non-Caucasian Ethnicity Research Articles

Periodontitis and Hypertension: Is the Association Causal?

High blood pressure (BP) and periodontitis are two highly prevalent conditions worldwide with a significant impact on cardiovascular disease (CVD) complications. Poor periodontal health is associated with increased prevalence of hypertension and may have an influence on BP control. Risk factors such as older age, male gender, non-Caucasian ethnicity, smoking, overweight/obesity, diabetes, low socioeconomic status, and poor education have been considered the common denominators underpinning this relationship. However, recent evidence indicates that the association between periodontitis and hypertension is independent of common risk factors and may in fact be causal in nature. Low-grade systemic inflammation and redox imbalance, in particular, represent the major underlying mechanisms in this relationship. Neutrophil dysfunction, imbalance in T cell subtypes, oral-gut dysbiosis, hyperexpression of proinflammatory genes, and increased sympathetic outflow are some of the pathogenetic events involved. In addition, novel findings indicate that common genetic bases might shape the immune profile towards this clinical phenotype, offering a rationale for potential therapeutic and prevention strategies of public health interest. This review summarizes recent advances, knowledge gaps and possible future directions in the field.

Efficacy of Combined Suprachoroidal Stent and Cataract Surgery in Patients With Glaucoma.

The purpose of this study was to evaluate the efficacy of intraocular pressure (IOP) control after combined CyPass Micro-Stent implantation and cataract surgery (combined surgery). All cases of combined surgery performed from February 2017 to July 2018 at Stein and Doheny Eye Institutes were reviewed. The primary outcome was a qualified success with stratified IOP targets based on criteria: final IOP (A) ≤18 mm Hg and reduction of 20%, (B) ≤15 mm Hg and reduction of 25%, (C) ≤12 mm Hg and reduction of 30%. Secondary outcome measures included postoperative IOP and number of medications, complications, additional glaucoma surgery, and postoperative refractive error. Predictive factors for failure were investigated. IOP spike was defined as a postoperative IOP ≥30 or >10 mm Hg increase from preoperative IOP. One hundred forty-one eyes (107 patients) were included. Mean (±SD) preoperative IOP was 15.4±3.4 mm Hg on an average of 2.2±1.1 medications. A statistically significant reduction in IOP and number of medications was seen at 12 months (13.8±4.2 mm Hg, 1.3±1.3 medications, P<0.001). Fifteen eyes (10.6%) had a postoperative IOP spike. Thirteen eyes (9.2%) experienced 17 complications (12.1%). Additional glaucoma surgery was performed in 3 eyes (2 patients). Cumulative success rates at 1 year based on criteria A, B, and C were 42%, 33%, and 28%, respectively. Lower preoperative IOP, greater preoperative medication number, the occurrence of postoperative IOP spike, and non-Caucasian ethnicity were associated with failure. Combined CyPass Micro-Stent implantation and cataract surgery may reduce glaucoma medication burden with a success rate of 28% to 42% at 1 year.

T79. BALANCING EFFECTS WITH SIDE-EFFECTS: EXAMINING COMPARATIVE METABOLIC CONSEQUENCES OF 18 ANTIPSYCHOTICS IN TREATMENT OF SCHIZOPHRENIA USING NETWORK META-ANALYSIS

