CAM Group Research Articles

A Randomised, Multicentre, Phase II Trial of Camrelizumab with or without Metastasis-directed Stereotactic Body Radiotherapy in Recurrent or Metastatic Nasopharyngeal Carcinoma

PurposeTo investigate the efficacy of metastasis-directed therapy (MDT) when added to camrelizumab (Cam) in patients with recurrent or metastatic nasopharyngeal carcinoma (R/M-NPC). MethodsWe conducted a randomised, controlled, multicentre, phase II trial in 3 centres from China (NCT04830267). Patients with R/M-NPC, without prior exposure to immunotherapy, who presented with ≥2 lesions, and at least 1 measurable lesion were randomised 1:1 to either Cam alone or Cam plus MDT (Cam+MDT). Patients randomised to the MDT group must have 1 lesion that is amendable to stereotactic body radiotherapy (SBRT) prescribed to 27Gy in 3 fractions every other day. Primary endpoint was objective response rate (ORR) of unirradiated lesions by RECIST v1.1. ResultsBetween April 2021 and August 2023, 39 patients were randomly assigned to receive either Cam (n=20) or Cam+MDT (n=19). 17/39 (43.6%) patients had oligometastatic disease (≤3 lesions); 18/39 (46.2%) had liver involvement; 3/39 (7.7%) had locoregional recurrent disease. ORR of unirradiated lesions did not differ between the treatment groups (26.3% [Cam+MDT] vs 30.0% [Cam], P=1.0). DCR of unirradiated lesions was 73.7% in the Cam+MDT group compared with 60.0% in the Cam group (P=0.571). After a median follow-up of 25.8 months, median progression-free survival was 9.3 (95% CI: 6.2-NR) months in the Cam+MDT group and 8.8 (95% CI: 3.3-NR) months in the Cam group (P=0.750). Exploratory analyses suggested a longer overall survival (OS) with Cam+MDT for patients with >3 lesions (HR 0.23 [95% CI: 0.07-0.77], P=0.009). G3 and above adverse events were comparable between the treatment groups (15.8% [Cam+MDT] vs 20.0% [Cam]). Overall rate of capillary proliferation was 17.9% (7/39) on the trial. ConclusionsOur study did not meet its primary endpoint of superior ORR of unirradiated lesions with the addition of MDT to Cam in patients with R/M-NPC.

Relationship Between Hip and Groin Pain and Hip Range of Motion in Amateur Soccer and Australian Rules Football Players

Background: The relationship between hip/groin pain and hip range of motion (ROM) is unclear. Purpose: To explore the relationship between hip/groin pain and hip joint ROM and examine the influence of sex and cam morphology on this relationship. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 184 amateur soccer and Australian Rules football players (276 hips; 20% women; median age, 26 years; interquartile range, 24-30 years) with hip/groin pain >6 months and a positive flexion-adduction-internal-rotation (FADIR) test, and 50 matched asymptomatic control players (98 hips; 28% women, median age, 26 years; interquartile range, 23-31 years). Hip ROM measures were flexion, internal and external rotation at 90° of hip flexion, total rotation (internal and external), and bent-knee fall out (BKFO). Cam morphology was determined from anteroposterior pelvis or 45° Dunn radiographs, defined by an alpha angle ≥60°. Linear regression models with generalized estimating equations were used to examine the relationship between group (symptomatic and asymptomatic) and each ROM measure. Interaction terms (group × cam morphology or group × sex) were included to examine if relationships between group and hip ROM were influenced by cam morphology or sex. Where appropriate, models were adjusted for sex, age, and cam morphology. Results: An interaction between the relationship between group × cam and internal rotation ROM was found. Symptomatic players with cam morphology had lower internal rotation ROM than controls with cam morphology (adjusted mean difference [AMD] = −4.5°; 95% CI, −7.4° to −1.6°). Hip/groin pain was not associated with internal rotation ROM if cam morphology was absent. A significant interaction was also found for group × sex and BKFO and total rotation ROM. Symptomatic women had lower total rotation ROM than control women (AMD = −8.2°; 95% CI, −14.1° to −2.2°), but no difference was seen in men. BKFO range was lower in men with hip/groin pain compared with control men (AMD = 1.6 cm; 95% CI, 0.3-3.0 cm), but no difference was seen in women. Flexion and external rotation ROM did not differ between symptomatic and control hips. Conclusion: Cam morphology was an effect modifier of the relationship between hip/groin pain and internal rotation ROM. Sex-related differences were also observed in the relationship between hip/groin pain and hip ROM.

A randomized, multicenter, phase II trial of camrelizumab (Cam) with and without metastasis-directed therapy (MDT) in recurrent/metastatic nasopharyngeal carcinoma (R/M-NPC).

