Citations

Introduction: Language barriers represent an often-overlooked determinant of health equity. This study evaluates the impact of limited English proficiency (LEP) on major adverse cardiac events (MACE) and mortality in patients undergoing cardiovascular surgery. We hypothesized that patients with LEP have a higher incidence of adverse outcomes compared to English proficient patients. Methods: We conducted a retrospective cohort study using Cosmos, a longitudinal national electronic health record dataset. Patients were classified as having LEP if their record indicated a preferred language other than English. Adult patients aged 18-95 years who underwent coronary artery bypass grafting, valvular surgery, or thoracic aorta surgery in the United States (January 2016 - February 2025) were included. Exclusion criteria were missing language data, first in-person encounter <1 year prior to surgery, history of metastatic cancer or dialysis, and nursing home residence within 90 days of surgery. The primary outcome was MACE, a composite of stroke, revascularization, and hospitalization for myocardial infarction or heart failure. The secondary outcome was all-cause mortality. The cumulative incidence of MACE was estimated via a competing risk framework, while the cumulative incidence of mortality was estimated with the Kaplan-Meier method. Multivariate Cox proportional hazard regressions were fitted for all outcomes. Results: The cohort included 12,706 LEP patients (28.8% female) and 393,612 English-proficient patients (33.2% female). Differences in baseline characteristics included age, race, and comorbidity burden. The unadjusted cumulative incidence of MACE was higher in LEP patients, but all-cause mortality was lower (Figure 1). Over the follow-up period, the incidence rate of MACE for English proficient patients vs LEP was 185 vs 219 per 1000 patient years and 39 vs 36 per 1000 patient years for mortality. The adjusted hazard ratio for MACE was 0.97 (95% CI: 0.94 - 1.01, p = 0.19) and 0.89 (95% CI: 0.83 - 0.95, p <0.001) for mortality. Conclusions: LEP was associated with higher unadjusted cumulative incidence of MACE and lower mortality, but only the association with mortality persisted after regression analysis. Our findings highlight the need for further research into the impact of language proficiency on outcomes after cardiac surgery and the potential benefit of targeted interventions to address language-related disparities.

Introduction: Corticosteroid therapy has been demonstrated to improve prognosis and reduce mortality in patients with severe Coronavirus Disease 2019 (COVID-19) infection by attenuating the exaggerated inflammatory response that emerges in the late phase of infection. However, its impact on patients with pre-existing cardiovascular disease, who are at higher risk of complications, has not been specifically studied. The aim of this study is to evaluate the effect of corticosteroid therapy on mortality and long-term COVID-19 symptoms in this high-risk population. Methods: We analyzed the prospective registry HOPE-2. Patients with previous cardiovascular disease were selected, and 18-month all-cause death was defined as the primary endpoint. Long-term COVID-19 symptoms were considered as secondary endpoints. A total of 1188 patients with previous heart disease were included, of which 453 received corticosteroid treatment. Propensity score matching analysis in a 1:1 fashion was performed based on baseline variables that exhibited a p-value < 0.05 in the univariant analysis and outcome variables that defined corticosteroid use, with a final matched population of 796 patients. Results: In patients with pre-existing heart disease, corticosteroid treatment was not associated with differences in 18-month all-cause mortality (p = 0.52). However, a shorter duration of hospitalization (median: 8 days [IQR: 4–14] and 11 days [IQR: 7–18]; p < 0.001) was observed in patients who received corticosteroids. No significant differences in long-term COVID-19 symptoms were observed between the two groups. Conclusions: In patients with pre-existing heart disease, the absence of a clear harmful effect suggests that the positive effects of corticosteroids may be offset by their potential adverse effects which could contribute to the persistence of long COVID symptoms. This finding may reflect a differential response to corticosteroids in this high-risk subgroup, highlighting the need for further studies to clarify the role of this therapy in such patients.