BackgroundAntipsychotic treatment is associated with metabolic disturbance. However, the relative degree to which metabolic alterations occur in treatment with different antipsychotics remains unclear. Furthermore, predictors of metabolic dysregulation are poorly understood, and association between metabolic-change and change in psychopathology is uncertain.MethodsWe searched Medline, EMBASE and PsychINFO from inception until June 30, 2019. We included blinded randomised controlled trials (RCTs) comparing 18 antipsychotics and placebo in acute-treatment of schizophrenia. We performed frequentist random-effects network meta-analyses (NMAs) to investigate treatment-induced changes in body weight, BMI, total/LDL/HDL-cholesterol, triglycerides, and glucose. We performed meta-regressions to examine relationships between metabolic change and age/gender/ethnicity/baseline-weight/baseline-metabolic parameter level. We examined the association between metabolic change and psychopathology change by estimating the correlation between symptom severity change and metabolic parameter change.ResultsOf 6532 citations, 100 RCTs met inclusion criteria, including 25,952 patients. Median treatment-duration was 6-weeks. According to our NMAs, mean differences for weight-gain compared to placebo ranged from -0.23 (95% CI: -0.83, 0.36) for best (haloperidol) to +3.01kg (1.78, 4.24) for worst (clozapine); for BMI from -0.25 (-0.68, 0.17) for best (haloperidol) to +1.07kg/m2 (0.90, 1.25) for worst (olanzapine); for total-cholesterol from -0.09 (-0.24, 0.07) for best (cariprazine) to +0.56mmol/L (0.26, 0.86) for worst (clozapine); for LDL-cholesterol from -0.13 (-0.21, -0.05) for best (cariprazine) to +0.20mmol/L (0.14, 0.26) for worst (olanzapine); for HDL-cholesterol from +0.05 (0.00, 0.10) for best (brexpiprazole) to -0.10mmol/L (-0.33, 0.14) for worst (amisulpride); for triglycerides from -0.01 (-0.10, 0.08) for best (brexpiprazole) to +0.98mmol/L (0.48, 1.49) for worst (clozapine); for glucose from -0.29 (-0.55, -0.03) for best (lurasidone) to 1.05mmol/L (0.41, 1.70) for worst (clozapine). Greater increases in glucose were predicted by higher baseline-weight (p=0.001) and male-gender (p=0.008). Non-Caucasian ethnicity was associated with greater increases in total-cholesterol (p=0.04). Improvements in symptom severity were associated with increases in weight (rho=0.36, p=0.002), BMI (rho=0.84, p<0.0001), total-cholesterol (rho=0.31, p<0.05), and LDL-cholesterol (rho=0.42, p=0.01), and decreases in HDL-cholesterol (rho= -0.35, p=0.04).DiscussionThere are marked differences between antipsychotics in terms of metabolic side-effects, with olanzapine and clozapine exhibiting the worst profiles. By contrast, compared with placebo, lurasidone and cariprazine respectively reduce fasting glucose and LDL-cholesterol, while aripiprazole and brexpiprazole increase HDL-cholesterol. Baseline weight, male gender, and non-Caucasian ethnicity predict vulnerability to antipsychotic-induced metabolic change. Considering the increased prevalence of metabolic syndrome, cardiovascular disease, and cardiovascular mortality in schizophrenia, these data may be used to inform antipsychotic-prescribing, especially in those at-risk groups we have identified. However, clinical decisions to preferentially use an antipsychotic with fewer metabolic side effects should consider that clinical improvement appears to be associated with development of these side effects.

Should Pre-Transplant Esophageal Dysmotility Preclude Candidacy for Lung Transplantation?

Esophageal dysmotility can decrease luminal clearance and increase the risk of aspiration and GERD and contribute to allograft dysfunction. We sought to determine the impact of pre-transplant esophageal dysmotility on allograft function, GERD, rejection and survival after lung transplantation. From 2012 to 2018, 699 patients underwent lung transplantation at our institution. Gastroesophageal physiological testing included esophageal manomentry, 24 hour pH measurement and gastric emptying tests before and after transplantation. High resolution manometry (HRM) was available in 337 patients including 120 patients with abnormal HRM (20-aperistalsis, 10-Distal Esophageal Spasms, 8-Jackhammer Esophagus and 82-Ineffective Motility). Allograft function was assessed by Forced Expiratory Volume in 1-second (FEV1) over time. Long-term risk of mortality was assessed non-parametrically by Kaplan-Meier method and parametrically by a multiphase hazard model. Pre-transplant esophageal dysmotility was not associated with worse survival after lung transplantation (P= .7). One year overall survival was 95%, 92% and 90% respectively for patients with aperistalsis, dysmotility and normal motility while 5-year OS was 67%, 69% and 65% respectively. On univariate analysis, patients with non-caucasian ethnicity and group B disease were more likely to have dysmotility. On post-transplant pH testing, patients with abnormal motility had greater acid exposure time and higher Demeester scores along with lower residual LES pressure. Abnormal HRM prior to lung transplantation was not significantly associated with biopsy proven acute lung rejection (P= .5) or allograft function (P= .5). Esophageal dysmotility is not associated with poor allograft function or worse post-transplant survival. Favorable outcomes can be achieved with careful selection and post-transplant management. Such patients should not be disqualified solely on the basis of esophageal dysmotility.