141 Background: To investigate the on- and off-target treatment responses of MDT when added to camrelizumab – an anti-programmed cell death 1 antibody in patients with R/M-NPC. Methods: We conducted an open-label, randomized, controlled, multicenter, phase II trial in 3 centers from China (NCT04830267). Patients with R/M NPC, without prior exposure to immune checkpoint inhibitors, who presented with ≥2 lesions, and at least 1 measurable lesion were screened and randomized 1:1 to either Cam (200 mg IV 2-weekly) alone or Cam plus MDT (Cam+MDT). Patients randomized to the MDT group must have 1 lesion that is amendable to MDT using stereotactic body radiotherapy (SBRT) prescribed to 27Gy in 3 fractions every other day between the first and second dose of Cam. Primary endpoint was off-target objective response rate (ORR) by RECIST v1.1. Secondary endpoints included on-target ORR, disease control rate (DCR), progression-free (PFS), overall survival (OS), and safety. Results: Between March 1, 2021, and August 16, 2023, 39 patients with R/M NPC were randomly assigned to receive either Cam alone (n=20) or Cam+MDT (n=19). 17/39 (44%) patients had oligometastatic disease (≤3 lesions); 18/39 (46%) had liver metastasis. Median duration of Cam was 4.1 mo (95%CI: 2.4-10.9) and 4.7 mo (95% CI: 2.3-11.0) in both treatment groups, respectively. Sites of MDT included lungs (8/19, 42%), followed by liver (4/19, 21%), bones (4/19, 21%), and lymph nodes (3/19, 16%); median SBRT target volume was 5.8 cc (IQR: 2.7-13.5). Off-target ORR did not differ between the treatment groups (26% vs 30%, P=0.51), although DCR was 74% in the Cam+MDT group compared with 60% in the Cam only group ( P=0.37, Table). After a median follow up of 25.8 mo, median PFS was 9.3 mo (95% CI:6.2-NR) in the Cam+MDT group and 8.8 mo (95% CI: 3.3-NR) in the Cam group (P=0.75), and median OS was not reached in the Cam+MDT gorup (95% CI: 20-NR) and 13.7 mo (95% CI: 11-NR) in the Cam group. Interestingly, exploratory analyses suggest a longer OS with Cam+MDT for patients with >3 metastatic lesions ( HR 0.228 [95% CI: 0.067-0.769]), and no liver involvement ( HR 0.287 [95% CI: 0.068-1.208]). G3 and above adverse events were comparable between the treatment groups (14.3% vs 12.5%). Conclusions: We did not observe a difference for off-target ORR with the addition of MDT to Cam in patients with R/M-NPC, although DCR was higher with combinatorial treatment due to a higher proportion of stable disease. Interestingly, OS was prolonged with Cam+MDT in a subset of patients with >3 lesions and no liver involvement. Clinical trial information: NCT04830267 . [Table: see text]

Usefulness of Elastic Bandage Compression Compared to Calf Massage to Prevent Venous Thromboembolism-A Retrospective Evaluation.

Background: Manual calf massage and passive ankle motion (CaM) can reduce the incidence of venous thromboembolism (VTE) after total hip arthroplasty (THA). However, these methods cannot be used in all patients; thus, elastic bandage (EB) compression is an alternative method. The efficacy of EB compression in preventing VTE has not yet been investigated; thus, this study aimed to compare the effects of EB compression and manual calf massage. Methods: Of the 363 patients who underwent unilateral primary THA at our hospital between 1 August 2018 and 31 October 2023, CaM without anticoagulation therapy was administered to 206 patients (CaM group) and 157 patients underwent EB without anticoagulation therapy (EB group). Duplex ultrasonography was performed 7 days postoperatively to check for deep vein thrombosis (DVT) in both legs. Results: The surgical time (122.2 min vs. 155.5 min), the incidence of DVT (4.5% vs. 4.8%) and pulmonary thromboembolism (PTE) (0% vs. 0.7%), intraoperative bleeding (305.4 mL vs. 301 mL), and estimated actual blood loss (846.6 mL vs. 811.6 mL) were not significantly different between the CaM and EB group. However, there was one case of symptomatic PTE in the EB group. Conclusions: The incidences of DVT, PTE, and intraoperative bleeding were not significantly different between the groups. Moreover, EB can be administered to patients with DVT and is considered to be a DVT prophylaxis method that can be used in a larger number of patients. Therefore, we recommend that EB be performed in all the patients undergoing THA.

