NH Patients Research Articles

57. Safety of Hormonal Therapy Prior to DIEP Reconstruction: A Matched Cohort Analysis

PURPOSE: Hormone therapy is a mainstay in the treatment of receptor positive breast cancers. There have been conflicting reports regarding the effects of pre-operative hormonal therapy on outcomes after autogenous breast reconstruction (ABR). Here, we present a matched cohort analysis to determine if hormonal therapy truly affects outcomes following ABR. Method: A review was conducted of patients undergoing bilateral deep inferior epigastric perforator flaps (DIEP) between 2016-2020. Patients were split into two cohorts: hormonal therapy (HT) (tamoxifen or aromatase inhibitor), and not on hormonal therapy (NH). A 1:1 propensity match was conducted based on risk factors for complications following DIEP, including BMI, smoking, history of radiation and diabetes. RESULTS: A total of 356 patients were entered in the analysis. From this, 108 patients were matched into the HT and NH cohorts. Overall, patients in the HT cohort were significantly more likely to develop a complication (HT: 44 (41%) vs NH: 25 patients (23%); p=0.006). Incidence of intraoperative thrombosis was similar between the cohorts as was incidence of post-operative total flap loss (HT: 3 patients (2.8%) vs NH: 2 patients (1.9%); p=0.65). HT patients were at a significantly increased risk of venous thromboembolism (VTE) when compared to NH patients (HT: 3.7 % vs NH 0%; p=0.04). CONCLUSION: This is the first study examining the effect of pre-operative hormonal therapy on DIEP breast reconstruction, with matched cohorts to control for comorbidities. HT patients had a significantly higher risk of complication and VTE, suggesting patients should discontinue hormonal therapy prior to surgery.

Intellectual, Psychological, and Clinical Predictors of Quality of Life in Patients with Epilepsy from a Level IV Epilepsy Center in South Florida

Abstract Objective To examine clinical, cognitive, and psychological predictors of Quality of Life (QOL) among Hispanics and non-Hispanics with epilepsy. Participants and Method Data was collected from 90 patients (52 Hispanic; H, 38 Non-Hispanic; NH) diagnosed with epilepsy and referred for neuropsychological evaluation that included measures of depression (BDI-II), anxiety (BAI), and QOL using the Personal Impact of Epilepsy Scale (PIES). We conducted multiple linear regression models with patient’s full-scale IQ, age of seizure onset, duration of seizure disorder, and anxiety and depression symptom severity entered as predictors, with the PIES as outcome measure. Results There were no significant differences between H and NH on any demographic or clinical variable except for longer duration of seizure disorder (t = 2.20, p = 0.03) in H. For the complete sample, higher FSIQ predicted better QOL in relation to the perceived disabling effects of seizures (β = .28, p =.02), higher BDI-II scores predicted more negative medication side effects and greater mood related disruption in QOL (β = -2.27, p =.03; β = -3.82, p =.00), and higher BAI scores were the best predictor for worse overall QOL (β = -.29, p = .05). When the sample was divided according to ethnic background, longer seizure duration was associated with the adverse effects of less medication in the H group (β = .32, p =.04), with all other findings being identical to those of the complete sample. When results for NH patients were analyzed, none of the intellectual, psychological and clinical variables were significantly associated with any of the QOL scales; however, the relationship between the BAI and comorbid mood dysfunction approached significance (β = -1.45, p = .059). Conclusions Our data indicates that overall QOL was primarily predicted by the severity of anxiety symptoms, but not influenced by overall intelligence, symptoms of depression, and clinical seizure variables.

Exploring racial disparities of actionable mutations in gynecologic cancers.

