Higher Average Body Mass Index Research Articles

#2822 Can KDPI estimate long-term graft survival in a cohort of Portuguese patients?

Abstract Background and Aims The Kidney Donor Profile Index (KDPI) was introduced in the United States in 2014 to support clinicians' decision-making regarding the acceptance or decline of potential donors. In Portugal, there is no valid stratification score to assist physicians in accepting or declining an organ offer. Our study aims to characterize a cohort of Portuguese kidney transplant recipients and donors and evaluate the correlation between KDPI and long-term graft survival. The results are interpreted considering the nuances of the Portuguese allocation system, which favors an age-matched donor-recipient allocation. Method We conducted an observational single-center retrospective cohort study, which included patients who received a deceased donor kidney transplant at our unit between January 2013 and December 2015. We excluded patients for whom the donor KDPI index was unavailable for retrieval. Besides the KDPI index, we collected data regarding the receptor's demographic, clinical, and immunological characteristics, as well as graft and recipient survival. The primary outcome was death-censored survival, and follow-up ended on the 31st of December 2023. The secondary outcome was survival with a functioning graft. Survival estimates were obtained using Kaplan-Meier curves. We performed univariate and multivariate survival analysis with log-rank tests and Cox proportional-hazards regression models. Results We selected 364 deceased-donor kidney recipients and 212 kidney donors. The mean KDPI was 60% and 53.3% of donors were classified as expanded criteria. The kidney recipients were predominantly male (68.4%), with a mean age of 50.16 years and an average of 4 HLA mismatches. Median follow-up was 102 months. Considering recipient characteristics according to pre-defined KDPI strata (≤ 20%, 21-85%, > 85%), recipients from higher KDPI were significantly older, with a mean age of 40.6, 48.8, and 61.1 years, respectively (p < 0.001), and had a higher average body mass index (p = 0.041). There were no significant differences regarding the number of HLA mismatches (p = 0.624) or the proportion of hypersensitized patients (p = 0.253) between classes. During follow-up, 16.8% patients presented graft failure and 9.9% died with a functioning graft. Cumulative death-censored graft survival at 5, 8, and 10 years was 87.7%, 87.1%, and 84.4% respectively. The cumulative percentage of patients living with a functioning graft at 5, 8, and 10 years was 83.6%, 76.7%, and 68.6%. Death-censored graft survival was lower in recipients of donors with higher KDPI (Fig. 1), although it did not reach statistical significance (p-value = 0.166). The number of HLA mismatches (p = 0.592) or the recipient's age (p = 0.513) did not significantly impact death-censored graft survival, whereas delayed graft function (DGF) was the variable with the strongest association in univariate analysis (p < 0.001). In a multivariate Cox regression model, KDPI (HR 1.02, p = 0.005) and DGF (HR 3.2, p < 0.001) correlated with graft loss, while older recipients (HR 0.971, p = 0.019) seemed to have a protective effect over death-censored survival. Patient survival with a functioning graft was significantly associated with KDPI strata (p = 0.008; Fig. 2), the recipient's age (p = 0.006), and DGF (p < 0.001) in univariate analysis. Considering KDPI kidneys ≥ 90%, 10-year cumulative death-censored survival was 67.9%. Conclusion In our sample, despite not reaching statistical significance, there was a trend for improved death-censored graft survival in patients with lower KDPI, which further emulates the results of other European cohorts. Nevertheless, the 10-year cumulative death-censored survival of higher KDPI kidneys (≥ 90%) was remarkable, showing that long-term acceptable outcomes can be achieved. The impact of KDPI on patient survival with a functioning graft is probably overestimated, given the bias introduced by the Portuguese matching system, which rewards an “old-for-old” donor-recipient allocation.

Fractures in Patients With Diabetes Mellitus: Findings From a 20-year Registry at a Single Level 1 Trauma Center.

Diabetes mellitus (DM) is a risk factor of infection. Although DM has been associated with worse functional outcomes after acetabular fracture, literature regarding the effect of DM on surgical site infection and other early complications is lacking. A 20-year registry from a level 1 trauma center was queried to identify 134 patients with DM and 345 nondiabetic patients with acetabular fractures. The diabetic patient population was older (57.2 versus 43.2; P < 0.001) and had higher average body mass index (33.6 versus 29.5; P < 0.001). Eighty-three patients with DM and 270 nondiabetics were treated surgically (62% versus 78%; P < 0.001). Diabetic patients who were younger (54.6 versus 61.4; P = 0.01) with fewer comorbidities (1.7 versus 2.2; P = 0.04) were more frequently managed surgically. On univariate analysis, patients with DM more commonly developed any early infection (28.4% versus 21%; P = 0.049) but were no more likely to develop surgical site infection, or other postoperative complications. Older patient age, length of stay, baseline pulmonary disease, and concurrent abdominal injury were independent predictors of postoperative infection other than surgical site infection. Diabetics that developed infection had more comorbidities (2.4 versus 1.5; P < 0.001) and higher Injury Severity Score (24.1 versus 15.8; P = 0.003), and were more frequently insulin-dependent (72.7% versus 41%; P = 0.01). Independent of management strategy, diabetic patients were more likely to develop an infection after acetabular fracture. Insulin dependence was associated with postoperative infection on univariate analysis. Optimal selection of surgical candidates among patients with DM may limit postoperative infections.