A Comparative Evaluation of Marginal and Internal Fitness of Zirconia Monolithic Crown Fabricated with Different CAD\CAM Systems: (In Vitro Study)

The precision of computer-aided design/computer-aided manufacturing (CAD/CAM) systems is reliant upon their technical attributes and reliability in producing the designated restorations. The evaluation of this precision is primarily conducted through the examination of the marginal and internal fitness of said restorations. Consequently, the objective of this research endeavor was to analyze and compare the marginal and internal fitness of zirconia crowns fabricated using various CAD/CAM systems. The samples were categorized into four groups, each consisting of 10 samples, based on the specific CAD/CAM equipment employed for crown fabrication as follows: Group I fabricated using Sirona CAD\CAM milling machine, Group II fabricated using Dentium CAD\CAM machine, Group III fabricated using XTCERA CAD\CAM machine and Group IV fabricated using IMES-ICORE CAD\CAM machine. Tooth preparation done following the guidelines recommended by KATANA TM Zirconia (Kurary Noritake Dental Inc., Japan). To ensure standardization, one CAD/CAM program designed parameters was selected to be used for all CAD/CAM machines. Cement thickness was directly measured using sectioning technique to assess the crown's internal and marginal fitness. After performing sectioning, measurements were conducted using a digital microscope with a magnification of 230x. Eleven predetermined measuring locations were selected for each sample, representing four distinct areas: two marginal points, two chamfer points, four axial points, and three occlusal points. Results showed that none of four CAD\CAM machines tested was able to accurately reproduce the designed cement space parameter except Group I (Sirona) showed the closest results. As a conclusion, no CAD\CAM system is 100% accurate however, crowns fabricated using Sirona CAD\CAM milling machine showed the closest recordings to selected parameters among other CAD\CAM milling machines tested.

The Effect of Thermo Cycling on Fracture Resistance Of Temporary Prosthesis Fabricated By CAD/CAM With Composite- Based Material

Aim: The objective of this study was to evaluate the effect of thermo cycling on fracture resistance of temporary prosthesis constriction by computer-aided design/ computer-aided manufacturing (CAD/CAM) with those of composite materials. Material and Methods: A dentoform maxillary molar tooth was prepared for full coverage crown, temporary prosthesis was constriction and divided into the following groups: CAD/CAM poly (methyl methacrylate) (PMMA) blocks, and auto- polymerizing temporary material. All specimens were subjected to thermo cycling and then fracture strength was measured by a universal testing machine. Results: The mean ± Stander deviation values for CAD CAM group before thermo cycling (560.50 ±83.581 Newton) and after thermo cycling (901.00± 311.598 Newton) were recorded statistically significant higher fracture resistance mean compared with composite fabricated interim restorations. Conclusion: Interim prosthesis constructed using CAD CAM technique showed higher fracture

Radiological signs of femoroacetabular impingement are linked to pelvic version in asymptomatic subjects

IntroductionWith the recent interest in hip-spine relationship, the link between femoroacetabular impingement (FAI) and the lumbar-pelvic-femoral complex (LPFC) appears decisive. The objectives of this study were (1) to compare the pelvic version, as well as (2) all the parameters of the LPFC between two populations of healthy subjects, comparing those with radiological signs of FAI to those without and finally, (3) to evaluate the LPFC parameters according to the type of FAI. HypothesisAsymptomatic subjects with radiological signs of FAI had superior pelvic anteversion. Materials and methodThis retrospective study was based on a prospective cohort of 118 voluntary asymptomatic patients including 62 men (52.5%) with a mean age of 25.6 years±4.4 (19–39). The following parameters: pelvic version (PV), pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), hip flexion, intrinsic (IER) and extrinsic (EER) extension reserve were measured using EOS imaging™ in the reference standing position and the lunge position. The radiological signs of FAI (cam, pincer, mixed) were identified on these acquisitions then separated into 2 groups. The first was the group presenting with one or more images of FAI (FAI+) and the second group with no images of FAI (FAI–). ResultsThere were 143 hips in the FAI+ group compared to 93 hips in the FAI– group. There were 36.4% cams and 45% pincers. With an average of 9.08°±7.81 (–11.0; 27.0) versus 12.33°±8.94 (–5.0; 55.0), the PV was significantly lower (p=0.022) in the FAI+ group compared to the FAI– group. A post-hoc power analysis on the primary outcome (PV) confirmed sufficient power (1–β=0.809). Compared to the FAI– group, the cam group presented a significantly lower IER and EER (respectively p=0.014 and p=0.047). The comparative analysis between the FAI– and pincer groups found a significant difference in PI (p=0.001), PV (p<0.001), IER (p=0.017) and hip flexion (p<0.001), SS in lunge position (p=0.031) and EER (p=0.039). ConclusionAsymptomatic subjects with radiographic signs of FAI present with weak pelvic version when standing. This pelvic hyper-anteversion is mainly found in the event of a radiological pincer sign. Level of evidenceIII, retrospective comparative study.