Gaps in patient-reported outcome measures in randomized clinical trials of cardiac catheter ablation: a systematic review.

The aim of this systematic review was to evaluate randomized clinical trials (RCTs) of cardiac catheter ablation (CCA) and to assess the prevalence, characteristics and reporting standards of clinically relevant patient-reported outcome measures (PROMs). Electronic database searches of Medline, Embase, CENTRAL, and the WHO Trial Registry were conducted in March 2019. The study protocol was registered on PROSPERO (CRD42019133086). Of 7125 records identified, 237 RCTs were included for analysis, representing 35427 patients with a mean age of 59 years. Only 43 RCTs (18%) reported PROMs of which 27 included a generic PROM that measured health-related quality of life (HRQL) necessary to conduct comparative effectiveness research. There was notable under-representation of certain patient groups-only 31% were women and only 8% were of non-Caucasian ethnicity, in trials which reported such data. The reporting standard of PROMs was highly variable with 8-62% adherence against CONSORT PRO-specific items. In summary, PROMs play a crucial role in determining the clinical and cost-effectiveness of treatments which primarily offer symptomatic improvement, such as CCA. Their underuse significantly limits evaluation of the comparative effectiveness of treatments. Using CCA as an exemplar, there are additional issues of infrequent assessment, poor reporting and under-representation of many population groups. Greater use of PROMs, and specifically validated HRQL questionnaires, is paramount in giving patients a voice in studies, generating more meaningful comparisons between treatments and driving better patient-centred clinical and policy-level decision-making.

The impact of discharge contracture on return to work after burn injury: A Burn Model System investigation.

Despite many advances in burn care, the development of extremity contracture remains a common and vexing problem. Extremity contractures have been documented in up to one third of severely burned patients at discharge. However, little is known about the long-term impact of these contractures. The purpose of this study was to examine the association of extremity contractures with employment after burn injury. We obtained data from the Burn Model System database from 1994 to 2003. We included in the study cohort all adult patients who were working prior to injury and identified those discharged with and without a contracture in one of the major extremity joints (shoulder, elbow, wrist, hip, knee and ankle). We classified contracture severity according to mild, moderate and severe categories. We performed descriptive analyses and predictive modeling to identify injury and patient factors associated with return to work (RTW) at 6, 12, and 24 months. A total of 1,203 participant records met criteria for study inclusion. Of these, 415 (35%) had developed a contracture at discharge; 9% mild, 12% moderate, and 14% severe. Among 801 (67%) participants who had complete data at 6 months after discharge, 70% of patients without contracture had returned to work compared to 45% of patients with contractures (p < 0.001). RTW increased at each subsequent follow-up time point for the contracture group, however, it remained significantly lower than in no-contracture group (both p < 0.01). In multivariable analyses, female sex, non-Caucasian ethnicity, larger burn size, alcohol abuse, number of in-hospital operations, amputation, and in-hospital complications were associated with a lower likelihood of employment. In adjusted analyses, discharge contracture was associated with a lower probability of RTW at all 3 time points, although its impact significantly diminished at 24 months. This study indicates an association between discharge contracture and reduced employment 6, 12 and 24 months after burn injury. Among many other identified patient, injury, and hospitalization related factors that are barriers to RTW, the presence of a contracture at discharge adds a significant reintegration burden for working-age burn patients.

High prevalence of impaired awareness of hypoglycemia and severe hypoglycemia among people with insulin-treated type 2 diabetes: The Dutch Diabetes Pearl Cohort

ObjectivePeople with type 2 diabetes on insulin are at risk for hypoglycemia. Recurrent hypoglycemia can cause impaired awareness of hypoglycemia (IAH), and increase the risk for severe hypoglycemia. The aim...

Efficacy and safety data for the XEN45 implant at 2 years: a retrospective analysis

AimTo report efficacy and safety measures for XEN45 in a National Health Service setting after 24-month follow-up.MethodsThis is a retrospective, non-comparative audit of records of patients who underwent XEN45 procedure...

