Judged 3-Minute Oral Presentation Session II

Background/Significance:

Magnesium sulfate (Mg) is a safe and effective option for the management of atrial fibrillation or atrial flutter with rapid ventricular response (AFF RVR); however, the optimal dose is unknown. Prior research on its effectiveness has primarily used high-dose regimens (4-9g), which are associated with increased adverse effects, such as hypotension and bradycardia. Whether lower doses can provide comparable rate-control benefit while reducing adverse events is unknown.

Purpose:

The objective of this study is to compare the efficacy of lower doses of intravenous (IV) Mg to successfully decrease the ventricular rate to under 120 beats per minute (bpm) in the management of AFF RVR for patients receiving IV diltiazem.

Methods:

This is a prospective, double-blind, randomized controlled trial comparing Mg sulfate 2 g vs. 4 g vs. placebo for patients presenting with AFF RVR. All study patients receive standard weight based IV diltiazem after study drug administration is complete. The primary endpoint is rate control within the first 2 hours of IV Mg administration, defined as a ventricular rate of less than 120 bpm. Secondary endpoints include the mean change in heart rate (HR) at pre-specified time points after the administration of Mg and diltiazem and mean change in HR up to 24-hours after Mg infusion. Descriptive statistics, tests, chi-squared, and ANOVA tests were used for data analysis. All tests were two-tailed and p values of 0.05 were considered statistically significant. Power analysis indicated the need for 153 subjects, 51 in each group, to detect a difference of 40 bpm.

Results:

A total of 78 patients (n=24, n=26, and n=28 in the placebo, Mg 2 g, and Mg 4 g arms, respectively) were enrolled as of October 31, 2025. The percentage of patients who achieved rate control within 2 hours was 75% vs. 73% vs. 64% in the placebo, Mg 2 g, and Mg 4 g arms respectively (p=0.65). The mean reduction in HR at 15 minutes after Mg infusion was 1 bpm, 26 bpm, and 20 bpm in the placebo, Mg 2 g, Mg 4 g arms, respectively (p=0.008). There were no documented incidences of hypotension or bradycardia observed.

Conclusion:

Magnesium appears to demonstrate a statistically significant reduction in HR at 15 minutes compared 19 to placebo, without observed hypotension or bradycardia. These findings need to be validated with the full sample size, which is anticipated to provide sufficient power to detect a significant difference.

Background/Significance:

Post-operative pancreatic fistula (POPF) remains a challenging complication after distal pancreatectomy (DP). CT scan is commonly used to evaluate postop fluid collections/ POPF. We sought to identify predictive factors of POPF in our post-operative cohort with focus on patients who underwent post-operative CT due to suspicion for fistula at our institution.

Purpose:

The primary objective of this study was to evaluate the rate of POPF in all DP patients, and POPF in DP patients with negative post-operative CT (NegCT). We hypothesized that BMI (>30) would increase risk of NegCT in setting of POPF. The secondary objective of this analysis was to determine risk factors for pancreatic leak.

Methods:

A retrospective review of patients who underwent DP at community quaternary referral center was performed. Demographic information, operative details, and imaging data were collected for statistical analysis. Pearson’s Chi-squared test and multivariable logistic regression analysis were used for tests of significance.

Results:

158 patients underwent DP from 01/2017-12/2023; Of these patients, 32 (20%) developed clinically relevant (ISGPF Grade B/C) POPF. Most (63%, n = 99) had a CT scan within 90 days of surgery. Of these, 35 of 44 (80%) non-obese patients had NegCT compared to 37 of 55 (67%) obese patients. This difference was not statistically significant (p = 0.3). In patients with NegCT prior to discharge, 31% ultimately developed POPF (Grade A-C) compared to 22% with no CT prior to discharge (p = .02). LOS was greater in the NegCT pre-discharge vs. NoCT groups (median 7.0 [IQR 6-10] vs. 5.0 [4-6] days, p < 0.001). Factors associated with increased odds of pancreatic leak included higher BMI (OR 1.13 [95%CI 1.06-1.22] p < 0.001) and diabetes (OR 2.74 [1.05-7.82], p = 0.048). Younger age (OR 0.97 [0.94-1.00], p = 0.047) and decreased operative time (OR 0.96 [0.92-0.99], p = 0.027) were protective factors. Tobacco use had no significant effect (OR 1.29 [0.83-2.01], p = 0.3).

Conclusion:

POPF is a common complication of DP. Obesity was more common in patients with POPF but was less common in patients with occult POPF who had an initial NegCT. Clinical suspicion must remain high for early detection and management. A negative pre-discharge of CT was not associated with a decreased risk of POPF. Routine use of predischarge CT is not recommended for the early detection of POPF.

Background/Significance:

Catheter ablation via pulmonary vein isolation (PVI) is the first-line treatment for paroxysmal atrial fibrillation (PAF). It is unclear whether additional lesions with PVI using the pulsed field ablation (PFA) technique affect outcomes in this population.

