Annual Follow-up Research Articles

Transient M-Proteins: Epidemiology, Causes, and the Impact of Mass Spectrometry: The Istopmm Study

Background: Among clinicians, it is well-known that the identification of a monoclonal(M) protein may disappear at a later timepoint (transient M protein) after certain infections, in the setting of some automimmune conditions, or other conditions. However, there is no information from a systematic study investigating patterns of transient M-proteins in a prospectively monitored cohort.The aim of this large, population-based study was to describe the epidemiology and characteristics of individuals with transient M-proteins in the prospective screening manner based on the Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) study. Furthermore, given the recent introduction of highly sensitive mass spectrometry (MS) based assays for the identification and quantification of M proteins, we were motivated to investigate whether transience is also related to an increased sensitivity of the assay used in a comparison with conventional serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE). Methods: The iStopMM study is an ongoing nationwide screening study for multiple myeloma precursors in Iceland. A total of 75,422 Icelanders ≥40 years old (51% of the population) were screened for M protein using SPEP and free light chains. Participants with a detectable M-protein entered a randomized controlled trial with three arms where arms 2 and 3 underwent initial testing and longitudinal follow-up. The transient M-protein cohort was defined as individuals with a positive SPEP who at a later timepoint returned a negative SPEP/IFE sample. Comorbidity data and prescription medicine use was acquired from three high-quality national disease and prescription medicine registries. MS (EXENT®, Binding Site, Birmingham, UK) analyses were performed on the original diagnostic sample and a follow-up sample with a cutoff of 0,02g/L considered as positive. We evaluated comorbidity and medication use comparing individuals with transient M protein to age- and sex-matched subjects with persistent M protein in a 4:1 matched nested case-control study. Differences between the groups were analyzed with chi square tests. Results: Overall, the iStopMM MGUS cohort comprises 3,358 individuals. Of those 2,037 underwent annual follow-up testing. A total of 198 (9.8%) individuals were identified as having transient M protein according to SPEP and IFE. In the transient M protein cohort we observed an increased prevalence of infections, autoimmune disorders, cancer, and obstructive pulmonary conditions (Table 1). We even observed increased usage of corticosteroids (17.7% vs 9.8%; p = 0.01), immunosuppressive medications (5.6% vs 2.2%; p=0.02), azithromycin (9.6% vs 4.9%; p=0.02), and diuretics (20.7% vs 13.3%; p=0.03). These drugs were found to be given between one year prior to one month after the subjects tested negative for M protein with SPEP/IFE. Among 198 individuals reported to have transient M protein according to SPEP and IFE, baseline MS samples were positive at in 183 (92%). The remaining 15 (8%) did not have an identifiable M protein on MS at baseline. Twelve (80%) of these 15 individuals had an active infection, autoimmune disorder, or active cancer at the initial measurement. Of the 183 individuals who had M protein identified at baseline by both SPEP/IFE and MS, MS identified the same M protein in 70% (129/183) of the cases at follow-up when SPEP/IFE was negative. Fifty four individuals were observed to be MS positive at baseline and negative at a follow-up testing indicating a prevalence of transient M-proteins of 2.6% within a cohort of MGUS patients when measured by MS. MS showed good concordance with IFE (Table 1), and, as expected, use of more sensitive MS in baseline samples results in additional increase by 33% in low-concentration M protein spikes, compared to conventional SPEP/IFE. Conclusion: In this large prospective study we found that M proteins were transient in almost 10% of cases. Using a more sensitive MS, the proportion of transient M proteins was only 2.6%. Thus, most of individuals with transient M proteins based on SPEP/IFE are falsely negative, when using MS as the benchmark. Our prospective cohort study provides novel insights on longitudinal patterns of abnormal serum proteins, it highlights how the use of MS results in the identification of low M proteins, and it shows that transient M proteins are often only below the limit of detection with conventional SPEP/IFE. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Impact of the COVID-19 pandemic and associated lockdown measures on the management, health, and behavior of the cystic fibrosis population in France during 2020 (MUCONFIN).

