Follow-up Exams Research Articles

532-P: The Longitudinal Determinants of Diabetic Complications in the Pima Indians of Arizona

The 5 components of the metabolic syndrome (MetS) increase the likelihood of developing diabetes, heart disease, and stroke, but their association with neuropathy and diabetic kidney disease (DKD) is less understood. We examined the longitudinal association between the components of the updated National Cholesterol Education Program criteria for MetS, neuropathy and DKD in Pima Indians with type 2 diabetes, after substituting BMI for waist circumference. The primary outcome for neuropathy was the Michigan Neuropathy Screening Instrument index, for cardiovascular autonomic neuropathy (CAN) was the expiration/inspiration ratio, and for DKD was the Glomerular Filtration Rate. At baseline and during annual follow-up exams, participants underwent metabolic phenotyping and outcome measurements. Linear mixed effects models with a random patient effect were used to evaluate the associations between the number of MetS components and neuropathy, CAN, and DKD outcomes. We also examined mixed models for each outcome with individual MetS components. Between 11/1/2013 and 7/1/2019, we studied 141 Pima Indian subjects, who were followed an average of 3.2 years. The mixed effects models revealed a significant interaction between the number of MetS components and follow-up time for neuropathy (point estimate (PE): 0.07, CI: 0.02-0.11), indicating that the rate of neuropathy increases as the number of MetS components increases. Additionally, we found that neuropathy (year PE: 0.30, CI: 0.24,0.35) and DKD (PE: -14.2, CI: -16.8,-11.4), worsened over time, but CAN did not. The mixed models with individual MetS components revealed SBP was associated with each complication: neuropathy (PE: 0.23, CI: 0.07,0.39), CAN (PE: -0.02, CI: -0.03,-0.02) and DKD (PE: -10.2, CI: -15.4,-5.1). Neuropathy progression was the complication most affected by the number of MetS components. Neuropathy and DKD worsened during follow-up, emphasizing how quickly these complications can change within this population. Disclosure E.L. Reynolds: None. R.G. Nelson: None. G. Akinci: Advisory Panel; Spouse/Partner; Aegerion Pharmaceuticals, Regeneron Pharmaceuticals. Speaker’s Bureau; Spouse/Partner; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Sanofi-Aventis, Servier. R. Henn: None. A. Patterson: None. E.L. Feldman: Consultant; Self; Novartis Pharmaceuticals Corporation. B.C. Callaghan: None. Funding National Institutes of Health (R24DK082841, T32NS0007222, R01DK115687); Program for Neurology Research & Discovery; Robert and Katherine Jacobs Environmental Health Initiative; Robert E. Nederlander, Sr. Program for Alzheimer’s Research; Sinai Medical Staff Foundation

The efficacy of low vision aids with contact lenses in pediatric population.

To compare the efficacy of contact lens use with low vision aids (LVA) with the efficacy of spectacle use with low vision aids. Thirty-six pediatric patients with low vision were enrolled in this study between January 2015 and March 2017. The patients were examined for best-corrected visual acuity (BCVA) with spectacles, spectacles with LVA, contact lenses and contact lenses with LVA. Toleration of the patients with contact lenses and LVA were recorded at the final follow-up exam. The mean BCVA with spectacles was detected as 1.11 ± 0.25 log MAR and the mean BCVA improved to 0.35 ± 0.13 log MAR with the use of spectacles and LVA, which was statistically significant. The mean BCVA with contact lens, which was 0.99 ± 0.22 log MAR, improved to 0.40 ± 0.21 log MAR with contact lens and LVA, which was also significant. There was a statistically significant improvement in BCVA of the patients with contact lenses only when compared to spectacles only. The mean BCVA significantly improved in patients using LVA with contact lenses when compared to LVA with spectacles. Tolerations of the patients with contact lenses and LVA were found to be well at 29 of 36 (80.55%) at final follow-up (26.11 ± 6.85 months). Contact lens use in pediatric patients with low vision especially with LVA offers better visual acuity, a decrease in nystagmus amplitude, wider field of view and comfort.

