Medicine and Health Sciences Commons^™

Establishing Diagnostic Criteria For Degenerative Cervical Myelopathy [Ao Spine Recode-Dcm Research Priority Number 3], Bryn Hilton, Emma L Gardner, Zhilin Jiang, Lindsay Tetreault, Jamie R F Wilson, Carl Moritz Zipser, K Daniel Riew, James D Guest, James Harrop, Michael G Fehlings, Ricardo Rodrigues-Pinto, Vafa Rahimi-Movaghar, Bizhan Aarabi, Paul A Koljonen, Mark R N Kotter, Benjamin M Davies, Brian K Kwon

Department of Neurosurgery Faculty Papers

Study design: Narrative review.

Objectives: To discuss the importance of establishing diagnostic criteria in Degenerative Cervical Myelopathy (DCM), including factors that must be taken into account and challenges that must be overcome in this process.

Methods: Literature review summarising current evidence of establishing diagnostic criteria for DCM.

Results: Degenerative Cervical Myelopathy (DCM) is characterised by a degenerative process of the cervical spine resulting in chronic spinal cord dysfunction and subsequent neurological disability. Diagnostic delays lead to progressive neurological decline with associated reduction in quality of life for patients. Surgical decompression may halt neurologic worsening and, in many cases, improves function. …

Degenerative Cervical Myelopathy: Development And Natural History [Ao Spine Recode-Dcm Research Priority Number 2]., Aria Nouri, Enrico Tessitore, Granit Molliqaj, Torstein Meling, Karl Schaller, Hiroaki Nakashima, Yasutsugu Yukawa, Josef Bednarik, Allan R Martin, Peter Vajkoczy, Joseph S Cheng, Brian K Kwon, Shekar N Kurpad, Michael G Fehlings, James S Harrop, Bizhan Aarabi, Vafa Rahimi-Movaghar, James D Guest, Benjamin M Davies, Mark R N Kotter, Jefferson R Wilson

Department of Neurosurgery Faculty Papers

Study design: Narrative review.

Objectives: To discuss the current understanding of the natural history of degenerative cervical myelopathy (DCM).

Methods: Literature review summarizing current evidence pertaining to the natural history and risk factors of DCM.

Results: DCM is a common condition in which progressive arthritic disease of the cervical spine leads to spinal cord compression resulting in a constellation of neurological symptoms, in particular upper extremity dysfunction and gait impairment. Anatomical factors including cord-canal mismatch, congenitally fused vertebrae and genetic factors may increase individuals' risk for DCM development. Non-myelopathic spinal cord compression (NMSCC) is a common phenomenon with a prevalence …

Developing Peri-Operative Rehabilitation In Degenerative Cervical Myelopathy [Ao Spine Recode-Dcm Research Priority Number 6]: An Unexplored Opportunity?, Timothy F Boerger, Allison S Hyngstrom, Julio C Furlan, Sukhvinder Kalsi-Ryan, Armin Curt, Brian K Kwon, Shekar N Kurpad, Michael G Fehlings, James Harrop, Bizhan Aarabi, Vafa Rahimi-Movaghar, James D Guest, Jefferson R Wilson, Benjamin M Davies, Mark R N Kotter, Paul A Koljonen

Department of Neurosurgery Faculty Papers

Study design: Narrative review.

Objective: Degenerative cervical myelopathy is one of the most frequent impairments of the spinal cord encountered internationally in adults. Currently, surgical decompression is the recommended treatment for people with DCM (PwCM) presenting with moderate to severe symptoms or neurological deficits. However, despite surgical intervention, not all patients make a complete recovery due to the irreversible tissue damage within the spinal cord. The objective of this review is to describe the state and gaps in the current literature on rehabilitation for PwCM and possible innovative rehabilitation strategies.

Methods: Literature search.

Results: In other neurological disorders such as …

A New Framework For Investigating The Biological Basis Of Degenerative Cervical Myelopathy [Ao Spine Recode-Dcm Research Priority Number 5]: Mechanical Stress, Vulnerability And Time, Benjamin M Davies, Oliver Mowforth, Aref-Ali Gharooni, Lindsay Tetreault, Aria Nouri, Rana S Dhillon, Josef Bednarik, Allan R Martin, Adam Young, Hitoshi Takahashi, Timothy F Boerger, Virginia Fj Newcombe, Carl Moritz Zipser, Patrick Freund, Paul Aarne Koljonen, Ricardo Rodrigues-Pinto, Vafa Rahimi-Movaghar, Jefferson R Wilson, Shekar N Kurpad, Michael G Fehlings, Brian K Kwon, James Harrop, James D Guest, Armin Curt, Mark R N Kotter

Department of Neurosurgery Faculty Papers

Study design: Literature Review (Narrative).

