Bimodal Age Research Articles

Odontogenic Carcinosarcoma: Clinicopathologic and Molecular Features of Three Cases, a Literature Review and Nomenclature Proposal.

Odontogenic carcinosarcoma (OCS) is a rare odontogenic malignancy with limited characterization and unexplored molecular features. We report clinicopathologic and molecular findings in 3 additional OCS and review the literature. 3 OCS (5.1%) were identified among 59 malignant odontogenic tumors (in our archives from 1992 to 2022). Clinical, radiologic, histopathologic, immunophenotypic, and molecular findings were reviewed. Data from prior case reports and systematic or non-systematic reviews were extracted for analysis. Three mandibular OCS (age range: 66 to 72 years; 1 male, 2 females) were identified. Case 1 had novel clear-cell morphology, multiple recurrences, and a lethal outcome 28 months after resection. EWSR1 rearrangements were negative, but the tumor showed focal nuclear β-catenin and strong LEF-1 immunoreactivity. Case 2 demonstrated ameloblastic and sclerosing features and encased the inferior alveolar nerve; the patient was disease-free 22 months after resection with adjuvant chemoradiation therapy. LEF-1 was again strongly positive, and next-generation sequencing demonstrated 9p region-(CDKN2A, CDKN2B) copy number loss, and 12q region-(MDM2, CDK4) copy number gain. Case 3 showed clear-cell and markedly sclerosing features; no follow-up information was available. Literature review along with the current cases yielded 20 cases. OCS showed a male predilection (1.5:1), mandibular predominance (80%, typically posterior), and a bimodal age distribution (modes: 27.7 years, 62.7 years). OCS presented as masses (100%), often with pain (55%), and paresthesia (45%). Tumors were typically radiolucent (88.9%), with bone destruction (61.1%), and/or tooth effacement (27.8%). Preoperative biopsy was sensitive for malignancy (85.7%). At least 45% show evidence for a precursor lesion. 3-year DSS and DFS were 58% and 35%, respectively. Regional and distant (usually lung) metastatic rates were 25% and 31.3%, respectively. Increased mitotic rates and presence of tumor necrosis trended toward worse DSS and DFS. OCS is a rare but aggressive malignancy, often arising from precursor tumors and may represent a terminal phenotype rather than a distinct entity. We describe novel clear-cell and sclerosing morphologies. Wnt pathway alterations appear important. Mitotic rates and necrosis may be adverse prognosticators. In keeping with nomenclature trends in other sites, OCS may be more appropriately designated as "biphasic sarcomatoid odontogenic carcinomas."

Mucoepidermoid carcinoma showing continuity with the surface mucosa of the oral cavity: a report of 14 cases

We aimed to characterize the histology and the clinicodemographic features of mucoepidermoid carcinoma (MEC), showing continuity with the oral surface mucosa. We reviewed 138 cases of intraoral MEC to identify cases that showed continuity with the surface mucosa and compared their clinicodemographic findings with those of MECs not showing continuity. We compared the sex ratio using the 2-sample Z-test and compared the age distribution using the 2-sample Kolmogorov-Smirnov test. Of the 138 cases examined, 14 showed continuity with the surface mucosa. Their histology showed surface mucosa with an apparent transition to an infiltrating tumor with mucous, intermediate, and epidermoid tumor cells growing in solid and cystic patterns. Their clinical appearance ranged from firm submucosal nodules to erythematous to ulcerated lesions. They showed a strong female predilection (6:1) and sharply bimodal age distribution, with sharp peaks in the fourth and seventh decades. Mucoepidermoid carcinomas that show continuity have a demographic pattern distinct from that of conventional MECs, showing a striking female predilection and bimodal age distribution and suggesting a difference in etiology. Pathologists should remain aware that MEC in the oral cavity can have a histologic appearance of surface origin to reach the correct diagnosis.