Soluble urokinase plasminogen activator receptor (suPAR) levels predict damage accrual in patients with recent-onset systemic lupus erythematosus

ObjectiveThe soluble urokinase plasminogen activator receptor (suPAR) has potential as a prognosis and severity biomarker in several inflammatory and infectious diseases. In a previous cross-sectional study, suPAR levels were shown to reflect damage accrual in cases of systemic lupus erythematosus (SLE). Herein, we evaluated suPAR as a predictor of future organ damage in recent-onset SLE. MethodsIncluded were 344 patients from the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort who met the 1997 American College of Rheumatology classification criteria with 5-years of follow-up data available. Baseline sera from patients and age- and sex-matched controls were assayed for suPAR. Organ damage was assessed annually using the SLICC/ACR damage index (SDI). ResultsThe levels of suPAR were higher in patients who accrued damage, particularly those with SDI≥2 at 5 years (N = 32, 46.8% increase, p = 0.004), as compared to patients without damage. Logistic regression analysis revealed a significant impact of suPAR on SDI outcome (SDI≥2; OR = 1.14; 95% CI 1.03–1.26), also after adjustment for confounding factors. In an optimized logistic regression to predict damage, suPAR persisted as a predictor, together with baseline disease activity (SLEDAI-2K), age, and non-Caucasian ethnicity (model AUC = 0.77). Dissecting SDI into organ systems revealed higher suPAR levels in patients who developed musculoskeletal damage (SDI≥1; p = 0.007). ConclusionPrognostic biomarkers identify patients who are at risk of acquiring early damage and therefore need careful observation and targeted treatment strategies. Overall, suPAR constitutes an interesting biomarker for patient stratification and for identifying SLE patients who are at risk of acquiring organ damage during the first 5 years of disease.

Cytomegalovirus seropositivity is independently associated with cardiovascular disease in non-dialysis dependent chronic kidney disease.

Cardiovascular disease (CVD) is the leading cause of early death in patients with chronic kidney disease (CKD). Previous work has described an association between Cytomegalovirus (CMV) seropositivity and CVD amongst patients with dialysis dependent end stage renal disease. Whether CMV seropositivity is associated with CVD in non-dialysis dependent CKD has not been established. Investigate whether past CMV infection is associated with prevalent CVD in patients with non-dialysis dependent CKD. A retrospective observational study using the Renal Impairment in Secondary Care cohort, a study evaluating bio-clinical determinants of outcomes in patients with progressive CKD. We assayed cryopreserved serum samples collected at inception for anti-CMV IgG antibodies from 764 patients with stages 2 to 5 CKD (pre-dialysis) and investigated its relationship with prevalent CVD. Median estimated glomerular filtration was 24 ml/min/1.73 m2 (IQR 19-32). Sixty-eight percent of patients were CMV seropositive. CMV seropositivity was associated with older age, non-Caucasian ethnicity, diabetes and higher social deprivation index score. On univariable analysis, CMV seropositivity correlated with higher systolic blood pressure (P = 0.044), prevalent CVD (P < 0.001), ischaemic heart disease (P < 0.001) and cerebrovascular disease (P = 0.022). On multivariable analysis, CMV seropositive patients nearly twice as likely to have CVD compared to seronegative patients [Odds Ratio (OR) = 1.998, CI 1.231-3.242, P = 0.005]. In patients with non-dialysis CKD, CMV seropositivity is independently associated with a higher prevalence of CVD.

A pooled analysis of the cardiac events in the trastuzumab adjuvant trials.