Objective: To propose a new framework, to support the investigation and understanding of the pathobiology of DCM, AO Spine RECODE-DCM research priority number 5.

Methods: Degenerative cervical myelopathy is a common and disabling spinal cord disorder. In this perspective, we review key knowledge gaps between the clinical phenotype and our biological models. We then propose a reappraisal of the key driving forces behind DCM and an individual's susceptibility, including the proposal of a new framework.

Results: Present pathobiological and mechanistic knowledge does not adequately explain the disease phenotype; why only a subset of patients with …

Partial Treatment Response To Capmatinib In Met-Amplified Metastatic Intrahepatic Cholangiocarcinoma: Case Report & Review Of Literature, Daniel S Lefler, Marni Brisson Tierno, Babar Bashir

Department of Medical Oncology Faculty Papers

Cholangiocarcinoma is a highly morbid gastrointestinal malignancy for which available therapies are limited. Standard of care includes cytotoxic chemotherapies such as gemcitabine, platinum agents, nab-paclitaxel, and fluoropyrimidine analogues. However, tolerability of these regimens varies, and patients who do not tolerate chemotherapy have limited targeted therapies and immunotherapy options. In cholangiocarcinoma, mesenchymal-epithelial transition factor (MET) amplification may present an additional opportunity for a targeted therapeutic approach, especially considering emerging data in non-small cell lung cancer. In this case, we present a metastatic cholangiocarcinoma patient with high-level MET gene amplification for whom capmatinib, a tyrosine kinase inhibitor with activity against c-MET, …

Chronoradiobiology Of Breast Cancer: The Time Is Now To Link Circadian Rhythm And Radiation Biology, Nicolas Nelson, Joseph Lombardo, Lauren Matlack, Alexandria Smith, Kamryn Hines, Wenyin Shi, Nicole L Simone

Department of Radiation Oncology Faculty Papers

Circadian disruption has been linked to cancer development, progression, and radiation response. Clinical evidence to date shows that circadian genetic variation and time of treatment affect radiation response and toxicity for women with breast cancer. At the molecular level, there is interplay between circadian clock regulators such as PER1, which mediates ATM and p53-mediated cell cycle gating and apoptosis. These molecular alterations may govern aggressive cancer phenotypes, outcomes, and radiation response. Exploiting the various circadian clock mechanisms may enhance the therapeutic index of radiation by decreasing toxicity, increasing disease control, and improving outcomes. We will review the body’s natural circadian …

A Word From The Writing Center (February 2022), Pam Walter, Mfa, Liz Declan, Ma, Mfa

A Word From the Writing Team (Newsletter)

This issue includes:

• Introduction to Liz Declan
• Upcoming Workshops
• Quick Tip: When to Use Semicolons

Secondary Syphilis Mimicking Marginal Zone B-Cell Lymphoma, E. Correia, Laura Gleason, Shalini Krishnasamy, Alexa Cohen, Safiyyah Bhatti, Neda Nikbakht

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

A Twist To The Kirby-Bauer Disk Diffusion Susceptibility Test: An Accessible Laboratory Experiment Comparing Haloferax Volcanii And Escherichia Coli Antibiotic Susceptibility To Highlight The Unique Cell Biology Of Archaea, Heather Schiller, Criston Young, Stefan Schulze, Manuela Tripepi, Mechthild Pohlschroder

College of Life Sciences Faculty Papers

Archaea, once thought to only live in extreme environments, are present in many ecosystems, including the human microbiome, and they play important roles ranging from nutrient cycling to bioremediation. Yet this domain is often overlooked in microbiology classes and rarely included in laboratory exercises. Excluding archaea from high school and undergraduate curricula prevents students from learning the uniqueness and importance of this domain. Here, we have modified a familiar and popular microbiology experiment-the Kirby-Bauer disk diffusion antibiotic susceptibility test-to include, together with the model bacterium Escherichia coli, the model archaeon Haloferax volcanii. Students will learn the differences and similarities between …

