Gender-matched General Population Research Articles

Long-Term Results of Mitral Valve Repair.

IntroductionCurrent guidelines state that patients with severe mitral regurgitation should be treated in reference centers with a high reparability rate, low mortality rate, and durable results.ObjectiveTo analyze our global experience with the treatment of organic mitral regurgitation from various etiologies operated in a single center.MethodsWe evaluated all surgically treated patients with organic mitral regurgitation from 2004-2017. Patients were evaluated clinically and by echocardiography every year. We determined early and late survival rates, valve related events and freedom from recurrent mitral regurgitation and tricuspid regurgitation. Valve failure was defined as any mitral regurgitation ≥ moderate degree or the need for reoperation for any reason.ResultsOut of 133 patients with organic mitral regurgitation, 125 (93.9%) were submitted to valve repair. Mean age was 57±15 years and 52 patients were males. The most common etiologies were degenerative disease (73 patients) and rheumatic disease (34 patients). Early mortality was 2.4% and late survival was 84.3% at 10 years, which are similar to the age- and gender-matched general population. Only two patients developed severe mitral regurgitation, and both were reoperated (95.6% at 10 years). Freedom from mitral valve failure was 84.5% at 10 years, with no difference between degenerative and rheumatic valves. Overall, late ≥ moderate tricuspid regurgitation was present in 34% of the patients, being more common in the rheumatic ones. The use of tricuspid annuloplasty abolished this complication.ConclusionWe have demonstrated that mitral regurgitation due to organic mitral valve disease from various etiologies can be surgically treated with a high repair rate, low early mortality and long-term survival that are comparable to the matched general population. Concomitant treatment of atrial fibrillation and tricuspid valve may be important adjuncts to optimize long-term results.

Incidence, mortality, and causes of death in physician-diagnosed primary Sjögren's syndrome in Korea: A nationwide, population-based study.

The objective of this study was to investigate the epidemiological features of primary Sjögren's syndrome (pSS) in Korea at a national level, including the incidence, mortality, and causes of death. We used a national, population-based registry database called the Rare Intractable Disease Registration Program from the Health Insurance Review and Assessment Service to obtain pSS patient data for the period between 2010 and 2014. pSS was diagnosed by a physician based on uniform criteria. We also used data from Statistics Korea to confirm the mortality and causes of death. Between 2010 and 2014, the total number of patients newly diagnosed with pSS was 5891, resulting in an annual incidence of 2.34 per 100,000 individuals. The female-to-male ratio was 14.5:1. A total of 114 pSS patients died during the study period. The overall survival rate of pSS patients was 99.0%, and the 1-year, 2-year, and 5-year survival rates were 98.7%, 98.1%, and 97.1%, respectively, and the standardized mortality ratio (SMR) was 1.47 (2.14 for males and 1.35 for females). The most common causes of death were respiratory disease (n = 25; 21.9%) followed by circulatory diseases (n = 21; 18.4%), musculoskeletal connective tissue diseases (n = 21; 18.4%), and cancer (n=19; 16.7%). The national incidence of pSS in Korea presented in this study was lower in comparison with reports from other countries. However, the mortality rate was significantly higher than the corresponding values in the age- and gender-matched general population. The higher mortality in pSS patients is attributable to respiratory diseases and lung cancer.

Results of the Ross procedure in adults: a single-centre experience of 741 operations.

