Lower Percentage Of Patients Research Articles

Comparison of Patients with and without Predicted Surgical Indication between Clusters of Adult Spine Deformity (ASD) Patients.

Multicentric, retrospective analysis of prospectively collected data. To utilize machine-learning (ML) for clustering and management prediction (conservative vs. operative) in surgically treated adult spine deformity (ASD) patients, and to compare the attainment of the Minimum Clinically Important Difference (MCID) between predicted surgical and conservative patients. Management choice in ASD is complex. ML can identity patient clusters and predicted treatment, but it is unclear whether patients treated according to the prediction also show better clinical outcomes. ASD patients (2-year follow-up) were divided into groups using k-means clustering. Management choice was predicted among operated patients in each cluster. The MCID for the Oswestry Disability Index (ODI) and the Scoliosis Research Society-22 (SRS-22) was calculated and compared between patients with and without surgical prediction. In Cluster 1 (idiopathic scoliosis, n=675, 150 surgeries), 57% of patients had a conservative prediction. Of these, 52% and 49% achieved MCID for ODI and SRS-22, respectively, compared to 68% and 75% for those with surgical predictions (OR=2 and 3.1, respectively).In Cluster 2 (moderate sagittal imbalance, n=561, 200 surgeries), 12% had a conservative prediction. Of these, 29% and 46% achieved MCID for ODI and SRS-22, respectively, compared to 47% and 56% for those with surgical predictions.In Cluster 3 (significant sagittal imbalance, n=537, 197 surgeries), 17% had a conservative prediction. Of these, 12% and 15% achieved MCID for ODI and SRS-22, respectively, compared to 37% and 45% for those with surgical predictions (OR=4.2 and 4.5, respectively). Patients with a concordant surgical prediction and management had higher odds of achieving the MCID, indicating a good correlation between prediction and clinical outcomes. In Cluster 3, the low percentage of patients with conservative prediction achieving the MCID suggests that machine learning could well identify patients with poor clinical outcomes.

Examining factors associated with poor metered-dose inhaler technique in a cohort of bronx patients with uncontrolled asthma

Objective Most studies investigating at-risk groups for poor inhaler technique (PT) have been in adolescents. However, evidence suggests older age correlates with PT. This study aimed to correlate patient characteristics with PT in an adult asthma cohort in the Bronx. Methods We categorized 237 patients with uncontrolled asthma by demonstration of good inhaler technique (GT) (n = 112) or PT (n = 58) at their initial visit. Independent variables included age, sex, ethnicity, language, insurance status, BMI, depression severity, and socioeconomic data. Two logistic regression models were created to assess odds of PT among independent variables at initial visit and odds of improvement in technique at follow-up. Results At the initial visit, patients with PT had a mean age of 53.74 (±13.54) versus 45.12 (±13.26) among those with GT (p= <0.001). The PT group also had a lower percentage of patients with private insurance (52.53% versus 71.15%, p = 0.037). When controlling for language, ethnicity, insurance status, and educational attainment, the odds of PT increased with age (OR, 1.051; CI, 1.017-1.087, p = 0.003) and BMI (OR, 1.065; CI, 1.010-1.123, p = 0.020). Males had lower odds of PT (OR, 0.379; CI, 0.144-0.997; p = 0.049). While insurance status did not affect odds of PT, Medicaid users had lower odds of improving technique (OR, 0.184; CI, 0.040-0.854; p = 0.031). Conclusions At baseline, individuals with PT were younger and more likely to be on a public health insurance plan. Increasing age, increasing BMI, and female sex were associated with higher odds of PT at the baseline visit, but were not associated with improvements in technique.

Veterans Affairs Medical Center Racial and Ethnic Composition and Initiation of Anticoagulation for Atrial Fibrillation