Abstract Purpose: AXL, a receptor tyrosine kinase related to oncogenic processes, is aberrantly expressed in various cancers and associated with treatment resistance. Enapotamab vedotin (EnaV), a novel anti-AXL human IgG1 and monomethyl auristatin E antibody–drug conjugate, demonstrated antitumor activity in preclinical models, including non–small cell lung cancer (NSCLC). This phase 1/2 study assessed the safety and preliminary efficacy of EnaV in solid tumors. Patients and Methods: This study comprised dose-escalation and dose-expansion phases; both phases investigated EnaV once every 3 weeks (Q3W) and EnaV on days 1, 8, and 15 of a 28-day cycle (3Q4W). Primary objectives determined the maximum tolerated dose (dose escalation) and safety (dose expansion). Pharmacokinetic profile, antitumor activity, and AXL expression were also assessed. Results: During dose escalation, 32 patients received EnaV Q3W; 15 received EnaV 3Q4W. The maximum tolerated dose and recommended phase 2 dose were 2.2 mg/kg in Q3W and 1.0 mg/kg in 3Q4W schedules. In dose expansion, 189 patients received EnaV Q3W; 70 received EnaV 3Q4W. Common adverse events in dose expansion included fatigue, constipation, nausea, decreased appetite, and diarrhea. Overall response rates ranged from 4.5% to 12.5% with Q3W dose schedule and from 9.1% to 11.5% with 3Q4W dose schedule. Disease control rates for NSCLC cohorts were 40.9% to 50.0%. NSCLC subset analysis demonstrated correlation between radiomics signature and disease control. The relationship between clinical activity and AXL expression was not apparent. Conclusions: EnaV had an acceptable safety profile; however, because the evaluation of antitumor activity did not show clinically meaningful responses, clinical development of EnaV was discontinued. Significance: EnaV, an anti-AXL human IgG1 and monomethyl auristatin E antibody–drug conjugate, showed single-agent antitumor activity in preclinical models. This phase 1/2 study of EnaV demonstrated a manageable safety profile and antitumor activity in selected tumor types. Further studies exploring alternative targeting modalities, patient selection, and/or combinations are needed.

Abstract Disclosure: S. Saad-Omer: None. M. Stan: None. M.R. Castro: None. J. Brito: None. J.E. Hallanger-Johnson: None. M.M. Ryder: None. Background: Thyroid fine needle aspiration (FNA) is a widely utilized diagnostic tool for evaluating thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) provides a standardized framework for classifying cytologic findings and guiding management. This study retrospectively reviews thyroid FNA cases at a large academic institution to analyze the distribution of Bethesda classifications.Methods: A retrospective review was conducted of all thyroid FNA cases done in the department of Endocrinology at a large academic institution performed from January 1st 2019 to October 3rd 2023. Thyroid FNA results were divided into categories according to the Bethesda classification system, such as benign, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), follicular neoplasm (FN), suspicious for malignancy, malignancy and non-diagnostic. FNA results that were not able to be classified were labelled as other.Results: A total of 3,291 thyroid FNA cases were included in the analysis. The distribution of cases across the Bethesda categories revealed a significant proportion of benign findings, with 73.6% classified as benign. This was followed by 8.1% follicular neoplasm, 6.56% Papillary Thyroid Cancer, 6.62% Non-diagnostic, 2.4% Atypical, and 2.3% Suspicious. 0.5% of FNA results were classified as other.Conclusion: Overall our cohort was found to have similar findings in terms of benign and confirmed PTC nodules compared to recent literature; however, the rate of atypical and non-diagnostic nodules was found to be lower. Presentation: Monday, July 14, 2025