Although the Ross procedure provides excellent long-term survival and a high quality of life, only a limited number of centres perform it as an alternative to the standard aortic valve replacement in adults. In the present study, we evaluated our 16-year results of using the Ross procedure in adult patients. Between 1998 and 2014, 741 adult patients underwent the Ross procedure. The mean patient age was 47.4 ± 12.8 years (range, 18-67 years). The total root replacement technique was used in all patients. Right ventricular outflow tract (RVOT) reconstruction was performed with pulmonary allograft in 175 (23.6%) patients, with different types of xenografts in 561 (75.7%) and with polytetrafluoroethylene conduits in 5 (0.7%) patients. The early mortality rate was 3.0%. The mean follow-up duration was 5.8 ± 2.2 years. The survival rate at 10 years was 90.7% and was comparable with survival of an age- and sex-matched general population. The rate of freedom from autograft reoperations was 94.1 and 88.3% at 5 and 10 years, respectively. The aortic annulus dilatation was the only independent predictor of autograft failure. The 10-year freedom rates from reoperations for allograft, diepoxide- and glutaraldehyde-treated pericardial xenografts as well as porcine aortic root grafts were 100, 94.4, 82.7 and 80.6%, respectively. The use of xenografts and young patient age were associated with increased risk of RVOT conduit failure. The Ross operation provides long-term survival rates that are comparable with an age- and gender-matched general population. The dilated aortic annulus is a risk factor for late autograft valve insufficiency. A cryopreserved pulmonary homograft is the best option for RVOT reconstruction. Diepoxide-treated pericardial xenografts can be an alternative to allografts in elderly patients when an allograft is not available.

Expectation and quality of life after aortic valve replacement over 85 years of age match those of the contemporary general population.

In the transcatheter aortic valve implantation (TAVI) years, very elderly patients with aortic stenosis (AS) are referred to surgery with reluctance despite excellent hospital outcomes. A poorly assessed outcome of discharged survivors might further overlook the actual efficacy of the surgical strategy in this cohort. We thus evaluated life-expectancy and functional results in discharged survivors over 85 years operated on for AS. Between January 2001 and December 2013, 57 consecutive patients aged ≥85 years underwent aortic valve replacement (AVR) with or without concomitant procedures at our institution. Late survival rate (SR), New York Heart Associaion (NYHA) functional class and quality of life (RAND SF-36) were assessed. SR and quality of life (QoL) were than compared to the contemporary general population matched for age and gender, as calculated by the Italian National Institute of Statistics. Overall in-hospital mortality was 8.8% (5 pts). In patients without concomitant coronary artery bypass grafting (CABG), in-hospital mortality was 2.9%. Survival at 5 and 9 years was 57.7 ± 8.4% and 17.9 ± 11.4%, respectively. No predictors of late mortality including concomitant CABG were identified at Cox analysis. The mean NYHA class for long-term survivors improved from 3.1 to 1.6 (p<0.001). Survivors reported better QoL-scores compared to the age- and gender-matched contemporary general population in 4 RAND SF-36 domains. Life-expectancy resulted comparable to that predicted for the age and gender-matched general population. Isolated AVR in patients aged ≥85 years can be performed with acceptable risk. Survivors improve in NYHA class and, when compared to age- and gender-matched individuals, show a similar life expectancy and a no lower QoL.

Survival and freedom from aortic valve-related reoperation after valve-sparing aortic root replacement in 1015 patients.

The aim of this study was to characterize mortality and aortic valve replacement after valve-sparing aortic root replacement (V-SARR) in a multicentre cohort. Between 1994 and 2014, 1015 patients had V-SARR with (n = 288, 28%) or without cusp/commissure repair (n = 727, 72%) at the centres of Lübeck (n = 343, 34%), Stuttgart (n = 346, 34%), Hamburg (n = 109, 11%) and Freiburg (n = 217, 21%), Germany. Comparative survival of an age- and gender-matched general population was calculated. Log-rank tests and multiple logistic regression were used to identify risk factors. The mean follow-up was 5.2 ± 3.9 years. Cumulative follow-up comprised 2933 patient-years. Early survival was 98%. NYHA status and aneurysm size were predictive of death during mid-term follow-up (P = 0.025). Freedom from aortic valve replacement was 90% at 8 years, with the type of V-SARR (root remodelling, David II) being a risk factor (P = 0.015). Bicuspid aortic valve (P = 0.26) and initial valve function (P = 0.4) did not impact reoperation. The need of additional valve repair (cusps/commissures) was not linked to reoperation: freedom from aortic valve replacement at 8 years was 84% if cusp repair was performed versus 90% if V-SARR alone was performed (P = 0.218). Marfan syndrome had no impact on survival or on aortic valve replacement. Mid-term survival of patients after V-SARR is comparable with that of a matched general population. The regurgitant bicuspid aortic valve is a favourable substrate for V-SARR. Prophylactic surgery should be performed before symptoms or large aneurysms are present to achieve optimal mid-term outcomes.