Racial and ethnic disparities exist in anticoagulation therapy for atrial fibrillation (AF). Whether medical center racial and ethnic composition is associated with these disparities is unclear. To determine whether medical center racial and ethnic composition is associated with overall anticoagulation and disparities in anticoagulation for AF. Retrospective cohort study of Black, White, and Hispanic patients with incident AF from 2018 to 2021 at 140 Veterans Health Administration medical centers (VAMCs). Data were analyzed from March to November 2023. VAMC racial and ethnic composition, defined as the proportion of patients from minoritized racial and ethnic groups treated at a VAMC, categorized into quartiles. VAMCs in quartile 1 (Q1) had the lowest percentage of patients from minoritized groups (ie, the reference group). The odds of initiating any anticoagulant, direct-acting oral anticoagulant (DOAC), or warfarin therapy within 90 days of an index AF diagnosis, adjusting for sociodemographics, medical comorbidities, and facility factors. The cohort comprised 89 791 patients with a mean (SD) age of 73.0 (10.1) years; 87 647 (97.6%) were male, 9063 (10.1%) were Black, 3355 (3.7%) were Hispanic, and 77 373 (86.2%) were White. Overall, 64 770 individuals (72.1%) initiated any anticoagulant, 60 362 (67.2%) initiated DOAC therapy, and 4408 (4.9%) initiated warfarin. Compared with White patients, Black and Hispanic patients had lower rates of any anticoagulant and DOAC therapy initiation but higher rates of warfarin initiation across all quartiles of VAMC racial and ethnic composition. Any anticoagulant therapy initiation was lower in Q4 than Q1 (69.8% vs 74.9%; adjusted odds ratio [aOR], 0.80; 95% CI, 0.69-0.92; P < .001). DOAC and warfarin initiation were also lower in Q4 than in Q1 (DOAC, 69.4% vs 65.3%; aOR, 0.85; 95% CI, 0.74-0.97; P < .001; warfarin, 5.4% vs 4.5%; aOR, 0.82; 95% CI, 0.67-1.00; P < .001). In adjusted models, patients in Q4 were significantly less likely to initiate any anticoagulant therapy than those in Q1 (aOR, 0.88; 95% CI, 0.78-0.99). Patients in Q3 (aOR, 0.75; 95% CI, 0.60-0.93) and Q4 (aOR, 0.69; 95% CI, 0.55-0.87) were significantly less likely to initiate warfarin therapy than those in Q1. There was no significant difference in the adjusted odds of initiating DOAC therapy across racial and ethnic composition quartiles. Although significant Black-White and Hispanic-White differences in initiation of any anticoagulant, DOAC, and warfarin therapy were observed, interactions between patient race and ethnicity and VAMC racial composition were not significant. In a national cohort of VA patients with AF, initiation of any anticoagulant and warfarin, but not DOAC therapy, was lower in VAMCs serving more minoritized patients.

Disparities in the prevalence of febrile neutropenia in patients hospitalized with lung cancer: An observational study.

e24133 Background: Lung cancer is a leading cause of cancer-related deaths in the United States and globally.Febrile neutropenia is a well-known and often fatal condition that occurs in 10-40% of lung cancer patients undergoing chemotherapy but has not been widely studied so far in these patients. We conducted a retrospective analysis to understand better the prevalence and disparities of febrile neutropenia in patients with lung cancer. Methods: The National Inpatient Sample (NIS) for the years 2017-2020 was utilized to identify patients with a primary discharge diagnosis of lung cancer which included both regional and metastatic disease. The cohort was stratified based on the presence or absence of Febrile Neutropenia (FN). Basic demographic variables were analyzed in order to identify disparities in the prevalence of FN among patients with lung cancer. Multivariate regression analysis was employed to determine the association between FN and lung cancer. Results: Among 461,975 hospitalized lung cancer patients, 4,355(0.09%) had concurrent diagnoses of febrile neutropenia (FN). Patients who developed FN were younger than those who did not (65.42±11.69 vs 68.81±10.39, p &lt; 0.001). Older patients had a decreased likelihood of developing FN (36-45: OR = 0.36(0.16-0.79), p = 0.011; 46-64:OR = 0.26(0.13-0.51), p &lt; 0.001 ; &gt; 65: OR = 0.19(0.09-0.38), p &lt; 0.001 ). The FN group had a greater proportion of black (17.81% vs 12.81%) and Hispanic (7.37% vs 5.25%, p &lt; 0.001) populations, and these groups were more likely to develop FN than white patients (Black: OR = 1.39(1.14-1.69), p = 0.001; Hispanics: OR = 1.4(1.03-1.88), p = 0.027 ). Patients with a Charlson Comorbidity Index of 3 or higher had an increased likelihood of FN (OR = 1.39(1.09-1.76); p = 0.006). The FN group had a higher percentage of patients with Medicaid (15.46% vs. 9.81%) and private insurance (25.21% vs. 22.1%) and a lower percentage of patients with Medicare (56.96% vs. 65.9%), p &lt; 0.001. A greater percentage of patients with FN were discharged to home with home health services (37.35% vs. 31.92%), while a greater percentage of patients without FN were discharged to home (65.31% vs. 59.91%) and skilled nursing facilities (2.06% vs. 1.98%), p = 0.032. Patients in medium and large hospitals were less likely to have FN compared to smaller hospitals (OR = 0.64(0.5-0.82), p = 0.001 and OR = 0.69(0.55-0.86), p = 0.001, respectively). Patients with fluid and electrolyte disorders were more likely to have FN (OR = 1.61(1.37-1.88), p &lt; 0.001). Conclusions: Lung cancer patients who developed Febrile Neutropenia were younger and more likely to be Black and Hispanics. Patients hospitalized in the medium and large size hospitals were less likely to have Febrile Neutropenia in comparison to smaller hospitals. The statistics provide valuable insights for optimizing care and addressing disparities across different age and racial groups.