Most of the studies on cystic fibrosis (CF) focused on SARS-CoV-2 prevalence and suggested a low incidence of infection in this population. We aimed to assess the impact of the pandemic and related lockdown measures implemented in May 2020 in response to the first wave of SARS-CoV-2 infection on healthcare access, health, and behavior in CF patients. A national questionnaire opened online from May 15th, 2020 to June 11th, 2020 was completed by 751 CF-patients, aged 14 years and over. It comprised questions about access to healthcare, anxiety and depression, smoking, alcohol, drug and psychotropic drug consumption, adherence to CF treatment, and constraints. A semi-structured comprehensive interview was performed no later than 1 month after the end of the lockdown in 16 CF-patients. The mean age of the population was 28.0 [interquartile range (IQR) 20.0-37.0] years old. More than 75% of in-person consultations scheduled during the lockdown were canceled. Alternatively, 27% were postponed, and telehealth consultations were proposed and accepted in almost 40% of cases. More than 75% of the scheduled physiotherapy sessions were canceled and replaced mainly by self-drainage. Annual follow-up clinic visits were consistently postponed whereas required hospitalizations at CF centers for exacerbation were maintained in most cases. While 43.2% CF-patients had signs of anxiety, 51.0% presented symptoms of depression, both associated with increased use of psychotic medications and inversely correlated to COVID-19 prevalence. Among the lower and lower middle classes, very little medical information was obtained or requested by the patient, participation to sports or other activities was low, while excessive home confinement and isolation were more frequent. In contrast, in the upper middle and upper classes, individuals solicitated help to their CF centre, had more physical activities, and maintained contact with friends or families. The first lockdown in France had only minimal impact on the management care of CF-patients but was associated with increased symptoms of anxiety and depression, together with behavioral changes that varied with social class. NCT04463628.

Multiple Case Study of Changes in Participation of Adults with Myotonic Dystrophy Type 1: Importance of Redesigning Accomplishment and Resilience.

Myotonic dystrophy type 1 (DM1) is the most prevalent adult form of neuromuscular disorders, for which a decrease of participation with age is known. However, little is known about facilitators and barriers to participation, especially from the perspective of both patients and caregivers. This study explored and explained changes in participation post-diagnosis with myotonic dystrophy type 1 from the perspective of six adults, their relatives and nurse case managers. A multiple case study was carried out with these triads (n = 6) using semi-structured individual interviews, medical charts, and a participation patient-reported outcome measure. The six cases were built around three women and three men (age: 40-56 years; disease duration: 19-39 years). Their "relatives" were mainly family members. Nurse case managers had done annual follow-ups with all the adults for approximately ten years. Changes in participation were characterized generally by: 1) heterogeneity, 2) insidious increase in restrictions, and more specifically by: 3) redesigning accomplishment, 4) progressive social isolation, 5) restrictions in life-space mobility, and 6) increasingly sedentary activities. Important facilitators of participation were the adult's resilience, highly meaningful activities, social support, living arrangement, and willingness to use technical aids. Barriers were mostly related to symptoms and a precarious social network, and were affected by misfit and potential syndemic interactions between personal (e.g., comorbidities) and environmental (e.g., stigma) factors. This study identified key facilitators and barriers and their underlying processes, which should be integrated into the evaluation and intervention framework to optimize participation over time.

A longitudinal investigation of non-suicidal self-injury persistence patterns, risk factors, and clinical outcomes during the college period.

Although non-suicidal self-injury (NSSI) is known typically to begin in adolescence, longitudinal information is lacking about patterns, predictors, and clinical outcomes of NSSI persistence among emerging adults. The present study was designed to (1) estimate NSSI persistence during the college period, (2) identify risk factors and high-risk students for NSSI persistence patterns, and (3) evaluate the association with future mental disorders and suicidal thoughts and behaviors (STB). Using prospective cohorts from the Leuven College Surveys (n = 5915), part of the World Mental Health International College Student Initiative, web-based surveys assessed mental health and psychosocial problems at college entrance and three annual follow-up assessments. Approximately one in five (20.4%) students reported lifetime NSSI at college entrance. NSSI persistence was estimated at 56.4%, with 15.6% reporting a high-frequency repetitive pattern (≥five times yearly). Many hypothesized risk factors were associated with repetitive NSSI persistence, with the most potent effects observed for pre-college NSSI characteristics. Multivariate models suggest that an intervention focusing on the 10-20% at the highest predicted risk could effectively reach 34.9-56.7% of students with high-frequency repetitive NSSI persistence (PPV = 81.8-93.4, AUC = 0.88-0.91). Repetitive NSSI persistence during the first two college years predicted 12-month mental disorders, role impairment, and STB during the third college year, including suicide attempts. Most emerging adults with a history of NSSI report persistent self-injury during their college years. Web-based screening may be a promising approach for detecting students at risk for a highly persistent NSSI pattern characterized by subsequent adverse outcomes.

Diabetes incidence in subjects with PREDIABetes from ReUNion Island: the PREDIABRUN observational cohort study protocol

IntroductionImproved knowledge of prediabetic subjects’ profile and their risk of developing type 2 diabetes mellitus (T2DM) would enhance secondary prevention. The primary objective is to describe factors associated with incident...

Marginal Bone Loss and Clinical Complications in Surviving Implants and Recently Placed Implants Splinted Together: A Retrospective Study.