Ball-milled PET plastic char as an electron shuttle accelerated anaerobic degradation of 2,4,6-trichlorophenol in water environment

11The number behind BMPC denotes the pyrolysis temperature.The combination of carbonaceous materials and microbial degradation is an attractive measure in improving the removal efficiency of organic pollutants in water environment. In this study, the anaerobic dechlorination in a coupled system of ball-milled plastic chars (BMPCs) and the microbial consortium were investigated. The anaerobic microorganism cultured from raw sludge (CAM) contributed to the dechlorination of the 2,4,6-trichlorophenol (2,4,6-TCP) into 4-chlorophenol (4-CP) as the final product via ortho-dechlorination in all testing groups. The dechlorination rate was accelerated in different BMBC plus CAM groups than that in only CAM group (0.048 d−1), of which, it was greater in BMPC-500 plus CAM group (0.375 d−1) than that in BMPC-700 plus CAM group (0.171 d−1). The electron exchange capacity (EEC) of BMPCs decreased with the increase of pyrolysis temperature (0.053 mmol e−/g for BMPC-500 and 0.037 mmol e−/g for BMPC-700), which directly affected anaerobic dechlorination. Direct interspecies electron transfer (DIET) of BMPCs also boosted the biogas yield by 1.5 times compared to that without BMPCs. Microbial community analysis illustrated that BMPCs helped to enrich the putative dechlorinating bacteria. The abundance of Clostridium_aenus_stricto_12, as a dominant dechlorinator, significantly increased from 0.02 % to 11.3 % (without BMPCs), 39.76 % (BMPC-500) and 9.3 % (BMPC-700), and followed by， Prevotella and Megaspheara, which was reported to take part in anaerobic dechlorination and digestion as H2 producers, also increased in the presence of BMPC. This study contributes to the realization of 2,4,6-TCP in-situ reduction technology and provides a scientific reference for anaerobic dechlorination by cultured anaerobes combined with BMPCs.

The quest for optimal femoral torsion angle measurements: a comparative advanced 3D study defining the femoral neck axis

PurposeThere is high variability in femoral torsion, measured on two-dimensional (2D) computed tomography (CT) scans. The aim of this study was to find a reliable three-dimensional (3D) femoral torsion measurement method, assess the influence of CAM deformity on femoral torsion measurement, and to promote awareness for the used measurement method.Methods3D models of 102 dry femur specimens were divided into a CAM and non-CAM group. Femoral torsion was measured by one 2D-CT method described by Murphy et al. (method 0) and five 3D methods. The 3D methods differed in strategies to define the femoral neck axis. Method 1 is based on an elliptical least-square fit at the middle of the femoral neck. Methods 2 and 3 defined the centre of mass of the entire femoral neck and of the most cylindrical part, respectively. Methods 4 and 5 were based on the intersection of the femoral neck with a 25% and 40% enlarged best fit sphere of the femoral head.Results3D methods resulted in higher femoral torsion measures than the 2D method; the mean torsion for method 0 was 8.12° ± 7.30°, compared to 9.93° ± 8.24° (p < 0.001), 13.21° ± 8.60° (p < 0.001), 8.21° ± 7.64° (p = 1.00), 9.53° ± 7.87° (p < 0.001) and 10.46° ± 7.83° (p < 0.001) for methods 1 to 5 respectively. In the presence of a CAM, torsion measured with method 4 is consistently smaller than measured with method 5.Conclusion2D measurement might underestimate true femoral torsion and there is a difference up to 5°. There is a tendency for a higher mean torsion in hips with a CAM deformity. Methods 4 and 5 are the most robust techniques. However, method 4 might underestimate femoral torsion if a CAM deformity is present. Since method 5 is independent of a CAM deformity, it is the preferred technique to define expected values of torsion.

Patients with cam-type femoroacetabular impingement demonstrate increased change in bone-to-bone distance during walking: A dual fluoroscopy study.

Cam-type femoroacetabular impingement (FAI) syndrome is a painful, structural hip disorder. Herein, we investigated hip joint mechanics through in vivo, dynamic measurement of the bone-to-bone distance between the femoral head and acetabulum in patients with cam FAI syndrome and morphologically screened controls. We hypothesized that individuals with cam FAI syndrome would have larger changes in bone-to-bone distance compared to the control group, which we would interpret as altered joint mechanics as signified by greater movement of the femoral head as it articulates within the acetabulum. Seven patients with cam FAI syndrome and 11 asymptomatic individuals with typical morphology underwent dual fluoroscopy imaging during level and inclined walking (upward slope). The change in bone-to-bone distance between femoral and acetabular bone surfaces was evaluated for five anatomical regions of the acetabulum at each timepoint of gait. Linear regression analysis of the bone-to-bone distance considered two within-subject factors (activityand region) and one between-subjects factor (group). Across activities, the change in minimum bone-to-bone distance was 1.38-2.54 mm for the cam FAI group and 1.16-1.84 mm for controls. In all regions except the anterior-superior region, the change in bone-to-bone distance was larger in the cam group than the control group (p ≤ 0.024). An effect of activity was detected only in the posterior-superior region where larger changes were noted during level walking than incline walking. Statement of clinical significance: Patients with cam FAI syndrome exhibit altered hip joint mechanics during the low-demand activity of walking; these alterations could affect load transmission, and contribute to pain, tissue damage, and osteoarthritis.