Incidence of Major Hemorrhage Among CLL and MCL Patients Compared to the General Elderly Population: An Analysis of the US SEER-Medicare Linked Database

Introduction: Patients with B cell malignancies have an inherent increased risk of bleeding. However, the incidence of major hemorrhage among patients with MCL and CLL has not been described. The objective of this study is to evaluate the risk of major hemorrhage in a real world setting by using a population-based data source.Methods: The SEER-Medicare linked database, a database of SEER cancer registry data linked to individual Medicare administrative claims, was utilized to follow a cohort of persons newly treated for CLL or MCL to estimate the incidence of major hemorrhage (CNS and non-CNS). Major hemorrhage was defined as having at least one code for hemorrhage in a critical area or organ or having another bleeding code with a transfusion within 14 days of the event. Patients with a cancer diagnosis on or after 1/1/2000 were followed through disenrollment from the database, death, the occurrence of major hemorrhage, or the end of the study period (12/31/2011), whichever came first. Incidence rates (IR) of major hemorrhage were characterized in terms of incidence per person-years (pys) of follow-up with 95% confidence intervals calculated according to a Poisson distribution. Rates in the CLL and MCL populations were compared to those in the age and gender-matched general population of a sample of non-cancer Medicare patients using Cox proportional hazards models.Results: A total of 1,587 treated MCL patients, 6,717 treated CLL/SLL patients, and 14,816 age and gender-matched non-cancer patients were identified in the database. Median age among all three cohorts was approximately 75 years. Among patients treated for MCL, 287 (18%) had at least one major hemorrhage, corresponding to an incidence of 5.8 per 100 pys. Among 6,717 CLL patients, 1,211 (18%) had at least one major hemorrhage (IR: 6.0 per 100 pys). In the age and gender-matched non-cancer population, incidence of major hemorrhage was 1.6 per 100 pys. The hazard ratio for development of any major hemorrhage among CLL patients compared to the non-cancer cohort was 8.3 (95% CI: 7.5-9.2), and for MCL compared to the non-cancer cohort was 8.8 (95% CI: 7.6-10.2). IR of CNS hemorrhage was also higher among MCL and CLL patients (0.9 and 1.2 per 100 pys, respectively) compared to the non-cancer cohort (0.04 per 100 pys). Gastrointestinal hemorrhage was the most frequent site of occurrence.Conclusions: Among persons newly initiating treatment for CLL and MCL, incidence of major hemorrhage was found to be over 8 times higher than that of the age- and gender-matched general population. Additional analyses to establish whether this increased risk is attributable to the disease itself, comorbid conditions, choice of cancer therapy, or concomitant medications in the patient population and/or other risk factors are planned. Baseline risks among CLL and MCL patients should be considered when establishing risk/benefit profiles of a particular treatment. DisclosuresGifkins:Johnson and Johnson: Employment. Matcho:Johnson and Johnson: Employment. Yang:Pharmacyclics, Inc: Employment. Xu:Johnson and Johnson: Employment. Gooden:Pharmacyclics, Inc.: Employment. Wildgust:Janssen Pharmaceuticals, Inc.: Employment.

TYPE 2 DIABETES IN PATIENTS WITH MAJOR DEPRESSIVE DISORDER: A META-ANALYSIS OF PREVALENCE ESTIMATES AND PREDICTORS.