Total Carotenoid Intake Reduces the Odds of Frailty over 9 Years in Older Adults: Results from the Framingham Offspring Study

Abstract Objectives Frailty occurs in 10–15% of community-living older adults. The benefit of a Mediterranean style diet in reducing frailty is not well established in older Americans. The aim was to determine the association of Mediterranean-Style Dietary Pattern and related antioxidants (vitamin C, E and total carotenoids from diet and supplements) with the odds of frailty over 9y in older adults from the Framingham Offspring study. Methods The Mediterranean-style dietary pattern score (MSDPS) was used to characterize a Mediterranean-style diet in 2541 men and women with completed food frequency questionnaires at baseline (1998–2001). Average intake of each antioxidant (vitamin C, E and total carotenoids, mg/d) at baseline and one prior exam (1995–98) was calculated. Total carotenoids were calculated as the sum of intake of α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein and zeaxanthin. Frailty was assessed using Fried's frailty criteria at baseline and follow-up exam (2005–08). Participants categorized as frail at baseline were excluded (n = 27). Logistic regression was used to calculate odds ratios and 95% confidence intervals (95% CI) adjusting for age, sex, follow-up time, BMI, energy intake, current smoking and multivitamin use. Antioxidants were adjusted for each other in the same model. Results Mean age (±SD) was 60 ± 9y (range 33–86), 55% were female and mean follow-up time was 6.6y (range 3.7–9.1). Mean (±SD) was 45 ± 13 (range: 10.8–84.1) for the MSDPS, 36.5 (±32.3) mg/d for vitamin C, 16.4 (±199) mg/d for vitamin E and 1.8 (±0.8) mg/d for carotenoids. Prevalent frailty at follow-up exam was 5%. Although not significant, a 10 unit increase in MSDPS reduced the odds of frailty by 8.7% (95% CI: 0.78–1.08, P = 0.28) in the combined sample of men and women. Each 10 mg increase in total carotenoid intake reduced the odds of frailty by 29% (95% CI: 0.53–1.01, P = 0.02). Neither Vitamin C (P = 0.79) or E (P = 0.25) were individually associated with frailty. Conclusions A Mediterranean style diet was not significantly associated with frailty in this sample of largely older adults. However, total carotenoids intake reduced the odds of frailty. Future work should consider if a Mediterranean style diet and related antioxidants delay the progression of frailty. Funding Sources Boston Claude D. Pepper Center OAIC and Peter and Barbara Sidel Fund.

The Relationship Between Household Food Insufficiency and Development of Type 2 Diabetes over 10 Years in a Sample of U.S. Black and White Adults

Abstract Objectives Household food insufficiency (HFI) is associated with type 2 diabetes (T2D) but longitudinal studies are scarce. Our objectives were to test the relationship of 1) HFI during young-to-middle adulthood with risk of T2D 10 years (y) later; and 2) transient (1 time) or persistent (2 times) HFI with odds of T2D. Methods We used data from 3672 black and white adults (32–49y) from Year 15, 20, and 25 follow-up exams of the Coronary Artery Risk Development in Young Adults (CARDIA) Study (2000–2011). Participants with missing HFI or T2D data, prevalent T2D at Year 15 (and Year 20 for objective 2), or reported pregnancy were excluded (n = 720), for a total of n = 2952. At each exam, a screener question captured HFI over the past 12 months. Participants reporting that the food they had to eat was not always what they wanted, sometimes not enough, or often not enough were categorized with HFI. Participants with enough of the kinds of food they wanted were categorized with household food sufficiency. T2D was defined as fasting serum glucose ≥126 mg/dL or hemoglobin A1c ≥6.5%. Multivariable-adjusted repeated-measures and logistic regression models tested the relationships between HFI at Year 15 with risk of T2D at Year 25, and between transient or persistent HFI from Years 15 to 20 with odds of T2D at Year 25, respectively. Results T2D prevalence was 4.7% at Year 20 and 9.7% at Year 25. At Year 15, 13.2% reported HFI, and 14.6% and 5.2% were categorized with transient or persistent HFI, respectively. Adjusted for age, sex, and race, HFI at Year 15 was associated with 36% higher risk of T2D by Year 25 (Risk Ratio (95% Confidence Interval (RR (95% CI)): 1.36 (1.02, 1.80); P < 0.05), though the relationship was attenuated after adjustment for education (1.28 (0.96, 1.71)). Compared to no HFI at Years 15 and 20, participants with persistent, but not transient, HFI had higher odds of T2D at Year 25 in fully-adjusted models (Odds Ratio (OR (95% CI)): persistent HFI: 2.06 (1.09, 3.67), P < 0.05; transient HFI: 1.26 (0.76, 2.01)). Conclusions Transient or persistent exposure to HFI in young-to-middle adulthood may be a risk factor for developing T2D among black and white adults. Preventing and reducing HFI may be a strategy to reduce socioeconomic and racial disparities in T2D prevalence in the U.S. Funding Sources SDSU University Grants Program; NIH NHLBI K01.

