Left-hemispheric ischemic strokes are more frequent overall and often have a worse outcome than their right-hemispheric counterparts. We hypothesized that the right-left propensity of CE cerebral infarcts differs between patients with standard and bovine arch variants. We retrospectively identified all patients with acute stroke of the anterior circulation admitted to our primary stroke center between January 2011 and June 2017 who had moderate- to high-risk cardio-embolic sources according to the SSS-TOAST classification. From amongst these patients, only those with available cross-sectional imaging of the aortic arch were included. Lesion side and patterns on diffusion-weighted magnetic resonance imaging were determined blinded to the aortic arch imaging. One hundred and nineteen patients met the TOAST criteria for moderate- or high-risk cardio-embolic source. Of these, 58 (49%) were men and the median age was 71.9 years; 33% of the patients had a bovine arch. The most common etiologies of CE were atrial fibrillation (n = 80 [67%]) and congestive heart failure with ejection fraction <30% (n = 18 [15%]). In patients with bovine arch there was an approximately 50% chance of having a right- or left-sided infarct. Although there was a trend towards right-sided lesions in patients with standard arches, this did not reach statistical significance. No statistically significant difference in embolic stroke laterality was demonstrated in our relatively small sample. Bovine arch could be an independent risk factor for cardio-embolic embolism. Clin. Anat. 31:310-313, 2018. © 2018 Wiley Periodicals, Inc.

Background: Cancer patients may carry a worse prognosis with SARS-CoV-2 infection. Most of the previous studies described the outcomes of hospitalized cancer patients. We aimed to study the clinical factors differentiating patients requiring hospital care vs. home recovery, and the trajectory of their anti-cancer treatment.Methods: This study was conducted in a community cancer center in New York City. Eligible patients were those who had cancer history and were diagnosed of SARS-CoV-2 infection between March 1 and May 30, 2020, with confirmatory SARs-CoV-2 virus test or antibody test. Four groups were constructed: (A) hospitalized and survived, (B) hospitalized requiring intubation and/or deceased, (C) non-hospitalized, asymptomatic, with suspicious CT image findings, close exposure, or positive antibody test, and (D) non-hospitalized and symptomatic.Results: One hundred and six patients were included in the analysis. Thirty-five patients (33.0%) required hospitalization and 13 (12.3%) died. Thirty (28.3%) patients were asymptomatic and 41 (38.7%) were symptomatic and recovered at home. Comparing to patients who recovered at home, hospitalized patients were composed of older patients (median age 71 vs. 63 years old, p = 0.000299), more who received negative impact treatment (62.9 vs. 32.4%, p = 0.0036) that mostly represented myelosuppressive chemotherapy (45.7 vs. 23.9%, p = 0.0275), and more patients with poorer baseline performance status (PS ≥ 2 25.7 vs. 2.8%, p = 0.0007). Hypoxemia (35% in group A vs. 73.3% in group B, p = 0.0271) at presentation was significant to predict mortality in hospitalized patients. The median cumulative hospital stay for discharged patients was 16 days (range 5–60). The median duration of persistent positivity of SARS-CoV-2 RNA was 28 days (range 10–86). About 52.9% of patients who survived hospitalization and required anti-cancer treatment reinitiated therapy. Ninety-two percent of the asymptomatic patients and 51.7% of the symptomatic patients who recovered at home continued treatment on schedule and almost all reinitiated treatment after recovery.Conclusions: Cancer patients may have a more severe status of SARS-CoV-2 infection after receiving myelosuppressive chemotherapy. Avoidance should be considered in older patients with poor performance status. More than two thirds of patients exhibit minimal to moderate symptoms, and many of them can continue or restart their anti-cancer treatment upon recovery.

