Function In Adult Patients Research Articles

Dynamic Brow Restoration Using a Soft Tissue Expander in Adult Patients With Arteriovenous Malformation.

Impaired brow function in adult patients with arteriovenous malformation is a serious disability that can even influence the field of vision. Brow reanimation techniques are used to recover a more natural appearance and brow function. Many static procedures have been set to augment brow elevation, but only dynamic procedures can lead to better functional results. In this study, the experience of a single surgeon addressing the challenge of brow restoration with dynamic procedures is presented. A retrospective review was performed using the records of 4 adult patients who underwent dynamic procedures using a soft tissue expander for brow restoration after arteriovenous malformation excision in the unilateral site of the forehead with the expander on the contralateral side. Movement and electrodiagnostic examinations were performed postoperatively at 2 months. The patients included 3 males and 1 female (mean age, 20.5 ± 4.04 years). Brow improvement was noted in all patients. The results of the electrodiagnostic examination showed synchronous and spontaneous motor unit potentials and compound muscle action potentials with the contralateral forehead. Dynamic procedures using a soft tissue expander can provide both static and dynamic functional brow elevation of the contralateral frontalis and skin.

P670 RV function in adult patients with repaired tetralogy of Fallot: assessment by three-dimensional echocardiography, comparison to CMR findings and relationship to pulmonary artery distensibility

Abstract Purpose The purpose of this study was to examine right ventricular (RV) function by three-dimensional speckle-tracking echocardiography (3DSTE) in patients after correction of tetralogy of Fallot (TF), the accuracy of 3DSTE compared to cardiovascular magnetic resonance (CMR) findings and assess pulmonary arterial (PA) distensibility in order to achieve a more comprehensive understanding of the matching between RV performance and PA load. Methods Twenty-one patients (mean age 39 ± 16 years) with repaired TF and twenty-one age-matched healthy subjects selected as controls were studied. CMR findings were available in 14 patients. RV volumes, RV ejection fraction (RVEF) and RV longitudinal and circumferential strains were calculated by three-dimensional echocardiography and three-dimensional speckle tracking echocardiography. The main pulmonary artery was interrogated by color, pulsed, and continuous-wave Doppler. Pulmonary regurgitation (PR) was assessed by color-flow mapping and graded as none, mild, or greater than mild using the measurement of the regurgitant jet width in relation to the outflow tract diameter. Right pulmonary artery (PA) was visualized from suprasternal view by two-dimensional echocardiography. Tissue Doppler Imaging (TDI) mode was activated in B-mode imaging to examine arterial motion, then mode was changed to color-mode with the beam line aligned perpendicular to the superior and inferior walls of the right PA. PA distensibility and strain were determined. Data analysis was performed offline. Results Overall, 3D RVEF and RV longitudinal strain were reduced in TF patients compared to the control group. Nine patients had moderate or moderate-to-severe PR. PA strain and distensibility were decreased (p = 0.003) compared with controls, both in the presence and absence of PR. PA strain had a positive correlation with RVEF (r = 0.79, p < 0.005) and RV strain (r = 0.82, p < 0.001). RV end-diastolic and end-systolic volumes by 3DE correlated with the respective parameters by CMR (r = 0.88,p < 0.001 and r = 0.87,p < 0.005 respectively). Patients with moderate-to-severe PR had more prominent PA strain changes (p = 0.02). Conclusions Three-dimensional right ventricular ejection fraction and RV strain are impaired in patients with repaired TF, in agreement with CMR data. Reduced PA strain is associated with reduced RV 3DSTE parameters and is more pronounced in the presence of pulmonary regurgitation.

Brain Aminergic Deficiency in Absence Epileptic Rats: Dependency on Seizure Severity and Their Functional Coupling at Rest

