Differences In Age Research Articles

6741 Serum Urate-Lowering Effects Of Sodium-Glucose Transport Protein 2 Inhibitors Compared To Dipeptidyl Peptidase-4 Inhibitors In Gout Patients With Type 2 Diabetes Mellitus: A Population-Based Cohort Study

Abstract Disclosure: R.K. Shariff: None. C. Chung: None. P. Huang: None. S. Mon: None. K. Ma: None. Background/Purpose: Effective management of gout in patients requiring long-term urate-lowering therapy involves maintaining serum rate levels within specific ranges. Hyperuricemia and gout have been associated with an increased risk of Type 2 Diabetes Mellitus (T2DM), with a reported prevalence of 16% in gout patients. Pharmacological approaches to glycemic control, including Sodium-glucose Transport Protein 2 Inhibitors inhibitor (SGLT2i) and Dipeptidyl Peptidase-4 Inhibitors (DPP-4i), have showed potential serum urate lowering effects. However, a direct comparison of these effects in patients with gout and concomitant T2DM is lacking. This study aims to evaluate the serum urate-lowering effects of SGLT2i compared to DPP-4i in this patient population. Methods: This was a population-based cohort study of patients with gout diagnosed following the 2015 Gout classification criteria in the American College of Rheumatology/European League Against Rheumatism collaborative initiative and T2DM diagnosed following the American Diabetes Association criteria, respectively. Subjects treated between 2008 and 2023 at 92 United States hospitals were screened. Propensity score matching was used to balance the baseline differences in age of gout onset, sex, comorbidities, and past medical history between the two groups. The primary predictor variable was the use of therapies of SGLT2i and DPP-4i. The primary outcome of interest was the serum urate more than 6 mg/dL during the follow-up period. Kaplan-Meier analysis and log-rank tests were utilized to compare if the numbers of serum urate were higher than 6 mg/dL in both arms. A Cox proportional hazards model was utilized to estimate the association between the use of SGLT2i versus DPP-4i and the numbers of serum urate higher than 6 mg/dL. Inclusion criteria include patients with gout and concomitant T2DM, age over 18, and must have serum uric acid level data available. Results: Of the 11,495 gout patients, including 3,593 users of SGLT2i users, were propensity score-matched to 3593 DPP-4i users. Among gout patients with T2DM on SGLT2i, 598 experienced serum urate levels exceeding than 6 mg/dL, while in the DPP-4i group, 920 patients had serum urate higher than 6 mg/dL. The use of SGLT2i was associated with significantly lower odds of serum uric acid exceeding 6 mg/dl compared to DPP-4i. (OR: 0.580 [0.517-0.651]). Conclusion: Our study suggests that SGLT2i may offer a more effective means of managing serum uric acid levels in gout patients with concomitant T2DM compared to DPP-4i. Clinical trials are required to validate the findings. For clinical practice, the dosage for SGLT2i to cause the urate-lowering effect needs to be investigated. With further studies and clinical trials, the rationale of choosing SGLT2i over DPP-4i may be incorporated into the management of T2DM in gout patients with T2DM. Presentation: 6/1/2024

6913 Clinical Prognosis in Patients with Thyroid Nodules Expressing PPAR-Gamma Gene Fusion on Thyroid FNA Cytology

Abstract Disclosure: R. Hammoudeh: None. E. Morariu: None. A. Wald: Other; Self; Technical consultant to Sonic Healthcare USA.. W.R. Doerfler: None. Y. Linwah: None. M. Nikiforova: Owner/Co-Owner; Self; Owner of intellectual property related to ThyroSeq, receive royalties through the University of Pittsburgh; consultants for Sonic Healthcare USA. Y.E. Nikiforov: Owner/Co-Owner; Self; Owner of intellectual property related to ThyroSeq, receive royalties through the University of Pittsburgh; consultants for Sonic Healthcare USA. Background: PPARG rearrangements, typically PAX8-PPARG, are common genetic alterations in follicular thyroid carcinoma and follicular variant of papillary thyroid carcinoma (FVPTC). Most tumors appear to be indolent, however distant metastasis has been reported. The aim of this study was to determine the prevalence and type of malignancy in a series of thyroid nodules positive for PAX8 rearrangement in thyroid fine-needle aspiration (FNA) samples. We also aimed to evaluate the impact on patient management, prognosis and outcomes. Methods: Thyroid nodules positive for PAX8 fusion on ThyroSeq v2 and v3 genomic classifier testing of FNA samples from May 2008 to February 2022 were identified. Clinical data was obtained by retrospective chart review. Results: Overall, 44 nodules positive for PAX8/PPARG fusion were identified. None of these nodules expressed additional genetic mutations on molecular testing. Surgical pathology was available for 40 patients, which identified 35 (87.5%) malignant, 3 NIFTP (7.5%), and 2 benign (5%) lesions. In the malignant group, FNA cytology revealed 1 (2.8%) benign, 13 (37.1%) AUS/FLUS, 12 (34.2%) suspicious for SFN/FN, 5 (14.3%) suspicious for PTC and 4 were not classified. In the non-malignant group, FNA cytology revealed 2 (40%) benign, 2 (40%) AUS/FLUS, 1 (20%) SFN/FN. With regards to surgical intervention, 30 (75%) patients had total thyroidectomy and 10 (25%) underwent lobectomy, of which 8 were followed by completion thyroidectomy. Among the malignant and non-malignant groups, there was no difference in sex (82.8% vs 100% female, p=1), age (43.6 vs 50.2 years, p=0.2), or tumor size on surgical pathology (3.26 vs 4 cm, p=0.23). In the malignant group, histology showed 30 (85.7%) FVPTC, 2 (5.7%) conventional PTC, 2 (5.7%) follicular carcinoma and 1 (2.9%) solid variant PTC. Of the FVPTC group, 9 had oncocytic cell features, 3 focal solid patterns, and 1 showed focal solid growth and progression to poorly differentiated thyroid carcinoma. Only 1 showed lymphatic invasion, 10 showed angioinvasion. Following the ATA thyroid cancer risk stratification, 23 (65.7%%) had low risk, 9 (25.7%) intermediate risk and 3 (8.6%) high risk. 18 patients in the malignant group underwent RAI ablation. Average follow up for the malignant nodules was 49.7 months (0-170). 1 had suspected recurrence on thyroid ultrasound after a year. No evidence of distant metastasis was documented. Conclusions: The majority of thyroid nodules with PAX8/PPARG rearrangement found on FNA were cancers, predominantly follicular variant PTC, and some were benign or NIFTP. The majority were low risk, but intermediate and high-risk cancers with more aggressive histology, angioinvasion, and poorly differentiated cancer were also identified. While only one recurrence was identified on short follow-up, longer follow-up duration is required for better understanding the behavior of these tumors. Presentation: 6/3/2024