Prevalence of complementary and alternative medicine despite limited perceived efficacy in patients with rheumatic diseases in Mexico: Cross-sectional study.

Complementary and alternative medicine (CAM) is frequently used by patients with rheumatic diseases (RD) to improve their symptoms; however, its diversity and availability have increased notably while scientific support for its effectiveness and adverse effects is still scarce. To describe the prevalence and diversity of CAM in patients with RD in Chihuahua, Mexico. A cross-sectional study was conducted in 500 patients with RD who were interviewed about the use of CAM to treat their disease. The interview included sociodemographic aspects, characteristics of the disease, as well as a description of CAM use, including type, frequency of use, perception of the benefit, communication with the rheumatologist, among others. The prevalence of CAM use was reported by 59.2% of patients, which informed a total of 155 different therapies. The herbal CAM group was the most used (31.4%) and included more than 50 different therapies. The use of menthol-based and arnica ointments was highly prevalent (35%). Most patients (62.3%) reported very little or no improvement in their symptoms. Only a fourth of the patients informed the rheumatologist of the use of CAM. The use of CAM was influenced by female sex, university degree, diagnosis delay, lack adherence to the rheumatologist's treatment, family history of RD, and orthopedic devices. The use of CAM in our population is highly prevalent and similar to reports in different populations suggesting a widespread use in many different societies. We found high use of herbal remedies; however, there were many different types suggesting a lack of significant effect. Patients continue using CAM despite a perception of no-effectiveness. Recurrent use of CAM is explained by factors other than its efficacy.

Complementary and Alternative Medicine and Health Literacy in Fibromyalgia

OBJECTIVE: Many patients with fibromyalgia benefit from complementary and alternative therapies (CAM) in addition totraditional therapy. Health literacy (HL) refers to the ability to seek, understand and apply health information. The aim of thisstudy is to investigate the relationship between CAM use and HL in female patients with fibromyalgia.MATERIALS AND METHODS: An open-ended questionnaire, which also evaluates CAM preferences, was applied to 160 patientswith FMS, and their data were evaluated in a cross-sectional analytical design. Visual analogue scale (VAS) for pain, fibromyalgiaimpact questionnaire (FIQ) and HL Questionnaire (HLS-EU-Q47) were applied. The patients were divided into two groups (usingCAM (Group 1); not using CAM (Group 2)).RESULTS: According to the results of the questionnaire, the HL score was 30.94 ± 8.40 (problematic-limited level). There was nosignificant difference between the two groups in terms of demographic, clinical parameters, HL and sub-indices (p&amp;gt; 0.05). Theresults of the evaluations made according to the most commonly used CAM methods showed that there is no difference betweenthose who use the relevant CAM method and those who do not, according to the HL general score and subscale scores. The mostpreferred CAM methods were prayer (37.9%), wet cupping (21.8%), herbal therapy (16.30%), dry cupping (12.9%) and thermal bath(11.40%), respectively.CONCLUSION: The results of our study showed that the use of CAM is common among women with FMS, and spiritual methodsare the leading methods. In addition, disease severity and health literacy levels were similar in CAM users and non-users.

What Is the Impact of a CAM Impingement on the Gait Cycle in Patients with Progressive Osteoarthritis of the Hip?

(1) Background: The femoroacetabular impingement (FAI) type cam leads to a conflict between the acetabular rim and a bony thickening of the femoral neck junction. While maximal excursions in flexion, adduction and internal rotation provoke pain, the aim of this study was to analyze if a cam morphology shows an impact on gait pattern. (2) Methods: Fifty-five patients with end-stage hip osteoarthritis performed gait analysis before hip replacement as well as three, six and 12 months postoperatively. Thirty-three (60%) of them presented an FAI type cam. An ANOVA was used to compare the hip angles in sagittal, frontal and transversal planes between patients with a FAI type cam (group “+cam”) and without (group “−cam”). (3) Results: Before surgery the patients of the +cam-group showed a tendency towards a reduced flexion and internal rotation at the heel strike (p &gt; 0.05). Over time, the differences were adjusted by total hip arthroplasty. (4) Conclusions: We did not find any differences in the gait analysis of patients with a FAI type cam compared to patients without.

