ACD Patients Research Articles

So Close yet So Far: The impact of undercorrection of cervical sagittal alignment during adult cervical deformity surgery − An Incremental correction analysis

BackgroundTo compare degrees of cSVA correction and to theorize possible minimum and maximum thresholds of cSVA correction for patients to benefit clinically. Methods657 operative ACD patients in a retrospective cohort study of a prospectively enrolled database with complete baseline and two year radiographic and HRQL data were examined. Patients were grouped into an optimally corrected cohort (OC; postop cSVA ≤ 4 cm) and an undercorrected cohort (UC; postop cSVA > 4 cm) based on postoperative radiographs. Results265 patients met inclusion criteria (mean age 58.2 ± 11.4 years, BMI 28.9 ± 7.5, CCI 0.9 ± 1.3). 11.2 % of patients were UC, while 88.8 % of patients were OC. UC cohort experienced a significantly greater occurrence of radiographic complications (47.8 % v. 27.6 %, p = 0.046). UC also demonstrated a significantly greater rate of severe 6 M DJK (p < 0.001) and 1Y DJK (26.1 % v. 2.7 %, p < 0.001). In terms of HRQLs, the OC cohort demonstrated significantly greater 2Y EQ5D-Health values (76.9 v. 46.7, p = 0.012). Being UC was a significant predictor of moderate-high 1Y mJOA score (OR 3.0, CI 95 % 1.2–7.3, p = 0.015) Still, in terms of CIT, the threshold for DJF risk increased significantly (p = 0.026) when the cSVA were surgically corrected greater than 5 cm. ConclusionUndercorrection of cSVA yielded worse clinical outcomes and posed a significant risk for radiographic complications. Although undercorrection does not seem to be efficacious, surgical correction beyond certain thresholds should still be respected as there is a risk for DJK on either end of the spectrum.

Neutrophil Infiltration in Allergic Contact Dermatitis to Nickel.

Allergic contact dermatitis (ACD) is traditionally recognized as a T-cell-mediated delayed-type hypersensitivity reaction. However, many patients with ACD have been reported to experience rapid-onset ACD reactions within hours of re-exposure on skin areas previously exposed to the contact allergen. In this study, three nickel-allergic patients were patch tested for nickel twice at the same skin site over 21 days. The results demonstrated that neutrophils are rapidly recruited to the skin sites previously exposed to nickel, leading to the rapid onset of ACD. Considering that many patients with ACD are frequently re-exposed to contact allergens on the same skin areas in their daily lives, we propose that mechanisms involved in neutrophil recruitment could be potential targets for future ACD treatment.

Outcomes and survival analysis of adult cervical deformity patients with 10-year follow-up

BACKGROUNDPrevious studies have demonstrated that adult cervical deformity patients may be at increased risk of death in conjunction with increased frailty or a weakened physiologic state. However, such studies have often been limited by follow-up duration, and longer-term studies are needed to better assess temporal changes in ACD patients and associated mortality risk. PURPOSETo assess if patients with decreased comorbidities and physiologic burden will be at lessened risk of death for a greater length of time after undergoing adult cervical deformity surgery. STUDY DESIGN/SETTINGRetrospective review. PATIENT SAMPLETwo hundred ninety ACD patients. OUTCOME MEASURESMorbidity and mortality data. METHODSOperative ACD patients ≥18 years with pre-(BL) and 10-year (10Y) data were included. Patients were stratified as expired versus living, as well as temporally grouped by Expiration prior to 5Y or between 5Y and 10Y. Group differences were assessed via means comparison analysis. Backstep logistic regression identified mortality predictors. Kaplan-Meier analysis assessed survivorship of expired patients. Log rank analysis determined differences in survival distribution groups. RESULTSSixty-six total patients were included (60.97±10.19 years, 48% female, 28.03±7.28 kg/m2). Within 10Y, 12 (18.2% of ACD cohort) expired. At baseline, patients were comparable in age, gender, BMI, and CCI total on average (all p>.05). Furthermore, patients were comparable in BL HRQLs (all p>.05). However, patients who expired between 5Y and 10Y demonstrated higher BL EQ5D and mJOA scores than their earlier expired counterparts at 2Y (p<.021). Furthermore, patients who presented with no CCI markers at BL were significantly more likely to survive until the 5Y-10Y follow-up window. Surgically, the only differences observed between patients who survived until 5Y was in undergoing osteotomy, with longer survival seen in those who did not require it (p=.003). Logistic regression revealed independent predictors of death prior to 5Y to be increased BMI, increased frailty, and increased levels fused (model p<.001). KM analysis found that by Passias et al frailty, not frail patients had mean survival time of 170.56 weeks, versus 158.00 in frail patients (p=.949). CONCLUSIONSOur study demonstrates that long-term survival after cervical deformity surgery may be predicted by baseline surgical factors. By optimizing BMI, frailty status, and minimizing fusion length when appropriate, surgeons may be able to further assist ACD patients in increasing their survivability postoperatively.

ALLERGIC CONTACT DERMATITIS: ETIOLOGICAL MATRIX

The article discusses the main links of the pathogenesis of allergic contact dermatitis and gives the results of patch testing in patients who were examined to determine the etiological factors of the disease. Screening showed that nickel, cobalt, methylisothiazolinone, phenylenediamine, formaldehydes and fragrances are the most common etiological factors of ACD. Named haptens cause the absolute majority of positive reactions in the selected group of patients, and also cause the largest number of reactions of pronounced intensity. Patch testing is an informative and useful method for a balanced planning in ACD patients treatment strategy, because it reveals the etiological matrix of the pathological process occurrence in the skin.