Patients with depression may be at increased risk of type 2 diabetes mellitus (T2DM), which is a risk factor for cardiovascular diseases and premature mortality. We aimed to clarify the prevalence and predictors of T2DM in patients with major depressive disorder (MDD) and where possible compare the prevalence of T2DM in those with MDD versus general population controls. We searched major electronic databases until December 2014 for studies reporting T2DM prevalence in patients with MDD. Two independent authors extracted data and completed methodological quality appraisal in accordance with the meta-analysis of observational studies in epidemiology (MOOSE) guidelines. A random effects meta-analysis was utilized. The initial electronic database search resulted in 145 valid hits and 16 publications with clearly defined MDD (n = 15,8834; 31% male; mean age = 39-78 years) met the eligibility criteria. The overall prevalence of T2DM was 8.7% (95% confidence interval [CI] = 7.3-10.2%). Mean age of the MDD sample predicted a higher prevalence of T2DM (β = 0.0411; 95% CI = 0.0032-0.079, P = .03; R² = .22). A comparative meta-analysis revealed people with MDD (n = 154,366) had a higher risk of T2DM versus general controls (n = 2,098,063; relative risk [RR] = 1.49; 95% CI = 1.29-1.72; P < 0.001, N = 10). The RR (N = 3) focusing on age- and gender-matched general population controls (n = 103,555) was 1.36 (95% CI = 1.28-1.44; P < 0.001, n [MDD] = 10,895). T2DM is significantly more common in people with MDD compared with the general population. The current meta-analysis indicates that action is needed in order to curb the diabetes epidemic in this high-risk population.

Prognostic factors of health-related quality of life in patients after tibial plafond fracture. A pilot study

BackgroundTibial plafond fractures are a uncommon injury, and the outcomes described in literature are generally poor. The purposes were to determine the effect of the tibial plafond fractures on general health-related quality of life, and to examine the factors that influence these outcomes. MethodsRetrospective study of 43 patients with average age of 45.6 (range 18–69) years who were also invited for a clinical and radiological reassessment. The primary outcome measure was quality of life assessed by the Short Form-36 questionnaire. Visual analogue scale for pain, and motion of both ankle and subtalar joints were also assessed. Radiological evaluation was performed to assess bone healing, fracture reduction quality, and tibial alignment. ResultsThe mean follow-up at last visit was 8.1 (range, 4–12) years. Patients who had suffered plafond fracture had significantly poorer quality of life compared with age- and gender-matched general population of our country regardless of the treatment method used. Multivariate analyses showed that the age had influence on the emotional outcomes, educational level and fracture pattern on physical outcomes, and marital status, fracture reduction quality, and ankle motion on both physical and mental component summaries. ConclusionTibial plafond fractures have a significant negative impact on general health-related quality of life regardless of the operative treatment used which reflects injury severity. In addition, psychosocial characteristics of patients may influence the outcomes.

Long-term survival and quality of life after intensive care for patients 80 years of age or older.

BackgroundComparison of survival and quality of life in a mixed ICU population of patients 80 years of age or older with a matched segment of the general population.MethodsWe retrospectively analyzed survival of ICU patients ≥80 years admitted to the Haukeland University Hospital in 2000–2012. We prospectively used the EuroQol-5D to compare the health-related quality of life (HRQOL) between survivors at follow-up and an age- and gender-matched general population. Follow-up was 1–13.8 years.ResultsThe included 395 patients (mean age 83.8 years, 61.0 % males) showed an overall survival of 75.9 (ICU), 59.5 (hospital), and 42.0 % 1 year after the ICU. High ICU mortality was predicted by age, mechanical ventilator support, SAPS II, maximum SOFA, and multitrauma with head injury. High hospital mortality was predicted by an unplanned surgical admission. One-year mortality was predicted by respiratory failure and isolated head injury. We found no differences in HRQOL at follow-up between survivors (n = 58) and control subjects (n = 179) or between admission categories. Of the ICU non-survivors, 63.2 % died within 2 days after ICU admission (n = 60), and 68.3 % of these had life-sustaining treatment (LST) limitations. LST limitations were applied for 71.3 % (n = 114) of the hospital non-survivors (ICU 70.5 % (n = 67); post-ICU 72.3 % (n = 47)).ConclusionsOverall 1-year survival was 42.0 %. Survival rates beyond that were comparable to those of the general octogenarian population. Among survivors at follow-up, HRQOL was comparable to that of the age- and sex-matched general population. Patients admitted for planned surgery had better short- and long-term survival rates than those admitted for medical reasons or unplanned surgery for 3 years after ICU admittance. The majority of the ICU non-survivors died within 2 days, and most of these had LST limitation decisions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-015-0053-0) contains supplementary material, which is available to authorized users.

