Citations

INTRODUCTION: The risk of progression to esophageal adenocarcinoma in Barrett's esophagus (BE) increases with advancing degrees of dysplasia. There is a critical need to improve the diagnosis of BE dysplasia, given substantial interobserver variability and overcalls of dysplasia during manual community pathologist reads. We aimed to externally validate a previously cross-validated BE dysplasia diagnosis deep learning model (BEDDLM) that predicts dysplasia grade on whole slide images (WSIs). METHODS: We digitized nondysplastic BE (NDBE), low-grade (LGD), and high-grade dysplasia (HGD) histology slides from 3 external academic centers. A consensus read by 2 expert study pathologists was used as the criterion standard. Slide stain characteristics were normalized using cycle-generative adversarial networks. WSIs were assessed by BEDDLM using an ensemble approach, combining a “You Only Look Once” model followed by a ResNet101 classifier model. RESULTS: We included 489 WSIs. Consensus histopathology revealed 232 NDBE, 117 LGD, and 140 HGD WSIs. The mean age (SD) was 66.9 (11.4) years; 413 (84.7%) were men. Using the BEDDLM ensemble model, sensitivity and specificity for NDBE were 73.3% (95% confidence interval [CI]: 67.09%–78.85%) and 93.4% (95% CI: 89.62%–96.10%); for LGD, 84.6% (95% CI: 76.78%–90.62%) and 80.6% (95% CI: 76.26%–84.54%); and for HGD, 80.7% (95% CI: 73.19%–86.89%) and 94.8% (95% CI: 91.97%–96.91%), respectively. The F1 score was 0.81, 0 0.69, and 0.83 for NDBE, LGD, and HGD, respectively. DISCUSSION: Our externally validated deep learning model demonstrates substantial accuracy for the diagnosis of BE dysplasia grade on WSIs.

Background: Recurrent Clostridioides difficile infection (rCDI) occurs in up to 35% of patients with CDI, and further recurrence is common. Fecal microbiota, live-jslm (RBL) is safe and effective for preventing rCDI in adults following antibiotic treatment for rCDI when administered rectally. There is clinical interest in alternative routes of administration. Objectives: CDI-SCOPE assessed the safety and clinical effectiveness of RBL when administered via colonoscopy to adults with rCDI. Design: Single-arm, exploratory phase IIIb trial conducted at 12 sites in the United States. Methods: Eligible adults with rCDI received one administration of RBL consisting of one 150-mL dose of RBL, delivered via colonoscopy to the right side of the colon. The primary endpoint assessed RBL-related treatment-emergent adverse events (TEAEs) within 8 weeks of RBL administration or until confirmed treatment failure. Secondary endpoints included treatment success (absence of CDI recurrence for 8 weeks following RBL administration), physician experience administering RBL via colonoscopy, and physician perception of participant benefit. Results: Of 54 participants screened, 41 were enrolled and received RBL via colonoscopy; 39 participants completed the 8-week visit. Five TEAEs in four participants (9.8%) were assessed as related to RBL, all of which were gastrointestinal and mild in severity. Overall, 18 participants (43.9%) experienced 33 TEAEs within 8 weeks, most of which were of mild (25/33; 75.8%) or moderate (5/33; 15.2%) severity. No TEAEs led to intensive care unit admission or death. Overall, 39 participants (95.1%) experienced treatment success; 2 participants (4.9%) withdrew consent and had an indeterminate outcome. Among physicians, 90.2% of investigators indicated a “positive” or “very positive” experience administering RBL by colonoscopy. All physicians assessed participant benefit as “much” or “very much” improved. Conclusion: This single-arm study suggests RBL administered via colonoscopy is practical, safe, and effective for preventing CDI recurrence following antibiotic treatment in adults. Trial registration: ClinicalTrials.gov: NCT05831189.