Objective: Cognitive impairments are common complaints among people with epilepsy with its occurrence to emanate a great topic in the course of the illness, so our study aimed to examine the executive functions in adult patients with idiopathic epilepsy. Methods: Forty consecutive adult patients with idiopathic epilepsy (either generalized or focal) with age range from 18 - 45 years old, IQ > 85, treated with either monotherapy or polytherapy, matched with forty healthy adult volunteers by age, sex and educational level. They were examined in executive functions tests: cognitive flexibility and set shifting (Wisconsin Card sorting Test), Planning (Tower of London), response inhibition (Continuous Performance Test) and working memory (verbal and visuospatial). Results: Patients with epilepsy showed deficits in all executive functions tests, with no difference between patients with generalized and focal epilepsy except for correct response time mean in CPT. There was significant positive correlation between frequency of seizures and mean total time, mean number of extra movies in TOL, in verbal working memory (digit back word), and omission errors in CPT; at the same time there was significant negative correlation between target accuracy rate and frequency of seizures in CPT, and in visuo-spatial part of working memory (Corsi Block-Tapping Test). Conclusion: Adult patients with idiopathic epilepsy had executive dysfunctions than healthy control, with no difference between generalized and focal epilepsy except for correct response time mean in CPT; the increase of the frequency of seizure is associated with impairment in planning, attention and working memory (either verbal or viuso-spatial).

Neurocognitive Functions in Bipolar Disorder in Relation to Comorbid ADHD.

Bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD) often co-occur in adult population. Both conditions present various neurocognitive and behavioral problems. We aimed to examine neurocognitive functions in adult patients with comorbid BD and ADHD (BD+ADHD) in comparison to patients with only BD, only ADHD and healthy controls (HCs). An extensive cognitive battery which evaluates verbal learning and memory, visual memory, processing speed, attention, executive functions, working memory and verbal fluency, was used to assess neurocognitive functions respectively in adult (age 18-65 years) patients with BD (n=37), ADHD (n=43), BD+ADHD (n=20) in comparison to HCs (n=51). The Multivariate Analysis of Covariance models, where age, level of education and total BIS-11 scores were included as covariates, were used for comparing neurocognitive scores among groups. Both BD and BD+ADHD groups showed significantly poorer performance than HCs in processing speed, attention, executive functions, and verbal fluency domains. The BD group had additional significant deficits in executive functions, verbal learning and memory domains. There were no significant differences between BD and BD+ADHD groups with regards to verbal learning and memory, visual memory, processing speed, attention, executive functions, working memory and verbal fluency domains. Patients with only ADHD showed significantly poorer performance than HCs in verbal fluency domain. Our results show similarities in the neurocognitive functions of adults with BD and BD+ADHD across a wide range of cognitive domains. The findings point to the need for further exploration of diverging and converging neurodevelopmental trajectories of BD and ADHD.

Neural correlates of performance monitoring in adult patients with Gilles de la Tourette syndrome: A study of event-related potentials

ObjectivesGilles de la Tourette syndrome (GTS) is a neuropsychiatric condition characterized by motor and vocal tics. There is undoubtedly basal ganglia involvement, which are also important for cognitive processes including performance monitoring and interference resolution. We investigated these functions in adult patients with GTS compared to healthy controls (HCs). MethodsWe compared a group of N = 23 adult patients with GTS to N = 27 HC on a flanker task during an EEG recording. Reaction times and error rates were recorded, as well as N2 and Ne/ERN amplitudes. The N2 is an index of interference resolution. The Ne/ERN is a negative fronto-central component, occurring when participants make mistakes. ResultsPatients’ reaction times were enhanced on incongruent trials compared to HC. Electrophysiological data revealed more frontal components, as well as significantly increased Ne/ERN amplitudes in patients with GTS compared to HC (p = 0.026). ConclusionsAltered electrophysiological correlates of error processing in adult patients with GTS compared to HC cannot be attributed to differential error probabilities. Potentially, patients recruit compensatory resources from frontal networks to maintain behavioural performance. SignificanceThis study gives further insight into cognitive deficits of patients with GTS, and the underlying neural processes of these functions.

Impact of cerebral blood flow changes due to arterial bypass surgery on cognitive function in adult patients with symptomatic ischemic moyamoya disease.