Investigation of fasciculation and elongation protein ζ-1 (FEZ1) in peripheral blood reveals differences in gene expression in patients with schizophrenia.

Schizophrenia (SZ) is a chronic neuropsychiatric disorder characterized by affective, neuromorphological and cognitive impairment, deteriorated social functioning and psychosis with underlying molecular abnormalities, including gene expression changes. Observations have suggested that fasciculation and elongation protein ζ-1 (FEZ1) may be implicated in the pathogenesis of schizophrenia. Nevertheless, our current knowledge of the expression of FEZ1 in peripheral blood of schizophrenia patients remains unclear. The purpose of this study was to identify the characteristic gene expression patterns of FEZ1 in peripheral blood samples from schizophrenia patients. We performed quantitative reverse-transcriptase (qRT-PCR) analysis using peripheral blood from drug-free schizophrenia patients (n = 29) and age and gender-matched general population controls (n = 24). For the identification of FEZ1 gene expression patterns, we applied a comparative threshold cycle (CT) method. A statistically significant difference of FEZ1 mRNA level was revealed in schizophrenia subjects compared to healthy controls (p = 0.0034). To the best of our knowledge, this study is the first describing a down-regulation of FEZ1 gene expression in peripheral blood of patients with schizophrenia. Our results suggested a possible functional role of FEZ1 in the pathogenesis of schizophrenia and confirmed the utility of peripheral blood samples for molecular profiling of psychiatric disorders including schizophrenia. The current study describes FEZ1 gene expression changes in peripheral blood of patients with schizophrenia with significantly down-regulation of FEZ1 mRNA. Thus, our results provide support for a model of SZ pathogenesis that includes the effects of FEZ1 expression.

Prevalence and risk factors of atherothrombotic events among 1054 hemophilia patients: A population-based analysis

IntroductionReports on the prevalence and risk factors of atherothrombotic events (AEs) are conflicting in persons with hemophilia (PWH). MethodsThis study evaluated the prevalence and risk factors of AEs among 1054 male hemophilia patients, using data collected from Taiwan’s National Health Insurance Research Database between 1997 and 2010, by comparing variable to those of an unaffected 10540 age- and gender-matched general population. ResultsThe proportions of all AEs among PWH, including 26 ischemic stroke, 29 coronary artery disease and 5 peripheral arterial disease were comparable to those in the general population. The mean age at diagnosis of AE among PWH was younger than that in the general population: 49.0 (95% CI, 43.6-54.5) and 55.8years (95% CI, 54.5-57.0), P=0.019, respectively. PWH with Chronic Obstructive Pulmonary Disease (COPD), hypertension, and hyperlipidemia were associated with greater risk for the occurrence of AEs, with hazard ratios (95% CI) of 3.42 (1.25-9.38), 4.15 (2.11-8.17), and 2.84 (1.39-5.79), respectively. PWH who needed replacement therapy had a lower risk of AEs than those who did not need, with a hazard ratio (95% CI) of 0.41 (0.21-0.81). ConclusionsThe study indicated the prevalence of AEs among PWH was comparable to that of the general population. AEs appeared at an earlier age among PWH. COPD, hypertension, and hyperlipidemia were risk factors for AEs. PWH who needed replacement therapy may have a lower risk of AEs.

Reoperation for persistent pain after groin hernia surgery: a population-based study.