e17098 Background: Next Generation Sequencing (NGS) guides targeted therapy and clinical trial enrollment for patients with gynecologic malignancies. South Florida is a key region to explore biomarkers and molecular alterations common in Hispanic (H) patients due to the high proportion of H individuals. While NGS testing is increasingly used in clinical practice to aid in treatment planning, ethnic minorities are at risk for health disparity including clinical trial enrollment. The objective of this study was to determine if frequently reported mutations are also common in a predominantly H population with gynecologic cancers. Methods: Clinicopathologic data was obtained from women treated at our institution from Jan. 2014 to Jan 2019 for gynecologic malignancies. Women with ovarian (OC), endometrial (EC), and cervical cancer (CC) with NGS results from Caris Life Sciences were included for analysis. Women self-report ethnicity based on initial hospital intake form. Mutations based on point mutations, indels, fusions and copy number variations were identified. Descriptive statistics are reported. IRB approval was obtained. Results: A total of 233 patients with 117 ovarian (OC), 24 cervical (CC) and 92 endometrial cancers (EC) were included. Among the 233 women, 96 (41%) were H, 137 (59%) identified as NH. There were 38 H and 48 NH patients with EC; 50 H and 62 NH OC patients; and 8 H and 13 NH CC patients. Among EC patients, TP53 appeared in 42% vs. 47%, PTEN 26% vs. 30% , PIK3CA 32% vs. 17%, CTNNB1 32% vs. 17% , and KRAS 16% vs. 21% of H and NH cases respectively. In the OC cohort, TP53 appeared in 74% vs. 75% , BRCA1/2 10% vs. 19%, KRAS 16% vs. 16% and PIK3CA 8% vs. 6% of H and NH cases respectively. In CC patients, TP53 appeared in 25% vs. 23%, KMT2C 12.5% vs. 7.6% and PIK3CA 0 vs. 38% of H and NH cases respectively. There were no statistical differences in the mutation rates between the two groups. Conclusions: There is limited data reported on the variation of mutations based on ethnicity in women with gynecologic cancers. Our study suggests there may be different driver mutations based on ethnicity. Future studies in larger cohorts are needed to further assess genomic differences, potential responses to treatment and further increase H population enrollment into clinical trials.

Statin use associated with improved overall and cancer specific survival in patients with head and neck cancer

ObjectivesStudies have shown the utility of lipid-lowering agents in improving outcomes in various cancers. We aim to explore how statins affect overall survival and cancer specific survival in head and neck cancer patients using population-based datasets. Patients and methodsUsing the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset, we separated HNC patients into three groups: those with no hyperlipidemia (nH), those with hyperlipidemia and not taking a statin (HnS), and those with hyperlipidemia and taking a statin (H + S). Overall survival (OS) and cancer specific survival (CSS) were compared between the three groups based on disease subsite (oral cavity, oropharynx, and other) using Kaplan-Meier and multivariate Cox regression analysis (MVA), controlling for demographic, socioeconomic, staging, treatment, and comorbidity covariates. Using Pearson chi-square analysis, we also compared the incidence of cancer-related toxicity events. ResultsThere were 495 nH, 567 HnS, and 530 H + S patients. H + S patients had superior OS and CSS (73.0, 81.2%) relative to nH (58.6, 69.1%) and HnS groups (61.7, 69.2%) (p < 0.01). On MVA, H + S patients showed improved OS (p < 0.01) and CSS (p = 0.04) compared to nH (HR = 1.64, 1.56) and HnS (HR = 1.40, 1.37). MVA stratified by subsite yielded similar results for oral cavity and oropharyngeal disease. Toxicity-related events did not differ significantly between the groups. ConclusionHNC patients with hyperlipidemia and taking a statin demonstrated improved outcomes compared to nH and HnS patients, further supporting statins' role as a potential adjuvant anti-neoplastic agent in HNC. Further prospective studies to investigate the impact of statins on HNC outcomes are warranted.

ENA-78 Is a Novel Predictor of Wound Healing in Patients with Diabetic Foot Ulcers.

Objectives Chronic foot ulceration is a severe complication of diabetes, driving morbidity and mortality. The aim of our study was to identify novel biomarkers of impaired wound healing in diabetic foot ulcers. Methods 109 patients with neuropathic diabetic foot ulcers and 30 burn victims otherwise healthy participated. Antibody-coated glass slide arrays were used to determine the levels of 80 human cytokines in pooled plasma or pooled wound exudate of diabetic foot ulcers with rapidly healing (RH, n = 12) and matched nonhealing (NH, n = 12) patients. Potential biomarkers were confirmed in an independent cohort by enzyme-linked immunosorbent assay (ELISA). Results Protein array profiling identified 27 proteins or 15 proteins significantly altered in protein profiling of pooled plasma or pooled wound exudate of 12 RH patients compared with 12 matched NH patients, respectively. In an independent cohort, quantitative ELISA validation confirmed a decrease in MCP-2 and ENA-78 levels in NH patients versus RH patients or burn victims. After adjusting for the traditional risk factors (sex, age, body mass index, fasting plasma glucose, ulcer area, HbA1C, diabetes duration, hyperlipidemia, and antibiotic therapy), only wound exudate level of ENA-78 remained having a significant association with an increased odds ratio (OR) for wound healing by binary logistic regression analysis (P < 0.05). Conclusion Decreased wound exudate ENA-78 was independently associated with wound healing of patients with diabetic foot. Exudate ENA-78 level is implicated as a novel predictor of wound healing in patients with diabetic foot ulcers.