Pain Catastrophizing and Impact on Pelvic Floor Surgery Experience

ABSTRACT Duration, intensity, and management of pain and discomfort may all be affected by experience, personality, and medical and psychosocial comorbidities. A negative cognitive-affective response to actual or anticipated pain, which impacts the pain experience, is called pain catastrophizing. The scale utilized for identifying individuals who magnify, feel helpless to manage, anticipate, or ruminate on pain is known as the Pain Catastrophizing Scale (PCS) and is composed of a 13-question validated measure and 3 subscales. The scale's score ranges from 0 to 52, where scores of 30 and greater indicate pain catastrophizing (30 points is the 75th percentile for PCS score distribution in patients with chronic pain). Pain catastrophizing is associated with increased pain severity, pain persistence, and opioid consumption following surgery, as well as poorer response to endometriosis treatments. Approximately 300,000 prolapse surgical procedures are performed in the United States annually, and because little is known about pain catastrophizing on perioperative pain, pelvic floor symptom distress/impact, and voiding trial (VT) performance following urogynecologic surgery, the authors' primary aim was to assess baseline pain catastrophizing on preoperative pelvic floor symptom impact and distress. The secondary aims included assessing the impact of pain catastrophizing on voiding function and postoperative pain following pelvic floor surgery. The patients for this prospective cohort study included self-identifying female patients undergoing surgery for stress urinary incontinence (SUI) and/or pelvic organ prolapse from March 2020 to December 2021. Inclusion came following completion of appropriate surveys and subsequent surgery. Exclusion was merited through surgery for reasons besides SUI or prolapse. At the baseline patient visit, a PCS score of 30 or greater was defined as pain catastrophizing. The initial visit also included recording data such as body mass index, age, benzodiazepine use, chronic opioid use, anxiety and depression diagnoses, postoperative prolapse stage, bothersome urgency urinary incontinence, and preoperative postvoid residual volume. Charts were used for abstracting surgical data, such as operative time, estimated blood loss, type of pelvic reconstructive surgery performed, and midurethral sling placement. Surgeries were all performed by fellowship-trained reconstructive pelvic surgery providers. Postanesthesia care unit (PACU) nurses and clinic staff were masked to preoperative PCS scores obtained in the PACU and postoperative clinic visits. A standardized void trial was performed. Of 320 participants in this cohort, 46 had a pain catastrophizing score of ≥30. Mean age was 60.0 ± 12.8 years. Bivariate analysis indicated that the pain catastrophizing group had higher average body mass index and greater preoperative use of benzodiazepines. Variants such as SUI rates, urgency urinary incontinence, or prolapse stage had no significant differences between groups, yet preoperative pelvic floor symptom distress and impact scores were clinically and statistically significantly higher in the catastrophizing group. Higher PACU pain scores were associated with pain catastrophizing, but not first postoperative VT failure. A significant association between pain catastrophizing and symptom distress remained following multivariable analysis, as well as a relationship between high PCS scores and symptom impact. All quality-of-life subscales maintained the significant associations. This study, although unique in describing pain catastrophizing in this setting, includes various limitations such as its single-institutional nature, which may limit external generalizability. Furthermore, generalizability may also be limited for those electing nonsurgical management, as the study selected for women choosing surgery. Study strengths include its large number of patients cared for by fellowship-trained providers in a similar manner with uniform surgical practice and timing of measures for assessing pelvic pain and pelvic floor symptoms. Also, a relatively standard VT method was utilized. Although further investigation is warranted for describing pain catastrophizing and its role with pelvic floor symptoms and pain postoperatively, the results of this study support other investigative findings, which indicate the importance of understanding pain catastrophizing and its potential effect on patients undergoing pelvic floor surgery. Future studies around this relationship can potentially enable health care providers to tailor perioperative care for individuals with pain catastrophizing.

Intraoperative frozen section for determining the extent of surgery in papillary thyroid carcinoma: comprehensive risk factor assessment.

There is much debate on the optimal treatment approach of papillary thyroid carcinoma (PTC). Different guidelines base recommendations on various risk factors. While diagnosing the various risk factors is difficult due to the technical limitations, intraoperative frozen section (IFS) may be a feasible method. We aim to real-time evaluate the multiple risk factors, including lymph node metastasis (LNM), extrathyroidal extension (ETE), multifocality using IFS, and then identify a more effective surgical plan, which may help avoid the need for a second surgery and improve prognosis of patients. We retrospectively reviewed the medical records of 364 patients from January 1, 2021 to December 31, 2021. All the patients were initially recommended to undergo a hemithyroidectomy (HT) with isthmusectomy and ipsilateral central compartment neck dissection (CCND). IFS would be executed immediately. Further total thyroidectomies (TTs) would be performed if: (I) results of IFS showed >5 LNM, or (II) there are 1≤ LNM ≤5 but with ETE and/or multifocal carcinoma. The patients were divided and investigated according to the extent of surgery. Based on the results of IFS, 72 patients underwent TT. The TT group displayed larger average tumor diameter, greater age, higher average body mass index (BMI), and elevated incidence of hypertension and hyperlipidemia compared to the HT group. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of IFS were 77.61%, 100%, 100%, and 88.46%, respectively. IFS is a highly reliable procedure. Comprehensively evaluating central compartment LNM, ETE, and multifocal carcinoma through IFS helps identify a more reasonable surgical option under the current clinical consensus, which may thus help avoid the need for a second surgery.