Some adult patients with moyamoya disease (MMD) undergoing revascularization surgery show an improvement or decline in cognition postoperatively. Revascularization surgery for ischemic MMD augments cerebral blood flow (CBF) and improves cerebral oxygen metabolism. However, cerebral hyperperfusion, which is a short-term, major increase in ipsilateral CBF that is much greater than the metabolic needs of the brain, sometimes occurs as a complication. Cerebral hyperperfusion produces widespread, minimal injury to the ipsilateral white matter and cortical regions. The aim of the present prospective study was to determine how changes in CBF due to arterial bypass surgery affect cognitive function in adult patients with symptomatic ischemic MMD and misery perfusion. Thirty-two patients with cerebral misery perfusion, as determined on the basis of 15O gas positron emission tomography, underwent single superficial temporal artery-middle cerebral artery (M4 in the precentral region) anastomosis. Brain perfusion single-photon emission computed tomography (SPECT) studies were performed preoperatively, on the 1st postoperative day, and 2 months after surgery. Neuropsychological tests were also performed preoperatively and 2 months after surgery. Postoperative neuropsychological assessments demonstrated cognitive improvement in 10 cases (31%), no change in 8 cases (25%), and decline in 14 cases (44%). Based on brain perfusion SPECT and symptoms, 10 patients were considered to have cerebral hyperperfusion syndrome, and all of these patients exhibited a postoperative decline in cognition. Relative precentral CBF on the 1st postoperative day was significantly greater in patients with postoperative cognitive decline (167.3% ± 15.3%) than in those with improved (105.3% ± 18.2%; p < 0.0001) or unchanged (131.4% ± 32.1%; p = 0.0029) cognition. The difference between relative precentral CBF 2 months after surgery and that before surgery was significantly greater in patients with postoperative cognitive improvement (17.2% ± 3.8%) than in those with no postoperative change (10.1% ± 2.4%; p = 0.0003) or with postoperative decline (11.5% ± 3.2%; p = 0.0009) in cognition. Cerebral hyperperfusion in the acute stage after arterial bypass surgery impairs cognitive function. An increase in CBF in the chronic stage without acute-stage cerebral hyperperfusion improves cognitive function in adult patients with symptomatic ischemic MMD and misery perfusion.

Functional near-infrared spectroscopy for intraoperative brain mapping.

.Functional near-infrared spectroscopy (fNIRS) is a relatively new seizure-free technique and its value for intraoperative brain mapping is unknown. We examine the feasibility of fNIRS for intraoperative functional brain mapping. A density fNIRS probe specially designed for intraoperative use was used to map brain function in adult patients undergoing awake brain surgery and performing motor and/or language tasks. The ability of fNIRS for functional mapping was compared with direct cortical stimulation (DCS) and regression was used to determine if mean blood pressure (MBP) and blood hemoglobin influenced fNIRS measurements. Eighteen patients underwent awake craniotomy and performed 19 language- and 17 motor-related tasks. fNIRS mapping was highly correlated with DCS for 10 language- and 7 motor-related tasks. fNIRS was able to detect functional language () and motor areas (). Compared to DCS, fNIRS was less accurate in determining both functional language (at least 22.64%, ) and motor areas (at least 32.74%, ). Higher MBP and blood hemoglobin were associated with better fNIRS results ( and 0.007, respectively). No seizures or other complications occurred during fNIRS measurement. fNIRS is a promising seizure-free technique for intraoperative brain mapping. The accuracy of current technology needs further development for clinical use.

Effects of cardiopulmonary bypass perfusion temperature on perioperative renal function in adult patients undergoing cardiac surgery

Aims and objectiveThe primary objective of this investigation was to study the effects of cardiopulmonary bypass (CPB) perfusion temperature on renal function parameters [serum creatinine, creatinine clearance, urine albumin, urine protein, and urine albumin/creatinine ratio (ACR)]. The secondary objective was to detect renal complications of CPB. Materials and methodsThis is a prospective longitudinal study of 30 adult patients (17 men, 13 women; mean age, 53.37 ± 16.02 years) who underwent valvular heart surgery [with or without coronary artery bypass grafting (CABG)]. Serum creatinine, creatinine clearance, urine protein, urine albumin, and urine ACR were collected during CPB (at 28 °C, 32 °C, and 37 °C) and postoperatively (at 12 hours, 24 hours, and 48 hours). Data were analyzed using one-way repeated-measures analysis of variance (ANOVA). A significant ANOVA was followed by a Bonferroni–Holm post hoc test. ResultsAlthough serum creatinine (p < 0.001) and creatinine clearance (p = 0.0016) underwent a significant ANOVA change (p < 0.001 and p = 0.0016, respectively) after CPB, there was no statistically significant change compared with their baseline values. Urine ACR showed a significant change at 28 °C (p < 0.01), 32 °C (p < 0.01), and 37 °C (p < 0.05) as compared with baseline values. No significant change in urine albumin was observed during CPB or up to 24 hours. A significant change occurred after 48 hours of CPB (p < 0.05). A significant increase in urine protein was noted after CPB at 12 hours (p < 0.01), 24 hours (p < 0.01), and 48 hours (p < 0.01). Overall, 12 (40%) patients had acute kidney injury (AKI). Ten (33.33%) patients had stage I AKI, one patient progressed to AKI stage II, and another to AKI stage III. Of the 10 patients who had stage I AKI, eight had complete recovery within 48 hours. ConclusionsCPB with moderate hypothermia for valvular heart surgeries can be performed safely in patients with adequate renal functional reserve. The glomerular permeability across the Bowman’s capsule increases after CPB as evidenced by significant proteinuria at 12 hours and increased albuminuria at 48 hours after surgery. There is an increased risk of transient stage I AKI after CPB, from which patients recover within 48 hours.

