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Alcohol and drug abuse continue to be major causes of morbidity and mortality and have significant social and economic ramifications. Studies have shown that for every $1 spent on substance use disorder treatment, $4 are saved on healthcare costs. Characterizing the healthcare resource utilization of these patients may shed light on the burden of disease and opportunities for intervention. A retrospective chart review of all patients admitted to the ICU between July 1, 2017 and December 31, 2017 was completed. Variables regarding demographic and clinical characteristics as well as healthcare resource utilization were collected. Of 737 admissions to the ICU, 158 (21%) were due to acute or chronic complications of alcohol or drug abuse. Even though alcohol and drug users were significantly younger (average age 50 years) than the general ICU cohort (average age 66 years), resource utilization was similar between these patients. The median length of stay in the ICU was similar. The number of patients transferred to in-patient rehab was low (8%), and all of those were due to comorbid psychiatric illness. The total hospital charges for the alcohol and drug abuse cohort was over 7 million dollars for the 6 months observed. A significant number of patients had at least one ER visit (49%) during the previous year, and most of these had numerous visits. ICU resource utilization by patients with acute and chronic sequelae of drug or alcohol abuse disorders continues to be high. These patients utilize resources at rates similar to an older group with other disease processes. Patients are unlikely to receive intervention for their disorder unless they have a comorbid psychiatric illness. Patients admitted to the ICU with alcohol or drug-related illness were frequently seen in the ER or were admitted to the hospital in the year prior to ICU admission, providing opportunities for intervention.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an organism causing significant mortality and morbidity with nosocomial infections. Ceftaroline is a new cephalosporin antibiotic that has activity against MRSA. In the USA, this antibiotic has not been approved for use in pneumonia caused by MRSA. Objectives: To review the use of ceftaroline in MRSA pneumonia in a US hospital and evaluate its clinical success. Methods: A retrospective study was conducted in an urban community hospital assessing the use of ceftaroline for MRSA pneumonia. Results: The clinical success was comparable to the currently approved treatment for MRSA pneumonia. Conclusion: The results of our study showed a favorable result for the treatment of MRSA pneumonia. Well-designed studies need to be performed for further validation of these results.

Heparin-induced thrombocytopenia (HIT) is an immune-mediated response to heparin administration that causes thrombocytopenia and a prothrombotic state. Heparin is the most commonly used anticoagulant drug for the prevention and treatment of thromboembolic diseases in hospitalized patients. Heparin exists in two main forms, pure unfractionated heparin (UFH) and low molecular weight heparin (LMWH), which is derived from UFH. Though HIT is relatively rare, occurring in less than 5% of patients receiving UFH and less than 1% of patients receiving LMWH, it has the potential to cause significant morbidity and mortality. The main complication of HIT is thrombosis, most commonly deep vein thrombosis (DVT) or pulmonary embolism (PE). More rarely HIT can manifest as occlusion of a limb artery, acute myocardial infarct, stroke, a systemic reaction or skin necrosis. In the current chapter the topic of HIT will be reviewed in terms of its pathophysiology, diagnosis, and treatment.

For patients with primary lung cancer, accurate determination of the tumor type significantly influences treatment decisions. However, techniques and methods for lung cancer typing lack standardization. In particular, owing to limited tumor sample amounts and the poor quality of some samples, the classification of primary lung cancers using small preoperative biopsy specimens presents a diagnostic challenge using current tools. We previously described a microRNA-based assay (miRview squamous; Rosetta Genomics Ltd., Rehovot, Israel) that accurately differentiates between squamous and nonsquamous non–small cell lung cancer. Herein, we describe the development and validation of an assay that differentiates between the four main types of lung cancer: squamous cell carcinoma, nonsquamous non–small cell lung cancer, carcinoid, and small cell carcinoma. The assay, miRview lung (Rosetta Genomics Ltd.), is based on the expression levels of eight microRNAs, measured using a sensitive quantitative RT-PCR platform. It was validated on an independent set of 451 samples, more than half of which were preoperative cytologic samples (fine-needle aspiration and bronchial brushing and washing). The assay returned a result for more than 90% of the samples with overall accuracy of 94% (95% CI, 91% to 96%), with similar performance observed in pathologic and cytologic samples. Thus, miRview lung is a simple and reliable diagnostic assay that offers an accurate and standardized classification tool for primary lung cancer using pathologic and cytologic samples.