Pre-polycystic ovary syndrome and polymenorrhoea as new facets of polycystic ovary syndrome (PCOS): Evidences from a single centre data set.

Polycystic ovary syndrome (PCOS) is a complex disorder with diverse metabolic implications. Diagnosis typically relies on oligo-amenorrhoea (OA), hyperandrogenism (HA), and polycystic ovarian morphology (PCOM). However, the role of polymenorrhoea in PCOS remains understudied. Additionally, limited information exists regarding metabolic disturbances in women with partial PCOS phenotypes that do not meet diagnostic criteria. This extensive database aims to provide substantial evidence on the metabolic implications of polymenorrhoea and partial PCOS phenotypes. Prospective observational study. In this single-centre study, 6463 women with PCOS-like characteristics and 3142 age-matched healthy women were included. The study compared clinical (anthropometry, modified Ferriman Gallwey [mFG] score), hormonal (serum testosterone), and metabolic (plasma glucose, serum lipids, insulin) characteristics between women diagnosed with PCOS, those with partial PCOS phenotypes, and the healthy control group RESULTS: In all, 5174 women met Rotterdam criteria for PCOS diagnosis, while 737 were classified as Pre-PCOS, including HA (n = 538), OA (n = 121), or PCOM (n = 78). Common clinical features included oligomenorrhoea (75.5%), hirsutism (82.9%), obesity (27.2%), hypertension (1.6%), metabolic syndrome (19.6%), and diabetes mellitus (5.6%). Women diagnosed with PCOS, HA only, and OA only exhibited higher average body mass index, plasma glucose levels (both fasting and 2 h after the oral glucose tolerance test), and lipid fractions in comparison to those with PCOM and the healthy controls. However, indices of insulin resistance were similar among women with PCOS, HA, PCOM, and OA, albeit higher than in the healthy controls. The polymenorrhoea subgroup (5.9%) had lower BMI and serum testosterone, but similar mFG score, plasma glucose, insulin, and lipid levels as the oligomenorrhoea subgroup. The metabolic disturbances observed in Pre-PCOS women highlight the need to reassess diagnostic criteria. Including the polymenorrhoea subcategory in PCOS criteria is recommended due to similar metabolic dysfunctions as the oligomenorrhoea group.

Body mass index-associated responses to an ABVD-like regimen in newly-diagnosed patients with Hodgkin lymphoma.

Background: The role of body mass index (BMI) in the treatment outcomes of lymphoma patients is controversial. While investigating the efficacy of ABVD-like regimen in Hodgkin lymphoma (HL) patients, we observed that obese patients had poor responses. To better understand this clinical phenomenon, we evaluated the effect of BMI on responses to ABVD-like chemotherapy in HL patients. Methods: This retrospective cohort study evaluated the clinical outcomes of all 67 patients with confirmed HL who were treated at the First Affiliated Hospital of Soochow University from November 2016 to March 2023 with an ABVD-like regimen as first-line chemotherapy. Baseline patient characteristics and clinical outcomes were compared across different BMI categories. The primary end-point was the overall response rate defined as the proportion of the HL patients who achieved complete response or partial response. The additional end-points included progression-free survival and overall survival. Results: The median age of the HL patients was 31years old. Of the patients, 10.4% were obese, and 17.9% patients were overweight. Interim and end-term response evaluations revealed overall response rates of 98.5% and 83.6%, respectively. The proportion of patients with potential poor prognostic factors (IPS risk factors) did not differ significantly in the responders versus non-responders. However, non-responders had a higher average BMI when compared with responders (p = 0.002). Poor overall response rates in higher BMI patients indeed manifested with shorter progression free survival (p = 0.013). The minimum relative dose of the ABVD-like regimen in the overweight and obese groups was significantly lower than in the normal weight group (p < 0.001). Conclusion: Our analyses show that >80% of newly-diagnosed HL patients responded to the ABVD-like regimen. We find that being obese or overweight at the time of diagnosis correlated with a poorer overall response rate and that BMI was an independent risk factor in HL patients treated with the ABVD-like regimen. Lower doses of ABVD-like regimen contributed to the discrepant findings of responses in the high BMI groups. These findings indicate that newly-diagnosed, obese HL patients receiving an ABVD-like regimen require personalized treatment.

