Increase In Mean Length Research Articles

Clinical outcomes of malignant portal vein thrombosis in patients with pancreatic cancer: A retrospective analysis.

784 Background: Portal vein thrombosis (PVT) includes portal vein blockage with a blood clot. Recently, there has been an increase in the incidence of PVT with solid malignancy. Portal vein thrombosis (PVT) is a potentially high-risk complication associated with pancreatic cancer. A hypercoagulable state is frequently observed in pancreatic cancer, with the incidence of thromboembolic events reported to range between 17% and 57%. We wanted to analyze the prevalence of PVT in patients with pancreatic cancer and its impact on hospital outcomes. Methods: We performed a retrospective analysis using the National Inpatient Sample Database (NIS) from 2018 to 2020. Patients with the primary diagnosis of pancreatic cancer and age >18 were diagnosed using ICD-10 codes. They were then stratified based on the presence of portal vein thrombosis. The Chi-square test was used to analyze categorical variables, and the T-test was used to analyze continuous variables. The confounders were adjusted using multivariate regression analysis. We observed the outcomes on mortality, length of stay, and total hospital charges. Results: A total of 336894 patients were diagnosed with a primary diagnosis of pancreatic cancer. Of them, 0.04% (n=13475 patients) were diagnosed with metastatic portal vein thrombosis. The mean age of the patients was 64 years (p <0.001). Out of them, 47% of patients were female. In comparison, the remaining 53% were male (p-value: 0.5). Almost 71% f the patients were White, 13% were African American and 0.09% were Hispanics (p-value <0.001). The presence of PVT was found to be associated with increased mortality in pancreatic patients (aOR 1.6, p-value <0.001) as compared to those without PVT. It was also associated with an increase in mean length of stay (LOS)(7.1 vs 6 days, p-value 0.009) and total hospital charges ($86,000 vs $73794, p-value <0.001). It was also observed that the presence of PVT was associated with increased odds of secondary outcomes, including venous thromboembolism (p-value <0.001), stroke (p-value 0.5), and acute kidney injury (p-value <0.001). Conclusions: The presence of portal vein thrombosis (PVT) in pancreatic cancer patients is associated with significantly worse hospital outcomes. These findings emphasize the importance of early detection and aggressive management of PVT in this patient population. Comparison of hospital outcomes between pancreatic cancer patients with and without portal vein thrombosis. Hospital Outcomes Pancreatic cancer patients with PVT Pancreatic cancer patients without PVT Adjusted Odds Ratio (aOR) 95% CI P-value Mortality 9.4% (n=1310) 7.2% (n=23300) 1.3 0.3-1.5 <0.001 LOS (Days) 7.1 6.0 1.6 1.1-2.3 0.009 Venous thromboembolism (VTE) 11% (n=1645) 4.2% (n=13734) 2.9 2.5-3.3 <0.001 Stroke 0.03% (n=5) 0.02 (n=79) 1.8 0.2-14 0.5 Acute Kidney Injury 21% (n=2970) 20% (n=68499) 1.2 1.09-1.3 <0.001

Clinical and morphologic features of macular telangiectasia type 2: natural course of the disease

Purpose: The purpose of this study is to report the clinical characteristics of macular telangiectasia type 2 (MacTel 2) in a natural disease course. Materials and Methods: A retrospective analysis of patients diagnosed with MacTel 2 over a 4-year period. Best-corrected visual acuity (BCVA), fundus photography, and optical coherence tomography (OCT) images were reviewed. Differences in BCVA, fundoscopic findings, and OCT parameters were compared between the initial and final visits. Results: The study included 28 eyes from 14 patients (11 women, 3 males), with a mean age of 65.5 ± 9.8 years. The mean follow-up period was 55.6 ± 32.9 months. The mean BCVA at baseline and final follow-up were 0.51 ± 0.6 and 0.7 ± 0.62 logMAR, respectively. At the first and last visits, the right-angle venules were the most common fundoscopic finding (78.6% for both). Subretinal neovascularization (NV) was initially present in two eyes and developed in one eye during follow-up. The mean temporal macular thickness decreased significantly during the follow-up period, while the central and nasal thickness did not show a significant change. At the last visit, focal ellipsoid zone (EZ) loss was found in 27 eyes (96.4%), compared to 24 eyes (85.7%) at baseline. External limiting membrane (ELM) loss was found in 23 eyes (82.1%) at the first visit and in 25 eyes (89.3%) at the final visit. The increase in mean length of the EZ and ELM loss during the follow-up was not statistically significant. Conclusion: Despite the progressive effect of the disease on central visual acuity, it is very important to closely monitor these eyes for the development of secondary NV, which may develop due to degenerative and atrophic changes in the macula.

