Citations

PURPOSE To provide evidence-based recommendations to practicing clinicians on the management of patients with small-cell lung cancer. METHODS An Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, community oncology, research methodology, and advocacy experts were convened to conduct a literature search, which included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2022. Outcomes of interest included response rates, overall survival, disease-free survival or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 95 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations were developed to address systemic therapy options, timing of therapy, treatment in patients who are older or with poor performance status, role of biomarkers, and use of myeloid-supporting agents in patients with small-cell lung cancer. Additional information is available at www.asco.org/thoracic-cancer-guidelines .

Abstract Brown, FSA, Fields, JB, Jagim, AR, Baker, RE, and Jones, MT. Analysis of in-season external load and sport performance in women’s collegiate basketball. J Strength Cond Res 38(2): 318–324, 2024—Quantifying and monitoring athlete workload throughout a competitive season is a means to manage player readiness. Therefore, the purpose of the current study was to quantify practice and game external loads and to assess the relationship between such loads and basketball-specific performance metrics across a women's collegiate basketball season. Thirteen National Collegiate Athletic Association Division I women basketball athletes (age 20.08 ± 1.55 years) wore Global Positioning Systems sensors equipped with triaxial accelerometers for 29 games and 66 practices during the 2019–20 season. A multivariate analysis of variance was used to assess differences in external load between high- and low-minute players and across quarters within games ( p < 0.05). Bivariate Pearson correlation coefficients were run to determine relationships between external loads and metrics of basketball performance. Findings indicated that high- and low-minute athletes experienced different loads during games and practices ( p < 0.001). External loads differed by quarter, such that player load (PL) was highest in Q4 ( p = 0.007), PL·min −1 was highest in Q1 and lowest in Q4 ( p < 0.001), and explosive ratio (i.e., ratio of PL and explosive efforts) was lowest in Q3 ( p = 0.45). Relationships existed between PL·min −1 and field goals ( r = 0.41; p = 0.02) and between the explosive ratio and free throws ( r = 0.377 p = 0.04). These results can be used to inform design of training sessions with the intent to prepare athletes for the demands of the competitive season. It is recommended that future research continue to explore the relationship of sport-specific performance metrics and athlete external load.

Purpose: Complex repetitive discharges (CRDs) are incompletely understood needle electromyography (EMG) waveforms seen in both myopathic and neurogenic disorders including radiculopathies. This study aimed to clarify the significance of CRDs in patients with radiculopathies. Methods: This case–control study randomly identified 100 patients with needle EMG evidence of radiculopathy demonstrating at least one CRD in the electrodiagnostically involved myotome between January 2017 and January 2022. These patients were compared with 100 randomly selected patients with EMG evidence of radiculopathy without CRDs controlled for sex, age at EMG testing, and affected nerve root segment. Patient clinical symptoms, neurologic examination, EMG features, and imaging were analyzed. A paired sample t-test for categorial data and χ2 test for nonparametric data were used for statistical analysis with significance defined as P < 0.05. Results: Patients with radiculopathies with CRDs had longer disease duration averaging 59 months (range 1–480) compared with patients with radiculopathies without CRDs averaging 26 months (range 1–192, P < 0.01). Clinical symptoms of paresthesias and weakness were both significantly more common in patients with radiculopathies with CRDs than those without CRDs (P < 0.01 and 0.01, respectively). Needle EMG demonstrated a greater average number of muscles with neurogenic motor unit potentials per radiculopathy in patients with radiculopathies with CRDs compared with those without CRDs. Imaging studies of patients with radiculopathies with CRDs were more likely to reveal evidence of nerve root compression (P < 0.01). Conclusions: The presence of CRDs in patients with radiculopathies is consistent with clinically more symptomatic radiculopathies and a longer duration of nerve root compromise.

Background: Congenital mesoblastic nephroma is the most common renal tumor in children under the age of 6 months, comprising 3–10% of all kidney tumors in children. It is a rare and mostly benign tumor. It divides into cellular, classic, and mixed subtypes. It is typically detected in the third trimester of pregnancy using ultrasonography and magnetic resonance imaging. The best treatment is surgically by completely removing the tumor. Case presentation: We reported a case of a one-day-old female who was born at 31 weeks gestation weighing 1670 g. Preterm labor was due to polyhydramnios, which was diagnosed predelivery. A large mass was detected in the left hypochondrium using computerized tomography, total nephrectomy was performed, and the histopathological examination of the specimen confirmed the diagnosis of congenital mesoblastic nephroma. Clinical discussion and conclusion: Early polyhydramnios could be the most significant sign of renal tumors in infants, especially congenital mesoblastic nephroma.