#4725 INCIDENCE OF ACUTE KIDNEY INJURY IN PATIENTS WITH COVID-19 AND ITS IMPACT ON THE COURSE OF THE ACUTE INFECTION AND POST-COVID PERIOD

Abstract Background and Aims It is known that SARS-CoV-2 virus infection can contribute to kidney damage. In the literature, the incidence of acute kidney injury (AKI) during the acute period of COVID-19 is estimated to range from 5 to 36.6%. This complication significantly aggravates the course of both the acute phase and post-COVID period. However, the number of studies investigating these interactions is currently insufficient. To determine the incidence of AKI in the acute phase of COVID-19 and to assess the impact of this complication on the post-COVID period. Method The international register “Dynamics analysis of comorbidities in SAES-CoV-2 survivors” (ACTIV) (NCT04492384) was established to assess the course of COVID‑19 in the Eurasian region and involved specialists from 7 countries. ACTIV is a multicenter, non-interventional, real-world clinical practice register that included men and women over 18 years of age with a confirmed diagnosis of COVID-19. The analysis included 9206 patients with reported evidence of kidney damage or its absence. In the register, the presence of AKI was determined from the attending physician's notes in the medical records (according to modern diagnostic criteria) and the difference in serum creatinine levels ≥ 26.5 µmol/l during inpatient treatment for COVID-19. The post-COVID period was analyzed using telephone surveys of 3099 patients at 3 months, 2493 patients at 6 months and 1782 patients, at 12 months after recovery from COVID-19. Results AKI was detected in 11.6% (n = 1068) of cases during the inpatient treatment of the acute SARS-CoV-2 infection. Among markers of severe infection, AKI was more common (p&amp;lt;0.001) than cytokine storm (7.46% of patients) or sepsis (0.17% of patients). Analysis showed that AKI occurred in patients with higher average body mass index (BMI) (29.6 kg/m2 (25.1; 33.5) vs. 27.8 kg/m2 (24.8; 31.6) without AKI, p = 0.018) and serum glucose levels (6.0 (5.2; 8.55) mmol/l vs. (5.8 (5.0; 7.0) mmol/l without AKI, p = 0.011). AKI increased the odds of death in the acute period of COVID-19 by 3.94 times (95% confidence interval (CI) 3.24–4.78; p = 0.0001). Similar results were recorded 3 months after recovery (Table 1). Conclusion AKI was reported in 11.6% of patients with COVID-19 who were hospitalized for treatment of acute infection. Kidney damage occurred in patients with higher BMI and serum glucose levels. Patients with AKI during SARS-CoV-2 infection had a significantly higher risk of death in the first 3 months after recovery.

BODY MASS INDEX (BMI) - PREDICTOR OF DISEASES ONSET AND REGULATOR OF PREVENTION?

The Body Mass Index (BMI) is a well-known tool for measuring normal, healthy weight. Nowadays, we can also use it as a prognostic factor for various diseases. Purpose: Our study aims to confirm or decline the correlation between body mass index and the onset of different diseases. Methods: The study was conducted among a random sample of 550 people (324 women and 226 men) from the district of Stara Zagora, Republic of Bulgaria. The participants in the study were aged between 18 and 65. The connection between BMI and the occurrence of diseases of different systems has been researched. A statistically significant relationship was found at p&lt;0.05. The statistically significant influence of BMI on the occurrence of diseases is proved by the results of the ANOVA procedure. Results: The results give us reason to believe that not only obesity but also overweight is a risk of cardiovascular disease. This is evidenced by our study, according to which people with the highest average BMI (BMI = 28.72 kg/m2) have diseases of the cardiovascular system. People with a BMI around and above 25.87 kg / m2 often suffer from diseases of the endocrine system, and those with a BMI around 25.60 kg / m2 are at risk for diseases of the musculoskeletal system. Conclusions: BMI would find its daily implementation in the activities of every physician working in every field of medicine. BMI can be used as a tool to predict the onset of disease and a regulator of prevention.

Clinical spectrum of COVID-19 complications in young adults: combined analysis of the American Heart Association COVID-19 Cardiovascular Disease Registry and the Outcomes Registry for Cardiac Conditions in Athletes

BackgroundWhile young adults 18–24 years old bear a significant proportion of COVID-19 diagnoses, the risk factors for hospitalisation and severe COVID-19 complications in this population are poorly understood.ObjectiveThe objective of...

MP62-10 CAN PATIENTS ON SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITORS SAFELY RECEIVE A UROLOGIC IMPLANT?