Associations between Antenatal Care Visit Attendance and Infant Mortality and Growth.

This study examines the association between antenatal care (ANC) attendance and infant mortality and growth outcomes. The study used data from the Nouveux-nés et Azithromycine: une Innovation dans le Traitement des Enfants (NAITRE) trial conducted in Burkina Faso. This analysis included 21,795 neonates aged 8 to 27 days who were enrolled in the trial and had ANC data available. Infants were followed until 6 months of age. The analysis adjusted for potential confounders including infant's sex, maternal age, education, urbanicity, geographic region, season (dry versus rainy), pregnancy type (singleton versus multiple), number of previous pregnancies, if the infant was breastfed, and if the facility had an onsite physician to account for level of care. We used logistic and linear regression models to evaluate the association between ANC visits and all-cause infant mortality and infant growth measurements at 6 months. There was no significant association between ANC visits and 6-month mortality. Higher ANC attendance was associated with improved growth outcomes in infants at 6 months of age. After adjusting for potential confounders, each additional ANC visit was associated with a 0.03 kg increase in mean weight, 0.07 cm increase in mean length, 0.04 SD increase in mean mid-upper-arm circumference, 0.04 SD increase in mean height-for-age, 0.04 SD mean weight-for-age, and 0.02 SD mean weight-for-length Z-scores. These mean differences were statistically significant (except for weight-for-length Z-scores) but may not be clinically meaningful. Further research is warranted to explore the relationship between ANC attendance and longer-term health outcomes among infants.

Low recruitment drives the decline of red porgy (Pagrus pagrus) along the southeast USA Atlantic coast: Inferences from fishery-independent trap and video monitoring.

Red porgy (Pagrus pagrus) is a reef-associated, economically-important, winter-spawning, protogynous Sparidae species that appears to have declined in abundance in recent years along the southeast United States Atlantic coast. We used spatially-explicit generalized additive models built with fishery-independent chevron trap (1990-2021) and video data (2011-2021) to quantify the ways in which red porgy relative abundance and mean size varied across temporal, spatial, environmental, and habitat variables. Mean red porgy relative abundance from traps declined by 77% between 1992 and 2021, and declines were similarly large (69%) on video between 2011 and 2021. The largest two-year decline in relative abundance occurred early in the COVID-19 pandemic (2019-2021)- 32% in traps and 45% on video-despite already low abundance. Highest red porgy relative abundance from traps and video occurred in deep areas (i.e., 60-100 m) between southern North Carolina and north Georgia, and red porgy preferred low relief but continuous hardbottom habitats (i.e., pavement). We confirmed recent low recruitment of red porgy in the region based on the large increase in mean length (29%) and severe (~99%) declines of juvenile red porgy caught over the 32-year trap survey. Evidence suggests that recruitment failure is partially or mostly responsible for red porgy abundance declines, and, moreover, the regulation of harvest is unlikely to achieve sustainable management goals until recruitment increases.