Care Patterns and Outcomes for Intrahepatic Cholangiocarcinoma by Rurality of Patient Residence in a Midwestern State.

Intrahepatic cholangiocarcinoma (ICC) is the second most common malignancy of the liver and has the worst prognosis of any tumor arising from the liver, with a 5-year survival as low as 10%. However, whether the rurality of a patient's residence impacts care received and survival has not been well studied. We aimed to assess differences in care patterns associated with the rurality of patient's residences and their impact on survival outcomes, hypothesizing that patients in rural areas would experience lower survival. Adult patients diagnosed with ICC between 2010 and 2020 were identified in the Iowa Cancer Registry. Chi-square tests were used to compare values categorical variables by rural/urban status. Cox proportional hazards regression was used to determine associations with cancer-specific mortality. Of 672 patients diagnosed with ICC during the study period, 53%, 27%, and 21% resided in metropolitan, micropolitan, and rural areas, respectively. There were no significant differences in age, sex, stage at diagnosis, the proportion receiving chemotherapy within 12 weeks of diagnosis, and undergoing surgery across all groups. Additionally, the proportion receiving definitive care at a National Cancer Institute (NCI) designated center was comparable across the three groups (37% metro vs. 43% micro vs. 35% rural). However, rural residents had the highest proportion of traveling ≥ 50 miles for definitive care (22% metro vs. 41% micro vs. 56% rural). In multivariable analysis of patients with Stage 1-3 disease, younger age, receipt of chemotherapy, surgery, and definitive care at an NCI center were independently associated with decreased mortality risk. However, rural residence was not significantly associated with survival (HR: 0.64 [95% CI: 0.38-1.06]). Similar to other complex cancer diagnoses, we found that definitive care at an NCI center was associated with decreased mortality risk for patients with ICC. Although rural residence was not independently associated with survival in this cohort, rural residents traveled significantly longer distances to access definitive care. This highlights a crucial need to improve access to specialized centers for complex cancer care.

The influence of proliferative tissue on Hounsfield unit and its correlation with BMD in middle-aged and elderly patients with lumbar degenerative diseases

PurposeThe difference of Hounsfield Unit (HU) value in different regions of L3 vertebra in middle-aged and elderly patients with lumbar degeneration diseases (LDD) was analyzed. To investigate the influence of proliferative tissue on HU value of cancellous bone and its correlation with bone mineral density (BMD).MethodsThe medical records of middle-aged and elderly patients with LDD in our hospital from December 2020 to December 2023 were retrospectively analyzed. The patients were divided into osteophyte group and no-osteophyte group according to the presence or absence of osteophyte formation on lumbar spine X-ray. In osteophyte group, cancellous bone HU value, containing cortical bone overall HU value and containing osteophyte overall HU value in L3 vertebra were measured on the lumbar CT cross-section. In no-osteophyte group, only the cancellous bone HU value and the containing cortical bone overall HU value were measured. Differences in HU value in different regions of the L3 vertebral body were compared within and between groups of middle-aged and elderly patients with LDD, respectively. To investigate its effect on cancellous bone HU measurements and to do a correlation analysis with patients’ BMD.ResultsA total of 115 patients with LDD were included in this study, including 65 males and 50 females, with an average age of 67.83 ± 6.59 years. The results of the study showed no statistical differences in age (P = 0.15), gender (P = 0.57), smoking (P = 0.88), drinking history (P = 0.76), medical history (P > 0.05) and BMI(P = 0.29) between the two groups. In osteophyte group, the mean cancellous bone HU value was 98.00 ± 25.50 HU, the containing cortical bone overall HU value was 189.02 ± 46.18 HU, and the containing osteophyte overall HU value was 232.69 ± 56.01 HU. The overall HU values containing cortical bone and containing osteophyte were significantly higher than cancellous bone HU value (P < 0.001). In no-osteophyte group, the mean cancellous bone HU value was 102.04 ± 19.64 HU, and the containing cortical bone overall HU value was 175.00 ± 28.97 HU, which was statistically significantly different (P < 0.001). There was no significant difference in cancellous bone HU value and the containing cortical bone overall HU value between the two groups (P > 0.05). The results of the Pearson correlation analysis showed a significant correlation between the cancellous bone HU value of the L3 vertebrae and the QCT BMD value of the patients (r = 0.95, P < 0.001). However, there was no significant correlation between containing cortical bone overall HU value and containing osteophyte overall HU value and the patient’s QCT BMD value (P > 0.05).ConclusionsVertebral HU value is an alternative measurement that effectively reflects the patient’s BMD. In middle-aged and elderly LDD patients, HU values in different areas of L3 vertebra are significantly different, and hyperplastic tissues such as cortical bone and osteophytes may exponentially lead to higher HU value in patients. Compared with other measurement areas, vertebral cancellous bone HU value have the advantage of accurately assessing patients’ BMD.