Characterization of the "gut microbiota-immunity axis" and microbial lipid metabolites in atrophic and potential celiac disease.

IntroductionPotential celiac disease (pCD) is characterized by genetic predisposition, positive anti-endomysial and anti-tissue transglutaminase antibodies, but a normal or almost normal jejunal mucosa (e.g., minor histological abnormalities without villous atrophy). To gain further insights into basic mechanisms involved in the development of intestinal villous atrophy, we evaluated and compared the microbial, lipid, and immunological signatures of pCD and atrophic CD (aCD).Materials and methodsThis study included 17 aCD patients, 10 pCD patients, and 12 healthy controls (HC). Serum samples from all participants were collected to analyze free fatty acids (FFAs). Duodenal mucosa samples of aCD and pCD patients were taken to evaluate histology, tissue microbiota composition, and mucosal immune response.ResultsWe found no significant differences in the mucosa-associated microbiota composition of pCD and aCD patients. On the other hand, in pCD patients, the overall abundance of serum FFAs showed relevant and significant differences in comparison with aCD patients and HC. In detail, compared to HC, pCD patients displayed higher levels of propionic, butyric, valeric, 2-ethylhexanoic, tetradecanoic, hexadecanoic, and octadecanoic acids. Instead, aCD patients showed increased levels of propionic, isohexanoic, and 2-ethylhexanoic acids, and a lower abundance of isovaleric and 2-methylbutyricacids when compared to HC. In addition, compared to aCD patients, pCD patients showed a higher abundance of isobutyric and octadecanoic acid. Finally, the immunological analysis of duodenal biopsy revealed a lower percentage of CD4+ T lymphocytes in pCD infiltrate compared to that observed in aCD patients. The functional characterization of T cells documented a pro-inflammatory immune response in both aCD and pCD patients, but the pCD patients showed a higher percentage of Th0/Th17 and a lower percentage of Th1/Th17.ConclusionThe results of the present study show, for the first time, that the duodenal microbiota of patients with pCD does not differ substantially from that of aCD; however, serum FFAs and local T cells displayed a distinctive profile between pCD, aCD, and HC. In conclusion, our result may help to shed new light on the “gut microbiota-immunity axis,” lipid metabolites, and duodenal immune response in overt CD and pCD patients, opening new paradigms in understanding the pathogenesis behind CD progression.

Mucosal Healing in Celiac Disease: Villous Architecture and Immunohistochemical Features in Children on a Long-Term Gluten Free Diet.

Considerable heterogeneity exists across studies assessing intestinal mucosal recovery in celiac (CD) patients on a gluten-free diet (GFD). We aimed at investigating histological and immunohistochemical features in CD patients on a long-term GFD and to correlate them to the GFD duration. Morphometrical and immunohistochemical analysis were retrospectively performed on duodenal biopsies in three groups of children: 33 on a long-term (>2 years) GFD (GFD-group), four of which remained seropositive despite dietary adherence, 31 with villous atrophy (ACD-group) and 76 heathy, non-celiac (CTR-group). Moreover, in the GFD-group, we correlated immunohistochemical alterations to the GFD duration. The villous to crypt (V/C) ratio significantly improved after the GFD and completely normalized in all patients, becoming even higher than in the CTR-group (median value 3.2 vs. 3, p = 0.007). In parallel, the number of CD3+ and TCRγδ+ cells in the epithelium were significantly reduced in the GFD compared to ACD patients, even if they remained higher than in the CTR-group (p < 0.05). In contrast, CD25+ cells in the lamina propria significantly decreased after the GFD (p < 0.05) and become comparable to the CTR-group (p = 0.9). In the GFD-group there was no difference in the immunohistochemical parameters between seropositive and seronegative patients and alterations did not correlate to GFD length. In conclusion, a GFD is able to both restore a normal V/C ratio and reduce inflammation, but the epithelium maintains some stigmata of the disorder, such as an increased number of CD3+ and TCRγδ+ cells. These alterations persist regardless of the duration of the GFD.