Disparities in cancer care utilization in patients with brain tumors: A nationwide analysis.

e23142 Background: Brain tumors are highly aggressive and are associated with poor prognosis. Minority populations still experience inequities in the delivery of cancer care, despite concerted efforts to reduce such disparities. We studied disparities in receipt of cancer care for patients with primary brain tumor. Methods: National Inpatient Sample 2017-2020 was queried to identify the patients admitted with brain tumor. Results of the study were reported in accordance with the STROBE guidelines. We divided the cases into two groups i.e., the patients undergoing curative cancer care (CC) and palliative care (PC). We performed descriptive analysis and analyzed predictors of getting PC or CC using logistic regression analysis. Results: Among 144,355 patients hospitalized for primary brain tumor, 33,645 (23.3%) received PC. Mean age of PC group was 60±20.1 years, while the CC group had mean age of 52.9±21.3 years ( P &lt; 0.01). Compared to patients &lt; 45 years, the patients with age 46-64 years and ≥65 years were more likely to receive PC (OR = 1.9, 95% CI 1.6-2.4 and OR = 2.23, 95% CI 1.8-2.8, P &lt; 0.01, respectively). The proportion of Black patients in the PC group was more compared to the CC group (10.4% vs 7.6%). However, the proportion of White patients in the PC group was lower than the CC group (74.8% vs 77.9%), P &lt; 0.001. Black patients were more likely to receive PC (OR = 1.5, 95% CI 1.3-1.7, p &lt; 0.01), while no difference was observed in other ethnic or racial groups. Compared to CC group, PC group had a higher percentage of patients with Medicare (50.9% vs 35.9%), Medicaid (14.4% vs 13.8%) and a lower percentage of patients with private insurance (31.9% vs 47.0%) p &lt; 0.01. Patients with private insurance were less likely to receive PC (OR = 0.7, 95% CI 0.6-0.8, p &lt; 0.01). PC group had a higher percentage of low-income group patients compared to the CC group ($1-$49,999: 22.5% vs 20.6% and $50,000-$64,999: 25.3% vs 24.2%, P &lt; 0.01). Patients in teaching hospitals had decreased odds of PC (OR 0.8, 95% CI 0.7-0.9, P = 0.01) compared to non-teaching hospitals. Patients with major depressive disorder (OR 1.3, 95% CI 1.1-1.4, P &lt; 0.01), electrolyte disorders (OR 1.6, 95% CI 1.5-1.8, P &lt; 0.01), and atrial fibrillation (OR 1.3, 95% CI 1.1-1.5, P = 0.01) had increased odds of receiving PC. Conclusions: The patients who underwent PC were older, more likely to be Black, and of low-income groups. Patients in teaching hospital had a decreased likelihood of undergoing PC. The health care disparities should be addressed to achieve a better quality of care across all groups. [Table: see text]

The value of cardiopulmonary comorbidity in patients with acute large vessel occlusion stroke undergoing endovascular thrombectomy: a retrospective, observational cohort study

BackgroundChronic lung and heart diseases are more likely to lead an intensive end point after stroke onset. We aimed to investigate characteristics and outcomes of endovascular thrombectomy (EVT) in patients with acute large vessel occlusion stroke (ALVOS) and identify the role of comorbid chronic cardiopulmonary diseases in ALVOS pathogenesis.MethodsIn this single-center retrospective study, 191 consecutive patients who underwent EVT due to large vessel occlusion stroke in neurological intensive care unit were included. The chronic cardiopulmonary comorbidities and several conventional stroke risk factors were assessed. The primary efficacy outcome was functional independence (defined as a mRS of 0 to 2) at day 90. The primary safety outcomes were death within 90 days and the occurrence of symptomatic intracranial hemorrhage(sICH). Univariate analysis was applied to evaluate the relationship between factors and clinical outcomes, and logistic regression model were developed to predict the prognosis of ALVOS.ResultsEndovascular therapy in ALVOS patients with chronic cardiopulmonary diseases, as compared with those without comorbidity, was associated with an unfavorable shift in the NHISS 24 h after EVT [8(4,15.25) versus 12(7.5,18.5), P = 0.005] and the lower percentage of patients who were functionally independent at 90 days, defined as a score on the modified Rankin scale of 0 to 2 (51.6% versus 25.4%, P = 0.000). There was no significant between-group difference in the frequency of mortality (12.1% versus 14.9%, P = 0.580) and symptomatic intracranial hemorrhage (13.7% versus 19.4%, P = 0.302) or of serious adverse events. Moreover, a prediction model showed that existence of cardiopulmonary comorbidities (OR = 0.456, 95%CI 0.209 to 0.992, P = 0.048) was independently associated with functional independence at day 90.ConclusionsEVT was safe in ALVOS patients with chronic cardiopulmonary diseases, whereas the unfavorable outcomes were achieved in such patients. Moreover, cardiopulmonary comorbidity had certain clinical predictive value for worse stroke prognosis.

