Clinical Outcomes In Young Patients Research Articles

Effectiveness of switching from first-generation basal insulin to Glargine 300 U/mL in children and adolescents with type 1 diabetes: results from the ISPED CARD database.

Glargine 300 U/mL (Gla-300) has been recently approved for use in children and adolescents with type 1 diabetes (T1D). However, real-world effectiveness data are scarce, and aim of this analysis was to assess clinical outcomes in young patients with T1D switching from 1st generation basal insulin (1BI) to Gla-300. ISPED CARD is a retrospective, multicenter study, based on data anonymously extracted from Electronic Medical Records. The study involved a network of 20 pediatric diabetes centers. Data on all patients aged < 18years with T1D switching from 1BI to Gla-300 were analyzed to assess clinical characteristics at the switch and changes after 6 and 12months in glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and standardized body mass index (BMI/SDS). Titration of basal and short-acting insulin doses was also evaluated. Overall, 200 patients were identified. The mean age at the switch to Gla-300 was 13years, and mean duration of diabetes was 3.9years. Average HbA1c levels at switch were 8.8%. After 6months, HbA1c levels decreased by - 0.88% (95% CI - 1.28; - 0.48; p < 0.0001). The benefit was maintained after 12months from the switch (mean reduction of HbA1c levels - 0.80%, 95% CI - 1.25; - 0.35, p = 0.0006). Trends of reduction in FBG levels were also evidenced both at 6months and 12months. No significant changes in short-acting and basal insulin doses were documented. The study provides the first real-world evidence of the effectiveness of Gla-300 in children and adolescents with T1D previously treated with 1BI. The benefits in terms of HbA1c levels reduction were substantial, and sustained after 12months. Additional benefits can be expected by improving the titration of insulin doses.

Primary Arthroscopy-Assisted Foveal Repair of Triangular Fibrocartilage Complex Associated with Acute Distal Radius Fractures in Young Adults

Abstract Background In distal radius fractures (DRFs) occurring in nonosteoporotic age groups, it is known that triangular fibrocartilage complex (TFCC) injuries are frequently combined, with some experiencing persistent symptomatic instability. However, a gold standard treatment for these associated lesions has not yet been established. Purpose Our purpose was to investigate the outcomes of primary arthroscopy-assisted transosseous foveal repair of the TFCC associated with DRFs in young adults. Methods Fifteen patients aged &lt;65 years who underwent open reduction and internal fixation for DRF and arthroscopy-assisted repair for foveal tear of the TFCC were included. Those patients were observed to have complete peripheral TFCC tear on preoperative wrist magnetic resonance imaging and intraoperative distal radioulnar joint (DRUJ) stability tests. This was confirmed with an arthroscopic examination. The transosseous technique was used to repair the TFCC after firm fixation of the DRF. The patients were immobilized with the long-arm splint in a neutral position for 2 weeks postoperatively and a removable short-arm splint was applied for another 2 weeks. DRUJ stability, grip strength, and patient-reported outcomes, including disabilities of the arm, shoulder, and hand (DASH) and Patient-Rated Wrist Evaluation scores, were evaluated as primary outcomes at 3, 6, and 12 months postoperatively. Results All patients showed a stable DRUJ throughout the follow-up period. The average grip strength ratio compared to the unaffected side was 69, 83, and 90% at 3, 6, and 12 months after surgery, respectively. The mean DASH score was 26.9, 18.4, and 6.7 at 3, 6, and 12 months postoperatively, respectively. Conclusion Primary arthroscopy-assisted transosseous foveal repair of the TFCC with internal fixation of the distal radius resulted in early recovery and good clinical outcomes in young patients. Level of evidence Therapeutic, level IV.

The salvage role of allogeneic hematopoietic stem-cell transplantation in relapsed/refractory diffuse large B cell lymphoma

To clarify the role of allogeneic hematopoietic stem-cell transplantation (allo-HSCT) in the chimeric antigen receptor T-cell therapy era, we analyzed the clinical characteristics and outcomes of 52 patients treated with allo-HSCT with relapsed/refractory diffuse large B cell lymphoma. Most enrolled patients had previously undergone intensive treatments, the median number of chemotherapy lines was 4, and the median time from diagnosis to allo-HSCT was 27.1 months. Patients were divided into remission-achieved (n = 30) and active-disease (n = 22) groups before allo-HSCT. Over a median follow-up period of 38.3 months, overall survival (OS) and event-free survival (EFS) rates were 38.4% and 30.6%, respectively. The cumulative incidence of relapse (CIR) and the non-relapsed mortality (NRM) were 36.7% and 32.7%, respectively. OS, EFS, and graft-versus-host disease-free, relapse-free survival (GRFS) outcomes were significantly superior in the remission-achieved group with lower CIR. In a multivariate analysis, a shorter interval from diagnosis to allo-HSCT reflected relatively rapid disease progression and showed significantly poor OS and EFS with higher CIR. Patients with active disease had significantly lower EFS, GRFS, and higher CIR. Previous autologous stem-cell transplantation was associated with better GRFS. Allo-HSCT is an established modality with a prominent group of cured patients and still has a role in the CAR T-cell era, particularly given its acceptable clinical outcomes in young patients with chemo-susceptible disease.