Comparison Of Automated Ribotyping, Spa Typing, And Mlst In 108 Clinical Isolates Of Staphylococcus Aureus From Orthopedic Infections, Stefano Ravaioli, Davide Campoccia, Werner Ruppitsch, Franz Allerberger, Alessandro Poggi, Emanuele Chisari, Lucio Montanaro, Carla Renata Arciola

Rothman Institute Papers

108 isolates of Staphylococcus aureus, belonging to six large ribogroups according to the automated Ribo-Printer® system, were studied with two highly used molecular methods for epidemiological studies, namely multi-locus sequence typing (MLST) and spa typing, followed by BURP and eBURST v3 analysis for clustering spa types and sequence (ST) types. The aim was to evaluate whether automated ribotyping could be considered a useful screening tool for identifying S. aureus genetic lineages with respect to spa typing and MLST. Clarifying the relationship of riboprinting with these typing methods and establishing whether ribogroups fit single clonal complexes were two main objectives. …

Extreme Longevity: Analysis Of The Direct Or Indirect Influence Of Environmental Factors On Old, Nonagenarians, And Centenarians In Cilento, Italy, Silvana Mirella Aliberti, Francesco De Caro, Richard H W Funk, Luigi Schiavo, Joseph S. Gonnella, Giovanni Boccia, Mario Capunzo

Department of Medicine Faculty Papers

Longevity is rightly considered one of the greatest achievements of modern society, an achievement understood as the possibility of increasing the healthy part of life and not only its full duration. This study investigated the phenomenon of regional longevity in Cilento by analyzing the association between longevity indicators and some environmental factors, in order to understand if factors such as altitude, climate, UNESCO protected areas, and hinterland can directly or indirectly influence the measure of healthy living and lead to longevity. Demographic and environmental data were collected through the Archives of the Cilento municipalities, the National Institute of Statistics, the …

Burnout: Exploring The Differences Between U.S. And International Medical Graduates., Joan E St Onge, Heidi Allespach, Yvonne Diaz, Alexandria Poitier, Leonardo Tamariz, Charles Paidas, Ana Palacio

Department of Surgery Faculty Papers

Background: International medical graduates (IMGs) have less burnout than U. S. medical school graduates (USMGs) during residency training. This study evaluates possible correlates of differences in burnout rates between USMGs and IMGs.

Methods: We surveyed 375 first-year residents at orientation in June/July 2017. We assessed burnout using the Copenhagen Burnout Inventory (CBI) and used validated scales to measure stress, quality of life (QoL), mastery, and spirituality. We collected data on gender, place of graduation, language fluency, and specialty. We compared CBI scores between USMGs and IMGs, performed a multivariate linear regression analysis of relationships between covariates and CBI subscales, and …

Alcohol Consumption, Bone Mineral Density, And Risk Of Osteoporotic Fractures: A Dose-Response Meta-Analysis, Justyna Godos, Francesca Giampieri, Emanuele Chisari, Agnieszka Micek, Nadia Paladino, Tamara Y Forbes-Hernández, José L Quiles, Maurizio Battino, Sandro La Vignera, Giuseppe Musumeci, Giuseppe Grosso

Rothman Institute Papers

Excess alcohol consumption is known to be detrimental to human health. However, the role of light-to-moderate alcohol intake is under investigation for potential certain health benefits— mostly related to the cardiovascular system. Nevertheless, there is no univocal agreement on this matter, and research is still ongoing to clarify whether there might be other potential outcomes affected by alcohol intake. In this regard, there is evidence that excess alcohol intake may negatively influence the risk of osteoporotic fractures. However, there is no comprehensive evidence of literature assessing the role of alcohol consumption in bone mineral density (BMD) and the risk of …

The Demographics Of Pain After Spinal Cord Injury: A Survey Of Our Model System., James J Bresnahan, Benjamin R Scoblionko, Devon Zorn, Daniel E Graves, Eugene R Viscusi

Department of Anesthesiology Faculty Papers

STUDY DESIGN: Survey OBJECTIVES: Better understand the demographics of pain after spinal cord injury (SCI).

SETTING: Academic Level 1 trauma center and SCI Model System.