Background: Meta-analyses have shown the success of SMBP in BP control. We aim to describe an SMBP QI program at our primary care clinic and assess its impact on BP. The Einstein CPC is a safety net practice that serves a socially and economically disadvantaged population facing many HTN management barriers. Methods: This program utilized a QI approach for BP control and patient-provider connection. Patient demographics, clinical features, and SDOH were assessed at baseline. Patients with uncontrolled HTN (SBP >140 mmHg) were asked to participate. To date, 111 patients enrolled. Patients were given a Bluetooth-enabled BP monitor connected to a mobile health app, HTN education, DASH diet recommendations, and orientation to SMBP protocols. Those reporting social needs or depression were referred to behavioral resources. Health staff continuously telemonitored patient usage, BP, and individualized interventions. We evaluated the difference in BP from baseline BP and estimated the change in time using a linear multilevel model with random intercept and random slope for each patient. We also calculated time in target range defined as time in SBP 100-130 and DBP 70-80 in mmHg. Results: Patient characteristics (Table 1). Those with at least 3 d of BP readings - 93% (103/111) were included in the BP analysis (Figure 1); mean follow-up 69±67 d and BP readings 42±52. Over 90 d, SBP, and DBP decreased by 11 (95% CI: 4-17) and 5 (95% CI: 3-8) mmHg, respectively. Conclusions: A QI-based SMBP program with robust telemonitoring and individualized interventions may effectively promote short-term adherence to remote BP monitoring and BP control in a socially and economically disadvantaged population.

Background: International data on COVID-19 infection in immunosuppressed populations is limited. Heart transplant (OHT) recipients requiring immunotherapy are at risk for potentially increased complications with COVID-19 infection, including long-covid and oxidative stress during initial infection. The availability of vaccination and temporal trends in this population has not been well described. We report outcomes in immunosuppressed patients during the initial years of the COVID pandemic. Methods: All patients who underwent heart transplantation at Mayo Clinic in Florida were reviewed from March 2019 to October 2021. Patients were divided into two groups: those diagnosed with COVID-19 (based on a positive SARS-CoV-2 RT-PCR) and those not. A p value of 0.05 was considered significant using the Chi-squared test. Results: A total of 98 patients were reviewed. Of these, 49 were COVID-19-positive (CP), and 49 were negative (CN). The cohort was well matched, with a median age of 58 years (49 - 65) in both groups. 20 females in the CP group and 9 in the CN group. Diabetic status (p = .07), history of hypertension (p=.5), BMI (p=.41), GFR (p=.19), and ejection fraction (p=.29) were not significantly different between the two groups. Immunosuppression was not significantly different for CP or CN patients, with a median trough tacrolimus level of 7.68 vs. 8.70 (p = .26). The median time from transplant to CP was 384 days (237 - 677). The CN group’s median follow-up after transplant was 947 days (737 - 1191). CP hospitalization rate was 24% (5 Pfizer, 3 unvaccinated, 4 Moderna) with only 1 death. Hospitalized patients’ markers of inflammation were: IL6 19.2 (12-48), D-dimer 1408 (763 - 2227), and CRP 54 (20 - 90). The CP group was more vaccinated than the CN group (92% vs. 78%, p = .025). More CP patients received the Pfizer vaccine compared to Moderna (p = .018). Conclusion: We found that patients after OHT on similar immunotherapy regimens did not carry the same risk of contracting Covid-19 despite being vaccinated. CP patients were generally infected in the first 1.5 years after OHT. This may indicate an increased infection rate due to a weakened immune system or lack of bivalent boosters before 2022. Vaccine efficacy in this population should be evaluated in larger studies.

Background: African American men are disproportionately affected by hypertension compared to other racial/ethnic groups. Self-management practices such as following a diet rich in fruits and vegetables can lead to improved hypertension control. However, healthy options may be inaccessible for some African American men, Gardening may provide easy access to fruits and vegetables. Methods: We conducted a mixed-methods study exploring African American men’s experiences with hypertension from Tennessee who regularly engaged in personal or community gardening and their gardening benefits (diet, physical activity, stress management), preferred diets and food selection. Participants completed semi-structured interviews and the Dietary Approaches to Stop Hypertension (DASH) diet questionnaire which was compared to the U.S. Department of Agriculture (USDA) MyPlate. Results: Participants (N=9, mean age 65 [SD 5.4] years) reported that gardening improved their regular physical activity, stress management, and satisfaction with providing for others. Several themes emerged including that participants preferred to manage their hypertension through diet modification by alternating traditional diets (high fat/sodium) with heart-healthy (low fat/sodium) meals and that they recognized the continuous nature of healthy food selection. Diet questionnaire responses revealed mean daily fruit (2.9 [SD 1.7]) and vegetable (2.8 [SD 1.1]) servings were below DASH diet recommendations but above MyPlate guidelines. Further, mean daily meat/protein (3.7[SD 1.1]) and fat/oil intake (6.4 [SD 7.2]) servings exceeded both recommendations. Conclusion: Our study suggests that personal and community gardening may provide a means for African American men to improve hypertension self-management practices through physical activity, stress relief, and healthy food access. Further studies of gardening interventions on blood pressure control among this group are warranted.