Real-world data of early-onset colorectal cancer (EOCRC) in private health system in Brazil.

e18830 Background: Incidence of EOCRC has been sharply rising in the past decades in the US and present distinct clinical features when compared to late-onset CRC (LOCRC). Data from other countries are scarce. We compared clinical characteristics and treatment outcomes between patients ≤45y (EOCRC) and ≥60y (LOCRC). Methods: Retrospective study evaluating 510 patients with metastatic CRC treated at 5 Oncoclinicas centers in Brazil from January 2011 to December 2019. Demographic and clinical data were retrieved from electronic medical records. The median OS was calculated by Kaplan-Meier method and prognostic factors were evaluated via multivariate Cox Regression. Results: After excluding patients with ages between 46 and 59, 326 patients were identified. EOCRC was represented by 72 (22%) patients (median age 39) and LOCRC by 254 patients (median age 69). Median follow-up was 39.5m, with 231 deaths (71%). Median OS was 33.2m and 40.9m (p = 0.971), respectively. Likewise, stage IV at presentation was similar between the groups (68% vs 58%, p = 0.215), as well as the rate of dMMR status (4% vs 6%, p = 0.655). Clinical and treatment characteristics that were statistically different between the groups are described in Table 1. In multivariate analysis, presence of RAS mutations (HR:1.83), and undergoing triplet chemotherapy (HR:3.24), primary tumor resection (HR:0.40), and metastasectomy (HR:0.45) were the variables with prognostic effect on OS. Conclusions: In this real-world analysis of mCRC, EOCRC patients presented similar clinical presentation and OS, but they were more aggressively treated compared to the older patients. There is no evidence that more intensive treatments translate into superior clinical outcomes in young patients. Real-world data have been progressively adopted in clinical practice and should be considered before clinical decision making in order to offer treatments with minimal toxicity burden to the patients. Future studies with larger population are needed and may bring additional data. [Table: see text]

What Is Driving Early-Onset Colorectal Cancer?

What Is Driving Early-Onset Colorectal Cancer?

Short-Term Outcome of Rehabilitation Program with Hybrid Assistive Limb after Tendon Lengthening in Patients with Cerebral Palsy.

In this study, we aimed to evaluate the short-term outcomes of a rehabilitation program with the Hybrid Assistive Limb® after soft tissue lengthening in young patients with cerebral palsy. We assessed six patients with cerebral palsy who underwent soft tissue surgery followed by gait training using the Hybrid Assistive Limb®. Clinical assessments were conducted preoperatively, before, immediately after, and at 1, 2, and 3 months after gait training. Gross Motor Function Measure was improved 5.93 ± 6.11% (mean ± standard deviation, p &lt; 0.05), Canadian Occupational Performance Measure performance was improved 3.12 ± 1.53 points, and satisfaction was improved 3.80 ± 2.14 points (p &lt; 0.05). The knee extension strength on the operated side was changed 7.75 ± 4.97 Nm after the intervention (p = 0.07). In ambulatory patients, gait speed was changed 8.37 ± 1.72 m/min, stride length was changed 10 ± 6.16 cm, and 6 min walking distance was changed 52 ± 16 m after the intervention. Training with the Hybrid Assistive Limb® may improve walking ability and clinical outcomes in young patients with cerebral palsy after soft tissue lengthening.

Uric Acid and Clinical Outcomes in Young Patients with Ischemic Stroke.