P6328Relationship between exercise capacity and muscle function in adult patients with heart failure

Abstract Introduction Physical fitness is a multidimensional concept and is of great importance to assess in heart failure (HF) patients, due to that HF is associated with exercise intolerance, dyspnea and fatigue. Some measures of physical fitness have been associated to HF severity, rehospitalization and mortality risk. Purpose The aim of this study was to explore the relationship between two different measures of physical fitness in patients with HF: exercise capacity and muscle function. Methods This is a secondary analysis performed on the baseline data of a multi-centre RCT study aimed at exploring the effect of exergame access to improving exercise capacity in HF patients. Physical fitness was assessed by two different measures: exercise capacity assessed by the 6-minute walk test (6MWT), and muscle function assessed by 3 different isometric tests of upper and lower limbs. Descriptive statistics, Spearman correlation and principal component analysis were used to analyse the data. Results In total, 605 HF patients were included in this analysis (mean age 67±12, 29% women, 90% NYHA II/III). Exercise capacity (6MWT) was correlated with all of the muscle function tests, with correlation-coefficients ranging from r=0.23 to r=0.50 (p&lt;0.001). Principal component analysis showed a bi-dimensional nature of physical fitness, with the first dimension including the lower body strength and the second dimension including the upper body strength and exercise capacity. These two dimensions explained 71% of the total variance of the measured variables. Correlation matrix (n=605) 6MWT Right Heel-Lift Left Heel-Lift Shoulder abduction Right Shoulder Flexion Left Shoulder Flexion 6MWT 1 Right Heel-Lift 0.23** 1 Left Heel-Lift 0.26** 0.86** 1 Shoulder abduction 0.40** 0.30** 0.34** 1 Right Shoulder Flexion 0.47** 0.51** 0.48** 0.52** 1 Left Shoulder Flexion 0.50** 0.49** 0.48** 0.52** 0.83** 1 **p&lt;0.001. Principal Component Analysis Conclusions Although strong correlations between exercise capacity and muscle function tests, the measures loaded on two different factors. The results suggest that upper body strength and exercise capacity had a stronger relationship than with lower body strength. This may imply that muscle function tests for upper and lower limbs and exercise capacity represent different aspects of physical fitness and to attain a more complete assessment of physical fitness all three tests are important. Acknowledgement/Funding Swedish National Science Council, The Swedish Heart and Lung Association, The Swedish Heart and Lung Association, Swedish Heart-Lung Foundation

Fluid Balance and Recovery of Native Lung Function in Adult Patients Supported by Venovenous Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy.

Fluid overload is associated with increased mortality in adult patients with acute respiratory distress syndrome. In patients requiring venovenous extracorporeal membrane oxygenation (VV-ECMO), the effects of fluid removal on survival and lung recovery remain undefined. We assessed the impact of early fluid removal in adult patients supported by VV-ECMO and concomitant continuous renal replacement therapy, in an 18-bed tertiary intensive care unit between 2010 and 2015. Twenty-four patients met inclusion criteria, of these 15 (63%) survived to hospital discharge. In our patient group, a more negative cumulative daily fluid balance was strongly associated with improved pulmonary compliance (2.72 ml/cmH2O per 1 L negative fluid balance; 95% confidence interval [CI]: 1.61-3.83; P < 0.001). In addition, a more negative mean daily fluid balance was associated with improved pulmonary compliance (4.37 ml/cmH2O per 1 L negative fluid balance; 95% CI: 2.62-6.13; P < 0.001). Survivors were younger and had lower mean daily fluid balance (-0.33 L [95% CI: -1.22 to -0.06] vs. -0.07 L [95% CI: -0.76 to 0.06]; P = 0.438) and lower cumulative fluid balance up to day 14 (-4.60 L [95% CI: -8.40 to -1.45] vs. -1.00 L [95% CI: -4.60 to 0.90]; P = 0.325), although the fluid balance effect alone did not reach statistical significance.