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12019 Background: Cancer patients are more likely to use complementary and alternative medicine (CAM) than non-cancer patients for immune enhancement and symptom relief. Cancer patients with immigration background may seek out CAM use more readily due to the influence from their cultural background. Methods: We carried out a prospective questionnaire study surveying the use of 21 CAM types to cancer patients between 10/23/2015 and 10/31/2020, to evaluate the association of CAM use with patients’ age, sex, cancer types, stages, race/ethnicity, birthplace, immigration duration, first language, marital status, levels of poverty, education and anxiety. Results: 658 patients were included in this analysis. The median age was 62 years old. The prevalence of CAM use was 66.11%. CAM use was higher in females (71.98%) than the males (54.34%) (p = 1.13x10-5), and higher in patients ≥ 38 years old (67.09%) than < 38 years old (46.88%) (p = 0.0215). Patients of African American descent (both US born and foreign born) (n = 198) had statistically higher CAM use (72.73%) than the Caucasians and Others (including Middle-Eastern, Multi-Racial and Others) (n = 266) (63.53%) (p = 0.0371). There was no difference of CAM use between the US born patients (n = 301, CAM use 68.77%) and the immigrants (n = 347, CAM use 63.98%) as a whole; however, Asian born immigrants (n = 106) had statistically less CAM use (53.77%) than the US born and other non-Latin American born (n = 397, CAM use 66.50%) (p = 0.0161), while the Latin-American born had a trend towards higher CAM use (74.83%, P = 0.0608). The number of years living in the US by the immigrants did not have an association with CAM use. Among psychosocial economic factors, married patients had a lower CAM use (61.23%) than the unmarried group (defined as divorced, separated, widowed, or single status, 70.85%) (p = 0.0102). The levels of education, poverty and anxiety did not show a statistical difference in relation to CAM use. Earlier stages of disease had numerically higher CAM use than stage 4 patients, and patients with breast and GYN cancers had higher CAM use (72.30%, p = 0.00252), consistent with the data on the higher CAM use in females. Prayer and spirituality and Dietary medicine were the 2 most common CAM types used (25.91% and 16.12%, respectively). African Americans of the combined US and Non-US origin showed the highest rate of using Prayer and spirituality (84.72%), versus Hispanics (71.19%), Caucasians (53.85%), and Asians (40.32%). Chiropractic therapy was exclusively used by Caucasian CAM users (9.38%). Conclusions: Among cancer patients of multi-ethnic groups with immigration background served in a community hospital in Brooklyn, New York, CAM use appeared to be higher in the African American patients, and lower in the patients born in Eastern Asia, as compared to the US born, or to Caucasians. Cultural roots appeared to be a strong influencing factor among all the medical and socioeconomic factors.

Background: Previous studies have shown that cancer patients are more likely to use complementary and alternative medicine (CAM) than non-cancer patients for immune enhancement and symptom relief. We hypothesized that cancer patients with immigration background may seek out CAM use more readily than the US born patients due to the impact from their cultural background.Methods: This is a prospective, single institution, questionnaire study on cancer patient for the use of CAM. Correlates of CAM use with age, sex, cancer types, stages, race, birthplace, immigration duration, first language use, marital status, levels of poverty, education and anxiety, were studied.Results: Among 658 patients, the prevalence of CAM use was 66.11%. CAM use was 71.98% in females and 54.34% in males (p=1.13x10-5), 67.09% in patients ≥ 38 years old and 46.88% in patients < 38 years old (p=0.0215). Patients of African descent had higher CAM use (72.73%) than the Caucasians and Others (63.53%) (p=0.0371). There was no difference of CAM use between the US born (68.77%) and the immigrants (63.98%) as a whole; however, Asian born immigrants had lower CAM use (53.77%) than the US born (66.50%) (p=0.0161), while the Latin-American born had a trend towards higher CAM use (74.83%, P=0.0608). The number of years living in the US by the immigrants did not have an association with CAM use. Among psychosocial economic factors, married patients had a lower CAM use (61.23%) than the unmarried (70.85%) (p=0.0102). The levels of education, poverty and anxiety did not show a statistical difference in relation to CAM use, nor was the difference between the early or late stages of disease. Prayer and spirituality, and Dietary medicine were the two most common CAM subtypes used (25.91% and 16.12%, respectively). African Americans showed the highest rate of using Prayer and spirituality (84.72%) while the Asian Americans had the lowest rate (40.32%). Conclusions: Among cancer patients of multi-ethnic and immigration background, CAM use was higher in African American patients, and lower in Asian Americans, as compared to the US born, or to Caucasians. Cultural roots appeared to be a strong influencing factor for the selection of CAM.