Assessing Pregnant Patients' Postpartum Contraceptive Plans After the SCOTUS Dobbs Decision in a Highly Restrictive State [ID 2683439

INTRODUCTION: The June 2022 SCOTUS Dobbs decision removed federal protection to abortion access. In August 2022, a Tennessee trigger law made ending a pregnancy for any reason a felony. We hypothesized that this change would result in more pregnant patients desiring highly effective (long-acting or permanent) contraceptive methods after delivery. METHODS: This retrospective cohort analysis used electronic health records to capture demographic and pregnancy data for pregnant patients admitted for delivery in one East Tennessee hospital. Documented contraceptive plans chosen during pregnancy were categorized as highly effective (long acting or permanent) or moderate/least effective. Data were extracted from July 2019 to April 2020 (baseline) and compared to July 2022 to April 2023 (post-Dobbs). Chi-squared tests and binary logistic regression were conducted in SPSS. RESULTS: One-half (50.6%) of 7,489 records analyzed were post-Dobbs; 90.4% had a documented contraception plan upon hospital admission. Record of choosing a highly effective contraception plan during pregnancy decreased significantly baseline to post-Dobbs (47.2% to 39.6%; P&lt;.001). Logistic regression was used to further analyze the relationship between the Dobbs decision and highly effective contraception plan desired postpartum. Patients who delivered after the Dobbs decision had lower odds (adjusted odds ratio 0.726; 95% CI [0.652, 0.809]; P&lt;.001) of having highly effective contraception plans after controlling for age, number of living children, race/ethnicity, and insurance. CONCLUSION: A lower percentage of patients from the post-Dobbs cohort desired highly effective contraception after delivery. Further investigation should explore these surprising results. Regardless, patients should participate in patient-centered contraceptive counseling during prenatal care to make informed decisions after delivery.

The Removal of Total Knee Arthroplasty From the Inpatient-Only List has Improved Patient Optimization.

On January 1, 2018, the Centers for Medicare and Medicaid Services removed total knee arthroplasty (TKA) from the inpatient-only (IPO) list, expanding outpatient TKA (oTKA) to include patients with insurance coverage through their programs. These regulatory changes reinforced the need for preoperative optimization to ensure a safe and timely discharge after surgery. This study compared modifiable preoperative optimization metrics in patients who underwent oTKA pre-IPO and post-IPO removal. The authors hypothesized that patients post-IPO removal would demonstrate improvement in the selected categories. Outpatient TKA in a national database was identified and stratified by surgical year (2015 to 2017 versus 2018 to 2020). Preoperative optimization thresholds were established for the following modifiable risk factors: albumin, hematocrit, sodium, smoking, and body mass index. The percentage of patients who did not meet thresholds pre-IPO and post-IPO removal were compared. In total, 2,074 patients underwent oTKA from 2015 to 2017 compared with 46,480 from 2018 to 2020. Patients undergoing oTKA after IPO removal were significantly older (67.0 versus 64.4 years; P < 0.01). A lower percentage of patients in the post-IPO cohort fell outside the threshold for all modifiable risk factors. Results were significant for preoperative sodium (10.7% versus 8.8%; P < 0.01), body mass index (12.4% versus 11.0% P = 0.05), and smoking history (9.9% versus 6.6%; P < 0.01). Outpatient TKA has increased considerably post-IPO removal. As this regulatory change has allowed older patients with increased comorbidities to undergo oTKA, the need for appropriate preoperative optimization has increased. The current data set demonstrates that surgeons have improved preoperative optimization efforts for select modifiable risk factors.

Eliminate LDL cholesterol after heart attack … but only for a while.

There is a clear demonstration of the inverse linear correlation between LDL cholesterol levels and clinical benefit. However, the timing of the action of lipid-lowering drugs is not clear. According to animal studies with recombinant lipoprotein A-1, the composition of atherosclerosis changes within 40 h (with variations in lipid and inflammatory contents). Progression-regression studies of atherosclerosis in humans confirm the data, highlighting a rapid change in the plaque over 5 weeks. The data are also in line with what emerges from the survival curves of the old study comparing atorvastatin 80 mg vs. placebo (Myocardial Ischaemia Reduction with Aggressive Cholesterol Lowering). The spacing of the curves occurs after only 4 weeks, indicating the precociousness of the favourable effects of powerful statins. Finally, a recent Odyssey post hoc analysis compared the risk of cardiac death and coronary revascularization between a group in which alirocumab lowered LDL cholesterol to below 15 mg (Group 1 and in which the drug was therefore stopped) against the subjects in the placebo group (Group 2), applying a propensity score matching. The primary endpoint occurred in a lower percentage of patients in Group 1 (6.4 vs. 8.4%). Furthermore, patients in Group 1 had a significantly lower hazard ratio (HR) for major adverse cardiovascular events [0.72; 95% confidence interval (CI) 0.51-0.997; P = 0.047] compared with the entire alirocumab group vs. placebo (HR 0.85; 95% CI 0.78-0.93; P < 0.001). According to these preliminary observations, aggressive and early treatment of hypercholesterolaemia in subjects with acute coronary syndrome translates into improved clinical results compared with a strategy that provides for more gradual control. These data will need to be confirmed through further prospective clinical studies and ideally with early conducted atherosclerosis regression studies.

