African American Ethnicity Research Articles

976. Development and Validation of a Risk Score for Predicting Cardiovascular Events in HIV-Infected Patients

BackgroundHIV-infected individuals are at higher risk for developing cardiovascular disease (CVD). We aimed to develop a model to predict 10-year cardiovascular (CV) risk given that commonly used CVD risk assessment tools might not be accurate for HIV-infected patients.MethodsWe conducted a retrospective cohort study of HIV-infected patients seen at Boston Medical Center between March 2012 and January 2017. Exclusion criteria are shown in Figure 1. Patients were divided into model development and validation cohorts. Logistic regression was used to create a risk model for CV events using data from the development cohort. The relationship between risk factors and CVD risk was summarized using a point-based risk-scoring system. Areas under the receiver-operating-characteristics curve (AUC) were used to evaluate model discrimination. The model was subsequently tested using the validation cohort.ResultsOf 3,867 eligible HIV-infected patients, 1,914 individuals met inclusion criteria (Figure 1). There were 256 CV events in the development cohort. Ten independent prognostic factors were incorporated into the prediction function (Pmodel < 0.001). The model had excellent discrimination for CVD risk [AUC 0.94; (95% CI:0.93–0.96)] (Figure 2) and included the following variables: male sex (P < 0.001), African-American ethnicity (P = 0.023), current age (P = 0.020), age at HIV diagnosis (P = 0.006), peak HIV viral load (P = 0.012), nadir CD4 lymphocyte count (P < 0.001), hypertension (P < 0.001), hyperlipidemia (P = 0.001), diabetes (P < 0.001), and chronic kidney disease (P < 0.001). Scoring system and score sheets of risk estimates were developed to predict CV events in a 10-year follow-up period (Figures 3 and 4). The 10-parameter multiple logistic regression model also had excellent discrimination [AUC 0.96; (95% CI: 0.89–0.99)] when applied to the validation cohort.ConclusionWe developed and validated a risk-scoring system based on 10 clinical factors that accurately predict the 10-year risk for CV events in an HIV-infected population. This assessment tool may provide clinicians with a rapid assessment of cardiovascular disease risk among HIV-infected patients and inform prevention measures during the era of effective antiretroviral therapy. Disclosures All Authors: No reported Disclosures.

The association of KRAS mutation with primary tumor location and survival in patients undergoing resection of colorectal cancers and synchronous liver metastases.

Recent evidence suggests that a mutation in the KRAS gene has a significant impact on the clinical behavior and prognosis of patients with metastatic colorectal cancer. The KRAS mutation (m-KRAS) has been associated with decreased survival among patient undergoing treatment with a curative and palliative intent. This is believed to be secondary to a reduced response to anti-EGFR chemotherapy agents and a more intrinsically aggressive biology. The aims of this study were to identify risk factors for m-KRAS in patients with curatively resected colorectal cancer and synchronous liver metastases and to assess its association with disease-specific survival (DSS). The Surveillance, Epidemiology and End Results (SEER) Database was surveyed for patients undergoing resection of colorectal cancer and synchronous liver metastases from 2010 to 2015. A total of 806 patients were included, of which 40% hadm-KRAS. Right-sided primary lesions (OR 2.56, 95% CI: 1.90-3.44, P<0.001) and African-American ethnicity (OR 1.58, 95% CI: 1.05-2.40, P=0.03) were independently associated with m-KRAS on multivariable analysis. Compared to wild-type KRAS (wt-KRAS), m-KRAS was associated with decreased 3- and 5-year DSS (59% vs. 50% and 29% vs. 21%, respectively, P=0.024). After adjusting for confounders, a decreased DSS was observed in patients with right-sided lesions (HR 1.68, 95% CI: 1.32-2.12, P<0.001), while m-KRAS was associated with a trend toward decreased DSS (HR 1.15, 95% CI: 0.91-1.46, P=0.24). In patients undergoing surgical resection of colorectal cancer and synchronous liver metastases, m-KRAS was associated with right-sided lesions and African-American ethnicity. Compared to wt-KRAS, m-KRAS was associated with a reduced DSS. Additionally, right-sided lesions were an independent negative prognostic factor for DSS.

P6310Risk predictors of cardiac allograft vasculopathy after heart transplantation: results from the United States Organ Procurement and Transplantation Network

