Characterizing metastatic uveal melanoma patients who develop symptomatic brain metastases.

Metastatic uveal melanoma (mUM) is an advanced ocular malignancy characterized by a hepatotropic pattern of spread. As the incidence of brain metastases (BM) in mUM patients has been thought to be low, routine CNS surveillance has not been recommended. Notably, no formal assessment of BM incidence in mUM has to date been published to support this clinical practice. We aimed to determine the true rate of BM in mUM and to clarify the clinical and genomic risk factors associated with BM patients through a collaborative multicenter, retrospective research effort. Data collected from 1,845 mUM patients in databases across four NCI-designated comprehensive cancer centers from 2006-2021 were retrospectively analyzed to identify patients with BM. Brain imaging in most cases were performed due to onset of neurological symptoms and not for routine surveillance. An analysis of demographics, therapies, gene expression profile, tumor next generation sequencing (NGS) data, time to metastasis (brain or other), and survival in the BM cohort was completed. 116/1,845 (6.3%) mUM patients were identified with BM. The median age at time of UM diagnosis was 54 years old (range: 18-77). The median time to any metastasis was 4.2 years (range: 0-30.8). The most common initial metastatic site was the liver (75.9%). 15/116 (12.9%) BM patients presented with BM at the time of initial metastatic diagnosis. Median survival after a diagnosis of BM was 7.6 months (range: 0.4-73.9). The median number of organs involved at time of BM diagnosis was 3 (range: 1-9). DecisionDX-UM profiling was completed on 13 patients: 10-Class 2, 2-Class 1B, and 1-Class 1A. NGS and cytogenetic data were available for 34 and 21 patients, respectively. BM was identified in 6.3% of mUM cases and was associated with high disease burden and a median survival of under 8 months once diagnosed. Since most patients in this cohort were symptomatic, the incidence of asymptomatic BM remains unknown. These data suggest the use of routine brain imaging in all mUM patients at risk for developing BM for early detection.

Gestational weight gain in uncomplicated twin pregnancies by pre-pregnancy body mass index.

In 2009, the Institute of Medicine provided provisional guidelines for gestational weight gain (GWG) in twin gestations, citing limited research. We examined GWG by pre-pregnancy body mass index in a retrospective cohort of twin births uncomplicated by infant mortality, preterm birth, or low birth weight from Massachusetts in 2006-2017 (N = 273). Median (inter-quartile range [IQR]) GWG was 20.4 kg (IQR: 17.2-25.9 kg) for women who were normal weight pre-pregnancy, 21.3 kg (IQR: 17.2-25.9 kg) for women with overweight pre-pregnancy, and 13.6 kg (IQR: 8.6-20.9 kg) for women with obesity pre-pregnancy. Findings can inform the next generation of GWG recommendations for twin pregnancies.

Antigen dominance hierarchies shape TCF1+ progenitor CD8 T cell phenotypes in tumors.

CD8 T cell responses against different tumor neoantigens occur simultaneously, yet little is known about the interplay between responses and its impact on T cell function and tumor control. In mouse lung adenocarcinoma, we found that immunodominance is established in tumors, wherein CD8 T cell expansion is predominantly driven by the antigen that most stably binds MHC. T cells responding to subdominant antigens were enriched for a TCF1+ progenitor phenotype correlated with response to immune checkpoint blockade (ICB) therapy. However, the subdominant T cell response did not preferentially benefit from ICB due to a dysfunctional subset of TCF1+ cells marked by CCR6 and Tc17 differentiation. Analysis of human samples and sequencing datasets revealed that CCR6+ TCF1+ cells exist across human cancers and are not correlated with ICB response. Vaccination eliminated CCR6+ TCF1+ cells and dramatically improved the subdominant response, highlighting a strategy to optimally engage concurrent neoantigen responses against tumors.

Interest in Digital Dietary Support Among Adults With Kidney Failure Receiving Hemodialysis.