222. Development of a hierarchical approach to surgical planning in adult cervical deformity surgery

<h3>BACKGROUND CONTEXT</h3> Research has been concentrated on cervical deformity realignment thresholds for achieving desired clinical outcomes while decreasing worrisome complications, like distal junctional failure (DJF) and reoperation. The present study aims to establish a hierarchical order for realignment of spinopelvic parameters during ACD surgery. <h3>PURPOSE</h3> Develop a hierarchical order to cervical parameter realignment produces better 2-year HRQL metrics and decrease the risk of junctional failure during ACD surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective. <h3>PATIENT SAMPLE</h3> A total of 290 ACD patients. <h3>OUTCOME MEASURES</h3> Clinical outcomes, distal junctional failure, reoperation, radiographic realignment. <h3>METHODS</h3> Included: operative CD patients with up to 2-year (2Y) HRQL data. Outcome variables: distal junctional kyphosis (DJK) and failure (DJF); reoperation; and Virk et al good clinical outcome((meeting 2 of 3: NDI>20 or meeting MCID, mJOA >=14), NRS-Neck<=5 or improved by 2 or more points from baseline). Optimal outcome was defined as meeting good clinical outcome without developing DJF or undergoing reoperation. Descriptive analysis identified cohort demographics and radiographic parameters (C2 Slope, Cervical Lordosis, McGregor's Slope, TS-CL, cSVA, T1 slope). Using conditional inference tree (CIT) analysis, thresholds for each parameter were derived based on meeting optimal outcome. Patients meeting the best performing threshold in terms of optimal outcome were isolated and the threshold derivation was repeated for the remaining parameters. ANCOVA, controlling for age and baseline deformity, assessed outcome rates in patients meeting the hierarchical realignment. <h3>RESULTS</h3> A total of 133 ACD patients (61.8±9.9yrs, 27.6±5.8 kg/m2, CCI: 1.0±1.4, CD-FI: 0.4±0.1) who underwent surgery (7.6±4.0 levels fused, EBL: 781±853 mL, op time: 383±218 min, LOS: 5.9±4.4 days) were included. Twenty percent underwent an anterior approach, 46% posterior, 34% combined. Decompressions were performed in 52%, 83% underwent an osteotomy. After correction, there was a significant difference in meeting optimal outcome when correcting C2 Slope below 10° (85% vs 34%, p< .001), along with lower rates of DJF (7% vs 42%, p <.001). Next, after isolating patients above the C2 slope threshold, correction of T1 slope below 26° demonstrated lower rates of DJK and higher odds of meeting optimal outcome (OR: 4.2, p=.011). The best third step was correction of cSVA below 35mm.This hierarchical approach (11% of cohort) led to significantly lower rates of DJF (0% vs 15%, p<.007), reoperation (8% vs 28%, p < .001), and higher rates of meeting optimal outcome (93% vs 36%, p < .001), and maintained significance after controlling for age and baseline deformity. <h3>CONCLUSIONS</h3> This ordered realignment of cervical parameters has demonstrated strong correlation to HRQL metrics and complications. Correction of C2 slope should be prioritized during cervical deformity surgery, with subsequent correction of T1 slope and cervical SVA below the derived thresholds. Amongst the numerous radiographic parameters used in cervical deformity, these findings help the surgeon prioritize realignment in certain parameters to achieve successful outcomes. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

P113. At what point does degenerative become deformity: when good outcomes necessitate sagittal correction in adult cervical deformity surgery

BACKGROUND CONTEXT Current radiographic thresholds have shown inconsistent correlation with clinical outcomes. However, it has not been determined at what point in presenting deformity does sagittal correction tremendously improve clinical outcomes following cervical deformity surgery. PURPOSE Define baseline thresholds in cervical parameters that, when exceeded, benefit dramatically from surgical correction to achieve ideal clinical outcomes. STUDY DESIGN/SETTING Retrospective. PATIENT SAMPLE A total of 290 ACD patients. OUTCOME MEASURES Clinical outcomes, radiographic alignment. METHODS CD patients with baseline (BL) and 2-year (2Y) data included. Parameters assessed: C2 slope (C2S), C2-C7 Lordosis, C2-C7 SVA (cSVA), T1 Slope (T1S), TS-CL. Outcomes: Virket al Good Clinical Outcome (GCO): [Meeting 2 of 3: 1) an NDI>20 or meeting MCID, 2) mJOA >=14), 3) an NRS-Neck<=5 or improved by 2 or more points from baseline]. Binary logistic regression assessed each parameter to determine if correction was more likely needed to achieve GCO. Conditional inference tree (CIT) run machine learning analysis generated baseline thresholds for each parameter, above which, correction was necessary to achieve GCO. RESULTS Included: 105 CD patients. There were 57 (54%) of patients achieving GCO by 2Y. Correction was necessitated when baseline C2S was above 20° (OR: 6.8, [1.6-28.9]; p=.01) and when baseline C2-C7 Lordosis was below 10° (OR: 16, [2.4-107.5]; p=.004). Patients presenting with a cSVA above 20 mm more often achieved clinical success when corrected (74.2% vs 0.0%, p<.001). A baseline T1 slope above 23° was 16 times more likely to reach GCO with correction than those below this threshold (p=.005). TS-CL more likely required correction to reach GCO when above 26° at baseline (OR: 7.0, [1.7-29.1]; p=.007). When assessing patients above both the cSVA and C2S threshold versus the remaining cohort, these patients more likely met GCO when corrected in either parameter (OR: 22.5, [3.3-152.0]; p=.001). CONCLUSIONS Our study highlighted the importance of correction and the threshold at which it dramatically impacts clinical success. These new thresholds delineate patients obtaining superior benefit for sagittal correction and may better increase the utility gained from surgical intervention for cervical deformity. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Current radiographic thresholds have shown inconsistent correlation with clinical outcomes. However, it has not been determined at what point in presenting deformity does sagittal correction tremendously improve clinical outcomes following cervical deformity surgery. Define baseline thresholds in cervical parameters that, when exceeded, benefit dramatically from surgical correction to achieve ideal clinical outcomes. Retrospective. A total of 290 ACD patients. Clinical outcomes, radiographic alignment. CD patients with baseline (BL) and 2-year (2Y) data included. Parameters assessed: C2 slope (C2S), C2-C7 Lordosis, C2-C7 SVA (cSVA), T1 Slope (T1S), TS-CL. Outcomes: Virket al Good Clinical Outcome (GCO): [Meeting 2 of 3: 1) an NDI>20 or meeting MCID, 2) mJOA >=14), 3) an NRS-Neck<=5 or improved by 2 or more points from baseline]. Binary logistic regression assessed each parameter to determine if correction was more likely needed to achieve GCO. Conditional inference tree (CIT) run machine learning analysis generated baseline thresholds for each parameter, above which, correction was necessary to achieve GCO. Included: 105 CD patients. There were 57 (54%) of patients achieving GCO by 2Y. Correction was necessitated when baseline C2S was above 20° (OR: 6.8, [1.6-28.9]; p=.01) and when baseline C2-C7 Lordosis was below 10° (OR: 16, [2.4-107.5]; p=.004). Patients presenting with a cSVA above 20 mm more often achieved clinical success when corrected (74.2% vs 0.0%, p<.001). A baseline T1 slope above 23° was 16 times more likely to reach GCO with correction than those below this threshold (p=.005). TS-CL more likely required correction to reach GCO when above 26° at baseline (OR: 7.0, [1.7-29.1]; p=.007). When assessing patients above both the cSVA and C2S threshold versus the remaining cohort, these patients more likely met GCO when corrected in either parameter (OR: 22.5, [3.3-152.0]; p=.001). Our study highlighted the importance of correction and the threshold at which it dramatically impacts clinical success. These new thresholds delineate patients obtaining superior benefit for sagittal correction and may better increase the utility gained from surgical intervention for cervical deformity.