Traumatic Dens Fracture Patients Comprise Distinct Subpopulations Distinguished by Differences in Age, Sex, Injury Mechanism and Severity, and Outcome

Dens fractures are an increasingly common injury, yet their epidemiology and its implications remain underexamined. We retrospectively analyzed all traumatic dens fracture patients managed at our institution over a 10-year period, examining demographic, clinical, and outcomes data. Patient subsets were compared across these parameters. Among 303 traumatic dens fracture patients, we observed a bimodal age distribution with a strong goodness of fit centered at age 22.3 ± 5.7 (R= 0.8781) and at 77.7 ± 13.9 (R= 0.9686). A population pyramid demonstrated a bimodal distribution among male patients, but not female patients, which was confirmed with a strong goodness of fit for male patient subpopulations age <35 (R= 0.9791) and age ≥35 (R= 0.8843), but a weaker fit for a second female subpopulation age <35. Both age groups were equally likely to undergo surgery. Patients younger than age 35 were more likely to be male (82.4% vs. 46.9%, odds ratio [OR]= 5.29 [1.54, 17.57], P= 0.0052), have motor vehicle collision as their mechanism of injury (64.7% vs. 14.1%, OR= 11.18 [3.77, 31.77], P < 0.0001), and to have a severe trauma injury severity score (17.6% vs. 2.9%, OR= 7.23 [1.88, 28.88], P= 0.0198). Nevertheless, patients age <35 were less likely to have fracture nonunion at follow (18.2% vs. 53.7%, OR= 0.19 [0.041, 0.76], P= 0.0288). The dens fracture patient population comprises 2 subpopulations, distinguished by differences in age, sex, injury mechanism and severity, and outcome, with male dens fracture patients demonstrating a bimodal age distribution. Young, male patients were more likely to have high-energy injury mechanisms leading to severe trauma, yet were less likely to have fracture nonunion at follow-up.

Paediatric hospitalizations over three waves of COVID-19 (February 2020 to May 2021) in Italy: determinants and rates.

After a pneumonia outbreak in late 2019 in China, a new virus related to the Coronaviridae strain, called Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), was identified as the pathogen of an emerging disease known as COronaVIrus Disease 19 (COVID-19). Preliminary evidence outlines a higher prevalence in adults and lower susceptibility in children. However, recent epidemiologic research highlighted that transmissibility and susceptibility among children and adolescents become higher due to new virus variants. Infections among youth arises with mainly respiratory and gastrointestinal symptoms and malaise. Nevertheless, critical illness affects new-borns and fragile children, requiring hospitalization and possibly intensive care support. Aim of this study was to examine the impact of COVID-19 pandemic on hospital admissions among children and adolescents aged 0 to 17 years over three waves of COVID-19 (from February 2020 to May 2021) in Piedmont, a large Italian region, and to investigate the possible determinants of hospitalizations. A meta-analysis for risk assessment was performed over three waves of COVID-19 (from February 2020 to May 2021). Data were extracted from the official Italian National Information System and ISTAT. Overall, 442 paediatric patients were enrolled and admissions concerned mostly the age group 0-4 years (60.2%). Trends of hospitalization showed a slight increase of paediatric admissions already in March 2020 and a rise during second and third waves (November 2020, March 2021). Paediatric age-grouped hospitalizations (0-4; 12-17; 5-11) reproduced an analogous trend. The children and adolescent hospitalization rate appeared lower than overall population with a moderate slope of increase in comparison with population slope. Monthly hospitalization rate (per 100,000) of children and adolescents aged 0-17 years reproduced the increasing trend of hospitalization numbers. This trend was influenced, in particular, by the trend of hospitalization rates for children aged 0-4 years. The meta-analysis for risk assessment showed a decreased likelihood of rescue of hospitalizations in female, 5-11 and 12-17 age groups. Conversely, the meta-analysis showed a positive association between foreign nationality and hospitalizations. Our results show a comparable trend of paediatric hospital admissions for COVID-19 and of the entire population hospitalizations over three waves. COVID-19 hospital admissions increase with a bimodal age distribution and the most admissions are among patients aged ≤4 or 5-11 years. Significant predictive factors of hospitalization are identified.