Natural course of neuropsychiatric symptoms in nursing home patients with mental-physical multimorbidity in the first eight months after admission

Objective: Aging societies will bring an increase in the number of long-term care patients with mental-physical multimorbidity (MPM). This paper aimed to describe the natural course of neuropsychiatric symptoms (NPS) in patients with MPM in the first 8 months after admission to a geronto-psychiatric nursing home (GP-NH) unit.Methods: Longitudinal cohort study among 63 patients with MPM no dementia living in 17 GP-NH units across the Netherlands. Data collection consisted of chart review, semi-structured interviews, and brief neuropsychological testing, among which our primary outcome measure the Neuropsychiatric Inventory (NPI). Descriptive and bivariate analyses were conducted.Results: Our study showed a significant increase of the NPI total score (from 25.3 to 29.3, p = 0.045), and the total scores of a NPI hyperactivity cluster (from 9.7 to 11.8, p = 0.039), and a NPI mood/apathy cluster (from 7.7 to 10.1, p = 0.008). Just over 95% had any clinically relevant symptom at baseline and/or six months later, of which irritability was the most prevalent and persistent symptom and the symptom with the highest incidence. Hyperactivity was the most prevalent and persistent symptom cluster. Also, depression had a high persistence.Conclusions: Our results indicate the omnipresence of NPS of which most were found to be persistent. Therefore, we recommend to explore opportunities to reduce NPS in NH patients with MPM, such as creating a therapeutic milieu, educating the staff, and evaluating patient’s psychotropic drug use.

Abstract C81: Variations in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) across states in the United States

Abstract Background: Previous studies reported substantial racial and socioeconomic disparities in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) in the US. We examined variation in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) across states in the US. We also examined whether black/white disparity in receipt of curative-intent surgery varies by state. Methods: Patients with stage I or II NSCLC diagnosed in 2007–2011 were identified from 38 population-based cancer registries compiled by the North American Association of Central Cancer Registries (NAACCR). We calculated percentage for receipt of curative-intent surgery in each state. Adjusted risk ratios (RRs) were generated using modified Poisson regression to control for sociodemographic (e.g., age, sex, race, insurance) and clinical (e.g., grade, stage, tumor size) factors. NH whites and patients in Massachusetts used as reference for comparisons. Results: Receipt of curative-intent surgery for early-stage NSCLC varied substantially by state, ranging from 52.2% in Wyoming to about 75% in Massachusetts, New Jersey, and Utah. In a multivariable analysis, the likelihood of receiving curative-intent surgery for early-stage NSCLC patients was significantly lower in all states but seven states/registries and ranged from 7% lower in California (RR, 0.93; 95% CI, 0.89–0.97) to 25% lower in Wyoming (RR, 0.75; 95% CI, 0.59–0.95) compared with patients in Massachusetts. Receipt of curative-intent surgery was lower for NH black than NH white patients in all states though statistically significant in only two states (Florida, Texas) after accounting for differences in sociodemographic and clinical characteristics. Conclusions: Receipt of curative-intent surgery for early-stage NSCLC substantially varies across states in the United States, with the rate of receipt for both NH white and NH black patients generally lower and racial disparity higher in southern states. Citation Format: Helmneh M. Sineshaw, Xiao-Cheng Wu, W Dana Flanders, Raymond Uyiosa Osarogiagbon, Ahmedin Jemal. Variations in receipt of curative-intent surgery for early-stage non-small cell lung cancer (NSCLC) across states in the United States. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C81.

Reduced cortical thickness in right Heschl's gyrus associated with auditory verbal hallucinations severity in first-episode schizophrenia.