Abstract Background Cardiac allograft vasculopathy (CAV) is a major long-term complication after heart transplantation leading to chronic graft failure and increased mortality. Purpose The aim of this study was to determine recipient- and donor-related risk factors for the development of CAV in patients after heart transplantation. Methods Overall, data from 34,994 heart transplant recipients prospectively enrolled from July 2004 to March 2015 in the Organ Procurement and Transplantation Network (OPTN) were analyzed. Patients aged &lt;18 years and those without information about CAV and re-transplantation were excluded. Multivariable-adjusted analyses were performed to identify recipient- and donor-related risk factors for new-onset CAV. The mean follow-up time was 66.8 months. Analyses are based on OPTN data as of March 6, 2017. Results Of 34,994 patients after heart transplantation, 12,668 (36.2%) patients developed CAV. Mean age was 52±12 years for the recipients (76.1% men) and 31±12 years for the donors (71.0% men), respectively. In recipients, male sex (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.09–1.19, p&lt;0.001), African American ethnicity (HR 1.11, 95% CI 1.06–1.17, p&lt;0.001), body mass index (BMI) (HR per 5 kg/m2 increase 1.08, 95% CI 1.06–1.11, p&lt;0.001) and smoking (HR 1.07, 95% CI 1.01–1.13, p=0.03) were associated with incident CAV. Moreover, recipients with ischemic (HR 1.30, 95% CI 1.09–1.55, p=0.003) and hypertrophic cardiomyopathy (HR 1.26, 95% CI 1.02–1.57, p=0.03) had a higher risk for new-onset CAV than patients with other cardiomyopathies. In donors, age (HR 1.11, 95% CI 1.10–1.11, p&lt;0.001), male sex (HR 1.28 95% CI 1.22–1.34, p&lt;0.001), BMI (HR per 5 kg/m2 increase 1.04, 95% CI 1.02–1.05, p&lt;0.001), smoking (HR 1.09, 95% CI 1.04–1.13, p&lt;0.001), diabetes (HR 1.21 95% CI 1.09–1.36, p&lt;0.001) and arterial hypertension (HR 1.13, 95% CI 1.07–1.20, p&lt;0.001) were associated with new-onset CAV. Contrarily, African American (HR 0.93, 95% CI 0.88–0.98, p=0.007) and Hispanic ethnicity (HR 0.94, 95% CI 0.89–0.99, p=0.03) seemed to be protective. Conclusion Both recipient and donor male sex as well as the classical cardiovascular risk factors BMI and smoking were associated with incident CAV. On the donor side, additionally, diabetes and arterial hypertension were related to new-onset CAV. Diverse ethnicities were differentially related to new-onset CAV. Further studies are needed to clarify whether modification of cardiovascular risk factors as well as improved donor selection will reduce CAV burden.

1173 Patients Taking Proton Pump Inhibitors Are More Likely to Respond to Endoscopic Dilation of Benign Duodenal Stenosis, Regardless of the Etiology

INTRODUCTION: Benign duodenal stenosis (BDS) is usually managed by endoscopic balloon dilation (EBD), but there is very limited literature on this practice outcomes. We sought to investigate the etiological spectrum, response to EBD and predictors for successful EBD. METHODS: We performed a cohort study of a prospectively maintained database of benign duodenal stenosis at a tertiary referral center between 2013 and 2018. Pyloric stenosis patients were excluded. All patients that underwent EBD were analyzed. Dilation was performed using through the scope balloons. Technical and clinical success of initial and repeat EBD were compared among the BDS etiologies, location within the duodenum, and number of stenotic tracts. Logistic regression models were performed using SAS software. RESULTS: A total of 276 patients were analyzed, of whom 87 patients underwent EBD for BDS. Most common etiology was peptic ulcer disease (PUD) 42 (45%) (Table 1). Upon initial EBD, technical success was 96.5% and clinical success was 74.4%. Upon repeat EBD, technical success was 98.1% and clinical success was 78.7%. When comparing PUD vs. All others, initial clinical success was 77.8% vs. 71.4% (P = 0.52), and on repeat EBD clinical success was 72.0% vs. 86.4% (P = 0.23). When comparing Crohn’s disease vs. All others, initial EBD clinical success was 72.2% vs. 75.0% (P = 0.81), and repeat EBD clinical success was 91.7% vs. 74.3% (P = 0.20). When comparing location of the stenosis in the 1st portion of the duodenum vs. distal duodenum, initial EBD clinical success was 70.0% vs. 82.1% (P = 0.24), and repeat EBD clinical success was 75.0% vs. 78.7% (P = 0.36). When comparing single vs. multiple strictures, initial EBD clinical success was 73.0% vs. 100.0% (P = 0.57), and repeat EBD clinical success was 77.3% vs. 100.0% (P = 0.99) (Table 2). 15 patients underwent planned/prophylactic EBD, but this did not impact the outcomes. Males were more likely to have distal duodenum stenosis when compared to females (63.6% vs. 36.4%, P = 0.007). African American had a lower likelihood of clinical success (aOR 0.083, P = 0.004), and usage of PPI increased likelihood of clinical success (aOR 3.65, P = 0.04) (Table 3). CONCLUSION: EBD has very high technical and clinical success rates in BDS. Males tend to have more distal duodenal involvement; African Americans ethnicity are less likely to respond to EBD and importantly, PPI usage was an independent predictor for EBD clinical success regardless of etiology.