Trastuzumab-associated cardiotoxicity remains an issue for patients with HER2-positive breast cancer. This pooled analysis of 3 adjuvant trials investigated the incidence, timing, impact on treatment completion, and risk factors for trastuzumab-associated cardiotoxicity. This is an individual patient data level pooled analysis of HERA, NSBAP B-31, and NCCTG 9831 (Alliance Trials). Definitions of cardiac events were as per each individual study. A total of 7445 patients enrolled in the 3 trials were included in the analysis, of which 4017 were in the trastuzumab and 3428 in the control (observation) arms, respectively. Median follow-up exceeded 10years (119.2-137.2months). Nearly all patients (97.4%) in the trastuzumab arms received anthracycline-based chemotherapy. In total, 452 patients in the trastuzumab arms experienced a cardiac event (11.3%), with most being mildly symptomatic or asymptomatic left ventricular ejection fraction (LVEF) decrease (351 patients, 8.7%). Severe congestive heart failure was more common in the trastuzumab arm (2.3%) than in the control arm (0.8%). Most cardiac events occurred during trastuzumab treatment (78.1%) and cardiac events were the main cause of discontinuation across the sample (10.0%); nevertheless, a large majority of patients completed trastuzumab treatment (76.2%). Baseline risk factors that were significantly associated with the development of cardiac events were baseline LVEF < 60%, hypertension, body mass index > 25, age ≥ 60 and, non-Caucasian ethnicity. One year of trastuzumab increases the risk of cardiac events, though most consist of asymptomatic or mildly symptomatic LVEF drops. Adjuvant trastuzumab should be considered a safe treatment from a cardiac standpoint for most patients. Trastuzumab-associated cardiotoxicity is the main cause of discontinuation and further research is needed to individualize prevention and management.

A Genome-Wide Association Study of Sprint Performance in Elite Youth Football Players

Pickering, C, Suraci, B, Semenova, EA, Boulygina, EA, Kostryukova, ES, Kulemin, NA, Borisov, OV, Khabibova, SA, Larin, AK, Pavlenko, AV, Lyubaeva, EV, Popov, DV, Lysenko, EA, Vepkhvadze, TF, Lednev, EM, Leońska-Duniec, A, Pająk, B, Chycki, J, Moska, W, Lulińska-Kuklik, E, Dornowski, M, Maszczyk, A, Bradley, B, Kana-ah, A, Cięszczyk, P, Generozov, EV, and Ahmetov, II. A genome-wide association study of sprint performance in elite youth football players. J Strength Cond Res 33(9): 2344-2351, 2019-Sprint speed is an important component of football performance, with teams often placing a high value on sprint and acceleration ability. The aim of this study was to undertake the first genome-wide association study to identify genetic variants associated with sprint test performance in elite youth football players and to further validate the obtained results in additional studies. Using micro-array data (600 K-1.14 M single nucleotide polymorphisms [SNPs]) of 1,206 subjects, we identified 12 SNPs with suggestive significance after passing replication criteria. The polymorphism rs55743914 located in the PTPRK gene was found as the most significant for 5-m sprint test (p = 7.7 × 10). Seven of the discovered SNPs were also associated with sprint test performance in a cohort of 126 Polish women, and 4 were associated with power athlete status in a cohort of 399 elite Russian athletes. Six SNPs were associated with muscle fiber type in a cohort of 96 Russian subjects. We also examined genotype distributions and possible associations for 16 SNPs previously linked with sprint performance. Four SNPs (AGT rs699, HSD17B14 rs7247312, IGF2 rs680, and IL6 rs1800795) were associated with sprint test performance in this cohort. In addition, the G alleles of 2 SNPs in ADRB2 (rs1042713 & rs1042714) were significantly over-represented in these players compared with British and European controls. These results suggest that there is a genetic influence on sprint test performance in footballers, and identifies some of the genetic variants that help explain this influence.

Measuring variability between clusters by subgroup: An extension of the median odds ratio.

Investigating clustered data requires consideration of the variation across clusters, including consideration of the component of the total individual variance that is at the cluster level. The median odds ratio and analogues are useful intuitive measures available to communicate variability in outcomes across clusters using the variance of random intercepts from a multilevel regression model. However, the median odds ratio cannot describe variability across clusters for different patient subgroups because the random intercepts do not vary by subgroup. To empower investigators interested in equity and other applications of this scenario, we describe an extension of the median odds ratio to multilevel regression models employing both random intercepts and random coefficients. By example, we conducted a retrospective cohort analysis of variation in care limitations (goals of care preferences) according to ethnicity in patients admitted to intensive care. Using mixed-effects logistic regression clustered by hospital, we demonstrated that patients of non-Caucasian ethnicity were less likely to have care limitations but experienced similar variability across hospitals. Limitations of the extended median odds ratio include the large sample sizes and computational power needed for models with random coefficients. This extension of the median odds ratio to multilevel regression models with random coefficients will provide insight into cluster-level variability for researchers interested in equity and other phenomena where variability by patient subgroup is important.