The aim of the present study was to assess the outcome results after reoperation for persistent pain after hernia surgery in a population-based setting. All patients who had undergone surgery for persistent pain after previous groin hernia surgery 1999-2006 were identified in the Swedish Hernia Register (n = 237). Data on the surgical technique used were abstracted from the medical records. The patients were asked to answer a set of questions including SF-36 to evaluate the prevalence of pain after reoperation. The study group consisted of 95 males and 16 females, mean age 53 years. In 27 % of cases an intervention aimed at suspected ilioinguinal neuralgia was performed. The mesh was removed completely in 28% and partially in 13%. A suture at the pubic tubercle was removed in 13% of cases. Decrease in pain after the most recent reoperation was reported by 69 patients (62%), no change in pain by 21 patients (19%) and increase in pain in 21 patients (19%). There was no significant difference in outcome between mesh removal, removal of sutures at the tubercle or interventions aimed at the ilioinguinal nerve. All subscales of SF-36 were significantly reduced when compared to the age- and gender-matched general population (p < 0.05). Patients reoperated for persistent pain after hernia surgery often report a reduction in pain, but the natural course of persistent pain, the relatively low response rate and selection of patients make it difficult to draw definite conclusions.

Factors influencing sleep disturbances among spouse caregivers of cancer patients in Northeast China.

BackgroundIn China, spouse caregivers of cancer patients (SCCPs) are involved in all aspects of patient care and experience psychological distress which could result in sleep disturbance and fatigue. However, few studies have explored the differences between SCCPs and the general population, or what factors affect SCCPs' sleep. This study aims to (1) Compare the differences in sleep disturbances and fatigue severity between SCCPs and the age- and gender-matched general population, and (2) Identify selected personal characteristics, including coping style that affect sleep disturbances in SCCPs.Methodology/Principal FindingsThe Stress and Coping Model was used to guide this study. Participants were recruited from the northeast part of China and included 600 people from the general population and 300 SCCPs. Participants completed a socio-demographic form, Fatigue Scale-14, trait Coping Style Questionnaire, and Symptom Checklist-90.ResultsThe majority of the participants were middle age, most of whom (78.7%) spent more than 8 hours each day taking care of their spouses. Compared to the general population, the SCCPs experienced significant sleep disturbances with a mean of 7.30 (SD = 1.27), and fatigue severity with a mean of 8.11 (SD = 3.25). Among the selected SCCPs' personal characteristics, current poor health status (β = 0.14, P<0.001), having a spouse under mixed treatment (β = 0.13, p<0.001), and financial burden (β = 0.14, P<0.001) are the significant predictors for sleep disturbances. Positive coping is the predictor for fewer sleep disturbances (β = 0.27, P<0.001). Those who reported sleep disturbances also experienced higher physical and mental fatigue severity (P<0.001).ConclusionIntervention to improve coping style in SCCPs is needed. Further research is also needed to explore the other mediators and moderators that regulate sleep disturbance and health outcomes in the SCCPs.

Long-Term Lung Cancer Survivors Have Permanently Decreased Quality of Life After Surgery

BackgroundRetrospective evaluation of the long-term health-related quality of life (HRQoL) among survivors after non–small-cell lung cancer (NSCLC) surgery. Patients and MethodsA total of 586 patients underwent surgery for NSCLC in Helsinki University Central Hospital between January 2000 and June 2009. Two validated quality-of-life questionnaires, the 15D and the EORTC QLQ-C30 with its lung cancer–specific module, QLQ-LC13, were sent to the 276 patients alive in June 2011. Response rate was 83.3%. Results of the 15D were compared with those of an age- and gender-standardized general population. ResultsMedian follow-up was 5 years. Compared with a general population, our patients had a significantly lower 15D total score, representing their total HRQoL and scores for dimensions of mobility, breathing, usual activities, depression, distress, and vitality. The patients, however, scored significantly higher on vision, hearing, and mental function. ConclusionsNSCLC survivors may suffer postoperatively from permanently reduced long-term HRQoL compared to an age- and gender-matched general population. This is essential patient information as more patients are surviving longer.

The return to work experiences of middle-aged Australian workers diagnosed with colorectal cancer: a matched cohort study.