You have accessJournal of UrologyCME1 Apr 2023MP62-10 CAN PATIENTS ON SODIUM-GLUCOSE CO-TRANSPORTER 2 INHIBITORS SAFELY RECEIVE A UROLOGIC IMPLANT? Zachary Prebay, Halle Foss, David Ebbott, Jason Hyman, Michael Li, and Paul Chung Zachary PrebayZachary Prebay More articles by this author , Halle FossHalle Foss More articles by this author , David EbbottDavid Ebbott More articles by this author , Jason HymanJason Hyman More articles by this author , Michael LiMichael Li More articles by this author , and Paul ChungPaul Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003320.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) prevent the reabsorption of glucose and facilitate its excretion in urine. Patients taking these medications are at a hypothetical increased risk of urinary tract and genital infections given the mechanism of action. We questioned whether patients taking SGLT2i would be at an increased risk of genitourinary device infection or failure. METHODS: We queried the TriNetX database for all adult male patients undergoing Artificial Urinary Sphincter (AUS) or Inflatable Penile Prosthesis (IPP). For each implant, we separated patients into cohorts defined by those taking an SGLT2i within 1 year before and/or after surgery and those not taking an SGLT2i. Cohorts and outcomes were defined using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-10) codes. We used Age, Race, Ethnicity, Body Mass Index (BMI), Diabetes, smoking history, history of radiation, and history of prostatectomy to generate propensity score matching (PSM). Our primary outcome was need for re-intervention (revision, removal, or replacement surgery) at any point after implantation based on CPT codes. Secondary outcomes included infection rate and overall complication rate based on ICD-10 codes. Analytics were performed via TriNetX which calculated Risk Ratios. RESULTS: Analyses were run on October 14th, 2022. There were 9783 patients who underwent IPP and 4655 who underwent AUS (Table 1). After PSM, there were 340 and 82 patients in each IPP and AUS cohort with similar ages (60.9 vs 60.7 years; 68.6 vs 68.7 years) and similar comorbidity profiles except patients with an IPP on an SGLT2i had higher average BMI (31.9 vs 30.6 kg/m2, p=0.01). The average Hemoglobin A1c level was higher for patients taking an SGLT2i; 8.0% vs 7.1% (p<0.01) for IPP and 7.9% vs 6.9% (p=0.01) for AUS. Patients with an IPP on an SGLT2i were at a lower risk of overall complication (10.6% vs 19.9%, RR 0.53, p<0.01). There was no difference for AUS and risk of complication and no difference for either implant on risk of infection or re-intervention. CONCLUSIONS: Patients taking SGLT2is may be safely offered urologic implants. Patients taking an SGLT2 had a lower risk of complication for IPP, and there were similar rates of infection and re-intervention for both IPP and AUS. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e865 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Prebay More articles by this author Halle Foss More articles by this author David Ebbott More articles by this author Jason Hyman More articles by this author Michael Li More articles by this author Paul Chung More articles by this author Expand All Advertisement PDF downloadLoading ...

Enhanced Recovery After Surgery Protocol Allows Safe Same-Day Discharge in Expander Based and Oncoplastic Breast Reconstruction.

Data after enhanced recovery after surgery (ERAS) with same-day discharge in breast reconstruction is limited. This study evaluates early postoperative outcomes after same-day discharge in tissue-expander immediate breast reconstruction (TE-IBR) and oncoplastic breast reconstruction. A single-institution retrospective review of TE-IBR patients from 2017 to 2022 and oncoplastic breast reconstruction patients from 2014 to 2022 was performed. Patients were divided by procedure and recovery pathway: group 1 (TE-IBR, overnight admission), group 2 (TE-IBR, ERAS), group 3 (oncoplastic, overnight admission), and group 4 (oncoplastic, ERAS). Groups 1 and 2 were subdivided by implant location: groups 1a (prepectoral) and 1b (subpectoral), and groups 2a (prepectoral) and 2b (subpectoral). Demographics, comorbidities, complications, and reoperations were analyzed. A total of 160 TE-IBR patients (group 1, 91; group 2, 69) and 60 oncoplastic breast reconstruction patients (group 3, 8; group 4, 52) were included. Of the 160 TE-IBR patients, 73 underwent prepectoral reconstruction (group 1a, 25; group 2a, 48), and 87 underwent subpectoral reconstruction (group 1b, 66; group 2b, 21). There were no differences in demographics and comorbidities between groups 1 and 2. Group 3 had a higher average body mass index than group 4 (37.6 vs 32.2, P = 0.022). There was no significant difference between groups 1a and 2a or between groups 1b and 2b in rates of for rates of infection, hematoma, skin necrosis, wound dehiscence, fat necrosis, implant loss, or reoperations. Group 3 and group 4 showed no significant difference in any complications or in reoperations. Notably, no patients in same-day discharge groups required unplanned hospital admission. Many surgical subspecialities have successfully adopted ERAS protocols into their patient care and have shown both its safety and feasibility. Our research shows that same-day discharge in both TE-IBR and oncoplastic breast reconstruction does not increase risk for major complications or reoperations.

Associations between self-reported sleep patterns and health, cognition and amyloid measures: results from the Wisconsin Registry for Alzheimer's Prevention.