METHODS: A survey including general demographic questions, questions of specific interest to the authors, the standardized SCI Pain Instrument (SCIPI), International SCI Pain Data Set, Basic form (ISCIPDS:B), Patient Reported Outcomes Measurement Information System (PROMIS) neuropathic 5a (PROMIS-Neur), and PROMIS nociceptive 5a (PROMIS-No).

RESULTS: 81% of individuals with SCI experience chronic pain and 86% of individuals with pain have neuropathic pain. 55% of individuals had shoulder pain. Females and those who recall >5/10 pain during …

Colonoscopy Standardization: Insurance Verification And Direct Access, Connor Crutchfield, Jacqueline Chen, Kiernan Mcnelis, Luke Kelly

Physician Executive Leadership-Plus (PEL-Plus)

Outline

• Background
• Problem Scope
• Approach
• Progress
• Recommendations

Diabetic Care Pathway, Shalini Bansal, Kayla Brockmeyer, Nick Kieran

Physician Executive Leadership-Plus (PEL-Plus)

Presentation Outline

• The Impact of Diabetes
• Problem Statement
• Solution
• Looking to the Future

Evaluating Driver Fatigue Measures, Mia Belovsky, Stanton B. Miller, Md

Physician Executive Leadership-Plus (PEL-Plus)

No abstract provided.

3d Printed Liver In Surgery Education, Sara Belko, David Gordon, Yash Shah

Physician Executive Leadership-Plus (PEL-Plus)

No abstract provided.

Medication Reconciliation: Defining The Standard Of Care, Jenna Mandel, Matthew Matthew Piechnik, Rahul Muchintala

Physician Executive Leadership-Plus (PEL-Plus)

No abstract provided.

Corrigendum To: Impact Of Lymphopenia On Survival For Elderly Patients With Glioblastoma: A Secondary Analysis Of The Cctg Ce.6 (Eortc 26062-22061, Trog 08.02) Randomized Clinical Trial., Andrew J Song, Keyue Ding, Iyad Alnahhas, Normand J Laperriere, James Perry, Warren P Mason, Chad Winch, Chris J O'Callaghan, Johan J Menten, Alba A Brandes, Claire Phillips, Michael F Fay, Ryo Nishikawa, David Osoba, J Gregory Cairncross, Wilson Roa, Wolfgang Wick, Wenyin Shi

Department of Radiation Oncology Faculty Papers

[This corrects the article DOI: 10.1093/noajnl/vdab153.].

Reactive Oxygen Species Reprogram Macrophages To Suppress Antitumor Immune Response Through The Exosomal Mir-155-5p/Pd-L1 Pathway, Xiang Li, Shaomin Wang, Wei Mu, Jennifer Barry, Anna Han, Richard L Carpenter, Bing-Hua Jiang, Stephen C Peiper, M G Mahoney, A E Aplin, Hong Ren, Jun He

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background: Cancer cells have an imbalance in oxidation-reduction (redox) homeostasis. Understanding the precise mechanisms and the impact of the altered redox microenvironment on the immunologic reaction to tumors is limited.

Methods: We isolated exosomes from ovarian cancer cells through ultracentrifuge and characterized by Western-blots and Nanoparticle Tracking Analysis. 2D, 3D-coculture tumor model, and 3D live cell imaging were used to study the interactions between tumor cells, macrophages and CD3 T cells in vitro. The role of exosomal miR-155-5p in tumor growth was evaluated in xenograft nude mice models and immune-competent mice models. Flow cytometry and flow sorting were used to …

Crossroads Of Drug Abuse And Hiv Infection: Neurotoxicity And Cns Reservoir, Shilpa Sonti, Kratika Tyagi, Amit Pande, René Daniel, Adhikarimayum Lakhikumar Sharma, Mudit Tyagi

Center for Translational Medicine Faculty Papers

Drug abuse is a common comorbidity in people infected with HIV. HIV-infected individuals who abuse drugs are a key population who frequently experience suboptimal outcomes along the HIV continuum of care. A modest proportion of HIV-infected individuals develop HIV-associated neurocognitive issues, the severity of which further increases with drug abuse. Moreover, the tendency of the virus to go into latency in certain cellular reservoirs again complicates the elimination of HIV and HIV-associated illnesses. Antiretroviral therapy (ART) successfully decreased the overall viral load in infected people, yet it does not effectively eliminate the virus from all latent reservoirs. Although ART increased …

