Summary Dietary carbohydrate restriction has been purported to cause endocrine adaptations that promote body fat loss more than dietary fat restriction. We selectively restricted dietary carbohydrate versus fat for 6 days following a 5 day baseline diet in 19 adults with obesity confined to a metabolic ward where they exercised daily. Subjects received both isocaloric diets in random order during each of two inpatient stays. Body fat loss was calculated as the difference between daily fat intake and net fat oxidation measured while residing in a metabolic chamber. Whereas carbohydrate restriction led to sustained increases in fat oxidation and loss of 53±6 g/d of body fat, fat oxidation was unchanged by fat restriction leading to 89±6 g/d of fat loss and was significantly greater than carbohydrate restriction (p=0.002). Mathematical model simulations agreed with these data, but predicted that the body acts to minimize body fat differences with isocaloric diets varying in carbohydrate and fat.

In the version of this paper published online on August 13, there were three errors that were generated in the preparation of the article by the authors. In Figure 3G, the colors and labels of the RC and RF graph lines were reversed erroneously, depicting less fat mass loss with the RF diet than the RC diet. Rather, the RF diet leads to more fat loss, as described in the text and the figure legend. Table 4 and Table S2 incorrectly stated that the overnight-fasted plasma insulin units were pg/ml when they are actually mU/ml. We included online comments about these errors as soon as we realized the mistakes. These errors have now been corrected online and in print, and we sincerely apologize for any confusion that may have resulted from these errors.

Diffuse Large B Cell Lymphoma (DLBCL) is a heterogeneous disease with a variety of chromosomal abnormalities contributing to differences in management. While it is known that Double Hit Lymphomas (DHL) warrant more aggressive chemotherapy regimens, debate remains on how to treat Double Expresser Lymphomas (DEL). We present a case of a DEL treated with an aggressive regimen of 2 alternating cycles of R-CODOX-M (rituximab, cyclophosphamide, doxorubicin, vincristine and methotrexate) and R-IVAC (rituximab, ifosfamide, etoposide and high dose cytarabine). The regimen resulted in a significant response to treatment with marked reduction in tumor size and avidity, and an acceptable side effect profile. There was, however, residual metabolic activity on repeat PET CT scan. After consolidation with 36 Grey radiotherapy, a PET CT demonstrated a complete metabolic response. Debate remains regarding treatment approaches in DEL. Our case supports the categorization of DEL alongside DHL as resistant lymphomas requiring a more aggressive regimen than standard therapy.

e18182 Background: The 2018 ASCO palliative care guidelines recommend palliative care team (PCT) involvement within 8 weeks for patients with an advanced cancer diagnosis. However, the optimal timing of PCT consults in the inpatient setting has not been established. We investigated whether early PCT involvement for in-patients with an advanced cancer diagnosis affected discharge outcomes. Methods: We queried the Hahnemann University Hospital’s Palliative Care In-patient database between 2015 and 2018 for patients with advanced cancer and an estimated life expectancy of < 6 months. Dates of admission, initial PCT consult and discharge were examined. PCT consults within 7 days of admission were defined as early consults and those > 7 days as late consults. Chi square analysis was used to determine differences in LOS and time from PCT consult to discharge between the two groups. Cost-savings estimates were based on the Kaiser State Health Facts, which list an average cost per inpatient day in US hospitals of $2,289 in nonprofit and $1,791 in for-profit hospitals. Results: The majority of cases (69.7%) had PCT involvement < 7 days from admission and were associated with an overall shorter LOS of 12 days compared to 30 days with consults called > 7 days (p = < 0.001). Furthermore, early PCT involvement led to a 2-day shorter time to discharge (p = < 0.02) for an average cost-savings of at least $4,578 at a non-profit hospital and $3,582 at a for-profit hospital. Conclusions: Our findings show that the majority of patients at our institution with advanced cancer had early PCT involvement, which was associated with reduced hospital length of stay. These findings suggest that PCT involvement may expedite hospital discharge and by extension lead to increased cost-savings and patient quality of life. Future studies will aim to investigate the impact of early PCT involvement on hospital readmission rates and discharge to hospice care among other indicators of improved patient well-being.[Table: see text]