Long-term outcomes of conservative management in juvenile recurrent parotitis: A 10 year retrospective study.

Objectives:Long-term outcomes following matrix-induced autologous chondrocyte implantation (MACI) are required to better demonstrate later-stage clinical outcomes, patient satisfaction and longevity of repair tissue. This prospective study sought to present the long-term (minimum 10 year) clinical and radiological outcomes of the largest prospectively assessed MACI dataset yet to be reported and compare outcomes in patients undergoing tibiofemoral (TF) versus patellofemoral (PF) MACI.Methods:Between September 2002 and December 2012, 204 patients that underwent MACI were prospectively registered into a research program and assessed pre-surgery and at 2, 5 and 10 years. Of these, 168 patients (182 grafts) were available for clinical review at a minimum 10 years (range 10 to 16 years), of which 151 also underwent MRI. Included in the 182 MACI grafts with minimum 10-year review were: 83 medial femoral condyle (MFC), 32 lateral femoral condyle (LFC), 35 trochlea and 32 patella.Clinically, patients were evaluated with the Knee Injury and Osteoarthritis Outcome Score (KOOS), the 36-item Short Form Health Surveys (SF-36), a visual analogue scale for pain frequency (VAS-F) and severity (VAS-S), satisfaction and peak isokinetic knee extensor and flexor strength. Limb symmetry indices (LSIs) were calculated for strength measures. Grafts were scored on MRI via the magnetic resonance observation of cartilage repair tissue (MOCART) system, with a focus on tissue infill and an overall MRI graft composite score.Results:All PROMs significantly improved (p<0.0001) over the pre- and post-operative period to 2-years post-surgery (Figure 1), with no statistical change (p>0.05) from 2-years to final 10-year follow-up. While the peak isokinetic knee extensor LSI improved significantly over time (p=0.016), at final follow up the mean LSI for peak isokinetic knee flexor and extensor strength was 99.1% and 92.8%, respectively. At final follow-up, 93% of patients were satisfied with MACI to provide knee pain relief, 77% were satisfied with their ability to participate in sports and 89% were satisfied overall. A statistically significant decline was observed from 5 years post-surgery to final follow-up in the MOCART variable of subchondral lamina (p=0.002), while a non-statistical decline was observed in tissue infill (p=0.066) and the overall MRI composite score (p=0.072) (Figure 2), with the MRI-based progression of one patient over the period demonstrated in Figure 3. Of the 151 grafts reviewed via MRI at 10 years or beyond, 14 (9.3%) had failed as defined by graft de-lamination or a graft bed devoid of any repair tissue. Furthermore, of the 36 patients (out of the prospectively recruited 204) that were not available for longer term review, 7 had already proceeded to total knee arthroplasty (TKA) and 1 patient had undergone secondary MACI at the same MFC site due to earlier graft failure. Therefore, a total of 22 patients (10.8%) had essentially failed at or before the final review time. At final follow-up, patients that underwent MACI in the TF (versus PF) joint reported significantly better KOOS sub-scale scores for Pain (p=0.013, TF mean 86.5, PF mean 80.1), Sport (p<0.001, TF mean 71.5, PF mean 60.5) and Quality of Life (p=0.010, TF mean 65.8, PF mean 58.7), as well as a greater knee extensor strength LSI (p=0.002, TF mean 96.0%, PF mean 85.8%). While the TF group demonstrated better 10-year MOCART scores for tissue infill (p=0.027, TF mean 3.2, PF mean 2.9), there were no other differences in MRI-based scores including the overall MRI composite score (p=0.481, TF mean 3.0, PF mean 3.1).Conclusions:This study reports the largest prospective series of patients with long-term review, demonstrating good clinical scores, levels of patient satisfaction and graft survivorship beyond 10 years. Patients undergoing TF (versus PF) MACI reported better long-term clinical outcomes, despite largely similar MRI-based outcomes.