In silico trial for the assessment of givinostat dose adjustment rules based on the management of key hematological parameters in polycythemia vera patients.

Polycythemia vera (PV) is a chronic myeloproliferative neoplasm characterized by excessive levels of platelets (PLT), white blood cells (WBC), and hematocrit (HCT). Givinostat (ITF2357) is a potent histone-deacetylase inhibitor that showed a good safety/efficacy profile in PV patients during phase I/II studies. A phase III clinical trial had been planned and an adaptive dosing protocol had been proposed where givinostat dose is iteratively adjusted every 28 days (one cycle) based on PLT, WBC, and HCT. As support, a simulation platform to evaluate and refine the proposed givinostat dose adjustment rules was developed. A population pharmacokinetic/pharmacodynamic model predicting the givinostat effects on PLT, WBC, and HCT in PV patients was developed and integrated with a control algorithm implementing the adaptive dosing protocol. Ten in silico trials in ten virtual PV patient populations were simulated 500 times. Considering an eight-treatment cycle horizon, reducing/increasing the givinostat daily dose by 25 mg/day step resulted in a higher percentage of patients with a complete hematological response (CHR), that is, PLT ≤400 × 109 /L, WBC ≤10 × 109 /L, and HCT < 45% without phlebotomies in the last three cycles, and a lower percentage of patients with grade II toxicity events compared with 50 mg/day adjustment steps. After the eighth cycle, 85% of patients were predicted to receive a dose ≥100 mg/day and 40.90% (95% prediction interval = [34, 48.05]) to show a CHR. These results were confirmed at the end of 12th, 18th, and 24th cycles, showing a stability of the response between the eighth and 24th cycles.

Results of Primary Total Knee Arthroplasty in Patients on Chronic Psychotropic Medications

BackgroundPsychotropic medications are commonly used to treat several mental health conditions. The aim of this study was to determine the impact of psychotropic medications in patients undergoing primary total knee arthroplasty (TKA) with respect to postoperative opioid use, complications, patient-reported outcome measures, and satisfaction. MethodsThis is a retrospective cohort study of 514 consecutive patients undergoing primary TKA. There were 120 patients (23.3%) who were excluded due to preoperative opioid usage. The remaining 394 patients had a minimum 1-year follow-up. Of those, 133 (34%) were on psychotropic medications preoperatively and were compared to the remaining 261 (66%) patients who were not on psychotropics. Clinical data, satisfaction, Knee Society (KS) scores, Western Ontario McMaster Universities Arthritis Index, Patient-Reported Outcomes Measurement Index Score, Forgotten Joint Scores, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, postoperative opioid medication usage, and complications were compared. ResultsThe study cohort (psychotropic medications) had significantly lower postoperative KS Function, KS Knee, Forgotten Joint Scores, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Western Ontario McMaster Universities Arthritis Index, and Patient-Reported Outcomes Measurement Index Score compared to the control group. The study group had a lower overall satisfaction score (Likert scale 1 to 5) and a lower percentage of patients either satisfied or very satisfied (4.55 versus 4.79, P < .001; 92.0 versus 97.24%, P = .03, respectively). Postoperative opioid usage was significantly greater in the study group at both 6.4 weeks (range, 4 to 8) and 12-month follow-up (52.76 versus 13.33%, P < .001; 5.51 versus 0.39%, P = .002, respectively). There were no differences in complications and revisions between the groups. ConclusionsPatients on psychotropic medications should be educated on the risk of increased opioid consumption, diminished satisfaction, and patient-reported outcome measures following primary TKA. Given the large number of patients on psychotropic medications undergoing TKA, additional studies are needed to further improve clinical outcomes in this group.

What Are the Recurrence Rates, Complications, and Functional Outcomes After Multiportal Arthroscopic Synovectomy for Patients With Knee Diffuse-type Tenosynovial Giant-cell Tumors?

What Are the Recurrence Rates, Complications, and Functional Outcomes After Multiportal Arthroscopic Synovectomy for Patients With Knee Diffuse-type Tenosynovial Giant-cell Tumors?

Predictions of Programmed Cell Death Ligand 1 Blockade Therapy Success in Patients with Non-Small-Cell Lung Cancer

Lung cancer is responsible for the most cancer deaths worldwide, with non-small-cell lung cancer (NSCLC) making up 80% of cases. Some genetic factors leading to NSCLC development include genetic mutations and Programmed Cell Death Ligand 1 (PD-L1) expression. PD-L1 proteins are targeted in an NSCLC treatment called PD-L1 blockade therapy (immune therapy). However, this treatment is effective in a low percentage of patients. This study aimed to create machine learning models to use features, like the number of mutations and the number of PD-L1 proteins in cancer cells, along with others, to predict whether a patient will receive clinical benefits from immune therapy. This was carried out by downloading and merging datasets from cbioportal.org to create a sample size for the model. Features that were highly correlated with clinical benefits were identified. Three machine learning models (Gaussian naïve Bayes, decision tree, and logistic regression) were created using these features to predict clinical benefits in patients, and each model’s accuracy was evaluated. All three models had accuracy rates between 55 and 85%, with two of the models averaging an accuracy rate of around 75%. Doctors can use these models to more accurately predict whether immune therapy treatment is likely to work in a patient before prescribing it to them.