Factors associated with resorption of calcific deposits in the shoulder with extracorporeal shock wave therapy

BackgroundFocused extracorporeal shock wave therapy (FSWT) is effective for treating calcific tendinitis of the shoulder. However, only a few reports exist on the factors related to calcium resorption after FSWT. Thus, this study aimed to investigate the factors associated with calcium resorption. MethodsIn 117 shoulders with chronic calcific rotator cuff tendinitis, FSWT was administered nine times once every 2 weeks (a total of 16 weeks). After nine sessions of FSWT, the shoulders were radiographed and categorized into complete resorption (CR) and incomplete resorption (ICR) groups. Evaluated parameters included age, duration of disease, Gärtner classification, size of calcium deposits, presence of blood flow around calcium deposits using the Doppler function of the ultrasound imaging system, Japanese Orthopaedic Association (JOA) score, University of California at Los Angeles score, disability of the arm, shoulder, and hand (UCLA) score, and tenderness. ResultsThe CR group included 93 shoulders (79.4%) and the ICR group included 24 shoulders (20.6%). In the two-arm comparison, CR showed significantly longer disease duration (P=.012) and high tenderness (P=.0013). Blood flow around calcium deposits was observed in 79.5% of shoulders in the CR group (P<.0001) and 29.1% in the ICR group. Type 1 Gärtner classification (P=.0009) was observed in 28 shoulders (30.1%) in the CR group and 17 shoulders (70.8%) in the ICR group. The two groups had no significant differences in age, size of calcium deposits, JOA score, or UCLA score. Multiple logistic regression analysis was performed using the following items that showed significant differences: absence of blood flow (odds ratio [OR], 8.51, 95% confidence interval [CI]: 2.24–22.8), Gärtner classification (OR, 5.60, 95%CI: 1.73–13.3), and duration of disease (OR, 1.06, 95%CI: 0.97–1.26). Longer disease duration, Gärtner type 1, and absence of blood flow around calcium deposits resulted in difficulty in calcium resorption. ConclusionPatients with Gärtner type 1 with prolonged disease duration and absence of blood flow around calcium deposits may have difficulty in achieving complete resorption.

DAXX is associated with early recurrence of pancreatic neuroendocrine tumors after R0 resection

IntroductionATRX, DAXX, MEN1, and PTEN mutations are proposed drivers of pancreatic neuroendocrine tumor tumorigenesis and independent prognostic factors for metastasis and mortality. However, their implications after R0 resection remain debated. Thus, we sought to identify genomic signatures of pancreatic neuroendocrine tumor disease-specific mortality and recurrence after surgery for curative intent. MethodsPancreatic neuroendocrine tumor patients who underwent whole exome sequencing with available survival data were identified using cBioPortal. Clinicopathologic variables, genomics, and outcomes were analyzed. ResultsSeventy patients who underwent R0 resection were identified. Forty-five of 70 patients were disease free at last follow-up, whereas 25 of 70 patients had disease-specific mortality or recurrent disease and therefore were categorized as part of the recurrent cohort. There were no significant differences in age (P = .245), sex (P = .201), or median follow-up (38.9 vs 33.7 months, P = .122) between groups. Clinicopathologically, the recurrent cohort had significantly greater tumor size (median 5.0 cm vs 3.2 cm, P = .012) and were more likely to have vascular invasion (88% vs 40%, P = .000), positive lymph nodes (68.0% vs 35.6%, P = .013), and metastatic disease (44% vs 4.4%, P < .000). For both cohorts, most tumors were well or moderately differentiated. Tumor mutation burden was greater in the recurrent cohort (median 0.77 vs 0.43 mutations/Mb, P = .004). DAXX mutations were more frequent in the recurrent cohort (36% vs 11%, P = .026) and in those with vascular invasion (51% vs 92%, P = .010). ConclusionOur analysis demonstrated the prognostic significance of DAXX mutations after curative-intent surgery. Future studies investigating DAXX mutations as a biomarker for aggressive features to guide treatment are warranted.