Benefit of Long-Term Dual Anti-Platelet Therapy in Patients Treated With Drug-Eluting Stents: From the NHLBI Dynamic Registry

Blunt trauma remains a significant cause of morbidity and mortality in the pediatric population. The use of conservative management for blunt renal trauma is widely accepted in adult trauma literature and is now increasingly accepted for use in the pediatric patient population. This study aimed to review current practices in pediatric blunt renal trauma management and to highlight current practices in conservative protocols, success rates of conservative management strategies, as well as short- and long-term outcomes of blunt renal trauma management. This is a systematic review of PubMed, Ovid, and the Cochrane Library. The following search was performed in each of the three databases: (Renal or Kidney) AND (Pediatric or Children) AND Trauma AND Management. Publications were limited to publish date after January 1, 2000. Inclusion criteria were (1) original research articles regarding management of pediatric blunt renal trauma, (2) involvement of cases of high-grade renal (Grades IV and V) trauma, and (3) more than one patient presented per study. Literature reviews and meta-analyses were excluded. Titles and abstracts (n = 308) were screened to identify scientific articles reporting original research findings. A total of 32 articles met the selection criteria and were included in the review. The literature supports application of conservative management protocols to high-grade blunt pediatric renal trauma. Criteria for early operative intervention are not well understood. At this time, emergent operative intervention only for hemodynamic instability is recommended. Minimally invasive interventions including angioembolization, stenting, and percutaneous drainage should be used when indicated. Short- and long-term outcomes are favorable when using conservative management approaches to Grade IV and V renal injuries. Further studies including prospective studies and randomized control trials are necessary. Cost analyses of current treatment protocols are also necessary to guide efficient management strategies. Systematic review, level III.

SAT0506 Early postoperative identification of patients at risk for unfavourable long-term outcomes

This retrospective study assessed long-term clinical outcome in a series of patients undergoing anterior cervical discectomy (ACD) for treatment of myeloradiculopathy secondary to one- to two-level cervical discoarthrosis. To verify concerns about long-term adverse clinical effects following ACD, a review of literature on the topic was also made. The clinical course and long-term outcome of 125 consecutive patients with cervical myeloradiculopathy operated on by ACD 5 to 19 years ago (mean, 11.3 years) were reviewed. Seventy-four patients (59%) showed a clinical picture of pure radiculopathy, and 51 patients (41%) had myeloradiculopathy. Long-term clinical outcome and Visual Analog Scale (VAS) scores for neck and arm pain were recently assessed and compared with post-surgical status. Clinical outcome was graded according to the criteria of Odom et al. (JAMA 166:23-28, 36). The survey of the literature on long-term clinical outcome after ACD was internet-based. Long-term clinical outcome was excellent in 61% of patients, good in 26%, satisfactory in 9% and poor in 4%. The same figures at the time of discharge were 65%, 29%, 6% and 0%, respectively. Mean long-term neck and arm pain VAS scores were 2.5 and 0.8, respectively, while postoperatively, the same values were 2.1 and 0.5. Additional discectomy at an adjacent level was performed in five patients 10 months to 8 years after the first operation. In our series, 96% of patients had a sustained favourable long-term clinical outcome after ACD. These favourable results confirm data in the literature and support our preference for ACD as the simplest, fastest and cheapest surgical option for treating myeloradiculopathy secondary to one- to two-level cervical discoarthrosis.

Children with surgically repaired Hirschsprung's disease (HD) and those with internal anal sphincter (IAS) achalasia may develop obstructive gastrointestinal symptoms and/or enterocolitis due to a functional obstruction caused by an inability of the IAS to relax. Anal sphincter Clostridium botulinum toxin (BoTox) injections may provide a reversible therapy. However, there is limited information regarding the long-term outcomes of children receiving this therapy. The primary aim of this study was to determine the long-term clinical outcomes of BoTox therapy in children with a nonrelaxing IAS. The secondary aim of this study was to determine prognostic factors predicting a favorable outcome following BoTox IAS injection. We conducted a retrospective review of children with nonrelaxing IAS who received anal sphincter BoTox at a tertiary medical center. Children were classified into one of four long-term clinical outcome groups (excellent, good, fair, poor). A total of 73 children (30 HD, 43 IAS achalasia) received anal sphincter BoTox injections and had a mean follow-up of 32.1+/-2.9 (s.e.) months. A mean of 2.7+/-0.2 injections were given to each child, with 56 (76.7%) children receiving multiple injections. An initial clinical improvement was seen in 65 of 73 (89%) children after the first injection. A total of 39 (53.4%) children had an excellent or good long-term outcome that was maintained for a mean of 17.1+/-3.1 months from the time of the last BoTox injection. Hospitalization rates significantly decreased in those previously hospitalized before initial BoTox injection. Seven (9.5%) patients developed transient fecal incontinence, and one (1.3%) developed significant pain after an injection. Factors predicting a favorable long-term clinical outcome were initial short-term improvement after the first BoTox injection and having IAS achalasia rather than HD. Anal sphincter BoTox may be an effective and safe long-term therapy for children with nonrelaxing IAS.