Short-term safety of inactivated SARS-Cov-2 vaccines in Chinese patients with central nervous system inflammatory demyelinating diseases

ObjectiveThis study aims to evaluate the short-term safety of inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in Chinese patients with central nervous system inflammatory demyelinating diseases (CNS IDDs). MethodsA web-based survey was conducted among patients with CNS IDDs from April 15 to 19, 2022 in China. In total, 645 patients with CNS IDDs were identified, including 425 patients with multiple sclerosis (MS), 194 with neuromyelitis optica spectrum disorder (NMOSD), and 26 with other CNS IDDs. The questionnaire consisted of demographic data, clinical records, history of SARS-CoV-2 vaccination, and vaccination-related symptoms within one month after vaccination. The demographic data, clinical information, and relapse rates between vaccinated and non-vaccinated patients were compared. ResultsAmong 645 patients with CNS IDDs, 78 were vaccinated and 567 were non-vaccinated with the vaccination rate of 12.1 %. Compared to non-vaccinated group, a lower percentage of patients on DMDs therapy (41.0 % vs. 71.8 %, P < 0.001) and an increased proportion of patients with other vaccination in past 3 years (17.9 % vs. 4.8 %, P < 0.001) were observed in vaccinated group. Six patients experienced a relapse within 30 days of a vaccination. Additionally, vaccine-associated relapse rates in vaccinated patients did not significantly differ from these in non-vaccinated patients among 2020, 2021, and from January 1 to October 1, 2022. ConclusionsNo increased risk of vaccination-associated relapses among Chinese patients with CNS IDDs indicated that inactivated SARS-CoV-2 vaccines appear to be safe for this population.

Bowel cleansing effectiveness and safety of 1L PEG + Asc in the real-world setting: Observational, retrospective, multicenter study of over 13000 patients.

Background and study aims Effective bowel cleansing is critical for detecting lesions during colonoscopy, highlighting the importance of bowel preparations. 1L polyethylene glycol (PEG) + ascorbate (Asc) is the only recommended 1L PEG product in Europe and the United States. Its efficacy was demonstrated in large-scale controlled trials and confirmed in smaller-scale real-world studies. However, no large-scale real-world data exist. Patients and methods This observational, retrospective, multicenter study, used outpatient follow-up data from medical records from 10 centers in Spain and two in Portugal. Outpatients aged ≥18 years using 1L PEG + Asc as bowel preparation were included. The main outcome measures were overall adequate colon cleansing (Boston Bowel Preparation Scale [BBPS] score ≥6 with BBPS score ≥2 in each segment) and high-quality cleansing of the right colon (BBPS score=3). Results Data from 13169 eligible patients were included. Overall cleansing success was achieved in 89.3% (95%CI 88.7%-89.8%) and high-quality cleansing in the right colon in 49.3% (95%CI 48.4%-50.2%) of patients. For the overnight split-dose and same-day regimens, overall adequate quality cleansing success rate was 94.7% and 86.7% ( P <0.0001) and high-quality cleansing of the right colon rate was 65.4% and 41.4% ( P <0.0001), respectively. Colonoscopy was completed in 97.3% of patients, with non-completion due to poor preparation in only 0.8%; 2.3% of patients experienced at least one adverse event (AE). Conclusions This large-scale, real-world study demonstrates the effectiveness of 1L PEG + Asc in the total and right colon, with a low percentage of patients with AEs in routine clinical practice.

Pharyngeal Flap Versus Sphincter Pharyngoplasty for the Treatment of Velopharyngeal Insufficiency in 22q11.2 Deletion Syndrome: Preliminary Findings From a Systematic Review.

The purpose of this study was to examine and compare surgical and speech outcomes of the posterior pharyngeal flap and sphincter pharyngoplasty following surgical management of velopharyngeal insufficiency in patients with 22q11.2 deletion syndrome (22q11.2DS). This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses checklist and guidelines. Selected studies were chosen using a 3-step screening process. The 2 primary outcomes of interest were speech improvement and surgical complications. Preliminary findings based on included studies suggest a slightly higher rate of postoperative complications with the posterior pharyngeal flap in patients with 22q11.2DS but a lower percentage of patients needing additional surgery compared with the sphincter pharyngoplasty group. The most reported postoperative complication was obstructive sleep apnea. Results from this study provide some insight into speech and surgical outcomes following pharyngeal flap and sphincter pharyngoplasty in patients with 22q11.2DS. However, these results should be interpreted with caution due to inconsistencies in speech methodology and lack of detail regarding surgical technique in the current literature. There is a significant need for standardization of speech assessments and outcomes to help optimize surgical management of velopharyngeal insufficiency in individuals with 22q11.2DS.