Symbiotic propagation of Dendrobium bigibbum Lindl. with selected saprophytic Basidiomycota

Abstract. Bautista NS, Valentino MJG. 2023. Symbiotic propagation of Dendrobium bigibbum Lindl. with selected saprophytic Basidiomycota. Biodiversitas 24: 3519-3527. Compatible mycorrhizal association of orchids with fungi is required for the germination and seedling development. In the present study, the mycorrhizal association of Dendrobium bigibbum with three species of saprophytic Basidiomycota, in particular, Volvariella volvacea, Lentinus tigrinus, and Pleurotus florida were evaluated. Co-culture technique was carried out during rhizoid and seedling development of D. bigibbum. Results revealed that the growth of D. bigibbum in rhizoid and seedling stages was enhanced when symbiotically grown with V. volvacea and L. tigrinus. D. bigibbum grown with V. volvacea had the highest mean length of the 1st leaf during the rhizoid stage. In seedling stage, V. volvacea and L. tigrinus significantly increased the growth of D. bigibbum in terms of length of 2nd leaf and fresh weight of the seedlings. For the length of root, increase in mean length was observed only in D. bigibbum co-cultured with L. tigrinus. In addition, the presence of peloton colonization was observed both in rhizoid and seedling stages. Thus, both V. volvacea and L. tigrinus formed compatible mycorrhizal association with D. bigibbum.

Quantifying microcracks on fractured bone surfaces – Potential use in forensic anthropology

Bone fracture surface morphology (FSM) can provide valuable information on the cause of failure in forensic and archaeological applications and it depends primarily on three factors, the loading conditions (like strain rate), the ambient conditions (wet or dry bone material) and the quality of bone material itself. The quality of bone material evidently changes in taphonomy as a result of the decomposition process and that in turn is expected to affect FSM. Porcine bones were fractured by a standardised impact during the course of soft tissue decomposition, at 28-day intervals, over 140 days (equivalent to 638 cooling degree days). Measurements of the associated microcracks on the fractured cortical bone surfaces indicated a progressive increase in mean length during decomposition from around 180μm-375μm. The morphology of these microcracks also altered, from multiple intersecting microcracks emanating from a central point at 0-28 cumulative cooling degree days, to longer linear cracks appearing to track lamellae as soft tissue decomposition progressed. The implications of these findings are that taphonomic changes of bone may offer the real possibility of distinguishing perimortem and taphonomic damage and also provide a new surrogate parameter for estimation of post-mortem interval (PMI) in forensics.

Introduction of a homeless health outreach team in Northern New South Wales: is acute service usage reduced?

To examine if there is a relationship between introducing a Homeless Health Outreach Team (HHOT) and reduced acute Mental Health service usage. Electronic Medical Record (EMR) data were collected on a group of clients of the Tweed Byron HHOT 6months before and after establishing the service. The data were evaluated for demographics, and differences in Emergency Department (ED) presentations, mental health admissions, length of stay and community mental health engagement. The introduction of the team coincided with a significant reduction in ED presentations and an increase in community mental health engagement. There was an overall reduction in bed days but an increase in mean length of stay for those admitted post-intervention. The establishment of the HHOT coincided with reduced acute mental health service usage via ED and inpatient Mental Health Units (MHU). There is scope for expansion of such a service as well as exploration of costings analysis. A long-term focus on 'housing first' and outreach approaches to homeless service provision could improve individual and service provision outcomes.

Scrotal approach for tunica expansion procedure (TEP) for penile girth and length restoration during penile prosthesis implantation in patients with penile angulation due to Peyronie's disease and erectile dysfunction: technique and outcomes.

Peyronie's disease is often comorbid with erectile dysfunction and can cause significant penile shortening. We describe our modified tunica expansion procedure (TEP) technique of penile length preservation and girth enhancement with correction of penile angulation in patients with mild Peyronie's disease (<30 degree angulation, or hourglass deformity, no hinging) and erectile dysfunction presenting for inflatable penile prosthesis (IPP) surgery. A retrospective review of IPP placement from one high volume surgeon was performed. A total of 474 patients' charts from June 2017 to June 2021 were reviewed and those charts of patients undergoing modified TEP in the setting of Peyronie's disease were analyzed. Average increase in length and girth were measured and means with standard deviations calculated. The modified TEP is performed through a scrotal approach and involves complete eversion of the penis with dissection of Buck's fascia off the underlying tunica. Subsequently, staggered scorings of the underlying tunica are performed allowing for circumferential girth enhancement and length preservation. In men with Peyronie's disease, these scorings are preferentially concentrated on the side of the plaque to allow straightening without loss of length. A total of 32 patients with Peyronie's disease from the larger cohort underwent the modified TEP. Mean increase in length of distal corpora was 2.8 ± 0.8 cm (range 2.0-3.4 cm) (measured using Furlow before and after penile eversion with TEP), while mean increase in girth (measured at midphallus prior to prosthesis insertion and after IPP inflation) was 1.6 ± 0.4 cm (range 1.2-2.2 cm). There were no reported complications. A scrotal approach to TEP is an easy to perform technique that can be used to restore length and enhance girth in men with Peyronie's disease undergoing insertion of IPP. Additionally, it is a customizable approach that can also be used to correct mild penile angulation.