The Association of Therapy Adherence and Thyroid Function in Adult Patients with Phenylketonuria

Background: The standard, lifelong therapy of phenylketonuria (PKU) is a natural protein-restricted diet complemented with phenylalanine (Phe)-free L-amino acid mixtures that provide the daily necessary micronutrients. Objective: To assess thyroid function and structure and the iodine status of early-treated adult PKU (ETPKU) patients in Hungary. Methods: Sixty-nine PKU patients (aged 18–41 years) and 50 healthy controls were enrolled in the study. Thyroid hormones, serum thyroglobulin, thyroid antibodies, urinary iodine, and selenium concentrations were measured, and thyroid ultrasound was performed. Results: The incidence of thyroid dysfunction was infrequent (n = 2). Blood Phe was negatively correlated with thyroid-stimulating hormone (TSH), and PKU patients had higher free thyroxine and lower TSH levels than healthy controls. Although optimal iodine status was found in the entire PKU population, by dividing the patients according to their therapy compliance, we observed that lower therapy adherence was associated with mild iodine deficiency and lower urinary selenium levels. Conclusions: The results of this study suggest that iodine status is strongly influenced by the adherence to therapy in ETPKU patients. No or not enough medical food consumption combined with a low-Phe diet can lead to subclinical iodine deficiency.

P224 The effect of protein supplementation on inflammatory markers, body composition and lung function in adult patients with cystic fibrosis

P224 The effect of protein supplementation on inflammatory markers, body composition and lung function in adult patients with cystic fibrosis

P153 Impact of Achromobacter xylosoxidans on the respiratory function of adult patients with cystic fibrosis

P153 Impact of Achromobacter xylosoxidans on the respiratory function of adult patients with cystic fibrosis

Acute Effects of Aerobic Exercise on Executive Function and Attention in Adult Patients With ADHD.

Aerobic exercise can improve cognitive functions in healthy individuals and in various clinical groups, which might be particularly relevant for patients with ADHD. This study investigated the effects of a single bout of aerobic exercise on attention and executive functions in adult patients with ADHD, including functional MRI to examine the underlying neural mechanisms. On two different days, 23 adult patients with ADHD and 23 matched healthy controls performed in a flanker task, while functional MR images were collected, following 30 min of continuous stationary cycling with moderate intensity as well as after a control condition (watching a movie). Behavioral performance and brain activation were tested for differences between groups and conditions and for interactions to investigate whether exercise improves executive function to a greater extent in patients compared to healthy controls. Exercise significantly improved reaction times in congruent and incongruent trials of the flanker task in patients with ADHD but not in healthy controls. We found no changes in brain activation between the two conditions for either group. However, a subgroup analysis of ADHD patients with a higher degree of cardiorespiratory fitness revealed decreased activation in premotor areas during congruent trials and in premotor and medial frontal cortex during incongruent trials in the exercise compared to the control condition. Our results indicate exercise-induced improvements in attention and processing speed in patients with ADHD, demonstrating that adult patients with ADHD may benefit from an acute bout of exercise. These findings could be of high relevance for developing alternative treatment approaches for ADHD. In addition, results of the current study contribute to elucidate the neurophysiological mechanisms underlying the beneficial effects of exercise on cognition and to better understand the role of cardiorespiratory fitness on these effects.