BackgroundFew studies have been undertaken to understand the employment impact in patients with colorectal cancer and none in middle-aged individuals with cancer. This study described transitions in, and key factors influencing, work participation during the 12 months following a diagnosis of colorectal cancer.MethodsWe enrolled 239 adults during 2010 and 2011who were employed at the time of their colorectal cancer diagnosis and were prospectively followed over 12 months. They were compared to an age- and gender-matched general population group of 717 adults from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Data were collected using telephone and postal surveys. Primary outcomes included work participation at 12 months, changes in hours worked and time to work re-entry. Multivariable logistic and Cox proportional hazards models were undertaken.ResultsA significantly higher proportion of participants with colorectal cancer (27%) had stopped working at 12 months than participants from the comparison group (8%) (p < 0.001). Participants with cancer who returned to work took a median of 91 days off work (25–75 percentiles: 14–183 days). For participants with cancer, predictors of not working at 12 months included: being older, lower BMI and lower physical well-being. Factors related to delayed work re-entry included not being university-educated, working for an employer with more than 20 employees in a non-professional or managerial role, longer hospital stay, poorer perceived financial status and having or had chemotherapy.ConclusionsIn middle-adulthood, those working and diagnosed with colorectal cancer can expect to take around three months off work. Individuals treated with chemotherapy, without a university degree and from large employers could be targeted for specific assistance for a more timely work entry.Trial registrationACTRN12611000530921Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-963) contains supplementary material, which is available to authorized users.

Gender-based comorbidity in benign paroxysmal positional vertigo.

It has been noted that benign paroxysmal positional vertigo (BPPV) may be associated with certain disorders and medical procedures. However, most studies to date were done in Europe, and epidemiological data on the United States (US) population are scarce. Gender-based information is even rarer. Furthermore, it is difficult to assess the relative prevalence of each type of association based solely on literature data, because different comorbidities were reported by various groups from different countries using different patient populations and possibly different inclusion/exclusion criteria. In this study, we surveyed and analyzed a large adult BPPV population (n = 1,360 surveyed, 227 completed, most of which were recurrent BPPV cases) from Omaha, NE, US, and its vicinity, all diagnosed at Boys Town National Research Hospital (BTNRH) over the past decade using established and consistent diagnostic criteria. In addition, we performed a retrospective analysis of patients’ diagnostic records (n = 1,377, with 1,360 adults and 17 children). The following comorbidities were found to be significantly more prevalent in the BPPV population when compared to the age- and gender-matched general population: ear/hearing problems, head injury, thyroid problems, allergies, high cholesterol, headaches, and numbness/paralysis. There were gender differences in the comorbidities. In addition, familial predisposition was fairly common among the participants. Thus, the data confirm some previously reported comorbidities, identify new ones (hearing loss, thyroid problems, high cholesterol, and numbness/paralysis), and suggest possible predisposing and triggering factors and events for BPPV.

Risk of Pneumonia in Adults With Closed Versus Unclosed Atrial Septal Defect (from a Nationwide Cohort Study)

Atrial septal defect (ASD) is associated with pulmonary hyperperfusion and inflammation and has been linked with increased risk of pneumonia. We investigated the risk of pneumonia in patients with ASD and the impact of ASD closure in a nationwide cohort study. All adults in Denmark (n= 1,168) diagnosed with ASD from 1977 to 2009 were identified through Danish public registries. We compared the risk of hospitalization for pneumonia, use of antibiotics, and mortality with age- and gender-matched general population controls. The median follow-up from time of diagnosis was 9.6years (range 1 to 33). Cox regression analysis showed that both patients with closed (n= 863) and unclosed (n= 305) ASD had a higher risk of hospitalization for pneumonia (adjusted hazard ratios [HRs] 2.8, 95% confidence interval [CI] 2.3 to 3.5 and 3.1, 95% CI 2.4 to 4.0, respectively) than controls. Patients with ASD also used more antibiotics (adjusted HR for closure 1.4, 95% CI 1.3 to 1.5 and adjusted HR for no closure 1.4, 95% CI 1.2 to 1.6) than the controls. Antibiotic use normalized (adjusted HR 1.1, 95% CI 1.0 to 1.3) and the risk of pneumonia decreased (adjusted HR 1.8, 95% CI 1.1 to 3.0) within 5years after closure. The proportion of patients with ASD with pneumonia-related death (8.4%) was comparable with that of the general population (9.5%). In conclusion, patients with ASD had a substantially higher risk of hospitalization for pneumonia and used more antibiotics than the general population. The pneumonia risk diminished, but did not completely normalize, 5years after closure.