Growth Performance of Clarias Gariepinus and Clarias Anguillaris Obtained from three Ecological Zones in Nigeria

The growth performance was conducted using Clarias gariepinus and Clarias anguillaris obtained from 3 ecological zones namely; Argungu (Clarias anguillaris), New Bussa (Clarias gariepinus) and Yola (Clarias gariepinus) respectively, to evaluate the differences in survival and growth rates to have fast growing fingerlings for replenishing stock. Eight (8) weeks periods were taken to conduct this work using a semi-flow through a system of fish culture, under open shade containing 25 litres of plastic bowls filled with 20 litres of water, in which 20 fry each from the parental crosses and their reciprocals were randomly selected and stocked in each bowl of the 9 treatments with 3 replicates each. The growth was found to vary from each eco-zone which was highly significant (P&lt;0.05&gt;). Survival 70-90%, the highest mean weight gained was 106.7±21.246 (NB♂ x YY♀) while the least was 45.5±1.674 (AR♂ x YY♀) while the mean increase in length was 20.867±0.664 (NB♂ x NB♀) and 16.467±0.333 (NB♂ x AR♀) and New Bussa broodstocks are recommended for our fish farmers as they proved to have the basic potentials required in aquaculture.

Clostridioides difficile infection in hospitalized patients with leukemia: A nationwide analysis of incidence and outcomes.

e19042 Background: Clostridioides difficile infection (CDI) is the most common cause of nosocomial diarrhea. The incidence and severity of CDI have increased in adults. However, CDI has not been well studied in leukemia patients in the recent years. This study aims to evaluate incidence, mortality, and health care burden in patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML) and chronic lymphocytic leukemia (CLL). Methods: The United States Nationwide Inpatient Sample was used to extract hospitalization data of patients admitted between Jan 1st, 2016, to Dec 31st, 2019. Using International Classification of Diseases 10th revision codes, we identified adults with a discharge diagnosis of CDI and a concomitant leukemia diagnosis. The control group included non-leukemia patients with CDI. Primary outcome was in-hospital mortality. Secondary outcomes were length of stay (LOS) and hospital charges. Multivariate logistic regression was used to adjust for relevant variables. Results: An estimated 1,235,465 patients were admitted with CDI during the study period. CDI incidence per 100 discharges was higher among leukemia patients, particularly in AML and ALL patients (4.1 and 3.6, respectively) vs. 1 in general population. After adjusting for comorbidities and demographic variables, AML and ALL were independently associated with increased odds of mortality (adjusted odds ratio [AOR] 2.19 and 1.90 respectively: P &lt;0.01). Additionally, both AML and CML had significant mean increase in length of stay (7.2 and 3.1 days respectively; P &lt;0.01) and hospital charges (115,245$ and 87,198$ respectively; P &lt;0.01) compared to non-leukemia patients. Conclusions: Among leukemia patients admitted with CDI, those with AML and ALL have significantly higher adjusted odds of mortality, length of stay, and hospital charges. AML and ALL patients also had the highest incidence of CDI. Applying antibiotic stewardship and appropriately diagnosing and treating CDI is pertinent in these high-risk patients.[Table: see text]