Elevated AST/ALT ratio is associated with all-cause mortality in patients with stable coronary artery disease: a secondary analysis based on a retrospective cohort study

The aim of this study is to explore the association between the aspartate amino transferase (AST)/alanine aminotransferase (ALT) ratio and all-cause mortality (ACM) in stable coronary artery disease (CAD) patients treated by percutaneous coronary intervention (PCI). The study is a secondary analysis of a retrospective cohort study involving 203 stable CAD patients. Patients were divided into two groups, based on the optimal AST/ALT ratio threshold calculated by the ROC curve (low group: AST/ALT ratio < 1.40; high group: AST/ALT ratio ≥ 1.40). Results were compared using hazard ratio (HR) and a 95% confidence interval (CI). ACM occurred in 18 patients after an average follow-up time of 749 (435–1122) days. Among them, ACM occurred in 6 patients in the low group and 12 patients in the high group, with significant differences between the groups (4.65% versus 16.22%, P value = 0.005). In the Kaplan–Meier analysis, an elevated AST/ALT ratio was associated with increased ACM in stable ACD patients (HR 3.78, 95% CI 1.44–9.93, P value < 0.001). An elevated AST/ALT ratio was still found to be an independent prognostic factor for ACM (HR 2.93, 95% CI 1.08–7.91, P value = 0.034) after adjusting for potential confounders. Therefore, an elevated AST/ALT ratio is an independent prognostic factor for ACM in stable ACD patients.

Paediatric Crohn’s Disease Patients Have Increased Inflammatory Markers Compared to Adult Patients prior to Biological Treatment

Background. Recent epidemiological studies in inflammatory bowel disease (IBD) indicate that paediatric onset of IBD (pIBD) more often requires biological therapy compared to adult onset of IBD (aIBD). Whether this is due to a more aggressive disease phenotype or lower threshold of prescribing biologicals is unknown. In order to expand these findings in a clinical setting, we compared the inflammatory burden in pIBD and aIBD patients requiring biological therapy. Methods. We retrospectively included 70 pIBD and 83 aIBD patients initiating biological therapy. Symptoms and biomarker levels were recorded prior to and 6, 14, 22, and 52 weeks after initiation of biological therapy. Results. In Crohn’s disease (CD), the baseline levels of faecal calprotectin and C-reactive protein (CRP) were increased in paediatric CD patients compared to adult CD patients ( p &lt; 0.0001 and p = 0.01 , respectively). No significant differences were seen in ulcerative colitis (UC). In CD, baseline vitamin D levels ≥ 75 nmol/L and baseline CRP levels &lt; 5 mg/L were associated with higher remission rate ( p = 0.02 ) at the end of follow-up. Moreover, aIBD patients had a higher risk of loss of response to biological therapy and treatment discontinuation compared to pIBD patients ( HR = 4.7 [1.6-13.4], p = 0.004 ). Conclusions. pCD patients had increased inflammation markers compared to aCD patients prior to biological treatment. In addition to this, vitamin D &lt; 75 nmol/L and high CRP levels predicted poor response to treatment in IBD patients.

The Specific Changes of Urine Raman Spectra Can Serve as Novel Diagnostic Tools for Disease Characteristics in Patients with Crohn's Disease.

PurposeCrohn’s disease (CD) is a chronic recurrent intestinal inflammatory disease that requires repeated invasive examinations. Convenient and noninvasive diagnostic tools for CD are lacking. Surface-enhanced Raman spectroscopy (SERS) can rapidly provide specific metabolite information in various samples. Our previous study has showed urine Raman spectrum can distinguish CD patients from healthy controls noninvasively. In this study, we further investigated the value of urine Raman spectra on identifying the disease characterizations in patients with CD.Patients and MethodsUrine samples were analyzed by SERS to acquire specific changes of the spectra from 100 active CD (aCD) patients and 88 inactive CD (iCD) patients. The accuracy of classifier models yielded by SERS was assessed by principal component analysis and support vector machine (PCA-SVM) to investigate spectral differences and disease characterizations.ResultsGiven a panel of 16 specific Raman spectra, the classifier model was established to predict disease activity between patients with aCD and iCD and achieved higher efficacy than fecal calprotectin (AUC value, 0.864 vs 0.596, P=0.02). After leave-one-patient-out cross-validation, the classifier model still obtained 75.5% of accuracy. The correlation analysis showed it had negative correlation with endoscopic results (r=−0.616, P<0.0001). We further established the classifier model in identifying disease location to discriminate colonic-type from ileal-type CD with 63.6% of accuracy with the significantly increased intensity of 1643 cm−1 band, and the model to predict the spectra changes of before and after treatment in tumor necrosis factor inhibitor responders with 91.2% of accuracy with a panel of 11 specific spectra. The metabolic changes of amino acids, proteins, lipids, and other compounds in urine levels were noted by SERS in patients with CD.ConclusionThe specific changes of urine Raman spectra can reflect changes in urine metabolism. It has the potential value on being the promising diagnostic tool for disease characterizations in CD patients by a convenient and noninvasive way.