The objective of this study was to compare marginal bone loss (MBL) and clinical complications between surviving implants (SIs) and recently placed implants (RIs) splinted together to support a fixed partial restoration (FPR). This retrospective study employed the medical records of patients treated with implant-supported FPRs in the Maccabi-Dent Dental Clinic. Patients were included if they were over the age of 18 years, were treated with RIs adjacent to existing SIs that had previously supported FPRs for more than 1 year, and the RIs and SIs were splinted to support new FPRs. Patients who did not receive annual follow-up or whose records had nondiagnostic radiographs or lacked sufficient restorative data were excluded. MBL was assessed at the last available radiograph and compared to one taken 1 year after loading the splinted RIs and SIs together. Clinical complication data were gathered from patient records. The medical records of 1,907 patients treated with a total of 7,306 implants were examined. Data from 187 implants were extracted from 46 patient records that met the inclusion criteria, with 96 RIs and 91 SIs supporting 56 FPRs. Mean followup was 39 ± 17.5 months. During the follow-up, two implants failed. The overall survival rate was 98.94% (98.96% in RIs and 98.91% in SIs), and the mean MBL in all implants was 0.41 ± 0.58 mm (0.4 ± 0.53 mm in RIs and 0.42 ± 0.45 mm in SIs). Peri-implantitis was reported in eight (4.3%) implants (four RIs and four SIs), screw loosening was reported in nine (4.8%) implants (three RIs and six SIs), ceramic chipping was reported in three (5.3%) restorations supported by four RIs and six SIs, and decementation was reported in one (1.8%) restoration supported by one RI and one SI. There was no statistically significant difference in survival rate, MBL, peri-implantitis, or screw loosening between RIs and SIs. There was no statistically significant difference in MBL or clinical complications between RIs and SIs. Splinting RIs and SIs for new prosthetic restoration support is a reasonable treatment choice with a high implant survival rate, low incidence of complications, and acceptable MBL.

PSAT030 A Clinically Dormant Adrenal Incidentaloma Evolving to A Cortisol Secreting Adenoma, A Ten Year Follow Up Experience

Abstract Intro Adrenal incidentalomas (AIs) are found in approximately 3–4% of abdominal computed tomography (CT) scans performed for other reasons. Most of these masses are found to be nonfunctioning. Studies showed that subtle cortisol secretion in AIs and disruption in the hypothalamic-pituitary-adrenal axis are more frequent than expected. Here we report a case of a small AI progressing to a hormone-secreting adrenal mass causing Cushing's syndrome (CS) after a period of a decade, in which dexamethasone suppression test was the confirmatory diagnostic procedure. Case 66-year-old woman was referred to Endocrinology in 2007 for assessment of abnormal abdominal CT finding indicating minimal nodularity of the right adrenal gland followed by an MRI performed 2 years later with suspicion of a small adenoma measuring 1.4 cm. Patient's past medical history included coronary artery disease, impaired glucose tolerance controlled by diet. No reported family history of relevant endocrine tumors. At time of initial assessment, functional hormonal baseline workup was normal including ACTH: 23 pg/mL [5-27 pg/mL], AM Cortisol level: 13.6 mcg/dL [4-22 mcg/dL], 24h U-Cortisol: 16.4 mcg/24h/1g Cr [4-50 mcg/24h/1g], and DHEAS: 30 mcg/dL [<185 mcg/dL] Patient was re-evaluated annually. Over the course of the follow-up, she was found to have poor healing after surgical repair of ankle fracture in 2012, as well as depression necessitating medical therapy in 2015. Her previously diet-controlled diabetes significantly progressed, requiring combination therapy and ultimately basal/bolus insulin. Moreover, patient developed hypertension with antihypertensive medication doses increased from Valsartan 40mg to Valsartan/HCT 80/12.5 in a 5-year period. The patient was found to have normal ACTH, serum, and urine cortisol levels throughout her follow-up period. Annual CT imaging demonstrated no change in right adrenal mass. In 2017, overnight low dose dexamethasone suppression test was found to be 16.2 mcg/dL[<1.8 mcg/dL], which is significantly increased from 0.9 mcg/dL in 2011. In 2018, CT abdomen showed a marked increase in the adrenal mass size to 2.8 cm. In 2020, she underwent right-sided adrenalectomy with no complications. Both blood pressure and glucose levels improved postoperatively. The preoperative use of mifepristone therapy controlled her blood sugar and pressure and eliminated the need for postoperative glucocorticoid replacement. She is currently controlled on diet and lifestyle modifications alone. Discussion Our case highlights the limitations of current guidelines in the management of AIs that recommend discontinuing annual follow-up if no significant growth occurs after 5 years. Careful long-term follow-up of AIs provides an opportunity to detect the subclinical hormonal alterations, development of new hormonal abnormalities, or any change in mass size. These findings indicate the need for good communication between radiology, primary care, and endocrine providers to assure periodic hormonal and morphological evaluation. This case also suggests that the dexamethasone suppression test may be useful in the evaluation of CS in patients without significant hypercortisolemia. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Association of cardiovascular health with diabetic complications, all-cause mortality, and life expectancy among people with type 2 diabetes