Background and PurposeThere is limited available evidence for the relationship between uric acid (UA) levels and ischemic stroke in young adults. We aimed to explore the association between UA levels and acute ischemic stroke (AIS) in young patients.Materials and MethodsThis was a prospective and observational study. We recruited young patients aged 18–45 years with AIS at our tertiary hospital. Patients were categorized into four groups according to quartiles of UA levels. The primary outcome was functional outcome at 3 months. The secondary outcomes included stroke severity, in-hospital complications, and functional outcome at discharge. Modified Rankin Scale (mRS) scores were used to assess functional outcome as poor (mRS=2-6) or favorable(mRS=0-1).ResultsA total of 636 patients were enrolled in the current analysis. The four groups were defined as follows: Q1≤289.8 µmol/L, 289.8 µmol/ L<Q2≤349.0 µmol/L, 349.0 µmol/L<Q3≤421 µmol/L, and Q4>421 µmol/L. Multiple logistic regression analysis showed that UA levels were not significantly predictive of functional outcome either at discharge or at 3 months after AIS. However, compared to Q1, higher UA levels were significantly negatively associated with the rate of moderate-severe stroke (NIHSS≥5) at admission (p for trend =0.016). Furthermore, a reduction in the risk for in-hospital pneumonia was significantly associated with higher UA levels compared to Q1 (P for trend < 0.0001).ConclusionSerum UA was a protective factor for stroke severity and in-hospital pneumonia after AIS in young patients. However, we were unable to identify the predictive significance of UA for functional outcome either at discharge or at 3 months after AIS.

Outcomes of Endovascular Therapy in Young Patients with Acute Basilar Artery Occlusion: A Substudy of BASILAR Registry Study.

This study aimed to investigate clinical outcomes in young patients with basilar artery occlusion (BAO) receiving endovascular therapy (EVT). Consecutive patients with BAO within 24h who underwent EVT from the BASILAR Registry study were enrolled. We compared clinical outcomes of young patients (aged 18-55years) with older patients (aged > 55years) with stroke due to BAO at 90days and 1year after EVT. The primary and secondary outcomes were improvement in modified Rankin scale scores (mRS) at 90days and either favorable (mRS 0-3) or mortality at 90days, respectively. A total of 646 patients were included, of which 152 (23.53%) were aged 18-55years. Dyslipidemia (42.11% vs. 30.36%, p = 0.007) and good collateral circulation (60.52% vs. 46.35%, p = 0.002) were more frequent in young patients than older. Stroke etiologies in young patients included large artery atherosclerosis (67.11%), cardioembolism (15.13%), and vessel dissection (5.26%). Young patients were associated with better prognosis (mRS: adjusted odds ratio (aOR) 1.73; 95% confidence interval [CI] 1.21-2.48; mRS 0-3: aOR 1.60; 95%CI 1.01-2.54; mortality: aOR 0.60; 95%CI 0.38-0.93) at 90days. Baseline National Institutes of Health Stroke Scale (NIHSS) score, posterior circulation Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS), and sex were independent predictors of clinical outcomes of young patients at 90days after EVT. Young patients with BAO had better clinical outcomes after EVT than old patients. Predictors of clinical outcomes in young patients undergoing EVT included baseline NIHSS score, pc-ASPECTS, and sex. Clinical Trial Registration-URL: ChiCTR180001475 ( www.chictr.org.cn ).

De Novo myelodysplastic syndromes in patients 20–50 years old are enriched for adverse risk features

Data concerning the treatment approach and clinical outcomes in younger patients with myelodysplastic syndromes (MDS) are lacking. Furthermore, published results from genomic profiling in the young adult MDS population are few. We identified patients aged 20–50 at diagnosis evaluated for de novo MDS at our institution over a 32-year period. Clinical information and results from sequencing panels were extracted for analysis. 68 eligible patients were found, including 32% with multilineage dysplasia and 29% with excess blasts-2 WHO subtypes. Revised International Prognostic Scoring System for MDS (IPSS-R) categorization had 47% high/very high-risk, and this classification held prognostic significance. The median overall survival was 59 months, and most patients (75%) underwent allogeneic hematopoietic cell transplantation (alloHCT). Thirty-four patients had mutational profiling; the most commonly mutated gene was TP53 and most commonly altered gene category was epigenetic regulators. Younger patients with de novo MDS represented a unique subset with high-risk disease features (adverse cytogenetics, higher R-IPSS) frequently observed along with alterations in TP53 and genes related to epigenetic and transcription pathways.

Incidence trends and long-term outcomes of myocardial infarction in young adults: Does gender matter?