Comparison of Epstein–Barr virus and Kaposi’s sarcoma-associated herpesvirus viral load in peripheral blood mononuclear cells and oral fluids of HIV-negative individuals aged 3–89 years from Uganda

We previously found that age, sex and malaria were associated with KSHV in individuals from Uganda. In this study, we have evaluated these same factors in relation to EBV in the same specimens. Overall, 74% (oral fluids) and 46% (PBMCs) had detectable EBV. This was significantly higher than observed for KSHV (24% oral fluids and 11% PBMCs). Individuals with EBV in PBMCs were more likely to have KSHV in PBMCs (P = 0.011). The peak age for detection of EBV in oral fluids was 3–5 years while that of KSHV was 6–12 years. In PBMCs, there was a bimodal peak age for detection of EBV (at 3–5 years and 66 + years) while for KSHV there was a single peak at 3–5 years. Individuals with malaria had higher levels of EBV in PBMCs compared to malaria-negative individuals (P = 0.002). In summary, our results show that younger age and malaria are associated with higher levels of EBV and KSHV in PBMCs suggesting malaria impacts immunity to both gamma-herpesviruses.

Use of Distal Tibial Cortical Bone Thickness and FRAX Score for Further Treatment Planning in Patients with Trimalleolar Ankle Fractures.

A total of 193 patients with a trimalleolar ankle fracture treated between 2011 and 2020 were included. Patient registries were reviewed regarding demographics, mechanism, and type of injury. The CBTT was assessed in radiographs and CT images. The FRAX score was calculated to estimate the probability for an osteoporotic fracture. A multivariable regression model was calculated to identify independent variables affecting the cortical bone thickness of the distal tibia. Patients older than 55 years were 4.22 (95% CI: 2.12; 8.38) times more likely to be female. In the multivariable regression analysis, female sex (β -0.508, 95% CI: -0.739; -0.278, p < 0.001) and a higher age (β -0.009, 95% CI: -0.149; -0.003, p = 0.002) were independent variables associated with a lower CBTT. Patients with a CBTT < 3.5 mm had a higher 10-year probability for a major osteoporotic fracture (12% vs. 7.75%; p = 0.001). The assessment of the peripheral bone quality in routine computed tomography demonstrated that higher age and female sex are significantly associated with reduced cortical bone thickness of the distal tibia. Patients with a lower CBTT showed a higher probability for a subsequent osteoporotic fracture. In female patients with reduced distal tibial bone quality and associated risk factors, an osteoporosis assessment should be evaluated.

Comparison of hand grip strength in patients with distal radius fracture that are treated by closed reduction with cast versus open reduction and internal fixation

Distal radius fracture are one of the most common fractures presenting at emergency rooms. It has bimodal age distribution. Historically, fractures were treated by manipulation and casting with or without K-wire. Modern techniques of JESS fixation and volar plating have been advocated to restore anatomical alignment and allow early mobilization. There is still debate on, which is the best method to manage these fractures. Grip strength is most used as an outcome measure of functional recovery of patients with distal radius fracture of which the most common tool is hand dynamometer. The study was observational study, which aimed to analyse the comparison of hand grip strength in patients with distal radius fractures that were treated by closed reduction and casting to open reduction and internal fixation twelve months post action. The result of this study indicates that the assessment of handgrip from open reduction internal fixation in the case of distal radius fracture with the results of statistical tests (P&amp;#62; 0.05), which mean there is no significant difference in the strength of hand between the internal fixation and casts after twelve months of action. Grip strength was found to be consistent and reliable outcome measure. It was found by evaluation of grip strength that the outcome of close reduction and casting, and open reduction internal fixation of distal radius fracture are equal and comparable.

HISTOPATHOLOGICAL SPECTRUM OF CENTRAL NERVOUS SYSTEM TUMOURS IN A TERTIARY CARE CENTRE.