2893 Epidemiology of Sub-Epithelial Gastrointestinal Lesions and Factors Influencing Their Tissue Yield by EUS Guided Sampling in a Predominantly African-American and Hispanic Population at a Tertiary Care County Hospital

INTRODUCTION: Gastrointestinal subepithelial lesions are generally found incidentally during endoscopy or abdominal imaging, with an approximate prevalence of 0.4%. Our study aims at obtaining the Epidemiology of Sub-Epithelial Gastrointestinal lesions and factors influencing their Tissue yield by Endoscopic Ultrasound guided sampling in a predominantly African- American and Hispanic population. METHODS: In this retrospective observational study, we included the patients from a busy tertiary care County hospital, who underwent EUS from Jan 2010 through Jan 2018 for Sub-Epithelial Gastrointestinal lesions or found to have and SEL on EUS. Data was collected on basic demographic factors, EUS indications, finding, Histopathology and mode of final diagnosis. After collecting the data, we performed analysis with STATA 14.0 College Station, Texas. with Univariate and Multivariate Logistic Regression analysis for tissue sampling yield. RESULTS: 84 patients were included in our study of which 53% women 31% men. 18.6% of our population was uninsured and 41.4% were of African American ethnicity. Out of all the lesions majority were Gastric nodules [54.9%], 21.4% esophageal, 14.3% duodenal, 7.1 rectosigmoid and 1.2% periampullary. Of the total patients, 52.5% had some form of a tissue sampling [FNA, FNB, Forceps biopsy or EMR] and 47.6% had no biopsy. Of all the lesions seen in EUS, 41.7% were less than 1 cm nodules and 4.8% nodules measured &gt;4cm. Echogenicity and the layer of lesion were also assessed. Univariate and Multivariate Logistic Regression to analyze the tissue sampling yield based on the above variables which showed that none of the variables had a statistically significant correlation to the tissue sampling yield, thus inferring that the yield may likely be dependent on the sampling method and the operator. CONCLUSION: Subepithelial lesions are those located beneath the epithelium and originate from any layer of the gastrointestinal wall.EUS is the best imaging modality to assess gastrointestinal subepithelial lesions and can be used for EUS guided tissue sampling, in addition to diagnostic sonological imaging of the nodule. It helps to distinguish extrinsic lesions from intramural ones based on the originating layer, echogenicity and tissue acquisition to reach an accurate diagnosis. In clinical practice, cytological and immunocytochemical results determine the final diagnosis. In contrary to other literature available, our study was done in a predominantly African American and Hispanic population.

Association between Charlson-Deyo Score and delay to colonoscopy in veterans subsequently diagnosed with colorectal cancer.

288 Background: Colorectal cancer (CRC) is the second most common cause of cancer deaths in the United States and expected to cause 51,020 deaths in 2019. Early detection with yearly fecal occult blood test (FOBT) has been proven to decrease CRC mortality. A 30-day delay from positive FOBT to colonoscopy is associated with increased risk of CRC. The Veterans Affairs Health System (VAHS) treats approximately 11% of CRCs in the United States. The effects of an aging population, physician shortage, and increased military personnel entering the VAHS may increase demands on VAHS resources. The primary aim of this study was to determine risk factors that caused delay to colonoscopy. Methods: We retrospectively reviewed records of 600 patients referred for colonoscopy from January 1999 to January 2009, who were subsequently diagnosed with CRC. Patients with a prior CRC diagnosis were excluded. The final study cohort consisted of 530 patients. We analyzed the relationship between 10 variables and delay in time from initial consultation to colonoscopy. Variables consisted of age, sex, race, ethnicity, CRC location, marital status, history of mental health diagnosis, tobacco use, substance abuse, Charlson/Deyo (C/D) score and season of referral for colonoscopy. A delay in time was defined as 30 days or greater. Logistic regression analysis adjusted for age, race, CRC location and C/D score. Results: A total of 87.17% of patients experienced a delay in time from initial consultation to colonoscopy. When analyzed with a predictive variable of delay to colonoscopy, C/D score of ≥ 2 versus 0, was associated with higher odds of delay in time to colonoscopy (OR = 2.18, p = 0.02). African American race and Hispanic ethnicity was associated with a higher odds of delay in time to colonoscopy, but was not statistically significant (OR = 1.47, p = 0.47, OR = 1.37, p = 0.48). Conclusions: Patients with a C/D score ≥ 2 were 218% more likely to have delay in time from initial consult to colonoscopy, resulting in a delayed CRC diagnosis. C/D score may be used to determine which patients should have more frequent reminders to schedule their colonoscopy to prevent delays in care. Randomized and prospective studies will need to be performed.