Abstract Family history of hematologic malignancy (FHHM) is an established risk factor for developing lymphoma, but studies examining associations between self-reported FHHM and lymphoma prognosis during the recent treatment era are limited. Utilizing a prospective cohort study, we evaluated associations between FHHM and prognosis for common lymphoma subtypes, including diffuse large B-cell (DLBCL), follicular (FL), marginal zone (MZL), mantle cell (MCL), Hodgkin (HL), and T-cell (TCL) lymphomas. We used the Mayo Clinic component of the Molecular Epidemiology Resource, a prospective cohort study of newly diagnosed lymphoma patients enrolled from 2002 to 2015. Self-reported FHHM (HL, NHL, leukemia, or multiple myeloma) in a first-degree relative was obtained via questionnaire. Primary outcomes were overall survival (OS) and event-free survival (EFS; time from diagnosis to disease progression, initiation of second-line therapy, or all-cause death). Secondary outcomes were failure to achieve 24 months of event-free survival (EFS24; associated with aggressive disease and poor outcomes) and lymphoma-specific survival (LSS; time from diagnosis to death from lymphoma or lymphoma treatment-related complications). We used multivariable Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for the association of FHHM with OS, EFS, and LSS, and logistic regression to estimate odds ratios (ORs) and 95% CI for the association with failure to achieve EFS24. All models were adjusted for sex and a lymphoma subtype specific prognostic index. The cohort consisted of 650 DLBCL, 679 FL, 291 MZL, 178 MCL, 254 HL, and 196 TCL patients. The prevalence of FHHM ranged from 9.7% in TCL to 14% in FL. FHHM was not associated with OS in any subtype, but MCL patients with FHHM showed an inferior EFS (HR=1.70, 95% CI 1.02-2.85; p=0.04). For EFS24, FHHM was associated with failure to achieve EFS24 only in FL (OR=1.57, 95% CI 0.99-2.48; p=0.05). Similarly, FHHM was associated with inferior LSS in FL patients (HR=1.98, 95% CI 1.11-3.53; p=0.02). In a treatment subgroup analysis of FL patients, the FHHM associations with failure to achieve EFS24 (OR=2.48, 95% CI 1.04-5.74; p=0.04) and inferior LSS (HR=2.68, 95% CI 1.09-6.58; p=0.03) strengthened among those treated with frontline immunochemotherapy (IC). In summary, there were no evidence of associations between FHHM and OS across lymphoma subtypes, but MCL patients with FHHM displayed inferior EFS. FL patients with FHHM were more likely to not achieve EFS24 and to ultimately die of their lymphoma or a lymphoma treatment-related complication. This finding was stronger in more aggressive FL requiring frontline IC. This novel finding would suggest that genetic or environmental factors associated with FHHM may underlie pathways that impact disease aggressiveness and early clinical failure in FL. Citation Format: George Cholack, Raphael Mwangi, Thomas M. Habermann, Verena Hinder, Rosalie Griffen, Dennis Robinson, Andrew L. Feldman, Thomas E. Witzig, Stephen M. Ansell, Brian K. Link, Yucai Wang, Carrie A. Thompson, Susan L. Slager, Matthew Maurer, Anne J. Novak, James R. Cerhan. Family history of hematologic malignancy and prognosis across lymphoma subtypes: Novel association with poor outcomes in follicular lymphoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 7344.

Background: Cardiac rehabilitation (CR) is essential to secondary cardiovascular disease prevention and management of cardiac patients. Despite its proven benefits, CR remains underutilized with enrollment and completion rates ranging from 10-30% in the US. Yet, there is a scarcity of nationally representative data among diverse populations on socioeconomic differences in barriers and beliefs of CR participation and delivery mode preferences. Hypothesis: The perceptions (barriers, beliefs), CR delivery mode preferences, and CR utilization (prior enrollment) varies by socioeconomic status (SES) among CR-eligible individuals. Methods: We conducted an anonymous national electronic survey from March 2023 to January 2024 of individuals self-reporting a prior CR-eligible diagnosis. The 22-item CR Barriers Scale assessed perceived barriers to CR enrollment and participation using a 5-point Likert scale (strongly disagree to strongly agree). A 13-item, validated questionnaire assessed 4 subscales pertaining to patients’ beliefs about CR, each rated on a 5-point Likert scale (strongly disagree to strongly agree): perceived necessity, concerns about exercise, practical barriers and perceived suitability. CR delivery mode preferences were ascertained (eg, virtual, at-home, etc.). Mean barriers and belief scores as well as delivery mode preferences were stratified by SES. Low SES was defined as ≤ high school education, Medicaid insurance, or uninsured. High SES was defined as > high school education and non-Medicaid health insurance. Responses were analyzed using descriptive statistics with R software. Results: A total of 466 participants completed the survey (38.1% women, 30.6% minoritized racial/ethnic group, 29.6% low SES, 95% response rate) ( Table 1 ). The majority indicated prior enrollment in CR (81.5%) with no difference by SES. CR barrier scores did not differ significantly by SES (p=0.331) ( Table 2 ). Beliefs about CR perceived necessity and perceived suitability differed by SES (p<0.001 and p=0.025), but beliefs regarding concerns about exercise and practical barriers did not. The low SES group reported a higher preference for completely at-home CR compared to the high SES group (33.6% vs 7.4%, p<0.001). Conclusion: Our findings suggest that CR beliefs varied by SES while utilization did not. For CR-eligible patients experiencing socioeconomic disadvantage, at-home CR may be a preferred alternative to center-based CR to increase CR participation and adherence.