Long-term outcomes after elective isolated mechanical aortic valve replacement in young adults

The aim of this study was to determine long-term survival and clinical outcomes after elective isolated mechanical aortic valve replacement in young adults. A clinical observational study was conducted in a cohort of 450 consecutive adults less than 65 years of age who had undergone elective isolated mechanical aortic valve replacement (AVR) between 1997 and 2006. Patients who had undergone previous cardiac surgery, and those undergoing concomitant procedures or urgent surgery were excluded. Follow-up was 93.3% complete with a mean follow-up of 9.1±3.5 years. The primary end point was survival. Life table analyses were used to determine age- and gender-matched general population survival. Secondary end points were reoperation and valve-related complications. Overall actuarial survival at 1, 5, and 10 years was 98%±1%, 95%±1%, and 87%±1%, respectively, which was lower than expected in the age- and gender-matched general population in Quebec. Actuarial freedom from prosthetic valve dysfunction was 99%±0.4%, 95%±1%, and 91%±1% at 1, 5, and 10 years, respectively. Actuarial freedom from valve reintervention was 98%±1%, 96%±1%, and 94%±1% at 1, 5 and 10 years, respectively. Actuarial survival free from reoperation at 10 years was 82%±2%. Actuarial freedom from major hemorrhage was 98%±1%, 96%±1%, and 90%±2% at 1, 5, and 10 years, respectively. In young adults undergoing elective isolated mechanical AVR, survival remains suboptimal compared with an age- and gender-matched general population. Furthermore, there is a low but constant hazard of prosthetic valve reintervention after mechanical AVR.

SAT0073 Arterial Hypertension In Rheumatoid Arthritis Without Cardiovascular Disease: High Prevalence, Low Awareness, Poor Control And Increased Vascular Damage-Associated “White Coat” Phenomenon

BackgroundRheumatoid arthritis (RA) is associated with a high cardiovascular disease (CVD) risk, whereas the prevalence and significance of arterial hypertension, the major modifiable CVD risk factor, is still a matter...

Trends and Predictors of Non–AIDS-Defining Cancers in Men and Women With HIV Infection

The incidence of non-AIDS-defining cancers (NADCs) in HIV-positive patients has increased over recent years. Most studies of the risk and spectrum of NADCs are primarily based on male populations, and only a few have provided specific information regarding females. We retrospectively analyzed all incident NADCs occurring in a cohort of HIV-positive patients followed up between 1985 and 2011. Incidence rates before and after the introduction of highly active antiretroviral therapy (HAART) were examined using Poisson regression models. Standardized incidence ratios (SIRs) were used to compare the cancer risk of HIV-infected subjects with that of the age- and gender-matched general population as estimated by the Milan Cancer Registry. Five thousand nine hundred twenty-four patients (4382 men and 1542 women) contributed 50,990 person-years to the follow-up. Among them, 144 had new NADC diagnosis. The overall incidence increased from 1.0 case/1000 person-years in the pre-HAART period to 4.5 cases/1000 person-years in the HAART period (P < 0.01). In women, the risks were higher than expected in the case of cancer of the vulva (SIR = 69.2), Hodgkin lymphoma (SIR = 7.5), anal cancer (SIR = 41.2), and lung cancer (SIR = 4.8). In men, the risks were higher than expected in the case of anal cancer (SIR = 91.5), Hodgkin lymphoma (SIR = 13.0), tonsil cancer (SIR = 10.9), lung cancer (SIR = 2.1), and liver cancer (SIR = 7.1). The spectrum and incidence of NADCs in our cohort increased over time. The incidence of NADCs, especially virus- and smoking-associated cancers, was significantly higher than expected in HIV-positive men and women.