BackgroundWe aimed to assess the impact of healthy cardiovascular health (CVH) on diabetic complications, mortality, and life expectancy among people with type 2 diabetes and to explore whether inflammation marker mediate these associations.MethodsThis prospective cohort study included 33,236 participants (aged 40–72) with type 2 diabetes from the UK Biobank with annual follow-up from 2006 to 2010 to 2020. Type 2 diabetes was ascertained from self-report, glycated hemoglobin ≥ 6.5%, hospital inpatient registry, or glucose-lowering medication use. Information on mortality was derived from the national death registry. Favorable CVH metrics consisted of non-smoker, regular physical activity, a healthy diet, non-overweight, untreated resting blood pressure < 120/<80 mm Hg, and untreated total cholesterol < 200 mg/dL. Participants were categorized into three groups according to the number of favorable CVH metrics: unfavorable (0 or 1); intermediate (any 2 or 3); and favorable (4 or more). Inflammation marker, as measured by C-reactive protein (CRP), was assessed at baseline and categorized as low (≤ 3 mg/L) and high (> 3 mg/L). Data were analyzed using Cox regression models, flexible parametric survival models, and mediation models.ResultsDuring the follow-up (median: 11.7 years), 3133 (9.4%) cases of diabetes complications and 4701 (14.1%) deaths occurred. Compared to unfavorable CVH, favorable CVH was associated with a reduced risk of diabetes complications (HR, 0.35; 95% CI, 0.26–0.47) and all-cause mortality (HR, 0.53; 95% CI, 0.43–0.65). In participants with unfavorable CVH, life expectancy at age 45 had a significantly reduction of 7.20 (95% CI, 5.48–8.92) years compared to those with a favorable CVH. Among people with type 2 diabetes, the proportions of diabetes complications and all-cause mortality that would be reduced by promoting the favorable CVH was 61.5% and 39.1%, respectively. CRP level mediated 14.3% and 29.7% of the associations between CVH and diabetic complication and all-cause mortality, respectively.ConclusionA favorable CVH was associated with lower risk of diabetes complications and mortality risk, and was associated with a longer life expectancy among people with type 2 diabetes. This association may be in part accounted for by inflammatory processes. Our findings highlight the importance of favorable CVH for the prevention of diabetic complications and all-cause mortality among people with type 2 diabetes, and underscores the need to monitor inflammation among people with unfavorable CVH.

Body Mass Index Trajectories Preceding Incident Mild Cognitive Impairment and Dementia

Body mass index (BMI) trajectories before the onset of mild cognitive impairment (MCI) and during the progression from MCI to dementia remain unclear. To assess the long-term BMI trajectories preceding incident MCI and dementia and explore whether they are associated with brain pathologies. The Rush Memory and Aging Project (MAP) was an ongoing community-based cohort study. This study included cognitively intact participants aged 60 to 90 years at baseline with annual follow-up from October 1997 to December 2020 (maximum follow-up of 22 years). During the follow-up, participants underwent brain autopsies. Data were analyzed from August 2021 to February 2022 using mixed-effect models. BMI was calculated using height and weight measured at baseline and follow-ups. Incident MCI and dementia were diagnosed following standard criteria. Neuropathological assessments (including global Alzheimer disease and vascular pathology) were performed for autopsies. A total of 1390 participants (mean [SD] age, 78.4 [6.5] years; 1063 female [76.5%]) were included in the study. In the analysis of BMI trajectories before MCI (n = 939), during the follow-up (median [IQR] duration, 6 [3-9] years), 371 participants (39.5%) developed MCI, of whom 88 (23.7%) progressed to dementia. Those who developed MCI were older (mean [SD] age, 79.6 [5.9] years vs 76.9 [6.6] years), consumed less alcohol (median [IQR] consumption, 0 [0-5.8] g/day vs 1.1 [0-6.9] g/day), had a lower BMI (mean [SD], 27.2 [4.9] vs 28.2 [5.9]), and were more likely to be apolipoprotein E (APOE) ε4 carriers (89 of 371 [24.0%] vs 98 of 568 [17.3%]) compared with those who remained cognitively intact over follow-up. Those who developed dementia were older (mean [SD] age, 81.0 [5.2] years vs 79.1 [6.0] years), had a lower level of physical activity (median [IQR] activity, 1.0 [0-2.5] h/week vs 1.8 [0.2-3.8] h/week), and were more likely to be APOE ε4 carriers than those who were dementia-free (33 of 88 [37.5%] vs 56 of 283 [19.8%]). Compared with participants who remained cognitively intact, in those with incident MCI, BMI tended to decline earlier and faster. From 7 years before diagnosis, people with incident MCI had an associated significantly lower BMI (mean difference, -0.96; 95% CI, -1.85 to -0.07) than those who were cognitively intact. Among people with incident MCI, the slopes of BMI decline did not differ significantly between those who did and did not develop dementia (β, -0.03; 95% CI, -0.21 to 0.15). In the analysis of BMI trajectories before autopsy (n = 358), BMI was associated with a faster declination among participants with a high burden of global Alzheimer disease pathology (β for pathology × time highest vs lowest tertile, -0.14; 95% CI, -0.26 to -0.02) or vascular pathology (β for pathology × time2 highest vs lowest tertile, 0.02; 95% CI, 0-0.05). Results of this cohort study suggest that among cognitively intact people, significantly lower BMI occurs beginning approximately 7 years before MCI diagnosis. After MCI diagnosis, BMI declines at the same pace in people who develop dementia and those who do not. High brain pathologies may underly the BMI decline preceding dementing disorders.