Utility Of Blood As The Clinical Specimen For The Diagnosis Of Ocular Toxoplasmosis Using Uracil Dna Glycosylase-Supplemented Loop-Mediated Isothermal Amplification And Real-Time Polymerase Chain Reaction Assays Based On Rep-529 Sequence And B1 Gene, Bahman Rahimi Esboei, Shirzad Fallahi, Mohammad Zarei, Bahram Kazemi, Mehdi Mohebali, Saeedeh Shojaee, Parisa Mousavi, Aref Teimouri, Raziyeh Mahmoudzadeh, Mirataollah Salabati, Hossein Keshavarz Valian

Wills Eye Hospital Papers

Background: Ocular infection with Toxoplasma gondii is a major preventable cause of blindness, especially in young people. The aim of the present study was to assess detection rate of T. gondii DNA in blood samples of clinically diagnosed of ocular toxoplasmosis using uracil DNA glycosylase-supplemented loop-mediated isothermal amplification (UDG-LAMP) and real-time quantitative PCR (qPCR) based on REP-529 and B1.

Methods: One hundred and seventeen patients with clinically diagnosed ocular toxoplasmosis (OT) were participated in the study as well as 200 control patients. Peripheral blood samples were assessed using UDG-LAMP and qPCR techniques targeting REP-529 and B1.

Results: Detection limits of …

Pathogenic Tnf-Α Drives Peripheral Nerve Inflammation In An Aire-Deficient Model Of Autoimmunity, Yan Wang, Lily Guo, Xihui Yin, Ethan C Mccarthy, Mandy I Cheng, Aline T Hoang, Ho-Chung Chen, Anushi Y Patel, Denise Allard Trout, Erin Xu, Natalie Yakobian, Willy Hugo, James F Howard, Katherine M Sheu, Alexander Hoffmann, Melissa G Lechner, Maureen A Su

Department of Neurology Faculty Papers

Immune cells infiltrate the peripheral nervous system (PNS) after injury and with autoimmunity, but their net effect is divergent. After injury, immune cells are reparative, while in inflammatory neuropathies (e.g., Guillain Barré Syndrome and chronic inflammatory demyelinating polyneuropathy), immune cells are proinflammatory and promote autoimmune demyelination. An understanding of immune cell phenotypes that distinguish these conditions may, therefore, reveal new therapeutic targets for switching immune cells from an inflammatory role to a reparative state. In an autoimmune regulator (Aire)-deficient mouse model of inflammatory neuropathy, we used single-cell RNA sequencing of sciatic nerves to discover a transcriptionally heterogeneous cellular landscape, including …

Synthesis, Characterization And Physicochemical Properties Of Biogenic Silver Nanoparticle-Encapsulated Chitosan Bionanocomposites, Sreelekha Ediyilyam, Mahesh M Lalitha, Bini George, Sarojini Sharath Shankar, Stanisław Wacławek, Miroslav Černík, Vinod Vellora Thekkae Padil

Department of Medicine Faculty Papers

Green bionanocomposites have garnered considerable attention and applications in the pharmaceutical and packaging industries because of their intrinsic features, such as biocompatibility and biodegradability. The work presents a novel approach towards the combined effect of glycerol, tween 80 and silver nanoparticles (AgNPs) on the physicochemical properties of lyophilized chitosan (CH) scaffolds produced via a green synthesis method.The produced bionanocomposites were characterized with the help of Fourier transform infrared spectroscopy (FTIR) and Scanning electron microscopy (SEM). The swelling behavior, water vapor transmission rate, moisture retention capability, degradation in Hanks solution, biodegradability in soil, mechanical strength and electrochemical performance of the composites …

Langerhans Cells And Cdc1s Play Redundant Roles In Mrna-Lnp Induced Protective Anti-Influenza And Anti-Sars-Cov-2 Immune Responses, Sonia Ndeupen, Aurélie Bouteau, Christopher Herbst, Zhen Qin, Sonya Jacobsen, Nicholas E Powers, Zachary Hutchins, Drishya Kurup, Leila Zabihi Diba, Megan Watson, Holly Ramage, Botond Z. Igyártó