Introduction: CNS tumours represent unique heterogenous population of neoplasms which include both benign and malignant neoplasms. Aims and objectives: The aimofthe study istoanalysehistopathologicalspectrum of CNStumours. Material And Methods : Aretrospective studywas carriedoutin the Department of Pathology from January 2018 to October 2021 at a tertiary health care centre. WHO fascicle 2007 was followed for the classication of CNS tumours. Results: In ourstudy, Two hundredfty (250) CNS neoplasms were analysed. There was a bimodal age peak in 31-40 years(60 cases, 24%) and the otherin 51-60 years (80 cases, 32%). The most common tumourwasschwannoma (70 cases, 28%) and was present most commonly in age group of 51-60 years (40cases). Conclusion: The present study highlights the histologicaldiversityofCNStumoursinvariousage groups

Human papillomavirus genotypic characteristics of 60,685 subjects under age-expansion vaccination of the nine-valent human papillomavirus vaccine: A cross-sectional study

BackgroundHuman papillomavirus (HPV) vaccination is a key initiative to promote the WHO global strategy to accelerate the elimination of cervical cancer, and this study aimed to investigate the current status of HPV infection and genotypic characteristics of the population under the impact of age-expansion of nine-valent HPV vaccination policy in China. MethodsThe clinical data of 60,685 subjects who were admitted in the Renmin Hospital of Wuhan University and underwent HPV genotyping from January 2017 to October 2022 were retrospectively analyzed. ResultsThe total number of positive HPV genotyping in the included population was 10,303, with a positivity rate of 17.0 %. The HPV positivity rate in the male and female populations increased slowly year by year, with a higher rate of positivity in men (32.7 %) than in women (16.7 %) (P < 0.001). HPV was predominantly single infection in all populations, with higher prevalence of high-risk HPV than low-risk HPV in females, while low-risk HPV infection was predominant in the male population. The age distribution of female subjects infected with HPV, with HPV52 as the most common type, showed a bimodal pattern. As for HPV infected male subjects, HPV6 was the main type, and there was no bimodal age distribution. The expanded age vaccination of the nine-valent HPV vaccine will result in 42.4 % efficiency of vaccine protection for 49.9 % of age-eligible women. If the nine-valent HPV vaccine were open to males in China, it would reduce HPV infections in men by 56.4 %. ConclusionsThe HPV positivity rate in the population remains high and tends to increase, and the age-expansion of the nine-valent HPV vaccine would contribute to reducing the threat of disease caused by HPV infection for age-eligible women. Moreover, attention should be paid to enhancing HPV screening in males and opening up vaccination when appropriate.

Estimates of Golf-Related Upper Extremity Injuries in the United States: A 10-Year Epidemiology Study (2011-2020).

Golf is one of the most popular sports in the United States (US) and is played by participants of all ages and skill level. Given the popularity and sport-specific demands on the upper torso, golf poses a considerable risk for upper extremity (UE) injuries. Therefore, the aim of the current study was to (1) determine the incidence rate of UE golf injuries presenting to emergency departments (EDs) in the US, (2) determine the most commonly injured body parts and mechanisms of injury, and (3) compare current injury epidemiology with previous trends in the literature. Male sex, bimodal age extremes (young and elderly), and utilization of golf carts (vs walking) are associated with a higher incidence of golf-related UE injuries. Descriptive epidemiology study. Level 3. The National Electronic Injury Surveillance System (NEISS) is a statistically validated injury surveillance system that collects data from ED visits as a representative probability sample of hospitals in the US. We queried the NEISS for the years 2011 to 2020 to examine the following variables for golf-related UE injuries: sociodemographic, diagnosis, body part, and mechanism of injury. From 2011 to 2020, there were a total of 1862 golf-related UE injuries presenting to participating EDs, which correlates to an estimated 70,868 total injuries. Overall, male golf players were disproportionately affected (69.2%) versus female golf players (30.8%) and the most commonly injured age groups were those aged >60 and 10 to 19 years. The most common injuries included fractures (26.8%), strains/sprains (23.4%), and soft tissue injuries (15.9%). The joints injured most frequently were the shoulder (24.8%), wrist (15.6%), and joints in the hand (12.0%). The most common mechanisms of injury were cart accidents (44.63%), falling/tripping (29.22%), and golf club swinging/mechanics (10.37%). Golf-related UE injuries can be acute or due to chronic overuse. Male athletes >60 years of age were the population most commonly presenting to the ED with a golf-related injury. Further, the shoulder, forearm, and wrist were most commonly injured. These findings are consistent with previous epidemiological trends in the literature. Interventions to reduce the incidence of injury should be sport-specific and focus primarily on equipment and golf cart safety and swing modification to optimize the biomechanical function of the UEs. Our findings indicate that golf-related injury prevention programs should target UE injuries, particularly among young (<19) and older (>60 years) golfers with poor swing mechanics.