Systemic inflammatory markers: Predictors of survival in mucinous appendix cancer patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

IntroductionInflammatory markers have been investigated as predictors of prognosis in various malignancies, but their role in mucinous appendix cancer (MAC) remains controversial. We evaluated the association between complete blood count-derived markers and survival in MAC patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). MethodsWe conducted a retrospective analysis of a single-center database (1998–2023) including newly diagnosed MAC patients who underwent complete (CC-0/1) CRS/HIPEC. Preoperative values of neutrophil-to-lymphocyte ratio (NLR), derived NLR, platelets-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were calculated. For markers strongly associated with survival, we used time-dependent ROC analysis to define cutoffs to predict 5-year overall survival (OS). The Kaplan-Meier method with and Cox regression were employed for survival analysis. ResultsOf 626 CRS/HIPEC cases, 211 were eligible. NLR (p=0.049), dNLR (p=0.049), and MLR (p<0.001) were significantly associated with OS, while PLR was not. MLR demonstrated the strongest prognostic power (AUC=0.682) with the optimal cut-off 0.29. There were no significant differences in age, grade, or peritoneal cancer index (PCI) between patients with MLR<0.29 and MLR≥0.29. Five-year progression-free (PFS) and OS were 72.2 % and 83.2 % for MLR<0.29 and 54.2 % and 66.6 % for MLR≥0.29, respectively. After adjusting for age, PCI, and grade, MLR≥0.29 was associated with worse 3-year PFS (hazard ratio [HR] 1.74, 95 % confidence interval [CI]:1.02–2.97, p=0.044) and 3-year and 5-year OS (HR 1.87, 95 %CI: 1.00–3.47, p=0.049). ConclusionMLR has emerged as an independent predictor of survival in MAC patients undergoing CRS/HIPEC. Along with other prognostic factors, MLR≥0.29 may be potentially used for preoperative risk stratification.

A-281 Comparison of C-reactive Protein, Procalcitonin, and Presepsin in Blood and Synovial Fluid as Diagnostic Biomarkers for Septic Arthritis

Abstract Background Early detection and prompt treatment are crucial for managing septic arthritis (SA). However, diagnosing SA at an early stage can be challenging since the symptoms are non-specific, and there is no definitive diagnostic test available. This study aimed to investigate the potential of biomarkers as a reliable diagnostic tool for SA. Methods A prospective study was conducted to collect residual blood and synovial fluid samples from patients who underwent blood sampling and arthrocentesis for differential diagnosis due to suspected SA. The collected samples were analyzed for C-reactive protein (CRP), procalcitonin, and presepsin. The data obtained from the analysis were subjected to statistical analysis. Results From January to November 2023, 58 patients were enrolled. They comprised 24 men and 34 women with a median age of 71.1 (interquartile range, IQR 64.0-79.3) years. Twenty-one patients were diagnosed with SA and 37 with non-SA, including osteoarthritis (n=2), osteonecrosis (n=1), meniscus tear (n=1), abscess (n=1), contusion (n=2), and mechanical complications of implants (n=30). There were no significant differences in age or sex distribution between the two groups. The median blood and synovial fluid CRP levels were 4.24 and 1.85 mg/dL, respectively, in the SA group and 0.24 and 0.11 in the non-SA group. The median blood and synovial fluid procalcitonin levels were 0.0383 and 0.0403 ng/mL in the SA group and 0.0358 and 0.0488 in the non-SA group. The median blood and synovial fluid presepsin levels were 307 and 1389 pg/mL in the SA group and 192 and 959 in the non-SA group. Except for blood procalcitonin, all showed statistically significant differences between the SA and non-SA groups. In the ROC curve analysis, blood CRP displayed the highest area under the curve (AUC) of 0.795 with a 0.47 mg/dL cut-off value, 90.5% sensitivity, and 64.9% specificity. Synovial fluid CRP displayed similar results of 0.786 AUC, 0.30 mg/dL cut-off value, 85.0% sensitivity, and 71.4% specificity. Blood and synovial fluid procalcitonin had low AUCs of 0.532 and 0.659, respectively, and were insufficient to differentiate between SA and NS groups. The AUC (0.696 vs. 0.704), sensitivity (76.2% vs. 76.2%), and specificity (67.6% vs. 62.2%) of blood and synovial fluid presepsin were similar; however, synovial fluid showed a significantly higher cut-off value, 4.5 times that of blood (237 pg/mL vs. 1087 pg/mL). Conclusions Procalcitonin was not a reliable marker for distinguishing between SA and non-SA, regardless of whether it was measured in blood or synovial fluids. However, CRP and presepsin proved useful markers when measured in either blood or synovial fluid. In particular, when measuring presepsin in synovial fluid, an optimal cut-off value is needed.

Management of myocardial infarction with non-obstructive coronary arteries (MINOCA) in Germany: a single-center study on hospital resources and healthcare economics.

Patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) present as a main feature ≤50% stenosis upon angiography despite clinical symptoms and biomarker elevation related to acute coronary syndrome. Due to broad availability of high sensitivity troponin testing as well as invasive and non-invasive imaging, this clinical entity receives increasing clinical awareness. We aimed to investigate the in-hospital work flow and economic impact of MINOCA vs. MICAD (myocardial infarction with obstructive coronary artery disease) patients and related clinical outcomes in a single-center patient collective of a large university heart center in Germany. We retrospectively screened and analyzed all patients who were admitted to our hospital under the suspicion of an acute coronary syndrome within a 12-month period (2017-2018) for further diagnostics and treatment. All included patients showed a pathological troponin elevation and received invasive coronary angiography for acute coronary syndrome. Associated in-hospital costs, procedural and various clinical parameters as well as timelines and parameters of work-flow were obtained. After screening of 3,021 patients, we included 660 patients with acute coronary syndrome. Of those, 118 patients were attributed to the MINOCA-group. 542 patients presented with a "classical" myocardial infarction (MICAD group). MINOCA patients were less frail, more likely female, but showed no relevant difference in age or other selected comorbidities except for fewer cases of diabetes. In-hospital mortality (11% vs. 0%; p < 0.001) and 30-day mortality (17.3% vs. 4.2%; p < 0.001) after the index event were significantly higher in the "classical" myocardial infarction group (MICAD)- Despite a shorter overall length of hospital stay (9.5 ± 8.7 days vs. 12.3 ± 10.5 days, p < 0.01) with a significantly shorter duration of high care monitoring (intensive/intermediate care or chest pain units) (2.4 ± 2.1 days vs. 4.7 ± 3.3 days, p < 0.01) MINOCA patients consumed a relevant contingent of hospital resources. Thus, in a 12-months period a total sum of almost 300 days was attributed to high care monitoring for MINOCA patients with a mean difference of approximately 50% compared to patients with classical myocardial infarction. With average and median costs of 50% less per index, MINOCA treatment costs were lower compared to the MICAD group in the hospital reimbursement system of Germany. Consequently, MINOCA treatment was not associated with a relevant profit for these expanses and a relevant share of nearly 40% of the total costs was generated due to high care monitoring. In light of lower mortality than MICAD and growing scarcity of staff, financial and capacity resources the clinical symptom complex of MINOCA should be put under particular consideration for refining care concepts and resource allocation.

Analysis of clinical features and outcomes in patients with ocular myasthenia gravis according to anti-acetylcholine receptor antibody-seropositivity.

To comparatively analyze the clinical characteristics of patients with ocular myasthenia gravis (OMG) referred to an ophthalmology clinic, according to anti-acetylcholine receptor antibody (AchR Ab)-seropositivity. Retrospective Cohort Study. Medical records of patients with OMG who presented to a tertiary eye care center between 2003 and 2020 were retrospectively reviewed. Demographics, ophthalmologic characteristics, response to medical treatment, presence of autoimmune thyroid disease and thyroid autoantibody were compared between the AchR Ab seropositive and seronegative groups. A total of 130 patients with OMG were identified; among them, 46 patients (35.4%) had autoantibody against acetylcholine receptors. The mean age at symptom onset was 42.4 ± 18.9 years. There were no differences in mean age at symptom onset, gender ratio, and mean follow-up period between patients with seropositive and seronegative OMG. Graves ophthalmopathy was significantly more frequent in seronegative patients (p = 0.04), while thymic disease (p < 0.01) was more frequent in seropositive patients (p < 0.01). Among patients with seropositive OMG, 52.3% showed a good response to medical treatment, while only 31.4% of the seronegative patients were classified as good responders (p = 0.01). Thyroid dysfunction was found in 27.4% patients with OMG and the proportion of thyroid dysfunction was not different according to anti-acetylcholine receptor antibody-seropositivity. Seropositivity to acetylcholine receptor antibody is associated with a better response to medical treatment and lower risk of concomitant autoimmune thyroid disease in patients with OMG.

A-213 Comparison of low-density lipoprotein cholesterol (LDL-c) estimates by in-lab and point-of-care devices in the context of emerging LDL-c equations

Abstract Background Low-density lipoprotein cholesterol (LDL-c) and lipid measurements are used for hyperlipidemia diagnosis, cardiovascular disease risk classification, and medication management. Millions of lipid panels are performed annually. Given the widespread need for lipid testing, there are two CLIA-waived point-of-care (POC) lipid testing devices. These devices were FDA-approved using the Friedewald equation to estimate LDL-c based on measurements of (triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), and total cholesterol (TC). However, in laboratory-based testing, the Friedewald equation is being replaced by newer, more accurate equations such as the NIH-Sampson equation. These equations use the same lipid panel results to estimate LDL-c and only differ in the arithmetic of the estimation. The study objective is to evaluate how differences between the in-clinic POC machines and in-laboratory lipid measurements affect the estimated LDL-c results and are compounded by differences in the equations used for LDL-c estimation. Methods This retrospective observational study collected deidentified lipid results (TG, HDL-c, TC, LDL-c) and demographic data (age, gender) for all samples that had lipid panel results from in-lab and POC within twenty-four hours of each other in a single hospital system between 2014 and 2023. Three hundred twenty samples were identified; samples with non-numerical values or results outside of the reportable range for TG, HDL-c, or TC were not included in subsequent LDL-c calculations using the Friedewald and NIH-Sampson equations (69 results). Patients under the age of 18 were excluded (2 results). Two hundred and forty-nine samples met inclusion criteria; this cohort showed non-significant differences in lipid, age, and gender distributions relative to all POC results tested in the same time frame. Results Consistent with prior reports, we observed discordance between POC and the in-lab lipid measurements, particularly for TG (Bland-Altman: bias:-23.04 mg/dL, standard deviation:61.3 mg/dL). Regardless of the testing platform, LDL-c results are higher on an individual and population-based level with the NIH-Sampson equation. These analytical differences may not change clinical management if the cardiovascular risk classification using estimated LDL-c is unchanged. However, the risk classification based on the in-lab versus in-clinic testing differed for 20-30% of patients. The most pronounced difference in LDL-c estimation occurred when the POC machine used Friedewald and in-lab testing used NIH-Sampson, and resulted in 5% more patients differentially classified. Conclusions This study highlights the need for transparency in lipid panel reports regarding which LDL-c equation is used in both POC and in-lab testing formats, and the need for readily available tools for conversion between different LDL-c estimation equations.