Previous studies suggest associations between self-reported sleep problems and poorer health, cognition, Alzheimer's disease pathology and dementia-related outcomes. It is important to develop a deeper understanding of the relationship between these complications and sleep disturbance, a modifiable risk factor, in late midlife, a time when Alzheimer's disease pathology may be accruing. The objectives of this study included application of unsupervised machine learning procedures to identify distinct subgroups of persons with problematic sleep and the association of these subgroups with concurrent measures of mental and physical health, cognition and PET-identified amyloid. Dementia-free participants from the Wisconsin Registry for Alzheimer's Prevention (n = 619) completed sleep questionnaires including the Insomnia Severity Index, Epworth Sleepiness Scale and Medical Outcomes Study Sleep Scale. K-means clustering analysis identified discrete sleep problem groups who were then compared across concurrent health outcomes (e.g. depression, self-rated health and insulin resistance), cognitive composite indices including episodic memory and executive function and, in a subset, Pittsburgh Compound B PET imaging to assess amyloid burden. Significant omnibus tests (P < 0.05) were followed with pairwise comparisons. Mean (SD) sample baseline sleep assessment age was 62.6 (6.7). Cluster analysis identified three groups: healthy sleepers [n = 262 (42.3%)], intermediate sleepers [n = 229 (37.0%)] and poor sleepers [n = 128 (20.7%)]. All omnibus tests comparing demographics and health measures across sleep groups were significant except for age, sex and apolipoprotein E e4 carriers; the poor sleepers group was worse than one or both of the other groups on all other measures, including measures of depression, self-reported health and memory complaints. The poor sleepers group had higher average body mass index, waist-hip ratio and homeostatic model assessment of insulin resistance. After adjusting for covariates, the poor sleepers group also performed worse on all concurrent cognitive composites except working memory. There were no differences between sleep groups on PET-based measures of amyloid. Sensitivity analyses indicated that while different clustering approaches resulted in different group assignments for some (predominantly the intermediate group), between-group patterns in outcomes were consistent. In conclusion, distinct sleep characteristics groups were identified with a sizable minority (20.7%) exhibiting poor sleep characteristics, and this group also exhibited the poorest concurrent mental and physical health and cognition, indicating substantial multi-morbidity; sleep group was not associated with amyloid PET estimates. Precision-based management of sleep and related factors may provide an opportunity for early intervention that could serve to delay or prevent clinical impairment.

An evaluation of radiation therapy patient body mass index trends and potential impact on departmental resource planning.

Radiation therapy (RT) offers a less invasive management option for bariatric cancer patients. As the proportion of Australians categorised overweight or obese approaches 70%, it is not well understood how this growth will impact RT departments. The aim of this study was to evaluate the current and potential future body mass index (BMI) of RT patients at one centre, with the purpose of identifying variables that may impact resource planning decisions. De-identified demographic data including gender, age, diagnosis code, activity code and BMI were obtained from MOSAIQ® oncology information system for 5548 courses of RT commenced between 2017 and 2020, and retrospectively analysed. Descriptive statistics were used to summarise the data. Simple and multiple linear regression was used to analyse for statistically significant relationships between variables. Of all patient courses, 64% were overweight or obese. Average BMI increased over time by 0.3 kg/m2 per year. Courses related to the young and elderly had a lower average BMI. Breast, brain/skull, and pelvis/prostate treatment sites had a significant association with a higher average BMI. Thorax treatment sites had a lower average BMI, but this average is increasing at the fastest rate of all treatment sites. Prone breast courses had an average BMI 5.58 kg/m2 higher than IMRT/VMAT courses. Results demonstrate that patient BMI is increasing. Resources related to breast courses (breast board, prone board) and thorax courses (lung board) may experience increased strain in the future. Modifications to department workflow and scheduling are likely required. Further research into staffing implications is recommended.

Whole Exome Sequencing Reveals Rare Variants in Genes Associated with Metabolic Disorders in Women with PCOS.

Polycystic ovary syndrome (PCOS) is a complex genetic trait, the pathogenesis of which is governed by an interplay of genetic and epigenetic factors. However, the aetiology of PCOS is not fully understood. The objective of this study was to investigate the genetic causes of PCOS by identifying rare variants in genes implicated in its pathophysiology. This was a hospital-based observational study. We used whole-exome sequencing for 52 PCOS women to identify the rare variants in genes related to PCOS pathogenesis. Subsequently, we analysed these variants using in silico prediction software to determine their functional effects. We then assessed the relationship between these variants and the clinical outcomes of the patients. Student's t-test and Fisher's exact test were used to compare clinical parameters and frequency differences amongst PCOS patients with and without variants. A total of four rare exonic variants in obesity- and hyperinsulinaemia-related genes including UCP1 (p.Thr227Ile), UCP2 (p.Arg88Cys), IRS1 (p.Ser892Gly) and GHRL (p.Leu72Met) were identified in eight patients. Significant differences were observed between the patients carrying variants and those without variants. PCOS patients with identified variants exhibited significantly higher average body mass index and fasting insulin levels of PCOS subjects with identified variants compared to those without variants (P < 0.05). Additionally, there were significant differences in the variant frequencies of four variants when compared to the population database (P < 0.05). This study shows a prevalence of rare variants in obesity and hyperinsulinaemia-related genes in a cohort of PCOS women, thereby underscoring the impact of the identified rare variants on the development of obesity and associated metabolic derangements in PCOS women.

Risk Factors for Deep Infection and Conversion Total Hip Arthroplasty After Operative Combined Pelvic Ring and Acetabular Fractures.