126. Proximal and distal reciprocal alignment changes following cervical deformity correction

<h3>BACKGROUND CONTEXT</h3> Hyperextension of C0-C2 is a painful compensatory mechanism used to maintain horizontal gaze that is analogous to high pelvic tilt to maintain upright posture. The magnitude and impact of relaxation of this hyperextension following CD correction are not well understood. <h3>PURPOSE</h3> To investigate whether correction of cervical sagittal malalignment allows for relaxation of C0–C2 hyperextension and improved clinical outcome. <h3>STUDY DESIGN/SETTING</h3> Retrospective review. <h3>PATIENT SAMPLE</h3> This study included 65 ACD patients with 1- or 2-year follow-up. <h3>OUTCOME MEASURES</h3> Radiographic alignment, range of motion (ROM). <h3>Methods</h3> CD patients undergoing surgery short of the occiput and the pelvis were included. In addition to the classic alignment parameters, ROM and reserve of extension were calculated across the C2-C7 and C0-C2 segments. After describing the cohort in terms of preoperative information, correlations and hierarchical stepwise regressions investigated the association between C2-C7 correction and change in C0-C2 reserve of extension while controlling for maintenance of horizontal gaze. Stratification by ΔC2-C7 percentile was conducted followed by paired t-tests to investigate changes in TK, C0-C2 and reserve of extension within each percentile. <h3>Results</h3> Sixty-five patients were included (61.8yo±9.6, 68%F). At baseline, they presented with a cervical kyphotic alignment (C2-C7: -11.7°±18.2; TS-CL: 38.6°±18.6), a negative global alignment (SVA: -12mm±71), and hyperlordosis at C0-C2 (33.2°±11.8). The ROM was 25.7°±17.7 and 21.3°±9.9 at C2-C7 and C0-C2, respectively, with an associated reserve of extension of ∼9° for each segment. Limited C0-C2 ROM and reserve of extension significantly correlated with the Neck Disability Index (r=-0.371 & -0.394) and with decreased general health (r=0.455 & 0.512) (all p<0.005) The mean number of levels treated was 7.0±3.1 (24.6% ACDF, 43.1% posterior), with 49.2% of the patients receiving an osteotomy, and 16.9% a 3CO. At 1 year, C2-C7 increased to 5.5°±13.4, SVA became neutral (12mm±54), C0-C2 decreased to 27.7°±11.7, and TK increased to -49.4±18.1 (all p <0.001). At C2-C7 ROM decreased significantly to 9.5°±14.1, and increased to 27.6°±8.1 at C0-C2 without change in reserve of extension. The horizontal gaze significantly improved (4.5±13.3 vs -0.5±9.3 p=0.003). Controlling horizontal gaze, change in C2-C7 lordosis significantly correlated with increased TK (r=-0.615, p<0.01), decreased C0-C2 (r=-0.686, p<0.001), and increased C0-C2 reserve of extension (r=0.414, p<0.015). Larger C0-C2 ROM and reserve of extension correlated with decreased in Neck Disability Index (r=-0.571 & -0.470 p<0.05). Stratification by ΔC2-C7 percentile highlighted the reciprocal change above and below the fusion. Within the lowest percentile (ΔC2-C7: 2°±9.6), no significant difference was noticed between pre and 1 year, while within the highest percentile (ΔC2-C7: -42.8±14.1), C0-C2 decreased (-9.7°±10.5, p=0.001), TK kyphosis increased (14.3°±7.5, p<0.001) and C0-C2 reserve of extension increased (5.8°±6.4, p=0.026). Subanalysis on patients with available 2-year data (N=42) demonstrated similar trends. <h3>Conclusions</h3> Correction of cervical malalignment can significantly impact proximal (C0-C2) and distal (T2-T12) compensation. Restoration of a more natural alignment resulted in an increase of the reserve of extension between C0-C2 and was associated with improved clinical outcomes. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Impact of allergic contact dermatitis on the quality of life and work productivity

Background: Contact dermatitis is a skin reaction to physical, chemical and biological substances that are very prevalent in the environment in particular at work. Objective: To evaluate ACD patients' quality of life and to study their work productivity effects of this disorder.Methods: The patient's comprehensive history including age, sex, occupation type, duration of current employment, duration of existing dermatitis and distribution of skin injuries. History was asked concerning the use of protective apparel, hobbies, correlation with the use of various products such as medications, topical soap, jewellery and history of pre-treatment. Dermatological or systemic illness related if any. For the quality assessment of ACD patients, we have used the Dermatology Life Quality Index (DLQI). It is a 10-point instrument that measures the effect of skin disease on a person's quality of life.Results: Male dominance was seen with 66% and females were 34%. The maximum patients belonged to the age group of 30 to 40 yrs with 32%. In work related consequences due to contact dermatitis, 17% of the cases were transferred, 9% of the cases had decline in income, In 7% of the cases, work loss was seen. In 2% Change of company was done in only 2%. Hand Eczema was seen in 60% of the cases. Dermatology Life Quality Index (DLQI) score band. In Majority of the patients in 51% it had very large effect on patient's life. Extremely large effect on patient's life was seen in 22% of the patients. The mean DLQI score was 20.20 and standard deviation was 5.40 and P-value was 0.005 which was significant.Conclusion: The issue of allergic contact dermatitis is also a contentious issue since the social, socio-professional and familial consequences of this disease are prevalent with a severe impairment. It impacts the quality of life and work of patients, something all occupational practitioners and dermatologists should consider.