Department of Microbiology and Immunology Faculty Papers

Nucleoside modified mRNA combined with Acuitas Therapeutics' lipid nanoparticles (LNPs) has been shown to support robust humoral immune responses in many preclinical animal vaccine studies and later in humans with the SARS-CoV-2 vaccination. We recently showed that this platform is highly inflammatory due to the LNPs' ionizable lipid component. The inflammatory property is key to support the development of potent humoral immune responses. However, the mechanism by which this platform drives T follicular helper (Tfh) cells and humoral immune responses remains unknown. Here we show that lack of Langerhans cells or cDC1s neither significantly affected the induction of PR8 HA …

A Taxonomy Of Childhood Pedal Cyclist Injuries From Latent Class Analysis: Associations With Factors Pertinent To Prevention, Joseph Piatt

Department of Neurosurgery Faculty Papers

Background: Studies of pedal cyclist injuries have largely focused on individual injury categories, but every region of the cyclist's body is exposed to potential trauma. Real-world injury patterns can be complex, and isolated injuries to one body part are uncommon among casualties requiring hospitalization. Latent class analysis (LCA) may identify important patterns in heterogeneous samples of qualitative data.

Methods: Data were taken from the Trauma Quality Improvement Program of the American College of Surgeons for 2017. Inclusion criteria were age 18 years or less and an external cause of injury code for pedal cyclist. Injuries were characterized by Abbreviated Injury …

Interplay Between An Atp-Binding Cassette F Protein And The Ribosome From Mycobacterium Tuberculosis, Zhicheng Cui, Xiaojun Li, Joonyoung Shin, Howard Gamper, Ya-Ming Hou, James C Sacchettini, Junjie Zhang

Department of Biochemistry and Molecular Biology Faculty Papers

EttA, energy-dependent translational throttle A, is a ribosomal factor that gates ribosome entry into the translation elongation cycle. A detailed understanding of its mechanism of action is limited due to the lack of high-resolution structures along its ATPase cycle. Here we present the cryo-electron microscopy (cryo-EM) structures of EttA from Mycobacterium tuberculosis (Mtb), referred to as MtbEttA, in complex with the Mtb 70S ribosome initiation complex (70SIC) at the pre-hydrolysis (ADPNP) and transition (ADP-VO4) states, and the crystal structure of MtbEttA alone in the post-hydrolysis (ADP) state. We observe that MtbEttA binds the E-site of the Mtb 70SIC, remodeling the …

Flash Glucose Monitoring In Type 2 Diabetes Managed With Basal Insulin In The Usa: A Retrospective Real-World Chart Review Study And Meta-Analysis., Anders L Carlson, Timothy Dilon Daniel, Andrea Desantis, Serge Jabbour, Esra Karslioglu French, Davida Kruger, Eden Miller, Kerem Ozer, Tom Elliott

Division of Endocrinology, Diabetes and Metabolic Diseases Faculty Papers

INTRODUCTION: Evidence supporting use of continuous glucose monitoring in type 2 diabetes treated with basal insulin is unclear. This real-world study aimed to assess the impact on glycated hemoglobin (HbA1c) of flash glucose monitoring use in adults with type 2 diabetes managed with basal insulin.

RESEARCH DESIGN AND METHODS: Medical records were reviewed for adult individuals with type 2 diabetes using basal insulin for ≥1 year with or without additional antihyperglycemic medication, HbA1c 8.0%-12.0% prior to FreeStyle Libre Flash Glucose Monitoring use for ≥90 days and an HbA1c measurement recorded between 90 and 194 days after device use. Exclusion criteria …

Implementation Of An Outpatient Hd-Mtx Initiative, Kelsey Sokol, Kelley Yuan, Maria Piddoubney, Ellen Sweeney, Anne Delengowski, Katlin Fendler, Gloria M. Espinosa, Judith Alberto, Patricia Galanis, Carol Gung, Meghan Stokley, Mercy George, Mary Harris, Ubaldo E. Martinez-Outshoorn, Onder Alpdogan, Pierluigi Porcu, Adam Binder

Department of Medical Oncology Faculty Papers

Introduction: Methotrexate (MTX) a folate antagonist is often given in high doses (≥500 mg/m2) to treat a variety of disease processes. While inpatient administration has been the norm, outpatient administration, has been shown to be safe, effective, and patient centered. Here in we describe development of an outpatient HDMTX protocol and our initial experience.

Methods: All patients were to receive their first cycle of HDMTX in the hospital to ensure they tolerate it well and also to use this time to assist in training for home administration. The outpatient protocol involved continuous IV sodium bicarbonate, along with oral leucovorin and …