Incidence of Lyme Borreliosis in the Dutch General Practice Population: A Large-Scale Population-Based Cohort Study Across the Netherlands Between 2015 and 2019

Background: There is a need for updated incidence rates (IRs) of Lyme borreliosis (LB) in Europe, including the Netherlands. We estimated LB IRs stratified by geographic area, year, age, sex, immunocompromised status, and socioeconomic status (SES). Methods: All subjects registered in the PHARMO General Practitioner (GP) Database without prior diagnosis of LB or disseminated LB and having ≥1 year of continuous database enrolment were included. IRs and corresponding confidence intervals (CIs) of GP-recorded LB, erythema migrans (EM), and disseminated LB were estimated during the period 2015‒2019. Results: We identified 14,794 events (suspected, probable, or confirmed) with a diagnostic code for LB that included 8219 with a recorded clinical manifestation: 7985 (97%) with EM and 234 (3%) with disseminated LB. National annual LB IRs were relatively consistent, ranging from 111 (95% CI 106‒115) in 2019 to 131 (95% CI 126‒136) in 2018 per 100,000 person-years. Incidence of LB showed a bimodal age distribution, with peak IRs observed among subjects aged 5‒14 and 60‒69 years in men and women. Higher LB incidence was found in subjects who were residents of the provinces of Drenthe and Overijssel, immunocompromised, or of lower SES. Similar patterns were observed for EM and disseminated LB. Conclusions: Our findings confirm that LB incidence remains substantial throughout the Netherlands with no indication of decline in the past 5 years. Foci in two provinces and among vulnerable populations suggest potential initial target groups for preventive strategies such as vaccination.

Epidemiology and healthcare utilization for rectal foreign bodies in United States adults, 2012–2021

IntroductionPresentations to the emergency department for rectal foreign bodies are common, but there is little epidemiologic information on this condition. This limits the ability to provide evidence-based education to trainees regarding the populations affected, the types and frequency of foreign bodies, and factors associated with hospitalization. To address this, we analyzed national estimates of emergency department presentations for rectal foreign bodies from 2012 to 2021 in the US. MethodsWe queried the National Electronic Injury Surveillance System for any injury to the ‘pubic region’ or ‘lower trunk’ with an accompanying diagnosis of foreign body, puncture, or laceration. Two authors manually reviewed all clinical narratives to identify cases of rectal foreign bodies. National estimates were determined using weighting and strata variables, incidence rates calculated using census data, trends assessed by linear regression, and factors associated with hospitalization identified by multivariable logistic regression. ResultsFrom 885 cases, there were an estimated 38,948 (95% CI, 32,040-45,856) emergency department visits for rectal foreign bodies among individuals ≥15 years from 2012 to 2021. The average age was 43, 77.8% were male, 55.4% of foreign bodies were sexual devices, and 40.8% required hospitalization. The annual incidence of presentations for rectal foreign bodies increased from 1.2 in 2012 to 1.9 per 100,000 persons in 2021 (R2 = 0.84, p < 0.01). Males have a bimodal age distribution peaking in the fifth decade, while females have a right-skewed age distribution peaking in the second decade. Female sex (odds ratio [OR] 0.4; 95% confidence interval [CI], 0.2–0.6) and, compared to sexual devices, balls/marbles (OR 0.2; 95% CI, 0.05–0.6) or drugs/paraphernalia (OR 0.1; 95% CI, 0.05–0.4) are associated with a reduced odds of hospitalization. ConclusionsPresentations to the emergency department for rectal foreign bodies increased for males and females from 2012 to 2021 in the United States. These epidemiologic estimates for a complex form of anorectal trauma provide preclinical information for emergency medicine, surgery, and radiology trainees.