Neurocognitive functioning in adults with phenylketonuria: Report of a 10-year follow-up

BackgroundThe long-term prognosis of early treated phenylketonuria (PKU) is still under discussion. Aim of this controlled long-term study was to assess the neurological and neuropsychological outcome in adult patients with early-treated PKU. MethodsWe investigated 35 patients with early-treated classical PKU aged 29 to 51 years (mean age 41 years) and 18 healthy controls matched for age and socioeconomic status. Patients and controls were assessed for their intelligence quotient (IQ), attention and information-processing abilities. Magnetic resonance imaging (MRI) of the brain was performed in all patients. Neuropsychological assessments and MRI were repeated at a five-year and a ten-year follow-up. ResultsIn the entire interval IQ, information processing and attention of patients and controls remained constant. At both follow-up assessment times the IQ scores were significantly lower in patients compared to controls. Older adult patients (> 42 years) showed poorer information processing and attention at both assessment times compared to young adult patients (< 42 years) and controls. IQ, information processing and attention showed no correlation to imaging results. IQ, however, was significantly correlated to blood phenylalanine (Phe) levels in patients´ childhood and adolescence, and Phe levels had been higher in the adolescent years of older adult patients. ConclusionsCognitive performance in adult patients with early-treated PKU does not seem to deteriorate in a ten-year interval. Neuropsychological assessment in adults with PKU revealed neurocognitive impairment particularly in older adult patients. This seems to refer to an early relaxation of diet that was recommended when the older patients were adolescents. Results indicate a benefit of dietary control during adolescence in PKU.

The Mid-Term Results of Pulmonary Valve Replacement on the Right and Left Ventricular Functions in Adult Patients with Repair of Tetralogy of Fallot

The Mid-Term Results of Pulmonary Valve Replacement on the Right and Left Ventricular Functions in Adult Patients with Repair of Tetralogy of Fallot

Neuromuscular electrical stimulation improves exercise capacity in adult patients with chronic lung disease: a meta-analysis of English studies

Neuromuscular electrical stimulation (NMES) has been suggested as an alternative rehabilitative therapy to enhance exercise performance and skeletal muscle function in adult patients with chronic lung disease. However, the results of individual studies have been inconsistent. We performed a meta-analysis to evaluate the effectiveness of NMES with regard to increasing exercise capacity, quadriceps strength, muscle mass, cross-sectional area, and quality of life and decreasing dyspnea in adult patients with chronic lung disease. A systematic search was conducted of the PubMed, Cochrane Library and EMBASE databases for randomized controlled trials (RCTs) published in English-language journals before January 2018. Data were extracted using standardized forms, and the weighted mean difference (WMD) or standardized mean difference (SMD) with 95% confidence intervals (CIs) was calculated. Eleven RCTs involving 368 patients were included in this meta-analysis. The pooled results showed that NMES significantly improved the 6-min walk distance (WMD: 37.93 m, 95% CI: 19.53-56.33 m; P<0.0001; P for heterogeneity =0.11; I2=47%) but not the incremental shuttle walk test (WMD: 18.18 m, 95% CI: -79.41 to 115.77 m, P=0.72; P for heterogeneity <0.0001, I2=94%) or endurance shuttle walk test (ESWT) (WMD: 96.73 m, 95% CI: -45.58 to 239.03 m, P=0.18; P heterogeneity =0.22, I2=34%). Moreover, NMES was associated with a significant improvement in quadriceps strength (SMD: 1.14, 95% CI: 0.86-1.43, P<0.00001; P heterogeneity =0.02, I2=58%). This systemic review and meta-analysis provided evidence supporting the beneficial role of NMES in improving exercise capacity in patients with chronic respiratory disease.

Patient-Reported and Neurocognitive Outcomes in Patients Treated with Axicabtagene Ciloleucel