Estimated clinical efficacy and radiographic response characteristics of PD1 inhibition in newly diagnosed and recurrent glioblastoma in clinical practice: A report from the iRANO Working Group.

2521 Background: Despite concerns of immunotherapy-induced inflammatory response during PD1 inhibition, questions remain as to the true incidence of inflammatory response and potential clinical implications. The goals of the project were to use GBM patients pooled from academic centers to estimate radiographic PFS and OS, as well as determine the incidence of immunotherapy-induced inflammatory response. Methods: 152 patients with newly diagnosed (N = 57) or recurrent (N = 95) GBM treated with either nivolumab or pembrolizumab from Dana-Farber (N = 88), UCLA (N = 35) or UCSF (N = 29) were included in this study. Radiographic progression was defined by a 25% increase in bidirectional measurements according to RANO. Results: Median PFS and OS for newly diagnosed patients was 162 and 520 days, respectively, while median PFS and OS for recurrent patients was 72 and 225 days, respectively. No difference in OS was observed in recurrent patients treated with nivolumab vs. pembrolizumab (P = 0.58), but recurrent patients treated with nivolumab trended toward a longer PFS (P = 0.097). Of the recurrent patients with OS and PFS data available and radiographic progression, 95% of them progressed within 6 mos of starting treatment. Median post-progression survival (PPS) in recurrent patients with PFS < 6 mos was 151 days, while PPS for patients with PFS > 6 mos was 178 days (P = 0.51). In the 77 recurrent patients who progressed within 6 mos, 36.4% had an OS that was > 9 mos, while 63.6% had an OS < 9 mos, suggesting the majority of patients with “early progression” also died early and a minority of patients had what could be considered “immune-related inflammation”. Of the 81 recurrent patients with documented progression, only 2.5% showed stabilization within 3 mos of first progression, 30.9% died before the 3-month confirmation scan could be obtained, 24.7% showed continued tumor growth by 3 months, and 48.1% had no follow-up confirmatory imaging exams. Of the 70 patients who progressed within 6 mos and had documented death, 2.9% had disease stabilization, 31.4% died before the 3-month confirmation, and 75.7% had either documented tumor growth or had no follow-up confirmatory imaging exams. Conclusions: This study suggests immunotherapy-induced inflammation followed by a favorable PPS is uncommon in GBM. While patients treated with other types of immunotherapy may exhibit different imaging characteristics, these data provide an important basis to refine the iRANO criteria.

Deep vein thrombosis after “Tennis Leg” injury: A clinical case

Abstract Background “Tennis leg” is a common lesion in sports with quick accelerations and stops, consisting of an injury to the fascia joining the soleus muscle with the medial gastrocnemius. In these cases, a differential diagnosis must be performed, considering possible complications such as a deep vein thrombosis (DVT) of the veins of the deep musculature of the lower leg. The aim of this clinical case is to alert professionals regarding possible complications of these injuries and to train professionals to detect a possible vascular problem. Case Description A 42 year old male who attends a physical therapy consultation 24 hours after suffering a “muscle pull” in the gastrocnemius. After a medical diagnosis of tennis leg he received appropriate standard regulated physical therapy treatment procedures. A follow-up ultrasound exam was performed eight days after the injury and at 14 days after a worsening of symptoms, at which point a vascular alteration was detected which was diagnosed and treated as DVT. Results The patient came for consultation and we observed a vascular alteration and therefore we referred the person to the emergency room, where he was diagnosed with DVT. Discussion DVT is a possible complication of gastrocnemius injuries. The present case describes a clinical presentation of DVT after 14 days evolution. It is essential to evaluate and reevaluate the clinical condition of the patient with all the diagnostic tools possible to detect possible red flags. Conclusion Ultrasound is an essential tool for the detection of possible complications after a musculoskeletal injury.