Abstract Disclosure: Y. Ahmed: None. S.M. Saad-Omer: None. R.M. Castro: None. M. Rivera: None. M.N. Stan: None. Background: Fine-needle aspiration (FNA) is a cornerstone in the evaluation of thyroid nodules. Its accuracy during long term follow up is not well established though. Our project aims to address that. Objective: To assess long-term accuracy of FNA results at Mayo Clinic Rochester including diagnostic classifications, procedural and cytologic variables, and concordance with surgical pathology. Methods: We conducted a retrospective cohort study of patients who underwent thyroid FNA at Mayo Clinic Rochester in 2014, to allow for the long-term follow-up. Descriptive statistics summarized patient demographics, nodule characteristics, and procedural factors. Cross-tabulation was used to evaluate concordance between FNA cytology and surgical pathology. This is an interim analysis. Results: Among 199 patients (from 741 FNAs that year), the mean age was 58.6 ± 14.1 years, and 73.7% were female. The average BMI was 29.6 ± 6.4 kg/m². Most had non-toxic multinodular goiter (69.3%) or non-toxic solitary nodules (27.6%). Nodules were 45% solid, 8% cystic, and 47% mixed, with a mean size of 2.3 cm. FNA results were predominantly benign (Bethesda II, 80%), followed by malignant (Bethesda VI, 8%), suspicious for follicular neoplasm (Bethesda IV, 7.5% ), non-diagnostic (Bethesda I, 3%), and suspicious for malignancy (Bethesda V,1%). There were no cases read as Bethesda III (AUS) in 2014. Of the 16 Bethesda VI cases, 15 had surgery; 14 were confirmed malignant, and 1 was benign (Hurthle cell adenoma). Both Bethesda V cases that underwent surgery were benign. Of the 15 Bethesda IV cases, 12 had surgery; 11 were benign and 1 was malignant and 3 had long term follow up (2 benign, and one malignant based on the available data). Overall the malignancy rate for Bethesda IV was 13.3%. Surgery was performed in 12 Bethesda II cases, with final pathology available for 11; 9 were confirmed benign, while 2 were malignant. In the other 147 cases of benign FNAs that didn’t undergo surgery we have not identified any indication of necessity for surgery during the mean of 9 years of follow-up, presumably indicating their benign character. Overall malignancy rate for this group was 1.3%. We had only 6 non diagnostic FNAs (Bethesda I), with all of them during follow up proven benign (2 by surgery, 2 by repeat FNA and 2 by long term follow up). Conclusion: Long term follow up data (over 9 years) support the continued reliability of Bethesda II and VI , while conversely raising questions about the significance of the Bethesda V classification. The malignancy rate in Bethesda IV (likely including the Bethesda III category at the time) is consistent with our institutional data, although it remains lower than that reported by other institutions. We’re currently enriching our cohort to verify and strengthen our conclusions. Presentation: Monday, July 14, 2025

ABSTRACT Anesthetic technique affects surgical outcomes and oncological prognosis. Recognizing the critical role of surgery in cancer treatment, this narrative review aims to improve anesthesiology practices for cancer patients by evaluating actions that positively influence outcomes. Anesthesiologist experience helps guide technique choice in complex cases. Decisions should be customized based on the type of surgery and patient condition, as different techniques can significantly impact results. The expertise of the entire team at specialized centers further enhances outcomes.

ABSTRACT Introduction Sinonasal sarcomas are exceedingly rare entities, constituting less than 7% of head and neck sarcomas. Their complex histology needs specialized treatment, which is often based on multimodal approaches including surgery, radiation therapy, and/or chemotherapy. This manuscript aims to gather expert opinions to establish common management principles for sinonasal sarcomas. Methods This international consensus followed a modified Delphi method in seven steps, including statements definition by the core group, expert panel recruitment, and a two‐round survey. Sixty‐two statements on sinonasal sarcoma management were developed. Experts from multiple continents participated, and results were anonymized and analyzed between March and May 2025. Results A total of 44 invited experts were recruited, 43.2% otorhinolaryngologists/head and neck surgeons, 31.8% medical oncologists, and 25% radiation oncologists. Participants varied in age and experience, representing Europe (70.5%), North America (18.2%), South America (6.8%), and Asia (4.5%). Among all histologies, biphenotypic sarcoma, chondrosarcoma, leiomyosarcoma, and myofibrosarcoma are principally treated with an upfront surgical management, differently from Ewing sarcoma and rhabdomyosarcoma in which chemotherapy, eventually associated with radiotherapy, is often chosen. In the remaining histologies (angiosarcoma, liposarcoma, malignant peripheral nerve sheath tumor [MPNST], osteosarcoma, and synovial sarcoma), a precise multimodal treatment is less standardized and needs to be discussed on a case‐by‐case basis. Conclusion Sinonasal sarcomas require a histology‐driven approach to determine upfront treatment, whether surgical, medical, or multimodal. Despite this structured strategy, prognosis remains highly variable across subtypes. Multidisciplinary evaluation and individualized management in referral centers are crucial to address the biological diversity and anatomical complexity of these rare malignancies.