Opioid-related mortality: Dynamic temporal and spatial trends by drug type and demographic subpopulations, Massachusetts, 2005–2021

BackgroundFatal opioid-related overdoses (OOD) present significant public health challenges. Intuitive and replicable analytical approaches are needed to inform targeted public health responses. MethodsWe obtained fatal OOD data for 2005–2021 from the Massachusetts Registry of Vital Records and Statistics. We conducted heatmap analyses to assess trends in fatal OOD rates per 100,000 residents, visualizing rates by death year and decedent age at one-year intervals, stratifying by race/ethnicity, sex, rurality, and involved substances. We calculated Getis-Ord Gi* statistics to identify spatial clusters of OOD rates. ResultsAmong 20,774 fatal OODs, rates were higher among males, and highly variable by race/ethnicity, age group, and rurality. While fatal OOD rates increased in urban before rural communities, rates were higher in rural communities by 2018–2019. Stimulant-related fatal OODs were elevated in 2020 and 2021. Fatal OOD rates involving fentanyl and stimulants increased precipitously and simultaneously in the non-Hispanic Black population in 2020 and 2021, with a bimodal age distribution peaking among those in their 40s and 60s. Elevated rates among 30-to-60 year old Hispanic residents were largely tied to synthetic opioids from 2015 to 2021. Spatial clusters were detected for prescription opioids, heroin, and stimulants in western Massachusetts. For synthetic opioids, hotspots became more ubiquitous across the state from 2016 to 2021, intensifying in southeastern Massachusetts. ConclusionOur novel approach uncovered new time varying and spatial patterns in fatal OOD rates not previously reported. Identified shifts in fatal OOD rates by sex, age, and race/ethnicity can inform location-specific field actions targeting subpopulations at disproportionally high risk.

Abstract P4-03-08: Breast cancer incidence rates in Japan turned into bimodal age distribution in this decade

Abstract BACKGROUND: Japan is the globe’s fastest ageing country: 32.0 % of the female population are 65 or older in 2021. The birth rate was 1.30 children per woman in 2021. Japan’s population has been constantly shrinking since 2011 with aging. The number of breast cancer cases has increased rapidly in the course of low birth rate and aging population. Breast cancer has increased and accounted for the first place of all of cancers in Japanese women. OBJECTIVES; Number of breast cancer has increased recently and accounted for the first place of all of female cancers in Japan. Detailed analytics of the increase and aging of breast cancer are not studied. We elucidate the transformation of Japanese breast cancer by ages at diagnosis over the past decade. MATERIALS: We used the registry data of Japanese Breast Cancer Society and Statistics Bureau of Japan in 2018. Female breast cancer new cases were 59,389 patients in 2008 and 93,858 patients in 2018, respectively. The total female population was 65.441 million in 2008 and 64.911 million in 2018, respectively. 65 years and older women accounted for 23.4% in 2008 and 31.0 % in 2018, respectively. METHODS: We compared incidences and incidence rates of breast cancer by ages in 2008 and 2018, respectively. We used the statistical method of Ameijeiras-Alonso et al for mode assessment. RESULTS; Total number of incidences and incidence rates of breast cancer in 2018 were higher than those in 2008 among all ages. Difference of number of incidences were maximum in age of 60-69 in both years. Difference of incidence rates in both years reached maximum in age of 75-79. Incidence rates in 2008 showed unimodal age distribution with the gentle peak. Incidence rates in 2018 showed bimodal age distribution with two peaks of 45-49 and 65-69. CONCLUSIONS; Incidences and incidence rates of breast cancer increased rapidly among all ages in this decade in Japan. The incidence rates increased most in ages of 75-79 and turned into bimodal age distribution in 2018. Citation Format: Ken Uchida, Hitoshi Ohashi, Hiroko Nogi, Satoki Kinoshita, Ryouko Nosaka, Makiko Kamio. Breast cancer incidence rates in Japan turned into bimodal age distribution in this decade. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-08.