AimsData about long-term clinical outcomes of young patients experiencing an acute myocardial infarction (MI) and about the potential impact of gender on juvenile MI incidence and prognosis are scant. Methods and resultsHospital Discharge Register records of Piedmont region (Italy) from 2007 to 2018 were interrogated to identify incident juvenile MI cases and MI recurrences. Patients were considered young if the first MI occurred before or at 47 years of age (5th percentile). Incidence of first juvenile MI event and overall survival were the primary outcomes. Gender differences and survival rate after an MI recurrence were secondary outcomes. Out of 114.816 hospitalizations due to MI, 4482 (3.9%) occurred in people aged ≤47. Average incidence rate of juvenile MI over the study period was 24.5 (23.8-25.2) per 100.000 person-years, with a decline among men and a stable trend among women through the years. The risk of in hospital death was higher for women (1.9% vs. 0.9%, p = 0.02), while the survival rate at 10 years after the first MI was 94.8%, without gender differences (HR 1.05: 0.69-1.60). MI recurrence occurred in 348 (7.8%) and was less common in women (HR 0.72: 0.52-0.99). After multivariate adjustment, MI recurrence was associated with a significantly higher risk of death at follow-up as compared with a single MI episode (HR 3.05: 1.9-4.80, all CI 95%). ConclusionAmong young patients with MI, women had a higher in-hospital mortality compared to men, but long-term prognosis after hospital discharge did not differ. MI recurrences were associated with increased mortality at follow up.

294 Incidence trends and long-term outcomes of juvenile myocardial infarction: does gender matter?

Abstract Aims Data about long-term clinical outcomes of young patients experiencing an acute myocardial infarction (MI), along with the potential impact of gender on incidence and prognosis in such subset are scant and mostly including USA populations. Thus, there is a paucity of data about European patients suffering from a juvenile MI. Purpose. The purpose of the current study was to investigate temporal trends, survival, MI recurrence, and sex differences among subjects who experienced their first MI at young age in the Piedmont region (Italy) between 2007 and 2018. Methods and results Hospital Discharge Register records of Piedmont region (Italy) from 2007 to 2018 were interrogated to identify incident juvenile MI cases and MI recurrences (ICD-9-CM codes: ‘410’, ‘411’, and their subcodes). Patients were considered young if the first MI occurred before or at 47 years of age. Incidence of first Juvenile MI event and subsequent overall survival among patients who survived to hospital discharge were defined as primary outcomes of interest. Subgroup analysis were performed according to sex category, comorbidities and clinical intervention (obtained from the HDRs records). Incidence of MI recurrence among patients who survived to hospital discharge was defined as secondary outcome of interest. Lastly, we evaluated whether experiencing a MI recurrence was associated with a lower overall survival at follow-up. Out of 114 816 hospitalizations due to MI, 4482 occurred in people aged ≤47, with median age 44 years old. At baseline, men had more hypertension (13% vs. 9.4%, P &amp;lt; 0.006) and dyslipidaemia (18.2% vs. 9.9%, P &amp;lt; 0.001), while women more cardiac arrest at presentation (2.9% vs. 1.7%, P = 0.03), cardiogenic shock (2.1% vs. 1.3%, P = 0.06), and less likely to undergone PCI (53.9% vs. 74.3%, P &amp;lt; 0.001). More women (n = 14; 1.9%) than men (n = 33; 0.9%) died while in-hospital, adjusted OR: 2.12; 1.13–3.99. After a median follow-up was 7.2 years (IQR: 4.2–9.9), the survival rate after the first MI was 94.8%, without differences between men and women (HR: 1.05; 0.69–1.60). Age at first MI, year of hospitalization, hospitalization length, chronic kidney disease, cardiogenic shock, third degree atrio-ventricular block, and PCI were found independent predictors of long term survival. 348 (7.8%) experienced at least one MI recurrence and it was more common in men than women (adjusted HR: 0.72; 0.52–0.99). After multivariate adjustment, MI recurrence was associated with a significantly higher risk of death at follow-up as compared with a single MI episode (HR: 3.05; 1.9–4.80, all 95% CI). Conclusions In young patients with a MI, women had more in-hospital mortality compared to men, but among patients who survived to hospital discharge, overall long-term prognosis did not differ. MI recurrences were more common in men and were associated with lower long-term survival rate.

Incidence trends and long-term outcomes of juvenile myocardial infarction: does gender matter?