Increased expression of extracellular matrix metalloproteinase inducer (EMMPRIN) and MMP10, MMP23 in inflammatory bowel disease: Cross-sectional study.

It has been reported that EMMPRIN is involved in the regulation of immune response and the induction of MMPs production by fibroblasts. The aim of this study was to describe the intestinal gene expression and protein production of EMMPRIN, MMP23 and MMP10 in patients with ulcerative colitis (UC) and Crohn's disease (CD) and compared them with a control group. Gene expression of EMMPRIN, MMP10 and MMP23B was measured by RT-PCR. In order to determine EMMPRIN and MMP protein expression, colonic tissues were immunostained. The results of the study showed EMMPRIN gene expression was upregulated in rectal mucosa from active (a)UC versus aCD patients (P=.045), remission (r)CD group (P=.0009) and controls (P<.0001). We detected differences between rUC and aCD (P=.004), rCD (P<.0001) or control group (P<.0001). EMMPRIN showed a higher expression in mucosa (intraepithelial lymphocytes), submucosa and adventitia (endothelial cells) from aCD patients. MMP23 levels were increased in aUC and aCD compared to rUC and rCD and the control group (P=.0001). EMMPRIN+/MMP23+─expressing cells were localized mainly in mucosa, muscular and adventitia from active UC patients. MMP10 gene expression was increased in aUC versus CD patients and the control group (P=.0001). MMP10 gene expression is associated with inflammation in UC patients (P=.0001, r2 =.585). EMMPRIN+/MMP10+─producing cells were found mainly in all intestinal layers and perivascular inflammatory infiltrates from aUC patients. In conclusion, EMMPRIN, MMP23 and MMP10 were upregulated in patients with active UC versus remission UC , CD and control groups suggesting that, they are involved in the inflammatory process.

Early- and late anthracycline-induced cardiac dysfunction: echocardiographic characterization and response to heart failure therapy

BackgroundAnthracycline-induced cardiac dysfunction (ACD) is a notorious side effect of anticancer treatment. It has been described as a phenomenon of a continuous progressive decline of cardiac function, eventually leading to dilated cardiomyopathy (DCM). This progressive nature suggests that patients with a delayed ACD diagnosis have greater compromise of cardiac function and more adverse remodeling, with a poor response to heart failure (HF) treatment. This study aimed to delineate the impact of a delayed ACD diagnosis on echocardiographic characteristics and response to HF treatment.Methods and resultsFrom the population of our cardio-oncology outpatient clinic, 92 ACD patients were included in this study (age 51.6 ± 16.2 years, median cumulative anthracycline dose 329 [200–329] mg/m2), and a median follow-up of 25.0 [9.6–37.2] months after ACD diagnosis. Median time to ACD diagnosis for patients diagnosed early (< 1 year) and late (> 1 year) was 4.0 vs. 47.7 months respectively. There were no echocardiographic differences between patients diagnosed early vs. late (LVEF 43.6 ± 4.9% vs. 43.0 ± 6.2% and iEDV 63.6 vs. 62.9 mL/m2). Eighty-three percent of patients presented with mild LV dysfunction and in 79% the LV was not dilated. Patients diagnosed early were more likely to have (partial) recovery of cardiac function upon HF treatment initiation (p = 0.015).ConclusionsIn the setting of a cardio-oncology outpatient clinic, patients with ACD presented with a hypokinetic non-dilated cardiomyopathy, rather than typical DCM. Timing of ACD diagnosis did not impact HF disease severity. However, in patients receiving an early diagnosis, cardiac function was more likely to recover upon HF treatment.

P086 Identification of constitutive modifications in plasma cells and B lymphocytes in patients with inflammatory bowel disease