Risk factors for venous thromboembolism in total shoulder arthroplasty

BackgroundAlthough venous thromboembolism (VTE) has been studied in lower-extremity arthroplasty, there are few guidelines regarding established risk factors for VTE in total shoulder arthroplasty (TSA). With literature suggesting the VTE rate may be as high as 13%, VTE prevention and risk factors should be considered in preoperative planning.MethodsAll TSAs from 2011 through 2016 were queried from the National Surgical Quality Improvement Program database. Age, sex, body mass index, American Society of Anesthesiologists class, ethnicity, functional status, comorbidities, discharge destination, surgical indication, length of stay, and operative time were compared between patients with and without 30-day postoperative VTE. Pearson χ2 and t tests were used to assess baseline categorical and continuous variables, respectively. Multivariate logistic regression analysis was conducted to determine associated independent risk factors for VTE.ResultsThe analysis included 13,299 patients; VTE developed in 83 patients (0.62%). Patients with VTE were older (72 years vs. 69 years) and had a longer hospital stay (3.5 days vs. 1.9 days). Compared with patients with no VTE, patients with VTE were more likely to undergo TSA for proximal humeral fractures, to be discharged to a rehabilitative center, to have a preoperative albumin level lower than 3.5 g/dL, to undergo non-elective surgery, to have an American Society of Anesthesiologists class of 3 or greater, to have a surgical-site infection develop, and ultimately to need a shoulder reoperation (all P < .05). Multivariate logistic regression analysis revealed that hypoalbuminemia (albumin level < 3.5 g/dL), an increased length of stay, and African American ethnicity were independent risk factors for VTE development.ConclusionPatients with hypoalbuminemia, an increased length of stay, and African American ethnicity are at an increased risk of VTE after shoulder arthroplasty. A high index of suspicion is warranted for elderly patients with fractures who may need preoperative medical optimization.

A functional role for the cancer disparity-linked genes, CRY\u03b2B2 and CRY\u03b2B2P1, in the promotion of breast cancer

BackgroundIn the USA, the breast cancer mortality rate is 41% higher for African-American women than non-Hispanic White women. While numerous gene expression studies have classified biological features that vary by race and may contribute to poorer outcomes, few studies have experimentally tested these associations. CRYβB2 gene expression has drawn particular interest because of its association with overall survival and African-American ethnicity in multiple cancers. Several reports indicate that overexpression of the CRYβB2 pseudogene, CRYβB2P1, and not CRYβB2 is linked with race and poor outcome. It remains unclear whether either or both genes are linked to breast cancer outcomes. This study investigates CRYβB2 and CRYβB2P1 expression in human breast cancers and breast cancer cell line models, with the goal of elucidating the mechanistic contribution of CRYβB2 and CRYβB2P1 to racial disparities.MethodsCustom scripts for CRYβB2 or CRYβB2P1 were generated and used to identify reads that uniquely aligned to either gene. Gene expression according to race and tumor subtype were assessed using all available TCGA breast cancer RNA sequencing alignment samples (n = 1221). In addition, triple-negative breast cancer models engineered to have each gene overexpressed or knocked out were developed and evaluated by in vitro, biochemical, and in vivo assays to identify biological functions.ResultsWe provide evidence that CRYβB2P1 is expressed at higher levels in breast tumors compared to CRYβB2, but only CRYβB2P1 is significantly increased in African-American tumors relative to White American tumors. We show that independent of CRYβB2, CRYβB2P1 enhances tumorigenesis in vivo via promoting cell proliferation. Our data also reveal that CRYβB2P1 may function as a non-coding RNA to regulate CRYβB2 expression. A key observation is that the combined overexpression of both genes was found to suppress cell growth. CRYβB2 overexpression in triple-negative breast cancers increases invasive cellular behaviors, tumor growth, IL6 production, immune cell chemoattraction, and the expression of metastasis-associated genes. These data underscore that both CRYβB2 and CRYβB2P1 promote tumor growth, but their mechanisms for tumor promotion are likely distinct.ConclusionsOur findings provide novel data emphasizing the need to distinguish and study the biological effects of both CRYβB2 and CRYβB2P1 as both genes independently promote tumor progression. Our data demonstrate novel molecular mechanisms of two understudied, disparity-linked molecules.

Alcohol Use and Ethnicity Independently Predict Antiretroviral Therapy Nonadherence Among Patients Living with HIV/HCV Coinfection.

Adherence to antiretroviral therapy (ART) is important to counter synergistic effects of HIV and hepatitis C (HCV) in patients living with coinfection. Predictors of ART nonadherence among patients living with HIV/HCV coinfection are not well established. This knowledge would be advantageous for clinicians and behavioral health specialists who provide care to patients living with HIV/HCV coinfection. The purpose of this study was to assess prevalence and predictors of ART nonadherence in a sample of patients living with HIV/HCV coinfection who were actively in HIV clinical care. A sample of patients living with HIV/HCV coinfection who received care at a university-affiliated HIV clinic (n = 137) between January 2013 and July 2017 were included in the study. Computerized patient-reported data or outcomes (PROs) and electronic medical record data of these respective patients were collected and analyzed. Binomial logistic regression was used to examine predictors of ART nonadherence. The prevalence of ART nonadherence was 31%. In multivariate analysis, African American ethnicity (OR = 3.28, CI 1.241-8.653, p = 0.017) and a higher number of alcoholic drinks per drinking day (OR = 1.31, CI 1.054-1.639, p = 0.015) were positively associated with ART nonadherence. Behavioral health providers are encouraged to incorporate alcohol use reduce interventions in HIV clinical settings to reduce ART nonadherence among patients living with HIV/HCV coinfection. Additionally, public health professionals and researchers, and clinicians are encouraged to use inductive methods to discover why ART nonadherence disproportionately impacts African American patients living with HIV/HCV coinfection and to develop approaches that are sensitive to those respective barriers.