Abstract Background Data about long-term clinical outcomes of young patients experiencing an acute myocardial infarction (MI), along with the potential impact of gender on incidence and prognosis in such subset are scant and mostly including USA populations. Thus, there is a paucity of data about European patients suffering from a juvenile MI. Purpose The purpose of the current study was to investigate temporal trends, survival, MI recurrence and sex differences among subjects who experienced their first MI at young age in the Piedmont region (Italy) between 2007 and 2018. Methods Hospital Discharge Register records of Piedmont region (Italy) from 2007 to 2018 were interrogated to identify incident juvenile MI cases and MI recurrences (ICD-9-CM codes: “410”, “411” and their subcodes). Patients were considered young if the first MI occurred before or at 47 years of age. Incidence of first Juvenile MI event and subsequent overall survival among patients who survived to hospital discharge were defined as primary outcomes of interest. Subgroup analysis were performed according to sex category, comorbidities and clinical intervention (obtained from the HDRs records). Incidence of MI recurrence among patients who survived to hospital discharge was defined as secondary outcome of interest. Lastly, we evaluated whether experiencing a MI recurrence was associated with a lower overall survival at follow-up. Results Out of 114.816 hospitalizations due to MI, 4482 occurred in people aged ≤47, with median age 44 years old. At baseline, men had more hypertension (13% vs 9.4%, p&amp;lt;0.006) and dyslipidemia (18.2% vs 9.9%, p&amp;lt;0.001), while women more cardiac arrest at presentation (2.9% vs 1.7%, p=0.03), cardiogenic shock (2.1% vs 1.3%, p=0.06) and less likely to undergone PCI (53.9% vs 74.3%, p&amp;lt;0.001). More women (n=14; 1.9%) than men (n=33; 0.9%) died while in-hospital, adjusted OR 2.12: 1.13–3.99. After a median follow up was 7,2 years (IQR: 4.2–9.9), the survival rate after the first MI was 94.8%, without differences between men and women (HR 1.05: 0.69–1.60). Age at first MI, year of hospitalization, hospitalization length, chronic kidney disease, cardiogenic shock, third degree atrio-ventricular block and PCI were found independent predictors of long term survival. 348 (7.8%) experienced at least one MI recurrence and it was more common in men than women (adjusted HR 0.72: 0.52–0.99). After multivariate adjustment, MI recurrence was associated with a significantly higher risk of death at follow-up as compared with a single MI episode (HR 3.05: 1.9–4.80, all CI 95%). Conclusions In young patients with a MI, women had more in-hospital mortality compared to men, but among patients who survived to hospital discharge, overall long-term prognosis did not differ. MI recurrences were more common in men and were associated with lower long-term survival rate. Funding Acknowledgement Type of funding sources: None.

Clinical characteristics and outcome of mycosis fungoides among children, adolescents, and young adults: Single institution study.

e19576 Background: Mycosis fungoides (MF) is the most common subtype of cutaneous T cell lymphoma (CTCL) [1]. MF is characterized by the skin infiltrate of small to medium size T lymphocytes with cerebriform nuclei. The incidence of MF increases significantly with age, with a median age at diagnosis of 60 years, and predominantly in white males [2]. The clinical outcome has not been evaluated among children, adolescents, and young adults. This study aimed to evaluate the characteristics and outcomes in this population. Methods: We retrospectively reviewed clinical data on 90 patients with MF at Moffitt Cancer Center between 2000 and 2020. Fifteen patients were diagnosed before the age of 20 years. Our cohort was compared to the largest US epidemiological report by Nath et al. using SEER database, which consists of 4892 patients from 1998-2008 [2]. The Chi-square test was used for comparison. Overall survival (OS) was calculated from diagnosis until death or last contact. OS between different groups was compared using the Kaplan-Meier curve. Hazard ratio and p-value were calculated using the log-rank test. Results: Of 90 patients, the median age at diagnosis was 32 years (range 6-39). The male to female ratio was 1.3:1. White and black races account for 57% and 27% of the patients. Compared to historical control, black patients were significantly higher in the current cohort (27% vs. 13%, p &lt; 0.001). The difference widened in children and adolescents. More patients present with early stage MF in the current cohort (95.6% vs. 83%, p = 0.003). Clinical characteristics, including stage, LDH, WBC, ferritin level, were similar between children/adolescents and young adults. However, our cohort had significantly higher CD8 positive MF, and nearly half of children and adolescents were CD8 positive. Young adults had a higher rate of coexisting skin malignancy; however, this was not statistically significant due to small patient size. Time to diagnosis remained long, especially in children and adolescents’ group. However, the outcome is excellent. At a median follow-up of 4.9 years, four patients deceased, and the median OS was not reached. The prognosis remains poor in patients with advanced disease (HR = 39, p &lt; 0.001) and large cell transformation (LCT) (HR = 8.5, p = 0.009). Conclusions: Compared to historical cohorts, higher proportion of black and female patients were noted in our young cohort with more early-stage and CD8 positive disease. This observation likely represents the different underlying biology of the disease [3]. Clinical outcome in young patients was excellent. However, patients with LCT or advanced stage carry a poor prognosis and need better therapies.

