Vermont State Hospital, alternately known as the Vermont State Asylum for the Insane and the Waterbury Asylum, was a mental institution built in 1890 in Waterbury, Vermont to help relieve overcrowding at the privately run Vermont Asylum for the Insane in Brattleboro, Vermont, now known as the Brattleboro Retreat. Originally intended to treat the criminally insane, the hospital eventually took in patients with a wide variety of problems, including mild to severe mental disabilities, epilepsy, depression, alcoholism and senility. The hospital campus, much of which now houses other state offices,[citation needed] was listed on the National Register of Historic Places in 2016. Partly as a replacement for this facility, the state currently operates the 25 bed Vermont psychiatric care hospital in Berlin, VT.
Introduction:Temporary epicardial pacing wires (TEPWs) are utilized for arrhythmia management in postoperative cardiac surgery. TEPWs that cannot be removed are sometimes left in situ, which can lead to rare complications such as vessel stenosis and thrombosis. This case report describes the use of small biopsy forceps advanced to the superior mesenteric artery (SMA) through a steerable sheath to remove a partially endothelialized TEPW. Case Presentation:A 66-year-old man with a history of orthotopic heart transplantation presented for routine follow-up 2 years post-transplant. Imaging revealed a linear foreign object extending from the descending aorta into the SMA. The partially endothelialized object was successfully retrieved via percutaneous femoral access using an 8.5-Fr steerable sheath to advance endoscopic biopsy forceps, followed by a trilobed snare. The retrieved object measured 20 cm × 0.1 cm and was confirmed to be a retained TEPW. Post-procedural angiography showed no abnormalities, and the patient was discharged without complication. Clinical Discussion:Although a rare occurrence, there are no established clinical guidelines on the management or monitoring of retained TEPWs to avoid potential complications. In this report, the main concern was bowel ischemia, which urged object retrieval. Catheter snares are the preferred tools for intravascular foreign body retrieval. However, in this case, an uncommon approach involving a steerable sheath to advance endoscopic biopsy forceps into deep vasculature was successfully employed to retrieve the partially endothelialized wire. Conclusion:This case highlights an alternative retrieval technique for retained TEPWs and underscores the need for clinical guidelines to manage asymptomatic cases and prevent serious complications.
Abstract Colorectal cancer (CRC) is the fourth most common cancer and the second leading cause of cancer related deaths in the United States. While CRC incidence increases with age, rates are rising among individuals younger than 50 years old (early-onset CRC; EOCRC). Most sporadic EOCRC tumors are microsatellite stable (MSS), and MSS tumors generally do not respond favorably to immunotherapy. The age-associated differences within the tumor microenvironment (TME) remain poorly understood. We hypothesize that EOCRC tumors have a more immunosuppressive microenvironment, which may influence treatment response. Methods: Tumor tissues were collected under an approved IRB protocol from Waterbury Hospital and UConn John Dempsey Hospital. Patients ≤50 years were classified as EOCRC (n = 8) and ≥60 years as late-onset (LOCRC; (n = 10). A total of eighteen regions of interest (ROIs) from tumor sections were selected by a pathologist. Imaging mass cytometry (IMC; 27-marker panel) was performed to spatially characterize the epithelial and immune cell populations. Images were processed to identify single cells, the data were adjusted to remove technical differences, and cells were grouped based on markers and visualized using MCD Viewer software. We also examined how different cell types were spatially arranged and interacted within the tissue. Statistical comparisons were performed using Welch’s t-test and permutation-based tests. Results: Using IMC, a total of 142,992 single cells across 18 ROIs were analyzed. Unsupervised clustering identified 19 cell populations, including epithelial (40%), stromal (18%), CD45+ lymphocytes (11%), myeloid subsets (11%), and rare intra-epithelial lymphocytes (<1%). Cluster identities were validated by marker expression and spatial localization. EOCRC tumors showed a significantly higher abundance of FoxP3+ CD4+ Tregs (P = 0.047), indicating an immunosuppressive TME. LOCRC samples trended toward higher intra-epithelial lymphocytes. Spatial analysis suggested a direct Treg-M2 macrophage interaction due to their colocalization, suggesting the possibility of suppressive niches forming within EOCRC. Immune-enriched stromal regions were slightly more abundant in EOCRC (20.3% of cells) than in LOCRC (16.5%). These regions were enriched with Tregs, CTLs, and M2 macrophages, with Treg infiltration being significantly higher in EOCRC (P = 0.032). These findings support a localized immunosuppressive phenotype. Conclusion: EOCRC tumors display a more immunosuppressive microenvironment, characterized by increased Treg infiltration and a higher M2 macrophage presence in immune cell-enriched regions. These findings suggest that age-related immune differences may exist within tumors of CRC patients. Ongoing validation by multiplexed immunohistology will strengthen these results and inform the development of age-tailored therapeutic strategies. Citation Format: Niti Jani, Michael Martinez, Christopher Flynn, Hatano Yuichiro, Zhongqiu Zhang, Daniel W. Rosenberg. Spatial profiling reveals distinct immune microenvironments in early vs late onset colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 2083.
We examined the impact of the COVID-19 consortium recommendations on the surgical management of breast cancer during the first year of the pandemic. Patients with newly diagnosed ER + DCIS, ER- DCIS, AJCC Stage cT1-2N0-1 ER + , HER2-, HER2 + , and triple negative breast cancer were identified from the National Cancer Database from 2018 to 2021. An interrupted time series design evaluated differences in surgical delay and use of neoadjuvant chemotherapy/immunotherapy (NAC) and endocrine therapy (NET) before and after the pandemic. A total of 895116 female patients were included in the study with a mean age of 61.7 years. Time to surgery decreased by an average 5.5 days from January 2020 to May 2020 for all breast cancer types, corresponding with a 62.2
Alcohol-associated liver disease (ALD) is a leading cause of liver-related deaths in the United States and worldwide, occurring in persons with alcohol use disorder (AUD). Effective treatment of AUD is essential to curtail the progression of ALD and/or reverse the disease course, yet there is a paucity of information on care models for the concomitant treatment of AUD in persons with ALD, particularly when liver transplant is not imminent or warranted. Here, we reviewed existing literature on care models for the concomitant treatment of ALD and AUD among individuals not undergoing liver transplant evaluation or consideration. A comprehensive search of electronic databases including Cochrane Library, CINAHL, Ovid MEDLINE, Ovid Embase, Scopus, Google Scholar, PubMed, and Web of Science Core Collection from inception to July 2024 was conducted to identify original studies reporting care for both ALD and AUD in persons not undergoing liver transplant evaluation or consideration. From the 1146 publications identified, 43 studies were selected for further review, of which three articles were selected for data charting and inclusion in the review. Concomitant treatment of ALD and AUD were implemented both within inpatient and outpatient settings, with multidisciplinary care teams typically involving hepatology and addiction medicine and/or addiction psychiatry. One study showed that attention and care for AUD led to improvement in liver disease and a decrease in emergency department visits and frequency of hospitalization. The studies reviewed suggest that concomitant care for ALD and AUD in the nontransplant setting may improve outcomes for some patients. The limited number of studies highlights the need for more prospective and longitudinal studies evaluating concomitant treatment, especially in persons for whom liver transplant may not be an option or a consideration.