Methods and reporting of kidney function: a systematic review of studies from sub-Saharan Africa.

Globally, chronic kidney disease (CKD) is an emerging public health challenge but accurate data on its true prevalence are scarce, particularly in poorly resourced regions such as sub-Saharan Africa (SSA). Limited funding for population-based studies, poor laboratory infrastructure and the absence of a validated estimating equation for kidney function in Africans are contributing factors. Consequently, most available studies used to estimate population prevalence are hospital-based, with small samples of participants who are at high risk for kidney disease. While serum creatinine is most commonly used to estimate glomerular filtration, there is considerable potential bias in the measurement of creatinine that might lead to inaccurate estimates of kidney disease at individual and population level. To address this, the Laboratory Working Group of the National Kidney Disease Education Program published recommendations in 2006 to standardize the laboratory measurement of creatinine. The primary objective of this review was to appraise implementation of these recommendations in studies conducted in SSA after 2006. Secondary objectives were to assess bias relating to choice of estimating equations for assessing glomerular function in Africans and to evaluate use of recommended diagnostic criteria for CKD. This study was registered with Prospero (CRD42017068151), and using PubMed, African Journals Online and Web of Science, 5845 abstracts were reviewed and 252 full-text articles included for narrative analysis. Overall, two-thirds of studies did not report laboratory methods for creatinine measurement and just over 80% did not report whether their creatinine measurement was isotope dilution mass spectroscopy (IDMS) traceable. For those reporting a method, Jaffe was the most common (93%). The four-variable Modification of Diet in Renal Disease (4-v MDRD) equation was most frequently used (42%), followed by the CKD Epidemiology Collaboration (CKD-EPI) equation for creatinine (26%). For the 4-v MDRD equation and CKD-EPI equations, respectively, one-third to one half of studies clarified use of the coefficient for African-American (AA) ethnicity. When reporting CKD prevalence, <15% of studies fulfilled Kidney Disease: Improving Global Outcomes criteria and even fewer used a population-based sample. Six studies compared performance of estimating equations to measured glomerular filtration rate (GFR) demonstrating that coefficients for AA ethnicity used in the 4-v MDRD and the CKD-EPI equations overestimated GFR in Africans. To improve on reporting in future studies, we propose an ‘easy to use’ checklist that will standardize reporting of kidney function and improve the quality of studies in the region. This research contributes some understanding of the factors requiring attention to ensure accurate assessment of the burden of kidney disease in SSA. Many of these factors are difficult to address and extend beyond individual researchers to health systems and governmental policy, but understanding the burden of kidney disease is a critical first step to informing an integrated public health response that would provide appropriate screening, prevention and management of kidney disease in countries from SSA. This is particularly relevant as CKD is a common pathway in both infectious and non-communicable diseases, and multimorbidity is now commonplace, and even more so when those living with severe kidney disease have limited or no access to renal replacement therapy.

Do Women have Adequate Knowledge about Pelvic Floor Dysfunctions? A Systematic Review.

We sought to investigate whether women present adequate knowledge of the main pelvic floor disorders (PFDs) (urinary incontinence - UI, fecal incontinence - FI, and pelvic organ prolapse - POP). A systematic review was performed in the MEDLINE, PEDro, CENTRAL, and Cochrane databases for publications from inception to April 2018. A total of 3,125 studies were reviewed. Meta-analysis was not possible due to the heterogeneity of primary outcomes and the diversity of instruments for measuring knowledge. The quality of the articles included in the analysis was evaluated with the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. Two authors performed data extraction into a standardized spreadsheet. Nineteen studies were included, comprising 11,512 women. About the methodological quality (NOS), most of the studies (n = 11) presented a total score of 6 out of 10. Validated questionnaires and designed pilot-tested forms were the most frequently used ways of assessing knowledge. Some studies were stratified by race, age, or group minorities. The most used questionnaire was the prolapse and incontinence knowledge questionnaire (PIKQ) (n = 5). Knowledge and/or awareness regarding PFD was low to moderate among the studies. Urinary incontinence was the most prevalent PFD investigated, and the most important risk factors associated with the lack of knowledge of the pelvic floor were: African-American ethnicity (n = 3), low educational level (n = 4), low access to information (n = 5) and socioeconomic status (n = 3). Most women have a gap in the knowledge of pelvic floor muscle dysfunctions, do not understand their treatment options, and are not able to identify risk factors for these disorders.

Prospective assessment of demographic characteristics associated with worse health related quality of life measures following definitive chemoradiation in patients with locally advanced non-small cell lung cancer.