Purpose:

We aimed to assess freedom from atrial arrythmias in patients with PAF stratified by lesion set at 12 months.

Methods:

From March 2024 to July 2024, PAF patients (n=184) from 4 different centers within a hospital system underwent first-time ablation with PFA. Recurrence was defined as any atrial arrhythmia ≥30 seconds in duration after a 90-day blanking period. Patients were divided into 2 groups: PVI only (PVI) (78, 42%) and PVI plus additional lesions in the left atrium (PVI plus) (106, 58%). A chi-square test was used for categorical variables, and the Wilcoxon rank-sum test was used for continuous variables. A Kaplan-Meier estimate was used to analyze freedom from recurrence in the PVI and PVI plus.

Results:

Median (IQR) age (years) was 64 (56, 69) in PVI and 68 (63, 75) in PVI plus (p=0.0002). Hypertension was significantly higher in PVI plus (77, 73%) compared to PVI (44, 56%), p=0.02. The mean (SD) CHA2DS2-VASc score was significantly higher in PVI plus (2.72 ±1.61) vs PVI (2.03 ±1.45), p=0.006. Additional baseline characteristics sex, race/ethnicity, body mass index, diabetes mellitus, coronary artery disease, cerebrovascular accident, obstructive sleep apnea, valvular heart disease, congestive heart failure, prior anti-arrhythmic drug use and left atrial volume index were similar (p>0.05). There was no difference in recurrence at 12 months between groups from the four centers (p=0.71).

Conclusion:

Findings at 12 months suggested additional lesions may not affect freedom from atrial arrhythmia recurrence, but future multivariate analysis is warranted. Randomized studies are needed to validate these results.

Background/Significance:

Transhiatal Endoscopic with Transcervical Endoscopic Esophageal Mobilization (THE TEEM) esophagectomy is a minimally invasive novel approach to treating esophageal cancers and is a technically demanding operation requiring multiple surgical specialties. This study aims to identify the learning curve for this novel approach.

Purpose:

To evaluate the learning curve for a novel approach to esophagectomy.

Methods:

A retrospective review of 154 consecutive patients who underwent THE TEEM between 2/2015 and 12/2021 was conducted. Patients were divided into chronologic quartiles by surgery date (Q1-Q4). Demographics and perioperative outcomes were compared, including length of stay (LOS), intensive care unit (ICU) disposition, ICU LOS, operative time, and lymph node yield. Continuous variables were compared using Kruskal-Wallis testing; categorical variables with chi-square testing.

Results:

Overall, 154 patients underwent THE TEEM and were divided into quartiles by date of surgery (Q1 n=39, Q2 n=38, Q3 n=38, Q4 n=39). Median age 68 years (IQR 60-74), 18.2% female, and 61.7% were treated at St. Luke’s. Tumors were primarily lower third (91.6%) and adenocarcinoma (85.1%); 84.4% received neoadjuvant therapy. Across quartiles, there were significant improvements in perioperative efficiency and resource utilization. Median operative time decreased from 231 min (IQR 208-257.5) in Q1 to 170 min (IQR 150.5-184) in Q4 (p<0.001). LOS declined from a median of 9 days (IQR 7-11) in Q1 to 5 days (IQR 4-6) in Q4 (p<0.001). ICU disposition decreased markedly, from 100% in Q1 and Q2 to 73.7% in Q3 and 23.1% in Q4. ICU length of stay decreased from 3 days (IQR 2-4) in Q1 to 0 days (IQR 0-0.5) in Q4 (p<0.001).

Conclusion:

Proficiency for THE TEEM approach to esophagectomy occurred after approximately 110 operations. Operative time, ICU admission rate, and hospital LOS decreased markedly with experience.

Background/Significance:

Patients with cardiac amyloidosis (CA) are at high risk for morbidity. It remains unclear which biomarkers or echocardiographic parameters can help identify CA patients at the highest risk of short-term hospitalization.

Purpose:

We investigated whether biomarkers or echocardiographic parameters could help identify CA patients at the highest risk of hospitalization within one year.

Methods:

We performed a single-center cohort study of all CA patients from 2019 to 2025 who had a left ventricular ejection fraction (LVEF) and right ventricular- pulmonary arterial pressure coupling (RV-PA coupling ratio) reported at baseline. Patients were divided into groups based on number of heart failure hospitalizations at 1 year: 0 vs 1-2 vs ≥ 2 hospitalizations. The cardiac biomarker N-Terminal pro B-type natriuretic peptide (NTproBNP) and echo-based parameters e.g. LVEF, tricuspid annular plane systolic excursion (TAPSE), and RV-PA coupling ratio as defined by TAPSE/pulmonary artery systolic pressure were compared across groups.