LV twist predicts prognosis in children and adolescents with non-compaction cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Background Left ventricular non-compaction cardiomyopathy (LVNC) is associated with poor clinical outcome in childhood, with heart failure, arrhythmias, and embolic events as main clinical manifestations. LV twist has recently been demonstrated having good predictive value in diagnosing LVNC in young patients. However, how LV twist may influence long-term clinical outcome of LVNC children and adolescents is still unknown. The aim of this study was to analyse a set of echocardiographic parameters to find imaging predictors of worse clinical outcomes in a long-term follow-up of LVNC children and young patients. Methods Children and adolescents, followed from May 2012 to June 2020, were enrolled in a retrospective study. All patients underwent 2-dimensional speckle tracking echocardiography and cardiovascular magnetic resonance imaging (1.5 Tesla) at our Institution’s first evaluation. Death, heart failure hospitalization, aborted sudden cardiac death, ventricular arrhythmias (sustained and non-sustained ventricular tachycardia), and embolisms (i.e. stroke, peripheral arterial embolism and/or pulmonary thromboembolism) were registered and referred to as major adverse cardiovascular events (MACEs). Results Recruited for the study were 47 children (mean age: 11.1± 5; age range: 0–18 years). Twenty-three patients fulfilled the cardiovascular magnetic resonance imaging diagnostic criteria for LVNC (LVNC group), while the remaining 24 did not and were included in the LV hypertrabeculation group (LVHT). They were followed for 4.9 ± 1.0 years, and MACEs were registered. Thirteen children (56% of LVNC, 28% of total) had at least one MACE. Global longitudinal, circumferential and radial strains (GLS, GCS, GRS), LV twist and LVEF resulted being significantly reduced in children with MACEs at follow-up. A multivariable analysis was performed by combining four parameters: LV ejection fraction, GLS, GCS, LV twist. These independent variables were chosen according to univariable analyses and clinical relevance. The results from the analysis demonstrated that LV twist was the only independent predictor (P = 0.033, coeff. B 0.726) of worse clinical outcomes in young patients with LVNC. Conclusions LV twist is a promising tool to stratify and predict prognosis in LVNC young patients. Our findings show the importance of LV twist assessment to detect the severity of LVNC and to plan for early clinical intervention.

Severe endometriosis: low value of AMH did not affect oocyte quality and pregnancy outcome in IVF patients.

The aim of this pilot study was to determine whether the low anti-müllerian hormone (AMH) serum level, due to severe endometriosis, was associated with diminished oocyte yield, poor oocyte/embryo quality and reduced in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) clinical outcomes in young patients (<37 years old). A total of 50 IVF cycles of patients younger than 37 with severe endometriosis were retrospectively analyzed in a single center between November 2016 and July 2018. The clinical outcome was then compared to a control group of 84 patients with no story of endometriosis and normal AMH value. AMH value was evaluated within three months before the stimulation. In these two groups, number and maturation of retrieved oocytes, embryo quality, and pregnancy outcomes were evaluated and compared using Student's t-test and Fisher's test. The number of oocytes retrieved per cycle and the percentage of mature oocytes (MII) were significantly lower (p < 0.001) in IVF patients with severe endometriosis and AMH value ≤ 1.1 ng/ml (Group A; 3.8±2.6 retrieved oocytes, 70% MII) compared to patients without endometriosis and AMH levels > 1.1 ng/ml (Group B; 6.9±4.6 retrieved oocytes, 83% MII). On the other hand, embryo morphology, implantation rate (31% vs. 33%; p = 0.833) and pregnancy rate (50% vs. 49%; p = 1) were comparable in the two groups. This study shows that younger patients with an impairment of the ovarian reserve due to severe endometriosis, displayed a diminished oocyte yield but not a reduction in embryo quality and pregnancy outcomes. These results suggest that serum AMH levels should not be adopted as a criterion for discouraging these patients from undergoing IVF/ICSI treatments.

Value of a Machine Learning Approach for Predicting Clinical Outcomes in Young Patients With Hypertension.