Abstract Background Plasma cells (PCs) and B lymphocytes (BLs) are a source of immunoglobulins (Ig), being IgA essential for intestinal homeostasis. An unbalanced intestinal Ig production has been described in inflammatory bowel disease (IBD). Nevertheless little is known about the role of mucosal Ig-producing BL and PC in IBD, reason why we decided to study them. Methods We included 12 healthy controls -HC-, 10 patients with ulcerative colitis (three active -aUC- and seven quiescent -qUC) and 10 patients with Crohn’s disease (three active -aCD- and seven quiescent -qCD). Disease was located in the distal colon in all patients, although the quiescent ones had no inflammation (endoscopic Mayo = 0; SES-CD = 0–1). Distal colon biopsies were collected together with peripheral blood. Mucus layer and epithelial barrier was removed from the biopsies and lamina propria mononuclear cells were harvested using the ‘walk-out’ protocol. Peripheral blood mononuclear cells were obtained after ficoll centrifugation. In both cases, cells were stained with specific antibodies, acquired in a FACSCanto II cytometer, and analysed with FlowJo. Median percentage of PC and BL (and their subsets) relative to each tissue was calculated and compared using non-parametric statistics, considering statistically significant p &amp;lt; 0.05. Results The proportion of plasmablasts, blood-precursors of PC, was higher in the blood of active IBD patients (HC: 0.8%; aUC: 5.3%; aCD: 3.4%). Even though there were no differences in the colonic proportion of PC between the study groups, there was a constitutive lower proportion of IgA-producing PC in IBD, irrespective of its type (UC or CD) or presence of inflammation (HC: 88%; qUC: 55%; aUC: 38%; qCD: 70%; aCD: 44%). Moreover, aCD patients also showed a significantly higher proportion of IgM-producing PC (HC: 6% vs. aCD: 10%), and a higher proportion PC expressing CD19 compared both with HC and qCD (HC: 43%; qCD: 52%; aCD: 74%). The proportion of BL and their subsets did not show differences between the study groups, neither in blood nor in colon. However, in UC patients, some circulating subsets displayed a lower proportion of cells expressing the gut-homing integrin β7: naive BL (HC: 11.5%; qUC: 2.9%; aUC: 0.6%) and IgM memory BL type CD27+ (HC: 43%; qUC: 30%; aUC: 23%) and also CD27- (HC: 32% vs. aUC: 5%). Conclusion IBD patients have a diminished percentage of colonic IgA-producing PC, which is irrespective of the type of IBD or the inflammatory status; this reduction could compromise the correct microbiota regulation in IBD. The reduction of the percentage of β7-expressing BL in the blood of UC patients could potentially point to a specific pathogenic mechanism of UC.

PS1293 OSTEOGENESIS IMPERFECTA: A NEW UNRECOGNIZED ETIOLOGY FOR FUNCTIONAL IRON DEFICIENCY

Background:Osteogenesis imperfecta (OI) is a genetic disorder of connective tissue primarily affecting bone with a wide spectrum of clinical expression that varies from death in the perinatal period to normal life expectancy. Although data is scarce, we observed a high frequency of anemia in patients with OI and hypothesized that functional iron deficiency (FID) may occur secondary to the inflammation resulting from frequent fractures and multiple surgical procedures.Aims:The aim of this work was to study the frequency of anemia in children with OI and try to classify them according to iron status by conventional tests to analyze the possibility of presence of FID and the possible association of hepcidin level with such etiology.Methods:A cross‐sectional study included 56 patients diagnosed with osteogenesis imperfecta regularly following at the genetics clinic, Children'sHospital, Ain‐Shams university. All patients were subjected to detailed clinical scoring with complete blood count, serum iron, serum ferritin, and total iron binding capacity, C‐reactive protein (CRP) and serum hepcidin by ELISA, Dexa scan and lateral and AP spine x‐ray. Patients were classified into five groups, Group‐1 including 7 OI patients fulfilling criteria of FID; serum ferritin &gt; 100ng/ml, TS &lt; 20% and CRP&gt; 1 mg/dl, Group‐2 including 27 OI patients fulfilling criteria of combined ACD&amp;IDA; serum ferritin level was ≤ 100ng /ml, TS &lt; 20% and CRP&gt; 1 mg/dl, Group‐3 including 16 OI patients without anemia according to WHO classification, other anemia group including 6 OI patients with anemia that could not be classified according to the classification adopted in this study, IDA anemia including zero OI patients as there were no patients fulfilling criteria of pure IDA; ferritin &lt; 12ng/ml in children aged &lt;5 years, or ferritin &lt;15ng/ml in children aged &gt; 5 years, when the corresponding CRP was &lt;1 mg/dl and TS &lt; 20%.Results:The frequency of anemia among the studied patients with osteogenesis imperfecta was 71.4%. Combined IDA and FID formed 48.2%, 12.5%, 28.6% and 10.7% hadFID, no anemia and other anemia groups respectively. functional iron deficiency was found in 60.7%.Median hepcidin level was significantly increased in pure FID patients 120 (100 – 510 ng/mL) as compared to those in no anemia patients 80 (65 – 100 ng/mL) and other anemias 60 (50 – 70 ng/mL). The serum hepcidin concentration was mildly reduced in ACD patients with ID with a median of 100 (60 – 150 ng/mL).Patients with severity score levels less than 70% had significant higher number of WBCS, platelets and serum hepcidin levels and significant lower serum iron compared to patients with severity score levels more than 70% and less than 90%.Summary/Conclusion:Anemia is an unrecognized complication in patients with OI. Functional iron deficiency constitutes a significant etiology adding to dietetic problems. New therapeutic approach for FID is suggested to improve the quality of fracture healing in such group.

PB1965 CLINICAL UTILITY OF RETICULOCYTE HEMOGLOBIN EQUIVALENT TO DIFFERENTIATE BETWEEN FUNCTIONAL IRON DEFICIENCY ANEMIA AND TRUE ANEMIA AND DIFFERENT FROM ANEMIA OF OTHER CAUSES OF CHRONIC DISEASE.