Results:

65 patients were included for analysis (mean age = 78 years, 80% female). 25 patients had Hereditary Transthyretin (TTR) CA, 20 were Wild Type TTR CA, 2 patients AL CA, and 18 had unknown subtypes. Median NTproBNP levels were significantly higher among patients with increasing number of hospitalizations within one year (0 vs 1-2 vs ≥ 2, 1618 pg/mL vs 3036 pg/mL vs 8006 pg/mL, p<0.0001). Other echocardiographic markers such as baseline LVEF (50% vs 46% vs 45%, p=0.368), baseline TAPSE (15.5mm vs 14mm vs 16.5mm, p=0.185), and baseline RV-PA coupling (0.38 vs 0.32 vs 0.4, p=0.06) did not differ between groups.

Conclusion:

Amongst CA patients, increasing NTproBNP levels were associated with an increasing number of heart failure hospitalizations within one year of CA diagnosis. Echocardiographic parameters did not appear to identify patients at a higher risk of short-term hospitalization in our population. Further research is needed to understand which CA subgroups are at the highest risk of short-term morbidity and thus might benefit from early intervention.

Background/Significance:

Depression and anxiety are serious and alarmingly common challenges adolescents face, with 19.2% of teens screening positive for depression in 2023. Many barriers to mental health care exist, including social stigma, treatment cost, and limited provider availability. Little is known on the utility of other supplemental mental health tools for teens. Mental health wearables are a novel concept, with limited past research. To our knowledge, no studies have evaluated the effects of nonelectronic wearable tools on adolescents’ mental health.

Purpose:

The purpose of the pilot study was to distribute LIVE FOR Bands (LFBs) to Adolescent Medicine Clinic patients and obtain feedback to understand the utility and potential benefits of wearing LFBs. Ultimately, we hope to prove that LFBs are a simple way to support mental health among adolescents.

Methods:

The LIVE FOR Pilot Study is a prospective, single site, observational study to identify the utility and benefits of wearing LFBs. Adolescent Medicine Clinic patients age 12+ at the AMG Outpatient Center in Aurora, IL were eligible to participate. LFBs were customized based on patient preference, assembled by the study team, and shipped to participants within one week of enrollment. After 4-6 weeks, participants returned for a routine follow-up visit where they completed a 13-question feedback survey. Data was collected, managed, and analyzed in REDCap. Descriptive statistics, including means and frequencies, were generated for key variables.

Results:

LFBs were distributed to 46 patients between August-December 2025. Thirty patients (65%) completed the REDCap survey. Twenty-three (76.7%) identified as female, 7 (23.3%) identified as male, and the mean age was 15.7. Utilization of LFBs was high, with 12 (40.0%) participants wearing LFBs every day, and 5 (16.7%) wearing LFBs 4-6 days per week. Participants identified benefits to wearing the LFB, with 24 (80.0%) stating that the LFB helped them cope or improve their mood, and 27 (93.1%) stating that wearing the LFB reminded them of something/someone positive in their life. Nearly all participants (96.7%) would recommend LFBs to a friend or family member.

Conclusion:

LFBs can serve as a supplemental mental health tool to help promote positive coping among teens.

Background/Significance:

High-flow nasal cannula and low-flow nasal cannula are widely used in bronchiolitis, the leading cause of infant hospitalization. Limited evidence informs optimal duration of monitoring after discontinuing oxygen before discharge, resulting in wide practice variation.

Purpose:

Our primary objective was to determine if the duration of monitoring patients with bronchiolitis off supplemental oxygen before discharge was associated with differences in 7- and 30-day emergency department (ED) visit or hospital readmission rates. Our secondary objective was to assess how the following characteristics are associated with observation time off oxygen: age, prematurity, last oxygen modality used, viral pathogen, time of oxygen discontinuation, intravenous fluids (IVF) or nasogastric (NG) feeds during hospitalization, and length of stay.

Methods:

This retrospective cohort study included 970 patients 0-24 months admitted with bronchiolitis (identified by ICD-10 codes) on the general pediatric floor at both campuses of Advocate Children’s Hospital between 11/1/2022-11/30/2024. Observation time off oxygen was divided into 6 groups for analysis (1-3.9, 4-5.9, 6-7.9, 8-11.9, 12-23.9, and 24+ hours). Logistic regression models assessed association between time off oxygen and revisit rates. Linear relationships between patient characteristics and time off oxygen were assessed through Pearson correlation. Significance was defined as p < 0.05.

Results:

Across the 6 groups of observation times, there were no significant differences in 7-day all cause or respiratory related ED visit or readmission rates (all p > 0.45). 30-day respiratory ED visits showed a difference across groups (p = 0.020), with the 8-11.9 hour group having the highest rate, although absolute differences were small. Younger age and use of IVF or NG feeds were associated with longer observation off oxygen. Median age was 6 months in the 24+ hour observation group, compared to 11 months in the 0-3.9 hour group.

Conclusion:

In this retrospective cohort study of infants with bronchiolitis, shorter observation time off oxygen was not associated with increased risk of 7- or 30-day ED visit or readmission rates. This represents an area in which providers may safely do less. Younger patients and those with concurrent dehydration/feeding difficulties were observed longer. Further studies are needed to inform the optimal observation of time off oxygen in bronchiolitis.