OBJECTIVE: This study assessed interest in digital dietary support among adults with kidney failure receiving hemodialysis. METHODS: We recruited English-speaking adults with kidney failure receiving hemodialysis 2+ times per week online and in dialysis clinics to complete a brief survey. Participants were asked if they were interested in participating in an online patient community with access to a registered dietitian (RD) (not at all, slightly, somewhat, very, or extremely interested). Participants who reported owning a smartphone or tablet computer were asked about their interest in communicating with an RD about their kidney diet using a secure app (not at all, slightly, somewhat, very, or extremely interested). RESULTS: Participants (N = 100) were on average 53.5 (standard deviation: 16.0) years old, 48% were female, and 69% non-Hispanic white. The majority (83%) went online daily in the past 4 weeks, 80% reported having a Facebook account, and 70% looked online for information about kidney failure in the past 4 weeks. Forty-six percent were very/extremely interested in participating in an online patient community with access to an RD (18%-66% across subgroups). Of the 83% of patients who owned a tablet and/or smartphone, 39% were very/extremely interested in using an app to communicate with an RD about their kidney diet (21%-58% across subgroups). CONCLUSIONS: In this relatively young and tech-connected sample of patients with kidney failure, many were interested in digital dietary support from an RD. Future research is needed to examine what patients desire in an online patient community and how digital support can complement and enhance support provided by RDs. RDs working with patients receiving hemodialysis may want to refer patients to evidence-based online resources and explore connecting with patients via social media or mobile app.

Characteristics Associated With Facebook Use and Interest in Digital Disease Support Among Older Adults With Atrial Fibrillation: Cross-Sectional Analysis of Baseline Data From the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) Cohort.

BACKGROUND: Online support groups for atrial fibrillation (AF) and apps to detect and manage AF exist, but the scientific literature does not describe which patients are interested in digital disease support. OBJECTIVE: The objective of this study was to describe characteristics associated with Facebook use and interest in digital disease support among older patients with AF who used the internet. METHODS: We used baseline data from the Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF), a prospective cohort of older adults (≥65 years) with AF at high stroke risk. Participants self-reported demographics, clinical characteristics, and Facebook and technology use. Online patients (internet use in the past 4 weeks) were asked whether they would be interested in participating in an online support AF community. Mobile users (owns smartphone and/or tablet) were asked about interest in communicating with their health care team about their AF-related health using a secure app. Logistic regression models identified crude and multivariable predictors of Facebook use and interest in digital disease support. RESULTS: Online patients (N=816) were aged 74.2 (SD 6.6) years, 47.8% (390/816) were female, and 91.1% (743/816) were non-Hispanic white. Roughly half (52.5%; 428/816) used Facebook. Facebook use was more common among women (adjusted odds ratio [aOR] 2.21, 95% CI 1.66-2.95) and patients with mild to severe depressive symptoms (aOR 1.50, 95% CI 1.08-2.10) and less common among patients aged ≥85 years (aOR 0.27, 95% CI 0.15-0.48). Forty percent (40.4%; 330/816) reported interest in an online AF patient community. Interest in an online AF patient community was more common among online patients with some college/trade school or Bachelors/graduate school (aOR 1.70, 95% CI 1.10-2.61 and aOR 1.82, 95% CI 1.13-2.92, respectively), obesity (aOR 1.65, 95% CI 1.08-2.52), online health information seeking at most weekly or multiple times per week (aOR 1.84, 95% CI 1.32-2.56 and aOR 2.78, 95% CI 1.86-4.16, respectively), and daily Facebook use (aOR 1.76, 95% CI 1.26-2.46). Among mobile users, 51.8% (324/626) reported interest in communicating with their health care team via a mobile app. Interest in app-mediated communication was less likely among women (aOR 0.48, 95% CI 0.34-0.68) and more common among online patients who had completed trade school/some college versus high school/General Educational Development (aOR 1.95, 95% CI 1.17-3.22), sought online health information at most weekly or multiple times per week (aOR 1.86, 95% CI 1.27-2.74 and aOR 2.24, 95% CI 1.39-3.62, respectively), and had health-related apps (aOR 3.92, 95% CI 2.62-5.86). CONCLUSIONS: Among older adults with AF who use the internet, technology use and demographics are associated with interest in digital disease support. Clinics and health care providers may wish to encourage patients to join an existing online support community for AF and explore opportunities for app-mediated patient-provider communication.

Social Media and Obesity in Adults: a Review of Recent Research and Future Directions.

PURPOSE OF REVIEW: Social media is widely used and has potential to connect adults with obesity with information and social support for weight loss and to deliver lifestyle interventions. The purpose of this review is to summarize recent observational and intervention research on social media and obesity. RECENT FINDINGS: Online patient communities for weight loss abound but may include misinformation. Systematic reviews and meta-analyses suggest that social media-delivered lifestyle interventions modestly impact weight, yet how social media was used and participant engagement varies widely. The rapidly changing social media landscape poses challenges for patients, clinicians, and researchers. Research is needed on how patients can establish supportive communities for weight loss and the role of clinicians in these communities. Emerging research on meaningful engagement in, and the efficacy and cost-effectiveness of, social media-delivered lifestyle interventions should provide insights into how to leverage social media to address the obesity epidemic.