Dietary Supplementation with Camelina sativa (L. Crantz) Forage in Autochthonous Ionica Goats: Effects on Milk and Caciotta Cheese Chemical, Fatty Acid Composition and Sensory Properties.

Simple SummaryCamelina sativa (L. Cranz), commonly known as false flax, is an annual dicot species belonging to the Brassicaceae family. The plant is characterised by extreme rusticity and is able to grow in different climatic and soil conditions, including those of the Southern Italy marginal areas. Camelina is studied as a sustainable crop for food and non-food exploitation. Its interest in animal nutrition is due to the fatty acid (FA) composition of its oil, high in polyunsaturated FA (PUFA). This study aimed to evaluate the effect of dietary supplementation with Camelina sativa fresh forage in autochthonous goats on the chemical composition and fatty acid profile of milk and Caciotta cheese, a traditional short-term ripened cheese with a soft ivory-coloured rind, compact texture, semi-soft paste, acid fermented odour, and delicate sweet taste. The milk from the Camelina group showed a greater content of conjugated linoleic acid (CLA) and PUFA, with benefits for human health. Under the nutritional point of view, Caciotta cheeses were similar between the two groups, but the recruited panellists appreciated the cheese obtained from the Camelina group more for its better palatability.The research studied the effects of dietary supplementation with Camelina sativa fresh forage on the chemical and fatty acid composition of milk and Caciotta cheese, and its sensory properties. Twenty Ionica goats were randomly assigned to the following two groups (n = 10): the control received a traditional forage mixture (Avena sativa, 70%; Vicia sativa, 20%; Trifolium spp., 10%), while the experimental group was given Camelina sativa fresh forage (CAM). All of the dams grazed on pasture and received a commercial feed (500 g/head/day) at housing. The milk from the CAM group showed a higher (p < 0.05) content of dry matter, fat, lactose and concentrations of C6:0, C11:0, C14:0, C18:2 n-6, CLA and PUFA, while lower (p < 0.05) amounts of C12:0, C18:0 and saturated long chain FA (SLCFA). The Caciotta cheese from the CAM group showed a greater (p < 0.05) content of n-6 FA and n-6/n-3 ratio, although close to four, thus resulting adequate under the nutritional point of view. The overall liking, odour, taste, hardness, solubility and “goaty” flavour were better (p < 0.05) in the CAM cheeses. Further investigation would be advisable in order to evaluate the effect of feeding Camelina forage obtained from different phenological stages, and the application of ensiling techniques.

Abstract P6-12-11: Implementation of a digital platform to improve patient care through better multidisciplinary team communication: Experience of a Brazilian breast oncology practice

Abstract Background: The possibility of prompt interaction with the involved professionals in a health system has a great positive impact and represents one of the determining factors for the quality of care provided to cancer patients. Breast cancer treatment involves the use of long-term therapies, most of them oral, with constant possibility of side effects which are frequently not reported during medical visits. Trials using digital platforms for patient electronic monitoring have showed increased survival and patient satisfaction, favoring to the adoption of this strategy. In Brazil, to our knowledge, no such trials have been conducted. CLION / CAM Group is a large multidisciplinary private oncology practice located in the northeast part of Brazil, mostly dedicated to the care of breast cancer patients. Here we describe our experience in developing and implementing a digital platform to improve patient care and further developments focused on treatment side effects and patients reported outcomes. Methods: The project started in May 2017 with the development of a mobile platform (versions web, iOS and Android-based) and internal tests. In January 2018 the platform was lunched with a chat center specifically designed for the patient and multidisciplinary team (doctors and nurses initially). To improve user experience, some implementations were idealized: 1) groups for multidisciplinary case discussion on a safe digital environment; 2) fast and friendly view of the medical agendas and scheduling of each patient through the application; 3) integration with the electronic health record; 4) sending questionnaires to specific groups, allowing monitoring of therapeutic adherence to oral medications and more complex adverse reactions. Results: until July 7th 2019, 601 users downloaded the mobile platform. There were 31 doctors, 32 non-medical professionals (nursing staff, pharmacy, nutrition, psychology, physical therapist and dentistry) and 538 patients, of whom, 425 with breast cancer diagnosis including 121 taking oral therapy. A total of 1537 chats were initiated, with 27886 messages, 1618 images and 160 documents exchanged. Conclusion: Implementing a digital mobile platform for cancer patient care is feasible in a private oncology practice in Brazil and resulted in an intense and productive multidisciplinary team interaction. Systems of this nature should be encouraged in order to keep the communication channel open to patients and families, improving the care to be rendered. Simple measures, inexpensive to the health care system and, demonstrably, highly effective. A prospective clinical trial comparing patient reported outcome with conventional care vs using the mobile platform is been developed with breast cancer patients using oral oncologic drugs at our institution. Citation Format: Jorge HS Leal, Carlos Augusto Malbouisson, Ricardo Gomes, Ivana Lebre, Adriano Magno, Ana Carla Rocha, Janyce Cassiolato, Livia Lopes, Daniel FST Argolo. Implementation of a digital platform to improve patient care through better multidisciplinary team communication: Experience of a Brazilian breast oncology practice [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-12-11.