The impact of surgical technique on very early functional outcomes after radical prostatectomy.

To determine the very early functional as well as oncological outcomes after robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) at a single institution. We identified patients who underwent RARP or ORP at our institution between August 2021 and July 2023. The main criterion for surgical technique selection was patient preference. Primary endpoints included anastomosis leakage rate, very early continence rate reported by standardized pad-test, and positive surgical margin rate. Furthermore, we analyzed operation time, hospital stay, postoperative analgesia, and complication rates. In this prospective study, we analyzed data from 222 radical prostatectomies (111 RARP and 111 ORP). There were no significant differences in preoperative age, prostate size, and risk stratification among the groups. Patients who underwent RARP had lower anastomosis leakage rates (8.1% vs. 18.9%) and slightly lower early continence rates (76.6% vs. 78.4%) when compared to patients who underwent ORP. Positive surgical margin rates were similar, and complication rates were also comparable. Operation time was similar for both techniques, but the hospital stay was significantly shorter in the RARP group (6.3 vs. 9.1 days, p=0.03). The ORP group experienced significantly higher opioid administration postoperatively (p<0.001). From a functional and oncological point of view, both techniques are safe and provide excellent outcomes when performed by experienced surgeons. Nevertheless, patients are likely to benefit from a shortened hospital stay and reduced postoperative pain after RARP.

Characteristics of risk factors and molecular genetic parameters in children with chronic kidney disease

Introduction. Information about the health status of children with nephrological pathology includes many manifestations of functional system disorders. However, early diagnosis of chronic kidney disease (CKD) is rarely carried out due to the lack of reliable predictors of this process.The aim: To analyze the association of anamnestic signs, laboratory and genetic research results with chronic kidney disease in children to identify potential predictors of the disease.Material and Methods. The data were obtained from a single-center retrospective catamnestic cohort study (2011–2022). The main group included 128 children with chronic kidney disease aged 1 to 17 years. The comparison group consisted of 30 children without diagnosed kidney pathology aged from 1 to 17 years. There were no statistically significant differences in sex and age between the two groups. The informative value of more than 150 features, including anamnestic ones, the state of the mother’s health during pregnancy, antenatal and perinatal factors, features of the child’s development and manifestation of the disease, the results of clinical, laboratory, and genetic research methods were evaluated. An integrated approach to the study included methods for hypotheses testing on statistical significance of indicators differences, regression analysis, and ROC analysis.Results. Hereditary burden of nephrological pathology in the family, unfavorable course of pregnancy (anemia, toxicosis of the first half), obstetric and somatic pathology in the mother, the serial number of childbirth are associated with the subsequent development of CKD. Erythrocytes in the urine and daily protein loss were detected only in the group of children with CKD. In this group, a decrease in the number of red blood cells, increased erythrocyte sedimentation rate (ESR), allergies at an early age, otitis media, persistent viral and bacterial infections, and a number of signs of connective tissue dysplasia were more common. The main group statistically significantly differed from the comparison group by a number of polymorphic genetic markers. It can be assumed that the polymorphisms AGT1 Thr174Thr, AGT2 Thr235Thr, NO3 C786T are associated with a predisposition to CKD, and the products of polymorphisms AGT1 Thr174Met, AGT2 Met235Met, R1 AGT2 C1166C, NO3 T786T may have a protective effect according to development of CKD.Conclusion. The risk factors for CKD identified in this study can be used to develop software to support medical decision making for early detection of children at high risk of disease progression.

Comparison of static teeth exposure in different postures and its influencing factors of orthognathic surgery patients.

This study aimed to explore the differences and influencing factors of static teeth exposure in different postures of orthognathic surgery patients. A total of 148 patients were collected before or after orthognathic surgery. Photographs were taken in the upright and supine positions, and the static teeth exposure values were measured to compare whether the difference among different positions was statistically significant. The patients were classified in accordance with gender, presence or absence of orthodontic brackets, measurement time (preoperative or postoperative), and maxillary movement direction (forward or backward), and the difference of static teeth exposure was compared. The correlation between the difference of static teeth exposure and age was analyzed. The diffe-rence of static teeth exposure between the two positions was 0.99 mm±0.95 mm, which was statistically significant (P=0.000). A statistical difference in the difference of static exposure was observed between female and male (P<0.05). No statistical difference in the difference of static exposure was observed among orthodontic brackets, preoperative or postoperative time points, and maxillary movement direction. In addition, no significant correlation was found between the difference of static teeth exposure and age (r=-0.087, P=0.291). Compared with the upright position, the static exposure of teeth increased by approximately 0.99 mm in the supine position. The difference of static exposure under different postures was greater in males than in females. Furthermore, orthodontic bracket, maxillary surgery, maxillary movement direction, and age had no effect on the difference of static teeth exposure in different postures.

Significant reduction in blood product usage, same early outcomes: blood conservation in infants undergoing open-heart surgery.