The Effect of Donors' Demographic Characteristics in Renal Function Post-Living Kidney Donation. Analysis of a UK Single Centre Cohort.

Introduction: There is a great need to increase the organ donor pool, particularly for living donors. This study analyses the difference in post-living donation kidney function according to pre-donation characteristics of age, genetic relationship with the recipient, sex, ethnicity, and Body Mass Index (BMI). Methods: Retrospective single centre analysis of the trajectory of estimated Glomerular Filtration Rate (eGFR) post-living kidney donation, as a measure of kidney function. Mean eGFR of the different groups was compared at 6 months and during the 60 months follow up. Results: Mean age was 46 ± 13 years, 57% were female, and 60% Caucasian. Mean BMI was 27 ± 5 kg/m2, with more than a quarter of the cohort having a BMI > 30 (26%), and the majority of the donors genetically related to their recipients (56%). The higher decline rate in eGFR was at 6 months after donation, with female sex, non-Caucasian ethnicity, and age lower than 60 years being independently associated with higher recovery in kidney function (p < 0.05). In the 60 months follow up, older age, genetic relationship with the recipient, and male sex led to higher percentual difference in eGFR post-donation. Conclusion: In this study, with a high proportion of high BMI living kidney donors, female sex, age lower than 60 years, and non-genetic relationship with recipient were persistently associated with higher increase in post-donation kidney function. Ethnicity and BMI, per se, should not be a barrier to increasing the living donor kidney pool.

Patients at Risk for Exceeding CJR Cost Targets After Total Ankle Arthroplasty

The Comprehensive Care for Joint Replacement (CJR) model includes total ankle arthroplasty (TAA), under which a target reimbursement is established. Whether this reimbursement is sufficient to cover average cost remains unknown. We hypothesized that a substantial number of TAAs still exceed cost targets, and that risk factors associated with exceeding the target cost could be identified preoperatively. Two hundred two primary TAAs performed at a single tertiary referral center under the CJR model from June 2013 to May 2017 were retrospectively reviewed. Patient demographics, comorbidities, outcomes, and costs were extracted from the electronic medical record using a validated structured query language (SQL) algorithm. A comparison cohort of 2084 CJR total hip arthroplasty (THA) and total knee arthroplasty (TKA) cases performed during the same period was also reviewed. Twenty TAAs (10%) exceeded the target cost of care, significantly fewer than CJR THAs/TKAs (29%) performed during the same period (P < .0001). These patients did not differ significantly in age, sex, body mass index, number of Elixhauser comorbidities, or the American Society of Anesthesiologists score. The average cost for these patients was $17 338 higher than those who did not exceed the target cost, and they were less likely to be married or have a partner (45% vs 79%, P = .001). Non-Caucasian status also reached significance (P < .0001). Those exceeding the target cost had a significantly longer length of stay (2.6 vs 1.5 days, P < .0001) and were more likely to be discharged to either skilled nursing or a rehabilitation facility (60% vs 1%, P < .0001). Even high-volume TAA centers still exceed target costs in up to 10% of cases, with length of stay, discharge location, and readmissions driving many of these events. Potential risk factors for excess cost include marital/partner status and non-Caucasian ethnicity, but further work is needed to clarify their effects and whether other risk factors exist. Level III, comparative study.

Factors Associated With Recovery Room Intravenous Opiate Requirement After Pediatric Outpatient Operations.