10528 Background: Lung cancer is the leading cause of cancer deaths in the US. Treatment options are determined by tumor subtyping, for which there is lack of standardized, objective, and highly accurate techniques. In 20%-30% of cases significant limitations of tumor quantity and quality prevent full classification of the tumor using traditional diagnostic methods. Using microRNA microarray data generated from over a hundred formalin-fixed, paraffin-embedded (FFPE) primary lung cancer samples, we have identified microRNA expression profiles that differ significantly for the main lung cancer types. Based on these findings, we have developed and validated a microRNA-based qRT-PCR assay that differentiates primary lung cancers into four types: squamous cell carcinoma, non-squamous non-small cell lung cancer, carcinoid and small cell carcinoma. Methods: Over 700 primary tumor samples from different histological types of lung cancer were collected. Samples included FFPE blocks from resection or biopsies and cell blocks from cytology specimens including fine needle aspiration, bronchial brushing and bronchial washing. High-quality RNA was extracted from the samples using proprietary protocols. Expression levels of potential microRNA biomarkers were profiled using microarrays followed by a sensitive and specific qRT-PCR platform. An assay for lung tumors classification using 8 microRNAs on qRT-PCR was developed based on data from 261 samples. This assay was validated on an independent blinded set of 451 cytological and pathological samples. Results: Using the expression levels of 8 microRNAs measured in qRT-PCR, accurate classification of the primary lung tumors into the four main cancer types is obtained. The microRNA-based assay reached an accuracy of 94%. Moreover, cytological samples composed over 50% of the validation set and reached an accuracy of 95%. Conclusions: We present here a new microRNA-based assay for the classification of the four main types of lung cancer based only on the expression of 8 microRNAs. This assay displays very high levels of accuracy for both pathological and cytological samples. The assay comprises a standardized, well-tested and objective tool which can assist physicians in the diagnosis of lung cancer.

Background: Lung cancers have traditionally been subdivided into two main groups: Small Cell Lung Cancer (SCLC) and Non Small Cell Lung Cancer (NSCLC). Due to limited tumor sample amounts and an abundance of poor quality samples, accurate subclassification of primary lung cancer using small pre-operative biopsies presents a diagnostic challenge using current tools (H&E and immunohistochemical stains). For patients with primary lung cancer, accurate determination of the tumor type significantly influences treatment decisions. Our previous studies have shown that microRNAs are differentially expressed in different subtypes of lung cancer; hence microRNA expression profiling holds a promising new strategy for the precise subclassification of lung cancers. Based on these findings, we present here the development of a microRNA-based qRT-PCR diagnostic assay that uses pathology and cytology samples in order to classify primary lung cancers into four subtypes: squamous, non-squamous, SCLC and carcinoid. Methods: FFPE tissue blocks and cell blocks from different histological subtypes of lung cancer, taken from primary lung cancer resection or pre-operative diagnostic procedures, were collected. High-quality RNA, including the well-preserved microRNA fraction, was extracted from the samples using proprietary protocols. Expression levels of potential microRNA biomarkers were profiled using a sensitive and specific qRT-PCR platform. Results: We find that combinations of a few microRNAs can successfully differentiate between different histological types of lung tumors. A classification algorithm was developed that reached high accuracy in the identification of the four main subtypes of lung tumors. Conclusion: We developed a highly accurate microRNA-based diagnostic assay that classifies primary lung cancer types with very high sensitivity and specificity. This assay is a simple and reliable diagnostic assay which will offer an accurate and standardized tool for primary lung cancer cytological samples, including those that presently fail pathological evaluation. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4943. doi:10.1158/1538-7445.AM2011-4943

Background: Lung cancers have been traditionally subdivided into two main groups: neuroendocrine and non-small cell lung cancer (NSCLC). In 20-30% of lung cancer cases it is difficult to make a definitive diagnosis of the tumor subtype based on the cytological specimen (e.g., fine-needle aspirates). In general, the classification of lung cancers poses a diagnostic challenge and there is lack of standardized techniques for cancer sub-typing. For patients with lung carcinoma, accurate determination of tumor type significantly influences treatment decision. MicroRNA expression profiling is a promising new strategy for the precise subclassification of lung cancers. We have previously described a microRNA-based assay which accurately differentiates between squamous and non-squamous NSCLC in FFPE derived from resections as well as from cytological samples. We have also used microRNA microarray data generated from over a hundred formalin-fixed, paraffin-embedded (FFPE) samples of primary lung cancer, to identify microRNA expression profiles that differ significantly for various sub-types of lung cancer samples. Based on these findings, we present here the development of a microRNA-based assay that is able to differentiate primary lung cancers into neuroendocrine vs. NSCLC and then further sub-classify NSCLC into squamous vs. non-squamous and neuroendocrine into SCLC vs. carcinoid using pathology and cytology samples. Methods: FFPE of resections and cell blocks from different histological subtypes of lung cancer, taken from primary lung cancer resection or pre-operative diagnostic procedures, were collected. High-quality RNA, including the well-preserved microRNA fraction, was extracted from the samples using proprietary protocols. Expression levels of potential microRNA biomarkers were profiled using a sensitive and specific qRT-PCR platform. Results: We find that combinations of small numbers of microRNAs can successfully differentiate between the four different histological types of lung cancers, with very high sensitivity and specificity. These microRNAs are able to subclassify lung cancer FFPE samples derived from pathological and cytological samples. Conclusion: We identified microRNAs that represent excellent biomarkers for the classification of lung primary cancers. These findings are the basis for the development of a simple and reliable qRT-PCR based diagnostic assay which will offer an accurate and standardized tool for primary lung cancer pathological and cytological samples, including those that presently fail pathological evaluation.