Background:Iron Restricted Erythropoiesis can be: 1.Absolute iron deficiency2. Iron sequestration [impaired iron trafficking]3. Functional iron deficiency [FID]4. Heriditary conditions with impaired iron transport &amp; utilization.Anaemia of chronic disease [ACD] is defined as hypoproliferative anaemia of no apparent cause.Ret He is hemoglobin content equivalent of reticulocytes.Monitors iron supply during erythropoiesis over last 2‐3 days, increases within 2‐4 days of iron therapyAims:To compare Ret He and % Hypo values with standard biochemical markers of iron metabolism: serum iron, TIBC, Transferrin saturation, serum ferritin, sTfR [Soluble Transferrin Receptor] levels and to assess in diagnosing iron deficiency.Methods:[n = 120] analysed [15 M: 10 F ratio,age 10 – 87 yrs]CBC samples [K2 EDTA] analysed on Sysmex XN1000 series.Ret He and Hypo He % identified in the reticulocyte channel by Fluorescence flowcytometry using polymethine dyePatients with Haemoglobin &lt; 10 g/dl tested[1]:Normal patients [n = 25] 20.8 %. [2]: IDA Patients [n = 45] 37.5 %. [3]: CKD Patients on haemodialysis treated with variety of erythropoietin doses [n = 12] 10 %. [4]: CKD Patients [n = 7] 5.8 %. [5]: ACD Patients [n = 31] 25.8 %.Ret‐He: Sensitivity: 97.87 %,Specificity: 96.15 %,PPV: 98.92 %,NPV: 92.59 %Results:20 % Normal patients Ret He 33 pgIn 5% of ACD,IDA co‐existented so differentiate ACD and ACD/IDA as iron supplementation is beneficial for ACD/IDA patients but deleterious for ACD patients. 37 % IDA Patients Ret He was &lt; 23.6 pg.3.3 %patients of thalassemia with IDA, Ret‐He: 19.5pg.STfR elevated in IDA cases, but was normal in ACD &amp;FID casesHypo He % in FID [&gt; 5%],IDA [&gt;10%] ACD [&lt;5 %]. Hypo He % measure is time average marker of iron restricted erythropoiesis [20‐120 days].10% CKD patients on erythropoietin doses Ret‐He &lt; 25.5 pg presents FIDNormal Range for Ret He: 31‐35 pg. Summary/Conclusion:Serum Iron, TIBC, % T Sat. Screens anemia but Ret He detects &amp; gives expended information at cellular levels so assess true status of iron and predictor of marrow iron stores imageDetects IDA, FID, ACD which helps differential diagnosis Ret He &lt; 23.6 pg. suggest classical iron deficiency &amp; also predicts FID in those receiving ESA [erythropoietin stimulating agent] therapy. Indicates a non responder to rHuEPO/ ESA or FID

Role of Soluble Transferrin Receptor and Transferrin Receptor-Ferritin Index to Detect Iron Deficiency Anemia in Regular Hemodialysis Patients.

BACKGROUND:Several iron indicators can be used to detect iron deficiency anaemia (IDA) where confounding comorbidities occurred such as patients with regular hemodialysis.AIM:This study was aimed to determine the diagnostic value of serum transferrin receptor (sTfR) and transferrin receptor-transferrin index (TfR-F index) and to combine these two markers in detecting IDA in regular hemodialysis anaemic patients.METHODS:There were 70 patients recruited consecutively. IDA was diagnosed based on TS < 20% and ferritin level < 200 ng/L and functional iron deficiency when TS < 20% and ferritin > 200 ng/L. TfR-F index calculated as sTfR/log ferritin.RESULTS:Correlation of ferritin to iron level was changed when its correlation adjusted by confounding inflammation (CRP level > 10). The correlation strength of ferritin to iron serum before adjusted was r = 0.37 with p = 0.02 but became r = 0.65 with p = 0.023 after adjusted to CRP > 10. In inflammation (CRP > 10), ferritin mild-moderately correlated with iron but became moderately strong when there was no inflammation (CRP < 10). AUC for sTfR was 0.77 with p = 0.028 (95% CI 0.55-0.99), and for TfR-F index has larger AUC 0.85% with p = 0.004 (95%CI 0.69-1.00), hence TfR-F index more superior than sTfR. sTfR and sTfR-F index were not correlated with CRP with p > 0.05, and sTfR and TfR-F index mean level was different between IDA and ACD patients although not statistically significant.CONCLUSION:When sTfR and the TfR-F index used in combination to detect IDA, we found the largest AUC on ROC 0.98 (95% CI 0.94-1.00).

Chronic hand eczema: is IL-36α helpful in diagnosis and classification?

Chronic hand eczema (CHE) is not a homogenous disease, necessitating complex differential diagnostics. Interleukin (IL) -1 family members are significantly up-regulated in ACD and psoriasis patients skin. The present study aims to deepen the knowledge about clinical assessment and characterization of patients affected by chronic hand dermatitis (CHD) as well as to investigate the role of possible biomarkers which may help in the diagnostic process. An observational case-control study was performed enrolling 30 CHD patients and 20 healthy controls. Each patient underwent detailed medical history, clinical examination, epicutaneous patch test, and lesional skin biopsies for histological and immunohistochemical analysis. Patient history, clinical examination and patch testing led us to a final CHD characterization in only 8/30 subjects (26.7%). In the remaining subjects, clinical and histological features suggested a diagnosis of psoriasis in 9/22 (30%) and idiopathic chronic hand eczema (CHE) in 13/22 (43.3%). Trying to find a possible marker for the latter dermatosis, we analyzed IL-1 family in all the recruited subjects. IL-1 members were increased in all conditions, but IL-36α was the only analyzed cytokine able to characterize patients who end up with a diagnosis of idiopathic CHE. In conclusion, we can assess that medical history and patch testing remain essential investigations in CHD patients even if not always sufficient to perform a final diagnosis. Moreover, IL-1 members are probably involved in CHE skin inflammation, with IL-36α being a possible future biomarker which might help in the complex diagnostic process of CHE.