BackgroundAuditory verbal hallucinations (AVHs) represent one of the most intriguing phenomena in schizophrenia, however, brain abnormalities underlying AVHs remain unclear. The present study examined the association between cortical thickness and AVHs in first-episode schizophrenia.MethodHigh-resolution MR images were obtained in 49 first-episode schizophrenia (FES) patients and 50 well-matched healthy controls (HCs). Among the FES patients, 18 suffered persistent AVHs (“auditory hallucination” AH group), and 31 never experienced AVHs (“no hallucination” NH group). The severity of AVHs was rated by the Auditory Hallucinations Rating Scale (AHRS). Cortical thickness differences among the three groups and their association with AVHs severity were examined.ResultsCompared to both HCs and NH patients, AH patients showed lower cortical thickness in the right Heschl’s gyrus. The degree of reduction in the cortical thickness was correlated with AVH severity in the AH patients.ConclusionsAbnormalities of cortical thickness in the Heschl’s gyrus may be a physiological factor underlying auditory verbal hallucinations in schizophrenia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0546-2) contains supplementary material, which is available to authorized users.

Resident health-related quality of life in Swiss nursing homes

BackgroundHealth-related quality of life (HRQOL) levels and their determinants in those living in nursing homes are unclear. The aim of this study was to investigate different HRQOL domains as a function of the degree of cognitive impairment and to explore associations between them and possible determinants of HRQOL. MethodFive HRQOL domains using the Minimum Data Set - Health Status Index (MDS-HSI) were investigated in a large sample of nursing home residents depending on cognitive performance levels derived from the Cognitive Performance Scale. Large effect size associations between clinical variables and the different HRQOL domains were looked for. ResultsHRQOL domains are impaired to variable degrees but with similar profiles depending on the cognitive performance level. Basic activities of daily living are a major factor associated with some but not all HRQOL domains and vary little with the degree of cognitive impairment. LimitationsThis study is limited by the general difficulties related to measuring HRQOL in patients with cognitive impairment and the reduced number of variables considered among those potentially influencing HRQOL. ConclusionHRQOL dimensions are not all linearly associated with increasing cognitive impairment in NH patients. Longitudinal studies are required to determine how the different HRQOL domains evolve over time in NH residents.

Long-Term Follow-Up After Preoperative Trastuzumab and Chemotherapy for HER2-Overexpressing Breast Cancer

BackgroundNeoadjuvant chemotherapy and trastuzumab is an established treatment for locally advanced HER2-positive breast cancer, providing favorable rates of clinical response and pCR. Minimal data describe long-term outcomes after neoadjuvant HER2-directed therapy. This study aimed to explore long-term efficacy and toxicity after neoadjuvant trastuzumab and chemotherapy for HER2-positive breast cancer. Patients and MethodsEligible patients participated in 1 of 2 single-arm phase II neoadjuvant trials, receiving either paclitaxel/trastuzumab (TH) or vinorelbine/trastuzumab (NH) for stage II-III HER2-positive disease. Postoperative chemotherapy, with or without trastuzumab, was offered. Charts were reviewed to identify recurrence, death, and treatment-related toxicities. Association of long-term outcomes with baseline characteristics and pathological response to primary therapy was explored. ResultsEighty patients were identified; 33 (41.3%) received TH and 47 (58.8%) received NH. Fourteen (17.5%) had pCR at surgery. Most (96.3%) received anthracycline-based adjuvant chemotherapy; 78.7% of NH patients also received adjuvant trastuzumab. At a median follow-up of 8.8 years, 23 (28.8%) patients have experienced recurrence, with 16 breast cancer-related deaths. Four-year RFS in patients with pCR was 92.9% (95% confidence interval [CI], 79.4%-100%) versus 72.4% without pCR (95% CI, 63.9%-82.1%). All initial symptomatic cardiotoxicity resolved during extended follow-up. New symptomatic cardiotoxicity in long-term follow-up was rare, primarily occurring in patients requiring retreatment with a cardiotoxic agent. ConclusionNeoadjuvant chemotherapy and trastuzumab for HER2-positive breast cancer resulted in favorable long-term survival with minimal late toxicity. Trends in this data set suggest an association between pCR and improved long-term RFS. Retreatment with cardiotoxic agents might increase risk of late cardiotoxicity.

The molecular signature of impaired diabetic wound healing identifies serpinB3 as a healing biomarker.