The purpose of this study was to evaluate baseline demographic characteristics which may be associated with worse health related quality of life (HRQOL) for patients with locally advanced non-small cell lung cancer (NSCLC) receiving definitive chemoradiation (CRT). Patients with NSCLC were prospectively enrolled on an Institutional Review Board-approved clinical trial between 2009 and 2012. HRQOL assessments were collected pre-radiation therapy (RT), during RT, and within 3 months post-RT using Euroqol (EQ-5D), MD Anderson Symptom Inventory (MDASI), and Functional Assessment of Cancer Therapy General (FACT-G). HRQOL correlation was assessed with categorical variables by Wilcoxon rank sum tests and with continuous variables by Pearson correlation. P<0.05 was defined as statistically significant. Forty-three consecutive patients received definitive concurrent CRT and completed assessments at one or more time-points. Patients most commonly had stage IIIB disease (72%), were married or with a partner (70%) and Caucasian (91%). Median patient age was 65 (range: 39-79) years and Charlson comorbidity index (CCI) was 0 (range: 0-5). Female gender, African-American ethnicity, age, chemotherapy type, baseline hemoglobin, and CCI were associated with worse post-treatment HRQOL measures. We have identified novel characteristics associated with worse quality of life following definitive CRT for lung cancer. Patients at risk for worse post-treatment quality of life may benefit from earlier follow-up and greater supportive measures following treatment.

Collaborative Alliance of Parent and Child Welfare Caseworker.

This secondary analysis of data describing 3,035 parents, drawn from the National Survey of Child and Adolescent Well-Being II, identified factors fostering the collaborative alliance of parents and caseworkers within the child welfare system. We used generalized least squares random effects modeling for panel data. We sought associations between caseworker engagement as perceived by parent and parent's interpersonal capacities, intrapersonal dynamics, problem severity, and racial/ethnic background, and between that perception and caseworker turnover. Parents in our sample had been substantiated for maltreatment of their children. Results showed that parent's perceived caseworker engagement was associated positively with seven factors: parent's social support, parent's mental health, kinship care, out-of-home placement, parent's African American ethnicity, parent's Hispanic ethnicity, parent/caseworker shared ethnicity, and family income. Perceived engagement was associated negatively with caseworker turnover (i.e., number of caseworkers assigned, by turns, to parent's case). Implications for practicing social work within the child welfare system are discussed.

Stroke Risk in Atrial Fibrillation: Beyond the CHA2DS2-VASc Score.

Stroke prevention is the cornerstone of atrial fibrillation (AF) management and the anticoagulation decision is currently based on CHA2DS2-VASc risk score. We discuss several novel risk factors besides those included in CHA2DS2-VASc score and alternative models for stroke prediction. Several clinical markers including obstructive sleep apnea and renal failure, laboratory markers like brain natriuretic peptide, imaging criteria including left atrial appendage morphology, spontaneous echo contrast, and coronary artery calcium score may predict stroke in AF patients. Addition of African American ethnicity to CHA2DS2-VASc score also improves stroke prediction in AF. Finally, novel models including TIMI-AF score, ATRIA score, and GARFIELD-AF scores have potential roles in risk stratification for stroke. While CHA2DS2-VASc score is the currently recommended risk stratification model for stroke prediction in AF, use of additional clinical, laboratory, imaging markers, ethnicity, and novel stroke prediction models may further assist in decision to anticoagulate the AF patient for stroke prevention.

Contemporary Incidence and Mortality Rates in Patients With Testicular Germ Cell Tumors.

We comprehensively tested contemporary incidence and mortality rates in patients with germ cell tumor of the testis (GCTT). Within the Surveillance, Epidemiology, and End Results database (2004-2015), statistical analyses included estimated annual percentage changes, multivariable logistic regression (MLR) models, Kaplan-Meier curves, and multivariable Cox regression (MCR) models. Of 13,114 GCTT patients, 7954 (60.6%) harbored seminoma germ cell tumors of the testis (SGCTT) and 5160 (39.4%) non-SGCTT (NSGCTT). Relative to SGCTT, NSGCTT patients harbored more advanced stage (for stage III 824 [16.0%] vs. 279 patients [3.5%]; P< .001). In MLR, higher rates of stage II/III affected those with never-married status (odds ratio [OR], 1.6; P< .001) and African American ethnicity (OR, 1.5; P= .005) for SGCTT and never-married (OR, 1.3; P= .002) and Hispanic ethnicity (OR, 1.3; P< .001) for NSGCTT. Significant differences in 5-year cancer-specific mortality (CSM) distinguished SGCTT (stage I: 0.4; stage II: 3.4; stage III: 11.4%; P< .001) from NSGCTT (stage I: 1.6; stage II: 2.5; stage III: 22.2%; P< .001). In MCR, unmarried status independently predicted higher CSM for SGCTT (hazard ratio [HR], 2.1; P= .007) and NSGCTT (HR, 1.9; P< .001). Stage I and stage III NSGCTT survival is worse, than for SGCTT. Never-married, Hispanic, and African American individuals are at higher risk of more advanced stage and/or CSM in SGCTT and NSGCTT.

