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SESSION TITLE: Lung Transplantation: New Issues in 2022 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: This population-based study describes the changing demographic trends of Lung Transplants (LT) across the United States (U.S.) over the last two decades (2001 vs 2021). METHODS: We utilized the Organ Procurement and Transplantation Network (OPTN) registry to gather data on LT recipients across the U.S. for the year 2001 and 2021. Total yearly lung transplant numbers were recorded from 1988 to 2021. The recipients were categorized into subgroups based on age (<1, 1-5, 6-10, 11-17, 18-49, 50-64 and >65 years), race (Whites, Blacks, Hispanic/Latino, Asians, and Others) and most common diagnosis, and data was tabulated to compare for the years 2001 and 2021. RESULTS: From 1988 to 2021, 46,109 LTs were performed in the U.S. The yearly LT recipients increased from 1,059 in 2001 to 2,524 in 2021. The most common reason for LT was Emphysema/COPD (Chronic Obstructive Pulmonary Disease) in 2001 (n=464) and IPF (Idiopathic Pulmonary Fibrosis) in 2021 (n=899). In both 2001 and 2021, most LT recipients were in the age group 50-64 years (45.8% vs 58.1%) but the proportion of patients > 65 years receiving LT increased noticeably from 3.4% in 2001 to 36.9% 2021. Most LT recipients in both 2001 vs 2021, had “O” blood group (~ 45%). White patients comprised the majority of those registered for and those who underwent LT in both 2001 (n=940;88.80%) and 2021 (n=1,778;70.40%), although the relative percentage reduced by 18.40%. The relative percentages for Blacks, Asians, Hispanics receiving LTs increased from 2001 to 2021 by 2%, 3.3% and 11.8% respectively. In both 2001 and 2021, the states where maximum LTs were performed included– California (10.8% vs 12.6%), Pennsylvania (9.6% vs 9.3%) and Texas (7.3% vs 10.7%) while the states with the least LTs included– Connecticut, Mississippi, Oregon. CONCLUSIONS: There has been a general uptrend in the total number of LTs year-on-year, and the likely drop in LT recipients in 2020 and 2021 was due to the COVID-19 pandemic. The most common diagnosis for transplant changed from Emphysema/COPD in 2001 to IPF in 2021. There are appreciable racial and geographical disparities in receiving LTs in the United States but there are encouraging improvements in 2021 compared to 2001. There is an increasing trend of LTs in elderly patients (> 65 years), likely due to increased supportive care and improved life expectancy. CLINICAL IMPLICATIONS: Changes in socio-demographic trends in lung transplant recipients help us understand existing disparities and access to advanced lung disease centers so that we can better address these with equitable healthcare delivery tailored to changing transplant trends. DISCLOSURES: No relevant relationships by FNU Amisha No relevant relationships by Perminder Gulani No relevant relationships by Manuel Hache Marliere No relevant relationships by paras malik No relevant relationships by Divya Reddy
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SESSION TITLE: Diagnosis of Lung Disease through Pathology Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: This report describes the case of a patient presenting with pneumothorax and Severe Acute Respiratory Syndrome (SARS) Coronavirus-2 (SARS-cov-2) infection leading to Coronavirus Disease 2019 (COVID-19) pneumonia, with worsening presentation, later found to have underlying Pleuroparenchymal Fibroelastosis (PPFE). CASE PRESENTATION: A 68 year old male with a past medical history of hypertension and type 2 diabetes presented to his primary care clinic with shortness of breath. He underwent a Chest X-Ray as an outpatient which revealed a moderate right-sided pneumothorax (PTX), and he was sent to the Emergency Department by his primary care provider. He was found to be COVID positive on initial workup, also requiring supplemental oxygen. Other routine laboratory tests did not reveal any significant abnormalities. His shortness of breath worsened and on repeat X-rays his pneumothorax increased in size therefore a chest tube was placed by Cardiothoracic Surgery. Computerized Tomography of the chest revealed moderate right pneumothorax, bilateral diffuse ground glass opacities and pulmonary micronodules [Figure 1]. The patient had mild initial improvement and the chest tube was removed but he had recurrence of the PTX and he underwent urgent Video Assisted Thoracoscopic Surgery (VATS), with right upper lobe wedge resection and talc pleurodesis. A biopsy of the resected lung revealed a benign lung with fibroelastotic scarring, diffusely involving subpleural tissue and prominently extending into and entrapping areas of underlying alveolated tissue, with no inflammation, granulomas or pneumonia noted. Workup for tuberculosis, autoimmune disorders, HIV was negative. He eventually was discharged