Background: Axicabtagene ciloleucel (axi-cel) is a CD19 targeted chimeric antigen receptor (CAR) T-cell therapy that may induce durable responses in relapsed/refractory lymphoma patients whose survival prospects are otherwise poor. Recent FDA approval of axi-cel and other CAR T-cell therapies is expected to lead to a growing population of cancer survivors treated with these therapies. Little is known about patient-reported outcomes (PROs) such as symptomatology and quality of life (QOL) in these patients. The goal of the current observational study was to examine PROs and neurocognitive functioning in adult patients in the first 90 days after treatment with axi-cel.Methods: Patients who were scheduled to undergo axi-cel therapy as part of a clinical trial or standard of care at Moffitt Cancer Center were recruited prior to conditioning chemotherapy. Patients completed items from the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) at enrollment and 14, 30, 60, and 90 days post-CART. A total of 20 symptoms were selected for inclusion based on clinician-rated toxicity of CART reported on clinical trials as well as symptoms likely to be of concern to cancer patients (e.g., fatigue, insomnia, diarrhea, constipation, nausea, decreased appetite). Patients also completed the Medical Outcomes Study Short Form 36 (SF-36) QOL measure at baseline and 90 days. Neurocognitive assessments were completed at baseline and 30 days using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Means, SDs, frequencies, and Wilcoxon signed rank tests were used to characterize outcomes and change over time.Results: Participants were 29 patients (28% female; mean age=58, SD=13; 52% treated on an interventional trial). Participants were diagnosed with diffuse large B-cell lymphoma (76%), follicular lymphoma or transformed follicular lymphoma (10%), mediastinal large b cell lymphoma (3%), or other indications (11%). Of these, 11 completed neurocognitive testing at baseline and 30 days. Patient-reported symptoms spiked at 14 days post-CAR-T before returning to levels similar to baseline. The most common symptoms at 14 days post-CAR-T were decreased appetite (95% any severity, 48% moderate to severe), fatigue (95% any severity, 43% moderate to severe), and dry mouth (85% any severity, 38% moderate to severe). By 90 days post-CAR-T, the most common symptoms were fatigue (82% any severity), insomnia (55% any severity), and joint pain (45% any severity); no patients reported moderate to severe symptoms at this time. Non-significant improvements were observed in physical health QOL (mean increase=1.43; p=0.37) and mental health QOL (mean increase=2.66, p=0.07) from baseline to 90 days. Patients demonstrated non-significant declines in total RBANS percentile score from baseline to day 30 (mean decrease=-8.18, p=0.32). Updated results will be presented at the meeting.Conclusions: This study is the first to our knowledge to report on both PROs and neurocognitive outcomes in patients treated with CAR T-cell therapy. Results indicate that moderate-to-severe patient-reported symptoms were transient following axi-cel, although a majority of patients reported ongoing, low-grade symptoms at 90 days post-treatment. Quality of life and neurocognition did not significantly change over time. These preliminary findings warrant larger future studies with longer follow-up to better understand changes in PROs and neurocognition in cancer survivors treated with CAR-T. DisclosuresJim:Janssen: Consultancy; RedHill Biopharma: Consultancy. Locke:Kite Pharma: Other: Scientific Advisor; Novartis Pharmaceuticals: Other: Scientific Advisor; Cellular BioMedicine Group Inc.: Consultancy.

Effectiveness of Aquatic Therapy on Reducing Pain and Increasing Physical Function in Adult Patients with Hip and/or Knee Osteoarthritis

Effectiveness of Aquatic Therapy on Reducing Pain and Increasing Physical Function in Adult Patients with Hip and/or Knee Osteoarthritis

Association of Muscle Strength and Walking Performance in Adult Patients With Pompe Disease.

BackgroundThe loss of the ability to walk is among the most prominent signs of Pompe disease. The associations with muscle strength have not been described.ObjectiveThe objective of this study was to estimate the associations of walking performance with muscle strength in 4 specific lower extremity muscle groups along with other factors in adult patients with Pompe disease.DesignThis was a single-center, cross-sectional study.MethodsMuscle strength (hand-held dynamometry of hip flexion and abduction and knee extension and flexion) and walking performance (unable to walk, able with aids, walking without aids but with a waddling gait, or walking without aids and with a normal gait) were assessed in 107 patients at their first visit. Relationships between walking performance and muscle strength were studied through multivariate analyses and regression modeling. Age, sex, body mass index (BMI), disease duration, and use of ventilator support were taken into account as potential confounders. The results were transformed into a nomogram to allow the probability of a patient having a certain level of walking performance to be calculated based on the values of the independent variables.ResultsWalking performance declined significantly with decreasing muscle strength of hip flexion and abduction and knee extension and flexion. The final selected model, including strength of the hip abductor and knee extensor, BMI, age, sex, and use of ventilation, predicted 66% of the cases accurately.LimitationsThese results are based on cross-sectional data and do not predict future changes.ConclusionsIn adult people with Pompe disease, walking performance can be explained by muscle strength, BMI, age, sex, and ventilation use. The proposed model gives insight into how an individual is expected to walk based on his or her risk factors and serves as a starting point to unraveling factors associated with walking performance and ultimately to developing a prognostic model.