RNA editing alterations in a multi-ethnic Alzheimer disease cohort converge on immune and endocytic molecular pathways.

Little is known about the post-transcriptional mechanisms that modulate the genetic effects in the molecular pathways underlying Alzheimer disease (AD), and even less is known about how these changes might differ across diverse populations. RNA editing, the process that alters individual bases of RNA, may contribute to AD pathogenesis due to its roles in neuronal development and immune regulation. Here, we pursued one of the first transcriptome-wide RNA editing studies in AD by examining RNA sequencing data from individuals of both African-American (AA) and non-Hispanic White (NHW) ethnicities. Whole transcriptome RNA sequencing and RNA editing analysis were performed on peripheral blood specimens from 216 AD cases (105 AA, 111 NHW) and 212 gender matched controls (105 AA, 107 NHW). 449 positions in 254 genes and 723 positions in 371 genes were differentially edited in AA and NHW, respectively. While most differentially edited sites localized to different genes in AA and NHW populations, these events converged on the same pathways across both ethnicities, especially endocytic and inflammatory response pathways. Furthermore, these differentially edited sites were preferentially predicted to disrupt miRNA binding and induce nonsynonymous coding changes in genes previously associated with AD in molecular studies, including PAFAH1B2 and HNRNPA1. These findings suggest RNA editing is an important post-transcriptional regulatory program in AD pathogenesis.

The Prevalence of DPYD*9A(c.85T>C) Genotype and the Genotype-Phenotype Correlation in Patients with Gastrointestinal Malignancies Treated With Fluoropyrimidines: Updated Analysis

IntroductionThe dihydropyrimidine dehydrogenase gene (DPYD)*9A (c.85T>C) genotype is relatively common. The correlation between DPYD*9A genotype and dihydropyrimidine dehydrogenase (DPD) deficiency phenotype is controversial. In a cohort of 28 patients, DPYD*9A was the most commonly diagnosed variant (13 patients [46%]) and there was a noticeable genotype-phenotype correlation. In this study we genotyped a larger cohort of a mixed racial background to explore the prevalence of DPYD*9A variant and to confirm the genotype-phenotype correlation. Patients and MethodsBetween 2011 and 2018, in addition to genotyping for high-risk DPYD variants (DPYD*2A, DPYD*13 and DPYD*9B), genotyping for DPYD*9A variant was performed on 113 patients with gastrointestinal malignancies treated with fluoropyrimidines. Fluoropyrimidines-associated toxicity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 5.0). Fisher exact test was used for statistical analysis. ResultsHeterozygous and homozygous DPYD*9A genotypes were identified in 46 (41%) and 11 (10%) patients, respectively. Among patients with DPYD*9A genotypes (n = 57), men and women represented 30 (53%) and 27 (47%) patients, respectively. Caucasian, African American, and other ethnicities represented 29 (50.9%), 26 (45.6%), and 2 (3.5%) patients, respectively. Grade 3/4 toxicities were experienced in 26 patients with DPYD*9A genotype (3 patients had homozygous status) and in 20 patients with wild type DPYD*9A (P = .4405). In patients who received full-dose fluoropyrimidines (n = 85), Grade 3/4 toxicities were experienced in 22 patients with DPYD*9A genotype (2 patients had homozygous status), and in 17 patients with wild type DPYD (P = .8275). ConclusionIn our updated analysis, the prevalence of heterozygous and homozygous DPYD*9A genotypes were 41% and 10%, respectively. The correlation between DPYD*9A genotype and DPD clinical phenotype was not reproduced. The noticeable correlation that we previously reported is likely because of small sample size and selection bias.

Opportunity for Cancer Prevention: 1 in 4 Unaffected Women Meet Hereditary Cancer Testing Criteria [26O

INTRODUCTION: Estimates show 5-10% of cancer is hereditary. OB/GYNs play an important part in identifying hereditary cancer syndromes (HCS) for women unaffected with cancer; however, the prevalence of HCS in this population is not well studied. This study describes the prevalence of HCS among unaffected female patients as measured by meeting National Comprehensive Cancer Network (NCCN) criteria for genetic testing for BRCA-related, Lynch, and/or polyposis syndromes. METHODS: A personalized link was sent to patients prior to their annual OB/GYN visit requesting that they report personal and family cancer history (PFHx) to a digital tool that aligns PFHx to NCCN genetic testing criteria for HCS. Responses were collected between 2/1/18 and 9/1/18; data were then de-identified and analyzed. RESULTS: Of 4226 possible patients, 2334 entered PFHx into the digital tool, 94% (n=2199) of whom were unaffected. 23% (n=506) of unaffected patients met NCCN criteria for HCS genetic testing including 82% for BRCA, 15% for Lynch syndrome, and 3% for polyposis syndromes; 6.5% met criteria for multiple syndromes. An additional 1.3% met criteria due to a reported familial mutation. Unaffected patients who reported PFHx averaged 42 years of age (range: 18 to 83) and 93% reported Caucasian (60%), Asian (16%), African-American (10%), or Ashkenazi Jewish (7%) ethnicity. CONCLUSION: Nearly 1 in 4 unaffected patients presenting for annual OB/GYN visits met NCCN genetic testing criteria for HCS. Many patients may benefit from OB/GYNs employing standardized ways to identify HCS.