home with close pulmonology and cardiothoracic surgery follow ups, planned for disease surveillance and malignancy workup. DISCUSSION: PPFE is a rare entity, and classified amongst rare causes of idiopathic interstitial pneumonias (IIP) [1]. It is characterized by upper lobe fibrosis, supleural and parenchymal scarring. It can occur at any age, and the usual presentation is of pneumothorax in a thin male, with a shortened anteroposterior diameter of the chest. Radiographic findings typically include subpleural nodular or reticular opacities in the upper lobes, usually sparing the middle and lower lobes. Pathology reveals increased elastic tissue and dense collagen fibers, along with subpleural fibrosis [2]. Pulmonary function testing reveals a restrictive pattern with reduced diffusion capacity and it is usually resistant to steroids [3]. CONCLUSIONS: PPFE is an uncommon cause of insidious, slowly progressive fibrotic lung disease often limited to the upper lobes. It should be suspected in any person presenting with recurrent pneumothorax or blebs without other known inciting causes. Lung biopsy helps establish the diagnosis. Patients with this condition need close pulmonology follow up to assess progression. Reference #1: Travis WD, Costabel U, Hansell DM, King TE Jr, Lynch DA, Nicholson AG, Ryerson CJ, Ryu JH, Selman M, Wells AU, Behr J, Bouros D, Brown KK, Colby TV, Collard HR, Cordeiro CR, Cottin V, Crestani B, Drent M, Dudden RF, Egan J, Flaherty K, Hogaboam C, Inoue Y, Johkoh T, Kim DS, Kitaichi M, Loyd J, Martinez FJ, Myers J, Protzko S, Raghu G, Richeldi L, Sverzellati N, Swigris J, Valeyre D;ATS/ERS Committee on Idiopathic Interstitial Pneumonias. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2013 Sep 15;188(6):733-48. doi: 10.1164/rccm.201308-1483ST. PMID: 24032382;PMCID: PMC5803655. Reference #2: Frankel SK, Cool CD, Lynch DA, Brown KK. Idiopathic pleuroparenchymal fibroelastosis: description of a novel clinicopathologic entity. Chest. 2004 Dec;126(6):2007-13. doi: 10.1378/chest.126.6.2007. PMID: 1559 706. Reference #3: Watanabe K. Pleuroparenchymal Fibroelastosis: Its Clinical Characteristics. Curr Respir Med Rev. 2013 Jun;9(4):299-237. doi: 10.2174/1573398X0904140129125307. PMID: 24578677;PMCID: PMC3933942. DISCLOSURES: No relevant relationships by FNU Amisha No relevant relationships by Perminder Gulani No relevant relationships by Hyomin Lim No relevant relationships by paras malik No relevant relationships by Divya Reddy
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Introduction: There is a subset of NSCLC patients ineligible for benefit from TKIs/Immunotherapy (e.g. STK11 mutation conferring resistance to Immunotherapy). Besides, many patients cannot afford these therapies. Metformin has anticancer properties acting both on glycolytic metabolism and tumor microenvironment. In vitro studies suggest synergism between metformin and pemetrexed. STK11 deficient cell lines are more sensitive to metformin. Clinical studies combining metformin with chemotherapy are limited by small sample size. We conducted an exploratory phase-2 clinical trial of metformin with pemetrexed/carboplatin in advanced non-squamous NSCLC. Methods: This was a single center, open label, single arm phase 2 clinical trial with a Simon’s two stage design. The null hypothesis was that the combination would not improve the 6-month PFS rate by 15%, from 50%. Treatment-naive, non-diabetic patients aged 18-75 years with NSCLC (adenocarcinoma/not-otherwise-specified) with stage IV disease having ECOG PS 0-2 with unmutated EGFR/ALK and without brain metastasis or with asymptomatic brain metastases were treated with pemetrexed-carboplatin chemotherapy and metformin for six months. The primary outcome was 6-month progression free survival (PFS) rate. Secondary outcomes were safety, overall survival (OS), overall response rate (ORR), proportion of STK 11 mutation and effect of STK 11 mutation on 6-month PFS rate. PFS and OS were estimated using the Kaplan-Meier method. Targeted sequencing was attempted for available tissue specimens. Results: The first interim analysis was performed after enrollment of 26 patients for the first stage (before the target accrual of first stage was reached) due to slow accrual, in view of COVID pandemic. The study was terminated after first stage for futility. The median age of patients in the study was 52 years (range, 30 to 68) and 18 patients (69.0%) were males. Half of the patients had ECOG-PS 2. Brain metastases were present in eight (31%) patients and among these four (50%) were symptomatic at presentation. The median follow-up time was 25 months. The median PFS was four months. 