ObjectiveTo evaluate the effect of a blood conservation program on trends in use of donor blood products and early clinical outcomes in infants undergoing open-heart surgery. MethodsFour hundred and nine patients under 1 year of age undergoing open-heart surgery between October 1st, 2020 and June 30th, 2023 were reviewed. The study period was divided into 4 eras with the first era as a pre-blood conservation baseline using traditional blood management. The following 3 eras comprised incremental implementation and evolution of blood conservation strategies. The total volume of blood products transfused for each surgical hospitalization was calculated and indexed to body weight at time of surgery. ResultsThere was no significant difference in age at surgery, body weight, distribution of STAT categories and in post-operative length of mechanical ventilation, intensive care unit or hospital length of stay or post-operative mortality (p>0.05 for all) across the 4 eras. Median total volume of blood products administered during hospitalization decreased from 128 (92, 220) mL/kg during the baseline period to 21 (6, 44) mL/kg in the last era (p<0.01). Multivariate analysis demonstrated that later eras were associated with decreased odds of experiencing exposure to blood products during hospitalization. ConclusionsBlood conservation is associated with significant reduction in usage of blood products during open-heart surgery in infants with no significant effect on early outcomes. This trend is observed across all categories of surgical complexity. Additional studies are needed to prove consistency and to determine the longer-term clinical impact of this strategy.

Who Are They? Redefining Demarcation of Research Participant Characteristics and Related Conceptualizations

ABSTRACTIn any research that involves people, whether as respondents or participants, demarcation of their characteristics is crucial for necessary context. These can include their roles (e.g., patient, caregiver), relationships (e.g., partner), and demographics such as age range, [dis]ability, ethnicity, gender, language, race, socio‐economic group or geographic region. Yet, despite this need for precision, terminology used for demarcation is often treated as intuitive (“y'know”). For example, age demarcations seem to be obvious but are often laden with vagueness, lack of standardization, and/or acknowledgement of differences in age ranges. Some demarcations might also be influenced by country norms or by disciplinary interpretations (e.g., legal vs medical). Considering the emphasis on respect for diversity and the need for rigor in research it seems timely to open a discussion of the many questions to be answered when demarcating characteristics of research participants. Using examples, this panel will explore some applications and definitions of demarcations.

Evaluation of health-related quality of life and adherence among pre-extensively drug-resistant tuberculosis patients receiving either Bedaquiline or Delamanid regimen at a teaching hospital in Eastern India

ABSTRACT Background: The foremost concern and challenge in managing drug-resistant tuberculosis is ensuring a high health-related quality of life (HRQoL). The effectiveness of pre-extensively drug-resistant (Pre-XDR) tuberculosis management hinges on patients adhering to therapy, a crucial factor in averting the development of drug-resistant strains, ultimately enhancing HRQoL. Methodology: This analytical longitudinal study spanned two years at a teaching hospital and involved collaboration between the Departments of Pharmacology and Pulmonary Medicine. A case record form was utilized to gather baseline data, encompassing patient demographics, medication details, WHO BREF HRQoL scores, and treatment adherence. Patients were classified as either adherent or nonadherent using three distinct criteria: the guidelines of the Revised National Tuberculosis Programme (RNTCP), the Morisky-Green-Levine Scale (MGLS), and the Batalla test. The sample size was determined based on 30% nonadherence rates from preliminary analysis of prior data, resulting in 86 patients included in the study. The association between the improvement of HRQoL score from the baseline with the predictor variables was assessed with a linear regression model. Comparison of nonadherence with the different predictors of the study population was assessed with binary logistic regression model. Results: Analysis of demographic data revealed no notable differences in age and BMI between the Bedaquiline and Delamanid groups. However, there was a gender-related difference in treatment distribution, with more men in the Bedaquiline group. Other factors, such as marital status, socioeconomic status, employment status, stigma/discrimination, comorbidity, and addiction, showed no significant differences between the groups. Comparing HRQoL scores at baseline and after six months showed substantial improvements in all domains, indicating a positive impact of the treatment. Linear regression analysis revealed a strong association between QoL improvement and adherence. Adherence patterns did not significantly differ between the two treatment groups, as assessed by various criteria. The patients with high stigma, newly diagnosed Pre-XDR cases, and the presence of adverse events had higher odds of nonadherence. Conclusion: This study highlights the substantial impact of Bedaquiline and Delamanid treatment on the HRQoL of Pre-XDR TB patients in Eastern India. Adherence to treatment plays a crucial role in improving QoL, and factors like stigma, newly diagnosed Pre-XDR patients, and adverse drug reactions influence adherence adversely. The findings emphasize the importance of patient support and education to enhance treatment outcomes.

Incidence of Tibial Tubercle Fractures in Patients With and Without Osgood-Schlatter Disease.