Co-cultivation with blue mussels increases yield and biomass quality of kelp

Integrated multi-trophic aquaculture (IMTA) has to date largely centred on a fed species, often finfish or shrimps, alongside which extractive species, such as bivalves or seaweeds, have been placed. In comparison, IMTA systems excluding a fed component have received little research. Here we report a field study of an IMTA cultivation of the sugar kelp, Saccharina latissima, and the blue mussel, Mytilus edulis, on the Swedish west coast. Kelp were cultivated at two depths, 1-2 m and 3-4 m, either 10 m downstream of commercial scale blue mussel farms, or at control (monoculture) sites at least 500 m from the nearest farm. Significant enhancement of kelp yields in terms of both blade length and biomass was observed in IMTA treatments compared to monoculture, with a mean increase in length of 22% and biomass of 38%. Moreover, kelps co-cultivated with mussels displayed an epiphyte reduction of more than half compared to kelps grown in monoculture, with a 15% coverage in monoculture compared to 6% in co-culture. Significant increases in pigment content were also detected, with higher levels of chlorophyll a, fucoxanthin and phaeophytin in IMTA treatment kelps in comparison to monoculture. This study provides evidence for the potential of IMTA systems containing solely extractive species and presents factors beyond nutrient enrichment as drivers for enhanced growth in these systems.

Evaluating the Effects of a Deep-Water Marine Protected Area a Decade After Closure: A Multifaceted Approach Reveals Equivocal Benefits to Reef Fish Populations

Marine protected areas (MPAs) are increasingly used to rebuild fish populations. In 2009, eight MPAs were designated off the southeast United States with the goal of rebuilding populations of long-lived deep-water reef fishes. We tested whether reef fish within the largest of these MPAs, the Snowy Wreck Marine Protected Area (SWMPA), have increased in size and abundance relative to a nearby control area and compared to pre-closure. Hurdle models fitted through Bayesian inference on echosounder data collected in 2007–2009 and 2018–2020 yielded no evidence of an MPA effect. Comparisons of catch-per-unit-effort (CPUE) of all reef fishes yielded similar null results. However, CPUE of reef species with formal stock assessments increased 47% in the SWMPA and decreased 50% in the control area. We found significant increases in mean length of red porgy (Pagrus pagrus) inside the SWMPA but not in the control area. We also found community composition changes, including shifts away from groupers (Serranidae; Epinephelinae) and toward snappers (Lutjanidae) and tilefish (Malacanthidae) in both areas, though we did not detect an MPA effect with this analysis. Our equivocal results indicate that more time and stricter enforcement may be necessary before more biological effects of the SWMPA can be detected.

Impact of idiopathic pulmonary fibrosis on the clinical outcomes of patients admitted for acute decompensated heart failure: an analysis of U.S national inpatient sample

Abstract Background The cardiovascular manifestations of idiopathic pulmonary fibrosis (IPF) include heart failure, pulmonary hypertension, coronary artery disease, cardiac arrhythmias and cardiac manifestations of drugs used to treat IPF. Cardiac disease can be worsened by hypoxia and pulmonary hypertension by IPF. The impact of IPF on the outcomes of acute decompensated heart failure (ADHF) is not well studied. Purpose We aim to determine the outcomes of patients admitted for ADHF with co-morbid IPF. Methods Data were extracted from the National Inpatient Sample (NIS) 2016 - 2018 Database. The NIS was searched for hospitalizations for adult patients with ADHF as principal discharge diagnosis with and without IPF as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Secondary outcomes are detailed in table 1. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. A univariate screen was done to further confirm that these factors affected outcomes with variables having a p-value less than 0.2 included in the multivariate regression analysis. STATA software was used to for analysis. Results Of 1,007,824 patients admitted for ADHF, 1850 (0.2%) had IPF. Patients with IPF were significantly younger at the time of hospitalization for ADHF (71 years vs. 76 years, p&amp;lt;0.001). There were 46% females in IPF group compared to 48% in the non-IPF group, p=0.451. The adjusted odds ratio (aOR) for inpatient mortality for ADHF with IPF compared to those without IPF was 2.82 (95% CI 1.897–4.215, p&amp;lt;0.001). Patients with comorbid IPF had 1 day increase in mean length of stay (95% CI 0.475–1.525, p&amp;lt;0.001). Detailed outcomes are listed in table 1. Conclusions Co-morbid IPF leads to higher inpatient mortality and higher length of hospitalization in patients with acute decompensated heart failure. It is prudent to risk stratify these patients to improve overall morbidity and mortality. Funding Acknowledgement Type of funding sources: None.