Correlates, Trends, and Short-Term Outcomes of Venous Thromboembolism in Hospitalized Patients with Hepatocellular Carcinoma.

The incidence and overall mortality of hepatocellular carcinoma (HCC) in the US have been increasing over the past decade. Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in cancer patients. This study aims at examining the epidemiology, risk factors, and short-term outcomes of VTE in hospitalized patients with HCC. We utilized the National Inpatient Sample for the years 2008-2013. Using the International Classification of Diseases codes, ninth edition, we identified hospitalized adult patients with a prior diagnosis of HCC who were diagnosed with VTE. Weighted multivariate logistic regression models were used to examine the effect of patients' sociodemographic and clinical characteristics on the occurrence of VTE, and to evaluate the impact of VTE on in-hospital mortality and length of hospital stay. We identified a total of 54,275 hospitalized patients with a prior diagnosis of HCC. The prevalence of VTE in the study cohort was 2.8% (2.5% in 2008 to 3.0% in 2013, a statistically significant increase). Older age, African American ethnicity, history of metastasis, and higher Elixhauser comorbidity index were associated with higher odds of VTE. However, having a prior diagnosis of cirrhosis, hepatitis C, or diabetes mellitus were associated with lower odds of VTE in HCC patients. Furthermore, development of VTE was associated with longer hospital stay and increased in-hospital mortality. Our work highlights significant age, racial, and comorbid factors in the development of VTE in hospitalized patients with HCC in the US. These findings can help in stratification of HCC patients according to their VTE risk. Patients at higher risk of VTE may benefit from more aggressive pharmacologic prophylaxis, an area for future investigation.

SAT-275 “Nutritional Rickets: Still A Problem In The 21StCentury”

Background: Nutritional rickets is common despite educational efforts and prenatal counseling with recent resurgence in the developed world. Possible reasons are parental lack of knowledge about need for supplementation and complex socio-economic factors. Vitamin D and Calcium (Ca) deficiency are the commonest etiologies. The presentation is varied, ranging from being asymptomatic to bony changes, weakness, and seizures. Objective: We aimed to evaluate the presentation, patient characteristics, management and recovery of inner city children presenting with Rickets. Methods: We reviewed medical records of 14 patients between ages 0-3 years, seen at our center with a diagnosis of active rickets between 2013 and 2017. Data are reported as mean ± SD. Results: 14 patients were included in the study. The patients were aged 3-18 months [8.7 ± 4.0mo], weight SDS -1.35±1.29, length SDS -2.07±1.62, weight-for-length SDS -0.06 ±1.9. Most of the patients were male [93.8%] with 57% Arabic and 28% African-American. Most patients (58 %) presented with unrelated symptoms and were found to have rickets by exam and/or with lab work; 21% presented with seizures and 21% with musculoskeletal symptoms. Mean age of exclusive breast-feeding was 7.8± 4.4mo. Only one of the 14 patients was on vitamin D supplementation. Labs at presentation showed hypocalcemia (mean Ca level of 6.65±1.61mg/dl), hypophosphatemia (3.92±1.06mg/dl), hypomagnesemia (1.87±0.29mg/dl), elevated alkaline phosphatase (1234±764 U/L), low 25OH-vitamin D (8.25±2.82ng/ml) and elevated PTH (90-742pg/ml). Most of the children had X-ray changes in the knee and wrists with metaphyseal flaring and widening being the most common findings. In addition to the usual management with Calcium and Ergocalciferol, Calcitriol was used in 5 out of 14 patients (35%) to help normalize calcium levels. Time to normalize total calcium levels ranged from 1-22 days [7.44±6.98 days], time to achieve 25OH-vitaminD level of >20 ng/ml ranged between 7 and 285 days. Labs at first clinic follow-up showed improvement with calcium of 9.3±1.0mg/dl, Phosphorus of 4.4±1.4mg/dl, 25OH-vitamin D level of 26±13ng/ml. PTH level was still elevated in two patients at follow-up. Conclusion: Nutritional rickets is still a prevalent problem especially among infants of Arabic and African-American ethnicity. At least 42% of the patients present with significant morbidity including seizures and musculoskeletal abnormalities. Treatment with vitamin D and calcium (for a short period to avert hungry bone syndrome) improves vitamin D status and decreases the risk of hypocalcemia. Adequate counseling of mothers in Prenatal and Pediatric clinics regarding vitamin D supplementation needs to be a priority. Consideration may need to be given to screening for vitamin D deficiency in mothers with risk factors like ethnicity, nutritional restrictions or other contributing factors.