Mini-Mental State Examination and Montreal Cognitive Assessment as Tools for Following Cognitive Changes in Alzheimer's Disease Neuroimaging Initiative Participants.

Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are two commonly used cognitive screening and diagnostic tools. Our goal was to assess their efficacy for monitoring cognitive changes, as well as the correlation between the two tests. At baseline, participants in the Alzheimer's Disease Neuroimaging Initiative (ADNI) were divided into four groups based on their cognitive diagnoses: healthy control (HC), early mild cognitive impairment (EMCI), late mild cognitive impairment (LMCI), and Alzheimer's disease (AD). MMSE or MoCA scores were compared among the four groups using an analysis of variance (ANOVA) model with repeated measures with post-hoc Bonferroni correction. For those participants who had both MMSE and MoCA assessments done, a Pearson correlation analysis was performed between the two assessments for each visit. The MMSE scores were significantly different among the four groups at baseline, which was true for each of the three annual follow-up visits. By contrast, the MoCA scores were not significantly different between HC and EMCI groups at either baseline or any of the follow-up visits. For participants with a diagnosis of LMCI, the cognitive performance deteriorated in a linear manner 12 months after the baseline, which was independent of MMSE or MoCA. At last, the MMSE scores were moderately related to MoCA scores, which got stronger along with the time of follow-up. MMSE and MoCA are comparable as cognitive assessment tools to monitor cognitive changes. In addition, the measurements of MMSE and MoCA are moderately correlated for the follow-up visits.

Recurrent pregnancy loss and incident arthritis in midlife: an exploratory longitudinal analysis of the Study of Women's Health Across the Nation

To explore the association between recurrent pregnancy loss (RPL) and incident arthritis in midlife women. We analyzed the U.S. Study of Women's Health Across the Nation, a multi-ethnic cohort following pre- or peri‑menopausal women, using data from baseline up to the tenth annual follow-up visit. Discrete survival analysis was used to estimate adjusted hazard ratios and 95% confidence intervals for risk of incident arthritis at annual intervals in women with versus without RPL. Of the 2159 participants analyzed, 8.5% reported a history of RPL. Cumulative incidence of arthritis was 43.3% in women with RPL and 40.1% in women without RPL, though differences between groups varied over time. Significant associations were observed only at visits three to seven, with the strongest associations at visits four to six. The adjusted hazard ratios (95% confidence intervals) were 1.80 (1.30-2.50) at visit 4 (median age=50 years), 1.95 (1.38-2.75) at visit 5 (median age=51 years), and 1.82 (1.28-2.58) at visit 6 (median age=52 years). Women with previous RPL may have elevated risk of arthritis specifically when entering their 50s, on average. Additional research is needed to determine whether women with a history of RPL may benefit from early detection of arthritis in midlife.