Chronic foot ulceration is a severe complication of diabetes, driving morbidity and mortality. The mechanisms underlying delaying wound healing in diabetes are incompletely understood and tools to identify such pathways are eagerly awaited. Wound biopsies were obtained from 75 patients with diabetic foot ulcers. Matched subgroups of rapidly healing (RH, n = 17) and non-healing (NH, n = 11) patients were selected. Proteomic analysis was performed by labelling with isobaric tag for relative and absolute quantification and mass spectrometry. Differentially expressed proteins were analysed in NH vs RH for identification of pathogenic pathways. Individual sample gene/protein validation and in vivo validation of candidate pathways in mouse models were carried out. Pathway analyses were conducted on 92/286 proteins that were differentially expressed in NH vs RH. The following pathways were enriched in NH vs RH patients: apoptosis, protease inhibitors, epithelial differentiation, serine endopeptidase activity, coagulation and regulation of defence response. SerpinB3 was strongly upregulated in RH vs NH wounds, validated as protein and mRNA in individual samples. To test the relevance of serpinB3 in vivo, we used a transgenic mouse model with α1-antitrypsin promoter-driven overexpression of human SERPINB3. In this model, wound healing was unaffected by SERPINB3 overexpression in non-diabetic or diabetic mice with or without hindlimb ischaemia. In an independent validation cohort of 47 patients, high serpinB3 protein content was confirmed as a biomarker of healing improvement. We provide a benchmark for the unbiased discovery of novel molecular targets and biomarkers of impaired diabetic wound healing. High serpinB3 protein content was found to be a biomarker of successful healing in diabetic patients.

Management and Outcomes of ST-Elevation Myocardial Infarction in Nursing Home Versus Community-Dwelling Older Patients: A Propensity Matched Study

ObjectivesThe influence of admission source (nursing home [NH] versus community-dwelling) on treatment strategies and outcomes among elderly patients with ST-elevation myocardial infarction (STEMI) has not been investigated. ParticipantsNationwide Inpatient Sample databases from 2003 to 2010 were used to identify 270,117 community-dwelling and 4082 NH patients 75 years of age or older with STEMI. DesignRetrospective observational study. MeasurementsPropensity scores for admission source were used to assemble a matched cohort of 3081 community-dwelling and 3132 NH patients, who were balanced on baseline demographic and clinical characteristics. Bivariate logistic regression models were then used to determine the associations of NH with in-hospital outcomes among matched patients. ResultsIn-hospital mortality was significantly higher in patients with STEMI presenting from a NH as compared with community-dwelling patients (30.5% versus 27.6%; odds ratio [OR] 1.15, 95% confidence interval [CI] 1.03–1.29; P = .012). Overall, NH patients were less likely to receive reperfusion (thrombolysis, percutaneous coronary intervention, or coronary artery bypass grafting) (11.5% versus 13.4%; OR 0.84, 95% CI 0.72–0.98; P = .022). However, rates of percutaneous coronary intervention alone were similar in both groups (9.9% in NH versus 9.1% in community-dwelling; OR 1.10, 95% CI 0.93–1.30; P = .276). Mean length of stay was also similar in both groups (5.68 ± 5.40 days in NH versus 5.69 ± 4.98 days in community-dwelling, P = .974). ConclusionCompared with their community-dwelling counterparts, older NH patients are less likely to receive reperfusion therapy for STEMI and have higher in-hospital mortality.

The Hospital Anxiety and Depression Scale—Dimensionality, reliability and construct validity among cognitively intact nursing home patients

BackgroundDepression and anxiety are particularly common among individuals living in long-term care facilities. Therefore, access to a valid and reliable measure of anxiety and depression among nursing home patients is highly warranted. AimTo investigate the dimensionality, reliability and construct validity of the Hospital Anxiety and Depression scale (HADS) in a cognitively intact nursing home population. MethodsCross-sectional data were collected from two samples; 429 cognitively intact nursing home patients participated, representing 74 different Norwegian nursing homes. Confirmative factor analyses and correlations with selected constructs were used. ResultsThe two-factor model provided a good fit in Sample1, revealing a poorer fit in Sample2. Good-acceptable measurement reliability was demonstrated, and construct validity was supported. LimitationsUsing listwise deletion the sample sizes were 227 and 187, for Sample1 and Sample2, respectively. Greater sample sizes would have strengthen the statistical power in the tests. The researchers visited the participants to help fill in the questionnaires; this might have introduced some bias into the respondents׳ reporting. The 14 HADS items were part of greater questionnaires. Thus, frail, older NH patients might have tired during the interview causing a possible bias. ConclusionLow reliability for depression was disclosed, mainly resulting from three items appearing to be inappropriate indicators for depression in this population. Further research is needed exploring which items might perform as more reliably indicators for depression among nursing home patients.