To determine risk factors for deep infection and conversion total hip arthroplasty (THA) after operative management of combined pelvic ring and acetabular injuries. Retrospective case control study. Level 1 trauma center. We reviewed 150 operative combined pelvic ring and acetabular injuries at our institution from 2010 to 2019, with an average follow-up of 690 (90-3282) days. Deep infection and conversion THA. Patients who developed deep infection (N = 17, 11.3%) had higher rates of hip dislocation ( P = 0.030), intraoperative transfusion ( P = 0.030), higher body mass index (BMI) ( P = 0.046), increased estimated blood loss ( P < 0.001), more intraoperative units transfused ( P = 0.004), and longer operative times ( P = 0.035). Of the 84 patients with 1-year follow-up, 24 (28.6%) required conversion to THA. Patients requiring conversion THA were older ( P = 0.022) and had higher rates of transverse posterior wall fracture pattern ( P = 0.034), posterior wall involvement ( P < 0.001), hip dislocation ( P = 0.031), wall comminution ( P = 0.002), and increased estimated blood loss ( P = 0.024). The order of the pelvic ring versus acetabular fixation did not affect rates of conversion to THA ( P = 0.109). Multiple logistic regression showed that an increased number of intraoperative units transfused [adjusted odds ratio (aOR) = 1.56, 95% confidence interval (CI) = 1.16-2.09, P = 0.003] and higher BMI (aOR = 1.10, 95% CI = 1.01-1.16, P = 0.024) were independently associated with an increased odds of deep infection. Posterior wall involvement was independently associated with an increased odds of conversion THA (aOR = 5.73, 95% CI = 1.17-27.04, P = 0.031). Rates of deep infection and conversion THA after operative fixation of combined injuries were 11.3% and 28.6%, respectively. Higher average BMI and number of intraoperative units of blood transfused were independently associated with deep infection, whereas posterior wall involvement was independently associated with conversion to THA in these patients. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Picking the Right Plane: A Comparison of Total Submuscular, Dual-Plane, and Prepectoral Implant-Based Breast Reconstruction.

Implant-based breast reconstruction has evolved, with a recent resurgence of prepectoral techniques. Comparative reconstructive outcomes and complications have not been elucidated fully among the total submuscular, dual-plane, and prepectoral planes of implant placement. All immediate implant-based breast reconstructions from March of 2017 through August of 2019 were reviewed retrospectively. Cases were divided into total submuscular, dual-plane, and prepectoral cohorts. Demographics, operative techniques, and reconstructive outcomes and complications were compared among groups. A total of 826 cases (510 patients) were identified and divided into total submuscular ( n = 392), dual-plane ( n = 358), and prepectoral ( n = 76) cohorts. Average follow-up for all patients was 27 months. The prepectoral cohort had a higher average body mass index and rate of previous reduction or mastopexy. Overall complications were lowest in the total submuscular group, although this difference was not statistically significant. Major infection occurred more frequently in the dual-plane group compared with the total submuscular cohort. The prepectoral cohort had a significantly increased incidence of wound dehiscence than the total submuscular group; both the dual-plane and prepectoral groups had higher rates of seroma formation and explantation compared with the total submuscular group. Overall reconstructive complication rates were comparable among the cohorts. Compared with those undergoing total submuscular reconstruction, the dual-plane cohort was more likely to develop a major infection or require explantation, whereas the prepectoral group had significantly higher rates of isolated dehiscence, seroma formation, and explantation. This suggests that the absence of overlying vascularized muscle may lead to an inherent inability to tolerate wound-healing complications, although further research is needed to clarify these observations. . Therapeutic, III.

Breakfast Skipping in a Multi-Ethnic Population of Middle-Aged Men and Relationship With Sociodemographic Variables and Weight Status.

BackgroundBreakfast eating is regarded to be necessary for maintaining a healthy body weight. On the other hand, breakfast skipping has been linked with obesity incidence. This study was carried out to determine the prevalence of breakfast skipping among a multi-ethnic group of middle-aged men living in Saudi Arabia and the association between breakfast skipping and sociodemographic variables and weight status.MethodsThis cross-sectional study included 1,800 middle-aged men aged 36–59 years. Participants' sociodemographic information and frequency of breakfast eating were obtained through personal interviews. The body mass index was determined after measuring body weight and height using standardized methods.ResultsThe prevalence of breakfast skipping was 42.1% of the study participants. Nationality was a predictor of breakfast skipping. Bangladeshi participants (N = 100) have the lowest rate of breakfast skipping (9.0%), whilst Saudi participants (N = 161) have the highest rate (73.3%). Weight status was another predictor of breakfast skipping as breakfast skippers had a significantly higher average body mass index (27.1 ± 3.8) than breakfast consumers (26.2 ± 3.5). Overweight/obese participants have a significantly higher breakfast skipping rate (44.9%) than participants with underweight/normal weight (36.6%).ConclusionThe rate of breakfast skipping is relatively high among middle-aged men living in Saudi Arabia. The data support a link between breakfast skipping and sociodemographic variables and weight status.

Air Pollutants and Asthma Hospitalization in the Medicaid Population.