Many children recovering from anesthesia experience pain that is severe enough to warrant intravenous (IV) opioid treatment within moments of admission to the postanesthesia care unit (PACU). Postoperative pain has several negative consequences; therefore, preventing significant PACU pain in children is both a major clinical goal and a moral/ethical imperative. This requires identifying patient-level and perioperative factors that may be used to predict PACU IV opioid requirement. This should allow for the development of personalized care protocols to prevent clinically significant PACU pain in children. Our objective was to develop prediction models enabling practitioners to identify children at risk for PACU IV opioid requirement after various painful ambulatory surgical procedures. After Institutional Review Board approval, clinical, demographic, and anthropometric data were prospectively collected on 1256 children 4-17 years of age scheduled for painful ambulatory surgery (defined as intraoperative administration of analgesia or local anesthetic infiltration). Three multivariable logistic regression models to determine possible predictors of PACU IV opioid requirement were constructed based on (1) preoperative history; (2) history + intraoperative variables; and (3) history + intraoperative variables + PACU variables. Candidate predictors were chosen from readily obtainable parameters routinely collected during the surgical visit. Predictive performance of each model was assessed by calculating the area under the respective receiver operating characteristic curves. Overall, 29.5% of patients required a PACU IV opioid, while total PACU analgesia requirement (oral or IV) was 41.1%. Independent predictors using history alone were female sex, decreasing age, surgical history, and non-Caucasian ethnicity (model area under the receiver operating characteristic curve [AUROC], 0.59 [95% confidence interval {CI}, 0.55-0.63]). Adding a few intraoperative variables improved the discriminant ability of the model (AUROC for the history + intraoperative variables model, 0.71 [95% CI, 0.67-0.74]). Addition of first-documented PACU pain score produced a substantially improved model (AUROC, 0.85 [95% CI, 0.82-0.87]). Postoperative pain requiring PACU IV opioid in children may be determined using a small set of easily obtainable perioperative variables. Our models require validation in other settings to determine their clinical usefulness.

Role of ethnicity in thrombotic and hemorrhagic complications of myeloproliferative neoplasms.

e18555 Background: Philadelphia-chromosome negative myeloproliferative neoplasms (MPN) are a group of hematologic malignancies with known complications of hemorrhage and thrombosis. Age and a previous history of thrombosis are well-documented risk factors for future vascular events. Variations in the rates of these complications among ethnicities and sexes have not been extensively explored. Methods: Our retrospective analysis included 301 adult patients with a diagnosis of MPN without a history of thrombosis or hemorrhagic event seen at the Indiana University Simon Cancer Center between 1992 and 2019. Relationships between ethno-racial backgrounds and vascular complications and disease outcomes were evaluated using multivariate logistic regression analysis and Cox regression models. Results: Two hundred seventy-one patients (90.0%) were Caucasian and 30 patients (10.0%) were non-Caucasian. Non-Caucasian patients were comprised of African America, Asian, and Middle Eastern ethnicities. Median age at diagnosis was 56 years, and 43.9% were male. No association was found between the incidence of thrombotic complications and ethnicity using the log-rank test ( p 0.68). The incidence of hemorrhagic events was significantly increased in non-Caucasian patients (OR = 4.33; 95% CI [1.15 – 16.36], p 0.03). Patients with higher hemoglobin concentration at diagnosis were at a significantly lower risk of bleeding complications (OR = 0.79; 95% CI [0.65 – 0.95], p 0.01). Non-Caucasian patients were at 2.98 times (95% CI [1.19 – 7.44], p 0.02) higher risk when vascular complications were pooled together. Our models also showed that male sex (OR = 0.14; 95% CI [.02 – .98], p 0.048) and a higher platelet count at the time of diagnosis (OR = 0.99; 95% CI [.993 –.999], p 0.03) had a marginally significant association with decreased rate of progression to acute myeloid leukemia. Conclusions: This study suggests that in patients without a history of thrombosis or bleeding, non-Caucasian ethnicity was associated with an increased adjusted risk of hemorrhagic complications in patients with MPN. This observation may inform future studies to further characterize those disparities in outcomes at the genetic or socioeconomic level.