Aims To compare short and long-term outcomes after tibial plateau levelling osteotomy (TPLO) and lateral fabello-tibial suture (LFTS) techniques for the management of cranial cruciate ligament disease in small dogs with high tibial plateau angles (TPA). Methods In this retrospective study, the medical records of two veterinary specialist practices in the United Kingdom were searched for dogs (<20 kg) that underwent TPLO or LFTS between 2000 and 2010, and had a preoperative radiographic TPA >30° with either short-term (6 weeks) and/or long-term (>3 months) follow-up data. Data collected at a 6-week post-surgical re-examination was derived from orthopaedic examination and radiographic assessment and included the incidence of major and minor complications and scoring of the short-term outcome. Long-term outcome was scored based on results of a subjective owner questionnaire and veterinary orthopaedic examination. Results A total of 61 (84 stifles) dogs were included in the study: 24 (30 stilfes) and 37 (54 stifles) dogs underwent LFTS and TPLO, respectively. Long-term clinical outcome was different (p = 0.017) between groups; 15/15 stifles in the TPLO group had a good or excellent long-term clinical outcome, compared to 4/8 (50%) in the LFTS group. There was no evidence of a difference in short-term post-operative outcome or owner subjective long-term outcome between treatment groups. Stifles in the LFTS group were more likely (p = 0.027) to have palpable stifle pain at long-term follow-up. Owners reported that 5/16 (31.3%) dogs in the LFTS group required oral non-steroidal anti-inflammatory drug (NSAID) treatment at least monthly (4/5 required daily treatment), whereas no dogs in the TPLO group required treatment with NSAID more frequently than three times per year (p = 0.011). No correlation was found between short-term outcome and owner subjective long-term outcome but there was a positive correlation between short-term outcome and long-term clinical outcome. There was no evidence of a difference in overall major complication rates between treatment groups. The occurrence of complications was associated with heavier body weight at the time of surgery. No other variables were shown to be risk factors for complications. Conclusion and clinical relevance Small breed dogs with high TPA that underwent TPLO had better long-term clinical outcomes and were less likely to require NSAID administration than those that underwent LFTS. The risk of complication increased with the weight of the dog at surgery. There was a positive correlation between short-term outcome and long-term clinical outcome.

Long-term clinical and radiographic outcomes after inverted-bearing reverse total shoulder arthroplasty: a multicenter study with the Affinis Inverse prosthesis.

Complete elbow ankylosis secondary to heterotopic ossification: operative management leads to fair to excellent long-term outcomes

Usefulness of Mean Platelet Volume as a Biomarker for Long-Term Outcomes After Percutaneous Coronary Intervention

IntroductionShockable rhythm following pediatric out-of-hospital cardiac arrest (pOHCA) is consistently associated with hospital and short-term survival. Little is known about the relationship between shockable rhythm and long-term outcomes (>1 year) after pOHCA. The aim was to investigate the association between first documented rhythm and long-term outcomes in a pOHCA cohort over 18 years. MethodsAll children aged 1 day–18 years who experienced non-traumatic pOHCA between 2002–2019 and were subsequently admitted to the emergency department (ED) or pediatric intensive care unit (PICU) of Erasmus MC-Sophia Children’s Hospital were included. Data was abstracted retrospectively from patient files, (ground) ambulance and Helicopter Emergency Medical Service (HEMS) records, and follow-up clinics. Long-term outcome was determined using a Pediatric Cerebral Performance Category (PCPC) score at the longest available follow-up interval through august 2020. The primary outcome measure was survival with favorable neurologic outcome, defined as PCPC 1–2 or no difference between pre- and post-arrest PCPC. The association between first documented rhythm and the primary outcome was calculated in a multivariable regression model. Results369 children were admitted, nine children were lost to follow-up. Median age at arrest was age 3.4 (IQR 0.8–9.9) years, 63% were male and 14% had a shockable rhythm (66% non-shockable, 20% unknown or return of spontaneous circulation (ROSC) before emergency medical service (EMS) arrival). In adolescents (aged 12–18 years), 39% had shockable rhythm. 142 (39%) of children survived to hospital discharge. On median follow-up interval of 25 months (IQR 5.1–49.6), 115/142 (81%) of hospital survivors had favorable neurologic outcome. In multivariable analysis, shockable rhythm was associated with survival with favorable long-term neurologic outcome (OR 8.9 [95%CI 3.1–25.9]). ConclusionIn children with pOHCA admitted to ED or PICU shockable rhythm had significantly higher odds of survival with long-term favorable neurologic outcome compared to non-shockable rhythm. Survival to hospital discharge after pOHCA was 39% over the 18-year study period. Of survivors to discharge, 81% had favorable long-term (median 25 months, IQR 5.1–49.6) neurologic outcome. Efforts for improving outcome of pOHCA should focus on early recognition and treatment of shockable pOHCA at scene.