Analysis of clinical features of ovarian cancer (OC) and breast cancer (BC) among BRCA-mutated (BRCA+) and sporadic (NH) double tumours.

5548 Background: The clinical outcome of double OC and BC is specifically unknown either BRCA+ and in double tumours NH patients. Methods: The present databases made of 106 patients, 67 cases of NH (negative, no-tested or ongoing test for BRCA1/2 mutations) and 39 of BRCA+, were constituted to identify the clinical and pathological features of BC and OC. The primary endpoint was to evaluate biological characteristics of both cancers and clinical outcome of OC in coexistence with BC. Patients were censored at last follow-up or death (any cause) for determination of overall survival (OS). OS were determined using the Kaplan-Meier method and log-rank test to compared the different levels of a variable. Pearson Chi-Square or Fisher’s exact test were used to compare relationship between variables in to groups and Mann-Whitney U test to compare the medians. Results: 32/39 (82 %) BRCA+ and 44/67 (66 %) NH had BC as their first malignancy. As regards the genetic test on NH patients, 28 were BRCA negative, 22 have not been tested and in 10 patients the test is still in progress. All BRCA2 patients had BC as first malignancy, while 20/22 of BRCA1. Bilateral BC was more frequent in BRCA+ than in NH (33 % vs 9 %), resulted in a fivefold higher risk (p = 0.002). III-IV stage OC at diagnosis was 79% in BRCA+ vs 55 % in NH (p = 0.013); indeed BRCA+ patients have a threefold higher risk (however moderate) to develop an advanced stage OC. Death for progression of ovarian cancer involved both groups, and third neoplasm was involved in death cause in 1/1 of BRCA and 5/6 of NH. Two BRCA1 with OC as first neoplasm are alive. Conclusions: III-IV stage OC is more frequent in BRCA+ than in NH, and the main cause of disease progression and death is due to OC. Eventually the most relevant conclusive assessment is the suggestion of a more conserving management for BC and an intensive follow-up for OC in patients with double tumours, irrespective of their pathological or genetic features. Prospective trials are also indicated.

Non-steroidal anti-inflammatory drug hypersensitivity in adults and the factors associated with asthma

Characteristics of non-steroidal anti-inflammatory drug (NSAID)-hypersensitivity (NH) associated with underlying/accompanying diseases has not been studied in Turkey. In addition, the factors associated with asthma in NH patients are not well known. The present study aimed to investigate the relationship between NH and chronic urticaria, rhinitis/rhinosinusitis, and asthma in an effort to identify NH phenotypes. The study's secondary aim was to identify the factors associated with asthma in NH patients and the NSAID reaction pattern in asthmatics. Data for 1137 NH patients in our hospital's allergy clinic database were retrospectively analyzed. Patients were divided into 5 groups based on their accompanying diseases (chronic urticaria, asthma, rhinitis/rhinosinusitis). Asthmatic patients were compared to non-asthmatic patients to identify the factors associated with asthma. Reaction patterns and patient characteristics in each group differed from those in the reference group (NH only group). Asthma in patients with NH was associated with female gender, sinonasal polyposis/polyp surgery, rhinitis/rhinosinusitis, NSAID-induced rhinitis/asthma or a blended reaction pattern, immediate reaction following NSAID intake, self-reported history of food allergy, and family history of asthma; the odds ratios and 95% CIs were1.35 (1.02-1.78), 13.52 (8.74-20.9)/10.94 (6.73-17.77), 12.06 (9-16.17), 15.28 (10.45-22.36)/2.43 (1.70-3.45), 1.76 (1.31-2.35), 1.49 (1.04-2.14), and 3.1 (2.35-4.08), respectively. The characteristics of the asthmatic patients that had urticaria/angioedema-type reactions to NSAID intake (pseudo Samter's syndrome) differed from those in the asthmatics with rhinitis/asthma-type reactions. Chronic urticaria, rhinitis, and asthma commonly accompany NH. NSAID response patterns in NH patients may help differentiate groups of patients. The present study identified factors associated with asthma in NH patients and observed that there seems to be different phenotypes of Samter's syndrome, for which a new classification scheme was proposed.