Metaphorical Perceptions of Esports Coaches to the Concept of Esports

Esports is a sports discipline in which strategies and plans are heavily involved, requires physical and mental effort, has started to interact with modern sports and is based on online games. The aim of this research is to reveal the metaphorical perceptions of trainers, one of the important parts of the discipline, towards the concept of esports. A total of 50 coach candidates, 40 male and 10 female, who attended the esports 1st level coaching course, which was held for the first time in our country in 2021, participated in the research. Phenomenology design, one of the qualitative research methods, was used in the research. In obtaining the data, a personal information form was applied to each coach candidate, and among the coach candidates, “esports is like/similar to ……; because ...…” were asked to complete the sentence. The data collection tool was implemented by researchers personally. In addition, all participants took part in the study on a voluntary basis. In the analysis of the data, the stages of naming, screening, category development, ensuring validity and reliability, calculating, interpreting and examining the frequencies of the resulting metaphors were followed. Although the fact that computer games are seen as unhealthy is an indicator of bigger problems for esports, it was seen in this study that most of the coach candidates gave positive feedback on the concept of esports. It is recommended to repeat the study in order to determine the coaching needs of esports trainers, which may occur with technological developments, with annual follow-ups.

Predictors and Consequences of Not Seeking Healthcare during the COVID-19 Pandemic: Findings from the HEAF Cohort.

The COVID-19 pandemic resulted in a dramatic reduction of routine healthcare availability in many European countries. Among a cohort of English middle-aged adults, we explored pre-pandemic and pandemic factors associated with not seeking healthcare during lockdown, and their effect on subsequent self-reported health measures. Longitudinal data from the Health and Employment After Fifty (HEAF) cohort were used. Pre-pandemic data came from the 5th annual follow-up (2019), when participants were aged 56–71 years, and pandemic data were collected by e-survey in February 2021 and November 2021. Response rates of the two e-surveys were 53% and 79%, respectively. Pre-pandemic predictors of not seeking healthcare were: female gender, higher BMI, higher comorbidity, poorer self-rated health and depression; non-care seekers were also more likely to report that family or friends were affected by COVID-19 and to have been advised to shield. Not seeking healthcare during lockdown was associated with a higher risk of reporting worsening of physical, but not mental, health during the later phase of the pandemic. In this cohort, those with generally poorer health were disproportionately more likely to not seek healthcare during lockdown, which may potentially exacerbate pre-existing inequalities and lead to longer-term health consequences.

Factors impacting educational outcomes for students with traumatic brain injury in BrainSTEPS

Purpose: To describe child pre-injury and injury factors impacting post-injury educational outcomes for students with traumatic brain injury (TBI) participating in a state-wide, school-based, school re-entry consultation program, BrainSTEPS in Pennsylvania. Method: Retrospective analysis of a BrainSTEPS annual follow-up survey. Result: A total of 296 parent surveys were completed. Analysis revealed a significant difference between levels of severity of TBI and current educational placement (p < 0.001), receipt of current therapy (p < 0.05) and need for additional consult (p < 0.05). Severity of TBI was not related to other examined educational outcome variables (i.e. school performance, current symptoms). History of TBI, symptoms and treatment were not found to be associated with educational outcomes. Conclusion: These results both support findings from previous studies, and extend previous work by highlighting ongoing needs, including continued, individualised support, of children who sustain a moderate–severe TBI during childhood, and are currently in the chronic stages of injury, with consideration of pre- and post- injury factors. Programs such as BrainSTEPS provide identification of educational needs and provide needed services and supports for children with TBI. Sensitive, validated measures are needed to further understand the role of pre-injury and injury factors on educational outcomes, particularly in programs like BrainSTEPS.

Development of the Breast Cancer Survivors Symptom Checklist for Use in Follow-Up Multidisciplinary Appointments.

BackgroundBreast cancer survivors are primarily followed up to monitor the effectiveness of treatment and complications and to detect recurrences. Many breast cancer survivors may experience prolonged adverse physical and psychological effects, which should also be addressed at follow-ups. The objective of this study was to develop a brief symptom assessment tool for breast cancer survivors to be used as a guideline for the survivors and all health care professionals conducting the routine follow-up. The second objective was to describe the women’s individual experiences with follow-ups.MethodsA literature review, a focus group of 6 healthcare professionals using a nominal group technique process, and the experience and feedback via qualitative interviews with 16 breast cancer survivors was used to develop the Breast Cancer Survivors Symptom Assessment Checklist (BCS-SC).ResultsThe BCS-SC consists of a set of 13 symptoms/burdens and one question. On a scale from 0 (no symptom) to 10 (worst imaginable), survivors indicated the extent to which they experience each symptom. All survivors perceived the annual follow-ups as important, but none prepared for them. Eight of the 16 survivors reported that they had 2 or more of the symptoms/burdens listed in the BCS-SC. However, only one of the survivors had mentioned her symptom to the doctor at follow-up.ConclusionThe BCS-SC is a comprehensive assessment tool for symptoms/burdens that are common among breast cancer survivors and can aid efforts to optimize their follow-up. Furthermore, the BCS-SC allows for a more patient-initiated and focused consultation, leading to more patient-centered quality care.

