e16547
Background: In 2021, there was an estimated 76,000 patients diagnosed with kidney cancer in the United States, and 90% of these patients were diagnosed with renal cell carcinoma (RCC). The ...current treatment for RCC is the use of immune checkpoint inhibitors (ICIs), which allow the body to naturally fight against cancer cells without impedance. A common side effect of this therapy, however, is immunotherapy-related adverse events (irAE), which are toxicities where the bodies overactive immune system attacks noncancerous organs. When irAEs arise, the patient’s immunotherapy is stopped, and a steroid regiment is begun to dampen the immune system before re-starting immunotherapy. Time is crucial when treating irAEs, and this study is aimed to identify barriers in the onset of steroid treatment and identify interventions that can help providers and patients identify toxicities and begin steroid treatment as soon as possible. Methods: We conducted a retrospective study analyzing adult patients (ages 18-75) being treated for RCC at UT Southwestern Medical Center and Moncrief Cancer Institute (MCI). We specifically looked at patients being treated with ipilimumab, nivolumab, and pembrolizumab. The first portion included a chart review to identify patients and identify barriers to prompt treatment, i.e. fear of worsening hyperglycemia in diabetics, access to healthcare, delay of re-initiating immunotherapy. The second portion of this study will be to identify and test a possible intervention for these patients to ensure timely recognition of toxicities and prompt initiation of steroids. Results: Upon review of 201 patients with RCC stage III/IV, the most common toxicity found was colitis (28.4%), followed by transaminitis (9.0%) and pneumonitis (9.0%). The most common method for identification of toxicities was routine lab work performed before immunotherapy administration (30.4%), check-ins at regularly scheduled appointments (21.7%), and after-hour physician telephone lines (19.6%). Additionally, the average time from irAE identification to steroid administration was 1.45 days. Excluding toxicities found either at office appointments or on routine lab work, the average time to steroids from identification was 3.55 days. Our data collection also demonstrated that routine labs were the most likely factor to identify immunotherapy toxicity in a timely manner. Conclusions: Continuation of current practices can lead to further decreases in time to steroid treatment. This study can be used as a blueprint and expanded to further investigate irAEs in other solid tumors as well as contribute to management of the ever-evolving immunotherapy landscape.
Introduction During slow-wave sleep, episodic memories are reactivated and consolidated. Using the targeted memory reactivation (TMR) technique, we can facilitate this memory consolidation process by ...presenting the sensory stimuli that were paired with the episodic memories during slow-wave sleep. Several studies have shown the effectiveness of TMR in learning word lists; however, the field lacks data on whether TMR facilitates the learning of classroom materials or whether such effects are long-lasting. Methods Fifty college students (mean age=21.16±2.77, 70% female) completed a college-level microeconomics lecture while listening to classical music. After the lecture, when participants entered slow-wave sleep, we randomly assigned them to TMR (replay the identical classical music) or control (white noise) conditions. The next morning, all participants completed a microeconomics test which contained questions that they were trained to solve (trained questions) and questions that required application of learned principles (novel questions). Approximately nine months later, 31 participants completed a similar follow-up microeconomics test. Results We excluded participants who discontinued the study, experienced protocol deviations, or did not have music/white noise played during slow wave sleep (N=41 remaining). Prior to randomization, the two groups performed similarly during the lecture (control: 84.85±9.50%, TMR: 85.53±13.28%, p=.85). Importantly, the next morning, the TMR group outperformed the control group on the trained questions (control: 58.33±29.39%, TMR: 72.22±27.09%, p=.13) and novel questions (control: 28.79±26.93%, TMR: 47.37±31.83%, p=.05). This immediate benefit of TMR was not significantly sustained at the nine month follow-up for trained questions (control: 34.82±23.24%, TMR: 32.41±23.79%, p=.79) or novel questions (control: 11.11±11.88%, TMR: 22.22±26.80%, p=.20). Conclusion The benefits of slow-wave based TMR translate to complex, ecologically-valid educational learning materials. This benefit included application of learned principles to solve novel problems, which is key to academic success. However, because the effects of a single TMR session are short-lived, future research should test whether multiple sessions of TMR facilitates long-term learning outcomes in classroom settings. Support (If Any) N/A
Introduction Organic chemistry is an infamous course for many STEM and pre-health undergraduate students. Failure and drop-out rates in organic chemistry range from 30-50%, with 75% of students who ...drop the pre-medical designation indicating struggling with organic chemistry as the primary reason. Some concerning research indicates that drop-out rates are disproportionately elevated in female students. There are currently no data on whether sleep impacts organic chemistry outcomes, but previous laboratory work suggests that mild sleep restriction can impair learning and increase stress reactivity. Methods Participants included 100 college undergraduate students who had not previously taken organic chemistry. We developed an interactive lecture and exam to simulate a prototypical organic chemistry class. Prior to taking the lecture, we randomly assigned participants to either normal time in bed (8 hours) or restricted time in bed (6 hours). Sleep/wake state was monitored using wristband actigraphy, and experimenters were masked to participant conditions using sealed envelopes. When participants returned to take the lecture, we applied blood pressure and electrocardiography monitors, and asked them to estimate how well they would learn the material and perform on a later test (meta-cognition). Results Prior to taking the lecture, female participants were significantly less confident in their ability to learn organic chemistry if they were sleep restricted (M=45.6%) than if they were well-rested (M=55.9%), p<.05. Females’ pre-lecture estimates were well-calibrated to their actual test performance in the normal sleep condition (M=62.6%), p>.05, but very miscalibrated in the sleep restriction condition (M=66.9%), p<.001. Male participants were not significantly affected by the mild sleep restriction manipulation, ps >.05. Additional analyses will include physiological measurements of stress reactivity (e.g., heart rate variability). Conclusion Female students may experience heightened anticipatory stress, diminishing their confidence in being able to learn organic chemistry. In laboratory settings, such students can overcome a single night of mild sleep restriction, and low meta-cognitive predictions, to perform well on an organic chemistry test. However, in naturalistic settings, sleep-loss-induced stress and poor meta-cognitive awareness may increase risk for course drop-out. Support (If Any) N/A
PDF