Barrett’s Epithelial Thickness, Assessed by Volumetric Laser Endomicroscopy, Is Associated With Response to Radiofrequency Ablation

Radiofrequency ablation (RFA) is the most common treatment for flat Barrett's esophagus (BE), but reasons for varying outcomes are poorly understood. A recently developed contrast-enhancement algorithm allows reliable measurement of Barrett's epithelial thickness (BET) from volumetric laser endomicroscopy (VLE) images and correlation with response to RFA. Using this algorithm, we investigated whether patients with thicker Barrett's mucosa are less likely to respond to RFA. In the future, this algorithm may guide choice of RFA dosing or endoscopic resection. We performed a retrospective analysis on all patients with BE who received a baseline VLE scan between May 2015 and October 2016, followed by RFA and 1 follow-up exam, from 14 institutions participating in the United States VLE registry. We measured BET on equidistant locations by estimating the distance between the esophageal surface and the superficial edge of the deepest lamina propria. The primary outcome variable was the percentage reduction in Prague length; secondary outcome variables were complete remission of intestinal metaplasia (CRIM) and presence of strictures after 12 months. Images from 61 patients were included in our final analysis. Mean BET per patient ranged from 224 μm to 705 μm. A 100 μm thicker mean BET per patient resulted in a 12% lower response to treatment, measured by a reduction of Prague length (P = .03), after adjustment for confounders. We found an association between mean BET and CRIM, but not with stricture formation. Based on measurements on contrast-enhanced VLE images, we found that BET correlates with response to RFA. For clinical implementation, larger studies with a standardized follow-up and development of computer-aided image analysis systems are needed.

Generalized Anxiety Disorder is Prospectively Associated With Decreased Levels of Interleukin-6 and Adiponectin Among Individuals from the Community

BackgroundAnxiety disorders have been related to cardiovascular diseases via low-grade inflammation, but longitudinal studies on the association between generalized anxiety disorder (GAD) and inflammatory biomarkers are sparse. Furthermore, no studies have examined the association between GAD and the “cardio-protective” adipocytokine adiponectin in this context so far. MethodsIn a Swiss population-based sample of 2,415 adults participating in baseline and follow-up exams (mean follow-up duration=5.5 years), we diagnosed a total of 55 persons (2.3%) with GAD using a validated semi-structured psychiatric interview. We prospectively examined the relation between GAD and circulating levels of inflammatory biomarkers (i.e., C-reactive protein, interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and adiponectin), in linear regression models, statistically controlled for the baseline inflammatory marker, socioeconomic status, cardiovascular risk factors, health behaviors, and psychiatric disorders. ResultsCompared to those without GAD, individuals with GAD had lower IL-6 (β=-0.249, 95%-CI -0.493-(-0.004), p=0.046), and adiponectin (β=-0.264, 95%-CI -0.482-(-0.045), p=0.018) levels at follow-up after adjustment for all covariates. Moreover, GAD was unrelated to several other inflammatory measures. ConclusionIndividuals with GAD do not seem to exhibit chronic low-grade inflammation, suggesting different underlying biobehavioral mechanisms to those from other anxiety disorders. Low adiponectin levels may be linked to symptoms of GAD through brain areas directly involved in the processing of fear and anxiety.

Dissect or not to dissect? Easy solution

Throughout the recorded past (from Edwin Smith Surgical Papyrus) anatomy education did not experience dramatic changes. Practically until the last 5–10 years we were using only a text and a cadaver. Only did generation Z start to experience an intervention of AI and VR in our dissection rooms and lecture halls. Literature research exhibits convincing evidence of the positive impact of these new pedagogical tools on student’s success and overall performance (Freeman et al. 2014; Michael 2006). Some new methods of active learning, however, have been proven to be more effective than others. Lombardi et al. (2014) observed that students who used plastic models, rather than prosected specimens or virtual dissections, scored considerably higher on both initial and follow‐up exams despite student perceptions that the different forms of actual dissections were of more value. Fancovicova et al. (2014) observed that students who had admittance to multiple forms of active learning performed at a higher level than students who had access to only one form (including dissection). Herur et al. (2011) reported that students who utilized multiple forms of active learning had significantly higher levels of retention at 15 and 30 days after the class than those who learned by passive means.There is a perception that dissection continues to be recommended as the golden standard of anatomical education. Our presentation will present our experience of exploration of the possibilities to improve student’s success through the creation of a technologically advanced anatomy classroom that allows the learning anatomy of living human beings, not only cadavers. First‐time students are able to hold their own 3D printed organs during lab exercises. We can observe anatomical variations and their effects on living specimens in real time. At the same time, traditional cadaver dissections allow us to appreciate the complexity of the human body.