Natural history and consequence of patent processus vaginalis: An interim analysis from a multi-institutional prospective observational study

BackgroundThe prevalence and natural history of patent processus vaginalis (PPV) are unknown. An interim analysis was performed of a multi-institutional, prospective, observational study in neonates undergoing laparoscopic pyloromyotomy during which bilateral inguinal canals were evaluated. MethodsInfants under 4 months undergoing laparoscopic pyloromyotomy were enrolled at 8 children's hospitals. The presence of a PPV was evaluated and measurements recorded. Patients with a PPV are undergoing annual phone follow-up to 18 years of age. Interim analysis was performed. ResultsIn a cohort of 610 patient, 80 did not have a PPV examined, 4 had consent issues and were excluded, leaving 526 patients. Of these, 433 (82%) were male, median age 1.2 months (IQR 0.9, 1.6), median weight 3.89 kg (IQR 3.4, 4.46), and EGA 39 weeks (IQR 37, 40). There were 283 PPVs, 132 bilateral (47%), 116 right (41%), and 35 left (12%). Patients with a PPV were significantly younger (1.1 months (IQR 0.9, 1.5) vs 1.3 months (IQR 0.9, 1.7), p=0.02), weighed less (3.76kg (IQR 3.35, 4.26) vs 3.9kg (IQR 3.4, 4.5) p=0.03) and had a significantly lower EGA at birth (38 weeks (IQR 37, 40) vs 39 weeks (IQR 38, 40) p=0.003). Of 246 eligible infants, 208 (85%) responded to at least one annual follow-up. Two patients had an inguinal hernia repair for a symptomatic hernia, 49- and 51-days post pyloromyotomy. One had an orchiopexy and incidental inguinal hernia repair 120 days post pyloromyotomy; for a total of 3 (1.2%) hernia repairs. No additional hernias were identified in 116 patients with the PPV patients who have been followed for > 1 year. ConclusionsThe presence of a PPV at the time of pyloromyotomy is common but the need for hernia repair is rare within the first year of life. Continued long-term longitudinal follow-up of this cohort is needed. Level of EvidenceII

The relationship between executive functioning and addictive behavior: new insights from a longitudinal community study

RationaleAlthough there is evidence that impaired executive functioning plays a role in addictive behavior, the longitudinal relationship between the two remains relatively unknown.ObjectivesIn a prospective-longitudinal community study, we tested the hypothesis that lower executive functioning is associated with more addictive behavior at one point in time and over time.MethodsThree hundred and thirty-eight individuals (19–27 years, 59% female) from a random community sample were recruited into three groups: addictive disorders related to substances (n = 100) or to behaviors (n = 118), or healthy controls (n = 120). At baseline, participants completed nine executive function tasks from which a latent variable of general executive functioning (GEF) was derived. Addictive behavior (i.e., quantity and frequency of use, and number of DSM-5 criteria met) were assessed using standardized clinical interviews at baseline and three annual follow-ups. The trajectories of addictive behaviors were examined using latent growth curve modeling.ResultsAt baseline, we found weak to no evidence of an associations between GEF and addictive behavior. We found evidence for an association between a lower GEF at baseline and a higher increase in the quantity of use and a smaller decrease in frequency of use over time, but no evidence for an association with an increase in the number of DSM-5 criteria met.ConclusionsLower EFs appear to lead to a continuing loss of control over use, whereas addictive disorders may develop secondarily after a long period of risky use. Previous etiological models assuming lower EF as a direct vulnerability factor for addictive disorders need to be refined.

Association of beta blocker use with new-onset heart failure and mortality in atrial fibrillation without pre-existing heart failure: the Fushimi AF registry