Background Global efforts to raise delirium awareness have been made over the past years, such as the formation of the iDelirium group and the institution, in 2017, of the annual World Delirium Awareness Day (WDAD) in March. In 2023, our group and researchers from around the world conducted a global one-day point prevalence study of delirium on WDAD. These strategies appear to improve delirium recognition and management. Objective To assess participants’ perceived impact of participating in the WDAD 2023 one-day point prevalence study and to gather feedback on the survey process to inform future campaigns. Methods An online survey was administered to multiple national and clinical collaborators from 44 countries participating in the one-day global point delirium prevalence study on WDAD 2023. Using SurveyMonkey®, the survey was distributed via a snowball system, with participants’ consent implied through their involvement. The survey, developed iteratively to balance time and detail, consisted of six core questions, including closed and open formats. Data were collected from September 9th to October 9th, 2023, and qualitative and quantitative analyses were performed using Excel®. Quantitative data underwent statistical analysis using IBM® SPSS Statistics28. Results 49 out of 53 (93.45%) healthcare professionals responded to the survey: 71.43% reported increased awareness, and responses were almost equally divided between those who initiated projects (46.94%) and those who did not (53.06%). Most participants (93.88%) did not find the WDAD 2023 one-day point prevalence study in March burdensome, and all expressed interest in future participation. The WDAD 2023 one-day point prevalence study highlighted diverse projects, primarily focused on delirium awareness and education. The survey found suggestions for future improvements emphasizing more efficient, digital, and engaging research methods and a clear need for educational resources, particularly in ICU delirium. Conclusions Our survey finds that participation in WDAD 2023 one-day point prevalence study boosted delirium visibility, leading to ongoing awareness, interest in future studies, and practice changes that benefit patients and the healthcare system. Further evidence-based research is needed to assess the impact of these campaigns on delirium recognition and management.

Background and importance Emergency airway management in the emergency department (ED) is a high-risk procedure associated with patient outcomes. First-attempt success is a widely recognized quality metric, as multiple attempts are associated with an increased risk of peri-intubation complications. In Brazil, where emergency medicine is a recently established specialty, many ED are staffed by physicians without formal emergency medicine training. The association between emergency medicine training and intubation outcomes in this setting has not been well characterized. Objective To assess the association of physician specialty with first-attempt success and immediate peri-intubation complications in Brazilian EDs. Design Secondary analysis of a multicenter, prospective cohort study from the Brazilian Airway Registry Cooperation. Setting and participants This study included adult patients who underwent tracheal intubation in EDs between March 2022 and April 2024. Patients were excluded if the intubation occurred outside the ED, during cardiopulmonary resuscitation, or for elective procedures. Intubations performed by medical students were also excluded. Physicians were categorized by specialty as emergency medicine or nonemergency medicine. Outcome measures and analysis The primary outcome was first-attempt success; secondary outcomes included peri-intubation complications (severe hypoxemia, hemodynamic instability, and cardiac arrest). Multivariable logistic regression was used to assess the association between physician specialty and outcomes. Main results Among 2582 patients, 1087 (42.1%) were intubated by emergency physicians and 1495 (57.9%) by other physicians (mainly internal medicine and surgery). Intubations by emergency physicians were associated with a higher rate of first-attempt success [80.4 vs. 70.9%, adjusted odds ratio [aOR]: 1.63, 95% confidence interval (CI): 1.34–1.97]. There was also a higher odds of intubations without major complications (aOR: 1.20, 95% CI: 1.01–1.42). Conclusion In this study, there was a higher rate of first-attempt success in intubations performed by board-certified emergency physicians compared with other physicians working in Brazilian EDs.