscopy, and imaging than urogynaecologists. Ultimately, 21.4% of all patients underwent a surgical procedure. Patients who were seen by urogynaecology, underwent GU examination, urodynamic testing, or cystoscopy had higher likelihoods of eventually undergoing surgery (procedure under anaesthesia). Conclusion: Female rUTI patients referred to urology or urogynaecology undergo considerable evaluation and testing. The majority of patients are ultimately managed medically rather than surgically, indicating continued need for resource stewardship. Level of evidence: Not applicable.

Abstract Introduction: In a multiple myeloma mouse model (MM), we determined that subcutaneous (SC) continuous lenalidomide (Len) delivery demonstrated superior tolerability and efficacy to the active control Len given by daily i.p. over a 28 day cycle. Healthy volunteer studies showed that at a daily dose of 9.6 mg a day (400 mcg/h) the Len AUC0-24 was ∼60% less than that observed with an oral 25 mg Len dose. We hypothesized that this modality could improve Len’s therapeutic index by lowering the hematologic toxicity while maintaining or improving the efficacy. Methods: A phase 1b study in 2nd line or greater relapsed/refractory MM was performed to confirm the animal findings and determine if continuous Len can improve its therapeutic index with no negative impact on the cellular immune system. In brief, an RVd regimen was utilized wherein SC Len 9.6 mg/day was administered with an FDA registered ambulatory pump in a continuous fashion using a 28/28 day cycle. Patients were either trained to operate their pump and change the pre-filled cassettes at home or were managed in the clinic on M-W-F. All patients were seen in the clinic to receive weekly bortezomib 1.3mg/m2 and dexamethasone dosed weekly at 40/20mg, according to age. Patients who received bortezomib in a prior cycle were required to demonstrate sensitivity defined as durability for 6 months after discontinuation of the bortezomib. Results: Between September 2023 and November 2024, 6 relapsed/refractory MM patients were enrolled from 2 US community-based investigational sites in the phase 1b study. Median age was 73, male to female ratio 1/1, Caucasian 100%, and median lines of previous therapy were 2 (range 1-7). Two patients were refractory and 4 were relapsed to their prior treatment. Four patients were previously exposed to Len, one of which was discontinued from a prior regimen because of severe fatigue, and 6 had received prior bortezomib. Patients had received 3-12 cycles of study therapy. No drug-related grade 3/4 hematologic or non-hematologic toxicity occurred within cycle 1. No patients experienced drug-related anemia, neutropenia, leukopenia, or thrombocytopenia greater than grade 2 in up to 12 cycles of therapy. All 6 patients achieved an objective response (CR=1 / PR=5). One patient who achieved a partial response experienced grade 2 skin reaction during cycle 3 and withdrew from the study. Five patients are continuing treatment per protocol with a median PFS of &gt; 10 mo. Len pharmacokinetics produced median steady-state blood levels (Cmax) of 39 ng/mL (range 26-94) (N=6) and were above the minimum target of 25 ng/mL. The Len regimen produced a median AUC0-24 of 921-1h*ng/ml (range 630-1503). Immune profiling did not show significant increases in immune checkpoint expression associated with T-cell exhaustion while CD19+ B cells were significantly depleted. Conclusion: Continuous delivery of low dose Len provides meaningful efficacy and improved tolerability with no grade &gt;3 drug-related hematologic toxicity. Further studies in MM and chronic lymphocytic leukemia are planned. Citation Format: Nash Gabrail, Keith Lerro, Mohamad A. Hussein, Asher A. Chanan-Khan, Jamie C. Oliver. Continuous subcutaneous lenalidomide delivery improves the therapeutic index and avoids drug-related grade 3/4 hematologic toxicity in patients with relapsed/refractory multiple myeloma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_2):Abstract nr LB207.

Background Severe alcohol-associated hepatitis (sAH) is a life-threatening condition with high mortality, where corticosteroid use is the only treatment that has shown short-term benefits. Pentoxifylline, an anti-tumour necrosis factor-alpha agent, has been proposed for its potential to improve outcomes, especially in patients with acute kidney injury (AKI). We aimed to evaluate the impact of pentoxifylline on mortality in patients with sAH and AKI in a well-characterised global cohort. Methods We conducted a retrospective, registry-based study including patients meeting the National Institute on Alcohol Abuse and Alcoholism clinical criteria for sAH and AKI. Mortality was the primary endpoint, with liver transplantation as a competing risk. Statistical analysis included Cox regression and Kaplan-Meier survival estimates. Results We included 525 patients from 20 centres across eight countries. The median age was 48 years, with 26.1% females, and 76.9% had a history of cirrhosis. Multivariable Cox regression models showed that pentoxifylline use was not associated with survival (HR 1.20, 95% CI 0.85 to 1.69, p=0.291). Factors associated with mortality included age (HR 1.23, 95% CI 1.10 to 1.36, p<0.001), Model for End-Stage Liver Disease score at admission (HR 1.06, 95% CI 1.04 to 1.08, p<0.001) and renal replacement therapy use (HR 1.39, 95% CI 1.05 to 1.84, p=0.019). The main causes of death were multiple organ failure (42%), infections (10%), oesophageal varices bleeding (7%) and renal failure (6%). Conclusion Pentoxifylline showed no significant benefit on mortality in patients with sAH and AKI. Further studies are needed to refine treatment strategies for this high-risk group.

Abstract Background We aimed to evaluate the effectiveness and safety of risankizumab (RZB) for Crohn’s disease (CD) in routine clinical practice. Methods We performed a retrospective review of a multicenter consortium of CD patients treated with RZB. Co-primary outcomes were week 12 clinical remission (Harvey Bradshaw Index [HBI] score of ≤4 or physician global assessment in those without HBI or with ileostomy) and 6-month endoscopic remission (Simplified Endoscopic Mucosal Assessment for Crohn’s Disease of 0-1 or absence of ulcers). Secondary outcomes included steroid-free clinical remission, clinical response, radiographic response, cumulative clinical and endoscopic remission rates at 6 and 12 months, and adverse events. Results A total of 309 patients were included (median disease duration 14 years [IQR, 6-24]; median follow-up 7.1 months [IQR, 4.1-10.3]). Most patients (85.8%) were advanced therapy (AT)-exposed, and 169 (54.7%) had prior ustekinumab (UST) exposure. Week 12 clinical remission rates were 49.7% (98/197) overall, and 44.2% (50/113) vs 57.1% (48/84) in UST-exposed vs naïve patients (P = .073). Among those with active disease on baseline endoscopy (n = 122) who had an available follow-up at 6 months, 52.4% (22/42) achieved endoscopic remission. Cumulative rates of clinical and endoscopic remission at 12 months were 65.0% and 49.5%, respectively. Cumulative 12-month endoscopic remission was 33.9% (19/56) in UST-exposed and 68.1% (32/47) in UST-naïve patients (P &lt; .001). Risankizumab was well-tolerated with no new safety signals identified. Conclusions In this large multicenter cohort of patients with CD, RZB was well-tolerated and effective in achieving favorable clinical and endoscopic outcomes in both AT-exposed and naïve populations, including those with exposure to UST.