Pediatric dermatoses pattern at a Brazilian reference center

ObjectiveThe aim of this study was to identify the pattern of pediatric dermatoses of patients evaluated at a dermatologic clinic of a reference center in Brazil and to compare these results to similar surveys conducted in other countries. MethodsA retrospective study was performed of patients up to 18 years old, evaluated at a dermatologic clinic between January 1, 2017 and December 31, 2017. Variables collected for analysis included age, gender, dermatological diagnosis, multidisciplinary follow-up, hospitalization, and complementary exams. ResultsA total of 2330 patients were included for analysis, with a mean age of 9.7 years. 295 patients were diagnosed with more than one skin disease, leading to a total of 2668 diagnoses. Skin diseases were organized into categories and inflammatory dermatoses corresponded to the largest group (31.2%), mostly due to atopic dermatitis (18.3%). The other main categories were: genodermatoses (14.2%), infectious diseases (12.6%), adnexal disorders (12.5%), cysts and neoplasms (10.7%), and vascular disorders (7.0%). Fifty-six patients needed to be admitted to the dermatology ward; 25 of them (44.6%) for management of worsening of the skin disease, mainly atopic dermatitis, psoriasis, and drug reactions. There were 885 biopsies performed in 38.0% of the subjects and 751 patients (32.2%) required multidisciplinary care; most of them had some genodermatoses. ConclusionsDermatologic disorders are very common in the pediatric age group and differ from those in adults, suffering influence from cultural, ethnic, socioeconomic, and environmental factors. Knowing the magnitude and distribution of these dermatoses is important to better plan healthcare policies.

The Association of Metal Frame Construct of ESIN and radiographic bone healing of pediatric forearm fractures

IntroductionThe gold-standard surgical procedure of both-bone forearm shaft fracture repair is elastic stable intramedullary nailing (ESIN). Disadvantages effects of ESIN have suggested to be a consequence of inappropriate surgical techniques, while recommendations are not always followed. The purpose of the study was to analyze the effect of inadequate metal frame construct on impaired fracture healing, refracture and changing alignment. Materials and MethodsIt is a population-based study including all consecutive patients, aged less than 16 years, who had been treated for forearm shaft fracture by ESIN during the ten-year period 2009–2018. Altogether 71 patients were included. Non-union, delayed union, and re-fracture during the following 12 months were taken as the main outcome, while inferior metal frame construct of ESIN and the surgical technique characteristics were taken the explanatory factors. Radiographic loss of reduction was a secondary outcome and a change >5° in alignment at any postoperative follow-up exam was recognized. ResultsTwo out of 71 fractures (3%) failed to unite, and ossifying operation was needed. Five cases (7%) showed delayed bone healing, but they ossified in five months without any intervention. These seven patients (10%) had been treated more often with larger nails (> 0.7x MCD) (p = 0.027) and by open reduction (p = 0.02), compared with thinner nails and closed reduction, respectively. Two (3%) patients had a second fracture; however, they happened 2 years after the initial injury. Other surgery or fracture related factors didn't associate with impaired ossifying.Regarding the secondary outcome, altogether 24 (35%) of the analyzed 67 patients showed >5° change in alignment during the postoperative follow-up but only one patient had clinically significant instability that required re-reduction. The alignment changed more usually in distal-third fractures, compared with middle or proximal third fractures (p = 0.019). ConclusionsESIN resulted in good radiographic bone healing in the vast majority (90%) of the patients and completely perfect metal frame construct was not required.

514 Post-burn Malnutrition and Associated Cardiomyopathy

Abstract Introduction It is known that systolic dysfunction (dilated cardiomyopathy) may occur in a high percentage of patients with large TBSA burns. The reversible myocardial depression may be due to many factors: thermal injury, sepsis, severe malnutrition. Malnutrition and delayed wound healing may occur with a combination of primary and secondary protein-energy undernutrition. Methods Serial transthoracic and transesophageal echocardiographic parameters were measured during perioperative care (ejection fraction, fractional shortening, pericardial fluid) in 8 patients with evidence of malnutrition (low BMI, low albumin and prealbumin, muscle wasting) and a delayed presentation to the hospital. Initial echocardiography was performed post-injury day 30 -142; follow-up exams were performed in some patients at 2 years post-injury. Acutely-injured patients or those with sepsis were excluded. Results From 2015–2017, echocardiographic measurements were obtained in 8 patients, ages 7–21. The presenting TBSA ranged from 30–82% and included flame injury, electrical burns, and 1 case of pemphigus vulgaris. The initial ejection fraction ranged from 12–45% in patients with a BMI range of 10–25. The mean initial albumin was 2g/dL; the mean prealbumin was 9.5mg/dL. Two patients had mild to moderate pericardial effusions, which resolved after 1 month of proper nutrition. Selenium deficiency was noted in 1 patient. Four patients required perioperative short-term dobutamine. Conclusions Patients presenting with malnutrition and impaired wound healing all had evidence of cardiomyopathy; however, the degrees of systolic dysfunction varied significantly. BMI, albumin, and prealbumin all had a strong correlation with the degree of myocardial depression. Despite the lower ejection fractions, many patients maintained an adequate cardiac index and did not require inotropic medications. With time and adequate nutrition, cardiac function improved, although many remained with mild dysfunction in the first year. Applicability of Research to Practice This case series demonstrates the continued need for early recognition of malnutrition and cardiomyopathy in this patient population and the need for early intervention. Echocardiographic diagnosis may improve acute perioperative care. In addition, future studies are needed to determine the chronic cardiac effects of reversible dilated cardiomyopathy. Nutrition, refeeding, and perioperative management require a multidisciplinary team.