6-month PFS rate was 28% (95% CI - 0.12 to 0.46). Of the 25 evaluable patients, five (20%) had a partial response, and eight (32%) had stable disease;13 (52%) of the patients had disease control. The median OS was 16 months. During combined therapy, 14 (54%) and 3 (11%) patients had any grade and grade 3 anemia respectively. One patient had grade 3 neutropenia. Among non-hematological toxicities, gastrointestinal toxicities (nausea, vomiting and diarrhea) were the most common. No grade 4 toxicities were reported. There were no treatment discontinuations, however treatment delay due to grade three toxicities was present in two patients. Dose modification for Metformin was required in four patients. Targeted Sequencing was possible in nine cases. Two of these patients had STK11 mutation and an associated bad outcome (PFS < 2 months). Conclusions: We could not demonstrate the benefit of combination of Metformin with pemetrexed-carboplatin in terms of improvement in 6-month PFS rate. The addition of metformin to pemetrexed-carboplatin has an acceptable safety profile. Future trials should test metformin in specific subsets (STK11 mutated) and in combination with immunotherapy and TKIs. Keywords: Metformin, NSCLC, STK11
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This book explains the global business management domain in the current scenario and it covers the latest concepts in business and technologies applied for their successful implementation. The growth of global corporations has led to the development of new business strategies by the applications of new technologies. The critical success factors of business management depend on the successful applications of information systems and information technologies. To achieve competitive advantages, business management is applying strategies from technological perspectives for various concepts such as customer relationship management, cost management, marketing management, etc. Competitive Trends and Technologies in Business Management describes the applications and concept of IS in business management and presents the success stories of business. The book assesses competitive business management from an IS and IT perspective, examining business development policies linked to the profitability of global firms. The book covers comprehensive topics such as use of green technology in business processes, machine learning in business education, and artificial intelligence in the business sector. This book will drive readers to actively think through the most fundamental business concepts developed by IS and IT in the current competitive landscape and provides answers to questions such as: What are the new drivers of Business Management? and how do businesses apply IS and IT? The current Covid pandemic has caused serious financial loss to developing countries, and this book will help to explore new options of expanding markets for businesses by the applications of IS and IT. © 2022 by Nova Science Publishers, Inc.
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Background: COVID-19 pandemic has been a challenge with globally 12,567,457 coronavirus cases reported and 561,879 deaths as of July 11, 2020 Isolated small studies have reported the prevalence of comorbid chronic liver disease (CM-CLD) and COVID-19 associated acute liver injury (COVID-19-ALI) in hospitalized patients In this metaanalysis, we assessed the association of comorbid liver disease and acute liver injury and outcomes in COVID-19 hospitalized patients Methods: Observational studies describing the CM-CLD and COVID-19-ALI and outcomes of COVID-19 hospitalized patients from December 1, 2019, to June 30, 2020, were identified. Data was extracted following MOOSE guidelines with a consensus of four independent reviewers. Adverse outcomes were defined as admission to intensive care unit (ICU), oxygen saturation <90%, invasive mechanical ventilation (IMV), severe disease and in-hospital mortality Data was analysed using Review Manager 5 4 The odds ratio (OR) and 95% confidence interval (95%CI) were obtained and forest plots were created using randomeffects models The p value <0 05 was considered statistically significant. Results: 12 studies with 7564 confirmed COVID-19 patients were included Out of these, 12 studies (7564 patients) and 3 studies (146 patients) provided data on CM-CLD and COVID-19-ALI, respectively The pooled prevalence of CM-CLD was 2 67% [(202/7564)∗d COVID-19-ALI was 22 6% [(33/146)∗ patients with poor outcomes, the prevalence of CM-CLD was 2 4%(54/2233) and COVID-19-ALI was 32% (18/56) In meta-analysis, CM-CLD had no significant association with poor outcomes (OR:0 89;95%CI:0 65-1 22;p=0 47) with no heterogeneity in the data (p=0 93;I2=0%) COVID-19-ALI had higher odds of poor outcomes with OR of 2 49 (95%CI:1 09-5 69;p=0 03) and without any significant heterogeneity between studies (p=0 67;I2=0%) Conclusion: Our meta-analysis suggests that acute liver injury was significantly associated with COVID-19 severity and poor outcomes Future studies should evaluate changing levels of biomarkers amongst liver disease patients to predict poor outcomes of COVID-19.