A STUDY ON EXPRESSION OF LATENT MEMBRANE PROTEIN 1 OF EPSTEIN BARR VIRUS IN NASOPHARYNGEAL CARCINOMA IN SOUTH INDIA

Background- Nasopharyngeal carcinoma arises from the nasopharynx epithelial lining and is caused by Epstein Barr virus. Latent Membrane Protein 1(LMP 1) expressed on cytoplasmic portion of cell surface of Epstein Barr virus is an oncoprotein which triggers multiple cell signalling pathways and facilitates the expression of virus infected cell population at an early stage of development of nasopharyngeal carcinoma. Aims and Objectives- To study the age,sex distribution, clinical presentation, histologic spectrum and expression of LMP1 in the histologic types of nasopharyngeal carcinoma. The present study is a cross sectional study done over a Material And Methods- period of two years at a tertiary care hospital.Histologic typing of nasopharyngeal carcinoma done on light microscopy followed by expression of Latent Membrane Protein 1 by Immunohistochemistry. The present study showed a male predominance (75%), bimodal age Results- distribution in second and fth decades of life, presented most commonly as nasal obstruction (82.5%), non keratinising undifferentiated type being the commonest histologic type (80%) and LMP 1 expression in 45% of cases. The detection of Latent Membrane Protei Conclusion- n 1 by immunohistochemistry helps in early diagnosis of nasopharyngeal carcinoma and may aid in treatment as a therapeutic target

P599 Similar efficacy of mesalazine in adult and elderly patients: post-hoc analysis of randomised non-inferiority trial of 1600 mg versus 400 mg tablets of mesalazine for the treatment of mild-to-moderate ulcerative colitis

Abstract Background Ulcerative colitis (UC) incidence has bimodal age distribution with a peak in the second to fourth decade and a second smaller peak in the sixth to eighth decade. We assessed the difference in rates of clinical and endoscopic response and remission in adult (≤60 years of age) and elderly (&amp;gt;60 years of age) mild-to-moderate (Mayo Clinic Score ≥5) UC patients treated with mesalazine. Methods We performed a post-hoc analysis of data from a phase 3 non-inferiority trial of 817 UC patients treated with mesalazine for 8 and additional 38 weeks in a double-blind and open label study, respectively (D’Haens et al. Aliment Pharmacol Ther.2017;46:292–302). The differences between groups were analysed using Wilcoxon rank sum or chi-square test with continuity correction. P-value of &amp;lt;0.05 was considered to be statistically significant. Results Elderly patients had longer disease duration, higher body mass index, higher number of co-morbiditities and concomitant medications recorded prior and during the trial, when compared with adults participating in the study (Table 1). These patients also had higher baseline Mayo endoscopic score (2.38±0.486 standard deviation [SD] in elderly vs. 2.26±0.439 SD in adult patients; p-value=0.0077). No difference in rates of combined clinical and endoscopic remission, clinical remission and response, endoscopic remission and response were observed at week 8 and 38 (Table 2). Conclusion We observed similar rates of clinical and endoscopic response and remission in adult and elderly mild-to-moderate UC patients treated with mesalazine for 8 and 38 weeks.

De novo adamantinomatous craniopharyngioma with long-term pre-diagnostic imaging

Adamantinomatous craniopharyngioma has a bimodal age distribution occurring in children aged 5–15 years and less frequently in adults aged 45–60 years. The current embryogenetic hypothesis suggests that adamantinomatous craniopharyngioma (ACP) arises from epithelial remnants of the craniopharyngeal duct or Rathke's pouch. It is thought that this tumor exists early on during childhood but remains indolent, growing very slowly until it is diagnosed incidentally or due to symptoms. Recent reports of de novo development of ACP, however, have challenged this theory. Herein, we present a case of an incidentally discovered de novo adamantinomatous craniopharyngioma that was documented to arise de novo on serial MRIs performed for a different indication. To our knowledge, this is the first report of a middle-aged patient who is diagnosed with a de novo ACP documented with contrast-enhanced MRIs of the sella over a 16-year period. This case challenges our current understanding of the pathophysiology of adamantinomatous craniopharyngioma.