Posterior acetabular uptake on 18F-fluoride positron emission tomography/computed tomography reveals a putative contrecoup region in patients with femoroacetabular impingement.

The pathology of the posterior acetabular lesions, so-called "contrecoup regions", in femorocacetabular impingement (FAI) has not been elucidated fully. 18F-fluoride positron emission tomography/computed tomography (PET/CT) can visualize abnormal uptake caused by impingement. Therefore, we aimed to evaluate posterior acetabular uptake on PET/CT in FAI patients. Patients with FAI who underwent 18F-fluoride PET/CT between October 2014 and October 2016 were retrospectively evaluated. The maximum standardized uptake value (SUVmax) in the posterior acetabulum was evaluated. The mean SUVmax of FAI with cam morphology (the cam group) was compared with that of FAI with pincer morphology (the pincer group). In addition, the numbers of cases with SUVmax ≥ 6 and SUVmax < 6 in each group were evaluated. The entire study cohort was also grouped according to SUVmax, and the mean α and center edge angles were evaluated. In total, 41 hips were analyzed (34 hips in the cam group and 7 in the pincer group). The mean SUVmax of the cam group (11.2 ± 7.4) was significantly higher than that of the pincer group (4.9 ± 1.9) (p < 0.01). The incidence of cases with SUVmax ≥ 6 in the cam group was significantly high (p < 0.01). In the overall cohort, the mean α angle of the SUVmax ≥ 6 group was significantly higher than that of the SUVmax < 6 group (p < 0.01). Evaluation of posterior acetabular uptake suggests an association between cam morphology and increased posterior acetabular uptake.

Characterizing the Prevalence of Cam-Type Hip Impingement in Women’s Professional Ice Hockey Players

Objectives:Participation rates in women’s ice hockey is increasing in North America. Recent studies have demonstrated an increased prevalence of femoroacetabular impingement (FAI) in elite male ice hockey players, yet little is known about hip pathology of players in the National Women’s Hockey League (NWHL). The primary purpose of this study was to determine the prevalence of radiographic FAI in women’s professional ice hockey players. The secondary purpose was to analyze the relationship between the presence of radiographic cam deformity and hip ROM, clinical impingement signs and age of menarche.Methods:In this IRB-approved study, physical examination and demographic data were prospectively collected for 27 NWHL players. Alpha angles were measured on 45-degree Dunn views with an alpha angle >55° defined as cam-positive. Pearson correlations were performed to analyze the relationship between alpha angle and ROM measurements, clinical impingement signs and self-reported age of menarche. Players were grouped into those with and without cam impingement and group differences were assessed using the student’s t-test. Statistical significance was set at p<0.05.Results:Twenty-seven athletes were included in the study. Nineteen of the 27 players (70%) had radiologic evidence of cam-type impingement with alpha angle >55 degrees; 14 players (52%) had bilateral cam deformity. The average age of menarche was 13.9±1.5 years. There was a significant association between age of menarche and right alpha angle (R=0.57, CI [0.16, 0.81], p=0.011), as well as age of menarche and left alpha angle (R=0.48, CI [0.03, 0.77], p=0.039). There was no statistically significant association between alpha angle and any ROM measurement. Additionally, there was no difference in the incidence of clinical impingement for players with or without an alpha angle >55°.Conclusion:This study suggests that elite female ice hockey players have a significantly higher prevalence of cam-type morphology than the general population. The clinical significance of this radiographic finding is uncertain as the majority of these deformities seem to be asymptomatic. Interestingly, the positive association between alpha angle and age of menarche lends support to the etiological hypothesis that cam lesions are a result of activity-related stress at the proximal femoral physis. This data suggests that players with earlier menarche (and therefore earlier physeal closure) seem to be less vulnerable to the development of cam deformity of the proximal femur.