Risk stratification of young patients with hypertension remains challenging. Generally, machine learning (ML) is considered a promising alternative to traditional methods for clinical predictions because it is capable of processing large amounts of complex data. We, therefore, explored the feasibility of an ML approach for predicting outcomes in young patients with hypertension and compared its performance with that of approaches now commonly used in clinical practice. Baseline clinical data and a composite end point-comprising all-cause death, acute myocardial infarction, coronary artery revascularization, new-onset heart failure, new-onset atrial fibrillation/atrial flutter, sustained ventricular tachycardia/ventricular fibrillation, peripheral artery revascularization, new-onset stroke, end-stage renal disease-were evaluated in 508 young patients with hypertension (30.83±6.17 years) who had been treated at a tertiary hospital. Construction of the ML model, which consisted of recursive feature elimination, extreme gradient boosting, and 10-fold cross-validation, was performed at the 33-month follow-up evaluation, and the model's performance was compared with that of the Cox regression and recalibrated Framingham Risk Score models. An 11-variable combination was considered most valuable for predicting outcomes using the ML approach. The C statistic for identifying patients with composite end points was 0.757 (95% CI, 0.660-0.854) for the ML model, whereas for Cox regression model and the recalibrated Framingham Risk Score model it was 0.723 (95% CI, 0.636-0.810) and 0.529 (95% CI, 0.403-0.655). The ML approach was comparable with Cox regression for determining the clinical prognosis of young patients with hypertension and was better than that of the recalibrated Framingham Risk Score model.

Comparison of intracapsular fracture neck of femur treated with dynamic hip screw versus cannulated cancellous screw: A retrospective study

Objective: The aim of this study was to compare clinical outcomes of young patients with intracapsular neck of femur fractures operated with dynamic hip system (DHS) or cannulated cancellous screw. Methods: One hundred patients with femoral neck fractures were treated by closed reduction internal fixation with a DHS (n=50; 36 males and 14 females; mean age: 39.1 years) or cannulated cancellous screws (n=50; 36 males and 14 females; mean age: 33.2 years) between January 2014 and December 2018 at JLN Medical College and Hospital, Ajmer, Rajasthan. The groups were retrospectively studied till September 2019 (with minimum follow-up of 9 months) and compared by clinical and radiological outcome and modified Harris hip score. Results: The average follow-up time was 23 months (range, 9-60 months). No statistically significant differences in the rates of nonunion (2% vs. 8%) and avascular necrosis of the femoral head (4% vs. 6%) were observed in DHS and CCS groups. DHS group has significantly less (12%) complication rate than CCS group (28%). The mean modified Harris Hip score was significantly higher in DHS group (90.05) compared to CCS group (85.34) (p value 0.015) with greater range of motion in former group. Conclusion: The DHS and cannulated cancellous screws might be equally effective in terms of postoperative fracture union. However, the DHS has advantages over cannulated compression screws for lesser no. of complications, especially neck shortening, non-union and osteonecrosis, higher range of motion, more clinical and radiologically favourable outcome and a better mean modified Harris hip score.

Unique molecular features and clinical outcomes in young patients with non-small cell lung cancer harboring ALK fusion genes.

This study aimed to determine the molecular features and clinical outcomes of young patients with non-small cell lung cancer (NSCLC) harboring ALK fusion genes. We interrogated the genomic profile of 1652 patients with lung cancer who underwent targeted next-generation sequencing to screen for candidate oncogenic drivers using histological specimens acquired from January 2016 to December 2018. ALK fusions were identified in 101 NSCLC patients, and 52 of them were diagnosed before the age of 50 years (52/367, 14.2%). Of the 52 patients with early-onset disease, 22 (42.3%) were male and 43 (82.7%) never smoked; the median patient age was 44years (range 28-50years). The most frequently occurring ALK fusion partner was EML4, which was identified in 80.8% (42/52) of young patients. Compared to the older patients, patients with early-onset disease were more likely to harbor EML4-ALK variant 1 (38.5% vs. 14.3%; P = 0.007). We also identified rare ALK fusions, including CHRNA7-ALK, TACR1-ALK, HIP1-ALK, DYSF-ALK and ITGAV-ALK, in patients with early-onset disease, and patients with these fusions responded well to crizotinib treatment. A statistically significant difference was observed in progression-free survival (PFS) between the young patients and older patients who received crizotinib as the first-line therapy (17.5months vs 9.0months, P = 0.048). However, the median PFS of young patients harboring concurrent TP53 mutations was only 6.2months. Unique genetic characteristics were found in ALK-rearranged NSCLC patients with early disease onset, and these patients responded better to crizotinib and had longer PFS compared to patients with later disease onset. However, patients with concomitant TP53 mutations may not have a significant response to treatment.

Long-term (>10-year) clinical follow-up after young embolic stroke/TIA of undetermined source.