B-PO02-142 IDIOPATHIC PULMONARY FIBROSIS LEADS TO INCREASED INPATIENT MORTALITY IN PATIENTS ADMITTED FOR ATRIAL FIBRILLATION: ANALYSIS OF INPATIENT SAMPLE

Idiopathic pulmonary fibrosis (IPF) has been reported to be significant predictor of development of atrial fibrillation (AF). We sought to determine the impact of idiopathic pulmonary fibrosis on clinical outcomes of hospitalizations for atrial fibrillation. To determine the impact of idiopathic pulmonary fibrosis on the clinical outcomes of atrial fibrillation. Data were extracted from the National Inpatient Sample (NIS) 2016 - 2018 Database. The NIS was searched for hospitalizations for adult patients with AF as principal discharge diagnosis with and without IPF as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Secondary outcomes are shown in table 1. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used to for analysis. Of 1,236,540 patients admitted for AF, 1170 (0.09%) had co-morbid IPF. The adjusted odds ratio (aOR) for inpatient mortality for AF with IPF compared to those without IPF was 2.75 (95% CI 1.319 - 5.729, p=0.007). Patients with comorbid IPF had 0.8 day increase in mean length of stay (95% CI 0.300 - 1.344) compared to the patients without IPF. Detailed outcomes are listed in table 1. Patient admitted for AF with comorbid IPF have higher inpatient mortality and longer length of stay compared to patients without IPF.

Emollient Therapy in Preterm & Low Birth Weight Neonates: A Randomised Clinical Trial.

To assess the impact of emollient therapy on gain in weight and length among preterm and low birth weight babies. Randomised controlled trial. Department of Pediatric Medicine, KEMU / Mayo Hospital Lahore, from January till June 2018. Infants with birth weight between 1.5 and 2.5 Kgs or preterm neonates born between 28 and 37 completed weeks of gestation were included in the study. Neonates with genetic syndrome, infection or with a history of admission in NICU due to any reason, were excluded.They were randomly divided into two groups-A and B, by lottery method. Mothers of the neonates in group A were advised massage with sunflower oil; while mothers of the neonates in group B were advised massage without any emollient. Babies were closely followed up and their weight and length were measured at two months of age and were analysed using SPSS version 23.0. For 140 neonates, the mean increase in weight was 489.84 ± 297.48 grams among group-A neonates (emollient therapy group) and it was 373.43 ± 276.31 grams among group-B neonates (p = 0.018). The mean increase in length was 6.5 ± 1.1 cm, among group-A neonates and 4.8 ± 1.3 cm in group-B neonates (p ˂0.001). Conclusion: Massage with emollient therapy leads to significantly more increase in weight and length compared to massage alone, among preterm and low birth weight neonates.Emollient therapy is an effective non-pharmacological intervention for increasing weight and length in low birth weight and preterm neonates. Key Words: Emollient, Massage, Low birth weight, Preterm neonates, Weight, Length.

The provision of neuro-oncology and glioma neurosurgery during the SARS-CoV-2 pandemic: a single national tertiary centre experience.

