Advocate Aurora Health (AAH) is a non-profit health care system with dual headquarters located in Milwaukee, Wisconsin, and Downers Grove, Illinois. As of 2021, the AAH system has 26 hospitals and more than 500 sites of care, with 75,000 employees, including 10,000 employed physicians. The health system formed as a result of a merger between Illinois-based Advocate Health Care and Wisconsin-based Aurora Health Care. AAH is a teaching affiliate of the University of Wisconsin School of Medicine and Public Health.
The epidemiology of myelodysplastic syndromes/neoplasms (MDS) is challenging to define due to inconsistent reporting, complex diagnostic procedures, and evolving diagnostic criteria. Using the National MDS Natural History Study-a prospective cohort with centrally adjudicated histopathology and genetic variant review-we characterized the landscape of MDS across the United States and identified differences across demographics. Among 2115 participants, 64% (1346) had an MDS spectrum condition, including MDS (24%), MDS/myeloproliferative neoplasm (5%) and precursor conditions-clonal cytopenia of undetermined significance (22%) and idiopathic cytopenia/dysplasia of undetermined significance (13%). The median age was 74 years, and participants were predominantly male (66%), White (91%), and Non-Hispanic (92%). Myeloid-associated variants were detected in 68% of participants, most commonly in TET2, DNMT3A, ASXL1, SF3B1, and SRSF2. Black, compared to White, participants were younger at diagnosis (69 vs. 74 years, p = 0.01), had equal or increased prevalence of higher-risk MDS, lower hemoglobin, and higher peripheral blood blasts, yet were less likely to receive MDS-directed therapy (14% vs. 42%, p = 0.008). Black and Hispanic participants had fewer detectable gene mutations than White participants. Females had lower variant allele frequencies and fewer RNA splicing gene mutations than males. After multivariable adjustment, TP53 mutations, MDS diagnosis, and higher-risk disease were associated with worse progression-free and overall survival; age was also associated with overall survival. Black race trended toward improved progression-free survival. These findings highlight the need for enhanced understanding of MDS pathogenesis across patient groups and refined prognostic tools to improve personalized management of MDS spectrum conditions. Trial Registration: ClinicalTrials.gov identifier: NCT02775383.
Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by fibroblast growth factor 23 (FGF23)–secreting phosphaturic mesenchymal tumors. We report a 63-year-old man with TIO whose sacral tumor was identified after 2 years of nonlocalizing functional imaging. Owing to the surgically challenging location, computed tomography (CT)-guided cryoablation was performed. The patient's FGF23 level normalized 1 month postprocedure, and biochemical remission has been sustained for over 4 years. This case demonstrates that CT-guided cryoablation provides durable remission for sacral phosphaturic mesenchymal tumors not amenable to surgical resection, representing one of the longest reported follow-ups for cryoablation of sacral TIO.
Penicillin-allergy assessment within sexual health clinics is critical for timely, safe, and effective syphilis treatment among marginalized populations who experience multiple barriers to care. It is also an important public health measure to support antibiotic stewardship in populations at high-risk for antibiotic use. This report describes a quality improvement project in a sexual health clinic that used nursing protocols for penicillin-allergy assessment with a validated risk scoring tool (PEN-FAST) and direct oral amoxicillin challenge. In the first year of protocol implementation, just over 75% of patients with syphilis who reported penicillin allergy were treated safely with benzathine penicillin G.