Rationale: Risk of asthma hospitalization and its disparities associated with air pollutant exposures are less clear within socioeconomically disadvantaged populations, particularly at low degrees of exposure. Objectives: To assess effects of short-term exposures to fine particulate matter (particulate matter with an aerodynamic diameter of ⩽2.5 μm [PM2.5]), warm-season ozone (O3), and nitrogen dioxide (NO2) on risk of asthma hospitalization among national Medicaid beneficiaries, the most disadvantaged population in the United States, and to test whether any subpopulations were at higher risk. Methods: We constructed a time-stratified case-crossover dataset among 1,627,002 hospitalizations during 2000-2012 and estimated risk of asthma hospitalization associated with short-term PM2.5, O3, and NO2 exposures. We then restricted the analysis to hospitalizations with degrees of exposure below increasingly stringent thresholds. Furthermore, we tested effect modifications by individual- and community-level characteristics. Measurements and Main Results: Each 1-μg/m3 increase in PM2.5, 1-ppb increase in O3, and 1-ppb increase in NO2 was associated with 0.31% (95% confidence interval [CI], 0.24-0.37%), 0.10% (95% CI, 0.05 - 0.15%), and 0.28% (95% CI, 0.24 - 0.32%) increase in risk of asthma hospitalization, respectively. Low-level PM2.5 and NO2 exposures were associated with higher risk. Furthermore, beneficiaries with only one asthma hospitalization during the study period or in communities with lower population density, higher average body mass index, longer distance to the nearest hospital, or greater neighborhood deprivation experienced higher risk. Conclusions: Short-term air pollutant exposures increased risk of asthma hospitalization among Medicaid beneficiaries, even at concentrations well below national standards. The subgroup differences suggested individual and contextual factors contributed to asthma disparities under effects of air pollutant exposures.

Thoracoscopic sympathetic block to predict compensatory hyperhidrosis in primary hyperhidrosis.

BackgroundCompensatory hyperhidrosis is the main cause of patients’ dissatisfaction following sympathectomy for primary hyperhidrosis. Therefore, thoracoscopic sympathetic nerve block before sympathectomy can be used to predict compensatory hyperhidrosis after sympathectomy. The objective of this study is to review our recent experience with the nerve block procedure, describing efficacy, safety and validity.MethodsWe retrospectively reviewed the medical records of 107 patients who underwent thoracoscopic sympathetic nerve block with a local anesthetic for primary palmar and craniofacial hyperhidrosis using a 2-mm needlescope from March 2017 to November 2019. A week later, the patients were interviewed, and a decision made as to whether to proceed with sympathectomy. We analyzed the perioperative data of patients who underwent the predictive procedure either followed, or not followed, by sympathectomy.ResultsPrimary hyperhidrosis was relieved in all patients by the predictive procedure without severe complications. Compensatory hyperhidrosis happened to 32 patients (29.9%). Seventy-eight patients (72.9%) decided to undergo sympathectomy (group A) and 29 patients (27.1%) refused the sympathectomy (group B). Group B tended to have higher average body mass index (24.5 versus 23.2 kg/m2, P=0.082) and compensatory hyperhidrosis rate after predictive procedure (37.9% versus 26.9%, P=0.269) compared to group A. The compensatory hyperhidrosis rate after sympathectomy in group A was 76.9%. The effective duration of sympathetic block was significantly longer in group A than in group B (33.5 versus 13.9 hours, P=0.001). The predictive procedure had 94.4% specificity and 33.3% sensitivity for prediction of compensatory hyperhidrosis.ConclusionsThoracoscopic sympathetic block may be safe and feasible as a procedure for predicting compensatory hyperhidrosis after sympathectomy, and beneficially, it allows the patients to experience the effect of sympathectomy on primary hyperhidrosis and occurrence of compensatory hyperhidrosis. However, a longer effective duration of sympathetic block is needed to help patients to decide whether to proceed with the surgery.

413 Inpatient Sleep Screens: Effective for Screening but Poor Follow Up

Abstract Introduction Only 20% of adult Americans with Obstructive Sleep Apnea (OSA) are thought to have been diagnosed. Portable monitors (PM) can provide shorter time to diagnosis and treatment in at risk populations including inpatients. Data on inpatient sleep screen testing outcomes and population phenotypes are limited. We hypothesized that inpatients undergoing sleep screens via PM have higher disease severity but are less adherent to follow up. Methods We conducted a retrospective observational study comparing severity of OSA based on apnea-hypopnea index (AHI) and compliance with follow up between patients who received inpatient vs. outpatient sleep screens. There was a total of 347 patients, 18 years and older, who received a sleep screen from August 2017 to August 2018. Exclusion criteria were cancellations/no shows (13.56% inpatients vs. 13.51% outpatients) or loss of data (26.12% inpatients vs. 23.72% outpatients). For analysis, t-test and chi-square were used for continuous and categorical variables respectively. Results The patients diagnosed with severe OSA were more than double in the inpatient group vs. the outpatient group, 46.7% and 21.7% respectively. The inpatient group had a higher average AHI (30/h) compared to the outpatient group (20.3/h). 30.7% of the inpatient group were adherent with their follow up vs. 83.3% of the outpatient group. A chi-square test of independence demonstrated a significant difference between testing location and follow up (p &amp;lt; .001). Those in the inpatient group were significantly older (mean 60.4 years old) than the outpatient group (47.5 years old). There was no significant difference in gender between the groups. The inpatient group had significantly higher average body mass index (39.9 kg/m2) when compared to the outpatient group (34.3 kg/m2). Conclusion Hospitalized patients screened for OSA with portable monitors are significantly more likely to have severe disease when compared to outpatients. Despite this, adherence to follow up is poor. Systematic evaluation of inpatient OSA screening program effectiveness and factors impacting adherence to follow up and treatment are needed. Support (if any):