ABSTRACTIntroductionArtificial Urinary Sphincter (AUS) placement is the preferred treatment for moderate to severe incontinence following prostate cancer treatment. While device related outcomes related to device survival are well reported, literature on quality‐of‐life outcomes, including the use of validated measures is limited.MethodsWe queried a prospectively maintained database of male patients undergoing primary AUS implantation from 2015 to 2023 at our institution. All patients completed a preoperative Michigan Incontinence Symptom Index (M‐ISI) and Patient Global Impression of Improvement (PGI‐I). Postoperative quality of life data was obtained by mailed correspondence. Surveys obtained following AUS reoperation/revision were excluded. Pairwise comparisons were performed between preoperative functional status and the Postoperative responses. Logistic regression analysis was performed to identify preoperative variables associated with a favorable PGI‐I score defined as “very much better or much better,” or a decrease in pad usage from > 1 pad per day to ≤ 1 pad per day.ResultsDuring the study timeframe, 383 patients underwent primary AUS placement, of which 163 patients (42%) completed a postoperative survey and were included in the study. Median age was 69.0 (IQR: 64–74) and 54.6% of patients had a history of pelvic radiation. The median time from surgery to the postoperative survey was 2.2 years (IQR: 0.9, 4.3). Compared to baseline, following AUS placement there was a significant improvement in the total M‐ISI score (10 [6, 16) vs 26 [22, 30]; p < 0.0001) (Minimally Important Difference = 4). This included improvements in the SUI subscore [4 (IQR 2, 6) vs 10 (IQR: 9, 12); p < 0.0001] and bother score [1 (IQR: 0, 3) vs 6 (IQR: 5, 7); p < 0.001)]. Pad usage significantly decreased following device placement (p < 0.0001). The vast majority of patients (90.7%) would “definitely or probably recommend to a friend/family member.” On univariable analysis, active smoking (ref. never) was associated with adverse pad use outcomes (OR: 0.1, 95% CI: 0–0.8; p = 0.03) and older age was associated with adverse PGI‐I outcome (OR: 0.93, 95% CI: 0.87–0.99; p = 0.02).ConclusionsFollowing AUS implantation, most patients have significant improvement in validated quality of life outcomes and low pad usage. These findings persist despite multiple preoperative comorbidities and should be considered when counseling patients before AUS placement.

Objectives Few studies have investigated health outcomes associated with arthritis in low-middle-income countries. Our objective was to examine the association between arthritis and all-cause hospitalization and mortality among middle-aged and older adults in Mexico. Methods Our sample included 12,106 participants aged >50 years from the 2012, 2015, and 2018 waves of the Mexican Health and Aging Study. Logistic regression was used for the associations between arthritis and hospitalization. Kaplan–Meier and Cox proportional hazard models were used for the association between arthritis and mortality. Results Arthritis was associated with higher odds of hospitalization (OR = 1.23; 95% CI = 1.09–1.38), but not mortality. Arthritis with physical limitations had the highest odds of hospitalization (OR = 1.48; 95% CI = 1.27–1.73). Arthritis with joint pain (OR = 1.24; 95% CI = 1.10–1.41) and medication use (OR = 1.28; 95% CI = 1.11–1.48) had higher odds of hospitalization. Conclusion Among middle-aged and older adults in Mexico, arthritis was associated with a high risk of hospitalization.