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e22524 Background: Genetic testing has been applied increasingly widely in oncology, as detection of hereditary cancer syndromes can guide prophylactic surgery, intensive surveillance and family member testing. We hypothesized that the profile of mutation prevalence may be different from the general knowledge in patients with immigrant background. Methods: Cancer patients who have been treated in Maimonides hospital and have had a genetic test performed between 1/1/2010 until 1/31/2022 were eligible. Patients were randomly approached for consenting for the study. The results from the first 122 patients enrolled in this study were analyzed. Results: Among 122 patients, there were 86 breast, 22 GYN, 8 GI, 5 GU and 1 lung cancer. The ethnicities were African American (n = 38), Asian (n = 36), Caucasian (n = 32), Hispanic (n = 10) and mixed races (n = 6). Six patients had 2 primary cancers and 2 patients had 3 primary cancers. 25 patients (20.49 %) had germline mutations. A complete list of cancer type, mutation type, age of onset and cancer characteristics is shown in the table below. All of the 13 mutation positive breast cancer patients met the NCCN criteria for genetic testing, including 7 for age < 50 and 6 with family history of breast cancer. Among the 2 patients with NF1 mutation, one had no skin change while the other had neurofibromatosis; both had family history, with pancreatic or breast cancer respectively. The patient with APC mutation had family history of numerous cancers including gastric, but no colon cancer. 48% patients had the onset of disease at older than 50 years old. Conclusions: In this multi-ethnicity cohort, 20.49% mutations were detected in patients who met the genetic testing criteria. A higher prevalence of BRCA 2 were found in both breast and ovarian cancer patients, and rare mutations of NF1, APC, FH and ATM were also detected. A large percentage had onset at an older age. More studies should be done in communities enriched with immigrants to gather further knowledge of unusual prevalence of genetic mutations, and an extensive panel for gene testing should be offered.[Table: see text]

e24128 Background: Genetic testing detects hereditary cancer syndromes and guides prophylactic surgery, intensive surveillance and family member testing. Despite its surge in use, research studies exploring the cancer patient’s perception and emotional reactions of their genetic test result is sparing. We hypothesized that the patient’s perception may be influenced by their ethnicity, educational level and English speaking status. Methods: Cancer patients who had genetic testing performed in the last 10 years were consented to take a questionnaire survey. The correctness of understanding their genetic test results were studied and compared among various ethnic groups, education levels and first spoken languages. We also evaluated the patient’s emotional reaction towards the result. Results: The data for the first 100 patients were analyzed. The primary tumor sites were breast (n = 71), gynecological (n = 16), gastrointestinal (n = 7), genitourinary (n = 5) and lung (n = 1). Eighteen patients were mutation carriers. The correctness in understanding mutation status was 65.7%, 54.2%, 70% and 45.5% in African American, Asian, Caucasian and Hispanics respectively. The correctness was 60%, 64.5% and 66.67% in patients with education levels of grade school or below, high school, or college or higher respectively. None of the 3 patients who carried a mutation with education level of grade school or lower understood the implications of their mutations. Details of correctness in understanding in patients with and without mutation are provided in the table. The correctness was 61.72% and 63.15% in English speaking vs non-English speaking patients. Patients could recall pre-test counseling in 76% and posttest counseling in 67% of cases. Among mutation carriers, 22.2% had anxiety or stressful feelings about the test result, while in patients with no mutation, 20.7% had anxiety/depression. 67% patients carried out prophylactic surgery as recommended. Conclusions: The correctness of understanding their genetic test results across all ethnic groups, education levels and language was below 70%. Patients with education level below grade school encountered in the immigrant population need more attention. Improvement in communication and patient education is imperative in order to carry out recommendations. Structured emotional support to the patient should always complement genetic counseling and testing.[Table: see text]