BackgroundThe COVID-19 pandemic has resulted in a significant disruption in the provision of healthcare globally. The aim of this study was to assess the implications of the COVID-19 pandemic on the provision of neuro-oncology surgery and comparison with a similar 3-month period in 2019.MethodsRetrospective review of prospectively curated database of patients requiring neuro-oncology surgery at our tertiary referral centre between 1st March 2020 and 31st May 2020. We also analysed data for the same time period (1st March–31st May) in 2019 for comparison. Number and type of tumours operated on, postoperative morbidity and mortality, COVID-19-related complications and delays in treatment were recorded.ResultsDuring the 3-month periods studied in 2020 and 2019, there were 127 and 139 admissions for neuro-oncological surgery, respectively. Sixty patients underwent surgery for gliomas during the 2020 period vs 56 in the 2019 period. We observed no increase in mean length of time from referral to inter-hospital transfer (mean of 76 h in 2020 vs 93 h in 2019 (p = 0.10)) or in mean length of time from admission to surgery in the acute admissions (2.39 days in 2020 vs 2.89 days in 2019). The postoperative 30-day morbidity and mortality rates were lower in 2020; 8.7% (n = 11) compared with 10.1% (n = 14) in 2019. There was one COVID-19-related death which occurred in a patient with B cell lymphoma with negative preoperative COVID-19 test.ConclusionThe provision of neuro-oncological surgery can be safely continued during respiratory illness epidemic or pandemic if a rigorous testing and staffing framework is implemented.

Development and Testing of Compatible Diagnosis Code Lists for the Functional Comorbidity Index: International Classification of Diseases, Ninth Revision, Clinical Modification and International Classification of Diseases, 10th Revision, Clinical Modification.

The Functional Comorbidity Index (FCI) was developed for community-based adult populations, with function as the outcome. The original FCI was a survey tool, but several International Classification of Diseases (ICD) code lists-for calculating the FCI using administrative data-have been published. However, compatible International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM versions have not been available. We developed ICD-9-CM and ICD-10-CM diagnosis code lists to optimize FCI concordance across ICD lexicons. We assessed concordance and frequency distributions across ICD lexicons for the FCI and individual comorbidities. We used length of stay and discharge disposition to assess continuity of FCI criterion validity across lexicons. State Inpatient Databases from Arizona, Colorado, Michigan, New Jersey, New York, Utah, and Washington State (calendar year 2015) were obtained from the Healthcare Cost and Utilization Project. State Inpatient Databases contained ICD-9-CM diagnoses for the first 3 calendar quarters of 2015 and ICD-10-CM diagnoses for the fourth quarter of 2015. Inpatients under 18 years old were excluded. Length of stay and discharge disposition outcomes were assessed in separate regression models. Covariates included age, sex, state, ICD lexicon, and FCI/lexicon interaction. The FCI demonstrated stability across lexicons, despite small discrepancies in prevalence for individual comorbidities. Under ICD-9-CM, each additional comorbidity was associated with an 8.9% increase in mean length of stay and an 18.5% decrease in the odds of a routine discharge, compared with an 8.4% increase and 17.4% decrease, respectively, under ICD-10-CM. This study provides compatible ICD-9-CM and ICD-10-CM diagnosis code lists for the FCI.

Use of the Actiwatch-Mini® in dog safety studies as an early indicator for drug-induced behavioural changes

Clinical observations are routinely used to address drug-induced behavioural changes in dogs. To deal with the limitations of this methodology, we evaluated Actiwatch-Mini® as a tool to monitor continuously locomotor activity in dogs and to provide objective parameters that could be linked to behavioural changes after compound administration. Eight Beagles were equipped with Actiwatch-Mini®. As a reference drug, a PDE2-inhibitor was administered daily for six days at doses known to cause minor or severe behavioural changes. While traditional observation showed no behavioural changes - except sedation - dogs receiving 0.5mg/kg/day, showed significant increases in % immobile time (+15.8%) and mean length of immobile phases (+1.2min) but no change in number of immobile phases (+2.2). At 1mg/kg/day, light to severe changes in behaviour were present. Actiwatch-Mini® recorded an increase in mean length of immobile phases (+1.9min) and a decrease in mean number of immobile phases (-7.4) in the first four hours after each dosing while total % immobile time was not significantly increased (+4.9%). Actiwatch-Mini® was able to detect changes in immobility parameters in dogs dosed with a PDE2-inhibitor while no or only minor behavioural changes were observed. The system can be used for continuously monitoring the activity of dogs, to provide objective scores for evaluation of activity. It provides an inexpensive and low labour-intensive method for detecting changes in activity and possible early indications of drug-induced behavioural changes.