IntroductionBreast reconstruction (BR) is offered to improve quality of life for women with breast cancer undergoing mastectomy. As most women will be long-term breast cancer survivors, high-quality information regarding the...

6518 Background: This exploratory analysis examined potential relationships between dasatinib exposure and the long-term safety and efficacy outcomes of subjects enrolled in CA180-034, a phase III dose-optimization study in CML-CP patients with 4-arms (100 mg QD, 50 mg BID, 140 mg QD, and 70 mg BID). The following endpoints at 2-year follow-up were examined: (a) long-term outcomes [progression free-survival (PFS) and overall survival (OS)], (b) durability of complete cytogenetic response (CCyR), and (c) development of Gr 3/4 nonhematologic adverse events (AEs). Methods: Exposure-response (E-R) analysis was performed with summary steady-state measures of dasatinib exposure determined previously from a population pharmacokinetic (PPK) model (peak [Cmax], trough [Cmin], and time-averaged [Cavg] plasma concentration) in 567 subjects enrolled in CA180-034, for whom exposure data were available (Wang et al, ASCO 2008). E-R analysis of PFS, OS, and durability of CCyR were examined by Kaplan-Meier (K-M) analysis of subjects grouped by quartiles of Cmax, Cmin, and Cavg. E-R of Gr 3/4 non-hematologic AEs was examined by comparing distributions of dasatinib exposure in subjects with and without these AEs. Results: The 2-year survival and long-term CCyR response rates were similar across quartiles of Cavg, as were the rates of Gr 3/4 nonhematological AEs (Table). K-M estimates of survival across quartiles were not significantly different by log-rank test. However, the 2-year PFS was marginally lower at the lowest quartile of Cavg. Similar results were observed across quartiles of Cmax and Cmin. Conclusions: Similar and favorable long-term outcomes were achieved in CML-CP patients across dasatinib exposure investigated in CA180-034. The incidence of Gr 3/4 nonhematologic AEs was not related to differences in exposure. Cavg quartiles Q1 Q2 Q3 Q4 PFS at 24 months (%) (N=567) 69.7 80.0 81.0 79.7 OS at 24 months (%) (N=567) 88.4 92.8 93.8 90.9 CCyR maintained at 18 months (%) (N=305)* 89.1 93.7 93.5 86.3 Gr 3/4 nonhematological toxicities (%) (N=567) 38.0 33.1 36.9 45.8 * Only subjects with CCyR. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Bristol-Myers Squibb Bristol-Myers Squibb, Chemgenix, Merck, Novartis, Wyeth Bristol-Myers Squibb, Novartis Bristol-Myers Squibb, Merck, Novartis Bristol-Myers Squibb, Novartis

Background and ObjectiveMultiple studies highlighting the diagnostic utility of neurofascin-155 (NF155)–immunoglobulin G4 (IgG4) in chronic demyelinating inflammatory polyradiculoneuropathy (CIDP) have been published. However, few studies comprehensively address the long-term outcomes or clinical utility of NF155–immunoglobulin M (IgM) or NF155–immunoglobulin G (IgG) in the absence of NF155-IgG4. We evaluated phenotypic and histopathologic specificity and differences in outcomes between these NF155 antibody isotypes or IgG subclasses. We also compare NF155-IgG4-seropositive cases to other seropositive demyelinating neuropathies.MethodsNeuropathy patient sera at Mayo Clinic were tested for NF155-IgG4, NF155-IgG, and NF155-IgM autoantibodies. Demographic and clinical data of all seropositive cases were reviewed.ResultsWe identified 32 NF155 cases (25 NF155-IgG-positive [20 NF155-IgG4-positive], 7 NF155-IgM-seropositive). NF155-IgG4-seropositive patients clinically presented with distal more than proximal muscle weakness, positive sensory symptoms (prickling, asymmetric paresthesia, neuropathic pain), and gait ataxia. Cranial nerve involvement (11/20 [55%]) and papilledema (4/12 [33%]) occurred in many. Electrodiagnostic testing (EDX) demonstrated demyelinating polyradiculoneuropathy (19/20 [95%]). Autonomic involvement occurred in 45% (n = 9, median composite autonomic scoring scale score 3.5, range 1–7). Nerve biopsies from the NF155-IgG4 patients (n = 11) demonstrated grouped segmental demyelination (50%), myelin reduplication (45%), and paranodal swellings (50%). Most patients needed second- and third-line immunosuppression but had favorable long-term outcomes (n = 18). Among 14 patients with serial EDX over 2 years, all except one demonstrated improvement after treatment. NF155-IgG-positive, NF155-IgG4-negative (NF155-IgG-positive) and NF155-IgM-positive patients were phenotypically different from NF155-IgG4-seropositive patients. Sensory ataxia, neuropathic pain, cerebellar dysfunction, and root/plexus MRI abnormalities were significantly more common in NF155-IgG4-positive compared to myelin-associated glycoprotein (MAG)–IgM neuropathy. Chronic immune sensory polyradiculopathy (CISP)/CISP-plus phenotype was more common among contactin-1 neuropathies compared to NF155-IgG4-positive cases. NF155-IgG4-positive cases responded favorably to immunotherapy compared to MAG-IgM-seropositive cases with distal acquired demyelinating symmetric neuropathy (p < 0.001) and had better long-term clinical outcomes compared to contactin-1 IgG (p = 0.04).DiscussionWe report long-term follow-up and clinical outcome of NF155-IgG4 cases. NF155-IgG4 but not IgM or IgG cases have unique clinical–electrodiagnostic signature. We demonstrate NF155-IgG4-positive patients, unlike classical CIDP with neuropathic pain and dysautonomia common at presentation. Long-term outcomes were favorable.Classification of EvidenceThis study provides Class III evidence that NF155-IgG4-seropositive patients, compared to patients with typical CIDP, present with distal more than proximal muscle weakness, positive sensory symptoms, and gait ataxia.