Abstract Background Heart failure (HF) is one of the major complications in atrial fibrillation (AF). We previously reported that not a few AF patients without pre-existing HF (defined as prior HF hospitalization, New York Heart Association functional class≥2, or left ventricular ejection fraction (LVEF)&amp;lt;40%) subsequently developed new-onset HF. Beta blockers are the established therapy for HF, but it remains unclear whether beta blockers prevent new-onset HF and improve outcomes in AF patients without preexisting HF. Methods In the Fushimi AF registry, 778 of 3,262 patients without pre-existing HF were receiving beta blockers at baseline. We investigated the incidence of new-onset HF defined as cardiac death or HF hospitalization, and all-cause death in a propensity-matched cohort (N=1,198; mean age, 71 years; 39% female; mean LVEF, 66%). Additionally, annual follow-up prescription data before the onset of events were collected in 294 of patients with beta blockers and 395 of those without beta blockers. We also investigated the association of starting or stopping beta blockers with the incidence of new-onset HF and all-cause death. Results During the median follow-up of 5.8 years, new-onset HF and all-cause death occurred in 77 (12.9%) and 118 (19.7%) of patients with beta blockers, and 70 (11.7%) and 131 (21.9%) of those without beta blockers, respectively. Incidence of new-onset HF was comparable between patients with and without beta blockers (Figure 1), and incidence of all-cause death was also comparable between the two groups (Figure 2). In exploratory subgroup analyses, there was no interaction in the association of beta blockers with the incidence of events, except for pulse rate for new-onset HF and left atrial size for all-cause death. Hazard ratio of beta blockers for new-onset HF tended to be lower in patients with higher pulse rates (&amp;gt;84 bpm) (Figure 1), and that for all-cause death was lower in those without left atrial enlargement (Figure 2). Of patients with follow-up prescription data, beta blockers were stopped in 55 (18.7%) and started in 97 (24.6%) patients, respectively. Patients with starting beta blockers had higher pulse rate (78.5±17.3 vs 74.9±13.9 bpm; p=0.03) and more symptomatic AF (58.8% vs 46.0%; p=0.03) compared to those without starting beta blockers, while there was no difference in baseline characteristics between those with and without stopping beta blockers. During the follow-up, the incidences of new-onset HF and all-cause death were also comparable between the patients with and without stopping beta blockers and those with and without starting beta blockers. Conclusion Beta blockers were not associated with the incidence of new-onset HF and all-cause death in AF patients without pre-existing HF. However, the exploratory subgroup analyses suggested the existence of subjects who may benefit from beta blockers. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Boehringer Ingelheim, Bayer Healthcare, Pfizer, Bristol-Myers Squibb, Astellas Pharma, AstraZeneca, Daiichi Sankyo, Novartis Pharma, MSD, Sanofi-Aventis, and Takeda Pharmaceutical.

S3234 A Cancer Encasing the Porta Hepatis: An Aggressive Intra-Abdominal B Cell Lymphoma Presenting as a Post-Obstructive Jaundice With Reactivation of Hepatitis C Virus

Introduction: Hepatitis C virus (HCV) is a lymphotropic virus that promotes HCV-mediated B-cell proliferation and transformation to Non-Hodgkin Lymphoma (NHL). Here we present a case of reactivation of HCV presenting as an aggressive intra-abdominal B cell lymphoma. Case Description/Methods: A 68-years-old-male with history of eradicated HCV with recombinant interferon-alfa and resolved HBV infection presented with painless jaundice and pruritus. CT abdomen revealed a 9.6 x 11.5 x 9.5 cm heterogeneous mass causing CBD and intrahepatic biliary duct dilation. Labs revealed reactivation of HCV infection with worsening of liver function tests with total bilirubin of >40mg/dl. FNA biopsy confirmed mature B-cell lymphoma. Given persistent worsening jaundice despite biliary stent, trial of high dose steroid was initiated to improve lymphoma burden in order to get a window to initiate chemotherapy. After tumor board discussion, he received radiation therapy for tumor shrinkage for this aggressive lymphoma. Prior to initiation of planned R-CHOP chemotherapy, he developed severe sepsis with hepatic abscess. Patient and family opted for hospice care and comfort care was initiated. Discussion: Chronic HCV is a fast-growing epidemic in the U.S.A which carries an enormous threat to general population and healthcare. HCV becomes chronic in >70% of infected patients with risk for cirrhosis, hepatocellular carcinoma and lymphoma. HCV can cause NHL via lymphocyte proliferation from viral antigenic stimulation, HCV replication inside B-cell and mutation via B-cell damage. Among patient who achieve sustained viral response (SVR), reactivation occurs in 1%, 11% and 15% among low-risk monoinfected HCV, high-risk monoinfected HCV and HIV/HCV coinfected group respectively. Treatment of HCV with resolution of NHL has been reported and there is some literature with sequential chemotherapy followed by antiviral therapy (AVT) showing promising results in HCV-NHL cases. Concurrent use of AVT and chemotherapy is primarily discouraged due to hematological toxicity. More evidence and studies need to be explored for such aggressive HCV-NHL management. Patient with SVR should have at least an annual testing and periodic follow-up to access for HCV reactivation or reinfection. Hepatitis C education regarding risk factors reduction and transmission prevention should be encouraged at every healthcare level and in general community and only then we can achieve WHO aim of eradication by 2030.

Protocol for Guo’s aortIc Arch recoNstrucTion: a prospective, multicentre and single-arm study to evaluate the safety and efficacy of the WeFlow-Arch modular inner branch stent-graft system for aortic arch lesions (GIANT study)

IntroductionEndovascular repair of the entire aortic arch provides treatment opportunities for patients with aortic arch lesions who are intolerant to open surgery. However, the complex anatomical configuration, high-speed blood flow...