A high prevalence of autoimmune indices and disorders in primary nummular headache

BackgroundsNummular headache (NH) is currently considered a form of peripheral neuralgia originating from the terminal branch in epicranial tissue but its etiopathogenesis is still unknown. Since autoimmune disorders often involve the trigeminosensory nerve to provoke craniofacial pain, we hypothesize that autoimmunity aberration may play a role with regard to NH. MethodsWe examined the antibodies to antinuclear factor, ds-DNA, extracted nuclear antigens, rheumatoid factor, as well as antiphospholipid antibodies, in 23 primary NH patients. ResultsAmong them were 16 patients (69.6%) found as having at least one abnormal autoimmune index, namely, antibodies to antinuclear factor in 8 patients, SSA/La in 6 patients, rheumatoid factor in 4 patients, SSB/Ro in 2 patients, and ds-DNA in 1 patient. An abnormal increase of blood anti-beta2-glycoprotein I antibody was noted in 4 patients and lupus anticoagulant in 1 patient, whereas HLA-B27 seropositivity was detected in 1 patient. Except for 2 patients positive for antinuclear factor without other associated features, 15 patients (65%) were finally diagnosed as having Sjogren/sicca syndrome, rheumatoid arthritis or antiphospholipid antibody syndrome. ConclusionsA high prevalence of abnormal autoimmune indices and disorders is present in primary NH patients, suggesting a probable relationship between autoimmunity aberration and epicranial neuralgia in NH.

Analysis of clinical features of ovarian cancer (OC) and breast cancer (BC) among BRCA-mutated (BRCA+) and sporadic (NH) double tumors.

e12037 Background: Women BRCA+ are at significant risk of developing both OC and BC. Double tumors could arise also in NH patients. Whether the clinical outcome of double OC and BC is different in BRCA+ and in NH subjects is unknown. Methods: The databases of the Istituto Oncologico Veneto (IOV), Medical Oncology Department of Mirano (VE) and Thiene (VI) were searched to identify the clinical and pathological features of (BC) and (OC) arisen in BRCA+ subjects as well as patients with both malignancy but tested negative/no-tested/unknown for BRCA1/2 mutation (NH). The primary endpoint was to establish if OC instead of BC needs a more intensive follow-up because it principally affects patient’s prognosis. Patients were censored at last follow-up or death (any cause) for determination of overall survival (OS). OS estimates were determined using the Kaplan-Meier method and compared by means of log-rank test. The Fisher’s exact test and the t-test were used to compare frequencies and means between groups, respectively. Results: 24/31 (77%) BRCA+ and 30/49 (61%) NH had BC as their first malignancy (p=0.15). Among NH, 20 were BRCA test negative, 20 were untested and 9 unknown. BRCA+ were younger than NH at diagnosis of first malignancy (mean age 51 vs 56y, p=0.055). Bilateral BC was more frequent in BRCA+ than in NH (78.6% vs 28.6% p=0.001). Stage III-IV OC at diagnosis were 74% in BRCA vs 61% in NH (p=0.34). Locally advanced (stage II-III) BC was significantly more frequent in BRCA+ vs NH (75% vs 42%, p=0.03). No OS difference was observed between BRCA+ and NH subjects (P=0.99). Death for progression of ovarian cancer was observed in 11/31 (35%) in BRCA+ vs 10/49 (20%) patients in NH (p=0.19). No progression of breast cancer was reported in either groups. Conclusions: OC is the killer malignancy among patients affected by OC and BC, both in BRCA+ and in NH subjects. In patients with double tumors, irrespective of their pathological features, a more conserving management for BC and an intensive follow-up for OC are suggested.