Abstract P426: Cumulative 30-year Alcohol Use From Young Adulthood and Mid-life Cognitive Function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Alcohol use is common in the United States. Most studies describe a J-shaped relationship between alcohol consumption and cognitive function: frequent heavy consumption alters brain functions and decreases cognitive performance; regular light and moderate consumption may have protective impact. We are unaware of any reports utilizing longitudinally collected data to derive a cumulative exposure of alcohol use and assess its association with cognitive function. Hypothesis: Cumulative 30-year exposure to alcohol has a J-shaped association with mid-life cognitive function. Methods: We included 3,068 participants aged 18-30 years at the baseline examination (1985-86) and having up to 8 follow-up exams at 2- to 5-year intervals including at 30 years (2015-16). Cumulative “drink-years” exposure to alcohol was estimated at each exam by multiplying the usual number of drinks/day reported by the number of years since last exam, and then summing across exams. We used multivariable adjusted linear regression models to assess the independent associations of number of drink-years with 6 measures of cognitive function studied at Year 30: Rey Auditory Verbal Learning Test (RAVLT), Digit Symbol Substitution Test (DSST), Stroop Test, Montreal Cognitive Assessment (MoCA), Category Fluency Test, and Letter Fluency Test. We used inverse probability of censoring weighting to account for potential informative censoring. Linear regression models estimated standardized mean test scores for the cumulative alcohol use categories (drink-years: >0 and <15, 15-29.9, 30+). Too few participants were available for assessment of higher categories of use. Results: Compared with never drinking, the 3 categories of cumulative exposure were unassociated with any of the cognitive function measures. Conclusions: Cumulative 30-year alcohol use is not associated with cognitive function in middle-aged adults in the CARDIA study.

Abstract MP01: Multiple Social Determinants of Health Disparities Increase the Risk of Diabetes and Mortality in the Reasons for Geographic and Racial Differences in Stroke Study

Introduction: The Healthy People 2020 initiative proposed that social determinants contribute to disparities in health outcomes. While studies have documented the influence of individual social determinants of health (SDOH) on health outcomes, few studies have examined how the aggregation of multiple SDOH within the same person affect health. Hypothesis: We hypothesized that as the number of individual-level and neighborhood-level SDOH increased, the relative risk of incident diabetes and mortality also increased. Methods: This study included 15,310 black and white adults aged > 45 years at baseline (2003-2007) who did not have prevalent diabetes and who completed the 10 year follow-up exam (2014-2016) or died prior to follow-up in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study. Exposures included 6 SDOH which have been associated with increased health risks: annual household income <$35,000, black race, < high school education, lack of health insurance, residing in a zip code with ≥ 25% poverty, and living in a state with poor public health infrastructure for 10 years prior to 2003. Outcomes were all-cause mortality or incident diabetes, defined as fasting glucose >126 mg/dL, random blood glucose >200 mg/dL, or taking diabetes medication or insulin. Multinomial logistic regression models examined associations of number of SDOH with death and incident diabetes, adjusting for other demographics, health behaviors, and medical conditions. Results: At follow-up, 1,170 (8.7%) had developed diabetes, and 3,790 (26.8%) had died. As the number of SDOH increased, the relative risk of both diabetes and death increased significantly (p for trend <0.001) in both crude and adjusted models (Figure). Conclusions: Counting the aggregate number of SDOH that an individual is exposed to may be a simple way to identify those at greater risk of developing incident diabetes or dying over 10 years. This approach has potential for application in both clinical practice and population health management.