Gestational diabetes mellitus in a multiethnic population in Spain: Incidence of and factors associated to impaired glucose tolerance one year after delivery

Background and aimWomen with history of gestational diabetes mellitus (GDM) are at increased risk for diabetes. Ethnicity may modify such risk, but no studies have been conducted in our environment. The aim of this study was to assess the incidence of type 2 diabetes mellitus and prediabetes one year after delivery in women with GDM and in a multiethnic background and to identify the associated factors. Patients and methodsA retrospective analysis of a prospective, observational cohort of women with GDM who attended annual postpartum follow-up visits at Hospital del Mar from January 2004 to March 2016. ResultsThree hundred and five women attended postpartum follow-up visits. Of these, 47.2% were Caucasian, 22% from South-Central Asia, 12% from Latin America, and 10% from Morocco and East Asia. Incidence rates of type 2 diabetes mellitus and prediabetes in these patients were 5.2 and 36.6%, respectively. In a multivariate analysis, non-Caucasian origin (OR=3.15, 95% CI [1.85–5.39]), recurrent gestational diabetes (OR=2.26, 95% CI [1.11–4.59]), and pre-pregnancy body mass index (OR=1.09, 95% CI [1.04–1.15]) were independent predictors of impaired glucose tolerance. ConclusionsIn a multiethnic Spanish population of women with GDM, incidence of impaired glucose tolerance in the first year after delivery was 41.8%, with a three-fold increased risk for women of non-Caucasian ethnicity.

Early Life Microcirculatory Plasticity and Blood Pressure Changes in Low Birth Weight Infants Born to Normotensive Mothers: A Cohort Study.

BACKGROUNDCapillary rarefaction (CR) is an established hallmark of essential hypertension (EH). The aim of this study was to examine early changes in capillary density (CD) and blood pressure (BP) in low birth weight (LBW) infants who are at risk of developing EH in later life.METHODSWe studied 77 LBW infants and 284 normal birth weight (NBW) infants, all born to mothers with normotension, in a longitudinal multicenter study. Intravital capillaroscopy was used to measure functional basal capillary density (BCD) and maximal capillary density (MCD) at birth, 3, 6, and 12 months.RESULTSWe found that LBW infants, born preterm and at term, had a significantly higher CD at birth, then underwent significant CR in the 1st 3 months culminating in a CD similar to that seen in NBW infants. NBW infants showed a gradual reduction in CD between birth and 12 months. Non-Caucasian ethnicity and preterm birth were significant predictors of a higher CD at birth. Systolic BP in NBW infants increased significantly from birth to 3 months, and we identified a significant negative correlation between systolic BP and MCD.CONCLUSIONSThis study has identified a process of early “accelerated capillary remodeling” in LBW infants, which corrects their higher CD at birth. This remodeling is unlikely to explain the CR seen in adult individuals with, or at risk of developing EH. Further follow-up studies are required to determine the timing and mechanisms involved in CR, which is likely to occur after the 1st year of life but before early adulthood.

Gaps in Patient Reported Outcome Measures in Randomised Clinical Trials of Cardiac Catheter Ablation: A Systematic Review

Background: Patient reported outcome measures (PROMs) in randomised clinical trials (RCTs) in cardiology are rarely collected despite many policy and professional interventions to mitigate this. For expensive and increasingly used interventions such as cardiac catheter ablation (CCA) that offer symptomatic improvement rather than prognostic benefit, PROMs are a key tool in determining the relative benefits compared to medical therapy. We aimed to systematically evaluate RCTs of CCA and to assess the prevalence, characteristics and reporting standards of clinically relevant PROMs. Methods: For this systematic review, electronic database searches of Medline, Embase, CENTRAL and the WHO Trial Registry were executed in March 2019. The study protocol was registered on PROSPERO (CRD42019133086). Findings: 237 RCTs were included for analysis, representing 35,427 patients with a mean age of 59 years. There was notable under-representation of certain patient groups - only 31% were women and 8% were of non-Caucasian ethnicity, in trials which reported such data. 43 (18%) RCTs reported PROMs, of which 27 included generic PROMs that measured health-related quality of life central to comparative effectiveness research. The reporting standard of PROMs was highly variable with CONSORT PRO specific criteria being fulfilled between 8-62% of the time. Interpretation: PROMs play a crucial role in assessing the clinical and cost-effectiveness of CCA, but they are infrequently assessed, poorly reported and many population groups are underrepresented. Greater use of PROMs is paramount in giving patients a voice in studies, generating more meaningful comparisons between treatments and driving better patient-centred clinical and policy-level decision making. Funding Statement: YC and MN were funded by National Institute for Health Research Academic Clinical Fellowships during the course of this work. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: PROSPERO (CRD42019133086)