Macroscopic changes in sural nerve after gastrocnemius recession: a cadaver study

Gastrocnemius recession is a common foot and ankle procedure and various techniques that have been utilized are mainly delineated by the anatomic position of the gastrocnemius transection; the 2 common ones are the Baumann and Strayer procedure. Both can adversely affect the sural nerve. The objective of this study was to evaluate the macroscopic changes in the sural nerve following gastrocnemius recession, and to compare the efficacy of the two procedures, regarding the improvement of maximal ankle dorsiflexion. Ten fresh-frozen, above knee cadaveric legs were assigned to one of two gastrocnemius recession techniques: Baumann (n = 5) or Strayer (n = 5). A goniometer was used to measure degree of ankle dorsiflexion before and after the surgery. The sural nerve was meticulously dissected and marked with two suture knots, 2 cm apart. The ankle was passively dorsiflexed from 90° to maximal dorsiflexion in 5° degree increments, and the distance between two suture knots was measured at each increment. The distance between the two cut ends of gastrocnemius muscle was measured with the ankle at 90° and at maximal dorsiflexion. Overall, a mean increase in length between the suture knots on the sural nerve was 0.2 cm, from 90° to maximum ankle dorsiflexion (130°); both the Baumann and Strayer techniques resulted in 0.2 cm increase. The mean improvement in maximal ankle dorsiflexion in the Baumann and Strayer group was 22.6° and 22°, respectively. The mean change in distance between the two cut ends of the gastrocnemius muscle in the Baumann and Strayer group was 1.0 cm and 0.9 cm, respectively. Increased dorsiflexion of the ankle following Strayer or Baumann gastrocnemius recession resulted in similar macroscopic change in the sural nerve, which may contribute to the development of sural neuritis. Further clinical studies are warranted to assess clinical implications of these findings.

1064 Influenza in Cirrhosis Patients: A Multi-Year Nationwide Analysis

INTRODUCTION: Influenza is an acute and usually self-limited febrile respiratory illness. However, it is associated with increased morbidity and mortality in certain high-risk populations including patients with liver disease. Interestingly, the data on this group has been always limited. METHODS: The Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (2010-2014) was used for this analysis. Using with International Classification of Diseases, Ninth Revision, Clinical Modification codes (ICD-9-CM), the patients with a primary discharge diagnosis of influenza were identified. Similarly, the patients with a secondary discharge diagnosis of cirrhosis were identified. Our primary outcome is to assess the effect of cirrhosis on inpatient mortality among patients who were admitted with influenza. Our secondary outcomes include the length of stay and hospitalization charges. Categorical variables were compared using the chi-square test, and continuous variables were compared using Student t-test. All P values were 2 sided, with .05 as the threshold for statistical significance. All analysis was performed with SPSS 25 (IBM, USA). RESULTS: There were 36,680 discharges with a primary diagnosis of influenza between 2010 and 2014; 444 of these discharges (1.2%) have a secondary diagnosis of cirrhosis. Patients with influenza with and without Cirrhosis had comparable mean age, sex, and race (Table 1). Cirrhosis among patients with Influenza was associated with a higher mortality rate of 5% compared to 1.8% in patients without cirrhosis (OR 2.85, 95% CI 1.85 to 4.41, P &lt; 0.0001). There was a minor increase in mean length of stay in influenza patients with a history of cirrhosis compared to non-cirrhotics (5.26 days vs 4.48 days, P &lt; 0.0001). The mean hospitalization cost was significantly higher in influenza patients with cirrhosis ($45059.66 vs $32421.75, P &lt; 0.0001). After adjustment for patient characteristics on a multivariable analysis (Table 2), cirrhosis was independently associated with higher mortality among patients with influenza (OR 3.09, 95% CI 1.99 to 4.78, P &lt; 0.0001). CONCLUSION: Among the patients who were admitted with influenza, cirrhosis was associated with nearly three times higher mortality compared to non-cirrhotics. The mean length of stay and mean hospitalization cost were also higher in patients with cirrhosis.