Treatment and outcome of the Dutch Childhood Craniopharyngioma Cohort study: First results after centralization of care.

Childhood craniopharyngioma (cCP) has excellent survival, but quality of life may be severely hampered by hypothalamic dysfunction. We aimed to evaluate treatment and hypothalamic outcomes of a Dutch cCP cohort, and evaluate the effect of centralization of care. A retrospective cohort study was performed, including cCP patients diagnosed between 2004 and 2021. Treatment characteristics and hypothalamic outcomes were evaluated and compared before and since centralization of care in May 2018. We included 87 cCP patients. Cyst drainage/fenestration was performed in 29.9%, limited resection in 27.6%, near-total resection in 16.1%, and gross total resection (GTR) in 25.4%. Radiotherapy was given in 46.0%. After a median follow-up of 6.5 years, hypothalamic obesity (HO) was present in 24.7% and panhypopituitarism with diabetes insipidus in 71.3%. Higher body mass index (BMI) SDS at diagnosis and Muller grade II at last magnetic resonance imaging of follow-up were associated with overweight/obesity. No association was found between extensiveness of resection and overweight/obesity at last follow-up. When comparing before and after centralization of care, rates of GTR remained similar, but BMI outcomes changed; mean ΔBMI SDS 1 year after diagnosis from 1.12 (SD 1.15) to 0.81 (SD 1.24), and HO after 1 year decreased from 33.3% to 12.0% (P = .067), and after 2 years from 28.6% to 6.7% (P = NS). In our nationwide cohort, GTR was performed in a relatively low percentage of patients and extensiveness of resection was no longer associated with HO at follow-up. A trend toward improvement of BMI is observed since centralization of care, which needs further exploration.

Efficacy and safety study of osimertinib in advanced non-small cell lung cancer (NSCLC) with EGFR mutation.

e21150 Background: The frequency of transmission on EGFR is more frequent in women and non-smokers. It is characteristic of the Asian population (10% in the Caucasian race). EGFR tyrosine kinase domain inhibitors (EGFR-TKIs) are the standard first-line therapy in non-small cell lung cancer (NSCLC) with EGFR mutations. The efficacy and safety of osimertinib (third generation TKI-EGFR) were evaluated in the FLAURA phase III clinical trial, comparing it against first and second generation TKI-EGFR (erlotinib and gefitinib) in patients with advanced NSCLC. The objective is to evaluate the efficacy and safety of osimertinib in routine clinical practice at the Juan Ramon Jimenez Hospital. Methods: Descriptive observational, and retrospective study of patients with advanced NSCLC and EGFR + treated TKI-EGFR in the period 2015-2022. We analyzed (IBM SPSS Statistics 22) sociodemographic and clinical variables, toxicity profile, objective response rate (ORR), treatment response and progression-free survival (PFS) with Kappan-Meier curves. Results: We included 41 patients (p). 24 women (58.5%). The median age 66 years. 61% had a smoking habit (39% active smokers and 22% ex-smokers). 1p South American race, rest Caucasians. Present histologies: adenocarcinoma (87.8%), squamous cell (4.9%) and signet ring cells (2.4%). EGFR mutations: 53.7% exon 19 deletion and 36.6% exon 20 mutation and 9.8% were not specified. In 10 p the T790 mutation was analyzed, positive in 14.6%. Stage at diagnosis: IV (87.8%); III (12.2%). Symptoms at diagnosis: persistent cough (22%), pain (22%), dyspnea (19.5%) and constitutional syndrome (12.2%). Status Performance: 0-1 (85.4%). Pulmonary (48.8%), bone (36.6%), lymph node (29.3%), liver (22%), brain (22%), and adrenal (14.6%) metastases. 58.5% received osimertinib in the first line, 17.1% in the second. ORR: 77.4% partial response, 9.7% complete response and 12.9% disease progression. Toxicity (T) 90.9%. Digestive T: Diarrhea: grade G1 36.7%, G2 13.3%, G3 6.7%; nausea: G1 3.3%; hyporexia: G1 25.8%; hypertransaminasaemia: G1 3.2%. Dermal T: skin dryness: G1 20.7%, G2 10.3%, G3 3.4%; onycholysis: G1 19.4%. Asthenia: G1 25.8%, G2 12.9%, G3 12.9%. Pneumonitis: G1 3.2%, G2 3.2%, G3 6.5%. Hematological T: anemia: G1 6.5%, G2 16.1%, G3 3.2%. Dose reduction to 40 mg (37.5%). 12.5% discontinued osimertinib. mPFS in 1st line (L): 14 m (m). mPFS in 2nd L: 8 m. 95% CI (0-31.5). 95% CI (9.8- 18.1. mOS: 21 m (95% CI: 17.73-24.26). Conclusions: Osimertinib presents an adequate safety profile for patients with G1, G2 toxicities, generally easy to manage in clinical practice. A very low percentage of patients had to discontinue treatment. No fatal adverse event was reported. Our results in OS and PFS, although favorable, are somewhat lower than those of the FLAURA clinical trial, possibly due to dealing with real-life patients and/or the size of the sample, which is not entirely sufficiently representative.