Abstract P241: Psychosocial Profiles and Cardiovascular Disease Risk Factor Control: The Coronary Artery Risk Development in Young Adults (cardia) Study

Introduction: Psychosocial factors are associated with the onset of chronic disease, however few studies have examined the association between these factors and cardiovascular disease risk factor (CVDRF) control over time in individuals who already have a chronic disease. Thus, the goal of this study was to evaluate associations of psychosocial factors with a composite measure of CVDRF control. Methods: This study includes 1,018 CARDIA participants (51.6% Black; 41.6% Male) with prevalent hypertension (n = 604), hypercholesterolemia (n = 636), and/or diabetes (n = 210) in 2000-2001 (Year 15 follow-up exam). Latent Profile Analysis (LPA) was used to identify distinct psychosocial profiles based on a combination of personality, social life, and psychological health factors (Table). We used generalized estimating equations to determine associations of the psychosocial profiles with composite control, defined as HbA1c < 7.0%, systolic blood pressure (SBP) < 140 mm Hg, and LDL-cholesterol < 100 mm/dl, all measured in 2005-2016. Results: The LPA revealed an optimal model of three psychosocial profile groups (AIC 87,467.545; entropy = .895) namely “Healthy”, “Depressed Mood” and “Discriminated Against”. There were no significant differences in composite control across the profiles. Looking at HbA1C, SBP, and LDL separately in the unadjusted models, we found participants in the Depressed and Discriminated Against profiles were less likely to meet guidelines for SBP compared to individuals in the Healthy profile. Participants in the Discriminated profile were significantly less likely to meet the guidelines for HbA1C levels compared to the Healthy profile. These associations were attenuated with adjustment for sociodemographic covariates. Conclusions: Psychosocial profiles were associated with CVDRF control in unadjusted models, but not independent of socio-demographic characteristics.

The "salt and pepper" pattern on renal ultrasound in a group of children with molecular-proven diagnosis of ciliopathy-related renal diseases.

While typical ultrasound patterns of ciliopathy-related cystic kidney diseases have been described in children, ultrasound findings can overlap between different diseases and atypical patterns exist. In this study, we assessed the presence of the "salt and pepper" pattern in different renal ciliopathies and looked for additional ultrasound features. This single-center, retrospective study included all patients with a molecular-proven diagnosis of renal ciliopathy, referred to our center between 2007 and 2017. Images from the first and follow-up ultrasound exams were reviewed. Basic ultrasound features were grouped into patterns and compared to genetic diagnoses. The "salt and pepper" aspect was described as enlarged kidneys with heterogeneous, increased parenchymal echogenicity. A total of 41 children with 5 different renal ciliopathies were included (61% male; median age, 6years [range, 3days to 17years]). The "salt and pepper" pattern was present in 14/15 patients with an autosomal recessive polycystic kidney disease (ARPKD). A similar pattern was found in 1/4 patients with an autosomal dominant polycystic kidney disease and in 1/11 patients with HNF1B mutation. Additional signs found were areas of cortical sparing, comet-tail artifacts, and color comet-tail artifacts. Although the "salt and pepper" ultrasound pattern is predominantly found in ARPKD, it may be detected in other ciliopathies. The color comet-tail artifact is an interesting sign when suspecting a renal ciliopathy in case of enlarged hyperechoic kidneys with no detectable microcysts on B-mode grayscale ultrasound.

Novel educational adjuncts for the World Health Organization Basic Emergency Care Course: A prospective cohort study.

IntroductionThe World Health Organization's (WHO) Basic Emergency Care Course (BEC) is a five day, in-person course covering basic assessment and life-saving interventions. We developed two novel adjuncts for the WHO BEC: a suite of clinical cases (BEC-Cases) to simulate patient care and a mobile phone application (BEC-App) for reference. The purpose was to determine whether the use of these educational adjuncts in a flipped classroom approach improves knowledge acquisition and retention among healthcare workers in a low-resource setting.MethodsWe conducted a prospective, cohort study from October 2017 through February 2018 at two district hospitals in the Pwani Region of Tanzania. Descriptive statistics, Fisher's exact t-tests, and Wilcoxon ranked-sum tests were used to examine whether the use of these adjuncts resulted in improved learner knowledge. Participants were enrolled based on location into two arms; Arm 1 received the BEC course and Arm 2 received the BEC-Cases and BEC-App in addition to the BEC course. Both Arms were tested before and after the BEC course, as well as a 7-month follow-up exam. All participants were invited to focus groups on the course and adjuncts.ResultsA total of 24 participants were included, 12 (50%) of whom were followed to completion. Mean pre-test scores in Arm 1 (50%) were similar to Arm 2 (53%) (p=0.52). Both arms had improved test scores after the BEC Course Arm 1 (74%) and Arm 2 (87%), (p=0.03). At 7-month follow-up, though with significant participant loss to follow up, Arm 1 had a mean follow-up exam score of 66%, and Arm 2, 74%.DiscussionImplementation of flipped classroom educational adjuncts for the WHO BEC course is feasible and may improve healthcare worker learning in low resource settings. Our focus- group feedback suggest that the course and adjuncts are user friendly and culturally appropriate.