Lisa S. Krivickas Clinician/Scholar Travel Award: Characterizing the Prevalence of Cam-Type Hip Impingement in Women’s Professional Ice Hockey Players

PURPOSE Recent studies have demonstrated an increased prevalence of femoroacetabular impingement (FAI) in elite men's ice hockey players, yet little is known about the hips of players in the National Women’s Hockey League (NWHL). The primary purpose of this study was to determine the prevalence of radiographic cam-type FAI in women’s professional ice hockey players. The secondary purpose was to analyze the relationship between the presence of cam deformity and hip ROM; clinical impingement signs; and age of menarche. METHODS Clinical, radiographic and demographic data were collected for NWHL players during pre-participation physicals. Alpha angles were measured on 45° Dunn radiographs, with alpha angles >55° defined as cam-positive. Spearman correlations were performed to analyze the relationship between alpha angle and both ROM measurements and menarchal age. Players were grouped into those with and without cam lesions and group differences were assessed using the student's t-test. RESULTS Twenty-seven athletes were included. Nineteen (70%) had alpha angles >55°; 14 (52%) had bilateral cam deformity. Average menarchal age was 13.9 ±1.5 years. There was a significant association between age of menarche and alpha angle (right hips, p=0.01; left hips, p=0.04). There was no significant association between alpha angle and either hip ROM or clinical impingement signs. CONCLUSION This study suggests that elite female ice hockey players have a higher prevalence of cam-type morphology than the general population. The positive association between alpha angle and age of menarche lends additional support to the etiological hypothesis of the cam lesion resulting from activity-related stress at the proximal femoral physis; players with earlier menarche (and therefore earlier physeal closure) seem to be less vulnerable to the development of cam deformity of the proximal femur. Thus, professional women’s ice hockey players have a high risk of developing cam-type morphology of the proximal femur, although each player’s age of menarche may mediate her individual risk for cam lesion development.

Characterizing the Prevalence of Cam-Type Hip Impingement in Women’s Professional Ice Hockey Players

PURPOSE: Recent studies have demonstrated an increased prevalence of femoroacetabular impingement (FAI) in elite men's ice hockey players, yet little is known about the hips of players in the National Women’s Hockey League (NWHL). The primary purpose of this study was to determine the prevalence of radiographic cam-type FAI in women’s professional ice hockey players. The secondary purpose was to analyze the relationship between the presence of cam deformity and hip ROM; clinical impingement signs; and age of menarche. METHODS: Clinical, radiographic and demographic data were collected for NWHL players during pre-participation physicals. Alpha angles were measured on 45° Dunn radiographs, with alpha angles >55° defined as cam-positive. Spearman correlations were performed to analyze the relationship between alpha angle and both ROM measurements and menarchal age. Players were grouped into those with and without cam lesions and group differences were assessed using the student's t-test. RESULTS: Twenty-seven athletes were included. Nineteen (70%) had alpha angles >55°; 14 (52%) had bilateral cam deformity. Average menarchal age was 13.9 ±1.5 years. There was a significant association between age of menarche and alpha angle (right hips, p=0.01; left hips, p=0.04). There was no significant association between alpha angle and either hip ROM or clinical impingement signs. CONCLUSION: This study suggests that elite female ice hockey players have a higher prevalence of cam-type morphology than the general population. The positive association between alpha angle and age of menarche lends additional support to the etiological hypothesis of the cam lesion resulting from activity-related stress at the proximal femoral physis; players with earlier menarche (and therefore earlier physeal closure) seem to be less vulnerable to the development of cam deformity of the proximal femur. Thus, professional women’s ice hockey players have a high risk of developing cam-type morphology of the proximal femur, although each player’s age of menarche may mediate her individual risk for cam lesion development.

Controlling joint instability after anterior cruciate ligament transection inhibits transforming growth factor-beta-mediated osteophyte formation

Abnormal joint instability contributes to cartilage damage and osteophyte formation. We investigated whether controlling joint instability inhibited chronic synovial membrane inflammation and delayed osteophyte formation and examined the role of transforming growth factor-beta (TGF-β) signaling in the associated mechanism. Rats (n=94) underwent anterior cruciate ligament (ACL) transection. Anterior tibial instability was either controlled (CAM group) or allowed to continue (SHAM group). At 2, 4, and 8 weeks after surgery, radiologic, histopathologic, immunohistochemical, immunofluorescent, and enzyme-linked immunosorbent assay examinations were performed to evaluate osteophyte formation and TGF-β signaling. Joint instability increased cartilage degeneration score and osteophyte formation, and cell hyperplasia and proliferation and synovial thickening were observed in the synovial membrane. Major findings were increased TGF-β expression and Smad2/3 following TGF-β phosphorylation in synovial membarene, articular cartilage, and the posterior tibial growth plate (TGF-β expression using ELISA: 4 weeks; P=0.009, 95% CI [260.1-1340.0]) (p-Smad2/3 expression density: 4 weeks; P=0.024, 95% CI [1.67-18.27], 8 weeks; P=0.034, 95% CI [1.25-25.34]). However, bone morphogenetic protein (BMP)-2 and Smad1/5/8 levels were not difference between the SHAM model and the CAM model. This study showed that the difference between anterior tibial instability caused a change in the expression level of TGF in the posterior tibia and synovial membrane, and the reaction might be consequently involved in osteophyte formation.