A Clinical, Radiological and Histopathological Review of 74 Ossifying Fibromas

BackgroundOssifying fibroma (OF) is a fibro-osseous lesion of the jaws and craniofacial bones. Accurate diagnosis can be challenging due to significant overlap of clinicopathological features. This study aimed to evaluate the clinical, radiological and histological features that can aid in diagnosis and identify characteristics that allow categorisation into the three subtypes: juvenile trabecular, psammomatoid and cemento-ossifying OF.MethodsA total of 74 cases of OF were systematically reviewed for their principle features. Of these, 46 cases were evaluated for their radiographic features including size, location and relationship to the teeth. Histological assessment and stereological point counting were performed in 69 cases to assess the pattern, type and proportion of calcification, the nature of the stroma, the border of the lesion and the presence of secondary changes. Fisher’s exact test and Chi-squared tests were used to determine associations between clinicopathological parameters and maxillary, mandibular, odontogenic, non-odontogenic and psammomatoid or trabecular lesions.ResultsOF showed a female predilection (F: M; 2:1) and a slight bimodal age distribution with peaks in the second (23%) and fourth decades (27%) (Mean age: 32.4 years). 83% of cases presented as an intra-oral swelling, with the mandible being the most common site (73%). Histologically, a range of morphological patterns were seen, with 50% of cases showing mixed trabecular and psammomatoid features. However, there were no significant differences between the variants of OF in terms of age, gender or histological features.ConclusionHistological features of OF cannot be used to differentiate between the subtypes.

Lichen Sclerosus

ABSTRACT Lichen sclerosus is a chronic inflammatory condition characterized by irritation and dyspigmentation in the genital and perianal areas. Although this condition can affect any individual, it typically has a bimodal age distribution, occurring most frequently in postmenopausal women followed by prepubertal children. Physical examination often reveals thin, hypopigmented and hyperpigmented patches or plaques in the vulvar, perineal, or perianal region. The exact etiology of lichen sclerosus is unknown but is believed to be multifactorial with a combination of genetic, environmental, infectious, and autoimmune factors. Once diagnosed, this condition has a chronic course and long-term treatment is required to sustain remission. We present a case of lichen sclerosus involving the vulvar, perineal, and perianal regions in an elderly female patient that improved with topical clobetasol.

Higher Prevalence of Generalized Pustular Psoriasis in Asia? A Population-Based Study Using Claim Data in China and a Systematic Review

Background: Few studies have reported the burden of generalized pustular psoriasis (GPP), a severe and potentially life-threatening skin disease, especially at a national level. Objectives: The aim of this study is to estimate the nationwide burden of GPP in China and make a systemic review of the published data. Methods: We conducted a population-based study using Urban Basic Medical Insurance in China from 2012 to 2016. GPP cases were identified by primary diagnoses including the international classification of Diseases codes (ICD-10: L40.1 and ICD-9: 694.3). A systematic review was conducted using relevant databases up to January 2022. Results: The crude prevalence and incidence of GPP in 2016 were 1.403 (95% confidence interval [CI]: 1.115–1.691) and 0.629 (95% CI: 0.483–0.775) per 100,000 person-years, respectively. The rates were higher in males than in females for both prevalence (1.429 vs. 1.135) and incidence (0.635 vs. 0.520). The prevalence and incidence showed a bimodal age distribution, with the first peak occurring in the 0- to 3-year age-group and the second peak occurring in the 30- to 39-year age-group. The per capita total cost per year for 1 patient with GPP was 609.26 (± 45.77) US dollars. Seven studies were identified in a systematic review, according to which the prevalence (per 100,000) of GPP tended to be higher in Asian countries (0.746–8.178 in Japan and 12.230 in Korea) than in France (0.176), Sweden (6.25), and Brazil (0.7). Conclusions: This is the largest study concerning the disease burden of GPP, and in this study, the prevalence seemed to be higher in Asia. Although the direct economic burden of GPP did not seem high during the study period, the future usage of biologics and the humanistic burden should also be considered for policy-related decision-making.