Nummular headache: 21 new cases and therapeutic results

To evaluate the clinical feature of nummular headache and the efficiency of treatment in China. The data of 21 NH patients treated from February 2006 to February 2008, were analyzed. They were 9 men, 12 women, aged 37 +/- 12 (18 - 63) years. Headache history ranged from 7 days to 30 years. 13 patients reported head pain confined to a circular area of 0.6 to 5 centimeter, and the other 8 patients had pain in an elliptical area of 1 - 2 centimeter x 1.5 - 3 centimeter. The symptomatic area was located in the parietal (n = 7), occipital(n = 8), temporal (n = 6), or border regions between temporal and parietal (n = 1). The right side was affected in 10 patients and the left side in the 9 patients, the middle of occipital and parietal areas were affected in 1 patient, respectively. Seven patients had mild pain, 8 patients had moderate pain and 6 patients had severe pain. The characteristics of headache included stabbing pain (n = 6), sharp pain (n = 3), pulsating apin (n = 3), grinding pain (n = 1), exploding pain (n = 5), included light-dull apin (n = 3). Three patients were treated by local nerve block with lidocaine plus dexamethasone phosphate/acetate and one of them got some 30 hours of prominent pain relief, no relief was obtained for other two patients. One patient obtained pain remission by acupuncture after amitriptyline, paroxetine had been tried ineffectively. One patient, woman, 38 years old, was treated by carbamazepine (tegretol) and amitriptyline for 3 months and pain relief was obtained gradually and the head pain disappeared finally. 8 patients were treated effectively by amitriptyline combining indomethacium, ibuprofen or carbamazepine. One patient was treated effectively by nimodipine. 2 patients were treated ineffectively by amitriptyline combining indomethacium. 4 patients were not treated. 3 patients were lost to follow-up. NH is not very rare and some of NH patients may be treated effectively by acupuncture or amitriptyline combining indomethacium, ibuprofen or carbamazepine.

Circadian variations of transferrin saturation levels in iron‐overloaded patients: implications for the screening of C282Y‐linked haemochromatosis

The phenotypic screening for genetic haemochromatosis (GH) relies upon the determination of transferrin saturation (TS). In large-scale screening programs, the time of blood sampling can be uneasy to control. We studied the circadian variations of TS at 08.00 hours, 12.00 hours, 18.00 hours and 00.00 hours in 46 C282Y homozygous patients (GH) and 47 non-GH patients (NH), to determine whether the time of blood sampling influenced the results of screening. In both groups, there were significant circadian variations in TS, with the highest values at 08.00 hours and the lowest at 00.00 hours. For any given time-point, TS was significantly higher in the GH group when compared with the NH group (P < 0.0001). For both groups, there was a significant decrease in TS between 08.00 hours and 00.00 hours (P < 0.0001) but this decrease was not as significant in GH when compared with NH patients (interaction P < 0.0073). Receiver operating characteristics (ROC) curves generated for TS at 08.00 hours, 12.00 hours, 18.00 hours and 00.00 hours, presented the same efficiency of diagnosis of GH, with TS threshold varying between 64% at 08.00 hours and 36% at 00.00 hours. In conclusion, for screening studies of C282Y homozygosity, determination of transferrin saturation may be performed at any time during the day.

THROMBIN ACTIVATION IN CARDIAC SURGICAL PATIENTS RECEIVING PREOPERATIVE HEPARIN INFUSIONS

Introduction: Patients on heparin infusions (H) have a diminished activated coagulation time (ACT) response to the heparin bolus given for cardiopulmonary bypass (CPB), [1] which may place them at risk for inadequate anticoagulation. The High Dose Thrombin Time (HiTT), a specific measure of heparin activity, may be useful for patients on heparin therapy. [2] We compared patients receiving (H) and not receiving (nH) heparin with respect to ACT, HiTT, and thrombin generation during CPB. Methods: With IRB approval, 65 consecutive patients undergoing elective CPB were studied. Using bovine heparin 300 U/kg, ACT>or=to400 sec was maintained. ACT, and HiTT were measured at multiple time points. Plasma levels of F1.2, thrombin-antithrombin III complex (TAT), and fibrin monomer were determined at baseline, 30 min into CPB and after protamine administration. Blood loss and transfusions were recorded. Patients were compared using ANOVA, and Mann Whitney-U test where appropriate. P<0.05 was considered significant. Results: ACT values differed significantly in H (dotted line, n=32) vs. nH (solid line, n=33) patients, (p<0.003). HiTT values did not significantly differ between groups (p=0.33). (Figure 1) The two groups did not differ in any marker of thrombin formation or activity. (n=20, see Figure 2) Neither CTD (722 +/- 520 ml vs. 724 +/- 311 ml) nor transfusion requirements differed between groups.Figure 1Figure 2Discussion: H patients often receive additional boluses of heparin to maintain ACT>480 sec. Our data suggest that thrombin formation and activity are not enhanced in patients receiving H therapy despite a diminished ACT response to heparin. The utility of ACT in patients receiving H therapy and the threshold values perceived as indicative of adequate anticoagulation for CPB are questioned. The use of HiTT is currently under investigation.