Ophthalmology, an outpatient surgical specialty, depends on regular in-person encounters to manage complex eye disease. The coronavirus disease 2019 (COVID-19) pandemic has brought about unprecedented challenges in how we take care of our patients. At Vanderbilt University Medical Center, we have gone to great lengths to implement expeditiously a telemedicine platform for safely and securely evaluating our patients during the pandemic. Since implementing live videoconference appointments in late March, 840 patients received ophthalmic care during a 12-week period among all subspecialties at the Vanderbilt Eye Institute. Of these, the majority (79.6%) were either return or postoperative visits. Live telehealth visits were more amenable to certain ophthalmic subspecialties, with paediatrics, neuro-ophthalmology and oculoplastics encounters making up 80.5% of all telemedicine visits. As demonstrated through this care model and our initial experience, live video telemedicine is a sustainable and safe care delivery approach to extend ophthalmic care delivery during the COVID-19 pandemic and even post pandemic.

De novo and acquired resistance to platinum therapy such as cisplatin (CDDP) is a clinical challenge in gastric cancer treatment. Aberrant expression and activation of Aurora kinase A (AURKA) and eukaryotic translation initiation factor 4E (eIF4E) are detected in several cancer types. Herein, we investigated the role of AURKA in CDDP resistance in gastric cancer. Western blot analysis demonstrated overexpression of AURKA and phosphorylation of eIF4E in acquired and de novo CDDP-resistant gastric cancer models. Inhibition of AURKA with MLN8237 (alisertib) alone or in combination with CDDP significantly suppressed viability of CDDP-resistant cancer cells (p<0.01). Additionally, inhibition or knockdown of AURKA decreased protein expression of p-eIF4E (S209), HDM2, and c-MYC in CDDP-resistant cell models. This was associated with a significant decrease in cap-dependent translation levels (p<0.01). In vivo tumor xenografts data corroborated these results and confirmed that inhibition of AURKA was sufficient to overcome CDDP resistance in gastric cancer. Our data demonstrate that AURKA promotes acquired and de novo resistance to CDDP through regulation of p-eIF4E (S209), c-MYC, HDM2, and cap-dependent translation. Targeting AURKA could be an effective therapeutic approach to overcome CDDP resistance in refractory gastric cancer and possibly other cancer types.

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transparency legislation is intended to reduce the ambiguity of hospital charges and the resultant financial stress faced by patients.OBJECTIVE To evaluate the availability, usability, and variability of standard reported prices for ophthalmologic procedures at academic hospitals. DESIGN, SETTING, AND PARTICIPANTSIn this multicenter economic evaluation study, publicly available price transparency web pages from Association of American Medical Colleges affiliate hospitals were parsed for standard charges and usability metrics. Price transparency data were collected from hospital web pages that met the inclusion criteria. Geographic practice cost indices for work, practice expense, and malpractice were sourced from the Centers for Medicare & Medicaid Services. Data were sourced from February 1 to April 30, 2021. Multiple regression was used to study the geographic influence on standard charges and assess the correlation between standard charges.MAIN OUTCOMES AND MEASURES Availability and variability of standard prices for Current Procedural Terminology (CPT) codes 66984 (removal of cataract with insertion of lens) and 66821 (removal of recurring cataract in lens capsule using laser). RESULTSOf 247 hospitals included, 191 (77.3%) provided consumer-friendly shoppable services, most commonly in the form of a price estimator or online tool. For CPT code 66984, 102 hospital (53.4%) provided discount cash pay estimates with a mean (SD) price of $7818.86 ($5407.91). For CPT code 66821, 71 hospital (37.2%) provided discount cash pay estimates with a mean (SD) price of $2041.72 ($2106.44). The top quartile of hospitals, prices wise, listed included prices higher than $10 400 for CPT code 66984 and $2324 for CPT code 66821. Usability issues were noted for 36 hospitals (18.8%), including requirements for personal information or web page navigability barriers. Multiple regression analysis found minimal explanatory value for geographic practice cost indices for cash discount prices for CPT codes 66984 (adjusted R 2 = 0.54; 95% CI, 0.41-0.67; P < .001) and 66821 (adjusted R 2 = 0.64; 95% CI, 0.51-0.77; P < .001).CONCLUSIONS AND RELEVANCE Despite recent legislature that codified price transparency requirements, some current standard charges remain ambiguous, with substantial interhospital variability not explained by geographic variability in costs. Given the potential for ambiguous pricing to burden vulnerable, uninsured patients, additional legislation might consider allowing hospitals to defer price estimates or rigorously define standards for actionable cash discount percentages with provisions for displaying relevant benchmark prices.