BackgroundTo date, the pathophysiology of first-ever and recurrent stroke/TIA still remains unclear in young patients with embolic stroke/TIA of undetermined source (ESUS). Clinical studies with long-term follow-up in young ESUS patients are necessary to investigate the underlying pathophysiology of first-ever and recurrent stroke/TIA in this patient population, in particular the role of new-onset atrial fibrillation.AimsOur aim was to study the long-term (>10-year) clinical outcome of young patients (<50 years) with ESUS.MethodsThis cohort study included all patients aged ≤ 50 years who underwent transoesophageal echocardiography for diagnostic work-up of ESUS during 1996–2008 from one tertiary center. All patients were contacted by telephone between September–November 2018 to update clinical information from medical records. The clinical outcomes of this study were incidence rates of all-cause and cardiovascular mortality, recurrent stroke/TIA, new-onset clinical AF, and ischemic vascular events.ResultsIn total, 108 patients (57% female, mean age 40 ± 7.2 years [range 19–50 years], n = 72 stroke) were included. Across clinical follow-up (median 13[IQR 10–16] years), 24 patients died (n = 14 cardiovascular). The 15-year incidence rate of recurrent stroke/TIA was 15% (incidence rate = 1.09[95%CI 0.54–1.65]/100 patient-years) and a 5.5% incidence of new-onset clinical AF (incidence rate = 0.44[95%CI 0.09–0.79]/100 patient-years) following ESUS.ConclusionsThe incidence of recurrent stroke/TIA is relatively high during long-term clinical follow-up of young patients with ESUS. In contrast, new-onset clinical AF is relatively low and therefore may not play an important part in the pathophysiology of first-ever and recurrent stroke/TIA of these patients.

P5500Acute coronary syndrome in young patients: frequency, mechanisms and clinical outcomes following percutaneous coronary intervention

Abstract Introduction Acute coronary syndromes (ACS) mainly affect older patients and little is known on the frequency, the underlying causes and outcomes following ACS in young. Purpose To investigate the frequency, mechanisms and clinical outcomes of young patients suffering from ACS and undergoing percutaneous coronary intervention (PCI). Methods Between February 2009 and December 2016, 6720 consecutive patients undergoing PCI for an ACS were prospectively enrolled. We defined young patients as male &lt;45 years or female &lt;50 years. The primary endpoint was the patient-oriented composite endpoint (POCE) defined as the composite of all-cause death, myocardial infarction or any revascularization at 12 months. The mechanisms of ACS in young patients (atherosclerotic vs. embolic vs. spontaneous coronary artery dissection) were retrospectively assessed by an adjudication committee based on clinical and angiographic criteria. Results Among 6720 ACS patients, 378 (5.6%) patients were young (41±5 years, 73% male). Young patients, as compared to old patients, presented more frequently with STEMI (64% vs. 45%; p&lt;0.001) and single vessel disease (85% vs. 74%; p&lt;0.001). Cardiovascular risk factors were more frequent in young patients including BMI&gt;30 kg/m2 (34% vs. 22%; p&lt;0.001), smoking (68% vs. 31%; p&lt;0.001), positive family history of coronary artery disease (35% vs. 23%; p&lt;0.001) and baseline LDL-C levels (3.3±1.1 mmol/l vs. 2.9±1.1 mmol/l; p&lt;0.001). Diabetes mellitus was less frequent in the young patient group (10% vs. 21%; p&lt;0.001). The mechanisms of ACS in young patients were atherosclerotic in 87%, coronary embolism in 9%, and spontaneous coronary artery dissection in 4%. At 12 months, the primary endpoint POCE occurred less frequently in young patients (9.3% vs. 17%; HR 0.52, 95% CI 0.37–0.73; p&lt;0.001). The rates of the individual components of the primary endpoint were lower in young patients including all-cause death (3.4% vs. 9.4%; HR 0.36, 95% CI 0.21–0.62; p&lt;0.001), myocardial infarction (1.9% vs. 3.7%; HR 0.48, 95% CI 0.22–1.01; p=0.053) and any revascularization (5.6% vs. 7.7%; HR 0.68, 95% CI 0.44–1.05; p=0.083). Young patients with coronary embolism or spontaneous coronary artery dissection had a higher rate of cardiac death at 12 months as compared to young patients with atherosclerotic disease (embolic vs. atherosclerotic: 9.4% vs. 2.2%; HR 4.3, 95% CI 1.11–16.71; p=0.02; spontaneous coronary artery dissection vs. atherosclerotic: 17.6% vs. 2.2%; HR 8.1, 95% CI 2.1–31.1; p&lt;0.001). Conclusions Approximately one out of 20 ACS patients undergoing PCI was young and the main presumed mechanism of ACS was atherosclerosis (87%) followed by coronary embolism (9%) and spontaneous coronary artery dissection (4%). While young ACS patients carry a lower risk for future cardiovascular events as compared with older patients, the high cardiac death rates following embolic disease or spontaneous coronary artery dissections deserves particular attention.