The CAIDE Dementia Risk Score and the Honolulu-Asia Aging Study

Introduction: The CAIDE (Cardiovascular Risk Factors, Aging, and Incidence of Dementia) dementia risk score is based on demographic, genetic, and modifiable risk factors in midlife and has been shown to be predictive of later-life dementia. Objective: To test the predictive capacity of the CAIDE dementia risk score among a cohort of Japanese-American men. Methods: Midlife measures were obtained from a sample of 3,582 Japanese-American men in the Honolulu Heart Program (1965–1968, average age = 53.1 years). A follow-up exam in 1991 (average age = 77.8 years) assessed cognitive impairment using the Cognitive Abilities Screening Instrument (CASI). Severe cognitive impairment was defined as a CASI score <60. Results: In this cohort, the CAIDE dementia risk score demonstrates significant association with later-life severe cognitive impairment (OR = 1.477, 95% CI: 1.39–1.58). However, the area under the receiver-operating characteristic curve c-statistics suggests poor predictive ability (c = 0.645, 95% CI: 0.62–0.67). Using a score cut-point of 10, the accuracy is acceptable (0.82), but the sensitivity is low (0.50). Conclusion: While the CAIDE dementia risk score at midlife is associated with later development of cognitive impairment in Japanese-American men, its predictive capacity in this population is weak.

The Clinical Non-Motor Connectome in Early Parkinson's Disease.

Background:Non-motor symptoms (NMS) of various anatomical origins are seen in early stage idiopathic Parkinson’s disease (IPD).Objective:To analyse when and how NMS are linked together at this stage of the disease.Methods:Prospective study recruiting 64 IPD patients with ≤3 years of disease duration and 71 age-matched healthy controls (HC). NMS were clustered in 7 non-motor domains (NMD): general cognition, executive function, visuospatial function, autonomic function, olfaction, mood, and sleep. Correlation coefficients ≥|0.3| were considered as significant. Bootstrapped correlation coefficients between the scores were generated in both groups. Fourteen IPD patients and 19 HC were available for a follow-up study two years later.Results:The mean age of both groups was similar. 58% of IPD patients and 37% of HC were male (p = 0.01). At baseline IPD patients performed less well than HC on all NMD (p value between 0.0001 and 0.02). Out of 91 possible correlations between NMD, 21 were significant in IPD patients and 14 in HC at the level of ≥|0.3|. The mean correlation level was higher in IPD patients than in HC, as evidenced by the higher box plot of correlation coefficients. Visuospatial scores at baseline were predictive of the motor deterioration at the follow-up exam.Conclusion:At early IPD stage various NMS are linked together, although not connected by anatomical networks. Such a clinical NMD connectome suggests almost synchronous disease initiation at different sites as also supported by fMRI findings. Alternatively, there may be compensation-driven interconnectivity of NMD.

Unusual diagnostic findings in temporal lobe epilepsy: A combined MRI and 18F-dopa case study

Temporal lobe epilepsy is the most common focal epilepsy in adults and often causes pharmacoresistant seizures. Magnetic resonance imaging (MRI) and PET studies have widely demonstrated a number of morphological and molecular abnormalities in epilepsy. However, considering the dopaminergic system, only a bilateral 18F-DOPA uptake reduction within the basal ganglia has been described. We report the unusual finding of increased 18F-DOPA uptake in a patient with focal recurrent seizures and "deja vu" experiences in the setting of cortical swelling detected at MRI exam. The final diagnosis was in in keeping with hippocampal sclerosis, confirmed during follow-up MR exams. In this case 18F-DOPA uptake may represent increased dopamine transport induced by seizures. Nuclear medicine physicians and radiologists should be aware of clinical and electroencephalographic findings when interpreting brain areas of tracer uptake, which are not always related to malignancy.