Background Lower heart rate (HR) is associated with more favourable long-term outcome in patients with heart failure with reduced ejection fraction (HFrEF). However, an optimal threshold of HR remains unclear. Targeted HR (THR), defined by echocardiographic deceleration time (DCT) to eliminated overlap of E and A waves, may aid in risk stratification of HFrEF patients. Purpose In this study, we aimed to clarify the impact of on long-term clinical outcome in patients with HFrEF. Methods In the multicenter WET-HF registry, 4000 consecutive patients hospitalized for acute decompensated HF (ADHF) were registered between 2006 and 2017. Among them, the patients with EF ≥40% or a history of atrial fibrillation were excluded. THR was calculated based on their DCT value measured in compensated HF phase during the index admission. The following formula was applied; THR (bpm)=93 - 0.13 × deceleration time (DCT, msec). A total of 876 patients with HFrEF were included in the present analysis (age: 72 [60–81], male: 69%) and the patients were divided into the 2 groups of HR at discharge ≤ THR (L group) and &amp;gt; THR (H group). The primary endpoint (PE) was defined as the composite of all-cause death and ADHF re-admission. Results Compared to the H group, the L group showed higher prevalence of males (74% vs. 66%, P=0.025) with higher body mass index (BMI, 23.2 vs. 22.2, P=0.016), hemoglobin (Hb, 12.9 vs. 12.4, P=0.031), albumin (Alb, 3.7 vs. 3.6, P=0.039) and larger left atrial diameter (LAD, 44 mm vs. 41 mm, P=0.002) and tricuspid regurgitation pressure gradient (TRPG, 29 mmHg vs. 27 mmHg, P=0.012). Age, estimated glomerular filtration rate (eGFR), LVEF (29% vs. 30%, P=NS) and E/e' (17.7 vs. 16.8, P=NS) were similar for both groups. At discharge, HR was lower in L group (66 [60–71] bpm vs. 80 [74–86] bpm, P&amp;lt;0.001), albeit there were no significant differences in b-blocker prescription (90% vs. 85%, P=0.069) or its dose (3.75 [1.25–7.25] mg vs. 2.5 [1.25–5] mg, P=0.11). In the survival analysis, the L group showed a significantly lower rate of PE (P=0.03), whereas there was no significant difference in the incidence of PE between the patients with HR at discharge ≥70 bpm and &amp;lt;70 bpm (P=NS). Multivariate Cox hazard analysis showed that HR at discharge ≤ THR was an independent predictor of PE (hazard ratio 0.67 [0.46–0.97], P=0.037), even after adjusting for confounding factors including age, sex, BMI, Hb, Alb, and b-blocker prescription, whereas HR at discharge &amp;lt;70 bpm was not (hazard ratio 0.94 [0.65–1.33], P=0.71). Conclusion THR was associated with long-term outcomes in patients with HFrEF after acute decompensation, suggesting that it may aid in tailored treatment for HR reduction in these patients. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2