Patients with Osgood-Schlatter disease (OSD) may be at increased risk of tibial tubercle fractures due to an underlying weakness of the tibial tubercle apophysis relative to the patellar tendon as a result of repetitive microtrauma. The purpose of this study is to analyze the incidence of tibial tubercle fractures in patients with and without Osgood-Schlatter disease. We hypothesized that the incidence of tibial tubercle fractures would be higher in patients with Osgood-Schlatter disease. A retrospective cohort analysis of the PearlDiver database was performed by querying all patients diagnosed with Osgood-Schlatter disease between January 2010 and October 2022. An OSD cohort of 146,672 patients was captured using International Classification of Diseases, Ninth Revision (ICD-9), Tenth Revision (ICD-10) billing codes, and age as inclusion/exclusion criteria. The Student t test and the χ 2 analyses were used to compare the demographics and obesity between the OSD and control cohorts. Multivariable logistic regressions, controlling for residual differences in age, sex, and obesity, were used to compare rates of tibial tubercle fractures. Patients with a recent history of OSD were found to have higher rates of tibial tubercle fractures than the control group at all measured time points ( P <0.001). The 1-year rate of tibial tubercle fractures was 0.62% in the OSD group. The incidence of tibial tubercle fractures in the OSD group was 627.3 cases per 100,000 person-years compared with 42.7 cases per 100,000 person-years in the control group ( P <0.001). Male sex and obesity were also associated with an increased risk of sustaining a tibial tubercle fracture within these patient populations ( P <0.001). We report a significantly higher incidence of tibial tubercle fractures among patients with OSD compared with controls. This increase was most significant at 1 month following OSD diagnosis, however, held true for all measured time points. In addition, male patients and those with obesity were also noted to have increased incidence of tibial tubercle fractures regardless of an OSD diagnosis.

Efficacy of a smoking cessation program for patients with lung cancer.

357 Background: Smoking cessation improves overall mortality and cancer-specific mortality in patients with lung cancer. However, cessation is rarely successful without medical assistance, indicating a need for focused intervention in patients with lung cancer. Referrals for formal counseling can facilitate access to smoking cessation resources and serve as an impetus for cessation. In this study, we analyzed the efficacy of the smoking cessation program at our institution’s cancer center and identified opportunities for improvement in patient outreach, education, recruitment, and retention. Methods: A retrospective chart review of patients at our institution's cancer-dedicated smoking cessation center was conducted between January 1, 2022, to August 31, 2023. All referred patients with primary lung cancer or documented lung metastasis were included. Patient demographic and medical information were collected from the electronic medical record. Data was analyzed with descriptive (frequency, mean, median, interquartile ranges (IQR), 95% confidence interval) and inferential (t-test, Chi-Squared/Fisher’s Exact) statistics. P-value &lt;0.05 was deemed significant. Results: 138 patients were referred for smoking cessation counseling, 24 (17.4%) attended counseling, and 14 (58.3%) attended ≥2 visits. Patients had a median time from referral to first session of 14 days (IQR=8.5). All counseled patients were prescribed nicotine replacement therapy (NRT) with 19 receiving multiple modalities. Of the 23 patients actively smoking at first meeting, 19 (82.6%) saw some reduction in packs/day (PPD) compared with 55 (51.9%, n=106) in actively smoking non-counseled patients (p=0.006). Counseled patients saw improvement in packs/day smoking with a mean reduction of 0.66 PPD (p=0.0001, [0.36, 0.95 95% CI]). Patients who attended &gt;2 meetings saw a mean PPD reduction of 1.13 (p=0.004, [0.49, 1.78 95% CI]). In patients who did not attend counseling, 82 (71.9%, n=114) were never successfully contacted. There was no significant difference in age, gender, race, or insurance between patients who attended or did-not-attend counseling. Conclusions: Our smoking cessation program demonstrates effectiveness in facilitating a significant decrease in PPD. However, low utilization presents an opportunity for quality improvement to identify barriers to engagement and improve patient outreach. Proposed interventions include strategies such as patient-portal mediated outreach, provider reminders in the EMR, and utilization of referral and scheduling at initial oncology appointment as quality metrics. Smoking cessation program. Program Efficacy Number of Visits Mean Packs/Day Decrease [95% CI] 1 (n=9) 0.31 [-0.12, 0.73] 2 (n=6)* 0.56 [0.20, 0.91] &gt;2 (n=8)** 1.13 [0.49, 1.78] Total (n=23)*** 0.66 [0.36, 0.95] Attended Counseling n (%) Did Not Attend Counseling n (%) Patients with Any Decrease in Packs/Day* 19 (82.6) 55 (51.9) Patients Attaining Relapse Free Cessation 9 (37.5) 26 (22.8) *p&lt;0.05, **p&lt;0.005, ***p&lt;0.0005.

An analysis of radiologic and anatomical parameters associated with medial osteochondral lesions of the talus in non-traumatic cases

The study aimed to provide a comprehensive analysis of radiological and anatomical measurements in patients with medial osteochondral lesions of the talus (OLT), particularly those without a history of trauma. The retrospective cross sectional study evaluated 23 medial OLT individuals aged 18–45 with no history of trauma who were identified by magnetic resonance imaging (MRI) between 2016 and 2020. The control group consisted of 27 individuals between the ages of 18 and 45 who did not have OLT and applied for other reasons. Measurements were performed with 16 parameters from anteroposterior (AP) and lateral weight-bearing ankle conventional radiographs (CR). All individuals' demographic data were assessed. A total of 50 patients aged 18–45 years, including 26 males and 24 females with a mean age of 30.28±4.46 years, were evaluated in the study. No significant differences in age or gender were found between the groups (P>0.05). Analysis of both the OLT and control groups revealed a significant association of decreased talar declination angle (P<0.001) and Meary-Tomeno's angle (P = 0.003) with medial OLT. There was no relationship between other radiological parameters and medial OLT development. In conclusion, a decreased talar declination angle and a decreased Meary-Tomeno's angle appear to have significant relationship with development of medial OLT in individuals without a history of trauma. These findings also indicate that a possible cause of medial OLT is a lower-angled positioning of the talus relative to the ground and the first metatarsus in the sagittal plane.Level of Clinical Evidence: Level 3 cross sectional study