Background Scoring for the United States Medical Licensing Examination (USMLE) Step 1 was recently announced to be reported as binary as early as 2022. The general perception among program directors (PDs) in all specialties has largely been negative, but the perspective within ophthalmology remains uncharacterized. Objective This article characterizes ophthalmology residency PDs' perspectives regarding the impact of pass/fail USMLE Step 1 scoring on the residency application process. Methods A validated 19-item anonymous survey was electronically distributed to 111 PDs of Accreditation Council for Graduate Medical Education-accredited ophthalmology training programs. Results Fifty-six PDs (50.5%) completed the survey. The median age of respondents was 48 years and the majority were male (71.4%); the average tenure as PD was 7.1 years. Only 6 (10.7%) PDs reported the change of the USMLE Step 1 to pass/fail was a good idea. Most PDs (92.9%) indicated that this will make it more difficult to objectively compare applicants, and many (69.6%) did not agree that the change would improve medical student well-being. The majority (82.1%) indicated that there will be an increased emphasis on Step 2 Clinical Knowledge (CK) scores, and many (70.4%) felt that medical school reputation will be more important in application decisions. Conclusion Most ophthalmology PDs who responded to the survey do not support binary Step 1 scoring. Many raised concerns regarding shifted overemphasis on Step 2 CK, uncertain impact on student well-being, and potential to disadvantage certain groups of medical students including international medical graduates. These concerns highlight the need for reform in the ophthalmology application process.

The authors present a case report of melanoma-associated retinopathy that was successfully managed with a combination of rituximab, IV immunoglobulin, and intravitreal corticosteroids. Electroretinographic parameters, which were initially very poor, were tracked throughout the course of treatment, and normalized. Acuity returned to 20/20 in both eyes. Pembrolizumab for metastatic melanoma did not worsen melanoma-associated retinopathy.

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Introduction Management of retroperitoneal and lateral pelvic lymph nodes (RLPN) in rectal cancer remains unclear. With total neoadjuvant therapy (TNT), more patients have radiologic complete clinical response (rCR). We sought to evaluate the impact of radiographic persistent RLPN after neoadjuvant therapy on survival. Materials and Methods Patients with rectal adenocarcinoma with isolated RLPN metastasis, who received neoadjuvant therapy before surgery were included from the United States Rectal Cancer Consortium database. Primary outcomes were recurrence‐free survival (RFS) and overall survival (OS). Results Of 77 patients, all received neoadjuvant therapy, with 35 (46%) receiving TNT. Posttreatment, 33 (43%) had rCR while 44 (57%) had radiographic persistent RLPN. Median number of radiographic positive RLPN was 1 (IQR 1–2). Receipt of TNT was associated with radiographic RLPN rCR (OR 4.77, 95% CI 1.81–12.60, p < .01). However, there was no difference in RFS and OS between patients who achieved rCR or with persistent RLPN (all p > .05). Conclusions Radiographic persistence of RLPN was not associated with worse survival in well‐selected patients and may not be a reliable indicator of pathological response. TNT may be the preferred management strategy to select patients given its association with rCR. Radiographic persistence of RLPN after preoperative therapy should not necessarily preclude surgery.