Genetic Ancestry, Race, and Severity of Acutely Decompensated Cirrhosis in Latin America

Genetic ancestry or racial differences in health outcomes exist in diseases associated with systemic inflammation (eg, COVID-19). This study aimed to investigate the association of genetic ancestry and race with acute-on-chronic liver failure (ACLF), which is characterized by acute systemic inflammation, multi-organ failure, and high risk of short-term death. This prospective cohort study analyzed a comprehensive set of data, including genetic ancestry and race among several others, in 1274 patients with acutely decompensated cirrhosis who were nonelectively admitted to 44 hospitals from 7 Latin American countries. Three hundred ninety-five patients (31.0%) had ACLF of any grade at enrollment. Patients with ACLF had a higher median percentage of Native American genetic ancestry and lower median percentage of European ancestry than patients without ACLF (22.6% vs 12.9% and 53.4% vs 59.6%, respectively). The median percentage of African genetic ancestry was low among patients with ACLF and among those without ACLF. In terms of race, a higher percentage of patients with ACLF than patients without ACLF were Native American and a lower percentage of patients with ACLF than patients without ACLF were European American or African American. In multivariable analyses that adjusted for differences in sociodemographic and clinical characteristics, the odds ratio for ACLF at enrollment was 1.08 (95% CI, 1.03-1.13) with Native American genetic ancestry and 2.57 (95% CI, 1.84-3.58) for Native American race vs European American race CONCLUSIONS: In a large cohort of Latin American patients with acutely decompensated cirrhosis, increasing percentages of Native American ancestry and Native American race were factors independently associated with ACLF at enrollment.

(041) LGBTQ+ Young Adult Males’ Views on Antidepressants and Conversations About Sexual Dysfunction

Abstract Introduction Mental illness among US young adults has risen dramatically among LGBTQ+ people. LGBTQ+ young adults are also at a notably higher risk for suicide. Selective Serotonin Reuptake Inhibitors (SSRIs), the first-line treatment for anxiety and depression, are believed to cause sexual dysfunction in many users. Previous studies indicate a low percentage of patients who experience iatrogenic sexual dysfunction discuss these issues with physicians. This lack of open communication is particularly of concern for sexual minority people because of preexisting societal prejudice. Despite this, there is a paucity of research characterizing the willingness of LGBTQ+ people to discuss sexual dysfunction with peers or care providers and their opinions about antidepressants. Objective To assess if LGBTQ+ young adult males endorse different attitudes towards disclosure of sexual dysfunction and preference for sexual-sparing antidepressants compared to heterosexual young adult males. Methods An anonymous questionnaire was distributed to biological males ages 18 to 35 via social media. The questionnaire assessed demographic information, sexual identity, the Patient Health Questionnaire-8 (PHQ-8), the General Anxiety Disorder-7 (GAD-7), and attitudes towards antidepressants. Participants were asked to indicate their perceptions of three deidentified antidepressants (SSRIs, Bupropion, and Mirtazapine) after being prompted with their most common side effects. Conversations about sexual health were analyzed using a 5-point Likert scale (1= strongly disagree; 5 = strongly agree). Participants also ranked their top three most difficult discussion topics with doctors across seven areas of health (ie. mental, libido, erectile function); a “difficulty score” was given for each selection (unranked = 0; 1st choice = 3). Results Of the 665 questionnaires distributed, 505 were received (76% response rate). Nineteen responses were excluded due to extremely low duration of time to completion. Of the 486 responses included, 100 participants identified as LGBTQ+ (Table 1). LGBTQ+ males scored significantly higher on PHQ-8 and GAD-7 surveys compared to heterosexuals and had higher rates of previously diagnosed mental health illness (Table 2). While our overall sample displayed a strong preference for atypical antidepressants over SSRIs, LGBTQ+ males displayed an even greater preference for these sexual-sparing agents compared to heterosexuals (p = 0.023). Compared to heterosexual respondents, LGBTQ+ males were reportedly less embarrassed to talk about general sexual problems with friends and doctors (p = 0.0197; p = 0.0099) yet reported greater difficulty specifically in discussing with a doctor their ability to have sex with a partner (p = 0.0010) (Table 3). Conclusions Our data supports previous evidence that LGBTQ+ young adults report greater levels of mental illness and use of antidepressants compared to heterosexual peers. Our LGBTQ+ respondents’ stronger preference for sexual sparing antidepressants and lower levels of embarrassment in talking about sexual problems may reflect the open, sex-positive culture fostered within the LGBTQ+ community. Despite these findings, pervasive societal stigmatization of sexual minority people may contribute to why some topics of sexual function were more difficult to broach with a provider compared to heterosexual respondents. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Dadi, Teleflex, Lina